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

Sunday, 30 October 2011

Rockover GROWL

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Today saw the first of the Rockover Climbing walls GROWL competitions. The sun was out as we went over there at about 11am as the first of the eager competitors were registering - though it was rapidly clouding over - perhaps a better day to be inside than out for a decent bit of climbing.

Tom and Simon had been busy setting up new problems for the competition, just over 40 of them ranging from V0 to about V7-8ish. Perfect for general competitions in the UK, but there were a couple of worried glances as Shauna Coxsey and Alex Puccio arrived at the door - concern that they would just flash all the problems and head out for a beer. However, it seemed that the vast majority of the climbers would be challenged by the routes.

The new walls and volumes provided an excellent challenge, and the training and circuit boards upstairs were being used to great effect.

Not only was there a general competition with a final climb off at the end, but there was a cash prize route - with anyone who climbed it getting a share of the cash. Obviously the more people that do the route, the lower the prize, so unsurprisingly, anyone who managed to get up it was being quite secretive about their beta.

We were there very much in a volunteer capacity, helping out with arm de-pumps and general advice about injury (generally referring back to the RICE protocol), though we were collecting donations for Mountain Rescue as well - which is a charity organisation close to our hearts as climbers and mountain goers.

We have already had some fantastic feedback from the guys at the wall- both the organisers and the competitors about our services, with several climbers mentioning that after a short treatment they felt like they hadn't even climbed yet. My response being - well get back on the wall then!

We were there until the end of the bouldering comp and saw a fair few people during that time, always good to make friends down at the wall - and I look forward to seeing them again, and climbing with them once my leg gets better (but that's another story for another post).

Unfortunately we were not able to stick around for the dry-tooling competition as we had a prior appointment elsewhere, but from the photos, it looked like a great time was had by all. Hopefully next time we should be able to have a go!

If you weren't there, get to the next one, good routes, good food, good company, and of course, good massage. The next one is on December 3rd. See you there!

Friday, 28 October 2011

Continual Professional Development

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What are we doing to make our services better for you?

We spend a considerable amount of time reading, researching and learning new techniques so that our clients get the very best treatments. We have an extensive library of books which are continually being pulled of the shelves, and the internet is abound with resources for us to delve into. Whenever we come across a new health condition or injury we spend a lot of time learning about it.

Being able to give each other treatments and practicing new techniques, is great. It means that when we come to provide you with a treatment our skills have been tried and tested - plus we know what it feels like.

Finally, we go on courses to learn practical skills and new knowledge from the myriad of experts in our field. The next courses we are attending are:

6 November - Lynne is attending a course in Manchester run by Professor Shirley Sahrmann: Differentiation and Effective Management of Lumbar Spine and Hip Pain using the Movement System Syndromes Approach. Lynne will be learning about "the factors that contributing to these syndromes of the lumbar spine and hip, how to correct any offending movements and as such be far better equipped in determining the regional source of back and hip pain AND, more importantly, how to successfully train and rehabilitate the person."

11-14 November - Tim will be attending an Advanced Therapy Course run by John Gibbons in Oxford. This course focuses "mainly on the treatment of postural dysfunction for the major joints" and aims to give therapists "the knowledge and practical experience to competently assess, treat and be able to identify specific dysfunction within the musculo-skeletal framework."

This is a selection of the things we do to keep our knowledge up to date with what is going on in the world. All of these modalities of study count towards our Continual Professional Development. As level 4 members of the Sports Massage Association we are bound to complete a minimum of 40 hours per year of CPD. Both of us far exceed this requirement and are always seeking new knowledge to improve our treatments for you.

Friday, 21 October 2011

Rest Days

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Knackered. Run down. Beat up. However, you still feel like you should go to the gym, go on that run, do a hang board session or go to the climbing wall.
Really? Is that going to do you much good?

Think about how many times you train during the week.
Actually, more importantly, how many days do you REST during the week? Note that this doesn't mean how many days do you not go to the gym or run if on that day you do some other activity, that's a change, not a rest.

How often do you actually take a break and let your muscles, cardiac system and nervous system rest?
Chances are it isn't very often.

One of the main reasons for getting run down, and, more importantly from a training perspective - getting injured is because an athlete does not get enough rest. This can be rest and recovery on a day to day basis, but it must also manifest itself in time away from the active stimulus of exercise.
I for one can find this a little difficult. I eat a fair amount, and I have quite a lot of excess energy, so on a day when I am resting and not getting out there to bike, run or climb, I have to think about what I'm doing so that I don't end up bouncing off the walls by the end of the day.

A rest day is a day away from hard exercise. It can include some light stuff, like a walk to the park, a leisurely cycle around a lake, a light massage something like that, or even just a day of not lifting weights.
Why? What is so important about this?

Our bodies respond to outside stimuli - muscles, nerves, brains etc. When there is a constant overload to one or more of the systems, the body releases hormones which enable the Sympathetic Nervous System to take over. This is the "fight or flight" side of the nervous system. If you are constantly in a state of tension, constantly on edge and ready to "go", it has a negative effect upon the body.

Added to this, when you exercise, you burn fuel, which breaks down muscle. With exercise your muscles suffer microtrauma. The muscle and neurological pathways then regrow and retrench themselves when you are not using them. The body needs down time to repair and regenerate itself before you put it through the next "test".

Indeed, stress from competition or trauma can lead to sympathetic dominance, and a series of potential issues such as breathing disorders, digestive upset, disrupted sleep patterns and immune system weakness against illness and disease.

If the body doesn't have enough time to regenerate, it begins to breakdown, you will feel more and more tired, more and more run down and at some point, it will break. Your body will react to the constant overload in your training programme as overtraining. The body responds to long term stress, physiological or psychological, with a general sympathetic response - a series of physiological and hormonal adjustments. I'll look at stress a little more specifically in a later blog.

A way to stop this from happening is to take adequate rest. To give yourself time to regroup and regenerate. If you don't know how often you are doing this, then try keeping a rest diary. I'm sure a number of you keep training or running diaries, you may even keep a food diary. But a rest diary is just as important. Write down what recovery practices (rest, sports massage, foam rollering) you are doing on a day to day basis, and note when you are taking a total rest day away from any type of athletic stimulus.

For everything you do, there must be an equal amount of rest or recovery. If you work too hard and don't rest enough, you will pay.
If you rest too much and don't work enough, you won't get fit.

But remember, Everything costs something. In the end, everyone must pay the price of rest for the work they do. Taking small chunks of intelligent rest throughout the months will make it far less likely that you will have to take an enforced layoff when your body tells you "that is enough" and decides to take you out of it completely, be that from injury or overtraining.

Tuesday, 18 October 2011

Stretching 5 - A summary

A while ago, in August, we wrote a series of blogs on stretching. We thought it would be helpful to give you a summary on stretching:

Warm up before you stretch.

When you stretch, don't count, just go with what feels right.

You are NOT looking for pain, you are looking for a pleasant sensation. If it's painful, its more likely that you are damaging muscles, not making them better.

Stretch gently and slowly (unless warming up for an event).


Breathe some more.

Make sure that you are stretching all the muscles that you are meant to be stretching. The most common one is stretching out one muscle in the calf and not the other one. Know what you are stretching.

Muscles have lots of different fibres. Don't just stretch in one direction, do it in multiple directions to stretch as many of the fibres as possible. Your muscles are not 2D and linear, they are 3D and work in multiple planes. Make sure they are flexible across them all.

Stretch before exercise (lightly) and, more importantly, stretch AFTER exercise.

Be aware of your limitations. This is not a competition. Every person is different, and has different things that need to be stretched. This is why there is not a stretching "routine" telling you what to stretch and for how long. It is as individual as you are. Find out what is inflexible in you, find out what the ranges of motion are meant to be, go away and gently stretch them.

Don't expect to get visible results in a day, a week, or even two weeks. You may have spent more than a decade getting tighter and tighter. You won't undo all that tension in a matter of a single stretching session. Be patient.

Its not just muscle you are stretching, but tendon and fascia.

And don't forget to DRINK WATER. Your muscles and tendons and fascia are more than 70% water. If they are dehydrated your body is like a swamp. Boggy and unresponsive. You need it to be more like a river. Trying to make dehydrated tissue flexible is like trying to make an old elastic band stretchy again. Its just going to break eventually. Luckily, unlike the elastic band, the body can regenerate. Drink water.

I hope at least some of the stuff I've written down has been of some use to someone, and I hope it hasn't totally confused you.

Once more I shall say, if you don't want to stretch, don't, but if you do, do it sensibly.

Monday, 10 October 2011

Herniated disc

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Your spine is made up of vertebrae, each separated by intervertebral discs made of fibrocartilage.  The discs are made up of inner and outer parts - a soft gel like elastic inner core called the nucleus pulposus and the tough annulus fibrosus being the outer rim of cartilage. The nucleus pulposus is there to distribute the pressure of each disc when they are put under load, i.e. they are shock absorbers. They also enable each vertebrae to glide over the other, keeping movements smooth.

What is a herniated disc?
Also called a slipped, ruptured or prolapsed disc. What happens is the soft inner nucleus pulposus herniates - it bulges through a tear or distortion in the annulus fibrosus into the vertebral canal or intervertebral foramen. The damage to the annulus fibrosus can happen because the disc is compressed beyond its normal range.

Depending on which way the bulge protrudes will determine what symptoms are felt. The disc can compress the spinal cord or nerves which can lead to reduced, or loss of function to the areas of the body served by the nerves. To you, this will feel like mild to severe back ache with or without burning, tingling, numbness or other sensations. If really severe muscle function can be affected or even paralysis. It really depends how severe the injury is, and what structures are affected.

Why does it happen?
For a fit and healthy person it is usually caused by sudden trauma, generally because of strenuous exertion (e.g. lifting a heavy object) or exercise (e.g. improper technique when weight lifting). Trauma can occur because of the lightest of movements, e.g. picking up a small object, and this would point to an underlying cause, or with forceful trauma to the vertebral discs such as in a fall or car accident. Poor posture can also contribute to this condition. In the healthy/young population the herniation is generally sudden and acute.
For older people the herniation can occur because of wear and tear - bone disease or degeneration, and the onset can be more progressive and chronic. That said, the onset, i.e. when you feel the pain, is usually sudden and sharp.

Can it be prevented?
Obviously accidents and traumatic occurrences are difficult to prevent. You can however ensure you perform lifting with proper technique, and keep yourself generally fit and healthy. Avoiding repetitive twisting movements is generally a good idea as this can put extra pressure on the discs. In a gym ensure your trainer shows you correct posture and technique and continues to monitor you so that you continue to do the exercises correctly. This should minimise the risks.

How to treat it?
Immediate care is rest and application of ice initially, heat can be applied after the acute stage has passed. Seeing your GP or emergency doctor may be appropriate. With medical intervention anti-inflammatory and pain medication may be prescribed.  As the injury progresses bed rest may be applicable for a period but generally normal activity should be undertaken ('active rest') to prevent muscle guarding and keep the spine mobile. If there is pain then stop what you're doing. Longer term, you should be looking to undertake strengthening and flexibility exercises with a sufficient warm up. It should go without saying that sudden or excessive heavy lifting is to be avoided to prevent re-injury. In severe cases surgery may be necessary but the majority of cases resolve with this being necessary.

Can Sports Massage help?
Yes, it can. Providing the therapist avoids treating on a day when symptoms are bad then there are no reason not to massage. Sports Massage will help to relieve muscle spasms, muscle guarding and tension which is your body's natural reaction to 'protect' the area. The intention of massage is to create space around the affected vertebrae, thereby allowing for the retreat of the herniated tissues.

Massage will also help to manage pain. A good therapist will look at the wider issues occurring in your body which might be contributing to, or a result of the disc injury. For example, postural imbalances, muscle functioning (what might be inhibited or short), firing pattern dysfunction and gait reflexes should be considered as part of the treatment. The aim is to look for the cause of the issue, as well as managing the acute area and muscles surrounding the injured disc. 

It is often appropriate with this condition for massage therapy and osteopathy treatments to be included in the overall treatment plan. This is to allow the soft tissues and bony structures to be worked in tandem, since both are involved.

Friday, 7 October 2011

Sporting Injuries and the NHS

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Talk about a can of worms.

Having spoken to a few people (fell runners) recently about nightmares with ligament ruptures and misdiagnosed breakages, I thought I might write a little something on here.
When you "do" sport, you tend to put yourself under a fair bit of risk. Some sports are more risky than others, but the vast majority have the opportunity in which to do something pretty nasty to your body, should you mess it up.

Its interesting that if you go to the doctor with hypertension, overweight, general un-wellbeing and feeling rubbish, they will tell you to get out more and lead a healthy life. Do some sport, stop sitting around being unhealthy.
However, go into a GP with muscle injuries or aches and pains from doing a sport, and if you haven't got the fortune to go to someone who has a genuine interest in Sports injuries, the chances are, you are going to be given some pain killers, some fairly generic advice and told to go away and stop doing it until it heals.

So imagine I've been out running for a good number of years, and my knee starts hurting. Ouch. Not a good thing. Right. Not to worry. I'll carry on running and see if it gets worse. Yep.
Ouch. That REALLY hurts.
An average runner (from what I've seen) will continue on with this cycle for about 6-8 months, changing terrain, running shorter and shorter distances, getting frustrated, and generally hurting more and more, until it actually starts hurting when they walk.
At this point, ooooh, now it REALLY REALLY hurts, I think I should go to the doctor. They fix bodies.

So they go to a GP and get a response of, oh, there doesn't seem to be any structural damage. Here's a prescription for some decent pain killers. Go away, stop running, and take pain killers and everything will be alright.
(I'm paraphrasing here, obviously, and different doctors will say different things).
So the idea is that you stop hurting because you are taking pain suppressants. Great. So you aren't actually NOT in pain, you are still actually in pain, its just that the pain killers are stopping you from feeling that pain. So the thing that is actually causing the pain is still there, but you can't feel it.
That's why, when you finish the course of pain killers, you go back to running (or whatever) and it STILL hurts. The original problem has not been fixed.
Other times, the GP may not even prescribe you pain killers. From personal experience, I went to one with pain in my shoulder, and was in not so many words told not to waste her time. Great. So now I have a pain in my shoulder, and the only guidance is not to do what I normally do. Yes, I could get a referral to a physio, but there is another problem associated with that.

If you are the runner that I have mentioned earlier, and have been running on the knee that hurts for 6 months, you eventually go to the GP, who refers you to a physio - that takes about 6 weeks. So now you've been waiting 7 and a half months to get an injury seen to that is going to cause compensation issues for a year or so, maybe more, down the line.

Quickly back up to personal experience again. Knee injury skiing. Bummer. However, still able to walk, but not run, in any shape or form. We suspect a meniscus tear, so we go to see the GP, who after a while agrees to refer to a knee specialist. Great. That takes 6 weeks to come through, and he recommends an x-ray. Lovely, a 5 week wait, then the x-ray, another 3 weeks until you get an appointment with the specialist again for him to say - nope, there is nothing showing up on that. Great. We request an MRI, it may have been on the cards, but we push for it anyway. Another 6 weeks waiting and finally get the scan. Then 3-4 weeks wait and see the knee specialist again who says that yes, indeed, there is a meniscus tear. Its taken THAT long, and that's going to see the GP straight away and not trying to run on it for a while before going to see anyone about it. Injury done in Feb and finally got someone to talk to us about whether or not to get an operation in about July/August. And that was in London.
Things do not run quickly.

OK, so that's a bit of an extreme case which needed an MRI, but think about other issues that don't need drugs, but do need some kind of help. Do you want someone to cursorily prod your arm/knee for 3 mins of the 7 that are allocated to you by someone who mainly deals out prescriptions to ill people. The GP is generally more concerned about giving out or withholding drugs. They are more likely than not tell you to stop what you are doing, and as a secondary thought, refer you to a physio.

Not wishing to blow my own trumpet, wouldn't it be better to go to a Soft Tissue Therapist, or a physio who can test, prod, poke, feel and understand what is going on with your injured limb/shoulder and see how the compensation patterns are distributing across the body, rather than dosing it up with excessive pain killers.
Yes, it costs money.
Yes, it may take time. But it will take an hour of your time. It won't take months of waiting, not knowing what is going on, and constant pain when you try to run.

If you get injured, get it seen to. Go to a GP if you wish, but I'd rather not waste their or my time.

GPs are great for some things. If I have a stomach upset, viral infection, or another issue that can be solved with drugs, or if something has happened that I don't understand with my digestive system etc. that is the place I will go. They are stressed people, and they should be given respect. They do a lot of things that I, and many other people cannot do.
I'm just saying that when it comes to sporting injuries, there are better places to go and get understanding of what is happening. If the therapist is not able to help, or recognises that you need a scan or to see a doctor, they will send you straight there.

At the end of the day, its your body, decide what it is worth to you. If it isn't worth much, don't waste your money on it. If it is, I'd suggest spending all you can on it. You only get one. Maintain it.

Monday, 3 October 2011

Marathon training

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As the London and Manchester Marathon places have just been released, there are a number of first time marathon runners (and also more experienced runners) who are about to start training in earnest for the events early next year.
For those of you who are planning on running a marathon, read on! We have worked with many marathon runners in the past and all have benefited from ensuring their training programmes include regular sports massage.

Why is that?

Well the simple answer is that regular maintenance massage can help to keep your muscles healthy and injury free, which is of great importance to long distance runners.
Of course it is more complicated than that - depending how much you want to know about anatomy and physiology. But for you, the runner, massage therapy is a must if you want to help prevent injuries, improve your running times and have greater energy.

London 2010 marathon runners

Sports Massage works with the muscles, tendons, fascia and all soft tissue structures in the body which are put under stress when running. After a run, your muscles will have suffered microtrauma - tiny amounts of damage which you are not able to detect. It's unavoidable, but how you deal with it is what matters because microtrauma is one of the paths which can lead to injury. Essentially, microtrauma is tiny tears in muscle fibres as a result of overloading or overuse. It's the same result that happens when you have a muscle tear, though perhaps not as obvious or painful - so underlying the trauma there will be bleeding, inflammation, swelling and formation of scar tissue.

Through soft tissue therapy we can prevent the build up of scar tissue by breaking down any adhesions (what you might feel as knotty areas) and keeping muscle fibres aligned along the functional lines which are needed to stay injury free and to keep you running strong.

The danger of not dealing with microtrauma and vulnerable areas is, as we've mentioned, injury, but also muscle imbalances elsewhere in your body. Joints then become stressed and biomechanically inefficient which can lead to tendons becoming overly stressed and less efficient movement patterns. An example of injury which can be the result of untreated and repetitive microtrauma is tendinitis. For runners, one area which often suffers is the Achilles tendon.

Repeated microtrauma = weak & damaged muscle fibres = chronic muscle strain = injury

If muscles are chronically strained then the collagen (which helps to build muscles) is reabsorbed and results in the weakening of soft tissues in that area.

Weak soft tissues = injury susceptibility

Massage is also good at improving circulation in your body. If you have poor circulation then you'll feel sluggish, lack energy and generally not be enjoying your runs. When we say circulation, we're talking about blood (which carries oxygen and nutrients essential for optimal muscle functioning) and lymph (interstitial fluid involved in the removal of waste products and bacteria).  The interesting fact about the lymphatic system is that it has no built in pump; it relies totally on one way valves and other systems in your body (muscle contraction, arterial pulsation) to assist the movement of fluid. Massage therefore, can help with lymphatic flow by encouraging it to return into the circulatory system appropriately.

Better circulation = improved energy = better running

The challenge of running a marathon is quite a big one for most people. Motivation to run the 26 miles (42 kilometres) has many origins. The risk of injury is the same for everyone (well more or less the same - there's intrinsic and extrinsic factors which have to be taken into account). If you choose to put your body through a rigorous and lengthy training plan then you must respect your body enough to look after it along the way.

Sports Massage can benefit all runners, regardless of background, support or motivation. Here's an overview of some of the benefits Sports Massage can offer you:
  • Injury prevention
  • Faster personal bests
  • Greater flexibility and increased range of movement
  • Functional muscle balance
  • Improved circulation
  • Faster recovery times
  • Pain relief
  • Greater energy
  • Relaxation
  • Improved posture
The best way to look after your body and keep strong for running is to have regular monthly maintenance massage - let us, the experts, keep you healthy and help you to prevent injuries.