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

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.