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Olympics Sports Massage

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Well, I got an email through the other day saying that my application to be a Sports Massage Therapist at the 2012 Olympics has (finally) been accepted and approved, which is nice.

I have been assigned to a couple of events throughout the whole thing. Not everything lasts for the whole two weeks, so I am going to be shuffling about between locations. One part is going to be in the olympic park, and the other is off site.

Unfortunately I can't really go into too much detail about what I'm going to be doing on which day, or apparently even which events I'm going to be at - Locog have bascially issued the following guidelines about volunteers, the olympics and social media:

• not to disclose their location
• not to post a picture or video of Locog backstage areas closed to the public
• not to disclose breaking news about an athlete
• not to tell their social network about a visiting VIP, eg an athlete, celebrity or dignitary
• not to get involved in detailed discussion about the Games online
• but they can retweet or pass on official London 2012 postings

So there you go. I'm very happy to be accepted, and excited about going, though there appear to be a large number of hoops to jump through before I finally, actually get there.

Tim Budd

What can we do for injury? Part 1: ACUTE

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Looking back over notes that I wrote a few years ago, studying to be a Sports and Remedial Massage Therapist, I came across a few things that I thought might be interesting reading about recovery from injury and what you as an individual can do, and what Sports Massage can do to help recover.
Injuries in ACUTE stage - immediate to 72 hours after injury.
Perhaps the most important time period of all. Normally the time when you sit there thinking... its not all that bad, maybe I can just try and walk on it. "AGH" no. Not yet.
Maybe now? "AGH" nope. Not yet. (etc, ad nauseum). This is perhaps NOT the best thing to be doing.

What is happening in your body?
Inflammation
Arteries, veins and capillaries are dilating (getting bigger), bringing blood to the area hence it will be
RED, warm (potentially hot) and blood plasma will be escaping.
Dysfunction
Blood will bring fibroblasts and macrophages to the area.
Macrophages "eat" dead tissue which has been injured.
Fibroblasts synthesise ground substance to begin the healing process.
PAIN is produced by pressure from the SWELLING and the release of chemicals like histamine which stimulates pain receptors.

What can you do about it?  RICE:

• REST
• ICE
• COMPRESSION
• ELEVATION

DON'T test it, if it isn't as bad as you fear it is, it will get better soon, if it is as bad as you fear it is, the RICE protocol will set you up perfectly for the next stage.
Protect the area - ensure you keep the area immobile and safe from knocks and bumps. This will probably be a natural reaction anyway.

What can a Massage Therapist do for you?
Assistance with pain management and support rest and sleep. The body needs to be relaxed and put into a less stressed position. The injured area may be looked at, and lymphatic drainage AWAY from the site toward the body will be useful - getting the waste products from the injury away from the area so they can be re-synthesised or excreted from the body, supporting circulation and enabling the body to be less stressed in general are some of the best things you can do for it at this stage.

We can also provide reassurance about your injury, or advise you to get it checked out further (for example for xrays) if we think the injury is more serious than you first thought.

Next post I'll look at things which happen and can be done in the Sub-Acute stage. From 3 days after the injury to approximately 6 weeks after. There will be a final post in this series covering the Chronic stage.

Overtraining

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It's got to the 2nd or 3rd week of the year, you might be feeling a bit tired from the exertion of you current new found training scheme.

Add caption

But is there more? Are you not sleeping well despite exercising more? Are you beginning to feel listless, unmotivated, inflexible and generally run down? Are you beginning to think that if exercise makes you feel like this, then really, what is the point?

Maybe you've already hit a level of overtraining, it isn't hard to do. The problem is that when overtraining happens and you get tired, all motivation collapses in on itself, and you stop going out and bettering yourself, ending up falling back into the same rut that you have done for the past few years.

Overtraining is something that can happen to anyone and everyone, from the beginner on the block, right up to the most experienced person in the gym or in the race. It can occur because of a sudden change to the Frequency or Intensity of training.


As hinted in the first paragraph, the symptoms of overtraining can appear in many guises. The most obvious one being feeling sore after training, classic DOMS, or Delayed Onset Muscle Soreness. This is not too bad a thing. Rest, Ice on the area which feels sore and when you feel better, Drink more water, and continue on training at a slightly lower intensity, building up slowly. The pain is coming from a variety of issues, none of which are particularly worrisome, as long as you take it easy in training for a while. Training at an easier, more sustainable level is better than either:

1. continuing on through the pain - something will break at some point.
2. just giving up. Think about why you started exercising in the first place, does that motivation still hold? Don't give up.

However, overtraining can be a bit of an issue if the symptoms are a little less obvious than pain in specific muscles.
If for the past few days you've been feeling one or more of these...

• Listless
• Unmotivated
• Exhaustion
• Chronic Joint Pain
• Insatiable thirst
• Decreased performance
• Stiff muscles
• Excessive weight loss
• Unable to sleep
• Inability to concentrate
• Generally not particularly "feeling it"

...and for the past few days or weeks you have upped the training somewhat, you may well be overtraining. If you continue on training at the same level, you have an increased susceptibility to minor injuries and illness.

The reason for the various issues you are feeling stem from a Sympathetic dominance of the Nervous system, the so called "fight or flight" reflex. Continual stressing of the body - brought on as a response to exercise, excitement, anticipation and performance - causes the nervous system to excrete hormones and chemicals into the body which make it continually ready for action. This has an effect on everything throughout the body, from the thickening of ground substance - the stuff that makes up muscles, tendons and ligaments - to the inhibition of normal gastric movement and a restless mind, constantly thinking about things throughout the day, stressing the brain, as well as the body. Although it may not feel like it, the whole of your being is constantly on edge because of the dominance of various hormones released by the new stress of the (perhaps ambitious) exercise regime. It doesn't feel able to relax, calm down, or give itself time to repair itself. A number of problems can be associated with this including slowed recovery, emotional agitation, breathing disorders and digestive upset.

Without some downtime, the body will begin to be inefficient, physically and mentally causing some, maybe all of the issues listed above.

While the body needs Sympathetic Dominance during work and exercise, there must be a balance, and during rest, the Parasympathetic should come to the fore. This is where other hormones are released and the body is able to relax, heal and look after itself. But if the MIND is still stressed, the body will not be in a position to release the hormones, and will continue in Sympathetic Dominance.

How do we get to a place where Parasympathetic dominance takes over? Some people find meditation works, others, just sitting reading a book, chilling out, not even THINKING about exercise or anything that stresses them - which can cause a negative hormonal effect. If you are far down the overtraining route, and are beginning to get niggles, just laying off the training might not be enough.

I know it may seem like an obvious thing for someone like me to say, but get a massage. It doesn't have to be a "hard, painful" massage, something to relax out the muscles, normalise the tissues in the body, increase blood flow and enable the body to relax from the outside, in. The action of kneading muscles and tissues increases the circulation and warms up the ground substance - enabling the body to actually relax more.

With the benefit of quality "downtime" your exercise regime will gain quality as well enabling you to continue aiming for the goals you have set yourself, without crashing and burning in the first month.

As Coach Keefe says from Strength and Performance, "Every athlete or avid gym goer should be getting some form of sports treatment, from a relaxing, flushing massage right up to deep myofascial release. It all works, its just when to use each one to the benefit of your training. You have to treat each massage like training itself, so after hard strenuous training sessions I would recommend more of a flushing, lymphatic and circulatory based massage, as this will aid in blood flow and the repair of the muscle tissues, plus it will help relax you!! Save the deep tissue therapy for days when you aren't going so hard in the gym."

Rockover Growl 3

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Yesterday was spent down at Rock Over Climbing Wall in Manchester for the third GROWL contest. Reports from the first and second contests can be found here for the October event and here for the December event.

January's contest started off quiet, just a few dozen competitors there for the initial briefing. There was no sign of hanging ball problems today, instead some tricky looking volumes to negotiate. We were impressed to see so many of the climbers going through serious warm up routines - looking after your body like that is a great way to help prevent injuries, especially on a cold winter day.

Early remedial treatment on neck/shoulder muscles

Craig demonstrating his skill

Early arrivals taking time to consider moves and watch others on the problems before it got busy

Total focus and determination on the final move.....

Receiving soft tissue therapy to forearms...tired from climbing, or treating an underlying issue caused by daily postural biomechanics?

The tricky spot prize problem....not many topped out on this one!

Jordan Buys receiving post-contest soft tissue therapy and missing his prize being awarded!! Thankfully Naomi was on hand to collect it for him.

Paul being lifted and dropped by the prize winning ladies.....causing lots of amusement!

Thanks to all of you who came along for a chat about climbing, injury prevention or to have a free treatment. As always at these events, donations are gratefully received and we went away with £15 for Glossop Mountain Rescue Team; we know they will appreciate it.

See you all at the 4th and final GROWL on Saturday 11th February.

January Book of the Month

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A new month brings new reading books for us. This month's choices are:

Lynne has chosen Meet Your Body by Noah Karrasch. Since meeting Noah on a CPD course (CORE Fascial Release for the Shoulder) this book has been on her list to read.


For Tim this month it's A Massage Therapist's Guide to Treating Headaches and Neck Pain by Sandy Fritz and Leon Chaitow.

Soft Tissue Therapy in action

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Tim Budd, Sports & Remedial Massage Therapist at Global Therapies, shown here providing soft tissue therapy to Sean Keefe, Co-Founder of Strength & Performance.

Global Therapies provide sports and remedial massage, soft tissue therapy and advice to clients at S&P on Mondays and Thursdays.

December Reading - Fascial Release

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My book for December's reading was Fascial Release for Structural Balance by James Earls & Thomas Myers. Tom Myers is well known to me because of his work with integrative structural therapy. His book Anatomy Trains should be in every massage and soft tissue therapists library. This months book is also worthy of a place in the library. James Earls studied with Tom Myers and also follows the anatomy trains approach to bodywork, something we incorporate in our work too. Knowing the authors credentials alone gave me confidence that my book for the month was going to be a good read.

As with Tim's book choice, this is one which I have dipped in on numerous occasions. The bulk of the book is made up of chapters corresponding to individual areas of the body - a review of anatomy and a look at relevant techniques and concepts of fascial release that are applicable. In the introduction the authors are keen to note that the body is not made up on separate and isolated components. Comparing the body to a car is an oft used analogy, but humans are not the same - we cannot simply take out a muscle when injured and replace it like a broken spark plug. There are much wider reaching implications for damage to one part of the body, and it is those connections - through the fascial webbing which pervades all of our body - which Earls & Myers explore in this text.  Paraphrasing them, the reality of human anatomy is that we have one muscle poured into 600 (or so) pockets of fascial webbing - the distinctions between muscles are useful, but the reductive process shouldn't block the reality of the unifying and connected whole.

Key messages I will take from this book (some of which reinforce reading from other sources):

• Fascial webbing that pervades our bodies has been building, refolding and remodelling since the foetus was 2 weeks old - it remains constant (ever present) and changing (adapting) throughout all our life.
• Everything is a compromise - the stability vs mobility balance is always being played out in our body.
• Congestion and mechanical strain often affects the body in distant parts - because the fascial web is altered.
• Fascia is contractile*.
• Tensegrity** is key; "The body is designed to distribute strain globally, not focus it locally".
• The fascial system is a repository for chronic issues because of its ability to accept change slowly and retain the changes it makes. Chronic tension because of inappropriate fascial shortness can lead to trigger points, fascial thickening and compensation patterns throughout the body.
• Fascial tissue deforms because of injury, abuse, misuse or disuse - but because of its plasticity it can be reformed with manual therapy, stretching and awareness (such as changing postural habits).

* Until recently it was thought that only muscles contracted but it is now known that myofibroblasts exert a force on the fascia causing contractions. Not as quick to respond as muscles (perhaps 20mins), fascia does however retain the contraction for hours - leading to sustained mechanical tension and postural changes.

** A word on tensegrity - engineers build houses and structures to withstand forces applied to them, just as the body does - but, the body is able to maintain its structure when, for example, held upside down or when pressure it exerted on one area.  Through deforming one part of the body small amounts of deformation are felt throughout the body, and a tensegrity model can demonstration this. An amazing Christmas present was given to me this year which allows me to demonstrate this to our clients:

No tension applied

Tension applied by right hand

The two photos above aim to demonstrate what happens when there is tension applied to one area of the tensegrity model. The right hand is pulling on a cord at the top, and you can imagine this is a tight muscle, tendon or area of restricted fascia within the body. On a quick glance you will notice that the whole structure has become deformed, squashed and distorted a little if you like. On closer inspection you will see that there are changes visible throughout the model. As one example, take the yellow node held in the left hand - it forms a triangle with a blue node above and another out of sight node; see how that triangle has altered in size. So while the cord at the top of the model is being pulled it has affected this distant area, just as fascial restrictions in for example the calf can affect the hip, lower back or elsewhere. It is difficult to demonstrate a 3D model with a photograph, but I hope you can see the basic idea behind strain being applied globally, not just locally. It is this principle which we apply in our massage and remedial treatments.

I will be continuing to read this book over the coming months - there are six chapters on the different body areas (foot & lower leg; knee & thigh; hip; abdomen, thorax & breathing; spine; and shoulder & arm). There is good guidance on postural assessment and clear diagrams on various anatomical structures - so don't be surprised if I show you this book (or the tensegrity model) when you come for a treatment. It really is a good tool for all manual therapists who are keen to educate their clients and give them the best possible treatment and home care advice.

Lynne Taylor

December Reading - Shirley Sahrmann

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For my December reading I was slightly inspired by Lynne going to see Shirley Sahrmann in Manchester, and raving about the experience and everything that she learnt. We have had her book, Diagnosis and Treatment of Movement Impairment Syndromes for quite a while, and while I have dipped into it from time to time, I haven't really got to grips with the meat of the book.

It's quite a tome, and heavy going if you try to read the whole thing. Considering it is more like a reference/text book, I decided to take only one section of the book in order to give myself something to get into and understand as comprehensively as possible, rather than spread myself out across the whole thing, and only really get a general understanding of the general content.

In the past few months I have been seeing more and more people with various issues and pain patterns with the Shoulder Complex. Rotator Cuff Syndrome, bicipital tendonitis/tendonosus, painful shoulder syndrome, call it what you will, there are a large number of issues that could well impact on the whole area. My decision was based upon this, and so I chose to look at the introductory chapter, to get the general concepts behind the book, and also the final chapter, about the Shoulder and various Movement Impairment Syndromes that can be seen, diagnosed and corrected.

Having skipped through the chapters in the past, in a fairly cursory manner, the deep and specific reading that I was doing threw up a number of very interesting and exciting things about various muscles, syndromes, and issues that affect the shoulder.

I will not go into more specific detail here, but suffice to say, since reading this part of the book, my knowledge of the musculature, how the whole joint fits together, what can, and indeed does go wrong, and how to identify potential issues has gone through the roof. I thought I knew a fair bit about the shoulder, having had a few injuries in the past, (climbing and snowboarding have that effect...) but this is a whole new level. I have a lot more confidence now, speaking with clients about their shoulders and what may or may not be wrong with them, and am much more specific in terms of looking at particular points of the musculature and how it affects the shoulder, and also the body, as a whole.

Although this book is titles "Diagnosis....." I am under no illusions that I am now able to diagnose. As a Massage Therapist I can have an idea of what may be wrong, and just by reading and understanding a text such as this, it does not change that stand point.

I suspect that in the next few months I will be going back to this resource time and again to refresh my memory. Also, I will definitely be using the other chapters as specific reading material later on this year.
This is an excellent book for all types of manual therapists and PT's alike. It can be a little difficult to get into if you are not academically minded, but persevere and your knowledge of movement and impairment of movement will be transformed.

Last race report of the year

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Sorry, there are no pictures on this one, but Lynne was running... not taking pictures, might have to get used to that in the next year... unless I manage to work out how to run and shoot at the same time... Instead, you can have a link to my Garmin track

The Map

Its been a while since I did a race report, mainly because I haven't been racing since September/October. (For various reasons including, but not limited to, minor injuries to toes, heels, and other less important running parts, not being in the right place at the right time, and generally there not being a whole lot of races in the area to jump in on).
However, the last race of the year, the Peak "O" trial is just in our back garden, starting from the Grouse Inn, just up the hill, and organised by the indefatigable Des of Wormstones and Chunal race route fame. The new thing about this race is that Lynne was also running it, and has just finished her report which is on her blog here.

We got up to the Grouse in plenty of time, registered and stood around for a bit. I realised that I hadn't brought full body cover, so jumped in the car for a quick journey home to pick up some trousers.... and also a whistle that I had neglected to switch from one bumbag to the other, and straight back up the hill again. Once again ensconced in the pub, Lynne was chatting with Andy from Pennine, and admiring his rather impressive scar on his knee- caused by falling off a bike onto a metal gridded bridge - not a pretty sight - think bone, and we generally chatted with a number of people who wandered in.
Good to see Nick (baba) there, I'm sure he has something on his blog, so I'll link to that one too, Julien, Mark Ollerenshaw, Ian, Carl and Beryl were there from Glossopdale, also great to see our wandering companion Carl Bedson back from Africa and Dave, and Rory who I haven't seen in ages. And of course Andy A turned up pretty much as he was due to start. Perfect timing. (or not, depending on your perspective).

It was an Orienteering/ timetrial format, so a number of people got their maps and left in 2 minute intervals. There were 2 routes, Long Score, with 7 checkpoints and Short Score, with 5, missing out the 2 checkpoints furthest South on the Long Score.
I lined up at 1022, got the map and had the 2 minute mantadory map looking time, deciding the best direction to take, attack points and general information before heading off into the countryside. All too soon we were told GO! and we ran off up the road. I had had enough time to take in the general gist of the map, what was going to be up and down, the direction of the wind, and how that was going to affect the direction of travel (not too much fun running into the wind in the second half of the race), and what it would be like at the end. (either a slight downward run, or an uphill slog) I decided on the uphill slog at the end. Why not? Everyone else was going to be tired at that point, and maybe I could use that to my advantage if it came to a "sprint" finish.

Off to Monks road and then up and over into access land to get to the first checkpoint, there were a lot of people milling around making unsuccessful forays into places where the dibber might have been, and a few running around like headless chickens, while others seemingly stood around waiting for others to work out where it was. I wandered around for a short while, looking for the obvious, and while doing that, Nick, who started out 2 mins after me, caught up. Damn.
Another minute of idiocy - I blatently hadn't got my attack points sorted out in the slightest, I orientated myself and where the point was most likely to be, over a fence, and pretty much straight on to it. That took far too long.
Next stop, Lantern Pike, I know my way there from various races, and also a bit of Mountain Biking in the area, so I hammered away, taking care not to overdo the pace, watching Nick become further and further away - he's got a bit good recently. As I got most of the way up to the top of the hill, he came bounding down past me, but I thought I had a better line from there to the next Check point, we'll have to see how it goes. Although in Orienteering you shouldn't really compare yourself to someone else, it was nice to get to the top of the hill before another couple of people who started climbing it before me. Clip the dibber (by now I had decided that I REALLY couldnt be bothered to take the map out of the plastic I had brought with me when clipping, too much faff taking off gloves and trying to get it back in the right way round etc.) so I just clipped it straight through the plastic. Boom.
Off on a slightly different line to Nick, and within the next couple of km I had gained a fair amount of time and distance on him, passing another runner, and getting to the next point in Rowarth before 2 others that I recognised from earlier on in the race.

We had a little bit of trouble finding the dibber at the pub, it wasn't exactly where it was meant to be- round the corner and down the way a bit, but after a brief look, all was fine and we dibbed in. Nick shot off, and I doggedly carried on. From here to the next point was a part of the Coombs tor race, and also I had run a portion of this in the Rowarth O event back in the summer, so navigation wasn't too much of an issue. Up the hill and over for a decent few km, pulling back a couple of other runners, and seeing a couple of navigational mistakes by others which helped me pull more time back. Over to the plantation and I passed Ian from Glossopdale in his BRIGHT luminous top. He was running into the sun and didn't see me.
Clipped the point, over the fence and along the top of Cown Edge rocks, Nick was disappearing from view, and the wind was buffetting strongly from the West - thankfully blowing us runners away from the edge, not towards. Along and down, down, down, the next point was in a Quarry, and I figured going all the way down, and in from the road. I noted a couple of runners heading off toward the top of the quarry, wondered what they were doing, and, in the best O spirit, I thought "ignore the others, stick to the plan". Ran to the bottom and a local bloke, washing his car (or some such thing) commented that you couldn't get into the quarry that way, you need to go back up the track and in over the wall...

Argh.

Back up the hill, find a small divot in the wall, through and into the quarry. The people I was catching up with, all done, been and gone. Dammit. Nothing to do but run down into the quarry, clip, up and out.
Next- choices... do I go straight to the road and up it, Monks Road, cycled up that... its a bit damn steep. Or, up the path I've just come from, and through the path at the top. The path wins out, and as I churn up the path, overtaking 2 who caught up with me, I catch sight of Carl, storming down the path- impressive considering he appeared to be wearing road shoes!
Up the hill, retracing steps to the top, with the wind blowing in my right ear... the buff got taken off my arm and pulled firmly down over my ears - a welcome relief from potential earache... then, at the top a guy in a bright orange top is gains on me quite significantly. I paused on the crest as I decide that the original line to the next control that I had in mind - a direct bash following fence lines, probably isn't going to be as expedient as going down the hill a little way and using the path across to the Nab and he takes the opportunity to run ahead.
Down to the path, and overtaking the same guy as he stops to check his map. Down past the farm, and a choice of going left or right around the trees. I go left, and overtake another person, and then a delightful horrendously steep descent down the top part of the Nab over rough and broken ground with all kinds of craziness. Just my kind of terrain. I shot down to the control, dibbed my bit of paper and back off up the hill. From here, its just a reverse Wormstones race route home, I'll only need the map for dibbing. The guy ahead of me is walking. My legs are burning, but, he is walking. That means, if I run, I can catch him up. Right, faster feet, and run. Up the hill, I can see the optimal line across to the next gate, he goes too high, still plodding away, I break off, still maintaining my stride (if you can call it a stride), and over to the gate. I don't stop to look back, I know that there are now at least 3 in relatively close pursuit.

Up and up, over the top and I can see the Grouse. It's on the other side of a not inconsiderable valley that I have to go down and up to finish. Still, I need that final check point before I can consider that. Below me I see another runner, contouring around, I have the altitude advantage and use it well, charging down the hill to the corner where the checkpoint is. Hang on, am I in the right place? I look at the shape of the hill, and realise that I've come down just a bit too early, run along the wall, ah, here it is, the hill on the other side drops away almost like a precipice, over the fence, and there is a runner coming up behind. So this is going to be the final run off then. I dib, and launch down the ridiculously steep hill, 3 steps, slide, fall, slide on my bum, up again, and repeat until at the bottom. Not even mudclaws were gripping on part of that descent, but no time to think of that now, up and across the river, and up the other side.
The hill was over in a surprisingly short time, though I have no idea what was going on behind me, up, through a gate, again up, and through a gate to the road, and the final 400metres against the wind, traffic inches from my feet, and up to the pub.

Lynne with her winnings

Finish in 1:46:58 by my watch. 16.93km.

Soup, rolls, cake, scones and drinks were laid on by the Grouse, and very much appreciated by all who ran, there was some good sharing of knowledge around open fires, and great conversation. Congrats to Nick who came in Second, and Mark Ollerenshaw who was Third by the smallest of margins. Lynne did herself well and won the Ladies Short Score event, so we at least have a bottle of wine to celebrate with.
Thanks again to Des who organised the whole thing, and to Gordon who printed the maps and was a route advisor - or some such thing.
A great turn out for a last race of the year, good to see you all out.

Benefits of Sport & Remedial Massage: an overview

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Benefits of Sport & Remedial Massage

• Injury prevention
• Enhanced training
• Greater energy
• Pain reduction & management
• Faster recovery
• Increased flexibility & agility
• Improved mobility & range of movement
• Functional muscle balance
• Normalised fluid movement (blood & lymph)
• Emotional relaxation and stimulation
• Increased body stamina
• Reduced soft tissue tension & binding
• Improved physical & mental performances

Benefits for systems of the body:

• Skeletal system: reduced thickening of connective tissue, restore range of movement, decrease stress on joints and bones, improve muscle tone balance 
• Muscular system: release tension, decrease stiffness, decrease spasms, decrease restrictions, decrease adhesions, normalise scar tissue, improve tissue functionality 
• Cardiovascular system: increase blood flow, increase oxygen and nutrient uptake, remove of toxins and waste products 
• Nervous system: increase endorphin production, stimulate and soothe sensory receptors (decrease pain), proprioceptive balance restoration, deactivate trigger points 
• Digestive system: improve peristalis and fluid movement 
• Lymphatic system: increase white blood count & lymph movement

Rockover Growl 2

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On Saturday I went over to Rock Over Climbing wall to help out with their second GROWL competition. After the success of the first one, which I blogged about here, I was really looking forward to seeing some interesting route setting, good climbing, and a lot of people having fun.

Lynne and I provided free arm and shoulder massages at the last one, so I knew there would be some demand for us there again. Unfortunately Lynne couldn't be there this time, so it was just me holding the fort. I got there nice and early, watching the first competitors float through the door, from the cold outside to the not every so much warmer inside, filling out their forms and taking in the look of the problems on the walls.
The guys had excelled themselves in terms of routes, and the very obvious amusement was "the Death Star", or, alternatively known as "Simons dangly bits". A hanging sphere of plastic volume between 2 walls. According to Simon, getting onto and across was the easy part of the problem. Excellent.

The "death star"

As more and more climbers came in, I set up the table and talked with a lot of the guys and girls wandering around. The temperature slowly began to rise, and at 11am the competition was kicked off.

As ever, the first hour or so was spent talking to the injured climbers, looking at injuries and giving advice on what to do, and, more often than not, what not to do. Then, as things began to get swinging (as it were) there was an influx of competitors for massage and de-pumps.

The general consensus from the guys I was talking to was that it was a bit harder than last time, but just as enjoyable. I certainly had a good time, and I'm looking forward to trying out a load of the problems on my next visit.

December Book of the Month

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This month sees us reading the following books:

Tim's choice: focusing on shoulders after seeing a sudden increase in rotator cuff injuries

Lynne's choice - more depth being added to her knowledge of fascia

Reciprocal Inhibition - or - why your muscles don't work

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Reciprocal Inhibition. What a title for a post. I can barely say it at this time in the morning, but its quite an important concept for people with tight muscles.

What is it?
Reciprocal Inhibition (RI) is what happens to antagonistic muscles - i.e. muscles that work in opposite directions on the same joint. For ease of imagination/demonstration think about the arm and bending your elbow. When you flex your arm at the elbow joint (your hand travels toward your shoulder) you are contracting your Biceps brachii - at the same time, the Triceps - on the back of the arm - are relaxing. (this isn't EXACTLY what happens by the way - its just a simplified version in order to get the general concept across).

Now, when you extend the arm - (the hand moves away from you) the triceps are
contracting, and at the same time the Biceps are relaxing.
Right. This is simple inhibition. As in the example above, the Biceps contract and the triceps relax. As your brain turns on the neural "path" to the Biceps telling it to contract, at the same time, there is another signal that goes to the Triceps telling it NOT to contract - it must relax - it INHIBITS the triceps. In fact, it reciprocally inhibits the muscle.
In the same way, as the Triceps contracts, there is a neurological signal to the Biceps to NOT contract - it must relax.

This works with all antagonistic muscles - quads/hamstrings, adductors/abductors, internal and external rotators, hip flexors/ hip extensors. You name it, it works.

(Don't worry about the mechanism for the moment, if you really want to know how it does it, drop me a line and I'll see about writing a more in depth post).

So why are you talking about this and how does it affect me?
Ah, well.
Lets talk for a moment about resting muscle tone- which is very pertinent to this issue. Lets take the same example of the biceps and triceps, (we'll expand on it in a moment). Imagine, if you will, that your Biceps is permanently high in tone - it is permanently "switched on". Not to a level that means your hand is constantly by your shoulder, but to the point that your arm is constantly half bent.
Right.
If the biceps is CONSTANTLY switched half on and you find it difficult to relax it, the triceps are always going to be switched off - they will always be Reciprocally Inhibited. Even when you try to use the triceps, because it is used to being switched off, the action that it produces is weakened, and it cannot do everything it is meant to do.

So a high resting tone in one muscle reciprocally inhibits the antagonist - causing it to be in a weakened state at rest. This means that the weakened muscle is going to be weakened in contraction as well - so it is a muscle that is being held weak, and contracts weakly - which obviously can't help you in what you are meant to be doing.

Hope you followed that. If not, tell me and I'll try and explain it better.

Update on ITBS

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Thanks to whoever the Anonymous poster on the ITBS post was saying you should NEVER foam roller your ITB... an interesting point which I shall get to in a bit. I'm glad that they commented, because the post does need a little bit of updating.
I somewhat arrogantly stated that THE reason for ITBS is lack of musculature/ strength in the deep 6 rotators. Now this is indeed true, but it is not the ONLY reason for friction to occur down on the knee.

First of all, lets clear something up.
Illiotibial Band (Friction) Syndrome is actually caused by the LENGTHENING of the ITB. Yes, I wrote that correctly. Generally, the Tensor Fascia Latae- as mentioned in the previous post- the muscle that attaches to the ITB- and tensions it, becomes shortened- and as that becomes shortened, it pulls on the ITB - making it LONGER and causing it to become tighter along its whole length - but the key is that it is long and tight.

This is where the anonymous post comes in - if your ITB is already Long and Tight, why would you even consider lengthening it by rolling on it? Exactly. You wouldn't want to lengthen it any more. Its plainly not a good idea.
As for NEVER foam rollering it - I'm not so sure - if you are rollering your Vastus Lateralis - the quad on the far outside of the leg - which I often have cause to do - where exactly does the Vastus Lat stop and the ITB start? You can't really say - simply because the structures exist in 3 dimensions and in order to get to the whole of the tissue I am trying to roll out, I have to roll on the ITB.

So. There is a reason for not rollering your ITB if you have friction syndrome, but its pretty naive to say you should NEVER roll on the ITB.

I say, if it gives you a little relief, by all means go for it, but you should really be focusing on strengthening other structures around the hip which will stop you getting pain from the dreaded ITBS.

As already mentioned, it could be weak lateral rotators.
It could be (and is more likely to be) weakness in the Glutes (glute max and med)
It could be that your adductors (muscles on the inside of the leg) are too tight and are INHIBITING your Glutes- causing the tensor fascia latae to shorten.
It could be that the arch of your foot is flattening more than is optimal (some people might call this over-pronating) which is causing the tibia to torsion medially (rotate inward) causing the ITB to lengthen and create friction around the knee.
It could be that a nerve root in your spine is trapped and is inhibiting nervous signals to the glutes, bringing you back to the shortened tensor fascia latae.
It could be that the hips (innominate and sacrum) are slightly out of alignment and this is causing a biomechanical imbalance, the weak point being your knee - and thus causing pain.

It could be any number of things.
The vast majority of people I have seen with ITB friction syndrome have issues with deep rotators and glutes that don't fire properly.
Don't run on only half the muscles in your legs- practice firing those glutes- clench your butt! More to come on that later.

Trigger Point Therapy for Myofascial Pain

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My book of the month was Trigger Point Therapy for Myofascial Pain by Donna Finando and Steven Finando. It is actually more of a manual than a book to read from cover to cover, a guide to common trigger points in the body and their referral patterns.

A quick explanation of trigger points - in case you don't know what they are - is that they are specific points in muscles which are hyperirritable, found in taut bands of muscle fibre and frequently refer pain to a different area of the body. People often refer to them as 'knots' or 'lumps', and indeed they can often be easily felt within muscles.

The book divides the body into regions, further split into separate muscles. For each muscle included there is a standard format including information on how to locate the muscle, pain referral patterns, causative factors, affected organs, stretch and strengthening exercises plus a few other bits. Each muscle is accompanied by a diagram showing where, in the experience of the authors, they've found to be the most likely areas for trigger points to develop, and another showing pain referral areas. This is the useful part because a therapist can easily look at where pain is felt by the client and then go to a specific muscle to potentially find a trigger point. In practice it doesn't work this way - unless a whole treatment is set up purely to look for trigger points it is more usual to locate the trigger point within a dysfunctional muscle when we palpate it during the course of a treatment. By applying compression on the trigger point we can often replicate the pain a client feels, and with treatment erradicate them.

The introductory chapters are very useful for us as therapists to read and refresh our knowledge. Chapter 1, The Nature of Muscles and Trigger Points, has some good information on phasic and postural muscles. It talks a lot about dysfunction and the reasons that may come about due to postural stresses and physical activities which involve repeated movements. This leads on to areas prone to trigger points because of increased mechanical strain and decreased circulation.  "Our ability to operate in a physiologically optimal manner are all affected by holding patterns of muscular constriction.".

Chapter 2, Qi, Movement and Health, explores the Eastern and Western ways of treating trigger points. There are two points that stand out in this chapter. Firstly is that Eastern and Western therapists would both benefit from studying the others way of viewing the body. However each treats, we do so by seeking to remove constrictions that cause pain and trigger points. Importantly, we both do so by affecting the body on a physical level through movement and the release of contrictions. So, Finando & Finando suggest that Eastern practitioners would benefit from studying myofascial and muscular structures, and Western therapists by studying meridians.

The second point I take away from reading this chapter is related to movement. "Health requires movement, when movement ceases, life ceases." That may seem like a dramatic sentence to highlight, but it has stuck in my mind. Ultimately, without movement comes death. On a less dramatic, but very significant level, without movement your muscles become dysfunctional, pain affects your body and constrictions occur (and thus trigger points).  When the constrictions are released by a therapist the muscle can return to function and this will lead (directly and indirectly) to freedom thoughout the body, at both superficial and deeper levels. The chapter also talks about fascial lines, quoting Dr Paula Scariati on trauma or fascial changes:

Moving on, Chapter 3, Informed Touch, was a good reminder to me as a therapist about the process and thought that goes behind palpation. It's not just about hands on the client, there is so much more thought that goes into the process - from both a physical and emotional point of view. Key point from this chapter is to have a mental image of what your are palpating; know what to expect, then you can see whether there is dysfunction present. Good knowledge of anatomy is vital.

The final chapter, Diagnosis and Treatment gives an overview of what a therapist should be doing - observing the client, evolving palpation skills, listening closely, treating with precision and attention, extending treatment beyond the clinic (i.e. homecare), and allowing feedback from palpation to guide the treatment.

Although a short read, this book (or should I say manual) was good to review. I'll certainly be showing the diagrams to clients more often so they can visualise pain referral patterns, and why when they say the pain is felt in one area I might look to treat elsewhere.

F.I.T.T. Principle

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Ever heard of the F.I.T.T. Principle?
If not, read on - it's important to anyone wanting to progress in their chosen sport.

So you have a training programme but are you following the F.I.T.T. Principle? Well you should be. It's a guideline that will help you get the best out of your training and it stands for

Frequency: how often you train

Intensity: the level of effort you put into each session

Type: the activity you are doing

Time: the duration of a session

Lets expand on those a bit, so you know what you're doing and why this principle is something everyone should adopt. With a word of caution, these are general principles - there's always going to be some people who do things differently, overloading or just beasting themselves!

Frequency:
How often you train for a particular activity is important. There are different frequencies for different things, think about weight training and aerobic training. With weights you really shouldn't train the same muscle groups every day. Neither would you want to do a hard hill session daily. It's all about balance and making sure you give yourself and the muscles worked time to recover adequately between sessions. Muscles get damaged when we use them, even without injuring them so you'd notice, and it's this microtrauma you need to give time to repair sufficiently so that your muscles stay strong and can perform optimally.

Intensity:
How hard you train in a session and how much energy is expended. I'm not going to go into max heart rates, zones and percentages of max - but it's all this stuff you need to factor into your training to get the most out of a session. Work out what you're trying to achieve - is it the 100m sprint record or an ultra-marathon? Training intensity needs to reflect your goals. You need balance here - sufficient intensity to tax your body but not too much so you end up injured or you're overtraining.

Type:
Cardio, weights, mixed sessions (circuits). Are you running, swimming, lifting weights, walking, doing strength and conditioning, circuits, yoga, boxercise classes? Regardless of your overall aim, be it a top 10 finish in a fell race or to beat your PB, you need to mix up your training.  This ensures all muscle groups are being worked, you won't get bored of simply counting down the mileage, and your body becomes stronger by being constantly challenged.

Time:
The duration of your training session will vary, depending on the activity and your goals. If you're working on improving fitness by walking you wouldn't get very far if you did 2 minutes walk, 1 minute rest and repeating 5 times. But for a hill session running these times up a 20% incline would be appropriate. In general, the higher the intensity, the less time you spend training.

Essentially what all this boils down to is that you have to be sensible about your training. No sudden increases in what you're doing. If you're a new runner, don't expect to be able to run 5 miles at marathon pace after only a few training sessions. Build up slowly - use the 10% rule - keep all increases to no more than 10%.  This might seem overly cautious, but it ensures your body adapts to changes and helps to prevent injury.

Guest blog at Combat Sports Clinic

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In October we were asked by Rosi Sexton if we wanted to contribute an article for the Combat Sports Clinic blog. Of course we jumped at the chance - Rosi, in her own words... "...is the founder of Combat Sports Clinic and is a registered osteopath and sports massage therapist. She is also a professional MMA fighter, and is currently ranked amongst the top 10 female fighters in the world."

The topic for our article is the Physiological Benefits of Sports Massage for Athletes it was published in two parts. Enjoy the read of both Part 1 and Part 2 - and as always, let us know if you have any comments.

Advanced Therapy Course

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I was down in Oxford this weekend just gone doing an Advanced Therapy Course with John Gibbons, who has more letters after his name than in it, and is involved in more world class sports teams than I could actually name. (I know he has a new website being made, so when I know where it is I'll link to it).

The idea of doing this course was to get some new ideas, new techniques and get some insights into the structural world of the body. I am mostly concerned with muscles and soft tissue, John comes from an osteopathic background, so to see his take on things was very useful.

Some of the things that stick in my mind - especially now I have had the time to look at and write up my notes are the differences in Spinal mechanics, both in neutral and non-neutral positions, and, perhaps more importantly, how to identify and recognise them. We went through the mechanics and motion of the innominate and sacrum (pelvis) and how to identify and fix dysfunction through various methods.

There was an excellent re-cap on muscle firing patterns, which, although I know, and have been taught, was a welcome reminder, and gave me a few more ideas as to WHY firing dysfunctions may happen, and also more ideas on how to re-fire, and re-educate muscles into correct patterns.

There was more, much more, but I don't have time or space to go into it all now.
I can't wait to put the things I've learned into practice, rest assured they will be tested out and refined on Lynne first before being unleashed on other people!

If there are other therapists who have heard about the Advanced Therapy Course, or even if you haven't, I'd suggest going on it. It was very educational, thoroughly worth the money, and I will be constantly learning from my notes for the foreseeable future. It'll be great when it has all been assimilated into my head, and even better when it is in my style.