I was recommended a visit to John by a colleague after living with a knee injury for the past 2 years. John and I are currently working towards getting me back running which is something I have really missed since my injury. In my first 3 sessions, John has taken a really holistic approach to my injury and has identified different links and factors that haven’t been highlighted to me before, but which make a lot of sense. Now we are working on the way I sit and stand in normal life (which leaves a lot to be desired especially as my job is largely desk based) as a starting point to work towards running. I’m not having to do loads of exercises every day but rather I am trying to think about and be aware of how I’m holding myself (or try not to think too much as this seems to be the problem!) and to re-programme old habits. I have booked a 10k race in October so this is what we are working towards, fingers crossed!
Last week I did Neural Flossing, by the end of the week I was experiencing hip pain in my left hip and stiffness when I stood up after sitting for long periods of time. To combat this, John provided me with a different stretch – putting my legs in a sort of figure of 4 while lying on my back, this stretched my lower hip and upper leg area – after a couple days of doing this the hip pain disappeared. The combining of this and the Neural Flossing is working on increasing the degree of movement in my left leg.
This week I went on the treadmill to look at how I walk and run; a muscle in my left hip/upper bottom does not engage when I walk, I almost learn back which could be contributing to my back pain, as well as twisting my upper body while walking and even more so when running. While running I bounce up and down a lot and I put my heel out in front of me, which means that I am not exerting energy in the right places while running.
To combat these habits John gave me the following exercises to work on over the week:
5-5: Setting the treadmill on 5 incline & 5 speed, where I need to engage my core and lean forward to promote me walking on the front of my foot rather than leaning back on the heel. While doing this I put my hands on my hips/upper bottom to make sure my muscle was engaging.
Use the treadmill to lean forward like a ski jumper, and using one leg at a time to practice my leg movement where my foot will land in line with my body (rather than out in front), this is through pretending I was on a scooter with an angry horse leg that goes up, round and down. Then using the treadmill to pretend that I was bump starting a car – this was to help me with leaning forward, bouncing less while running, and running with my feet landing below me not out in front of me.
Arm Swing – stationary – this is engaging my core and standing like a person about to skip – moving my arms forwards and backwards close to my body in an exaggerated running movement, but not allowing my body to twist as I moved. Then doing this while on the balls of my feet – this I found a lot harder due to my inability to balance.
John also sent me a video clip that provided tips on running and form to improve over stepping – it focused on bum kicks, skipping and running barefoot.
This week took a lot of thought as I had to concentrate on a lot of different areas of my body at once, but it’s crazy what difference engaging your core can do.
‘I suffered a severely fractured Calaneum (heel) bone during a stag do in Berlin in the summer of 2014. It resulted in open reductive surgery where a plate and screws were fitted and I was unable to weight bear for 3 months.
Once able to weight bear I was limping and in quite a lot of discomfort. I would get easily fatigued after periods of standing and after a day on my feet at work would need to spend the entire evening recovering. If I did socialise out after work I would pay for it the following day or sometimes days with further stiffness and pain.
I received hydrotherapy and physiotherapy sessions soon after fully weight bearing and although this helped to a degree it was still painful to walk. I still had a limp, some days were worse than others and I got to a stage where my physiotherapist expressed doubt about his ability to help me any further as I was unable to perform a heel raise on the one foot, usually doable by this stage.
John was recommended to me by a work colleague who had had a running injury. I was feeling mentally defeated at this point as it had been a year since my injury and I still couldn’t walk without some degree of discomfort. I had recently been to a wedding reception after a day at work and as a result the 2 weeks that followed had been more uncomfortable than usual. I was having severe doubts about ever being able to walk properly again.
After explaining my situation to John he worked the surrounding areas of my foot and manipulated areas in my back. I physically saw a change in my flexibility between the beginning and end of this first session. I could now move my right foot back as far as my left which I was unable to do before and it was noticeably easier walking up and down hills as I didn’t have this flexibility before. I’m now also able to perform a heel raise on the right foot and can hold this position for around 30 seconds. My confidence has improved considerably and I’m optimistic that I may even be able to resume more physical activities in the near future.’
I first came to see John three weeks ago after damaging my knee. The injury was caused, about a fortnight beforehand, by performing the (slightly ridiculous) task of standing up with a friend on my shoulders whilst on the side of a fairly steep slope; as I stood up I felt something lock and, as soon as I had put my friend back onto the floor, I felt a painful ‘ping’ inside my knee.
The day after I had sustained my injury I could barely walk, I limped up and down stairs and generally avoided putting any weight onto the leg. The knee had swollen and was fairly painful to the touch, causing movements or weight-bearing to be difficult. Thankfully, at first, the swelling seemed to reduce with each passing day and the pain involved in using the joint subsided with it. This lasted for around a week at which point my recovery seemed to stall and I contacted John.
My first physio session was mainly focused on determining the cause of the pain and swelling: John spent a long time testing my flexibility and movement range, along with probing my knee for ligament damage. He said that, at first, he had suspected my ACL had been damaged due to the injury being caused whilst facing downhill on a slope, luckily this was not the case. By the end of the session John believe the cause was likely to be a twisting within the kneecap caused by muscle imbalance that had caused the fat pad to become upset and possibly to catch.
We ended the session by discussing “dynamic sitting”, a method of adjusting seated posture to relieve muscle tightness and fatigue that will hopefully correct my postural imbalances. I feel that this is particularly important to me as my job involves a large degree of “screen time”.
During my second session with John we continued to discuss my postural imbalances and to try and work through some of their causes, along with trying to mitigate against their effects. We worked through some tests to determine neural strength and found that, in many places, the muscle on the left side of my body had decreased mobility with respect to the right: particularly those associated with the L5 nerve root. John performed some manipulations on my back that seemed to immediately have a positive effect on these areas – I was able to raise my left leg an additional 10° from my attempt before the manipulation!
At the end of my second session we discussed dynamic sitting some more. I have now purchased a standalone keyboard and mouse that I am using to correct my posture whilst at a computer and it seems to be having a positive effect. We also discusses ” neural flossing ” and John set me some homework to investigate and try this.
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.
OUCH! HIP PAIN
Week two of not being able to run and after a pain-filled weekend trying to juggle a two year old who refuses to walk down the stairs, I hastily book a second appointment with John at his AAA-Physio Clinic in Bristol BS8. As I hobble (very much a left leg limp) the short distance from my office to Moti, I am aware that every step is pinching my left hip and is a struggle.
And so the debrief, I have managed to spin and row in the week since I first saw John, but the pain I’m experiencing hasn’t eased at all. In fact, if anything it’s much worse. Carrying said two-year-old halfway across the Downs to the circus certainly didn’t help.
I’ve been to the doctors (usual anti-inflammatory prescription and inconclusive x-ray) to no avail and am told it could be six weeks before I can run again…
After a brief look at the extension on my left hip (or lack of it) John sets to work on my back. I’m shocked at how painful my lower back is. Ten years post-surgery, I am somewhat used to niggling there but as John works his way around my lower spine, I feel sharp shooting pains that actually make me scream. And so, the initial diagnosis is reiterated. In my inability to stabilise my core, I’m causing myself all kinds of problems in my neck, arms and, most painfully, my hip.
BACK TO RUNNING
I think it’s going to be a slow road back to stability and running, but leaving the clinic, into the driving Bristol rain, I’m already feeling a bit stronger and if I really put my mind to it, can see how strong core (deep breath in relax into the stomach) does help ease the pain. Another challenge…and one I’m determined to win.
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.
These drills from The Running School (R) , have great potential for improving the trunk and lower limb strength and stability in a range of age groups.
I can see this style of exercise being particulary effective and engaging for teenagers. JS Physio MSc
Bristol Physio John Stephenson has been providing movement retraining courses for Health Professionals & Physiotherapists since 1999. He also works on a 1:1 basis with private clients wishing to improve their low back stability and running efficiency. Or for a more gentle introduction, ask about the Walk:BacK & Row:BacK programmes!
Book a consultation or free minute open clinic online:
Shoulders benefit from hands-on physiotherapy
Steroid injections and manual therapy are equally effective in relieving shoulder pain, say researchers who compared these two common treatments.
But patients who had an injection went back to their doctor more often than those who had had physiotherapy.
Daniel I. Rhon, of Brooke Army Medical Center in Texas, and colleagues studied 104 adults of working age. All had been diagnosed with shoulder impingement syndrome, which covers a number of common injuries causing shoulder pain.
The volunteers were randomly selected to receive either a single steroid injection or a course of manual physiotherapy.All were also given exercises to do at home. The injection group had the option of up to two further injections during the following year, if necessary. The physiotherapy group received six half-hour sessions over a period of three weeks.
Both groups enjoyed a significant improvement in their pain and disability, both after treatment and during the following year. But by the end of the year, 60 per cent of the injection group had gone back for more treatment, compared with 37 per cent of those who had manual physiotherapy. Rhon DI et al. One-Year Outcome of Subacromial Corticosteroid Injection Compared With Manual Physical Therapy for the Management of the Unilateral Shoulder Impingement Syndrome:A Pragmatic Randomized Trial. Annals of Internal Medicine 2014.