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.