How to have effective home workouts

With most of us in self-isolation and exercise equipment scarce, the need for high quality exercise sessions with as little equipment as possible is at an all time high. Many of us rely on a gym and base our routines on the equipment available. With all of this taken away, many of us are struggling to devise workouts at home or are concerned that they are not getting the same benefit.

Effective exercise always depends on your goal; whether its strength, cardio or power, home workouts can help you achieve it.

I’ve teamed up with Harry Smith (Personal Trainer) to give you some good tips to get the most from your home workouts!

 

Competing Supersets

Supersets have two main subcategories, competing and non-competing. Non-competing supersets, the more commonly known superset, is where two exercises done back to back hit different muscle groups (for example a deadlift and chest press).

Competing supersets are where both exercises will challenge each other, this is done to increase the difficulty, increase fatigue and achieves more effective reps with lower weights.

An example would be body weight squats and Bulgarian split squats.

Supersets allow for lower load exercises to reach enough stimulus for hypertrophy and strength.

 

Household items can be gym equipment too!

Things like books in a bag, Tupperware or any other sort of plastic lid, towels and paint cans are great examples of home workout equipment without the need for splashing out for the, now overpriced, equipment online.

Tupperware can be used to reduce friction to make slider exercises, towels can be fixed securely in doors for a basic TRX, and bags filled with books can be used to load up lower leg exercises!

The goal of the paint cans or liquid containers is to add a stability component to the exercise, this increases the challenge of the exercise and can help get more out of each rep!

These suggestions will hopefully give you a few ideas for your own home and hopefully sprout some other ideas of things you could use. 

 

Unilateral exercise

Unless you’re a novice, movements like bodyweight squats and hip thrusts aren’t challenging enough. Whilst we will discuss pushing to failure next, doing 20+ body weight squats is asking for a lot of reps and can make the session longer than it needs to be.

Shifting to unilateral (single arm or leg) movements such as single leg squats and hip thrusts are a viable way of making the exercise challenging without increasing rep demand drastically.

Another way would be to focus on a unilateral movement in a bilateral exercise. This would be done by adding height to one arm in a push up, for example. This allows people to get effective upper body workouts without having to do something very difficult like a single arm push up!

Push to failure

This is arguably the most crucial way to gain good effects from your home exercise regime. Exercising to failure has shown in research to be the best stimulus for building muscle and strength.

Exercising to failure is essentially continuing an exercise until you are physically unable to perform another repetition.

For home workouts, load is limited which is one of the easier ways to stimulate exercising to failure. The other way would be to increase the amount of repetitions.

We advise finding out yourself how many you can do when you first try the exercise, usually between 10-20, and then aim for at least that in the following sessions.

Don’t mistake failure for difficult! Many people when not given an amount of reps to aim for can just stop when it gets difficult, rather than when they can’t physically complete another repetition of an exercise.

Focus on slow eccentric movements in the exercises, this increases the difficulty to allow you to get more from each exercise.

If you’re not sure how hard you should be pushing, you shouldn’t be able to do the same work out again the next day!

 

Conclusion

We’ve gone over some basic tips to help you get the best out of your home exercise routine. Many of us are having to think outside the box and this is a learning experience for everyone!

Finally, try not to mimic the gym – make the most of the new adapted exercises rather than trying to replicate the exact same thing. This can help keep you motivated in these trying times!

If you want to find out more about Harry here’s a link to his website and his Instagram where he has a free home workout guide!

Thanks for reading and stay safe.

Aran and Harry.

Aran Pemberton

Aran qualified as a Physiotherapist graduating from the University of Worcester in 2017. He has since been working within the NHS, rotating into different specialities such as the Emergency Department, Critical Care, Orthopaedics and MSK.  He has worked with people of all ages and different levels of health and fitness, encouraging exercise as an essential part of health and wellbeing and providing the best care for his patients.

Aran has a keen interest in soft tissue mobilisation and movement re-education as part of the rehabilitation process. He has an interest in sports injuries and has experience treating players and working with the strength and conditioning coaches under the physio in Worcester County Cricket Club.

 

Harry Smith79601070_2613934638892800_4524255439859370786_n

Harry lives his life by a mantra: “Honesty, always. Better, together. Science matters, and so do you. No detail is too small.“ From fat kid, to skateboarder, to avid gamer / Netflix connoisseur before settling on Natural Bodybuilding.

Harry has always had a deep appreciation for the Golden Era physiques of old. Wanting to replicate these physiques is what led Harry on a journey of discovery through just about every internet forum, qualification, course and publication out there related to muscle growth, Finally leading him to the coach he is today.

Harry loves nothing more than having his opinion challenged and changed through an intense debate. The nittier and grittier, the better. Want to get in his good books? Make sure your critical thinking skills are up to scratch.

Further Reading

Lasevicius, Thiago et al. “Muscle Failure Promotes Greater Muscle Hypertrophy In Low-Load But Not In High-Load Resistance Training”. Journal Of Strength And Conditioning Research, 2019, p. 1. Ovid Technologies (Wolters Kluwer Health), doi:10.1519/jsc.0000000000003454.

Santos, Wanderson Divino Nilo dos et al. “Resistance Training Performed To Failure Or Not To Failure Results In Similar Total Volume, But With Different Fatigue And Discomfort Levels”. Journal Of Strength And Conditioning Research, 2019, p. 1. Ovid Technologies (Wolters Kluwer Health), doi:10.1519/jsc.0000000000002915.

Wallace, William et al. “Repeated Bouts Of Advanced Strength Training Techniques: Effects On Volume Load, Metabolic Responses, And Muscle Activation In Trained Individuals”. Sports, vol 7, no. 1, 2019, p. 14. MDPI AG, doi:10.3390/sports7010014.

Exercise and the immune system

Exercise, as we all know, is an essential part of our physical and mental well-being. And with the COVID-19 running rampant, health officials are still telling us to still exercise daily – why is that?

Many have shown the benefits of exercise to pain, cardiovascular health and our brain. Our immune system, as quoted by my biology teacher, is “magic”. It works tirelessly preventing a whole range of conditions and diseases day in, day out. We know that diet, sleep, age and genetics influence our immune system – but so does exercise.

The effect of exercise on our immune system is still being researched with many articles suggesting new mechanisms of how this occurs. We will quickly discuss what benefits and potential risks exercises pose for our immune system. Exercise has a profound impact on our bodies – almost every cell in our body is affected during and after exercise (1). Exercise works, we’re just not completely sure how!

Long-term effects of exercise

We’ve known for a while that lifelong activity and exercise is a crucial way to reduce the risk of many diseases such as cancer, heart conditions and other chronic conditions (2). However, there is increasing evidence showing that keeping an active lifestyle lowers chances of contracting a range of infectious diseases such as bacterial and viral infections (3).

This study (4) showed that adults over 60 years who were active undertaking vigorous exercise upwards of three times a week showed significantly higher immune system responses to a vaccine than a sedentary group of the same age. Suggesting that consistency of exercise, throughout our lifetime, is key in looking after our immune system.

Age related decline of our immune system is a natural process where detection of disease, clean up and protection from further disease all slow down; it’s inevitable – right? Well, it’s been shown that active individuals over 60 that have kept consistent throughout their lifetime, slow and negate some of the aging processes of our immune system (5).

Short-Term effects of exercise

Whilst long-term benefits of regular physical activity have been shown, the effect of a single session of exercise is still disputed (6).  Many say that high intensity and volume of exercise can be detrimental to your immune system in the short– term, making your body at higher risk of contracting an infectious disease (7). Perhaps this adds to the notion that too much of anything can be a bad thing?

However, others have investigated the immune systems of elite athletes and show that over the course of a year of following intense training of ultra-marathon runners, showed an average report of sickness days of 1.5 days versus the US average of 4.4 (8). This may contradict the notion that high intensity or volume of exercise is detrimental – as the highest level of athletes with the highest intensity and volume of exercise, show less risk of sickness than the average person.

Maybe the question we should be asking is does a level of exercise that we are not prepared for, have detrimental effects to our immune system?

Conclusion

We have briefly touched on the long-term effects of exercise and the surrounding debate around the short-term effects. Exercise has a profound effect on our immune systems. The benefits of exercise have clearly been highlighted, but how this happens we still don’t fully know!

In these troubling times its important to look after yourself and that means keeping active. Be kind, stay at home and wash your hands!

Thanks for Reading.

Aran Pemberton

Aran qualified as a Physiotherapist graduating from the University of Worcester in 2017. He has since been working within the NHS, rotating into different specialities such as the Emergency Department, Critical Care, Orthopaedics and MSK.  He has worked with people of all ages and different levels of health and fitness, encouraging exercise as an essential part of health and wellbeing and providing the best care for his patients.

Aran has a keen interest in soft tissue mobilisation and movement re-education as part of the rehabilitation process. He has an interest in sports injuries and has experience treating players and working with the strength and conditioning coaches under the physio in Worcester County Cricket Club.

References

1. Kostka T, Berthouze SE, Lacour J, Bonnefoy M. The symptomatology of upper respiratory tract infections and exercise in elderly people. Med Sci Sports Exerc (2000) 32(1):46–51. doi:10.1097/00005768-200001000-00008

2. Warburton DER, Bredin SSD. Health benefits of physical activity: a systematic review of current systematic reviews. Curr Opin Cardiol (2017) 32(5):541–56. doi:10.1097/HCO.0000000000000437

3. Pape K, Ryttergaard L, Rotevatn TA, Nielsen BJ, Torp-Pedersen C, Overgaard C, et al. Leisure-time physical activity and the risk of suspected bacterial infections. Med Sci Sports Exerc (2016) 48(9):1737–44. doi:10.1249/MSS.0000000000000953

4. Kohut ML, Arntson BA, Lee W, Rozeboom K, Yoon KJ, Cunnick JE, et al. Moderate exercise improves antibody response to influenza immunization in older adults. Vaccine (2004) 22(17–18):2298–306. doi:10.1016/j.vaccine.2003.11.023

5. Campbell, John P., and James E. Turner. “Debunking The Myth Of Exercise-Induced Immune Suppression: Redefining The Impact Of Exercise On Immunological Health Across The Lifespan”. Frontiers In Immunology, vol 9, (2018). Frontiers Media SA, doi:10.3389/fimmu.2018.00648.

6. Walsh NP, Gleeson M, Shephard RJ, Gleeson M, Woods JA, Bishop NC, et al. Position statement. Part one: immune function and exercise. Exerc Immunol Rev (2011) 17:6–63.

7. Nieman DC, Johanssen LM, Lee JW, Arabatzis K. Infectious episodes in runners before and after the Los Angeles Marathon. J Sports Med Phys Fitness (1990) 30(3):316–28.

8. Martensson S, Nordebo K, Malm C. High training volumes are associated with a low number of self-reported sick days in elite endurance athletes. J Sports Sci Med (2014) 13(4):929–33.

“I’m active during my job, I don’t need to exercise”

Many people we see have very busy, sometimes physically demanding, jobs which by the end of the day may feel like a day’s worth of exercise. Working 7-12 hours physically and mentally drained by the end, must be exercise, right?

Surprisingly, this isn’t the same as exercising and potentially have the opposite effects to our health and well-being.

It was found that cleaners that had relatively high occupational physical activity (OPA) were more at risk of cardiovascular diseases (CVD) and had a higher resting heart rate and blood pressure than those with lower OPA(2).

Why isn’t my job exercise?

Exercise, defined by the World Health Organisation, is a subcategory of physical activity that is planned, structured, repetitive, and purposeful(4). It also aims to maintain or improve our cardiac output (how much of our blood our heart pumps out in one minute).

Here are 6 potential reasons why activity from your job is not the same as exercise or leisure time activity(1):

1. Too low over too long – Job related activity is too low intensity over too long a duration to provide any benefit to your fitness or health, not putting enough demand on the heart.

2. Raises HR It raises your resting heart rate during and even after you finish work. This is a risk factor for CVD and mortality.

3. Raises BP – Prolonged static postures or heavy lifting raises your 24-hour blood pressure which is also a risk factor for CVDs. Whereas, heavy lifting over short, controlled conditions does not raise 24-hour BP.

4. Lack of Rest – There’s not enough recovery during or between activity within the occupation. This is similar to over-training, where consistent fatigue and exhaustion over consecutive days may increase risk to health problems.

5. Lack of control – Over factors such as: tasks, speed, schedule, hydration and access to rest which may contribute to the harmful effects of OPA. In contrast LTPA is performed under self-regulated conditions and the person has control over these factors.

6. Raises levels of inflammation – These inflammation markers will stay raised until the body has recovered. High OPA over consecutive days can cause prolonged and continual inflammation which increases risk of CVD and all cause mortality.

Physically demanding jobs can put too much on the body which results in the opposite effects of exercise(2). There are of course many varied risk factors for health problems and heart disease, but just because you’re busy doesn’t mean you’re exercising with any positive benefits.

What can I do?

It is important to be active outside of your job to have positive effects to your health.

The world health organisation recommends moderate intensity for 150mins/week or 75mins/week of vigorous intensity aerobic activity or any combination to maintain and improve heart health.

The World Health Organisation – What is Moderate vs Vigorous?

MET is the ratio of a person’s working metabolic rate relative to their resting metabolic rate. One MET is defined as the energy cost of sitting quietly and is equivalent to a caloric consumption of 1kcal/kg/hour.

If you have a busy manual job, you are still able to gain the positive benefits from doing vigorous exercise in only one or two days a week if this is all you can manage in your schedule(3).

The idea is to improve your fitness and strength to cope with the stresses of your job and keep you happy and healthy.

Thanks for Reading.


Aran Pemberton

Aran qualified as a Physiotherapist graduating from the University of Worcester in 2017. He has since been working within the NHS, rotating into different specialities such as the Emergency Department, Critical Care, Orthopaedics and MSK.  He has worked with people of all ages and different levels of health and fitness, encouraging exercise as an essential part of health and wellbeing and providing the best care for his patients.

Aran has a keen interest in soft tissue mobilisation and movement re-education as part of the rehabilitation process. He has an interest in sports injuries and has experience treating players and working with the strength and conditioning coaches under the physio in Worcester County Cricket Club.

References

  1. Holtermann A, Krause N, van der Beek AJ, et al. The physical activity paradox: six reasons why occupational physical activity (OPA) does not confer the cardiovascular health benefits that leisure time physical activity does. British Journal of Sports Medicine 2018;52:149-150.
  2. Korshøj, M., Lidegaard, M., Krustrup, P., Jørgensen, M. B., Søgaard, K., & Holtermann, A. (2016). Long Term Effects on Risk Factors for Cardiovascular Disease after 12-Months of Aerobic Exercise Intervention – A Worksite RCT among Cleaners. PloS one11(8), e0158547. doi:10.1371/journal.pone.0158547.
  3. O’Donovan G, Lee IM, Hamer M, et al. Association of “Weekend Warrior” and Other Leisure Time Physical Activity Patterns With Risks for All-Cause, Cardiovascular Disease, and Cancer Mortality. JAMA Intern Med 2017;177:335–42.
  4. World Health Organisation. Global recommendations on physical activity for health. http://www.who.int/dietphysicalactivity/factsheet_recommendations/en/ 

Tips to stay ‘injury free’

As we roll into the summer, we start to become very aware of how our new years resolution to get fit is drifting away. At TA Physio we see many clients who started fitness programs in the first few months, stop, then try again with injury or alarming pains. There are a few ways to help remove these undesired results and still get fit for the summer.

There are many reasons for injury, especially in sports with contact which result in direct trauma, but there are many internal reasons for injury too. These are things that you may not be aware of when you start your sport or activity, such as weak muscles, reduced range of movement and level of fitness (1).

Here are some tips to help reduce the risk of injury:

  • Start small and build – Up to 40% of injuries in athletes are due to a rapid change in training(2). Even the fittest need time to adapt. People often decide to start a sport or activity from doing very little, to upwards of 3 to 4 times a week. This can be too much too soon for your body, it may not be able to deal with the new stresses and load. Getting fit is also about patience!

  • The importance of a warm-up and cool-down – We all know the rush when you’ve only a short amount of time to do your workout and skip the warm-up/cool-down. Neglecting this can leave you prone to easily avoidable injuries (3). On the other side, stretching hasn’t been found to be effective in reducing the risk of injury(4) – but we know it feels good so no need to stop!

  • Resistance Training – It is important to add strength and conditioning into your program to reduce the risk of injury. Resistance training once or twice a week is effective in reducing the risk of sports injuries by up to 1/3 and overuse injuries by 1/2 in active individuals(4).

  • Rest – Probably one of the most important is making sure you have rest days, enough sleep and look after yourself. Sleep has been shown to improve memory, performance and reduce risk of injury (5). It is recommended that adults get at least 7 hours of sleep to get the full benefits(6). Recovery is just as important as the work itself.

Injury prevention is specific to each individual – with age, sex, fitness, general health, mobility, strength and previous injury all being risk factors (1).

Hopefully this has helped you think about what you might be neglecting, and given you a few ideas of what you can do to help keep yourself pain free.

Thanks for reading.


Aran Pemberton

Aran qualified as a Physiotherapist graduating from the University of Worcester in 2017. He has since been working within the NHS, rotating into different specialities such as the Emergency Department, Critical Care, Orthopaedics and MSK.  He has worked with people of all ages and different levels of health and fitness, encouraging exercise as an essential part of health and wellbeing and providing the best care for his patients.

Aran has a keen interest in soft tissue mobilisation and movement re-education as part of the rehabilitation process. He has an interest in sports injuries and has experience treating players and working with the strength and conditioning coaches under the physio in Worcester County Cricket Club.

References

  1. Murphy DF, Connolly DAJ, Beynnon BD Risk factors for lower extremity injury: a review of the literature British Journal of Sports Medicine 2003;37:13-29.
  2. Gabbett TJ, The training—injury prevention paradox: should athletes be training smarter and harder?British Journal of Sports Medicine 2016;50:273-280.
  3. Herman K, Barton C, Malliaras P, et al, The effectiveness of neuromuscular warm-up strategies, that require no additional equipment, for preventing lower limb injuries during sports participation: a systematic review. BMC Med 2012;10:75.
  4. Lauersen JB, Bertelsen DM, Andersen LB The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials British Journal of Sports Medicine 2014;48:871-877.
  5. Roberts SSH, Teo W, Warmington SA Effects of training and competition on the sleep of elite athletes: a systematic review and meta-analysis British Journal of Sports Medicine 2019;53:513-522.
  6. Ohayon M ,Wickwire EM , Hirshkowitz M, et al, National sleep foundation’s sleep quality recommendations: first report. Sleep Health 2017;3:6–19.

Patellofemoral Pain in Runners

Patellofemoral pain (PFP) is pain associated around or behind the kneecap; it is the one of the most prevalent running injuries, with 9 – 15% of the active population reporting PFP at one time or another. This pain in runners is debilitating, often varied in how it presents, and the true source of pain is very difficult to narrow down (Stefanyshyn et al. 2006; Barton et al. 2012).

“THAT’S A FACT: RUNNERS TEND TO OVERDO AND PUSH THROUGH PAIN”

Jean-Francois Esculier – The Running Clinic

Should I stop running?

When you get PFP it’s not to say you should stop running completely, but perhaps you can modify your training for the moment? Can you reduce the distance, or slow your pace down and see if this helps?

According to Esculier et al. (2017) you should experience no more pain than 2/10 (in a 0-10 model for pain with 0 being nothing and 10 being the worst possible pain) whilst running; have no pain after an hour stopping the run and have no pain the next day. They found that this simple guidance, then building this activity up gently, was found to be effective in treating PFP.

There is an agreement that the position and glide of the patella is influenced by the soft tissue and biomechanics of the general lower limb and the joints. This means that muscle imbalances can put certain stresses on the patella and can be a reason for your pain (Neal 2019).

The role of strengthening the glutes has shown to be important in runners with PFP– they need to manage 4 x your body weight whilst running (Lenhart et al. 2014).

There’s a good glute’s circuit by Tom Goom (running physio) to help get people started – this isn’t appropriate for everyone and always best to be assessed first, or consult your healthcare professional if you’re unsure.

What this all means?

The take home message is to adjust your running regime to a more manageable pain level and gradually build from there. Maybe you’ve increased your pace, distance or number of sessions recently and your body isn’t ready just yet and needs to build up slowly?

Evidence suggests that effective treatment is about modifying activity, strengthening and education tailored to the individual (Lack et al. 2015; Barton et al. 2015). Everyone is different and in injuries there’s rarely, if at all, a “one size fits all” approach.

At TA Physiotherapy we aim to incorporate this into our assessment and treatment. If you have concerns or feel you need a thorough assessment book with one of our physiotherapists or our running coach.

Aran Pemberton

Aran qualified as a Physiotherapist graduating from the University of Worcester in 2017. He has since been working within the NHS, rotating into different specialities such as the Emergency Department, Critical Care, Orthopaedics and MSK.  He has worked with people of all ages and different levels of health and fitness, encouraging exercise as an essential part of health and wellbeing and providing the best care for his patients.

Aran has a keen interest in soft tissue mobilisation and movement re-education as part of the rehabilitation process. He has an interest in sports injuries and has experience treating players and working with the strength and conditioning coaches under the physio in Worcester County Cricket Club.

References

Barton CJ, Lack S, Hemmings S, et al. The ‘Best Practice Guide to Conservative Management of Patellofemoral Pain’: incorporating level 1 evidence with expert clinical reasoning Br J Sports Med 2015;49:923-934.

Barton CJ, Lack S, Malliaras P, et al. Gluteal muscle activity and patellofemoral pain syndrome: a systematic review Br J Sports Med 2013;47:207-214.

Lack S, Barton C, Sohan O, et al. Proximal muscle rehabilitation is effective for patellofemoral pain: a systematic review with meta-analysis Br J Sports Med 2015;49:1365-1376.

Lenhart R, Thelen D, Heiderscheit B. Hip muscle loads during running at various step rates. J Orthop Sports Phys Ther. 2014;44(10):766–A4. doi:10.2519/jospt.2014.5575

Neal BS, Lack SD, Lankhorst NE, et al. Risk factors for patellofemoral pain: a systematic review and meta-analysis Br J Sports Med 2019;53:270-281.

Stefanyshyn DJ, Stergiou P, et al.  Knee Angular Impulse as a Predictor of Patellofemoral Pain in Runners. The American Journal of Sports Medicine 2006, 34(11), 1844–1851.

Running Analysis & Technology

We’re always keen to provide runners with the best opportunity to understand more about running and specifically how runners run. We love using technology and combined with assessment this works well for helping runners to get over injury and improve performance. As a team of techno geeks, imagine our delight when we got our hands on DorsaVi. A wearable device that AAEAAQAAAAAAAAOEAAAAJGEyYTk4ODA1LWZhMzctNGNjNy1iZTVkLTMwZTkxOWRiNDE4ZQrunners or teams can use to monitor kinetic running data & kinematic knee data to understand the loads and biomechanics of the athlete.

Wearable devices have been used for several years in sport specifically HR monitors & GPS trackers used to monitor load, distance and intensity of players, both in training and competition situations. Even though new evidence is being published to help us understand that training loads are one factor linked to injury, this study from expert Gabbett is particularly comprehensive [Gabbett. 2007].

It’s become more complex to measure biomechanics in the field of play because we need 3D motion capture to fully assess motion in team sports, which is unpredictable in many team sports [Willy, 2017]. The assessment of biomechanics in runners within any sporting environment is extremely difficult, hence the advent of such technologies that help assess movement naturally are welcomed by us.

Running

What we we look for?

Ground Reaction Force [GRF] – The force created by contact with the ground is referred to as the ground reaction force (GRF). This is the force the ground exerts on the body as we move.  According to Newton, for every action there is an equal and opposite reaction [Newton’s 3rd Law of Motion – Law of Reaction]. As we make contact with the ground, gravity is constantly impacting the body [Young-Hoo Kwon, 1998: http://www.kwon3d.com/theory/grf/grf.html%5D.ViMOve

Initial Peak Acceleration [IPA] – Correlates the vertical acceleration and loading rate through the tibia on ground contact, measured in G’s. The IPA being increased has been linked to higher rates of stress fractures [Crowell, 2011] and changes can be noted with alterations in cadence [Rios et al, 2010]. This graph illustrates these measurements nicely [DorsaVi ViMove2, Running Module Guide].

Cadence calculates steps per minute, two steps make up one stride. Recent research indicates shortening stride length and increases in cadence can help to reduce running injuries [https://www.runresearchjunkie.com/is-the-180-cadence-a-myth-or-something-to-aim-for/].

Absolute Symmetry Index [ASI] – is the calculation of average GRF Left vs Right. An example in DorsaVi would be a negative value indicates the right side is carrying more force compared to left.  A positive values shows left side is accepting more force than the right side. A normal deviation in ASI is 5% so we would want to reduce this whilst running [Herzog et al, 1989].

Speed – Looks at average speed over the course of the running time measured, usually measured in metres per second [m/s].

 

Everybody runs differently and this is dependent on multiple factors including:

1. Activity participation [distance runners, sprinters, team sports]

2. Running surface, environment & terrain [surface type, inclination, weather]

3. Running footwear

4. Position within a team or squad [defender Vs attacker]

5. Level of activity participation [elite Vs recreational]

 

What happens when these factors change?

Sports physio Paddy volunteered to test out the DorsaVi. We looked at his existing running style and implemented changes in order to measure the differences in kinetics data.

Within 15 minutes, we were able to assess Paddy clinically and on the treadmill. We looked at Paddy running at 9km/hr, 12km/hr & 16 km/hr. At each assessment, Paddy changed something in his gait to see what changes we noted in his kinetic data. The difficult question is, does kinetic data correlate to kinematics?

As the overview graph illustrates, Paddy completed 3 runs at 9 km/hr but what we can’t see from the graph is what kinematics changed.

  1. Rep 1 at 9 km/hr Paddy was running his normal gait pattern with no problems reported.
  2. Rep 2 at 9 km/hr Paddy changed his foot strike pattern which resulted in a reduction in cadence
  3. Rep 3 at 9 km/hr paddy attempted to shorten stride length and increase cadence
  4. Rep 4 at 12 km/hr increased speed which initially he achieved by increasing his cadence
  5. Rep 5 at 12 km/hr Paddy maintained his speed and his cadence settled to 173.
  6. Rep 6 at 16 km/hr we noted a huge ASI change which correlates to a previous lower limb injury Paddy has suffered on his right side. Increased IPA & GRF despite GCT becoming more symmetrical compared to previous speeds.

Conclusions

Overall, the DorsaVi running module kit is a game changer for us. It is portable and ease of use on the iPad. I would recommend it as suitable for all types, levels and style of runners. We only explored the running module in this article but the knee and lumbar spine assessment modules are great additions to any clinical assessment. The smart therapist would with clinical information, training information along with goal setting to get results with patients and athletes. The versatility of DorsaVi means its suitable for everyone not just sports people.

I’m yet to see any normal data ranges for athletes with GRF, IPA and GCT but differences in assessment and correlation can lead us to make assumptions – if the data supports the hypothesis of injury, then it can be used to change running gait, ultimately reduce pain and improve performance.

However, one question remains in my mind which I’ve not seen in research yet – Does kinetic data correlate to kinematics?

Thanks for reading.

Twitter: @taphysio

Instagram: @taphysio

 

References:

Gabbett & Domrow. (2007). Relationships between training load, injury, and fitness in sub-elite collision sport athletes. Journal of sports sciences. 25. 1507-19. 10.1080/02640410701215066.

Young-Hoo Kwon. (1998). Webite: http://www.kwon3d.com/theory/grf/grf.html. Accessed December 2017

Harrison Philip Crowell and Irene S. Davis. (2011). Gait Retraining to Reduce Lower Extremity Loading in Runners. Clin Biomech (Bristol, Avon). 2011 Jan; 26(1): 78–83.

Jaqueline Lourdes Rios, Mário Cesar de Andrade, Aluisio Otavio Vargas Avila. Analysis of Peak Tibial Acceleration During Gait in Different Cadences. Human Movement 2, December 1, 2010.

HerzogNiggReadOlson . (1989). Asymmetries in group reaction force patterns in normal human gait. Med Sci Sports Exerc; 21: 110114

Baggaley, Willy, Meardon. (2017). Primary and secondary effects of real‐time feedback to reduce vertical loading rate during running. Scandinavian journal of medicine & science in sports 27 (5), 501-507

Sensorimotor System – What does it mean & What’s the implication for rehab? Bec van De Scheur

IMG_2527After hitting heavy traffic, turning what should have been a swift two hour car trip into an eventful six hour journey to Birmingham, we finally reached the Therapy Expo 2017!

 

Fuelled with coffee, we sat in on a number of interesting presentations. Although there was diversity amongst the guest speakers a common theme seemed to present itself, the role of the sensorimotor system in injury rehabilitation.

 

Steven Hawking said it perfectly when he stated:

 

“Intelligence is the ability to adapt to change”

 

The human body is of no exception. Our desire to move after injury sees that we will go to great lengths to keep our bodies mobile. Often completely subconscious, we find ways to move around pain, stiffness, or imbalances. Thus, compensatory movement patterns or “muscle patterns” are born.

 

Jo Gibson [Twitter: @shouldergeek1], well renowned shoulder rehabilitation specialist, whose lecture we were lucky enough to attend at the Expo, has been quoted to explain it like this in relation to the shoulder:Jo Gibson januar 2016 (2)_edited1

 

“Muscle Patterning refers to inappropriate recruitment, commonly of the torque producing muscles of the glenohumeral joint e.g. Latissimus Dorsi, Pectoralis Major, Anterior /Posterior Deltoid. This unbalanced muscle action is involuntary and ingrained. Patients with muscle patterning essentially have a muscle recruitment sequencing problem that results in abnormal force couples, destabilising the joint.”

It is an important topic, as failure to correctly diagnose a structural instability versus a functional instability is a common factor in patients failing conventional rehabilitation or surgery.

‘Rehabilitation in this situation should be aimed at ‘normalising’ muscle recruitment patterns around the shoulder girdle and this involves appropriate facilitation throughout the kinetic chain. Balance, coordination and core control are all factors that must be addressed to optimise neuromuscular control mechanisms.’(1)

 

Our ability to adapt to change is both the human body’s greatest strength and its biggest weakness.

As a short term strategy compensation is a great tool. It is protective against further injury and it enables us to get on with our daily function. However, when these newfound motor patterns become long term and supersede our normal programming we will at some stage hit a point of failure, which usually manifests as injury or failed rehab.

 

It can be explained like this…..

 

Your weekend football team is down a player and you have no choice but to replace your star striker with the goalkeeper. Chances are he will manage to get the job done for a period of time, but because his training has not been specific to the role of striker and he is not conditioned or well rehearsed to the demands of this position, at some point in the game he will fatigue, his reaction time will diminish and his ability to generate power and keep up with the pace of the game will become apparent, leaving him vulnerable to injury.

 

Similarly, if you delegate a task to a muscle that it is not designed for, it can deal for a time, but ultimately it will not be able to withstand the extra demands that have been placed upon it.

 

For therapists this is very important to recognise as it will guide how we structure our rehabilitation. When patterns become maladaptive and cemented centrally, rehabilitation takes on a different level of complexity. We are no longer treating an isolated system.

 

It is easier to learn than to unlearn a skill. My father always says, “Practice does not make perfect, perfect practice makes perfect”. As performing something in a sub optimal way over and over again only leads you further away from skill mastery.

 

So lets break it down….

 

What does sensorimotor mean?

 

The term sensorimotor system describes, ‘the sensory, motor, and central integration and processing components involved in maintaining functional joint stability’. This encompasses neuromuscular control and proprioception. (2)

 

Sensorimotor Diagram
Neural Basis of sensorimotor learning: modifying internal [Lalazar & Vaadia, 2008] https://www.sciencedirect.com/science/article/pii/S0959438808001578
 

Lets look at this in relation to a common injury such as an inversion injury of the ankle….

 

It is generally known that the primary risk factor for an ankle sprain remains a history of a previous sprain (5). It is thought that the initial damage to the lateral ankle ligaments alters the function of mechanoreceptors of these ligaments disrupting the ability to sense motion at the joint (4) and can lead to functional instability of the ankle. It is often described as frequent episodes of “giving way” or feelings of instability at the ankle joint.

 

A number of authors support the idea that some patients with functional ankle instability have deficits in neuromuscular preparatory or anticipatory control, which increases the risk of injury to the ankle, as it is less protected in an inadequate ankle joint position. Add to this a sub optimal rehabilitation program and paving the way towards a chronic ankle issue.

 

So what does this mean in terms of exercise prescription?

 

Benoy Mathew [Twitter: @function2fitnes] from Harley Street Physiotherapy during his talk regarding “the problem ankle” discussed the benefits of dynamic exercises such as sport specific plyometrics, which utilises sensorimotor training to promote anticipatory postural adjustments as well as optimise agility, landing technique and reaction time.

 

When it comes to overall running efficiency Mike Antoniades [Twitter: @runningschool], Performance & Rehabilitation Director of The Running School agrees:

 

“To change running technique, theoretical information and tips will not do the trick. The body needs to learn movement through movement – mostly while running but also through other re-patterning exercises”

(1)

 

During his workshop at the Therapy Expo, Mike gave us great examples during a live running assessment of particular movement dysfunctions that result from motor patterning, which often lead to muscle imbalances, poor technique and may be a factor in the recurrence of injury.

 

A common example is poor gluteal activation, which leads to compensatory hamstring dominance. Recognising this as the main offender of a patients running pain is a great start but strength training alone will only get you so far if it is a neuromuscular issue and ‘sensory motor amnesia’ is the primary reason why certain muscles fail to activate during movement.

 

There is a lot to think about during clinical diagnosis to ensure we are not ‘band-aiding’ a sensorimotor issue with strength exercises and manual therapy.

 

It is our responsibility as physiotherapists to ensure that we are continuously looking for opportunities to enhance our clinical skills. By optimising our assessments we are giving each person that seeks our advice the best opportunity to reach their full potential.

 

  1. Antoniades, M (2016), Mikes view on therapy expo 2016. Retrieved December 10, 2017, from http://runningschool.co.uk/blogs/mikes-view-on-therapy-expo-2016/
  2. Foundation of Sports Medicine Education and Research (1997). The role of proprioception and neuromuscular control in the management of knee and shoulder conditions.; August 22–24; Pittsburgh, PA.
  3. Gibson, J (n.d), Advances in rehabilitation of the shoulder. Retrieved December 10 2017, from http://www.physioroom.com/experts/expertupdate/interview_gibson_20041031_1.php
  4. Hertel J. (2002). Functional anatomy, pathomechanics, and pathophysiology of lateral ankle instability. Journal of Athletic Training. 37(4) 364–75.
  5. Milgrom C, et al. (1991). Risk factors for lateral ankle sprain: a pro- 
spective study among military recruits. Foot Ankle. 12(1), 
26–30.
  6. Lalazar & Vaadia, (2008). Neural Basis of sensorimotor learning: modifying internal models.  https://www.sciencedirect.com/science/article/pii/S0959438808001578

 

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Sticks & Stones – Bec Van de Scheur

STICKS AND STONES…

 

Best selling author Don Miguel Ruiz in his book The Four Agreements reveals what he believes to be the primary sources of self-limiting beliefs. The first and most important of these principles is to be impeccable with your word.

 

It sounds easy enough, as a professional we are under the agreement to ‘do no harm’. As a colleague, friend, family member or acquaintance we aim to be courteous, thoughtful, and kind. The problem is not so much our intention but our awareness of the words that we use to convey meaning. Some of which may, without our knowing, pass through the filter and hold more weight than what we give them merit.

Because the fact is, words do ‘hurt’ and not just emotionally.

 

This-is-a-cartoon-image-of-brain-coupling-during-communicationThere have been a number of studies detailing placebo and nocebo patient responses to explanations regarding interventions by a professional within their field of expertise.  An example of this is a study by Varelmann et, al. (2010), where one hundred and forty healthy women at term gestation requesting analgesia were randomized to either a placebo (“We are going to give you a local anesthetic that will numb the area and you will be comfortable during the procedure”) or nocebo group (“You are going to feel a big bee sting; this is the worst part of the procedure”). Pain was assessed immediately after the local anaesthetic skin injection using visual analog scale scores of 0 to 10. Median pain scores were significantly lower when reassuring words were used compared with the more intense nocebo words. This study and many others are beginning to show a pattern suggesting that more reassuring words may improve the subjective experience.

 

Lorimer Moseley has stated that:

 

‘100% of the time, pain is a construct of the brain’.

 

 

Now this is not to say we lie to our patients. We also have an ethical obligation to be truthful and transparent when gaining consent, giving a diagnosis, a prognosis or offering advice. However it is important to recognise that therapists are in a powerful position in their ability to influence a patient’s perception regarding pain and recovery. It is our responsibility to have an awareness of words that we use and whether or not they have a connection to negative suggestions and connotations, as this may feed into a fear generated belief system and adversely affect recovery.

 

 

“The human mind is a fertile ground where seeds are continually being planted, the seeds are opinions, ideas and concepts. You plant a seed, a thought, and it grows. The word is like a seed and the human mind is so fertile. The only problem is that too often it is too fertile for the seeds of fear” (Ruiz, 1997).

 

IPainf a patient comes to you with concerns about an injury, anxieties about returning to sport or a fear of whether their pain will ever resolve it is important for us to recognize the power of the words we use and the long-term impact they may have on a persons wellbeing.

 

…We do not want to be unconsciously watering the seeds of doubt, fear or despair.

 

It sounds relatively simple to strip down and remove some of these negative connotations. However, some of these words are more subtle than we realise. They are words we use often without acknowledgement. For example;

 

  • Words such as ‘try’ suggest anticipated failure.

 

  • A statement like ‘don’t worry’ is associated with there being something to worry about (Allen, et al, 2011).

 

Terms such as ‘chronic’, ‘disc’ ‘damage’ or  ‘osteoarthritis’ may be enough to set off a flag for danger and generate a fear or anxiety driven response.

 

 

So where to from here?

I invite you to be impeccable with your word.

 

Below is a list of resources to assist in better understanding this concept, strategies for intervention and some great tools that can be shared with patients. Knowledge is power.

 

 

Resources

 

 

 

 

 

 

 

References:

  1. Cyna, A.M, Marion, A.I, Tan, S.G.M, & Smith, A.F. (2011).Handbook of

  Communication in Anaesthesia & Critical Care: A Practical Guide to   

  exploring the art. New York, United States: Oxford university press.

 

  1. Ingraham, Paul (updated Nov 18, 2016, first published 2010)

  Pain is Weird. Retrieved April 26, 2017, from

https://www.painscience.com/articles/pain-is-weird.php

 

  1. Ruiz, D.M & Mills, J. (1997). The Four Agreements: A Practical Guide to

  Personal Freedom (A Toltec Wisdom Book). California, USA: Amber-

  Allen Publishing

 

  1. Varelmann, D, Pancaro, C, Cappiello, Eric C & Camann, W. R. (2010)

Nocebo-Induced Hyperalgesia During Local Anesthetic Injection

Anesthesia & Analgesia: 

March 2010, Volume 110, Issue 3, pp 868-870.

Retrieved from http://journals.lww.com/anesthesia- analgesia/Fulltext/2010/03000/Nocebo_Induced_Hyperalgesia_During_Local.42.aspx

 


 

Becs Van de Scheur – Physiotherapist & Pilates Trained [Mat Work Level I]

From the East Coast of Australia, Bec graduated with a Degree in Human Movement Science before going on to complete her studies as a Physiotherapist in which she graduated in 2012 from the University of Newcastle, Australia.

With a background in private practice and aged care Bec enjoys working with individuals of all ages and all sporting backgrounds placing a large emphasis on education, with an aim to empower individuals by providing them with the skills they require to take ownership over their own health.

With a keen interest in holistic management and pain science Bec believes in offering a combination of hands on therapy and individualised exercise prescription.  Bec has completed her Level 1 Mat work pilates training and also offers Dry needling and Western acupuncture techniques when indicated.

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Marathon Tips – Roger Kerry

Going the distance

Marathon season has begun and this weekend it’s the iconic London Marathon. Well done to everyone who is competing on getting this far, and the very best of luck – particularly if you’re beach runningplanning to attempt it dressed in a hot, heavy and generally unsuitable fancy dress costume!

Leading expert Roger Kerry, of the Division of Physiotherapy and Rehabilitation Sciences in the School of Health Sciences, believes from a physiotherapist’s view that running the marathon will be about three things: performing well; not getting injured; and most of all – having fun! Here are his top 10 tips for getting the most out of your London Marathon experience…

  1. Prepare – It’s too late now to think about more training, but you should prepare properly for the day in all other respects. Make sure you have checked all your kit at least the day before, and that all your food and drinks are organised in good time – there’ll be no time to dash to Runners Need on Sunday morning.
  1. Taper – The evidence behind tapering (progressively lowering your mileage leading up to the event) is a bit hit-and-miss. However, for a long race, basic principles of exercise suggest that it is not a great idea to be cramming in long or hard sessions the week before the race. Start to relax and do just what you need to keep you motivated and active, but not much more. At this stage, noting will change your fitness in time for Sunday.
  1. Eat – You need the right type and right amount of fuel for Sunday. Start to think about that now, but don’t do anything that your body isn’t used to. Avoid strategies with inconsistent evidence, like dramatic ‘carbo-loading’. Make sure you have wholesome, simple complex-carbohydrates the night before – plenty of brown rice or pasta, supplemented with dried fruit etc. Before an intense, prolonged effort, progress towards at least 10g of carbohydrate per kilogram of bodyweight in the days leading up to Sunday.
  1. Drink – Again, the golden rule: don’t do anything your body isn’t used to. You obviously need to be well hydrated before, during, and after the race. However, over-hydration can be just as (if not more) problematic that dehydration, so you don’t need to guzzle 3 pints of water every few hundred yards. Aim for no more than 0.8 litres of fluid/hour. You will need carbs to keep you going as well, so if you’re used to a specific sports drink or gel, than use that, but don’t start experimenting during the race though!
  1. Shoes – Don’t run in new shoes! Make sure your socks are fitted well, with no small creases or seams. A tiny crease at the start will seem like a boulder at 10 miles, and increase your chance of blistering. Make sure your heel is captured well, but remember that in a long run your forefoot will expand, so avoid ultra-tight lacing in your lower laces. Use thick, or double-layer socks, or Vaseline, to reduce chance of blistering. Use plasters is you’re used to them – again, nothing new please!  

  1. Warm-up – OK, so in 26 miles there’s plenty of time to warm-up, however, it is still absolutely sensible to make sure your muscles are ready for action and your vital organs are ready to be stressed. Do some gentle, progressive running or drills to get ready and try and keep moving on the start-line. The evidence for stretching (especially static stretching) or massage suggest that these don’t help in either performance of injury prevention, so you’re better off spending your time moving and preparing your tissues for load.
  1. Pace yourself – The crowd will most likely prevent you from sprinting off, but aim for negative splits, i.e. the first half of the race being slower paced than the last half. Use your GPS if you need to, but better still, listen to your body. Have confidence in all that fantastic training you have done, and know that you can achieve your marathon aim if you don’t stray too far from what your body is used to.
  1. Keep control – In line with the point above, consider strategies to put in place when you start to fade. Going through rough patches is normal, even if your fitness and fuel control is in order. It’s what you do during these patches that’s important. Try not to get worried about a drop in your pace. If you do, you will try and speed up at a time when your body and mind is asking you not to. Rather, try and focus on your form: work from top to bottom – recalibrate your head posture and your shoulder height, make sure your torso is not slumping and affecting your breathing, make sure your arm swing is even and synched with your leg movements, keep control around your pelvis, shorten your stride length and/or increase cadence, and think about your foot strike. You’ll soon be back in the zone!
  1. Finish strong – Let the crowd motivate you during the last few miles, but don’t blow up before the finish line! You have put in months of training, and this is where it all comes together. Make sure you save something for that last kilometre. You might get a bit of euphoria with two or three miles to go, but avoid that last burst until the finish line is in sight.
  1. Re-fuel, refresh, and reflect – You’ve done it! 26.2 miles in the bag, and an amazing london-marathon-the-mallexperience. But it doesn’t stop here. How you feel for the next few days, and whether you remain motivated to ever do this again will depend on what to do in the few hours post-race. You will need to gradually take on some replenishing carbs and protein, and get your hydration status balanced, considering electrolyte also. Again, stretching or massage won’t necessarily help the recovery process, and may in fact contribute to a delayed recovery. A sensible reduction in tissue load, whilst maintain some movement is key for that next 72 hours. That means keep your legs moving, as long as they are comfortable. You can expect to introduce steady running again after a few days. No hard sessions for a good three weeks or so though. And finally, reflect on your experience to maximise your enjoyment as well as learn from it – for next time!

We have a physiotherapy service available for injury reviews, sports massage & running related advice at Tom Astley Physiotherapy. Sessions can be bookd online HERE.

Post-Pregnancy: When and How To Return To Exercise

As a physiotherapist, I regularly see patients who are unsure how and when to get back into exercise after giving birth, so I’ve written this article to help.  As you’ll see, there are plenty of benefits of getting back into a safe workout routine.  We’ll discuss what to do and how much, as well as looking at some of the complications that may occur and how to know if you’re overdoing it.  I’ve also included some pilates-based exercises for you to try at home, based on your ability and desired challenge!

 

 

Benefits of exercise post partum

 

It’s great if you are motivated to get back to exercise after giving birth!  It has many benefits, including:

  • Promoting weight loss;
  • Restoring muscle strength;
  • Raising energy levels;
  • Improving cardiovacular fitness;
  • Reducing risk of urinary incontinence;
  • Stress relief
  • Improving your mood;
  • And it gives you opportunity for increased social interaction.

 

However, after giving birth, the important questions are:

  • How much is safe?
  • And how soon should you return?

 

Everyone is different, so make sure you are following the individualised advice from your midwife.  Your return to exercise will depend on several factors including:

  • The strength of your pelvic floor muscles;
  • The number of pregnancies you have had;
  • The type of delivery (recovery following a caesarian will always be longer than a natural birth so you will therefore take longer to return to exercise);
  • The level of exercise you were completing ante natally;
  • And whether you have any pelvic girdle pain (PGP) or diastasis recti (keep reading to find out more about these conditions).

 

If you had a normal birth, you should be able to start easing back into gentle exercise as soon as you feel ready.  You should not start any high level or impact exercise until at least 6 weeks post partum, as long as your midwife clears you to do so at you 6-week check up (according to the NHS guidelines).  However, 12-16 weeks post partum is probably a more realistic time frame because the weakness of your pelvic floor muscles following pregnancy will take time to retrain and strengthen.  Doing too much exercise too soon can result in a prolapse which can be both uncomfortable and painful.

 

 

What is a prolapse?

 

A prolapse is when the organs in your pelvis drop down into the vagina, rather than being held in their normal position.  This can result in a heaviness sensation, there may be bulging present, and it can result in pains or aching in the lower back and stomach.

 

 

Why do prolapses happen?

 

A  number of factors associated with pregnancy can cause weakening of the pelvic floor muscles and surrounding ligaments.  Your pelvic floor muscles are often left weak and stretched, and this will put you at increased risk of having a prolapse.  This can happen for several reasons including:

  • The weight of the growing baby;
  • The pelvic floor muscles and ligaments may have been overstretched if you had a vaginal birth;
  • You may not have completed your pelvic floor muscle exercises as often as you recommended during your pregnancy;
  • Or you may have increased your exercise too quickly after childbirth (returning to high impact exercise too early will put you at particular risk).

 

 

PGP & Diastasis Recti

 

Along with risk of prolapse due to weakened pelvic floor muscles, pelvic girdle pain (PGP) and diastasis recti will also play a part in how quickly you can return to exercise.

 

Pelvic girdle pain includes pain in one, or several areas around the pelvis:

  • Pain over the pubic bone;
  • Pain in you perineum (area between your vagina and anus);
  • Pain across your lower back.

It is often aggravated by activities such as walking, going up stairs, standing on one leg, or turning over in bed.

 

Diastasis recti is separation of the 2 muscles that run down the middle of your stomach. You can check for diastasis recti yourself:

  • Lie on your back with your legs bent and your feet flat on the floor;
  • Raise your shoulder blades off the floor and look down towards you belly button;
  • Use the tips of your fingers to feel between the edges of the stomach mucles, where they should join in the middle, both above and below the belly button;
  • See how many fingers you can fit into the gap between your muscles;

If a gap of 2cm or more is present this is classed as diastasis recti.  You should notice this gap gradually decreasing over the first 8 weeks after the birth of your child.

 

If you think you may have either of these conditions, it will contraindicate you from completing the intermediate or advanced exercises suggested in this article.  It is advisable to see a physiotherapist or healthcare professional to help to improve or resolve these symptoms as soon as possible.

 

 

How do I know if I am overdoing it?

 

If you experience any of the following symptoms, you should reduce the level of exercise you are completing, or rest completely until they resolve:

  • Fatigue;
  • Slow recovery from exercise;
  • Disproportionate muscle aches and pains for the level of exercise you have completed;
  • Increase in flow of lochia (vaginal discharge after giving birth containing blood, mucus, and uterine tissue);
  • Change of colour of lochia to pink or red;
  • Lochia restarts flowing after it has stopped.

 

 

Which types of exercise are safe to help you get back into sport post pregnancy?

 

Low impact exercises such as: swimming (once lochia has stopped); walking; yoga; and pilates are all great ways of easing you back into sport after pregnancy.  Try the following exercises for an introduction to pilates!

 

 

***

 

 

Getting back into exercise:  A pilates-based programme you can try at home!

 

All of the following exercises should be pain free to complete.  If you experience any pain whilst completing them, or disproportionate aches or pains for the level of exercise you have completed following your pilates home session, stop and seek assessment and advice from a healthcare professional.  Please closely follow the advice on exercise progression, and only progress to the next difficulty if you meet the criteria stated.

 

 

Basic

 

These exercises should be safe to be completed by any new mum:

 

 

  • Deep neck flexor exercise:
    • This will help improve your upper body posture and reduce neck pain
    • Lie on your back with your head supported by a pillow
    • Lengthen through the back of your neck, and push the back of your head down into the pillow (a bit like you are making a double chin)
    • Hold for 10 seconds, then relax
    • Repeat 10 times

 

  • Transversus abdominus & pelvic floor activation:
    • This is the action of drawing your belly button in towards your spine, and drawing up through your pelvic floor muscles as if you are stopping yourself from going to the toilet
    • This muscle activation exercise should be practiced in sitting, lying, standing, high kneeling, side lying & 4pt kneeling
    • Hold the muscle contraction for 10 seconds, then relax
    • Repeat 10 times

 

Pelvic tilt

  • Pelvic tilts:
    • Lie on your back with your knees bent (crook lying)
    • Gently tilt your pelvis forwards and backwards
    • You should feel your lower back arching and flattening on and off the floor
    • Repeat this 10 times in each direction

 

 

Intermediate

 

If you have mastered the basic exercises, are not experiencing any pelvic girdle pain, and do not have diastasis recti, you should be safe to progress to completing these exercises:

 

  • Dumb waiter in standing:
    • Stand tall, with your pelvis in a neutral position, engage your deep stomach muscles and pelvic floor muscles, and have your arms by your sides with your elbows bent
    • Rotate your arms outwards, and stretch out to the side
    • Then bring your elbows back into your sides and rotate your arms inwards to return to the starting position
    • Repeat 10 times

 

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  • Spinal twist in high kneeling:
    • Kneeling up, with your pelvis in a neutral position, engage your deep stomach muscles and pelvic floor muscles, squeeze your bottom muscles (glutes), and cross your arms in front of you
    • Keeping your pelvis pointing forwards, rotate through your middle back round to the left, then slowly back to the centre
    • Repeat to the right
    • Repeat 10 times in each direction

 

 

  • One leg stretch in 4 point kneeling:
    • On your hands and knees (knees under hips, & hands under shoulders), with your pelvis in a neutral position, engage your deep stomach muscles and pelvic floor muscles
    • Slowly slide one foot back behind you, trying to keep your back and pelvis still
    • Slowly slide your leg back in towards you, and repeat with the other leg
    • Repeat 10 times with each leg

 

 

  • Breastroke preps:
    • Lie on your stomach with your hands by your sides, with your pelvis in a neutral position, engage your deep stomach muscles and pelvic floor muscles, and make sure you are aiming your tail bone down towards the opposite wall so your back isn’t arching
    • Squeeze your shoulder blades back and down, lift your hands an inch from the floor, stretch them down towards your feet, and lift your head and chest an inch off the floor
    • Slowly lower
    • Repeat 10 times

 

 

  • One leg stretch:
    • Crook lying, with your pelvis in a neutral position, engage your deep stomach muscles and pelvic floor muscles
    • Slide one heel away from you, trying to keep your back and pelvis still
    • Slowly draw your heel back into towards you
    • Repeat on the other side – alternate legs
    • Repeat 10 times on each leg

 

 

  • Clams:
    • Side lying, with your pelvis in a neutral position, engage your deep stomach muscles and pelvic floor muscles
    • Keeping your pelvis still and your ankles together, lift your top knee, then lower it slowly
    • Repeat 10 times
    • Turn over and complete on the other side

 

 

Advanced

 

If you have mastered the basic & intermediate exercises, if you are not experiencing any pelvic girdle pain, and do not have diastasis recti, you should be safe to progress to completing these exercises:

 

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  • Lunges with spinal twist:
    • Standing tall, with your pelvis in a neutral position, engage your deep stomach muscles and pelvic floor muscles
    • Step one foot forwards, and lunge down, making sure you are keeping up tall through your spine
    • Reach your arms out in front of you
    • Open one arm out to the side, then bring it back to the centre, then repeat on the other side
    • Step your front leg back, so you are back in the neutral standing position
    • Repeat with the other side – alternate legs
    • Repeat 10 times on each leg

 

 

  • Swimming (advanced level):
    • On your hands and knees (knees under hips, & hands under shoulders), with your pelvis in a neutral position, engage your deep stomach muscles and pelvic floor muscles
    • Slowly slide one foot back behind you, and lift it up, whilst simultaneously lifting and reaching the opposite arm, whilst trying to keep your back and pelvis still
    • Slowly bring your leg and arm back in towards you, and repeat with the other leg
    • Repeat 10 times on each side, alternating sides

 

 

  • Scissors level (advanced level):
    • Crook lying, with your pelvis in a neutral position, engage your deep stomach muscles and pelvic floor muscles
    • Bring your legs up one at a time into double table top (90 degree bend at the hip, 90 degree bend at the knee) and hold them there
    • Tap one foot down to the floor, then return it to double table top
    • Repeat with the other leg
    • Repeat 10 times on each side, alternating legs

 

 

  • One leg stretch (advanced level):
    • Crook lying, with your pelvis in a neutral position, engage your deep stomach muscles and pelvic floor muscles
    • Bring your legs into double table top as you did with Scissors
    • Stretch one leg away, making sure you keep your lower back still on the floor (don’t let it arch or twist), then bring your leg back into double table top
    • Repeat with the other leg
    • Repeat 10 times on each side, alternating legs

 

 

This article has been provided to give only general advice to new mums regarding graded return to exercise post partum.  It does not replace individualised assessment and advice provided by healthcare professionals.  When following advice from the article, if you experience pain or discomfort, please stop and seek advice and assessment from a healthcare professional.  If you are not sure whether you have pelvic girdle pain or diastasis recti, please ask your healthcare professional.

 

Anna Meggitt of Tom Astley Physiotherapy provides 1:1 pilates assessments and small group sessions at Project: Me, 84 Park Road, Crouch End, N8 8JQ.  Bookings available by phone (0203 659 3545), or email (info@taphysio.co.uk).