Thursday, 12 December 2013

Article about thoracic mobilisation

Came across this article via LinkedIn. The article explores thoracic mobilisation by outlining the issue and then offering a solution in the form of a self-help tool. The problem is introduced and the importance of the thorax described as follows:

Musculoskeletal pathology of the thoracic spine and ribs is often thought to be self-limiting in nature.1 Recent interest in the thorax from a clinical perspective has been related to the recognition of the thoracic spine and ribs not only as a source of local and referred pain but also the influence of thoracic spine mobility on movement patterns in other regions of the spine and the shoulder girdle. Range of motion (ROM) in the thoracic region is necessary for a number of daily activities and sporting tasks such as golf, throwing sports, tennis, and rowing. Dysfunction of the thoracic spine can also play a role in breathing difficulties and may be linked to postural issues in the later stages of life.

The article recognises the importance of the role of the therapist in treatment, but is primarily concerned with offering a suggestion for self-mobilisation and treatment. The proposal is to use a device to assist mobilisation and the treatment of trigger points. The tool consists of two tennis balls taped together like this:

The picture is from the article, but I made one myself and will give it a try later today.

The article then proposes a series of exercises that can be performed with the tool lying transverse to or parallel to the spine.

Rather like a foam roller, I think it might be useful if used appropriately, and the article certainly supports the need for a client to be taught how to use the device effectively.

The concern I have is for unmonitored use. In other words when people use these sorts of things without any real knowledge of what they are doing and how tissue might respond. It's not that I want to make manual therapy into some sort of mystical art, but having studied through a course I'm so much more aware of what I'm doing and how I stretch and look after my own soft tissue.

It's too easy for people to get into the mindset that if it hurts it must be working. I had a client at an event who stated, "Pain is my friend." While some aspects of manual therapy can be uncomfortable, the pain should always be manageable, a "good hurt" as some have described it.

Anyway, I'll give my new contraption a try and report back. Being a tennis player, tennis balls are in plentiful supply in my house, so making one this morning over breakfast wasn't hard. Perhaps it's a new opportunity to recycle all the old tennis balls!

Friday, 29 November 2013

Patella Femoral Pain

I came across a video discussing some of the contributing facts in PFP, which was really interesting. The video can be found here. One of the key factors suggested was VMO activation along with quadricep strength.

Worth a watch if you're interested.

There's also a blog by the presenter of the talk here.

Friday, 15 November 2013

Anterolateral knee ligament

In case you've missed the anatomy news of the week, if not the year at the very least, researchers have apparently discovered a ligament in the knee that was described in 19th century but not noted since then.

Strange to think that a ligament like this could go unnoticed for so long, what with all the technology we've developed over the years and the number of dissections that must have taken place in the intervening years. What is interesting is whether there is a relationship between ACL damage for example and this ligament. One wonders what role it plays in stabilising the knee. Perhaps it works with the LCL given it's proximity, but we shall have to wait and see what the experts discover.

Tuesday, 12 November 2013

More on hip mobility and low back pain

I came across another interesting article about low back pain and hip mobility the other day. It came in an email about tennis coaching rather than a therapy newsletter. Written by Dr Josh Renkens, DC, MAT, ART, the article was titled "Is Your Limited Hip Mobility Causing Your Low Back Pain". Because it came in an email, there was no publication source, so I can't give you a reference to find it for yourself.

Anyway, he suggests that lack of internal (medial) hip rotation is a contributory factor in low back pain experienced by golfers and tennis players. Actually he refers to an imbalance in hip rotation rather than limited rotation in one direction. He says:

In one study, 48% of subjects with low back pain (LBP) had increased lateral rotation and a deficit in medial rotation of the hip (Ellison, JB).

Another interesting point he makes was that:

Researchers found that a statistically significant correlation was observed between a history of LBP and decreased lead hip internal rotation (Vad, Journal of Sports Medicine).

The obvious thing might be to assume that the limited medial rotation come from tight lateral rotators, and that can certainly be true. But don't ignore the possibility that it might be that the medial rotators are not engaging properly. I've certainly seen that with at least one recent client where medial rotation wasn't restricted, it just didn't happen readily.

Friday, 18 October 2013

Functional Movement Screening: The LTA Protocols

If you've read Gray Cook's books you will know all about FMS, you may even use it in your assessments of clients. There is a growing interest in FMS across a number of sports and I recently discovered a resource specifically aimed at tennis. Sadly you only seem to be able to access the screening document from the coaches area of the LTA website, but the booklets (there are two of them) are quite helpful.

The first booklet uses seven screening tests, the second has a more comprehensive series of ten tests, although not all are instantly recognisable as FMS tests. They are, however, useful measurements to make.

The booklets set out the tests but don't tell you how to interpret the results or what to do next. Understandable really, given that these are not manuals for therapists. However, they are interesting from the perspective of applying the principles of functional movement to sport specific situations.

The LTA's stated goal in both booklets focuses on elite young players and injury prevention. But there's an application too for these tests to anyone working with recreational athletes too.

If you want to have a look at these booklets, find yourself a friendly tennis coach who might get them for you, or maybe even the LTA has a print copy you could get hod of. I can't see anywhere on the website where you can order printed versions, but I'm guessing they are out there somewhere.

I've got Gray Cook's other book Movement: Functional Movement Systems: Screening, Assessment, Corrective Strategies on my Kindle, but I haven't read too much of it as yet.

Monday, 16 September 2013

Ankle mobility

Came across this video via James Dunne's blog, Kinetic Revolution.

 As someone who knows only too well the issues of limited ankle mobility, I'm going to give this a try when I go out to play tennis today!

If you've never really stretched your calf muscles or mobilised your ankle, or if you've suffered an injury either recently or in the past, then you will want to progress gently with this, as you would with any new exercise.

Event work

So the last couple of weekends have been busy with a couple of events. On Sunday 8th September I was at the London to Brighton bike ride doing post event massage for riders. I was working with World Cancer Research Fund. A friend works for the charity and I helped out last year. This year I was the principle therapist and treated most of the riders who came for a massage.

On the 15th I was at the Royal Hospital Chelsea for the "Beating Blood Cancer" bike ride. Bit of a cycling theme developing! Working with Leukaemia and Lymphoma Research, a team of 9 therapist worked in rather muddy conditions to provide post event treatment to about 150 cyclist over 6 hours.

The conditions weren't great, but the team did a fantastic job and no one moaned about the mud and the  way the ground moved every time to shifted position!

Today's tasks include cleaning the couch and getting the dirt of my shoes!

Tuesday, 27 August 2013

Tensegrity and massage at Optimum Sports Performance

You may or may not have come across the principle of tensegrity, but I'm guessing that if you are involved in any sort of soft tissue treatment you will have discovered that sometimes the area that presents with pain or problems is not always the area that you need to treat.

Sometimes therapists are guilty of making these relationships sound way too mystical as if there's some sort of secret knowledge that reveals the true root of the problem. A more straightforward understanding simply points out that the soft tissues are are dynamic structure that works under load and tension. Tightness in ove muscle or group is bound to have an impact on other tissues and structures with which it has a connection. Tensegrity is just one way of describing these relationships.

Anyway, there are a couple of interesting articles about some recent studies that explore these principles at Optimum Sports Performance. Part 1 is here and part 2 is here.

Sunday, 25 August 2013

Treating my plantar fascial pain

Well it's been a few weeks since I started to develop some pain under my heel, a classic sign of plantar fasciitis. Getting moving in the morning was uncomfortable rather than painful, so I took a fairly typical approach and just hoped it would go away! It didn't!

Knowing how difficult it is to get an appointment with my doctor, and knowing that the solution would probably be an injection rather than soft tissue therapy, I decided that my foot was accessible enough to treat it myself. Massaging the are under my foot with one of my spikey massage balls and also with something a little harder and stretching both the fascia and the calf muscles and calcaneal tendon seem to have worked a treat. I also applied some K tape to the area.

All in all, this simple approach has reduced my pain to zero in the morning and I can put my heel down as soon as I get out of bed.

It's just another reminder to me that stretching and working on flexibility is such an important component  to remaining healthy and retaining effective range of motion! I'm off to take part in the South of England Veterans Tennis tournament on Monday without the worry of the discomfort of landing on my right heel when I jump and run.

Friday, 16 August 2013

Eccentric Training and Flexibility

I found an interesting article looking at a range of studies that suggest that eccentric training has a significant effect on flexibility and injury prevention. Eccentric exercises are those that involve the lengthening phase of a muscle through a controlled eccentric contraction.

I always recommend a dynamic form of stretching for warm ups rather than static stretching, and I wonder how this relates to the concept of eccentric training. something to think about.

You can read the article here.

Monday, 24 June 2013

Are your hamstrings really tight, or is it somewhere else?

I remember the moment when it suddenly struck me that not every short muscle is a tight muscle. I can't give you an exact date and time, it wasn't quite that sort of epiphany, but it was a jump in my understanding of soft tissues and how to treat them.

I was reminded of this today when I came across a short article over at Kinetic Revolution looking at the issue of tight hamstrings when the real cause lies the position of the pelvis. An anteriorly tilted pelvis can make the hamstrings feel tight when in fact the issue possibly lies with the flexors pulling the pelvis forward and lengthening the hamstrings.

Treating the hamstrings as tight could lead you to think that they need stretching, but that only exacerbates the actual tightness in the flexors. Release the flexors and the hamstrings will sort themselves out in all probability.

The implication here is that when you test the hamstrings, then you should be looking at the pelvis not just at how far the client can bring the hip into flexion with a straight leg. And of course you should also test the hip flexors.

Tuesday, 18 June 2013

My Clinic

I blogged a while ago that I was opening a new clinic, and today's the day I'm making a start. I've been offered some space at the Robert Clack Leisure Centre in Dagenham. I'm of there this afternoon to sort out the room, take some advertising, and generally start to get a feel for the place. Not having done this before I'm not sure what to expect, but I'll give it a go!

My plan is to try and organise myself around some fixed times (Tuesdays and maybe some Saturdays) to start. That way I'm not having to go in for a treatment one day and then another, but I can do several back-to-back. If Tuesday works out to be a bad choice I'll have to review it, but again we shall see.

Setting a price per session is easy when you don't have to tell anyone and you don't have any clients! It gets a bit more challenging once you start signing people up. So I've picked my figure based on what I think it should be and what I would be prepared to pay. I'm also planning on offering some discounts and maybe special offers along the way.

My other thought is to offer some open events, like a free chat about stretching and flexibility, or maybe some short taster sessions. I've also done some CPD on K-taping, so I might offer that too.

I'm also planning a clinic at home using a rather nice looking log cabin in the garden rather than the lounge. I've set out the base and have gravitated towards a building. I just need to order it, build it, and get power to it. I think my wife will be quite pleased to get some of the equipment out of the house!

Thursday, 6 June 2013

COPA Show: Physicool

I spent the morning at the COPA Practice Show today. I met some really helpful folk and came some interesting stuff too. From software to CPD, there was an good mix of products and information available. Not the biggest show, but worth the visit.

When I've sorted out all the bits and pieces I collected, I'll blog about what I discovered.

One product that caught my eye was a cooling bandage. Physicool is a great, possibly better, alternative to strapping ice to an injury. The bandage is reuseable and rechargeable too. I tried on out, and while you don't get the instant sense of cold you get with ice, it develops over the course of ten minutes or so.

The big advantage of the bandage is that it covers a larger area and it provides compression as it cools. well worth a look.

Check out the website. There were some special offers available at the show, and I'm sure they are open to discuss prices if you're interested in buying in volume.

Monday, 3 June 2013

New Clinic Opening

Well, I'm finally getting to open my own clinic. Well a room at a local Leisure Centre to be precise, but it's a place to start! I don't know how much business it will generate, and I'm not solely relying upon it, but it's a good opportunity to get underway in a wider setting.

Saturday, 1 June 2013

Lunge with a twist!

I like lunges as part of a dynamic warm up and even as part of a body-weight circuit for training purposes. My balance and flexibility isn't great, so I find that not only does a lunge provide a good dynamic exercise, it also helps me develop better balance too. Adding dumbells increases the resistance element, and adding a twist or even swinging arms can be great for dynamic warm up. But which way do you twist, over the front leg or away from it? you can do either, but there are some important considerations.

I was watching a short video about a range of different lunges (forwards, backwards, to the side and at 45 degrees) used to warm up before running. Someone raised a question about the impact of adding a twist for clients with an ACL injury history. Apparently twisting to the same side as the forward leg places the least amount of stress on ACL. Worth knowing if you have someone with an old ACL injury and they either come with an issue that shows up because they are doing a forward lunge with a twist, or if you recommend the exercise for some reason.

All this assumes that you can perform the twisting lunge without losing control or balance. If you can't do that, then better to learn how to do a simple forward lunge without falling over first before progressing to the more challenging twist. Otherwise you might be adding stress through poor control.

Monday, 20 May 2013

STR Videos

I found this series of videos on the application of STR to a wide variety of muscles when we did STR on my course. They were really helpful then, and having just watched a quick snippet now, they still are quite helpful.

Mostly passive techniques, it's a really helpful reminder of how to access and stretch some of those more difficult muscles to get at and into, let alone remember how to open up.

Sunday, 19 May 2013

Does K-Tape really work?

Kinesiology tape seems to be one of those mysterious practices that evokes either mild disbelief or resounding, almost evangelical enthusiasm. Having spent a little time learning how to apply the tape and using it in one or two situations, it is strange how it seems to work. Personally I've used the tape to reduce knee pain and help treat a wrist problem. I've also used in on swollen foot to good effect and sore shoulder. So I have to say I'm quite enthusiastic about the potential benefits K-tape offers.

A case study on shows some very impressive results using K-tape on a serious bruise. The pictures say it all!

Friday, 10 May 2013

Can you touch your toes?

I mentioned is a previous post, albeit with an exclamation mark, that I've long since given up on trying to touch my toes. Let me tell you the whole story and explain why I'm working on regaining the ability to get closer if I can.

Years ago I hurt my back. Can't remember what I did, but it hurt. I even passed out one night from the pain of trying to stand up straight. Nothing structural showed up on x-rays, and to be honest I think the doctors gave up looking for a solution. With rest, exercise and help from a chiropractor things improved, but it took a fairly long time, and I've had bouts of back pain but never as bad.

About 6 years or so later I was in Chicago on a conference and got up one morning and decide to stretch a little. I reached up to the ceiling and down to my toes, and ping, my back pain returned. It was agony, and for the next few days I walked gingerly and took painkillers and did what I could to sort things out. I vowed not to try to touch my toes again!

The problem is, bending is a significant part of daily life. A lack of flexibility can be a real hindrance, more so when it comes to playing sport. And I know I lack flexibility. I can no longer do the kind of deep squat I could do years ago, and I want to try at the very least to stop the slow drift towards being totally inflexible, maybe even reverse it!

Enter Gray Cook. Having done an excellent weekend on dysfunction with  Chris Newton at NLSSM, I bought Cook's book The Athletic Body in Balance. Reading the book opens up a whole new thought process about functional movement and flexibility. Realising that I need to work on my flexibility is not a new realisation, and doing Cook's movement screening was a salutary and sad confirmation that I'm not as balanced and flexible as once I was. My complete failure to be able to do a deep squat, even a fairly shallow one really, suggests it's time to get serious about flexibility. But I don't want to risk my back!
Havg done an excellent weekend on dysfunction with

Progression is therefore key. If you are like me and struggle to reach your toes comfortably, then you need to find your starting point and go from there. In his book, Cook, shows a simple toe-touch progression that starts with your toes elevated by an inch or two. It's a surprisingly interesting and eye-opening exercise to do, and surprise, surprise i can actually touch my toes without having to run to the medicine cabinet and look for ibuprofen and and ice-pack!

So, if you're interested in reading a really good book about movement, balance and conditioning, then have a look at Gray Cook's book. It's even endorsed by Andy Roddick!

Wednesday, 8 May 2013

Ideas for wellness in the workplace

If you're looking for ideas for promoting wellness in your workplace, then you might like to have a read of this article for inspiration.

Somme of the ideas are very simple, like setting boundaries about email, others require a bit more effort and maybe even using an outside provider.

- Posted using BlogPress from my iPad

Tuesday, 7 May 2013

Useful stretching website

Not just useful for all the information about stretching, there's stuff about sports and rehab too. But when it comes to stretching, this a pretty comprehensive website. Videos, even software, are all available to view or purchase through the site.

One useful freebie is the stretching tips e-book. More of a leaflet, or monograph than a book, it's a helpful run-down of the important fundamentals of stretching. There are sections on specific sports and injuries, and a section for professionals.

I have two of Brad Walkers books on my shelves, one on injuries and one on stretching, which are both really helpful. The website is an equally valuable resource, maybe even more so with the videos to watch so you can check the form of a stretch.

Visit the website and explore!

Wednesday, 1 May 2013

Hip extension and running

Interesting piece about the role of hip extension in running gait over on the Kinetic Revolution blog. Not just useful for those who run, but also for anyone who could do with working on getting those extensors firing!

Also useful for reminding runners that they should not ignore core stability.

From a therapy perspective there's quite a lot to be gained too. For example, when you find a tight rec fem, do you just treat that or do you go on to check hip extension too? How often do you find that tight flexors are coupled with weak extensors or misfiring glutes? Many clients will spend the vast proportion of their day in a flexed position. They sit at a desk, sit on the sofa, and even curl up in bed. So, working on hip etension may be a key component of their treatment.

The post also has a couple of videos for hip flexor stretches and glute activation exercises.

Tuesday, 30 April 2013

Slowly does it

I was at a conference in Chicago  a good many years ago when I decided to do a little stretch one morning. Naively I tried to touch my toes, which turned out to be the worst idea I'd had in a long time as I overstretched something in my lower back and now I couldn't stand up straight without pain. I'd damaged back before I knew instantly that I was in a for a very painful few days at the very least.

I no longer try to touch my toes!

Anyway, years later I've learnt a lot about stretching and I'm much more careful these days. One of the key principles has to be stretch slowly and stretch progressively. Muscles don't like to be wrenched into a new length. They will respond and contract to protect themselves.

If you haven't done much stretching, and your suffering with inflexibility, then don't try to go from stiff to supple in one session. Plot your course and listen to your body. You can even keep a simple chart of how your range is changing. For example, you could estimate the degree of flexion you can get at your hip and see how it improves over the course of a week or month with regular stretching.

And if slow is the first principle, then doing the stretch properly has to be second if not equal first. I see poorly executed stretching all the time. Understanding what your trying to stretch and how to stretch it will bring better results long term. It might look impressive that you can get your leg up on the railing at hip height, but if you end up curling your back while trying to stretch your hamstrings, it's not going to work. Pick a bench, and use your body mechanics more efficiently!

So, stretch slowly, stretch specifically, don't overstretch, do it properly and do it progressively.

Friday, 26 April 2013

Welcome to summer sports!

As the rugby season ends and the cricket season gets underway, there will no doubt be a few folk trying to squeeze themselves into last year's whites! If it hasn't happened already, one or two will no doubt have also noticed a stiffness in a few joints and a tightness in a few muscles that didn't seem to be there last year.

I played cricket from quite an early age into my late twenties. A back injury, not from sport, didn't help, and I stopped playing seriously by the time I was thirty. As a left arm, reasonably quick bowler, I knew the ups and downs of hamstring and lower back problems. Shoulders were never an issue, but had I known then what I now know about gait, body mechanics and muscle balance, I think I could have sorted out a number of issues before they got too bad.

If you want to stay loose, get good rotation through the shoulder and back, then don't ignore the value of sports massage and soft tissue work. If you're collapsing through your bowling action, it might be because of a soft tissue issue that can be addressed through massage.

Bowler, batsman, fielder and wicketkeeper all need to stretch too. A few good dynamic stretches before you take to the field can make all the difference.

Thursday, 25 April 2013

Stability and mobility

Came across this joint relationship outline while exploring articles about hip mobility.

Foot = Stability
Ankle = Mobility
Knee = Stability
Hip = Mobility
Lumbar Spine (lower back) = Stability
Thoracic Spine (middle back) = Mobility
Shoulder Blade and Rib Cage = Stability
Shoulder = Mobility
Interesting. The original post is here. When you think about, if there is a restriction in one of the mobility joints, how is the body going to adapt to perform a given movement? The brain will work something out, and that leads to compensation or adaptations which in turn lead to dysfunction and then most possibly pain and/or limited movement elsewhere.

I've seen it with tennis players suffering from limited abduction of the shoulder. In order to get their arm up and extended above their heads to serve or smash, they go into lateral flexion of the spine, which has all sorts of implication for the way the play the shot and the control they have over it.

Yet more things to think about then.

Hip Mobility and Lower Back Pain

Writing as a newly qualified, (and therefore definitely not an expert), in sports and remedial massage, I'm intrigued by the relationship between hip mobility and lower back pain. Possibly because I've become more aware of the connection because of the course I've done and my own experience of recurring lumber stiffness and occasional low intensity pain.

Anyway, being up rather early today, I was thinking about nothing in particular when the phrase "hip mobility and low back pain" wandered into my brain and poked me in the proverbial mind's eye. I've been treating a couple of clients with low back issues and I met quite a number of folk with similar complaints while doing my practice hours as a student. During that time I became aware of the connection between tight and/or short hip flexors and hamstrings and low back pain. Sometimes, actually quite often, stretching these muscle groups delivered relief.

But there was one thing to which I didn't pay as much attention as I would now, and that's overall hip mobility.

Through my own experience of regularly stretching and mobilising the muscles of the hip, I've found it releases my lower back really well. No surprise when you think about it. So now, without overloading my clients with too many new things at once, I teach them not just to stretch hamstrings, quads and hip flexors, but I also teach them to stretch rotators and extensors too. Simple glute stretches and a good piriformis stretch seem to go a long way to reducing lower back issues.

I love what I'm learning!!

Wednesday, 24 April 2013

Hamstring stretch

Everyone has a way to stretch their hamstrings. When I play tennis, I usually find a bench or even a low fence to work with. The trick is getting your body mechanics right so that you actually stretch the target muscle and don't just look like you're stretching!

If you're stretching at home, or at the gym, or somewhere where you're lying on a flat surface, then an effective hamstring stretch can be quite difficult. Which one of you can reach behind your shin, keep you leg straight and your neck, head and shoulder on the ground to perform a stretch? I thought so!

Of course you can use a towel or strap around your heel to extend your reach, but one technique you can try is to use your lower leg as a lever to apply the stretch to your hamstring. Here's a video showing you how to do that:

Let me make a few observations. Apart from the obvious comment that it might just be a tad of an overstatement to describe this as "the best hamstring stretch ever", it can be very effective and fairly easy to apply.

From personal practice and teaching it to clients, I've discovered a few things. Firstly, I've added breathing to the way I teach the stretch. Taking a deep breath and releasing it helps you get that relaxation phase that always seems to help me when I stretch. There is also a tendency in clients to hold their breath as the stretch and count, so the breath is helpful to stop them doing that. Second, I'm not sure you need necessarily to dorsiflex the ankle to get a stretch in the hamstrings. you certainly get a stretch into your calves that way, and I've heard people refer to this action as adding a neural stretch to the exercise, but you can get a good stretch in the hamstrings without it.

Lastly, it may be beneficial to some client to work on getting their leg straight before moving the position of the knee. Knee position seems to help in targetting slightly different regions of the muscle.

Anyway, I'd suggest exploring it yourself to see how useful you find it as an alternative to other self-stretches. And one last thing before I go, keep an eye on the other leg and the pelvis. They should remain nice and neutral to get the most out of the stretch of course.

Friday, 19 April 2013

The Subtle Art of Self-stretching

Okay, so how many of us stretch before and after exercise, or simply for the benefits of flexibility? Thought so! Even those of us who ought to know better are pretty poor at self-stretching, me included.

One of the things I've noticed about stretching is how little attention we generally pay to what we are trying to do and the feedback our bodies give us when we stretch. You see it all the time when people do a quad stretch. They grab their foot, pull it up behind them and that's it. The hip flexes or the pelvis tilts, and in the end very little gets stretched.

Having done the sports massage course, I'm now much more aware of what
I'm trying the achieve when I stretch and how to get the most out of my stretches. I've also learnt the subtle art of relaxing to stretch.

In both MET (Muscle Energy Techniques) and PNF (Proprioceptive Neuromuscular Facilitation) we use a a similar breath in, exhale and relax cycle to facilitate the stretch. You can do the same with your self-stretching. Simply take the target muscle into a stretch, count down from 10, take a deep breath around 6 and let it out slowly. As you hit zero, relax the muscle as you hold the position of the stretch. If it's worked you will feel a slight give in the muscle and you should be able to move into a deeper stretch.

When you can't feel the give, then you've probably reached the limit of the stretch, or you've discovered that you don't know how to switch the muscle off! Both useful bits of information.

- Posted using BlogPress from my iPad

Thursday, 18 April 2013

Get smart at the gym

Came across this list of 17 ways to be more productive at the gym.

It all makes quite logical sense, incorporating ideas like progressive overload, good hydration, and knowing what you are trying to achieve. Being in a gym you're surrounded by a bewildering array of machines and equipment. Having a plan is really helpful.

Of course your gym induction, assuming you got one, will have set out a basic plan, but if you're still doing the same thing after 6 months, then it's time to revise your plan or get someone to do it for you. I have my plan in my head, but a better idea is to write out a few plans on index cards and carry them in your bag. That way you can pick a routine and do it.

If you don't know about things like FITT principles, then you should do a bit of research. It will help you develop your understanding of how to get the most out of your fitness routine.

And lastly, you can take all these principles and apply them to exercise outdoors. or even at home. You can do a very effective exercise routine in your lounge with just a chair, a resistance band and a bit of creativity. I wrote a blog post about a simple 8 exercise circuit that can be done really easily with no expensive resistance machines required. Add a bit of cardio by going for a walk and you've saved yourself the cost of a gym membership if that's what's getting in the way.

Tuesday, 9 April 2013

Spikey Massage Balls

I bought a set of these massage balls from Physioroom for an experiment. One of the rugby players I've been treating suffers from tension in the sub-occipitals and I was wondering if these might help relieve some of that tension.

Rather like the foam roller, you need to understand how to apply the pressure if you're going to use them for self-massage, but they have possibilities. The biggest drawback is getting your hair tangled in them. The spikes aren't long, but they it can be quite tricky to get them working. I ought to try an old tennis ball, but I suspect the same would be true, it's not just a function of spikes!

These balls are more suited to working on things like feet and into the anterior area of the shoulder. The shoulder can be accessed by leaning on the ball on a work surface or dining table for example (being posh, I can use my therapy couch of course), and the sole of the foot simply by standing on it!

Of course nothing beats the application of deep tissue therapy by a professional (!), but not everyone comes to a therapist.

Blogging about this product is not an endorsement of the product or its application. The content of this post is not intended to be prescriptive.

Foam Roller

I've heard one or two people mention using a foam roller so I thought I'd give it a try. You can do all sorts of exercises using a roller, but most people use them for self-massage particularly if they have what they perceive to be a tight ITB (Iiliotibial band).

For those who don't know, your ITB runs from your hip to your knee down the outside of you thigh. It's a band of connective tissue that contrary to popular belief doesn't stretch. What it does seem to do is get stuck to the muscles and other soft tissue around it. If you get pain in the outside of your knee when you run, then you might have an issue with your ITB.

Anyway, I got hold of a roller and tried it out earlier this week. Lying over the roller with my outer thigh on the roller I began to roll up and down along the length of of my thigh. Some areas were rather painful, and if you're not ready for it, it can be really painful. Moving slowly and carefully is the key to using a roller effectively. Knowing something about massage and anatomy probably helps to understand what you are doing and what it should feel like. You can reduce the pressure by controlling the amount of body-weight that goes through the roller, but it's not easy. Rollers come is different densities, so if you find the one you first try too hard, a less dense model might be better.

I experimented with accessing the side, front, and back of my thigh, and it worked quite well. I also had a go at my notoriously tight peroneals (outside of the calf).

The jury is still out on the effectiveness of the foam roller for self-massage, I've only had a couple of goes with it, but it may prove to be a useful tool to have to hand. There are lots of ways you can use the roller for exercise too, so it's not just a instrument of self administered pain!

Blogging about this product is not an endorsement of the product or its application. The content of this post is not intended to be prescriptive.

Starting Out

So, I've been a qualified Sports & Remedial Massage Therapist for over a month now! I still can't quit get used to the idea that I managed to pass the course at the first attempt given how nervous I was and how addled my brain had become! But I did, and now I'm busy exploring what to do next and how to get my practice off the ground.

I've treated four or five clients since qualifying. The strangest thing is getting used to asking for money. Setting an appropriate fee was the first challenge. I didn't want to sell myself short, but I didn't want to be seen as too expensive either. I decided that the best solution was to set a fee and then discount it. That way I hope that my clients will feel like they are getting a good deal and I get to earn some money.

The next piece of the puzzle is where to practice. Currently I'm working mainly from home. That's okay, but I need a better space from which to do this. The plan is a nice log cabin in the garden for home based work, but I need to build a client base so I've been looking at treatment rooms in gyms. 

One opportunity that I hadn't thought about was advertising in local sports club programmes. I work as a volunteer therapist at a local rugby club, and they offered to put a free ad in the match day programme. So far I haven't found another local team that has a programme, but I'll keep looking, it may be a reasonably priced way to advertise.

Of course the best advertising comes from satisfied clients, so let's hope my few clients so far fall into that category!

Rice, price, meat and now POLICE!

You've all probably come across the rice protocol (rest-ice-compression-elevation) for the early stages of injury treatment, and you're probably aware of the addition of protect to that protocol too. MEAT stands for Movement-Exercise-Analgesics-Treatments.

Recently I came across POLICE where the OL stands for Optimal Loading. The basic idea is that as tissue repairs it needs to be loaded in order to encourage the formation of scar tissue in a more organised pattern. We've all learnt that scar tissue is laid down in a fairly random pattern and that's what we try to break up with soft tissue work post injury after the tissues have healed appropriately.

Clearly loading the tissue requires skill and knowledge, and should be carefully monitored to prevent further damage to already injured tissue. Loading must take account of the severity of the initial injury and the rate of healing that is taking place.

I don't suppose that there's a lot that is revolutionary and new in such an idea. Appropriate movement at the right stage was presented in the literature that I was reading during my training in 2012. But it might help when you're trying to convince someone that just resting their strained calf muscle is not the best rehabilitation plan!

The original article was published in the British Journal of Sports Medicine as: Bleakley C M,  Glasgow P,  MacAuley D C (2011) ‘PRICE needs updating, should we call the POLICE?’ British Journal of Sports Medicine 46:220-221

And I read about it here.

Wednesday, 20 March 2013

Interesting article about hamstrings!

Saw this via a tweet from Kate B, one of the tutors from NLSSM.

Proximal Hamstring Tendinopathy

Could be a useful read, especially if you do a lot of work with runners!

Tuesday, 19 March 2013

Anatomy apps

There are several anatomy apps available for the iPhone and iPad, and I guess there are some for Android and other platforms too but I'm a Mac user, so these are the ones I've been looking at!

Both are by the same developer Real Bodywork.  Muscles is an iPhone app that allows you to see muscles in their locations and relative positions.

You can choose the area you want to study, e.g. arm, torso etc, either pick out a muscle or just go through them. It's quite useful for getting the orientation and placement of some of the muscle groups.

The app will work on the iPad, but only as a small screen size equivalent to the iPhone. Okay if you don't want to buy two apps! If you don't mind buying one app for the phone and one for the tablet, then their iPad offering is rather entertaining!

Offering three-dimensional views, you can rotate a skeleton through 360 degrees, adding and revving muscles as it goes. Then, if you want to look say at the shoulder, you can do that and rotate it too.

Neither app is a complete guide to every muscle, but it seems to cover most of what we need. At the moment there is a special offer on the iPad app, but it might not be there much longer.

If anybody else has an app they use, share the news!