http-equiv='refresh'/> Global Therapies: May 2011

Tuesday, 31 May 2011

Hope Wakes Fell Race


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29 June 2011: Hope Wakes Fell Race - 7.30pm
We are onsite for pre and post event massage at this popular fell race in the glorious Hope Valley. More information on the Hope Wakes Fell Race website at here. Here's the route if you're interested:

Pain under the foot? Plantar Fasciitis.


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Ever got out of bed, put your foot on the ground and felt like you were standing on a pin? Then after ascertaining you AREN'T actually standing on a pin, trying it again, and having to go through an excrutiating few minutes as you wander around with this horrific shooting pain right underneath your heel?

Welcome to the world of plantar fasciitis, or, policemans heel. I've been a victim of it, and have treated a good number of people for it, from footballers to people who haven't been able to get fitted for ski boots because of the pain. What the heck is it? What causes the pain? Why does it affect some people and not others and most importantly, what can be done to allieviate it?!

Under your foot is a long ligament called the Plantar Fascia. It goes from the Calcaneus (heel bone) to the toes, and it is this piece of tissue where the pain is generally focussed. The tension in this ligament is partially what helps keep longitudinal arches in your feet in place as you walk.

The reason for it becoming painful is that it has become inflammed and tender as a result of either excess pressure on the area, or because of an issue slightly further up the body - generally in the calf muscles. (in my experience, the soleus rather than the Gastrocnemius, but we'll come to that later).

As you may know if you read the post about fascia, everything in the body is connected, so no one issue in the body can be looked at in isolation to the rest of the body. This is no exception. Calf muscle complex (the triceps surii - if you want to get technical) can develop excessive tone - get too tight, which pulls up on the heel. This then transfers down through mechanical loading so that the plantar fascia is pulled toward the heel, and stretches it tighter than it should be. The ligament is stretched over the boney spur which it attaches to, and becomes painful and inflammed, and hey presto - you have a very very painful spot on the bottom of your foot.

There are a number of mechanisms of injury for this. The most obvious one being hard shoes on hard surfaces - hence the name "policemans heel". Walking on hard surfaces with shoes without sufficient shock absorbancy, or with bad mechanics is going to end up making the tissues under the heel very tender. A number of city boys walking around in very snazzy shoes end up with pain under their heels, because the biomechanics of their feet don't work with the shoes, and the ligaments end up screaming in protest. The most recent case that I've seen was a footballer playing excessive amounts of football at the end of the season, on ground that was scuffed up and rock hard from a season of games, with a pair of football boots that were best suited for soft grass. Unsurprisingly his heels were not thanking him for it, and he had to miss a couple of games because of pain in the left heel.

Some of the advice on the net is to get yourself a tennis or a squash ball, (or if you're REALLY sadistic, a golf ball), and stand on it, rolling it around the base of the foot so that you can stretch out the ligament. Now, that's a great plan, and is very useful, but, as I'm always banging on about, thats looking at the smoke - not the fire. No matter how much you waft the smoke away, the fire is going to continue to create more of it.

The actual issue is most likely coming from the Soleus. (note that this is not a definite be all and end all, just what I have seen in my experiences so far). When I tell people that the pain is coming from a tight calf muscle, there are normally exclaimations that they ALWAYS stretch their calf muscles out, and it couldn't possibly be the reason.
The Calf comples- quite complex- as you can see, the Black muscle- the Gastrocnemis- the one you see on muscley peoples legs- attaches ABOVE the knee, and is stretched when the knee is straight.

What they mean is they always (ahem, well, sometimes) stretch out the Gastrocnemius, which is the most superficial (closest to the surface) muscle. This muscle attaches to the achilles tendon at the bottom, and just above the knee at the top. Doing a normal calf stretch, with the back leg straight is fantastic for this muscle, and stretches it marvellously. However, there is another muscle which I referred to earlier - the Soleus. It is deep to the Gastrocnemius and while it attaches to the same place at the bottom - the achilles tendon, at the top, it attaches BELOW the knee. All the time you stretch out the calf with a straight leg, the Soleus doesn't get a look in, and when you start exercise, its like you're starting with a cold muscle.

As you can see- the Soleus, which is deep to the gastroc (black muscle in the last pic) attaches to the achilles tendon at the bottom, but BELOW the knee at the top. Hence it is not stretched when the knee is straight.

If you want to stretch out the soleus, or at least get some blood into it before you head off on your walk/run/cycle/bog snorkel/netball game, do what you would do to stretch out your "calf" and then bend that back knee. It'll feel odd, but thats the point. Don't stretch to failure, or to pain, stretch to a slight tension.
And do it again at the end of the exercise session as well to get the waste metaabolic products out again.

How does this affect us with painful heels?

Well, because the Soleus is never stretched out properly, it retains its shortened state, and pulls on the achilles tendon, which pulls on the fascia around the heel, which pulls on the plantar fascia, and bang, you have tight tissue right the way down the back of the leg to the heel, and PAIN on the bottom of your foot.
It is THIS that may well be the fire.

You should be able to work out the pulling relationship of the calf muscles on the heel, and hence why pain appears on the bottom of the heel from this photo.
As a massage therapist I would look at the tension in Soleus and use a variety of techniques to relax it out. It would most likely be ridiculously painful to touch, so a gentle start, moving into some slightly more robust techniques would be called for - lengthening tissues, making them more pliable and generally assisting it to be less tight and ischaemic.

In terms of self-help - by all means use the balls on the bottom of your feet - you could also use a foam roller (as discussed in the ITB post) on the calf muscles - though be aware that it might not go deep enough to affect the soleus. It may be that you need to change your footwear - are they worn out? do you perhaps need to consider looking at orthotics? One thing I would suggest not falling back on as a first resort is buying "squidgy" footbeds - designed to be like a gel under your foot - again this is blowing away smoke - you are not correcting what is wrong, you are simply trying to make what is wrong feel better - not a good plan.

If you DO want to put something in your shoes which might make it better - look at getting a pair of pre-moulded footbeds like Superfeet- they don't squidge, but they do try and make your foot more biomechanically efficient - a better option than nothing.

Right, I hope that gave you some food for thought. Stretch that soleus, stand on a golf ball, and see a massage therapist. If they don't start prodding around in the compartments around your calf, go to another one. They may even track the biomechanical inefficiencies back up to the hips, or elsewhere in the body - don't be surprised. Everything is connected to Everything else.

Rock Over Climbing Wall Birthday Party


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Global Therapies will be providing FREE Sports Massages at the Rock Over Climbing Wall Birthday Party. See the Rock Over Climbing website for details of the party.


Saturday, 28 May 2011

May Queen fell race- Hayfield


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Back over to Hayfield for the last of the May Queen trilogy- (some what spread out this year rather than being all over the same weekend), and back to the Scout hut for the actual May Queen run.
I signed in and met up with a fair old gaggle of Glossopdale runners, good to see some friendly faces amongst the crowd. It was pretty damn parky out there, it has to be said, and I really wasn't looking forward to standing around in a vest and shorts waiting for the start to happen.

A lot of people were running around warming up, so I made a bit of an effort, toddling around while wearing my fleece, practicing running on cambers and things, but not actually burning much energy. As we headed over to the line up I spotted Dave, whom I beat (just) at the first race, and beat soundly at Lantern Pike, mainly because he didn't race- having just finished the Old County Tops. Standing around listening to the pre-race info and bits and bobs, I saw him bend down to tighten a shoe- at which point the pre-amble finished and Ready Steady Go, we were off... uh Dave... you might want to.. ah well, I'll just head on out.


Off we went, Adults and Juniors together on the same course, the kids tore away down the road, to be caught up by the rest of us as they huffed and puffed their way around the corner. Oddly enough, after leaving Dave behind doing up his shoe at the start, I caught up with him 300 yards down the road... what the...? I swear that man has learnt to teleport.

Then we got to the uphill, along through a wood, overtaking a couple of people, and then we got stuck. Well and truely stuck behind a Pennine runner who just wasn't good on the hills. It was single track and there was no way to overtake. Nothing for about 400 metres. Up, out of the wood and up again, ah, a chance to overtake, and up again.
Lungs burning at this point, but still using aerobic energy, my legs feel ok, and my breathing isn't laboured, I could keep this up all day.
Catching up with someone else, and then overtaken by a junior. (not a junior junior- but still not one old enough to know what a hangover is...) right, War.

Running up, and up the speed, damn, more anerobic, and the heart rate rises...
The climb continued, and then it flattened out, over a couple of stiles, and we can see the summit. I overtook another guy- this is almost unprecedented- me- overtaking on an ascent?! and then, within 20 metres of the top, I'm topping out on Heart rate, my breathing is going all over the place, and its all I can do to keep it together and not walk, 2 people came past, a Pennine guy and the young'un in a pair of x-talons.

I figured I could let them have it as we crested the rise as I'd quite happily take them on the descent. There was no way that I was going to get any more out of my legs or lungs on that ascent.
Over the top and down.
Down the off camber slippy slidey heathery craziness. Best stuff to run on. My heart rate comes back down, and breathing returns to somewhere near normal.
Yup.
Caught up with them easily, overtaking one young'un easily, and then overtook the two that took me on the ascent as they took a wrong turn down through the heather, jumping down through the springy stuff, it soon turned back into hard path- very glad I was wearing the roclites not the Baregrips... that would have seriously hurt...

I headed off down the hill, onto a road section and round a sharp hairpin, then an up- rasping breath behind me, and the Pennine guy overtook... damn it. There was more downhill to come, so not too much concern. Up over a field, and then down the hill, back to our original track that we came up. Down, down down, I was right on his heels... whoever you are, you need to practice your descending mate.
And then, final, last uphill, he strode away after holding me back on the descent, 4 metres, 5, then 10. I just couldn't keep in touch down the last 300 metres along the flat. At that point I was very purposefully NOT looking behind me- never look back, never surrender.

My lungs were seriously burning, legs felt like lead, and I was beginning to taste the sausage and mash I'd had a bit earlier. However, keep your eyes on the guy in front and don't even think about whats going on behind you. No-one is going to overtake now. I'm not going to let them. 
If there was space down that descent, I might have held onto a lead at the end, but there was no chance this time. I tried, but just couldn't catch him.

And into the funnel- 12th, in a time of about 24:326 seconds slower than that Pennine guy, ah, next time...
but hey, I beat Dave. (his son destroyed me by about a minute, so I guess thats one up one down...)
Still need to practice on those uphill sections on the back end of races, thats where I'm not necessarily losing places, but certainly where I am failing to make them up.


We stuck around for a bit, watching people pick up prizes, and then a surprise. 3rd bloke overall in the May Queen series... Me! 3rd fastest person to have actually got around to going to all 3 events.
Wow. I've actually won a prize! Not for a specific event, but for the series overall. Well knock me over with a feathered silk bowler hat with knobs on. I did not expect that.

So, my first fell running - well, actually any running prize. I am most chuffed and will be in touch with Andy to claim my IOU prize just as soon as he gets back from a minor little run somewhere in Scotland. The Isle of Jura I do believe. Good luck y'all up that way. Enjoy the race.

Wednesday, 25 May 2011

Cramp


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What is it? Excruciating. That's what. Out running last week and my left calf decided to cramp. I knew I needed to stop...not much choice really...and stretch out the muscles. But why it was happening is another thing, which I'll come to later.

Back to the what. Well, it is an intensely painful sensation caused by a sudden onset of involuntary muscle contractions or severe muscle shortening. What essentially is happening is an acute muscle spasm. This forces the blood out of the muscle: this is bad, it means oxygen and nutrients aren't getting to where they should be. Lack of oxygen and the muscle contraction stimulate pain receptors and hey presto – you're bent over in agony. Cramp is most common in the calves, quadriceps (thighs) and arches of the feet.

So why do muscles cramp? Although the exact cause (or causes) are not known; there are many theories: fatigue, low sodium and/or potassium in the blood, dehydration, low carbohydrates, and overexertion. More recent research could point to there being disturbances in the central and peripheral nervous systems, connected to neural excitability, but this is still a hypothesis and hasn't yet been proved. I'll be on the look out for more on this theory.

What to do about it? In a pre-emptive sense, the main thing you can do is to ensure your body is in a healthy state. You may be physically fit, you may not be, however, if your electrolyte balance isn't optimal then as you dehydrate, the balance of sodium/potassium/carbs in your blood and thereforei n your muscles is going to be off. Generally you should avoid dramatically increasing your mileage, duration or intensity of activity, or undertaking any strenuous activity to which you're unaccustomed. Gradual increases are the way to go. I suspect that my run last week and the ensuing cramp was a combination of overexertion (I had just climbed about 150m in 0.4km after 4km of already uphill running), electrolyte imbalance and some residual tightness in the calf muscles (gastrocnemius and soleus – which merge into the achilles tendon). I'm now having regular massage on my calves to decrease the change of this reoccurring.

When cramp does strike, you need to stop the activity and stretch out the muscles, gentle massage can help too. What you're aiming to do is to relax out the muscles and increase blood flow to the area, thereby improving circulation and delivering fresh oxygen and nutrients to the muscle fibres. There is often pain or stiffness felt in the affected muscles for a few days afterwards. This is because the effects of cramp is the same as a muscle strain. Fibres can be damaged because of the lack of oxygen and the severe muscle contractions. Treatment following any occurrence of cramp should follow the RICE protocol (Rest, Ice, Compression, Elevation), just as though you had suffered a strain, because it possible you have without realising it. We don't tend to think of cramp as the cause of injury, but it can be. Added to that, I've read that incorporating plyometrics and eccentric muscle strengthening can help, as well as regular massage and elimination of trigger points (these can be the source of already taut bands of muscle).

Tuesday, 24 May 2011

ITBs (Illotibial Band Syndrome)


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ITB syndrome is relatively common among the runners and triathletes that I have treated. It's described variously as a sharp pain on the lateral (outside) edge of the kneecap, so painful that its like someone is poking a hot pin in there and twisting it around. It can also be felt further up the Band, toward the hip, but for this article, Im going to concentrate on the knee problem.
The distal (bottom) part of the ITB, and potential painful spot.

As you would expect, this tends to have an effect upon running style, generally a pronounced limp, followed swiftly by a walk, and then a phone call home to get picked up.

For those who don't know, the Illiotibial Band is a wide strip of collagen fibre stretching from the hip down to the knee. It attaches at proximally (at the top) to the fascia around the hip and (more importantly) to a muscle called the Tensor Fascia Latae (hereafter known as TFL). The TFL is kind of embedded in the fascia as opposed to being the controlling muscle of it.
Distally (at the bottom), the ITB attaches to the fascia around the kneecap on the lateral (outside) of the knee. It is here that the pain from ITB syndrome usually hits.
The ITB (in blue) and the TFL (in Black)

Why does it happen?!
I'm going to have to split this up into 2 sections, Fire and Smoke.
Fire-
The actual underlying reason this happens is based in the gluteal region, (your bum). As you walk/ run, there are a series of 6 muscles called the Deep 6, (or lateral rotators), their job is to keep the leg in the optimal position with the hip. In effect they act like a guy rope to keep the leg in line.
Just for reference, these muscles in this group are the Piriformis, Obturator Externus, Obturator Internus, Quadratus Femoris, Gemellus Inferior and Gemellus Superior.
The Deep 6 (the observant of you will notice I have only drawn 5 on there, the Obturator Externus is best drawn on from the front- and a bit more difficult to visualise from the back- so to prevent confusion, I refrained from drawing it.)
 Other muscles involved in this action are Gluteus Maximus, Gluteus Medius (both in your bum), also Psoas major, Sartorius and Iliacus, but we shall skip over the last few for the time being.

Now, if these muscles are not working as they should, ie. they aren't strong enough, or they are inhibited (as most of the triathletes I have seen), they are not able to stabilise the leg in the correct position as you walk/run. The only thing that the body can really do at this point is use the ITB - a length of non-contractile tissue - to hold the leg - and therefore the knee - in the right place.

So instead of a group of 10 or so muscles keeping the leg in line, the body is relying on a single piece of collagen - whose original job is to keep the knee-cap in the right place - to keep the whole leg in line with the hip.
All the muscles around your bum. Its quite packed in there, if they aren't working properly, or are inefficient, its pretty obvious that something is going to have to give. Generally, its going to be the ITB.

Smoke
We know that the ITB is now doing the vast majority of the work because of the inefficiencies of the muscles in the bum. The ITB is made up of collagen - which is an awesome substance. It responds to stress by getting thicker and tighter. So, as you pound your way down the road (or the fell), the ITB is getting thicker and tighter all the time, if it is that tissue that you are relying upon to keep the hip, leg and knee in line, it's going to get tighter. As it does so, it begins to pull the kneecap laterally (outwards), and can have the effect of making the kneecap track incorrectly - wearing out the inside of the kneecap - but the beginnings of pain are generally the feeling of tightness on the lateral (outside) edge of the knee- just where the ITB attaches to the fascia.

Treatment

A lot of people swear by foam rollering, or "stripping" the ITB, which is as painful as it sounds. If it has gone far enough, the collagen has plasticised (my words) itself into a form that is supporting the knee and the leg. The stripping of the band is necessary to re-educate the collagen so that it loosens off and doesn't pull on the kneecap anymore.
A foam roller of the foam variety

The problem with this is that its taken a few years to get into this state, and just rollering it a few times isn't going to make it just go away. You have lengthened it a bit, but as stated, its like plastic. It needs a long time to go back to the way that it was. If you have ITB pain, you are going to need to be using that roller for quite some time before it gets educated to go back to the way it should be.
A foam roller of the improvised variety. It doesn't NEED to be Rescue Ale, but it benefits Woodhead MRT if it is.
 If you do go to someone and they start digging into the ITB in a way that makes your eyes bulge and your throat go hoarse, they should also be looking at that muscle we spoke about earlier- the TFL- its a small muscle, embedded in the ITB up toward the hip. This muscle helps create tension in the ITB, and if the collagen band itself is being treated, the muscle which assists it should definitely be looked at as well. 

However.
If you just get the ITB "stripped" thats just the start. The Lateral Rotator muscles need to be trained to work better. If they don't do their job, the ITB will continue doing more than it should be doing, and hey presto, it will come back, and you'll do the whole thing all over again.
If you see a physio/massage therapist who just does your ITB and sends you on your merry way, get another one. They are using you as a cash cow.
They should be looking at the musculature around the hip, the muscles may be weak/inhibited, they may be biomechanically inefficient and need stimulating massage as well - (just as a warning, this may be as uncomfortable as the ITB stripping). They should also give you ideas as to what to do to strengthen the muscles in order to help reduce the pain in your knee.
Examples of things you could use as a Roller for your ITB. (I didnt have a 2 litre coke type bottle, but you could use one of those as well, even better if its pressurised and you don't have to drink it)

Golden Rule 1
If you have ITB syndrome, get it seen to by a professional, the quicker you get it sorted, the quicker you will be running pain free, and the less chance you have of the injury compounding.

Golden Rule 2
If you talk to a professional about knee pain, and you HAVEN'T hit your knee - but they only look at the knee, go to someone else. If there hasn't been a contusion to the knee structure itself, the issue is far more likely to be in the hip or the foot. And if these are not looked at in some detail, well, thats a bad thing.

I hope thats been a decent intro into Illiotibial Band Syndrome, what it is and why it happens. If you have any comments, I'd be happy to hear them.

A portrait of the artist hard at work

Monday, 23 May 2011

DOMS - an explanation this time


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It has been brought to my attention that I did not really explain DOMS in my last post. I looked at it today and realised that its very short, and just talks about me.

Hmmm, maybe this time I might be able to give a bit more information as to what it is, why it happens, and how to avoid it.

DOMS stands for Delayed Onset Muscle Soreness. It is the feeling of painful, tired muscles that you get maybe 24, maybe even 48 hours after hard, unaccustomed exercise. You think you've got away with it, and then all of a sudden, you wake up and you can barely stand up, let alone walk down the stairs to make a cup of coffee.

What is it?
There are a few theories about this. The main one being that when you exercise, the blood brings oxygen to the muscles, and then takes away metabolic waste, e.g. hydrogen ions, which create carbonic acid, and lactic acid, which makes the pH level in the muscle too low for it to work properly - hence causing fatigue etc - taking it back to the lungs/liver etc to be dealt with.

If after significant exercise, you stop, and don't warm down, don't stretch, and just sit down for a beer, (or even if you chug a "recovery" drink, those metabolic waste products just sit there in the muscles. The blood isn't pumping as hard, and doesn't continue getting it out of the system.

Another theory is micro-trauma to the muscle cells resulting in an inflammatory process within the muscles, or it could be increased interstitial fluid (intercellular fluid) increasing pressure on pain sensitive structures.

Whichever one (or more likely a combination of these) factors it is, it results in increased muscle tension, swelling, stiffness and resistance to stretching.
(the lactic acid and muscle spasm theories have mostly been discredited, but muscle damage has a decent scientific basis)

Why does it happen?
Oddly enough, eccentric activity has been shown to be the main culprit for DOMS. (eccentric muscle activity is when the muscle is being loaded while lengthening- so if you were to lift a book, your biceps shorten- concentric- but if you put it back down, your biceps are still working- against gravity- even though the muscle is lengthening - eccentric)
When running/walking down hill, a massive eccentric load is placed upon the quad muscles on the front of your legs. Coming off a hill at the end of the day, and then sitting down in a pub is a recipe for really quite painful legs on the morrow.

However, it is not exclusively eccentric activity that causes DOMS. Cycling is pretty much only concentric muscle contractions, but I can definitely report having DOMS after an unaccustomed long hard ride.

Right- how to avoid it.
You are more likely to get DOMS if you change your mileage in a big way, if you do a strenuous workout that you haven't done before or if you aren't used to the stresses you are putting on your body because you suddenly do something different. If you are looking at changing an exercise plan, do it slowly, or Muscle Soreness will probably result. If something changes in your fitness regime/life, and uses muscles that you didnt know you had, or pumps blood through areas which don't normally get it - expect to get it.

Changes to Type of exercise
Changes to Time of exercise
Changes to Intensity of exercise
Changes to the Frequency of the exercise
If you do any of these 4 you are more likely to get DOMS.

If there is no way to avoid it - like you just HAVE to go on a 17 mile run over some hills today, or you HAVE to wander over that hill to see what is on the other side, or you HAVE to go to that aerobics class, at the end, WARM DOWN. Stretch out, if you can, ice your muscles, jump in a cold bath, (or glacial stream) for 10 mins, get waste products out of your muscles, have a post event massage, anything like that.

DOMS is avoidable, and I mostly rely on the icebath/ contrast shower recovery method, a bit of stretching and post event massage.

Fascia. Fascianating stuff


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Fascia. (or myofascia) its the buzz word in physical therapies at the moment. If you are involved in them, you may know pretty much everything I'm about to write, if you aren't a practitioner, and are vaguely intrigued by the thought that there maybe something else in your body - other than muscles and tendons which may be giving you gyp, read on.

When you cut a piece of meat - a chicken breast for example, there is generally that white stringy stuff which is of a very different consistency to the meat around it. A bit like this:


It connects it - and is difficult to cut through because it is strong, kind of stretchy and doesnt break very easily. THIS is fascia. In dissections in the past, for many years, centuries, in fact, this was seen as biological packaging - the bubble-wrap of the body - which had to be cut away and disgarded to enable the dissector to get at what they wanted to see. The muscles and ligaments.

It wasn't until about 30 years ago that people really began to get intrigued about fascia - and it would seem that it was people like Tom Myers who began dissecting according to new "rules" not following directions from previous generations looking for old theories - but looking at tension lines across the bodies - and seeing fascia as a connecting tissue, which really kickstarted the whole thing into a new paradigm.

At this point, I must add a side note about Dr Ida Rolf who originally created Rolfing - which uses fascia as a connective tissue as a basis for treatment, but I should probably leave that for another day, else, I'll be writing a thesis.

So, the body is bound up with fascia. It interconnects all our muscles, tendons, bones, organs, everything. If a part of the fascia in the right leg gets bound up because of a strange way of walking/jumping etc, the repercussions can be felt right through the body. That issue in the leg pulls on tissue around the bum, which in turn pulls on tissue in the back - which at varying levels and layers through the body may pull on other tissues leading up to the neck - or through the body to the organs - and all of a sudden, it's not just the leg that hurts, and a limp which the client has, but potentially, neck ache and disgestive trouble.
From a leg injury.

Fascia is a plastic kind of material. Think back to the stringy bits in the chicken. Imagine if all the fascia in your body was gel like - sticky and not very mobile. The muscles wouldn't glide very well, you would be stiff, and movement would be very inefficient. Think if this stuff was closer to a sol (liquid) state - how much easier it would be to move, muscles would glide, and there would be less chance of binding.

That is exactly what fascia is like. It responds to water. If it is wet - and is closer to sol than to gel, you will be smoother, glidier (if such a word exists), and generally more happy. If you are closer to a gel state - the opposite will be true.

The plastic analogy continues.
If the body is used to doing something a certain way, the fascia will bunch and stretch in specific places to make it more efficient at this activity. If you sit at a desk, the fascia around the muscles in your shoulders will become stiffer, in order to help the muscles around the neck support your head in a slightly incorrect way - forward and looking down. If you are a gymnast, the fascia will become more and more bendible, if you kick right footed, the fascia around your legs will "deform" to make the leg more powerful and stable - and if you were dissected (in the right way)- this plasticness would be easily recognisable.

The plasticity however, takes a while to manifest itself. If fascia is stretched, it goes back to its original shape very quickly. It must be taught over a long period of time. 6 months to 2 years - thats the time it takes for fascia to renew itself.

Now, as a brief intro goes, this is getting a little long.
There is more though - fascia, originally thought to be just packing material, it was discovered had usage throughout the body - and now, from groundbreaking research at Ulm in Germany, fascia has been proved to have movement sensors in it. Fascia is the largest sensory organ that we as humans have. It even seems to have contractile properties - like smooth muscle.
New things are being discovered as we go along - hence the rather exciting feeling of being at the cutting edge of research into the human body.

As an upshot to all this, (which I have skipped over very briefly, and have probably missed out so much), the bodyworker and the physio and the Personal Trainer should no longer be looking at which specific muscle does a single action, which particular bit hurts - on its own or thinking in terms of a limb on its own, diconnected from the rest of the body.
The body as an organism is a whole integral unit. Fascia connects everything to everything else. A bicep curl does not just affect the bicep - the fascia around it links so much more in, although your neck hurts, it could be your ankle that is affecting fascia right the way up the body.
Don't isolate bits of your body - it is not there to be isolated - you will end up disconnected and disjointed. Think globally, think fascially.

I'm sure there are people out there who read this and will say - huh - he's missed X, which is SO important to this discussion... well, write a comment, I'm eager to have my mistakes corrected, and to learn more.

For further reading into this, google Rob Schleip for his research into fascia, Tom Myers for Anatomy Trains or Ida Rolf, for her pioneering development of rolfing and myofascial release.

Sunday, 22 May 2011

Lantern Pike


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That was a short, sharp lovely little race.
As we drove over to Hayfield from Glossop, Lynne remarked "you're going up that", as we looked at a hill ahead of us.
Oh.
It is not a long hill, but it is a bit of a shock to the system.
We got there in good time and parked in the field- the weather was nice going on ugly- Sunny spells interspersed with sudden downpours.

We wandered around, and recced the first 200 yards or so, just down to the stream - noting the small chicane around a fence- definitely a good idea to get in the first group before the fence, and then, well, we looked up. And up. and there were flags going up the hill.
Nice.

Back to the car before it tips it down again, and watch a couple of Pennine lads jog out for a quick recce.
We met up with Chris and a couple of other of the Glossopdale contingent who were't over at Old County Tops (incidentally winning the team category), and had a quick chat about the route. Then change and off to the start.

25 Hardy Fellrunners, huddling in the lee of a hedge against one of the squalls that came in, a lovely image.
Without too much further ado, Andy came forward, got us to the start line, said some stuff about stiles that we paid lots of attention to, and then we went.
Andy talking about stuff
Down the field to the chicane was dominated by Pennine - all of whom charged off like loons. It was all we could do to keep up. Down, past the whippy tree that more than a handful of us got in the face, through the brook and up the hill.
At this point I was about 10th, and Chris was panting alongside saying something like "damn they went off fast". I couldn't speak, but I promise I was thinking something witty.

Up the hill, round the corner, and then, the Hill. (note capitalization). Chris was immediately in front of me, and I decided not to take him up on his kind offer to go ahead of him. Correctly as it turned out as he strode up the hill.
I could see 3 at the front, pulling away, and then 7-8 others, of which I was the last in the group. And I assume the rest of the field was following close at hand, though I never looked back.
Up, and up, and I tried to stay in touch. Everyone else, pumping furiously at thighs with their arms, something I don't do - maybe I should, but I'll talk about that another time - suffice to say its something to do with muscles and oxygen.

At the second of the stiles, (I'm sure Andy said something about them... stability issues? oh, I don't know), up and over, down a slight hollow, and then back to the gruelling up - the last bit to the top.

Half-way up, the leaders have already started their descent. I'm still behind Chris, but not by much, more people starting the descent, and I'm in sight of the trig point.

By the time we got round the trig, the next guy in front of us is pretty much down the first part of the hill and back over the stile. Crikey. I might have to just be happy with taking Chris.

Trail of runners up t'hill
Which almost went badly wrong as I tripped over some heather. Thankfully, I roll, and am up, equal with Chris, who voices concern - but don't worry about me, I'm chasing the next bloke.

I reach the stile just as the last guys are coming over it on their way up, I can see a Pennine runner, now, a lot closer than he was. Down over the flat(ish) bit before the second crazy descent. I can see him gingerly going over the other stile. (what was it about those stiles...? Ah- that was it, barbed-wire).
I leap over the stile, and the Pennine runner is already halfway down. Right. Brain off.
And straight down. Catching, Catching, just about... bang, my right foot goes down, doesn't hit the floor where it should, my knee extends more, then blam - into a rabbit hole - shooting pain through the knee as I go down - and roll, and up again.
Damn, my knee hurts.
But I'm now level with that guy.
Limping (fast) down the hill, I keep ahead of him - there is another guy - in a red top - but I can hear breathing just behind me. Chase the red, ignore the knee.
Ouch - that really hurts.
I run after that guy in red, pursued all the way. Can I keep this up? Its so short, I have to.
Down, over the brook, and the last ascent, its all of 200 metres, but feels like hell. I catch the guy in red just as we are going through the last hedge, but still fearful of Pennine, I sprint for the line, pain in the knee forgotten as I pass him and into 8th place.
Getting the guy at the post
13 mins and 45 seconds. Now that was a mix of energy systems - and my lungs are burning.
Still, not a bad race, but my knee hurts.

We hung around for the kids race, and the prize giving, and then headed back. Spent an hour or so with my knee elevated above heart level with an ice pack on it. (Rest, Ice, Compression, Elevation), but then had a client to work with (calf strain issues).

Now my knee still hurts - mainly on the tibial tuberosity - where the quads attach on the distal aspect of the leg. More ice and rest, a bit of lymphatic drainage, and I'm afraid I won't be at Trunce tomorrow. This is not an overuse injury, but is very much an acute sporting injury. As ever though, rest, and NOT "running through it" is the way forward.

May Queen this Friday though... we'll see how the healing goes this week, I may well see you there.

Healing muscle strains - Treatment


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As mentioned in a post earlier this month (Processes involved in healing a muscle strain) what treatment aims to do initially in a muscle strain is to reduce pain, swelling, bleeding and secondary tissue damage by utilising PRICE (protection, rest, ice, compression and elevation).

At the acute stage treatment is, as mentioned, to follow the PRICE protocol. You should immediately stop the activity which caused or aggravated the injury. Protect the area, limit movement either with bandages or splints and keep it away from danger. From the perspective of a massage therapist you may think that there is little that can be done. But, regular (perhaps daily) lymphatic drainage massage is very helpful in keeping the good fluids moving into the area and the toxins flowing away – this will promote healing and a quicker recovery. Sessions may only need to last 10-15 minutes, maybe shorter, depending on the size and site of injury. It can also be a good idea to start gentle, passive movement in the midrange; this will encourage any scar tissue that is beginning to form to form in a functionally efficient way. At no point should there be any stretching of fibres which are damaged – this will only serve to compromise the delicate matrix of scar tissue which is in the early stages of forming. A good therapist will be looking for any evidence of compensation patterns and will start to address these – don't be surprised if treatment is on parts of you well away from where you are injured, this is perfectly normal! The application of ice immediately following injury slows blood flow to the area thereby limiting swelling. And don't forget elevation – if you've sprained your ankle you need to get your foot above your heart. It's no use just putting it on a chair because the aim is to use gravity to help the flow of fluids away from the injury.

The next stage of healing is the sub-acute stage, which can last anywhere from 3 to 21 days from the time of injury. This is the repair stage, with treatment varying according to how healing is progressing. We can now carry out controlled movement of the injured area both passively and actively – but still keeping to midrange movements to protect the delicate healing tissues. The aim is to encourage a mobile and functional scar. When I say scar, I don't necessarily mean surface scar which is visible after a cut to the skin. Scar tissues can form within muscles, on the fascia that wrap muscles and in all soft tissues within the body. This is one reason we can have muscular imbalances yet be uncertain where they stem.

One thing that happens following injury is muscle guarding; this is when muscles are in a state of readiness – i.e. partially contracted, and therefore not relaxed. They do this around the site of an injury to protect that area. In some ways this is good, but if the muscles remain contracted (partially or otherwise) for prolonged periods of time then they can become fatigued and inefficient. They can become part of the problem, perhaps adding to developing compensation patterns or causing muscle imbalances which can lead to other injuries later on. The good news is that as therapists we know to look out for these issues and help to prevent them. This is all part of managing compensation patterns in the sub-acute stage of healing a strained muscle.

So in the acute stage you were applying ice to the area, well now you can now use hot and cold therapy to help aid the healing process – applying ice (not directly on the skin) and heat with a hot water bottle or heat pack. Cold constricts blood vessels, preventing further inflammation and heat encourages fresh blood to flow to the area bringing oxygen and promoting healing. Both should only be applied for short periods of time to avoid further damage to soft tissues. Alternating the heat and cold helps to reduce pain and speed up recovery.

Proprioception (the ability to tell where your body is in space) can be disturbed following injury, meaning you are more likely to have a recurring injury at the same site if you don't do strengthening and balance exercises. The disturbance to your proprioception may not be noticeable to you but it is caused by the transmission of sensory information being disrupted when nerve endings and sensory receptors are damaged. This means the brain doesn't receive the correct information about where your body is positioned and, for example, in the case of an ankle sprain, can mean that if you start to go over on it again your brain won't get the right signals to prevent that from happening – the result being a re-injury.

The final stage of healing is called the remodelling stage because it is all about the tissues in the area maturing over a period of 3 weeks up to 2 years depending on the severity of injury. The tissues need to become fully functional through stretching and strengthening to ensure that the collagen fibres are aligning correctly. If they aren't then massage therapy using a variety of techniques can manage and reduce adhesions and encourage appropriate scar tissue development. Stretching can now be within the full range of the joint providing the healing process if going well. Tissue pliability can be restored and any remaining compensation patterns eliminated. The aim is to make tissues functional in response to their natural movement patterns. Taping the area can help at this stage to encourage correct alignment and functional use, and to assist in development of good proprioception.

Saturday, 21 May 2011

Aaah. Now my shoulder's gone.


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If you didn't know, I also blog about my training on testedtodestruction, however, it appears that it is more like my body that is destroying itself than me destroying gear.

As a bit of background, I had quite a lot of shoulder issues last year - pain on the acromion process whenever it was touched - which is odd as there are no soft tissues going over the process - and therefore, there should not be pain unless I bruised the bone. Which certainly did not happen.

The muscles all around the shoulder were short, and the entire right shoulder complex was raised - so I actually looked pretty lopsided. After having massage, it was clear that I had lots of trigger points around infraspinatus, supraspinatus and levator scapula, but even after relaxation of these muscles, some residual pain was still there.

After some more in depth research and movement research I noticed that the structure that was actually hurting more than anything was the long head of the biceps brachii - going anteriorly up over the shoulder complex. It was this that was in pain, and the shoulder was basically hunching over forward in order to slacken the tendon off, pulling the scapula forward, which caused an impingement on the bursae below the acromion process.

Bingo. Thats the reason for the pain.

For the past few months I have been taking time out of any overhead movement, pressing movements etc. and it seems to have got much better.
I went out and did a weights session last week - which turned out to be chest and arm work - and what do you know, the shoulder pain is back with a vengeance.

Plus side - I know exactly what caused it- and I shall be steering clear of overhead presses and excessive push-shoulder work for quite some time. I think static hold are ok - and wierdly enough, pulls are fine - so climbing is not actually affected.

Minus side - I'm back to square one on the shoulder issue - and rest is the only way forward for it. I shall be stretching and going back to rehab exercises, because if I don't, its just going to get worse.

Friday, 20 May 2011

A couple of thoughts on electrotherapeutic modalities


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Having been to a couple of physios in the past for various soft tissue issues- namely tenosynovitis in one of the tendons in my thumb, and once for a knee issue from fencing, the main treatment that was given to me was Ultrasound. The physios veered very much away from massage as a modality, and used a lot of the electric stuff.

There was also a lot of movement therapy, which was great, but only about 10 mins of actual manual therapy. This is fine as it is, but from a little research into clinical sports medicine I came across an interesting study on electrotheraputic modalities.
It would seem that electrotheraputic modalities have been tested on a clinic scale rather than a scientific scale. The study I was looking at specifically mentioned Ultrasound, which is marketed as reducing inflammation and promoting healing- of which apparently there is only limited evidence. Indeed, if ultrasound is being used as a modality, it should not be relied upon as the SOLE treatment, but should be used as part of a collection of treatments on the injury.
In my experience, this has not been the case, and has been relied upon as pretty much the only thing, apart from remedial exercises, to heal the injury.

Another thing thrown up by this study is that there is little evidence to suggest that ultrasound is of any use on Soft-Tissue injury (specifically overuse injuries)- BUT, it has been shown to work on non-union fractures - helping bone to regrow back together. There is a condition to this though - and that is that the Ultrasound used is LIPUS (Low Intensity Pulsed Ultrasound)- and that it is used for 20 mins a day on a daily basis.

Traditional ultrasound, by contrast can only be used for no more than 5 mins at a time, 3 times a week, which doesn't give enough time for it to actually work on soft tissue.

Now, I'm not saying that Ultrasound is useless for long term overuse soft tissue injury. From the reading I have done, it seems that it is good in accompaniment to other theraputic modalities. Obviously I'm a bit biased in saying that massage is one of the better ways in which to get that healing, but there are any number of modalities. Don't rely on just one of them though.

As a note, the information in this post has come from Clinical Sports Medicine, P140-142.
If there are any studies that dispute this, or you are coming at the Ultrasound thing from another angle, I'd be glad to read them and have my perspective changed. Please do point them out.

As they say, don't use science to prove you're right, use science to become right.

Thursday, 19 May 2011

Climbing and Massage


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Why on earth would you want sports massage if you are a climber? Is there ANY relevance at all?
well....

When you exercise your muscles use oxygen, and give out metabolic waste products. For muscles to operate efficiently, they need to contract and relax - a bit like a pump, getting new oxygenated blood in, and getting old blood out and back to the heart and lungs again. Climbing is an interesting one as the muscles are generally contracted for large amounts of time, and not relaxed so much - which means the pump - which works to a point, is not as efficient as it can be.
The tighter the muscle contraction is held, the less oxygenated blood can get in to the muscle to give it nutrients it needs - and the less waste product it can transport out.

This is where your Pump comes from after a hard session - blood which sits in the muscles and doesn't get out - if you don't stretch at the end of a session, and the metabolic waste products are not released from muscles for a while, they can cause cramps, pain, and DOMS - delayed onset muscle soreness. That's the pain you feel up to a couple of days after a hard session.

Massage helps get rid of these issues. It is not only good for helping with circulation - which is a very superficial part of the massage process.
I know some of you will have heard of Duputreyans condition- for those of you who haven't- look here http://www.ukclimbing.com/articles/page.php?id=1312 Massage - specifically a technique called Soft Tissue Release (or ART if you are American) can help as a preventative measure against this rather nasty condition.

I know a lot of climbers (myself included) who have had issues with the rotator cuff - a minor issue in saying I have a problem with the rotator cuff is which part of it?! There are from 4 to 12 muscles involved in the rotator cuff - depending on who you talk to. We can help- looking not only at the muscles, but also the fascia surrounding the joint complex.

Once injured, it is somewhat difficult to get it back to the exact working order that it was it previous to the injury. Preventative work may well be the way forward - maintenance massage once or twice a month, working out the kinks in the muscle and fascia through the areas that you use the most, getting an assessment as to how the tissues feel - whether you are working too hard, what feels tense, and what is painful - this self-knowledge will give you more of an idea of your body's overall health.

As a remedial modality, massage can help in rebalancing the muscles in the body. Be it for general posture, assisting in creating more body awareness and general proprioception, or even assisting in gaining greater flexibility. We can help you get better, or just get BETTER.

Back in the day- Mark Twight, Dr Death himself, advocated massage in his book, Extreme Alpinism, saying "deep tissue massage aids recovery. Treat yourself to a massage every 10-15 days. Shun those touchy-feely masseuses. Find someone who can dig, restructure and strip apart bound-up muscle tissue."
And more recently in his writings as director of Gym Jones- "Recovery is 50% of the process of training...Respect recovery... Deep tissue massage focused on restructuring muscle and fascia is a very effective monthly tool."

Eric Horst- writer of "How to climb 5.12", and more recently, "Training for Climbing" has said "Sports massage helps reduce the number of small and generally unfelt spasms that regularly occur in muscles. These spasms may go unchallenged by regular stretching and warm-up and left unchecked, may rob you of co-ordination and induce mechanical resistance and premature fatigue."

And our own Dave McLeod has said in "9 out of 10 climbers make the same mistakes" - "Consider experimenting with other stress relieving activities such as sports massage, stretching or yoga... don't underestimate the cumulative, long terms effects of poor recovery and management of training stress. It will put a lid on your improvement if you are ignorant of it. Treat your body nicely and it will return the favour."

Perhaps what Mark says is the most important. If you want to improve, if you want to get better, and, perhaps more importantly stay injury free, getting a massage isn't going to be about a relaxing, chillout massage. These are all very well for feeling nice and fluffy, and excellent if you are taking time out.
However, if you are training hard, and not resting enough, your muscles will be bound together with abnormal crosslinked fascia, it is likely that they may not be working efficiently, and your ability to get the maximum amount of power from them is compromised. Those muscles need to be worked on deeply, restructured, and made to be more efficient.

At Global Therapies we are versed in a number of types of massage from the relaxing, soothing "touchy feely" to the deep tissue restructuring, and fascial release side. We have the knowledge, we have the experience.

Sports Massage and Remedial Massage is beginning to become more popular at Climbing centres across the country - The Castle and the Arch down in London, Big Rock in Milton Keynes, The Barn in Devon.

We are proud to be helping climbers around the Manchester and Derbyshire/High Peak area recover more, and become better, harder climbers through recovery, restructuring and injury proofing. Don't wait until you break yourself, get a maintenance massage.

Wednesday, 18 May 2011

Pain


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We all experience pain, be it emotional or physical, at some point in our lives. Some people are lucky and only experience pain when they are injured, like when they twist an ankle running in the fells or cut themselves accidentally while chopping vegetables. Other people seem blighted with pain, going from illness to illness, often (and frustratingly) without a specific cause. But pain is pain, whatever the cause or reason for it. And the level of pain we feel is on a continuum, and it is difficult to be precise about this as ones own pain tolerance is unique. What is clear is that massage can be highly effective at reducing or eliminating pain, we'll see how below.

The degree to which you react to pain comes from many sources: biological, psychological, cultural - essentially pain is subjective because of who we are and what we have experienced and been influenced by in the past.

On a physiological level, the perception of pain is caused by the stimulation of nociceptors (sensory receptors) - either chemically, mechanically or thermally. The point at which a stimuli is perceived as pain is known as the pain threshold, and interestingly, this threshold is pretty similar for every person. It is how we react to the perception of pain which can be dramatically different. Some people are able to inhibit pain sensations, whereas others magnify them - for the reasons mentioned above. It is behavioural and emotional responses which either inhibit or magnify the perception of pain. So whether we are anxious about being hurt or withdraw from situations which may cause us pain, or whether we choose to accept that there is some risk of injury, is what makes us and our reactions to pain unique.

The nociceptors which detect pain send a signal to the brain via the spinal cord. That signal can be reduced by endorphins or increased by substance P (a neurotransmitter released from sensory nerves). Massage can influence these signals (for the better, i.e. reducing or removing pain sensations) and chemical responses, although the mechanisms of this are not clear.

What is interesting is that if somewhere in your body is painful (whatever degree or level that is perceived) then the muscles in that area can exhibit sustained contractions, which in turn restricts the blood flow through capillaries to the constricted area. The restriction of blood flow means that less oxygen is being delivered to the area and ischemia develops. Even a short exposure to such conditions (from a direct trauma or injury) can produce ischemic pain.  If local metabolism is increased like when a strong contraction occurs, then oxygen is burned quicker and the sensation of pain is not only apparent quicker but more intensely.

While the exact causes of ischemic pain are not clear there are contributing factors which can be identified: the presence of chemical stimuli (such as bradykinin or histamines - which are released when cells are damaged mechanically or chemically), when there is a build up of lactic acid, and when there is a reduction in the amount of oxygen delivered to the cells.

The original injury site (where pain sensations were perceived) causes the muscular contractions, that leads to ischemic pain and maintenance of those contractions results in a vicious circle because pain is caused by those very contractions. Associated with this are shortening of muscles and restricted range of movement - these can also cause more pain. When muscles become hypertonic they are excessively tight, have a shorter resting length with the myofibrils packed too close together - this reduces circulation and leads to restricted oxygen flow, and therefore pain. The aim of treatment needs to be to break the cycle, find the contributing factors, the location and what aggravates or alleviates the pain. Myofascial release, ischemic pressure and passive and active stretching of specific muscle fibres, reducing joint stress, normalising tissues, along with deactivating trigger points are all key. An assessment of your range of movement will highlight any tight areas and where imbalances are present.

Returning to nociceptors, the stimulation of nociceptive nerve endings are how pain is felt and these nerve endings are found throughout the body - in bones, cartilage, ligaments, tendons, fascia, bursa and neural structures. So damage to any of these will stimulate the nerve endings and you will perceive pain.
The longer a site is stimulated, either through mechanical damage (stretched fibres/structures, compression or trauma) or by chemicals (histamine or inflammation), the greater the risk of developing altered movement and compensation patterns. Think about a time you injured only one arm or one leg; your body will try to protect that area by avoiding its use, so the other (uninjured) side has to adapt its movement patterns to cope with either a weaker or painful opposite. Your body will not be functioning in an optimally biomechanical way. Even if you are not aware you are doing this, it can be happening because it can all happen at a microscopic level. And this is where massage can help to eliminate imbalances that can lead to longer term issues - which you would notice. Whether the initial pain source is your joints, ligaments, muscles, tendons, fascia or neural structures is essentially not important - they are all interlinked and will affect their neighbours both close and distant. This is why a remedial massage therapist will work on your feet, hips, back and neck if you have a knee problem. The pain you initially felt causes muscle spasms and tension throughout your body, so while you think your knee is the cause (and it may be), treatment has to look at the body as one unit. For treatment to be successful the fascia and muscle imbalances/tightness need to be eliminated and range of movement restored to normal. Part of that treatment will be the elimination of trigger points as mentioned above, but those are a whole topic of their own and we'll blog about TPs separately soon.

I've mentioned pain being the result of injury, but that isn't always the case. Poor posture (sitting at a desk all day), oxygen depletion (perhaps because you are stationary for too long or have restricted circulation), heightened anxiety levels or just your emotional state - these are all significant enough to trigger muscular contractions in a specific part of your body which can bring on that cycle of pain. Toxins build up and the metabolism in that area becomes impaired, leading to further damage to cells in the area. If this occurs over a period of time, it can even lead to scar tissue build up.

So how do we fix these things? How do we eliminate the pain (which can range from debilitating to a slight niggle)? Well, we could take medication - either over the counter pain-killers, or prescribed medication. There are risks and side effects to any medication (always seek medical advice before taking any medication) which I don't need to go into here. We could remove the stimulus which is making us perceive and feel pain - sometimes easy, sometimes not - it all depends on whether that stimulus is obvious to us. We could also have some form of bodywork - the power of touch alone could be sufficient to relax someone enough to remove the pain source. Or perhaps you could have deeper, specific massage techniques which can be employed to deactivate those trigger points that are causing headaches, relax out spasming muscles and rebalance the body to return dysfunctional postural patterns back to functional efficiency. Whether the cause of pain is known or not it needs to be eliminated through intervention.

Tuesday, 17 May 2011

abdominal massage and spasming diaphragms


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If you've read the post about the Mount Famine race, you may remember I mentioned a spasming diaphragm. This is a bit of a wierd one which I first felt a good few years ago when I was running in Japan. (just for fun, I must hasten to add... trying to lose weight to get better at climbing)

Sometimes, as I was running, I would get a really really bad pain in the abdomen, on the right side, just below the ribs. I knew it wasn't stitch- I've had that before, and it went pretty much as soon as I stopped running, only to return as soon as I started again. I then didn't run for a few months, and when I went out for a run again, it didn't hurt.
Wierd.
Didn't think much of it until recently.

The most recent time I had that pain was in Mount Famine, when I was really pushing it, and the time before that was in a (fun) winter time trial over 5km with some of the guys down in Greenwich Tritons. I was fine for 4.75km, then I thought I'd up the pace- boom, within about 20metres I had that stabbing pain in the abdomen, and it didn't go until I stopped. Mount Famine- it came, but by then, I figured out what it was.

Looking at the abdomen- the pain I was feeling was just under the ribs, on my right side. When I finished a hard run, it was slightly tender to touch- but the real issue was just to the left of the xiphoid process at the bottom of the sternum. That REALLY hurt, and, pressure there recreated the pain pattern that I was feeling during those all out aerobic efforts.
What could that be? What muscles attach there, and have bearing on breathing? The main one is the diaphragm- hence my suspicions of the spasming diaphragm. One might call this a Breathing Pattern Disorder- not one that is induced necessarily by bad posture, but perhaps one that is induced by breathing too hard(!)

So I sat (well, lay) down today to have a quick check around and see if I could sort it out. We studied abdominal massage during the course at NLSSM, and I have to say that I somewhat under-utilise it with my clients.
Using a soft touch, I worked my way around the area, noting that the area around the xiphoid process was tender and referring pain, especially under the ribs, my main abdominals felt tight, and the tissue between the ribs- the intercostals were really quite tender... all of this is probably because of a long period of exercise, and not getting enough massage to the muscles- hence the problems.
So I worked on the offending areas, working in the correct direction (so as not to disturb the peristaltic rhythms of the gut), feeling where there were adhesions between organs and muscular walls, and doing some Soft Tissue Release, especially on the diaphragm- that was pretty intense, and not without some discomfort.

However. I now feel much freer, more relaxed, and much more at ease with myself. It would seem that the phrase "a knotted stomach" is not just a metaphor, but also a physical condition which can cause anxiety and concern.
So, if you go to a massage therapist, don't just expect a back rub- those soft tissues, organs and the like may well be in desperate need of some care. We are used to having our posterior musculature rubbed and soothed- so why not the anterior? It seems a little wierd, however, it is soothing, relaxing, and when done correctly, most rewarding.
I shall be using abdominal massage as a modality within a modality a lot more from now on.

Sunday, 15 May 2011

yep- the knee is ok. Its my glute med that hurts now


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Thought I should probably write an update on the knee issue that I mentioned last week.
Its fine.

There we go.
The rest for a couple of days that I enforced on myself, along with the ice, compression and elevation for the first couple of days during acute and subacute phases appears to have done the trick. I abstained from deep squats for the next few days after that, though from an analysis of my squats, double legged squats do not appear to be the issue. Its the single legged ones that are the problem.
As I squat down, the knee starts tracking medially (inwards - toward the midline) which then strains the patella tendon- and at the point that I squat back up, THAT's when the tendon becomes overloaded. As it is at a biomechanical disadvantage while the pressure is being put through it, it is placed in a weakened position - the collagen fibres are not taking the strain as they do on a day to day basis, and the tendon becomes inflammed and tender to touch.

IF it was in the correct position, and I was squatting in a biomechanically efficient way, then the force generated would go through the tendon in the way it is meant to, in its strongest position, it would not become inflamed, and I would continue to build up muscular endurance.

Now, the issue with this is that when running, especially up and down hill, as fell running tends to demand, you rarely land on both legs at the same time. When you hit the floor, you do a mini squat - on one leg, on unstable ground. The chances are, you aren't giving the knee any chance to land in a biomechanically advantageous way... so therefore, more chance of being injured, and having a very tender spot below the knee cap, and maybe having to rely upon pain killers in longer races. (not a good idea, it masks the pain but the issue is still there).

How to sort this issue out?
I may have mentioned this in a previous post, but it boils down to a weak gluteus medius and deep lateral rotators. The best way to describe this muscle to imagine your shoulder- there is a large muscle covering the the shoulder- you can easily see how it influences movement in the shoulder. The gluteus medius does pretty much the same thing over the hip joint, being involved in almost every movement of the hip.
The lateral rotators - of which there are 6, rotate the hip outwards, and help prevent the upper leg diving in toward the midline as you single leg squat. So it's these muscles that need to be recruited and built up to prevent the knee diving, which, in turn, will stop the pain the knee.

The fact my glute med hurts after Mount Famine yesterday means that it has been overworking, needs a bit of rest, a bit of massage to get the waste products out of it, and blood back in, some foam rollering, and then a bit of strength work.

Slow single leg squats, in front of a mirror, ensuring the knee is tracking where it should be, accompanied by balance drills on a wobble board.
Simple.

The main take away from this is, if you have a knee issue, and there has been no specific trauma to the knee, chances are, your knee is NOT the problem, only the symptom.
If you see a massage therapist about your knee, and they start looking at issues in the hips or feet - that is a good thing. They are looking for the fire - not the smoke.

Saturday, 14 May 2011

Mount Famine


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Well, what a race. Brutal is a word you could use.
We got over to Hayfield with plenty of time to wander up and have a quick look at the final run in- and also at the start. Which is quite a daunting crazy hill straight up the side of a hill with a large amount of rather lush vegetation.
Changed and numbered up, I was running my first race in club colours- Glossopdale, and having had a couple of races in which I was put somewhat at a disadvantage by letting others charge off and waiting til the back to start, I thought I would go in with a slightly different race tactic of going hell for leather up the slope, and seeing how things pan out for the rest of the race. Maybe not my greatest tactical move ever.

3,2,1, off we go, not so much running as scrambling over the roots, brambles and through trees, then it gets steeper, and someone remarked that it was like breaking out of prison. (prison? which prison was that guy in?!). and after a mercifully short time, we were back on the flat and going oh, not flat, but up to the dragons back up toward Mount Famine itself.
I had done what I wanted, and was within spitting distance of the fast group, and slowly bleed places as I shuffled my way up the hill, trying with all my might to get my pulse back down to somewhere resembling a non-max HR. It didnt work.
So for the next couple of km's I steadily dropped back down the field, but not so much that I was particularly worried. I seem to be slower than average on the ups. Something of a theme in my running, and by the time I was at the first peak, I was with a team mate who indicated to the steep incline to our left and said- yup we've got to come back up that in a minute.
Down, up and down into the clough, I managed to hold my place there, but on the climb back up I had nothing. overtaken by another 3 guys, and then, after scrambling my way back to the top of Famine, a real hands and feet job, I turned and saw another of Glossopdale in close pursuit. Damn.

I stumbled off the top, leaden legs swinging my way toward home, back down the dragons back, finally managed to take back one of the places robbed of me on that last climb- (his shoe laces were coming undone by that point, so it didnt really count), and on, down into the the wood- nearly catching another who had caught me- when Dave comes past me saying "come on Tim"... nice- my retort... "I'll be with you in a minute".

We over took the next guy and he homed in on a- I think he was a Dark Peaker, but I just didn't have the legs in me at that point. I knew we were 400metres from home, and I'd done myself in. My breathing was laboured and my diaphragm was beginning to spasm. It would respond really well to Soft Tissue Release, or a session of MET, but at the end of a race, they aren't really an option. I was a good 30 metres behind them, and just about managed to stay in touch. The distance ground away, and I stopped concentrating on the guy behind, and followed Daves heels. He took the DPer on a short incline, then he was taken back, we hung a right, then a quick left into the play park, was still a good 30 metres behind, the funnel came into view, and even though a few moments ago I honestly thought I was a gonner, and my lungs were bursting somehow, from somewhere my legs started going, bang, it was like the other two had slowed down- I guess they hadn't because they were racing for the line, but in those last 20metres I had the final burst of speed and dropped them both, not even 5 metres from the end.


Just pipped them at the post- going so fast Lynne didn't have a chance to catch my face... (probably a good thing)


54.47 by my watch. (didn't know that til I looked on the computer- I was so excited by the end I forgot to stop my watch).
Me at the end. Watch still running
Nice to see so many of the Glossopdale lot out, and nice to feel properly knackered at the end of it as well. Couldnt stay for cake as my contact lenses were playing up.
Tactics need to be developed somewhat. As does my climbing...

Friday, 13 May 2011

interview with the olympics. (well, Locog)...


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Today saw us do a 400 mile round trip to the Excel Centre in London to be interviewed for our suitability as massage therapists for the upcoming London Olympics in 2012.
We registered on the site last year, and hadn't really heard much at all in the past few months, and so didn't really think anything had come of it.

Since moving away from London, we have suddenly been back in contact with them, and were invited to an interview event in the Excel centre. 7 tube stops away from our previous flat, and quite a bit longer from our current place in Glossop. As there was only 1 day available for our interviews, we went online at the same time, and managed to get the same time slot requested- around midday today- Friday 13th May.

To cut rather a long story short, we got down there in plenty of time, and spent time outside in the sun, drinking coffee and thinking how absurd it seems that we lived not 5 miles from there, only 5 weeks ago.
After faffing around, chilling out and generally mooching- attempting to think up questions which may or may not be asked of us in the interview, it eventually became time for us to wander in, and after sitting in the reception area for a short amount of time, I happened to see Susan Findlay- Director of NLSSM- and head tutor of our Sports Massage course- walk through the door. We ran over to say our hellos and so forth, at which point she said that she was certainly not doing our interviews- she was only doing people she had not tutored. Not giving anything away about the interview, we agreed to meet up after it was all over.

The majority of people in the "intake" we were in were volunteering for transport/logistics, but the co-ordiantor for the medical team was on hand to take us through the details of how the team was potentially going to be organised throughout the olympics- where we may or may not be be needed, and a general overview of how the whole thing should (theoretically) work.

Within the olympic village apparently there is going to be a huge medical centre, in which there will be a large amount of sports doctors, osteos, chiros, massage therapists, dentists etc. all of whom will be volunteers. It all sounds rather exciting, but, as you can well imagine, its all a basic framework at this point, and bits are being filled in on a daily basis as it goes.

After a short introduction to what we (or rather the transport people) were volunteering themselves for, there was a short film about the olympics and why volunteering is so important- finished off with a 3 min talk from Eddie Izzard (on the screen, unfortunately, not in real life), and off we went to the interviews.

As Massage Therapists we were interviewed by other qualified massage therapists- who had volunteered to be interviewers. There were all the volunteer type questions you would expect to be asked, and also, because of our speciality- a couple of curve balls were thrown in to make the interviewers aware of the level of our experience. They were assessing us not only on our massage skills, knowledge of body mechanics and contraindications, but also on how we deal with people, athletes, and our past experiences of volunteering.

All in all, it was a very thorough interview, and I hope I can say we came through it with flying colours. But we have to wait until much later in the year to find that out. With 5000 staff to recruit on the medical team alone, the whole thing is taking a massive effort, and it is possible to see why things do seem to take quite a while to get into motion.

Hopefully, all things being well, we shall be working at the Olympics- and I should make it clear that the reason we are volunteering is not solely so that Lynne can massage Usain Bolts bum.

After the interview we caught up with Susan and had a good old natter about how things are going at the school, and had a quick chat about the marking we are doing on the Anatomy and Physiology papers- which this time a couple of years ago, we were doing! Lovely to catch up, even if for such a short time, and then it was back in the car up the M1.

It would have been better to take the train- but when the car is only half as expensive... what choice do we actually have?

As a final word- just as we got home, we got a call from Tom at Rockover climbing wall asking if we would like to help out at a climbing comp in the near future. I suspect we'll be over there for Rockovers birthday, doling out massages- potentially in return for donations to Mountain Rescue. We'll keep you updated as and when we know more of whats going on.
And tomorrow... Mount Famine. Short. Sharp. Looks like it may be a tad boggy. My first race in club colours...