When I pulled my calf muscle I didn't think that I would be able run in the Cheltenham Half marathon, thankfully Stuart was able to help me. He provided an accurate injury diagnosis and rehabilitation plan. By following his advice and doing guided rehab in the gym I ran the half marathon and was pleased with my performance. Especially considering I didn't think I would make the start line!
As a rugby player injuries are bound to occur. I should of gone to see Stuart earlier to sort out my knee ligament after I tweaked it in preseason training. He gave me expert treatment and loads of advice so that I was well aware of the time scale of my recovery and what I needed to do. Stuarts support gave me the confidence I needed and I progressed week by week. He made me well aware of supporting my knee and building strength. I built up my training and was back to full contact after 6weeks. I would definitely recommend Stuart and I still do my exercises :)
Sarah and Stuart helped me back to running after an ankle injury and have provided me with the support not only to get back to running, but to take my sports to the next level. Without them there would be no way I would have been able to finish my half ironman triathlon season this year, or run my marathon at the end of it. A brilliant result given I couldn't run 3 miles without my ankle collapsing when I first came to see them.
Sarah and Stu at Straight Back Physio have helped me move from the point where I was regularly picking up muscle tears, to the point where I am fitter, stronger and training better than I have been in years. My injuries have been treated successfully, and more importantly for me, the underlying causes have been found and dealt with - meaning I no longer attract the nickname "Mr Glass" from my refereeing colleagues....
After living with knee pain for 4 years I sought help from Stuart when the pain was beginning to get too much, and stopping me from training for a big ride I had planned. I had been trying to treat my knee myself believing that I would be living with the pain for the rest of my life. Stuart instantly diagnosed the problem and in the first few weeks I made more progress than I had done in the previous 4 years....
Straight Back Physio provide a really friendly and professional service which helped me to make a quicker recovery from my injury. They taught me how to manage my body better to prevent the same injury from reoccurring. Great for ongoing treatment or the odd check up. Sarah and Stu treat everyone as an indiviual and offer what's best for them. Would recommend Straight Back Physio to anyone.
Posted by Stuart Fossella on Tuesday, July 19, 2016
Back Pain & Driving - Our Back Pain Report
Ok, So here is a sorry cautionary tale from me, and it's something that's been spreading like wildfire and can only get worse in the next few weeks.
Last week was the Fossella's now annual pilgrimage to Pembrokeshire, there isn't much better than dedicated family time and no Internet connection, but have you tried to live without any 4G connection or WIFI for a week-nightmare. But makes for good family conversation :-)
So even before we went away we'd seen 3 or 4 cases of Back Pain associated with holidays at Straight Back Physio. We've even treated a SunBed related injury in the past!!
It was the same old story...Travel, sitting, suitcases, uncomfortable beds all leading to Back Pain.
So by the time we'd taken in a service station or 2 (for daddy's toilet break and more coffee - The kids were Sparko in the back, having fallen asleep while watching the same movie for the 100th time). I'd been driving for more than 4 hours. Now I probably don't drive for that long in any given week let alone 1 day-I was setting myself up for some tasty Back Pain.
What’s going on then?
Well…unaccustomed activity can lead to the onset of pain and dysfunction as we stress joints and muscles in ways in which we usually don't in a day to day basis - we have mentioned this in relation to sport in some of our other Blog posts (have a look at some of the other useful bits of info we've created here)
Now you probably won't believe this next statement...but the weather in Wales wasn't exactly brilliant last week - The irony of that is not lost on me as I sit here sweating on the hottest day of the year so far.
The regular downpours of rain led to a fair bit more sitting around, traumatising my back more, and stressing my head having to watch some awful kids DVDs we picked up in a charity shop. When you have done 1 soft play venue, I'm certain that you have done them all (and its really hard to be in there for more than a couple of hours).
This lead me to think about the post we put up a few weeks ago when we said that SITTING was said to be as bad for the health as Smoking - Seems to be a bit of an exaggeration you might think?
Well it certainly can cause an increase in Back Pain, and its one of the most common complaints we find in people who have come for treatment of Back Pain.
But check out this BBC piece to shed a little more light on what's mentioned.
Posted by Stuart Fossella on Thursday, July 14, 2016
Here is a little something for you all. An article by Ben Young Strength and Conditioning Coach based here in Cheltenham - Throwing some light on the way and how you might want to be training...
Coordinating an Effective Training Programme
When implementing & designing a goal orientated training programme, it is important to understand what physical attributes you will need in order for you to be successful.
In Strength & Conditioning circles this would be called a Needs Analysis, the same goes for business with a SWOT Analysis where by you plot your strengths, weaknesses, opportunities and threats.
A Needs Analysis helps you identify which physical capacities should have priority for you to meet the demands of the environment you will participate within.
Extreme polar opposites in running would be Usain Bolt, whilst preparing for his 100m Olympic Gold will undertake vast amounts of strength, power & speed work, which will predominantly all be under anaerobic & maximal effort conditions in order to be explosive and extremely fast over a short period of time.
Whilst a marathon runner will need a vast aerobic capacity, a high lactate threshold, lean muscular strength endurance and economy to ensure they expend as little energy as possible for maximum return.
In court & field sports like Tennis, Basketball & Football you will require varying degrees of agility, speed (acceleration & deceleration), aerobic & anaerobic capacities, power, mobility and a deal of robustness in sports where physical contact can occur.
When you then add into the mix your own physical deficiencies and areas to improve, the resulting list of training priorities can be quite overwhelming.
However, when planning a programme there should be one underlying factor that influences all physical qualities: Coordination.
Coordination is more then just telling your Left from your Right. It’s an innate ability to subconsciously organise, sequence and recruit all the physiological factors required for you to physically move.
From as minute as the muscle fibres contracting & relaxing at the precise moments needed in order for you to move, to the perception-action coupling that occurs when you see a ball and manage to catch it instinctively within one hand without looking at it.
Coordination underpins everything. It also acts as an umbrella for all physical qualities.
The above graphic demonstrates how each physical attribute can influence and contribute to each other.
Power is the result of speed multiplied by force (strength). Strength cannot occur without mobility. Speed cannot occur without power and technical proficiency that agility provides, which also can’t be effective without the appropriate mobility.
All of which will be significantly inhibited by a lack of cohesion.
Where most amateur athletes become unstuck through performance or injury, is how they incorporate all facets with their training programme.
If we consider power, which is a pure form of strength, where maximal muscle fibre recruitment is needed at the required speed to produce an explosive outcome. The intent of a powerful movement is extremely high. This means that the coordination of the Central Nervous System (CNS) and the muscles required needs to be highly effective & efficient.
Strength underpins power. There are three types of muscle fibres in the body that influence your strength, they are; Slow Twitch (ST)(predominantly used in low intensity movements like jogging), Fast Twitch Type 1 (FT1) (predominantly used intermittently in court & field sports where several attributes are need as described previously) & Fast Twitch Type 2 (FT2)(predominantly high explosive sports like 100m sprints & Olympic lifting).
The significance of this is that depending on how intense you train, and thus stimulate the muscles; it will determine which muscle fibres are recruited. The higher the intensity, the more likely you will use either FT1, or if the intensity is maximal you will recruit FT2.
As an amateur runner, whose training solely consists of hard earned miles, without appropriate strength training, you’re body will not be conditioning all muscle fibres sufficiently due to the lack of CNS stimulation & training intensity.
The greater the neural demand of an activity, like sprinting which has a very high intent demand, the more frequently you need to train it in order for it to be effective. If you go longer than 5 days between sprinting/ power based sessions you’re body will detrain.
Where coordination comes in, is that the CNS needs to be able to recruit the appropriate muscle fibres in order to achieve the desired outcome with maximum efficiency, whilst being able to contract through its desired range of motion. If the CNS can’t recruit the muscle fibres necessary to produce the force required, then excess demand will be placed on tendons & muscles fibres that are ill-equipped for the task, the result at best will be a performance decrement or at worse potential risk of injury.
The CNS governs mobility. When you perform a stretch, the CNS will restrict unfamiliar ranges of movements that it does not feel confident it can deal with to protect the muscle. Should this occur through an movement dictated to by momentum, like running, and the forces are too great for the muscles to counter then a musculo-skeletal injury will most likely occur as the CNS fights against the momentum unsuccessfully. Therefore within a training programme mobility should be paramount for reprogramming the CNS to accept ranges of motion that will be required within performance.
The significance of strength training is that you can utilise large compound movements, where multiple muscles & joints are working in unison to achieve a desired task. In one exercise you can address strength, power, speed & mobility.
In Olympic Weightlifting, the athletes are scored on their ability to perform a Clean & Jerk and a Snatch, both skills require the athlete to lift the bar off the floor and raise it above the head. The ultimate goal here is to lift as much weight as possible successfully. As the weight increases so does the intent, as the athlete has to overcome the increased force of inertia. As the weight increases the speed at which the athlete needs to pick up the bar off the floor and pull them selves underneath it in order to successfully catch it increases. This requires significant levels of strength to produce the speed, but also to decelerate the body through the large ranges of motion at the hip whilst the core stabilizes the upper body.
All of this has to occur in less then a second! A prime example of how important coordination is within movement & strength.
Coordination plays an important role in every facet of training. Strength developed through complex compound movements allows for pillars from which the body can rely on as a stable movement pattern. In open environments where movement patterns are unpredictable having fundamental movements that are strong and stable enables the body to adapt & recover more effectively. With this is mind, core stability is essential.
When we assess core function, exercises like the plank and sit up are frequently used & misunderstood, as previously mentioned during Olympic lifting, the core needs to stabilise the body whilst the peripheral limbs move around it. This is known as Anti-Rotation training.
If you were to split your body up into segments, one being your hips, then your abdomen (between hips & ribs) and above that you’re thoracic (bottom of the ribs to the neck). Your core wants to be an anchor allowing both the thoracic & hips to move through all the required ranges of motion needed for skill acquisition.If you’re ability to control the core through rotation is inhibited, then that area will rotate and the thoracic and hips will start to lose their mobility and become stiff. Therefore the coordination to be able to brace the core whilst mobilising the upper & lower parts of the body is imperative to efficient movement in any sport, especially when the exercises are performed in specific environments that they will need to function within (running = upright position). Therefore a static plank, or a sit up does not cross over well to the function of the core whilst running, however, that is not to say they do not play a fundamental role in developing a foundation from which to develop functional stability.
The final considerationwith regards to incorporating coordination into your training is that of variability and thus Motor Learning.
The brain wants to be continuously challenged and will also search out the easiest solution to a problem, which for sports performance isn’t always the most efficient in the grand scheme of things.
Therefore repetition of the same exercises will overtime have a negative affect on performance, especially in varied sports like tennis & rugby where you need to react to an ever-changing environment. This is the true definition of agility, responding subconsciously to the environment with efficiency of speed, control & purpose.
In activities like running, without stimulating the brain, the body will drift into lazy patterns that get the job done with minimal energy cost, but puts too much strain on areas of the body that have the capacity to do more of the work. The Calf & Achilles are fine examples of muscle/tendon that will overwork to compensate for a lack of hip & glute function.
In order to learn the appropriate solutions to solve the problems a varied environment can produce, there also needs to be degrees to variation within you’re training. This can be termed as a constraints led approach, where by you change the dynamics of an exercise to produce a greater neural intent and thus a physiological adaptation to the new challenge.
In running this could be challenging stability on off road terrain or sprinting with a pole above your head to challenge the core, both create external environments that alter the way the body has to coordinate a skill like Gait. In the gym this could be performing lunges & rotating through the thoracic, jumping onto or off different height boxes or leaping over hurdles and turning to land in another direction whilst in the air. An exercise can be developed from being simple to complex depending on the skill level of the athlete and the context in which it is being implemented. All of which will require the body to coordinate all its motor skills to produce a positive outcome.
This is not to say that correct form in exercises like a squat or deadlift should be discarded, only that with a session or programme there always needs to be an element of variation amongst the core exercises to provide a stimulus for the brain to learn and apply its physical ability in varied ways. When learning a new skill, every repetition will have variety within it, not matter how simple the skill is. But at the skill starts to become subconsciously competent this is when a new stimulus needs to be injected.
Therefore, to maximise you’re potential so not to fall into the trap of mundane training, understanding the role coordination plays in everything is essential. It’s therefore always advised to consult a specialised Strength & Conditioning coach on how to optimise you’re training programme to reach you’re goals.
If you want to get hold of Ben to discuss any of the principles he mentions above, seek him out here:
Posted by Sarah Fossella on Saturday, July 02, 2016
Knee Pain in Netball and Prevention
This amazing article on Netball related knee pain and injury prevention was shown to me by a well meaning patient this week.
We treat loads of netball players and know that it's a super popular sport amongst Cheltenham and Gloucestershire. Off the top of my head I can think of more than a handful of previous patients who have been to see us with Knee Injuries picked up in Netball.
I can also think of loads of you who not only play but are umpires or coaches of local teams.
One thing I have definitely noticed among the Netballers out there is how determined you lot are to stay on the court. The amount of times I've had to tape limbs back on is unreal!
And even though I recommend that you lay off the Netball for a few weeks for your own good...I know that you don't listen to that advice very often :-)
It seems to be one of those super popular sports that the older Athlete 26yrs of age + seem to get back into after perhaps leaving it behind in school many years ago.
One of the most devastating knee injuries associated with Netball is Anterior Cruciate Ligament (ACL) damage. We have covered this kind of injury enough times already in previous Blog pieces and they can be found:
In fact the frequency of injury associated with Netball is actually joked about by the esteemed sports medicine doctor Peter Brukner. He suggests that netball was a game "invented by an orthopaedic surgeon", due to the strain it places on the knee.
"Basically that action of quickly running then stopping and pivoting places high amounts of pressure on the anterior cruciate ligament," he said. "Because the players are jumping and landing awkwardly there is quite a high incidence of ACL surgery compared to other sports."
SO WHAT CAN BE DONE TO PREVENT THESE KNEE INJURIES?
Well this great resource developed by The Australian Institute of Sport - The Knee Program goes a long way to assist in the prevention of disastrous knee injuries.