The power of being human in healing & recovery

Photo by Anete Lucina via unsplash.com, edited by KT

In the last month of 2016, I was deeply struck by the death of AA Gill, a "journo giant", who died from cancer. It inspired me to write this article about why being human to each other, and to ourselves, can have a profound affect in healing and recovery and at the very least make an individual feel that they matter, especially when facing terminal illness.

AA Gill's last article, published just one day after his death explained his traumatic and frustrating journey of care from the NHS in the last months of his life. I was struck by how beautifully he narrated his situation. He was denied a life lengthening treatment, immunotherapy, because it is too expensive to get on the NHS. He acknowledged the genuine care towards of the people who work within the NHS towards him, mentioning in particular a nurse who was devastated to learn that his chemo was no longer working. He ended his article by saying,  "you don't get that in the private sector" referring to the humanity and empathy of the nurse.

You can read AA Gill's parting gift to the world here:

http://www.thetimes.co.uk/article/more-life-with-your-kids-more-life-with-your-friends-more-life-spent-on-earth-but-only-if-you-pay-d7lwpht3j

Same same but same

The turn of a new year always makes us a bit more philosophical as we look back at what we have achieved and then look forward to what lies ahead for us. I see countless Facebook posts about 2017 being the year of kindness, of solidarity, peace, togetherness, humanity. I myself posted my new years message, urging people "to be the change you want to see".  New year or mid year, we all want the same thing to feel the humanity of others and to feel that we matter. It's what connects us and it has powerful healing properties.

How to be human 

Above all, whether you work with people or have people in your life who are in pain or recovering or not, the way we can help each other in a daily way is just by being human. Being human to me means being kind. It means holding space for someone when they need you; listening to someone in need of being heard; giving of your time, energy and love. It also means holding space for yourself, listening to yourself and allowing yourself to be quiet, giving back to and loving yourself. I believe the body knows how to heal itself otherwise our species would not have survived this long. It needs the right conditions - physically, mentally and emotionally to help it along. 

Humanity heals

This is relevant in our personal lives, in our work life and particularly in medicine and therapy when you seek help for illness and injury. Being human or what the medical profession often call "bedside manner", can have a profound affect on your perception and ability to recover.  It is really important that you choose therapists and medical practitioners you trust, have a good relationship with and who hold space for you without judgement or ego during your healing and recovery. If you feel you need more "human" than what is being offered do not be afraid to walk away and find therapists who better suit your needs. My new guru, the late Louis Gifford, believed that the human part of therapy and medicine is as important as the healing of tissue, because you, your consciousness, is part of that healing. Your synaptic connections, your thoughts, play a part in what messages get sent from the brain to the tissues. Feeling safe and cared for positively impacts your emotional and mental outlook on recovery.  

Human yourself  

And kindness and humanity doesn't always have to come from others. Being human to yourself is just as important. I firmly believe part of the self-management of your own injury or condition is being kind, loving and compassionate to yourself. So go be more human to yourself and others in 2017 and see what impact it has on your healing and recovery, your life and the lives of those around you.

If you are struggling with an ongoing injury, or have suffered with ongoing pain that just won't go away we can help. Please contact KT at KT@precisionmovement.co.uk for a complimentary phone conversation. 

Wearables - say What-ables?

Can you believe it?  Technology has now reached posture!  Technology now called "wearables" have become accessible to the public.  Consisting of a wearable piece that is linked to an app on your phone it tracks how you sit and stand and transmits a gentle vibration to remind you to sit up straight when you start slouching.  In this article I reveal the most popular wearables for 2016, the upside and the downside of using them and I explain why adopting one position for long periods of time is detrimental to the health and wellness of your body.  Read on to find out more...

The wearables of 2016

Lumolift is a small sensor that you place on your t-shirt at chest level.  It measures the angle of your torso and gently vibrates to remind you to sit up straight if you start slouching.  

ALEX is a wearable neck device that sits around the back of the neck monitoring alignment and sending out a vibration reminder when the wearer begins to slouch.  It is currently crowdfunding through Kickstarter so not available to the public right now.  

The upside

I am all for new technology.  Technology is woven into every part of our life now so it is natural that designers and product developers are thinking up ways to influence health, wellness and now posture.  

I think a positive about wearables is that they provide some sort of consistent reminder of what an individual is trying to achieve - in this case better posture.  When trying to improve posture in sitting, standing and corresponding movement, consistency is absolutely imperative to create change.  We build programmes for movement and posture that are stored in our brain.  The more we use these patterns the stronger they become.  I liken it to drawing a line in the mud with a stick - the more times you do this the deeper the groove in the mud becomes.  When we work on posture or a new movement pattern we cannot overwrite an old programme in the brain we can only build a new one and try to make it the preferred one.  The key to making a movement or posture pattern dominant is to repeatedly use it so it becomes stronger.  In essence a wearable can act as a consistent reminder to make a preferred posture pattern stronger. 

The downside

As a posture and movement specialist sitting and standing better is not just a matter of sitting/standing "up".  The changes in posture that an individual needs to make are as individual as their injuries and or discomfort.  

Everyone I work with here at Precision Movement receives bespoke programmes and bespoke cues for improving and changing posture.  What is really key in sitting and standing posture is the information you give an individual to elicit change.  

Often if you tell someone to sit up straight or stand better they get taller but often lean back.  They hinge from the mid-back and the position of the shoulders and head stay the same in relation to the chest and back.  This is no more correct than slouching forwards and can lead to as many if not more problems in time.  It is also common for an individual to "hold" themselves in a better posture creating a higher resting tension in muscles which is both metabolically inefficient and will lead to muscles becoming overworked, tired and sore.  

Posture and movement are intricate, delicate, and sensitive systems that require subtle, measured changes to achieve optimal joint centration and muscle balance. 

I give my clients a 10 minute audio posture meditation to listen to on their commute to work, during their lunch break or on their commute home to remind them of the cues for better posture.  You can listen to it below or click here to the article I wrote about it. 

Posture isn't static

The body is built for movement.  It is well known and certainly well written about that sitting at a desk is not good for posture.  It is true that sitting creates undesirable postures but stagnancy is equally to blame for poor posture, discomfort and injury.  

Movement helps prevent muscles, joints and connective tissue from stiffening up.  Movement helps pump blood into muscles, it pushes lymphatic fluid out and both provide cells with nutrients and remove toxins.  This also helps reduce discomfort.  

Rather than trying to sustain one good posture all day it is also beneficial to stand up and walk around the office or go out for lunch.  At Precision Movement we often give individuals stretches and mobilisations to do in their chair just to create a bit of movement away from sitting still for long periods.  

The solution

I think wearables could have a place in reminding an individual on a consistent basis to think about a better way to carry themselves.  But (and I rarely ever use the word but), the information given to an individual about how to improve alignment is absolutely crucial to the success of improved posture.  

So in conclusion, the cues that an individual is given to improve posture are the real gold here, the wearable can act as a positive reminder in the early stages of change.  I would recommend anyone wanting to use one to work with a posture specialist and incorporate the wearable in sessions.  I would also recommend a programme of stretches and mobilisations that can be done in an office setting also to encourage movement.  The ultimate goal is to find good posture and movement without the use of external stimulus so an appropriate phase out of the wearable should be considered also.

The 5 benefits of massage treatment (plus FREEBIE!)

Hello!  I'm back.  After a long sabbatical of blogging I've returned to share my insights, new finds and help information to help you all recover from injury effectively and maintain a healthy and enjoyable life through movement and fitness.

As many of your already know I am training to be a soft tissue therapist.  In it's simplest form I can be referred to as a massage therapist but the techniques I am learning also help with soft tissue injury recovery.  Massage is mostly regarded an enjoyable experience that helps you feel more relaxed.  But it has many other important benefits for health, injury recovery and training.  Read onto find out the top 5 benefits of regular massage treatment. 

The flow of fluids  

Massage has a pumping effect on blood circulation which helps transport nutrients for growth, repair and nutrition as well as removing waste products at a cellular level.   Lymph is fluid found in tissues that is not part of blood that holds certain nutrients and also collects waste products from cells.  Unlike the blood, the lymphatic system does not have a pump system.  Lymph is moved through muscle contraction.  However, if you are recovering from injury and unable to contract certain muscles then massage can help push lymph through the body more effectively.  

Body maintenance for regular training

For those of you who train regularly massage is an important maintenance tool for recovery and increased training gains.  When you exercise you create micro-trauma (tears) in muscle fibres.  The body responds by laying down repair tissues (scar tissue) for healing.  This is all perfectly normal.  However, with repeated training sometimes the tissues doesn't get enough time to heal so scar tissue can build up without you noticing until there is a significant impairment in muscle function or pain.  Regular massage therapy can help identify small areas of build up and break them down before they become an issue.  Post-workout massage can increase the rate of healing and recovery which means your body is in the best working condition for your next training session.  

Injury recovery

Massage can be a great contributor to the healing of soft tissue injury.  When muscle fibres are injured the body lays down scar tissue in the first stage of healing.  When the fibres are healed the body clears up the excess scar tissue.  However, sometimes due to a premature return to exercise scar tissue does not fully leave the healed area and then lays down more in response to micro trauma from exercise.  An excessive build up of scar tissue can lead to layers of muscle fibres, which ordinarily glide over each other, sticking together.  This can impair the function of the muscle and surrounding tissues and potentially lead to further injury.  Massage can help break down the scar tissue and adhesions and realign the fibres so the muscle can heal and return to full function.

Localised tissue flexibility

Sometimes rather than a whole muscle, only a portion of the muscle becomes tight.  Stretching the whole muscle cannot reach the portion that really needs to be stretched.  Certain massage techniques can help stretch and release localised tissue and also helps to draw muscle fibres and sheets of muscle fibres and fascia (connective tissue) apart in different directions.  Massage therapists can help identify areas of tightness before they start affecting performance and/or causing discomfort.  

Nervous system

The immediate effects from massage are felt mostly through the nervous system.  The direct affect of massage is that is stimulates nerve receptors in the tissues and reduces tissue tension.  Nerve receptors also respond to touch, warmth and pressure which helps place the body in a parasympathetic state - otherwise known as a state of relaxation, healing and recovery.  It helps decrease blood pressure, mental and emotional tension and encourages digestion.  That is why you feel so good after a massage!  

One stop shop

In fact, massage is beneficial on so many levels that in my opinion it can no longer be seen as a luxury or a treat.  With our busy lifestyles, it is imperative that we stop and take time to relax, heal and recover.  When you book a massage treatment you have no choice but to lie on the couch and be treated.  Even if you don't want to go because you have a million other things you think you should be doing, after your treatment you'll feel like a different person!  For me it's akin to the benefits of meditation or a micro-vacation!

Free massage

As part of my training I am required to log 100 hours of practice treatments.  I hold my free massage clinic on Fridays between 3-7pm in Mayfair.  Treatment is 100% free until I qualify in July.  The only charge is the clinic room hire of £20.  So, if you would like to experience some or all of the benefits of massage email me at KT@precisionmovement.co.uk and we'll get you set up with a date for treatment!  

Is this the best hotel gym space in London?

As many of your know Precision Movement has been making extensive additions and changes to our little Mayfair studio space courtesy of Grosvenor House Apartments.  And though she be little she is (mighty) fierce and versatile.  Here are the new changes to the space and how they optimise your workout.

The rig 

This March we had a custom designed BeaverFit rig installed into the ceiling.  This has been the most anticipated change in the studio since we moved in.  The rig will be used for pullup/chin up and brachiation training. Also check out the fat GRIPZ for extra intensity without extra load.  It has proved super popular so far! 

Suspension Training 

The rig also enables us to use TRx, Crosscore180 and Olympic Rings for suspension and aerial training.  Bring on the strength!  The rig is 3.5m long meaning we can have someone working on the Kinesis, someone working on the TRx and someone in the weight area quite comfortably.

The floorspace 

The matted floorspace has been increased by a third meaning more workable space for people to use and more people using the space at the same time.  It also means the floorspace becomes more versatile - we can bring out a barre for a ballet workout or clear the space for kickboxing or a yoga based work-in.  We have had some guests using the space to practice their karate katas and MMA moves.  We have left the space open for just this purpose because no single person's workout is the same and we want to cater to that as much as possible.

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We now have adjustable weights up to 41kg each alongside the original rack of 1-10kg.  We have a few olympic bars and weight plates for more traditional strength training as well as weighted medicine balls and powerbags.  The original Kinesis cable machine is still installed as well.

 The bring out put back system 

We have lots of different equipment that can be used in the space - kettlebells, powerbags, battling ropes, agility equipment, olympic bars, medicine balls.  We bring out what we need into the space for your specific workout and then put it back to open the space up again.  It sounds really obvious but many gyms, particularly hotel and residence gyms are the same space as our little studio but packed full of machines which limits the type of exercise you can do in the space. Training has moved on past machines... there are some uses for machine work but at Precision Movement we are more steered towards challenging your body in different ways. Which is why we think our space is becoming one of the best hotel gyms in London. 

The space is being used more than it ever has been and it's being used in many ways, for all kinds of movement, workouts and sports conditioning.  If you haven't been down to visit yet, then please do. We'd love to have you! 

How corrective exercise differs from regular exercise

KT at Precision Movement

The number one question I get asked is "Are you a physio?" - unfortunately I cannot lay claim to this esteemed profession!  I am not a physio.  The second question is, "So are you a personal trainer then?".  Again I cannot say I am a Personal Trainer either - well not anymore.  I fall somewhere between the two and work under the grandiose title of "Corrective Exercise Specialist".  This line of conversation invariably leads to a discussion about what type of exercise I do and how it differs from gym training.  I will now humbly attempt to explain in an effort to give you a better understanding of the difference....  Wish me luck!

What is corrective exercise?

Corrective exercise is a special type of exercise usually used as part of the rehabilitation process in healing and recovery from chronic pain, injury or surgery, or given to those who suffer from poor posture.  The emphasis really is on optimal alignment, stability, mobilisation and then strength development.

In comparison regular exercise that you might do in the gym or in sports has a different goal - often increased fitness, body shape change, weight loss etc.  As the goals are different the exercises and movement given are bigger and incorporate more muscles.  This helps co-ordination for sports and is also effective for conditioning the body to change shape and increase fitness.  If I were to give these exercises to someone who is in pain and has poor alignment, poor stability, mobility and strength they would not be able to perform them effectively and could potentially hurt themselves further.

It's important to mention here that corrective exercise also forms a foundation for all movement and exercise.  If your foundational principles are good then your risk of injury is much reduced.  When clients come to Precision Movement with fitness goals we still take them through foundational principles to make sure alignment, stability, and mobility is optimal for more complex movements.

The types of exercises

The majority of exercises I do with clients at the beginning of their programmes are floor or swiss ball based.  I ask them to repeat the repetitions many times to elicit postural change and I also ask them to engage in mindful exercise which includes some psychology techniques.  Corrective exercise rarely makes you sweat and definitely doesn't increase your heart or breathing rate.  It is not easy though!  The areas we stretch are usually tight and stiff and the muscles we train are weak to begin with.  When clients adapt and improve, programmes are updated to challenge them further.  

A classic exercise I teach clients is the horsestance series.  It looks very easy but it is actually quite challenging.  Before clients can do this exercise effectively I'll also teach and often reset their breathing mechanics, help them effectively activate their core and how to activate stability through their hands and feet.  When the exercise is performed correctly it is exceptionally effective in training stability and forms a solid foundation for more complex movements that you would do in the gym or in sports.  

Typical exercises you might see in the gym are squats, lunges, pullups and pushups.  These are all neurologically complex movements meaning the brain needs to send a huge amount of information to the muscular system to perform the movement successfully.  You might use a kettlebell swing which is a dynamic form of a deadlift pattern. Running, martial arts and many other sports are also exceptionally challenging to the body and brain. To perform these exercises and sports well you'll need optimal joint stability, understanding of core function, breathing mechanics, optimal joint mobility and to minimise the risk of injury good alignment throughout the body as well as in the movement.

When does corrective exercise become regular exercise?

At Precision Movement we are specialists in change.  Our goal with everyone is to get them to a fully functional movement state for life and whatever sports they participate in.  

We don't want someone lying on the floor doing a mundane exercise forever.  We may ask someone to do this in an early stage of rehabilitation to get certain muscles firing but when they adapt to the exercise we make it more challenging.  All the exercises we give have many many progressions right up to regular exercise that you'll recognise well.  Perhaps the difference in giving regular exercise at Precision Movement is we might make changes or modifications that are specific to an individuals needs eg.  A static lunge might include a band to emphasise the inclusion of the hip stabilisers that have a tendency to be lazy - they might now be strong but the band acts as a reminder for the individual to maintain good knee alignment.

In a way, we use corrective exercise like servicing a machine.  A machine that has been running for a while might need some parts changed, an oil or water change.  Similarly, we'll do a maintenance check and make sure all the stabilisers are firing correctly and alignment and mobility are good.

For more information on corrective exercise for postural alignment, pain relief and management of injuries and degenerative conditions please contact us.

How corrective exercise can help sciatica

sciatica

Sciatica is the irritation or compression of the sciatic nerve which originates in the lower spine and runs through the buttocks and down the legs.  Although very painful, sciatica is the cause of an underlying issue which I explore here in this article.  I also explain the value of exercise in helping to relieve discomfort and for management of sciatica going forwards.  

Sciatica is the irritation or compression of the sciatic nerve which originates in the lower spine and runs through the buttocks and down the legs.  Symptoms are often pain of varying degrees described as burning or tingling or a sharp stab in and around the buttock and down the legs and can also be accompanied by numbness, tingling, a giving way of the leg or a sense of weakness. Pain may also worsen with sitting and can make walking difficult.

Although sciatica can be debilitatingly painful the pain and irritation of the nerve is a symptom of the underlying cause which could be from a disc bulge or prolapse, disc degeneration, stenosis, spondylolisthesis,  piriformis syndrome and sacro-iliac dysfunction.  Any of these causes can compromise the exit of the nerve from the spine and compress it causing pain.  

The symptoms versus the cause 

The point I would like to emphasise here is the underlying cause - if we can get to the root of the problem and manage it effectively the symptoms of sciatica will go away.

Often sciatica is caused by a structure like a disc pushing on a nerve.  It is true you cannot fix structural damage but you can improve alignment, stability and strength of the surrounding area.  Malaglined discs are often associated with poor posture or weakness of the surrounding muscles.  Without wanting to complicate things further, an initial problem starting elsewhere in the body can cause the spine to adapt and change thus leading to sciatica.  Ideally when treating an injury or chronic pain the body should be observed as a whole.  

Exercise is essential

This is where exercise becomes invaluable as part of a long term recovery plan for sciatica sufferers because corrective exercise can help realign poor posture and strengthen weak muscles.    

Stretching can ease off localised tension that a muscle takes on when the nerve begins to hurt.  Exercise helps to strengthen weak areas of the spine, core and pelvis.  This in turn can improve alignment of the spine and reduce the pressure on the nerves.  As posture improves and the individual becomes stronger the chances of reoccurrence are reduced.

John Medina explains in his book Brain Rules how exercise also helps to increase the growth of new blood vessels throughout the body to get  deeper access into the tissues.  This helps the tissues dispose of toxic waste that builds up in and around an injury and areas of pain.  The more you exercise, the more tissues you can reach and the more toxic waste you can get rid of.  Exercise actually physically aids your recovery.  

What exercise can I do?

It is common to give stretches for sciatica because the affected muscles and the sciatic nerve itself can be stretched and this provides a certain amount of short term relief.  sciatic stretches alone are usually not enough to make a long term change to symptoms.  They are, however, a valuable inclusion in a bespoke series of exercises given to an individual.  Stretching and mobilisation of the fascia (connective tissues) and nerve flossing techniques are also common inclusions for sciatica exercise programmes. 

Exercise for sciatica is focussed around relieving discomfort and realigning, stabilising and strengthening areas of weakness as well as opening up areas of tightness that are contributing to poor alignment.  Finding out what the underlying causes are is imperative as it determines what exercise is needed.  Exercises given for disc related issues are almost the opposite for stenosis and spondylitis.  Ideally exercise should be bespoke to the postural needs of each individual.

What can I do now?

Ideally seek out a specialist in corrective rehabilitative exercise who can assess your  whole body postural alignment.  It is increasingly common to hear and see of patients doing their exercises poorly or completely wrong which can make symptoms worse.  It is imperative to do your exercises with good form and it is advisable to do them under the observation of a corrective exercise specialist like we have here at Precision Movement.  This is mainly because your body will have a preferred way (poor alignment way) of doing movement and with each repetition you do you'll need to remember and apply newly learned alignment to make desired changes.  From personal experience of this in my practice, for the first 3-4 weeks each repetition of movement requires a correction of alignment from me to the client until they start to learn new patterns of movement and create programmes in the brain for the new alignment.  

The back bone of life

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Last week I was asked to speak at the L Club in on Sloane Street about the importance of the spine for health throughout life.  I thought I would share with you what I shared with the audience of the L Club how your spine develops, what injuries it is most vulnerable to at certain parts during your life and how you can minimise the risk of injury as you age.  If you are tempted to just read what it says under your current age bracket this would be foolish.  Remember what you have done in the past and what you do now will all influence how the spine will respond in later years. Read on to find out more....

0-3 years 

When we are born our spines are curved like a shell.  In the first 2 years up to when we walk we go through huge amounts of development and change in the spine.  We learn how to move it and stabilise it and to sit up, crawl and walk the spine changes alignment.  As we grow our spines take on three curves - cervical, thoracic and lumbar and these curves are responsible for maintaining good posture, keeping our intervertebral discs in place and providing shock absorption.  This is one of the most important developmental stages of our lives and we should never underestimate the value of babies learning to move efficiently and effectively.  The movements and postures that babies learn here serve them for the rest of their lives which means if faulty movements are developed it will affect movement, co-ordination, posture and strength development in later years.

3-21 years

This is the time when we should move and learn sports.  Jumping around and pounding on our bones is the best way to make them dense and strong coupled with a good intake of calcium from leafy greens and vitamin D from the sun as well as good overall nutrition.  Any weight bearing sports are good for bone density development (swimming is a non-weight bearing sport).  Intense learning of sports is not recommended until age 7.  Ideally children should try out lots of different activities.  At age 7 if children show an interest in a particular sport they have enough neural development to learn more intensely.  Children should not lift heavy weights as it can stunt growth.  

21-30 years 

When we get to 21 we have fully grown but we can still increase our bone density.  Bone density is exceptionally important for the prevention of osteoporosis.  Between 30-35 our bones begin ageing and it is no longer possible to increase our bone density - we can only slow the rate of decline.  This is effectively done by weight bearing exercise such as strength training.  The discs between your vertebrae have fluid and a jelly like substance inside which acts as part of the shock absorption I mentioned earlier.  At at 30 our bones cannot get any denser.  From here our bones go through a process of becoming less dense.  

30-45 years 

This is the time when the spine is most vulnerable to disc injuries.  Mostly because of our lifestyles - too much sitting and not enough movement.  Up to age 45 the discs are refilled with fluid each night as part of the recovery process when we sleep.  This is why you are taller in the morning and shorter at night!  One of the reasons why disc injuries happen between 30-45 years is because of years of 'ligamentous creep' the connective tissues in the spine stretching over time to accommodate poor posture.  Ligaments are the strongest structures in our bodies connecting bone to bone and they give our skeleton stability.  Once ligaments are stretched they do not go back to their original length.  Over time, years of time, it makes the spine unstable and then the discs become vulnerable to pressing out on to the nerves.  

45-55 years 

Past 45 the discs begin to dry up and the spine becomes stiffer.  This actually has an advantage as the discs are less prone to pushing out against the nerves because they are less plump.  However, less fluid in the discs means loss of disc height.  Firstly, you lose height which is not so bad.  Secondly, your vertebrae are much closer together so the ligaments become lax and can create instability.  This hinders movement, particularly rotation, and can also lead to bone spurs and stenosis.  

55 onwards 

Depending on what you have done or not done with your body you may experience some pain or injury in your spine as you age - common but not normal issues are osteoporosis, arthritis, spondylitis, ankylosing spondylitis and postural imbalance.  What I always find interesting is that most people as they age will have some sort of disc degeneration but not all suffer with pain from it.  The key here is movement - the more active you are the less likely you are to feel pain.  

The most important point here is what you can do to minimise the risk of injuries and diseases when you are older.  Once you have these issues they can be managed but they are not reversible.

If you want to know more about minimising the risk of spinal complications when you are older or maybe you have a spinal injury that you'd like to know how to manage better then contact me at 

KT@precisionmovement.co.uk

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Does having a strong core relieve low back pain?

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Well the obvious answer is yes having a strong core contributes to the relief of low back pain.  The bigger questions here are what is the definition of 'the core'?  What muscles is the core made up of?  Is it only abdominal work I need to do?  The answer to this question is a resounding NO!  How do I activate 'the core'?  How do I move successfully whilst keeping my core activated?  If you would like to know the answers to these questions then read on.....

What is the core?

Unfortunately it is mostly referred to as the abdominal region and this is a classic example of how a little information can cause more harm.  Think of the anatomy of the core - the centre of your body -  it is a cylinder.  It has an anterior wall, the abdominals, but it also has sides, a back, a base and a lid.

Just like a house if you only re-inforce the front wall you will create imbalance in the house and the un-inforced parts will weaken and crumble.  If you only train the abdominals you will create an imbalance between the front and back of the body.  The abdominals will get stronger and the back muscles will get weaker.  the pull on the bones from the abdominals and the lack of counteraction from the back muscles will cause a more flat back and a posterior rotated pelvis.  For those with disc injuries this is just about the worst thing you can do because the discs are at even greater risk of coming out, irritating the nerve and causing you great discomfort.

The mechanics 

Activating your core is not as simple as contracting a few muscles.  The diaphragm acts as the lid of your core cylinder as well as playing a major role in respiration.  Your breathing is very much involved in optimal core activation.  If you have faulty breathing mechanics and/or the alignment of your ribcage and pelvis is out this affects the role of the diaphragm in core activation.  Ultimately successful and useful core activation is a blend of alignment, good breathing mechanics and the understanding of how to activate ALL the muscles that make up the core.

Gently does it

Activating your core for support is actually very gentle - about 10-15% of a maximal contraction.  If you contract to hard you'll do what is called a brace.  This is not bad and in some cases is necessary such as in ultra heavy lifting but what happens to the cylinder is it becomes rigid and immovable.  The point of activating the core for support is so you can move freely without restriction.  If you are going red or cannot breathe when activating your core you are contracting too hard.

Intra-related - it's complicated

There is no use thinking I'll train all those component parts separately.  In order to provide optimal support for your spine all these muscles need to work together.  You have to train the brain to switch on these muscles like a conductor begins an orchestra together.  If the firing order is out it will sound like a badly rehearsed concerto.

All together now

Once you have the component parts working in harmony then you must teach your body to move with this new core support system working.  At first it will be a conscious effort but over time it will become automatic.  This enables you to move effectively for life, for fitness, for your sport and with the correct support so you can move without pain and minimise the risk of injuring yourself further.  

So now you know that your core is more than just the abdominals I would recommend seeking out a specialist who can teach you correct alignment of the ribcage and pelvis, correct breathing technique and correct core activation to support your spine.  A good indication of a specialist in this field is one that can explain the mechanics and teach you the application simply and effectively.  

If you would like to know more about core activation and how it can help support your back and other joints effectively for movement contact me at KT@precisionmovement.co.uk.

5 common desk bound injuries and how to avoid them

ipad user slouching

The office environment does not lend itself to an optimal pain free and posturally aligned existence.  Our postural alignment is often the last thing we think about until we begin to experience pain.  Here are the 5 most common aches and injuries from a desk bound environment and how to avoid them.

RSI - Repetitive Strain Injuries 

This is an umbrella term given to a collection of upper limb injuries including thoracic outlet syndrome, double crush syndrome, carpal tunnel syndrome, golfers elbow, tennis elbow.....  These injuries mostly start in the neck and shoulder area and commonly come from postural misalignment.

How to avoid it 

Try to avoid typing for long periods of time - take a break for a few minutes every half hour or so.  If you have a smart phone with voice activation then use it to give your hands, fingers and wrists a break.  Take time off your phone and tablet by reading a newspaper or a book or listening to music.   

Low back pain

This is probably the most common complaint of all desk bound workers.  Back pain can occur for many different reasons and your office environment can contribute and exacerbate it.  The most common cause of back pain is slouching in your chair and then sustaining postures for long periods that encourage certain structures to be stressed more than others.

How it avoid it

Sitting for long periods is not great for your back.  Make sure you move frequently throughout the day.  Get out of the office for lunch, walk to the water cooler, take a few flights of stairs up or down between floors, get out a tube station early and walk the remaining distance to your office.  If you can exercise before or after work or even during your lunch break.  Without fail get your workspace assessed by an ergonomics specialist - insist on one from your company.  

Upper mid back pain 

Another common compliant especially from writers, architects, artists and anyone who hunches over their desk.  Mid thoracic aches and pains often come from an imbalance between the muscles in the front of the shoulder and chest area being too tight and the upper back muscles being too weak.  A common occurrence is a strained feeling which comes from the back muscles being stretched but at the same time contracting to stop you from collapsing over your desk.  It is call tautness - the muscles are weak and tight at the same time from being over worked.  

How to avoid it

Work on your upper back alignment - do not hunch over your desk.  If you are writing and reading or drawing a lot then invest in an architects desk that you can tilt to an appropriate angle for your work.  Invest in a few sessions with someone who can teach you upper back exercises and stretches for postural alignment that you can do daily to strengthen your upper back.

Neck pain 

Neck pain is exceptionally common especially these days with the use of smart phones and tablets that we look down to use.  Even at your desk you are inclined to crane your head forwards towards the computer screen in front of you.  This puts incredible strain on the neck and can cause injuries such as a cervical disc prolapse.   

How to avoid it

Mobilise your neck throughout the day with head rolls and shoulder rolls.  If you have a chair with a head support consciously press your head back into the support whilst you work.  Make sure your chair alignment is assessed by an ergonomics specialist.  This will help correct the alignment of your head and neck as you work.  Do not place the phone between your ear and your head - use your loud speaker or invest in a head set.  Use a stand for your tablet if you are working at your desk to avoid hunching over it.  

Shoulder pain 

Shoulder pain can come from excessive use of smart phones and even typing on your keyboard.  Mostly pain will come from misalignment and if often associated with neck and mid thoracic issues.  Shoulders are vulnerable joints so seek out help with postural alignment.

How to avoid it 

Mobilise your neck throughout the day with head rolls and shoulder rolls.  Make sure your workspace is optimally aligned for your arms and shoulders.  Take a rest from your smart phone - some phones now have voice activation so you can give your hands and arms a rest from the constant furious typing.  Find a corrective exercise specialist or a rehab specialist to help you with your shoulder alignment.

General advice 

If your pain does not resolve itself within 7-10 days and if it gets continually worse then seek treatment from a physiotherapist or osteopath.  Early treatment often results in a quick recovery.  It is tempting to ignore aches and pains until they become unbearable - the longer you leave something the longer it will take to recover.  If you would like more information on how to resolve a desk bound injury please email me at

KT@precisionmovement.co.uk

.  

How to avoid the 5 common causes of back pain

old lady stretching

One of the number one questions I get asked is how to I avoid back pain?   Nearly all of us will experience back pain at some point in our lives.  But how wonderful would it be to minimise the risk of getting back pain?  Read on to find out how.....

1.  Stress

We all know too much negative stress is bad for us and some of you may know that it affects us physically.  Stress is part of our lives and it helps us achieve success and conjure bravery when we need to step up to the plate.  You have a stress threshold - a line that once crossed begins to compromise your immune system.  It slows your recovery and healing rate so normal repairs that should occur result in tissues getting left and more damaged.  This can be as small as an ulcer or a big as your back pain.  The best source of information I can give to you is about your perception of stress and I cannot say it better than Health Psychologist Kelly McGonigal in her recent TED talk.  It's 8 minutes and a revelation you will not want to miss out on. 

2.  Lack of movement

You are designed to move.  Sustained poor posture is a major cause of back pain and structural damage.  Make sure you move throughout the day.  If you are desk bound, walk around the office, take the stairs for a few flights, leave for a lunch break.  In the recent article "The making of a corporate athlete" by performance psychologists Jim Loehr and Tony Schwartz that was published in the Harvard Business Review it is recommended that every person does at least 2 strength training workouts a week for endurance and to promote mental and emotional recovery.  

3.  Poor posture

Sit, stand and walk tall.  If you are exercising, exercise tall.  Another major contributor to back pain is poor posture.  If you already have back pain then poor posture will make it worse!  You may be blissfully unaware that your posture is bad but if you are currently pain free it is well worth investing the time and effort to work on your posture to minimise the risk of injuries occurring.  In this day and age, with the mountain of information and specialists to help you there is no excuse for poor posture.  Seek help.

4.  Repetitive faulty movement patterns

This is an extension of poor posture but relates more to exercising with poor form.  I have seen so many clients walk through my door who hit the gym 5 days a week but when I assess their movement patterns it is clear they do not have good technique and their movement patterns are contributing to their pain.  If you are working out in the gym and have not had any guidance at all in the past 6 months then ask a professional to look over your technique.  

5.  Poor nutritional intake

Your nutrients for every day micro damage to your body come from food.  Food provides you with the building blocks for repair, to create new cells, to strengthen your muscles, to strengthen your bones and connective tissue.  It is imperative that you take care of your nutrition and nourish your body it is as much a part of minimising the risk of injury as movement is.  

For more information on exercise for the prevention of injury and for back pain and injury recovery please email me at 

KT@precisionmovement.co.uk

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.

Featured Expert: Helen Skehan RSI physiotherapist

manual therapy

Helen Skehan specialises in the treatment of RSI (repetitive strain injuries).  She is the owner of

Physio Solutions

clinic in Islington, a clinic that she built herself over 16 years, houses 9 therapists and also offers massage and ergonomic assessments in the work place.  

KT:  Helen, what is RSI?

HS:  RSI stands for repetitive strain injury.  It is a term given to work related non-specific upper limb injuries and does not always mean the injury has come from repetition or is a strain.  Patients present with a number of symptoms that may not always be the same from person to person.  

KT:  What symptoms are common with RSI?

HS:  I test for many things - often clients present with varied pain in the neck, shoulder and arm, tingling ,numbness, temperature changes, swelling.  I look for specific tightness, muscular imbalance and postural misalignment.  I may also send clients to be tested by a rheumatologist to eliminate other underlying conditions.

KT:  How does RSI develop?

There are many different ways RSI can develop.  It is often a combination of a poor workstation, poor posture, lack of exercise (although not always sometimes I see patients who are real gym bunnies),not taking enough breaks at work, high stress, lots of typing and ignoring initial symptoms.  

KT:  How does stress play a part in the development of RSI? 

I would say stress exacerbates symptoms.  Mechanically, stressed induces increased muscle tension in the neck and shoulders where the nerves exit the spine and pass through the shoulder joint down the arm.    Also, breathing rate increases and during stressful times we tend to adopt a upper chest lead breathing pattern which utilises the accessory respiratory muscles surrounding the neck and shoulders.  The nerves are supposed to glide through neighbouring structures but if the muscles are contracted it can squeeze the nerves causing pain, numbness and tingling.

KT:  What is your opinion on exercise for RSI?  Does it create more strain or can it help?

HS:  I always try to get my patients to engage in some form of stretching, mobilization and exercises.  There is always a role for graded exercise in the recovery of RSI.  It is important to go by a tolerance factor - the patient should not work into areas of pain.  

KT:  What affect does posture have on the development of RSI?

HS:  Sustained postures for long periods in poor alignment are definitely not healthy and can contribute to RSI.   Typically patients that have RSI injuries have a rounded upper back, a forward head carriage and their shoulders are rotated inwards.  It is very common to find neck an shoulder stiffness as well as a lack of mobility in the upper back.  Some patients can suffer from headaches.  Even more distally you find that patients often have hamstring and calf tightness. 

KT:  What impact does modern technology like smart phones and portable laptops and tablets have on the recovery of RSI?

HS:  All these devices encourage a poor posture as you tend to look down at the device you are using.  People tend to overuse their smart phones which stresses the fingers, wrists, hands and forearms.  With tablets and laptops they can be heavy to carry around and we tend to look down when we use them which strains the upper back and neck.  

KT:  What advice can you give to people using smart phones and tablets for work?

HS:  Modern technology is improving all the time.  For smart phones you can use the voice activation system to cut down on your typing time.  Try to avoid using your phone and tablet when you travel on the tube and bus to give your hands and arms a rest.  At work place a tablet on a stand or a removable keyboard.  For laptops and desktop computers invest in an ergonomic mouse or a roller mouse that sits at the front of your keyboard. 

KT:  What are the early symptoms of RSI?

Any hand symptoms that are related to desk work including pain, muscle cramps, tingling, numbness, swelling or feeling of swelling and restricted movement.  Also be aware of any of these symptoms in the shoulder and neck area even repeated small episodes.  We should be able to function without pain.  I would recommend diarising your symptoms and check over a period of time whether the symptoms remain or get worse.  If in 10-14 days the symptoms are still there then seek treatment.  

KT:  What other advice would you give to those suffering with RSI?

HS:  For those with mild symptoms I would advise regular movement that is based on improving postural alignment and mobilising the upper back.  Backstroke can be helpful and calming to some.  Avoid cycling as the posture can encourage symptoms to get worse.  RSI is an injury that develops over time and through the continual use of bad habits.  The most important thing is educating yourself on how to minimise the risk of injury and taking responsibility for your health and wellness at work.  

For more information please visit the website at 

physiosolutions.co.uk

 or to make a booking with Helen please contact her clinic, Physio Solutions, on

0207 713 7780

.  For more information on how exercise can help you recover from RSI injury please contact me at

KT@precisionmovement.co.uk

.

What exercises can I do for back pain?

DSC_3564

I love this question!  It is something I get asked when I am out socially and people discover I work with back pain and injuries.  The truth is no one set of exercises fits all back pain problems.  In fact, every person I see in my practice is so completely different it never ceases to amaze me.  For instance someone with a disc prolapse may really benefit from a back extension mobilization and stretch.  If I give the same stretch to someone with stenosis (bone spurs) it will push on the already smaller spaces where the nerves exit the spine and aggravate their condition.  It gets more complex when I have someone who has both of these conditions or multiple spine issues.  Believe me there is no one size fits all.  Here are some golden rules about exercise that apply to most all back pain sufferers.....

1.  MOVE!!!

If there is one thing you take away from this article please make it the importance of movement.  Every day moving around trumps sitting or lying still every time.  The key to movement for relief of pain, especially when it is very sore, is to do it gently.  If you are desk bound at work get up and walk around, take the stairs for a few floors, get out for lunch, walk to the water cooler.   Walking can often provide a sense of relief (however if it makes it worse and sitting relieves it then take a rest periodically).  Things to avoid are heavy lifting and too much bending over to pick things up off the floor.  

2.  Specific back mobilizations

I recommend my clients do gentle back specific mobilizations upon waking daily to ease the back into the day.  If you suffer from stiffness upon waking these mobilizations can be very effective at reducing your pain in less time.  Ideally you should have someone show you how to do mobilizations that are specific to your back problem.  However, you can download your copy of the

Precision Movement Daily Mobilizations

that I give my clients

here

. Be sure to read the instructions carefully - small and gentle is key!  

3.  Corrective exercise for postural alignment and stability

Here lies the key to getting your back pain sorted.  Corrective exercise focusses on your alignment, stability and core activation and moves your through stages of development from small isolating exercises right up to functional often loaded movement.  This is where you can get mobilizations, stretches and exercise tailored to your specific condition.  At Precision Movement I always give programmes for the relief of pain when your back is sore, daily home programmes, a set of stretches to do at your desk, and a programme for the gym as required.   

4.  The Gym

If you are suffering from intense back pain avoid lifting heavy weights.  Weights create axial (vertical downward) loading on your spine and if you are already in discomfort the worst thing you can do is increase the pressure on areas of discomfort.  You could seriously hurt yourself.  Do not use machines as a substitute either.  Machines isolate and stress your big muscles without using the stabilizers around the joints.  If your back is sore the last thing you want to do is make it more unstable or have the larger muscles pulling on it.  It would be better to do some gentle yoga or pilates work being mindful of your postural alignment and core activation until your back settles.  If you are a regular gym user make sure you have a professional with rehabilitation experience look over what you are doing.

5.  Running, biking, rowing and cross trainer cardio machines 

If you would like to do some cardio work the key to not aggravating your back is to change it up.  Sustained positions can be aggravating for the back.  When your back is sore avoid jumping and running as a greater amount of load is placed through the spine and this can be jarring to the back.  Cycling and cross trainer are gentler options for cardio and can be alternated.  For the bike make sure you are sitting properly and have a professional check your position before you begin.  I would avoid rowing when your back is bad especially if you have any disc prolapses and proceed with caution under supervision.  

For more information about how corrective exercise can help your specific back pain or injury contact KT at 

KT@precisionmovement.co.uk

.  Download my eBook '7 steps to getting your back pain sorted' - the link is on the right hand side (just scroll up a bit!).  

The core killer that negates a killer core

teddy in casts

I recently saw a man working out at my Mayfair studio who was wearing a back brace.  I asked him what it was for and he proceeded to tell me that he had terrible back pain and was advised to exercise with a sturdy back support.  If there is one thing that I find contradictory, it's wearing a brace that stops movement so that you can exercise/move in the gym.    If you want to make your back pain worse then wearing a back brace or support is the quickest way to do it and here's why....

Casting is for breaks

Have you ever broken any bones?  Last year I worked with a lady who broke her ankle.  She was in a cast for 6 weeks and a boot for another 6 weeks.  When she started her rehabilitation with me the difference in the musculature from left to right was incredible.  It looked like she had two separate legs!  You see the body is mighty clever.  If you are not using muscles they atrophy (shrink).  A similar phenomenon happens to astronauts when they go into space for long periods.  Because there is no gravity their bones become less dense.  The good news is that when there is an increased need for muscle the body responds and adapts to the stresses it is put under.  

This is why I am so adamantly against back braces for back pain.  If you have back pain from disc prolapses, spinal stenosis, disc degeneration, or non-specific back pain back braces are really not going to help you in the long term.  I am not saying do not wear one but I would like to educate you on what they do to the body so you can make a more informed decision about wearing one.

The off button

Effectively, just like a cast, a back brace will cause muscles to switch off.  One of the first things you learn when you start corrective exercise is how to activate the core.  Core activation is absolutely essential to the support of the spine and surrounding structures.  Switching off these muscles is just asking for trouble.  You cannot rely on a brace to give you the support you need - that is the job of your muscles and connective tissues!  If you stop conditioning the muscles under controlled conditions with gradual development you will leave your back even further unsupported and at risk of further injury.

Restricted movement

The point of exercising is to move.  Wearing a brace can result in muscles getting tighter as they are not able to move through a full range.  This will create further imbalance as certain muscles will become tighter and others will overwork to compensate further pulling you out of alignment and causing more stress on your back.  

Faulty messaging

If you are wearing something that restricts movement and causes muscles to switch off you will effectively change messages to your brain and alter movement patterns.  The brain responds to the movement patterns you put it through and with repetition it creates a blueprint that is stored for future use.  It means we do not have to learn a movement every time we come to do it.  However, if you change the variables for instance by putting a brace on, the brain will change it's blueprint accordingly.  When you take the brace off and go through daily movements, the brain will use the newly formed blueprints with restricted range of motion and less muscle activation.  This leaves you even more vulnerable to injuring yourself further.

What to do

You body has its own brace system - your core.  The great thing about the core is you don't have to put it on every day - it is always with you.  If you do not know how to activate it then seek out help from a corrective exercise specialist.  To find out more about your core read my article "Does having a strong core relieve low back pain?"  Equally important is your postural alignment.  If movement is not your specialist area then chances are you won't know if you have poor posture or to what extent your posture is affecting your back pain.  Optimal alignment, core activation and gradual progressive corrective exercise are the keys to getting your back pain under control.  There are no quick fixes.

If you are currently wearing a brace and would like to explore another option for improving your back pain then 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.