Tips to stay ‘injury free’

As we roll into the summer, we start to become very aware of how our new years resolution to get fit is drifting away. At TA Physio we see many clients who started fitness programs in the first few months, stop, then try again with injury or alarming pains. There are a few ways to help remove these undesired results and still get fit for the summer.

There are many reasons for injury, especially in sports with contact which result in direct trauma, but there are many internal reasons for injury too. These are things that you may not be aware of when you start your sport or activity, such as weak muscles, reduced range of movement and level of fitness (1).

Here are some tips to help reduce the risk of injury:

  • Start small and build – Up to 40% of injuries in athletes are due to a rapid change in training(2). Even the fittest need time to adapt. People often decide to start a sport or activity from doing very little, to upwards of 3 to 4 times a week. This can be too much too soon for your body, it may not be able to deal with the new stresses and load. Getting fit is also about patience!

  • The importance of a warm-up and cool-down – We all know the rush when you’ve only a short amount of time to do your workout and skip the warm-up/cool-down. Neglecting this can leave you prone to easily avoidable injuries (3). On the other side, stretching hasn’t been found to be effective in reducing the risk of injury(4) – but we know it feels good so no need to stop!

  • Resistance Training – It is important to add strength and conditioning into your program to reduce the risk of injury. Resistance training once or twice a week is effective in reducing the risk of sports injuries by up to 1/3 and overuse injuries by 1/2 in active individuals(4).

  • Rest – Probably one of the most important is making sure you have rest days, enough sleep and look after yourself. Sleep has been shown to improve memory, performance and reduce risk of injury (5). It is recommended that adults get at least 7 hours of sleep to get the full benefits(6). Recovery is just as important as the work itself.

Injury prevention is specific to each individual – with age, sex, fitness, general health, mobility, strength and previous injury all being risk factors (1).

Hopefully this has helped you think about what you might be neglecting, and given you a few ideas of what you can do to help keep yourself pain free.

Thanks for reading.


Aran Pemberton

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.

References

  1. Murphy DF, Connolly DAJ, Beynnon BD Risk factors for lower extremity injury: a review of the literature British Journal of Sports Medicine 2003;37:13-29.
  2. Gabbett TJ, The training—injury prevention paradox: should athletes be training smarter and harder?British Journal of Sports Medicine 2016;50:273-280.
  3. Herman K, Barton C, Malliaras P, et al, The effectiveness of neuromuscular warm-up strategies, that require no additional equipment, for preventing lower limb injuries during sports participation: a systematic review. BMC Med 2012;10:75.
  4. Lauersen JB, Bertelsen DM, Andersen LB The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials British Journal of Sports Medicine 2014;48:871-877.
  5. Roberts SSH, Teo W, Warmington SA Effects of training and competition on the sleep of elite athletes: a systematic review and meta-analysis British Journal of Sports Medicine 2019;53:513-522.
  6. Ohayon M ,Wickwire EM , Hirshkowitz M, et al, National sleep foundation’s sleep quality recommendations: first report. Sleep Health 2017;3:6–19.

Sticks & Stones – Bec Van de Scheur

STICKS AND STONES…

 

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.

 

This-is-a-cartoon-image-of-brain-coupling-during-communicationThere 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).

 

IPainf 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.

 

 

Resources

 

 

 

 

 

 

 

References:

  1. Cyna, A.M, Marion, A.I, Tan, S.G.M, & Smith, A.F. (2011).Handbook of

  Communication in Anaesthesia & Critical Care: A Practical Guide to   

  exploring the art. New York, United States: Oxford university press.

 

  1. Ingraham, Paul (updated Nov 18, 2016, first published 2010)

  Pain is Weird. Retrieved April 26, 2017, from

https://www.painscience.com/articles/pain-is-weird.php

 

  1. Ruiz, D.M & Mills, J. (1997). The Four Agreements: A Practical Guide to

  Personal Freedom (A Toltec Wisdom Book). California, USA: Amber-

  Allen Publishing

 

  1. 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.

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Marathon Tips – Roger Kerry

Going the distance

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 beach runningplanning 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…

  1. 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.
  1. 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.
  1. 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.
  1. 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!
  1. 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!  

  1. 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.
  1. 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.
  1. 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!
  1. 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.
  1. Re-fuel, refresh, and reflect – You’ve done it! 26.2 miles in the bag, and an amazing london-marathon-the-mallexperience. 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.

Post-Pregnancy: When and How To Return To Exercise

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;
  • Stress relief
  • 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:

  • Fatigue;
  • 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.

 

 

Basic

 

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

 

Pelvic tilt

  • Pelvic tilts:
    • 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

 

 

Intermediate

 

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

 

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  • 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

 

 

  • Breastroke preps:
    • 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
    • Slowly lower
    • 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

 

 

  • Clams:
    • 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

 

 

Advanced

 

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:

 

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  • 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 (info@taphysio.co.uk).

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.

Image

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.

RICE

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

HARM

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.

PEDAL_2915652a

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

 

Regards

Team TAP

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London to Paris – How To Survive

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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.

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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.

Pregnancy: To exercise or not to exercise?

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Advocate for fun and accessible fitness for all. Get in touch @rachael_PT

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.

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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.

 

aerobics.jpgOn 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.

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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 info@taphysio.co.uk

 

The author and contributor to the blog, Rachael, also works in North London and is available for private personal training.

Contact Rachael on rachael_pt@yahoo.co.uk

 

Commonwealth Day #10 – Refection #5

Well the end is in sight for Glasgow 2014 Commonwealth Games and I’ve had a blast so much so I might go to Rio.

Working in the poly clinic as a physio to the athletes has been a once in a lifetime experience and taught me so much about the world of elite multi-sport events.

I have had the opportunity to work under a great physiotherapy in Lynne Booth and a fantastic team of physio’s from across the UK.

The next goal for me is to get My Physio in sport bronze award and then continue multi-sport event physiotherapy through UK Athletics and BUCS pathways.

Thanks for reading my previous blogs.

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Commonwealth Day #9 – Reflection 4

XX Commonwealth Games
XX Commonwealth Games

 

The 2014 commonwealth games is coming to a close within the next few days. The Glasgow platform has provided some amazing sporting outcomes and a great experience for athletes, team officials, and Clydesiders alike. As part of the medical services, working in the polyclinic has given me a taste of the multi-sport elite level competition, and whilst it is hard work, it’s certainly something I have thoroughly enjoyed.

 

The What?

I have learnt a lot from being in the polyclinic environment and working alongside some fantastic physiotherapists over the past two weeks. When an athlete is injured, they usually transferred to the polyclinic, from the field of play, to receive world-class treatment. However, what happens when the athletes doesn’t listen?

 

So What?

A netball player presented to the polyclinic with an acute ankle sprain, 2 days previously, she sprained her ankle competing. Treatment was provided to aid recovery but as part of my assessment, I enquired as to when she was competing next, the reply I received was ‘5pm today’.

As physiotherapists, we naturally want to promote activity and sports participation, but sometimes the body needs time to heal. The athlete always wants to play and the coach always wants their best players fit for action. The difficulty comes when the coach is present to hear your opinion about an injury or doesn’t choose to hear it.

I advised the netball player that should not play on her ankle in its current state, despite the fact that she had a game that afternoon, and this is why.

The ‘envelope of function’ (according to Dye, 2005): increase in activities (both frequency and intensity) leads to tissue loading outside the zone of physiological homeostasis
The ‘envelope of function’ (according to Dye, 2005): increase in activities (both frequency and intensity) leads to tissue loading outside the zone of physiological homeostasis

The tissues within the body are maintained in homeostasis through training and competing. The tissues and structures in the body are pushed into ‘supraphysiological overload zone’ when competing, which means that are optimised within the ‘Envelope of Function’. When these tissues are overloaded beyond the ‘Envelope of Function’, i.e an injury occurs, then tissues fail and break or rupture. due to injury, the envelope of function is reduced and tissue homeostasis is disrupted.

 

What this means in the context of the athlete competing, is that they have a reduced physiological ability to perform to their highest level, which would be needed at an international event like the Commonwealth Games. If the athletes does compete with a reduced ‘Envelope of Function’, then they risk further injury as the tissues get overloaded beyond the envelope sooner. The cycle of boom and bust can re-occur until the tissue is given sufficient time to heal and repair to restore tissue homeostasis.

 

Now What?

1) Communicating the importance of tissue healing to athletes is difficult but needs to be emphasised to avoid boom and bust cycle of injury.

2) Communicating the outcomes of clinical assessments to the athletes medical team should be done immediately to discuss return to competition but athletes want to play and coaches want their best players available for selection, so getting this message through can be difficult.

3) Treatment of injuries should be looked at in the short-term and long-term outcomes with the athlete at the centre of the treatment goals

 

Reference

1) Dye SF. The pathophysiology of patellofemoral pain: a tissue homeostasis perspective. Clin Orthop Relat Res 2005; 436:100-110.