Sport

5 tips for better sleep tonight.

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We all feel better after a good nights sleep but how often do you wake up wishing for more, and not refreshed and ready to go? The lack of sleep is sometimes considered a chronic health issue, due to its links with lots of other modern problems including diabetes, depression, and stress.

Up until open hundred years ago, our daily lives were regulated by the sun. Candles and lamps were expensive and comparatively ineffective, so we worked when the sun shone and rested when it set. Although our bodies expect this, it is no longer the case, thanks to the electric light and modern 24 hour entertainments giving us far too many reasons not to go to bed.

This means that we are saturated with blue light. From the backlights of our televisions and mobile devices to the harsh illumination of an LED or low energy bulb, blue is far more visually and cortically stimulating than older bulbs, triggering the brain into thinking it’s still daytime and interrupting melatonin production, a vital hormone that helps us sleep better.

So we often self medicate with alcohol. That drink that helps us calm down, feel relaxed and far too often doze off in front of the tv actually stimulates us a few hours later, as the sugars in it are metabolised and converted into fuel, which the body doesn’t actually need, leading to a restless night.

The result of which is the need for a stimulant in the morning to kick-start our day and another later to get us through the evening. But time these wrongly and yet another restless night will follow, repeating the pattern. It’s far better to suffer an afternoon of feeling sluggish but allow your adrenal glands to unwind and therefore help you sleep better than it is to take yet more energy drink.

But this stress is a chronic problem for many of us, where our bodies are constantly in a state of fight, flight or freeze, trapped in a biological cycle of not knowing how to respond to a situation it cannot control. We are flooded with cortisol, elevating blood pressure, blood glucose and adrenaline and when we finally collapse, exhausted into bed, we sleep tense, grinding our teeth, stiffening our muscles and waking once again feeling just as tired as when we pulled the covers up.

Similarly, we know exercise is good for us, but too much too late at night can have a stimulating effect, pumping up our blood supply and kicking the adrenaline levels back into action, just when we’d prefer to be unwinding. If you need to stay awake for long periods of time, simple whole body exercises have been shown to help, so why do it if you want to rest?

How to solve this modern health crisis? Research has shown that there are a few simple things we can do to make massive improvements in our sleep, which most of us did for our children yet forget to do for ourselves as we get older.

1) Turn off that screen. No blue lights, LEDs or TVs for at least an hour before bed. Instead read, bath, any activity you enjoy that allows you time to relax and unwind. Gradually turn the lights down, creating your own sunset effect and losing the blue.

2) Have a fixed routine. The body is controlled by circadian rhythms, patterns when it knows and expects events to happen. Experimentation and research has shown that melatonin is typically released between 9pm and 2am, so turning in at 10.30 would maximise your exposure to its beneficial effects. Also, getting up at the same time every day also helps stabilise the routine, improving productivity and effectiveness during the working day.

3) Sleep in the dark. Light is stimulating, be it a control LED on a clock radio or the dull glow of a tv on standby. Tape over them or even better, remove as many electrical items as you can from the bedroom. Think like a caveman, invest in blackout curtains or a really good eye mask.

4) Avoid eating or drinking anything stronger than water or herbal teas for a couple of hours before you sleep. You don’t need the energy in them, they are stimulating and you need to give your body time to digest and sort itself out. In terms of anything properly stimulating i.e. coffee or energy drinks, they have a long metabolic half-life, so at least 8 hours is a good window. In reality, this often means none after 2-3pm for many people.

5) If you are plagued with restless thoughts at night, get up, write them down and reset the pattern. If, in the morning, there is something that you know you can action, get it done and make steps to sorting it out. If there are more troubling issues surfacing regularly, go and see a professional for assistance. Whatever the problem, you are not the only person in the world with that issue.

Restful nights and busy days.

3 dietary changes that could save you

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Clinically, we all ask the endocrine questions during our case history taking. Are you sleeping ok? Do you feel tired all the time? Have you noticed any untoward changes in your hair, your skin, your weight? Are you feeling much more thirsty? Are you feeling too hot, too cold? These cover many different symptoms and pathologies and if any of them don’t add up, we know to refer to other medical professionals for further investigation and treatment.

But what of those subclinical ones, changes that are sitting in the background, induced by life patterns. Borderline type 2 diabetic, adrenal fatigue, chronic overtraining. Is there any advice we can safely give that could help that person and make sure they don’t fall over the edge and need medical intervention?

Cushing syndrome describes the signs and symptoms produced due to prolonged and excessive cortisol exposure (from overstimulation of the adrenal glands due to pituitary gland issues).

These include [1,2]:

  • Centralised (around the torso) weight gain
  • Fat pads on the back of the neck and clavicle,
  • Thinning of the skin
  • Bone loss
  • Glucose insensitivity
  • Memory changes and concentration issues

Some of these symptoms may look remarkably like the effect of prolonged stress on many people who will be presenting to us as patients.

Another cause of adrenal fatigue is over training in athletes. To them, if some is good, then more is better. The flaw in this logic is that, past a certain point, more becomes destructive, with the body no longer able to deal with the training load, leading the athlete to slow down, more tired and more prone to injury and illness. So they push harder, train longer and eventually run the risk of systemic collapse. The hormonal response in this depends on the sex and makeup of the person in question but in all cases, there may be evidence of adrenal fatigue, insulin resistance and muscle metabolisation [3]

Type II diabetes, or late onset occurs when the body becomes resistant to insulin and is often caused by obesity. Typical symptoms include increased thirst, increased frequency of urination and increased hunger. The effects of diabetes in any form are multi factorial, leading to potential peripheral neuropathy, damage to the eye sight, systemic organ failure and increased healing times in the skin. This is most commonly treated through a combination of diet, exercise and medication if necessary.

The commonality between these conditions is the recommendations offered for recovery and healing. If a patient is suffering from Cushing Syndrome  they are advised to take a low carbohydrate, low calorie, high potassium diet [2]. In diabetes, the patient is told to lose weight, change their dietary patterns and reduce their carbohydrate intake significantly. In a recovering athlete, they need to reduce the stress on the body, look at their dietary patterns and ensure they have sufficient protein in their diet to allow full muscle and immune system recovery. Magnesium is also recommended as it has been shown to lower cortisol, help improve mood swings, improve glucose sensitivity and help manage blood pressure [4]. Omega 3 oils have been indicated as beneficial in helping deal with the mental effects of cortisol and as such, can help with cognitive processes in all the above cases.

The message, time and again, is that a lower carbohydrate diet is beneficial. There is little evidence we need carbohydrate to the extent that we need proteins and fat. It is a highly efficient source of fuel but one that needs to be used rapidly, otherwise it is metabolised into fat in the liver. With athletes, it is important that they receive sufficient energy to support their performance and healing but some believe that this should be achieved by increasing their fat intake. Quite how much carbohydrate is still in discussion but the consensus appears to be drifting to less than 100g for sedentary people (strict advocates would suggest lower). For athletes it is harder to factor, since they are burning so much more but they might consider fueling around training sessions and health status with fat as the dominant energy source.

Take home tactics?

  1. Magnesium supplementation (250mg per day)
  2. Significantly less carbohydrate
  3. Omega 3 oils

Simple and with reduced adrenal stimulation, very successful.

References

1: http://en.wikipedia.org/wiki/Cushing’s_syndrome

2: Pathophysiology Made Easy, Lippincott, Williams and Wilkins 2006

3: http://en.wikipedia.org/wiki/Overtraining

4: G. Paolisso, A. Scheen, F. D’Onofrio, P. Lefèbvre (1990), ‘Magnesium and glucose homeostasis’, in Diabetologia, 33: 511-514

168 Hours

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There are 168 Hours in a week.

We sleep, on average, for 56 (8 hours a night)

We sit and work for 45 (9 hours a day, 5 days a week)

We sit and commute for 10 (1 hour each way, 5 days a week)

We sit eating, reading or watching TV for 21 (3 hours a day, 7 days a week)

That leaves 36 hours to do other things, mostly at the weekend.

That which we do the most of, we become.

An hours exercise or movement a day really doesn’t seem much to ask does it? And if you recieve treatment for half an hour a week and change nothing else, how can you expect it to work?

Wobbly sticks and string

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Most people have seen a tensegrity model. These are clever constructions of sticks and elastic that use balanced tension and compression to created self supporting shapes.

(Image taken from http://dotensegrity.blogspot.co.uk/2011/01/make-your-own-tensegrity-model.html)

It is possible to consider the body as a tensegrity model, where the bones, muscles and ligaments all act together to support, articulate and move.

Although simplistic and missing huge elements of the effects of fascia, organs, inflammation and so forth, it is a useful analogy to hold, especially when trying to educate patients.

Recently, I have been considering the lumbar spine and the need for good abdominal support around it. The metaphor I use it that of a wobbly stick attempting to link upper and lower halves of the body. The pelvis is a fairly stable, solid object and the thoracic spine is well held with the ribs. This leaves the cervical spine (a wobbly stick with a block on top) and Lumbar spine to do a lot of work. Therefore, we need plenty of active muscles recruited to provide stability, support and movement.

So, no matter how much we may train that six pack and work to get well toned abs, if we cannot recruit them during activity, its fairly pointless.

I have 3 basic exercises I start with for every patient and, if they can do those, move to the next level. These are:

Pelvic control: The patient lies supine, slides one heel up the couch or floor, whilst attempting to maintain a level pelvis, the ASIS not deviating significantly posteriorly. Recruitment of the TA is particularly useful in this.

Cat crunches: On all 4s, the patient pulls their navel towards the spine, attempting to keep everything else still. A count of 5 and release slowly. This helps recruit deep obliques and the thoracolumbar fascia attachments.

Gluteal raises (trendelenburg drops). The patient stands sideways on a step and allows one leg to drop. They raise it back up again, using the opposite glutes, minimising recruitment of QL or lumbar erector spinae if possible.

Once they’ve got these, then the neuromuscular paths are working better and we can progress to more dynamic tests.

No more wobbly stick, less back pain.

Thoughts on taping

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Having recently attended a very interesting taping course, I have been thinking more about possible mechanisms of function.

If you have not worked with modern kinetic tapes, they are woven cotton strip, normally 5cm wide, with an adhesive backing. The materials used in manufacture mean that the tape has the ability to stretch, allowing it to support or follow the skin. This also means that it has less ability to support or inhibit motion, since there is less strength in the cloth.

The tape can be applied either under tension or free, which apparently gives it different functionality and there is some evidence that it is effective, not just in supporting injuries, but also in reducing eodema and bruising.

It is the method of function that interests me, as unlike the older zinc oxide white tape, which is used to immobilise and support an area, this is used to guide and improve movement.

Others are doing far better research on this, but my overall impression of this tape is that, rather than guiding a muscle or joint through the physical properties within the material, it is improving neuromuscular feedback and athletic perception of the affected area, in turn leading to better patterns. I also suspect that it is dynamically guiding the fascia, around the structures, which in turn is improving the allowed function there. And, as we know, the fascia can connect many apparently unrelated structures so again, complete examination is required to ensure the most effective placement.

With these thoughts in mind, I am considering the use of kinetic tapes more in my practice and attempting to be more creative with their application.

The use of compression wear in recovery from injury

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Many people use compression wear for racing, training and recovery. However, I’ve been thinking about using for recovery from injury.

As of yet, I haven’t been able to design a suitable controlled trial but we have been trialing it in clinic with some athletes and other active clients.

We noted that it seems to help improve recovery time in people with both calf injuries and tendonopathies. It appears that the compression wear (in this case compressport calf guards) helps reduce buildup of oedema when worn overnight and support the muscle during everyday activity during the day.

We are going to continue trialing this and hopefully will have sufficient day to draw a more solid conclusion soon but i thought i’d put it out there for general consideration. We are also going to try the quad guards for hamstring and quad injuries if suitable clients present.

Movement

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We need to move, we evolved through movement. Its just that with our current life choices, we don’t move enough. We have cars, internet shopping, sofas, take away food. We no longer need to hunt, track, think or work for dinner. Our survival no longer depends on moving.

If you watch a child, they move naturally and gracefully. No one has taught them to keep a straight spine and bend at the knees when lifting, they just do.

And if we look closer at their movement patterns in comparison to ours, we can see that they initiate their movements from the centre, the torso, long before the limbs are used. This is where they know they have power, not in the shoulders, arms or legs but starting, rooted in the core. As adults, we have learned that our arms and legs are strong and neglect the trunk, the point where it is all connected.

A common set of movements, sometimes known as the primal movement patterns are, in developmental order:

Flex
Twist
Push
Pull
Squat
Lunge
Walk
Run
Play

We should become like children again and do these every day. Only then will we start to find out how we are restricted and what we need to change to get the best from our bodies.

80:20

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There is an idea called the Pareto law. This says that 80% of the work takes 20% of the time. It can be used in almost any situation, from business management to problem solving, personal training to writing a book. I use it to illustrate a patients recovery plan (and will try to cover this in a post soon).
I also think it applies to our area, not just in terms of treatment processes, but in terms of techniques.Far too many people don’t use their training, expertise and experience sufficiently when working with clients. Instead they fall back on what they know works and do the same thing for everybody. (80% of problems can be solved with 20% of our skill). But every body is not the same. Each client is unique and each time we see them they have changed.

From a therapeutic perspective, this means that we need to reassess and reinterpret them each time, not just do the same thing and hope it will work.

When carrying out a fitness program, this also stands. We can draw up a framework for the series of sessions but need to be flexible enough to modify it as necessary. We should and need to concentrate on what they are saying, how they are responding and whether we are achieving their goals. In either mode, we especially need to take into consideration current research and thinking to ensure we are up to date with what the experts are doing. As with every other part of life, we need to remember the loop: observe, think, apply. Only then will we be doing the best for our clients and ourselves.

Foot strike, thinking backwards?

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There are lots of discussions at the moment on running, foot strike,injury and so forth. These discussions have probably been around for as long as people have gathered to talk about the science of running.

Which is odd, as we have been running for far longer and seem to have got it pretty much right for the majority of that time.

We talk about heel striking, forefoot striking, a midfoot pattern and all combinations in between. Yet it is inevitable that the foot is going to strike the ground, Gravity always wins!

Why not, instead, think about how the foot pushes off again. That, to me, requires far more thought as it has to happen consciously. And a good push off has to have come from a solid foot strike.

Rather than concentrating on how the foot strikes the ground, think about the feeling of the correct area of foot pushing off, the forefoot driving away, the force passing through it and propelling the runner forwards. For this to occur, all the muscular chains have to fire correctly.

So perhaps we should turn it upside down and think about driving forwards, not striking, and see if that makes a difference.

By all means wear minimal shoes, learn to run barefoot (it is bio-mechanically highly efficient when  learned properly) and look after your body, but flip the idea upside down every now and then.

Program design in fitness

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Following some recent research, I have been thinking about the way we approach fitness training.There is some evidence that there are 2 modes in the body and we need to activate both for the best output. There is the short time, high intensity work and then the long, slow output.The problem is, when we train with people, we don’t focus on these, we fall onto the middle ground. It’s easy. We don’t need to work hard, we don’t need to push the client. But then they don’t improve, they get disheartened and our reputation isn’t enhanced.

Instead of taking them for a jog around the park, change it up. Make them sweat, push them hard. Use the primal patterns, look at complex movements if they are capable of them. And if they’re not, get them ready.

And then guide them to being more active every day (the long slow stuff). Help them change their diet so they eat clean.

They will see changes and you will enhance your reputation too!