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  • Carpal Tunnel Syndrome

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    Overview

    Carpal Tunnel Syndrome (CTS) is a form of repetitive strain injury (RSI) which occurs as a result of damage to soft tissue structures (such as tendons) and in some cases bones of the wrist. Women are three times more likely to develop CTS than men, with approximately 3 to 6 percent of adults in the general population being affected. The condition is particularly common in people who use their hands repetitively, for example individuals working on computers or assembly lines. It is quite common to develop CTS in both hands, however symptoms tend to be worse in the side of the dominant hand.

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    Anatomy

    The Carpal Tunnel is a narrow passage made up of ligaments and bones at the base of the hand. The Median Nerve and tendons responsible for bending your fingers passes through this passage. The median nerve is the receptor (provides feeling and feedback) for the palm side of your thumb, index, middle and part of your ring fingers.

    CTS develops when swelling or damage to the structures of your wrist creates pressure on the median nerve. In addition to swelling due to soft tissue injury inflammation any swelling can develop as a result of medical conditions such as diabetes and arthritis. It can develop during pregnancy, in this case it will probably disappear after delivery.[/fusion_text][/fusion_builder_column][fusion_builder_column type=”1_2″ type=”1_2″ spacing=”” center_content=”yes” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” hover_type=”none” border_size=”0″ border_color=”” border_style=”solid” border_position=”all” box_shadow=”no” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” filter_type=”regular” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″ first=”false” last=”true” padding_bottom=”0px” margin_bottom=”0px” padding_left=”0px” element_content=””][fusion_imageframe image_id=”4671|full” max_width=”400PX” style_type=”” blur=”” stylecolor=”” hover_type=”none” bordersize=”” bordercolor=”” borderradius=”” align=”center” lightbox=”no” gallery_id=”” lightbox_image=”” lightbox_image_id=”” alt=”” link=”” linktarget=”_self” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″]https://store.livewellhealth.co.uk/wp-content/uploads/2021/01/carpal-tunnel-877×1024-1-e1611597571302.jpg[/fusion_imageframe][/fusion_builder_column][fusion_builder_column type=”1_1″ type=”1_1″ spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” hover_type=”none” border_size=”0″ border_color=”” border_style=”solid” border_position=”all” box_shadow=”no” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” filter_type=”regular” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″ first=”true” last=”true” element_content=”” padding_top=”1%” padding_right=”2″ padding_bottom=”” padding_left=””][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”default” rule_size=”” rule_color=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=””]

    Symptoms

    Symptoms tend to develop gradually over time, beginning with slight discomfort and deteriorating progressively if left untreated. Initially symptoms usually appear in one or both hands during the night. As symptoms get worse, tingling may be felt during the day, especially with repetitive activities such as typing or using a mouse.

    Common signs and symptoms of CTS include:

    • Pain, tingling and numbness in your hand, wrist and also your thumb and fingers.
    • Fingers may feel and/or appear swollen.
    • Hand weakness and difficulty gripping.
    • Partial loss of sensation in the affected thumb and fingers.
    • In severe cases, where left untreated, muscle wastage of the muscles at the base of the thumb can occur

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    Causes

    CTS is often a combination of many factors which increase pressure on the median nerve rather than a problem with the nerve itself.

    Recent studies indicate that CTS can be idiopathic (no identifiable direct cause) and that there may be a genetic component which increases the possibility that an individual develops CTS.

    Activities considered high risk for CTS include any which involve repetitive and/or forceful use of one or both hands. In terms of sports this can include gymnastics, weightlifting (Olympic style in particular), racquet sports, cycling, rowing, baseball and golf. CTS also has a high incidence in individuals who regularly use vibrating hand tools (e.g. hammer drill).

    Research has shown that certain conditions can increase the risk of developing CTS by causing fluid obstruction in the carpal tunnel. These include:

    • Pregnancy
    • Menopause
    • Obesity
    • Renal failure/haemodialysis
    • Hypothyroidism
    • Use of oral contraceptives
    • Congestive heart failure
    • Tumours
    • Autoimmune disease (eg, rheumatoid arthritis)
    • Wrist fracture/dislocation/deformity
    • Age – The majority of those affected are in range 40 to 60 years old, CTS usually only occurs in adults.

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    Diagnosis

    To determine the cause of your CTS your doctor may conduct a physical examination of hands, arms, shoulders and neck. This can help them to decide if the condition is being caused by daily activities, an underlying disorder, or if it is a condition which presents similar symptoms to CTS. They will look for abnormalities in wrist tenderness, swelling, warmth and colour. Your doctor will probably conduct nerve testing to establish sensation in each thumb and finger any check for muscle atrophy (wasting).

    You should inform your doctor of any history of fractures, arthritis or diabetes. It will also be helpful if you can provide them with an insight in to your daily activities and hobbies. They will discuss when your symptoms occur, improve or get worse.

    They may ask you to have and X-Ray (to check for fractures or arthritis), an ultrasound (which can show if the median nerve is an abnormal size) or an MRI (to check the wrist anatomy).

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    Treatment

    It is important not to ignore the symptoms of CTS. You can often treat it yourself, but it can take months to get better. Leaving the condition untreated can lengthen recovery time considerably.

    REST – Where possible stop any activities which make your symptoms worse. Ask an occupational health advisor how you can modify your work station and/ or the activities that cause the pain.

    ICE – Applying an ice pack for 5-10 minutes every 1-2 hours in the early stages of the pain/numbness may help reduce swelling and the pressure on the nerve.

    SUPPORT – A wrist splint will help limit movement of your wrist which may help reduce the pain and risk of further swelling.

    ELEVATION – Try and keep your wrist elevated to reduce the potential for swelling in your wrist. When you lie down this may mean resting your hand on pillows.

    MASSAGE – A Sports Massage Therapist can help to relive the pressure in your carpal tunnel by encouraging the proper flow and drainage of fluids to and from your wrist. They may use Soft Tissue Release (STR) to lengthen and normalize the muscles from your wrist in some cases up to your neck. These muscles often become very tight when performing repetitive tasks, this tension can exacerbated the symptoms of CTS. If your therapist is trained in the use of Kinesiology taping they can also use this to create space in the carpal tunnel and support the soft tissue structures of your wrist. Because the problem may be caused, or made worse, by structures as far up as the neck, your therapist will be keen to address these problems as well as the ones at your wrist. Treating the cause of a problem is always more effective than treating the symptoms alone if the condition is to be resolved.

    PHYSIOTHERAPY – Consider seeing a Physiotherapist if other treatment have not improved the symptoms.

    CTS can be resolved without invasive procedures, following treatments such as those outlined above has been shown to reduce symptoms effectively if properly followed. It is important to be consistent with treatments for CTS as it may take a number of moths for the issue to resolve.

    STEROID INJECTION – A medical professional may suggest a treatment involving a steroid injection to reduce inflammation.

    SURGERY – In some cases surgery may be necessary but only after all non-surgical methods have been tried.

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    Exercises

    The exercises shown in the video are designed to improve the flexibility and strength of your wrist and also stretch other muscles which may be putting pressure on the median nerve supplying your wrist. Make sure you are pain-free at all times and take care not to progress too quickly. Where possible stop any activities which make your symptoms worse. We have given suggested sets and repetitions, but everyone is different so your practitioner may give guidance that is more specific to you. It is important to perform the exercises correctly and at the frequency prescribed in order to reach a successful outcome.

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    Prevention

    As CTS can be idiopathic it is not easy to prevent its occurrence. If possible avoid repetitive activities, when unavoidable take time to perform stretches and take regular breaks. Be aware of the first signs of symptoms developing, the earlier you start treatments the quicker it can be resolved.
    The video above is not just to help rehabilitate the area it will also help in strengthening the area and again you should seek professional advice for this.

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    Is It Tendonitis or Tendinopathy…

    Tendonitis or Tendinopathy?

    The Overview

    Tendonitis and Tendinopathy are often used interchangeably as they both present very similar symptoms however the conditions are very different.

    Tendonitis: Tendonitis is when a tendon (attachment point of muscles) becomes swollen / inflamed. This can be because of a number of issues such as overuse or a specific injury / movement. The inflamed tendon can become stiff and can cause joint pain as it will be affected in the way it functions. Usually, but not always tendonitis is presented once you finish an exercise or immediately after you have rested it for a period of time and can go away during exercise or use. However it can also present as a dull ache more frequently.

    Tendinopathy: Tendinopathy, also referred to as tendinosis, is the breakdown / de-generation of collagen in the tendon. This causes burning pain as well as reduced functionality of the tendon, flexibility and range of movement. While tendinopathy can of course affect any tendon, it’s more common in the Achilles tendon, rotator cuff tendons, patellar tendon and hamstring tendons.

    Some suggest that tendinitis precedes tendinopathy (tendinosis) however the fact that a healthy tendon can be up to twice as strong as the muscle is true. This would in turn make the body of the tendon unlikely to tear, unless the tendon is already weakened by degenerative change.

    So the very idea that tendinitis is the initial stage of tendinopathy as it will presume micro-tears and inflammation precedes collagen degeneration is wrong. Recent research shows that torn fibres, scar tissue, and calcification are only found in conjunction with tendinosis some of the time, and inflammation are rarely found in tendinosis, which would support the idea that tendinitis occurs secondarily to tendinosis

    Symptoms

    The symptoms of tendonitis and tendinopathy are very much similar at will present itself at the insertion point where the tendon meets the muscle. The symptoms typically include:

    • Pain often described as a dull ache, especially when moving the affected limb or joint
    • Tenderness to touch
    • Swelling
    • Pain or Stiffness in the morning
    • Pain or stiffness after long periods of rest

    Causes

    Although tendinitis / tendinopathy can happen through a sudden injury or event the condition is much more likely to appear over a long period of time due to overuse or repetitive movements.

    Treatment

    Tendonitis and Tendinopathy can both be treated in the same way. In more cases Tendonitis will be more effectively treated through conservative methods of rehabilitation as well as rest. The initial advice would be to rest of area that is causing pain, so for example if you are running and that is causing pain to the Achilles tendon then we would advise you to stop that activity an rest usually for around 3-6 weeks depending on the severity. Through this rest period there will be exercises to do in order to strengthen the tendon in question but also by offering stretching techniques and massage to the affected area / muscle attachment.

    Tendinopathy can be treated as above however in some more severe cases surgery can be recommended and can also be very effective in providing around 90-95% range of movement and great results.

    Iliotibial Band Syndrome

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    Overview

    Iliotibial Band (ITB) syndrome is a condition that often causes pain in the outside of the knee. The ITB itself is a thick connective tissue that originates at the hip and inserts into the knee; it is composed of the tendinous portions of the Tensor Fascia Latae and Gluteal muscles. The ITB’s purpose is to stabilise the knee joint and assist with movement

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    Anatomy

    The ITB is a large thick band of fasia lata, that originates at the anterolateral iliac tubercle of the exernal lip of the iliac crest & inserts into the lateral condyle of the tibia at the Gerdy’s tubercle. Meaning it begins at the top part of your pelvis, runs down the lateral side of the thigh & attaches at the top of the shinbone, just under the knee cap. It is composed from the Tensor Fascia Lata & Gluteal muscles, then becomes proportionately thickened before attaching into the knee. This thick fibrous sheath then helps to stabilize the lateral side of the knee during flexion & extension, as well as aiding with hip abduction. When the knee is in a flexed position, the ITB is behind the lateral epicondyle, as you start to straighten the leg the ITB then travels forward across the epicondyle.[/fusion_text][/fusion_builder_column][fusion_builder_column type=”1_2″ type=”1_2″ layout=”1_2″ spacing=”” center_content=”yes” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” hover_type=”none” border_size=”0″ border_color=”” border_style=”solid” border_position=”all” box_shadow=”no” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” filter_type=”regular” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″ first=”false” last=”true” padding_bottom=”0px” margin_bottom=”0px” padding_left=”0px” element_content=”” padding_top=”7px”][fusion_imageframe image_id=”4780|full” max_width=”” style_type=”” blur=”” stylecolor=”” hover_type=”none” bordersize=”” bordercolor=”” borderradius=”” align=”center” lightbox=”no” gallery_id=”” lightbox_image=”” lightbox_image_id=”” alt=”” link=”” linktarget=”_self” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″]https://store.livewellhealth.co.uk/wp-content/uploads/2021/02/it-band.jpg[/fusion_imageframe][/fusion_builder_column][fusion_builder_column type=”1_1″ type=”1_1″ layout=”1_1″ spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” hover_type=”none” border_size=”0″ border_color=”” border_style=”solid” border_position=”all” box_shadow=”no” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” filter_type=”regular” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″ first=”true” last=”true”][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”default” rule_size=”” rule_color=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=””]

    Causes

    ITB syndrome is an overuse injury that usually presents as pain in the lateral aspect of the knee due to inflammation of a portion of the band, most commonly near the knee. It is most common in runners due to the repetitive knee flexion and extension (bending and straightening) of the knee required.

    When the knee repetitively bends and straightens, the band slides of the lateral femoral condyle of the knee, causing excessive friction and thus inflaming the band, resulting in pain. It has been found that individuals diagnosed with ITB syndrome often have thickening of the band itself, which inflames the space between the ITB and femoral condyle.

    A number of training factors have been suggested to be risk factors for ITB syndrome:

    • Excessive running in the same direction on a track
    • Increased running mileage
    • Downhill running
    • Wearing worn out shoes with improper support

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    Symptoms

    If you are suffering from ITB Syndrome you may notice;

    • Sharp pain, particularly on the outside of the knee
    • Pain when the knee is bent to approximately 30 degrees
    • Tightness and reduced flexibility
    • Tenderness on the outside of the knee
    • Pain when running or cycling.

    If you suffer with any of these symptoms and suspect you may have ITB syndrome, contact your GP or local Sports Therapist/ Physiotherapist who can complete a thorough assessment to determine a clear diagnosis.

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    Diagnosis

    Our therapists at LIVEWELL are highly qualified in assessing and treating musculoskeletal conditions; you may find that you would benefit from soft tissue therapy, particularly of the TFL and hip-flexors to reduce tightness and improve flexibility. We can also assist in determining whether your bio-mechanics need altering and helping with strength programmes to target the desired muscles.  With our areas of knowledge and expertise we can help you overcome ITB syndrome and have you back running pain free.

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    Treatment

    The immediate goal when treating ITB syndrome is to reduce the local inflammation and thus limit the pain. Ice and anti-inflammatory medications may assist in the reduction in the initial pain, however the most important aspect of initial treatment is activity modification. It could simply be that the individual needs to cease downhill running or running in one direction on a track- educating the individual on correct running techniques is very important.

    Once the inflammation has subsided, a programme can be introduced to begin strengthening the gluteal muscles and stretching the TFL/ITB complex. When the gluteal muscles do not function correctly, other muscles must compensate and perform work that they are not suited for.

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    Exercises

    If you believe you have ITB Sydrome, you should firstly rest your leg & apply ice to the lateral side of knee joint. As it is an overuse injury initially reducing the load on the structure can help to relieve pain. When the pain starts to ease, some stretching and strengthening exercises can help improve symptom’s and aid recovery.

    Please see some exercise examples in our video.[/fusion_text][/fusion_builder_column][fusion_builder_column type=”1_2″ type=”1_2″ layout=”1_2″ spacing=”” center_content=”yes” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” hover_type=”none” border_size=”0″ border_color=”” border_style=”solid” border_position=”all” box_shadow=”no” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” filter_type=”regular” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″ first=”false” last=”true” padding_top=”0px” margin_bottom=”15px” margin_top=”15px”][fusion_youtube id=”https://youtu.be/b2SPz9V8AMU” alignment=”center” autoplay=”false” api_params=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” css_id=”” /][/fusion_builder_column][/fusion_builder_row][/fusion_builder_container]

    DOMS and how massage can help

    What is DOMS?

    Delayed-onset muscle soreness (DOMS) describes muscle pain and tenderness that typically develops several hours post-exercise and consists of predominantly eccentric muscle actions, especially if the exercise is unfamiliar. Although DOMS is likely a symptom of eccentric-exercise–induced muscle damage, it does not necessarily reflect muscle damage. Some prophylactic or therapeutic modalities may be effective only for alleviating DOMS, whereas others may enhance recovery of muscle function without affecting DOMS.


    What are the benefits of massage to help with DOMS?

    As we all know, massage helps in a number of ways to flush out a range of toxins and hormones from arteries, veins and lymph system, which your body produces to help it understand when you need to slow down or stop when it comes to exercise.

    These toxins and hormones are is a good thing during exercise; they help you understand when you need to give your muscles a break so you don’t strain them or injure a tendon or ligament.

    However, post-exercise this can be an annoying effect of your training and can hinder your goals and plans.

    There is a solution and it comes in the form of a qualified massage therapist. If you were to arrange a massage post-exercise, this could really help eliminate DOMS all-together or at least speed up your recovery and limit the DOMS effect substantially so you can continue with your training plans the next day.

    Sports Massage helps not just to flush your system of these painful and limiting toxins but it also helps lengthen your tight muscles to a normal range and remove any adhesions and trigger points that may have built up over the time you have been training.

    To find out more about how this can help and to put a plan in place contact one of our sports massage therapists today and we can give you some free help and advice on this and other sport related issues.

    Our therapists are based in Birmingham and operate across the Midlands, offering a fully mobile service so no matter how much pain you are in with your DOMS, we can help!