Injury of the month: Musicians' Injuries

Injury of the month: Musicians' Injuries

Physio Remedies' Physio Stuart Mailer has worked with world famous bands from the UK and the USA and been on tour with them, so we asked him to talk about injuries suffered by musicians and how to prevent and treat them.

For many musicians injuries can be hugely debilitating and, like any professional athlete, this can cause significant problems when performing.

Musicians can suffer from a range of injuries depending on their instrument of choice. For example, a violinist may suffer from a rotator cuff impingement or cervical pain. A bass player may suffer from elbow dysfunctions or injuries. Even being highly skilled and trained does not mean that the musician is void of injury.

Injuries can occur from trauma or overuse such as increased volume of loading/playing or changing instrument. For example the different action of a guitar or fret width or even changing the seating position on the piano can affect tissue loading .

Drummers go through constantly high loads when performing. For example, in a 60 min performance there may be 5,000 impacts on the bass peddle, their heart rate may be sitting at 75%  or averaging at 140-160bpm - similar to having a long run. This is same as many elite athletes experience. Further to this there is also a high amount of load on their lower back, neck and forearms.

It is not uncommon for drummers to suffer from low back problems such as discogenic injuries or cervical problems. These can be treated and managed well by adapting sitting position or technique and drum kit set up. Also undergoing specific exercises and injury prevention prehab can help reduce the likelihood of injury.

If you play an instrument and suffer from injury it is certainly advisable you see a Physiotherapist to assess and check your biomechanics and playing position to help in assisting your recovery or intervention.

If you'd like an appointment with Stuart or any of our other Physios, please call us on 020 30 12 12 22.

Words by Stuart Mailer.

Injury of the month: marathon injuries

Injury of the month: marathon injuries

With the London Marathon* approaching fast it’s a critical time for participants as they increase their running distances preparing for the gruelling 26.2 miles ahead.  It’s a time when niggles may well turn into more significant injuries so it is key to be aware of some of the common injuries; how to spot them and what to do to try to avoid them progressing and ensure you get to the starting line but more importantly the finishing line!

Here are two of the main injuries we see related to marathon training:

Shin Splints

Shin splints is a bit of an umbrella and non-specific term which refers to pain in and around the shin. There are two main areas which cause problems.

Anterior shin pain located in the muscles at the front of the shin occurs when there is excess load in these muscles and they can become inflamed, as can the fascia (the surrounding tissue around the muscle).  Typically this will be painful when pointing the toes and ankle up and during running, to the point where it can cause you to stop.

The other area is on the inside of the shin, MTSS (Medial Tibial Stress Syndrome). Again the muscles and the fascia become overloaded and inflamed and here the can affect the bone as well. The tension from the soft tissue can place load on the bone which then becomes inflamed and in more severe cases can lead to stress fractures.

Resting pain, pain at night and significant pain to touch the shin may indicate a more severe injury. Poor biomechanics, inappropriate footwear, tight calf muscles, poor stability and excessive training loads are contributing factors.

ITB friction syndrome / runner's knee

Although not exclusive to runners, the above pathology is seen mainly in runners and in particular longer distance runners.  The actual cause of the pain itself is still uncertain but the consensus is that there it is from excessive friction between the tendon on the outside of the knee (Iliotibial Band tendon) and the structures underneath it attaching to the outside of the knee. 

The friction is mainly caused at about 30 degrees of knee flexion which is the approximate angle the foot hits the floor when running.  The pain is very well located to the outside of the knee, can be sharp and stabbing like.  The pain often comes on after a specific time or distance of running and can be severe enough to cause you to stop. As it becomes more intense, it may even be painful to bend the knee and not just be painful with running. 

Again, contributing factors can be, weak gluteal muscles, tight thigh and anterior hip muscles, poor running biomechanics, and inappropriate increase in training loads.

Treatment

For both of the above injuries it is important to get an early diagnosis as this will help prevent the injury from worsening. The quicker earlier intervention is implemented the better the chance that the injury can be managed for the rest of the training until race day.

A physiotherapist will be able to assess the injury and assess what the contributing factors are by having a detailed assessment of the body, the way it moves and also look at external factors such as training methods.

With not long to go, it may well be a case of reducing the training and substituting some runs with some rest and gym sessions to work on problem areas. Marathon runners often over train the running aspect and neglect the strength and gym work which is crucial to maintaining good biomechanics and reducing the load on sensitive structures.

As well as correcting any imbalances with hands on treatment, a physio will put together a rehab plan with exercises and self help advice to ensure all areas are covered.

As always, prevention is better than cure so if you'd like us to check out any issues or if you'd like a pre-marathon sports massage, call us on  02030 12 12 22 to make an appointment.

* Other spring marathons are available.

Words by Alex Manos.

Paul Martin's Low Down on the Winter Paralympics

Paul Martin's Low Down on the Winter Paralympics

In his other life Physio Remedies' Physiotherapist and Director Paul Martin is Technical Lead Physio for Paralympic Sport with English Institute of Sport. Once again he's been working with ParalympicsGB athletes to get them ready for the Winter Paralympics and will shortly be heading to PyeongChang to support the team during the Games.

We asked Paul to give us the lowdown and his 'ones to watch' of the Winter Paralympics:

Preparations:
 

As the Winter Olympics draws to an end, preparations start for the Winter Paralympics in PyeongChang to start with the opening ceremony on 9th March. As part of the handover process, some of the Paralympics GB delegation will be in the Village for the final 2 days of the Olympics to start planning how we will use the space and to ensure our space is prepared for the arrival of the athletes, some of whom will enter the Village on the first day of opening on 3rd March.

New Kit:

Now it's a case of packing the essentials and making sure the final preparations for the team are set. The official kit arrived in early January (which gave ample time to get rid of some of the Christmas bulk that made it look just a little too tight!) and as might be expected for a winter games, it is a lot bulkier and warmer than the summer games kit. It is essentially what you have seen the Team GB athletes wearing with the Paralympics 'face on' lion rather than the Team GB lion in profile. This means there is much less space for packing and given the Opening and Closing Ceremonies wear (provided by Asos, it is very warm and very bulky!), extra kit space will be at a premium.

Competition Events:

There are 6 competition events in the Winter Paralympics with a total of 80 medals at stake; Alpine Skiing, Biathlon, Cross Country Skiing, Para-Ice Hockey (formerly known as Sledge Hockey), Snowboarding and Wheelchair Curling. Paralympics GB has athletes competing in Alpine Skiing, Biathlon, Cross Country, Snowboarding and Wheelchair Curling and the medal target from UK Sport is 7 medals (in a range of 6-12). This is quite a challenging total and within the first 3-4 days there should be a good idea of whether we will hit our target as many of our best events are early in the Games.

Ones to Watch:

Many of these will come in the Alpine Skiing where GB athletes have perfromed well so far this year and are improving. Kelly Gallagher will be defending her Super G (visual impairment) gold medal from Sochi with guide Gary Smith. They will be pushed across all their events by Millie Knight (with guide Brett Wild) who competed in Sochi as a 15 year old and Menna Fitzpatrick (with guide Jen Kehoe) who have won 10 medals in 10 World Cup events this season. James Whitely and Chris Lloyd will be competing in the standing classification in the Men's events.

For the first time in 20 years we have an athlete competing in Biathlon and Cross Country. THis is a new sport for Scott Meenagh who transferred from rowing and in 14 months is starting to make his mark iin both disciplines. The former Royal Engineer has been improving through the season and any top 10 finish would represent an excellent Games for him in his 8 events.

Snowboarding makes it's debut in Pyeongchang with events in Banked Slalom and Snowboard Cross. Owen Pick, Ben Moore and James Barnes-Miller will be flying the flag and with a couple of podium finishes for them already this year, and in a sport that can be unpredicatable at the best of times, anything is possible!

Finally, the GB Curlers won Bronze in Sochi and Aileen Nelson and her experienced team will be looking to better that. They have beaten everyone on the circuit at one point or another this season so hopes are good.

Enjoy the show!

Words by Paul Martin.

Injury of the month: lower back pain

Lower Back Pain

Research studies show that over 80% of our population experiences lower back pain in their lifetime. In some people this can also be persistent or recurrent lower back pain.

What is lower back pain?

Lower back pain is pain is pain anywhere from the bottom of the rib cage to the buttock creases. Sometimes people with lower back pain may also feel pain in their legs and feet.

What causes the pain?

There can several structures contributing to lower back pain and these include the spinal joints, discs, nerves and the connective tissue such as the tendons/muscles and ligaments.

Why does it occur?

This depends on whether the lower back pain is a new episode, exacerbation, acute pain or persistent pain.

A diagnosis should always be established by your health professional, as causes can sometimes include infection, fracture, inflammatory conditions, malignancy or other systemic illnesses of the body.

However most commonly the cause will be related to sedentary lifestyles or incorrect training technique and posture.

 

How can physiotherapy help?

Your physiotherapist is specially trained to help diagnose your lower back and work with you to formulate the best treatment management plan for your recovery. Often this include hands on treatments such as mobilisations, massage, postural assessment, education on prevention and self-management at home and at work as well as prescribed exercises to assist you with pain reduction, increased mobility and strength.

If you'd like an appointment with either of our Spinal Specialists, Sarah and Paul, please call us on 02030 12 12 22.

Words by Shari Randall.

Nick Smith's Guide to Ski and Snowboard Injuries and How to Avoid Them

Nick Smith, Shoulder Specialist Physio: Having assessed and treated two significant shoulder injuries this month that both required surgery - one from snow boarding and the other skiing - I thought I would  explain some of the the common snow boarding and skiing  related injuries and how they can affect you.

Soft Tissue Injuries

Soft tissue injuries occur when falling awkwardly. The rotator cuff muscles are most commonly injured, resulting in pain, loss of shoulder movement and power. Low grade injuries can be treated successfully with physiotherapy. More significant injuries may require a shoulder specialist referral and imaging, and then physiotherapy. Other structures often injured include the shoulder cartilage, bursa, tendons and chest muscles. Be aware of significant bruising to upper arm and chest muscles and changes in muscle contours.
 

Shoulder Joint Dislocation

Shoulder joint dislocation generally occurs when falling and your arm is away from your body. Acromioclavicular (joint on the top of your shoulder) separation occurs with direct impact to the top of your shoulder. Pain, joint deformity, loss of shoulder movement and swelling usually result. Depending on your age and grade of injury, research indicates physiotherapy is your best choice of treatment.

Bone Fractures

Bone fractures to upper arm, shoulder joint, clavicle (collar bone) and shoulder blade occur with impact injuries either with your arm away from your body, onto your elbow, or direct trauma to the shoulder joint. Be aware of pain, joint deformity, loss of movement.

Wrist injuries

Snow boarders have a significant increased risk of injury to the wrist, hand or thumb. These injuries occur due to falling on an outstretched hand (FOOSH) and trying to break your fall. Wrist guards can be worn to help protect and limit the damage.

Injured?

If you sustain any of the above injuries get them checked out, most low grade injuries respond with physiotherapy!

How to be safe(r) when skiing/snowboarding: 

1. Do not over estimate your own ability/fitness - Altitude can cause fatigue, shortness of breath, headache and nausea within the first 48 hours. Drink more water, avoid salty foods, eat high carb foods e.g. pasta, fruit, vegetables. 
2. Consider the terrain and snow conditions - If you are in a white out or flat light, slow down and use your poles by keeping them in contact with the ground, stay relaxed, look out for markers on the piste, use the correct goggles and keep them clean.  When conditions remain excellent, remember that the risk of avalanche remains high in most places this season.
3. Check your equipment - every day before you ski or snowboard and have any faulty equipment repaired or replaced before you hit the slopes.
4. Avoid excessive alcohol - it's obvious, but before you order that last vin chaud, consider whether it could be your undoing on your ski back from the bar to your chalet.

If you'd like an appointment to see one of our physios, please give us a call on 02030 12 12 22.

Words by Nick Smith.

Injury of the month: Headaches

Is Your Headache Really a Neck Ache?

Headaches are often caused by disorders of the neck or physical and emotional tension. For many people, headaches start as pain or tension at the top of the neck. As the pain worsens, it may spread to the back of the head, the temples, forehead or behind the eyes. This happens because the nerves in the upper part of your neck are connected to the nerves in your head and face. A disorder of the upper neck or muscles can cause referred pain to your head. 

Does this sound like you?

• Pain radiates from the back to the front of your head?

• Headache with dizziness or light-headedness?

• Headache brought on or worsened by neck movement of staying in the same position for a long time?

• Headache which always feels worse on the same side of your head?

• Headache eased by pressure to the back of your skull?

• Headache which persists after your doctor has checked for other causes?

How We Can Help:

Postural neck ache can usually easily be treated with some gentle mobilisations by a   physiotherapist and a stretching programme to prevent recurrence.

Physiotherapists can successfully treat headaches originating from the neck or soft tissues and show you how to prevent the pain from occurring. Even if you think your headache doesn’t come from your neck we can often help to reduce the intensity.

1. Mobilisation

2. Manipulation

3. Massage

4. Relaxation therapy

5. Functional and rehabilitative exercise

6. Encouraging normal activity

7. Postural assessment, correction and advice

8. Muscle activation and re-education

Your physiotherapist can also offer you self-help advice on ways to correct the cause of headaches, such as practical ergonomic tips for work and in the home; adjusting furniture, relaxation, sleeping positions, posture and exercise.

If you'd like an appointment with our Spinal Specialist, Shari Randall, please call us on 02030 12 12 22 or send an email to info@physioremedies.com .

Words by Kara Mulvein.

Fraser Cartmell: How Does Racing as a Professional Athlete Work?

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Somebody racing as a full time professional triathlete is quite clearly not common amongst the general population, and so from time to time I am asked by those who are curious enough, to explain "how does that work?" when I mention what it is that I do with my time.

Ultimately there are a number of different pathways towards professional triathlon racing - nothing is set in stone, which makes for exciting opportunities at different points in life for people, depending on their own circumstances and lifestyle choices.

The Traditional Route

For me, I suppose it was a more traditional route - at least here in the UK anyway - which began as a junior athlete who was finishing school and embarking on my university studies. Representation for GBR at championships events across the world came my way through the National Federation 'system', which in turn supported me to simultaneously combine my University degree with many hours of swim, bike and run training. Ultimately I wasn't good enough at this format of 'draft - legal' or Olympic distance ITU racing to reach major events as a senior athlete and the Federation support (financial / medical / logistical) fell away.

The Non-Drafting Route

However, I still loved the sport and was keen to explore the concept of 'non drafting' or Ironman racing. This would mean braving the world of racing without the outside the 'support bubble' I had been fortunate to receive, but equally it would give me the freedom to choose whatever type of race I might want to do, rather than what I "had" to do as previously determined by the Federation and their qualifying criteria.

National Lottery Funding

These are two different pathways to racing, but both allow triathletes to race professionally and earn a living. In the UK athletes are very fortunate to access the much lauded National Lottery Funding and the associated support structures. However you have to be exceptionally good to reach this level, and of course to stay there year on year is no easy task either. When this funding disappears athletes can understandably struggle with how to move on and can at times be lost to sport at an elite/professional level because they simply can't continue to make ends meet.

Sponsorship

Nonetheless, racing the 'non drafting' Ironman circuit of events - as I have done for many years now - can provide all sorts of new opportunities to work with a host of different potential sponsors. These could either be brands from within the industry providing equipment sponsorship, or indeed non-endemic companies you have some association with (perhaps locally) who in turn can hopefully provide the financial support that was lost from the aforementioned Federation.

Essentially the long term goals of reaching the pinnacle of your event will remain. Previously that may have been the World ITU championships or even the Olympic Games, and now it has become Ironman Hawaii, for example. The only real difference is who you are representing when you get there. It will either be a national federation or likewise a group of personal sponsors who share your goals and agree to support your journey in whatever way they can.

If you're interested in sponsoring Fraser, just pop an email to us at info@physioremedies.com and we'll put you in touch with him.

Client News: Toby Swims The Channel

Physio Remedies client Toby Davis planned to swim The English Channel at the end of July in aid of The Cystic Fibrosis Trust but the weather wasn't playing ball during his window. However, he did eventually get the call to swim and his Channel Swim Report follows.

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Finally, I'm off!

After a frustrating two week wait for the weather, at 11pm on Monday 7th August I finally lowered myself off the boat and walked up Shakespeare Beach (just around the corner from Dover Harbour) to clear the water feeling calm and relaxed, reminding myself to enjoy what might well be a once in a lifetime experience. Then the klaxon sounded to signal the start of my 21 mile channel swim from England to France and we were off - I dived in and swam out to my boat SUVA's spotlight in the water, which I would use as a marker over the next 6 hours of darkness.

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Ready for the off!

The first few hours

That first few minutes were exhilarating but I managed to control the adrenaline and settle into a decent rhythm fairly quickly. I fed every hour and my first feed was very quick - a quick roll onto my back, down the carb drink and confirm to my crew that I felt good, then off again. About 15 seconds, which was the plan. Over the whole swim it turned out my longest feed was 40 seconds and average time about 20 secs which I was very pleased with. 

After the first feed the next 2.5 hours flew by and I knew it was going well. Swimming in the dark was fun, it gave me the opportunity to solely focus on getting my stroke right and making sure I was enjoying the swim as planned. 

Hour 4

Around hour 4 it started to feel a bit more of an effort and, when I stopped for a feed I realised why - suddenly where before I had been floating on my back next to the boat, now when I did that I had to kick furiously just to stay alongside. That brought home just how strong the tide I was swimming in was, and ended any over optimistic thoughts in my head about the possibility of making it across in a super quick time.

Around this time I also got some jellyfish stings to my back, legs, shoulder and most interestingly across my mouth and nose - I didn't really mind these actually, they were a bit like an extra strong stinging nettle and helped jolt me out of any autopilot swimming. 

Sunrise

Around 5:30am we were treated to the most amazing sunrise which brought the darkness section of my swim to a dramatic end. To witness that from sea level in the middle of the channel was truly spectacular.

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I am a very dark shadow in the foreground in this one but quite rightly the sunrise takes centre stage!

Hour 11

I swam steadily and pretty comfortably until the 11th hour when my crew told me they needed a big push in terms of effort. So I sprinted at 100% for an hour, which felt like forever. The fascinating thing was that, despite having swum for 10 hours already, every time my brain told me I needed to slow down I could override it and just kick harder.

Unfortunately the spring tide turned out to be too strong for me to fight across it and hit land at Cap Gris Nez, which tends to be the fastest place to end a crossing. So I found myself being swept up the coast by a strong turned tide, which meant the sprinting had to continue as I tried to fight far enough through it to hit land.

Hour 13

Around hour 13 I got frustrated as France had seemingly disappeared from view (it was actually hiding behind the boat on my right as I got swept north past the Cap) and I asked for a marker to give me an idea of how close I was. Neil my pilot told me I was deep into French inshore waters, and shortly after that the coast came into view again seemingly within touching distance.

Despite being no more than a couple of kilometres out, I spent another 2 hours pushing across the tide to get in - that time actually went quite quickly as I knew that I would get in eventually and that it was just a matter of time. I had to stop myself celebrating in my head though as I knew lots of swimmers still failed to hit the shore from that close. But finally I got close enough to see the houses and beach on the shoreline and knew I was swimming into Wissant. 

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Me sprinting against the ferry

The final 20 minutes!

The last 20 mins were pretty special, just making the most of the experience and thinking about all of the people who had supported me through the months and months of training. It got slightly emotional. I could walk up the last 50 metres and had a great time running and jumping through the waves to stand clear of the water for the klaxon to sound the end of the swim after a total of 15 hours 04 minutes! 

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Channel Swimmer!

It felt incredible to have finished the swim and even better that physically I still felt pretty good. I could easily lift my arms above my head and hold up my 4 month old in celebration once we got back to Dover, which I think is a good result!

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The team - Neil the pilot, Toby the co-pilot, Kate, me, Alice and Tony the official observer

I was back in the water (with pain free shoulders) within 2 days which was a huge bonus and a ringing endorsement for Ray Gibbs' coaching and the technique work he has done with me, as well as the excellent physio I had received in advance of the swim from Sarah Lawson at Physio Remedies.

Now to relax a bit and work on my future swim bucket list with a cold drink in hand!

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Toby's Channel Swim has raised over £10,000 to date. If you're as impressed as we are at Toby's feat, you can donate to The Cystic Fibrosis Trust via his Just Giving page.

Words and images by Toby Davis.

Injury of the month: hip & groin pain

‘It’s jungle country down there, mate.’ These were the words of a hip surgeon relative of a physio friend of mine when referring to an area of the body known as the femoral triangle. The rationale for this comment was variabilities in local anatomy from person to person can make it very difficult to consistently predict the location of sensitive structures between individuals. The challenge with a lot of hip and groin pain is that there are a lot of structures that can refer symptoms to the area which can lead to subsequent overload of inhibited structures.

Image source - Health Appointments

Within any injury or pain system, whilst there may be a single causative factor or structure it is often the case that there will be an element of affect across muscle and tendons, joints, the nervous system and some connective tissue. Within the groin, there are many muscles, both big and small that affect the hip joint and many nerves and blood vessels that pass through the area to supply the lower limb. Keeping these muscles in balance is part of the approach, however it is often not as straightforward as that.

Tight Hip Flexors?

An often-reported problem for people with groin pain is that they have tight hip flexors. This is all well and good, however it doesn’t explain either why they are tight or what to do about it beyond stretching. Whilst tightness in the front of the hip can be common in groin pain, there might be good reason why this is an overriding finding in that they are often overloaded. One of the major hip flexors (psoas major) originates from the front of the lumbar spine.

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Image source: Health Appointments

Weak Hip Flexors?

With poor abdominal control, they are in a good place to offer some stability to the front of the lumbar spine. Often addressing abdominal muscle control and timing is enough to offload these muscles. However, during my time working with elite athletes, we found many of the sprinters would complain of groin pain which we attributed to these mystical tight hip flexors, so we worked on the gluteals and hamstrings which we found were often inhibited. Our problems didn’t get any better until someone suggested that perhaps the hip flexors were weak and needed some strength work alongside appropriate abdominal work. After starting this approach our groin pain reports dropped significantly.

Solution: Restore Control

Much like the shoulder (another interface between limb and torso), the hip and groin areas are complex areas that are links between areas requiring controlled stability and movement. Restoring control of the trunk and effective timing of abdominal musculature can allow pain related to overloaded structures to settle and start to regain balance within this area.

Paul is our hip & groin specialist - if you'd like to book an appointment with him please call us on 02030 12 12 22 or email us on info@physioremedies.com.

Words by Paul Martin.

Fraser Cartmell: Kit for getting started in triathlon

This month, our pro triathlete, Fraser Cartmell, writes about the basic kit that you need to get started in triathlon and his favourite bits of kit for each discipline.

Looking in from the 'outside', triathlon by its very nature can be viewed as a complicated sport, given the combination of three separate sports (or disciplines) within a sport! Indeed, when I began racing triathlon as a young junior in the north east of Scotland, nearly twenty years ago it appeared a daunting task to begin with, but as with most things in life, baby steps (and plenty of borrowed items) got me started on the journey. It's safe to say I've been hooked ever since.

The sport is littered with different bits and pieces of equipment that you can appear to *need* in order to toe the start line - triathlon is undoubtedly a marketing dream! However, stripped back to the bare essentials it can hopefully resemble a far more attainable event for the everyday person who might want to give it a go, just to see how they find it. The *need* for the shiny and sparkling equipment can come later!

Swim

To begin your triathlon journey the pool triathlon is a great starting point. As long as you have a trusty swimming costume and goggles, you're all set. Fancy, once piece triathlon suits, and expensive wetsuits for open swimming can come later if you decide you're keen. One thing I will advise against is using a regular surf wetsuit with the belief that "it'll work fine"... I used a friends' windsurf version for my very first open water event and it was a miracle I ever made it ashore! But you learn quickly, and these days my tri specific wetsuit, complete with far thinner and more flexible neoprene is certainly one of my key pieces of race equipment.

Bike

As a youngster who explored the countryside after school on his trusty mountain bike, I was familiar with riding off road, rather than on a road bike. And so, conveniently my first taste of racing a triathlon was an off road event, which I loved. Once the inevitable triathlon seed had been sown, we (my parents) were able to borrow a road bike from (another!) friend for the remainder of that summer until Christmas came around for my very own set of speedier wheels. My point here is that the *need* for expensive, aero tri-specific bicycles isn't necessarily justified until you've really sunk your teeth into a number of local level events, to test your appetite. Perhaps inevitably however, my time trial bike resplendent with electronic gears and carbon wheels has become a firm favourite piece of kit that I spend extra care looking after.

Run

I always believe that shoes and footwear are as exciting to me as they are everyone else, but I'm not so sure? Personally, I love the smell of a new pair of trainers when they appear from the shoebox, and so over the years of racing professionally I have become spoilt with the deliveries of new shoes that sponsors have kindly sent.  Whether it be for training or racing, I'm a total sucker for a fresh set of trainers and I think after my bike these rank as 'next best favourite' items on my list, and I'll do my best to keep them in good condition. I might even have been known to machine wash shoes (which you are not supposed to... it's bad for both the washing machine AND the shoes apparently!) to keep them clean. It works a treat!

Accessories

As technology has rapidly progressed there are now all sorts of other 'extra' things that we *need* to train and race for triathlon, including (but not limited to) GPS running watches and cycling computers, electrolyte energy drinks and carbohydrate specific bars, racing helmets with visors and bike shoes with ratchets and straps. There are even special pedals that measure your power output (that the aforementioned cycle computer will tell you about) and many more I have limited time to write about!

Too many items to choose your favourite from I'd say ;)

Words by Fraser Cartmell.

Helpful Hints for the Holidays

Back and neck pain are common problems experienced when travelling or staying away from home - so here are some ideas to help you enjoy a more comfortable summer break.

In the car:

• Make sure you sit with good posture - if your car doesn’t have enough low back support use a rolled up towel (pick the right size!) or buy a purpose-designed lumbar roll.
• Don’t allow your chin to poke forwards as you peer out the windscreen - especially at night! This is a very common habit and can result in a stiff and sore neck. The back of your head should be just touching the headrest support and your chin should be tucked towards your Adam’s apple.
• Take breaks – get out and walk about every hour or so even if just for a few minutes.

On the plane:

• Don’t fall asleep in an awkward position - try and keep your back in its normal alignment (again a small lumbar roll can help with this) and use a horse shoe shaped neck support to help stop your neck kinking into the wrong position.
• Remember sustained positioning when your joints are not in neutral alignment can cause damage and pain – so avoid it.
• If you're on a long flight, get up and walk every two hours. This will also help your circulation.

In bed:

• Lots of people suffer as a result of sleeping in a strange bed. Whilst there’s not a lot you can do about the bed itself you can alter the pillows (or take your own).
• The pillow’s purpose is to fill the space between the head and neck and the mattress.  If you sleep on your back your pillow should be fairly flat.  If you’re on your side that pillow should fill the space between your shoulder and head to ensure your neck is held straight and doesn’t drop down toward the mattress (too flat pillows)  or is pushed away (too many pillows) - it should be ‘just right’.

And remember we are open throughout the summer holidays to help ease any aches and pains. Just call us on 02030 12 12 22 or send an email to info@physioremedies.com to make an appointment.

Words by Kara Mulvein.