The good Bike Fit

Yesterday I picked up my new road bike from Trisports.  With only 5 weeks to my first sprint triathlon I'm cutting it a little fine to say the least...  She is a Trek Lexa S, with rather awesome gold detailing (and a lid to match, of course!)  Last year I was riding a borrowed bike and towards the end of the season my back was in agony - I was well aware that the bike was too small for me, but unaware that my centre of gravity was so far forwards that it was making the handling dangerous!

As a Sports Therapist I see cyclists who clock-up anything from 20 - 300 miles a week, and a good bike fit is important for everyone.  Common problems associated with a poor bike-fit include numbness and tingling in the hands and arms due to impinged nerves, vertebral misalignment leading to back issues, and the obvious hip, knee and foot troubles due to shortened muscles and impinged tendons.

The science of bike fitting is clever, and a wee bit beyond me I'll leave that to the experts, so here is one in progress - Simon 'Bam' Douglas of Trisports.  Thank you guys for awesome service!  Credits Jayne Odell for on-the-fly iPhone photography ;-)

Gait Analysis – More than just the right shoes!

This weekend I returned to University of Bedfordshire as a student of  Sports Therapy UK to study Gait Analysis. It has been an absolutely enlightening couple of days and I have stacks of notes to write up and a huge amount of learning to integrate into my assessments!  It was great to be able to fire long pent-up questions to our tutor the highly experienced academic; ultra-runner, IronMan and former British Triathlon Assoc Coach, Senior Lecturer Pete Sheard.

How can I explain Gait Analysis to my clients?  Well I’ve thought long and hard about this…  When we walk/run on a treadmill in a running shop it’s for the purpose of buying a new pair of runners that are perceived to offer us the ‘right’ factors for our running style.  This is what most of us understand Gait Analysis to be.  True Gait Analysis is the study of your whole body’s movement – from the tip of your toes to the hair on your head, and via the path that you travel in a forwards, vertical, (and sometimes sideways!) motion.  Think ‘Gollum’ and his CGI dots that made him come to life in Lord of the Rings - that’s the type of advanced technology available at the University of Bedfordshire. Of course we don’t have that in a clinic environment, but we can use the principal visually when working with clients on a treadmill or walking /running anywhere.

It will result in informing your running shoe purchase, for sure – but it will also serve to help you understand why you move in the way that you do and, consequently why you injure in the way that you do.  A Therapist trained in Gait Analysis can identify the key factors of your motion which reduce your skill, performance, speed, and increase your likelihood of injury. Essentially Gait Analysis is about efficiency.

The topic of running shoes was of course still central to our learning…  Pronator or supinator?  Supported or inserts?  Nike or Adidas and New Balance vs Saucony.  Shoes are a lively topic - to learn about how they’re manufactured, what athletes ‘really’ train in when their sponsors aren’t looking, and quite what is essential technology and what’s just marketing tosh was incredibly valuable.  Oh, and there was of course the inevitable long discussion on barefoot or minimalist running…  Don’t get me started on that! 

Thank you Sports Therapy UK for one of the most worthwhile CPD courses I’ve attended. 

For further information I can be reached on 07588 605276 or visit www.gbsportstherapy.co.uk.

Hands-on Revision

I've been getting back to basics in the last 2 days revisiting techniques and anatomy topics that I've not practised in a little while, and I've had the benefit of learning more advanced skills alongside my older brother Alex who’s a chartered Physio.

Al is based in Hull and has just set up a mobile Physiotherapy practice.  He comes from an NHS / geriatric-care background, and wanted to offer more skills such as Sports and Remedial Massage, facilitated stretching etc as part of his tool-kit.  He covered massage a few years ago but we saw the opportunity to get together and skill-swap, and so organised 2 days-worth of patient volunteers and got stuck in!  Quite selfishly of course, because to have 48 hours with a Physio in ‘work mode’ is a fab opportunity to bounce theories and ideas… 

We started by hitting the books over a coffee and a cake at The Coach House, revising anatomy and discussing some hot topics that have been foxing us both such as the role and release of the neck-flexors in what’s known as Anterior Head Carriage…  Boring, I know – but it effects 35% of the desk-bound working population, and can be a nightmare to fix!  One successful conclusion later and we were ready to start pounding the flesh…

Every patient came in with a real niggle or problem to assess, and it’s been a great opportunity to set my theory against Alex’s and vice versa…  I absolutely love my job, but it can be quite isolating and to have the chance to try different techniques and test theories and ideas has been brilliant.  Interestingly we have been in agreement with all of our treatment plans for the problems presented and we've successfully diagnosed a couple of tricky conditions.  Hooray!

Al is now completely proficient in sports and remedial massage and I'm very pleased that my brother has become one of a small pool of Physiotherapists who are truly ‘hands-on’ with their treatment.  An unfair comment?  Well maybe, but my clinic is regularly attended by people who say that their NHS Physio didn't even lay their hands on them, and the role of healing hands is frequently unrecognised and dismissed.

A huge thank you to everyone who has given us their time over the last two days – you are superb, thank you :-)  I'm very lucky to have such brilliant clients and friends.

Georgie

A day in the human dissection lab

Last week I spent a day in a human dissection lab.  It’s not the normal place to spend a windy Wednesday, but nonetheless I’d been looking forward to it in the same kind of way as people look forward to going to Alton Towers for about 8 months.  In fact it was visiting Gunther von Hagen’s Bodyworlds Exhibition three years ago that made me decide I wanted to change careers.  The presentation of plastinated bodies in their sporting poses got me hooked on functional anatomy – what an incredible assembly of pullies and levers, electrical circuits, pumps and mechanics we are!

Bodyworlds Exhibit "Running Man"

But despite my enthusiasm as we climbed the stairs to the dissection lab at King’s College London my nerves began to kick in – what if I were to have an involuntary reaction that people speak about, and pass out on the floor?  What would the smell be like, and would I actually be able to bring myself to palpate the specimens?  We reached the double doors at the top of the stairs and I was ready to walk through and pick up my white coat and gloves and receive our briefing but BANG we were straight in – oh my goodness.  Within a few seconds I realised that this was the best way to do it though, there was no putrefaction smell and I breathed a sigh of relief.  We skirted around thirty gurneys - some closed and some open revealing various specimens, to our briefing area which was surrounded by pots full of further dissected specimens.  Wow!

We were given the format for the day, a little workbook, a white coat and gloves and invited to wander around and acclimatise ourselves to the environment.  And so it began…  I approached the first table really nervously and was presented with two legs dissected at the hip, with skin and fat removed to reveal the impressive musculature of the quads, hamstrings, gastrocs and soleus.  And now I can immediately understand how knee problems are created by muscle imbalances in the leg, and how a tight ITB can alter gait and hinder progression.  It’s one thing looking at 2d images and computer simulations but to see the muscles spiralling around a leg and inserting into the knee really helps you to understand how we move, and how injuries arise.

Bodyworlds Exhibit "Basketball Player"

We spent an hour or so picking up and palpating the specimens, seeing how muscles contract and lengthen in movement, checking out real origins and insertions, comparing the differences between specimens and pretty soon most of us were completely absorbed in what we were doing and all our nerves had disappeared.  I was blown away by the thickness of the sciatic nerve, and how it passes through/around piriformis in the buttocks which in itself was so surprisingly small.  Such a little muscle can cause so many problems!  And further amazed by the depth and thickness of psoas – no wonder it’s a nightmare to stretch and contributes to back pain and disfunction.

After a little while we were invited to open the closed gurneys which contained entire donors.  Their faces were covered and all we knew about them was their age, sex and cause of death.  It wasn’t the first time that I’d seen a corpse but for some people it was and we were mindful of our colleagues’ reaction as some chose to stand back or sit down.  Everyone was composed, dignified and completely respectful - carefully removing the plastic and choosing to keep the donor’s face covered.  Gently palpating and exploring the bodies I was struck by (and I know this sounds ridiculous), quite how lifeless and inanimate they were.  It didn’t upset me – their life had left, and what remained was a vehicle that served them all brilliantly until an excellent age of 80 plus.  This body, this complex assembly of sciences had escorted them through amazing lives and now these very generous people and their families were allowing students to learn from its successes and ultimate failure.  What very kind people these were, and how privileged were we.

Phewee…  What an amazing experience, and as somebody who struggles with books I learned more functional anatomy in that day than in two years of referring to my anatomy books.  A big thank you to the staff at King’s College London, the London Massage Company and of course to everybody who carries a donor card.  If you have any questions please email me at georgie@gbsportstherapy.co.uk.

New technique offers huge benefits for clients... Targeted, effective scar-tissue removal for improved function and performance.

Neuromuscular Re-education (NMR) is a “stand-alone” hands-on technique for the evaluation and functional treatment of 90+% of soft tissue injuries, and it’s now available via GB Sports Therapy.  I’ve chosen to incorporate this powerful technique because of its huge success in treating common injuries presented by athletes and more amateur trainers alike.  It’s quick, successful, targeted and actively involves the athlete in their treatment - encouraging participative investment in their own healing.

Dr Peter Levy, NMR Founder says; “When an area is injured, whether it's muscle, connective tissue, fascia, tendon or some combination of these elements (as most injuries are), the body handles this inflammatory response the only way it knows how - through a hyperplasia of the affected tissue followed by a fibrous healing, the laying down of a less elastic, second grade, poorly vascularized scar tissue to protect the involved areas. Adhesions occur wherever damage and inflammation have occurred and they limit both strength and range of motion". 

Once there is fibrous healing these adhesions pull us out of a three dimensional orientation with gravity. As a muscle tendon begins to stretch and encounters an adhesion, the muscle contracts to prevent any further stretching and to protect the area involved.

The result is that the muscles involved are not as strong and the range of motion is limited in the involved joint. Adhesions can affect areas that are quite small, sometimes just a few muscle fibers, and other times there can be a number of areas like that scattered throughout a muscle group.”

The NMR technique is now being incorporated into sessions where appropriate, and is also available as a 30 minute appointment where appropriate.  Please contact GB Sports Therapy for further info; 07588 605276.

Some time with Saracens Rugby Club

I’ve been very fortunate this week to spend some time with current England champions Saracens, at their home at old Albanians, St Albans.

I wanted to get hands-on with some seriously developed physique and see how the techniques that I use in everyday clinic need to be adapted to deal with the extreme forces that their bodies are put through, and get some top-notch rehab experience.  And of course, to be pitch-side at a game would be the icing on the cake! 

A friend of mine told me to expect injuries akin to being in a car accident – shoulder dislocations, whiplash and head trauma.  Blimey, she wasn’t wrong but I didn’t see any acute injuries of this degree as the season’s just opening, but I had great contact with all of the players that had surgery at the end of last season, and I was able to shadow their rehab and talk to them about their progress and hopes for the premiership.

The excellent experience was topped off with pitch support at a victorious game against Esher, where the Sarries won 30:10.

Below are a few select pics from my time with the Sarries, you can also view Training and Physio pics, and Sarries vs. Esher pics.  
I would like to thank the Vickers family, the Sarries medical team and of course the players for letting me sit in on their treatment.  

Physio Room

Richard Wigglesworth receives treatment
after sustaining a head injury
playing for England

Former England Captain Steve Borthwick
undergoes enough taping to constrain a small
mammoth.  Steve had AC shoulder
surgery at the end of last season

Hip-flexor stretch to Steve Borthwick.
Pelvis is stabilised by the physios weight

No 8 Ernst Joubert in proprioceptive
rehab for an  inversion sprain.

Assessing Ernst's flexibility and strength in anticipation
of return to the squad.

Dry needling to tibialis anterior and peroneals

Dry needing to tibialis anterior and peroneals

Prop Carlos Nieto has pressure and ice applied
to a grumbling hamstring

Increasing hip ROM with a belted technique

Saracens vs. Esher

Pitch support

With hooker Schalk Brits

Scrummage!

Kameli Ratuvou leads the dressing room celebrations

Photography for the GB Sports Therapy Website

A very good friend who is fortunately blessed with magnificent photographic skills, has buddied up with me over the last week or so; photographing treatments and various bits and bobs for the forthcoming GB Sports Therapy website. 

Thank you, Jayne Odell, Jim Rees, Tracey Davidson and Danielle Smith.

 Here’s a select few…

and finally...