HEADACHES: There are many headaches categories but for simplicity, two common types are discussed. 1. Vascular Headaches:( Migraines.) The causes are controversial but a common understanding involves blood vessels reducing their diameter (constricting ) causing the aura,prior to the migraine ,followed by blood vessels increasing their diameter (dilating) resulting in the throbbing headaches. The onset is usually rapid. Triggers can be food,too much or too little sleep. About 20% of migraines are caused by exercise. Treatment: Lie down in a dark room or take medication. 2. Neck Headaches:( cervicogenic headaches. ) Neck headaches originate for the joints in the upper 3 segments of the neck. The onset is slow taking days rather then hours, the pain spreading into the head and forehead. The cause is multi factorial but very often related to posture. Sitting for prolonged periods at the PC/laptop or texting (text neck ) can precipitate neck pain and or headaches. Treatment: Physio may help by freeing up the stiff joints using mobilisations and correcting postural stresses.An exercise program is useful to maintain the flexibility. If you use a laptop, raise it's height using a purpose made stand but you'll need a separate keyboard. Alan.

Trigger Points: Trigger points are areas of intense muscle pain distributed over the body, sometimes referred to as Myofascial pain. However, they cannot be identified, as the pathophysiology is unknown. They are unlikely to be a primary pain source but rather "triggered" from another area. eg low back or neck pain. Trigger points maybe treated by massage ultrasound etc but it is always worth identifying their causes.

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Ankle Injuries: Ankle injuries account for 14% of all sporting injuries. Two thirds of ankle injuries involve the lateral or outside ligament. The remaining third injuries may include fracture,Talar dome damage or sprained syndesmosis. If the pain is ongoing seek medical opinion. About 40% of ankle sprains reoccur. This maybe due to the disruption of motion and movement sensors. Taping isn't proven to prevent re injury but there is good evidence supporting balance exercises or proprioceptive exercises. Wobble boards exercises commenced when the acute pain has settled may help to prevent ongoing injury.

FAQ- Should I use ice or heat? Heat:- Is, generally used to relieve muscle spasm associated with neck or back pain. The muscle spasm is a response to the deeper pain cause such as a pinched joint, nerve or "slipped disc " The pain origin is too deep to be effected by heat ( or ice ) and therefore heat is relieving the symptoms. ICE: Is, best used for acute near surface injuries, such as shoulders, knees and ankles. Ice is particularly effective for the reduction of inflammation and swelling which may actually cause more collateral damage to other tissues not injured. ( ligaments or tendons.) Using heat may actually increase the inflammation ! A Word of warning. "Recovery underway- ice bath filling beer in hand"- tweet by John Senger. It maybe prudent to replace the beer with an ice derivative, AKA- water! Alan

Evidence Base Therapy:There are 5 levels of evidence. Level- 1 Highest Rank- determined by Random Control Trials (RCT) eg. used in drug testing Level -5 Lowest Rank eg. Expert Opinion. Sometimes we now things work but are not well tested. eg. Jumping out of a aircraft with with a parachute has a better outcome then jumping without a parachute ! This is only level 4 evidence or a case study. Some Physio treatments work but lack good evidence at this point of time. Nevertheless, evidence based treatments are important to help the sometimes uninformed public to decide between science and advertising (spin) Alan

STRETCHING: There is no compelling evidence proving that stretching prevents muscle injury during exercise or sport. However, the ability to move a joint smoothly throughout full range maybe dependent on muscle length. Short muscles may stress other body parts. For example, short Hamstrings contribute to low back pain, So, keep stretching!

Cramps: Exercise associated muscle cramping ( EAMC ) . The cause is unclear but maybe due to abnormal spinal reflex activity due to fatigue. This theory maybe supported by the effectiveness of passive stretching which reduces muscle and nerve activity within 10 to 20 seconds.

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