The Pain Relief Clinic is pleased to announce Consultant Physiotherapist, Nicky Snazell, has won a top award and national recognition for ‘Excellence in Patient Service’ at a Gala Dinner, held by The Acupuncture Association for Chartered Physiotherapists, (AACP). The prestigious awards dinner was held on Friday 13th May at the Hilton Hotel in Coventry as part of the AACP Annual Conference. The awards were held to recognise individuals who were honoured for their achievements and the contributions they have made.
Nicky Snazell, Clinical Director of The Pain Relief Clinics was honoured at The AACP Awards evening. Nicky was selected from more than 6000 physiotherapists in both NHS and private practice from across the UK to win the first ever ‘Excellence in Patient Service’ Award. Nicky was recognised for her incredible achievements and for making a significant contribution to the practice of acupuncture having successfully treated thousands of patients throughout her career spanning nearly thirty years.
The AACP celebrated Nicky’s patient-focused approach, holistic understanding and treatment of patients and excellence in practice. Nicky was said to be an inspirational leader in her field and having made a significant contribution to the practice of acupuncture in the UK. Collecting the award Nicky said,
“Winning this award inspires me to continue my work driving holistic physiotherapy practice forward. I believe it is every health practitioner’s duty to study and share with enthusiasm the secrets of good health. We should work in the wellness industry with preventative health advice and not just the illness industry”
Nicky’s drive to learn and discover better methods to treat pain was ignited by her frustration as a child watching her mother suffer years of terrible back pain. Despite Nicky’s mother seeing numerous professionals nothing ever really helped.
A qualified biologist, physiotherapist, spinal pain specialist and author; Nicky’s career has taken to her to China, Korea, Canada and many European countries, where she has been privileged to work alongside many pioneers in their field. Nicky is one of the few people in the world to have achieved the highest level of qualification and the first practitioner in the world to be awarded a fellowship from the Institute for the Study and Treatment of Pain.
It’s this work Nicky continues at her two clinics in Stafford and Harrogate.
Traffic light approach to health, what do I mean ?Traffic Light Approach to Health
At my clinic, I always ask my patients to fill in a questionnaire about their
current health, and their answers are incredibly useful in letting me see
where they need to improve their mindset, their nutrition, their fitness and
their lifestyle. I call it the traffic light approach to health because we analyse
these areas by saying whether the patient is green (good), amber (room for
improvement) or red (poor). These are your fitness keys, and they will tell
you where you need to improve. With this in mind, I have developed four
questionnaires – one for each key – and have placed them in the appendix
of this book. If you want to get the most out of this book, I urge you to
complete the questionnaire at the start of each chapter, and again after
you’ve absorbed the knowledge and implemented some of my suggested
changes into your life. Soon, you should start to see your traffic light scores
changing from red or amber to green on all counts. When this happens, you
are likely to be at your optimal health for your age, which means you’ll be
giving yourself the best possible chance if a disease or injury should occur.
So, to those therapists and doctors who want to go beyond their specific
training and look at the synergy of everything they know in order to create
their own map, here is mine.
If you don’t want to commit to a new, healthy you, then now is probably a
good time to leave my blogs. If, however, you desire to work towards a healthy, fit,
pain-free body, here we go. It’s time to take your health into your own hands
and get rid of all the pain that has been holding you back
The 4 keys to health, what is it about? A question that now rings in my ears most days from those that as yet have not read my book.This book is life transforming if you take in the advice and act on it.My dear friend who had always said she would love a book dedicated to her, died yesterday with the book in her room knowing the healing work we started, so many years ago will go on, in this and future books and talks.Rest in peace June.
Everyday I bump into people telling me their life story and how the 4 keys to health has changed the way they think about life and empowered them to make the changes they needed to.This warms my heart, and today it was suggested I regularly blogged about it.
Here is an exert from my book describing what it is about.
I have spent my life searching for ways to treat pain, and I have travelled
all over the world, meeting and learning from countless specialists and
professionals during this quest of mine. Now, I want to pour all of that
knowledge and all of my experience into this book, so that my methods can
become your methods, and so that you can conquer your pain, allowing
you to have a long, happy life. It sounds relatively simple, doesn’t it? Well, it
may be simpler than you think.
This book will discuss healing through an understanding of how neuroscience
works, and I believe that this holds the keys to wellness, mental excellence,
physical fitness, prosperity, relationship skills, society contribution and
having a purpose to live – not to mention, of course, keeping out of pain. I
like to imagine all of these things as breaking down into four main sections:
the four keys of health, featuring mindset, nutrition and hydration, fitness,
and lifestyle. You will be able to read about each of these four keys in the
following chapters, and you can learn about the fifth key – how to deal with
individual health problems – in my next book, The Human Garage. This
will talk about what is lovingly nicknamed the ‘clinic of last resort’ by my
Drawing from both modern medical technology and ancient healing
wisdom, this book will guide you through your health journey, giving you
the knowledge and the tools you need to create the best lifestyle for you. Say
goodbye to pain and say hello to a fitter, healthier, happier you.
Welcome back to the series of articles about physiotherapy and tennis elbow (also known as lateral epicondylitis, lateral epicondylosis and lateral epicondylalgia). So far we have covered who is affected by tennis elbow, the anatomy of the elbow and which muscles or tendons are most likely to be injured. This article will try to give an overview of a huge subject: the physiology of tendons and why they get injured, now this is a massive topic in physiotherapy and has been the subject of huge amounts of research (and in fact our knowledge on this topic is still developing) so I will only be touching the surface.
Firstly we need to look at what tendons actually are and why they might get injured in tennis elbow. Simply put a tendon is a piece of connective tissue that joins muscle to bone and is comprised of well organised mostly one directional collagen fibres (Wang et al 2003). Unlike muscles tendons can not contract themselves and are relatively inelastic (with a much lower proportion of elastin – only about 1-2% Jozsa & Kannus 1997). So basically muscles do the contraction and force generation but tendons, because they connect to the bones and are relatively inelastic, transfer that force over to the bones and move our joints. A key fact about tendons is that they generally will have a much lower blood supply than muscles and in turn have a lower metabolic rate which affects their ability to heal and makes an injury to a tendon much slower to recover and heal properly (Abate et al 2009). Furthermore the point at which muscle turns into tendon (the musculo-tendinous junction) is the point which is most often injured and is subject to large mechanical forces (Abate et al 2009).
Okay – how does this affect tennis elbow? Well, as we found out in the last article, extensor carpi radialis brevis (ECRB) is the most commonly injured muscle in tennis elbow and this muscle is most commonly injured at either the musculo-tendinous junction or at the lateral epicondyle (bony bit of the elbow) where the common extensor tendon inserts into the bone. Therefore understanding tendons and how they react and function is key to understanding tennis elbow.
The common extensor tendon as shown above is the continuation of all the extensors of the wrist and fingers and therefore any time you extend your wrist or your fingers to pick anything up it is put under stress. So it isn’t really a surprise that if you do too much of anything like picking things up then this tendon may get irritated and sore and that your physiotherapist will be able to find fairly easily a very sore spot on the lateral epicondyle of your elbow.
Next blog post will look in more detail at the physiology of what happens when the tendon gets injured in tennis elbow and hopefully manage to summarise and simplify decades of research on tendinopathies.
Abate M., Gravare-Silbernagel K., Siljeholm C., Di Iorio A., De Amicis D., Salini V., Werner S., Paganelli R. (2009) Pathogenesis of tendinopathies: inflammation or degeneration? Arthritis Research and Therapy 11 (3): 235
Jozsa, L., and Kannus, P., Human Tendons: Anatomy, Physiology, and Pathology. Human Kinetics: Champaign, IL, 1997
Wang J., Jia F., Yang G., Yang S., Campbell B., Stone D., Woo S., (2003) Cyclic Mechanical Stretching of Human Tendon Fibroblasts Increases the Production of Prostaglandin E2 and Levels of Cyclooxygenase Expression: A Novel In Vitro Model Study Connective Tissue Research 44: 128 – 133
Welcome back to the new series of articles about physiotherapy and common injuries and pathologies seen by physiotherapists. Last time we took a brief look at one of the most common musculo-skeletal conditions that a physiotherapist will encounter – tennis elbow (also known as lateral epicondylitis, lateral epicondylosis and lateral epicondylalgia). This article will now look at the anatomy of the elbow and the muscles connected to it in detail so that we can have a good idea of what is hurting or being injured in tennis elbow and can maybe start to have an idea of what causes it.
The elbow is an amazing piece of biomechanical design and is comprised of 3 bones – the humerus which is the upper arm bone and two bones in the forearm called the radius and ulna. The radius runs from the elbow to the thumb and the ulna starts at the bony prominence on the back of your elbow (olecranon process) and runs down to the wrist. To make it easy to remember which bone is which, when I was a student I used to repeat “the ulna is underneath the radius”. Simple I know but effective nonetheless when you are a physio student desperately trying to cram in your anatomical knowledge.
Now as we are looking at tennis elbow we are not going to look or worry too much about the actual elbow joint itself except to say that it has two ways of movement – flexion and extension (basically straightening and bending) and pronation and supination (pronation is rotating the hand palm down and supination palm up). It may seem strange that in a condition called tennis elbow we will be ignoring the elbow joint itself but hopefully the reason why will become clear soon.
The key part of the elbow in tennis elbow that we really need to examine is the lateral epicondyle – this is the point where all of the wrist extensors and finger extensors start from and is the point at which pain is felt in tennis elbow, it is also called the common extensor origin (for reasons which will become apparent soon) and is the site of attachment for the common extensor tendon. Pain here is the cardinal sign for tennis elbow that all physiotherapists look for.
Running from the lateral epicondyle and the common extensor origin are all of the muscles that extend the wrist and the fingers – extensor carpi radialis brevis, extensor carpi ulnaris, extensor digitorum, extensor indicis and extensor digiti minimi. Two other muscles have attachments at the lateral epicondyle – supinator and anconeus. All of these muscles merge together here to form what is known as the common extensor tendon which then attaches to the lateral epicondyle. So it is fairly obvious that this common extensor origin is an important point in wrist and finger extension and may well be a likely site of injury that physiotherapists will need to examine.
Before moving on it is worth considering the actions of a couple of these muscles in more detail extensor carpi radialis brevis and extensor carpi ulnaris have an important synergistic role in stabilising the wrist – they both act at the same time in concert with their flexor brothers (flexor carpi ulnaris and flexor carpi radialis) to prevent side to side movement at the wrist (ulnar and radial deviation). The two extensors also act together at the same time you grip an object to hold the wrist in extension a bit and prevent the finger flexors from flexing the wrist. In fact studies have shown that extensor carpi radialis brevis is the tendon most commonly injured in tennis elbow and the most common point that it is injured at is the common extensor tendon.
So hopefully from the above brief anatomy lesson we can now see that any extension or even flexion of the wrist is going to put a large amount of stress through the common extensor tendon and in turn if this tendon receives any injury we are likely to feel pain at the lateral epicondyle – which is where patients with tennis elbow will normally describe to their physiotherapist that they feel pain when they pick things up.
The next article will look at the physiology and some of the reasons why tendons get injured and why tennis elbow can often become chronic and last for a long time.