Avoid HARM for acute injuries (TOP TIPS)

Avoid HARM for acute injuries

After injuring yourself it can be difficult to know what to do. Do you use, ice or heat? Rest or movement? Elevation or massage? The asnwers to these questions are found in the type of injury that you have sustained.


Acute Injuries

An acute injury is an injury with a sudden onset, usually as a result of some sort of impact or trauma, such as a fall, sprain or collision. Acute injuries are sudden and sharp, occur immediately (or within hours) and cause pain (possibly severe pain). With this form of injury, two acronyms are extremely valuable to remember: RICE and HARM.


The RICE acronym is one that should be followed as the four factors help to reduce swelling and inflammation that is likely to occur within the first stages of healing for an acute injury. RICE stands for:

  • Rest
  • Ice
  • Compression
  • Elevation


In contrast, the HARM acronym provides four factors that should be avoided with acute injuries, and stands for:

  • Heat
  • Alcohol
  • Running
  • Massage

HARM is extremely important to remember within the initial 48 hours following an acute injury because both heat and alcohol cause the blood vessels to dilate (open up) – this increases the bleeding in the injured area. Exercising the body part or massaging the area also has the same impact and can be detrimental to the healing process.

Chronic Injuries

Differing to acute injuries, chronic injuries can be subtle and may emerge slowly, with no known factor that triggered it. Chronic injuries may come and go, and may cause dull pain or soreness. Long standing low back pain is a classic example of a chronic injury, and often results from overuse and repetitive movements. However, if an acute injury is not effectively treated, it may lead to a chronic problem.

Heat therapy

Heat therapy is frequently used for chronic injuries or injuries that have no inflammation or swelling – such as nagging muscle or joint pain. Using a heat pad, or getting into a warm bath can help to increase the elasticity of joint connective tissues and stimulate blood flow, which can consequently aid pain relief. Whilst this is often a temporary solution, it can provide relief nonetheless.

Prodced by JB Physio and re-produced with permissions via twitter

Cycling Technique and Muscles

Cycling Technique & Muscle Activation:

Thanks all for taking the time to read my blog about cycling. I’m only a physiotherapist and by no means a coach or bike fitter so these are just my observations and understanding from reading around the topic.


Cycling Muscle Co-ordination

The diagram to the left demonstrates the muscular sequence of events in the correct cycling pedal turn.

Right at the top phase of the pedal strike the power should come straight on via the glutes, the muscles of the bottom, and power down to a point where the large quadriceps muscles share the power and gradually become the dominant mover in the sequence.

During the lower section of this movement the calf muscles join the quadriceps to push the pedal through the lowest section of the pedal turn. It is then the turn of the muscles of the shin to pull the toes back up to level the foot out and the hamstring muscles to bring in a powerful pull back up. The final stage of the movement is the muscles of the hip flexors pulling the knee back up to the start phase.

When a cyclist cycles with this sharing of power there is much greater ability to create higher wattage, power, on the bike by not having any dead spots of power during the cycle rotation. It also means that there is greater use of all muscles and no overuse of one muscle group which helps prevent injury and muscle overuse issues.

Common Faults and Corrections

The most common problems that we see with cyclists of all levels are:

  • Overuse of the quadriceps – most people who cycle tend to rely too much on the big muscles of the quadriceps and this can result in reduced power due to inhibition
  • Lack of power on the lift phase – The current advice from British Cycling is that amateurs need to not be concerned regarding the upstroke of pedalling. The risk is an increased overload of the hip flexors. Training the hamstrings and the hip flexors to be able to perform this task is essential if you are to maximise all phases of movement. So an incremental increase in focusing on the pulling on the up stroke should be gradually introduced. However, this comes with a warning: DO NOT TAKE PRESSURE OFF THE OPPOSITE DOWN STROKE. Its easy when learning to ride smoothly to focus on too many things. The skill in using clip in pedals & shoes is timing, up stroke pulling whilst maintaining downward pressure on the opposite down stroke.
  • Tight muscles across hips and hip flexor strain– Its easy, in the beginning to overload the hip flexors due to the flexed nature of cycling. Like all sports, exposure should be gradual and incremental over a number of weeks. The hip is key in cycling and needs to work in an optimal range. The muscles around the hip, as we can see on the diagram above, are important for generating power (hip extensors) but also for moving the foot into the power phase (hip flexor). It’s important not to overwork the hip flexors and not to have too much hip flexion resulting in the anterior hip compression. If the hip has a lack of ability to efficiently bring the knee to the top phase of movement the body usually compensates through the upper body, resulting in swaying at the lumbar spine. This is commonly seen when you watch a cyclist from behind and see their back swaying from side to side with every pedal lift. This happens as the body makes room for the knee to be lifted through and puts a great deal of stress on the spine and the muscles of the lower back. Good range of movement and wiggins_2270877bstrength through the hips allows for good knee lift through the top end of pedal phase and power to go straight on, with the body holding tight and allowing maximum power transfer through the pedals. Lack of adequate range here also tends to result in repeated lower back tightness and pain.
  • Toes pointing down or toes pointing up? The current trend is neither, British cycling advocates a neutral foot position so that the power of the calf complex can be optimised.  If you watch cyclists you will see a vast number who cycle with the toes lower than the heels at all phases of movement. This style of rising will often be partnered with the body being positioned too far forward so that the knee can get over the pedal. This toe pointing style of riding makes it very difficult to use the glutes effectively in the first phase of movement and also makes it much harder to bring the knee back over the top phase of movement at the end of the pedal movement and be ready for starting the next phase. Equally, toes pointing up can result in a loss of power generation from the large calf complex which is particularly utilised in the down phase of the pedal stroke. Ultimately you should find your own style, don’t copy others, find what’s comfortable for you & riding styles can depend on your sport: For example, a triathlete might not be encouraged to ride with toes up because they might utilise their calf complex which in turn might inhibit the initial stages of their running. Yet on the other hand, should a world champion triathlete ask if they should change they’re cycling foot position, probably not: ‘if it ain’t broke, don’t try to fix it’
  • Knee alignment over toes. During all phases of cycle movement, when you watch from the front, the knee alignment should be almost directly above the line of the toes at all times. This is particularly important at the top and power phase of movement. This alignment during power phase allows all power that the cyclist generates to be transferred down through the leg and into the pedal. If this alignment is out the power will not be directed down into the pedal, therefore losing power. The added lateral movement through the body will add strain into the joints of the knee, ankles and pressure across the foot.


Thank you for reading and I hope this has given you some insight into cycling technique and mechanics of muscle use when partaking in all levels of the sport.


Always remember to enjoy cycling and Lycra is cool, whatever anyone else says. We offer physiotherapy, pilates, & sports massage in Crouch End & Finsbury Park. Please book online here



Team TAP


London to Paris – How To Survive


In May 2013 a friend emailed a small group of us and outlined his plans to cycle from London to Paris, with or without us. In the spirit of naivety four of us agreed to do it, and so the date was set for October 2013.

One would think this is plenty of time to prepare for such an event, and it is, as long as you do the preparation and don’t leave it to the last minute. The journey was planned and mapped out according to Donald Hirsch’s back road route via Newhaven and Dieppe (the route maps are available to print here).

The team consisted of four riderswiggins_2270877b; Oli, Alex, Hamish and myself. It was a simple plan – as are most things in theory – start on Thursday evening and finish on Sunday morning, a grand total of 220 miles. We even allocated roles within the team; Oli was to be the mechanic, Hamish was on map reading duties, Alex was our GPS reader and guide whilst I was to take on medical duties.

In preparation for the event we each undertook individual training regimes, but we all did one long ride (100 miles) together to gauge each other’s riding abilities and work on communication. On this ride it became apparent that we had different levels of fitness within the team, which meant we had to adopt our daily mileage to Paris according to the ‘weakest’ rider.

This is important in order to avoid over exhaustion early in the journey, and for everyone to be able to keep the pace for the duration of the 220 miles. The main training involved in preparing for the event was time spent on the bike getting plenty of miles under our belts. It sounds so obvious to say it, but if you want to be a good rider, you have to put in the mileage.

The other piece of advice I’d give relates to consecutive days of riding. Its vital that your body adapts to being in the saddle for consecutive days and pedalling the bike for consecutive days, in our case four days.

The Hirsch London-to-Paris route is a peaceful and enjoyable route which, once in Dieppe, consists mainly of riding Route Verte (disused railway), but it still takes three days to do it. We split the days into the following mileage:

– Thursday: London to Haywoods Heath (60 miles)

– Friday: Haywoods Heath to Newhaven (20 miles)

– Friday: Dieppe to Forges les Eaux (34 miles)

– Saturday: Forge les Eaux to Forete de St Germain (72 miles)

– Sunday: Forete de St Germain to Paris (35 miles)

The key to our journey being a success, in my opinion, was down to a few factors. First was using both the map and GPS tracker set up to navigate our way. Second was preparing our bikes to do touring distances; changing tyres, adding mud guards and adding saddle bags. Most of all we made the trip fun, because when you are covering those sorts of distances you have got to enjoy it, otherwise it soon becomes a chore and you start to resent doing it.



Having the right equipment meant we were able to limit tyre changes (not fun) and took time to enjoy long lunches, as well as coffee breaks, ensuring moral was maintained throughout. Overall, the experience of riding a bike from London to Paris was amazing, and without doubt one of the best experiences I have had in life. I strongly recommend it to others, but remember; plan for it, prepare for it, do it and enjoy it.

Tom graduated from UWIC with a degree in science, health, exercise and sport, and then specialised in Physiotherapy and graduated Coventry University in 2008. He has worked in musculoskeletal clinics and community based falls prevention rehabilitation, both for the NHS, and is currently clinical director at TA Physiotherapy. Outside of work, he enjoys staying fit and healthy by attending the gym, completing triathlons and road cycling.

Commonwealth Games 2014

So Amongst all the sporting events taking place this summer…..Glasgow is hosting the Commonwealth Games at the end of this month.

The commonwealth games will see all the top athletes from the commonwealth nations compete for medals.

From the precision of Lawn Bowls to the combat of Wrestling and Judo, the high adrenaline of track events, and the grace and beauty of Gymnastics – find out more about the 17 sports and the medals that will be fiercely competed for at the Glasgow 2014 Commonwealth Games.

I’m excited and immensely proud to be providing physiotherapy at the commonwealth poly clinic within the athletes village.

Watch this space for a Commonwealth Games Diary including top results, shock results, rehab updates and training advice.


Thanks for reading and watch this space for updates

Top 5 Cycling Injuries

Top 5 Cycling Injuries

The increased popularity with cycling both road and mountain bikes has seen an increased rise in cycling related injuries. Competitive cycling involves high speeds created by large gradient downhill sections and this can lead to falls. The higher the speed the greater the forces sent through the body and generally the more serious the injury, hence the essential helmet.

The TA Physio Top 5 Cycling Injuries:

1) Lower Back Pain

2) ITB Syndrome

3) AC Joint Sprain

4) Cuts & Grazes

5) Feet Numbness

What is it?

The repeated and prolonged held position in cycling means stress goes through the whole of the spine. The flexed position required to maintain good aerodynamic performance and generate force to pedal leads to lower back pain. In some cases this can lead to herniated lumbar discs and nerve root impinging, but this is rare.


Prevention is better than cure. Back pain can be avoided by simply having your bike set up correctly to avoid over reaching in the case of a frame being too large and hunched posture in the case of the frame being too small. Check out the frame size calculator. It is also essential to warm up, head to toe, cycling mainly involves the lower limbs but the spine is involved. Don’t neglect it!

2) ITB Syndrome

What is it?

The ITB (Ilio Tibial Band) is highly talked about in rehabilitation and physiotherapy, it’s seen as a problem in many knee injuries and is commonly affected amongst cyclists due to the repeated bending and straightening of the knee. It runs from your hip to the outside of your knee, so The repetitive motion of cycling, or running, can lead to ITB becoming irritated as it moves over the outside of the knee.


The prevention if ITB Syndrome is down to bike set up. Saddle height dictates knee position, if it’s too high then the knee over straightens, if it’s too low then the knee over bends. Ideally, the frame should have 1-2″ clearance from crotch to the top tub of the frame. The saddle height should be set to allow a small knee bend when the pedal reaches the bottom of the revolution. Also, Its advisable to avoid in toeing when cycling, this increases the stress through the ITB. The ITB can be offloaded and supported through the cycling motion with some SportTape Kineisiology tape.

Sport Tape UK ITB Taping
Sport Tape UK ITB Taping

3) AC Joint Sprain

What is it?

The Acromio Clavicular Joint (AC Joint) is one part to the should complex and consists of the collar bone joining to the front of the shoulder blade which is held together by strong ligaments.

The AC Joint Sprain refers to the damage to these stabilising ligaments. It takes a large force to cause these sprains like a fall or hitting a monster drop such as a pot hole or off road obstacle.

The position of holding the handle bars to control your bike means the elbows and wrists are generally locked in position. When a large force is applied, these forces are shifted to the shoulder joint.

Check the drop sign for AC Joint Sprains
Check the drop sign for AC Joint Sprains


The simple answer is to avoid falling. The AC Joint is vulnerable to injury during falls and large front wheel forces created by those lovely potholes. Try to use the elbows as a shock absorber if you can’t avoid those huge public road pot holes. AC Joint sprains occur at different degrees, and the severity of the injury dictates what can be done to rehab it.

4) Cuts, Grazes & Burns

What are they?

The cuts and grazes generally occur from falls to the ground, but most cyclists in competitive sport suffer friction pains at some point in their careers.

Saddle Position is Key, especially if its a 100mile sportive
Saddle Position is Key, especially if its a 100mile sportive

The commonest location for friction to occur is where the rider meets the bike, the saddle. Saddle sores are common amongst amateurs but miraculously professions and regular cyclist develop an iron like resilience to this issue.


The cuts and grazes can be avoided by concentrating on your ride and staying on your bike, there is no room for daydreaming in competitive riding.

The saddle sores can be aided by a comfortable saddle, correct saddle angulation, sufficient cycle short padding. The more you ride, the easier it gets, so ride regularly to get used to it. It may be possible settle this post ride by sitting on an ice pack for 10 minutes but this may raise some eyebrows in the post ride pub.

5) Foot Numbness

What is it?

Foot numbness is a loss of feeling in the feet, it is common amongst cyclists and it’s not solely down to the cold weather we suffering the UK. It can occur due to an ill-fitting cycling shoe squeezes the metatarsal heads, cleats being placed too far forward causing increased pressure around the ball of the foot, cycling technique including low cadence and excessive hill riding can lead to numbness.


Prevention of foot numbness can be achieved through correctly fitting shoes. Position of the cleats is important, ensuring that pressure is not focused on the ball of the foot. Hill climbing is important in cycling events but hill training should be tapered, so reducing hill climbing may help the problem. Hill climbing involves excessive push phases of cycling which means increased foot pressure, hence numbness.

Thank you for reading TA
Physio’s Top 5 Cycling Injuries.

Please contact us should you have any questions about your cycling injury.



Aerodynamics of Cycling

So the Tour de France is climaxing and Bradley Wiggins is holding on to the yellow jersey. Top cyclists analyse biomechanics & aerodynamics microscopically looking tweek their body position. Ever wondered how to reduce drag & improve aerodynamics in cycling? Well look no further.

Getting the correct body position can lead to reduced drag. Most cyclists think  by dropping down onto their handle bars, they go faster. But the reality is that most cyclists, unless well versed, can’t hold the position for long enough.

The fact is, it’s a good idea to get acquainted with the drops. A lower body position reduces the amount of drag you must overcome, so you save more energy—and can ride faster and longer.

Get your bike fitted:

To ride effectively in the drops you need to roll your hips forward, keeping the hip angle (between torso and thigh) open. If you’re getting into the drops only by bending at the waist or arching your back, your hip angle is closing, which means you’ll produce less power. Talk to a certified fitter at a bike shop—a saddle adjustment or swap could help.

Practice in Position:

To develop more power in the drops, twice a week, do three or four 6- to 8-minute intervals with your hands in the drops on an uphill grade of 1 to 3 percent. Start at a moderate intensity (perceived exertion level of 6 on a 1 to 10 scale); after two or three weeks, progress to an effort at or just slightly below lactate threshold (7 or 8). Or, use the drops whenever you do intervals on an indoor trainer, especially if you’re prepping for a race.

Encourage Flexibility:

If bike fit isn’t the problem, the culprit is likely your range of motion. Reaching the drops simply by straightening your arms may make you less aerodynamic. To cut drag, you need to lower your head and shoulders, which requires greater hip and lower-back flexibility. The exercises below will help you loosen up.

Stretch Out:

Lie on your back. Bend your left knee and place your left ankle just above your right knee. Slowly raise your right knee to bring your left ankle toward your torso, keeping your left knee even with your left ankle, so that you feel a stretch in your left glute. Hold for 10 seconds, three times on each leg.
  Step forward into a lunge position and drop your back knee to the floor. Then reach toward the ceiling as you push forward with your hips. You’ll feel the stretch through your torso, the front of your hip, and your quad. Hold for 10 seconds, three times on each leg.