The problem with glutes!

Some days the title of an email just makes you smile. Checking through my spam reports I came across a great email this morning that simply asked a question: Are weak buttocks ruining your training? I suggested to Anne that she might like to see if she could work that one into conversation at work later in the day!

Of course the email was raising an important point and wasn't sent out with this title just to amuse me. In its context it's a perfectly appropriate question. It's hardly news to most of us that many people have issues with their glutes, often around firing patterns. I remember being fascinated one morning when someone ran past me as I walked along the Thames Embankment and I watched as their left gluteus maximus didn't appear to be engaging at all. It just sort of flopped about, appearing to do very little. Quite what was going on I don't know and didn't think it polite to ask!

If you wonder how much your gluteal muscles are engaging then you could try a simple test. Find a slope and just walk up it  normally. Then clench your buttocks and walk up. Did you notice any change in power? If you did, then it might just be that when you walk or run your glutes might not be firing properly. With practice you can retrain your muscles to fire at the right time without having to hold them "on" as it were. It can make a real difference because active glutes allow the hamstrings to focus on their job rather than compensating for the inactivity elsewhere.

The article to which the email points was actually all about a training programme and quotes one sports physiotherapist who says:

"So many athletes with running overuse injuries of the lower limb present with poor gluteus medius function that I have come to the view that the strength and function of this muscle is probably the most important active component in the achievement of a biomechanically efficient running technique."

The more I read about hips the more fascinated I am by their seeming significance to so many aspects of our health and movement. Not surprising really given their strategic role and position between upper and lower body. When you first learn origins, insertions and actions, you don't really take the time to consider what that means in complex movements. The more I read and try to understand the mechanics of movement, the more one has to see muscles in groups, working together. So, for example, gluteus medius may primarily abduct the hip and the posterior fibres extend and laterally rotate whilst the anterior fibres do the opposite, but what does it do when you run or walk? How does it stabilise the pelvis during a complex movement?

The more I think about it, the more important it seems to become to me that if I want to be a good therapist, even and excellent one, then understanding movement patterns, compensations and their relationship to injury and rehab is also very important.

And as to my buttocks and hips, well maybe if I paid a bit more attention to having healthy hips, a few other things might sort themselves out on their own!

Musculoskeletal problems and the workplace

There's an interesting article on the business pages of the BBC website about musculoskeletal issues and work. Apparently:

Almost 31 million days of work were lost last year due to back, neck and muscle problems, according to the Office for National Statistics (ONS).

That's a not insignificant number.  It seems obvious then that there's a place for soft tissue therapy in the workplace, but how do you go about convincing business that it pays to have onsite therapy available? I don't know the answer to that, but I know from my time as a student working at a large media company that members of staff seemed to value having us available.

Of course we can't help everyone, but I do wonder whether, if we could somehow get more involved in the work place, then maybe we could address some of the muscular problems that might be affecting some workers as part of the bigger picture of well-being for all staff.

Tight Calves?

No, not money pinching young cattle, but those bits between your ankle and your knee that give you jip when they get stiff and tight. Typically the way we stretch our calf muscles is to lean into a wall or fixed object, flexing the ankle with our leg nice and straight. A good, simple, static stretch, but with limits.

Firstly, it only really targets one of the major calf muscles, the gastrocnemius (that's the big one you can feel at the back and, when well defined, shows up as two large bellies of muscle either side of the back of the calf). You can stretch the deeper soleus muscle by making the same flexing movement but  with your knee bent. This switches the gastroc off, allowing to target the other muscle. The second disadvantage is that it's not necessarily the best way to to stretch pre-exercise. Recent research points to dynamic stretching as the better pattern for pre-exercise stretching. In fact some suggest that static stretching before exercise is positively bad for you and actually increases the risk of injury.

So, how can you stretch your calf muscles dynamically and target both the superficial and deep muscles efficiently?

Heres a link to a short blog post at Kinetic Revolution that shares a video to do just that. According to the video/post this routine can help with some shin splint issues and issues with both the achilles (calcaneal) tendon and plantar fascia (that's the soft tissue under the foot).

Don't forget TFL!

A couple of weeks go my back got a little stiff and sore. Nothing unusual in that, I've suffered two significant back injuries in the past and at 6'3" I'm on the tall side on usual! Anyway, when my lower back gets tight I usually get down on the floor and do a series of stretches.

I work systematically through the hamstrings, quads, gluteus and piriformis. That usually does the job, but not every time and not this time. The one muscle that I often forget, and I'm not sure why, is TFL. Perhaps it's because I haven't yet found an easy way to stretch it on my own, although I've seen a few possible ways of doing it.

My solution was to get out one of the spikey massage balls I bought a while ago. Lying on my side, I placed the ball under my side and into TFL. Carefully I moved up and down and round in small circles over the ball. It's quite difficult to control the depth, but after a while I found it relatively easy to support myself enough to control it.

You could probably do a similar thing with a tennis ball or even the two tennis balls taped together tool I made. For me it solved by lower back pain and freed up my back considerably.

If you're going to try this on yourself and aren't sure where TFL is located, the easiest way to find it is probably to lie on your back and find the bony bit of your pelvis that sticks out on the side. TFL starts just behind that bump on the outside and runs down to the outside of your thigh. If you put your fingers on your thigh up near your hip and then turn your foot inwards you should feel a muscle tighten under your fingers. That's TFL.

Workshops

Last week I ventured into the world of education, not as a student, but as a teacher! Back in the autumn I was approached by a local college about doing some workshops for their dance students. They wanted me to talk about anatomy and physiology, nutrition, exercise and anything else I could think of that fitted with their curriculum. I, in turn, came up with a long, long list of possible topics and tried to work it into a 2.5 hour workshop.

In then end I had way too much stuff, but I expected that. Although I've been involved in preparing and delivering talks for many years, this was somewhat different and I could tell from the outline I prepared that we were simply not going to be able to get through it all in the time we had. But that was okay because the last thing I wanted to do was run out of stuff to do.

Overall i think the day went okay. Certainly from my perspective I was quite pleased with the atmosphere we created and how we managed to collaborate. Yes I'd do things differently next time. Mostly working out where to focus attention, but with enough room to explore the topics in ways that supported the student's learning objectives.

I thought I might struggle to build rapport with the students, but they were great. I tried to make the workshop as interactive as I could, and that helped.

So what's next? Well. hopefully, I might get to go back in at some point and revisit some themes and maybe do some stuff with next year's students. You never know, maybe I'll get other opportunities to similar projects. It certainly helps me to keep some of the things I've learnt fresh as I learn how to deliver them to a group. Mind you, I might need some training on how to use an interactive white board!

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!

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.