How to return to exercise after taking a break

Photo by Meiying Ng accessed from upsplash.com, edited by KT 

 (This is me actually setting an example!)...

Last year I suffered from an ongoing hamstring tendionpathy. It took it's time to get better and for the first time in my life I realised I am not invincible 😔 but that's ok! Here is a little sample of how to get back to exercise after taking a rest over the festive period, especially when you have a history of injury. 

Taking a rest
I took 2 weeks off exercise over Xmas because I really needed a proper physical and mental rest. When I was a dancer, many many moons ago now, my teachers always said take 2 weeks of complete physical rest every year. I don't know where this comes from and I wouldn't say this particular criteria applies to everyone but I do it and I really feel the benefits. I get to a place where I have too much energy and I really feel the need to move and expend it. Then I know I've had enough rest and it's time to get going again. 

First workout back
I always want to go running after not exercising for a while. I feel the need to "run out of" my laziness or restful state. However, from my past experiences with tendionpathies last year, I now know, and more importantly have accepted, that this is not a good idea. 

My body needs to be reintroduced to exercise in a gentler way. So I started with  a very modest body weight and Swiss ball workout. 6 exercises, 2 sets. I'd say it was 70% of max intensity. And 60% of my usual volume. Good joint mobilisation warmup and some specific stretching at the end. 

I decided I did not want to feel exhausted at the end of my workout, or to be sore the next day. I just wanted to feel my body in movement again, and to feel ok with taking it easy. 

Getting back to running
I went for my first run outside on Jan 1. I decided instead of running out of my rest state, I'd run into the new year! Usually I would bolt out of the gate and chase down any other runner on the road averaging 7-8k. Instead, I took the advice I give everyone I work with and I paced myself. I ran just 20 minutes, and took a minutes rest every 5 min. I kept a check on how my hamstring was doing. And it's doing just fine! 

Onwards
My plan for the next 2 weeks is to get back to full intensity for my strength training and running a 5k three times per week. 

I hope to achieve this within the next 21 days. I'll increase my total volume first, adding 3 workouts next week, 4 the following and back up to my usual 5 in the third week. 

But the most important thing to state here is that I'll keep checking in to see how my body feels. If I am tired, I'll rest and get more sleep. If I feel I can push myself a bit more then I will. This is an absolutely crucial part of self-management of your health. Listen to your body - it will tell you what it wants to do on any given day. If your body doesn't speak yet, that's ok. I work with many people who have lost the conversation with their own body. You just need a bit of time, and you may need a bit of help tuning back in. 

So if you are getting back to exercise after taking a break, ease into it and listen to your body to get back to your level over a few weeks to reduce the risk of injury for the start of 2017. If you're not sure you have a dialogue with your body and you need a bit of help with that then please do contact me at KT@precisionmovement.co.uk.  

Wishing you all an AMAZING 2017... be the change you want to see. 

Hugs and handstands!
KT

How I choose your exercises & progress you

I have been writing quite a bit about corrective exercise of late.  This blog entry is about an important exercise of corrective exercise called isolation to integration.  It explains more clearly through example the need for corrective exercise, how I use it and progress through exercises to get clients back to fully functional movement.  Read on for a geek out and an inside look into the working mind of KT!....

Isolation

When I first begin working with a client who has poor posture and or pain/injury I often, although not always, break movement right down into pieces.  There are a number of reasons why I do this.  

1.  Ready, aim.... 

The first is often certain muscles will not be firing enough or at all and in complex movements like the squat or a pushup other muscles will have taken the job of the lazy muscles which has caused an imbalance in posture.  In order to get the lazy muscles firing we isolate them so the other now stronger and 'preferred' muscles are less involved.  

2.  Brain training 

This leads to the second point of isolation,  when you create poor patterns where lazy muscles stop working and others take over this creates new movement blueprints that are stored in the brain.  The more you repeat the movement pattern the stronger the blueprint in the brain becomes.  Eventually, this faulty blueprint programme will run automatically.  To override it, we need to break the pattern down and build it back up again.  We often need to start by training the muscles in isolation to achieve this.  

3.  Easing into it 

This brings me neatly onto the third point; because your faulty movement blueprint is so strong, it takes conscious brain power and focussed concentration to retrain the muscles and movements for a new preferred blueprint.  Isolated movements help the brain to adapt more easily and also help you to make progressive change that will minimise frustration.  

Integration

Is it needed?

After all that praise for isolation I am sure you must be thinking there is no place for integration in rehabilitation and corrective exercise.  Not true at all!  Integration is the ultimate goal here and I am keen to get you to integrated functional movement for life and sports safely and effectively as soon as possible.

Integration means using the isolated retrained muscles with other muscles in bigger more challenging complex movements.  This does not mean however, that you jump into what you have been doing before.  You'll need to go through certain progressive stages to successfully achieve higher quality complex movement function.  Some people I work with go through this very quickly, others take longer.  It depends on how body aware you are, how quickly your brain and body adapt and how diligent you are with the exercises you are given.

Progression is an essential part of successful rehabilitation and corrective exercise.  Particularly with injuries and those with chronic pain, muscle tissue needs time to adapt and change.  If you push too hard to fast you'll end up injuring yourself further and it will take longer to rehabilitate and correct posture.

An Example 

A classic example that I work with is a weakness in lateral and rotational hip stabilisers in a squat pattern.  This is a very simple explanation of a common and easy to fix problem, and is often combined with many other imbalances.  For this examples we'll keep it simple.  Please do not attempt these exercises without supervision from an exercise professional.

A very isolated exercise is the side lying wall angel.  This isolates the muscles that rotate the leg out and move the leg sideways.  

Screen Shot 2014-05-01 at 11.50.05

I may then move to integrating that with a hip extension by placing a band around the knees to work the muscles that rotate the leg out and move it sideways as well as the muscles that left the hips up (glutes and hamstrings).  From there I might add more load and range by upgrading it to a swiss ball hip extension with the band.  

Screen Shot 2014-05-01 at 11.55.44

This may lead to a squat pattern again with the band around the knees getting to a more functional pattern of movement.

Screen Shot 2014-05-01 at 11.54.13

In each stage above there are mini phases of development and some individuals may start at a higher level than wall angels.  

The point is these stages allow for retraining of the brain and the body for better movement patterns and alignment which help the healing and recovery of injury and pain, improve function and efficiency of movement, as well as reduce the risk of future injuries.  

I do hope this explanation of one of many of the concepts we use in corrective exercise helps you to understand how we can help you recover from pain and injury better.  If you have any questions or comment please

Contact Me

. 

Looking inside the body for the cause of your pain

MRI

Scans help identify whether structural damage is causing or exacerbating pain.  Personally I think knowing is better than not knowing so I would always go for a scan.  But what scan is best for you?  And what are the pros and cons to scans?  Read on to find out more....

What scans do

A scan can show nothing even though you may be experiencing excruciating pain but it can rule out structural damage so you can begin looking at other factors.  If a scan does show evidence of what is causing your pain this can provide a sense of relief.  It also helps the specialists, therapists and rehab practitioners tailor your recovery plan more effectively.  The important thing to remember is that whatever the scan shows, it is just information.  It is the decisions and actions you take from learning this information that will form your recovery plan.   The most common scans used for back pain are x-rays and MRIs. 

X-rays

An x-ray can tell you if there is anything wrong with your bones.  An x-ray will show up breaks, fractures, bony change like arthritis or bone growths called spurs.  What is can be really useful for in terms of potential causes of back pain is showing loss of disc height.  Structural damage to discs and also ageing can cause the discs to reduce in height.  This results in your vertebrae (bones that make up the spine) sitting closer together.  If the cause of reduced disc height is not known it may be better to opt for an MRI to gain a more comprehensive picture of what is going on.  

Pros:  cost effective, reduced wait time for scan if any

Cons:  restricted information, small dose of radiation

MRI scans 

An MRI scan (magnetic resonance imaging) can show you bones, muscles, connective tissue, nerves, discs, arteries and all other structures in the body.  It takes a series of images at very small slice increments and then puts it all together to create a complete picture.  Often with an MRI scan you get several slices to view which enables consultants to 'look through' structures beyond the surface.  It gives you a comprehensive view of everything in the area of pain.

Pros:  more accurate diagnostic tool 

Cons:  Expensive, often wait list on the NHS but  can go private, closed MRI scanners can be claustrophobic to some so ask for an open top one if available.

Getting an MRI quickly

There is often a wait list for an MRI scan on the NHS.  You can get a scan quickly through private medical insurance but if this is not an option there is an alternative solution.  Vista Diagnostics offer MRI scans from £200 with short notice appointments available.  You could potentially get a scan within a day and results within 2 days of your scan.  For more information visit www.vistadiagnostics.co.uk.  This option could eliminate much anxiety and frustration which can make your condition worse.  It could also mean starting treatment earlier so you can get better faster.  

Results

Whatever can you have make sure you understand the results.  The radiologist who interprets the results of your scan will send you and your specialist a letter explaining what has been found.  Once you know if there is any structural damage you can make a more informed decision about how to proceed with treatment.  If nothing is found that is totally ok - there are many people who suffer with back pain who do not have any structural damage.  Often pain is caused by poor posture, your lifestyle habits, your nutrition choices.  Discuss treatment options with your specialist and ask about manual therapy and corrective exercise as well as alternative forms of pain relief like acupuncture.  

Key points 

The key points to take from this are firstly MRI scans are the more comprehensive scan option and secondly, whatever the scan shows it is just information that will help you make a better decision about your recovery plan.  If you have structural damage like a disc prolapse or stenosis it's ok - you are not going to die!  Many many people have structural damage.  The most important thing is to put a multi-disciplinary recovery and management plan in place.  For more information on back pain and injury recovery and rehabilitation please contact me at KT@precisionmovement.co.uk.

My top 5 reads for chronic back pain sufferers

me with my books

I love sharing knowledge!  Which is why I have compiled a list of my top 5 reads for chronic back pain sufferers.  They are all easy to read and most of them have tips and information you can apply immediately.  If you are suffering from chronic back pain and you really want to know what to do about it and how to handle it then read on.... 

1.   Explain Pain by David S Butler and Lorimer Moseley

A comprehensive information packed book that explains how pain comes about and what it means.  Although it's a little pricey I think it is must read for chronic pain sufferers.  

2.  Painful Yarns by Lorimer Moseley

A wonderfully entertaining book that uses the authors personal anecdotes to explain the mechanisms of pain and about taking responsibility for recovery.  

3.  Treat your own back by Robin Mackenzie

This is a good book for anyone with disc prolapse.  It gives easy to understand advice and information and is a great starting point for approaching recovery.

4.  Sitting on the job by Scott L Donkin

This book is a bible of information if you are a desk bound office worker with back pain or any workplace associated injuries such as carpal tunnel or RSI.  

5.  How to eat, move and be Healthy by Paul Chek

I recommend this book to everyone I meet.  It looks at all areas of your health and wellness and is an integral part of healing nad recovery from any pain or injury.  

How to talk to your GP about your back pain

When you hurt the priority is to make it go away, quickly.  The problem with back pain is it takes a bit of time to settle and usually takes a combined of manual therapy, corrective exercise and optimisation of a few lifestyle factors.  If you are keen to sort out why you’re hurting but are skeptical about how your doctor can help read on for my 5 top tips for speaking to your GP about getting your back pain sorted.  

A GP checks and more often than not rules out urgent, serious and sinister issues and is then the gateway to further treatment options.  Personally, I’ve found that having a plan about what I would like to discuss with my GP before my appointment helps me to get the questions I have answered and also directs the conversation towards what is next in the process.

A whole approach

Back pain often needs a comprehensive approach which may include pain relief, physiotherapy, medical review and possible further investigations. Go in with a mindset of taking a whole approach to getting better.  A whole approach means taking on board all systems of your health and using more than one method to manage your back pain. 

pain medications

You and your GP may agree that you may benefit from taking pain relief. Ask your GP how the pain medication works - I always find if I know how something works I find it works better. Make sure you know the any possible side affects and talk to your doctor about dosage and how long you should take it for. If you are not keen on taking pain medication ask you doctor about alternative forms of pain relief such as acupuncture, heat or massage. Be sure to ask about whether you would benefit from a review with a sports doctor, consultant or physiotherapist.

Be specific

Notice patterns of pain, when the pain occurs, when it gets worse and what makes it get worse.  What makes it get better? Does it ease throughout the day?  All this information helps your GP to make a decision about how best to help you.  

What is the plan

Ask your GP what the plan is and what the next steps are. If you already know how you would like to manage your back pain discuss this with the GP. If a referral is indicated ask who you will be referred to and why.

Imaging

GPs will likely refer to a physiotherapist, sports doctor or consultant for the management of back pain. It is common to start with a course of physiotherapy but sometimes a GP may refer you straight to a consultant or sports doctor. It is at this stage imaging (ultrasound, x-ray, MRi, spect scans) are discussed and potentially ordered. Talk to your GP about whether you need a scan and if not now when it may be an option.  

Please note that a scan can be useful adding more information about your anatomy with respect to your presentation, but it is a snapshot of you when you are still. The body is infinitely more complex.  A scan, if indicated is added to the information about your presentation - it doesn’t supersede it.

Precision Movement’s top 10 tips to reduce back pain at work

sitting oldies

At Precision Movement I see so many clients with back pain who sit at a desk all day for their work.  Back pain, neck, shoulder and hip pain as well as RSI injuries are all very common amoungst those who are seated throughout the working day as the sitting position encourages us to adopt poor posture.  Also maintaining the same position for hours at a time is not good for your health of your back or body.  Here are Precision Movement’s top 10 must have adjustments to your workspace to minimize the risk of discomfort, pain and injury at work.

1. Awareness of alignment 

Slouching and poor sitting habits will contribute to back pain.  The longer you sit badly and pay no attention to your posture the more likely you are to incur discomfort, pain and injury.  Awareness and reminders throughout the day are a great start.  Set your computer screen saver to say SIT UP STRAIGHT or POSTURE PERFECT.  If you are on your phone throughout the day set your home screen with a similar message.

2. Chair/sit to stand desks 

Source a good chair for your work-space that supports your spine and deters you from slouching at work.  I like the range at www.back2.co.uk.  There is a fantastic product on the market that really helps with long periods of sitting – the sit to stand desk.  You can adjust the desk height easily throughout the day to alternate between sitting and standing.  I highly recommend this.

3.  Hand height

If you work at a computer then your forearms should be held at a 75-90 degree angle in relation to your upper arm.  The elbows and wrist can rest on the work surface if you regularly use telephones, calculators and write as this reduces strain through the shoulder and neck area.  For those that are drawing or designing at a drafting table angle the table up so you do not have to lean over your work.  A general rule of thumb is the closer your hands and eyes have to work together for a task the higher the desk height should be.

4. Height of chair 

Your chair height is determined by the height of your desk.  Ideally your knees should be at an angle of 90 degrees or slightly less and the feet should rest comfortably on the ground.  The backrest of your chair should sit right in the middle of your low back area.  The placement of the chair should be such that you do not have to lean over your desk to work or that you feel too cramped.

5. Seat pan 

You should be able to adjust the angle of the seat pan on your chair.  As a general rule if you read and write a lot then tilt your seat pan forwards which helps to maintain healthy spinal curves.  If you mostly sit in front of a computer screen then tilt your seat pan back (up to 5 degrees).  However, if you have a specific injury like a disc prolapse your seat pan position will be unique to you and I would advise taking expert advice – see the end of the article for more advice on this.

6. Foot position

Allow your feet to rest evening on the ground ideally with a 90 degree bend at the knee.  If your feet do not touch the ground when you are sitting in your chair then use a footrest and this should ideally be angled up at 15 degrees.  If you wear high heels I would advise that you work in flats when seated at your desk.  The increase angle through the ankle can lead to injury even when you are not weight bearing.  You can always quickly change into your heels to walk to a meeting although ideally flat shoes are better for you whether you are walking or sitting!

7. Computer screen height 

Set your computer screen height so that it is horizontal with your eyeline.  You definitely do not want to be looking down as this will encourage slumping forwards which strains the shoulder and neck area.

8. Computer screen distance 

The ideal distance between your eyes and the screen is 14-30 inches or 35-75cm.  If you screen is too close it will strain your eyes and if it is too far away it will encourage you to lean forwards thus pulling you out of alignment.

9. Headset  

Use a headset or a hands free kit if you are on the phone for much of the day.  If you are seated at a desk infront of a computer or need to hold documents while you are speaking you are more likely to hold the phone between your ear and shoulder which over time will most certainly lead to discomfort and potential injury.  A headset will enable you to work effectively without compromising your alignment.

10. Getting up through the day

The most important advice I can give you is to get up out of your chair throughout the day.  Not only will your back and body thank you for this but it will allow your mind to rest briefly before returning to the work you are doing.  Make a cup of tea, walk to the water cooler, walk to another floor for a meeting, definitely get out of the office for lunch.  If you can frame your work day with exercise such as cycling to work or hitting the gym even better.

KT at Precision Movement can provide bespoke ergonomic assessments and adjustments to your work space.  KT can also provide advice on ergonomic aids if your workspace is not as adjustable as it can be.  For more information email KT@precisionmovement.co.uk.