The temporomandibular joint (TMJ) is located in the face where the temporal bone (cheek bone) and the mandible (jaw bone) meet, often simply referred to as the jaw.

We have a TMJ on each side of the face and these can sometimes become sources of pain. When this occurs it is often referred to as ‘TMD’ or temporomandibular joint dysfunction. This is a catch all term which includes both intra-articular (joint and disc) and extra-articular (usually muscle, but also ligament and tendon) sources of pain.

TMD can be treated with many different physiotherapy techniques including manual therapy, electrotherapy, exercise and medical acupuncture (sometimes referred to as dry needling).

After 17 years as a practising Chartered Physiotherapist, completing an MSc as well as a Diploma in Medical Acupuncture, and having attended many further education courses on Physiotherapy related topics, I found myself earlier this year asking myself ‘what next?’.

Continuing professional development is very important to me both personally and professionally. However it was proving difficult to find courses and educational opportunities in physiotherapy either not already completed or relevant to my area of practice as a musculoskeletal specialist.

I have always had a keen interest in health in a broader sense, not just physical but also in relation to diet and nutrition, exercise as well as other lifestyle factors such as sleep, the role of sunlight, recreation, communication etc. All factors which can also have a profound impact on pain management and physical function which have helped me develop as a physiotherapist over the years.

In today’s world of constant technological growth and progress, it is important that we as chartered physiotherapists ensure our clinic is up to date with the software and systems we use, to allow our practice to grow and evolve in the modern era. Here at Mount Merrion Chartered Physiotherapy, we use an online practice management system called TM3 which leads to great benefits throughout our patient care and in the overall running of our practice.

The social and economic burden of lower back pain (LBP) is very apparent in our society. It was estimated that the prevalence of absenteeism due to LBP was a massive 32% for hospital employees in Ireland (Cunningham et al, 2006).

According to a 2006 review, the total costs associated with LBP in the United States exceed $100 billion per year, two-thirds of which are a result of lost wages and reduced productivity (Katz et al, 2006).

Following on from my last post where I emphasised the importance of moving frequently, here I’ll be discussing how we can take a few further steps towards improving physical health.

Strengthening

First up is the importance of pushing, pulling or lifting something reasonably heavy which would include our own bodies. This means taking some time out away from our normal day to day activities to do some focussed strengthening exercise.

So what are some of the benefits?

• You’re more likely to burn stored fat which is useful for weight management. That is assuming of course you’re not loading up on lots of sugar and other carbohydrates such as bread, pasta, potatoes etc. The body will burn carbohydrates as an energy source first, and if taken in excess will be stored as fat, not good if you are trying to lose weight.
  
  
• Regular movement helps reduce aches and pains, motion is lotion.
  
  
• Movement enhances brain function, concentration and memory.
  
  
• As well as the function of the heart, lungs and vascular system.
  
  
• Slow, regular movement helps with stress management and promotes longevity.

It was 10 years ago when I remember hobbling down the stairs to collect my next client. I was holding my back upright and rigid, almost afraid to move in fear that I might further strain what I suspected at the time was painfully ‘unstable’ sacroiliac or pelvic joint. I had also been assessed by an experienced clinician who had told me I was ‘misaligned’.

Roll on ten years and I now understand, based on current research and expert opinion that the pelvic joints really don’t move very much, hardly at all in fact. When reflecting on my injury and considering my age, gender and how I injured myself (pulling a suitcase awkwardly form under a bed), it became clear that my strained lower back and pelvis wasn't likely to have been left unstable. But at the time I did not have this knowledge and so felt very threatened by this part of my body. It felt weak and I lacked the confidence to move freely as well as run and exercise in the gym. The pain I felt added to this sense of threat.

I was watching Toby, our 5 year old, bending down to pick up his box of wooden blocks a few days ago. The box was reasonably heavy and a little awkward but this did not seem to deter him. He bent his hips and knees, also allowing his back to flex, then took hold of the box and while holding it close straightened up. He tottered with the box into the living room then reversed the process to put the box down onto the floor.

Why did this simple functional task get me thinking?

In recent years there has been a strong move away from this idea that we should be ‘bracing’ our backs before we bend and lift everyday objects. The notion of contracting your ‘core’ muscles, becoming rigid, not allowing your back to move before doing anything of a physical nature has been strongly challenged and is now considered by low back pain researchers to be very unhelpful. This way of moving, once considered the ideal, is now understood to promote pain, limit function and encourage people not to trust their backs.

Exercise is crucial to good mental and physical health, variety is also important, the body thrives on variety. My body was getting too used to going through the weekly motions. I am familiar with the CrossFit concept and was keen to shake up my exercise routine. So I decided to give it a go.

As a chartered physiotherapist I have treated many injured CrossFitters, I knew the potential risks. I was therefore keen to take it easy and hopefully not pick up an injury myself. Form and technique first, increase load later. When I turned 40, I asked for life advice, a sports doctor friend of mine simply said ‘look after your joints’.

Running is an excellent form of aerobic activity to improve your health status, reduce disease risk, modify body composition(best when combined with a good diet) and improve all around physical fitness. It is also a weight-bearing activity that helps in maintaining bone mass and preventing osteoporosis.

Current guidelines by the American College of Sports Medicine recommend 30 minutes of moderate intensity aerobic activity at least 5 days a week for adults. Brisk walking is an excellent activity to reach this desired level of activity as it is easy to perform, uses the large muscles of the body, both upper and lower, and it does not require any expensive equipment. Running will burn more calories than brisk walking due to the increased intensity of the activity. This is great for energy expenditure but does bring with it an increased risk of injury.

CrossFit has become hugely popular in Ireland over the last number of years. It is a form of training that incorporates resistance training and cardiovascular training and uses compound exercises (exercises that involve more than one joint) to develop greater functional movement.

CrossFit is not just for advanced clients. Participants range from high level athletes to absolute beginners and each workout can be customised to each individual. While high level athletes tend to suffer more overuse injuries, beginners commonly injure their shoulders, back, knees and ankles.

Myofascial pain relates to pain and inflammation in the body’s soft tissues. This includes muscles, fascia, nerves, blood vessels, bone, joints and organs. Myofascial pain tends to be achy, vague, difficult to localise and may sometimes include feelings of pins and needles. For this reason it may often be confused with nerve pain.

What is Fascia?

Fascia is a web of connective tissue that is continuous throughout the body and all structures within it. It surrounds and envelops every single organ, tissue and cell. You can imagine fascia as the pith of an orange. The pith is continuous throughout the orange separating each segment and becomes the juice cells of the orange- fascia envelops every structure and cell in the body in the same way.

Fascia has no one point, starting or end point, it attaches to any and all fibrous tissues including organ, bone, muscle, nerve, tendon etc. In this way all parts of the body are linked and integrated with each other through our fascia, no matter how remote.

Lateral epicondylalgia, or tennis elbow as it is often called is a common sports medicine condition. Pain usually felt at the outer side of the elbow and is aggravated by gripping or lifting movements. The pain associated with tennis elbow usually arises gradually 2-3 days after unaccustomed activity involving repeated bending of the wrist or gripping hand movements or activities. Examples include sports (usually racquet-based) and occupational and leisure pursuits (carpentry, bricklaying, sewing and knitting, computer use). This condition can affect any age group but is most common for those between the ages of 40 and 50.

How to Find Ideal Posture?

If you imagine a plumb line dropping from the ceiling by the side of the body. The plumb line should intersect the ear lobe, then run to the shoulder joint, then through the greater trochanter in the hip (the bony bit on the outside of the hip), then just in front of the knee joint and finally slightly in front of the lateral malleolus in the ankle (the bony bit on the outside of the ankle) before it reaches the floor.

If a body part, for example the earlobes is ahead of the line, then the head and neck are not in an ideal position and there is increased tension placed on the muscles in the shoulders such as the upper trapezius - which may lead to neck and shoulder pain. Another example is if the knees are locked back or overextended. In this case the knee joint line is behind the plumb line this can place increased pressure through the knee cap which may lead to knee pain.

A few weeks ago I attended a further education course on shoulder pain & dysfunction and how best to manage this from in a chartered physiotherapy setting. My aim in attending this course was to learn how to better treat shoulders, helping my clients recover more quickly from injury.

Here are ten highlights:

Your Bones

There are 206 bones that make up the skeletal body. Bone is a living tissue that is constantly being removed and replaced. Bones need normal sex hormones, calcium, vitamin D, proteins and weight bearing / strengthening exercise to keep them healthy. Peak bone mass is reached at 25-30 years old. After the mid-forties bone density is lost approximately 0.5-1% a year. As we get older and over 50, more bone is naturally lost than is replaced. This causes bones to become fragile and therefore, they can break easily.

What is Cognitive Functional Therapy in Physiotherapy and how may it help me?

What is CFT?

CFT is a pain management approach that focuses on the patient and targets their beliefs, fears and associated behaviours (both movement and lifestyle). This approach has been devised by Professor Peter O’Sullivan and his research team. Peter is a Specialist Musculoskeletal Physiotherapist (as awarded by the Australian College of Physiotherapists in 2005) and Professor of Musculoskeletal Physiotherapy at Curtin University. Internationally recognised as a leading clinician, researcher and educator in Physiotherapy, he has published more than 100 research papers, been keynote speaker at 60 national and international conferences and taught in 22 countries on the diagnosis and management of persistent pain disorders

Have you ever noticed your pain becoming worse after having a stressful day at work? Have you ever felt your pain to be worse following a bad night’s sleep? Have you ever drawn a link between busy days or busy life periods and an increase in pain? Before we discuss life factors, let’s discuss how the body feels pain.

Pain Explained

Nerve fibres in our periphery, i.e. on the outside of the body, allow you to feel pain. For example, if you stub your toe against a door your toe will feel sore. The nerve fibres in your toe will send a message up to your brain to let the body know it is experiencing pain.

Studies have shown that of the patients presenting with headaches to private practice chartered physiotherapy, approximately one third are neck related cervicogenic headaches, one third are muscular tension type headaches and another third are migraine headaches.

Cervicogenic headache is a headache whereby the cause of the headache is a neck disorder, usually felt on one side. In other words the muscles, joints and nerves of the neck may not be functioning correctly resulting in referred pain to the head region. Common causes are sustained faulty postures, certain neck movements resulting in injury to the neck for example while lifting or carrying and sometimes stress.Typically clinical findings with this type of headache include musculoskeletal impairments such as muscular trigger points, restricted neck movements and reduced strength and endurance in the deep neck flexor muscles.

Increasing numbers of ‘older’ people are performing regular physical activity including walking, swimming, lawn bowls, golf, Pilates and cycling. This is great news from a health and social perspective, leading in an improved overall quality of life.

But how do we define ‘older’? It has become more difficult to define by chronology due to the variability in health and functional status among those of similar age. The American College of Sports Medicine (ACSM) define the ‘older’ person as over 65, or between 50 and 64 with clinically significant chronic conditions and/or functional limitations. We must remember there can be a large discrepancy between how old you are and how old you feel and function.

Physical activity and exercise have an important role in successful ageing. Successful ageing involves longevity and survival free of chronic disease, impaired physical and cognitive functioning as well as incident related disability (e.g. following a fall).

What is knee osteoarthritis?

Osteoarthritis (OA) is the most common form of arthritis (Vioreanu, 2014). OA is a degenerative, ‘wear and tear’ type condition while largely effects the protective cartilage in the joint which may affect the the ability of the knee joint to take weight during upright activities like walking and climbing stairs. Symptoms can also include achy pains, sometimes sharp from either the inner or outer knee, sometimes both. You may also feel a stiffness or weakness in the knee which may affect your confidence. Other problems may include intermittent swelling, fully straightening or bending the knee as well as feelings of ‘crepitus’ or grinding (Vioreanu, 2014). The incidence of OA tends to increase with age, with over 50% of the population having OA by the age of 65 (Vioreanu, 2014).

What can be done to help – what do the medical experts suggest?

The National Institute for Clinical Excellence have published updated guidelines in 2014 suggesting:

Why is the warmup and cooldown so important?

The warm-up prepares the body for exercise and should be tailored for the specific exercise that will be undertaken. For football, both general and specific exercises should be performed.

The warm up may involve

1. General exercise jogging or cycling for 5-10 minutes to warm the muscles and enhance circulation in preparation for stretching
2. Gentle static stretching of key muscle groups such as the hamstrings, calves and hip flexors which are held for 20-30 seconds and repeated 2-3 times. It is also important to stretch/mobilise the spine gently, especially the ‘twisting’ movement.
3. Low level resistance exercises to ‘wake up’ important core stabilising muscles which will help support the back, hips and legs during training.
4. Once the muscles are well warmed up, more vigorous dynamic stretches can be performed carefully under supervision of the coach so as to avoid injury.

The cool down is important to safely restore the body back to its resting state. This may include:

As part of our new Pilates term in November, we are adding a weekly ‘Falls Prevention Class’ which will take the form of a 60 minute exercise class aimed at improving general strength, balance, mobility and physical activity. The class will be run by a Chartered Physiotherapist who is trained in tailoring therapeutic exercise for all age groups.

Why a Falls Prevention Class?

The proportion of the population over the age of 60 years is growing rapidly and is likely to continue to grow in the coming years [1]. More than 33% of community-dwelling people aged over 65 years unfortunately will experience a fall at least once a year, while 50% of those will have recurrent falls [2,3]. As age increases, the rate of falls can increase up to 60% [2,4]. Falling can badly effect confidence, reduce a persons feeling of independence and possibly result in isolation, with around 1 in 10 older people who fall becoming afraid to leave their homes for fear of falling again [5].

What is a Point Stimulator?

The point stimulator is similar in appearance to a large pen, it is a handheld device. The model we use in the clinic is the Pointer Excell 11 which we have found to be very effective and reliable.

The tip of the point stimulator, similar to the tip of the pen, sends a gentle current through the needle and into the muscle. This may enhance the sensory effects of dry needling which promote blood flow, healing and have local analgesic effects. The point stimulator also causes small micro-contractions within the muscle which may have additional mechanical effects as well as allowing accurate confirmation that the correct muscle is being needled.

Benefits of using the point stimulator are:

It can be used to ensure that the needle is inserted into the correct muscle so it is useful as a diagnostic tool.

It can also be used as a treatment tool by directly stimulating the needle for 2-10 second bursts with a 5 second rest in between for approximately 1-3 minutes, depending on the treatment dose and client’s response. Clinically this is particularly effective for reducing muscular tightness and deactivating painful myofascial trigger points within muscles.

What is the Quadratus Lumborum (QL)?

The Quadratus Lumborum is a quadrangular shaped muscle which attaches to the bottom rib, the verterbrae in your lower back and the top of your pelvis. It acts as a stabiliser of the lower back and can laterally flex the spine. It extends your lower back when working with the other side and it aids forced exhalation, for example when coughing.

Why is it relevant?

Myofascial trigger points in the QL muscle often mimic symptoms of discogenic low back pain i.e. back and leg pain caused by a problem such as a ‘slipped disc’. However 32% of such presentations have been shown to have QL muscle myofascial dysfunction as their primary issue, rather than a disc problem.

image courtesy of Wikipedia

What is Electro Acupuncture?

Electro Acupuncture (EA) is where an electric current is passed through the acupuncture needles. In the clinic there are two types of devices used – the Cefar Acus4 and ETO ES130 EA devices.

What are the Electro Acupuncture devices?

The EA devices are small and portable devices with leads that attach to the needles in order to transfer the current from the machine to the needles. The wires are comparable to jump leads which are used to restart a car engine just on a much smaller scale and with a much more gentle current! In comparison to the point stimulator it provides constant input into the muscle for 10-20 minutes again depending on the treatment dose required and the nature of the condition being treated.

We now have our Strength & Conditioning studio successfully up and running at the clinic.

I have been working with a diverse range of clients, a variety of ages and fitness levels here in the studio. My main goal for my clients is to reduce the risk of injury or reinjury when returning to sports and everyday activity. My clients’ goals thus far have included increasing core stability, weight loss, improving postural control, enhancing lower body strength, increasing balance, along with many others.

Sessions generally begin with a warm up on the bike, followed by a combination of aerobic, strength and flexibility exercises and finally a cool down of stretches. The combination of exercises depends on the goal of the client.

Where is my Coccyx?

The coccyx is the anatomical term used for tailbone which is the bone at the very bottom of your spine, so in your buttock region. The pelvic floor muscles as well the gluteus maximus muscle have attachments into the bone. There are also numerous fibrous ligamentous attachments in this area as well to the sacrum which help hold the bones together and keep them stable.

What causes pain in this region?

Pain in the tailbone region may be referred to as coccydynia and is most commonly is caused by a traumatic event. For example a fall onto the backside or during childbirth. This can cause bony bruising or a fracture of the bone. It can also cause inflammation which can lead to pain and discomfort. Other causes can be degeneration or wear and tear of the joint which links the coccyx to the sacrum or possibly other surrounding joints which can be often overlooked. Instability i.e excess or poorly controlled movement in the joint can also cause sensitivity and pain in the area. Pain in this area may also be referred pain from tight muscles containing trigger points for example the buttock or pelvic floor muscles. 'Sciatica' can also cause pain the tailbone region. In rare cases pain in the coccyx area can be due to tumors and infections.

Image courtesy ofWikipedia

Studies have shown almost 80% of people experience low back pain at some point in their life. Most episodes settle within 4-6 weeks with a course of physiotherapy allowing for a quicker recovery and a reduced likelihood of recurrence and chronicity.

There are body structures which may cause back pain either directly or indirectly, along with help form the central nervous system. These may include overly tense muscles which may contain trigger points, faulty nerves, sensitive joints which may be moving too much or may be 'stiff', possible wear and tear in the joints in the spine or direct injury where a joint in the spine was sprained or fractured or damaged. Back pain may also arise from organ's such as the kidneys, blood vessels and tumours which makes a thorough examination by a medically trained professional essential.

Firstly, what is the sympathetic nervous system?

The sympathetic nervous system (SNS) is a part of the autonomic nervous system (ANS) which is that part of the nervous system which controls most of our automatic bodily functions. In other words those that take place without us having to ‘think’ about them like pumping of the heart and breathing.

Most of our organs are under control of the ANS as well as other physiological functions such as the release of hormones and chemicals needed to keep the body operating smoothly. The ANS is also an important regulator of stress in the body and can affect how we think and feel at an emotional level (Hallman, 2013).

Peripheral nerve pain may result from what is commonly referred to as “Trapped Nerves.” In this blog, I have outlined a few key points in relation to peripheral nerve pain and what to expect in relation to recovery and symptoms.

What are Peripheral Nerves?

The nervous system in the body is divided into two parts the central nervous system and the peripheral nervous system. The central system consists of the brain and the spinal cord. The peripheral system is made up of the peripheral nerves. The peripheral nerves exit the spinal column at the various levels from the spinal cord and each nerve supplies a different part of the body i.e. a muscle, area of skin and/or organs. The peripheral nerves send sensory information to the brain and spinal column to tell the brain - for example the hands or feet are cold, that the object touched is sharp or that a joint or muscle is sore. The peripheral nerves also send signals to the muscles from the brain and spinal cord in order to generate an intended movement, for example, writing or walking. So basically the peripheral nerves communicate information back and forth from the muscles and organs to the central nervous system in order for tasks and functions to be carried out.

(Image courtesy of: Häggström, Mikael. "Medical gallery of Mikael Häggström 2014")

Acceptance and Commitment Therapy (ACT) is a form of therapy which can be used to treat many different conditions such as depression, anxiety and pain. It is best described as:

Getting to know unpleasant feelings, then learning not to act upon them (Noam, 2010)

ACT gets its name from its two core messages:

1. Accept what is out of your personal control – in this context, pain.
2. Commit to action that improves and enriches life

ACT utilises three key mechanisms:

A friend recently wrote to me asking how I was while sharing her progress with a recently adopted eating plan. After congratulating her on her discipline and good intentions (I was being most sincere) I suggested that I only partake in one diet, once a year. That is the Christmas diet, incredible effective at putting on weight.

Now that I am back to eating normally (for me) I feel a whole lot better. Since diet, or lifestyle eating, has been on my mind more than usual I’m compelled to share further interesting observations from the web.

Diet type depends on your 'over-eater' type

Obesity researcher Zoë Harcombe challenges yet again the efforts of main stream media. This time it is BBC’s Horizon programme and their study on personalised approaches to dieting based on genetics, hormones and psychology.

“My pelvis goes in and out of place!” or “my sacrum has gone out!” can be common beliefs for people who suffer from pelvic or lower back pain. This topic was discussed by Dr. Peter O’Sullivan, one of the leading back pain researches, in a recent BJSM podcast.  

As it turns out, up to date research would suggest this is an illusion and there is no evidence to prove that the pelvis or sacrum can in fact go in or out of place, or anywhere else for that matter! 

The facts based on research are as follows:

1. The pelvis and the sacroiliac joint (SIJ) joint are very secure and stable joints and move very little.

Although I didn’t completely lose all sense of self-control during the recent festive period, I have had to drop back a notch on my belt. I’m sure I am not the only person to have gained some additional weight over Christmas. As expected, the media is full of tips and ideas for getting back on a healthy track. I have recently come across a few tips that I feel are worth sharing.

A nutritionist specialising in women’s health and hormonal balance, Marilyn Glenville, shares these top tips:

• Stop eating sugar!
• Balance your omega-3 and omega-6 (choose krill oil)
• Take vitamin D
• Eat foods high in B vitamins and magnesium to support the adrenal glands

In my own experience, cutting out sugar will be the single most effective habit for aiding fat loss. Read the reasons behind these tips here - http://www.telegraph.co.uk/health/11320561/Health-and-fitness-advice-Simple-nutrition-advice.html

Health Hacks

Cancer researcher and professor or medicine, David B Angus, shares his top tips:

We’ve been told that sitting for prolonged periods is detrimental to our health, in fact I’ve seen infographics saying that our sedentary sitting habits will kill us. Well, you might have to drive to work but now you can spend your day walking without ever leaving your desk.

One ingenious solution to this common dilemma is the ‘walking work station’ - a treadmill type setup at your desk. There seems to be a logical progression happening here - from sitting to standing and now walking. The standing work station, simply an elevated desk that requires you to stand instead of sit, has been around for some time and I have even tried it myself for some months. Now I read that standing, although better than sitting, is still sedentary and not going to provide the counter benefits worthy of the change in setup. The next step (excuse the pun) is the walking work station.

An assessment and review of 180 participants, conducted at a University in the States, found walking work stations improve engagement during computer based activities; improving satisfaction, reducing stress and boredom and even varied levels of arousal (whatever that is supposed to mean).

Study findings here - http://www.sciencedaily.com/releases/2014/10/141029124618.htm

It is that time of year again when we are delighted to wish everyone a very happy New Year!

Are you committing to any New Year Resolutions? I sure am.

Each year I come across gloomy news headlines claiming the majority of people who commit to change in the coming year will fail miserably at their goals, even before the end of January.

I am not going to offer the supposed ‘ultimate method’ for goal planning and execution because if the process itself is too arduous then compliance becomes the goal, not the intended outcome. When you lose sight of the end result, the benefit to be gained, it is all too easy to become distracted and fall back into old habits.

Christmas is only a few days ahead and that means the festivities are well underway. They certainly are in my house with the mince pies coming out a week ago already. Instead of residing to the belief that I will simply put on unwanted weight during this period and then want to work it off in the New Year, I have chosen to take a smarter approach.

I will share with you

• Simply holiday eating tips
• 3 cunning strategies to avoid putting on weight
• How emotional awareness can help you make better choices

My smarter approach does not mean going without. Yep, I do view food as one of life’s pleasures, especially when enjoyed in a joyous and friendly social setting.

So, I’m going to enjoy the naughty treats for sure. I have to be careful though because I do put on weight easily, specifically belly fat (it’s a man thing), and I have become quite sensitive to excess sugar as a result of mostly cutting out refined sugars completely from my diet.

I believe we all need to figure out our own approach and what works for me might not work for you. I therefore will offer insights and ideas, sourced from others more ‘educated’ than I on the topics, who have influenced my strategy.

I hope they offer some inspiration.

Pilates has greatly benefited my Physiotherapy practise as well as benefiting me personally.

Firstly, being knowledgeable in Pilates and the different exercises involved in Pilates has equipped me with another valuable treatment tool. Pilates is very useful in therapeutic exercise prescription and choosing the most valuable and beneficial exercises to address the client’s particular physical problem.

Secondly, being a trained Pilates Instructor has increased my ability to identify abnormal patterns of movement in clients which may be contributing to their pain symptoms for example. When teaching Pilates, I am constantly observing the way people move to ensure that they are moving in the correct way. As a result I have become more observant in my clinical practice in recognising abnormal movements caused by muscles may be weak or overactive, joints which may be ‘stiff’ or overly mobile as well as issues relating to the nervous system’s control of the body.

Our next Pilates course schedule starts on the 12th January and includes our usual Beginner, Improver, Advanced and Aerobilates level classes, plus this term we have introduced a Maintenance and a Relaxation class. 

To view our course schedule please visit our website here - http://mmphysiopilates.com/dublin/join-a-class.html

To learn more about the competency/ difficulty level for the different classes see here - Level Descriptions 

How to join a class

Signing up for one of our courses is very simple. We have a secure online booking system where you can choose your class, register and pay using a debit, laser or credit card to reserve your place immediately. You will receive instant confirmation of the success of your booking.

Medical Acupuncture (MA) is a form of therapy in which fine needles are inserted into specific points on the body to bring about various processes within the body. Benefits include pain relief, tissue healing and tension release from tight muscles.

What is Patellofemoral Pain Syndrome (PFPS)?

PFPS is a term used to describe pain in and around the knee cap (patella) (Brukner & Khan, 2007). It is also known as ‘Anterior knee pain’, ‘Patellofemoral maltracking Syndrome’ and ‘Chondromalacia Patellae’ (Brukner & Khan, 2007). It is often cause by muscle imbalance and biomechanical dysfunction of the lower limb coupled with and increased activity load on the knee.

Aims of treatment

The overall aim is to allow the knee and and knee cap to move and function as normally as possible to as to remove mechanical stresses which may lead to the development of or perpetuate the symptoms of PFPS.

Apparently it is safer to ride to work on your bike, contrary to the beliefs of the Dublin public who feel commuting by bike is inconvenient, not enjoyable due to the wet climate, and is dangerous.

Public initiatives in cities around the world are trying to convince more people to drive less and bike more. This is not an easy task according to a new study in the Journal of Public Policy & Marketing, co-authored by a Marius C. Claudy from UCD. The authors point out that despite the public view about the weather, Dublin actually has a drier climate than many cities in the Netherlands, a country having a strong bicycle-commuter community.

The positive reasons in favour of converting from 4 to 2 wheels include cost-saving, improved physical fitness and health as a result of being more active as well as reducing C02 emissions.

You may have noticed a lot of news in recent years about rising obesity levels and apparently decreasing activity levels. Sugar and carbohydrates continue to be scrutinised for their weight-gain effects while the debate between the contrasting low-fat vs the low-carb-high-fat diets continue.

Understandably, alcohol is gaining more attention in this regards too and is considered to contain 7 calories per gram. In our more health-conscious society today it makes sense we could benefit from knowing the calorie content of our frequent tipple.

Due to the fact that alcoholic drinks are not recognised as food they are exempt from food labelling. However, before the end of 2014 the EU commission is due to make a decision about extending nutrition labelling, including calorie labelling, on alcohol.

Despite the clocks having changed for the so-called purpose of ‘daylight saving’, it hasn’t done much for me personally in obscuring the noticeable onset of the shorter, darker days of the coming winter.

This seasonal change has brought to my attention once more the important consideration about sleep. Specifically how our sleep duration and quality affects not only our physical performance but all aspects of our lives.

The other night I noticed I was starting to feel sleepier and ready for bed earlier than usual. I justified to myself (as we do) it was due to the earlier onset of darkness in the evening, that’s all. It got me thinking - should I consider going to bed earlier in line with this shift in season?

Such a change in routine doesn’t really suit me because despite the change in season my daily routine and commitments have not changed. Therefore how would it benefit me, or be possible, to try and live more in rhythm with the environment. That is the ‘natural world’ environment, not my local in-home environment where multiple devices are contributing to the excess of ‘blue light’ in our living room. Such light in the blue end of the spectrum just so happens to be the type that does an effective job at disrupting our natural body clocks.

How would you define healthy? Perhaps being an XS or skinny size trouser type person. Maybe you perceive healthy as a diet restricted to leafy greens and fruit, perhaps combined with a hyper-disciplined exercise regime demanding many hours each day in the hot and sweaty zone. Such pursuits don't conjure up a sense of 'balance' and in my view are more likely to result in long-term inconsistencies, both in your commitment and motivation.

'Consistency' is the key factor here, as is the concept of 'lifestyle'

When a way of being becomes very much a part of your way of life - it becomes easier to sustain in the long run. This is the major problem with crash diets or fitness fads - resulting benefits don't seem to last because the commitment required is either not sustainable or are too extreme that they are unable to become integrated lifestyle habits.

Our next Pilates course schedule starts on the 3rd November and includes Beginner, Improver and Advanced level classes. We also have a new class called Aerobilates which includes a more aerobic element to the class for a higher intensity workout.

We have just added an additional Beginner class due to demand which currently has 4 places left. This class is a Thursday evening class between 7pm-8pm, running for 7 weeks from the 6th November.

To view our course schedule please visit our website here - http://mmphysiopilates.com/dublin/join-a-class.html

How to join a class

Dr Mike Evans presents another of his usually wonderful videos. This video's subject - Save Brains.

Dr Mike focuses specifically on young brains so if you have children this video will be of great interest to you.

Some of the key messages are provided here plus the video:

• The first 1000 days is best time to stimulate a young brain
• A combination of health, good nutrition and play-based responsive stimulation are the best ways to stimulate a young brain
• Stress and adversity is a part of life and a child is more likely to have a healthy response to such stress if well supported by family and a community

Different types of stresses include:

Age-old exercise wisdom has always included stretching as part of the pre and post activity discipline. We've believed that a good stretch will help reduce injury, aid recovery from the stresses of exercise and even improve our performance during the event.

While some exercise specialists still hold these physiological benefits of stretching to be true the efficacy of such effects are being challenged by others.

Earlier this year Lorraine posted an article titled Important Tips For Stretching Properly

Some key points from the article:

Time to throw out the bread! A low-carb diet IS the most effective way to lose weight – and it cuts the risk of heart disease, too.

Zoë Harcombe, nutritionist-researcher-writer, has a no-nonsence approach to addressing obesity. Her personal insights and reviews of information published in main-stream media are always refreshing and challenging.

Zoë recently discovered some breaking news coming from the US on the back of a study looking at the effects of low-carbohydrate and low-fat diets. My interest peaked when I noticed her surprise that the study was 'refreshingly void of conflict' giving opinion that it is a rare thing to find a drug or food study genuinely independent and run so well. The results are intriguing.

I first began suffering the pain and symptons of patellar tendonitis near the start of this year. It has taken a long time to recover from this painful condition and every now and then I still feel a 'tweak' of pain in my knee.

Naturally, I find myself wondering how long it could take before my patellar tendonitis eventually heals completely.

Image: "Blausen gallery 2014". Wikiversity Journal of Medicine. DOI:10.15347/wjm/2014.010. ISSN 20018762.

The shoulder is vulnerable to a many differing problems due to its complex nature - combining several joints, tendons and muscles which allow for a broad range of movement. The shoulder is inherently unstable and its function can be likened to a seal trying to balance a ball on it's nose! It is very reliant of good muscle strength and function for support and stability and when this is not present, one of the common painful conditions which may develop is shoulder impingement also referred to as rotator cuff tendinopathy or impingement syndrome.

Treatments include Physiotherapy (usually the first approach) which may involve exercise, manual therapy and medical acupuncture/dry needling, as well as other procedures such as local injections and surgery in certain cases.

I am sure you have read or heard that running will naturally offer greater cardiovascular benefits for the body compared to walking. This is mainly due to the required increase in workrate of the heart to sustain the more intense acivity of running. This greater intensity demands a faster blood flow - good for moving oxygen around the body. This intensity also offers numerous benefits for the heart itself and the overall strength and fitness of the body.

We have written previously about the merits of running - Is Running The Best Exercise For Fitness

A critical consideration is the additional time and effort required to participate in a run versus a walk and whether this extra effort actually causes no activity to be taken.

Our autumn Pilates term gets underway today and it’s our biggest schedule we have ever run. We have 12 classes running per week across our usual 7 or 8 week courses and overall we have 94% of places booked. The demand for Pilates led by a Physiotherapist is very encouraging and we are delighted to see such interest in the maintenance of physical wellbeing.

In this article I thought I’d share a collection of recently published articles discovered across the web relating to the health benefits of physical activity. I hope some or all of these are of interest - so here goes…

Lifetime of fitness: Fountain of youth for bone, joint health?

Information coming out of the American Academy of Orthopaedic Surgeons suggests we can minimise or delay the effects of ageing by keeping physically fit and conversely a sedentary lifestyle will likely contribute to more rapid physical deterioration of our bodies and health.

Low back pain is very common in the general population with approximately 80% of people experiencing back pain at some point in their lives (Daulat, 2013). Many people with back pain are anxious to have a scan to investigate the apparent cause of their pain. 

According to Timothy Maus, an American Researcher:

We do go on about the value of exercise a lot, don't we? We do for a very good reason - exercise is one of the best, if not the best, efforts anyone can make for improving their short term and long term health.

We've written about the benefits of exercise in many previous blog posts - benefits such as improving your mood thanks to a release of feel good hormones, by challenging your heart and increasing blood circulation you are improving your cardiovascular health - reducing your chances of developing chronic disease, the list goes on and on...

Despite awareness of these tremendous health benefits many people still do not exercise regularly. The word 'awareness' here is key for creating new and positive habits in your life.

Developing greater awareness, not just about the benefits of regular exercise, but also awareness for what is preventing you from taking up a regular physical activity.

We like exercise, specifically Pilates led by a Physiotherapist, and we regularly promote its tremendous health benefits. We appreciate that finding the time to exercise can be tough for some people. With time constraints in mind I would like to share an interesting idea of ‘exercise snacking’ that I came across in an interesting article over on sciencedaily.com

The article’s focus is on an exercise method to help better control the blood sugar levels in people with insulin resistance. Whether you are knowingly insulin resistant or not controlling blood sugar levels is surely a smart thing for everyone to do, especially in our modern times when sugar is so prevalent in many of our food sources.

Controlling blood sugar levels will not only help you to reduce the risk of developing type 2 diabetes but will help you lose or control your weight better too.

Is the recommended 30 minutes of exercise really optimal?

A lack of time is one of the most common excuses given by people who don’t exercise. This report coming from the American College of Cardiology will be welcoming news for the time-poor non-exercisers:

"Running for only a few minutes a day or at slow speeds may significantly reduce a person's risk of death from cardiovascular disease compared to someone who does not run."

Running is a very popular form of exercise given it is easy to take up - no special equipment is needed other than a pair of running shoes and you can start and end right from your front door. A previous post of ours assessed the merits of running in more detail - Is Running The Best Exercise For Fitness?

The report from the American College of Cardiology states that even a 5-10min run is enough to provide significant cardiovascular benefits and a reduction in mortality risk.

Dublin has enjoyed some high temperatures so far this summer and understandably many of us are more active outdoors when the sun is shining. We must be aware of the potential issue of heat related injuries sustained from exercise in sport and other forms of strenuous work-related activity.

I don’t want to put a dampener on our untypical warm and sunny weather but rather my intention is to simply raise awareness. Many of us may not have a lot of experience training in such warm conditions but I do from my youth growing up in sunny South Africa.

It’s important to realise from the start that heat injuries can be life-threatening, if precautions are not taken. Heat injuries can start with mild forms of heat cramps which are easily treated if identified early enough.

Let’s look at different types of heat injuries.

It turns out that people have strong opinions about the association between weather and their back pain. 

As far as we can tell this ‘belief’ has never before been rigorously and scientifically evaluated so I was interested to read about an attempt to do so.

An article published by Chris Maher, a Professor of Physiotherapy in Sydney Medical School, describes how they used data from a different study to see if any correlations existed with historical weather conditions. This investigatory study was originally asking if the weather was more likely to distract you or make you feel fatigued during activity and if this had an affect of recurring back pain in 1000 primary-care patients over a 14 month period.

Since the original study had nothing to do with weather data there was no risk for any bias influence when the case-crossover analysis took place. Since the original study took place over 14 months there was historical weather data for all 4 seasons in the year.

You would be forgiven for considering golf to be a low injury-risk physical activity, after all it is a non impact-sport. However injuries to the golf player, whether a low or high handicapper, are quite common.

I wrote an extensive article last year about common golf injuries, the need for good flexibility and control while discussing the challenges of the modern golf swing. You can read the full post here.

We are in the middle of summer, a time when even the fair-weather golfers are out enjoying 18 holes be it on one of Ireland’s 300 courses or a foreign one. I thought this a good time to share a quick reminder about the risk, cause and prevention tips for one of the most common golfing injuries called ‘Golfer’s Elbow’.

What is Golfer's Elbow?

There is some debate as to whether golfer’s elbow or low-back pain is the most common golfing injury. Since both injuries can be caused by the repetitive motion of the golf swing and both requiring good technique to avoid injury I would suggest the level of risk for either injury to be fairly consistent.

What body part is affected by an ACL injury?

The anterior cruciate ligament (ACL) is one of the two major ligaments in the knee, the other being the posterior cruciate ligament (PCL).These ligaments perform the vital function of connecting the large femur bone of the thigh to the lower leg bone called the tibia.

The ACL’s main purpose is to maintain the overall stability and support of the knee, the largest joint in the body. The ligament is positioned just behind the kneecap and holds the leg and thigh bones in place preventing the leg bone from slipping forward and rotating during pivoting movements. The ACL is supported by the thigh, buttock and very importantly the hamstring muscle groups.

Ligaments are tough bands of tissue that connect various bones together within your bodies. Although they are very strong too much stress on them due to intensive sports or overloading during a sudden twisting movement can cause them to stretch too far, possibly even to snap. If the ligament snaps, that is a complete rupture, we use the technical term ‘’he did his ACL”.

My first two weeks of induction at Mount Merrion Physiotherapy were spent mostly with Katie and Simon in preparation for Katie's departure and my first official week.

Last week I officially took over from Katie and it was great to get started on my own and to meet many clients as well as to start teaching on the new summer term of Pilates.

My induction weeks were undoubtedly beneficial and I am very grateful to Simon and Katie for all their effort and time making this transition a smooth one. I really enjoyed my first official week and I am delighted to be a part of the Mount Merrion team.

Over the years the scientific understanding of "unexplained" chronic pain has increased. Some examples of "unexplained" chronic pain include conditions such as chronic low back pain or chronic whiplash or fibromyalgia or chronic fatigue syndrome.

The research now shows that a concept of central sensitization is the underlying cause of this "unexplained" phenomena. Central sensitization is a process where the brain is receiving too many messages from the nerves to inform the brain that there is a problem with the body, which causes an over-sensitization of the problem.The brain is being over-bombarded with alarm bells that there is something wrong with the body.

By being educated on this concept and how central sensitization works can help to improve understanding of pain and how pain works.

A review on chronic unexplained pain discusses practice guidelines for explaining "unexplained" pain. This educational process involves two sessions lasting 30 minutes each approximately.

The first step in this process is to meet face-to face with a therapist in order to improve your knowledge on pain inlcuding:

We usually prefer to talk about the fun and health-promoting benefits of exercises but in this article I want to highlight 2 reasons why exercise may possibly cause damage to your long-term health.

I appreciate that for some people exercising is a chore and is done out of a sense of obligation to their own health as a result of advice from a doctor, friend or relative. If you fall into this category then these risks I am about to talk about will likely not apply to you. In case you decide to stop reading this article right now let me leave you with one simple nugget of wisdom before you go - you need to find an activity that is fun. When you really enjoy the sport or activity you are doing it no longer feels like a chore. One sure way of finding more enjoyment in your activity might be less about the choice of exercise but rather your choice whether to exercise alone or with a partner. Sharing your workout time with a friend is a lot more fun and motivating than doing it alone.

Back to those who may be at risk, people like me. I have always loved to be physically active but as I get older I become more aware of the need to self-regulate. If I don’t, it catches up with me and negatively affects not only my body but how I think and feel about life in general.

Our next Pilates course schedule starts on the 30th of June and 26 places from 36 have already been booked. As of today we have 6 places left on our Beginner classes and 4 places on our Improver-Advanced class.

To view our course schedule please visit our website here - http://mmphysiopilates.com/dublin/join-a-class.html

Summer Promotional Price

We are offering our 7 and 8 week courses at the 6 week price of €120.00
This is to accommodate some flexibility for holidays. If you are able to attend the full course that's great, the extra 1 or 2 classes are on us.

Adequate preparation as well as appropriate rest and recovery from sport and activity can help prevent overuse injuries from occurring. However with every good intention an overuse injury is easily sustain and is a common type of injury we see here in our Physiotherapy practice.

To fully understand the nature of the overuse injury, how to treat it and prevent it from happening again we must take a look at some background information about this common condition.

What is an overuse injury?

As a result of our sport or activity we can sustain one of two types of injuries - acute or overuse types.

Acute injury

This type of injury can be characterised by the sudden onset of a ‘sharp’ pain with the potential for the sudden loss of function, usually as a result of a traumatic event. Some examples of acute injuries would be sprains of the ankle, dislocation of the shoulder, bone fractures, etc.

Overuse injury

This type of injury is quite different from the acute injury in that the presence of pain and in some cases inflammation too can be totally absent. Instead of the sudden onset of pain and dysfunction there are numerous and repetitive micro traumas that occur to the muscles, tendons, joints and bones. These micro traumas are subtle and if frequent enough they will eventually lead to pain and dysfunction due to the eventual breakdown of the affected body part.

We have written a fair few articles about the barefoot running movement, exploring the debate for and against the merits of ditching the traditional running shoe.

Recent article: Running Confusion - Shoes vs Orthotics vs Barefoot Movement

The very first version of the five-fingered running shoe (a flat, rubber soled slip on style shoe with glove like inserts for each toe) was made by a company called Vibram. Since this first design a lot of other manufacturers have produced a diverse range of flatter style shoes to meet the growing demand for the more ‘natural’ running with less supporting cushion under your feet, AKA barefoot running.

Arguments over the merits of barefoot running have been intense with questionable claims supporting for and against it. The company Vibram has just recently settled a claim of nearly $4million for deceptive marketing about the health benefits of the five-fingered. It seems an estimated 70 million Vibram customers might be getting a payout to some extent.

Read about the Vibram lawsuit here…- http://www.huffingtonpost.com/2014/05/10/_n_5302213.html

A couple of weeks ago I wrote about my personal experience in how I recognised I was suffering from patellar tendonitis. I covered some technical points about who is at risk and what some of the contributing risk factors are for developing patellar tendonitis.

If you are considering whether your knee pain might be patellar tendonitis then be sure to read my initial blog post - What Is Patellar Tendonosis

In this part 2 follow-up I want to share some of the first stage rehabilitation activities that I have been doing to help my recovery.

After doing all the wrong things at first I sought advice from the Mount Merrion Physiotheray team who set me straight on what I should be doing. Having an inquisitive mind for the detail I asked for some evidence-based literature on the treatment of patellar tendonitis which I duly studied and supports my personal account here.

It is incredible that many powerful healing effects can be achieved by simply inserting needles into the skin and muscle, positively influencing most of our bodily systems. Just as amazing is the fact that Acupuncture as a treatment technique was discovered many thousands of years ago and has been practised by the Chinese ever since.

Only much more recently, within the previous 40 years or so, has Acupuncture been introduced into our western society. For many of these years the Acupuncture taught and studied has been based on the traditional Chinese Acupuncture method, understandably. The Chinese Acupuncture system is one based on the energy meridian model, a system not subscribed to by the majority of our scientific community.

The term Medical Acupuncture relates to a more modern interpretation of the needling technique and one researched and explained in more scientific terms. This has caused something of a divide between the two camps of Traditional Chinese and Western Medical Acupuncture practitioners. This is also not much of a surprise and such opposing stances can be seen in many other health related topics. That said, some practitioners are able to rationalise both approaches and use Acupuncture with one foot in both camps so to speak.

The first time I felt the sharp and stabbing front of left knee pain was a few months ago while enjoying my usual afternoon run with my dog. It was unlike the more familiar muscle aches and pains and there was no swelling present. I remember worrying this could be a potentially serious issue because this was a knee pain I had not felt before.

I was experiencing for the first time a condition which has since been diagnosed by my Chartered Physiotherapist as patellar tendinosis. After discussing my condition with my physiotherapist he directed me to various evidence-based online information resources as well as sending on relevant journal articles to help me understand the condition better. What follows is an account of a knee problem from a patients point of view.

This condition can become a more serious and chronic issue requiring many months of rest and rehabilitation if not appropriately cared for in the early stages. My knee pain started with repeated deep squat movements in the gym with a heavily weighted bar across my shoulders. Oddly the pain did not last more than a second during the exercise and almost no pain followed in the days after. Naturally I did not give it much more thought at the time until many weeks later when the pain returned, much more intensely and persistently, during a less than demanding run.

I now find myself in a delicate situation having to manage my knee pain very carefully indeed with fear of my condition becoming a much more difficult one to cure if I don’t give it the right attention.

Lorraine and I are enjoying a busy 2014 with our young family, the busy clinic and Pilates studio as well as our University tutoring and lecturing roles. We are proud to be involved in higher education supporting upcoming students as well as fellow medical professionals and we’d like to share some of the details of what we have been up to.

Lorraine has been regularly lecturing as well as examining on the undergraduate physiotherapy programme as well as the prestigious Masters in Neuromusculoskeletal Physiotherapy at UCD over the last number of months. Given such positive student feedback she has once again been asked to be a clinical tutor for Masters degree students on placement at the Mater hospital over the coming weeks. Lorraine will again this month present a lecture in lower limb biomechanics and injury management to the Irish College of General Practitioners.

Physiotherapists regularly prescribe exercise as a fundamental part of the rehabilitation process, following a muscle or joint injury for example. Running is a very common form of exercise to which many patients will want to progress, when enough function has returned, in order to build up their fitness again. But is running the best exercise for improving fitness?

The short answer is no, in my opinion.

However, possibly a more appropriate answer would likely be that it depends on what your fitness goals are and how you want to define fitness.

Let’s take a look at a local event to help describe what I mean. The Great Ireland Run 10km recently passed earlier in April with the winners achieving some impressive results; men’s first place came in under 30 minutes and the women’s first achieved a 33 minutes and 39 seconds. How do we think the top running athletes prepare for such an event? They will do a lot of running training no doubt but I am certain this is not all they do. Athletes performing at this level need to be in peak physical fitness to sustain the demands they are placing on their bodies and to keep their risk of injury as low as possible.

You may be wondering what do top performing athletes have in common with patient rehabilitation and recreational running. Well, my point is that we can learn from the best in their field and adopt some of the principles used in their training. Naturally our training won’t be nearly as intense or demanding as that of elite athletes so what can we learn from them?

Do you think our early ancestors wore half-length or full-length orthotic shoe inserts? Would their video-recorded gait assessments have revealed more under or over-pronators in the general population?

If we try to imagine how life was back in the day of the caveman we could safely assume that his ability to run both short sprints and long distances was necessary for surviving in a wild environment. Without the ability to track food or flee from dangerous predators the human evolution may not have been possible. What we can also be sure of is the caveman did not run in a pair of Asics trainers with rear-foot gel-cushioning outer soles structured for either a neutral or over-pronating gait . Nope, our early ancestors would have been running barefoot.

Many thousands of years later and despite our advances in footwear design and technology there is a ‘barefoot running’ revolution gaining traction in some circles. The idea is that we as a species have spent more time running barefoot than we have in our fancy high-tech shoes and therefore we are more physiologically suited to running barefoot.

Know your risk level and how best to self-manage pain in pregnancy

Pelvic girdle pain (PGP) is common in pregnancy with some studies[1] indicating as much as 33-50% of pregnant women will experience PGP before 20 weeks of gestation, possibly increasing to 60-70% prevalence in the late pregnancy stages.

Pelvic pain as well as associated low back pain can vary in severity and its degree of debilitation which does not necessarily subside postpartum.

Not all pregnant women develop PGP and some women are more susceptible than others. Women at higher risk may include those with a past history of PGP, lower back pain or any past pelvic trauma. Other contributing factors considered in some studies include high stress levels and psychological variables such as catastrophising and fear-avoidance beliefs[2].

Widespread pain, such as the symptoms associated with Fibromyalgia, is a type of aching pain that affects multiple areas of your body. The unpleasant experience of such symptoms can negatively impact mental health as well as physical functioning. A Physiotherapist experienced in managing the condition of Fibromyalgia can offer effective pain relief and a better ability to cope, but sleep quality is also an important factor the individual can focus on by themselves.

Poor quality sleep can impact all aspects of our health in undesirable ways. When it comes to sleep consistency is as important as quality and that is because we rely on something known as our circadian rhythm. This internal body clock programs our wake and sleep cycles and influences the healthy functioning of our bodies.

Although the precise cause of Fibromyalgia is unknown contributing factors are believed to be such things as infection or injury and more focus is now being placed on sleep quality too. Disturbed sleep may not cause Fibromyalgia but is often associated with the condition and may impact of the severity of the symptoms as well as the ability of the sufferer to remain functional in day to day life.

Our next Pilates course schedule is now published and we are accepting registrations via our Pilates website.

Between the 28th of April and the 2nd of May we have a total of 9 Pilates classes commencing. This term we are running 3x Beginner level classes, 5x Improver and 1x Advanced class.

If you are not sure which level is best suited for your ability please read our level descriptions.

Signing up for one of our courses is very simple. We have a secure online booking system where you can choose your class, register and pay using a debit, laser or credit card to reserve your place immediately. You will receive instant confirmation of the success of your booking.

Do you sit at a desk all-day long?
Are you feeling stiff with rising tension in the shoulders and neck?

Posture related tension in the upper back, shoulders and neck area is a common complaint for desk workers and those who drive a lot due to the prolonged periods of time in the same position. People who work in high-stress jobs will also be familiar with this type of neck tension.

Eventually this ongoing state of tension can lead to headaches and migraines which become more difficult to treat.

This 1-hour 'Neck Tension Release' session will provide you with effective relief at intervals which suit you and your lifestyle in order to prevent more chronic conditions from developing.

Who will benefit?

• Those who feel generally stiff through the upper back as well as tight in the muscles across the shoulders and up into the neck
• May occasionally get headaches which feel they start in the neck and creep up the back of the head, sometimes around to the front
• Desk workers and drivers
• Anyone in stressful working environments who do not get an opportunity to take regular breaks

The idea that the common back pain, specifically lower back pain, can be a result of our modern lifestyles does make some sense. In general people are sitting more for extended periods of time which contributes to lower activity levels. These factors alone can negatively affect posture which often lead to problems in the synovial joints of the spine, nerves and surrounding muscles which all play their role in causing back pain.

The medical history of any back pain sufferer is an important consideration for the Physiotherapist when understanding how best to help relieve the symptoms. There is not a single most effective approach for all conditions of back pain and in fact sometimes the seemingly sensible treatment only makes the symptoms worse. We wrote about such back pain confusion in a previous article.

Over-reacting to back pain can cause both patient and Physiotherapist to take unnecessary measures and potentially over-treat the condition. The most important factor is intervening early before the pain progresses to a more chronic state. An experienced musculoskeletal Chartered Physiotherapist will be able to suitably educate you on your type of pain, potential causes and other important considerations such as the risks of fear-avoidance behaviour.

Anterior knee pain or patellofemoral pain syndrome (PFPS) is a common complaint that we see in the clinic. What we are dealing with here is pain located to the front of the knee, usually over or around the kneecap. It can be vague and difficult to say exactly where it is sore. The pain may be constant and made worse by certain activities, otherwise only painful when doing certain things. The pain often starts gradually for no obvious reason and may be aggravated by walking, running, ascending or descending the stairs or prolonged sitting with the knee flexed. You may have severe difficulties continuing the activity that causes you pain and discomfort.

Who is likely to suffer from this condition?

PFPS is more prevalent in females, they are 1.5 to 3 times more likely to develop the condition than males in the athletic population. It can be a significant and debilitating complaint that can affect as many as 1 in 10 active adolescent girls.

What exactly causes PFPS remains a misunderstood and controversial topic. Knee muscle weakness especially of the vastus medialis obliquus (inner thigh muscles which supports the knee cap), abnormal foot biomechanics - in particular abnormal pronation, weakness of the hip stabilising muscles and poor functional control of the femur during weight bearing tasks can be common causes of the syndrome. So in other words if you have weak thighs and hips, wobbly knees, flat feet and generally poor balance you may be at risk.

Do you suffer from frequent episodes of Low Back Pain?

We offer a 1-hour physiotherapy 'Low Back Pain Maintenance' treatment session specifically designed to help reduce the frequency and severity of your painful episodes.

Who may benefit?

Frequent episodes of low back pain has many causes. These may include generally poor conditioning of the spine, muscle stiffness with ‘trigger points’, low levels of activity, stress and other lifestyle factors. Your low back pain may also be due to a degree of 'wear and tear' of the spine, what is medically referred to as spondylosis or osteoarthrosis of the spine.

Recurrent episodic mechanical low back pain can be well managed with intermittent 'maintenance' physiotherapy sessions.

Our team of Chartered Physiotherapists have designed this 1-hour treatment session to assist you in the management of this type of low back pain with the intention of reducing how often and how severely the episodes occur.

Calf pain is more often a muscular complaint and we regularly treat such conditions here in our Physiotherapy clinic. However, calf pain can indicate a far more serious and dangerous health concern as I have been cautiously reminded of by a recent experience.

As Chartered Physiotherapists we are first-contact practitioners where patients can schedule consultations directly with us without having to go through their GP first. We therefore see many patients presenting with what they believe is muscular pain and dysfunction. In a recent case where calf pain was the complaint the more serious symptoms of Deep Venous Thrombosis (DVT) were presenting.

The medical training of Chartered Physiotherapists equips us with the knowledge and ability to identify these "red flag" symptoms and immediately refer for further medical review and investigation. As medical practitioners it is important we keep the differential diagnosis in mind and refer on if necessary.

Have you been caught up in the wave of polarised generalisations relating to health and fitness? Debates such as whether we should be running in our structured shoes or going barefoot, whether villainous sugar is the ultimate cause of rising obesity levels or is the low-carb and high-fat diet the universal solution?

Bold claims and prophet-like exclamations may be more effective at catching our attention but most of the time these are only half-truths.

For example; weight-resistance training is very effective for shifting excess fat and the many miles covered on the treadmill may indeed be doing you more harm than good. However, we shouldn't leap to broad generalisations and label either of these activities as right or wrong for everyone. Simplicity might be easier to sell but in reality we are individually complex with unique preferences.

Modern life seems to be getting busier for most of us and it seems the quest for ultimate efficiency is running away with itself. It's no surprise why sleep-time would be the obvious area to skimp on because sleeping does not seem to be a very productive activity for go-getters.

Notable persons in history have proclaimed their disdain for sleep

Thomas Edison described sleep

as a criminal waste

while Margaret Thatcher said

sleep is for wimps

In this article I offer some insight about nutrition and what to eat during pregnancy to complement Lorraine's recent article - 10 Top Tips for Coping With Back & Pelvic Pain During Pregnancy.

Lorraine provided some insightful advice, some based on her own experience in dealing with the physical demands of pregnancy and also offered some realistic self-managing techniques.

Firstly, I feel compelled to point out that our food choices are personal and we all need to discover what works best for our own bodies which is not necessarily the easiest of tasks. Personally, my own journey of discovery is constantly aided, sometimes challenged, by picking up ideas and insights from other people. It is for this reason I 'follow' a number of health related websites, blogs, journals, etc. I recently came across two articles over on the primaldocs website related to the choices you can make about what to eat during pregnancy. These articles, referenced below, served as my inspiration for this blog post. I hope to inspire your curiosity on a topic that perhaps you may not have given important consideration to in preparation for your pregnancy.

Its that time of year again when I am fortunate and privileged to offer my experience and clinical expertise at the UCD School of Physiotherapy. I am currently teaching as an external lecturer on the Musculoskeletal module with my main role to cover the more practical ‘hands on’ aspects of managing patients with spinal conditions.

There is a bridge to gap between the world of academia and course work as offered in the University setting, and the application of this knowledge in a real world clinical setting. This is where I come in as I try to help students learn the manual therapy, exercise and patient management skills to be able to help the patients they encounter as students and upon graduation.

This brings me to some criticism of the University system, which is that of attendance. Given that these skills are only taught once in this setting, I am concerned when the lecture and practical classes don't have a 100% attendance by the physiotherapy students. These are the basic skills anyone wanting to work in musculoskeletal physiotherapy requires to be effective, they are the bread and butter of our practice. The time to gain the knowledge is now, so why not make attendance a priority? The University are trying to address the issue by making practical attendance contribute to the final module grade, however as yet this has not quite made the full impact. I feel that students have to want to learn and that if the passion and enthusiasm is there, attendance would never be an issue.

Having gone through two pregnancies myself in the past three years I've had first hand and recent experience in dealing with the physical demands of pregnancy. Combining my own experience of back and pelvic pain with my knowledge and insights from my Physiotherapy practise I am able to offer you these ten top tips to help you cope.

1. POSTURE:

Your posture will change during pregnancy especially as your pregnancy progresses and as your baby grows. Your centre of gravity changes and moves more forwards, as such you tend to lean backwards to compensate for this and to avoid falling over. This can pinch the lower back region and make your back muscles work very hard which can lead to back pain during pregnancy.

When standing remember these tips:

• Head up straight & tuck your chin in slightly
• Shoulders back & your chest forward
• Knees straight but not locked
• Weight balanced evenly on both feet
• Lower tummy gently tightened which helps support your bump and flattens the lower back slightly
• Avoid standing in the same position for too long
• Alternate resting one foot at a time on an small elevated surface for short periods
• Take regular breaks from prolonged standing

Related article - Pregnancy Posture

Are you planning on making any New Year Resolutions for 2014? If you are then consider why it is necessary to spend more time considering how to keep your New Year Resolutions rather than what they are.

It is estimated that about half the population will commit to new year changes but maybe it is not so surprising to learn that most good intentions don't ever result in long lasting, positive change.

So why do we bother making such resolutions when we have such a high chance of being disappointed with ourselves when we break them? In fact, this raises a very important point about the habits we create in our lives. New Year Resolutions are usually about reforming old habits or achieving new goals. However, if we loosely create a whole bunch of unachievable or half-hearted resolutions that we fail to achieve then we are in fact creating a habit of failure. What started out as positive intentions for the new year actually end up causing longer term issues with feelings of self-doubt and lack of self-motivation.

Peaceful family gatherings and indulgent festive feasts is how I like to think of Christmas time. But there is the less harmonious side of Christmas too - the drunken office parties and the over-crowded shopping experience of gift buying.

Our social complexities mean that many of us find some or all aspects of Christmas rather stressful. Maybe the sense of obligation to attend the work Christmas party or the battling of the crowds at the shopping malls is the source of your anxiety. Large crowds, especially the seemingly intense crowds of Christmas consumers, really do spark the fight or flight response in me.

'Social Anxiety' is defined as the persistent fear of or anxiety about one or more social or performance situations that is out of proportion to the actual threat posed by the situation. For example, the fear of not attending the office Christmas party for fear of what others may think of you.

Okay, I admit the threat posed by an unusually large crowd at the local Blackrock shopping centre is probably minimal in reality but is enough to send me on a hasty retreat back to my desk and amazon.com

It would appear that according to the research evidence anti-inflammatories are indeed effective for pain relief but have shown no proven benefit in actually reducing the signs of inflammation, such as swelling, in a sprained ankle for example.

So, the answer is yes, but not in the way most of us would expect.

In a recent British Journal of Sports Medicine podcast, the effectiveness, use and safety of these commonly used drugs are discussed. The research would suggest that Paracetamol may be as effective in alleviating pain so this should be tried first as it has a lower risk of side effects.

The best pain relief may be achieved by combining Paracetamol with an anti-inflammatory such as ibuprofen (Neurofen) and often a lower dose of the anti-inflammatories is therefore required, thereby reducing the risk of side effects.

What is osteoporosis?

Osteoporosis means porous bones. It is a progressive bone disease in which a loss of bone mass and density may potentially lead to fracture. It can affect all age groups and both males and females. Women are at greater risk of developing osteoporosis than men, mainly due to the rapid decline in oestrogen levels after the menopause.

Bone is a living tissue that is constantly being absorbed and rebuilt. As we get older more bone is naturally lost than is replaced. However In osteoporosis the bone mineral density is reduced even further. The structure of bone begins to deteriorate and the amount and variety of proteins in bone are altered. This causes bone to become more fragile and more at risk of fracture through a minor fall or bump. The spine, hip and wrist are most commonly involved.

What are the symptoms of osteoporosis?

Osteoporosis is often referred to as the silent disease as it may not be diagnosed until a fracture has occurred. Fractures due to osteoporosis can lead to changes in posture (such as developing a stoop in your back), muscle weakness, loss of height and bone deformity of the spine.

Some people may experience pain in their bones and muscles, particularly in their backs. If you do experience any such symptoms and have some of the risk factors of osteoporosis it is important to talk to your GP.

The list of risk factors is extensive. Here are some of the more commonly associated risk factors:

Low back pain continues to be a topical issue within society and one which all of us can relate to. Undoubtedly each of us have either suffered with low back pain ourselves or know someone who does.

While for some it can be an acute episode that resolves over a short period of time for others it becomes an ongoing issue that may develop into a much greater problem, that of chronic low back pain.

We recently listened to a very interesting podcast by Dr. Kieran O’Sullivan, from the University of Limerick, on chronic low back pain. He discusses how we as Chartered Physiotherapists can improve our approach in the care of these patients suffering low back pain.

Some highlights from the podcast include:

By the time someone with chronic (around 3 months or more) low back pain attends the physiotherapist he or she may already have been in contact with several healthcare practitioners and undergone extensive diagnostic testing. Each of these practitioners may have had a slightly different explanation as to the cause of this person’s pain.

Trigger points can be found anywhere throughout the body but often give us most trouble causing neck pain and low back pain, both regions which can be implicated in the development of ‘muscular tension’ headaches.

Trigger points are the tender almost nodular feelings in generally taut bands of muscle. They are very good at creating a sense of vague achy, deep dull or boring pain, even sometimes sharp and ‘nervy’. They also result in stiffening and weakening of muscles such that they cannot do their job in supporting an upright posture for example.

Have a feel of the muscles between the neck and the shoulder, those that may feel tense when sitting all day or stressed. If the muscles feel ropey, stringy or hard with one or two spots that are exquisitely painful to press on, these are likely to be trigger points in your upper trapezius muscle.

The below statement was a recent message taken by our receptionist indicating a level of dissatisfaction from a client of ours, Mrs K. With the intention of resolving the client's concern as soon as possible I met with the attending Physiotherapist and together we reviewed the client case notes. This particular scenario has raised an important consideration about the healing process that I would like to share in this article for the benefit of our readers.

Can you call Mrs K back please, she is not happy that after 4 sessions she is still in pain and wants to know where she goes from here?

Although sometimes used interchangably the titles 'Physiotherapist' and 'physical therapist' are actually quite distinct from each other. Inspired by a recent question from one of our clients I will share some details that should help to explain what the difference is between a Chartered Physiotherapist and a physical therapist.

Definition - Physiotherapist

Physiotherapy is a health profession concerned with helping to restore well-being to people following injury, pain or disability. Using knowledge from our extensive scientific and clinical background Chartered Physiotherapists can help to assess, diagnose and treat conditions and illnesses that affect people of all ages and social groups.

Chartered Physiotherapists use manual therapy including manipulation, mobilisation and massage as well as alternative modalities including electrotherapy and acupuncture. The Chartered Physiotherapist also utilises prescriptive exercise as a rehabilitative tool to help patients achieve their full potential. While traditionally, physiotherapy was regarded as rehabilitative and mainly hospital-based, the profession has expanded greatly into other health care areas. We have invaluable expertise to offer in educational and preventative roles in the community, the workplace and in private practice.

Definition - Physical Therapist

The Institute of Physical Therapy and Applied Science Limited defines Physical Therapy as a holistic approach based on the manual treatment of soft tissue, i.e., muscles, tendons, ligaments and fascia.

It is often the case that the effectiveness of your treatment is a combined effort by our entire team. In this article I wish to share a brief insight in the amazing value of collaboration between healthcare professionals.

Starting with a coffee

Every Monday Katie, Paula, Lorraine and myself sit down to a cup of coffee (and often a treat from the Good Food Shop just next door to the clinic) for a team meeting.

We usually start by running through any household or general administration matters which may need discussing. This ensures the smooth running of the clinic and brings us all up to speed with any changes or advances in what we are doing to deliver our Physiotherapy service. Its essential we are all on the same page and to be consistency amongst us in terms of how we do what we do. It is also a great platform for feedback between team members which provides further opportunity for refinement and improvement our internal systems.

Chartered Physiotherapists are trained to assess an acute (recent) ankle sprain and using a specific set of assessment criteria known as the Ottawa Ankle Rules we can determine if a fracture is likely to have occurred. If we suspect a fracture we can refer you for an X Ray or MRI scan (In Ireland, depending on your health insurance policy, you may need your doctor to sign off on the request). The results of the scan will help us decide how best the ankle should be managed and depending on the extent of the damage, an orthopaedic specialist may need to be consulted in addition to receiving physiotherapy.

Most ankle sprains result in soft tissue injury, usually to the ligament structures which support the ankle joint. The lateral (outer) ligaments are more commonly injured which may result in pain, swelling, restriction of movement and a loss of function e.g. walking properly, or ability to run and take part in sports. If this type of injury is not treated correctly, on-going weakness and instability may result, making further injury much more likely down the road. Simply taking anti-inflammatories is not sufficient.

Are you suffering an episode of acute lower back pain? I encourage you to stay calm and don't panic. Lower back pain is common and it does heal, most of the time full activity is restored over a number of weeks.

There is a worrying trend to over-treat back pain with unnecessary and aggressive techniques while all that may be needed is rest and gentle manual therapy. An interesting article related to this issue is available on the Harvard Health blog and I encourage anyone who has had or is currently suffering from lower back pain to read.

Harvard Health blog excerpt:

Most routine back pain will improve on its own with conservative therapy in three months, often shorter than that,” says Dr. Bruce E. Landon, professor of health care policy at Harvard Medical School. “Even more importantly, when we do more aggressive things - such as injections, imaging, and surgery - the long-term outcomes don’t change at all. These things have very little impact on what is going on, and they have the potential to make things worse.

As human beings we are ambulatory creatures, that is we walk upright and are very reliant on our legs to move us about. How the foot strikes the ground and the knock on effect this has up the lower limbs to the knee, hips, pelvis and low back in particular has become a subject of much debate and controversy in recent years.

Lower limb biomechanics refers to a complex interplay between the joints, muscles and nervous system which results in a certain patterning of movement, often referred to as ‘alignment’.

Much of the debate centres around what is considered ‘normal’ and what is considered ‘abnormal’ in biomechanical terms as well as the extent to which we should intervene should abnormal findings be found on assessment.