How To Work From Home Pain Free

We don’t recommend working from home like this…

How To Work From Home Pain Free

Many of you are now working at home due to the coronavirus pandemic restrictions. Some of you will have home offices and others of you will be sitting at your kitchen / dining room tables.

Sarah has written up some tips on how you can make your home office set up more ergonomic and try to prevent unnecessary aches and pains.

1.      Sitting position:

• Always sit your bottom to the back of any chair.

• Knees and hips should be at a 90 degree angle and feet flat on the floor. If your feet are dangling, put something underneath to support them (big books / solid box).

• You should sit 3 - 6 inches away from your desk. Clear any clutter from under the table so you can get in close.

• Elbows bent to 90 degrees and close to the body.

• Wrists should rest in neutral.

• If you don’t have an ergonomic chair, you can roll up a small towel (not a cushion), put some tape around it to maintain the roll shape and place this into the small of your back to help maintain an upright posture. Or buy a lumbar support – see links below.

• Your head should be straight, shoulders relaxed, and your line of vision should be at the top third of your screen.          

2.      Laptops:

• If you are working off a laptop for long hours and you can afford a laptop stand, buy one now. Laptops were not designed for long periods of work and using one will cause pain long term as you have to look down. They can be as cheap as £15 and go up to £150 – see links below.

• Place your screen on the stand and make sure your line of vision is in the top third of the screen.

• If you have a lap top stand you will need a separate keyboard and mouse.

• If you do not have any of the above and continue to work on laptop, take even more breaks - every 20 mins - and do some stretches.

3. Desktop Screen:

• Your screen should be placed central to your body.

• Screen height should be in the top third of your vision – if not stick some books underneath it.

4. Mouse and keyboards:

• Keyboard should be placed central to the body, and at a height where the wrists remain in neutral and elbows at 90 degrees.

• Mouse should sit close to the keyboard on whichever side is best.

• You can use mouse and wrist rest if they help achieve this position.

• Make sure your keyboard and mouse stay within the circle, as shown above.

Other top tips:

• Take micro-breaks every 20 minutes: you should take a break and complete 20 seconds of micro movements. This could be shrugging the shoulders back, rotating your upper back from side to side, turning your neck side to side etc.

• Documents should be placed at the same height as your computer screen - try using a document holder.

• Allow your eyes to take a break from your screen by exercising them! Do this by focusing on objects in the distance regularly when you take a break from staring at your computer screen.

• Use a head set instead of a handheld phone. Handheld devices should be used only for short durations with the upper limb supported, which will reduce the strain through the neck.

• Handheld devices (phones, iPads, Kindles etc) should be held at eye level so to prevent strain on your neck from looking down for long periods.

• Your office should be well lit and well ventilated, with no glare from lights or windows on your screens.

• Stand hourly at a minimum.

• If you stand for prolonged periods, this also causes fatigue and your arms are not supported, so standing desks are not necessarily better than sitting desks in general which is evidence based supported. The key is taking regular breaks from static postures.

Remote workstation assessments:

If your office set up is a pain in the neck (literally!), get in touch with us! We can do remote ergonomic assessments of your workstation set up to see how we can help you. We are currently offering these at £55 for a 30 minute session.

And of course, if you’re in need of a physio appointment, we’re also offering those remotely too, via online video or phone.

Buying links:

Lumbar / McKensie rolls – by on Amazon and how to use them – McKensie roll position.

Laptop stands –  ebay – laptop stand  or Posturite Stand – which doubles up as document holder.

We have worked with Posturite for over 15 years and they have very kindly offered all our patients a 25% discount on any products bought from them. If you are a patient of ours, please contact Chris at chrishollely@posturite.co.uk, quoting PHYSIOREMEDIES, to get a quotation.

Words by Sarah Lawson.

Patient News: Alex Flynn - Certainly Uncertain

Patient News: Alex Flynn - Certainly Uncertain

Last year we announced that our patient, Alex Flynn, would take on the 4 Deserts Grand Slam Plus this year – racing 1,250km / 780 miles unsupported on foot across some of the most inhospitable landscapes in the world in the Namib Desert, Gobi Desert, the Great Caucasus of Georgia, the Atacama Desert and Antarctica - and that we’ll be supporting him in the lead up to this epic challenge.

Alex was diagnosed with Parkinson’s disease in 2008 at the age of 36. His diagnosis became the catalyst in his life for showing people the possibility of creating positive change in the face of adversity.

We asked Alex to write us an update on how things, including his training, are going, given the most recent turn of events.

Alex says:

I haven’t written for a while. Truth is I’ve been training for a race that may not happen.

Coronavirus has thrown everything in the air so to speak. Not only has it panicked many people and caused uncertainty across the world, it’s also made travel, insurance and racing in close proximity to others a game of Russian roulette.

I like things to be relatively certain. That’s why I like to train five times a week and take two days off. In typical Flynn style, my training graph would normally resemble the topography of K2; steep and unforgiving. I made this mistake in my past. Stress fractures and hotspots on my lower legs became frequent friends. Discussing this with Paul, I’ve managed to soften the curve of the graph by incorporating more cycling and cross-training into my regime. This is not just to obviate the risk of stress fractures but also cope with a changing physique that comes with being almost 50 years old.

So, training over the last few months has been a mixture of functional training with Gareth Batson at Cynergy PT, muddy trail and long road runs and cycling. In addition, I’ve spent time at the Park Club and have been working on my strength training with Quentin at the Engine House.

The result is that I’m stronger and fitter as well as benefiting me with fewer Parkinson’s symptoms. However, it’s not been without its aches and pains. Paul Martin has been amazing at managing my anxiety where I feel pain in my knee or ankle. He knows exactly the right thing to do. Paul helped me achieve my 10 millionmetres challenge and made it possible for me to #KeepMoving.  

I guess I will go with who I trust and know. After all, we are all looking for certainty.

Words by Alex Flynn. Images by 10MillionMetres.

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.

NEW: One To One Physio / Rehab / Yoga Sessions

NEW: One To One Physio / Rehab / Yoga Sessions

Our specialist physiotherapist, Alex, is now offering one to one physio rehab sessions which include the use of yoga to help strengthen your body. Of these sessions Alex says:

“These sessions are perfect for anyone who is curious about introducing yoga to their exercise routine. I often meet a lot of resistance from people who have thought about starting yoga but are overwhelmed at the thought of a class filled with super bendy people standing on their heads!

This is not what yoga is about and I'm here to help you find your way into your yoga journey in a safe and personalised way. I’ve been a Physio for almost 20 years now and this gives me a deep understanding of the body, its movements and limitations, and also how to work with any injuries you may have.

Yoga for me is about being 'flexible' (not the bendy type!) in how you practice and what suits you ,and having one to one sessions really is the best way to achieve the best outcomes. These sessions are also great if you are looking to enhance your overall strength, flexibility and wellbeing by training your body and mind in a very different way to before.

I meet many clients who are regular yogis and then come in with an injury which may or may not be related to their yoga practice. When we have looked at some of the postures together we can identify small areas and modifications which can make a huge difference in two main ways: one is by not stressing certain areas in a unhealthy way and the other is to gain more connection and balance on the mat, deepening your awareness of the pose you are in. The adjustment might be very small, but unless it's pointed out you won't feel the benefit of it.”

So if you've been thinking about it and want to find out more then please contact us to book in a session with Alex.

Getting Back To Exercise In The New Year

Getting Back To Exercise In The New Year

Noticed the number of gym adverts increase recently? Noticed a bit of an upturn in attendance at the gym in the past couple of weeks? A combination of the New Year's Resolution market and December excesses mean this is peak gym membership season. So what are we trying to work against?

Christmas Calories

Some sources estimate that during Christmas Lunch, an 'average' person may consume up to 5,200 calories through starter main course, dessert and drinks. These figures were sourced from a supplements firm, so there is a vested interest here, however the same article suggests this would take jogging 52 miles (i.e. 2 marathons) to burn it all off. Whilst this may not be everyone's preferred option to address the balance, come early January, with the December splurge behind us, it is a good time to start a new regime so that next Christmas we are ready for it!

However the initial push to get the ball rolling can end up with disillusionment, pain and injury or frustration at a lack of progress and subsequent withdrawal from the process. Here are a few easy steps to try to stay on target so that the monthly membership costs aren't going to waste:

Pace yourself

Don't try to burn 5200 calories in one go. It won't work (unless you are going to row the Atlantic in which case that's about a daily energy requirement and a little extreme). Ease into it, consistency is most important and in the early stages you may be better coming out of the gym or finishing your exercise thinking you could have done more. Build it up over a few weeks until you can hit it harder when your body will be better conditioned to the work.

You are where you are

Remember when you used to go to the gym twice a week 6 years ago? Regularly bench pressing 90kg, squatting 60kg and managing an hour on the treadmill? Easy there tiger, that was a little while back. If you are returning to the scene of previous triumphs, take those weights and reps right down. You will get much more getting your technique right on a light weight that you can increase over a few sessions than by jumping back in where you were. You might get away with it for a couple of sessions but your body's powers of recovery will take some honing as well.

Recovery is important

If it's been a while, build up from a couple of sessions per week. Most gains are made when the body is recovering and in the early stages there may be a lot to recover from. If every session feels like torture, give yourself a chance - do your exercise, but drop the weight or reps a little. Focus on technique or something different to what you might normally do. Preparation (warm up, the right food and hydration levels for you, making sure you are doing the best session for you) is important, but recovery (light refuelling, stretching, resting afterwards) is just as vital.

Enjoy it!

It is supposed to be fun! Exercise doesn't have to be about slamming away on the treadmill almost doubled over with exhaustion in a gym full of seemingly uberfit obsessives wondering how on earth Mo Farah does it.

It can be a cycle to the station, restarting some team sport, going for a longer walk with some friends, anything that gets your heart rate up for a prolonged period of time. It is often easier to exercise with someone as you are both doing the same thing and if you aren't feeling it one day, there is the perception you are letting someone else down if you pull out of what you were going to do together. Stick with it, long term it will be worth it!

Forming a habit

Our NoviceRunnerNik has written a blog post about forming a gym habit with some helpful tips which can be applied to other exercise too.

Injured?

If you do pick up an injury, get expert advice - call us for an appointment on 02030 12 12 22. Don’t give up on your hard earned fitness. Read our what to do if you get injured blog post for ways to keep up your morale and keep moving.

Words by Paul Martin.

What Does My Physio Think About: RED January

What do you think about RED (Run Every Day) January and other sign up type exercise initiatives?

What is RED (Run Every Day) January?

RED (Run Every Day) January and other sign up type exercise initiatives are becoming very popular, possibly because of the exposure they have on Social Media. People pledge to run or do another form of exercise every day for a month to raise awareness of or sponsorship money for a charity. They’re encouraged to post about their daily achievements on Social Media.

Are RED January and similar initiatives a bad idea?

Our spinal specialist Physio Shari says:

“Unfortunately this will very often lead to overuse injuries, which may range from strains, to tendinopathies, stress reactions in the bone to stress fractures. I wouldn't recommend suddenly running every day after a long period of inactivity or if your body isn't conditioned to it. I do have patients who run 6-7 days per week and love it and have been doing so for years, however there is obviously a reason that they are seeing me and it is for overuse/overload injuries and/or biomechanical problems! A balanced exercise regime is best with a gradual increase in loading and recovery days, particularly if starting exercising from a zero or low background level."

Physio Paul, who specialises in sports injuries, says:

“Be sensible! Initially you might be able to get away with a couple of bigger runs in short succession but at some point you'll need to slow down or plug in some recovery runs. Vary distance, volume and intensity through the period of time you are committing to.”

If you are intending to run every day this month or any month, do be very careful about overloading your body, particularly if you’re normally not particularly active. You could consider Moving Every Day - varying the forms of exercise that you take to reduce the risk of overuse injuries. Try cycling, walking, gym classes or weight lifting too.

Capitalise on your new found fitness too. At the end of the month continue Move Every Day sensibly to make it part of your ongoing routine to help you towards a more active life.

Are you a Gym Newbie? How to form a gym habit and enjoy it

Are you a Gym Newbie? How to form a gym habit and enjoy it

Thinking about making ‘going to the gym’ a new year’s resolution (again!)? Are you a bit of a gym newbie? Our NoviceRunnerNik was too this time last year but now she’s a committed gym goer. Here’s her story on how to form a gym habit and enjoy it.

Januaries are good months for gym owners

The owner of my gym told me last week that my gym’s February to December monthly membership income is typically half that of January’s. Lots of people sign up in the new year, the gym gets busy and then so many fade away. So if you’re going to decide to go the gym, how can you turn it into a long term habit, particularly if you’ve never really been a gym-goer?

I too was a gym newbie

Until November 2018 I could count the number of times I’d been in a gym on two fingers. The first time was definitely not in this century. So I nervously approached my local gym for a chat about how it works and what I could do there. I was keen to complement my running training (my first love) by doing some things that didn’t involve running. I’d signed up for a tough 32 mile ultramarathon in August this year and as I’m a bit prone to overtraining injuries, training in not running (or cross training as it’s apparently called) seemed like a good idea. I liked the look of lifting weights. So I signed up for a month of membership and a personal training session (in for a penny, in for a pound) and turned up the next week for my induction and first ever personal training session.

No one is watching you, they’re all watching themselves

I couldn’t really articulate why I was nervous about going to the gym. I think I was worried about looking like someone who didn’t know what they were doing. I think that somewhere inside of me, the old 14 stone, size 18 couch potato that I was until seven years ago, still lurks, wondering what on earth someone like me was doing in a gym.

The first thing I learned is that, just like real life, gym members come in all shapes, sizes, ages and fitness levels. The members at my gym range from older teenagers, through Junior Powerlifters competing at national level, to 70 something retirees (with impressive deadlifts!), each with their own reasons for training at the gym.

The second thing I learned was no one is watching you. They’re all watching themselves. And no one cares what you’re wearing, what you’re doing, how you’re doing it. That’s not to say they don’t care about you – all the gym goers I have met are lovely, friendly, chatty, polite and helpful.

Making the most of your gym sessions

I realised that I needed to make the most of each gym session, to make it worthwhile taking the time out to go three times a week. So to stop me aimlessly using the machines with no real idea of what helps, I asked my new personal trainer for a training plan to work to, in particular to help improve my core and arm strength. I have, like most runners, stronger legs and weedy arms – a t-rex body shape! He gave me a two week, push day (arms), leg day and pull day (arms), plan.

And then I just needed to learn the lingo: the different types of sets, tempos, names of the equipment and exercises and how to do them. I started recording what I was achieving for each exercise, weights and reps wise, in a spreadsheet on my phone as I trained so that I knew where to start the next time I was doing that day. It’s highly motivating when you smash your PBs each week when you first begin!

Personal training and diaries

I decided to have a personal training session once a week for a few months, partly to ensure I was doing it right and partly as he pushes me so much more than I push myself on my own. I changed the days I trained with him so that we went through all of the exercise sessions. I’ve also started doing 30 mins on the static bike or 5k on the rowing machine after each session, to make it even more worthwhile going. This is also great ‘brain occupation’ training for long distance running!

I put all my gym sessions in my diary so that they are appointments I will attend and I avoid booking anything else that clashes with them. This means I have no excuses to not go to the gym and the gym has become part of my daily routine. I also discovered my next door neighbour was toying with joining the gym to increase her strength which would make caring for her very frail husband slightly easier, so I encouraged her to start and now we encourage each other to turn up and train at the same time. We usually have a good chat on the crosstrainers as we warm up!

Learning to enjoy the gym

And after a few weeks, once I’d learnt the ropes and chatted to a few people, I started to look forward to, and enjoy, going to the gym, which amazed me! I even began to feel sad when my gym session was over.

Smashing gym PBs is a great feeling but it does happen less and less as you get stronger. I did have one leg training day a few months ago where I smashed every single PB on every single set. Whilst it left me wondering for a while why I’d not upped my weights much more previously, the fact that I could barely walk the next morning made me reconsider!

Benefits of gym training

I’ve experienced some great side effects from my gym training. I started smashing my running PBs without increasing my volume of running training, including parkrun times and I knocked 16 minutes off my first ever half marathon time when I ran the same half again this year. My knees in particular are less cranky when I run and I’m generally experiencing fewer niggles. I feel stronger when I run and I recover more quickly from big exertion running such as a 19.5 mile run around North Wales which included the summit of Snowdon, managing to leap out of bed the next day when I expected to be hobbling.

The 32 mile ultra in August, although hard and quite tiring, went like a dream. Recovery was quick. Thank you gym work!

My top 10 tips for forming a gym habit – make it hard to make excuses not to go

1. Find a gym that suits you and what you want to do – that its opening hours suit you, it’s easy to get to and park at, it has the equipment or classes you want. Ask friends or the internet for recommendations. Try several if the first one doesn’t work for you.

2. Pay automatically for monthly membership: if your chosen gym is for you, put your monthly membership payment on a standing order or direct debit. Then it gets paid without you having to think about it and you might feel you should go to the gym to make use of it.

3. Book your gym sessions in your diary, just like any other appointment and treat it as such. Be realistic about how many sessions a week you can manage.

4. Go to the gym at a time that works for you: if you prefer it when it’s quiet, find out when is off peak attendance time. Lunchtimes are usually, but not always, quieter in my gym.

5. Make the most of your gym sessions, part 1: have a training program written specifically for you, tailored to your goals and your likes, by a personal trainer, or find something that works online. Record your stats each session using Google docs on your phone or in a notebook so that you can see your improvement.

6. Make the most of your gym sessions, part 2: treat yourself to a personal training session every so often. You’ll learn a lot and will be pushed to work harder.

7. Vary your training regularly to keep you interested in going. If you only use the machines, try some free weights or some functional strength work like tyre flips, battle ropes, kettle bells. Change your program every few months.

8. Warm up, cool down and stretch to reduce the chance of injury. If you don’t know how to, ask a personal trainer at the gym.

9. Train with someone else for some accountability: you don’t need to actually train with them but if you agree that you’ll see them at the gym at a certain time and day, you’re more likely to turn up.

10. Remember that gym goers are all shapes, sizes, ages and fitness levels and everyone is watching themselves. Don’t be afraid to ask anyone for help or advice. You belong too.

Most importantly: when you start, or start back if you’re a seasoned gym-goer, at the gym in the new year, take it easy. Don’t leap in where you left off in the summer or start off with the really big weights as they look the part. Ease yourself in gently, up your weights gradually, move with control and reduce your risk of injury. Much as we love to see you, we’d prefer you didn’t hurt yourself in the first week of the new year!

If you do pick up an injury or would just like some advice about getting (back) to the gym, please call us on 02030 12 12 22 to book an appointment.

Words by NoviceRunnerNik AKA Nik Bathe.

Patient News: Wayne Collins' Ride To Rome Part 2

Patient News: Wayne Collins' Ride To Rome Part 2

Wayne Collins, one of our physio patients, recently cycled from London to Rome with his friends Alessandro, Dot and Aileen to raise money for two charities close to their hearts. The first is The Royal British Legion, specifically for their projects supporting Admiral Nurses who work with people (and their families who are often more affected) with Alzheimers, a disease that took Wayne’s father at an early age, and the courses that they run at the Battle Back Centre. The second charity is Demelza House, which is a hospice that provides respite care and end of life care for children with severe illnesses and life limiting conditions.

Wayne has very kindly blogged his experience for us in two parts – this is the second part - the actual ride. You can read the first part: the run up to the big event, here.

Our Ride To Rome!

And we were off!

We set off from the Coliseum Theatre in London early one Friday morning in late July.

Our first delay was the raising of Tower Bridge which in all my years of living and working in London I have never witnessed!

Our route out via Greenwich effectively ran alongside the A2 along some very rough sections of cycle paths to our first stop at Demelza House in Sittingbourne. Demelza is one of the two wonderful charities that we were raising money for. We received a very warm welcome and were fed with sandwiches and some lovely homemade cake to send us on our way to Dover.

First stop - at one of our charities, Demelza House.

The weather was kinder to us in the afternoon as we picked up the Via Francigena Pilgrimage route from Canterbury to Rome. We would crisscross this route many times over our 19 day adventure.

Unfortunately upon our arrival at Dover we soon realised that we would not be departing anytime soon! We loaded the bikes into the van ready to board the ferry and then spent the next 4.5 hours waiting to do so!

Through France

We arrived at our hotel in Paris at 1am in the morning and had to unload the contents of the support van into our rooms for security.

We were up again at 6am ready for Day 2, waking up to torrential rain that stayed with us for the whole day! Thankfully that was the only any like that which was a relief as it took the next two days for my shoes to dry out.

Luxurious accommodation in France - a stack of shipping containers as rooms

Over the next days we proceeded south through France largely following routes that we had driven during two recces in January and March. We encountered some road closures and subsequent diversions along the way just to keep us on our toes.

We cycled through some amazing scenery with the vineyards south of Reims being particularly impressive and memorable. We did our best to support the local farmers and agricultural economy along the way which meant we had to sample the local wines with dinner each night. It would have been very rude not to have done so!

Psychologically we had one of our hardest challenges ahead of us....the Alps!

Tackling The Alps!

Due to snow earlier in the year we had not been able to drive the Alpine passes so we really had no idea what laid ahead.

Please remember we are not club cyclists, purely amateur leisure cyclists with an average age the wrong side of 60.

As we approached the Alps we cycled down the entire Eastern side of Lake Annecy to Albertville, once the home of the Winter Olympics and not normally a place you would be cycling. Thankfully these days it’s the home of a state of the art cycle shop/repair centre and some very friendly generous staff.

We had now been cycling for 9 days averaging around 76 miles a day.

Day 10 was the “rest” day before we tackled the Alps. On this day we cycled the relatively short distance from Albertville to Beaufort to find ourselves sitting at the most amazing patisserie for breakfast whilst looking at the Ski Map across the road....are we insane? Should we really be in a ski resort on our bikes?

Beaufort the day before the Alps ascent

Time for some bike cleaning and maintenance before I, Alessandro and our driver Glyn headed up the Alpine climb to see what the next day would have I store for us. Last time Alessandro and I were there it was closed due to the snow.

It took us around 5 hours for me to drive the route and return.... not quite the rest day we had planned, however I am so pleased that we did drive the route. The ladies on the other hand enjoyed a lazy girlie day in the sun in Beaufort.

Alessandro spent many days planning the routes and then modifying them following our visits earlier in the year. We, the novice cyclists, clearly had not paid enough attention to his notes though! In order to cross the Alps by the “easiest” route it was not what we had imagined it would be, i.e. a long climb up and tricky steep decent down to Italy.

Oh No! It was a long 22km climb up to Cormet de Roseland which was part of this year’s Tour de France, albeit probably a little faster than us. This was followed by a steep decent down to Bourg St Maurice before a further 35km climb up to the Italian Border. We were definitely running on adrenaline on this day!

Part way up first climb over the Alps

This climb took us up over the Col du Petit Saint Bernard through the middle of La Rosiere Ski Resort. It felt very strange cycling under ski chair lifts and seeing signage relevant to being in a pair of skis, not on a bike!

Top of first alpine climb!

The steep difficult hairpin bend decent down into La Thuile in Italy at the end of that day was very tough as we were all so tired, however, we had made it over the Alps...what a relief!

And Then Italy

The next couple of days were down through Northern Italy where our choices of road through the steep sided valley were limited and the ride got even tougher in many ways with very, very bad road surfaces and heavy traffic including lots of trucks which were not that happy to see us.

Cycling through Italy was more challenging than our route through France with steeper climbs and more and more tired legs. The adrenaline rush of the Alps had left us and at times we really struggled. Tempers got a little frayed at times too, but we all stuck together and pushed each other to keep going.

The messages from home via our Facebook page from not only friends and family, but also from others who we did not know that had started following our challenge were very important to us and certainly kept us going.

1,000 miles in

Day 15 saw us reach the 1,000 mile mark! We were all very tired and whilst relieved to have made it that far, I don’t think it really started to sink in until we posted the pictures that evening and the messages from our supporters started to arrive.

Italy and 1,000 miles covered!

Day 15 saw us enter the beautiful region of Tuscany through which we carried on the next day. How different it looked in the blazing sun some 5 months after our drive along the route back in March. Still stunning, but so very different.

Energy levels were now very low, and even though Day 19 would see us reach Rome, we all struggled to remain in good spirits and to keep going at times. We had been blessed with overcast conditions through much of France, however we were paying the price now with temperatures in the upper 30s.

Day 19 and our final approach to Rome had a brief stop at the lake north of the City where the Pope has his Summer Residence.

And Finally, Rome!

Thankfully Rome itself was very quiet in August as it’s very hot and the residents and businesses were on holiday. There was a tiny amount of traffic compared with what had greeted us in March so we needn’t have worried so much.

Emotions were running high as we cycled first to the Vatican and then onto our final destination, the Colosseum.

At The Vatican

At The Colliseum

We Made It!

We had made it! 1,388 miles, averaging 76 miles a day, excluding the rest day at a mere 12 miles and we made it over the Alps without having to get off and walk!!

We did it!

What an adventure! One we will never forget and, thanks to our amazing sponsors, nearly £12,000 was raised for the Royal British Legion and Demelza House.

Words and images courtesy of Wayne Collins.

JUST AMAZING Wayne and team - well done!

Are you going on your own adventure and would like to share it with us? Send an email to us at info@physioremedies.com.

Body Part Of The Month: The Hip

Body Part Of The Month: The Hip

This month our body part of the month is the hip and so we’ve asked our hip and groin specialist, Paul Martin, to tell us about to tell us a little more about the hip:

One of the more important muscles around the hip is gluteus medius - shown in red in the image above. It’s not the biggest muscle in and around the hip and pelvis but its effects are wide ranging and having it function well is important for healthy functioning in many areas, the hip, lower back and knee to name but three.

When it’s all going well

What happens when it all works well for the lower back? When it works well (i.e. it is strong enough to bear the load and operative at the correct time to absorb the work), it is able to stabilise the pelvis on the hip. When we stand on one leg, gluteus medius works to keep the pelvis level providing a level base for the lower back to sit upon.

What happens when it works well for the hip? Gluteus medius plays a large role in keeping the ball of the hip squarely in the socket. It plays a key role in moving the leg away from the midline of the body but it also contributes to both internal and external rotation of the hip (i.e. rolling inwards and outwards) so will control excesses of these movements as well

What happens when it works well for the knee? Due to the control of rotation around the hip, when functioning well it can limit shear and rotation of the femur (long thigh bone) on the tibia (shin bone) which reduces risk of overload in other muscles to control this movement.

When it’s not going well

So what happens when it’s not working well? The opposite of the above. The pelvis will provide a less level base for the spine to support itself from, single leg standing (e.g. during gait) will likely be accompanied by some form of hip or pelvis on hip rotation depending on which parts of the muscle aren’t playing ball which means that a number of rotational forces will resolve themselves around the knee.

Sounds catastrophic! How can we possibly survive without gluteus medius functioning? The body has a phenomenal ability to create compensatory movements or actions that mean that we can still function if a few muscles aren’t doing what they should when they should. However if these things get out of control it can lead to tight muscles on the outside of the leg and Runner’s Knee, or tightness in the back muscles or even back pain.

How to get it going well

Keeping on top of this little muscle won’t cure all your ills, but it can certainly help keep some nasty aches and pains away.

The video in this link gives five good gluteus medius exercises and also shows progressions too. They are:

1. Side-lying abductions

2. The pelvic drop

3. Single leg deadlift

4. Single leg squat

5. Side bridge (or side plank).

Are your hips causing you concern? Call us on 02030 12 12 22 to book an appointment with one of our hip and groin specialist physios.

Words by Paul Martin.

If Office Christmas Parties Were Sporting Events...

If Office Christmas Parties Were Sporting Events...

It's that time of year that some people love and others dread.  For some it's a party every day and others it's one big blow out. 

Here are our specialist shoulder & elbow and sports injury physio (and man about town) Nick's top tips for:

Surviving the office Christmas party (or parties)!

1. Remember it's a marathon not a sprint! The booze will not run out within the 1st hour, so pace yourself.

2. Think like a triathlete! Drink, Eat and Dance, but not at the same time.

3. It's like a game of chess and tactics are essential! Don't get cornered by the office bore or the lustful one who's just eaten a packet of mints!

4. It's all in the preparation! Line that stomach before you start the race of units.

5. Hydration! Have a soft drink/water whilst drinking alcohol, this will make you feel better the next day.

6. If physical activities are part of the party, stay off the alcohol until its safe to drink!

7. It’s not an excuse for Cage Fighting and sorting out those grudges that have been building up all year! Avoid confrontation. Stay calm and give peace a chance!

8. Dancing on tables is not yet considered an Olympic Sport!

9. Dance floors can be dangerous. The majority of injuries happen from people slipping on liquid on the floor, or falling onto broken glass. And watch out for the over enthusiastic Whirling Dervish who might knock you over like a 10 pin bowling ball!

And Nick’s tips for hangover cures:

1. Don't rely on the hair of the dog. This will only delay your hangover. Alcohol is a diuretic making you urinate more and will dehydrate you further. Drink plenty of water.

2. Don't drink too much coffee. Caffeine is also diuretic. Try juice or water.

3. Go and do some exercise! The endorphins will kick start your recovery! Make sure you warm up and are sufficiently hydrated before pushing yourself too hard.

4. That fry up might sound appealing, however a banana or kiwi fruit will help replenish those lost nutrients, especially potassium.

We hope you manage to stay safe and upright at your Christmas parties but if you do sustain an injury by showing off on the ice rink, you know where we are.

Words by Nick Smith.

Patient News: Wayne Collins' Ride To Rome Part 1

Patient News: Wayne Collins' Ride To Rome Part 1

Wayne Collins, one of our physio patients, recently cycled from London to Rome with his friends Alessandro, Dot and Aileen to raise money for two charities close to their hearts. The first is The Royal British Legion, specifically for their projects supporting Admiral Nurses who work with people (and their families who are often more affected) with Alzheimers, a disease that took Wayne’s father at an early age, and the courses that they run at the Battle Back Centre. The second charity is Demelza House, which is a hospice that provides respite care and end of life care for children with severe illnesses and life limiting conditions.

Wayne has very kindly blogged his experience for us in two parts – this is the first: the run up to the big event.

Ride To Rome!

Having completed an amazing four day ride from London to Paris with the Royal British Legion in September 2018, I thought “where next?”!

“Why, London to Rome of course!”

It’s less than 1,400 miles. We can do it, of course we can! Dot, Aileen and I have only been cycling for a few years and the total of our ages is greater than 180 so we are no spring chickens and we are fairly slow.

Aileen and Dot agreed to join me in this latest crazy endeavour. Dot (we have not known each other that long) has since revealed that whilst she said yes she thought I was joking! She knows me better now. When I drove to France in January for four days to reccie the section of the route we had planned from Calais to the Alps she realised that I was serious and the event would take place!

Our Charities

During the ride from London to Paris I met some veterans who had received literally lifesaving help from the Royal British Legion, in particular through their Battle Back Centre. They are amazing, inspirational people. I have had, and still have and battle with to a degree, some major health challenges and problems in my life, but nothing compared with these people. I wanted to do more to help them.

The second charity, Demelza House, is an amazing organisation that has helped a close friend of mine, her severely disabled child and family in general for many years. Unlike many children’s hospices they focus on giving children and their families every possible opportunity and support during their lives. They make such an enormous difference daily to these families. Naturally they also provide outstanding end of life care too.

Logistics and Training

I enlisted the help of Alessandro Santangelo, an Italian Cycle guide that I had met on a cycling holiday a couple of years ago. Although our intention was to employ him, as we were raising money for these two amazing charities he only charged us for his expenses and not his time.

Alessandro planned the European mainland routes and we then drove them over two four days trips. This led to some adjustments and allowed us to identify our accommodation which we needed to book well in advance.

With regards to preparation we all cycled the Eden classic from the Eden Project in Cornwall.

Pasties after The Eden Classic.

Dot and Aileen are part of the HSBC UK Breeze cycle club in Cornwall. Breeze offers fun, free bike rides for women of all abilities across the UK. They cycle most Fridays, weather permitting, and obviously, being in Cornwall, they get a lot of hill training in!

Due to my work and other charity commitments I knew that if I was left to my devices regarding training I wouldn’t do enough to be able to survive the trip so in addition to training on my own I cycled the one day, 65 mile Poppy Ride for the Royal British Legion in May.

In June I then joined two friends for a cycle challenge/training down the Adriatic coast of Italy with Alessandro as our guide. In reality we spent very little time on the coast road as each day we came in land to view some stunning locations all of which seem to be at the top of long steep hills! We averaged around 60-70 miles a day.

Wayne and Alessandro at the end of our Adriatic training.

Shortly afterwards I followed up with the four day pedal from London to Ypres, a mere 320 miles, again with the Royal British Legion.

Ypres.

The final major training event for me was cycling the grand depart of the Tour de France one week ahead of the actual Ride To Rome. This event was raising money for prostate cancer. We suffered with extreme temperatures on the day and from a personal point of view, as I had never cycled 128 miles in one day before, it was an enormous challenge on many levels!

In addition to providing his guiding services and cycling every mile with us Allesandro also provided mechanical support whenever we had issues.

My pre-ride bike prep was generously provided by one of our sponsors, Pearson Cycles, who are still family owned and are the oldest bike shop in the UK. Next year they celebrate their 160th anniversary.

Our support van driver, daily fresh fruit and food buyer, water supply man and all round fantastic support was provided by Glyn who also volunteered his time free of charge for the whole trip and assisted with moving the van around in the build up to the event to help promote us and to have the stickers of our wonderful sponsors added. I don’t think he really knew what he was letting himself in for when he was “volunteered” by his wife and fellow cyclist Dot!

Provisioning for the Ride To Rome!

Tune in next month for Part 2 of Wayne’s blog post where he tells you just how much fun he had cycling from London to Rome!

If you’d like to make a donation The Ride To Rome donations page is still live and can be found here.

Words and images courtesy of Wayne Collins.

Are you going on your own adventure and would like to share it with us? Send an email to us at info@physioremedies.com.

What Does My Physio Think About: The Most Common Injuries We Treat

What Does My Physio Think About: The Most Common Injuries We Treat

Do you ever wonder what your physio thinks about your favourite forms of exercise or whether your health or lifestyle choices are a good idea? In the fourth of a series of blog posts entitled “What Does My Physio Think…?” we asked our physios and therapists “what is the most common injury you see in clinic?”

And here are their answers:

Our specialist spinal physio Shari says:

“In order:

1. Lower back pain

2. Neck pain/headaches

3. Shoulder pain

4. Knee pain

5. Mid-back pain

6. Ankle pain

7. Hip/groin pain

8. Elbow pain, and lastly

9. Hand injuries.”

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

“As a soft tissue therapist:

1. Knee pain and achilles problems from tight quads and calves in runners

2. Rotator cuff issues from incorrect stroke in swimmers

3. Above all, the most common injury is shoulder and neck pain from sitting at a desk!”

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

“Patella Femoral Joint Pain (PFJP) - injuries associated with the patella or kneecap.”

Physio Paul, who specialises in sports injuries, says:

“Necks and shoulders.”

Physio Nick, our shoulder specialist physio, unsurprisingly says:

“Shoulders!”

Help To Reduce Neck and Back Pain With Good Office Ergonomics

Not the best desk posture.

Help To Reduce Neck and Back Pain With Good Office Ergonomics

Shari, our spinal specialist physio, writes:

Many of my patients spend long hours working at their computer and poor desk set-up/ergonomics can lead to pain in our joints. I see a lot of patients in particular with neck, lower back and upper back pain exacerbated by poor office ergonomics.

I always recommend my patients have a thorough assessment of their work station by a specialist ergonomics physiotherapist or occupational therapist, but I have provided a few pointers below that may assist:

• Take micro-breaks: every 20 minutes you should take a break and complete 20 seconds of micro movements. This could be shrugging the shoulders back, rotating your upper back from side to side, turning your neck side to side etc.

• Your mouse and keyboard should be at the same height (elbow height) with your elbows close to the sides of your body ideally at 90 degrees. Make sure your mouse and keyboard aren’t too far away.

• Your wrists should be kept in a neutral position.

• You should work as close to the centre of our body as possible, i.e. not turned to one side.

• Any documents should be placed at the same height as your computer screen - try using a document holder.

• Allow your eyes to take a break from your screen by exercising them! Do this by focusing on objects in the distance regularly when you take a break from staring at your computer screen.

• Your head should be straight, shoulders relaxed, and your line of vision should be at the top third of your screen.

• Your chair should support a neutral posture and provide sufficient support for the length of the spine. Your bottom should be back in the chair and contact should also be maintained at the level of shoulder blades.

• Lumbar support such as an adjustable lumbar roll will help you maintain good spinal posture.

• Your knees should be bent at 90 degrees and not touch the under side of your work surface or the seat edge.

• Your feet should be flat on the floor and if they aren’t a foot stool is needed.

• Use a head set instead of a handheld phone. Handheld devices should be used only for short durations with the upper limb supported, which will reduce the strain through the neck.

• Handheld devices (phones, iPads, Kindles etc) should be held at eye level so to prevent strain on your neck from looking down for long periods.

• Your office should be well lit and well ventilated, with no glare from lights or windows on your screens.

• You should be able to manoeuvre yourself in/out of your desk chair without space restrictions or obstructions.

• Monitors should be centred on your desk.

• Stand hourly at a minimum.

• If you stand for prolonged periods, this also causes fatigue and your arms are not supported, so standing desks are not necessarily better than sitting desks in general which is evidence based supported. The key is taking regular breaks from static postures.

• If you use a laptop a separate mouse and keyboard should be used so that your arms are supported and your elbows bent at 90 degrees, and your laptop should be placed at a height such that your eye level when your head is straight is at the top third of the screen.

If your office set up is a pain in the neck (literally!), get in touch with us to see how we can help you.

Words by Shari Randall.

Body part of the month: the knee

This month our body part of the month is the knee and so we’ve asked our knee specialist, Alex Manos, to tell us about to tell us about two elements of the knee and their common injuries:

Anterior Cruciate Ligament (ACL)

The ACL is one of the four main ligaments of the knee, stabilising the knee both in a forward and back and rotational movement.

ACL Injury

Injury to this ligament is common in sports such as skiing, football, rugby and any other sport involving twisting and turning. More often than not, in contact sport, the injury actually happens without contact and occurs when an individual turns direction and the knee twists. The person usually hears a 'pop' and feels a sensation as if something has been torn.

The knee usually swells up quickly and becomes difficult to move and weightbear. Early diagnosis is key and the best route is to see a physiotherapist, sports doctor or knee consultant who will organise an MRI to look at the damage. Once it has been confirmed, there are two options: conservative or surgical management. The preference is usually surgery but factors such as age, fitness level, future goals and patient choice of course are taken into account. Either way, rehabilitation is absolutely necessary.

During surgery, the ACL is replaced with either a tendon from the patella or the hamstring, or sometimes an allogarft (graft from a donor cadaver) is taken. The rehabilitation following surgery can take anywhere from 6 months to a year depending on the extent of the damage and also how well the patient adheres to the rehabilitation program given by the physiotherapist. The goal, where possible, is to return the individual back to the previous level of function. This requires a very systematic approach and goal setting to ensure all markers are met in a safe and progressive manner. The knee needs to be strong and stable and function as it did prior to the injury in order to allow for a return to sport.

Iliotibial Band (ITB)

The ITB is a thick band of tendinous fascia which attaches to a muscle on the outside of the hip called the Tensor of Fascia Latae, a muscle which pulls the hip up and out.

ITB Friction Syndrome (ITBFS/runner’s knee)

ITBFS or runner’s knee as it’s often referred to is a condition which gives pain on the outside of the knee, the lateral side. It is mainly prevalent in runners hence the name but can also occur in cyclists and other sports. We still don't know exactly what causes it but we do know that friction between the ITB tendon and the knee joint causes irritation and inflammation of the bursae (a fluid filled sack) which sits between these two structures. The onset of pain is usually very specific. In running, for example, an individual usually has a distance or time when they can pin point the onset of pain. Once it kicks in, if acute and severe, the runner can't continue. It is described as a sharp stabbing pain on the outside of the knee. There may be local swelling but knee joint itself if not swollen. People find walking downstairs and also just bending the knee - particularly in the 0-45 degrees range - painful.

The injury is atraumatic, there is no tear so there is nothing to heal, but the inflammation has to settle. Usually within a couple days the knee feels ok again and there is no issue in day to day life until the aggravating activity is taken up again. Therefore we say that the injury is biomechanical or overuse in nature. The factors which could be contributing to it can be broken down into two categories: extrinsic and intrinsic.

Extrinsic factors are things like training loads, recent changes in training, training surfaces/hills, footwear and changing fitness levels. There is often a link between one of these and the onset of ITBFS, often a sudden increase in running load.

Intrinsic factors look at what is going on within the body, areas of tightness or weakness, imbalances, running styles or other areas apart from the knee which could be contributing.

A detailed examination of both by a specialised physiotherapist will be able to determine which factors need to be addressed and corrected. Advice, combined with manual therapy and rehabilitative exercises can be very beneficial in overcoming this problem. In recalcitrant cases, a corticosteroid injection can also provide benefit.

Is your knee giving you trouble? Call us on 02030 12 12 22 to book an appointment with one of our knee specialist physios.

Words by Alex Manos.

What does my physio think about ultra running?

What does my physio think about ultra running?

Do you ever wonder what your physio thinks about your favourite forms of exercise or whether your health or lifestyle choices are a good idea? In the third of a series of blog posts entitled “What Does My Physio Think…?” we’ve asked our physios what they think about ultra running.

What is Ultra Running?

Ultra running is defined as running any distance longer than a marathon (26.2 miles). Classic distances for ultra events are 50km (32 miles) and 100km (64 miles) but every year there are more events at almost any distance over 26.2 miles, including 100+ miles. Most events are trail events but some are held on tarmac or even on 400m atheltics tracks!

Is Ultra Running good or bad for me?

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

“For ultra distance, athletes usually work at low intensity, aerobic pace: it’s not uncommon to adopt walk/jog/run combinations. In that sense, there’s less stress on the joints and cardiovascular system than in shorter distance running. As long as the athlete gradually increases mileage during training, listens to their body (and their physio / trainer / coach), human bodies can adapt to many things that “modern human beings” find “impossible”.”

Our spinal specialist Physio Shari says:

“Whilst this isn't my expert area, my personal opinion is that I would be concerned about the long term effects on the person's joints. However, I will support my patients with their ventures and help to get them in the best form possible to compete in ultra running as long as it isn't aggravating existing injuries/issues. Complementing the ultra running with cross training and strength/stability training is really important as well.”

Physio Paul, who specialises in shoulder & elbow, hip & groin and sports injuries, says:

“As with any exercise, build gradually into something as demanding as ultra-running. Not everyone is designed for it but if you are, take a long term plan to build up to distances you would like to reach. Whilst increased volume will mean increased load on joints, the impact of this might be spread out if you build up sensibly.”

And Nick, another of our sports injuries specialist physios, recommends specialist training for ultra events to avoid injury.

Patient News: Alex Flynn takes on the 4 Deserts Grand Slam Plus in 2020

Patient News: Alex Flynn takes on the 4 Deserts Grand Slam Plus in 2020

In 2020, our patient Alex Flynn will take on the 4 Deserts Grand Slam Plus – racing 1,250km / 780 miles unsupported on foot across some of the most inhospitable landscapes in the world in the Namib Desert, Gobi Desert, the Great Caucasus of Georgia, the Atacama Desert and Antarctica - and we’ll be supporting him in the lead up to this epic challenge.

Alex was diagnosed with Parkinson’s disease in 2008 at the age of 36. His diagnosis became the catalyst in his life for showing people the possibility of creating positive change in the face of adversity.

Only eight people in the world have ever completed the 4 Deserts Grand Slam Plus and Alex Flynn is set to join this unique group of super athletes while being the first person with Parkinson’s disease to ever to attempt any RacingThePlanet / 4 Deserts ultra.

Endurance events are not new to Alex. He has completed marathons, ultra endurance races and triathlons, but nothing quite as challenging as this one. Alex’s endurance achievements so far include:

• Covering more than 6,200 miles to meet the 10MillionMetres challenge he had set himself.

• Completing the Marathon des Sables (a 250km race across the Sahara Desert).

• Attempting a 450km expedition in Sweden’s Arctic Circle in freezing temperatures.

RacingThePlanet’s 4 Deserts Grand Slam Plus poses Alex’s biggest challenge so far. Not only will temperatures rise well above 40 degrees C in the oldest desert in the world and well below freezing in Antarctica, but Alex will also be crossing the world’s highest sand dunes, waist deep rivers, fighting sand storms, racing above 10,000 feet and being at the command of Mother Nature in Antarctica.

Alex’s driver is to raise more than £1 million towards vital research to find a cure for Parkinson’s disease while inspiring and educating people about the illness along the way.

“I want a cure for millions around the planet and hope you do too. Together we can make change happen!” #KeepMoving

Alex Flynn is living proof that Parkinson’s disease is not an obstacle for success!

Back To Gym

Back To Gym

Summer holidays done and dusted? Check. Good food, good drink, good volumes? Check. Not quite managed the level of fitness work you’d hoped to fit in? Check. Looking at getting back in the gym to create some space for December? Check.

Ease your way back in there! As with any significant break in training routine, there will be a level of deconditioning and picking up exactly where you left off might not be the most comfortable approach to getting back into the swing of things. It is better to come out of the first two to three sessions feeling like you could have done more or that previously reactive areas or muscles don’t feel fully worked on than charging back in full pace and hurting yourself, leading to a longer period out.

Regardless of whether your workouts are class based, load based or volume based, take it down a notch or two for the first few sessions back. Spend this time during your workouts getting a feel for what is working well and what might need a bit of attention to get back up to full speed. E.g if some muscle groups are perhaps not responding as well as they might have done pre-break, what might you need to do to get them back to pre-holiday levels and how might that affect the rest of your workouts.

Once you have ironed these little creases out, pick it up again over the next two to three sessions and you’re back in the game!

Happy holidays!

Words by Paul Martin.

Jetlag and how to minimise it

Travelling long haul this summer? Our physio Paul has given us his top tips for reducing jetlag.

What is Jetlag?

Jetlag is the mismatch between the timing of the internal body clock and the external timing of the environment brought about by crossing several time zones in a short space of time. Such large shifts in time zones result in immediate changes to time cues which are driven by the new timings of day (ie light) and night (ie dark). Whilst there is an immediate change in environmental time cues, the the body clock(s) do not adapt immediately - the body clock resets slowly, so 'lags' behind.

Linking this with travel fatigue, a form of tiredness brought on by transition from one location to another or the demands of door to door travel, can lead to sleep disruption, fatigue, mood changes and risk of illness. As a guide, flying east will take one day to recover per hour time zone changed (ie six days for a six hour time difference), flying west will take one day per 1.5 time zones (ie four hours for a six hour time difference).

The type of person you are (eg more effective in the morning or more effective at night) may impact your recovery as well. Evening types will travel west better, delaying their body clock, morning people will do better travelling east, advancing their body clock. As always, some people are never affected by jetlag, but others have a constant battle with the changing of time zones. In general the risk of extreme jetlag crossing fewer than five hours is low and as a result most changes will likely be due to travel fatigue, so travelling west for fewer than five time zones will have little jetlag associated with it. However, this becomes more problematic if you are travelling east for more than six time zones.

Every individual will have their own strategies, but if jetlag is something you struggle with when going away, here are a few tips for pre-flight, in-flight and post-flight periods that may be of some benefit:

Pre-flight

To ensure you arrive in the best shape, prior to a long haul flight, it has been recommended that you try going to bed 30 minutes earlier or later for three to four days prior to flying. In theory this should start to shift sleep patterns, if not (especially if delaying sleep) the risk is being sleep deprived if it doesn't work - fitting an extra couple of hours in bed at the other end may not be compatible with work schedules as wel!. Ideally allow yourself to get enough sleep in the build up to the flight and minimise events that take place early morning or late evening and minimise time away from home.

In-flight

Some strategies focus on time for changes to be made during the flight, however this can be a difficult environment where limiting problems might be a better strategy. The plane environment can be unpredictable (eg turbulence, noisy neighbours, food and drink services) so starting your strategy here is quite high risk. As far as the flight is concerned, sleeping when you feel sleepy is the advised approach to attain more sleep leading to better wellbeing on landing. This sleepy time is likely to be between your usual bed and wake up times. It is unlikely that you will get seven to nine hours undisturbed sleep on a plane!

Post-flight

Due to the immediate changes in environmental time cues, the body clock will begin to align gradually. This can be aided by light exposure as an environmental cue. If trying to advance your body clock (ie on heading east) avoid light in the morning and seek light in the afternoon and vice versa for heading west (lots of light in the morning, less in late afternoon). Start small (eg for eight time zones east seek light for a couple of hours in the morning to begin with) and increase gradually eg by half an hour per day.

These are guidelines that may help, however many people have individual strategies that work best for them. If you do have your own strategies that work it is unlikely these will speed any processes up, however if jetlag is something that affects you, some of this advice may help reduce its effects on you.

Enjoy your trip!

Words by Paul Martin.

What does my physio think about joint health supplements?

Do you ever wonder what your physio thinks about your favourite forms of exercise or whether your health or lifestyle choices are a good idea? In the second of a series of blog posts entitled “What Does My Physio Think…?” we’ve asked our physios what they think about joint health supplements such as glucosamine.

What does my physio think about joint health supplements?

Do supplements for joint health, such as Glucosamine, really help / work? Are there any you'd recommend for preventative or treating purposes?

Our specialist spinal physio Shari says:

“Unfortunately, there is very limited research evidence. I don't routinely recommend them, although anecdotally some patients see improvements. If taking Glucosamine for joint health it needs to have chondroitin in it as well. Here's what the Arthritis Foundation has to say. ”

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

“Again, there are conflicting studies with supplements. As a coach, I find psychological / placebo effect outweighs all, so if an athlete really believes in it, I certainly won’t stop them unless their doctor deems it dangerous.”

Stuart, our specialist knee and foot & ankle physio says

“The early studies in Glucosamine and Chondroitin seemed positive with Osteoarthritis, however more recently there are mixed reviews but many people find improvements though taking this. Others such as Omega 3 fatty acids have anti-inflammatory properties and may assist in reducing cholesterol but again the evidence is mixed.”

Bodypart of the month: the foot and its common injuries

This month our bodypart of the month is the foot and so we’ve asked our foot & ankle specialist, Stuart Mailer, to tell us about to tell us about two elements of the feet and their common injuries:

Achilles Tendon

The Achilles tendon is an extremely thick and strong tendon that attaches the calf muscles, Gastrocnemius and Soleus, to the heel. It aids in providing propulsion during walking as well as running and any explosive activity. The Achilles tendon has to endure high forces during jumping, hopping or running and it regularly absorbs 2 x body weight during running, thus it is not surprising to hear that it can be injured.

Achilies Tendonitis

Common injuries are tendonitis, a short period of increased inflammation due to overloading. This can cause some swelling and pain but normally settles quickly.

Achilies Tendinopathy

Longer-term injuries are known as tendinopathies where one has had long periods of microtraumas and the tendon has failed to recover. This tendon becomes more degenerative and disrupted without the inflammatory response tendonitis has. This will present with stiffness and will ease after light activity but be painful after prolonged activity.

Treatment and Recovery

Rehabilitation of either tendon injury involves flexibility and strengthening exercises that are suitable for the health of your tendon at that time. This may involve strengthening your hips and gluteal muscles as well as your foot and ankle musculature.

Unfortunately, tendinopathies can take a long time to recover as tendon regeneration may take more than 3-4 months to occur. Full recovery taking more than 6 months is not uncommon, so patience and diligence are the keys to getting back.

Plantar Fascia

The tight band of fibrous tissue underneath the foot is known as the plantar fascia.

Plantar Fasciitis and Plantar Fasciopathy

Plantar fasciitis (short term) or plantar fasciopathy (longer term pain) is a condition whereby the plantar fascia becomes injured. This typically presents as pain at the heel area of the foot and is categorised as a sharp pain with the first step in the morning but reduces as we start to move. This injury progresses gradually over time and as it becomes more problematic it can then can be painful wearing flat shoes or unsupported footwear or standing for a long period of time.

There can be many contributing factors such as high arches or flat feet, change of footwear or increasing exercise volume too quickly to having tight calf muscles.

Treatment and Recovery

Treatment normally consists of stretching and strengthening the foot and surrounding musculature if there are imbalances. This can then help address the underlying weaknesses or biomechanical issues that may have contributed.

There have been many other interventions utilised that can assist such as orthotics, that can help reduce pain at the plantar fascia and improve your walking by giving the appropriate support your foot requires.

Night Splints, Shockwave therapy, acupuncture and cortisone steroids are all other common interventions, however each has a specific time to be utilised depending on your contributing factors and foot health. It is advisable to first undergo a course physiotherapy intervention and podiatric assistance to help determine causes, start an appropriate rehabilitation plan and aid your recovery.

If your feet are causing you pain or other issues, call us on 02030 12 12 22 to book an appointment with one of our foot & ankle specialist physios.

Words by Stuart Mailer.