Rest & Recovery

This is a short piece I wrote for our summer newsletter at the gym where I run a weekly clinic.

How is your fitness plan going now we’ve landed in the summer holidays? Are you still putting in the miles, hitting PB’s, upping the intensity, or are you taking a break, relaxing, making the most of time away from the treadmill? You might, if you've opted for the latter approach, be feeling a twinge of guilt. You might feel that if you don’t get out and do something you’ll suffer for it when you get started again, or maybe you worry you’ll never get started again.

Perhaps you’ve just joined the gym, having decided it’s time to get fitter, lose some weight or simply get active. You’re hitting the cross-trainer, looking at classes and are all pumped-up about the new you waiting to be revealed!

Whenever you start a new exercise or fitness routine one of the sometimes overlooked aspects of the plan is rest and recovery. Along with all those stretches we’re supposed to do pre- and post- training, but never quite find the time to actually do, taking rest and recovery seriously simmers away on the back burner of our training schedules. Someone somewhere once mentioned periodisation, but we can’t remember what it is and why it’s important. And anyway, we’re too busy training to take time off.

But here’s the thing, over-training can create chronic conditions that can be hard to treat and can even lead to not being able to participate in training the way you want to. Typical over-use injuries include things like tennis elbow, runner’s or jumper’s knee, tendonitis, joint and muscle pain. As their name implies, they come on slowly over a period of time rather than suddenly, although some show up suddenly with an acute pain, the symptoms have probably been developing over weeks and months. Some seem to cure themselves, usually because our technique improves, but others simply persist.

The good news is that if you factor in proper rest and recovery, you can reduce the risk of suffering a chronic injury. Soft tissue therapy can also play an important role in helping keep tissue healthy and helping in rehabilitating injuries when they occur.

Periodisation doesn’t have to be complicated and it isn’t just for competitive athletes. Everyone can develop a simple approach to keep themselves motivated and energised about their training. A simple plan might be set out over three months and broken down into three four-week cycles. Weeks 1-3 might be you’re most intense training patterns and the fourth week would be a light, rest and recovery week. You could even schedule a Sports Massage for week 4!

Stretching and the role of fascia

I'm working my way through Fascia in Sport and Movement, edited by Robert Schleip, reading the chapter on fascia as sensory organ. Fascia is a fascinating subject. It is an intricate and historically overlooked anatomical and physiological feature. These days there is more and more research being undertaken to explore the nature and function of what appears to be the largest sensory organ of the body (p31). I'm just reflecting on this paragraph:

Stimulation of the Golgi receptors tends to trigger a relaxation response in skeletal muscle fibres that are directly linked with the respectively tensioned collagen fibres. However, if tendinous extramuscular are stretched in a condition in which they are arranged in series with relaxed muscle fibres, then most of the elongation will be 'swallowed' by the more compliant myofibres. In this way, the respective stretching impulse may not provide sufficient stimulation for eliciting any muscular tonus change (Jami, 1992). A practical conclusion may be that a stretching impulse, aimed at reaching the tendinous tissues, may profit from including some moments in which the lengthened muscle fibres are actively contracting or temporarily resisting their overall elongation. (p33)

My first thought was isn't this what we do when we apply MET or PNF? In both those approaches to stretching we use the Golgi Tendon Organs to elicit a relaxation phase in the target muscle by contracting it against a resistance and 'turning off' the muscle spindles. But maybe this also explains why, having stretched a muscle it can quickly return to its shortened state. Perhaps it is simply not enough to target the compliant fibres, needing in addition to target those less compliant fibres. I don't know, and it definitely needs more thought. There are many other possible reasons why, after applying all our techniques and skills, some tissue simply refuses to respond as we would like. But it does look like a deeper understanding of an appreciation for the role of fascia could open up a whole new world of possibilities!

One of those possibilities that came to mind was to experiment with stretching by adding a small degree of stretch during the contraction phase. It's just a wild idea at the moment, and may prove totally fruitless. Even as I think about it, I wonder how you could do this in practice-stretch an already contracting muscle. I shall have to experiment on myself!

A germ of an idea

Okay, so as you know I'm off to the London Marathon tomorrow (Sunday 23rd April). It's my second year working with Against Breast Cancer, and as I said in the previous post, it's quite a small group of runners. And that got me thinking.

How many smaller charities have runners, maybe only one or two, raising money for them at this year's event? I don't know the answer to that question, I'm guessing someone, somewhere does, but it's not me. I'm pretty sure that although there might be a welcoming committee to cheer these runners home, I'm not sure how many will get the good bags and an offer of a post-event massage at the end of their 26 mile run.

So what if we got together and provided that service for a group of charities? Under some sort of collective banner a small team of 6 or 8 therapists could probably treat 100+ runners that might otherwise not get the opportunity.

I'm not sure how to organise something like that, but if a group of charities worked together I'm sure we could get a big enough marquee sorted. It's worth some thought.

Why I work for nothing

On the 23rd April 2017 I will once again be dragging my massage couch through St James Park to set up in a gazebo and prepare to treat a group of charity runners at the London Marathon. I've done this for the last 5 years and always as an unpaid volunteer.

Each year I see offers of 'paid work' but for me it's become somehow important that I give up my time for free. Each runner I treat has put themselves through some sort of training programme that has resulted in them just having run 26 miles. It might have taken them anything from 4 to 6 hours to complete the course. They've done it to raise money, often for a cause close to their hearts because of family loss or circumstances or experience.

Don't get me wrong, I don't have a problem with people getting paid to do what I choose to do for free. It is, after all, my choice. It doesn't make me or them better. It's a choice. I do get a bit annoyed when I discover that having volunteered some pull out of the volunteer role because a paid role has come along. That leaves the charity looking for volunteers in the difficult position of casting around for last minute replacements, and quite frankly I find that unacceptable.

This year I'm working with Against Breast Cancer again. We'll be somewhere in St James Park and I'm not sure how many runners they have in this year's event and how many will come for a post-event massage, but we'll be there, ready and waiting.

And if your chosen charity hasn't got post-event massage available and you fancy a 10 minute rub-down, then why not come and find me and I'll see what I can do.

Slings and Chains

There's been a lot of talk over the last few years about fascia. We've had symposia about it and there seems to be some interesting research taking place. We no longer see it as just a layer of tissue but as something more significant than that. It seems quite logical when you think about it that this cling-film like material that is wrapped around muscles and bones and that blends together to form something of a network throughout the body, should actually be playing a role in the complex systems of movement and posture.

Now, I'm no expert, so I'll leave the technical stuff to someone else, but as a therapist I'm fascinated by the relationships that exist through this fascial net, as I am about the non-isolated relationships between muscles. When we learn our basic anatomy it's usually done muscle by muscle as if they work in isolation. But we soon realise that this is not the case. Very quickly we discover agonist and antagonist as one relationship, then we begin to learn about co-contraction, eccentric and concentric contractions, synergists and stabilisers. Next we might start to think about movement patterns. Not just getting up from a seated position or taking a walk but about what happens when we kick a ball or hit a tennis serve.

These patterns are a series of complex interactions as muscles contract to produce movement at a joint or to stabilise a joint during movement. Suddenly our origins, insertions and actions of isolated muscles simply won't do the job of informing our understanding of these patterns.

Of course, from a therapy point-of-view, it's only when these patterns breakdown and cause an injury or a limitation that we tend to get involved. It's then that we start the detective work of trying to figure out what's going on and what we might be able to do to help fix it. I've never bought into the slightly "mystical" approach that I've seen some therapist apply. Personally I prefer to think a little more logically and dare one say scientifically about what I'm doing. For me there's nothing mysterious about a pain in the shoulder starting from the ankle on the opposite side when you understand a little more about how muscles interact and how fascia responds. It makes logical sense.

This is where myofascial slings are helpful as are muscle chains. Muscle chains got mentioned to me the other day and I'd not heard the term before, so I decided to do a quick bit of research. There's a lot more to be read, but at it's most basic a muscle chain simply traces the relationship between muscles and they cross joints or share attachment site. For example, think about the relationship between tibialis anterior and latissimus dorsi on the opposite side. TA shares and attachment site with peroneus longus, which in turn shares a site with bicep femoris. Follow this hamstring muscle and you'll find a connection with GMax via the sacrotuberous ligament. GMax and LD share an attachment via the thoracolumbar fascia. You could trace gastroc in a similar way. In fact, when a client comes to me complaining of tight hamstrings, I often check gastroc first with a simple test. Usually, even if the hamstrings are tight, there's tightness in the calf too. Where the client first feels this in a forward bend can be a clue as to where the primary problem might lie.

So, if you're just starting out in therapy remember to think about muscles in relationships and in movement patterns and not just in isolation, and maybe try to find a subtle way to get your gym bunny clients to understand that too!

The new muscle on the block

So, last year as I recall we were told about a new ligament in the knee and now we find out there's a new muscle in the quadriceps! They've given it the name tensor VI, or TVI. It lies between VL and VI and apparently the TVI combined with an aponeurosis merging separately into the quadriceps tendon and inserting on the medial aspect of the patella.

According to the abstract I read (you can find it here) this new extensor was found in all the lower limbs investigated. What caught my eye was the insertion on the medial aspect of the patella. Thinking out loud I wondered whether further research would point to the influence this newly discovered extensor might have on patella tracking. I don't know, and it would obviously depend on how that medial attachment relates to the patella tension and the quadriceps in general. That's something for the clinicians and sports science folk to play with!

It is quite amazing that with all the anatomy studies that have been done that we're still finding new stuff, but I guess we're more complex that we probably imagine.

Tennis Anatomy

I decided to read this book for two reasons. I'm both a therapist and a tennis player, so the book appealed to both aspects of my thinking. The book has value to both, but maybe not as much for the therapist as for the player.

As a therapist, the value of the book lies in the detailed analysis of which muscles are at work in the full range of tennis shots. Knowing where to focus your attention when working with any sports person can be a challenge, and of course it differ from sport to sport. As well as tennis players I get to treat a range of sports people from runners to rugby players.

The books provides a general introduction to how a tennis player moves and how they adapt to different surfaces and also how different styles of playing influence the way muscles are used. There's also a useful section at the end of the book on movement patterns that could be used to provide the basis for rehabilitation exercises, and a chapter covering common tennis injuries and stretches. The chapters in-between look at specific areas of the body (shoulders, wrists, core, etc). Chapter 8 is focussed on rotational strengthening.

Each chapter looks at the anatomy of the area, how it is used in tennis and then offers a series of exercises related to strengthening that area.

The reface makes the aim of the book very clear:

This book is written for serious competitive and recreational tennis players... In this book, we highlight the different muscles groups involved in each of the strokes and show you how to best train those specific muscle groups as part of a comprehensive approach to tennis-specific training.

The book certainly delivers on that level! From a therapy perspective, the book's value lies in increasing one's understanding of the mechanics of tennis. How you apply that knowledge is up to you!

My verdict: Not really a therapy book, but a useful read if you're dealing with racket sports.