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Unmasking the 5 Hidden Culprits of Neck Pain

Welcome to the Pain and Performance Physiotherapy Clinic in Lucan!

Today, we’re delving into the world of neck pain, but we’re going beyond the usual suspects such as disc degeneration and poor posture.

Instead, we’ll focus on helping you to uncover the lesser-known but often more relevant causes of neck pain.

In this blog, you will uncover 5 hidden culprits of neck pain, and what may be causing them.

Let’s get into it…

5 Issues Causing Your Neck Pain

Sensitisation of Nerves:

Neck pain can sometimes arise from the sensitisation of nerves in the neck region. This occurs when nerves become hypersensitive to various stimuli, leading to increased pain perception.

In these cases, educating patients about how their nervous system functions and offering strategies to desensitise nerves can be immensely helpful.

Cognitive Factors:

Our thoughts and emotions play a significant role in how we perceive pain. Stress, anxiety, and negative thought patterns can exacerbate neck pain.

Through therapeutic neuroscience education, we can guide patients to recognize and modify these cognitive factors, which can lead to pain reduction.

Movement Impairments:

Movement is a complex interplay of various factors, and any disruption in this symphony can contribute to neck pain.

Sometimes, subtle imbalances or muscle weaknesses can be the root cause.

Teaching patients about the importance of efficient and pain-free movement can empower them to address these impairments effectively.

Central Sensitisation:

This is a condition where the central nervous system becomes overly sensitive to pain signals.

It can lead to widespread pain, including in the neck area.

By explaining central sensitisation to patients and helping them understand how to modulate it, we can make substantial progress in alleviating neck pain.

Biomechanical Aberrations:

While we’re avoiding the common theme of “poor posture,” (because it’s more often the case that that staying in one position or maintaining the same posture is the problem) it’s essential to note that certain biomechanical issues in the neck region can be at the root of the problem.

Educating patients about these biomechanical aberrations, without blaming posture, is a more constructive approach.

Lifestyle Factors:

Choices in your personal life, such as a lack of sleep, poor nutrition, or inadequate hydration, can also contribute to neck pain.

Addressing these factors through education and guidance can be a pivotal part of the solution.

Environmental Triggers:

Sometimes, environmental factors like allergens or pollutants can lead to pain in your neck by triggering an inflammatory response.

Educating patients on how to minimise exposure to these triggers can be a valuable part of the treatment plan.

In conclusion, neck pain is a complex issue with a wide range of potential culprits.

By utilising therapeutic neuroscience education techniques and understanding the multifaceted nature of neck pain, we can provide more holistic and effective care to our patients.

Struggling With Pain In Your Neck?

If you’re struggling with neck pain or suspect it might be more than just the occasional stiffness, our team is here to guide you towards a life free from discomfort!

At the moment, we’re offering a FREE Telephone Consultation.

This is your opportunity to discuss your neck pain concerns with one of our expert physiotherapists.

You’ll have the chance to ask all your pressing questions and gain insights into how physiotherapy can be tailored to relieve your specific pain.

Tired of neck pain holding you back from enjoying your daily life or hobbies?

Take the first step to recovery and book your FREE Telephone Consultation.

Just give our Lucan clinic a call at 086 787 6358 and let’s start your journey to a pain-free neck

Other Free Resources For A Painful Neck

Read Our Blog – 3 Reasons For Your Persistent Pain

On Social Media? Follow Us On – Facebook, Instagram, YouTube 

3 Reasons For Your Persistent Pain

Physical factors like weak muscles, torn tendons, disc degeneration, and arthritis, are often identified as being the main source that remains.

With persistent pain or pain that comes and goes, these factors are NOT to blame.

The truth?

People can have disc bulges, joint degeneration, and muscle tears and have no pain at all.

You can become pain-free again without these things changing.

It seems logical to think that if your back is arched or your hips aren’t level then that’s what is causing your pain.

This isn’t true.

Being open to another understanding of why you have pain is all it takes to begin returning to all the activities you enjoy again.

Let’s explore three core reasons why your pain may be persisting.

What Do You Think is Going On?

Your mentality is important.

What you believe is happening can influence what you feel.

If you think you are weak and believe moving will cause more damage, your body can create pain as a protective response.

If you’ve been told in the past that your spine is fragile, that message will influence how you move and can subconsciously cause stiffness as a response.

Secondly, if you were told your shoulder pain is due to your rotator cuff tearing, naturally, you will dramatise when you feel that pain, and visualise your fibers splitting like a cloth tearing.

This will cause you to protect your shoulder, resulting in moving it less and causing a stiff shoulder.

Unfortunately, it’s the education and understanding of what’s happening that causes this protective existence.

Learned Helplessness

Your experience with pain, how it has affected you, the things you have been told about it, and how it has been dealt with can contribute to “Learned Helplessness”.

Learned Helplessness is where an uncontrollable bad event (e.g. an episode of pain), leads to a perceived lack of control.

The human mind naturally wants control.

You can be a very competent, capable person, but if you feel like you have no control over the pain you’re experiencing, often this can result in you becoming very passive.

This can result in you “giving up” in some areas, in the hope that some injection or “quick-fix” will help you.

Look at elephants, elephants such as this one could easily escape if they believed they had the power to.

Don’t let your mind hold you back.

Losing Your Sense Of Self.

I understand.

Pain can absolutely take over our lives.

It can take the important things away from you, those very things that define you.

Did you once take these things for granted and now you feel a space in your life?

Not being able to do these things such as exercising, or spending time with friends can be a massive struggle.

This can influence the amount of pain you experience.

General Health

Do you have any unhealthy habits?

Where can you be a bit healthier?

Many people can have disc issues and meniscus tears but it doesn’t affect them.

Being less healthy can increase your sensitivity to these issues.

Are there any exercises you can do that don’t cause a flare-up? Are you getting enough sleep each night?

How is your self-talk? Are you too hard on yourself?

There is no need to bully yourself for bad habits.

The good news is that you can learn strategies to help you improve these habits.

Struggling With Persistent Pain?

If you’ve recently been struggling with persistent pain or suspect it might be affecting your daily activities, we’re here to guide you on the path to relief

Right now, we’re offering you the chance to book a free telephone consultation where you can speak to one of our expert strength coaches about your pain concerns.

Ask your pressing questions and gain insights on how our clinic can be the solution to your persistent pain issues.

If you’re tired of pain affecting your daily life and limiting your activities, arrange a free telephone consultation by calling our Lucan clinic at 086 787 6358.

Other Free Resources For Persistent Pain  

Read Our Blog – 4 Tips To Manage Osteoarthritis Naturally And Maintain Your Independence

Read Our Blog – Patellofemoral Pain Syndrome

On Social Media? Follow Us On – Facebook, Instagram, YouTube 

Plantar Fasciitis – The Ins And Outs Of This Frustrating Condition!

Here at my clinic, I see plenty of patients suffering from heel pain. They almost always have a similar story:

“I have an extremely painful sensation right on the heel of my foot”
“My pain is always there in the mornings, and after I do any activity!”
“I’ve had to stop my running because I just can’t bear the pain”
“The pain seems to ease as I move but it kills me immediately after”
“If I sit at my desk for an hour or so, then get up to move I can’t walk with the pain in my heel!”

All of these complaints are those you would expect from somebody suffering from Plantar Fasciitis. You may have heard of this frustrating condition before – especially if you are a runner or work on your feet a lot!

In this week’s column, I hope to give you the correct and most up-to-date information on this condition and how to treat it.

What Is The Plantar Fascia?

The plantar fascia is a flat band of tissue that connects your heel bone to your toes and supports the arch of your foot.

What Is Plantar Fasciosis? Is It the Same As Plantar Fasciitis?

Plantar Fasciosis is an overload injury of the plantar fascia. It is degeneration of your plantar fascia. This condition has historically been called plantar fasciitis because it was believed that plantar fascia inflammation was the principal underlying cause. Plantar fasciosis is a more accurate name for this condition because it involves degeneration of your plantar fascia, not inflammation.

Why Me? What Can Cause Plantar Fasciosis?

It is very common in runners due to the repeated stress being placed on the fascia – can sometimes be linked to poor running technique but more often than not the process of doing too much too soon is enough to overload the fascia.

Plantar Fasciosis is very common among beginner runners who might go from doing no running at all straight into a 5km run. This is too drastic of a change for the body to handle in such a small space of time and the plantar fascia isn’t used to this amount of stress and becomes
irritated and painful.

Another common group of people who suffer from Plantar Fasciosis are those who work on their feet all day. 50% of Plantar Fasciosis sufferers are on their feet all day.

Our Top 6 Tips For Providing Some Relief!


Stretching of the plantar fascia and/or calf muscles can provide some people with relief! Try to gently stretch your calf and plantar fascia twice a day and you might see some

Gel Inserts/Heel Pads

these heel pads can be bought at a relatively no cost compared to more expensive custom orthotics and have been shown to be just as effective – give it a go and see if you feel the benefits!

Ice Or Heat

Applying Ice or heat to the Plantar Fascia has been effective in reducing symptoms short-term in a handful of patients but is not guaranteed to work in everyone. You could start by rolling your foot on a frozen water bottle for 10 minutes every few hours and see if it helps you! Remember to put a towel between your skin and the bottle to avoid ice burns!

Night Socks

There are a range of night socks available – some more comfortable than others, it’s important to find the one that you find most comfortable! Night socks don’t work with
everyone, however, they are only effective in about 1/3rd of people.

Reducing The Load On Your Foot

This is the most important tip we can give you. The act of adjusting your activity levels and reducing the stress on your plantar fascia can bring some decrease in symptoms – the important part then is how we load it back up.

Load It Back Up

Once the pain has settled a gradual loading programme has been shown to be the best way to gain long-lasting relief from this frustrating condition.

Struggling With Plantar Fasciitis?

If you’ve recently been diagnosed with plantar fasciitis or you suspect it could be why your foot is painful and swollen, we can help you get back to doing your favourite activities foot pain-free!

Right now, we’re offering you the chance to book a free telephone consultation where you can speak to one of our expert physiotherapists about your foot pain problems, ask your important questions and get clarity from the answers about how physiotherapy can help you!

If you’ve had enough of foot pain ruining your favourite sports and activities arrange a free telephone consultation by calling our Lucan clinic at 086 787 6358.

Other Free Resources For Plantar Fasciitis 

Read Our Blog – Shockwave Therapy For Plantar Fasciitis

Read Our Blog – Patellofemoral Pain Syndrome

On Social Media? Follow Us On – Facebook, Instagram, YouTube 

Six Key Tips for Smashing Rehab of Patellar Tendinopathy 

Recently experienced a patellar tendinopathy injury and you’re unsure about your next steps?

It’s understandable you may be confused as often patellar injuries aren’t explained very well, it can be a long recovery process and an unclear path dependent on your progress.

Patellar tendinopathy affects the knee and in turn, can affect the way you walk, the way you run or the way you play your favourite sports potentially meaning you miss out on valuable training time.

So we’ve written this blog to help you to stay in the game and give you some clarity on what a patellar injury really means and the six key steps to manage the recovery process that comes with it.

What Is Patellar Tendinopathy?

Patellar tendinopathy, commonly known as jumper’s knee, is a prevalent overuse injury characterized by pain and dysfunction in the patellar tendon.

This condition predominantly affects athletes involved in activities that require repetitive jumping and landing motions such as athletics-style sports including hurdles, long jump and high jump.

Patellar tendinopathy is a frustrating and debilitating injury, plus, its management is poorly understood, which can lead to mismanagement. But to help you manage your recovery better we’ve included six key factors to managing patellar tendinopathy and maximising results during the rehab process.

Step 1: Get An Accurate Diagnosis

The first step in managing patellar tendinopathy is obtaining an accurate diagnosis. This typically involves a thorough clinical examination, including detailed patient history and physical assessment.

The presence of localized pain, tenderness over the patellar tendon, and pain during activities such as jumping and squatting are key indicators of tendinopathy.

X-rays and MRIs are not required for the diagnosis, and can often delay the rehabilitative process.

Step 2: Understand Tendinopathy Injuries

Any tendinopathy injury can be frustrating for both athletes and individuals leading an active lifestyle.

One of the reasons for this frustration is the prolonged healing process associated with tendinopathies, which can often take longer than other soft tissue injuries.

Unlike muscle strains or ligament sprains that generally heal within a few weeks, tendons have a relatively poor blood supply, making them more susceptible to slow healing and tissue degeneration.

The slow pace of recovery can test one’s patience and resilience, requiring individuals to adopt a long-term perspective and commit to a comprehensive rehabilitation program.

Understanding the nature of tendinopathies and their extended healing timelines is crucial in managing expectations and remaining motivated throughout the recovery journey.

Step 3: Load Management

Load management has emerged as a key principle in the management of patellar tendinopathy. Instead of complete rest, it is now recognized that appropriately dosed loading is necessary for tendon adaptation and recovery.

The load applied to the tendon should be carefully managed to avoid excessive stress while still promoting tissue healing and remodelling.

This involves adjusting training volume, intensity, and frequency to find the optimal balance between tendon recovery and progression.

Step 4: Managing Your Pain

During tendon rehabilitation, it’s important to expect some discomfort. Mild to moderate pain during exercises is considered normal and even beneficial as it indicates appropriate loading for tissue remodelling.

However, it’s essential to differentiate between acceptable pain and excessive or lingering pain. Watching how the knee responds 24 hours after activity can be helpful in guiding progressions during the rehabilitation process.

Step 5: Strength Training

Gradual strengthening of the glutes and quadriceps forms an integral part of the rehabilitation process.

Both isometric and eccentric exercises have shown promising results in the management of patellar tendinopathy.

These exercises promote tendon remodelling and increased load tolerance. Below are some examples of exercises from our YouTube channel that can be incorporated throughout the rehab process.

Stage 1 Recovery Exercises

Stage 2 Recovery Exercises

Stage 3 Recovery Exercises

Step 6: Gradual Return to Sport

Returning to sports or activities should be a gradual process. Following a period of activity modification and strengthening, the individuals can make a gradual return to activities that were previously troublesome, such as running, jumping and cutting.

Poor management of patellar tendinopathy- such as an early return to sport- can lead to an increased risk of re-injury and sub-optimal athletic performance.

Struggling With A Knee Injury? Shockwave Therapy Could Help!

If you’ve recently had a knee injury and you’re in the midst of a recovery you think is never gonna end, shockwave therapy could help you accelerate the process AND get you Dublin Marathon ready!

Here at Pain and Performance Clinic, we’re passionate about getting you back to doing the activities you love without injuries getting in the way and stopping you from making the progress you strive for.

Right now, we’re offering you the chance to book a free shockwave telephone consultation where you can speak to one of our expert physiotherapists about your pain problems, ask your important questions and get clarity from the answers about how shockwave therapy can help you!

If you’ve had enough of knee pain ruining your favourite sports and activities arrange a free shockwave therapy telephone consultation by calling our Lucan clinic at 086 787 6358.

Other Free Resources For Shockwave Therapy & Injuries 

Read Our Blog – Shockwave Therapy For Plantar Fasciitis

Read Our Blog – Patellofemoral Pain Syndrome

On Social Media? Follow Us On – Facebook, Instagram, YouTube 

What is required for a comprehensive late stage ACL rehab programme?

A late stage ACL programme should be progressive, tailored to individual needs and should be split into resistance-based and field-based programmes. The athlete undergoing the programme should be supervised by a qualified physiotherapist.

The resistance based programme should focus on double and single leg strength progressing on from early stage rehab. The physiotherapist should choose 5-6 exercises to be performed 2-3 times per week. The exercises that are chosen should include two compound movements such as a squat or deadlift and the programme should allow for variety in the movements (front squat, split squat, single leg RDL etc.). The chosen exercises can progressed by increasing exercise load or depth of the movement. The resistance programme should also include single leg power exercises such as vertical jumps, bounds, lateral jumps and combined movements.

It is vital for the programme to address single muscle groups including the quadriceps, hamstrings and calf muscles. The importance of isolated quadriceps and hamstring movements is to prevent muscle strength deficits that may be masked in a squat or deadlift by high levels of hip strength. Finally, bonus exercises including core strengthening, hip and groin strengthening and higher level hops may also be incorporated.

The field-based programme should include a comprehensive warm up and light running drills, high speed running and sprinting which can be progressed to acceleration and deceleration movements, multidirectional movements and finally to sports-specific skills and drills.

Running drills and the warm up may mimic injury prevention programmes like the FIFA 11+ or GAA 15 programmes. This allows the athlete to return to light field-based training without compromising the ACL.

This programme can then be progressed to high speed running and sprinting. The distance and speed should be progressed over a number of weeks and should finish with the athlete reaching 100% of their pre-injury level pace. An example of an initial programme may look like:

  • Week 1-2 – 60mx5
  • Week 3 60mx5, x2 sets
  • Week 5-7 60mx5, x3 sets
  • Build 80%, 85%, 90%, 95%, 100%

Acceleration and deceleration may be introduced lightly by incorporating a walk-jog-run-jog-walk type drill.

  • Walk 10-15m, jog 25m, run 60m at 80-100%, jog 25m, walk 10-15m of a 130-145m GAA pitch

This drill can be progressed by shortening the distance to reach top speed and then to include short acceleration and deceleration bursts between cones. When an athlete is comfortable with double leg acceleration to deceleration, this should be progressed to single leg. Multidirectional and change of direction movements should be included following successful implementation of straight-line activities.

Finally, sports-specific skills and drills should be implemented including kicking, tackling, falling and rolling. The athlete should then be subjected to inanimate stress 1vs0 (cone) or coach stress (respond to certain skill). They should then be exposed  to player stress such as small sided games 1vs1 and progressed to small sides games 3vs3. The direction, speed, distance, combined drills and predictability of the drills should be manipulated to challenge the player. The athlete should be progressed through sport-specific drills/skills phases based on competence, confidence and volume.



A Simple Guide To ACL Rehabilitation

ACL injuries are often feared by many athletes given the long-term rehabilitation that is required to recover fully.

However, the principal message is always that ACL rehabilitation is a step-by-step process that gives the athlete an opportunity to condition themselves back to a pre-injury level of performance or even better!

A comprehensive ACL rehabilitation programme should be designed to address strength, stability, mobility and functional movement.

It should also consist of different phases that focus on criteria-based progression as opposed to time-based progression.

This post will take you through an ideal rehab programme for athletes who have been injured during their sport as well as some example exercises that can be used along with the stages of your programme.

Basketball Player With ACL Injury

The Prehabilitation Phase

Ideally, rehab should begin prior to surgery and is also known as prehabilitation. This phase allows the initial swelling from the knee to go down and settle and for the injured patient to regain as much strength and function as possible prior to surgery.

This can be achieved through regular icing of the knee, and low-impact exercises such as cycling and strengthening exercises.

It’s important to note that during this phase it’s important to avoid aggressive direction changes and high-impact activities such as running and jumping as this could aggravate the injury.

Athletes should also be provided with education regarding the surgery, expected recovery times, and the importance of compliance with the ACL rehabilitation program.

Following surgery, the emphasis of early rehabilitation is focused on restoring the normal range of motion in the knee, particularly a full extension of the knee. Emphasis should also be put on reducing pain and swelling while minimising any muscle wasting that could have happened post-surgery.

Phase Two

Once the range of motion in the knee has been restored phase two can commence.

This typically involves progressive strength training initially implementing light load or body weight exercises which can be progressed as tolerated. Cycling and easy plyometric exercises can often be re-introduced around the 4-6 week mark.

The main goals of this phase are to regain the majority of leg muscle strength, balance and function. An ACL rehabilitation programme during this phase should be performed three to four times per week.

Here are some examples of exercises to do in this phase:

Phase Three

Phase three of an ACL rehabilitation programme should focus on increasing strength and volume by progressing exercises’ intensity, resistance and complexity to challenge the muscles and enhance functional movements.

This phase usually allows for the reintroduction of field-based straight-line running into the programme. However, athletes must meet certain single-leg and plyometric criteria prior to this.

Change of direction, agility and plyometric exercises may be further progressed as the athlete tolerates following a successful introduction of straight-line running.

Here are some examples of mid-stage ACL exercises to try:

Phase Four

The fourth phase of an ACL rehabilitation programme shifts to a power focus to include exercises such as box jumps, plyometric lunge jumps, countermovement jumps and bounds. Strength and field-based training should be continued throughout this phase and the exercises should be sports-specific to prepare the athlete for their return to play.

Athletes generally return to sport around 6-9 months into their recovery, however, timelines may vary between individuals. Prior to returning to play, athletes must pass a number of hopping, strength and agility tests to ensure they’re ready to return to full play. The athlete’s psychological readiness to return to play should also be considered an important factor to return to play.

Preventing Re-Injury

The final step in an ACL rehabilitation programme should be to prevent another ACL injury. It’s important for an athlete to incorporate injury-prevention exercises into their normal routine. The injury prevention exercises should consist of double and single leg strength and plyometric movements.

Are You Having Trouble With An ACL Injury?

Have you recently experienced an ACL injury during sport and you’re unsure how you can progress? Or are you in recovery and are having no success improving your performance and getting back to your best to get back into your sport?

Here at Pain and Performance Clinic, we’re passionate about getting you back to doing the activities you love without injuries getting in the way and stopping you from making the progress you strive for.

Right now, we’re offering you the chance to book a free knee pain telephone consultation where you can speak to one of our expert physiotherapists about your pain problems, ask your important questions and get clarity from the answers!

If you’ve had enough of knee pain ruining your favourite sports and activities arrange a free knee pain telephone consultation by calling our Lucan clinic at 086 787 6358.

Other Free Resources For Knee Pain

Read Our Blog – You’ve Injured Your ACL – Now What?

Read Our Blog – Patellofemoral Pain Syndrome

On Social Media? Follow Us On – Facebook, Instagram, YouTube 

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