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Here our Liverpool physio runs through tennis and its most common injuries

Here our Liverpool physio runs through tennis and its most common injuries

Wimbledon might have finished way back in June but with the mild weather still here, the enthusiasm for the sport still lingers. Here at City Rehab Liverpool physio, we thought we’d take a closer look at some of the more common injuries that affect both amateurs and professionals. There are around 54 injuries for every 1000 tennis matches played. By understanding the mechanism for the most common injuries sustained you can take better action to avoid them. The most common injuries include sprained ankles, calf strain, shoulder pain and stress fractures.

Sprained ankle

A sprained ankle is a particularly common injury due to the multi-directional movements involved in the sport. If you’re feeling a little tired or the surface you’re playing on is slippery then it’s easy to roll the ankle damaging ligaments and soft tissue. To prevent we advise wearing ankle supports. They can be worn to reduce movement around the joint. Kinesiology taping is also a great idea providing support whilst still allowing full movement.

Calf Strain

Calf strains can occur when one or more of the muscles are forcibly stretched beyond its own limit, these comprise of the gastrocnemius, soleus and plantaris muscles. A calf strain usually occurs during the push when trying to return an opponents shot for example. Prevention should be based around your training regime. By strengthening the calf muscles during training you increase their force production capacity along with their flexibility and range of movement. You should also ensure your nutrition and fluid intake is to a high standard, as this will reduce muscle fatigue.

Shoulder pain

This is common due to repetitive stress especially during the serve. Overuse of the rotator cuff can cause pain around the shoulder. Prevention of shoulder pain lies in stability of the shoulder. It’s key in preventing these issues. Training routines should address strength and endurance of the rotator cuff as well as flexibility around the shoulder itself. Ensure progression is monitored however as overload must be avoided.

Stress fractures

These are common around the lumbar region and are most common in young players. It usually presents as an ache, which eventually increases when bending backward on a leg. Simply avoiding bending backward during a serve however can help a player avoid sustaining an injury such as this. Training should include core stability along with a lot of strengthening exercises to counteract the stress that’s inevitably placed on the back.

The next time you’re playing tennis and feel an ache in your back or a pull in your shoulder then consider sports rehab at our Liverpool based centre. Here at City Rehab, our Liverpool physio will not only help with current sports injuries but also advise you on how to prevent future ones too.

How to prevent the delayed onset of muscle soreness, otherwise known as DOMS.

How to prevent the delayed onset of muscle soreness, otherwise known as DOMS

The delayed onset of muscle soreness, or DOMS as it’s known for short describes a phenomenon of muscle soreness or muscle stiffness that happens around a day or so after exercise. It’s most often felt at the start of a new exercise program, a change of routine or when you dramatically increase the duration or intensity of your existing routine. Although for those new to working out, it can be somewhat alarming, the delayed onset of muscle soreness is actually a normal response to different or unusual exertion. It’s a part of the adapting process that leads to the body achieving greater stamina and strength. The muscles recover and build hypertrophy; for those who might not be aware, hypertrophy is the enlargement of an organ or tissue when its cells increase in size.

DOMS is not the same sort of muscle pain that you would normally experience during exercise, nor is it like the sudden, sharp or acute pain that you would naturally feel as the result of an injury such as a strain or sprain. The delayed muscle soreness that’s associated with DOMS is generally at its worst within the first couple of days following a new activity. It does however eventually subside after a few days.

So what exactly is it that causes muscles soreness after we exercise? Well it’s thought that DOMS is actually a result of microscopic tearing of the muscles fibers. Of course the amount of tearing depends on how hard and how long you push yourself during exercise and the type of exercise you do. This then relates directly to the severity of DOMS you would experience. Absolutely any movement that you aren’t used to can lead to DOMS however movements that would cause the muscle to forcefully contract while it lengthens seems to cause more soreness. This movement is known as eccentric muscle contractions and examples of these would be going down stairs and the downward motion of push-ups. Eccentric muscle contractions could also lead to swelling in a muscle as well as small tears; this would obviously contribute to soreness.

There are ways however that you can reduce the delayed onset of muscle soreness and that’s by helping your muscles to repair as quickly as possible. This can be achieved by delivering all the required nutrients to the muscle as quickly as possible and this can be done in a variety of ways. Here are just some strategies that we suggest here at City Rehab Sports Physiotherapy Centre.


Stretching can help prevent tightness in the muscles that you’ve used. Doing this after exercise is very important when it comes to reducing the chances of any injuries too.

Ice Baths

You may have heard of this and brushed it off as mad; athletes jumping into ice baths in training. Well there is actually method in their madness as a cold bath after you work out can narrow the blood vessels in the muscles, which leads to the blood being pushed back to the heart. When this happens, metabolites are cleared from the muscle.

When you jump out of the bath your vessels quickly dilate and allow the blood back to the muscle in an attempt to warm it up. This sudden influx of blood brings with it fresh nutrients that your muscles will be only too happy to use in order to repair. This then accelerates the recovery. When doing this it’s important to remember that you must gradually increase the duration of being submerged and gradually reduce the temperature too. This will prevent any adverse reactions. You should submerge your body, preferably in a standing position for no more than ten minutes.

Continue to move

A huge mistake that people seem to make is to sit down and stop moving. Yes we realise that sitting can’t always be avoided, especially if you have a nine to five office job however some movement is imperative. This is especially the case for the muscles you used during exercise. The reason for this is that without movement, blood flow is naturally reduced.

This decreases its access to vital nutrients that are needed to speed up recovery. As you can imagine this would naturally increase recovery time. The other reason for movement is that the body will begin to repair the micro tears in the static position they’re in. This means the fibers will adapt their length to suit this position, which would lead to tightness and some imbalance.

More Exercise

Simply put the more you exercise, the more your body will adapt to the strains you put on it. Your muscles will grow and become stronger, which will increase their threshold for micro damage. Your cardiovascular system will also become better at providing nutrients to the muscles through increased red blood cells and a much stronger heart and lungs; this will all reduce the recovery time. It’s also worth remembering too that the more you exercise, you more aware you’ll become of which strategies work best for you i.e. exercise, ice baths etc.

In spite of all these strategies, if you train hard you will indeed experience DOMS, which can in some cases negatively affect your training regime. If you’d like more advice on how to reduce DOMS or how best to deal with the onset of it, an appointment with one of our qualified physiotherapists may help.

Retraining your gait to help prevent runners knee

Retraining your gait to help prevent runners knee

Patellofemoral Pain Syndrome, otherwise known as Runner’s Knee is still the most common injury amongst runners today. Many aspects of this injury have been looked at however today we’ve decided to look at ways of adapting your gait to help prevent this syndrome. It must be remembered however that running style is very much an individual thing. There’s no one correct way to run and each runner will have undoubtedly developed a gait that feels comfortable to them. Changing of your running gait should certainly be carried out with caution.

A key concept in runners knee is very much about reducing the load going through the patellofemoral joint (where the femur meets the tibia forming the main knee joint) during your run. This will reduce the pain and there are a number of ways to do this. Today we’ll look at just two ways and we’ll categorise them into two groups titled the easy way and the hard way. We’ll begin by looking at the easy way.

The Easy Way

The easy way to reduce patellofemoral load during running is to increase your step rate and reduce your stride length and it’s a lot easier than it sounds. Step rate and stride length are actually rather intimately linked; if you increase your amount of strides, your stride length will naturally reduce. There have been three recent studies that showed a number of benefits to a higher step rate and smaller stride length. Benefits included a reduced load on the hip and knee joints ultimately reducing the risk of stress fractures and patellofemoral pain. An altered posture at foot-ground contact was also noted which showed increased knee flexion, a lower incline of the foot and a heel that was further under the bodies centre of mass. Lastly a change in hip position and glute activation was seen which reduced hip adduction and increased the activation of the gluteus in anticipation of foot-ground contact. During the studies a metronome was used to help runners increase their step rate by roughly 10%, which was enough to have significant effects without negatively affecting their performance. A metronome can be easily downloaded onto an MP3 player however you will need the help of one of our qualified physiotherapists to determine your current step rate and workout your target. There is always the option of simply running and if pain starts try increasing your step rate. Find a rate and stride that feels comfortable to you.

The Hard Way

The harder way to change your running style to help with runners knee is to reduce hip adduction and internal rotation angles during the impact phase, or in other words…become a woman. Allow us to explain. A study in 2011 treated eleven runners, all of which were women. All of these women had excess hip adduction (when the leg is brought back) during their running gait. Using 3D gait analysis they guided these women into altering their gait and the results were excellent. Sadly as promising as this all sounds, when you delve a little deeper into any study you’ll always usually come across a stumbling block. The study began with 170 participants and only 11 were found to suffer from excessive hip adduction thus qualifying for the study. As mentioned before, all of these subjects were women which begs the question, what about the men? It’s possible that this study simply suggests excessive hip adduction is more common in women and is something that can be corrected through gait re-training. It also suggests that with careful assessment, we are able to identify runners that would benefit from custom-made interventions. Here at City Rehab we’re very much fans of the tailored approach rather than the one size fits all as this just doesn’t account for individual differences. The reason this is considered the hard way is simply down to the equipment needed such as a 3D motion analysis system.

There is another method that more runners are now trying, a much more natural method and that’s barefoot running. In a recent study, barefoot running was seen to reduce the load on the patellofemoral joint however it was noted that it increased the load on the calf complex. Barefoot runners were seen to have a much shorter stride, which could be the key factor in the reported reduction in knee load. It must be remembered however that there are of course limits to what we can conclude from research.

In summary, patellofemoral pain is known to be a problem with many different factors and one of those is running gait. Altering your running gait may very well help symptoms and the easiest way to achieve this is by increasing the step rate and reducing the stride length, thus finding a comfortable style. It must be remembered however that with a multifactorial problem, a multimodal approach is often required and in order to get the best result possible, a professional should be approached. It’s therefore important to seek help when considering something as important as a gait change and whatever changes you make should be based on the detailed individual assessment from a qualified physiotherapist. If you’d like help with runners knee or any other sports injury you may be suffering from then please don’t hesitate to contact us today. Here at City Rehab, our highly qualified physiotherapists will have you on the road to recovery in no time at all.

Preventing marathon injuries with the help of Sports Massage Therapy

Preventing marathon injuries with the help of Sports Massage

For any regular runner, particularly those who are training for the marathon or any other long distance event, a huge challenge during training can be preventing injury. Failing that the next challenge for a runner would be limiting the effects and impact of an injury. By making sports massage therapy, something we offer here at City Rehab, part of your training we believe you’ll see a number of benefits. Benefits of regular therapy alongside your training include muscle stiffness and soreness reduced, faster recovery from your workouts, which gives you the ability to train more frequently. Sports massage can even help improve your posture and injury prevention overall. Let’s take a look at these in more detail.

Muscle stiffness and soreness reduced

If you think back to the last time you hurt yourself whether it was a scrape, a bump or even a running injury itself, you’ll find one of the first things you did was rub the area. Touch is an instinctive reaction to pain as well as a natural way to help the body heal. It’s also been scientifically proven to help kick start the body’s natural ability when it comes to healing too. Massage helps to increase the blood circulation within us and in doing so provides oxygen and nutrients to the tissues that need to recover. The manual pressure experienced during sports massage stimulates the arteriolar pressure and also increases the temperature of the muscle too. These two things combined help to enhance the exchange of substances between blood and tissue promoting metabolism and generally assisting the body during its remodeling phase after we workout. In addition to this, sports massage will also help break down scar tissue and any adhesions that would contribute to stiffness and pain during recovery.

Shorter recovery after workouts

Muscle soreness or DOMS (delayed onset of muscle soreness) is caused by waste products like lactic acid and carbonic acid. These will accumulate in the muscles after we workout however by increasing the circulation of the lymph flow through massage, these can be eliminated or in the most case severely reduced. During our workouts we can at times overwork or even traumatise the joints and the tissues that surround them. As a result of this they can sometimes tighten and become stiff. With the help of sports massage however we can improve the range of motion as well as muscle flexibility and decrease any muscle tension.

Improved posture

Sports massage therapy will stretch and loosen muscles that have become shortened during workouts. It will also help improve their range of motion too. In addition to this it will help to stimulate weak and flaccid muscles making them better able to support surrounding muscles. This combined will help rebalance the muscles significantly and can therefore dramatically improve posture by encouraging a more efficient movement and prevent (or at the very least reduce) current or future postural related injuries.

Faster rehabilitation after an injury

Sports therapy massage helps prevent and support the healing of injuries full stop. A lot of soft tissue injuries benefit from massage because of its ability to reduce the formation of scar tissue. It also helps influence the secretion of fluids that are necessary for tissue repair. This increased circulation of blood and lymph flow helps promote tissue regeneration as well as the reduction of inflammation. Massage can also be used to focus on specific muscles in order to keep them healthy and prevent any problems developing or any past injuries reoccurring.

Pain relief

Massage has also now shown to help reduce pain by blocking the pain signals that are usually sent to the brain. It’s also shown to encourage the relaxation of the muscles by stimulating the nervous system. This relaxation in turn can help reduce painful muscle spasms and cramping as well as enhance the blood flow to the nerves that have been damaged from an injury.

When it comes to running the majority of injuries tend to develop over time. They’re usually incurred through overuse or due to repeated impact. Clearly, given the nature of training involved when it comes to marathons, this is a huge concern for anyone preparing for or competing in the big event itself and the option of pulling out for some is simply not a consideration. To avoid having to pull out or worse still, compete when you aren’t working at your full capacity, we recommend not only seeking treatment early but also incorporating sports massage therapy into your training regime from the very beginning. If you haven’t already and are starting to feel a niggle then we recommend a visit as soon as possible. The best advice we can give is to get everything checked out as soon as possible to avoid causing further damage to an injury that may only be minor.

Here at City Rehab we offer a number of treatments aside from sports massage therapy should you need them and we’ll also be able to advise you on preventing further injuries in the future. With the help of our qualified physiotherapists we can have you injury free and training to the best of your ability up until the big day itself. Whether it’s prevention you need or help with a current injury then don’t hesitate to contact us today. We’ll make it so you’re only concern will be beating your personal best on the day. 

Osteoarthritis: It’s Not All Doom and Gloom!


You will have all heard at some point the term ‘Osteoarthritis’, you may even have a vague idea of what it is, but for many of you that is about as far as your knowledge regarding this subject will go.  Therefore this blog aims to hopefully enhance your knowledge of this troublesome condition and ensure you have a clear understanding about the what’s, whys and how’s!

What is Osteoarthritis?

Osteoarthritis (OA) is a condition that affects the joints of our skeletal system.  Although its name suggests an inflammatory background, i.e. –‘ITIS’, it is actually degenerative in nature.  The phrase ‘wear and tear’ is often used and that is because this joint condition affects the bony surfaces of a joint; they become damaged causing the joint to not move as smoothly as it should.  The cartilage that covers the bone ends should be shiny and smooth, when a joint develops OA this cartilage becomes pitted, thin and rough which consequently then causes the bone underneath to thicken (Felson et al., 2000).

As a result of this damage, tissues within and surrounding the joint structure will become more active changing the joints’ composition.  Bony spurs will form as a result of bone growth at the edges of the joint, the ligaments and capsule (supportive structure around the joint) will gradually thicken and contract with a view to making the joint more stable, but in reality causing stiffness, and the synovium, which is the inner layer of the capsule, may also thicken and generate extra synovial fluid causing the joint to swell.  In severe cases of OA, the cartilage can sometimes wear so thin that it is unable to act as a shock absorber between the bone ends and they will then actually rub against each other, causing the bones themselves to wear away.  Combine this with the loss of cartilage and formation of bony spurs, your whole joint can change shape and thus force your bones out of their natural functional position.

What causes it and what symptoms you might expect

Now that you’re a bit more in tune with what OA actually is, let’s discuss what causes it and what symptoms you might expect.  There are several factors that may lead to an increase in developing OA, age and gender being just a couple of them.  Unfortunately, OA is more common the older we get, the reason is unknown amongst researchers but they hypothesise that it could possibly be the amount of repetition we put our joints through over the years, the weakening of muscles or even quite simply the body being less able to heal itself.  It is also more prominent in females...sorry ladies!  Previous joint injury can also predispose you to the onset of OA as can joint abnormalities.

It is a misconception that normal exercise will cause OA, however very hard activities that are repeated over long periods can increase your risk.  Additionally, obesity is a risk factor for the development and progression of OA, particularly in the knee (Deyle et al., 2005). One thing that is overlooked is your biomechanics and how that will increase the likelihood of developing OA. Example: if you run regularly but your knee joint doesn’t move in the optimal line then it stands to reason that this will cause excessive pressure, wear and tear and overload on the cartilage and bone ends. With this in mind we believe one of the major contributing factors to OA is poor joint motion / biomechanics. So it stands to reason why age plays a role in OA. If you play any sport for a number of years with poor biomechanics its likely you will develop OA!

Pain and stiffness being the primary symptoms

Several symptoms are associated with osteoarthritis, pain and stiffness being the primary ones.  It is not fully understood where the pain comes from but many believe that it is down to the degree of structural damage to the joint as well as a chronic inflammatory response associated with the debris within the joint space as a result of the degeneration to the cartilage (Girbes et al., 2013).  Stiffness of the joint is felt more first thing in a morning and after periods of rest; the inactivity causes the joint and its surrounding structures to cool and therefore be much less pliable making the joint inflexible.  Once up and moving around you’ll find that the stiffness eases.  Swelling can also be a common symptom of OA, this can be soft in nature due to the production of extra synovial fluid or sometimes hard due to the thickening of bone.  You may also feel a grinding or grating sensation on movement, again this is likely to be as a consequence of the structural damage.

What can be done about OA?

So is there anything that can be done about OA?  Of course there is, unfortunately there is no way to rid you of the condition completely but there are plenty of things that can be done to reduce your pain, manage your symptoms and reduce the rate of its’ progression.  Other than just relying on taking medication to ease your pain, as sports injury specialists we know that there are plenty of other modalities that can improve your symptoms and not just for the short term.  The first thing is to keep mobile, within relatively pain-free parameters of course; movement of the joint helps to nourish it as well as warm it through making the surrounding structures more pliable.

You may be apprehensive to do this at first as you may experience some pain, but the more you move we promise you that the pain will ease.  Loosening off and stretching the tight muscles around the affected joint will also help with restoring mobility and better function as well as helping to reduce pain (Jamtvedt et al., 2008).  In addition to keeping the joint mobile, we want to strengthen it so that the muscles surrounding it can take the load rather than the joint itself.  Therefore we believe strengthening exercises are essential, (Petursdottir et al., 2010) in combination with correcting your biomechanical weakness or joint mal alignment when it comes to OA. By doing so will help to prolong the life of the affected joint and at the same time reduce your symptoms…so all in all its win win!

Osteoarthritis is one of the most frequent and disabling joint pathologies in modern society affecting the older population.  This degenerative condition affects the cartilage covering the bony surfaces of a joint and is likely to give rise to pain, stiffness, joint swelling and inevitably impaired function.  Although irreversible, there are steps that can be taken to ensure greater manageability of OA which will aid in reducing symptoms, improving function and prolonging joint health.  Keeping the affected joint mobile is key as this will reduce stiffness and pain.  This in combination with a stretching and strengthening programme will help to control and minimise the rate of progression of OA and allow you to lead a normal, active life.  Please don’t think that it is all doom and gloom because there are things that can be done, and here at City Rehab we really want to help!!!

Deyle, G.D., Allison, S.C., Matekel, R.L., Ryder, M.G., Stang, J.M., Gohdes, D.D., Hutton, J.P., Henderson, N.E. & Garber, N.B. (2005) Physical Therapy Treatment Effectiveness for Osteoarthritis of the Knee: A Randomised Comparison of Supervised Clinical Exercise and Manual Therapy Procedures Versus a Home Exercise Program. Physical Therapy: 85, 1301-1317

Felson, D.T., Lawrence, R.C., Dieppe, P.A., Hirsch, R., Helmick, C.G., Jordan, J.M., Kington, R.S., Lane, N.E., Nevitt, M.C., Zhang, Y., Sowers, M.F., McAlindon, T., Spector, T.D., Poole, R., Yanovski, S.Z., Ateshian, G., Sharma, L., Buckwalter, J.A., Brandt, K.D. & Fries, J.F. (2000) Osteoarthritis: New Insights. Part 1: The Disease and its Risk Factors. Annals of Internal Medicine: 133(8), 635-646

Girbes, E.L., Nijs, J., Torres-Cueco, R. & Cubas, C.L. (2013) Pain Treatment for Patients with Osteoarthritis and Central Sensitization. Physical Therapy: 93, 842-851

Jamtvedt, G., Dahm, K.T., Christie, A., Moe, R.H., Haavardsholm, E., Holm, I. & Hagen, K.B. (2008) Physical Therapy Interventions for Patients with Osteoarthritis of the Knee: An Overview of Systematic Reviews. Physical Therapy: 88, 123-136

Petursdottir, U., Arnadottir, S.A. & Halldorsdottir, S. (2010) Facilitators and Barriers to exercising Among People with Osteoarthritis: A Phenomenological Study. Physical Therapy: 90, 1014-1025