What does my physio think about foam rolling?

What does my physio think about foam rolling?

What is Foam Rolling?

Foam rolling -  rolling parts of your body over foam rollers, which come in a variety of densities, textures and sizes, using your bodyweight to apply pressure and give a self-massage before and after exercise to help with recovery – is very popular in the fitness world. The idea is that you roll slowly and when you find a tender spot, you focus in on it by rolling back and forth until you feel it soften or release. But does it actually help?

Is foam rolling good for me?

Our spinal specialist Physio Shari says

“As popular as foam rolling is, there isn't actually any research evidence that supports it. I don't routinely recommend it.”

Emily, our soft tissue therapist, triathlon coach, athlete personal trainer, comments: 

“It depends on where you roll and when you roll. There are many conflicting studies and reports. From an athlete’s point of view, it boils down to if it makes you feel better, roll it, if it causes pain more than 7/10, then don’t. Foam rolling can feel like a self-massage which should be done when the muscles are warm and as part of recovery.”

Stuart, our specialist knee and foot & ankle physio says:

“Foam Rolling or any other form of muscle release may help reduce tightness and soft tissue stiffness and thus can assist. It can be beneficial after exercise.”

Our sports injuries specialist Nick comments:

“Whilst there’s no credible evidence to back up claims of the magic of these things, if they help then why not? They won't do any harm.”

If you’re injured, in pain or just need some advice, call us on 02030 12 12 22 to book an appointment with one of our specialist physios.

How To Stay Injury Free Whilst (London) Marathon Training

How To Stay Injury Free Whilst (London*) Marathon Training

With the London Marathon* coming up at a rate of knots, we asked Stuart, our lower limb and sports injury specialist physio, to give us his advice on how to stay injury free whilst training for a marathon:

Runners, joggers and walkers view the marathon as the ultimate fitness test and challenge with a record number of people now participating globally. Many will have never completed this kind of run before and are also not seasoned runners. However, this does not stop many of us trying to complete this challenging and arduous task and getting that medal for the 26.2. 

Training for a marathon can be a daunting task as many people are worried about being injured and how they will react if this is the first time they have ventured into the higher mileage brackets. It has been viewed in the evidence that most people who do participate in the marathon will suffer from some injury during their training or the race. For example, it has been seen that novice runners sustained 30-38 repetitive strain injuries per 1000 hours of running while marathoners running more than 200 minutes per week sustained less than 10 RRIs per 1000 hours of running.

There are many ways to help reduce the likelihood of injury such as good preparation/warm up, having a good base level of strength and stability monitoring your build up gradually and of course having rest days:

Warm up:

The purpose of a warm up is to increase core body temperature, muscle activation, joint mobility and prepare the body for activity. The ability of the muscle to contract efficiently can benefit greatly as the quadriceps can help reduce up to 60% of the load through the knee joint when landing during a run thus being warmed up appropriately can prevent any knee injuries.

For the ideal warm up we should incorporate a high number of dynamic tasks such as lunges, calf raises, toe walks, leg swings. The evidence has been shown that a Dynamic Warm Ups performed pre training can also enhance and improve performance.

Strength and Stability Exercising:

A base level of strength and stability is required to undergo any exercise or physical task. For example if we are running and have a cadence speed of 140 then we are impacting 70 times on each leg every minute that requires the ability of the body to absorb force and propel us forward while trying to maintain good kinetic chain control and stability.

Resistance training has shown improvements of up to 8% following a period of resistance- or strength-based training during a normal running training plan. This can be attributed to improving running economy and improved neuromuscular control. When we consider that any small improvement can impact running economy the benefits may have a larger impact on long distances such as a marathon. 

Training plan: 

It is a advised that you don't increase your mileage by more than 10%. The 10% rule is one of the most important principles to adhere to help prevent injuries. As most running injuries are overuse in nature the 10% rule can help prevent this. It may be a long and slow process by only increasing the 10% but it will help keep you running safe and for longer.

Rest Days: 

Having rest days helps not just your body to recover but reduces the likelihood of injury. It has been seen that less than two days rest in endurance runners had an increase of 5.2 fold of overuse injuries. Every day that we exercise causes microdamage to muscles and without adequate rest we don’t repair. Build in a few rest days each week to help recharge, reduce injury and then improve your training and performance.

If you experience any prolonged niggles or pain during your marathon training period, don’t ignore it. Get expert advice and help. Call us on 02030 12 12 22 to book an appointment with one of our specialist physios.

* Other marathons are available.

Words by Stuart Mailer.

Tips for a happy, healthy and (hopefully) injury-free skiing trip

Physiotherapist and Director of Physio Remedies, Paul Martin writes: If you fail to prepare you are preparing to fail. This and hundreds of other nags from childhood frustratingly seem to prove themselves as we get older. This is just as true with a ski trip as anything else, so here are a few things to consider.

1. Prepare well

Try to arrive in good physical condition. Being stronger and well coordinated helps you be more robust as you hit the slopes, but aerobic fitness is important with regards to acclimatisation. The earlier you can start working on this, the better, however it’s never too late to start to make changes (starting three days beforehand might be pushing the bounds of physiological adaptation a little bit).

Ideally aerobic fitness levels should be worked on two tot three months prior to your holiday, whether it is running, swimming or biking. Increase your effort gradually over this time and then two weeks before keep training at a maintenance level appropriate for you.

2. Take a relaxing walk on arrival

Carrying bags, skis, kit and other peripherals adds extra load to travel, which is in itself an energy sapping experience. When you arrive at your hotel/chalet and have checked in, go for a walk to loosen off so you are not hitting the slopes tight and tired.

3. Stay hydrated

Dehydration can have effects on many body systems from the annoying (bad breath and dry skin) to something more important for physical activity (muscle cramps and slow response times).

On the plane/bus/car journey ensure you drink water or diluted juice drinks and during your trip be conscious of how much alcohol, drinks high in sugar and caffeine you are consuming, especially if you are unable to get water on board.

Quick checks are colour of urine (should be more straw yellow colour than milkless builder’s tea) or pinch a small area of skin – it should return to shape within two seconds if hydrated enough.

4. Get extra sleep

Get extra sleep on the first few days, better to go to bed early than having a lay in.

5. Pop your goggles on early

Start wearing your goggles half an hour before you are due to start your first run, as it allows your eyes to adapt to the change in colour which in turn will improve your reaction time on the run. Good reactions minimise risk of injury.

6. Allow time to find your 'ski-legs'

If it’s been a while since you last skied, allow yourself time to acclimatise and get your 'ski-legs'. Keep it simple, stick to easier runs initially and don’t push too hard too soon. After the first couple of runs and when you feel you have got your rhythm – enjoy!

7. Eat sensibly

Be sensible with your diet – keep it balanced with a slightly higher volume of carbohydrate as these break down most easily into useable energy.

8. Warm up and warm down every day

Make sure you warm up and warm down as what may seem no problem on day two, might well be a problem on day five. Tight and tired muscles can impede reaction time and enjoyment of skiing.

9. Do you really need to fit in that 'last run of the day'?

In the vast majority of post-injury physio sessions, when asked what happened to cause the problem the opening line is very often ‘It was the last run of the day and I thought I could just squeeze another one in’. If you are tired (but might not be feeling it), if things are getting icier (especially if your reactions are slowing down), if you have half a mind on what you are doing that evening rather than the slopes, is it worth the risk of a nasty injury?

10. A word about knee injuries

Although skiing injuries usually affect multiple areas of the body, the knee is the most commonly injured body part, with evidence indicating 42% in some studies. Further to this, the ACL (Anterior Cruciate Ligament) is the highest injury observed within the knee occurring in all ages, genders and technical levels.

Our knee specialist physio, Stuart Mailer, has written a blog post dedicated to avoiding knee-related skiing injuries.

Take home:

• Prepare well if you‘ve not been as active as you would have liked in the previous few months.

• Be mindful of what you eat for fuel and drink to remain hydrated

• Don’t take silly risks, especially early on in your holiday and at the end of the day

Stay safe and have a fabulous holiday!

If you do have an accident or pick up an injury whilst on your winter hols, call us on 02030 12 12 22 to book an appointment. We work with the top surgeons in the UK and can help put you back together again.

Words by Paul Martin.

Are you sitting comfortably on your bike?

Are you sitting on your bike comfortably?

If you are not sitting comfortably on your bike, at best, you will not be able perform to your best ability, at worst, you can cause damage to yourself. So here are some useful tips from our Soft tissue therapist and Triathlon coach, Emily Chong, to get you settled on your saddle.

Buying a bike

Regardless of colours or brand, if a bike doesn’t fit, it’s no use to you. Each brand and each bike model has a different geometry, so a bike of the same size but different brand can fit completely differently. Bike size in general is denoted by seat tube length. While this is indicative of the bike size, if the top tube is too long, then you won’t be able to reach the handle bar. A seat post can go up and down by 20-40cm, handle bar reach can only be adjusted by switching to a shorter or a longer stem or adjusting its angle, and this can only be increased or decreased by a few cm. So if shop just asks how tall you are and hands you a bike, politely decline and escape immediately. Everyone has a different leg to torso length ratio, you could have a short torso / long legs or vice versa, narrower shoulders or smaller hands. You should always get measured first before buying a bike new or second hand. If the bike shop doesn’t measure at least all of these - torso length, arm length, inside leg length, shoulder width, hip flexion, don’t bother buying from them.

You can also DIY by downloading a bikefit app such as Size My Bike where you can input all the above measurements and generate a recommended geometry, you can then find a bike (by comparing its geometry) that most matches it and get a bikefitter to fine tune the fit.

There are places where they can measure you and build a bike to your specifics from prestigious makes such as Condor to the budget conscious Planet X. A bike that fits will 100% be faster than one that doesn’t, regardless of how high its spec it is.

Worst and best riding positions.

Saddle sores

These are broadly two kinds of causes to this “pain in the butt” - friction and pressure. Most likely, pain is caused by both. Here is how to deal with it.

Pressure

If the pain feels like there’s too much pressure in a small area such as seat bones to the rear, or the soft tissue in the middle or in the general undercarriage area, then we need to first look at how hard you are pushing your pedals vs how much weight is on the saddle. To relieve the pressure, you’ll need to either increase the upward force by pedalling harder, go up a gear or reduce the downward force by lessening the weight on the saddle. If you are carrying a backpack for commuting, you could use a rack and panniers instead and you can also look at spreading your body weight between the handle bar and the saddle by leaning forward a little more.

Friction

If you are getting saddle sores that look like pimples, these are caused by follicle irritation or inflammation. Wearing bike specific shorts with pads (called chamois) will help as it covers the seams and provides a smoother surface. Bike shorts are supposed to be worn without any underwear (thus eliminating seams that would cause chafing) and with chamois cream (cream like lubricant) along the crease of your legs / bikini line and along the contact points between your bottom and the saddle. Any waxing and shaving will definitely increase the chance of follicles irritation, so it’s best to just trim hair to no shorter than 3cm should you feel the need to. For women, if the friction is felt in the middle soft tissue, try switching to a saddle with a centre cutout (see below), bike shorts that are not too heavily padded in the middle and apply “bedroom lubricant” to the inner tissue (regular chamois cream is not meant for internal use).

Saddle with a centre cut out

You could also try saddles with a split nose design which are becoming increasingly popular. These saddles are meant to be perched on with your seat bone therefore there is no body contact anything further in front. To be in this position, more weight will need to be through the upper body - which means these saddles are more suitable for Time Trial or tri bikes or racing bikes with handle bars much lower than the saddle.

Asymmetrical saddle sore

If you can see a pattern that only one side is affected, assuming your bike setup is symmetrical, then we’ll need a closer look to your range of movement and biomechanics. Issues such as limited back rotation, restricted knee bend and commonly tight hip flexors from prolonged sitting at your desk can contribute to your bike discomfort. It would be best to get checked out by a physio and focus on strength and conditioning.

Adaptive measures on the bike

If you have a condition that creates a permanent biomechanics impediment, for example a knee surgery that has limited how much you can bend one knee, then there are companies who can make adaptive changes to your bike from shortening your crank, to adding a swing crank to your pedal, all the way to a custom recumbent bike.

Not sitting comfortably?

If you’re not sitting comfortably on your bike, you can book a session with Emily, who is also a L3 bike mechanic, by calling us on 02030 12 12 22.

Happy riding!

Words by Emily Chong.

Injury of the month: Returning to exercise following an injury

Injury of the month: Returning to exercise following an injury

Keeping active and mobile is important after injury but needs to be done safely to prevent flare-ups and re-injury. The most common complaint that patients come to see our Spinal Specialist Physio Shari for is lower back pain. When lower back pain is acute, and the pain is constant and triggers twinges of pain with movement in all directions, then it is best to rest from the gym, however walking is still encouraged in most cases. When this acute pain settles down then slowly returning to training can be really important in your recovery. There are some tips below from Shari to help you return to exercise.

1. Exercise should never trigger pain in your back

• If you feel a twinge/sharp pain whilst exercising then stop that particular exercise

• There are 3 main reasons why the exercise might be causing pain:

a) it’s not the right exercise for your back at the stage of your recovery

b) your core and stabilising muscles are not engaged properly

c) your posture/alignment isn’t quite right particularly in your lower back

2. Usually low impact exercise is best to start with

• for cardio swimming or cycling are usually good

• remember to start gently and gradually build up the level you were at pre-injury

3. Slow, controlled movements during exercise is recommended

• When you perform slower, controlled movements this encourages the activation of your deeper stabilising muscles which will protect your back

4. Avoid High Intensity Interval Training (HIIT) initially

• Form can be compromised during HIIT type exercises

• Quick, sudden, unguarded movements can often cause twinges of pain and muscle spasm following injury when you are first recovering

5. Try to exercise in frequent shorter bursts rather than doing longer sessions

• During longer exercise sessions your body is more likely to fatigue when first recovering from injury, which could compromise your form

6. Stay positive, it’s common to have set-backs

• When exercising remember to allow your body some recovery time

• Don’t let muscle pain (Delayed Onset Muscle Soreness, DOMs) and stiffness following exercise de-motivate you, just let your muscles recover, usually a couple of days will do, and then try again.

7. Stretching is important

• Everyone should stretch, but it is even more important when you are recovering from an injury as your muscles and joints will be tight and “guarding” your injured area

• Gently mobilise your joints and muscles before and after exercise as well as daily

• Stretches should never be painful on your injured area

8. Warm-up and cool-down

• This is even more important when recovering from injury as your body will be stiffer than usual

9. If in doubt, see a health professional for guidance

• We can help to recommend and show you the best stretches and mobilisation exercises for your body and injury

• We can also identify areas of weakness in your body, and prescribe you with the best strength exercises for you and your injury

If you’re injured we can help you get back on your feet and back to exercise - call us on 02030 12 12 22 to book an appointment.

Words by Shari Randall.