All posts by physio support

Dr Mark Porter: Stiff knees may be a sign of arthritis, but exercise can help

Here is a link to a very interesting article by Dr Mark Porter on how physiotherapy and exercise can reduce the affects of arthritis…

https://www.thetimes.co.uk/article/dr-mark-porter-stiff-knees-may-not-be-a-sign-of-arthritis-just-that-you-need-to-do-some-exercise-xzj9fkvn3

cycling-bicycle-riding-sport-38296 small

For those with arthritis here’s a useful link to Arthritis Research UK for some excersises to help manage knee pain…

http://www.arthritisresearchuk.org/arthritis-information/conditions/osteoarthritis-of-the-knee/knee-pain-exercises.aspx

London Marathon Success!

We would like to congratulate all runners who took part in the London marathon on 23rd of April. A special congratulations to Annie and Rob Dixon who completed the marathon in 3:58:12 and 2:51:43 and also to Richard Edwards in 5:02:00 (who was still looking full of energy despite already completing 25 miles!) and all of whom completed it with no injuries!

0009

http://www.marathonfoto.com/Catalog/List/285322548?PIN=V54972&LastName=EDWARDS

Calf problems from posture: #04 Twenty six days to twenty six miles

Twenty six days to go and it hasn’t escaped my attention that there is one day left for every mile I will have to run. I feel that this is somehow apt – the marathon is not only run over the 26 miles on the day, but over the many more miles run over the days and months leading up to it. This miniature mountain of time and distance (and hills) already covered is what makes my sensations heighten as the event draws nearer – I have put in so much effort to get this far that I don’t want to miss out due to injury or illness at this late point.
The exercises John has recommended have adjusted my posture to the point that the right calf is much less problematic, although this adjustment does seem to have ignited soreness in the left achilles. I am working on my gait to push right through to the toes on the trailing leg, increasing speed and reducing effort in the legs. This weekend will be my last truly long run before the marathon. As long as that goes well it will be all about keeping the legs ticking over for a few weeks and giving absolutely everything on the big day.

To see Tim’s personal blog see: http://edenprojectmarathon.blogspot.co.uk/2015/01/twenty-six-days-to-twenty-six-miles.html

Calf problems from posture: #03 Whales and Marlins

I feel it is no coincidence that this Christmas I was given two books which are undoubtedly related: Hemingway’s ‘The Old Man and the Sea’, and Melville’s ‘Moby Dick’. Both describe the immense efforts of people to overcome multifarious obstacles in order to capture a monster far bigger than themselves (although I haven’t read Moby Dick yet). It may be over-dramatic, but in some way this is how the marathon has become for me. Particularly since the calf problems, it has been a daily struggle to stay on top and build the mileage back up enough to make the marathon plausible. I put in calf-strengthening exercises daily, I now also slot in postural exercises and some ‘neural flossing’ as recommended by John. I am careful to warm up and down thoroughly around each run. I run three times per week, unsure each time whether the calf will fail again, but monitoring and adapting my runs accordingly. Add to this that I will not be satisfied purely with finishing the marathon, but I would like to run a reasonable time. My running is currently limited not by my fitness but by the leg, which sometimes does not allow me to run further. This is concerning given that my longest mileage since the injury is 15 miles. Still, I believe that my approach is giving me the best chance possible. It combines patience, determination, and discipline. Keep doing the exercises even though you may be bored. Keep training even though the weather may be terrible. Keep believing even though other people may not hide their doubt. There is never a guarantee of success, but you can always put in your best effort possible.

BEFORE:

AFTER:

Calf problems from posture: #02 A two pillow sleeper

On my second appointment with John, he once again demonstrated to me the flaws in my posture. With me standing casually, a quick profile photo showed that my pelvis and nose stuck out in front of the rest of my body. I am curving my lower spine backwards and then my neck and head are pushing too far forwards from my shoulders (see photo); as John rightly pointed out, I am a two-pillow sleeper. These extra curves in my skeletal frame mean that the nerves strung over that frame have further to travel than they should, and therefore have less give in them. My first prescription was to sort out my posture during the many hours I use a computer (at the office and particularly when using my laptop at home, for which my posture is really pretty terrible).


Following this, we tried some little hops as if skipping, first on both legs then switching to one leg, showing that this was much worse on my right side. Similarly, when balancing on one leg, I would lean my upper body much further to the side on the right leg than when balancing on the left. It seems I am literally a lazy arse, at least on the right side, where the upper glute muscles do not want to work to keep me balanced. Prescription two was the sitting-to-standing posture exercise from the physiotherapy.co.uk website to wake these muscles up. You or I may well ask what all this has to do with my calf injury? I believe John’s answer might be that you treat the body and not the symptoms of injury, and the rest follows…there is a logic to this, and as a scientist I see that you can only test this theory by following the advice, so fingers crossed and here goes…

Calf problems from posture: #01 Open Clinic

I went to the Moti running shop hoping for a recommendation for a physio to assess some problems with my calf. Lucky for me, John walked through the door at that moment and offered me a free assessment. With pause only to make a vital cup of tea, we got to work. John walked me through the issues with my body, step by logical step, gradually revealing a complete picture which I feel he knew practically from the start. Neither of my feet land in a straight line down from the knee. The two legs are different, with the right (where I have the calf issues) worse than the left. My right side is weaker than the left in certain areas: lifting the knee up towards the chest, and pushing down around the big toe. John traced these issues to the L2 and L5 vertebrae in my lumbar spine, and demonstrated that these were more tender than the others. Overall, I’m no longer surprised that I am having problems running! Whilst there is a considerable list of problems with the posture of my body, having them pointed out with such clarity has given me genuine optimism that something can be done about them. I hope that optimism is well founded.

Back Pain Help – Final Session

For our final session – a follow-up after a three week break – I was glad to report that I’d been feeling no pain, and only a little discomfort and stiffness in my neck and shoulders still. This was usually in the morning, after sleeping on my side on rounded shoulders, as I always do. We discussed this and thought about how inevitable that might be, and which exercises and stretches actually alleviated that stiffness quite quickly.
Otherwise, John tested the power in my arms and hands, and the flexibility in my legs, all of which were significantly better and functioning quite well. There was still a bit of treatment we could do with the neck, so a bit of clicking and stretching later, I was feeling pretty well mobile and “stacked properly”, as John calls it.
I’m aware now that I really need to keep up the exercises and stretches I’ve been doing, to strengthen particular muscles and also keep my body mobile. I spend so much time in front of a screen at a desk that not to counter that with even the minimal amount of activity was putting huge amounts of strain on my joints, nerves, and muscles. I know now which joints, nerves and muscles these are, and at least part of the way to remedying the issues I’ve been having with them.
We agreed to check in after a couple of months or so to see how I’m doing. Right now, I’m incredibly happy with the progress I’ve made over six sessions, and pain-free.

Back Pain Help – Conscious Competence

Today I came to see John after two weeks off physio – I’ve noticed that the pain is almost entirely gone, and I’m now just a bit clicky and stiff at times. Any pain there is can be quite quickly resolved with posture amendments. Now, my challenge is to up my stretching, pilates and yoga so that it’s a part of a regular routine, rather than a remedy when I feel a bit stiff.
We talked about the ‘competence square’ (I think that’s what it was called) – travelling from Unconscious Incompetence (you don’t know what you’re doing wrong) to Conscious Incompetence (you know, but you’ve not yet fixed it) through to Conscious Competence (where I am now – I know what’s wrong and am fixing it)…next stage, of course, is Unconscious Competence. That should look like regular exercise, and less sitting at a screen; automatic dynamic sitting posture; better strength in my muscles and better posture all round; leading to better movement, and more comfort, zero pain.
We essentially came full circle today – most of the tightness in my pelvic region, glutes, and shoulders has been relieved easily by treatment and stretching. The remaining stiffness now is in my neck and thoracic spine, where the pain originally was that I came to get physio in order to alleviate. So there is a clear path I’ve taken, it seems, that has allowed me to work through the mobility problems throughout my body, and the significant problem areas are all that’s left.
After a bit of treatment, and checking what was stiff/painful/immobile, John and I talked a little about what I could do to maximise further recovery. Ultimately, it’s now up to me to incorporate into my regular routine the particular stretches I’ve been tasked with, experiment with other ones that may help, and generally optimise my lifestyle around my physical health. We’ve booked a follow up appointment to check in in three weeks time. I’m very happy with my journey from beginning to now!

Back Pain Help – First Session

John briefly went over what we had talked about the previous week in my assessment, and asked me whether I’d experienced any new pain from any of the exercise – which I hadn’t. We recapped dynamic sitting, to make sure I was enacting it correctly. Throughout the week, I had still been experiencing pain in my neck and shoulders, but I noticed it had eased significantly when I performed dynamic sitting. The remaining pain was most likely due to the fact that I hadn’t yet bought my planned amendments to my workstation – an adjustable laptop stand, and remote keyboard – and so my posture was still suffering from using a laptop in a way that adversely affected my posture. My vertebrae c3 and c7 were still overloaded much of the time, until I reminded myself to reset my posture which brought temporary relief.
He then tested my flexibility, from not only my neck and shoulders, but also in my hips and feet. He explained that this demonstrated the way that my nerves worked together throughout my body – the nerves, he explained, are like long bits of ‘floss’ that run throughout your body; when you stretch the right arm out, they pull rightwards along your shoulder blades, as though you’re flossing from left to right, and vice versa. Having this visual helped me to understand how and why my body was, or wasn’t, moving… For example, when lying flat my right leg could be raised over 90 degrees, and then adducted (turned inwards) with ease. Whereas my left leg struggled to raise to 90, and was incredibly painful in the hip and buttock when adducted at all.
John then felt the joints in my neck in a few places to identify issues, and clicked my back in a few places – which felt great. Testing the leg flexibility again, just five or ten minutes later, my left leg was almost as flexible as my right, with no pain whatsoever. John gave me a few exercises I could do to ease up the left leg joints and prevent the tightness in the nerves and joints. They were similar to some yoga moves I’d done before, and I could feel that they were quite relieving already.
That brought the session to a close, and we discussed meeting again the following week. I already feel that I’m progressing significantly, and a huge amount of that is in the explanation that John gives, and the resources he gives me to take away, such as videos of stretches and links to information about posture etc. This means I understand not only what to do to help myself, but why I’m doing it.

Back Pain Help – Assessment session

I was really glad of the option to have a 15 minute initial assessment. I’ve previously seen chiropractors, podiatrists, masseuses, and a physio, and so I was eager to accept what AAA Physio was offering: a free appointment that would tell me if a course of physio was right for me, and what it was that I might be able to address with another course of treatment at this point.
dynamic1_nospace
I was sure that I must have caused myself an injury, because my neck, shoulders and back were in almost constant pain, especially on my left side. I assumed that after years of discomfort issues which had got progressively worse, that I had only half-dedicated myself to resolving via one off appointments for treatment, I must have done some sort of irreversible damage – to the muscles in my neck particularly.
John very soon removed that fear, informing me that it was a nerve and particular joints – not a muscle – that was causing pain. He explained that there is a long nerve that runs between my vertebrae C3 and C7 that was likely causing the pain. He examined and adjusted my posture to demonstrate how my usual way of sitting was overloading those two particular joints. He told me that he believed we could achieve a “significant improvement with around 3 to 6 sessions.”
We ended the session by exchanging emails, and John gave me some exercises and examples of ‘dynamic sitting’ – all of which he gave me access to through his website so I could easily review them. That gave me something to work with until our first session.