injuries

On: Fitness

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A colleague had started going to the gym “to get fitter”. While admirable and absolutely to be celebrated, I did wonder how they would know when they had achieved that goal.

After some reflection, and a walk, I developed the thought that fitness can be broken down into 2 main components. A duration / distance one, and a strength / durability one.

Duration / distance is comparatively simple. Can the person go further, for longer, or faster. These are goals that can be defined, measured and checked. Walk for a mile, walk for an hour, finish a 5k event, run a marathon, cycle for 3 hours, push the wheelchair to the shops.

The other component is harder to measure. Yes, strength can be measured by increasing the amount you can move against resistance and for how long. But that doesn’t tend to serve an end purpose. I would posit that the role of strength for the vast majority of people, athletes included, is to help them carry out a defined task with more capacity, to be more durable and to recover faster. In Crossfit this may be to complete the prescribed workout faster, or with less fatigue. For others, it may be to be able to carry a child, lift down a suitcase or spend longer with their family before tiring. And for all, it should help reduce the risk of injury.

By redefining our initial goal of fitness, we can review the strength component in this capacity and then prescribe the correct stimulus to get the desired response.

Instead of saying you want to get fitter, define a goal, and a measurable, meaningful outcome. Then tune the exercise to that.

On: Heat

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The UK and much of Europe is currently experiencing a heat wave (mid July 2022).

We are, by and large, not used to this although I fear that we may need to adapt, due to climate instability.

For those of us who enjoy activity, being active in the heat is a challenge and can be a medical risk for many.

Because not only do we have to take into consideration the temperature on a thermometer, but we also need to account for the humidity, since this has an impact on the body’s ability to lose heat. It is possible to run marathons in the desert more safely than a humid summers day.

Hydration status, electrolyte balance and other physiological conditions also have a role.

So how do we develop flight rules for exercise in the heat?

Firstly, know your body, and pay attention to it. Getting off the aircraft from a cool region and plunging straight into a desert marathon is asking for trouble. Allowing time to adapt and preferably having mimicked the conditions previously is a much smarter idea.

Secondly, understand your hydration and physiological status. Medically, you should expect a fluid balance of approximately 30ml per kilo per day. This does include the water in vegetables and fruit so is not just liquid water. You will also need to maintain a good electrolyte balance for yourself. If you are a ‘salty sweater’ (your t shirt develops white stains as the sweat evaporates or your lips taste salty) then you will need to replace more of both sodium and potassium in the correct proportions. Most sports electrolyte supplements cover this and advertising aside (we are not sponsored) Succeed caps, SIS electrolyte tabs and High Five electrolyte tabs have always done well during my endurance training career. Others are available and you don’t need the sugary sweetness of most sports drinks for anything under an hour anyway.

The other, under reported element to track during activity is heart rate. In general, if your heart rate is higher than you would expect for a specific workload, then you are possibly dehydrated and certainly accumulating heat stress, with your body finding it hard to stay cool enough. If it is dropping and you are struggling to elevate it to the target ranges then you may be suffering with cardiac fatigue. In either case, back off, drink, reflect and wait for it to settle before making the decision to go or no go. A personal rule is to take off 10 beats from my target heart in non acclimatised heat as a safety margin.

Summary:

  • Heat is a stressor
  • Acclimatise and adapt if possible
  • Hydrate using electrolytes if indicated
  • Monitor heart rate if possible and set yourself safety limits

Onwards and stay cool.

And of course, if you need more detailed input on optimising your training, resolving injuries and improving your health span, contact us.

Note: this article is a generic guide and not specific advice. If you have any health concerns or underlying conditions, seek support from your registered medical professional and care providers.

On: technology, tests and treatment.

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Listen to the patients history, they will tell you the diagnosis.

Possibly not entirely, as patients sometimes miss detail or forget timelines.

However, subsequent to a thorough history and examination, all other tests should be used to confirm or deny your hypothesis, including imaging and blood tests.

The problem comes when we, as practitioners or medical professionals, get distracted by new technology or training. This means we look at what we can do, not what we should do.

Ethically, one should do the least for the most benefit. So just because I can order a blood test doesn’t mean I should, if it won’t change my subsequent decision tree. And just because I’ve bought a shiny machine, the information it produces won’t necessarily fundamentally alter the treatment plan.

As for treatment itself, the gold standard therapeutic ladder must always be applied. Physical intervention, then medication, then surgical intervention.

Knowing how to apply this, when to step up and down, the precise tool and most importantly when to stop, is what we spend years training for and why the patient needs to select their practitioner with care and recommendation.

Only then will they find the person that understands and diagnoses their presentation, educates and treats it effectively and most importantly demonstrates how to prevent its recurrence.

Whoever you, as a patient, go to, don’t be taken in by the technology and treatment modalities, look behind the curtain, look at outcomes and be driven by the outcome.

If you think we can help, please do call, we have over 20 years of experience, in both NHS and private practice, to help you work with your presentation.

On: Rehabilitation / Prehabilitation

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The best way to recover from an injury is to not have an injury.

Other than the sort you simply cannot predict, the majority of injuries are caused by poor preparation or the inability to adapt dynamically to the situation.

Rehabilitation goes through three main stages.

  • Pain management
  • Ranging
  • Loading

First, control the pain. This is both passively and actively. Once the pain is a under control, it is a return of function, within that pain free zone. Optimise the range of motion, or activity that is available without causing excessive complaint. Finally, the loading phase, where we return to activity, initially graded and then competition.

This is, of course, a gross simplification of the tasks at hand, offers no insight into the variety of techniques considered, but is offered as a thought guide for the observer.

As stated at the beginning, the best rehab is prevention, through prehab. Prepare better, prevent problems.

Everybody has a weakness, a compromise point, or an area that appears to be less effective, so train those out to become more capable.

Seek professional input if you are prone to niggles, seek professional input for coaching if required and build steadily. Social media is not your coach, a search engine doesn’t replace a doctor.

On: Beyond movement

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There are the eight prescribed movement patterns: flex, extend, rotate, push, pull, squat, lunge, walk.

But beyond that is the ability to do them smoothly and under load.

For example, when out walking, without losing step, run your fingers along the ground. That involves walking, flexing, lunging and an element of rotation.

Now repeat the action raising your hand over head to touch a tree leaf. Again, walking, extending, rotation.

The more complex the move, the more we challenge our neuromuscular system, the less spare capacity we have and greater the risk of subtle injury due to compromise.

Therefore, we should train these elements. Not just the standard gymrat moves, but through play.

Look at an object and play with it. A plate carried overhead. A tree branch that can be climbed on or over, or under. A line on the pavement to walk along, skip over, or walk backwards over.

Look at the environment as a playground, and use it to improve the way you move.

Injury proof yourself through play.

Why walking in their shoes will give you new insights.

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To understand someone better, it is said that we need to walk a mile in their shoes.

This is perhaps a little extreme but as with many statements, there is a lot of truth buried in there.

Walking in their shoes, or at least picking them up and looking closely at the wear patterns, both inside and out, will tell you much about the person’s interaction with the world. Do they currently have a prescription orthotic, or some form of insole? How has the outsole worn? Are both sides worn in the same way? Can you see the way the foot turns and loads inside the shoe?

By observing and considering the information provided, it can be possible to start gaining a better insight into how the person moves and hence any potential issues they may be adapting for.

If necessary, stand up and attempt to physically mimic their movement, and what leads them to that positioning.

Feeling it in your own body can be an eye opening experience and one that may hugely enhance your own practice.

Running it off does not work

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Each week, we see a number of runners and increasingly gym based athletes, who have had an injury for a while and have tried to train through it.

This never works for a number of simple reasons:

  • Unless it was a non traumatic injury, it will have happened due to a chronic issue somewhere, which needs to be addressed before the problem resolves fully
  • If it was traumatic, there will be a knock on effect, which can get worse if you attempt to train through in any way that loads the injured area
  • Training through, even if it does not dynamically load the injured place, demands modifications in your form and movement patterns, which can cause injury later on

The best approach instead is to use the PRICE principles and book in to get it checked by a professional, who is used to working with athletes.

PRICE:

  • Protect: Avoid loading the injured area and strap or support it if you do need to move
  • Rest: Cut back on your workload and give it some time to heal properly
  • Ice: If acutely injured, cold treatment can help reduce the swelling and pain
  • Compression: A simple bandage may help reduce the swelling and pain, particularly in joints
  • Elevate: By raising the effected area to level or higher than the heart, the chance of swelling is reduced, helping the body heal more effectively

Whether you’ve tweaked an achilles, strained your knee or have a chronic lower back problem whenever you run over a certain distance, don’t just ignore it, pop a pill and carry on, call in and get it resolved quickly and effectively.

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.

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.