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

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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Part 2: Beginners Outdoor Training

Hello, welcome back, so how did you get on with your first taste of outdoor training?

Courtesy of Nike Women Outdoors
Courtesy of Nike Women Outdoors

The time has come to move things along and challenge the system a little more. So I’m going to outline the next level with a new set of exercises. Each one will be slightly more advanced than the previous set but similar movement patterns.
As usual begin with your pulse raiser, run, cycle, light jog. Remember it’s only a pulse raiser so nice and easy. Once you’ve picked your spot begin your dynamic stretches. This session will follow a similar course as the previous one so you can stick with the same warm-up.

So to recap:

Dynamic warm-up: Heal kicks to bum, high knee run, high kicks (opposite leg to opposite hand), walking lunges, hamstring stretch, light squats. Finish off with arm swings (windmill motion) and hip rotation. A dynamic warm-up can be what ever you want, as long as it replicates your session.

Session: 20/25 minutes

We’ll do five exercises and three sets. As before if you feel you can tackle 4 then go for it but maybe for the first few sessions start with 3 and build from there. Mark out a 20 metre area for your jog/run as before (which will follow each exercise). You maybe already at the level where you can increase the distance or better still be able to sprint there and back.

1. Split squat x 10 reps per leg (20 metre run there and back)

Split Squat
Split Squat

Stand with one foot in front of the other, split stance, feet pointing forward. Torso nice and upright. Bend at the knees and pulse down until your back knee almost touches the floor. Your front knee should be nicely inline with your front foot. After 10 reps swap legs

2. Reverse lunge x 10 per leg (Run)

Reverse Lunge
Reverse Lunge

Much the same as a forward lunge only in reverse. Take a big step back bending both knees until they are at 90 degrees. Drive back through the heel and push forward. Then repeat on the opposite leg

3. Spider-man press up x 10 (Run)

Spider Man Press Up
Spider Man Press Up

Begin this exercise much in the same way as the traditional press-up. Arms directly under the shoulders, lower until elbows are pointing behind you. As you lower to the ground bend one knee to bring it up to your elbow. As you press back up your leg returns to start position. Repeat with opposite leg. Do five leg raises on each side

4. Single leg squat thrust x 20 (Run)

Single Leg Squat Thrust
Single Leg Squat Thrust

Start in the usual press-up position, body straight. Bring one knee forward under your chest. Jump one leg forward and one leg back at the same time. Alternate as quickly as you can

5. Reverse Bear crawl (begin at start point and crawl 20 metres, then run back)

Reverse Bear Crawl
Reverse Bear Crawl

Get down on all fours. Place one hand and opposite foot backwards and walk. Changing sides as you go. This is a little bit harder than walking forward and should really test your endurance. Once you finish, if you can, crawl (forward) back!

On completion of your first set rest for the usual 90 secs then go again. Hopefully with a few weeks under your belt you should be able to slowly cut down your recovery time. Once you’ve completed your 3 sets go for a light warm-down jog around the park for about 5 mins. Follow this with your usual static stretch, remembering to focus on all the big muscle groups, quads, hamstrings, calves, glutes, groin and hip flexors. Finishing with some arm stretches.
Like before I’ve set a fairly low rep rate to begin with. As you get used to the new set of exercises you’ll soon be adding extra reps and sets onto your routine. As a bit of variation mix up your session by adding in the odd exercise from our previous list. It keeps your body guessing and avoids getting too used to the same movement patterns. It’s also more fun. Look to do this set at least twice a week but three times will really get you moving and closer to your fitness goals.

Remember these exercises are all about quality and not quantity. Always focus on your form and posture.

Good luck and look forward to our next set of exercises as we progress forward.

Level 3 PT- Outdoor Training Specialist. Chris Watson
Level 3 PT- Outdoor Training Specialist. Chris Watson

**Please note this programme is designed if you already have a basic level of fitness. Any medical problems or injuries please seek professional advice before attempting this session**

Part 1: Beginners Outdoor Training

Now you’ve made the decision to head outdoors to train, it’s time to get some structure into your session. As a regular gym goer you’ll probably have your own routine and level you feel comfortable with, certainly an idea of what stage you’re at in terms of what you deem hard or easy. So lets pretend that this is a whole new experience and start at the beginning.

As a new client I would assess your fitness level and always start fairly easy and go up through the gears as your potential unfolds. The harder you work the faster you’ll progress. Progression can be achieved with every session, no matter how small.

Shall we begin?

We’ve started with our pulse raiser, as mentioned in my previous article Outdoor Training, this can be a run or a cycle. I would recommend about 10 mins at a nice steady pace, nothing too energy sapping as there’s plenty time for that. This is followed by a dynamic warm-up. Usually base this around what you intend to do during your session. For example, if you are planning a forward lunge set, incorporate some walking lunges into your warm-up. This ensures your legs are ready for this movement. Always keep your warm up stretches dynamic at the start. Static stretches come at the end.

Week 1: Beginner session (1 hour)
10 mins pulse raiser – Run/cycle at a light steady pace

5-8mins dynamic stretch: mark a distance, either, with cones or between two trees about 10m apart. A good range for this session would be: Heal kicks to bum, high knee run, walking lunges, high kicks (touching opposite leg with opposite hand), light squats and a two step hamstring stretch (walk two paces, bend from the hip, keeping your legs straight and sweep your hands across the ground). Follow this with some hip rotation, arm swings (in a windmill motion) and a chest stretch.

Session: 20/25 mins
We’re going to start with five exercises and do 3 sets at varying rep rates (depending on the move). After each exercise mark a distance of around 20 metres and jog there and back to your start point. As you get stronger turn your jog into a sprint raising the intensity of your workout.

1. Squat x 12 reps (run 20m and back again)

Squat: Feet shoulder width apart, relaxed stance, back in natural state. In one smooth motion bend your knees, sticking out your bum (as if about to sit on a chair), finishing with your thighs parallel to the floor.
Squat:
Feet shoulder width apart, relaxed stance, back in natural state. In one smooth motion bend your knees, sticking out your bum (as if about to sit on a chair), finishing with your thighs parallel to the floor.

2. Forward Lunge x 12 (alternate legs, 6 per leg. run)

Lunge: Large step forward, with hands on hips. Leading leg parallel to the floor with your knee at 90 degrees and nicely in line with the front of the foot. Drive back up through the heal and repeat on the opposite leg. Make sure your back leg doesn't touch the floor
Lunge:
Large step forward, with hands on hips. Leading leg parallel to the floor with your knee at 90 degrees and nicely in line with the front of the foot. Drive back up through the heal and repeat on the opposite leg. Make sure your back leg doesn’t touch the floor

3. Press-up x 12 (run)

Press-up: Body in a nice straight line, head, shoulder and bum. Arms under your shoulders. Slowly press down keeping your arms nicely tucked in and elbows pointing backwards. Keeping abs braced let the chest lightly brush the floor and push back up.
Press-up:
Body in a nice straight line, head, shoulder and bum. Arms under your shoulders. Slowly press down keeping your arms nicely tucked in and elbows pointing backwards. Keeping abs braced let the chest lightly brush the floor and push back up.

4. Mountain Climber x 12 (run)

Mountain Climber: Begin in an upright press-up position.
Mountain Climber:
Begin in an upright press-up position.
Mountain Climber: Now bring your right knee to your left elbow, with a slight twist of your torso. That's one rep. Repeat on the opposite leg
Mountain Climber:
Now bring your right knee to your left elbow, with a slight twist of your torso. That’s one rep. Repeat on the opposite leg

5. Bear Crawl (begin at start point and crawl about 20m. If you can crawl back. If too hard, one way is fine to begin with. Then run)

Bear Crawl: Drop on all fours.
Bear Crawl:
Drop on all fours.
Bear Crawl: Place one hand and opposite foot forward, walk forward changing sides as you go. The lower you go the harder it gets
Bear Crawl:
Place one hand and opposite foot forward, walk forward changing sides as you go. The lower you go the harder it gets

On completion of your first set rest for about 90 secs and go again. Take longer if needed but try not to exceed 2 mins. The aim is to cut the rest time as you progress. Once you have competed 3 sets and rested for a couple of mins, go for a light warm-down jog for about 5 mins. This is followed by our static stretch. Be sure to stretch of all the relative muscles. Start with the big muscles like the quads, hamstrings and calves. Follow that with hip flexors, groin and glutes. Finishing off with some arm stretches. Always remember to do as it helps with your recovery.

I’ve set a fairly basic rep rate for this session as it’s a good starting point. Complete your first 3 sets and see how you feel. You will be able to tell fairly quickly if you need to add more reps to each exercise or even an extra set. Don’t be scared to push it that little bit each time. Try and fit this in at least twice a week but I’d recommend 3 times.

cw
Level 3 PT- Outdoor Training Specialist.
Chris Watson

Give it a go a see how you get on.

Next time we’ll look at ways to progress your session and the benefits of this kind of training.
Chris

**Please note this programme is designed if you already have a basic level of fitness. Any medical problems or injuries please seek professional advice before attempting this session**

7 Minute Work Out

7 Minutes Is All It Takes To Make The Olympics
7 Minutes Is All It Takes To Make The Olympics

I recently read an interesting article titled “7 minutes to get fit” with the catch line “Do twice a week. Job done”. Instantly I was intrigued, fit in two 7min sessions, this ought to be good, or too good to be true. So I began to read.

Studies have found you don’t need to spend hours in the gym to achieve your fitness goals. By following a quick, tight regime you can make a big difference to your overall fitness. The 7 minute work out is a form of high intensity interval training (HIIT) which means extremely intense bursts of activity followed by brief periods of recovery. Research suggests 7 energy sapping minutes broken down into 12 exercises is comparable to a run and weights session combined.

As a strong believer in hard work and time spent in the gym, or park, I was a tad sceptical of a quick fix solution. It sounded a little like a short-cut way of getting fit and I therefore questioned its impact.

So I decided to put the 7 minute workout to the test. I selected a reasonably balanced set of exercises to begin with. Well I’ve got to say it’s a pretty tough 7 minutes. The combination of aerobic and resistance moves gave me a very
balanced and challenging workout. It has been said that HIIT has shown time and again to “deliver numerous health benefits in much less time than traditional programs”. This all sounds very intriguing and exciting but it’s time to let
the public decide.

Having tested it on myself I decided to let my clients decide if it’s a way of training they’d be interested in. I selected a couple of willing participants and designed a program based on the 7 minute workout structure. Carefully mixing
a variation of cardio and resistance movement patterns and timing each exercise at the desired 30 second length (with a 10 second reset between).

My guinea pigs, whom have a fairly good level of fitness, found the session “pretty challenging” but really enjoyed the variation and tempo, finding competing against the clock both fun and exciting. They really felt they’d worked hard and gained a lot from this way of working. As I had a full session to fill we did 3 sets of 12 exercises with a two minute rest between each set. This added another level to the challenge.

Only time will tell if the 7 minute workout will return the fitness goals we’ve set but it was certainly a good start.

See below an example of a structured session containing 12 exercises:

This way of working, I believe, is best done as part of a 3 set, 2-3 times a week routine. Doing two 7 minute workouts per week will undoubtedly improve your fitness levels but I’d suggest doing 2-3 sets twice of three times per week
(if time allows) for maximum potential. So give it a go and see how you get on. I’d be very interested to know your thoughts on this training approach and if you feel it’s working..

A little bit of advice when attempting the 7 minute workout. It’s pretty tough and only recommended if you have a fairly good base fitness due to it’s high intensity nature. If you’ve not exercised in a while then I would suggest a more gentle approach to begin with and build up to the 7 minute workout.

20131026-182636.jpg

Always concentrate on form and doing the exercise correctly and please research any moves you’re not familiar with to avoid any injury or bad habits.

Remember these exercises are all about quality and not quantity. Always focus on your form and posture.

Good luck and look forward to our next set of exercises as we progress forward.

Level 3 PT- Outdoor Training Specialist. Chris Watson
Level 3 PT- Outdoor Training Specialist. Chris Watson

**Please note this programme is designed if you already have a basic level of fitness. Any medical problems or injuries please seek professional advice before attempting this session**

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).

Saddle Issues for Female Cyclist by Bianca Broadbent

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As I am a female bike fitter, we tend to get a lot of female cyclists come in for a bike fit, with their primary complaint being saddle comfort (with numbness and soreness being the top issues within this). It is unfortunately normal for cyclists to think that saddle discomfort is something that needs to be tolerated, but this is simply not the case. In extreme cases cyclists report pain or difficulty urinating for several days post ride! Of course the exception being long distance cyclists or cyclists whom may not have “acclimatised” to spending periods of time in the saddle.

The saddle is the one of the most fundamental things to get right on the bike, and without this all other adjustments will be less than optimal.

You might ask yourself, what signs and symptoms should I look out for which tell me that my current saddle choice or set up isn’t right for me? Some of these might be:

  • Numbness
  • Lack of sensation when passing urine during the ride or after the ride
  • Soreness, whether this is in the genitals themselves, the perineum or the tops of the thighs
  • Saddle sores
  • Sexual dysfunction
  • Deformity to soft tissues

As a result, we have compiled a brief list of things to look out for and consider changing in order to make your cycling more comfortable and alleviate those unwanted pelvic symptoms.

 

 

Saddle

 

As we mentioned, some of the most common problems arise from the saddle itself. A decent saddle is worth its weight in gold. We have found that there are many factors that dictate which saddle will suit you best.

  • Saddle height – too high and you will rock on the saddle which will lead to possible chafing and friction
  • Saddle tilt – some saddles are actually designed to have a slight nose down tilt i.e. ISM. Others are supposed to be set up according to the middle third. As a result a lot of the saddles we see are often far too nose up!
  • Saddle fore/aft – too far forwards and too much anterior tilt can place a lot of pressure on soft tissues and thus shoulders. Consider moving the saddle further back to allow a neutral pelvic position and optimal load transfer through upper limbs
  • Riding style – if you adopt a more upright riding style you may want something slightly wider to support the contact points of your pelvis. Conversely, those who ride in a more aggressive position will need something that maximises pressure distribution otherwise soft tissues will take most of the weight
  • Sit bone width – this is more relevant for the recreational and upright riders, but women often have wider ischial tiberosities which may mean a wider saddle will help load bony prominences rather than soft tissue
  • Saddle “cutout” – many clients find relief from a small channel cut out which reduces pressure through the neural and soft tissues within the pelvis
  • Soft tissue anatomy – Cobb cycling have a very good article on “innies” or “outties”. It’s true that if you have more soft tissue exposed this will dictate what kind of saddle you will prefer.
  • Brands that we tend to find alleviate these problems are Cobb, Selle SMP, Specialized. It’s not that we don’t like other saddles, but when client’s have problems these tend to be the ones that resolve the issues

 

 

Pedals/cleats

If you have asymmetries in your pelvis (functional, leg length or you over pronate or supinate), this can lead to changes in how your hips and knees track. As a result this could cause chafing on one leg, or make you sit to one side. There are a variety of ways you can resolve these issues:

lemond-lewedge-pronation-supination

  • Cleat wedges – these are small angular pieces of plastic which will change the angle of your foot. They can be stacked or layered to stop the foot over pronating or supinating, or to address small leg length discrepancies
  • Cleat shims – these are thicker pieces of plastic that can be stacked to reduce the severity of the leg length. Bikefit.com produce very good products
  • Insoles – to help the knee track and thus reduce compensatory strategies at the hip
  • Combination of in the shoe adaptations e.g. heel wedges and forefoot wedges – however these are space occupying so can be an issue
  • Cleats too far forward may also change your tipping point and cause you to come further forward on the saddle

 

 

Cranks

rh_crank_lengths.jpg

Now the cranks are a widely overlooked aspect of bike fitting. It would be difficult to discuss them in great detail during this article, but what we do know is that the standard cranks that come on a bike aren’t always suitable for the rider on the bike. For example, we had a triathlete in recently who was approx 5ft 5 but running 175mm cranks! There are many reasons to pick cranks;

  • Leg length – it is suitable to pick cranks that roughly match the leg length of the rider NOT the height
  • Hip/knee flexibility –If this is lacking (or albeit even if it is not!) it is best to look for shorter cranks which allow you to pedal in a smooth motion, otherwise this movement often tracks back to the pelvis, where excessive rocking can cause shearing forces through soft tissue and thus pain!
  • Closed hip flexion positions lead to strains through pelvic floor musculature which can also impact on negative sensations and experiences

 

 

Handlebars

bontrager-biodynamic-saddle-posture-curvature

The handlebar position can have a HUGE impact on symptoms at the pelvis.  If the reach is too short you may round your pelvis and put yourself in an suboptimal position, too long and you may put too much pressure through soft tissues. Too low and you will end up with the same problem, it might not be an issue for 30-60 minutes but over the course of a long ride this is when problems can manifest. You might also want to consider shallow drop handlebars to reduce the pressure when riding on the drops.

 

 

Other

  • Seatpost – Believe it or not, changing the seatpost can be a VERY good way to help reduce pressures through the saddle. If you are especially sensitive consider a carbon seatpost or something with shock absorption to help dissipate the energy that would otherwise end up in your pelvis

 

Specialized CG-R
Specialized CG-R. Cyclocross Magazine
  • Chamois cream – anecdotally clients whom have had pelvic pains report that chamois cream helps immensely, particularly when their mileage has significantly increased or they have started doing longer riders

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  • Decent chamois – do not underestimate the benefits of a decent pair of shorts! A well designed chamois will help reduce friction and pressure through sensitive areas. Personally I find something with a little extra padding more comfortable, but less padding suits others. It’s worth spending the extra money, believe me! (Just made sure you put them on the right way round!!!!)

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As this is just a basic outline on bike issues, we will be publishing articles that address each bike component separately.

If you have any questions for us feel free to email info@fityourbike.co.uk or contact us on Facebook http://www.facebook.com/fityourbikeuk

If you are interested in booking a bike fit, we operate clinics in Birmingham and Essex, and our fitter is female so perfectly placed to empathise with any pelvic issues you may be having!

Pregnancy: To exercise or not to exercise?

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Advocate for fun and accessible fitness for all. Get in touch @rachael_PT

Rachael Field Roddis – Personal Trainer, pre & post-natal qualified trainer and mom of one has taken the time to write a piece for Tom Astley Physiotherapy blog. So sit back and relax with a cup of brew before making those plans for returning to exercise:

 

The mentality of eating for two and giving up exercise during pregnancy has thankfully waned in recent years. If a pregnancy is without complications and the mum-to-be is clear of injury and/or medical conditions there should be no reason to prevent safe, appropriate and modified exercise all the way to full-term. Like any fitness programme it should be prescribed to suit the woman’s own health, lifestyle and fitness levels, we are unique and so is each pregnancy. Using my own pregnancy as an example, you can see from the first to the third trimester different physiological and biochemical changes just require exercise adaptations to workout safely.

exercise-during-pregnancy

In the first trimester (0-12 weeks) training was hampered by sickness. Being sick on the gym floor was not going to make me any friends and so I trained less frequently due to the nausea and fatigue. One of the first valuable lessons I learnt about pre-natal exercise: “Listen to your body and don’t exercise to exhaustion.”

 

Changes in hormone levels require more care and attention to be taken when exercising. Asking the mum-to-be to look out for the signs and verbally screening before you start each training session is crucial. The hormone relaxin softens ligaments and connective tissues throughout the whole body, but is meant to primarily prepare the pelvis for delivery and cervix dilation. When I reached the second trimester (13-26 weeks) my joints started to feel unstable when running on a treadmill. To prevent injury I lowered the impact and used a cross-trainer. My flexibility increased and I had to be mindful of this when stretching and not taking exercises past the usual range of motion. Each woman will be different and some don’t feel these major changes but err on the side of caution at all times.

 

aerobics.jpgOn the homestretch, the third trimester (27-40 weeks) and more than anything the size of a woman’s bump will now probably dictate what exercise can and cannot be performed. For me it wasn’t the size of my bump but a change to my centre of gravity that forced me to adapt exercises. A lack of balance made it more difficult to perform exercises I’d usually find easy. To continue executing them I made modifications, for example by working unilaterally and using an inclined bench or wall for support.

 

Resuming exercise after the birth depends on the type of delivery and what happens during labour. At present it is suggested that after a vaginal delivery it should be at least six weeks and for a caesarean section it’s twelve weeks, to allow for post-operative healing. A medical professional must give the post-natal client the ‘all-clear’ before she starts exercising. I was grateful to receive an exercise sheet from a physiotherapist after the birth, which had safe gentle abdominal and pelvic floor exercises that I could do straight away. After the ‘all-clear’ from the GP it was a case of me creating time for fitness while adapting to motherhood and breastfeeding too.

Postnatal-Exercises-For-New-Moms
Pre and post-natal exercise has so many psychological and physiological benefits, why would we not promote it? As fitness professionals we have the ability to support, encourage and provide knowledge for risk-free enjoyable exercise during this remarkable period.

At Tom Astley Physiotherapy we advocate exercise participation through pregnancy and post-pregnancy, we can offer you pre & post natal Pilates classes in small groups lead by a qualified Physiotherapist – Anna Meggitt at Project: Me (N8 8JQ).

Contact us on 0203 659 3545 or info@taphysio.co.uk

 

The author and contributor to the blog, Rachael, also works in North London and is available for private personal training.

Contact Rachael on rachael_pt@yahoo.co.uk

 

Commonwealth Day #10 – Refection #5

Well the end is in sight for Glasgow 2014 Commonwealth Games and I’ve had a blast so much so I might go to Rio.

Working in the poly clinic as a physio to the athletes has been a once in a lifetime experience and taught me so much about the world of elite multi-sport events.

I have had the opportunity to work under a great physiotherapy in Lynne Booth and a fantastic team of physio’s from across the UK.

The next goal for me is to get My Physio in sport bronze award and then continue multi-sport event physiotherapy through UK Athletics and BUCS pathways.

Thanks for reading my previous blogs.

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Commonwealth Day #9 – Reflection 4

XX Commonwealth Games
XX Commonwealth Games

 

The 2014 commonwealth games is coming to a close within the next few days. The Glasgow platform has provided some amazing sporting outcomes and a great experience for athletes, team officials, and Clydesiders alike. As part of the medical services, working in the polyclinic has given me a taste of the multi-sport elite level competition, and whilst it is hard work, it’s certainly something I have thoroughly enjoyed.

 

The What?

I have learnt a lot from being in the polyclinic environment and working alongside some fantastic physiotherapists over the past two weeks. When an athlete is injured, they usually transferred to the polyclinic, from the field of play, to receive world-class treatment. However, what happens when the athletes doesn’t listen?

 

So What?

A netball player presented to the polyclinic with an acute ankle sprain, 2 days previously, she sprained her ankle competing. Treatment was provided to aid recovery but as part of my assessment, I enquired as to when she was competing next, the reply I received was ‘5pm today’.

As physiotherapists, we naturally want to promote activity and sports participation, but sometimes the body needs time to heal. The athlete always wants to play and the coach always wants their best players fit for action. The difficulty comes when the coach is present to hear your opinion about an injury or doesn’t choose to hear it.

I advised the netball player that should not play on her ankle in its current state, despite the fact that she had a game that afternoon, and this is why.

The ‘envelope of function’ (according to Dye, 2005): increase in activities (both frequency and intensity) leads to tissue loading outside the zone of physiological homeostasis
The ‘envelope of function’ (according to Dye, 2005): increase in activities (both frequency and intensity) leads to tissue loading outside the zone of physiological homeostasis

The tissues within the body are maintained in homeostasis through training and competing. The tissues and structures in the body are pushed into ‘supraphysiological overload zone’ when competing, which means that are optimised within the ‘Envelope of Function’. When these tissues are overloaded beyond the ‘Envelope of Function’, i.e an injury occurs, then tissues fail and break or rupture. due to injury, the envelope of function is reduced and tissue homeostasis is disrupted.

 

What this means in the context of the athlete competing, is that they have a reduced physiological ability to perform to their highest level, which would be needed at an international event like the Commonwealth Games. If the athletes does compete with a reduced ‘Envelope of Function’, then they risk further injury as the tissues get overloaded beyond the envelope sooner. The cycle of boom and bust can re-occur until the tissue is given sufficient time to heal and repair to restore tissue homeostasis.

 

Now What?

1) Communicating the importance of tissue healing to athletes is difficult but needs to be emphasised to avoid boom and bust cycle of injury.

2) Communicating the outcomes of clinical assessments to the athletes medical team should be done immediately to discuss return to competition but athletes want to play and coaches want their best players available for selection, so getting this message through can be difficult.

3) Treatment of injuries should be looked at in the short-term and long-term outcomes with the athlete at the centre of the treatment goals

 

Reference

1) Dye SF. The pathophysiology of patellofemoral pain: a tissue homeostasis perspective. Clin Orthop Relat Res 2005; 436:100-110.