Why you need a tight ITB?

The ITB is often cited as being tight and we are often advised how to stretch our ITB?


Well, factually we are not able to stretch our ITB, because it is a very strong collagenous rich fascia cable like structure at the side of the thigh.

Did you know that we are not born with a ITB (iliotibial band)?

In our first few months we don’t need the ITB, but the it develops as we start to weight bear, move and walk as it provides stability between the pelvis and the knee when we walk, run and with impact. The ITB is considered “the most robust contributor to anterolateral knee stability”.

I have viewed cadaver videos of the ITB (viewing the internal structures/layers of the body) and it looks like a cable and also is VERY strong, hence we cannot stretch it. Foam rolling the side of our thigh (which is generally uncomfortable) will not stretch or change the stiffness or movement of the ITB.

Stiffness and Tension is needed

In fact, we need that stiffness and tension for stability and to store and release elastic energy as move, especially important as we run and jump (read more here Running Elastically - the elastic recoil of our fascia).


The ITB starts at the front of the pelvis where it blends with the gluteus maximus and tensor fascia latae muscles at the side and is then continuous with the fascia latae of the thigh (which is all the connective tissue that encapsulates the thighs soft tissues and muscles). It then finishes at the lower lateral knee and so is linked to the hamstrings and the quadricep (patella) tendon, and because it crosses the knee joint it is linked to the lateral calf. 

To help any feeling of tightness or pain at the lateral thigh or knee, we need self-care and Sports Massage to treat the compressed soft tissues around and beneath the ITB. This is to restore balance and function of movement through the body, treating around the ITB but also the broader hip, knee and ankle and then to strengthen the core, hip and knee connections.

Any questions please let me know.

Nicky Holbrook

www.nickysportsmassage.co.uk

Why Regular Sports Massage & Myofascial Release Benefits Your Health, Glow and Body Confidence

Value Massage as Part of Your Health Routine

In recent times, the importance of self-care has become a central topic in health and wellness conversations—and Massage therapy could be exactly what’s missing from your routine.

We all know about the health benefits of exercise, and our modern culture constantly promotes external beauty through fitness, cosmetics and other enhancements. But massage is different. Massage works internally, focusing on you and your soft tissues—which includes fascia, muscles, ligaments, tendons, and skin—as well as supporting your joints, internal organs, blood flow, and breathing.

These systems are vital for movement and strength, which play key roles in our long-term health, well-being, and happiness. By investing in treatments that support healthy movement, you give yourself the foundation to enjoy daily life, family activities, sports, hobbies and work to the fullest.

What Are Sports Massage & Myofascial Release treatments?

I am a Soft Tissue Therapist and I use advanced hands-on and corrective techniques designed to support injury recovery, relieve chronic pain, and maintain healthy soft tissues to improve your physical function and well-being. The treatments could involve massage techniques, such as stretching, vibration, joint mobility and Myofascial Release are gentle compression, vibration, rocking, sustained holds and pulls as effective for acute injuries as treating chronic pain. 

Every treatment I provide is tailored to your personal needs, goals, and daily challenges.  

Injuries don’t just occur during sports—for example they can result from: 

Accidents - falls, gym exercises
Repetitive strain or overuse
Post-operative recovery
Whiplash
Poor posture or long-term muscular tension

This is why Sports Massage & Myofascial Release isn’t just for athletes—it’s for everyone. 

Massage therapy has a wide range of benefits: 

• Improves flexibility and joint mobility 
• Enhances athletic performance 
• Reduces muscle tension and chronic pain 
• Prevents injuries before they start 
• Provides a tranquil space for mental relaxation and stress relief 
• Helps with postural imbalances 
• Improves your connection to your body and mind 

Massage is a valuable part of self-care—whether you’re training for an event, managing daily aches and pains, dealing with migraines, or living with long-term conditions like neck and shoulder tension. 

I’m also fully qualified to support you through Pregnancy &Post-Natal recovery and to work with individuals affected by Cancer during or after treatment (Oncology Massage).

Let’s Talk

I offer free consultations to help you understand how I can support your health and well-being.

This is a quote from one of my recent Clients -“I enjoy Massage and it feels like medicine for my body”.

Sometimes we all need helping hands to feel better, move better, and get back to the things we love. 

Call or message today.

Nicky Holbrook

www.nickysportsmassage.co.uk

Email

Tech Neck

Long hours of sitting, looking down, and responding to stress with our shoulders can cause a build up of over worked, tired and tense muscles and soft tissues and cause pain and headaches.
The neck is burdened with the tedious task of supporting our heavy heads. Working and resting, in a technology driven society, we are all at risk of tension and microtrauma from desk based postures in our head, neck, shoulder and back areas.

Battling against gravity - our muscles and are designed to glide freely around joints and across neighbouring connective soft tissues to perform an array of specified movements. However, when we are static for so long, with poor posture and work exposed tension, combined with constant gravitational exposure (an adult head weighs approx. 5kg) the body adapts and creates stability with stiffness, and generally compromises movement.

MASSAGE & REMEDIAL THERAPY & MYOFASCIAL RELEASE are all hands-on techniques to ease and re-establish pain free movement in the head, neck and shoulders (the rest of the body too), plus treating to help you relax and lessen muscle and soft tissue tension.

Any questions please let me know.

nicky@nickysportsmassage.co.uk

Western Acupuncture (Dry Needling) and its Benefits

I have been practicing Western Acupuncture (also known as Dry Needling, they are the same) for over a year now and with some great results and positive feedback and I feel it has nicely complimented the Sports Massage and Myofascial release treatments. I certainly don’t use it in every treatment, but it is a very beneficial and productive treatment option to have.


Firstly I always explain the difference between Western Acupuncture and traditional Chinese Acupuncture as whilst they both include the insertion of fine needles often the aim of treatment is completely different. Traditional Chinese Medicine uses Acupuncture and involves inserting the fine needles into specific points on the body, to stimulate the flow of chi (energy) through the body, whereas Western Acupuncture follows the Western medical approach to musculoskeletal pain, restrictions and tension to treat the relevant problematic soft tissue or joint.


The goal of Western Acupuncture is a reduction in musculoskeletal and fascial pain and improvement of function.

Why use Acupuncture? 

What actually happens when we insert a needle?

What are the BENEFITS?

This explanation has a few medical terms but I wanted to give you a view of what is happening when we choose to use Western Acupuncture:



Enhances the blood flow and hence the oxygen saturation where the needle is inserted, so this increases local blood flow and decreases the concentration of sensitising hormones (our hormones are chemical messengers which coordinate different responses in our body). So the BENEFIT - this helps the inflammatory process and is great for injury recovery, enhancing the natural healing process and is beneficial for pain reduction and increasing mobility.



The stimulation of the painful area by the needles evokes a positive calming response from the relevant anatomical vertebral segment, so acupuncture in an area can have a positive effect on another area that is innervated by the same vertebral segment (in between each vertebrae, from the spinal cord nerves exit which provide sensory and motor control to all of the body). An example of this is treating the lower shoulder rotator cuff muscle (infraspinatus) to address a painful superior rotator cuff muscle the supraspinatus. So, the BENEFIT - acupuncture has a calming effect and de-sensitising effect on painful areas (including trigger points).



The acupuncture needles provide a non-threatening/positive sensory input which can stimulate an increase in our body’s naturally occurring opioids (these are our endorphins and enkephalins primarily produced by the brain (hypothalamus and pituitary gland). So the BENEFIT - this can decrease our pain pressure threshold giving us a better ability to move. Reduces the reflex activity in muscles - so enhances muscle relaxation



With the needles inserted for a a few minutes, the needles can be rotated and or pulled gently up/down and this stimulates our fibroblasts to remodel. Fibroblasts are the key cell of our fascia (connective tissues) and play a critical role in wound/injury healing. So….. the BENEFIT increasing fibroblasts activity aids our fascial healing.



Lastly, they are safe to use, no need to rest post treatment and very limited side effects.



If you have any questions on Western Acupuncture or particularly interested in receiving it as part of a treatment, please get in touch.



nicky@nickysportsmassage.co.uk

May '25

How Sports Massage & Myofascial Release treatments can help Chronic Inflammation and Pain

Inflammation is the body’s natural healing response and protective mechanism (so it part of our immune system response) and it is the first thing that happens when we are exposed to something harmful, both injuries and diseases. 

 

Upon injury or threat substances from the body’s white blood cells are released into the blood or affected tissues to protect your body from foreign invaders. This release of chemicals increases the blood flow to the area of injury or infection, and may result in redness and warmth. Some of the chemicals cause a leak of fluid into the tissues, resulting in swelling (1). 

Physical acute and specific injuries to our soft tissues, such as an ankle sprain, or a cut, can cause inflammation locally, and this inflammation naturally reduces as the healing process continues, notably subsiding in the first 3-5 days. However, sometimes healing is not able to happen and so inflammation persists, and can cause long-term chronic pain to our soft tissues and also our vital bodily organs and systems. Persistent inflammation can be caused by many different scenarios and conditions, for example returning to activities too much too soon, injury reoccurrence, osteoarthritis, auto-immune conditions, disease.


Inflammation itself is not painful but it can cause redness, swelling, heat or loss of function and so may stimulate our pain processing receptors, called nociceptors, and hence cause pain.

3 types of Musculoskeletal Pain

There are 3 types of musculoskeletal pain:

Nociceptive
Neuropathic
Nociplastic


Nociceptive Pain - Constant stimulation of the nociceptors causes sustained stress on our body and mind and so our normal self-protecting immune system becomes stressed and does not function properly, causing a constant chronic inflammatory response. This can cause a continuous cycle of persistent and sometimes increased pain and it may spread, as our body is one continuous 3D tensile structure and overtime the feeling of “thickness, spreads like a pull in a sweater or stocking”(2) or pain can wander and travel through the body. Consequently our flexibility and spontaneity of movement are lost, setting up the body for more trauma, pain and limitation of movement.


Neuropathic Pain - sometimes we experience nerve pain (neuropathic) as our nerves are actually physically damaged or impinged owing to soft tissue inflammation.


Nociplastic Pain - nerves can mostly heal, but they can also become and remain over-sensitised and continue to cause local and multifocal pain even when the soft tissues are healed. This is called central sensitisation or nociplastic pain - and it can occur in combination with a local pain or injury or in isolation. This type of pain is now being used to explain Fibromyalgia and explain some long-term Covid symptoms.

Chronic Inflammation

The extent and effects of chronic inflammation and chronic pain vary person to person (as pain is an output of the brain and hence an individual experience) and also varies with the causes of the injury, the condition or disease and the ability of the body to repair and overcome damage.


Treating chronic pain and positively changing the natural inflammatory and hence healing cycle is a balanced game of decreasing pain levels and increasing mobility and hence encouraging healing.

Massage Therapy to help treat Inflammation and Chronic Pain

Frequent treatments is the key component to changing chronic inflammatory patterns

In my experience I have found the key component to changing chronic inflammatory patterns is the frequency of Massage treatments. 

When treatments are more frequent, I observe that inflammation could be reduced enough so there is a window of opportunity to enable my Clients to feel better and to move freer and more.


Positive Sensory Touch Input

The sensory input from Massage, both from touch and movement (see the Power of Touch article), positively influences the sensory receptors, including our nociceptors (remember the pain receptors) of the nervous system. They respond positively to gentle and considerate touch and the movement of the soft tissues and joints with Massage and Myofascial Release techniques that could result in a reduction of our pain experience.

Massage can reduce muscle guarding enabling greater pain free movement and enable us to feel more energy and vitality, and experience better sleep, and stimulate the healing process. This can all reduce symptoms of pain, depression, anxiety, and improve our function mentally and physically.

Reducing Inflammation

Research is showing that the positive touch stimulus and physical manipulation of the soft tissues from Massage and Myofascial Release could reduce inflammation, both acute inflammation from a sporting and activity recovery perspective and also chronic inflammation giving the body a chance to rest, recover and heal. So Post-event Massage is useful to enhance the healing process and hence a quicker recovery period, plus for chronic inflammation Massage stimulates the healing process.

The research (3) suggests that Massage could do this by increasing circulation of the blood and lymphatic systems, reducing inflammatory by attenuating the production of inflammatory cytokines (4), which are proteins, that help control inflammation.

Each and every person I treat is an individual with individual objectives, needs and presentations and so every treatment is individual.

If you have any questions on any of the above or how I can contact you or someone you know please contact me.

Nicky Holbrook

Sports Massage & Remedial Therapist & Advanced Clinical Myofascial Release Therapist.
January 2025

References:
1. https://www.webmd.com/arthritis/understanding-arthritis-inflammation
2. John Barnes, 1990, Myofascial Release
3. https://pmc.ncbi.nlm.nih.gov/articles/PMC7739334/ and https://pmc.ncbi.nlm.nih.gov/articles/PMC3975781/
4. https://www.hfe.co.uk/sports-massage/articles/massage-therapy-and-inflammation/

To Stretch or Not to Stretch?

Stretching has long been associated with fitness, flexibility and muscle health. For many, being able to touch their toes or bend in different directions is seen as being fit. However, current research suggests that stretching, particularly before exercise, may not be as essential or beneficial as once thought. While it still offers value for overall soft tissue health and rehabilitation, it’s important to understand when to stretch and when not to stretch.  Read on to understand the benefits and limitations of stretching.

What Is Stretching?

Stretching generally refers to any movement aimed at lengthening the muscles and improving flexibility. There are two main types:


1. Static Stretching: Holding a position for at least 15 seconds to lengthen the muscle, e.g. bending forward to reach your toes.

2. Dynamic Stretching: Involves active movements where the muscle is stretched through motion, such as swinging your legs as part of a warm-up. 

Additionally, there are other forms of stretching e.g. PNF (Proprioceptive Neuromuscular Facilitation) is a popular one in exercise classes and involves alternating contraction and relaxation of the muscle.

Why Stretch?

The most common reason people stretch is because it feels good. 

Stretching helps to “release muscle tension”, promoting a sense of relaxation. There’s also a psychological benefit - practices like yoga or Pilates improve body awareness (proprioception), which enhances how we move and feel in space (read more on  What is Proprioception ). These types of movements help the body achieve a greater range of motion than daily activities would typically demand. 

I am a Yoga fan and it continues to be a once (or more) weekly practice for me.

Other practical benefits of stretching include:

- Muscle cramps: Stretching the cramping muscle can provide quick relief.

- Joint health: Regular stretching can improve the joint’s range of motion by increasing fluid circulation and promoting flexibility.

- Soft Tissue Health: Stretching also influences the surrounding fascia (connective tissue) to realign and reduce the buildup of scar tissue following injury or surgery.

- Stiff/creaky in the morning - waking up stiff is common, after all when we are sleeping we are not moving, gentle stretches can help wake and warm up your muscles and joints. 

Stretching can be performed at any time, it doesn't need to

be after exercise.

Happy looking tiger enjoying a stretch

What Happens During a Stretch?

When you stretch a muscle, its fibres elongate, which causes the fascia (the connective tissue around muscles) to lengthen too. This realignment of muscle fibres can be beneficial for rehabilitating scar tissue from past injuries. Stretching also temporarily reduces blood flow to the area, stimulating the body to increase circulation once the stretch is released. This improved blood flow delivers oxygen and nutrients to muscles, helping them recover.

Stretching Effectiveness: Most research suggests that holding a static stretch for 10 to 30 seconds is sufficient to achieve flexibility gains. In practice, the greatest increase in muscle length occurs in the first 15 to 30 seconds of a stretch.

An effective stretching technique I use in my clinical practice is a Muscle Energy Technique (MET). This involves a gentle isometric contraction of the muscle against resistance, relaxing, and then stretching it further, which helps to reset the muscle's tone and improve flexibility.

The Limitations of Stretching

While stretching can feel great, it’s important to note that muscle length does not permanently change as a result of stretching. Any flexibility gains after a stretch are usually temporary and after stretching your muscles are likely to return to their previous length unless you stretch consistently over time (as is often the case with professional athletes, like dancers or gymnasts).

Generally, when stretching what we feel are the skin and the superficial fascia stretch rather than the deeper muscle tissue, so it’s important to practice safe, controlled stretches without forcing the body into discomfort. 

Stretching to recover from DOMS, most studies show that stretching does speed up recovery. 

Benefits of Stretching

Despite these limitations, stretching does offer several benefits:

- Mind-Body Connection: Stretching generally feels good, reduces muscle tension and promotes relaxation, improving both mental and physical well-being.

- Joint Health: Stretching increases the range of motion in a joint, which is crucial for maintaining mobility and reducing the risk of injury. For older adults, stretching is a key part of a well-rounded exercise program to maintain joint flexibility and movement.

- Muscle Coordination: Regular movement and stretching through activities like strength training and functional movement help maintain balanced, coordinated muscle function. For example, in a bicep curl, the biceps contract while the triceps lengthen, demonstrating how muscles naturally stretch and work in harmony during movement.

- Post-Injury or Surgery Rehab: After an injury or surgery, soft tissue may become tight or form scar tissue, limiting movement. Stretching can help realign these fibres, improving recovery.

- Chronic Pain - with long-term pain stretching can help to retrain the soft tissues and the nervous system, both the sensory and mechanical neurons, that movement is “safe” and achievable. 

Always stretch in a comfortable range. Stretching should never be painful. On the pain scale of 1–10 (with 10 being excruciating), aim for a stretch intensity no higher than 5/10. 

When NOT to Stretch?

Stretching is not always appropriate:

1. Acute Injury: After a specific and recent injury, stretching can disrupt the healing process. Early rehabilitation should focus on controlled, comfortable movement rather than stretching, which could worsen the injury or “unknit” the healing tissue.

2. Before Exercise: Static stretching before a workout can reduce muscle strength and performance. Muscles need a certain level of natural elasticity for optimal movement, and prolonged static stretching can temporarily reduce this ability. Instead, opt for dynamic warm-up exercises that mimic the movements of your exercise/sport. (slow-mo video of Kenyan athletes warming-up)

3."Tight is Alright" - professional athletes are not generally flexible and for running inflexibility is associated with improved running economy.

Final Thoughts: Stretching – A Tool, Not a Cure

Stretching is a valuable tool for promoting flexibility, mobility and soft tissue health, but it’s not a complete solution.  

If you find that stretching helps alleviate tension and promotes relaxation, continue to practice it.

However, it is important not to rely solely on stretching to manage muscle tightness or recover from injuries, taking a balanced approach, seeking professional advise, strengthening exercises, proper warm-ups and recovery strategies, will likely yield better long-term results.

Of course, this is where Sports Massage & Remedial Therapy fits in and finding the balance between stiffness and flexibility.  Stretching needs to be specific to you and your needs.

Feel free to get in touch if you have any questions on any of the above.

REMEMBER this information is not intended as a substitute for medical advice, but rather as a summary based on experience and current research. If you have specific concerns, it’s always a good idea to consult with a healthcare provider or a fitness professional.


Nicky Holbrook
Sports Massage & Remedial Therapist
nicky@nickysportsmassage.co.uk
November '24

Christmas Gift Vouchers

 

Gift Vouchers for Christmas available to purchase online, email Nicky and can be delivered by email, collected or delivered locally in Lindfield or Haywards Heath.

60 minutes Voucher £60

90 minutes Voucher £90

3 x 60 minutes Voucher £175

Understanding Menopausal Musculoskeletal Syndrome

I have previously written about the importance of oestrogen for our musculoskeletal system (you can refer to my article on How the Menopause Affects Women’s Soft Tissue and Bone Health). Recently, I came across new research (1) that delves deeper into the impact of menopause on musculoskeletal health, and it’s too important not to share, especially as I treat the musculoskeletal system every day! The paper calls for the medical community to formally recognise Musculoskeletal Syndrome as a condition caused by diminishing oestrogen levels during the peri- to post-menopause stages of life.

As women are living longer, many will spend up to a third of their lives post-menopause, and musculoskeletal syndrome could significantly affect the quality of life for many of them.

Understanding the symptoms and what you women can do to help is key to maintaining health.

Key Facts: 

More than 70% of women will experience musculoskeletal symptoms during menopause. 

25% of women will experience symptoms severe enough to interfere with daily life between the transition from peri- to post-menopause.


While symptoms like hot flashes, brain fog, and sleep disturbances are well-known, the musculoskeletal symptoms affecting bones, muscles, tendons, ligaments, and joints are less recognised.

Key Changes in the Body During Menopause

The hormonal shifts during menopause, particularly the decline in oestrogen and it's most active form, estradiol, impact nearly all musculoskeletal tissues, including cartilage, which cushions our joints, and adipose tissue, which is our body fat. 

 
Here are the five key changes researchers from this paper (1) have identified:

1. Inflammation 

More than half of post-menopausal women experience joint pain. Oestrogen regulates inflammation, helping prevent joint pain. When oestrogen levels drop, the body becomes more prone to inflammatory responses, from exercise, stress, injury, operations, different conditions, that can degrade muscle proteins and slow muscle recovery. This can lead to chronic joint and muscular pain and stiffness, e.g. frozen shoulder, back pain.

2. Sarcopenia 

Sarcopenia refers to the age-related loss of lean muscle mass, and it becomes more pronounced after menopause. Women typically lose about 0.6% of muscle mass per year post-menopause. Oestrogen supports energy production in the mitochondria, the “powerhouses” of our cells, providing energy for muscle cell repair. When oestrogen declines, muscles become weaker and repair more slowly.

3. Decreased Satellite Cell Proliferation 

Satellite cells, which reside on muscle fibres, are crucial for muscle regeneration and adaptation. The decline in oestrogen reduces satellite cell activity, making it harder for the body to repair muscles post injury or exercise.

4. Osteoporosis 

Osteoporosis, the loss of bone density, is one of the most well-known effects of oestrogen deficiency. It increases the risk of fractures, and in the U.S., 70% of hip fractures occur in women. During menopause, women can lose an average of 10% of their bone density, making their bones more fragile.  Posture, low back pain, height can be affected.

5. Arthritis 

The decline in oestrogen contributes to cartilage damage, which is linked to osteoarthritis. Cartilage, the tissue that cushions joints, is partly regulated by oestrogen. As oestrogen levels fall, the risk of osteoarthritis increases, particularly around the time of menopause.

How Can You Help Yourself?

The symptoms mentioned above should not be viewed gloomily. Menopause and aging are natural processes, and there are effective ways to minimize the impact on your body. Here’s what you can do:

1. Exercise Regularly

Alongside cardiovascular exercise, it’s essential to include strength training in your routine. Oestrogen is anabolic, meaning it helps build muscle. Strength exercises stimulate muscle repair, growth, and adaptation, which can help counteract these effects of muscle loss. The NHS recommends strength training twice a week, and it doesn’t have to be at the gym—activities like cycling, heavy gardening, yoga, push-ups and sit-ups count too.

2. Diet and Hydration

A well-balanced, minimally processed diet is vital for overall health. Staying hydrated is equally important. Water is important and if you’re exercising for more than 45-60 minutes plus consider rehydrating with an isotonic drink to replace electrolytes.

After exercise, your body immediately begins the repair process. It works to rebuild the glycogen stores (the primary source of fuel for muscles) and repair the damaged muscle tissue. To optimise recovery and promote muscle growth, it's essential to provide your body with the right nutrients, particularly high-protein, for repair, and carbohydrate-rich (to refuel and your muscles and bodily systems, essential for endurance and repeat training). Your individual dietary needs depend on individual factors plus your activity and levels of activity, so it’s best to consult a nutritionist for personalised advice.

3. Rest

Rest is crucial for both physical and mental recovery. Adequate rest allows the body to repair and strengthens itself and regain energy. Therefore, rest days are essential to allow the body to recover and to improve performance. Prioritising rest can reduce inflammation and improve overall well-being.

4. Sports Massage & Myofascial Release Therapy

Hands-on soft tissue treatments can be powerful tools for managing musculoskeletal symptoms. These treatments promote quicker healing and recovery, increase mobility, and ease tension and pain. Regular maintenance treatments can help keep your soft tissues and joints in good condition and keep you "in-tune" with how you are feeling. Massages can also promote relaxation and better sleep, both of which are essential for recovery and overall health.


While menopause brings about many changes, you can take steps to manage its effects on your musculoskeletal health. 

If you have any questions or would like to explore hands-on Sports Massage or Myofascial Release, don’t hesitate to reach out.

Stay active, eat well, and take care of your body!




Nicky Holbrook
Sports Massage & Myofascial Release Therapist
September 2024

www.nickysportsmassage.co.uk

(1) The musculoskeletal syndrome of menopause, June 2024, Vonda J. Wright, Jonathan D. Schwartzman, Rafael Itinoche & Jocelyn Wittstein

Muscle Strains - what are they and what do they feel like?

It is so important to keep in tune with how our bodies are feeling and be aware aware of any small niggles, and certainly seek to treat any that are becoming more troublesome to avoid them developing into an injury.

So, I thought it useful to share some information on what actually happens when you have a muscular injury, what to look out for and to understand if the muscle pain you feel is a strain or actually a tear, and also is there a difference?

To explain let’s firstly look at what makes up a muscle?

Approximately 85% of muscle tissue is made up of muscle fibres and these fibres are organised in bundles, called fascicles, which are enclosed in fascia and together this is the endomysium. The fascicles are bundled together by their fascia and this is called the perimysium, which also carries the blood supply and nerves into the muscle fibres. The perimysium is enclosed by another rougher fascia, the epimysium. All 3 are joined together and wrapped in more fascia and all this creates a single muscle. 

Muscle fibres are mostly made up of collagen which provides the muscle with its elasticity and transmit the force of the muscle.

The protective covering of fascia also binds the tendons to the muscle and where these two merge is called the musculotendinous junction. There are tendons at either ends of muscles connecting the muscles to the bones.

So muscles are made up of groups of muscle fibres and fascicles and our bodies are organised this way so we can control our efforts. For simple easy tasks we only require a few muscle fibres to contract, whereas for harder, maximum efforts we obviously need every muscle fibres to be working to their best ability. This is muscle recruitment and is achieved by the nerves that supply the muscle, innervated by message from the brain and our reflexes. 

  

If a muscle cannot respond adequately to meet the demands of a task i.e. a run, tennis stroke, digging in the garden, it can become overloaded and tear under strain.

A tear or strain (same meaning) can occur for a few reasons:

• the muscle contraction required to perform the movement may be more than the muscle can generate. 
• there was not enough time to fully recruit the muscle fibres e.g. turning quickly, or slipping 
• restrictions in the muscle itself prevent the full contraction, this could be from lack of mobility of a joint, lack of strength, lack of recovery from previous activities 

- also muscles contract in two ways – they either shorten and so contract concentrically or a decelerating contraction is where the muscle slowly lengthens generally to slow-down and counteract a contractile force/or gravity and the later is more frequently when a strain may occur. 

Typically muscle injuries occur in one of three places:

• At the junction between the muscle and tendon (aka the musculotendinous junction). This is the most common area of the three. 
• Within the muscle belly itself (think meaty section of the muscle) 
• Where the tendon attaches to the bone 

What does a muscle strain feel like?

This happens when muscle fibres are overloaded and fibres start to rupture under the force.

The percentage of muscle fibres involved and the severity of the tear determine the classification of the strain and to follow are the 3 grades used by Medical professionals to diagnose an injury:

Grade 1 – is a mild strain, only a small numbers of fibres (< 5%) are stretched or torn. While the injury may be painful, strength and mobility are unaffected and recovery is quicker. Grade I is “micro-tear” territory. The fibres have been pushed to the point of starting to tear but not completely. Full recovery is usually 2-3 weeks and athletes are able to resume activity when they are pain free.


Grade 2 - moderate strain, more fibres involved and torn, it is a much larger injury and the symptoms include pain, swelling and bruising/discolouration. Strength and mobility are significantly reduced and function is also impacted. Grade II’s are more severe and take longer, averaging 2-3 months to fully heal the damage.


Grade 3 - complete rupture, a muscle or its tendon are completely torn in two. This is a severe injury and includes considerable swelling, bruising, and pain, a complete loss of muscle function with significant losses in strength and mobility. You may also see defects in the muscle (gaps, dents, changes to the muscle shape itself) as the swelling subsides. A grade 3 will require medical intervention and often surgery.

Healing - this is always the big question?

The healing time for soft tissues varies depending on the type and severity of the injury, as well as individual factors such as age, overall health, and the presence of any underlying medical conditions. But most of all the type of tissue that is affected will be a huge factor:

Muscle strains - going back to “what makes up a muscle”, it’s structure, blood, nerve supply, elasticity and contractile properties influence how a muscle repairs. Muscle tissue heals quicker than tendons and ligaments and this due to muscles’ broader blood and nerve supply. Damaged muscle fibres cells divide and then fuse with existing muscle fibres, to regenerate and repair the damaged fibres.

Tendon strain - tendons connect muscle to bone, they are stronger than muscles, and their fibrous collagen tissues are viscoelastic (not contractile like muscle) which means they allow the tendon to withstand tension. Tendons are slightly elastic and viscous and recoil to it’s normal length after stretch.

Tendons’ blood and nerve supply is sparse compared to muscles ( and is particularly bad where tendons wrap underneath or around bone e.g. at the ankle, elbow). The mostly collagen tissues are not able to regenerate. This means the healing process takes longer, after approximately 10 weeks the maturation stage of healing is reached. A strained area will never regain its original strength and viscoelasticity.

Ligament strain - ligaments connect bone to bone and are formed of densely arranged collagen fibres bundled in fascicles like tendons. They are viscoelastic like tendons, so have some elasticity and recoil, but not much so they tear before they stretch and again their blood supply is sparse and worse than tendons. It is generally understood that ligaments take longer to heal than tendons. However, a ligament does not need to recoil so it’s healing process is simpler and often ligaments heal close to it’s original structure but its viscoelasticity will never be the same. The site of injury will always contain scar tissue. This is why injured areas are prone to re-injury.


So I will finish where I started.....Sports Massage & Myofascial Release treatments are ideal to allow us to feel, importantly take the time to feel too, how our bodies are and be aware of any niggles, pain or restrictions in movement.  This allows us to take control, understand how to help ourselves and the relevant self-care and rehab.    

I hope you found this useful, any questions please let me know! 

Nicky Holbrook

Nicky'Sports Massage

www.nickysportsmassage.co.uk

Pelvic Health Treatments

I recently completed an advanced course on Pelvic Health delivered by a specialist Women’s and Men’s Health Physiotherapist and also a Myofascial Release practitioner. This course was delivered by Myofascial Release UK with whom I completed my Advanced Myofascial Release Diploma. The course was excellent, exploring the complexities of the pelvis, anatomy, pelvic pain and conditions and of course how to treat. 

The pelvic floor and wall muscles and it’s soft tissues are integral to the functional ability and hence movement of our lumbosacral spine (lower back and sacrum area), hips, legs and abdominal wall. 

Treatments are focused on these areas and also the pelvic floor and wall which are treatable with internal pelvic floor techniques. Treatments create awareness and enhance proprioception (which is our bodies own sense of how we move and adjust) and this helps our knowledge and “feel” and awareness of the pelvic floor area and so post treatment Client’s know what they need to do for self-care and rehab.

The reason for undertaking this course is to continue to expand my knowledge of the pelvis - how to discuss pelvic pain and what questions to ask? To enable me to use my soft tissue skills effectively in this area. Pelvic health can be an area so often overlooked - from women’ postpartum challenges, menopausal transitions and operations, injuries and stress incontinence. 


If you have any questions then please do get in touch.

Nicky Holbrook

Nicky'Sports Massage

www.nickysportsmassage.co.uk

Medical Acupuncture/Dry Needling explained and the benefits

Acupuncture/Dry Needling explained and the benefits?

Dry Needling involves the insertion of very fine needles into tight areas of your muscles or trigger points. The needles are gently inserted and then gently manipulated, which may elicit a slightly painful twitch response in the muscle. After a short period the needle is then removed.


The aim is to relax the soft tissues, to improve tissue healing and restore quality and quantity of movement. Plus it’s to reduce the associated pain and discomfort of “tight” muscles.


It is not a standalone treatment so I will combine dry needling with other hands on Sports Massage and Myofascial Release techniques to achieve the best rest results.

What are the benefits of Dry Needling?

Dry needling positively influences the complex neural pathways and chemical (hormonal) releases in the body. Essentially, it increases blood flow to the area, releases endorphins (natural hormonal painkillers) and may inhibit or partially block nerve pathways, aiming to alleviate pain and promote healing. 

The process of dry needling is very safe.


Some people may experience a slight ache when a needle is inserted but many don't feel the needles being inserted at all. After a session the treated area maybe slightly sensitised but there are no lingering effects, and most people can resume their daily activities immediately.


NICE (the National Institute for Healthcare and Excellence) recommends considering Acupuncture for chronic (long-term) pain, chronic tension type headaches and migraines.


I am qualified Medical Acupuncture Practitioner and registered and validated to practice Acupuncture by Mid Sussex County Council.


If you have any questions about Dry Needling/ Medical Acupuncture please get in touch.

Nicky Holbrook

Nicky'Sports Massage

www.nickysportsmassage.co.uk

Acupuncture treatments

Acupuncture now offered as part of treatments (as appropriate) or 

30 minutes Acupuncture specific treatments

I am practicing Western Medical Acupuncture, also called Dry Needling, which is an adaption of traditional Chinese acupuncture.  Needles are inserted into trigger points or dysfunctional spots in the muscles and it is primarily focusing on alleviating musculoskeletal pain and improving movement quality and quantity.

It does not follow the concept of qi, yin, yang or meridians. 

What is Sports Massage & Why it is relevant for EVERYONE?

We can ALL benefit….

When I talk to most people about my work as a Sports Massage and Remedial Soft Tissue Therapist, some take a deep breath in and go on to tell me about how they once had a Sports Massage and it was very painful, but “no pain no gain!” and similarly for those who have not experienced Sports Massage they associate it with a deep form of massage only for sporty people.


Please ditch both of those ideas.  Sports Massage is a title for advanced hands-on Massage, Stretching, Mobilising and Rehab techniques that are highly relevant for all us many sports amateurs and professionals  PLUS IT IS VERY RELEVANT FOR ALL OF US who enjoy life, participating in exercise and activities to keep moving, fit, happy and challenged.


Essentially I am a Soft Tissue Specialist and my advanced training enables me to deliver corrective soft tissue treatments which are great for helping the healing process of injuries, rehab and mobility plus and maintaining healthy soft tissues to enhance training and improve performance.  Injuries happen in many forms, not just from sporting incidents e.g. falls, accidents, overuse at work, in the gym, playing music or whiplash etc., and we all sometimes need “helping hands” to improve how we feel and can move and to enjoy and maintain our daily life pursuits. 

So this makes Sports Massage relevant for anyone!

This brings me on to explaining Remedial Soft Tissue Therapy which is the knowledge and training to deliver corrective treatment and rehab to help ease and minimise pain, whether it is acute (recent from an injury) or chronic (long-term) pain. 

So hands-on advanced Sports Massage, Remedial Soft Tissue and Myofascial Release * techniques are beneficial to aid injuries and many ease complaints and conditions that effect our movement, health and well-being:

• Aiding the healing process from injuries, operations or medical treatments
• Addressing postural adaptions resulting from injury, lifestyle, employment demands, RSI (repetitive strain injuries). 
• Managing conditions such as sciatica, carpel tunnel, stiff necks, headaches, frozen shoulder, fibromyalgia, jaw ache etc. 

Life throws many different things at us and hands-on treatments are great for relieving life’s every day tension, stress or pain from work or our favourite hobbies.


I hold qualifications to treat Pregnant and Post-Natal ladies and Oncology Massage to ease the discomfort of cancer treatments and operations, Dry Cupping and Kinesiology Taping too. Plus in early 2024 I will be qualified to offer Medical Acupuncture (Dry Needling).


* Myofascial Release Therapy uses gentle hands-on techniques that work deeply into the soft tissues to ease chronic pain, restore alignment, function and mobility to muscles and joints and also encourage soft tissue healing and rehab.

Any questions please let me know.

Nicky Holbrook

January '24  

Feeling heavy or tired legs, arms or abs after your exercise efforts?

New Year Motivation and feeling heavy or tired legs, arms or abs after your exercise efforts ?

Delayed Onset Muscle Soreness (the DOMS) explained

DOMS is a sore and aching feeling in the muscles after unfamiliar and/or intense exercise e.g. a sudden increase in activity, a new or repetitive movement.


DOMS is caused by largely an  immune system reaction caused by localised micro trauma to the muscles fibres AND to the surrounding fascia (fascia is all the connective tissues which create an interconnected tensional fibrous network)


We move using our muscles and fascia and sudden increased or new movements of an area of the body, causes tiny microscopic tears in the muscle fibres and the fascia is broken down. So the muscle fibres and fascia need to heal, a process started and managed by our immune systems.  The body’s first response to start the healing process is inflammation, which firstly causes heat, redness, swelling and is then followed by an increase in circulatory and fluid activity. All of these together put pressure on our sensory pain receptors (nociceptors) which are abundant in our muscles and fascia. The healing process starts slowly in the first 24 hours and then is at full pelt from day 2 onwards so this is why we may feel more achy/ sore 1-2 days after exercise.

DOMS does not indicate muscle damage. It should not be confused with an ache or pain after an acute feeling or injury.

Recent research links DOMS to the hypersensitivity of the epimysium of muscles. The epimysium is the dense fascia which encapsulates entire muscles and this fascia is capable of “tensing and morphing” depending on the load through the body. Plus, it also seems our central nervous system responds more to nociception (pain) stimulation from our fascia than from muscles.


Interestingly, it is scientifically proven that DOMS is felt more when there is an increase in activities using  our muscles and fascia in a lengthened position (this is called an eccentric movement) and for example occurs in the calves or hamstrings when we are running (in the push off phase as we leave the ground) or the quadriceps slowing us down as we run or walk downhill, or the triceps in the lowering phase of a bicep curl.


DOMS and building Muscle Strength - as previously mentioned DOMS is a key part of our healing.  After after exercise our body reacts to the increased load and stress the muscles have been put through by activating the release of growth factors involved in muscle development and this how soft tissue grows and how our body responds and adapts by strengthening the ability of our muscles to withstand future damage. Also our body adapts and the more you do the activity, the less you get this immune reaction because the system knows to expect a little damage.


DOMS generally gets better on its own after a few days but during this time range of movement and performance can be reduced.


DOMS and Massage - there is evidence that suggests Massage is beneficial in reducing inflammation and the intensity of the stiffness and pain associated with DOMS. 

There is also some evidence that compression garments, rest and some mineral supplements can reduce the duration of DOMS.


Please note though that causing muscle soreness to the point where we can’t even lift our arm, or walk, is too much! This could be a soft tissue strain or tear, which take longer to heal and are actually detrimental to muscle growth.

Nicky Holbrook

January '24

Taping can reduce pain intensity! What’s the reason for this multi-coloured tape?

To follow I highlight the benefits of Kinesiology Tape, aka the coloured sports tape, that we often see on athletes. It is becoming more popular amongst across many sports and people to support recovery from injury and strains and also to treat general “aches and pains”.

When treating my aim is to provide my clients with a window of opportunity that allows them to feel better, move easier and enjoy increased pain free movement. This is to help the healing process for acute (recent) pain from injuries, strains or operations and chronic (longer-term) pain. The use of taping (always at the end of a treatment) is an adjunct to hands-on treatments to continue to support healing, movement, doing rehab exercises and reduce pain.


There are many benefits of taping, which have all been demonstrated in research and studies, although it must be noted that the overall evidence remains inconclusive about the efficacy taping mostly because the exact mechanisms of how the tape may work remain unproven.

The benefits of taping can be:

Distraction

Taping on the skin can interfere with painful signals which are directed to the brain (1) and so this helps to change how the brain interprets and deals with the pain. You may have heard me explain that when we are in pain our sensory awareness of the affected area of the body is heightened and taping can turn down the pain volume.

Increases our proprioception & delays muscle fatigue

Taping can provide a positive feeling of support, body co-ordination and control positively influencing our proprioception (click here for an article to explain this) and so allows us to move better as if we weren’t hurt, helping to activate muscles and so helps the healing process.

It can also reduce muscle fatigue. When doing rehab exercises this is very important, not only for the parts of the body that are currently hurting, but also for the surrounding areas. as they help to pick up the slack for muscles that are currently not working well.

Distributes the forces of movement

The tape allows full movement of a taped area. The tape has elastic properties and quick recoil and it can help distribute forces to other nearby areas through the fascia, ligaments and bones.

Decompresses an area of swelling and inflammation

When tape is applied to the skin, it has a small lifting effect underneath the skin, so creates more space in between the many layers of myofascial tissue under the skin and this can help inflammed areas by speeding up the exchange of fluids in the area.



If you have any questions about taping and would like to discuss how it could help you please get in touch - call 07738257873 or email with any questions or to book your appointment, plus you can book online.

Nicky Holbrook
November 2023




(1) Rocktape - www.rocktape.co.uk/how-it-works/

Treating “knots” is all in a day's work!

Treating “knots” is all in a day's work!
This kind of soft tissue dysfunction is what massage was created for!

Many of us will be familiar with muscle knots and it’s a commonly used term to describe a small area of muscular tension and pain, but actually there is no such physical thing as a muscle knot.


We describe having and being able to feel sore “knarly, crunchy or stringy” spots, perhaps at the top of the shoulder blade or in the calf for example. You may experience pain when you touch them, or they might be there all the time. Scientists refer to these as Myofascial Trigger Points (1) and are defined as irritable spots in muscle which are painful upon compression.

So what causes these “knots”?

Our muscles are made up of lots of miniscule muscles fibres and in the case of these sore spot this is where muscle fibres have contracted (shortened) and when your muscles get damaged, even a little, this can cause inflammation in the muscle and also the fascia (fasica is our 3D connective tissue). The muscle overload could be from physical activity, postural imbalance, stress, injury or also from lack of use, a sedentary lifestyle - 8 hours plus sitting at a desk and looking down at your laptop etc. can all cause overload on the neck and upper shoulder muscles plus soft tissue conditions such as fibromyalgia or scar tissue from operations. 

When muscle fibres contract they become shorter, fatter and bunched up and this creates a physical squeeze on the circulation in the area. Vital supplies of fuel (oxygen and nutrients from the blood) for the muscles are reduced and also the removal of the noxious waste products by the lymphatic system becomes less efficient. So, the result is muscles which become exhausted, irritated, hot, possibly inflamed and painful.


This is also the start of a vicious cycle - the pain and spasm cycle. When we feel pain, our muscles contract and contracted muscles cause more sensitivity in our nervous system and so so again our muscles contract further, there's more pain and so it goes on! This becomes chronic pain and over time, if this is not addressed, chronic muscle tension causes other changes in the muscle tissues which become stiff and hardened which is a process called fibrosis. It is these small areas of bunched and hardened muscle fibres that we call knots and that either cause you pain in a certain area and you feel when you rub your own sore shoulders or calves or when I find and treat them through massage.


PLUS, sometimes the body’s nervous system’s involvement will add another layer of pain, as well as local pain these Myofascial trigger points can refer pain into other parts of the muscle or can refer pain to distant parts of the body.


Understanding how your body feels and why these knots may have formed is all part of your treatment and suggesting home care exercises and lifestyle changes could help too. For example - mixing up your exercise routine so you are targeting different exercises/muscles on different days. Different movements through the day and hydration can all be key too.


As a Sports Massage and Remedial Therapist treating these “knots” is all in a day's work. This kind of soft tissue dysfunction is what massage was created for. Chronic muscle tension, fibrosis and trigger points respond fantastically to the right massage treatment!


Please call 07738257873 or email with any questions or to book your appointment, plus you can book online.


Nicky Holbrook

November 2023



(1)Lavelle, Elizabeth Demers et al. "Myofascial Trigger Points". Anesthesiology Clinics, vol 25, no. 4, 2007, pp. 841-851. Elsevier BV, doi:10.1016/j.anclin.2007.07.003. Accessed 18 Aug 2020.

 

Ankle mobility is very Important for foot & leg performance and to minimise injury!

I have treated a few lateral ankle sprains recently and whilst the lateral ankle ligaments, which are stretched when we roll out on our ankle, have rightly felt tender the lateral calves of the same leg have also felt sore and tense resulting in lack of ankle movement.  Just after the injury, at the acute stage, this ankle stiffness is fine but past 1-2 weeks post injury increasing the mobility in the ankle joint is key for recovery and to avoid any compensatory patterns through both legs.  

I am often treating the ankles, calves and soles of the feet to increase mobility through the ankle joints.  

Whether it walking, running or to get more efficient effort, depth and strength with your gym movements (especially squats) the ability of our ankle and foot to be able to respond, adapt and dissipate forces through the leg is VERY important and plays a big role in your foot and leg mechanics and injury risk. 

Ankle Mobility

Dorsiflexion is the ankle movement which decreases the angle between your shin and the top of the foot (bringing your toes/top of foot up towards your body).  And this is normally the movement which is the most restricted at the ankle.  

When walking and running the whole foot should roll from the heel landing through to the push off the ground with the toes. When the whole foot is on the ground and as it prepares to push off the ankle has to flex and this action is Dorsiflexion. This is also when the foot, the leg and hip are absorbing the shock of landing and dispersing this shock through the leg. When squatting or jumping dorsiflexion allows us to get low to the ground to then push upwards.

Dorsiflexion requires mobility of the ankle as well as engagement from the muscles of the calf and the foot surrounding the joint.  Good dorsiflexion can help to avoid injuries in the knees, hips and low back areas.  

A good range of dorsiflexion movement is anywhere from 10 to 20 degrees (from the foot in neutral toes pointing straight up or forward).

Dorsiflexion

Dorsiflexion movement is achieved at the talocural joint, which is formed by the bottom of the shin ( the tibia bone) and the top of the foot closest to the shin (the talus bone). This joint provides backwards and forwards movement of the ankle/foot (dorsiflexion and plantarflexion) and allows the tibia (shin) to move forward, relative to the foot, which is crucial for correct body positioning and efficient production, application and absorption of force.

Lack of dorsiflexion

If we lack dorsiflexion then the tibia tends to be stuck in purely a vertical position and hence it can cause our body to lean forward, and/or to compensate by the knee bending inwards when we bend at the knee, or the arch of the foot collapses inwards, the bottom rotates out sideways or the lower back curves more. Plus the reduced ability to absorb force through the foot places higher demands on the knees and hips, which may lead to an increased risk of pain or injury in these joints and their associated soft tissues. 

Check your own dorsiflexion by trying this:

Place foot on the floor facing towards a wall (see right photo) and the other knee bent on the floor, and see what the maximum distance away from the wall your big toe is, with the knee bent forward touching the wall and heel remaining on the floor.  

If you can touch the wall with your foot approx. 8cm plus away from the wall your dorsiflexion is fine, less than that I advise you to do something about it, especially if you are active and running/walking is part of you and your life.  

I advise Soft Tissue Massage & Myofascial Release treatments PLUS self-care exercises to help lengthen and release tension in the calves and foot and mobilise the ankle joint. 

It’s worth taking time to care for your ankles because injuries can lead to further problems with both strength and flexibility in the muscles surrounding that joint.

What can cause poor dorsiflexion?   

Ankle sprains, strains or breaks causing a build up of scar tissue which is dense and stiff.
Achilles strains or tears
Overuse/training tension in the calves and/or Achilles tendon
Plantar fascitis (stiffness on the sole of the foot especially in the morning)
Wearing high heeled shoes (could be a heeled trainer too)
Arthritis (which causes inflammation of the joints)
(these are just examples)

To follow are 3 useful soft tissue exercises to try at home for ankle dorsiflexion.

Foam Roll the Calf

Standing, take one leg forward and a foot length back and again bend into the forward knee keeping the knee straight over foot so you can see the big toe

 

Banded ankle dorsiflexion – use a resistance band or similar and tie around a table leg (or something similar).  Place the band around the ankle joint, in the crease of the ankle (I feel lower than this picture shows) and bend into the front knee keeping the knee straight so you can see your big toe.

We have two calf muscles and to stretch the deeper one (the soleus) the knee needs to bend, hence the bent knees in the exercises above. 

Many of you will be more familiar with these 2 stretches and it is always good to do a mix of calf stretches:

 
1 - Standing, take one leg behind you to get a straight leg stretch (you can also lean into a wall for support to get a deeper stretch).

2- Standing on step, keep the ball of your foot on the step and allow one, or both ankles, to drop down off the step. 

These exercises are focused on creating mobility in the ankle joint. 


For any further advice and treatment please call or email.



Nicky Holbrook 

Sports Massage & Remedial Therapist

September 2023

Knee pain in Adolescents

This year I noted more treatments of adolescents with pain at the front of the knee and I had many more discussions with parents about this too. I am at the stage of having teenage children myself so I am in this “circle” and it was also  late winter/early spring so the later part of the season for popular sports such as football and netball.

The knee is a complex joint, allowing bending while supporting heavy loads and changing directions. 

It is sensitive to small problems in alignment, activity, training and overuse and any sport which involves a lot of running, jumping, change of direction or direct knee trauma is “hard” on the knees.

So, I want to explain why adolescents are susceptible to knee pain and what we can be done to prevent the knee pain next season and treatment options. 

The knee pain I am talking about here is not from a specific injury but gets better with rest and is worse with/after activity and generally I find it is accompanied by excessive quadricep tension.

Why adolescents are prone to anterior knee pain?

Adolescents grow fast, often going through growth spurts, and their bones grow quicker than the muscles, tendons and fascia (our soft tissues). For the knee this means the femur (thigh bone), tibia and fibular (lower leg bones) and the patella (knee cap) are growing and also changing shape. 

Recent research on teenage knee pain is pointing towards an association between the teenage knee pain and alterations in the knee cap shape and also the dislocation of the knee cap.

The two most common and identifiable causes of knee pain in adolescents are both underneath the knee cap. 

They are in slightly different sites at the front of the knee:

1- immediately underneath the knee cap - this is called Sinding Larsen Johansson Syndrome

2 - on the boney protrusion (tibial tuberosity) a little more underneath the knee cap - this is called Osgood Schlatter Disease.

The causes of the two are similar, they are both caused by the excess pulling of the patella tendon. The patella tendon is the tendon of the quadriceps muscles of the thigh, they merge into one tendon just above the knee and it continues down across and around the knee cap and inserts on the tibial tuberosity (a boney protrusion). Tendons attach muscles to bone.

In the case of Osgood Schlatters there is too much pulling on the insertion point of the tendon, the tibial tuberosity, which is cartilage and thought to be weak before maturity and this causes the tenderness, inflammation and sometimes a more pronounced “bump” on the tibial tuberosity plus sometimes thickening of the patella tendon. This normally occurs in girls age 8 -12 and boys 12 - 15 years.

For Sinding Larsen Johansson syndrome this is inflammation of the patellar ligament and so pain is immediately beneath the knee cap, again caused by too much pulling. Interestingly, this occurs mostly in younger boys and aged 10-13 years.

Both Osgood Schlatters and Sinding Larsen Johansson are not permanent diseases and they tend to ease with age when growth is less rapid. However it is worth noting that there is evidence suggesting some adolsecent knee pain correlates with knee pain into early adulthood .

What can be done to prevent this type of knee pain?

Knee pain can exist without there being the obvious pain from either of the two above diagnoses. The predisposing factor associated with anterior knee pain is “tight” quadriceps and hamstrings.

Adolescents who enjoy sport are naturally physically active and generally continue with their sport despite  pain. It is hard to stem their activities, as many are part of teams, any time out can be a LONG time for an adolescent and sport provides a great physical and mental outlet. 

However for symptom relief a combination of training load reduction or rest and the limitation of the movement/sport that generates pain needs to be considered for improvement. This should also be combined with progressive muscle strengthening and a progressive return to activity. The muscle strengthening aims to address muscle imbalances (muscle “tightness”, strength and weakness).

A recent study (2) over a 12 week period demonstrated high rates of success with knee pain improvement following a plan with included activity modification and load management in the first 4 weeks, then doing progressive home-based exercises and progressing to a gradual return to play over a 12 week period. Throughout the study pain levels were monitored and activity and exercises adjusted accordingly.

This result is encouraging and this approach appears a good first strategy.

Sports Massage and Remedial Therapy role is: 

to help reduce knee pain by treating the “tight” leg muscles (the quadriceps, hamstrings and calf muscles which all directly influence the knee) and to provide guidance to both the adolescent and parent on monitoring pain levels, modifying activities, home strengthening exercises and to advise on return to sport.

Other things to consider:

It is worth noting that there are other factors that may contribute to adolescent anterior knee pain: 

• Imbalance of thigh muscles (quadriceps and hamstrings particularly) that support the knee joint, one is tighter or stronger than the other. 
• Problems with alignment of the legs between the hips and the ankles 
• Using improper sports training techniques or equipment 
• Footwear suitability and changes in playing surface. 

As always any questions on any of the above please get in touch. 

nicky@nickysportsmassage.co.uk

Nicky Holbrook

June 2023