Injuries

Marginal gains: what are they and should I use them?

“Marginal gains” is the term made famous by the success of Team GB’s Olympic cycling team in winning multiple gold medals and by Team Sky winning the Tour de France.

They look for marginal gains by examining how they could gain 1% improvements through simple to achieve methods and have these 1% gains accumulate to make larger changes. They used a number of strategies for this including:

  • Providing each athlete with their own pillow and having a personal sleep strategy
  • Painting the floor of the mechanic area white to pick up on any dust particles which may get into the bikes
  • Analysing performance times to personalise training regimes as different people peak in the morning or afternoon. (This was linked to the sleep strategy to ensure peak performance)
  • Looking at the aerodynamics of the bikes
  • Improving infection control measures to reduce colds/infections
  • Improving diet

I personally much prefer Kevin Bridges’ marginal gains approach of losing weight: “switch from eating McCoys crisps to Quavers or have fried rather than deep-fried food”

Read more: How to treat tennis elbow

How does this apply to non-olympians?

The basic concept of marginal gains is to look for imperfections in your training/work/sport and improve them. Essentially a micro-managing of all aspects of your life. I can certainly think of a few things that I need to improve on without getting a microscope out (please feel free not to email me any suggestions!)

Where this can be useful from a physiotherapy perspective is in longer-term rehab. We regularly deal with conditions which require regular exercises over a prolonged period of time to allow a full recovery. For example, this could be after a  cruciate ligament injury to return to football; following joint replacement surgery to be able to walk around the shops or with shoulder rotator cuff injuries just to be able to put your jacket on.

Read more: What is Pilates and how can it benefit you?

Practical use of marginal gains can be just creating the time each day to work on your rehab by cutting something else out. It also applies to making sure you are physically ready to work on your exercises by finding out whether first thing in the morning or after work is a better option for you.

Diet and Sleep are key to recovery from injury and also to improving performance. We work alongside Ambition Nutrition who can advise on this more effectively than we can.

Marginal Gains for performance

At JMC Physiocures we can also offer advice on marginal gains for sports performance. This can be in the form of massage to reduce DOMS, advice on an injury prevention programme or a specific strengthening issue to help with technique. We also provide Pilates classes and work with personal trainers like Michael McCartney to help focus training on your goals.

Overall the idea of marginal gains is as simple and complicated as identifying the things you could do better and then making them better. If you are anything like me then I am sure you have a to-do-list or if you are like William then you will have 3472 post-it notes so all we have to do is pick one thing off the list at a time and make it better!

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Injuries

Balancing act: ankle injuries

A common complaint we hear from people is that they have “weak ankles” or in the sporting world it will be referred to sarcastically as “you’ve got chocolate ankles”.

It inevitably starts with someone going over on their ankle and sustaining a typical inversion injury to their lateral ankle ligaments.  Ankles are the most commonly injured body part – each year approximately 8 million people sprain an ankle.  Millions of those will then go on to sprain that same ankle, or their other ankle, in the future.  The recurrence rate for ankle sprains is at least 30% and depending on what numbers you use, it may be as high as 80%.

Read more: Pain in the neck? Exercises for neck pain

However, I believe and it is widely regarded within the physio world, that many of those second (and often third and fourth) sprains could be avoided with an easy course of treatment and rehab.

Patricia Flavel (AUS) finish line Athletics 2000 Sydney PG
© Sport the library/Tom Putt Sydney 2000 Paralympic Games Athletics – Patricia Flavel (AUS) at finish line

What is balance?

Balance is the ability to maintain your centre of gravity (vertical line from centre of mass) within your base of support with minimal postural sway.

A healthy balance system allows us to see clearly while moving, identifying our orientation with respect to gravity, determining direction and speed of movement, and the ability to make automatic postural adjustments to maintain posture and stability in various conditions and activities.

Maintaining balance requires coordination of input from multiple sensory systems that send information to our brain about our body’s position.

balance

How to improve my balance?

In essence, the key to improving your balance is simple: sand on one leg, try not to wobble, hold for a minute and repeat.

Balance training is supremely low-tech but several studies have shown that the treatment, simple as it is, can be quite beneficial. All you need is simply a little space, a table or wall nearby to steady yourself if needed and a pillow.  You need to firstly ensure that you can comfortably weight bear on the joint before starting balance training.

Read more: Five tips to help manage back pain

Begin by testing the limits of your equilibrium, with the aim being to stand safely and unaided for 1 minute, the pillow can then be used to introduce an unstable surface and make the exercise a little more challenging.  Once you can achieve this you have a good starting base to progress your rehab to the level of recovery that is required for each individual.  This can then be progressed to single leg standing whilst throwing/catching a ball or for the higher-level athlete it may consist of single leg hopping over a box whilst pivoting through 90 degrees.  Either way as their balance improves you will find that their pain subsides and their confidence returns, thus allowing them to return to the gym or football, or more importantly for others, being able to wear their heels again!

So please don’t keep living with those “weak ankles” that are stopping you from your sports, or just impacting your Saturday night out with friends.

If you want some helpful advice or treatment for any persistent injury then come and see one of our experienced members of staff at JMC Physiocures, 01236 425 661 or 07808 552 520.

Check out more of our blogs here.

Injuries, neck pain

Pain in the neck? Exercises for neck pain

Neck pain is a common problem and can often radiate out to the shoulders and arms or cause headaches.

Please try the exercises below to help with any neck pain. Also remember to take painkillers if needed and stay active as neck pain is rarely serious.

Thanks again to www.rehabmypatient.com for providing us with the exercises.

N.B. It is normal for these exercises to feel uncomfortable or mildly painful but do not push into severe pain.

Neck rotation:

neck rotation

Rotate your neck slowly to the left by looking over your left shoulder. Take your neck to a comfortable end of range. Repeat to the right. Make sure you keep your shoulder and back relaxed. This is an excellent exercise to improve rotation and mobility in your neck.

Repeat 4-6 times | Hold for 2-3 | Perform both sides

Video: http://youtu.be/UbHEH6t_OJQ

Neck side flexion mobilisation:

neck side flexion mobilisation

Ensuring your nose is pointing forwards, bend your neck as if you were taking your left ear towards your left shoulder. Now repeat to the right. Keep the movement gentle and rhythmical. This exercise will help improve mobility to your neck.

Repeat 4-6 times | Hold for 2-3 | Perform both sides

Video: http://youtu.be/MpUIDH-atys

Neck retraction:

neck retraction

Pull your head back as far as comfortable and down slightly. You will feel some gentle tension at the front and back of your neck. This exercise will help your neck and upper back posture.

Perform 2-3 seconds times daily | Repeat 6-8 times | Hold for 2-3

Video: http://youtu.be/VYcifC6BFgc

Pendulum:

pendulum

Lean over holding on to a chair or table, let your arm hang down by your side, and swing your arm gently in circles. Try to let momentum and gravity move your arm. Go anti-clockwise and clockwise. This exercise is a great way to passively mobilise a stiff shoulder.

Repeat 2-3 x 10 each direction times | Hold for 2-3 | Perform both sides

Video: http://youtu.be/YYvl59eU78M

Standing/sitting retraction:

standing or sitting retraction

Standing or sitting, with good posture, pull your arms backwards while squeezing your shoulder blades together. Hold the contraction and then relax, or simply hold the contraction for a longer period of time. You will feel a muscular contraction around and between your shoulder blades.

Perform 3-5 seconds times daily | Repeat 6-8 times | Hold for 2-3

Video: http://youtu.be/JYyw8Uewdms

Shoulder shrugs up:

shoulder shrugs up

Shrug your shoulders upwards, towards the ceiling, to increase strength in your upper shoulder muscles (upper trapezius).

Video: http://youtu.be/YT6qn6HVQyE

Shoulder shrugs back:

shoulder shrugs back

Shrug your shoulders backwards, squeezing your shoulder blades together. You will feel a muscular contraction around and between your shoulder blades (rhomboid and shoulder blade muscles).

Video: http://youtu.be/1MmXbrOeJ9c

Bruegger’s posture sitting:

bruegger's posture sitting

Sit on the edge of a chair, and open your legs and allow them to relax outwards. Keep your body and spine tall, lift the crown of your head towards the ceiling, and arch your lower back slightly. Turn your arms outwards so your palms are facing forwards, and draw your shoulder blades down and towards the midline. Make a gentle double chin with your head at the same time. Breathe deeply throughout. You will feel a stretch across your chest and front, as well as muscles working in your back, all helping to improve your posture.

Video: http://youtu.be/_uQ_-JeWTgU

If your neck pain is not improving and you would like some advice or treatment then find out how we can help by calling 01236 425661, email admin@jmcphysiocures.co.uk, contact us via Social media or visit our website on www.jmcphysiocures.co.uk 

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Injuries

How to treat tennis elbow

Tennis elbow, or lateral epicondylitis, is a common elbow overuse problem that is likely to affect around 40 percent of the population at some point in our lives.  And certainly from my clinical experience, I don’t think I’ve ever treated a tennis player for this type of problem; it’s usually the office worker or manual worker who is lifting and gripping a lot.

The injury is mainly due to an overuse of the wrist extensor muscles since the condition is actually an extensor tendinopathy: it affects the tendons that extend the wrist joint and attach to the outside of your elbow, known as the common extensor origin.  There are a few tendons that can be involved, the most notable being the extensor carpi radialis brevis and extensor carpi radialis longus.  Most literature states that the constant overuse of these tendons results in repetitive microtrauma to the extensor tendons, which in turn causes local inflammation and pain.  This overload can occur from racquet sports, typing at the computer, gardening, or any tasks that involve repetitive wrist extension.

tenis elow iv

 

Risk factors for tennis elbow:

  • Manual occupation or office worker
  • Aged between 30-50 years old
  • Taking part in a lot of racquet sports but with poor technique

Symptoms

Pain associated with tennis elbow will be concentrated on the outside of the elbow and can radiate into the forearm and wrist.  Due to the pain and weakness it may be difficult to:

  • Shake hands on grip hold of an object
  • Turn a doorknob or handle
  • Hold a cup of tea or lift a kettle
  • Pain to touch the outside of the elbow or to bump against the area

How do we treat tennis elbow?

Firstly, I should mention that 80-90% of people with tennis elbow make a full recovery within one to two years and physiotherapy is recommended as the first line of conservative management.

Physiotherapy can assess your elbow and upper limb to find the cause, provide activity modification advice, prescribe appropriate rehabilitation exercises and manual therapy to provide pain relief. Your physiotherapist can also assist in giving advice regarding your work set up or sporting equipment.  While no one treatment modality is proven to be effective entirely on its own, a combination of both mobilisation and exercise may reduce pain and improve function.

If you want some helpful advice or treatment for any persistent tennis elbow injury then come and see one of our experienced members of staff at JMC Physiocures, 01236 425 661 or 07808 552 520.

Check out more of our blogs here.

Injuries

IT band problems? Here’s what to know if you run or cycle…

ITB injuries are a common problem we see in our clinics especially when runners or cyclists are training for a race.

This normally presents itself as a vague pain or extreme tightness down the outside of the thigh, either after finishing an exercise session or towards the end of a session.

Similarly to shin splints this injury is more likely to happen when increasing the amount of exercise being done. It’s why marathons, 10ks, Tough Mudders and The Big Cycle tend to result in busier clinics for us at JMC Physiocures, as people regularly pick these injuries up during training.

tired runners.jpg

What is the IT band and what does it do?

ITB stands for Iliotibial band meaning it is a band which connects the ilium (crest of the pelvis) and the tibia (shin bone forming part of the knee). It also has attachments to other muscles such as quadriceps and hamstrings. Although there is some debate in physiotherapy about the range of functions of the ITB, its main purpose is to support the pelvis when standing to allow the opposite leg to swing through. It does this by pulling on the pelvis along with the gluteal muscles to lift the opposite side of the pelvis.

As you can imagine if you are training for a marathon or doing the Edinburgh to Glasgow cycle, this movement is repeated multiple times. If this gets inflamed or aggravated then it becomes increasingly difficult to keep exercising.

What causes it?

An exact cause for ITB syndrome or an agreed test/set of symptoms has yet to be identified. A sudden increase in training frequency or intensity appears to be linked with it. In my opinion, this problem typically comes with a muscle imbalance of the muscles of the hips and knees. I don’t like to use the term muscle weakness for this as the majority of people I see with ITB problems are fit and exercise regularly meaning they could not be described as weak.

The muscle imbalance can come from focusing on one type of exercise and forgetting to balance this out by working the opposing muscles. As all muscles have an opposite muscle which pulls against them; if one is stronger than the other this can lead to pain. This can prove difficult to manage as a number of sports require a slight muscle imbalance to improve performance, think of Andy Murray’s shoulder and the force he needs to generate forward compared to how much he has to move backwards. If the training programme is correct, balanced, and spread over the appropriate period of time then muscle imbalance can be a positive. If you are confused then welcome to the world of physio!

cyclist.JPG

How do I treat it?

As with all injuries prevention is better than cure. If you are planning to enter a race which is longer than you are used to, or if you are trying to improve your times (See our blog on marginal gains 😉) then starting with a well-thought out training plan is essential. This should allow you enough time to gradually increase your distance, load (resistance) or speed without any sudden changes. It is also important to consider how you will vary your training by introducing rest days, weight training for a variety of muscle groups, interval/speed work and possibly even yoga/pilates style gentle exercises.

Form is temporary class is permanent

For most sports I would say that getting your “form” or technique right is vital. Ensure your technique and equipment is right before starting any training. Ask a cycling club about your bike set-up, invest in new footwear, or speak to a running club about your running style.

If you are reading this because it is too late and you already have some pain then there is some good and bad news.

The good news is that it will get better, total rest isn’t likely to help and your physio can provide advice and treatment.

The bad news is that this will probably mean altering your current training schedule to reduce the exposure and will require an effort from you to work on exercises to address any imbalances.

There are also a number of techniques that your physio can use such as massage, mobilisations, and acupuncture which may provide some short term relief although the priority is to get your exercise regime correct.

If you have any questions or would like an assessment for thigh pain then please get in touch with us at www.jmcphysiocures.co.uk  or by calling 01236 425 661 to book an appointment in Lanarkshire today.

 

Injuries

New Year’s resolution to get fit? Here’s how to avoid injury

It’s a comment that we hear all the time in clinic and one that I’ve even muttered myself, “I’m going to get fit this year, it’s a new start for me.”

After the joys of the festive period there is often a renewed enthusiasm that the new year will bring opportunity for change and a new lease of life.

The new year eagerness to get fit can lead to starting a new 30-day challenge; or to run around the park everyday; or build up fitness to compete in a marathon, or even the Tough Mudder 2018!  All are excellent ideas and a great way to motivate yourself for the month of January, however more often than not you fail to complete your challenge to the end of the month and frequently that can be due to INJURY!

We are guilty of throwing ourselves in at the deep end and not approaching our new training program in a sensible manner, especially if the activity is new to you.

Running_Man_Kyle_Cassidy.jpg

 

Here are a few tips to avoid injury this coming year, and set you on the way to achieving your goals:

Do’s:

  • Find a good park that is suitable for walking or running. It is more stimulating to run in a park than on the streets, and the ground can be softer and more forgiving on the joints.
  • Exercise in the appropriate shoes, sports trainers that are light will help keep your feet comfortable and encourage you to exercise more.
  • Begin with gentle interval training for the first few sessions. This may be cycling 3km and resting for 500m, or running 1km and walking 500 m, then repeating as able.  Know your limits and build up slowly.
  • Give yourself a few recovery days between sessions to help deal with DOMS (Delayed Onset Muscle Soreness), this can sometimes provide people with an excuse as they are “too sore or too tight”.  However, DOMS is best overcome by light walking and general movement.
  • Set a goal and have an overall plan, as this will help motivate you on those wet mornings when you can’t get out of bed early to exercise, or those dark nights when you want to skip the gym.

Don’ts:

  • Don’t exercise every day, training daily will cause an excessive build up of lactate acid, fatigue, and wear and tear if you are not conditioned to it. Having every second day as a rest-day will reduce your risk of an injury.
  • Don’t run more than 5km or start with high intensity exercise on your first session. Trying to work through tightness or pain is more likely to cause injury
  • Don’t set unrealistic goals as you will inevitably pick up an injury when trying to achieve something that was beyond your level of fitness.
  • Don’t ignore warning signs: if you are starting to feel pain or an ache then it’s probably best to ease up with the training and avoid being afraid to miss a session. Missing one session could make a big difference and possibly prevent you form missing more in the future if you choose to ignore it.

The most important piece of advice I can give is to be sensible and patient with your training.  If you’re new to exercise and expect to run daily for 30 days or to do 50 press-ups for 30 days, you should be more reasonable in your expectations. It is unrealistic for the novice trainer to accomplish and more for someone better conditioned to regular daily training.

exercise

Secondly, you have to enjoy your exercise otherwise you will never stick at it long-term and your New Year’s resolution will be binned by February.  Maintaining a long-term exercise program is correlated with enjoying the program.  Remember exercise can range from walking, cycling, running, weightlifting, dancing, golf, tennis, aerobic classes and much more.  Try them all until you find something that work for you.

If you want some helpful advice or treatment for any persistent injury then come and see one of our experienced members of staff at JMC Physiocures, 01236 425 661 or 07808 552 520.