I originally saw John for a free consultation a few months after breaking my left hip in a bike accident. I had an emergency operation at the time of the accident fixing the break with 3 screws. My greatest passion in life is dancing so I was very keen to give myself the best chance for a full recovery and John was recommended to me as a physio with experience working with dancers. I decided to see John for a full consultation as I was having some discomfort and
pain when working my left quad in some movements, which didn’t seem to be improving over time.
John first asked me to do a simple test which involved jumping as if skipping on both legs, then my right leg and then my left. He showed me in the mirror how when hopping on my left leg I was leaning over to that side with my upper torso whereas when hopping on my right leg my spine remained vertical. This test immediately showed us that I was not trusting in my gluteus medius doing the work of stabilising my hip in a horizontal position. John performed a number of strength tests (asking me to push my leg against his hand) which showed that my left quad was lacking in power. They also showed him that this wasn’t due to a lack of muscle strength but a problem with the power supply which is provided via a nerve radiating from the L5 vertebrae.
John was curious about testing my upper body, rather than assuming the problem was just localised at around my hip. He performed some tests involving the abduction of my arms which showed that I had stiffness on my left side going up into L3 and my thoracic region. Also, he found that my neck vertebrae were not so springy on my left side. As I fell fully on my left side it might well explain the ongoing stiffness. John treated my upper spine with some manipulation which released some tension and resulted in my left arm abducting more freely. He also found that this resulted in improved quad strength and leg abduction when re-testing.
We then looked at the glute strength exercises I had been given by my NHS physio and found that my technique was poor. The exercise involved me lying on my side, extending my uppermost leg back and lifting it upwards. We spent quite a bit of time correcting my technique: he corrected the alignment of my head and neck so that I was keeping my neck long and in line with my spine; he talked about ‘shutting the door’ (activating my transverseabdominal muscles), correcting my hip position and using my fingers to make sure my glutes are working. We looked at my single leg squat exercise which I had been having a lot of difficulty with and which hadn’t been improving. John also identified my poor technique and I worked on making sure I wasn’t allowing my knee to go too far forward of my knee and that I was folding my hip in the same way as when doing the exercise on my left leg, which felt easy.
Finally we looked at my standing posture and looked at ‘shutting the door’ and ‘scapula setting’ to address the position of my shoulders which are habitually rolled forward. We also looked at John’s exercise sheets relating to ‘dynamic sitting’ and he suggested I work with those over the next few days if possible. John suggested we meet again the next week to see what difference doing the same exercises with my increased understanding has made.
I went in apprehensive at what to expect as having a physio beforehand and not seeing much improvement had made me this way. We started off by analysing how far each of my legs could stretch and my natural posture. John immediately recognised what my problem was and after clicking my backs joints a few times my flexibility was automatically increased.
He then went into detail on how to sit properly and it resonated. After the first session i walked out feeling like a different person and am looking forward to the next session to learn more.
We started the assessment with John redoing similar tests to my first appointment to strengthen his analysis and all the exercises gave the same results.
John used various techniques to determine my flexibility and movement range whilst talking me through everything he did. The best thing was comparing how I was at the beginning of the appointment to how I was after the 45 minutes. I started the appointment with stiffness in my right side with limited flexibility. He located where all the stiffness was in my back and then eased my spine by clicking it and releasing the pressure in several locations. Immediately we tested my leg flexibility and it was absolutely incredible to see the difference. I could move so much more and without pain or feeling weak.
It seems that years of my parents telling me to sit up straight fell on deaf ears as my posture has slumped, this could also be due to having a desk job for so long. John showed me ‘dynamic sitting’ which enables me to focus on how I am sitting at my office chair and adjust myself accordingly. Immediately I feel my core engaged and I feel taller and less slumped. The really helpful advice is to imagine lifting the label in the back of your shorts, it helped me roll my pelvis forwards whereas when I slump it just rolls back.
My homework is to continue with dynamic sitting and trying to think about how I am sitting every 20 minutes at work. Additionally I need to practice laying on my back and rolling back to my shoulders joint by joint into a pilates bridge and back down again. My first couple of attempts are shaky and my balance was all off but hopefully if I do at least 30 of these every evening I will improve.
My first ever physio appointment was a real eye opener.
After putting up with sharp right knee pain during running for over 4 years I thought it was finally time to have it assessed. After spending 30 minutes with John he had assessed me and discovered that it is lack of flexibility in my right hip that has caused lower back pain, knee pain and general leg weakness.
I was amazed to see the differences in both legs in terms of strength, flexibility, stiffness and movement. I was very impressed and keen to have my next session as soon as possible to find out more.
Here is an update on how I’ve been getting on since my last treatment session with you back in December. I’ve delayed sending this as I wanted to include an update of the Highlander Mountain Marathon.
When I came to Physio in December I had been suffering with a strained adductor muscle (since August) and recurrent problems with my calf and ankle muscles which you’d diagnosed were caused by poor upper body posture from working at a laptop all day. I was keen to get these problems sorted out so I could be fit enough to start training in earnest in the New Year for the Highlander Mountain Marathon at the end of April. My training runs prior to seeing you had been very irregular, at the most consisting of a long weekend run and one other 10k run per week.
Your physio sessions got me back running again and the advice you gave me about my posture and running form chimed with advice I’d been given by Susie Baker, my Alexander Technique teacher, in the past.
New leaf in 2015
I decided to turn over a new leaf in 2015 and set myself a target of running or walking at least 5km every day. I’m pleased to say this is something that I am still doing and I usually only have a walking instead of running day once a fortnight or so.
Running every day
Contrary to fears that running every day was going to exacerbate the calf and ankle problems I had been suffering with, I found that the aches and pains lessened and then disappeared completely. Running every day gave me the opportunity to concentrate on my posture more and to practice running with good form. Knowing that I have to do 5km every day means that as soon as I get any pains or niggles I treat them straight away with either stretching, wobble board or foam roller as appropriate. I have even had a couple of sports massages from Katherine Golik to treat tired legs. I’m going to continue with running every day for the foreseeable future: I’m used to it now and it’s become a habit. The only thing I would add is more core exercises to enable me to maintain good form over longer distances.
Highlander Mountain Marathon and Butcombe Trail
As well as the Highlander Mountain Marathon in April (running 32 miles with 3,890m of ascent over a weekend with a backpack containing food, clothes, sleeping bag and tent), I ran the length of the Butcombe Trail during one long day in March: an unsupported solo run of 48 miles in 11 hours (which included time for map reading and stopping in several pubs on the way round for tea, coffee and extra water).
Man v Horse marathon
My next challenge is the Man v Horse marathon in June followed by a 50+ mile ultra in September.
I’ve visited John in the past for knee issues but this time I was desperate…..
It all started last summer on a trip to Montenegro. It was a pretty active trip – climbing mountains, rafting, sea kayaking. Halfway through the trip I started to experience extreme pain in the left side of my ribs and abdomen. The pain was so bad I made two trips to the local hospitals – an interesting but fruitless experience. Back in the UK, I was poked and prodded. An x-ray, ultrasound and bloods revealed nothing. A viral infection of my intercostal muscles was the doctor’s diagnosis. It would pass. I stopped climbing (my favourite hobby) and tried a chiropracter. After a few painful weeks it had receded to a twinge but never went away.
> Then at Christmas my body started to misbehave again. This time the rib pain came back but it was accompanied by the emergence of painful lumps on my left hamstring. What next I thought? I’ve always been a healthy active person, and I’m only 35 but now I was anxious. Back at the doctors I had more tests, more scans, but still nothing. I left the doctors with no diagnosis and no follow-up planned, but still in pain.
> This is the point at which I found myself back at John’s clinic. Perhaps he could help. We discussed my history and my job, which is desk based but involves lots of travel up to London for meetings. The first thing John did was a bit of a mechanical review. He checked my posture. My head is sitting further forward than it should giving me a round shouldered effect. My range of movement rotating to the right is limited and my left hip flexor is really tight. John thought there may be problems at the top and bottom of my spine, both musculoskeletal and nerve related. The side pain could simply be because this is the area that has been forced to compensate for all the weaknesses elsewhere. He even thinks that the hamstring lumps could be the result of toxins being “dumped” here from other parts of my body.
> I was relieved that there could be light at the end of the tunnel. John performed a few manipulations and treatments and there was an improvement in my range of movement by the end of the session. He gave me some exercises to do and was confident that he can help me. But I know I have to put in the work and make the exercises part of my daily routine. We agreed to arrange another session and I left Moti a little lighter and a lot less anxious than when I arrived.
Top of right glute painful, John has identified that my right foot veers left just at the end of my stride, meaning my hip twists probably causing the pain. It’s only in the last month.
Question is what causes it; shoes, stance or what?
1. New tyres – popped in to Moti and the attentive chaps spent 45 mins sorting that in line with John’s instructions. Very different but comfy, hope an old foot injury in my foot isn’t aggravated as it always casts a shadow over new shoes.
2. Posture – while standing – ‘peering over cliff’, this is the one I’ve been concentrating on, feet, knees, pelvis and head, oh and chest and shoulders if a man can concentrate on more than 4 things at once! While sitting – pelvis, shoulders and head (superman eyes)
3. Running style – shorter stride landing on ball of foot not so heavily on heel, pelvis, elbows (pushing back and not too far forward), and the head, again. Needs working on at the next session.
I really should stretch more.
Been running and out on MTB, neither very good. Torn between resting and pain of getting fit again once John has worked his magic vs glute and back pain of continuing exercise.
The background: last year I got a stress fracture in my left foot: absolutely no fun at all, and quite possibly the most painful thing ever to have happened. While it was on the mend I came to see John at Moti who diagnosed all the bits of me that weren’t working as they should, by which I mean a foot which didn’t land correctly, a stiff hip, stiff shoulder etc etc. After much manipulation and spine-popping I was back on the road to running.
This year, I’m aiming to get myself back up to running 5 miles in 45 mins (or less). I was running for about 30 mins fairly regularly when a couple of weeks ago, my right calf muscle suddenly went pop. Or snap. Or some other not very scientific diagnosis. So I went back to see John.
The upshot is, after years of sitting at a desk, typing away, (and, weirdly, cycling slightly lopsided as well) I’ve turned into a bit of a spiral (I blame the spinning chair) with very tight neck muscles and hip muscles and so on – all down my right hand side.
So – I’ve been manipulated and spine-popped once more and already I feel freer and more likely to be able to hit my target time/distance by the end of May. Nothing like having a target to aim for.
Going for a run feels like a bit of a leap of faith when I have the spectre of pulled calf muscles hanging over me, but later this week I will be giving my new-found realignment a test run on the downs.
Watch this space…
I’ll be watching with interest – PhysioJohn
Speaking at the recent Physiotherapists in Sports conference, former Olympic USA coach Vern Gambetta called on delegates to consider the whole body and the brain when treating patients. ‘If it hurts, we look for where it hurts, and we rehab the hell out of that, and leave the rest of it,’ he said.
‘You can see a lot by watching’ – Gambetta said, ‘We miss what we don’t see. Sometimes it’s as simple as watching someone from all sides.’
This approach resonates and underpins everything we do in the AAA-Physio clinic at Moti – Which is why we get great results!
So if your are stuck in a loop of; injury – rest – re-injury and can’t see a way out. Book some expert help from the Therapy Team at Moti