Posture - Don't be a slouch!

Our bodies are amazing machines that adapt to the challenges we throw at them. Try and lift something heavy, you won't be able to straight away but your body will get stronger over time so you will be able to eventually. The same applies to running, you might be slow and not go far to start but the more you run the easier it will get and the faster you will go. This is the basic principle behind any athletes training, keep pushing the limits and your body will try it's best to adapt in order to meet the demands you ask of it.

So what if the demands are to sit at a desk 8 hours a day followed by a couple of hours commuting in a car? What does this do to our bodies? Unfortunately our bodies will still try to adapt to these demands too. The down side is that rather than make us stronger and faster postural adaptations occur  instead which can predispose us to pain and injury.

When we are sitting at a desk our hips are flexed, our shoulders internally rotate and we jut our heads forward. If we continue to spend long periods of time in this position our soft tissue responds.
For example the muscles in the front of our hips shorten. When we then stand up the shortened muscles pull on the pelvis where they are attached this in turn pulls the front of the pelvis forward and down. This will lead to increased pressure in the lower back region and can also lead to associated weaknesses around the lower back and abdomen. Higher up around shoulder level the soft tissue and muscles around our chest and arms pull our arms in and forward resulting in weaknesses in the upper back and shoulder blades. This can lead to abnormal movement patterns in the shoulder. Finally by jutting our heads forward we put pressure on our upper spine and cause the muscles in the back of our neck to become tight, this can lead to neck pain and head aches.
This is a very simple analogy of what happens but if people were a little more aware of the risks of bad posture they could take small steps to improving it before it leads to pain and injury.


There are some very easy steps you can take to helps prevent yourself from developing these postural changes.

• Get up and move! It's so simple but it works. I've already said how your body adapts to what you ask of it, if you ask it to move regularly it will not adapt into a position which inhibits you doing so. Try standing up after every phone call and going for a walk at lunch (rather than sitting at another table!) 
• Set up your work station properly. Moving is great but in reality some of us have no choice but to sit at our desk for long periods. If this is you, the least you can do is make sure your work station is set up to limit the stresses and strains put through your body in that position
• Think about what you do away from work. Challenge your body to move into different positions when you are not at your desk. Even lying flat on your back on the floor helps!
• Stretch. We've highlighted how areas become tight through prolonged sitting posture. Help them relax and encourage the tissue to maintain length by stretching. This could just be a couple of basic stretches when you get home or you could try foam rolling in the evening in front of your favourite TV show.
• Strengthen. This goes hand in hand with stretching. You will want to strengthen the areas that will help you maintain a good posture. These exercises are simple and can be done at home. For example drawing in your belly button towards you spine will help strengthen the muscles around your lower back and squeezing your shoulder blades together will help open your your shoulders
• Be aware. Ask you friend and family to point our when you slouch. Posture is a habit, if you try hard enough and work long enough at it you can turn a bad habit into a good habit.

These are some easy ways in which you can help your body and maintain a good posture. If like many of my clients you participate in sport in your spare time it is even more important that you maintain a good posture when working. Sport often requires a greater range of movement from our bodies, for example the range of movement required from your hip joint is greater when running than walking. Therefore if you are going to ask a task of you body like running don't spend 8 hours of your day restricting its movements.

A perfect example of the range of movement needed for sport
Image via www.news.com.au

If you would like more information about posture feel free to contact me on here or on twitter. I also offer full postural assessments that highlight postural changes and design personalised postural improvement plans for clients wishing to improve their posture and thus reduce risk of pain and injury. In addition to an exercise plan I also use Postural taping, manual therapy techniques and other clinical methods to help clients.

Gait analysis - Do I need it?

Whether it's because I'm a runner, due to my involvement with RunFitUK or because more people are running (it's probably a combination of all 3), I have noticed that I am seeing more and more runners in my clinic. Not just runners though, duathletes, triathletes and iron man athletes also. It seems everyone has suddenly realised how easy it is to get out there and run. Running is also key in other sports such as rugby, football, hockey etc. It's a key 'skill' yet one that very few of us are actually taught or try to improve. We crawl, we walk and then we run. There are that lucky few that make it look effortless, floating across the ground as if they weigh no more than a feather however in reality most of us are not so lucky and although we may enjoy running it is hard work. So what if we thought of running as a skill rather than something we just do?

If you are a golfer your are taught step by step how to perfect your swing, a tennis player spend hours working on their forehand and backhand, a swimmer does the same working endlessly on perfecting their stroke but runners just.. run! If you want to improve your running, why not look at how you run and work on improving it?

www.golfdigest.com

www.zero-drop.com

What's the right way to run?

I'm afraid there is no simple answer to that, we are all different. We grow up in different surroundings, our bodies are different shapes and sizes, we have different medical histories, different parents, the list could go on. As we are all different there is little point trying to fit all runners into the same mould but that is not to say that the way you currently run is the most efficient way for you. You may have picked up habits that your don't realise through past injuries, you might be running a certain way because your lifestyle away from running causes your muscles to tighten in a certain way (if you work at a desk or spend time driving this is probably you) or you may just be trying to run in a certain way because that's what someone told you to do! 

To find the right way to run you need to know how YOU run and then look at what you could do to improve that. Working with your own body's strengths and weaknesses to build on what you have. 

Here's an example - A really 'fit' runner who never gets out of breath and should in theory be able to run for miles. However in reality they can't run for more than 4 or 5 miles before their legs get tired and they get niggling injuries. This is nothing to do with fitness level, the problem is strength in some key muscles around their hips. This weakness causes other areas to be overloaded. This results in the runners potential being limited not by their fitness level but by by a weakness in a particular muscle or muscle group. If they didn't know this they would carry on training but no matter how many miles, intervals and hills they did they would unlikely be able to correct the problem. To be able to fix the problem it needs to be highlighted and then the runner can be given the tools to correct it you can not reach your potential.

That is a simplified example but highlights how as runners there may be significant advantages in viewing running as a skill that can be improved alongside the usual training plans that improve our fitness.

Gait analysis

If I had a pound for every time I have an injured athlete in my clinic who says that they don't know why they are injured as they had their gait analysed when they purchased their trainers I wouldn't be rich but I could certainly buy a few more pairs of trainers myself! Some of these are proper gait analysis' done by qualified experts who will take time and analyse all aspects of your running gait however the majority of clients I see who think they have had a gait analysis have not. What they actually had was someone briefly watch them run up the street or on a treadmill and advising on what shoes in their opinion would suit their running.  There is a place for this but it is not an 'analysis' it's advice based on what they see. Have you ever asked the person doing it what they studied for them to come to their conclusion? You may be lucky and get someone who has studied for years and understands what they see and are able to make a decision from seeing you run a few steps but if that's the case why are they now using that knowledge to sell trainers? The truth is the person may have been on a course lasting anywhere from a couple of hours to a couple of days, who knows they may be a student working part time in the shop to fund a degree that is not related to running at all, you don't know unless you ask. Don't just assume that because they work in a shop that sells trainers that they have more knowledge than you on what is best for you. Of course listen to their advice, ask questions and then make your own decision. Just remember this is not a full gait analysis it's someone helping you decide which trainers to wear.

A full gait analysis involves looking at your body as a whole, after all it's all connected! In my clinic I video clients and then review their gait in slow motion from different angles. I look at people running fresh and fatigued as many runners' problems occur mid way though a run, how else can you know what may be causing problems later on in a run unless you see someone running under fatigue. I would then combine these results with the results from a set of tests that reveal in more detail any muscle tightnesses, weaknesses and imbalances. This type of analysis will always highlight imbalances but the key is to know what changes could be made that may reduce injury risk and improve running economy. Other small 'imperfections' or asymmetries may not be limiting an athlete sufficiently to warrant trying to change. 

www.positivemovement.co.uk

Gait analysis - is it for you?

Gait analysis is not cheap, but then again neither is entry to a major city marathon and if you are training for a pb and are sacrificing time with friends and family then yes, having a gait analysis is a worth the money as it will help you reach your goals and highlight any potential injury risks. You don't need to be an elite athlete to have it done either. If you want to progress and improve your running economy it is a very interesting thing to do and you will surprised at how you can improve your running without your fitness changing so imagine what you can do with a good training plan combined with knowing areas of your gait that can be improved. The other main reason why athletes have their gait analysed is if they suffer from injury. In these cases I would recommend it as it could highlight key contributing factors to their injury. 

After having your gait analysis you should be given exercises and training cues that will help you alter your gait if it is needed. It may not be a quick fix, if there are muscle weaknesses and mobility restrictions these take time to correct but if you are prepared to put the effort in with a few key exercises you will reap the rewards. In some cases just highlighting a few areas and showing the athlete simple cues to help them correct a movement can result significant changes. It all goes back to what I said at the beginning, we are all different and so are everyones results.

If you would like to know more about having a gait analysis click here

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Benefits of 'Pre Operative' exercise

People often think that if they are going to have an operation (ligament repair, joint replacement, arthroscopy etc.) that there is nothing they can do before the operation that will improve the overall outcome. However in many situations this is not the case, in fact the 'pre-operative' period is an ideal time to prepare your body for surgery and can improve the overall outcome. This does necessarily mean you need to go out running every day it means having a specific plan designed for you and your condition.

What a pre-operative plan should include

When you are facing an operation it is important to prepare your body and the area being operated on for the surgery. This should include strengthening the muscles and tissues that act on and around the targeted joint/area and correct any muscle imbalances. After surgery your movement may be restricted for a period of time therefore if you improve your strength levels prior to surgery the effect of post surgery muscle loss will be reduced. As well as strengthening the area to be operated it is important not to neglect the rest of your body. If you are having a surgery on your knee the other leg will be required to work harder post surgery so it is important that this leg is strong and injury free to be able to work as it will be required. You may also spend time using walking aids so it is also important to consider your upper body and core strength. 

During early stages of recovery following surgery movement is often limited and your body will require time to rest and repair. During these periods your body will not move as much as normal day to day life and this itself can cause problems. This leads us to the another important area to be worked on, which is flexibility. Retaining good range of motion and flexibility prior to surgery will give your body a good base and help reduce stiffness post surgery. This is a key issue as later on in post surgery rehabilitation you will want to regain joint range of movement this will be more difficult is prior to surgery the range of movement was not maintained as much as possible.

It is well documented that overall health and fitness level is directly linked to post operative recovery and that patients with a better level of fitness reduced their risks of pot surgery complications.

What to do if you have are due to have surgery in the future

The aim of this blog is to provide the reader with some information and research on the benefits of a structured pre-operative (pre-habilitation) exercise plan. Ideally this would be combined with a post-operative rehabilitation plan to achieve the best possible surgical outcome for the individual. Always check with your GP and surgeon prior to starting a preoperative exercise plan.

Have a look at the links below for research supporting 'pre-habilitation' prior to surgery. If you would like any further information or would like to book a consultation contact me via this blog, on twitter @pos_movement or email me at cassie@positivemovement.co.uk

1. Shahril R, Shaarani, Christopher O'Hare, Alison Quinn, Niall Moyna, Raymond Moran, John M O'Brian. The effect of prehabilitation on anterior cruciate ligament reconstruction. The American Journal of Sports Medicine. http://ajs.sagepub.com/content/early/2013/07/10/0363546513493594.abstract
2. Robert Topp, RN, Ph.D, Ann Swank Ph.D., Peter M. Queada Ph.D, John Nyland, Ed.D, PT, Arthur Malkani, MD: The Effect of Prehabilitation Exercise on Strength and Functioning After Total Knee Arthroplasty. American Academy of Physical Medicine and Rehabilitation, 2009, Vol 1 (729 - 735) http://www.actiontherapyservices.com/pdf/prehabilitation.pdf
3. Robert Topp, RN, Ph.D., Phil Page, Med, PT: Improve Function before Knee Replacement Surgery. Functional Exercise and Activity for Healthy Aging, March-April, 2009, Vol.7 No 2 (1-8) http://www.thera-bandacademy.com/elements/clients/docs/Topp-Page-Prehab%20TKA%20FunctionalU_MarApr2009__200904DD_023000.pdf
4. Rooks D, HuangJ, Bierbaum B, Bolus S, Rubano J, Connolly C, Alpert S, Iversen M, Katz J: Effect of Preoperative Exercise on Measures of Functional Status in Men and Women Undergoing Total Hip and Knee Arthroplasty. Arthritis & Rheumatism (Arthritis Care & Research).2006; 55 [5], 700-708 http://www.mendeley.com/research/effect-preoperative-exercise-measures-functional-status-men-women-undergoing-total-hip-knee-arthroplasty/#page-1
5. Prehabilitation exercise for total knee replacement helps patients with severe end-stage arthritis. Academy Blog: Research and News, Feb. 22, 201 http://www.hygenicblog.com/2011/02/22/prehabilitation-exercise-for-total-knee-replacement-helps-patients-with-severe-end-stage-arthritis/
6. Improving Function after Total Knee Arthroplasty (TKA) with Balance Training. Academy Blog: Research and News, May 31, 2011 http://www.hygenicblog.com/2011/05/31/improving-function-after-total-knee-arthroplasty-tka-with-balance-training
7. Prehabilitation before total knee arthroplasty increases strength and function in older adults with severe osteoarthritis. J Strength Cond Res. 2011 Feb;25(2):318-25 http://www.ncbi.nlm.nih.gov/pubmed/21217530
8. Kent Brown, MS, CSCS; Joseph A. Brosky Jr., PT, MS, SCS; Dave Pariser, PT, PhD; and Robert Topp, RN, PhD: Preoperative exercise boosts TKA outcomes. Lower Extremity Review, March, 2011 http://www.lowerextremityreview.com/article/preoperative-exercise-boosts-tka-outcomes
9. Barbay, K.: Research evidence for the use of preoperative exercise in patients preparing for total hip or total knee arthroplasty. Orthop Nurs. 2009 May-Jun; 28(3):127-33 http://www.ncbi.nlm.nih.gov/pubmed/19494760

Compression socks why, when, which ones...

Not so long ago compression stockings were only seen in hospitals, you wouldn't see a runner out on the weekend with a pair of NHS green socks on out of choice! However in recent years this has all changed and you cannot go to the gym let alone a race without seeing someone in compression socks or other types of compression clothing.

Compression basics

Hospitals have been using compression stockings to improve venous flow for over half a century. These stockings are designed to apply graduated (more compression around the foot and ankle than higher up the leg) compression to improve venous flow. This simply means they help your veins return blood back up towards your heart. This helps prevent onset of DVT, lower leg oedema, leg ulcers and varicose veins. 

www.lymphoedema.org

More recently compression clothing has started to be seen on the start line of many races and after a race many athletes will wrap themselves up from head to toe in compression clothing. The reasons for this is that the same principles that make compression stockings ideal for use in hospitals have also been proven to help improve athlete performance and recovery.

For this blog I have decided to focus on compression socks and briefly review some current research to give the reader a basic understanding of the benefits of compression socks, when to use them and what to look out for when choosing some.

The Research

As I have already touched on how compression socks work by putting pressure on your legs which in turn increases the pressure on the veins to help the blood in the vein travel quicker. Ali et al (2007) examined the effect of graduated compression stockings: physiological and perceptual responses during and after exercise and found that there was a significant reduction in delayed onset muscle soreness or 'DOMs' following a 10km run in participants who wore compression socks to those that didn't. Kreamer et al (2001) also found evidence of reduced symptoms related to DOMs with the use of compression garments. However it seems that for every piece of research done supporting the use of compression garments there is another that doesn't. For example Ali et al (2010) found no significant differences in oxygen uptake, heart rate or blood lactate during 40 minute treadmill runs. There were also no benefits post-exercise.

Another area which needs more research is the effects on compression clothing on injuries such as shin splints. Hendrik Moan et al (2012) found no significant effect on using compression garments during a graded running programme for athletes with medial tibial stress syndrome however Brandon et al (2003) found evidence that wearing compression garments improve muscular torque and attenuate reaction forces thus possible reducing risk of injury.

So... should you wear them?

The answer I give to clients when they ask me is to try compression clothing. Even if some of the benefits are due to a placebo effect if you feel wearing them helps you perform or recover better then in my view that makes them worth it. Some people wear them during exercise and others put them on after, either way I would advise wearing medical graded socks. Medical grade compression socks are rated in mmhg, a sock labelled 15-20mHg will be 20 around your ankle and 15 at your calf. The amount of compression is another subject of debate, Ali et al (2011) found athletes maintained greater maintenance of leg power during a 10km run with only 12-15mmhg of compression. Generally anything that you find comfortable over 10mmHg that is not so tight that it restricts blood flow will work, some people like higher levels of compression than others.

www.runmummyrun.co.uk

References

Ali, A.; Caine, M. P.; Snow, B. G., Graduated compression stockings: Physiological and perceptual responses during and after exercise. Journal of Sports Sciences 2007, 25 (5), 413-419.

Ali, A., R.H. Creasy, J.A. Edge. 2010. Physiological effects of wearing graduated compression stockings during running. Eur J Appl Physiol 109(6):1017-25.

Ali, A.; Creasy, R. H.; Edge, J. A., The effect of graduated compression stockings on running performance. Journal of Strength and Conditioning Research 2011, 25 (5), 1385-1392.

Brandon K. D, Young-Hoo Kwon, Robert U. Newton, Jaekon Shim, Eva M. Popper, Ryan A. Rogers, Lori R. Bolt, M Robertson and W J. Kraemer. Evaluation of a lower-body compression garment. Journal of Sports Sciences, 2003, 21, 601–610

Kraemer, WJ, Bush, JA et al. 2001, ‘Influence of compression therapy on symptoms following soft tissue injury from maximal eccentric exercise’, The Journal of Orthopaedic and Sports Physical Therapy, 31(6), pp. 282–90.

Maarten Hendrik Moen, Leonoor Holtslag, Eric Bakker, Carl Barten, Adam Weir, Johannes L Tol and Frank Backx., 'The treatment of medial tibial stress syndrome in athletes; a randomized controlled trial. Sports Med Arthrosc Rehabil Ther Technol. 2012; 4: 12.

Thanks to Run Mummy Run for the photo of their snazzy compression socks, check out their website for more colours.

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When to ice and when to heat

This is a very common question I get asked by people with injuries - when should you apply ice and when should you apply heat to an injury? To answer this you need to understand the difference between acute and chronic pain and injury.

Acute Injuries

An acute pain is characterised by its sudden onset. There is often immediate pain which is as a result of a sudden traumatic incident or impact. The symptoms of an acute injury include pain, heat and swelling

http://www.footymatters.com/

Chronic Injuries

A chronic pain is often of gradual onset. There is often no specific incident which triggered the symptoms. Symptoms may be low grade and mild initially and progress to being long lasting and persistent. Overuse injuries such as shin splints are also classed as chronic injuries.

www.nhs.co.uk

There are different views on when an injury becomes chronic, but generally if symptoms persist for more than 6 weeks an injury is then classed as chronic.

Back to the original question

Now we know the difference between acute and chronic injuries we can look at when to use ice and heat. In future blogs I will go into each of these modalities and their physiological effects in more detail, the purpose of this blog is to set out some guidance that you can use when you get injured. 

Icing an injury reduces inflammation and pain as a result of vasoconstriction. Heat on the other hand relaxes tight muscles and causes vasodilation which aids the removal of waste products from the area. With this in mind the general rule is to apply ice to acute injuries and heat to chronic injuries. If you have a chronic injury heat will help ease the long term symptoms but if you exercise or aggravate the injury thus causing acute symptoms then ice is used during this time. 

Below is a table to help guide you as to when and how to apply ice and heat.

	ICE	HEAT
When	Acute injury such as sprained ankle, hamstring strain. Impact injury such as being hit with a hockey ball. When a chronic injury is irritated and become inflamed	Chronic pain or injury where there is no swelling or inflammation such as stiff/achy lower back, tight muscles.
How	There are many ice packs and gel packs available. Ice packs that are soft are better, if using ice cube crush first. Frozen peas are perfect as they mould to the area of the body. Protect skin by using a damp cloth in between ice and skin. When applying ice using the R.I.C.E (rest, ice, compression, elevation) is recommended.	Heat can be applied in many ways. There are packs that can be microwaved or there is the classic hot water bottle. Another option is bathing in a warm bath or applying a warm compress. If using a heat pack use a damp cloth in between the pack and the skin.
How long	Apply ice for 10-15 minutes depending on the size of the area and repeat every 2-3 hours.	Apply heat for 10-20 minutes depending on the size of the area and repeat every 2-3 hours.

Safety precautions

• Never apply heat/ice for long periods of time or when sleeping
• Never apply ice directly to the skin as this may cause ice burns
• Don't apply ice/heat to broken or irratated skin
• Seek medical advice if you have circulatory problems or diabetes
• Seek medical advice if symptoms persist

Subscribe to my blog for future posts on the physiological effects of ice and heat application and more details on different application techniques.

Forget 'Stoptober' try 'Stretchtober'

It's the first of October and everywhere I look today there seems to be initiatives for 'Stoptober'. Whether it be cleaning up your diet, cutting out alcohol or stopping smoking. These are all great ideas of course and good luck to you if you are taking up one or more of these challenges. It got me thinking though about how a smaller change made each day over a month could have a positive effect on your body and this led to 'Stetchtober'.
When treating patients I often prescribe stretches as part of home exercise plans to help with problems related to muscles imbalances and postural problems. Spending time stretching can have many benefits but unfortunately stretching is quite often the first thing to get dropped from our routine when we are pushed for time at the end of a workout or at the end of a busy day.

The Challenge

So here is the challenge - each day in October do an extra stretch on top of your normal routine. You can do any stretch, any time, any where. The only rule is to do it both sides (where applicable) and hold the stretch for 20-30 seconds. 

A few ideas are

• Stretch your calves over a step while your brushing your teeth
• Stretch your quads when your waiting for the kettle to boil
• Stretch your back before getting into bed

There are no strict rules as the idea is that you can mix up when, where and how you stretch and in the process will learn more about your body. By doing this you should become more aware of where you are tight and areas that are looser. This could help you develop a more personally specific post exercise stretching routine in the future. Hopefully after a month you will also start to notice and feel the changes that regular stretching has on your body.

So that's it - let me know how you get on by commenting on my blog or on twitter at @pos_movement using #stretchtober.

Good luck and happy stretching!

Foam Roller

I often get asked what the 'sausage things' are in the gym and what they are for. The item in question is a foam roller. A foam roller is quite simply a foam roll which can come in different sizes and be made from a variety of materials. The most basic foam rollers are lightweight and made of durable composition to maintain their shape. There are now numerous advances of the simple foam roller which vary in texture, shape, size and length. However they are all designed for self myofascial release.

Self Myofascial release

Myofascial release is the release of fascia and muscle thus self myofascial release is releasing fascia and muscle by using a tool or your own hands. It makes sense that for our bodies to work most efficiently it needs to be kept in the the best condition possible. This is not only true for athletes who try to push their bodies to their limits it is also true for the rest of us. A muscle imbalance or areas of tight fascia can lead to niggling injuries, aches and pains or eventually chronic injury and this will effect the bodies ability to function day to day. Therefore if you are a busy mother or professional working in a high pressure environment it is just as important to keep your body functioning and it is worth putting a little time each week into self myofascial release. In the long term this could be the difference between you having a long term injury or being pain and symptom free.

How to use a foam roller

Foam rollers are a versatile tool that you can use whenever you have a spare 10 minutes. There are a few key points when using a foam roller, these are

1. Do not roll over acute injuries - seek medical advise first
2. Do not roll over boney areas or superficial nerve tissue
3. Try to apply more pressure when rolling towards your heart
4. If you are have any medical conditions which means you are unable to have massage treatment you should not use a foam roller
5. If you have any doubts about whether you can use a foam roller seek medical advice first

Foam roller exercises

Here are a few basic foam roller exercises to get you started.

Calf

Tibialis Anterior

Hamstrings

ITB

Quadriceps

For more information about other foam roller techniques feel free to contact me below or on twitter at @pos_movement

Photos published with the permission of Tela Performance - see their website at www.tela-performance.co.uk  or follow them on twitter @TelaPerformance for more information on the foam roller seen in the photos and similar products.