Taking part in a cyling endurance event this summer? Read our 10 top tips for staying injury free and making it to the end!

I recently spent the weekend with my brother, Anthony, and his wife who live just outside Salisbury. Anthony has recently given up full time GP practice and now just helps out one day a week at a lovely, little, local practice.

Alongside his long career as a GP my brother has worked as the doctor for many charity bike rides. This has combined his love of cycling, travelling, photography and medicine as well as helping to raise a huge amount for various charities.

He has also learnt a thing or two about how to avoid injury and make it to your final destination in one piece!

Exciting announcement!

I’m proud to announce that Physio on the River is going to be one of the sponsors for the parents of Barnes Primary School who have formed a team of 42 cyclists and will be riding to Amsterdam this June to raise money for the school. We are keen to help them every way we can. So when visiting my brother I asked him for his top tips for doing a long cycling event like the one to Amsterdam. Together with some of our own ideas, here are 10 pieces of good advice.

Our 10 top tips for staying the distance

1. Gears

Get used to your gears – REALLY used to your gears. Otherwise you will simply get exhausted and you won’t make the distance.

2. Speed

You should be pedalling between 60-90 revolutions per minute. If you are going much faster, you will never make it to Amsterdam or wherever your heading.

3. Handlebars

Don’t grip the handlebars tightly. Get used to holding them loosely and let your elbows relax. Otherwise you can end up with Tennis Elbow or Carpal Tunnel syndrome (irritation of the nerve that passes across the front of your wrist and supplies your thumb, index and middle fingers).

You might even consider wrapping more sponge around your handlebars so you can’t grip as tightly. The padding will also provide more cushioning, so you are less likely to develop Carpal Tunnel syndrome.

4. Bums are less important than knees!

If you suffer from knee problems, have your saddle a little higher. If it’s too low your knees won’t make it to Amsterdam, but your bum will and it’s no good if you can’t walk when you arrive!

5. Saddles

Don’t wear a saddle cover because they slip around and can blister your bum. Get yourself a gel saddle but not a gel saddle cover. Don’t get anything with hair on it. Anthony once saw someone with a tiger fur covered saddle and the rider only lasted two hours! It just creates too much friction where you really don’t want friction…..

6. Training tips

When training don’t forget to throw in some swimming, especially backstroke as it’s great for strengthening your back and your back will take a lot of punishment on the ride. You want it to be strong and supple. It’s a great antidote to all that crouching over the handlebars.

In fact, my physio team and I would recommend plenty of variety in your training – not just cycling. Just like any big sporting event, addressing all aspects of fitness will help your performance.

Something like yoga or a stretching regime can help with flexibility. Hip flexors which cross the front of your hips, can get very short and tight in cyclists.  

Pilates exercises are great for improving your core strength. For your legs to power you efficiently you will need a strong core from which your leg muscles can work.

As mentioned earlier swimming is both good for back muscles and good for fitness. Going to the gym to strengthen your leg muscles is essential and whilst there, work on your aerobic fitness with some cardio work like rowing, running and cross trainer. Perhaps not cycling as I’m sure you will be spending plenty of time on that in your training already!

Try and mix up your training so you include a selection of activities through the week. If you need any help both Physios, Richard and Dave, offer personal training at our clinic.

7. Bike fitting assessment

It’s important to make sure your bike is set up absolutely correctly for you. Our cycling ‘guru’ and Physiotherapist, Richard Game, is trained to carry out Bike Fitting assessments in our clinic.

The advantage of having a Physiotherapist carry out your assessment is that they can not only look at how the bike fits you – but also, how you fit the bike.

Very few people are completely symmetrical and most of us have areas of weakness or tightness in our bodies. For example, even though your bike may be set up correctly for you, you may cycle with one knee falling inwards. This may be because your buttock muscles are weak and have nothing to do with the bike set up. This is something that a Physiotherapist will pick up on and can help you address.

8. Working proactively on injury prevention

Bike fitting

Physio Richard can do a Physio screening assessment to identify any weak points in your body that could start to give you problems as you increase your mileage and up your training. Remember that cycling is a very repetitive sport! Once identified he can design a bespoke programme of strength and conditioning and flexibility exercises. You can be working on this programme alongside your normal cycling training. Prevention is so much better than cure.

9. Getting your soft tissues in tip top condition

Many keen cyclists have a very sedentary day job. Spending lots of time in front of your computer can often lead to poor posture and tight hamstring, hip flexors, neck and back muscles. Having some regular sports massages can help to get your muscles and other soft tissues in the best condition.

The Massage Therapist can work on your tight muscle groups and improve your flexibility. Massage is also a useful way to aid recovery following the event. We have a team of three Massage Therapists who are all experienced in pre and post-event massage. In fact, Rachel is a triathlete herself, so knows all about preparation and recovery for big events.

10. Hydration and nutrition

Especially when abroad, use a capped water bottle. You are far less likely to get stomach problems – it’s amazing what the front wheel flicks up!

Anthony recommends that nibbling long-burn carbs/protein (nuts and fruit) is more fun than putting additives into your water bottle. The latter is only necessary on rides over 100k. Anthony advises to avoid meat at lunchtime as it ruins afternoon performance and isn’t needed.

He stressed the importance of ensuring you are pre-loaded with water at the start of your day. If you have not peed by 11 o’clock you should be worried. If you haven’t peed by 12.30, stop riding as dehydration lurks.

We hope you find these tips useful and we wish charity teams all the best for their endeavours over the summer months!

Next steps…..

If you would like to book a Bike Fitting Assessment or a Cycle Screening Physio Assessment with Richard, or you are interested in a sports massage, personal training or our Yoga and Pilates classes, just:

Call us on 020 8876 5690

Email us here

Or simply pop in for a chat – we are always happy to chat things through first.

Hear how Physio Dave helped a keen runner with persistent Achilles Tendinopathy

I recently caught up with one of our keen running clients, Patrick, who came to the clinic complaining of chronic Achilles Tendinopathy. Read on to find out how Physio, Dave Burnett, helped Patrick recover so that he could return to distance running again.

Hi Patrick- tell us a bit about yourself and what sport and exercise you do?

As a retired rugby player and triathlete my body has taken a bit of a battering over the years. Nowadays I cycle as my main sport but still enjoy running and swimming.

How and when did you develop your running Injury?

Achilles tendinopathyIt was probably a combination of not warming up properly, pushing too hard and the uneven surface that must have aggravated my Achilles tendon problem. When you are only a short distance out the tendency is to keep going to the end which probably just aggravated the situation even further.

What did your physiotherapy involve and how did you find it useful?

Dave at Physio on the River was great! Things were made easier as I was being treated by him for a shoulder injury at the time and he saw me hobble in and immediately diagnosed the issue – which was a Chronic Achilles Tendinopathy. So, after a couple of sessions of manual therapy treatment and stretching exercises for the calf, hamstrings and glutes (buttocks) we started the Shockwave treatment.

Describe your experience of shockwave therapy?

Shockwave for the achilles tendonI had 4 sessions of Shockwave which involved getting hammered by metal pads 100 times a second! It hurts the first time, although I think this was psychological and then after that it became quite therapeutic!

Whilst you mustn’t run immediately after the treatment, you can stretch and it’s important to do loaded strengthening exercises.

Every week I felt some progress. Once we had finished the Shockwave sessions we were able to progress to more explosive “plyometric” exercises. Apart from a blip when I may have done too much too soon, I was able to gradually build up the time and distance I was running and eventually the pace.

I am making great progress now. The important thing is to listen to your body and take your time. When you get injured after 50, it’s about managing the condition. The shoulder injury also helped as it forced me to go swimming and I was able to do more rigorous plyometrics in the pool. The positive benefits of swimming are extensive!

How are you getting on now and have you achieved your goals?

I’m in a good place now and am hopeful of continuing Park Run regularly and getting to that all important 22-minute milestone. My ultimate aim is to get back to half marathons.

What’s your brief understanding of how to manage your Achilles tendon problem in the long-term?

Should it return I should first  reduce the load, gradually re-load, add plyometric exercises and load even more -with marginal increments and take my time! Thanks very much Dave!

Thanks, Patrick, for sharing your story and illustrating so nicely how we treat and help people manage chronic tendon problems like yours.

Next steps….

If this has struck a chord with you and you’re suffering with a tendon problem, to make an appointment with Dave just:

Book online

Call 020 8876 5690

Email us here

Or pop in for a chat!

Is cadence important for running? Read Dave’s steps to success!

And why cadence may be something to consider……

If you have ever wondered what the Cadence measurement on your Garmin running data actually means, you should hopefully find the following advice useful!

Cadence (the total number of steps you make per minute) is dictated by your running style and can have a big impact on your running economy (i.e. your energy expended). It is also a risk factor for many running injuries.

What does the research tell us?

A 10% increase in step rate may reduce knee joint loading by up to 34% (Heiderscheit et al 2011).

Low cadence (<166 steps per minute) is linked with a 6-fold increase in shin pain versus a cadence less than 178 steps per minute (Luedke et al 2016).

Low cadence is typically seen with:

  • an “over-stride” pattern – see below left, versus good foot placement right. When over-striding the foot contact is made significantly ahead of the knee and the runner’s centre of mass. This is a common running style fault and injury risk factor.

  • similarly, increased ‘bounce’ or excessive vertical oscillation expends excessive energy and also poses a risk to injury.

So what is the ideal cadence for running?

The ideal cadence for running is thought to be approximately 172-190 steps per minute.

How do I go about making changes?

Changing your cadence can take some practice and it’s sensible to only increase by 5-7.5% at a time. Allow  2-3 weeks to accommodate this amount of change before you increase any further.

There are several mobile Apps available to help set and monitor your cadence and many running and sports watches will record cadence as part of their standard data. Additionally there are running coaching strategies and drills that can be learnt to aid the correction of over-striding or excessive bounce patterns.

How can we help you?

If you are unsure if your running style is a cause of any niggling injuries or are wondering if your running style is efficient, it’s best to have a Biomechanical Treadmill Assessment which we offer here at Physio on the River.

Physio Dave Burnett is our running guru and runs our running clinic. He can give your running style an MOT and coach you through any changes necessary. He can also help you resolve any old injuries you may be carrying.

Next steps……. (no pun intended!)

To book a Biomechanical Treadmill Running Assessment with Dave just:

Call 0203 916 0286

Email us here

Or simply pop in for a chat – we’d love to see you!

Keen cyclist? Read about our new Bike Fit service!

With Richmond Park and the Surrey Hills almost on our doorstep it’s not surprising that cycling has become such a popular sport in this area.

Cycling places unique demands on the body and, here at Physio on the River, we frequently assess and manage people with problems related to cycling. These include aches and pains caused by cycling and the way the bike fits the person, as well as movement issues and physical problems with their body that impedes their cycling – and often both at the same time!

Therefore, it is entirely appropriate that we are now able to offer a comprehensive ‘Bike Fit Assessment‘ by a Physiotherapist to ensure optimal performance, manage any individual musculoskeletal imbalances in the body, minimise injury risk and keep you pedalling joyously!

One of our team of Physios, Richard Game, is a keen cyclist and loves treating cycling injuries. He is also trained in carrying out Bike Fit Assessments. Read more about how Richard can help and the value of having a thorough Bike Fit.

10 most common cycling aches and pains

  1. Neck pain – whether you are on a road bike, mountain bike or a hybrid, your neck has to be unnaturally extended for long period of time in order to see the road ahead. This commonly causes neck pain and sometimes neck related headaches
  2. Hand pain – too much pressure on your hands (usually because of incorrect bike set up) can cause hand pain. Also pressure on the nerve can lead to finger tingling and weakness (a temporary nerve palsy)
  3. Forearm pain – this can be from over gripping the handlebars or incorrect set up causing too much load on the forearms
  4. Lower back pain – it’s not hard to see how flexing the back in an unnatural position for hours at a time can cause lower back pain! Correct bike set up can help to alleviate this.
  5. Hip pain – cycling involves an awful lot of repetition in a very static posture. Tightness across the front of the hips can pose a risk to developing hip pain
  6. Knee pain – incorrect alignment of the knee when cycling (allowing it to drift inwards or outwards) can provoke knee pain
  7. Ankle pain – the position of the foot on the pedal and the cleats can alter the alignment and loading through the ankle
  8. Foot numbness – pressure through the foot and toes can lead to numbness of the foot
  9. Saddle soreness – we’ve all experienced that I’m sure – but the position of the saddle in relation to handlebars and pedals can contribute more or less to this soreness
  10. AC joint soreness – the AC joint is a small joint that sits just above the main shoulder joint. It takes a lot of load transferred up from the arms and into the upper body. It too can get sore and lessening the load with correct bike set up can help to lessen the pain

So you can see that there are quite a few aches and pains that can develop and getting your bike fitted to you correctly can go a long way to alleviating the stresses through the various parts of your body.

What is the advantage of a Physiotherapist carrying out your bike fit assessment?

As Physios we can not only assess how the bike is set up correctly for you but we can also look at how well your physical make-up works on the bike! Not everyone is totally symmetrical and cyclists often carry old injuries and imbalances in their body. We have the background knowledge of the human body to assess what needs to be fixed in your skeleton and movement system for a more comfortable ride. So Physios can look at how well the bike fits you and how you fit the bike!

What is a bike fit assessment?

Bike fitting aims to maximise rider comfort. A well fitted rider should be able to sustain a relaxed position on the bike with minimal effort, without causing strain and overloading tissues.

Bike Seat position IS NOT a normal sitting position but on a bike! It’s an entirely different posture.

The key to a successful bike fitting is that the rider is relaxed, their posture is optimal, weight is distributed evenly and comfortably, the joints are extended optimally to produce power and the foot is stable.

What can you expect from your bike fit assessment?

Bike Turbo Trainer

A bike fitting will take approximately 75 minutes. You should attend wearing cycling clothing, the footwear you cycle in (cycle shoes with cleats if used) and of course, bring your bike!

You will have your bike connected to a turbo machine and expect to be riding for up to 25-30 minutes on and off whilst we carry out the assessment.

We may occasionally make recommendations on changes to components such as saddles, stems and handlebars and, as necessary, can help you to source them (though for most this shouldn’t be necessary).

We charge £180 for our new bike fit service.

Next steps…….

If you would like more information and a chat with our cycling physio guru Richard Game just:

  • call 0203 916 0286
  • contact us by email here

Need to exercise but short on time? Let us help you with some top tips!

I used to find exercising really easy as I had a lovely, lively, young Springer Spaniel who had bags of energy and was a struggle to keep up with! But sadly she is now 12 years old and, except on really good days or when she sees a unsuspecting squirrel, she is trailing several feet behind me! I realise that my old workout is no longer the aerobic fix I need….

I wonder if any of you watched the ‘Trust me I’m a doctor‘ programme on BBC 1 on Thursday 13th September? I love watching it when I’m around and that episode was particularly interesting.

The affects of ageing on our muscles

The programme explained how over the age of 50 we start to lose muscle mass at a rate of about 1% per year and muscle power at a rate of about 2% per year. This in part explains why older people become more ‘frail’ and are more susceptible to falls.

1% or 2% per year may not sound much but if you think about it that adds up to 30% loss of power by the time you are 80. This can have a significant effect on your ability to walk distances, climb stairs and even such simple things as getting up out of a chair. Muscle weakness can also affect your balance and increase your chances of having a fall.

So keeping up our exercise when we are over 50 is absolutely essential if we want to maintain our muscle mass and independence.

The shocking statistic is that 40% of middle aged adults take less than 10 minutes continuous brisk walking per month!

So what can you do to reverse this affect?

weight liftingThe programme also explains how important it is to do resistance exercise such as weight lifting at the gym, to combat this effect. They recommend you do this twice a week. They also demonstrated some simple body weight exercises (ones that we frequently prescribe to clients) that can be done without the need to go to the gym.

Common excuses for not exercising!

The most common excuse for not exercising is a lack of time. So some scientists at Bath university carried out an experiment looking at blood sugar levels and blood fat levels at intervals after a block of 30 minutes brisk walking and compared this to 6 x 5 mins of simple exercises and taking no exercise at all. The simple exercises included sitting to standing, going up on your toes in standing, squats and marching on the spot.

They chose blood sugar and blood fat levels as these can be harmful in the extremes. If not kept under control they can lead to Diabetes and heart disease.

The team of doctors were all surprised to find that both exercise groups benefited equally with a 40% drop in both blood sugar and fat levels following the experiment. Not surprisingly the control group who took no exercise had no drop in blood sugar or fat levels at all.

This is a really useful finding as it means that those who are time poor but can squeeze in 5 mins here and there into their daily schedule can still do something really worthwhile for their health!

Top tips for sticking to an exercise regime!

  • Exercise snacking! Remember that 5 mins brisk walking performed 6 times a day is just as good as 30 minutes of continuous brisk walking. So move regularly and take lots of mini breaks of exercise if you don’t have time to take it all in one go.
  • Find a gym buddy! Remember that weight training for the over 50’s has lots of benefits to health including preventing that decline in muscle power and helping bone density. A good way to increase your chances of sticking to it is to find a gym buddy. This extra bit of commitment and the thought you might be letting someone else down is a great way to motivate yourself. My gym buddy (my son, Sam) has been away in New Zealand for the last 5 years so I’m looking forward to his return a week today and his help in motivating me to go to the gym more often!
  • Joining a class can be a really helpful way to stick to exercise. The social aspect helps to make it fun and more than just exercise. We run 34 classes of Pilates, Yoga  and Dance,Tone and Stretch classes each week so there’s something here for everyone!
  • Diarising your exercise – simply popping a regular time in your diary can help to prevent other things taking over that time.
  • Get it done early! Its so easy to put things off as the day progresses so try and get your exercise done early in the day before you get too busy and distracted by other things.
  • Work exercise into your daily life – personally I walk to work (15 minutes) and on the way home I take a circuitous route for 50 minutes. It’s a great opportunity to listen to a book on audible or a podcast and I get home feeling refreshed and no longer thinking about the clinic! I know other people who cycle to work or walk their children to school and work exercise into their day that way.
  • Personal training – some people just like the one to one attention and motivation of a personal trainer to keep them on track. The advantage to this is that the trainer can tailor the exercises specially to you and your physical needs. We have two physios (Richard and Dave) who both have a background of sports science degrees before training as physiotherapists and they offer personal training in our studio at the clinic. Using a doubly qualified Physio for your training means their in depth knowledge of the body will keep you exercising safely!
  • Sign up for a charity event. There’s nothing like a good cause to spur you on! And it’s nice to share the experience with others.
  • Share your exercise resolutions with friends. Telling people your intentions makes it much more likely you will stick to it. They say it can take 21 days of doing something regularly to form a habit so persevere!

Here at Physio on the River we aim to support you by getting you better and more healthy and keeping you that way through appropriate exercise.

Next steps…..

If you’d like to join one of our classes or arrange for a personal training session with Richard or Dave just:

  • call us on 0203 916 0286 and speak to one of our receptionists
  • email us here
  • or pop in for a chat! We are always happy to talk things through first

If you have a physical health issue that is stopping you from exercising then one of our team of physios may be able to help you back to fitness. Or if you have an elderly relative who is becoming frail and is at risk of falling – find out more about our falls prevention programme.

Massage Monday – how we can help you recover from the London Marathon!

If you have just woken up after completing the London Marathon yesterday, you may well be feeling stiff and sore! This week I asked our new massage therapist, Rachel Jarvis, to tell us how massage can help you recover from a marathon.

Rachel recently jointed our massage team of three. She is a very keen runner herself and competes in triathlons and endurance cycling events so knows all about recovery!

Rachel qualified with a Level 5 Professional Diploma in Sports and Remedial Massage from the North London School of Sports Massage (NLSSM).

Rachel’s 6 top massage benefits

  • Massage reduces muscle soreness by flushing out the build up of toxins from the muscle and other soft tissues of the body. This reduces soreness or DOMS – short for ‘delayed onset muscle soreness’ which is the pain and stiffness felt in muscles several hours to days after unaccustomed or strenuous exercise. The soreness is felt most strongly 24 to 72 hours after the exercise.
  • Massage helps improve blood flow to the tissues which in turn helps the tissues to heal and helps you recover from the fatigue felt after the run.
  • A post event massage allows the therapist to assess the condition of your muscles and identify any particular areas of tension.
  • It helps to restore your flexibility through re-balancing the musculoskeletal system. If you don’t feel so stiff and sore you will move with more ease and be able to stretch further.
  • Massage can help to re-energise you through relaxation.

When is the best time to have a massage after the marathon?

If you have competed in a marathon before, you may have been offered a short post event massage at the finish line. This can start the process and this first massage will be gentle. Benefits can be seen for up to a week after the event. As the days go by after the event, a deeper and longer massage can be given.

Rachel recommends taking the immediate post event massage but it shouldn’t be a replacement for a proper treatment later in the week.

Are there any other self help things you can do to aid recovery?

Rachel recommends:

  • drinking plenty of water to rehydrate yourself and help to flush those toxins through your system
  • keeping active! It sounds like the wrong thing but taking a steady walk or very low intensity recovery run, swim or bike ride can actually help to prevent stiffness and soreness!

What should I do if I sustained an injury during the marathon?

We recommend coming to see one of our Sports Physiotherapists to get your injury checked out professionally. As soon as you can  it’s always a good idea to use the PRICE method of initial treatment:-

P for protection – bandage the injured part to give it support or use a crutch or stick if required

for rest – rest the part for the first couple of days

for ice the injured part. We have some very good ice packs we sell at POTR. They are gel ice packs that don’t lose their flexibility with freezing and have a very good cover to protect you from an ice burn.

C for compression – the supporting bandage or elastic support will help to compress the tissues and minimise excessive bleeding into the tissues and swelling.

for elevation – raise your injured part higher than your heart if you can! So if it’s your ankle, lie down and place your leg on a couple of pillows to help reduce swelling.

Next steps…..

If you’d like to take advantage of our special massage offer – 6 for the price of 5 – a saving of up to £62, or book an appointment with one of our Physios:

Call us on 0203 916 0286

Email us here

Book online here

Or just pop in for a chat first!

How Physio helps recovery from Anterior Cruciate Ligament skiing injury

With the Easter holidays underway, it’s that time of year again for skiing fun!

Hopefully you will have done your pre-skiing preparation but unfortunately, even with the best laid plans, injuries can still occur.

Katherine Ashmore is one of our team of Physiotherapists and a keen skier herself. In this blog she runs through the common mechanisms of ACL injury, how the diagnosis is made, the options for treatment and how Physio is vital to recovery whether you choose surgery or not.

Common mechanisms of injury

Common down-hill skiing injuries to the knees occur when landing from a jump or going over moguls, colliding with another skier as you exit the ski lift, or simply falling and twisting your knee.

We also see upper limb injuries when falling onto the outstretched hand or landing heavily onto the shoulder.  The injuries are often brought on by one too many at lunchtime, bad snow, tiredness at the end of a day or when bindings do not release!

The most prevalent types of injury are bone fractures, joint dislocations or soft tissue injuries such as ligament strains, tears and ruptures. The knee is the most common area to injure and more specifically –  injuries to the ACL (anterior cruciate ligament), MCL (medial collateral ligament) and medial meniscus (inner cartilage) tears being top of the list!  A combination of all three is called ‘The Unhappy Triad’.

Focusing on the Anterior Cruciate Ligament

sourced from www.sportsmedicineeuk.co.uk

The anterior cruciate ligament (ACL) is located deep inside the knee joint and attaches the thigh bone (femur) to the main shin bone (tibia). It keeps the knee stable by preventing the forward motion of the shin from going too far and the knee from rotating too much.

The vast majority of ACL injuries happen during slow-speed turns, often in sticky, slushy snow, towards the end of the day when the skier is distracted and tired. The ski goes one way and the skier’s body weight goes the other causing rotation of the knee. Because of the slow speed the bindings don’t release.

This tends to happen to beginners, but can also happen to experts who have their bindings very tight and get momentarily distracted in the conditions described above. At higher speeds, the bindings release and the injury is less likely; hence, the advice is to ski positively and ensure that the ski bindings set properly.

How do I know it’s an ACL injury?

With severe injury, one hears a loud pop or feels a snapping sensation, followed by intense pain and immediate swelling and difficulty walking.   Diagnosis is confirmed by a specialist (Physiotherapist or Orthopaedic Consultant) and MRI.  An arthroscopy can detect a partial tear. Much less usually very experienced skiers can carry on skiing after injury.

How can Physiotherapy help?

sourced from milfordphysio.co.nz

Once you have your diagnosis there are two routes – surgery versus non-surgery.

A surgeon will weigh up the factors with you: your age, lifestyle and sports interests and whether you wish to go through the surgical route.  The knee can be very strong and able without requiring a functioning ACL and these options will be discussed with you, including any associated risk of further injury or limitations in exercise or mobility.

Whether or not you opt for surgery, Physiotherapy is vital to strengthen the knee and get you back to full fitness. Without Physio the knee can remain weak and more susceptible to recurrent injury.

What is prehab?

Often if surgery is required, the surgeon will wait for the swelling to go down first.  This is a great opportunity to receive ‘prehab’. Our Physios will help you to strengthen your knee muscles prior to surgery and get you physically and mentally prepared for your operation. Having knowledge of the exercises you will need to do post surgery is a great help and we find our clients do better with this preparation.

Post op rehab

Where the prognosis indicates surgery, the surgeon will discuss with you whether you use one of your own tendons (commonly a bit of the hamstring) to repair the ACL or use a synthetic option. It is a very common procedure and depending on your level of exercise will take 8-12 months of graded physiotherapy rehabilitation to get back to full sport.  You may even be back to skiing within the year!

What does rehab involve?

Treatment will involve:

  • a carefully graded exercise programme
  • advice on swelling reduction measures
  • graded return to exercise (we can tell you what exercise, how much and at what stage) and
  • latterly sports specific exercise drills if required

Some surgeons have very specific protocols they like us to follow and others are not so prescriptive. but either way we have the expertise and experience to guide you through the process.

We work closely with Orthopaedic Consultants locally and in central London clinics and can fast track you to be seen quickly with one of them if necessary.

Should you receive a skiing injury we are here to help you with both diagnosis and treatment. 

Please don’t hesitate to book an appointment with our Physiotherapist,  Katherine Ashmore, or another member of our Physio team. 

To book an appointment:

Call 0203 916 0286

Book an appointment online

Email us here

Or just drop in for a chat with one of our Physios!

If you have enjoyed this blog and would like to read our other skiing blogs click here.

 

Are you considering joint replacement surgery? Read how we can help you prepare and recover!

This time of year is a popular time to consider having a hip or knee replacement – in the hope you will be fit in time for summer!

Many of our clients end up having both knees or both hips operated on and it’s noticeable how much quicker they recover after the second. This is usually because they know what to expect and are already familiar with the exercises and rehab that is required.

For this reason we would urge anyone considering the operation for the first time to come and see us about 3-4 months beforehand so that we can do some ‘prehab’. We can make sure they are as good as they can be before surgery and are fully informed about what the surgery and rehab will entail. Forewarned is forearmed!

What are the effects of having osteoarthritis?

 

Difficulty rising from a chair

Most clients awaiting surgery have had osteoarthritis in their joint for some years. The disease causes the following things to happen:

  • the muscles surrounding the joint become weakened and wasted
  • they lose some of their range of movement because of stiffness of the joint
  • the surrounding ligaments and muscles often tighten up further restricting movement
  • the pain and weakness causes the person to limp and usually limits their walking distance. They often resort to a stick or crutch.
  • Everyday activities such as getting up from a chair or ascending and descending stairs become harder to do
  • With activity levels limited people often take less exercise and put on weight which becomes a vicious cycle

How can Physiotherapy prehab help?

We carry out a comprehensive assessment of your range of movement, muscle strength, walking gait, posture and ability to do everyday activities. From this we can tailor a programme of exercises that will help to:

  • build back some muscle strength in your trunk, hip and knee
  • allow you to become familiar with the exercises that you will need to do after surgery
  • where possible restore some movement in your joint
  • improve your walking pattern and learn what a normal gait is and what you should concentrate on after surgery. Even practise using crutches in advance of your surgery
  • practise everyday activities and become better at performing them, as you gain more strength and flexibility

If you have limped for some time you tend to forget the normal way of walking as the limp becomes a learnt habit. People normally limp because they are in pain and because their muscles are weak. If you can strengthen the muscles that support the arthritic joint then the pain is often reduced and walking becomes easier.

We also give advice on:

  • footwear to reduce stress through the arthritic joint
  • some clients require an appointment with our podiatrist who can help them correct foot posture that may be having an adverse affect on their hip or knee – for example excessively rolling your ankle in or out too much
  • the benefits of low impact exercise which, although may be painful, does not have a harmful effect on the joint and will not make the disease any worse
  • the benefits of keeping your weight under control to reduce stress in the arthritic joint
  • what to expect after your surgery and a plan of how your rehab will progress

We do sometimes find that clients postpone their surgery as a result of working on their prehab particularly if they have not had Physiotherapy before being offered surgery!

Your post-op rehab

Sadly in many NHS hospitals patients are discharged with little or no Physiotherapy help with their rehab. It’s absolutely essential that the muscles surrounding the joint have their strength restored if you are to get the most potential from your new hip or knee. We see many clients who come to see us a year after surgery and who have failed to regain their movement and are struggling with everyday activities due to poor muscle strength.

The muscles that surround the hip and knee are some of the largest in the body. They waste very quickly and need focused attention to be restored to their former glory! They are the muscles that get you up from sitting, help you walk along the flat and up and down hills and help you climb the stairs. When these muscles are not retrained it’s common to develop lower back pain as the back will take much of the strain.

Retraining your walking pattern so you can shed your crutch or stick is an urgent priority. We will teach you drills to get you from climbing stairs one step at a time to climbing them normally. Our aim is to break all these tasks down into bite sized pieces and gradually progress the difficulty until you master the skill in question.

To book an appointment with one of our Physio team just:

Call 0203 916 0286

Contact us by email here

Book online

Or just pop in for a chat!

 

Read how new shockwave therapy can help those stubborn tendon problems and more!

Here at Physio on the River, we are always working to ensure we deliver the most up to date evidence based therapies to our clients.

We are very pleased to now offer Shockwave therapy . This is a very effective therapy for many chronic painful musculoskeletal problems, examples of which are: Plantar Fasciitis of the foot, Achilles Tendonopathy, Tennis Elbow and Calcific Tendonitis of the shoulder.

sourced from Complete Pain Care

This type of treatment is now recommended by the majority of Consultant Orthopaedic surgeons when muscular, connective tissue (the web of connecting tissue between structures) and tendon problems become chronic (i.e. lasting longer than 3 months).

What is shockwave therapy?

There are many different types of machines that use varying physical mechanisms to produce shockwaves. The machine manipulates these shockwaves to deliver the appropriate dosage to bodily tissues to achieve a therapeutic response.

The most recent mode of doing this is electromagnetic pulse shockwaves. Here at Physio on the River, we are excited that we can offer this type of shockwave therapy. It uses rapid electromagnetic pulses to create precise, low amplitude shockwaves directly to tissues. The major benefit of this is that it is far less painful than many other forms of shockwave production and delivery, for example compressed air.

Can it do any harm?

As well as having a large body of academic evidence for the positive outcomes of this type of therapy (e.g. Legat 2014; Loska 2017; Moya et al 2015), it has the added benefit of having very few risk factors or contra-indications.

The National Institute of Clinical Effectiveness (NICE) guidelines have been produced for the use of shockwave therapy for many common musculoskeletal conditions including: plantar fasciitis, tennis elbow, Achilles tendinopathy and trochanteric (hip) pain syndrome. As you may have read in the press NICE are a hard nut to crack and endorsement from this organisation carries weight.

At initial assessment, if shockwave is for some reason not the best clinical option for you, the physiotherapist will discuss alternative options either at Physio on the River or referring you to a different healthcare provider, as appropriate.

What does the treatment involve?

The package of care for shockwave therapy will involve an initial Physiotherapy assessment followed by a package of as many treatments as required. The number of treatments required on average vary between 4 and 10, depending on area to be treated and the reaction to treatment.

The machine has  a small hand-held device through which the shockwaves are given. The treatment is quite noisy and can sometimes feel uncomfortable but is only given in short bursts of time. We only treat to a person’s tolerance!

How much does it cost?

Sessions of Shockwave are typically charged at £150 -£200 per session throughout the clinics in London that provide it. We are offering outstanding value – a block of 4 Shockwave treatments (typically 4-10 sessions are required) for only £300 – meaning a potential saving of up to £500!

Some health insurance companies, including Bupa, are now offering cover for this treatment so if you hold a policy it is worth checking with your company first.

If you would like to book an appointment:

Call the clinic on 0203 916 0286

Book online by clicking here.

Contact us by email here.

Or pop into the clinic in person – we’d love to have a chat!

 

 

Feeling tired and rung out? Find out how to get a better night’s sleep with expert Rachel’s top tips!

Happy New Year!

The excitement of Christmas and New Year has come and gone but do you feel rested after your break?

Or are you feeling tired and rung out?

We all look forward to the Christmas break and expect to chill out and recharge our batteries. But the truth is that we often go back to work in January, knackered!  And add the dark, gloomy, grey days of January into the mix, and it’s no wonder you feel exhausted.

Apparently, January is THE month people go online scouring the internet for solutions to their sleep problems.

Why is this a tricky time for sleep patterns?

Most of us are manic before Christmas, tying up work projects before the end of the year and getting ready for the festivities.  Plus, we have probably experienced quite a few weeks of partying in the lead up to and during Christmas! This all adds up to disrupted sleep routines – going to bed late and getting up at irregular times.  And we’ve also been eating lots of richer and heavier food, maybe drinking too much alcohol and taking little or no exercise. More changes that impact badly upon our sleep.

Add to the fact that many of us have been on the move during the holidays, visiting relatives and friends.  Sleepless, restless nights on uncomfortable mattresses that leave the body aching and done in add further to the problem.

In short, the festive season is the perfect environment to get into bad sleeping habits and get your slumbers out of sync.

It’s not just us adults that feel out of whack, it’s the kids too.  Their routines have been disrupted, they’ve been on a high sugar diet for a few weeks and are wired – they’re craving sugar like candy!  Consequently, they’re not sleeping, they’re tired and they’re disturbing your sleep too.

So, what can you do to get back on track?

Here are a few of my top tips.

  1. Routine, routine, routine!

Good sleep routine

Did I say routine?  Routine is key, your brain loves routine!  Unfortunately, your brain doesn’t recognise weekends or holidays, so it’s essential that you go to bed at more or less the same time every night and get up at the same time each morning – you’ve probably got a 30 – 60 minute window of lie in time; or you could be suffering from what is known as “social jet lag”, where your body clock has moved into a different time zone over the weekend.

  1. Have a soak before bedtime

A warm bath or shower is great for relaxing you, but don’t make it too hot or it will make you sweat too much and raise your heart rate, which isn’t conducive to helping you fall asleep.  Allow at least 20 minutes to make sure your body cools down before hitting the sack.

  1. Step away from the tech

Using mobile in bed

Have a tech embargo at least an hour before going to bed, to reduce your exposure to blue light from screens, which disrupts your drive for sleep.  It’s not just the screen glare, the content you’re looking at could either stimulate or stress you, waking you up when you should be feeling sleepy.

Keep electronic devices to a minimum in the bedroom, no phones, tablets, laptops or televisions.  Not only do they emit electro-magnetic pollution, which disrupts your sleep,  but it also stops the temptation to either watch or use them in bed. Particularly important where children are concerned.

Are you struggling with your sleep?  If you are, would you like to have a free 15 minute chat to see how I can help you?

You can access my online diary here and pick a date and time that suits you.

Just CLICK HERE to make your booking.

Rachel McGuinness, our guest blogger, is an expert in sleep deprivation and solving sleep problems. She is trained in  Cognitive Behaviour Therapy for Insomnia and is a Neuro Linguistic Programming Master Practitioner. She runs her own business called Wake up with Zest . As well as helping individuals with sleeping problems she also gives talks to businesses about how to get into good sleeping habits.

  • Physio on the River

    The Old Ticket Office
    Barnes Bridge
    Barnes
    SW13 0NP
  • 020 8876 6152

  • Opening Hours

    Mon: 7am – 9pm
    Tues: 8am – 9pm
    Wed: 7am – 9pm
    Thurs: 8am – 9pm
    Fri: 7.30am – 7pm
    Sat: 8am – 2.30pm
    Sun: Closed

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