How to get the marathon result you want and know you deserve!

You’ve been pounding the pavement for weeks if not months in preparation. Honing your body and figuring out all the details like the right hydration and nutrition on the day. Maybe you’ve run a few test events in the run up. You’ve spent hours training, put off social engagements and neglected friends and loved ones in the lead up to the London Marathon.

So, how do you guarantee that you’ll perform your best on the day? How do you make sure that all the hard work doesn’t amount to disappointment? How do you avoid the “if only” feeling of missing out on the target you’ve set yourself?

The five points of performance

Well, I decided to consult James Parris of Parris Performance Coaching to get his take on success. James is a Performance and Behavioural Change Specialist.

Having coached Elite sport for over 15 years, the ONE thing that James found that works is a model called the 5 Points of Performance. It’s a simple model you can use for your sporting endeavours and anything else in your life you want to succeed at.

The 5 points are – circumstance, thoughts, feelings, actions and results.

Circumstance

Usually, people focus on the circumstance they find themselves in, which is generally NOT what they want. This leads to negative thoughts, which in turn makes them feel bad in some way. Feeling bad means that they don’t take the right actions and that leads to a poor result.

Focus on the result you want to get

What works is to focus on the results you want and reverse engineer a way of getting there.

You’ve heard it said a million times that you can’t change the circumstances you find yourself in. Only by getting the results you want will you find yourself in the circumstances you wish to have.

You’ve also heard it often said that you need to set goals if you want to achieve something. This is exactly right, but often it’s left at just that, a big hairy, lofty goal. Very few people think to actually engineer the steps to make their way to hitting the goal. Break it down into smaller bite size pieces.

So, let’s draw a line under the circumstance you find yourself in during the Marathon and set it to one side. Now, let’s work the model backwards from the results you want.

Results

Use all the standard goal setting tools you’ve previously heard about be it SMART (Specific, Measured, Achievable, Realistic and Timed), or which ever. Now write the goal out as if you have already achieved it, beginning with “I am”, or “I have”. Like this – I have run the London Marathon in a time of 3 hours and 55 minutes. I did this by running 9 minute miles, drinking a cup of water every 5 miles and having a gel every hour.

Now you need to make this into a Daily Declaration which you repeat to yourself every morning and evening in the lead up to the race.

Actions

Now you can move onto the exact actions you need to achieve the result you want. You want to map this out in minute detail. A great way of doing that is by using the Escape and Arrival framework.

This maps out the thing you want to Escape from – the current personal best you want to beat or maybe it’s ‘not having run a marathon’ – and marks out the exact steps you need to take in order to Arrive at the thing you want – a specific new personal best or ‘having run a marathon’. Along the way you write out the keystones you need to act on in order to progress to the next. I’ll give you a silly example – Escape from having an untied shoe lace and Arrive at having a tied shoe lace.

First keystone would be to check that you’ve got the shoes on the correct feet. Next keystone, pick a shoe to tie – left or right. Next take a lace in each hand. Next place the left lace over the top of the right lace. Next, tuck the bottom lace under the top and pull through. Next, make a loop with the left end and squeeze tight at the bottom. Next, wrap the right end around the loop where you’re holding it. Next… you get the picture!

You can even take each keystone and map out an Escape and Arrival for that as well. This gives you the exact map for your perfect marathon and will stop you procrastinating in the run up and during the race. Most people procrastinate either because the don’t know where to start or because they get lost half way through and don’t know what to do next.

The Escape and Arrival framework takes both of these ambiguities away.

Feelings

Just having your progress and the race plan mapped out in front of you will likely make you feel much better about performing on the day.

However, if you’re still feeling a little anxious, try some Super Suggestion. Super Suggestion works a little like post hypnotic suggestion, in that you place the feeling you want into your mind during a period of relaxation.

Self motivation concept. Negative words cut with scissors and became positive.

It’s been scientifically proven that if, when you feel nervous, you say three words to yourself – “I am excited” – your performance will be better. Super Suggestion can implant feelings of excitement into your mind when you need them.

Sit in a cool, calm location which is nice and quiet. Close your eyes and in your head count down from 20 to 1, then say “let go” whilst feeling all the tension drain out of each and every muscle in your body. Whilst in this relaxed state, breath steadily and repeat the feeling you want to implant over to yourself. Try to stay like this as long as you can, nice and relaxed, repeating the word to yourself. When you feel like you’ve had enough, simply count back up from 1 to 20 and then open your eyes. It doesn’t matter if you’ve done 2 minutes or 20 minutes like this, you will have implanted the feeling into your mind.

Thoughts

Actually, I need to clarify this as Self Talk. Your internal monologue. You need to develop a positive self talk if you want to keep in the right frame of mind to be able to execute the Actions.

Post hypnotic suggestion can work the other way as well, negative self talk leads to negative feelings. Which lead to poor actions. Pay attention to the negative self talk you have about your training, racing or the London Marathon specifically. Note them down whenever you have a moment of negative self talk and read it back to yourself aloud. Listen to how irrational it sounds when doing this.

You must eradicate your negative self talk. Put yourself up or shut up.

There you have it, your performance for the London marathon mapped out using the 5 Points of Performance. Take some time to work the model through and don’t leave anything out.

Good luck on the day from James Parris and our team of therapists at Physio on the River!

Next steps…

If you would like to contact James Parris for more information on how he can help with sports performance please email him at info@parrisperformancecoaching.com. If you would like to make a Physiotherapy appointment for a marathon injury then please call the clinic on 020 8876 5690 or email us here.

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.

 

Double jointedness – loose joints – joint hypermobility: what is it and how can physio help?

Do you or your children suffer different joint aches or seem to be constantly injuring different joints?  If so, you may have Joint Hypermobility. In this blog we describe this condition and give some useful tips to help you manage the symptoms and show how Physiotherapy can help.

20-30% of individuals worldwide have some level of hypermobility and it affects both children and adults.  In the past this condition was largely overlooked and management was often ineffective or even aggravating.  There is a real difference between being flexible,  having Joint Hypermobility and having  Joint Hypermobility Syndrome. There is a spectrum of flexibility seen within the population with some people seemingly stiff as a board and others super bendy and there is yet another group who have additional symptoms. Read on to learn more about the differences.

So what is joint hypermobility?

If you were to google it right now the differences in definitions can be quite alarming.  This can also cause inaccurate self diagnosis.

In summary:

Joint Hypermobility

double jointed thumb

People with joint hypermobility are particularly supple and able to move their limbs into positions that other people find impossible. Joint hypermobility is what some people refer to as having “loose joints” or being “double-jointed”.  Some people have just one or two joints involved and others have more – and this is measured on a scale called the Beighton scale.

It is often hereditary. Some people outgrow symptoms as they get older and their joints naturally stiffen up a little.

Many people with hypermobile joints don’t have any problems, and some people – such as ballet dancers, gymnasts and musicians – may actually benefit from the increased flexibility. This is because it allows them to perform at a higher level – but unfortunately it also makes them much more susceptible to injury.

Joint Hypermobility Syndrome 

However some people with joint hypermobility can have a number of unpleasant symptoms as well, such as:

  • pain and stiffness of the joints
  • Clicking joints
  • easy bruising
  • joints that dislocate (come out of the correct position) easily
  • fatigue (extreme tiredness)
  • recurrent injuries – such as sprains
  • digestive problems such as constipation and irritable bowel syndrome (IBS)
  • dizziness and fainting
  • thin or very stretchy skin

    Ankle Sprainpain and stiffness in the joints and muscles

(www.nhs.uk, 2017)

If hypermobility occurs alongside symptoms such as these, it is known as Joint Hypermobility Syndrom. This syndrome is widely thought to be a feature of an underlying condition affecting connective tissue called Ehlers-Danlos syndrome (EDS).  The Brighton Scale, Beighton scale and other clinical tests are often used to diagnose the syndrome.

How can Physiotherapy help?

Joint hypermobility is a long-term condition therefore it is important to know how to manage it.

  • Gentle, low-impact exercise such as swimming and cycling are advised because it is gentle on the joints – as opposed to high-impact exercise that involves running, jumping and hopping.
  • Maintaining a healthy weight is important to keep the loads placed through the joints to a minimum.
  • Not exercising can make the symptoms worse – it’s just a matter of finding the right sort of low-impact exercise.
  • It is also important to normalise hypermobility in children early because for them it is their norm and we need to encourage them to exercise to help manage their symptoms. We don’t want them to be afraid to move and become over protective of their joints.
  • Physiotherapy can help identify which areas of the body are affected. We can help you pitch the level of exercise and tailor an exercise programme according to your particular symptoms.
  • We can point you in the right direction to confirm full diagnosis if required.
  • Pilates is often very good for hypermobility because it is gently strengthening without putting pressure through the joints. It can help increase energy, reduce pain levels and allow movement without fear of dislocation. The benefit of training with a physiotherapist is the improvement of muscle strength, fitness, posture and balance. The level of exercise is targeted specifically to the individual and we take care to go at the individual’s pace.

Our Physiotherapist Katherine Ashmore has a special interest in Hypermobility and has trained especially in Pilates for Hypermobility.   If you suspect that you or your child may have Joint Hypermobility please do book an appointment with Katherine to be assessed and to attend her one-to-one Pilates sessions. Or see any one of our experienced team of Physiotherapists.

To book an appointment, simply:

Call 0203 916 0286

Email us here

Book a Physiotherapy appointment online here

Or just pop in for a chat!

12 top tips for avoiding a skiing injury this Spring!

At Physio on the River we work closely with the Orthopaedic Consultants at Wimbledon Clinics (at Parkside Hospital) who are specialists in managing skiing injuries. They are experienced and keen skiers themselves so understand the sport completely. If you are unlucky enough to get injured this Christmas or Spring we can refer you quickly to their fast track clinic for injured skiers.

However, prevention is so much better than cure!

We run a Get Fit to Ski class to help you prepare for the slopes and we will be continuing this class in the New Year to help those preparing for the half term or Easter holiday break. The class is Physio led and covers all aspects of fitness, flexibility, strength and conditioning and balance to get you in tip top condition. It’s also a great way to shed those extra pounds put on during the festive period!

Jonathan Bell from Wimbledon Clinics has written this excellent top 12 tips for avoiding injury, which I would like to share with you in this blog.

1. Take lessons

The better your technique, the less chance you’ll put undue strain on your joints.

2. Get the right kit

Have your ski or board bindings set up by a pro because, if your bindings are incorrectly adjusted, or you borrow a friend’s skis, you’re more likely to injure your knees. In the hire shop, provide an accurate weight and estimate of your ability and don’t use boards or skis that are too short or long.

3. Have a rest day

Ignore the “first lift / last lift” banter and take a break. You’re likely to get more from your holiday. Why? Because the highest risk of an accident is after 3pm on day three of your holiday as muscle fatigue reaches its peak 48 hours after you hit the slopes.

4. Take the lift at the end of the day!

vector graphics, modern flat illustration, eps 10

Later in the day, you’ll be tired, the pistes may be icy and crowded, and there will possibly be bare patches in the snow – all of which are risk factors for injury. So take the lift!

5. Control your weight

Good advice for life is to maintain a healthy weight. It’s also good to prevent injuries. The heavier you are, the more strain you put on your knees and the harder you fall.

6. Keep within your comfort zone

Control is good, bravado is bad, and icy moguls – especially if you already have any damage to your knees – are a menace. Mogul falls can result in serious injury, especially to the shoulder in
firm conditions.

7. Minimise alcohol at lunchtime

Alcohol slows your reactions and makes you more reckless.

8. Be careful getting off the chairlift

It’s easy to fall when trying to get off a chairlift. And, while it might be funny, it can be serious. We also see many people who’ve ruptured their knee ligaments when the person next to them
falls across their skis.

9. Ski off-peak

The quieter the slopes, the less danger there’ll be of being called on to take sudden evasive action. If your ability allows, learn to ski off-piste where it’s often quieter. Do make sure you learn about the risks before going off-piste and have the correct equipment and insurance.

10. Don’t wear a knee brace but do wear wrist guards if you snowboard

We recommend knee braces only for a small number of people. These include skiers returning to the sport with an old or partially healed ligament injury (they might want to use a hinged brace) or
those with mild arthritis (who might benefit from a neoprene sleeve).

Otherwise, skiing without a brace improves the ability of the muscles around the knee to respond effectively to the different stresses and strains. Wrist guards for snowboarding are useful and
significantly reduce incidents of wrist fractures.

11. Seek advice immediately after injury

Clinics in ski resorts are versed in treating ski injuries. Above all, do not ski with an injury – get it checked out. Even though it might be tempting to carry on skiing through an injury, ignoring it may result in a longer lay-off. Then, once you are home, speak to your physio about a referral to Wimbledon Clinics.

12. Wear a helmet

Helmets can reduce the severity of mild to moderate head injuries.

If you are interested in joining our Get Fit to Ski class or giving a loved one a voucher just:

Call us on 0203 916 0286

Email us by clicking here

Or simply pop by for a chat!

Read how Physio helps experienced runners improve performance and manage injury risk

If you are an experienced runner, it’s highly likely you’ve trained and competed whilst injured.

Indeed, research shows that runners often carry old “niggles” that have never been properly sorted out.

If you are a seasonal runner, or tend to aim for certain events, you may find that you are susceptible to injuries at certain times of the year, or points in your annual training cycle.

We asked Dave Burnett, who heads up our Running Clinic, to explain the common causes of injury and how we can help you reduce your risk and manage ongoing issues whilst at the same time improve your performance!

What caused my injury?

This is a commonly asked question at the clinic!

In the absence of an acute trauma or a specific isolated event, “overuse” is a common cause of injury.

To be more specific overuse usually means “training load errors”.  Simply put, if your training load (i.e. the frequency, intensity, time & type of training) is higher than what your tissues (e.g Achilles Tendon or Knee-cap Joint) can tolerate, you’ll get injured.

And why hasn’t my injury resolved yet?

Tissue tolerance is related to to several different factors and all of these can affect your ability to get over an injury:

  • your age – we all recognise that we become less elastic and quick to recover as we get older
  • our genetics – some people just have good genes
  • our general health and level of fitness
  • previous injuries we have suffered
  • our strength & flexibility
  • our biomechanics – the way we are built or the way we move
  • and finally our recovery, sleep, nutrition & lifestyle!

Runners that are at a higher risk of injury

Certain sub-groups of runners are at higher-risk of injury including

  • Beginners with less than 1 year’s experience
  • Runners with previous injuries (particularly in the first 3 months following the injury)
  • Marathon runners who run more than 40 miles/ 65km per week
  • Runners who rapidly increase their  speed or distance
  • Women with a low BMI or reduced bone density (Osteopenia or Osteoporosis)

(JAMA, 2014)

How can training load affect injury?

Various factors influence training load including:

  • The nature of your weekly running programme  – i.e. the frequency, intensity, time and duration)
  • Any other exercise or strength and conditioning you may do on top of your running
  • The nature of your running training is also a factor and some injuries are more commonly “volume-related” versus “pace-related”.

 

How can I improve my tissue tolerance?

Improving your tissue tolerance will reduce injury risk and can be achieved in several ways:

  • Cross-Training – using a variety of types of exercise in your training e.g. using swimming/cycling/cross-trainer
  • Optimising or adapting your running style– your running style will change the forces placed on your joints and muscles- small adaptations are often effective to help solve ongoing niggles and can help improve your economy and performance.
  • Optimising your footwear for your specific running biomechanics– this will help reduce load on the system
  • Taping can help offload your tissues so they have more tolerance to exercise
  • Running Specific Strength and Conditioning – it is now widely accepted that running performance can be improved by combining endurance training with explosive strength training. Adapting common gym-style strength work to make your programme specific to your running demands will help you improve your tissue tolerance more quickly
  • Maximise nutrition, hydration and sleep– these will undoubtedly help performance, recovery and tissue repair.

How Physio can help

At Physio on the River, we can help you both:

  • recover from injuries which are stopping you from running
  • help those ongoing niggles you are carrying whist continuing to run and
  • help reduce the risk of re-injury

Our physios are specialists at assessing the way you move and identifying the causes of injury. Combining our clinical skills and video gait analysis we can give you a really thorough screening and a baseline of information to create a tailor-made plan of action.

Our Standard 60 minute Running Assessment includes:

  • Establishing the specific details of your running history by exploring your training programme, coaching advice and goals for up and coming competitions
  • A physical screening to identify important biomechanical factors related to running (e.g joint and muscle flexibility tests and lower limb strength and muscle control measurements)
  • Treadmill analysis of your running with Hi-Speed video
  • A report of your video analysis findings
  • An exercise programme to help facilitate your rehabilitation

NB- if your Screening Assessment and/or running analysis identifies a specific injury requiring treatment then a course of physiotherapy can be provided.

How to book a Running Assessment with Dave or one of our team of Physios:

Call 0203 916 0286

Book online here

Email the clinic here

Or just pop in and speak to one of our Receptionists

If you found this useful and would like to read our other running related blogs just click here.

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