We specialise in soft tissue (muscles/tendons/ligaments) injuries and rehabilitaion. Available treatments include:
Sports and Remedial Massage has become incredibly popular over the past few years. It is a much deeper, more intricate form of the famous Swedish Massage, and has been developed specifically with sports people in mind, to restore function after injury and enhance normal function, to improve sporting performance. The key word is REMEDIAL - the techniques used in sports massage are corrective and preventative and will benefit anyone who has any kind of heightened muscle tension, whether through a sporting injury, or from sitting in-front of a computer everyday.
There is evidence of massage being used by the Greeks and Romans as part of training for the original Olympic athletes. Asian cultures were the first to include massage into training for the martial arts and dance. Dance is a special art form, requiring a unique mix of strength, flexibility, power, technique, and artistic talent. Sports massage is extremely beneficial in maintaining the body so that it can perform all of these actions effectively.
Most forms of massage will commence with ‘effleurage’. This literarily means ‘to stroke’ and allows the therapist to gain initial insight into areas of muscle tension that may require further attention. ‘Petrissage’ means ‘to knead’ and is incorporated into the massage routine to work at a deeper level in the muscle tissue. Effleurage serves to acclimatise the client to touch, generally warm the muscles and increase the circulation of both blood and lymph through the respective systems. Petrissage takes the warm, pliable muscle tissue and stretches it both longitudinally and transversely by wringing and lifting, which has a toning effect. Theses actions help to warm the muscle further and begin to break up light adhesions, improving muscle permeability and function. The pumping action of these techniques combined with the long strokes of effleurage, facilitate in removal of metabolic waste and the circulation of oxygen, by way of fresh blood rushing to the tissues. All of these benefits result in pain reduction and feelings of relaxation, leaving the client rejuvenated, with the blood flowing through previously ischemic muscles. This in turn, increases the sense of wellbeing.
‘Friction’ is a deep technique that is designed to target scar tissue and adhesions. The localised pressure breaks up any fibrous areas of tissue into smaller parts, which allows the blood to flow more freely through the muscle, facilitating the healing process and restoring normal function. So long as the tissue is stretched afterwards, friction is an effective way of realigning muscle fibers after for example, a chronic injury. When used on ligaments and tendons, friction can be helpful in stimulating circulation in the area, so as to aid healing and regeneration in this tissue, which does not normally have a very good blood supply. In these cases, friction can also serve to encourage the body to lay down fascia, as an extra protective layer for damaged ligaments, which do not always heal well when left untreated.
Fascia is connective tissue, which is found superficially as well as deep inside the structures of the body. It can be likened to a spider-web of continuous uninterrupted tissue, which supports organs, offers protection and allows muscles to glide as they contract and relax. On a deep level, it is found encasing each muscle fibre, in addition to each bundle of muscle fibres and again, around each complete muscle. Therefore, it plays an important role in muscle function. Fascia is made up of collagen, elastin and water and is both flexible and strong, but it is subject to injury, adhesion formation and tension in the same way as the muscle tissue itself. As muscle tissue weakens, the fascia can compensate by gaining strength. Although fascia facilitates the movement of muscles, through poor posture or trauma, this casing can become adhered to the muscle, leading to stiffness, ischemia (restriction in blood supply) and associated dysfunction. Tightness in the external layer of fascia around the muscles in the lower leg or forearm is a direct cause of Compartment Syndrome, where the muscles, nerves and blood vessels are compressed as the fascia does not stretch sufficiently to encompass them. The tendons that attach muscles to the skeletal system are a continuation of the fascia, which is thread in and around the muscle, therefore, changes in fascial tension can be related to conditions such as tendonitis as much as tension in the muscle itself. The elastic properties in fascia actually help to assist movement and take some strain off the muscles. This can be seen when someone flexes at the hips to pick up a pencil. The fascia around the lumbar spine will recoil to its normal position (when the back is straight), which helps to bring the person upright from the bent position.
Because the fascial network is one continuous web of connective tissue, it is of great importance in posture. A restriction in one part of the network can lead to pain and restriction in another seemingly unrelated part and as the fascial system spirals and winds through the body, these restrictions can produce systemic effects. Although fascia is strong, it is also very elastic and moulds easily with time. So long as a change in posture does not provide too great a resistance, it will slowly stretch the fascial fibres until a visible change of posture is apparent. It’s no wonder that after 70 years of sitting and standing in a progressively slouched position, that an older individual develops a hunch in their back and forward head position. Indeed, with the computer centred society that we live in, forward head positions and rounded shoulders are evident in many of the population as young as 20! Along with over stretching in parts of the fascia network, comes thickening and shortening of other parts, which serves to worsen the problem. A common example is where the upper back fascia stretches under the weight of the head and rounds the shoulders. Because of this, the rib cage shifts and the fascia around the abdomen tightens and becomes shorter, as does the fascia at the front of the chest, and in the front of the neck. In this way, asking someone with poor posture to ‘stand up straight’ may be very unhelpful, because the muscles (which are also affected) have to work against the strong, newly moulded fascia. This is partly why it is so exhausting trying to change posture quickly, or by not addressing the fascia. In the same way as it has taken time for the fascia to stretch into the undesirable position, it needs to be returned back into the correct position, taking into account its elasticity and tendency to mould. Myofascial release addresses this exact problem, by slowly stretching the connective tissue and freeing up restrictions, which may have taken years to build up.
Soft tissue release targets specific areas of tension and stress in muscle tissue. Because of this, it is particularly useful when just part of a muscle is affected by scar tissue or fibrosis, which can happen after an injury. A muscle in this state can be likened to three rubber bands that have been linked together, where one of the bands is thicker and less elastic than the others. When these bands are stretched, the weaker, more flexible bands tend to give way and the tight, thick one stretches very little. By creating a false origin in the muscle and applying pressure to the belly of it, it is possible to force this thick, inelastic part to stretch and eventually break up the scar tissue, which was causing the problem. It is especially effective when used on large muscle groups such as the hamstrings and quadriceps, as because of their size, particular areas of tension can tend to be problematic, leading to pain throughout the muscle. These areas need specific targeting as stretching the whole muscle will lead to the above-described scenario, where the tightest point may not actually stretch effectively. Soft tissue release is an excellent way of treating tendonitis in a muscle as it takes pressure off its point of origin, which is where the inflammation occurs in this condition. In this way, it is a very effective treatment for conditions such as lateral epicondylitis (tennis elbow). By locking into to the proximal end of the muscle near the elbow and asking the client to circle their wrist, this works the shortened muscle under pressure, thereby alleviating associated pain. This principle can be summarised as Shorten – Lock – Lengthen. It can help in increasing range of movement, reducing pain and preventing injury. It also stimulates the nervous system and re-educates the body.
Muscle tension is controlled by the nervous system. For this reason, the nervous system must be addressed when trying to reduce pain and ease stiffness. Trauma, bad posture or emotional stresses tend to increase muscle tension, which leads to a detrimental cycle described as ‘the reflex effect’ (Mel Cash, 1996). An individual with muscle pain or injury, tends to hold the muscle in a shortened position so as to reduce the pain felt when it is at its normal length. Over time, the nervous system begins to read this body position as ‘normal’, meaning the shortened position becomes part of the individual’s posture, often leading to more pain, and so the vicious circle continues. NMT intervenes with this cycle, to re-educate the nervous system and restore normal function by encouraging the individual to relax when pressure is applied to sensitive tissue, thus suppressing the reflex contraction.
Trigger Point Therapy is a form of NMT, which is used to treat specific areas of tension in muscle tissue. It is especially effective at targeting chronic pain. Firm pressure is applied to the tense tissue using the thumbs, fingers or even the elbow. The pressure can be held for up to 90 seconds, but if you are less able to cope with pain, ischemic pressure can be used, where the area is targeted for a couple of seconds at a time. This encourages blood flow to the area, and still allows more sensitive individuals to benefit from Trigger Point Therapy. There are two types of trigger points: active and latent. Active trigger points cause muscular pain and are special because they will refer pain to other areas of the body in predictable patterns. Latent trigger points only exhibit pain when compressed, they do not refer pain to other areas of the body. Trigger Point Therapy can be quite a painful, but very effective technique which is worth the discomfort. It is a way of 'bullying' a tense painful muscle into submission.
Muscle Energy Technique uses an individuals strength to induce relaxation in tense muscle tissue. There are two main variations of this technique.
Post Isometric Relaxation (PIR) can be used very effectively on muscles that have become shortened due to poor posture or injury. It is very useful in strengthening and lengthening affected muscles because there is an element of muscle contraction in addition to muscle stretching. The process of PIR begins with the therapist identifying the barrier point, where the affected muscle begins to feel restricted. The client may not feel an active stretch at this point as it is about mid-range of full range of motion (ROM). The client is then asked to perform an isometric contraction of the affected muscle against the resistance given by the therapist. This contraction is isometric as there is no movement of the muscle and should be held at approximately 25% of the client’s maximum strength for about 10 seconds. The client is then asked to take a deep breath in, and completely relax on the out breath. At this point, the therapist can take the relaxed, inhibited muscle, slightly past the point of restriction as it is in a state of increased relaxation following the contraction, which should allow for greater flexibility. This process can be repeated until the client is in full ROM and the final stretch should be held for an additional 20 seconds to allow the golgi tendon organ and muscle spindles (which monitor muscle tension) to send appropriate messages to the nervous system, indicating that the muscle has lengthened safely. PIR works very well on muscles that move joints with a larger ROM, for example the quadriceps, iliopsoas or biceps brachi. It is also effective in the later stages of rehabilitation following acute injury, although it should not be used in the acute stage. It would be best not to use this technique on already over lengthened muscles, although the isometric contraction, (without the stretch) might be beneficial in theses cases as over lengthened muscles are often weak. The process of contracting while stretching has a strong effect in breaking up fibrous adhesions, therefore PIR is a great aid in treating areas affected by fibrosis.
The second variation is called Reciprocal Inhibition (RI). Muscles work in opposing groups in order to counteract each other and allow the body to move freely. Obviously, if one muscle group is contracting, its opposing group must relax and stretch, otherwise, there would be no movement at all. The nervous system is designed to inhibit responses to the opposite group of muscles that are contracting, for example, when the bicep in the arm is contracted (the agonist), the triceps (antagonists) must be inhibited and vice versa. This is the principle on which Reciprocal Inhibition is based. Treatment using RI is not dissimilar from using PIR, except for one important difference. Instead of resisting the force in the opposite direction from that which is provided by the therapist (contracting the muscle about to be stretched), the client should attempt to contract the muscle in the same direction (contracting the opposing muscle from the one about to be stretched). RI is especially effective in treating more acute injuries, as the problematic tissue is not directly treated, just indirectly affected by treating the tissue that opposes it. This technique is also useful when addressing muscle cramps.
This is the most important action a dancer can take when they sustain any kind of injury. It can reduce recovery time by as much as 40%.
Cryotherapy is essentially the ICE in RICE (see below). It is used to constrict blood vessels and reduce the formation of intercellular fluid at the site of an acute injury. Apply for approximately 10-15 minutes per hour - don't allow the skin to turn red.
The most commonly accepted procedure to adopt following an acute soft tissue injury is described as RICE.
The injured individual must rest the affected muscle/ligament/tendon and stop dancing. Listening to your body and responding to pain is important - do not dance through pain! Rest can also include functional rest, where the individual is recommended to reduce all activity, including their normal daily routine (although maintaining movement within the pain free range is very important). Ice should be applied, through a tea towel or similar to avoid burning the skin. The aim here is to reduce blood flow by restricting the blood vessels. Therefore, it is important not to leave the ice for too long. The skin must not turn red, as this is an indication of blood rushing to the area (the opposite of what we want to achieve). About 10-15 mins every hour is a safe and effective length of time for cryotherapy. Ice also helps to numb the pain of the injury. Compression can be applied to facilitate the restriction of internal bleeding and reduce swelling, caused by the excess intercellular fluid at the site. This can be provided with an elastic bandage or tapping. Ideally, it is best to elevate the site of injury above the heart, in order to aid venous return. Although, this is not possible for all body parts, it works very well on sprained ankles (for example), to reduce the build up of blood at the site of injury.
Kinesio Taping® is a lymph correction technique that facilitates circulatory and lymphatic flow.
Liz Bayley is a fully qualified Kinesio Taping® practitioner.
See www.kinesiotaping.co.uk for more information.