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.

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:

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.

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.

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.

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

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

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.

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?