TREATING YOUR MUSCLES AS WE EASE OUT OF LOCKDOWN

A GREAT POST FROM AMAZING MASSAGE THERAPIST ALEX

“LOTS OF SITTING AT MY HOME DESK… TRAVELLING FROM ONE ROOM TO ANOTHER IS THE MOST MOVEMENT I’VE DONE TODAY… WATCHING TONS AND TONS OF TELE.”

These are the most frequent comments I have heard from my clients throughout lockdown. The amount of movement we do has largely decreased throughout the pandemic. Not helped by the fact that gyms and sports had ground to a halt, travelling to and from work is so much less and throughout the winter months we are limited on the time we can spend exercising outside. A whole year of this has caused stiffness in our joints, poor posture, tightened muscles and has had a negative impact on our body. So, what are we going to do about it?

The time to act is now! As we are easing out of lockdown, we need to prepare our bodies for the freedom they are about to endure. The classic quote of ‘don’t run before you can walk, is a perfect example of why we need to re-train and treat our muscles, before throwing ourselves into the fitness world again. We've been cramped up at home for so long our muscles will feel cramped and stiff too. Here’s my step by step guide on coming out of lockdown safely for your body, helping to reduce injury when you do get back on the horse (or bike!) again. 

STEP BY STEP GUIDE:

1. See a specialist - It is important to know how your body has adapted within lockdown. Going to see an Osteopath, Personal Trainer and/or a Massage Therapist, will give you a greater understanding of your body and what areas you’ll need to work on. One of the biggest problems I see with my clients is they rush straight into generic workouts, which can put huge pressure and stress on the body if it’s the wrong type of session for you. Being given specific exercises by a specialist can prepare and strengthen the areas that need the work safely, leading you to be confident when starting out in your sport or fitness journey.

Blog post by Alex Warren

2. Move in all planes - We have become very static during lockdown, with some of us only performing the majority of exercises in a linear motion, like cycling or running. Our bodies should move in all planes comfortably and efficiently, so adding in some transverse and frontal planes of motion (rotational and side to side movements), such as a banded trunk rotation/oblique twist or isometric lateral bear crawl with pull throughs, will help improve and strengthen total body function. Your specialist Back to Back will be able to set you up with some exercises tailored to you and your needs involving all planes. 

3. Build up strength SLOWLY - Going into the gym before lockdown and whacking on 100kg for the back squat may have been a breeze. Do not be lulled into a false sense of security when heading back into the gym thinking you could easily lift that 100kg again. Build up to that weight slowly again, no matter what exercise you are performing. Muscle memory will kick in and you will (hopefully sooner rather than later) get back to where you were. Receiving instruction from a personal trainer to look at form and technique is also a really sensible way to ease yourself back into training in a safe and effective manner. They can provide specific programmes to get you up to speed and even perform at a stronger level than before!

If we can help in any way, call us on 020 8605 2323 for an appointment with Alex or one of our great osteopaths.

The Glutes, the butt, the big one and lower back pain

Your Glutes!

A bit of contention, but we all have big butts for a reason.  Or compared to your biceps, shoulders or calves anyway!  This is because the Glutes need to be able to do so much.  They control the ‘top down’ movement of your head and trunk etc and also of the ‘bottom up’ part of you ….meaning of your legs and the reaction of you contacting with the ground.

Glutes NEED to be able to control movement and be strong.  So many of us extensively sit and this does nothing to help with strengthening your butts.  This even deconditions your glutes.  Then some of us go to the gym or exercise and only train this fantastic muscle in one plane.  To really get your glutes working well (‘switching on’ or firing) you really need to to a combination of multi-plane exercises.  The exercise that you do must not all be in one direction.  This should involve some side-to-side and some rotational loading.

Many people garden at this time of year and this involves a lot of bending down.  Great glutes will really assist with this.  Yet we do very little to help with our bending.

If I went to lift a heavy weight with my arm, many may say ‘that’s too heavy, you have not done that before.  You need to regularly exercise those muscles in your arms to be able to do that.  Your gluts are the same.  To enable you to bend well, your glutes need to be able help with the job of bending.  If a crane was only rated to lift 1000kgs – you would never load up that crane with 1500kgs because you would be worried it will fail.  And it probably would fail!

When we bend many muscles, our glutes included, have to be able to cope with the weight of our head, shoulders and trunk and then be able to sustain that bend for as long as we are bending.  If your butt or glutes are not strong enough, one of the parts that often fails is our lower backs.  And lower back pain is massively prevalent in today’s society.  There is way too much of it.

Dr Rangan Chatterjee recently did a post about back pain.  One of the things he mentions in his post was the butt and how it really helps our backs.  It is massively important!

The last think I wanted to say was that along with training your glutes in a multi directional way, you must train them in an ‘integrated’ way rather than in a ‘isolated’ way.  It is not just about that buzz word – ‘the core’.  All our muscles work as a team and no one muscle ever works by itself when we move.  Your glutes NEVER work by themselves and so you must train them in an integrated way.  For example, when you bend, your calves and hamstrings switch on along with your glutes and the muscles in your lower back.

Thinking about this when you train can make exercise much more fun, but also more challenging.

If you are worried about a problem or want some advice, come in and see one of our osteopaths at Back to Back.  Call 020 8605 2323.

Blog post by James Dodd

Functional Exercise and Training – The Why and the What!

Tri-Plane Movement and Functional Training, these are both current words used to describe movement and training by the personal training and allied health professions (osteopath, physiotherapist, exercise physiologist and chiropractor). The health and fitness industry is going through yet another change, just like the swiss ball was the man of the moment in the 90′s, pilates and the core were the trend of the early 2000′s, many trainers and health professionals are now focusing on training movement rather than muscle, training functional exercises rather than non functional exercises, training groups of muscles rather than muscles in isolation.

What this means in simplistic terms is that trainers and health professionals etc are now moving away from the body building approach to training and conditioning (that is isolated weight training) and moving towards training that integrates movement with resistance that mimics upright function such as gait and other movement patterns that we perform on a daily basis i.e. squat, sit to stand, step up and down, push, pull & rotate. Trying to use gravity as the driver by doing exercise on your feet or upright, rather than on your back or in a machine stimulates your proprioception much more effectively than fixing an area, therefore creating the correct chain reaction needed for full and appropriate muscle function.

This does not suggest that one training approach or philosophy is better than the other, it fundamentally comes down to what the specific individuals goal is. For a body builder looking to compete, then traditional weight lifting techniques that have been proven to produce muscle gain is required. For the olympic power lifter, olympic lifts are practiced. For the sporting indivdiual, there will be likely a combination of functional movement exercises as well as some strength, olympic and powerlifting techniques. For the individual wanting to improve their overall wellbeing, strength and mobility, there is also likely to be a combination of the above.

So what does Tri-plane movement, functional training etc etc mean. Tri-Plane movement simply refers to movement in the three planes (sagittal, frontal and transverse planes). If we look at the individual who is standing upright, the best way to describe movement in the sagittal plane is forwards and backwards movement. Movement in the the frontal plane refers to side to side movement (that is laterally stepping or performing a lateral lunge). Movement in the the transverse plane is when movement occurs with rotation. That is, whilst standing you twist and turn to move or lunge backwards and laterally. Everyday movement occurs in all three planes at a bone and joint level and this is why there is this growing change in the way that training is being carried out. Previously most gyms and training programs were focused on training muscles in machines and/or functional training was restricted to movement purely up and down i.e squat movement or forwards (anterior lunge). As our understanding of functional biomechanics and movement improves, so does our training approaches and philosophy. Now days we are seeing more and more clients perform movements that involve all three planes of movement, involving less equipment and with movements that mimic real life activity.

Functional Training is probably one of the biggest buzz words in the health and fitness industry at this particular moment. There are many indivdiuals out there claiming to provide functional training. Functional training is certaintly not something that is new, rather it has been around for many many years and simply relates to training that mimics how we function. How this training relates to how we function will depend totally upon what and why we are training. For an individual who sits for their job for their entire life and wants to improve this, then training should focus on improving their ability to sit whilst working. For those individuals who are wanting to improve their everyday movement, that is sit, stand, walk, step up and down, squat, lunge etc etc, then training should reflect this. For the sporting individual, the training should mimic the sporting requirements, movements or athletic components that are that sport. So functional training has many meanings and therefore can be interpreted in many different ways.

For the general public, when we look at the body and how it functions, the most common movements or positions we are in involve walking (gait), sitting, standing, squatting, lunging, stepping up and down, single leg balancing, pushing, pulling and twisting. All of these movements are impacted by gravity and ground reaction force and these are two other factors that should be taken into consideration when prescribing a program. Gravity is something that we are always working against to remain upright. Therefore gravity is something that can easily be used to increase or decrease the degree of difficulty of an exercise. Ground reaction force relates to Newton’s laws and how force in one direction results in an equal and opposite amount of force in the opposite direction. This can be related to jumping and landing on the ground whereby an amount of force is exerted downwards and then the force will be transferred back into the legs and must be either shifted or absorbed by the body. So when it comes to functional training and tri-plane movement training, hopefully now you will have a little bit more of an understanding of what, why and how this might be prescribed in relation to yours or anyone else’s training program.

In our opinion, functional exercise should be used more and more when rehabilitating injuries or with patients post surgery. The more you get patient’s bodies working proprioceptively and in 3 planes, their bodies can start to ‘switch on’ to allow them to recover better and stronger.

To find out more about changing your training program, making it a little bit more functional in relation to your specific goals, incorporating exercises that involve training in all three planes, then contact Back to Back – The Earlsfield Osteopath on 020 8605 2323 or click here

Adductor Function

I just LOVE this muscle!

It does most things other than adduct your hip!! If you lie on the ground on your side and lift you lower leg… sure… your adductors adduct your hip…..BUT during function, it does a fabulous job at not adducting your hip.

They are the adductor brevis, longus, magnus oblique and magnus vertical. The brevis and longus attach onto the posterior medial part of the femur, not just on the medial part as most people talk about.

A great and massively overlooked thing about this group of muscles is that they work with their opposite adductors. The right and left adductors are turned on in gait (differently) but at the same time.

If the right leg is forward the right adductors are stretched in the sagittal plane and they slow hip flexion. They are lengthened in the transverse plane (TP) and they help to internally rotate the femur. They are also shortened in the frontal plane (FP) with hip adduction.

As we walk, and as the left leg swings forward, the right leg becomes the back leg and the right adductors are lengthened by hip extension (posterior medial attachment). They are then lengthened in the FP by the pelvis leaning towards to the left leg causing hip adduction. It is then shortened in the TP are they externally rotate the femur. The facilitates top-down external rotation of the tibia and calcaneal inversion…. and locks out the mid tarsals ready for push off!

As I have said – both sets of adductors work as a pair…. The right adductor works with the left adductor to slow the movement of the pelvis to the left and visa versa. If the adductors and tight in any plane, they will inhibit other planes.

But they can also be responsible for other dysfunction. If the adductors are short or not permitting good function, your pelvis will be unable to move correctly in 3 planes of motion and so your lower back, mid back or neck may take the hit instead. You might end up seeing someone for your back pain all because of you adductors. This is why it is SO important to not always treat the symptom, but to go to the cause!!

If you have just injured yourself (especially after the marathon) or need to be assessed for injury or need treating, do give us a call at Back to Back on

Gastrocnemius function – How it assists in knee extension

Gastrocnemius function – How it assists in knee extension

This attaches above the knee into the femur and into the achilles tendon. It acts in a similar way to soleus, but as it attaches to the femur, its influence on the proximal joints and structures is more significant.

Gastrocnemius decelerates internal rotation of the femur when the foot is on the ground, but it is lengthened at both ends. One end in the frontal plane, the other end in the transverse plane. In the sagittal plane, it controls ankle dorsiflexion.

The knee flexion is transformed into knee extension by a number of muscles along with mass and momentum. As the front leg in gait is moving through towards swing phase, the tibia is slowed down by eccentric lengthening of the gastrocnemius and a number of other calf muscles. This slowing along with the momentum of the body creates knee extension as it pulls back on the distal femur as ankle dorsiflexion is decelerated.

So in function and gait…. the Gastrocnemius are a powerful knee extensor!

Hypermobility part 2 (March 2012)

Hypermobility Syndrome – part 2

James Dodd

Part 1 of this article looked at giving readers a better understanding of Hypermobility Syndrome (HMS) and the implications it may have on the musculoskeletal system. Having a greater understanding of the common problems associated with hypermobility syndrome, how it is diagnosed and its relationship to other connective tissues disorders provides us with a solid base by which we can then go about developing a corrective exercise program. Part 2 aims to provide a more extensive look at assessing the hypermobile patient and taking a region specific approach to training. A detailed case history and screening process should alert you to any problematic areas or regions which may be predisposing, maintaining or aggravating your patient’s musculoskeletal problems. Static observation will help you to define any asymmetries in posture. Observation from all three views (frontal, lateral and posterior) will help you focus on areas of possible dysfunction. Functional testing in sagittal, frontal and transverse planes may highlight other areas of dysfunction

Muscle and Movement Testing

Carry out stretches and tests to identify weak, tight and shortened muscles. Take particular care in the hypermobile patient as range of movement may be much greater than expected. They are also good at ‘cheating’ to hide a dysfunctional area.

Assess functional activities such as gait, step up/down, lunge, squat, one leg stand and reach, anterior reach, posterior reach and push up for functional capability. Look for asymmetries, imbalances and glitches within the movement patterns to alert you to potential areas of dysfunction. Common causes of dysfunctional movements could be inhibited/over facilitated muscle activity in agonist/antagonist or synergistic muscles, tight and short or weak and lengthened muscles, hypo/hypermobile joints or body regions and balance, proprioception and coordination problems.

Always remember to seek advice from your patient’s general practitioner, osteopath or physiotherapist if you suspect any serious possible musculoskeletal problems or red flags.

A Regional Approach to Training the Hypermobile Patient

Common presenting features in the hypermobile patient include the following:

Shoulder, hip, neck, lower back, knee and foot pain

Poor body awareness, balance and proprioception

Flat, pronated feet

Hyperextended knees

Anterior pelvis

Clicking/popping joints

Hyperkyphotic or reduced movement in the thoracic spine. This could also be chronic muscle spasm

Tight and shortened hamstrings, gastrocnemius, iliotibial band, tensor fascia lata, pectoralis major/minor muscles

Weak anterior deep neck muscles, iliopsoas, core stabilizers and gluteals

Poor core stability

Upper rib breathing and poor diaphragmatic breathing

A good case history, observation and assessment should highlight any areas of dysfunction and will help you to focus on devising a program that will help restore optimal health and posture. Foam rollers, static stretching, active stretching and Muscle Energy Techniques (MET) are treatment strategies that can help stretch, activate and restore muscle balance. Remember to train the patient as a whole. The body works as one, and all systems are connected. Therefore, any one problem or area can predispose to a dysfunction elsewhere. The tissues are generally weaker and more vulnerable to injury than the non-hypermobile patient.

Hypermobility and the Lower Back

Poor overall functional stability is common among those individuals with lower back pain. In conjunction with poor stability, the hypermobile patient may also have poor kinesthesia and proprioception.

Focus training on:

Improving body awareness (anterior and posterior tilting of the pelvis)

Finding neutral spine

Teaching diaphragmatic breathing

Activating core muscles

Incorporating core muscle activation into functional activities

Balance, proprioception and coordination

Look for an ability to activate the core muscles:

Without co-contraction of more global muscles such as the rectus abdominis and external oblique muscles

Independently breathing

Diaphragmatic breathing? (often you will observe upper chest breathing)

Exercises that will be useful for the patient with core stability issues include:

Anterior and posterior tilting of the pelvis (standing, supine).

Core muscle activation (supine, prone, side-lying and four-point kneel).

Core muscle activation standing, seated.

Remember to isolate muscle activation and then integrate into functional activities.

Hypermobility and the Neck

Hypermobile patients may present with a history of neck complaints, ranging from the acute ‘wry’ neck to chronic neck pain. Individuals may present with an upper crossed syndrome pattern, which could be predisposed, maintained and aggravated by hypermobility, work and lifestyle postures such as sitting and slouching.

Look for:

Forward head posture (chin poking forwards)

Increased kyphosis (rounding) through the thoracic spine and Cervico-Thoracic C7/T1 region (base of the neck)

Reduced mobility through the thoracic and cervical spine

Tight upper trapezius, levator scapular, pectoral minor, sternocleidomastoid and scalene muscles

Weak rhomboids, lower trapezius and deep anterior neck flexors

Winging, elevated or protracted scapulars. Look for asymmetries in static

observation, movement and muscle weakness in shoulder stabilizers

Focus training on:

Lengthening short and tightened muscles

Strengthening weak muscles

Activating inhibited and de-facilitating over active muscles

Balance, proprioception and coordination

Exercises that will be useful for the patient with upper crossed syndrome and neck pain include:

Scapular retraction and setting

Ys and Ts exercise

Other useful exercises that aim to improve mobility of the neck, strengthen deep anterior neck flexors and increase body awareness include:

Chin tucks (similar to an emu neck movement)

Isometric neck flexion (using soft ball to push head against)

Isometric lateral neck flexion (using soft ball to push head against)

Pulling shoulder blades backwards and down, whilst lifting sternum to the roof

For more information on isometric neck exercises, see Paul Chek’s “How to Eat, Move and Be Healthy!”

Hypermobility and the Shoulder

The shoulder is the most unstable joint in the body, and often the hypermobile person will have a glenohumeral joint and/or scapulothoracic joint dysfunction. Problems may develop due to poor neuromuscular control, increased laxity of the capsule and rotator cuff weakness. Individuals may also present with subacromial impingement signs and symptoms. In some circumstances, your patient may require referral to an osteopath or physiotherapist to rehabilitate and teach correct scapulothoracic setting and glenohumeral positioning before commencing an exercise program. Focus training on:

Scapulothoracic setting

Rotator cuff strengthening

Stretching tight and shortened muscles i.e. pectoralis major and minor

Strengthening weak muscles i.e. serratus anterior, rhomboids, lower trapezius

Training functional exercises which address adjacent areas (cervical, thoracics, lumbars and hip/pelvis), muscular slings, synergistic and agonist/antagonist muscles

Hypermobility and the Hip

Like the shoulder, the hip is a ball and socket joint that has a large range of movement. It is essential that the neuromuscular, active and passive systems are working effectively to allow adequate movement and yet stabilize the region sufficiently. The hypermobile person is more likely to suffer from clicking/popping hip. The exact cause of this could vary from an intra to extra articular causes such as a tight iliopsoas to a labral tear or loose body. It may or may not be associated with pain. In those individuals presenting with extreme or constant pain, refer them off to the GP, sports medical doctor, osteopath or physiotherapist for further assessment. Typically, hypermobile patients will have poor control of their hip, pelvic and lumbar regions, and these often need to be addressed to correct any imbalances and prevent further problems developing.

Focus training on:

Lumbar (lower back) stability

Hip stability

Weak iliopsoas

Weak gluteus medius and maximus

Tight hamstrings, iliotibial band, tensor fascia lata

Balance, proprioception and coordination

Hypermobility and the Knee

Patellofemoral problems are common in hypermobile individuals. The cause of patellofemoral problems can be both structural and non-structural related. Common causes include a variable Q angle, genu varum, increased foot pronation and biomechanical and muscle imbalances.

Focus training on:

Tight iliotibial band, tensor fascia lata, hamstrings, gastrocnemius

Weak vastus medialis, gluteal muscles

Pronation and supination foot

Balance, coordination and proprioception

Exercises that will be useful for the client include:

Seated heel presses (helps to activate vastus medialis)

Foam rolling ITB and quadriceps muscles

Exercises that will be useful for the patient include:

Seated heel press (helps to activate vastus medialis)

Lunge – Forward

Lunge – Multiplanar

Squat – Against Wall with SB

Squat Touchdown – 1 Leg

Step Up to Balance – Frontal Plane

Hypermobility and the Foot

Pronated (flat) feet is common in the hypermobile patient. Over pronating can lead to problems with the subtalar joint, mid and forefoot, possibly causing plantar fasciitis and other problems up the biomechanical chain. Over pronation will cause internal rotation of the tibia and fibula, therefore potentially creating dysfunctions further up the chain at the knee, hip/pelvis and lower back. Individuals with flat feet may benefit from an exercise program or orthotics prescription.

Focus training on:

Tight plantar fascia, gastrocnemius and soleus muscles

Activation and control of tibialis anterior, peroneal muscles

Tight iliotibial band and weak gluteal muscles

Balance, coordination and proprioception

Exercises that will be useful for the patient include:

Active plantarflexion and dorsiflexion of the foot

Rolling feet inwards (pronation) and outwards (supination)

Single leg balance (stable to labile surface i.e. wobble board, bosu ball)

Swiss ball squat with ball between the knees finishing with standing on toes

Exercises that will be useful for the patient include:

Side to Side Hip Swing (Hip)

Balance Hold 1 Leg – Overhead Anterior Reach

Balance Hold 1 Leg – Overhead Posterior Reach

Hypermobility and Balance and Proprioception

Hypermobile individuals are likely to have poor balance, proprioception and kinesthesia. Exercises that challenge these components will translate over to improvement of general daily activities and reduce the likelihood of injury.

Exercises that will be useful for the patient include:

1 Leg Balance

1 Leg Balance Reach (anterior, posterior, lateral)

Balance Hold 1 Leg – Overhead Anterior Reach

Balance Hold 1 Leg – Overhead Lateral Reach

Step Up to Balance – Frontal Plane

Equipment such as wobble boards, Bosu Balls, cones, Airex Balance Pad, Swiss ball, Theraband, etc. can be added to further challenge balance and proprioception.

References:

Cook, G. Athletic Body in Balance, Human Kinetics, USA, 2003.

Gray, G. Functional Video Digest Series

Gray, G. Total Body Functional Profile, Wynn Marketing, 2001.

Janda, V. Muscle Function Testing, Butterworths, London, 1983.

Keer, R. & Grahame, R. Hypermobility Syndrome, Recognition and Management for Physiotherapists, Butterworth/Heinemann, 2003.

Kendall, F et al. Muscle Testing and Function with Posture and Pain, Lippincott Williams & Wilkins, 5th Edition, USA, 2005.

Murtagh, J. General Practice, McGraw Hill, 3rd Edition, Sydney, 2003.

Osar, E. Complete Hip & Lower Extremity Conditioning.

Osar, E. Complete Shoulder & Upper Extremity Conditioning.

Petty, N.J & Moore, A.P. Principles of Neuromusculoskeletal Treatment and Management, Churchill Livingstone, London, 2004.

Santana, J.C. Functional Training: Breaking the Bonds of Traditionalism

Wolf, C. Human Motion: A Pictorial Guide to Functional Integrated Movement Patterns. Human Motion Associates.

Resources:

www.ehlers-danlos.org <http://www.ehlers-danlos.org>

www.hypermobility.org <http://www.hypermobility.org>

www.marfan.org <http://www.marfan.org>

www.marfanssyndrome.net <http://www.marfanssyndrome.net>

www.medicinenet.com/hypermobility_syndrome <http://www.medicinenet.com/hypermobility_syndrome>

http://medlineplus.gov/

www.oif.org <http://www.oif.org> (Osteogenesis Imperfecta)

www.nlm.nih.gov/medlineplus/osteogenesisimperfecta.html <http://www.nlm.nih.gov/medlineplus/osteogenesisimperfecta.html>

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