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Health, running, training

Zoom out – Rehabilitation with your eyes open

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The approach to treatment and rehabilitation is changing and for the better. Gone are the days (going anyway) of just treating the pain and symptoms. This approach lead to :

  • Short term outcomes: Pain relief, symptom relief (muscle spasm etc) and you feeling better.
  • Flare ups and frustration: But the pain kept coming back after these quick fixes.
  • Meaning more money spent in the long-term, more frustration and decreased quality of life.

The reason the quick fix approach doesn’t work for a lot of people is because the cause is not being addressed – The reason behind the pain and injury isn’t being rehabilitated.

When an injury, pain or niggles occurs you need to look above and below the area to find the contributing and causative factors.

Some examples? Here is a couple of common examples:

1. An office worker gets regular headaches that stops them doing what they love, playing on their mind and being very, very frustrating. They have had their neck treated in various ways – acupuncture, massage, trigger point release, joint mobilizations etc. All of these offer release – but they keep coming back!

bad posture and why it causes headachesOften the reason behind this is a rounded thoracic spine (upper back). This rounded spine pushes the head forward in a less than ideal position as you can see in the image to the right. This forward head position, one closes down the joint at the base of the skull and also every centimeter that the head is forward makes the neck muscles work four times harder! This will definitely cause muscle knots and stiff joints at the base of your skull AND headaches. So no matter how much you pull your head back, have the neck treated etc – If you do not treat your spine below the neck – You are going to keep getting headaches.

 

Patellofemoral pain syndrome. self treatment and rehab at home to decrease pain and get you back to it!

2. Another common example that will ring true with a lot of people, particularly runners, is anterior knee pain (Patello-femoral pain). Anterior knee pain is one of the most common running injuries and the pain happens because the knee cap doe not glide in its grove correctly. This is due to increased tension in your quads (particularly the outer quads) – pulling the knee cap laterally (to the outside) causing pain, inflammation and further muscle tension to due it grinding in the wrong place. Studies have shown that runners with PFPS have weak hip abductors and external rotators – This is a huge contributing factor as if these muscle are weak the knee is not controlled, in turns inwards, changing the tracking and position of the knee. So the knee can be treated, taped, dry-needled and exercises etc as much as you like but of hip strength and endurance isn’t improved then this will hang around and really frustrate.

 

 

core strength minimizes lower limb injuryIt is amazing how the body is connected, with no muscles and joints working in isolation. The body is full of synergies, with different muscles and tissues working together to move everything in unison, it really is an awesome machine.

But this is why when one thing goes wrong – multiple other areas can be affected. Other areas help out and work hard to compensate, some parts get more stress through them, leading to pain and niggles, that may bot be where the problem is!

 

This is why you need to rehab with your eyes open. If you have:

Look at your body holistically – Don’t just focus on the pain and getting a quick fix. Health care is changing; less pills, less anti-inflammatories, healthy food and less steroid injections – Become aware of your body and improve it for the long-term and Physioprescription is here to help you do that, giving you the tools, info and exercises to live better!

 

Please share, like and let me know how you get on!

 


foot pain, Health, running

Heel pain running? Check your shoes and hips…

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Plantar fasciitis treatment and exercisesHeel pain running is one of the most common running injuries and can really put the brakes on living an active life. Today we will sort out some hidden causes behind heel pain!

Heel pain running is most often caused by Plantar Fasciitis and this is what I will be writing about today. The pain will be on the base on your heel – if it is on the back of your heel where your Achilles tendon attaches to the bone, that is another matter and I see to this in a future post.

Plantar Fasciitis is the 3rd most common running injury behind “shin splints” and Achilles tendinopathy(Lopes et al, 2012), yet is something than can be improved quickly if the right things are done to help it. Earlier in the week I wrote a post explaining Plantar Fasciitis and how re rehabilitate it at home. Have a quick read of that as it gives you a good base knowledge for what we will talk about next and also shows you the exercises you should be doing if you have heel pain.

 

Why check your running (or walking) shoes?

Windlass mechanism, heel pain - self treatment and exercisesThis is very important, especially with the new craze at the moment being lightweight, flexible footwear. Giving the foot move movement is fantastic if you have great foot mobility, flexible, strong calves and fascia. But if you don’t have that then these can really increase your chances of getting heel pain OR worsen it. This is because when you are running, as the heel comes up off the ground, your big toe is pushed up, putting the fascia on the bottom of your foot on stretch. This is a natural spring-like mechanism called the windlass mechanism, which when you have heel pain, can really tug, pull and stretch at your heel – Causing you more pain and inflammation.

So what is the best footwear to wear if you have heel pain?

It doesn’t matter if you have Plantar fasciitis, achilles pain or shin splints, this applies to them all. You should wear running shoes with a supportive arch (some padding under the arch), heel support (not zero-drop shoes) and with reaonably inflexible sole. Over all it is very important to get your shoe matched for you as every persons foot is different and moves in a different way, there is no perfect or “normal” way for a foot to move.

If you are trying to venture into minimalist running shoes or even barefoot running, it is very important to do this progressively as your muscles work very differently in different foot wear or lack there of.

A recent study by Shih, Y et al 2013 showed what affects load and stress on the muscles and tendons most is your running technique and not shoes. So it is important to get you technique right (form before footwear) before heading into minimalist shoes or making any big change. The study also showed that forefoot running (which a lot of people start doing when they go into minimal or no shoes) increased the work of your calf muscles – leading to increased risk of shin pain, achilles pain and heel pain.

Hips:

Often with lower limb injuries there is glute weakness that is contributing to this. Having string hips that can control your foot and knee, absorb force and power you forward is so important and if you are not already regularly strengthening your hips, you should add this to your routine.

First of all it is good to test you hips to see if you do have a problem: Have a go at this quick balance and stability test to see how you stack up.

And HERE is the glut strengthening for you that I prepared earlier – This can really decrease your injury risk and improve not just your running but everyday function.

End note: Minimalist and flexible shoes are not a bad thing if you go about it the right way but for heel, calf or shin pain they should not be your first choice.

 

Please like, share and let me know how you get on ūüôā


diet, Health, training

How To Build Muscle – A Realistic Guide

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muscle-building-trainingHow to build muscle – As a health professional I see a lot of people who want and need to lose weight but also a lot of people who want to put on weight. More specifically they want to build more muscle. There are so many scams out there and myths about gaining weight, so I want to give you an easy to follow and simple guide, including a free recovery guide to really make the most of your training sessions.

So here is a guide full of tips, advice and training tools on how to put on muscle that are easy, realistic and developed by a professional Physiotherapist to help you reach your goal.

To safely and effectively gain muscle you need to cover a few important aspects:

  1. Nutrition
  2. Muscle overload
  3. Sufficient rest and recovery

If you just start drinking protein shakes or a plethora of steaks, you won’t get very far. If you start lifting weights but don’t challenge your muscles enough, you won’t get far. If you don’t give your body time to get stronger, you will fall to pieces. Below I will cover these three important aspects so that YOU can get bigger stronger and feel a lot better.

Nutrition:

During: A huge amount of people are dehydrated before they even start exercising. This is because thirst (eg dry mouth etc) are signs that it is too late Рyou should not reach this point as it limits your muscles, causes cramps earlier, and reaction time slows.  over the day women should drink 1.6Litres and men should consume 2 litres РAlthough if doing exercise, hot weather etc you should be drinking more. A general guideline is to drink 500ml 1-2 hours before training, 200ml every quarter-hour of exercise and 500mls of water or sports drink after exercise.

After workout: Protein, carbohydrates and water are needed post workout. Check out the ideal recovery schedule below for more detail. Muscle growth post workout depends a large amount on the availability of amino acids as these are the building blocks that create muscle. Amino acids are what make up protein and so without a good dietary intake – all your hard work would be for little.

A word on protein: You need to take in enough protein to support muscle growth. Your body can’t take on more than 30 grams of protein at one time so it is pointless taking more than this – it is recommended to consume 1.4 grams of protein per kg of body weight per day so you will need to spread it out through-out the day.

Sources of protein:

  • Red Meat
  • Poultry
  • Fish
  • Dairy
  • Eggs
  • Nuts

Diet food to assist build muscle for trainingGeneral nutrition: It is important to eat a healthy diet day in, day out as this gives you the energy, nutrients and all the building blocks that are needed.

Tip: Increase overall daily intake: if you want to put on more muscle and train more – you need to eat more, plain a simple.

Foods to avoid:

Sugar – Unless it is after exercise: Sugar causes a spike in insulin levels, increasing the muscles intake of sugar with amino acids to build muscle. At other times it will go straight into fat. Conclusion: avoid sugar except after workout – then you can have 40-100 grams.

Trans fat – Stay well away from Trans fat as just 5 grams of trans fats can increase your chance of heart disease by 25% among other things (generally things like canned foods, potato chips, pies, deep-fried chips and fried chicken all have over 5 grams – the easiest thing to do is check the packet nutritional info on the packet!).

Don’t be scared of fat: Other fats are needed in a healthy diet – 30% of our calorie intake should be from fat with roughly 10% saturated fat, 10% monounsaturated fat and 10% from omega 3 fats.

Sports drinks unless it is during or post workout.

Window of opportunity: The hour after exercise is when your body can take on fuel and re-load the best so it is very important to eat and drink within an hour (ideally within 1/2 and hour).

The ideal recovery guideline:

  1.  First 5 minutes РRehydrate and refuel. eat/drink carbs and protein (4:1 carbs to protein ratio) using high GI Carbs. eg recovery sports drink, banana and water.
  2. 5-20 minutes РCool down, light exercise for 5-10 and stretching for 5-10.
  3. 15-20mins РNatural recovery Рhot/cold showers, ice, foam rollers, continue to hydrate.
  4. Within the first hour – Continue hydration, take in more food (High and med GI carbs and proteins – a meal, protein shake etc).
  5. In the evening: continue to hydrate and refuel where appropriate. Apply a curfew, lights off etc to get a  good sleep.

 

Workout:

Tip: Train to failure – in order for your muscles to grow, get bigger and stronger they need to be challenged. Your body is continually adapting to the forces that are out through it so if you are pushing your muscles enough that you cannot do anymore after a set of 8-12 – they will adapt and get stronger!

Muscle recovery: Your muscles need 48-72 hours to fully recover after a workout (you have done a lot of little tears – they need time to heal and get stronger). This is why you need to have at least one rest day per week to allow the muscles to heal and adapt.

Note: If you find that you have sore muscle the day after – this is a good thing! It means your muscle have been working hard and will heal stronger. To decrease the DOMS (delayed onset muscle soreness) and also help your body recover faster and stronger – a warm up and cool down is essential.

Work your whole body! It is best to do a work out that incorporates your entire body and not just one muscle group such as chest or quads. Working on just chest or triceps etc is not functional at all and is only useful for bodybuilding, professional weight lifting etc as very rarely do we actually isolate and use one muscle group in real life.

How much should you push yourself? To gain muscle you will need to really push the muscles. It is also best to use free weights and body weight exercises as these engage your stabilizing muscles and are a lot more functional that weights machines.

Sets and reps: 3 sets of 8-12 repetitions.

Stretching:

  • Before activity: Dynamic stretching – this is best as it functionally lengthens the muscles while, warming them up and increasing muscle activation.
  • After activity: Static stretching can be done here and is great recovery.

Rest and recovery: Again, you need to have 1 rest day per week otherwise you will start falling to pieces. Make sure to get enough sleep also and decrease stress as much as possible.

  • it is important to remember that rest does not mean, sleep all day, play video games etc, it means take it easy – you can take a walk, a jog, a bike etc.

Conclusion on how to build muscle: You need to do resistance training that really tests your muscles, have a good nutritional intake that allows your muscles to grow and give the body a rest so that it can recover.

You might also be interested in:

Please Share, Like, Comment and any questions are welcome!


Health, Mobility, Shoulder pain, Upper limb

Shoulder Stretches: Only the Best

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Shoulder stretching is an essential part of gaining a Pain-free, functional and strong shoulder. Whether you have had shoulder injury in the past, have tight shoulders due to poor work posture or you just want to have full range for an overhead squat – then these shoulder stretches and for you – all of you!

(Skip down the page if you want to get straight to the Shoulder Stretches!)

Following injury: regaining flexibility and range in the joints and soft tissues is an important aspect to the rehab process and if not addressed, you can develop other, secondary injuries such as sub-acromial impingement, postural dysfunction and any number of neck problems.

Poor posture: In today’s world, too many of us have sedentary jobs which require a lot of time sitting at a desk or behind the wheel. This leads tightness in muscles the pull your shoulders forward (namely your Pecs and Upper Traps) and weakness in muscles that hold your shoulder in a good, functional position (lower traps, Serratus ant etc). This is explained well by the Jandas Upper Crossed Syndrome.

Overhead squat and shoulder range: To hold a barbell overhead and squat down  we need great mobility around the shoulder and hip to do this safely. The main muscle that affects this is the Lat (along with your Glutes and Thoracic extension) as the come all the way from your pelvis to your shoulder.

Exercises:

Ideally you should do these everyday – You can water it down and do it less often but you will not get thew best result and it will take longer.

Horizontal abduction stretch for the shoulder. posterior capsule and deltoid stretch

1. Posterior capsule stretch:

Action: Pull your arm across your body.

Hold for 1 Minute.

 

 

Shoulder stretch for the triceps muscle and inferior capsule to decrease shoulder pain

2. Triceps and inferior capsule:

Action: gripping the elbow as shown, pull back and across.

Hold for 1 minute.

Tip: bend upper body away from side being stretched.

 

 

 

sleeper stretch for the shoulder - to stretch the post capsule and rotator cuff

3. Sleeper stretch:

Lye on your shoulder with your arm in front of you and your elbow bent to 90 degrees. using your free arm, grip your wrist and rotate it down towards your feet until you feel a moderate stretch.

Hold for 1 minute

shoulder stretch for the pectorals and thoracic spine. good for swimmers, cyclists etc4. Streamline stretch:

This is a great stretch as it stretches, Pecs , Lats and thoracic spine.

No balls – You do not have to use a Swiss/Physio ball – I use the back of my couch.

Action: when on your knee place both arms on the surface and relax your shoulder and upper back down. you can adjust the force that goes through your shoulders by moving your knees further away or closer.

Hold for 1 minute.

TIP: to get more of a tricep stretch place your hands behind your neck with elbows on the ball/couch!

5: Lat Band Stretch: 

The best way I have found for stretching Lats is using a band (a technique picked up from Crossfit) – now you can use a proper exercise band or a simple belt (yes one of the ones that holds your pants up) at home. Below is a nice simple video on how to do it:

Overhead distraction with Band

Hold for 1 minute.

Tip: you can also do this by holding on to a pole.

streamlined

And THAT my fiends is ten minutes well spent!

For Best results combine the above stretches with a good Shoulder stabilisation regime and you will really reap the rewards.

 

Note if you feel any pain (other than stretching pain) or have range of motion limitations post surgery then consult a trained health professional.

 

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Core strengthening, running, Spine

The importance of Core Stability on injury

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core strength minimizes lower limb injuryHaving a stable core and pelvis has huge benefits through-out the body, including laying a stable base for your legs to work off. This means more bio-mechanical efficiency, less injury AND less pain.

In order to do any lower limb exercise well, including running, squat, weight lifting, tennis etc, you need to be in control of your core. If you don’t have a stable base, everything working off it is going to struggle and compensate. This can lead to tight hip flexors, ITB syndrome, patellofemoral pain, ankle sprains, niggles and more.

Imagine a tennis shot, for example. Your are stepping forward and driving off your back foot while at the same time swinging your raquet forward to strike the ball. If you core isn’t in control then you are losing force between your legs and arms – losing that strength of the drive from your legs.

Core strength makes your body stronger, not just your abs, by conserving and transmitting energy.

Just for clarification, as “core” can mean different things to different people. Core for me is your Lumbo-Pelvic stability. The combined control and strength of your spine and pelvic muscles.

Quick self test: A great way to test and see how good your Lumbo-pelvic stability is yourself is to do the Single Leg Squat Test. If you see your hip dropping or knee tracking inwards, then you are at risk or injury and need to get started strengthening ASAP.

 

Poor core stability can also lead to and contribute to all sorts of injuries and pain, including in your:

  • Low back
  • Shoulder and neck
  • Knee and hip

 

So how do we sort this problem you ask?

Below is an exercise program to get started on that will really make a difference if you stick to it. I also fully recommend finding a good Physio in your area to have your specific deficits assessed to get some manual therapy to speed things up.

Exercises to improve Core stability:


1. Single leg Bridge:Bridge 1 leg - glute activation, leg strength and core stability. the best exercise for hip stabiltiy, great for runners

Position: lying on your back, bend one knee so that your heel is close to your backside and straighten the other leg as above so that your thighs are horizontal. Your arms can be crossed over your chest or down by your side to make it easier.

Action: Pushing through your grounded heel, lift your bum off the ground as above, straighten your back and hold for 30 seconds then lower and repeat on both sides.

 

2. Clam Plus: (Do them right and they are surprisingly hard!)Clam exercise plus - gluteus medius strengthening, pelvic stability, leg strength

Position: Side lying  with top elbow on the ground, knees bent, ankles together and importantly the top knee sticking out 1-2 inches further that the bottom knee.

Action: Making sure not to let your pelvis rotate backwards and keeping your ankles together Рlift your top knee up roughly 20cm and lower down in control. Reps: Build up to 50 reps on each side.

If you have found in the past that normal clams don’t do much for you, try it this way with your hip s rolled forward more to isolate Glute Med better and get less Tensor Fasciae latae activation.

 

3. Double or single leg squatSingle leg Squat, Glut Med activation - hip stability and strength:DL squat
Try performing the Single leg squat, but if you are too unstable (cannot stop your knee going inwards) then start with the double leg squats.

Single leg: 2 sets of 12 reps

Double leg: 3 sets of 12 reps

Tips: stick your bottom out like you are going to sit down and keep your knees out!

 

4. Front Plank: 
plank

Hold this for 60  seconds (if you can, otherwise build up to this).

Tip: do not hang on your hip flexors, tuck your bottom in and bring your hip bones up towards your head.

 

 

 

 

5. Side plank: side plank

Again aim for 60 seconds here, keeping your body straight!

 

Too easy? Add in leg raises to this – Raising the top leg straight up and down, building up to 50.

 

 

Do this short program  DAILY and stick to it for at least 6 weeks -Let me know how you go!

 

You may also be interested in:

Iron out your running – What you never got taught

Get your spine moving

Smash your Glutes


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