SpaceClinics Physio helps Great Britain medal at World University Games: hear how here!

@spaceclinics physio 'King' Kenny Watt recently had the opportunity of attending the World University Games with Team GBR that took place in Kazan in Russia in July.

Here are his thoughts on the sports he covered, and the Games themselves.

"Judo, Shooting and Male Rugby 7’s all in 30 degree heat, a veritable smorgasbord of aggression, athleticism and weapons. What is not to love or get excited about these sports from a medical/physio standpoint?

Multisport events provide a unique occasion to get first hand experience of new sports and athletes and surround you with a rich learning environment. This proved to be the case throughout  my time at WUGS.  

My own NGB work at home revolves around volleyball, a sport with very little if any contact and certainly no weapons, so exposure to sports with an inherent risk of sports trauma proved at times intimidating, but made for a fantastic experience made possible by building close working relationships with the excellent Team GBR sports doctors.  

The Judo delegation were a tight knit group of three athletes and one coach who would only be in Russia for just over one week, including three days of training/gym and two days of competition. Pre-event we had discussed their needs and normal physio input as well as any regulations pertaining to medical support in competition. Training included sparing which provided my first real insight into the technicalities of the sport. It became apparent that it is an incredibly explosive sport placing huge demands on the whole body, and while they were incredibly adept at protecting themselves when thrown it obviously posed the risk of serious cervical injury. Alongside the Chief of Medicine we carried out a thorough check of the on-site medical facilities as well as the evacuation procedures, heavily relying on our interpreter who proved to be invaluable (this would also be the case when the rugby 7’s started a week later). 

The three athletes would compete over two days, two on day one, and one on day two, with the competition following a knockout format. Physio input during competition was tapered and planned in response to time between bouts, athlete requests and their previously discussed needs. A number of pre, inter and post event soft issue techniques, some of which I had learned on the ACPSEM Sports Massage course and use daily, were applied to all of the athletes as well as the odd thoracic and lumbar manipulation. 

Results were mixed for two of the athletes but Patrick Dawson (a young SCOTTISH athlete and potential commonwealth games competitor) only just missing out on a bronze medal fight. The judo proved to be one of the most fulfilling physio experiences I have ever had, the small number of athletes really gave me a chance to get to know them well personally and professionally. 

Shooting proved to be a far less intensive affair from a physio standpoint, but I was allowed to hold a number of the guns. That is all….. In all seriousness, this was another event I had never witnessed or been involved in but a sport that features heavily in all major games so again would prove invaluable experience.  Of the disciplines I observed the shooters are required to hold sustained postures, some in lying, some in kneeling, some in standing and in one event all three, one after another. This places quite a large degree of strain on arms, shoulders, necks and lower backs.  Any treatment was applied mostly back at HQ with gentle soft tissue techniques applied to the aforementioned areas after training sessions. I only spent two days with the shooters before handing them on to their designated physio but found the event quite eye opening.

The rugby 7’s was easily the most successful but intensive period of the games for myself and was rounded off….WITH A BRONZE MEDAL.  Through my clinic work in SPACE  I have a large exposure to rugby players but have spent next to no time covering games, and while the on pitch medical care was provided by Nikki the men’s appointed physio and Karen the Dr, the time spent doing a large number of tapings and treatments before, during and after training/games really gave my clinical skills a work out in what at times was cramped high pressure situations. 

The experience was made all the better by having a really good close working relationship with Nikki and the Dr, where communication and factor 30 sun cream were imperative (Karen is ginger and I’m see through Scottish white).  The Rugby 7’s medal triumph were a great way to round off my WUGS sporting experience, one that was made all the better by working with a great medical team who pulled together when needed and made the physio HQ one of the most fun places to be in the whole team GB building.  

19 days in Russia at WUGS was a long time, but one of the most fulfilling experiences  I have had. "

He's back in Scotland now so why not quiz him about the experience if you're a patient, and if you are from one of those sports listed then why not ask him to assess you next time you're injured?

Just another cancer tale? One close to SPACE...and personal! http://www.justgiving.com/Stephen-Mutch-Bill-Mutch

http://www.justgiving.com/Stephen-Mutch-Bill-Mutch

My dad's got terminal cancer.
"It doesn't look like cancer Mr Mutch" he heard in hospital. 

City of Edinburgh from the Pentland Hills

What appeared initially to be a few days in hospital for 'Observations' turned into over three weeks in a variety of wards under different Consultants. This ultimately resulted in keyhole lung surgery ultimately becoming an open incision of several inches' length.

It was then that the severity of the situation became apparent as his body recovered from the insult of surgery, and the deliberate irritations to the lining in order to generate a good outcome from what has now been diagnosed as Pleural Mesothelioma. You can read more about this here Mesothelioma: what is it?.


Despite a complete absence of working in an asbestos-laden environment or smoking history at any time in his life, he appears to have been unfortunate to have had some form of exposure which has resulted in this rare and aggressive cancer.

On learning that this situation had also affected the ability of the kidneys to function and the protein leaks that had been as a resultant, it became apparent that no medic was prepared to consider a timeframe in the prognosis. Having initially intimated days, they have hopefully extended this as dad distances himself from the surgery to the lung.

But the cancer is aggressive and spreading evidently, and the family is coming to terms with all that entails, including the hospital visits, tests and consultancies with doctors of various organs and body systems.

This has appeared to be a sudden decline, as my dad was dancing at the Scots' Country Dancing at the end of April, and continuing with his regular exercise at Dalmahoy in May.

At an early stage, fundraising of some description seemed appropriate when there is so little positivity in an improvement in the situation and an absence of available treatment. Of course many families have been through this and worse in multi-organ failure and cancers, but you have to play the cards dealt. It therefore seems a sensible option to try something associated with health, fitness and the city of Edinburgh in a bid for fundraising, even if dad may never become a patient of our chosen charity, St Columba's Hospice.

So I, Stephen Mutch, Physiotherapist and son, am attempting to run or row a minimum of 5 kilometres every day for 50 consecutive days. This has been a successful fundraising method for Comic Relief, and presents quite the logistical challenge: not least starting it up in South Africa when the joys of (outdoor) Urban Running can be tricky, hence the (indoor) rowing. Urban Running is now an attractive and inexpensive form of exercise, and hopefully this may also inspire some folks to try it, much as we have suggested SPACE Blog The Joys of Urban Running.

So if you fancy donating, or even sponsoring (at ten pence a kilometre that still draws in an attractive £25 for the 250 kms to be completed minimum!) then please try using the links attached, or check out the page and donate there. Most days I anticipate the runs to last between 6-10km.

St Columba's Hospice, Edinburgh

SPACE is seeking to establish links with St Columba's Hospice as a local Edinburgh based charity that has physiotherapy as an option for both Day Hospital and Palliative Care patients, and therefore is a natural fit for us. It needs to raise £3million each year to allow them to continue providing care for people with advanced illnesses and support for their families. http://www.stcolumbashospice.org.uk/

In the meantime we proceed with a positive mental attitude, and take each day as it comes.

Visitors are most welcome, but be warned my mum is running a spreadsheet detailing visiting times for morning coffee, lunchtime sandwiches, afternoon tea and the coveted dinner bed & breakfast options!

Click here to Sponsor Me NOW!

SPACE Physio helps Scottish Sport II - Mens' Volleyball (and social media helped too-here's how!)

Another competition another trophy for @SpaceClinics from Edinburgh! As described earlier in our blog Scotland benefits from SPACE there was a key contribution made from our physio, 'King' Kenny Watt. Here in his own words, he describes the experience of assisting these terrific part time athletes prosper in European competition.

In Sight-The Championships!!!

Proof he was in Cyprus!

"Being a small nation in the world of volleyball, qualification for any European or World championships is achieved through a two stage process starting with eight teams in two groups of four (with our group meeting  last June in Luxembourg) competing for the first two places in each group then the top four meeting a year later. 

This final qualification group was played out in Limassol, Cyprus at the beginning of June with the prospect of a first place finish providing qualification to the World Championships and second place qualification to the next round of the European Championships.  We entered the competition having spent the previous few months training almost every weekend so motivation was high as were expectations. 

The medical management of the squad in the build-up to this competition had been adapted and changed to allow for improved dissemination of information through the use of social media. A private Facebook group and YouTube channel were set up to allow the players access to videos of specific rehab exercise, travel health information, links to pertinent scientific papers and to give the players the chance to report any changes to on-going issues or new problems. 

Healthcare like so many other professions is now making more use of social media to raise their profiles but its use a “treatment tool” as such is just in its infancy. One of the first pieces of information placed on the Facebook group was new a review paper looking at the effect of travel on performance that had been published online by the British Journal of Sports Medicine in November 2012. The players were provided with the paper and then given the opportunity to discuss any information they didn’t understand or were given advice on how to implement the papers recommendations.  Some of the recommendations we implemented as a squad were:

-shifting the body clock to the new time zone through means of gradual, 1hr shifts in sleep   scheduling

-exposure to natural light, where possible, was preferred to artificial light

-Caffeine was avoided during travel, as a stimulant it can interfere with appropriately timed restorative sleep and alter ability to effectively adapt to a new time zone

-short (20-30min) naps were recommended in recovering from sleep deprivation and to help with restoring a normal state of arousal

-extra fluids were taken on during the flight to prevent dehydration

-players were instructed to avoid any non-bottled water, and where possible to avoid raw or minimally cooked foods and wash and peel any fruit.

On a performance front the first game against Luxembourg was to be one of our most important. We have struggled over the previous few meetings to get over the winning line pushing them to 4 or 5 sets each time but always narrowly losing out. 

Pool Session post victory

If we had any hope of qualifying we would have to win and sure enough we did, 3-0, with one of the best team performances I have ever seen us give. This was celebrated with a trip to the hotel pool to run through our post-game cool down and stretching. This active recovery was all important with three training sessions and three games in three days and was carried out after every game. 

Our next opponents Cyprus have consistently won the Small Nations competition and our record head to head is heavily in their favour, as such, we went into the game more hopeful than expectant. While we pushed them incredibly close in each set, once again we came up short and lost 3-0. 

This meant that a win against San Marino, and anything but a Luxembourg win against Cyprus would give us second place. The first two sets went to plan with comfortable wins but in the third set we

found ourselves 8 points down and only through a fantastic run of serves from GB Olympian Mark McGivern did we claw our way back in to win, confirming our place in the next round of the European Championships, one of the greatest achievements for Scottish Volleyball in the last 10 years. 

The trip was once again rounded off with a great personal achievement when I was presented with the trophy in recognition of my work and we can now look forward to SPACE being represented at one of the highest levels of international volleyball. "

SPACE Physio helps Scottish Sport I - Wheelchair Rugby League

Recently @Spaceclinics physio Ross Mayberry travelled into new territory, working with the Wheelchair Rugby League Scotland team on their bid for World Cup success!

Here are some of his thoughts on operating in a new sporting environment: as  always, physios are encouraged by SPACE to work in areas that can be outwith their comfort zones, and comlement their current range of skills!

"After arriving and familiarizing myself with the squad and staff, Scotland faced the defeated finalists from the last World Cup, Australia, in their opening group match at the Medway Centre in Chatham, Kent. I have to say the staff and volunteers here were excellent and were doing their best to address all the teams issues, and requirements.

I have to say it’s been a steep learning curve for me, getting to know the characters in the squad, their personalities, disabilities and injuries, but a mutual love for 1980’s classic movie “Big Trouble in Little China”, and the fortunes of the British & Irish Lions, seemed to be a point of common ground, and may have helped with team bonding. Apart from getting to know the the team I have also been learning about Wheelchair Rugby League (different from the more well known “Murderball”).

The sport was invented by a French Rugby League player in 2004, and more resembles the Rugby as we know, than “Murderball”. The key differences between the sports being Murderball allows forward passing and uses a round ball, where Rugby League involves lateral/back passes only, using a size 4 Rugby ball, though you are allowed a forward “kick”. There are 5 players on the pitch for each team and as with regular rugby league you have 5 tackles to try and score a try. A tackle is made by tearing a bit of cloth off your opponents arm, or by physically bringing them to a stand-still. The sport is surprisingly dynamic and fast moving, with collision inevitable. 

This link demonstrates these attributes in a recent 'friendly' between France and Australia.

Anybody interested in following how the tournament progressed can find all the information they need on this link http://www.rlfowc2013.com/article/9603/wheelchair-world-cup-draw-and and all the information they need about the Scottish team on Scottish Rugby League website http://scotlandrl.com/ or follow them on facebook https://www.facebook.com/scotlandrl"

Ross hopes that this recent experience with the wheelchair game might lead to further opportunities of working with the squad, and he enjoyed even participating in training! With SPACE at Dalry being wheelchair accessible, we look forward to seeing just how well the boinding went when we welcome some of the players to Inner SPACE in order for Ross to continue his excellent recent work!

Scotland benefits from SPACE - Scottish Volleyball qualify for Europeans in 2015!

We @SpaceClinics are thrilled and proud to have staff assisting the Scottish national teams across a variety of sports.
 

Scotland V-Ball Team with Kenny Watt Far Right Back Row

It is not always ideal for the valued customers of Dalry Road to have their regular physio headed for South Africa, Russia, France, Ireland, England or in Kenny's case recently,Cyprus. 
 
However, for the sports' teams that we are involved in, there are huge benefits seen by their staff and team members. The environment is a positive one for learning in, and the growth mindsets of our staff encourages SPACE to seek challenges for their physios in competitions where decisions have to be made rapidly, and treatment plans augmented frequently by quirky strappings that affect team selection and performance.
 
It is with great pleasure to report the success of the Scottish V-Ball Squad in qualifying for the 2015 European Championships-a qualification unseen by Scotland since 2003 (prior to the opening of SPACE in Dalry!).

Kenny's role  in that success was not overstated, with the coach, Simon Lofthouse moved to include him in his summary of the event, and the assistance of his management team. Quoted here from Scottish Volleyball report on Cyprus Qualifiers June 6-8th:
 

As usual I have lots of people to thank for helping us, firstly all the people on Facebook and Twitter your words of support and encouragement were unbelievable. The team were so appreciative to know that the country really was behind us. Kenny Watt is truly one of the best physios in the country and we are blessed to have him as part of the team.

So massive congrats to Scottish Volleyball, and to Kenny as part of that success we all say: well done, and we know you're good! Now get back to the clinic list please...
 
So when physios do return, they come armed with techniques and ideas that may actually benefit you the patient too-without you being the guinea pig! If as a patient you figure that your physio care is highly professional and thoughtful, it may also have its roots in competitive hockey, rugby, netball, touch rugby, wheelchair rugby, judo, table tennis, athletics, cycling and bowls as well as volleyball!

 

Are you drowning from the inside out...???

JT with a water bottle-Madrid style!

A recent trip with the Scottish women's rugby team took @SpaceClinics physio Jon "JT" Twynham to Madrid for a 12 day World Cup qualifying tournament. With local temperatures peaking at 29C, heat and hydration were hot topics in the medical camp.

Furthermore an increasing number of our patients at Space Clinics are opting for sporting events such as marathons and triathlons in warmer foreign climates. Understandable as the Scottish summer has not exactly been a memorable affair the last few years!

Clearly strategies for hydration were required to be examined within the Scottish camp, and JT himself reflected upon a profound experience in the summer of 2004.

" I was hiking up to the famed Yosemite falls in California with a friend, when we bumped into a Russian student, studying in the USA, who was hiking alone. Her American friend had refused to continue on the hike because the Russian student was not drinking 'enough' water. She explained that back home they were taught to make sure they were well hydrated before sporting activity or in this case hiking and that they would not require large amounts of water during activity even in the height of the Californian summer. I didn't totally agree with her logic, but she seemed perfectly fine so we all hiked on together with no dramas." 

This might be the perfect opportunity to address the topics of heat and dehydration  currently doing the rounds of the Medical and scientific world following popular blogs in April 2012 on the subject for ultra runners (SPACE Blog: 23.04.12 Fluid intake in ultra runners and in marathon runners (SPACE Blog 20.04.12 Water Stations in marathons).

JT at the side of the training
pitch 'under the midday sun'

As the air temperature rises it becomes harder for excessive body heat to radiate through the skin. This can lead to an accumulation of heat in the body causing a rise in core temperature. If this temperature reaches 41C then the individual will suffer from heat stroke, which can cause altered mental state, collapse and unconsciousness. Luckily the body has an in built mechanism to help combat this, namely sweating, which massively increases the ability to evaporate heat and increase heat loss. When heat accumulation does occur we either need to step up the heat loss or slow down the heat production. Hence marathon times in the heat tend to be slower.

Given the sweat response it seems logical that as we sweat more we must drink more to prevent dehydration. Severe dehydration can be detrimental to health and performance, but there is common misconception that you need to drink as much as you can. Before we continue to discuss hydration it is pertinent to be aware of a medical condition called hyponatremia. This condition is caused by a decrease in the sodium concentration in the blood and can lead to unconsciousness and even prove fatal. The main cause of hyponatremia is the excessive consumption of fluids, this tends to occur during endurance events, such as marathons and long distance triathlons. 

In fact in the 2002 Boston marathon 13% of all the finishers were clinically hyponatremic.

To become hyponatremic you need to consume more than 750ml of fluid an hour for more than 4 hours. This means sub 3.30hrs marathon runners would not be at risk as they just don’t have time to drink that amount of water, but with water stops now so frequently available at most events the plus 4 hour athletes need to be careful.

So where does this leave us with drinking during prolonged exercise? How do we know how much to drink? The sports drink industry has been fairly vocal in telling us to drink, drink, drink.

Luckily our body has another amazing function to help us with this: Thirst!

That is if you are thirsty you need to drink and not before, but the notion that "by the time you are thirsty you are already dehydrated" is what we are led to believe.

Studies have shown that elite marathon runners who only drink in response to thirst perform better than those who drink more regularly. In fact elite marathon runners can lose up to 10% of their body weight in a race with no affect on their performance.

As JT concludes wisely, “it seems like my Russian acquaintance was not far off the mark nearly 10 years ago.”

Our take home message is drink to thirst and don’t confuse being hot with needing to drink.

Cool yourself, don't drown yourself from the inside. 

Unforgettable Fergie...It was 30 Years ago today! Aberdeen European Champions!

Nat King Cole crooning around Old Trafford may have been the sentimental choice for Sir Alex Ferguson as Old Trafford on his final match pre-retirement.
But 30 years ago this weekend he achieved probably his greatest honour in the club game, by taking a provincial club with little financial clout to the summit of European competition.

As a young manager in his thirties he recollects the Aberdeen period as a great learning experience, but defeating giants of the European game then as now such as Bayern Munich and Real Madrid surely ranks as the peak of his career, even 38 honours later from Manchester United.

Young fans clutched new-look replica kits, and older fans their scarves whilst spectators such as Richard Gordon (now of BBC Scotland) have recounted tles of squandering/abusing/scoring personal loans from bank bosses to make the trip by plane or boat (the now legendary St Clair 2 day ferry ) across to Gothenburg, and the Ullevi Stadium for the 11th of May final, won by the Super Dons by 2-1.

What is less well known s that the omens were good prior to kick off, as Aberdeen stayed in a hotel by a name not unknown in the Doric/Aberdeenshire venacular: the 'Farrs Hatt' hotel! Please note in Swedish this means Father's hat, but a colloquialism is always welcome in sporting lore: check it out if you don't believe us farshatt hotel Gothenburg.

Double: will we see the like again?

It was a great time to be a Dons supporter, and it is unlikely that the record of 3 premier league titles, Scottish Cups and League trophies, not to mention the European successes in European Cup Winners Cup and Super Cup will ever be repeated again.

Certainly in this time of tributes to Sir Alex Ferguson, this day thirty years ago must still be highly prized as he looks forward to a happy retirement as ambassador for Manchester United, and probably still as a supporter of Aberdeen where it all really took off for him.

Is that your anus twitching as you run??? It may be useful!

Paul Hodges says so!
All those magnificent marathon runners in London recently will have involuntarily been contracting their anal sphincters with every step of the way. This coordinat functions requires the same muscles that are used to maintain IAP and spinal stability.

In fact Dr Hodges spoke extensively on the subject of optimal neuromotor control of the fascial system as a requirement for lumbopelvic control, with particular and unusual reference to the key elements of respiratory and the wider pelvic floor. He was a key speaker at the CONNECT soft tissues in sports medicine conference held a fortnight ago in Ulm, in Bavaria, Germany.

This depends essentially along the lines of the interaction of muscles with direct and indirect attachments, as the intra-abdominal pressure is critical to the mechanism of hoop tension (with respect to laPlace's law).

He was speaking to the points that Intra-abdominal pressure(IAP) augments intersegmental control,  and the use of preactivation and anticipatory feedforward mechanisms will provide the nervous system not only for control but for support of the lumbar spine & pelvis. The myofascial system operates to stabilise the spine in space, yet simultaneously allow dynamic movement, and the deepest portion is required for deep segmental control: too much or too little was deemed 'not useful'.

This coordination of functions requires the same muscles that are used in continence & breathing to maintain IAP and spinal stability are the same.

In walking or running gait, that much-debated muscle Transversus Abdominis is in a state of tonic activation, and never switches off.

In future blogs we will look at common running challenges prior to the Edinburgh Marathon, and other sporting performances.

And now you know a little bit more about how your insudes are all connected, and how optimum performance depends upon that connectivity!

Manipulation for back pain - more effective than drugs!

So medication for acute non-specific low back pain (or NSLBP) is not as effective as manipulation? We already know mobilisation of the spine works for chronic pain but this demonstrates improvement for acute pain!

Another hammer blow for the drugs industry? And is that physical treatment is available in Edinburgh?! Well certainly treatment rather than anti-inflamms seems sensible-and YES that treatment is right here!!!

A study of over 100 patients with back pain for over 48 hours duration were assigned treatment or medication (more of the non steroidal anti-inflammatory types of drugs such as in this case, diclofenac, alluded to in a previous blog TheEdinburghPhysioSPACEBlog NSAIDS ) or no active treatment.

Study: von Heymann et al 2013: 'Spine' Journal:HVLA Thrusts more effective than drugs or placebo

Both of the interventions made a difference on acute back pain, but the manipulation treatment group were significantly better off than the medicated group of patients with no adverse effects or harm registered.

These manipulations are essentially the therapeutic application of load to specific body tissues or structures and are broadly divided onto two categories, with one being high-velocity low amplitude, and the other low-velocity variable amplitude load.

Physios at SPACE are capable and skilled in the practice of manipulations for spinal pain here in Edinburgh's West End!

In the USA it is a different story, although there is evidence that the national physical therapy body is seeking to upskill our American colleagues to be able to add this form of treatment to their repertoire.

Dynamic Chiropractic: Warren Hammer 
This article from Dynamic Chiropractic cites an article written where manipulations can also be seen to be advantageous in the treatment of other spinal pain from the neck to the upper back, or thoracic spine ( Dunning et al JOSPT, 2012; 42(1): 5-17) and so our staff can have a significant effect on any area of your spine with manipulative techniques when appropriate, or other 'mobilisation techniques'. We have been practising them a while-and even the Cochrane Review has shown of their effectiveness in chronic as well as acute back pain as reported on our website: SPACECLINICS.com link to manips report.

Finally a study of spinal manipulation on low back pain from 2011 found that patients actually had the additional benefit of treatment of this kind in that their repositioning and body-awareness of their pelvis & lumbar(low back) area was enhanced even after 6 weeks following treatment. Even their response to sudden load was improved after undergoing treatment, as reproduced when the patient was blindfolded and subject to random loads in secure testing! Wilder et al 2011 Effect of spinal manipulation on low back pain

Don't reach for the medicines
 reach for the phone
01313133999

SO if you are in a bit of bother with your thoracic spine/mid back, have a pain in the neck, or are getting backache, lumbago or leg pain, it is sensible for you to seek expert assistance: instead of reaching for the medicine cabinet what about reaching for the phone or computer instead, and contacting SPACE for a health check and treatment that is more proven to work than drugs alone! 

Give us a call on 0131 3133999 for the good of your health!

Inflammation: Friend or Foe?

An age old question?
One posed recently in light of widespread anti-inflammatory interventions in musculo-skeletal injury. But it poses more questions than the use of non-steroidal anti-inflammatory drugs(NSAIDS) for mere traumatic injuries.

For example, exercise is known to cause a cascade of events including degeneration, inflammation, regeneration and fibrosis, with the regenerative events triggered by the inflammation phase.

So this poses questions as to our management of injuries, disease states and of exercise. Is it sensible to approach all inflammatory states with caution and viewing inflammation as a foe to be combatted? Or is it all part of our anthropological background in that inflammation is a necessary friend in acute states, and only when it becomes maladaptive is it a problem after the initial 36-38 hours? This has been raised by a paper from US Army Research in the latest Journal of Applied Physiology Urso ML March 2013.

The inflammation response needs a careful manipulation to ensure that that regeneration is effectively triggered, and injured skeletal conditions appropriately dealt with The Inflammatory Response to Skeletal Muscle Injury: Smith et al 2008. This may require a change in the way medics manage eccentric exercise programmes as well as injury-are ice baths really The Way Forward after a gym session for example, and should we monitor athletes' NSAIDS medications when the plan is for exercise plans to be based in pro-inflammatory states, i.e. hypertrophy and strength phases of weight training?

Physios and conditioning coaches need also look at their use of ice baths in these instances, as an anti-inflammatory effect has been claimed for short exposure use, but is a cascade of regenerative growth not something to encourage for muscle growth? The exercise-induced stress-response in skeletal muscle: Morton et al 2009

In tendon injuries, short term application of NSAIDs has been shown to have similar effect to heavy slow resistance training, but ends up being less effective in mid-long term follow ups with a better more highly prized collagen turnover with exercise rather than medication, therefore suggesting at least scrutiny of long term drugs use in sport needs to be challenged. Check out this reference RCT of medications v Exercises in Patellar Tendinopathy: Konsgaard et al 2009 for a randomised-controlled trial into clinical, structural and functional effects of the use of steroid injections, eccentric squat training and havy slow resistance training on patellar tendinopathy. 

It is fascinating stuff, and certainly adds to the weight of evidence and material suggesting that clear clinical reasoning in both health and disease states is required with a respect and understanding for the inflammatory process.

Watch your step-the frigid temperatures can have long lasting effects

Is this the last week of Winter?

Injuries sustained this week could still see you needing attention long into the Spring or even early summer (whenever that might be).

Geruatricians on Care of the Elderly wards used to talk with @Spaceclinics staffers in their NHS days as being comfortable with falls on the wards as that fact illustrated that our older population was at least trying to be mobile.

A colleague had recently indicated that his partner had sustained a wrist fracture with a slip, and was interested in the reasoning that at least this meant that she had the reactions and capability to put her hand out to break her fall.

As we get older that capacity for reactive abilities mean that it is less likely that we can get a hand out and instead the force is sustained elsewhere in the body, usually the upper leg causing the oft-seen fractured neck of femur.

Either way, physio could be useful in a rehabilitative phase to ensure a return to fitness. All in all, our twitter images of city of Edinburgh(https://mobile.twitter.com/SpaceClinics/status/311444486922309634)may have been beautiful but there is danger on the icy streets & the message to watch yoyr step is very well-intentioned, and we would urge our younger population and silver surfers to avoid the temptation to text whilst walking!

Days we'll remember all our lives...sport does that!

Wales used to empty for Scottish rugby fixtures.

The days of 20,000 Welshfolk descending on Edinburgh from the Tuesday onwards may be passed, but some teams have preserved some long-fought fixtures, especially in the Scottish borders and Edinburgh, prior to 'The Big One' at Murrayfield on the Saturday.

These days matches often commence at 5pm or later, on Sundays, and even have taken place on Friday nights, with television seeking to maximally expose the annual 6 Nations' rugby championship.

Here are some classic memories from bygone years in both Edinburgh and Cardiff, with the Welsh footage dominating, possibly unsurprisingly given results over the past decade.

BBC Sport Scotland v Wales highlights

Anyhow, as the 2 teams in 2nd place in the Championship play off this weekend, it still feels right to look back before we look ahead to the weekend, and the latest instalment of The Big One between the two Celtic nations...

Urban Running: Edinburgh Springtime Edition

February ended up with clear blue sun-filled skies and perfect air: terrific conditions for running through the streets of Edinburgh near @SpaceClinics Central!

We blogged a year ago about the joys of running through the cities of Europe, and even found some pleasures in the oft-choked citiescapes of North America.

Joys of Urban Running

Winter is a terrific time to be out and about: many of the patients we see at this time of year are in preparation for the marathons of London, Edinburgh or Paris. They are currently accumulating miles, and occasionally injuries or niggles for which they rock up at Dalry Road in a bid to maintain their mileage and ensure they are on course for 'their' time.

Marathons and running timetables are useful now as the demand for events has risen (eg Marathon & Running Events Calendar 2013), possibly as a result of urban running being an inexpensive way to 'keep fit' long after the gym membership has expired or been cancelled. This appears to be very much the case in cities such as Dublin, where JT & Stephen visited last Autumn, finding heaps of weekend running groups traversing the millenium-old roadways. We were told that gym membership was being seen as an expensive luxury item, and more folk were taking to the streets with their trainers and running in packs for cardio-vascular exercise.

And there are other events of lesser distances to which training is essential to prevent disappointment (and possibly injury).

Why wouldn't you, when you get to run through areas in Edinburgh such as these.

Of course, if you are anxious about commencing running, or have an injury that has you concerned about whether or not you should try running on roads, drop in to the clinic in Edinburgh's West End, or email us with a specific query: only too happy to help and get Scotland moving!!!