Sports Injury

Total body circuits for injury detection and prevention

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There are a few simple exercises that, if carried out correctly, can help prevent injury in other areas of training by allowing you to spot where and when you are weak.

Amongst my favourites are:

Kettlebell swings. Preferably a full range of motion. http://www.catalystathletics.com/exercises/exercise.php?exerciseID=251These work pretty much everything and can be used for strength, conditioning, warmup, incredibly useful.

Turkish getups. http://www.catalystathletics.com/exercises/exercise.php?exerciseID=255 They look simple but demand huge range of motion and coordination of all the major joints to be successful.

Single arm overhead squats. http://www.catalystathletics.com/exercises/exercise.php?exerciseID=236 Another all over body exercise which will make everything fire in the correct sequence.

Dead hang pull ups http://www.catalystathletics.com/exercises/exercise.php?exerciseID=39

Mountain climbers, just to finish off http://www.youtube.com/watch?v=1J4hRICVjRo Focusing on maintaining a stable trunk throughout the movement.

By doing these as a circuit, ensuring good form at all times, they should prepare you for any other, more focused gym work or training you wish to do. Or, if you’re time compressed, just doing a 10 minute of a few of them (not everybody has a suitable pull up station in their home) will bring huge benefits.

One of the best resources for improving mobility is Mobility WOD, which has hundreds of excellent videos for fixing all the areas you may feel are restricted.

And if in doubt, come and see us for a full assessment of the issues.

Unlock your potential

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What would happen if you could:

  • Train more effectively
  • Recover faster and more efficiently
  • Heal from injuries quicker
  • Maximise your resilience

It would unleash your performance in every area of your life. You would have more time to spend on relationships, work or play, achieve more when competing and have less noise in your head when the time comes to focus.

The secret? To get out of your own way. Most of us are held back by learned patterns, old injuries and poor habits, trying to do more and more with less and less. Restrictions in one area reduces the body’s capacity to deal with stress in others. A tight hip will shorten your stride and overload the achilles, a stiff upper back will drop your maximal squat, restricted shoulders will limit your press or swim stroke. Mentally, stress at work will reduce your ability to make solid nutritional choices, family concerns will eat into your training mindset, anxiety will limit your performance at competition time.

If you can figure out what is restricting you, then removing those blocks can make huge differences.

Each persons blocks are different. Physically, look first at the ankles, hips and thoracic spine. Any old injuries, scarring or tissue changes (tight, weak, short) can affect the rest of the body in many ways. Can you perform the basic movements (push, pull, bend, squat, lunge etc, cleanly and pain free?)

Another physical issue is not listening when we need to rest, by ignoring the subtle clues in our physiology. Is your resting heart rate elevated, are you feeling more fatigued than normal for this workout, is your nervous system tired? (This can be tested via heart rate variabiity apps and simple biomechanical tests). Are you sleeping sufficiently? Once those areas are cleared, look at specific areas related to your sport or discipline and optimise your strengths and minimise the weaknesses, a process that will take a lifetime of self observation.

Mentally, we are always fighting against the patterns and habits picked up from everyone around us. Fear that we are not training hard enough can lead to overtraining, learning not to listen to the inner voice of weakness during a difficult moment, belief in an internal monologue that tells we are not good enough, often imposed by others, copying or competing with our training companions when we should be backing off.

By reading the cues, listening to ourselves and seeking the support and expertise of professionals, you can unlock your true potential in every domain.

Power, paths and chains

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I have been thinking about simplifying stretching processes around exercise. Not when trying to repair or prevent injury but as a general mobilisation. Out of this, it is possible to spot a couple of patterns that are easy to follow, cover all the major muscle groups in the body and allow us to achieve the most benefit from our stretching time.

The body has an anterior and posterior chain (originally and well described in the work of Tom Myers), as well as the basic or prime moves.

By combining the basic requirements for movement (flex / extend / rotate) in all joints together with chain connections (it is possible to open up and stretch the whole body very smoothly.

Starting with the spine, we need to create flexion, extension, rotation and sidebending, focused on the articulation of the intravertebral joints rather than faking apparent range of motion with the peripheral limb movements. Hands on opposite shoulders (crossed in front of chest) and turn spine left and right, then flex forward (from the diaphagm) and arch back. Finally sidebending both directions to finish the moves.

For the front chain, step into a open lunge, keep the pelvis neutral (most important), extend the opposite arm as though stretching the chest and turn the upper body in the same direction. You should feel a gentle tension across the whole line. If you are unable to sustain this, it can be split into sections but needs to be considered part of the whole. The sections being kneeling lunge for upper body to pelvis and quad stretch for lower body. Repeat both sides, of course.

For the back line, a sitting figure 4 stretch (foot into opposite knee and lean into straight leg) covers most of the groups.

Finally, lie on your back, pull your knees up so knees and hips are comfortably angled, then let them drop to one side so that the glutes are stretched, together with the back chain. This can be amplified by putting the opposite arm out and stabilising the upper body.

Of course, these are best demonstrated in a clinical situation, so that they can be tuned to your body, however by paying attention to both your attention and intention, then good results can be acheived.

Pareto Principle

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Vilfredo Pareto, an Italian economist, observed that there in general, there is an 80/20 split to all things.

  • 80% of a businesses income will come from 20% of the customers
  • 80% of the commodities will be owned by 20% of the people
  • 80% of the work will take 20% of the time

Interestingly, this also seems to apply to the treatment of patients.

 

x = time, y = improvement

If we take the above plot (y = log x +2, where x = 0 to 10) we can see that, for a greater value of x, y takes proportionally longer to increase. A simplistic interpretation and a mathematician will be able to show that it never truly will be horizontal, (y will always change) but it can also be seen that the greatest increase in y happens very quickly (approximately within the first 20% of the graph).

We can therefore use this tool and curve as a multilayered example to discuss with our patients.

  • Intial improvement should be rapid, within the first few treatments. If it isn’t, are we as clinicians missing something important?
  • 80% of their improvement will take 20% of the treatment time
  • They will never reach 100% better. We are all carrying compensations from the moment we are born, there will always be niggles. Our job is also to educate the patient on when these are mild or serious.
  • Treatment is progressive and dynamic. As they pass the 80% improvement point (on the y axis) then they should be encouraged to take more responsibility for their improvement, through exercises, diet and behavioural changes.

The Pareto pricinple can also be applied to others areas of practice. We will get 20% of clients who are unusual presentations, 80% of problems will be resolved with 20% of our treatment techniques and so forth. It is that 20% that requires our focus and skill.

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.

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.

Tonight we dance: Lower back pain, tango and movement

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My friends recently bought a wii for their family and watching them play a dancing game, I noticed something that had been slowly dawning on me for a while.

One of them seemed a little more fluid than the other but as they are all very fit and active, at first I couldn’t understand why.

The answer appears to  lie in the lumbar vertebrae and their apparent lordosis. One of them had a slightly more lordotic spine, with more resulting anteriorisation in the pelvis than the other.

From that, the pieces fell into place. Shortening in the quadriceps and psoas had led to a slight increase in the anterior tilt of the pelvis, in turn reducing the available motion in the lumbar spine.

This pattern can commonly be seen in the wider population, especially those presenting clinically. On examination, we will generally find tight glutes, shortened psoas, a slight medial rotation to the thigh, hypertonicity in the superior insertion of quadratis lumborum, an anterior tilt to the pelvis and restriction motion in one or more planes in the lower lumbar spine. If active, they may also report hamstring problems.

Clinically, resolving this can have several approaches, depending on the level you wish to work. Posteriorise the pelvis (one colleague uses MET of the hamstrings, another does it manually side lying), lengthen the quadriceps, stretch or release any psoas restricitons and work on any QL points. Other, more distal, areas can then be incorporated to address the underlying issues that the body was adapting around. This is where it becomes interesting and the individual practitioners preferences come to the fore.

Once treated, this can often be prevented from returning by regular stretching and, interestingly, regular dancing or hoola-hooping! Both of these activities help keep the spine mobile and fluid, encouraging good movement patterns and core integration. And Tango? Particularly for the ladies, this elegant form of dance requires excellent upper body posture, with the ability to stabilise and extend the pelvis and leg smoothly.

As ever, all problems are individual and should be investigated professionally. None of the information above is a diagnosis or treatment plan.

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.