recovery

On: Bowls

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Imagine, if you will, 3 bowls. These bowls are inside you, one stacked above the other.

The first is your pelvis. Already described as a bowl, it supports and holds all above it.

The second is your diaphragm. Separating the organs in your chest from the organs in your abdomen, it forms the top of the abdominal cylinder and should move gently as you breathe.

The third is in your upper chest, at the top of your lungs and about the same level as your collarbones.

This being a conceptual experiment, fill them with water. Then, think about the way you are standing or sitting. Are those bowls going to overflow? Is the water going to run out of the front, the back, even the sides?

Stand easily if you can, weight distributed in the centre of your feet. Soften your knees and ankles.

Then, come up to the pelvic bowl. Tilt it forwards and backwards, until you find the centre, neutral position.

For the diaphragm, you can feel if it is forward or backward and correct.

Ditto the shoulders. Allow them to open, don’t force, allow. A subtle external rotation and lengthening of the clavicle.

Once reflected and considered individually, check in again with all three.

This is probably one of the quickest ways of achieving optimal posture smoothly, balance the bowls, check how they move when you breathe and then, get on with the business in hand.

Of course, if you need help balancing the bowls, can’t find a neutral position or are struggling to fix it in any other way, please book in, we are happy to help.

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: Breathing

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We all do it, 16 times a minute, it’s been written about on here before. But how much attention do you pay to it, as a messenger of your current internal state?

Start by putting your hands on your abdomen, and sniffing. You should feel your diaphragm move. If you have difficulty initiating belly breathing, this is a great technique to find it.

Breathe 10 slow breaths, in through the nose, controlled and slow out through the mouth. Focus on your diaphragm moving smoothly.

If you use this to do a quick body scan, you may find all sorts of areas of tension and holding that you were otherwise oblivious to. You can then note these to work on later, when you have mobility and movement practice.

As you become more adept, you will also notice when your breathing shifts, a cue to your internal stress levels, and a hint that your body is shifting gears for some reason. If you can pause, reflect and assess, it may help you focus on a message your body has been trying to tell you.

If you really want a challenge, pause your normal training for a week, and just focus on breath and mobility work. You may notice a significant improvement in your training when you return, not just from the rest and recovery you have allowed yourself, but in the way you are able to access other underlying systems.

Of course, if you find any areas of restriction or concern, see your general medical practitioner and come to us for further support, education and intervention.

Breathe. Live. Move.

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.

The basics of positive mental health

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Firstly, if you reached this via a random search on the internet and are feeling stuck, buried under unmanageable pressure, in a corner or suicidal, breathe.

If that is you now, if you have a plan, if you’re looking for ways to end your life, if it’s so dark that the relief of knowing how is a comfort, stop. Please. Call a mate, phone Samaritans, if you think you’re going to OD or have, get yourself to A&E.

If you need to self harm to relieve the pain, to give you something to focus on, try ice cubes. Squeeze them in your hand and feel the burning cold. Put down the sharp blade and open a window.

When we, as professionals, talk to people who’ve cut or attempted suicide after we’ve stabilised them, they almost all regret it. Most attempts are a cry for help, to get attention, to put down the enormous burden, to ask someone to take over, just for a while, to deal with the crap life has handed you.

If this is you, I’m sorry. I have no idea what demons you’re fighting but I do know that so many have been there before you and there is a solution, somehow. But the never ending darkness is not it. There are charities who are there to support you, pathways in place to show you that, however dark it is now, there is a way forward.

Please note that this is not about mental illness. This is not about PD, psychosis, mania or depression. These are the kind that leaves you debilitated and requiring professional assistance. For those who have such things, it is important that the rest of us do not stigmatise them, help support them in any way and be conscious that we are all a few steps and some genes away from their situation.

For the rest of us, who live every day with our own mental health, it is thankfully starting to become more commonly talked about in recent years. The typical English attitude of stiff upper lip and crack on is slowly becoming more less expected, but the underlying causes of poor mental health is less commonly discussed.

Positive mental health is much more of a holistic approach, a way of recognising that body and mind are inextricably linked, that we can influence those around us and by intercepting negative trends, and that we may be able to prevent or minimise darker times.

The sketch above shows the basic pyramid of mental health.

Positive health choices are obvious in retrospect. Avoiding drugs that effect mental state (alcohol, cannabis, tobacco, illicit chemicals), taking regular exercise, maintaining a healthy weight, getting sufficient rest.

Regular life patterns play a more subtle role. We all have a circadian clock, a biological rhythm that governs eating, sleeping, and even more complex processes. But we also have a human need for regularity. For work, for seeing friends, for doing things we enjoy. If we neglect this, or it is removed from us, we soon notice its absence.

Positive relationships make more sense. We have all had relationships that drag us down, that make us feel less than we like to be. These can be personal, romantic or work, but their effect is pernicious and corrosive.

We can tolerate shifts in any one of the points for a period of time, for example poor health choices by eating too much, drinking too much or not resting enough, but if we also have a few unsupportive or negative relationships and no regular life pattern then we are in a slippery slope to poor mental health.

Mental health is a gift to be nurtured, shared and to be grateful for.

When the going gets tough;

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Stop.

Breathe.

Think: Do I really need to be putting myself through this, is there a more efficient way?

 

If you’ve been banging your head against the same problem 42 times, perhaps the 43rd attempt won’t solve it either.

If its a workout, or a programmed training session, then dig in buttercup, the outcome is worth the effort. The same if its a challenging work scenario with a defined goal.

But if the task has no defined goal, no finishing line and seems apparently insoluble, then perhaps you need to take a break and reflect.

It could be that someone has been down that route before and talking to experts could save you hours of time.

It could be that “we’ve always done it that way” isn’t actually the best anymore.

And it could be that, however good your intentions, the goal isn’t going to fit your long term plan.

Stop, breathe, think.

Then get going again.

 

 

Get the basics right first 

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It doesn’t matter what supplements you take, what your morning ritual looks like, who your guru is or whether you prefer goji berries, blueberries or beetroot as your preferred superfood, if you’re not getting stronger, faster or any achieving any measure you’re aiming for, there’s something not working. 

Nothing happens without enough sleep, enough water, enough high quality macronutrients. If you don’t get the basics sorted first, you’re building your castle on sand. 

So before you start spending on the latest expensive magic product, check you’re getting:

7- 8 hours restful sleep

2-3L water / fluids

75-150g protein

Plenty of vegetables and berries

No? 

Figure those out then move forwards. Basic consistent steps climb mountains. 

80:20 Revisted

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With the forthcoming release of Dr Kelly Starrett’s new book, I have been reconsidering the advice we tend to offer injured (or preferably non injured) athletes. Dr Starrett (a Phd physical therapist) offers practical and applicable advice on injury prevention and recovery, stating that if you cannot perform basic functions safely (squatting, stretching etc) then you need to sort them out before you try running.

These days, with web access virtually ubiquitous in the western world, there is a surfeit of information available at our fingertips. The difficulty is in discerning what works and what doesn’t. With the rise of athletic “biohackers”, who promote tips and tricks for small percentage improvements, finding the signal amongst the noise is even harder.

For most of us, performance improvement comes down to three simple things.

  • Optimise Nutriton / Diet
  • Train efficiently
  • Recovery / Sleep

Dr Starrett covers much of this in his excellent book Becoming A Supple Leopard and reviews indicate he will cover this in the running guide.

Breaking down the above bullet points, optimising diet means ensuring you eat cleanly and sensibly most of the time, getting a suitable balance of proteins, fats and carbohydrates, with plenty of micronutrients. Nothing clever or fancy but by not doing this, you are ensuring that your body is not going to operate effectively. This is the base upon which all the others stand, mentally and physically.

The part we all think about is the training aspect. We plan, prepare and put in the hours and miles to attempt to achieve our goals. But are we doing it in the most efficient manner? Could we save time by cutting out junk miles or hours in the gym, since more is not always better. Is there such a thing as a recovery run, or easy workout? Would that time be better spent with friends and family, which might help improve our mental state, or doing mobility work (as described by Dr Starrett)?

This ties in to point 3, recovery and sleep. Do you recover enough? Are you waking refreshed and ready to go each morning without needing an alarm or two? There is no set formula for this since the factors involved in recovery are complex, including external stressors, but by tracking basic biomarkers (resting heart rate, blood pressure, oxygen saturation (SpO2) etc) and personal reflection, we are able to observe how our bodies are responding to the load we place upon them. If your resting heart rate is elevated and your SpO2 depressed then you are simply not recovering from the load. Another simple test is to attempt to create a change in your heart rate during a training session. If during a run or ride, you cannot easily elevate your heart rate by increasing pace or effort, then there is a possibility that you are neurologically as well as physically tired and as such, backing off would be advised.

Some people are beginning to use heart rate variability (HRV) to track their stress and recovery. Like many tools, this gives a view into the workings of the body, in this case the autonomic nervous system, which can be used to explore the effect training or stress is having. Many researchers and doctors have shown that there is a link between low variability and mortality from a number of causes but these are measured using ECG over a long period of time (24 hours), especially after an acute myocardial infarction. Some work is being carried out with regards to the use of HRV to track physiological changes due to stress and training and although this appears to be useful over long term measurements, such that trends can be visible, it appears to be a back up to the other measurements and as such, outside of the 80% rule of most efficient use of resources.

To conclude, eat to meet your nutritional needs, train efficiently and recover effectively. Then start making the 20% changes.