Back Pain

A client from a clinic in London called this week, he has a little disc bulge at L4/5 and had been doing all the functional prep work with Michelle at which is a training studio I defiantly hang my hat on the team there are truly fantastic. Any way I digress, he had been skiing for 4 days and then unfortunately had hit some ice and just as he recovered hit some more ice and lost control.

When I saw him he could hardly move, he had lost power in sit to stand and had pain transferring down through his hamstring. 

I did some muscular and fascia release work and vertebral mobilisations in the thoracic area as well as some pelvis mobs. 

He felt so good he called the next day and booked in another appointment for himself and his friend to make sure their skiing was optimal for their last day of skiing....  Ski more, hurt less



Skiing helps foot pain.

This time of year where I practice, (Chelsea and Mayfair), almost every patient wants to know whether they can ski with their injured or painful foot. More often than not the answer is yes. This is because a ski boot is a little like a plaster or air boot, it keeps the foot and ankle relatively safe and unloaded. There are some conditions however where skiing can really help.

Plantar fasciitis is a pathological process within the fibrous band that lines the arch of the foot. The Plantar fascia runs from the big toe to the heel and then continues into the calf (Gastrocnemius) and the Achilles tendon. It is an integral part of the mechanics of walking and standing. Pain from PF is deep within the heel and classically sore in the mornings or after periods of sitting down. If you have ever seen a physiotherapist or doctor for this, then one of the exercises you will have been given will have been calf stretching exercises. This calf stretch often helps the pain. The good news is that a ski boot encourages this. Ski boots throw you centre of gravity forward and force a stretch on your Achilles as they do so. This stretch all day long can really help, and sufferers often say their PF pain is not a problem whilst skiing.

All I need to do now is find a way to prescribe a ski holiday as a treatment option!




What are your top tips to prepare your body for a winter sports holiday?

1. Start to prepare at least four weeks before your holiday, particularly if you don't usually do much exercise. This will improve your stamina and enable you to enjoy yourself better and reduce risk of injury and fatigue 

2. Make sure you are aerobically and cardiovascularly fit

3. You need to have strong quads so work on quadriceps strengthening exercises before you go away

4. It's important to prepare your whole body, not just work on your lower limbs. Combine squats and other strengthening exercises with balance exercises such as standing on one leg 

What do you need to do during a holiday to give yourself the best chance of avoiding injury?

1. Make sure that you've got your bindings fitted properly to your skis according to your skiing ability, height and weight. This is to ensure that your bindings release appropriately to minimise the risk of, for example, a knee injury 

2. Don't drink too much the night before. There are statistics out there that show that anything up to 30% of people on the slopes can be over the legal driving limit

3. Be aware of all the other people on the slopes. Most of the serious injuries now are collisions with other skiers and snowboarders. It is well known that skiers and snowboarders have different fall lines and that the impact between the two are becoming more and more common and in fact can become more and more dangerous. Try and be as alert as possible to what is going on around you - not just below you down the mountainside but behind you as well if at all possible. While a helmet may protect you, the debate about helmets remains open as to whether the countries that have a high usage actually have a lower major head injury rate

4. Ski within your own limits. Only ski on runs that you are competent on 

5. Be aware of the weather conditions. A red run in sunny weather with good visibility might be fine, but with zero visibility it could be a nightmare 

 If an injury does occur, what advice would you give on quickly assessing whether an injury is serious or not? 

"If an injury does occur then things to look out for are severe pain, rapid swelling, bruising and inability to weight bear. The more this occurs, the more likely it is that you have got a serious injury. It is important to be seen locally at the bottom of the slopes by the relevant clinic. They have got great expertise but often limited imagine facilities and normally only have X-rays. Therefore even if you think that you have been seen properly when abroad, when you get back to the UK you should get referred to a UK specialist to get your injured knee of shoulder properly assessed and scanned. 

Even if you don't get much in the way of pain, bruising and swelling you still need to go back and see an appropriate consultant when you return to the UK." 




Skiers Injuries

At the beginning of January I headed back to London for a couple of weeks to touch base with colleagues and friends and most importantly clients...

Having returned to the Alps I have brought the snow with me! Heavy snow for the last few days has meant amazing powder days but the white out conditions and wind means there has been extra toll on the body.

Injury 1 - A snow boarder took a jump and caught the tip of the board on landing, unfortunately his knee took the brunt! On a quick examination it was apparent that he had squished his menisci and had a small strain in his medial ligament. After some soft tissue release and taping I managed to off load the area enough to reduce his pain by 50% and most importantly he was able to board the next day. It is very common for clients with small medial ligament injuries to find skiing and boarding more comfortable than walking due to the fact that you don't straighten your knee fully doing these sports.

Injury 2 - Chronic back pain always gets aggravated when skiing in white out days because of the lack of ability to predict the terrain means that the body can't prepare itself for the bumps. This means the shocks don't get absorbed in the normal way and the joints rather than the muscles take the brunt. A young client being treated by a physiotherapist back in the UK for a back complaint called and after a few techniques I was able to reduce some of the pain. I gave him some stretched as well but unfortunately unless he gets a bit of rehab to does a little more preparatory work the back pain will return.

Injury 3 - A young girl had ankle pain, on examination there was some inflammation and irritation of the anterior joint line on palpation but she had full range of movement. I had a look at her biomechanics which were poor and she showed signs of shin splints which if she had been a runner may have been more apparent. I did lots of release to her peroneal muscles and tib fib joint and her pain reduced dramatically. I explained though that these signs were secondary symptoms and that she needed to see a physiotherapist to give her some specific exercises to improve her hip function and thus change the load through her ankle joint.

Skiing and Snow boarding are sports that use muscle groups, movement patterns and skills which have to be respected and to make the most of your holiday you need to prepare as best you can but even this isn't always enough!!!

Written in the comfort of my best place in Val d'Isere to get away from it all and take time out, where else than the sofas in the blizzard. Luxury 




When a sprain is more that a sprain.

It would be quite easy but I suspect rather dull to reel off a list of all the trauma we see following our yearly pilgrimage to the snow. There is plenty written about various common simple fractures.

Foot and ankle trauma is not that common whilst skiing or snowboarding simply because the combination of a rigid boot and bindings generally protects the foot. All the energy tends to be transferred to the other joints. That’s why my knee colleagues are so busy.

The common fractures and the dramatic fracture are easy to diagnose and are generally picked up locally at the resort or at the local trauma centre. They are usually managed well locally, but prompt review on your return with a foot and ankle specialist is a good idea.

If, however you are reading this little blog, in pain, unable to ski / board with an injured foot that has been diagnosed as a sprain or bruising then please read on. 

A sprain is simply a torn ligament. A ligament is a fibrous structure that holds two bones together. Ankle sprains are of course common, but not common within the confines of a ski or snowboarding boot. The boot and bindings are usually so stiff, that the amount of movement needed to tear a ligament is fairly unlikely. 

There are 2 injuries however that we do see that are often missed.

One is a fracture of the Talus bone, commonly known as a Snowboarders fracture. The other a rupture of the ligaments that hold the ankle and leg together, known as a Syndesmosis injury.

 The mechanism of injury is the key. A ski boot or boarding boot / bindings, positions the foot and ankle in a slight dorsi flexed position. Dorsi flexion is when your centre of gravity is pushed forward over the foot. You are leaning forward and the weight is pushing through the front of your foot. This is a very stable position for the ankle, since the Talus bone is wedged in between the Tibia (the shin bone) and the Fibula (slender outer bone).This is a great position for skiing since it  feels strong and stable, and allows you to load a edge and carve. If however you hit a unexpected depression, (such as when in powder), or if you miss time a landing thing can go wrong.  The recoil of the ski/ board and your ongoing forward momentum will thrust the ankle and foot into further dorsi flexion. Essentially your ski –boot – foot will be pushed upwards and in this position the Talus is essentially crushed between the foot and the leg.

One of 2 injuries then happen. If you continue to flex forward, falling to the outside the outer side of talus eventually breaks. This is called a lateral process fracture or a “Snowboarder fracture”.

If you fall forward and rotate as you do so then the huge rotational force generated can rupture the ligaments holding the fibula and tibia together resulting in a Syndesmosis injury.  

Both are often misdiagnosed because patients can often walk, albeit with pain. X rays often initially look normal to casual inspection. Patients are advised rest and elevation.

Unfortunately both need prompt treatment and a period of absolute rest, initially at least in a plaster or boot to get a good result.

If your tale of woe fits this pattern and your injury seems more than a simple sprain, then prompt review is needed on your return.

Next time Ioan Tudor Jones talk a little more about how to diagnose such injuries and how we treat them.




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Happy boxing day



Make sure you are fully prepared a grumbling meniscus isn't ideal.

This week I had a call from a client saying that his knee was hurting but that he hadn't had a fall and wasn't sure what was wrong.

I went over to his chalet to have a little look, thinking that it was going to be a patella tracking problem or something similar. The clients knee was swollen, with no obvious injury, he had full range of movement but couldn't squat fully in a load bearing position.

Unfortunately for the client this was a true sign of irritation of a grumbling Meniscus. Not a true tear or injury but irritation due to poor control and more pressure and load being put through his knee joint than usual which was made worse due to the poor visibility and the client not being able to predict each and every turn. This knee problem wasn't directly due to his skiing holiday but due to a slow degenerative knee joint which is loaded differently during a skiing holiday and had increased demands put to it than under normal conditions of sitting behind a desk.

Advice given, client happy.

Ski more Hurt less.