Many people we see have very busy, sometimes physically demanding, jobs which by the end of the day may feel like a day’s worth of exercise. Working 7-12 hours physically and mentally drained by the end, must be exercise, right?
Surprisingly, this isn’t the same as exercising and potentially have the opposite effects to our health and well-being.
It was found that cleaners that had relatively high occupational physical activity (OPA) were more at risk of cardiovascular diseases (CVD) and had a higher resting heart rate and blood pressure than those with lower OPA(2).
Why isn’t my job exercise?
Exercise, defined by the World Health Organisation, is a subcategory of physical activity that is planned, structured, repetitive, and purposeful(4). It also aims to maintain or improve our cardiac output (how much of our blood our heart pumps out in one minute).
Here are 6 potential reasons why activity from your job is not the same as exercise or leisure time activity(1):
1. Too low over too long – Job related activity is too low intensity over too long a duration to provide any benefit to your fitness or health, not putting enough demand on the heart.
2. Raises HR It raises your resting heart rate during and even after you finish work. This is a risk factor for CVD and mortality.
3. Raises BP – Prolonged static postures or heavy lifting raises your 24-hour blood pressure which is also a risk factor for CVDs. Whereas, heavy lifting over short, controlled conditions does not raise 24-hour BP.
4. Lack of Rest – There’s not enough recovery during or between activity within the occupation. This is similar to over-training, where consistent fatigue and exhaustion over consecutive days may increase risk to health problems.
5. Lack of control – Over factors such as: tasks, speed, schedule, hydration and access to rest which may contribute to the harmful effects of OPA. In contrast LTPA is performed under self-regulated conditions and the person has control over these factors.
6. Raises levels of inflammation – These inflammation markers will stay raised until the body has recovered. High OPA over consecutive days can cause prolonged and continual inflammation which increases risk of CVD and all cause mortality.
Physically demanding jobs can put too much on the body which results in the opposite effects of exercise(2). There are of course many varied risk factors for health problems and heart disease, but just because you’re busy doesn’t mean you’re exercising with any positive benefits.
What can I do?
It is important to be active outside of your job to have positive effects to your health.
The world health organisation recommends moderate intensity for 150mins/week or 75mins/week of vigorous intensity aerobic activity or any combination to maintain and improve heart health.
The World Health Organisation – What is Moderate vs Vigorous?
If you have a busy manual job, you are still able to gain the positive benefits from doing vigorous exercise in only one or two days a week if this is all you can manage in your schedule(3).
The idea is to improve your fitness and strength to cope with the stresses of your job and keep you happy and healthy.
Thanks for Reading.
Aran qualified as a Physiotherapist graduating from the University of Worcester in 2017. He has since been working within the NHS, rotating into different specialities such as the Emergency Department, Critical Care, Orthopaedics and MSK. He has worked with people of all ages and different levels of health and fitness, encouraging exercise as an essential part of health and wellbeing and providing the best care for his patients.
Aran has a keen interest in soft tissue mobilisation and movement re-education as part of the rehabilitation process. He has an interest in sports injuries and has experience treating players and working with the strength and conditioning coaches under the physio in Worcester County Cricket Club.
Holtermann A, Krause N, van der Beek AJ, et al. The physical activity paradox: six reasons why occupational physical activity (OPA) does not confer the cardiovascular health benefits that leisure time physical activity does. British Journal of Sports Medicine 2018;52:149-150.
Korshøj, M., Lidegaard, M., Krustrup, P., Jørgensen, M. B., Søgaard, K., & Holtermann, A. (2016). Long Term Effects on Risk Factors for Cardiovascular Disease after 12-Months of Aerobic Exercise Intervention – A Worksite RCT among Cleaners. PloS one, 11(8), e0158547. doi:10.1371/journal.pone.0158547.
O’Donovan G, Lee IM, Hamer M, et al. Association of “Weekend Warrior” and Other Leisure Time Physical Activity Patterns With Risks for All-Cause, Cardiovascular Disease, and Cancer Mortality. JAMA Intern Med 2017;177:335–42.
We’re always keen to provide runners with the best opportunity to understand more about running and specifically how runners run. We love using technology and combined with assessment this works well for helping runners to get over injury and improve performance. As a team of techno geeks, imagine our delight when we got our hands on DorsaVi. A wearable device that runners or teams can use to monitor kinetic running data & kinematic knee data to understand the loads and biomechanics of the athlete.
Wearable devices have been used for several years in sport specifically HR monitors & GPS trackers used to monitor load, distance and intensity of players, both in training and competition situations. Even though new evidence is being published to help us understand that training loads are one factor linked to injury, this study from expert Gabbett is particularly comprehensive [Gabbett. 2007].
It’s become more complex to measure biomechanics in the field of play because we need 3D motion capture to fully assess motion in team sports, which is unpredictable in many team sports [Willy, 2017]. The assessment of biomechanics in runners within any sporting environment is extremely difficult, hence the advent of such technologies that help assess movement naturally are welcomed by us.
What we we look for?
Ground Reaction Force [GRF] – The force created by contact with the ground is referred to as the ground reaction force (GRF). This is the force the ground exerts on the body as we move. According to Newton, for every action there is an equal and opposite reaction [Newton’s 3rd Law of Motion – Law of Reaction]. As we make contact with the ground, gravity is constantly impacting the body [Young-Hoo Kwon, 1998: http://www.kwon3d.com/theory/grf/grf.html].
Initial Peak Acceleration [IPA] – Correlates the vertical acceleration and loading rate through the tibia on ground contact, measured in G’s. The IPA being increased has been linked to higher rates of stress fractures [Crowell, 2011] and changes can be noted with alterations in cadence [Rios et al, 2010]. This graph illustrates these measurements nicely [DorsaVi ViMove2, Running Module Guide].
Cadence calculates steps per minute, two steps make up one stride. Recent research indicates shortening stride length and increases in cadence can help to reduce running injuries [https://www.runresearchjunkie.com/is-the-180-cadence-a-myth-or-something-to-aim-for/].
Absolute Symmetry Index [ASI] – is the calculation of average GRF Left vs Right. An example in DorsaVi would be a negative value indicates the right side is carrying more force compared to left. A positive values shows left side is accepting more force than the right side. A normal deviation in ASI is 5% so we would want to reduce this whilst running [Herzog et al, 1989].
Speed – Looks at average speed over the course of the running time measured, usually measured in metres per second [m/s].
Everybody runs differently and this is dependent on multiple factors including:
1. Activity participation [distance runners, sprinters, team sports]
4. Position within a team or squad [defender Vs attacker]
5. Level of activity participation [elite Vs recreational]
What happens when these factors change?
Sports physio Paddy volunteered to test out the DorsaVi. We looked at his existing running style and implemented changes in order to measure the differences in kinetics data.
Within 15 minutes, we were able to assess Paddy clinically and on the treadmill. We looked at Paddy running at 9km/hr, 12km/hr & 16 km/hr. At each assessment, Paddy changed something in his gait to see what changes we noted in his kinetic data. The difficult question is, does kinetic data correlate to kinematics?
As the overview graph illustrates, Paddy completed 3 runs at 9 km/hr but what we can’t see from the graph is what kinematics changed.
Rep 1 at 9 km/hr Paddy was running his normal gait pattern with no problems reported.
Rep 2 at 9 km/hr Paddy changed his foot strike pattern which resulted in a reduction in cadence
Rep 3 at 9 km/hr paddy attempted to shorten stride length and increase cadence
Rep 4 at 12 km/hr increased speed which initially he achieved by increasing his cadence
Rep 5 at 12 km/hr Paddy maintained his speed and his cadence settled to 173.
Rep 6 at 16 km/hr we noted a huge ASI change which correlates to a previous lower limb injury Paddy has suffered on his right side. Increased IPA & GRF despite GCT becoming more symmetrical compared to previous speeds.
Overall, the DorsaVi running module kit is a game changer for us. It is portable and ease of use on the iPad. I would recommend it as suitable for all types, levels and style of runners. We only explored the running module in this article but the knee and lumbar spine assessment modules are great additions to any clinical assessment. The smart therapist would with clinical information, training information along with goal setting to get results with patients and athletes. The versatility of DorsaVi means its suitable for everyone not just sports people.
I’m yet to see any normal data ranges for athletes with GRF, IPA and GCT but differences in assessment and correlation can lead us to make assumptions – if the data supports the hypothesis of injury, then it can be used to change running gait, ultimately reduce pain and improve performance.
However, one question remains in my mind which I’ve not seen in research yet – Does kinetic data correlate to kinematics?
Thanks for reading.
Gabbett & Domrow. (2007). Relationships between training load, injury, and fitness in sub-elite collision sport athletes. Journal of sports sciences. 25. 1507-19. 10.1080/02640410701215066.
Young-Hoo Kwon. (1998). Webite: http://www.kwon3d.com/theory/grf/grf.html. Accessed December 2017
Harrison Philip Crowell and Irene S. Davis. (2011). Gait Retraining to Reduce Lower Extremity Loading in Runners. Clin Biomech (Bristol, Avon). 2011 Jan; 26(1): 78–83.
Jaqueline Lourdes Rios, Mário Cesar de Andrade, Aluisio Otavio Vargas Avila. Analysis of Peak Tibial Acceleration During Gait in Different Cadences. Human Movement 2, December 1, 2010.
Herzog, Nigg, Read, Olson . (1989). Asymmetries in group reaction force patterns in normal human gait. Med Sci Sports Exerc; 21: 110–114
Baggaley, Willy, Meardon. (2017). Primary and secondary effects of real‐time feedback to reduce vertical loading rate during running. Scandinavian journal of medicine & science in sports 27 (5), 501-507
Best selling author Don Miguel Ruiz in his book The Four Agreements reveals what he believes to be the primary sources of self-limiting beliefs. The first and most important of these principles is to be impeccable with your word.
It sounds easy enough, as a professional we are under the agreement to ‘do no harm’. As a colleague, friend, family member or acquaintance we aim to be courteous, thoughtful, and kind. The problem is not so much our intention but our awareness of the words that we use to convey meaning. Some of which may, without our knowing, pass through the filter and hold more weight than what we give them merit.
…Because the fact is, words do ‘hurt’ and not just emotionally.
There have been a number of studies detailing placebo and nocebo patient responses to explanations regarding interventions by a professional within their field of expertise. An example of this is a study by Varelmann et, al. (2010), where one hundred and forty healthy women at term gestation requesting analgesia were randomized to either a placebo (“We are going to give you a local anesthetic that will numb the area and you will be comfortable during the procedure”) or nocebo group (“You are going to feel a big bee sting; this is the worst part of the procedure”). Pain was assessed immediately after the local anaesthetic skin injection using visual analog scale scores of 0 to 10. Median pain scores were significantly lower when reassuring words were used compared with the more intense nocebo words. This study and many others are beginning to show a pattern suggesting that more reassuring words may improve the subjective experience.
Lorimer Moseley has stated that:
‘100% of the time, pain is a construct of the brain’.
Now this is not to say we lie to our patients. We also have an ethical obligation to be truthful and transparent when gaining consent, giving a diagnosis, a prognosis or offering advice. However it is important to recognise that therapists are in a powerful position in their ability to influence a patient’s perception regarding pain and recovery. It is our responsibility to have an awareness of words that we use and whether or not they have a connection to negative suggestions and connotations, as this may feed into a fear generated belief system and adversely affect recovery.
“The human mind is a fertile ground where seeds are continually being planted, the seeds are opinions, ideas and concepts. You plant a seed, a thought, and it grows. The word is like a seed and the human mind is so fertile. The only problem is that too often it is too fertile for the seeds of fear” (Ruiz, 1997).
If a patient comes to you with concerns about an injury, anxieties about returning to sport or a fear of whether their pain will ever resolve it is important for us to recognize the power of the words we use and the long-term impact they may have on a persons wellbeing.
…We do not want to be unconsciously watering the seeds of doubt, fear or despair.
It sounds relatively simple to strip down and remove some of these negative connotations. However, some of these words are more subtle than we realise. They are words we use often without acknowledgement. For example;
Words such as ‘try’ suggest anticipated failure.
A statement like ‘don’t worry’ is associated with there being something to worry about (Allen, et al, 2011).
Terms such as ‘chronic’, ‘disc’ ‘damage’ or ‘osteoarthritis’ may be enough to set off a flag for danger and generate a fear or anxiety driven response.
So where to from here?
I invite you to be impeccable with your word.
Below is a list of resources to assist in better understanding this concept, strategies for intervention and some great tools that can be shared with patients. Knowledge is power.
Ruiz, D.M & Mills, J. (1997). The Four Agreements: A Practical Guide to
Personal Freedom (A Toltec Wisdom Book). California, USA: Amber-
Varelmann, D, Pancaro, C, Cappiello, Eric C & Camann, W. R. (2010)
Nocebo-Induced Hyperalgesia During Local Anesthetic Injection
Anesthesia & Analgesia:
March 2010, Volume 110, Issue 3, pp 868-870.
Retrieved from http://journals.lww.com/anesthesia- analgesia/Fulltext/2010/03000/Nocebo_Induced_Hyperalgesia_During_Local.42.aspx
Becs Van de Scheur – Physiotherapist & Pilates Trained [Mat Work Level I]
From the East Coast of Australia, Bec graduated with a Degree in Human Movement Science before going on to complete her studies as a Physiotherapist in which she graduated in 2012 from the University of Newcastle, Australia.
With a background in private practice and aged care Bec enjoys working with individuals of all ages and all sporting backgrounds placing a large emphasis on education, with an aim to empower individuals by providing them with the skills they require to take ownership over their own health.
With a keen interest in holistic management and pain science Bec believes in offering a combination of hands on therapy and individualised exercise prescription. Bec has completed her Level 1 Mat work pilates training and also offers Dry needling and Western acupuncture techniques when indicated.
Marathon season has begun and this weekend it’s the iconic London Marathon. Well done to everyone who is competing on getting this far, and the very best of luck – particularly if you’re planning to attempt it dressed in a hot, heavy and generally unsuitable fancy dress costume!
Leading expert Roger Kerry, of the Division of Physiotherapy and Rehabilitation Sciences in the School of Health Sciences, believes from a physiotherapist’s view that running the marathon will be about three things: performing well; not getting injured; and most of all – having fun! Here are his top 10 tips for getting the most out of your London Marathon experience…
Prepare – It’s too late now to think about more training, but you should prepare properly for the day in all other respects. Make sure you have checked all your kit at least the day before, and that all your food and drinks are organised in good time – there’ll be no time to dash to Runners Need on Sunday morning.
Taper – The evidence behind tapering (progressively lowering your mileage leading up to the event) is a bit hit-and-miss. However, for a long race, basic principles of exercise suggest that it is not a great idea to be cramming in long or hard sessions the week before the race. Start to relax and do just what you need to keep you motivated and active, but not much more. At this stage, noting will change your fitness in time for Sunday.
Eat – You need the right type and right amount of fuel for Sunday. Start to think about that now, but don’t do anything that your body isn’t used to. Avoid strategies with inconsistent evidence, like dramatic ‘carbo-loading’. Make sure you have wholesome, simple complex-carbohydrates the night before – plenty of brown rice or pasta, supplemented with dried fruit etc. Before an intense, prolonged effort, progress towards at least 10g of carbohydrate per kilogram of bodyweight in the days leading up to Sunday.
Drink – Again, the golden rule: don’t do anything your body isn’t used to. You obviously need to be well hydrated before, during, and after the race. However, over-hydration can be just as (if not more) problematic that dehydration, so you don’t need to guzzle 3 pints of water every few hundred yards. Aim for no more than 0.8 litres of fluid/hour. You will need carbs to keep you going as well, so if you’re used to a specific sports drink or gel, than use that, but don’t start experimenting during the race though!
Shoes – Don’t run in new shoes! Make sure your socks are fitted well, with no small creases or seams. A tiny crease at the start will seem like a boulder at 10 miles, and increase your chance of blistering. Make sure your heel is captured well, but remember that in a long run your forefoot will expand, so avoid ultra-tight lacing in your lower laces. Use thick, or double-layer socks, or Vaseline, to reduce chance of blistering. Use plasters is you’re used to them – again, nothing new please!
Warm-up – OK, so in 26 miles there’s plenty of time to warm-up, however, it is still absolutely sensible to make sure your muscles are ready for action and your vital organs are ready to be stressed. Do some gentle, progressive running or drills to get ready and try and keep moving on the start-line. The evidence for stretching (especially static stretching) or massage suggest that these don’t help in either performance of injury prevention, so you’re better off spending your time moving and preparing your tissues for load.
Pace yourself – The crowd will most likely prevent you from sprinting off, but aim for negative splits, i.e. the first half of the race being slower paced than the last half. Use your GPS if you need to, but better still, listen to your body. Have confidence in all that fantastic training you have done, and know that you can achieve your marathon aim if you don’t stray too far from what your body is used to.
Keep control – In line with the point above, consider strategies to put in place when you start to fade. Going through rough patches is normal, even if your fitness and fuel control is in order. It’s what you do during these patches that’s important. Try not to get worried about a drop in your pace. If you do, you will try and speed up at a time when your body and mind is asking you not to. Rather, try and focus on your form: work from top to bottom – recalibrate your head posture and your shoulder height, make sure your torso is not slumping and affecting your breathing, make sure your arm swing is even and synched with your leg movements, keep control around your pelvis, shorten your stride length and/or increase cadence, and think about your foot strike. You’ll soon be back in the zone!
Finish strong – Let the crowd motivate you during the last few miles, but don’t blow up before the finish line! You have put in months of training, and this is where it all comes together. Make sure you save something for that last kilometre. You might get a bit of euphoria with two or three miles to go, but avoid that last burst until the finish line is in sight.
Re-fuel, refresh, and reflect – You’ve done it! 26.2 miles in the bag, and an amazing experience. But it doesn’t stop here. How you feel for the next few days, and whether you remain motivated to ever do this again will depend on what to do in the few hours post-race. You will need to gradually take on some replenishing carbs and protein, and get your hydration status balanced, considering electrolyte also. Again, stretching or massage won’t necessarily help the recovery process, and may in fact contribute to a delayed recovery. A sensible reduction in tissue load, whilst maintain some movement is key for that next 72 hours. That means keep your legs moving, as long as they are comfortable. You can expect to introduce steady running again after a few days. No hard sessions for a good three weeks or so though. And finally, reflect on your experience to maximise your enjoyment as well as learn from it – for next time!
We have a physiotherapy service available for injury reviews, sports massage & running related advice at Tom Astley Physiotherapy. Sessions can be bookd online HERE.
As a physiotherapist, I regularly see patients who are unsure how and when to get back into exercise after giving birth, so I’ve written this article to help. As you’ll see, there are plenty of benefits of getting back into a safe workout routine. We’ll discuss what to do and how much, as well as looking at some of the complications that may occur and how to know if you’re overdoing it. I’ve also included some pilates-based exercises for you to try at home, based on your ability and desired challenge!
Benefits of exercise post partum
It’s great if you are motivated to get back to exercise after giving birth! It has many benefits, including:
Promoting weight loss;
Restoring muscle strength;
Raising energy levels;
Improving cardiovacular fitness;
Reducing risk of urinary incontinence;
Improving your mood;
And it gives you opportunity for increased social interaction.
However, after giving birth, the important questions are:
How much is safe?
And how soon should you return?
Everyone is different, so make sure you are following the individualised advice from your midwife. Your return to exercise will depend on several factors including:
The strength of your pelvic floor muscles;
The number of pregnancies you have had;
The type of delivery (recovery following a caesarian will always be longer than a natural birth so you will therefore take longer to return to exercise);
The level of exercise you were completing ante natally;
And whether you have any pelvic girdle pain (PGP) or diastasis recti (keep reading to find out more about these conditions).
If you had a normal birth, you should be able to start easing back into gentle exercise as soon as you feel ready. You should not start any high level or impact exercise until at least 6 weeks post partum, as long as your midwife clears you to do so at you 6-week check up (according to the NHS guidelines). However, 12-16 weeks post partum is probably a more realistic time frame because the weakness of your pelvic floor muscles following pregnancy will take time to retrain and strengthen. Doing too much exercise too soon can result in a prolapse which can be both uncomfortable and painful.
What is a prolapse?
A prolapse is when the organs in your pelvis drop down into the vagina, rather than being held in their normal position. This can result in a heaviness sensation, there may be bulging present, and it can result in pains or aching in the lower back and stomach.
Why do prolapses happen?
A number of factors associated with pregnancy can cause weakening of the pelvic floor muscles and surrounding ligaments. Your pelvic floor muscles are often left weak and stretched, and this will put you at increased risk of having a prolapse. This can happen for several reasons including:
The weight of the growing baby;
The pelvic floor muscles and ligaments may have been overstretched if you had a vaginal birth;
You may not have completed your pelvic floor muscle exercises as often as you recommended during your pregnancy;
Or you may have increased your exercise too quickly after childbirth (returning to high impact exercise too early will put you at particular risk).
PGP & Diastasis Recti
Along with risk of prolapse due to weakened pelvic floor muscles, pelvic girdle pain (PGP) and diastasis recti will also play a part in how quickly you can return to exercise.
Pelvic girdle pain includes pain in one, or several areas around the pelvis:
Pain over the pubic bone;
Pain in you perineum (area between your vagina and anus);
Pain across your lower back.
It is often aggravated by activities such as walking, going up stairs, standing on one leg, or turning over in bed.
Diastasis recti is separation of the 2 muscles that run down the middle of your stomach. You can check for diastasis recti yourself:
Lie on your back with your legs bent and your feet flat on the floor;
Raise your shoulder blades off the floor and look down towards you belly button;
Use the tips of your fingers to feel between the edges of the stomach mucles, where they should join in the middle, both above and below the belly button;
See how many fingers you can fit into the gap between your muscles;
If a gap of 2cm or more is present this is classed as diastasis recti. You should notice this gap gradually decreasing over the first 8 weeks after the birth of your child.
If you think you may have either of these conditions, it will contraindicate you from completing the intermediate or advanced exercises suggested in this article. It is advisable to see a physiotherapist or healthcare professional to help to improve or resolve these symptoms as soon as possible.
How do I know if I am overdoing it?
If you experience any of the following symptoms, you should reduce the level of exercise you are completing, or rest completely until they resolve:
Slow recovery from exercise;
Disproportionate muscle aches and pains for the level of exercise you have completed;
Increase in flow of lochia (vaginal discharge after giving birth containing blood, mucus, and uterine tissue);
Change of colour of lochia to pink or red;
Lochia restarts flowing after it has stopped.
Which types of exercise are safe to help you get back into sport post pregnancy?
Low impact exercises such as: swimming (once lochia has stopped); walking; yoga; and pilates are all great ways of easing you back into sport after pregnancy. Try the following exercises for an introduction to pilates!
Getting back into exercise: A pilates-based programme you can try at home!
All of the following exercises should be pain free to complete. If you experience any pain whilst completing them, or disproportionate aches or pains for the level of exercise you have completed following your pilates home session, stop and seek assessment and advice from a healthcare professional. Please closely follow the advice on exercise progression, and only progress to the next difficulty if you meet the criteria stated.
These exercises should be safe to be completed by any new mum:
Deep neck flexor exercise:
This will help improve your upper body posture and reduce neck pain
Lie on your back with your head supported by a pillow
Lengthen through the back of your neck, and push the back of your head down into the pillow (a bit like you are making a double chin)
Hold for 10 seconds, then relax
Repeat 10 times
Transversus abdominus & pelvic floor activation:
This is the action of drawing your belly button in towards your spine, and drawing up through your pelvic floor muscles as if you are stopping yourself from going to the toilet
This muscle activation exercise should be practiced in sitting, lying, standing, high kneeling, side lying & 4pt kneeling
Hold the muscle contraction for 10 seconds, then relax
Repeat 10 times
Lie on your back with your knees bent (crook lying)
Gently tilt your pelvis forwards and backwards
You should feel your lower back arching and flattening on and off the floor
Repeat this 10 times in each direction
If you have mastered the basic exercises, are not experiencing any pelvic girdle pain, and do not have diastasis recti, you should be safe to progress to completing these exercises:
Dumb waiter in standing:
Stand tall, with your pelvis in a neutral position, engage your deep stomach muscles and pelvic floor muscles, and have your arms by your sides with your elbows bent
Rotate your arms outwards, and stretch out to the side
Then bring your elbows back into your sides and rotate your arms inwards to return to the starting position
Repeat 10 times
Spinal twist in high kneeling:
Kneeling up, with your pelvis in a neutral position, engage your deep stomach muscles and pelvic floor muscles, squeeze your bottom muscles (glutes), and cross your arms in front of you
Keeping your pelvis pointing forwards, rotate through your middle back round to the left, then slowly back to the centre
Repeat to the right
Repeat 10 times in each direction
One leg stretch in 4 point kneeling:
On your hands and knees (knees under hips, & hands under shoulders), with your pelvis in a neutral position, engage your deep stomach muscles and pelvic floor muscles
Slowly slide one foot back behind you, trying to keep your back and pelvis still
Slowly slide your leg back in towards you, and repeat with the other leg
Repeat 10 times with each leg
Lie on your stomach with your hands by your sides, with your pelvis in a neutral position, engage your deep stomach muscles and pelvic floor muscles, and make sure you are aiming your tail bone down towards the opposite wall so your back isn’t arching
Squeeze your shoulder blades back and down, lift your hands an inch from the floor, stretch them down towards your feet, and lift your head and chest an inch off the floor
Repeat 10 times
One leg stretch:
Crook lying, with your pelvis in a neutral position, engage your deep stomach muscles and pelvic floor muscles
Slide one heel away from you, trying to keep your back and pelvis still
Slowly draw your heel back into towards you
Repeat on the other side – alternate legs
Repeat 10 times on each leg
Side lying, with your pelvis in a neutral position, engage your deep stomach muscles and pelvic floor muscles
Keeping your pelvis still and your ankles together, lift your top knee, then lower it slowly
Repeat 10 times
Turn over and complete on the other side
If you have mastered the basic & intermediate exercises, if you are not experiencing any pelvic girdle pain, and do not have diastasis recti, you should be safe to progress to completing these exercises:
Lunges with spinal twist:
Standing tall, with your pelvis in a neutral position, engage your deep stomach muscles and pelvic floor muscles
Step one foot forwards, and lunge down, making sure you are keeping up tall through your spine
Reach your arms out in front of you
Open one arm out to the side, then bring it back to the centre, then repeat on the other side
Step your front leg back, so you are back in the neutral standing position
Repeat with the other side – alternate legs
Repeat 10 times on each leg
Swimming (advanced level):
On your hands and knees (knees under hips, & hands under shoulders), with your pelvis in a neutral position, engage your deep stomach muscles and pelvic floor muscles
Slowly slide one foot back behind you, and lift it up, whilst simultaneously lifting and reaching the opposite arm, whilst trying to keep your back and pelvis still
Slowly bring your leg and arm back in towards you, and repeat with the other leg
Repeat 10 times on each side, alternating sides
Scissors level (advanced level):
Crook lying, with your pelvis in a neutral position, engage your deep stomach muscles and pelvic floor muscles
Bring your legs up one at a time into double table top (90 degree bend at the hip, 90 degree bend at the knee) and hold them there
Tap one foot down to the floor, then return it to double table top
Repeat with the other leg
Repeat 10 times on each side, alternating legs
One leg stretch (advanced level):
Crook lying, with your pelvis in a neutral position, engage your deep stomach muscles and pelvic floor muscles
Bring your legs into double table top as you did with Scissors
Stretch one leg away, making sure you keep your lower back still on the floor (don’t let it arch or twist), then bring your leg back into double table top
Repeat with the other leg
Repeat 10 times on each side, alternating legs
This article has been provided to give only general advice to new mums regarding graded return to exercise post partum. It does not replace individualised assessment and advice provided by healthcare professionals. When following advice from the article, if you experience pain or discomfort, please stop and seek advice and assessment from a healthcare professional. If you are not sure whether you have pelvic girdle pain or diastasis recti, please ask your healthcare professional.
Anna Meggitt of Tom Astley Physiotherapy provides 1:1 pilates assessments and small group sessions at Project: Me, 84 Park Road, Crouch End, N8 8JQ. Bookings available by phone (0203 659 3545), or email (email@example.com).
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.
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:
In contrast, the HARM acronym provides four factors that should be avoided with acute injuries, and stands for:
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.
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 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
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 strength 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
As I am a female bike fitter, we tend to get a lot of female cyclists come in for a bike fit, with their primary complaint being saddle comfort (with numbness and soreness being the top issues within this). It is unfortunately normal for cyclists to think that saddle discomfort is something that needs to be tolerated, but this is simply not the case. In extreme cases cyclists report pain or difficulty urinating for several days post ride! Of course the exception being long distance cyclists or cyclists whom may not have “acclimatised” to spending periods of time in the saddle.
The saddle is the one of the most fundamental things to get right on the bike, and without this all other adjustments will be less than optimal.
You might ask yourself, what signs and symptoms should I look out for which tell me that my current saddle choice or set up isn’t right for me? Some of these might be:
Lack of sensation when passing urine during the ride or after the ride
Soreness, whether this is in the genitals themselves, the perineum or the tops of the thighs
Deformity to soft tissues
As a result, we have compiled a brief list of things to look out for and consider changing in order to make your cycling more comfortable and alleviate those unwanted pelvic symptoms.
As we mentioned, some of the most common problems arise from the saddle itself. A decent saddle is worth its weight in gold. We have found that there are many factors that dictate which saddle will suit you best.
Saddle height – too high and you will rock on the saddle which will lead to possible chafing and friction
Saddle tilt – some saddles are actually designed to have a slight nose down tilt i.e. ISM. Others are supposed to be set up according to the middle third. As a result a lot of the saddles we see are often far too nose up!
Saddle fore/aft – too far forwards and too much anterior tilt can place a lot of pressure on soft tissues and thus shoulders. Consider moving the saddle further back to allow a neutral pelvic position and optimal load transfer through upper limbs
Riding style – if you adopt a more upright riding style you may want something slightly wider to support the contact points of your pelvis. Conversely, those who ride in a more aggressive position will need something that maximises pressure distribution otherwise soft tissues will take most of the weight
Sit bone width – this is more relevant for the recreational and upright riders, but women often have wider ischial tiberosities which may mean a wider saddle will help load bony prominences rather than soft tissue
Saddle “cutout” – many clients find relief from a small channel cut out which reduces pressure through the neural and soft tissues within the pelvis
Soft tissue anatomy – Cobb cycling have a very good article on “innies” or “outties”. It’s true that if you have more soft tissue exposed this will dictate what kind of saddle you will prefer.
Brands that we tend to find alleviate these problems are Cobb, Selle SMP, Specialized. It’s not that we don’t like other saddles, but when client’s have problems these tend to be the ones that resolve the issues
If you have asymmetries in your pelvis (functional, leg length or you over pronate or supinate), this can lead to changes in how your hips and knees track. As a result this could cause chafing on one leg, or make you sit to one side. There are a variety of ways you can resolve these issues:
Cleat wedges – these are small angular pieces of plastic which will change the angle of your foot. They can be stacked or layered to stop the foot over pronating or supinating, or to address small leg length discrepancies
Cleat shims – these are thicker pieces of plastic that can be stacked to reduce the severity of the leg length. Bikefit.com produce very good products
Insoles – to help the knee track and thus reduce compensatory strategies at the hip
Combination of in the shoe adaptations e.g. heel wedges and forefoot wedges – however these are space occupying so can be an issue
Cleats too far forward may also change your tipping point and cause you to come further forward on the saddle
Now the cranks are a widely overlooked aspect of bike fitting. It would be difficult to discuss them in great detail during this article, but what we do know is that the standard cranks that come on a bike aren’t always suitable for the rider on the bike. For example, we had a triathlete in recently who was approx 5ft 5 but running 175mm cranks! There are many reasons to pick cranks;
Leg length – it is suitable to pick cranks that roughly match the leg length of the rider NOT the height
Hip/knee flexibility –If this is lacking (or albeit even if it is not!) it is best to look for shorter cranks which allow you to pedal in a smooth motion, otherwise this movement often tracks back to the pelvis, where excessive rocking can cause shearing forces through soft tissue and thus pain!
Closed hip flexion positions lead to strains through pelvic floor musculature which can also impact on negative sensations and experiences
The handlebar position can have a HUGE impact on symptoms at the pelvis. If the reach is too short you may round your pelvis and put yourself in an suboptimal position, too long and you may put too much pressure through soft tissues. Too low and you will end up with the same problem, it might not be an issue for 30-60 minutes but over the course of a long ride this is when problems can manifest. You might also want to consider shallow drop handlebars to reduce the pressure when riding on the drops.
Seatpost – Believe it or not, changing the seatpost can be a VERY good way to help reduce pressures through the saddle. If you are especially sensitive consider a carbon seatpost or something with shock absorption to help dissipate the energy that would otherwise end up in your pelvis
Chamois cream – anecdotally clients whom have had pelvic pains report that chamois cream helps immensely, particularly when their mileage has significantly increased or they have started doing longer riders
Decent chamois – do not underestimate the benefits of a decent pair of shorts! A well designed chamois will help reduce friction and pressure through sensitive areas. Personally I find something with a little extra padding more comfortable, but less padding suits others. It’s worth spending the extra money, believe me! (Just made sure you put them on the right way round!!!!)
As this is just a basic outline on bike issues, we will be publishing articles that address each bike component separately.
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 riders; 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.
Rachael Field Roddis – Personal Trainer, pre & post-natal qualified trainer and mom of one has taken the time to write a piece for Tom Astley Physiotherapy blog. So sit back and relax with a cup of brew before making those plans for returning to exercise:
The mentality of eating for two and giving up exercise during pregnancy has thankfully waned in recent years. If a pregnancy is without complications and the mum-to-be is clear of injury and/or medical conditions there should be no reason to prevent safe, appropriate and modified exercise all the way to full-term. Like any fitness programme it should be prescribed to suit the woman’s own health, lifestyle and fitness levels, we are unique and so is each pregnancy. Using my own pregnancy as an example, you can see from the first to the third trimester different physiological and biochemical changes just require exercise adaptations to workout safely.
In the first trimester (0-12 weeks) training was hampered by sickness. Being sick on the gym floor was not going to make me any friends and so I trained less frequently due to the nausea and fatigue. One of the first valuable lessons I learnt about pre-natal exercise: “Listen to your body and don’t exercise to exhaustion.”
Changes in hormone levels require more care and attention to be taken when exercising. Asking the mum-to-be to look out for the signs and verbally screening before you start each training session is crucial. The hormone relaxin softens ligaments and connective tissues throughout the whole body, but is meant to primarily prepare the pelvis for delivery and cervix dilation. When I reached the second trimester (13-26 weeks) my joints started to feel unstable when running on a treadmill. To prevent injury I lowered the impact and used a cross-trainer. My flexibility increased and I had to be mindful of this when stretching and not taking exercises past the usual range of motion. Each woman will be different and some don’t feel these major changes but err on the side of caution at all times.
On the homestretch, the third trimester (27-40 weeks) and more than anything the size of a woman’s bump will now probably dictate what exercise can and cannot be performed. For me it wasn’t the size of my bump but a change to my centre of gravity that forced me to adapt exercises. A lack of balance made it more difficult to perform exercises I’d usually find easy. To continue executing them I made modifications, for example by working unilaterally and using an inclined bench or wall for support.
Resuming exercise after the birth depends on the type of delivery and what happens during labour. At present it is suggested that after a vaginal delivery it should be at least six weeks and for a caesarean section it’s twelve weeks, to allow for post-operative healing. A medical professional must give the post-natal client the ‘all-clear’ before she starts exercising. I was grateful to receive an exercise sheet from a physiotherapist after the birth, which had safe gentle abdominal and pelvic floor exercises that I could do straight away. After the ‘all-clear’ from the GP it was a case of me creating time for fitness while adapting to motherhood and breastfeeding too.
Pre and post-natal exercise has so many psychological and physiological benefits, why would we not promote it? As fitness professionals we have the ability to support, encourage and provide knowledge for risk-free enjoyable exercise during this remarkable period.
At Tom Astley Physiotherapy we advocate exercise participation through pregnancy and post-pregnancy, we can offer you pre & post natal Pilates classes in small groups lead by a qualified Physiotherapist – Anna Meggitt at Project: Me (N8 8JQ).
Contact us on 0203 659 3545 or firstname.lastname@example.org
The author and contributor to the blog, Rachael, also works in North London and is available for private personal training.