Thursday 6 November 2014

Surgery or therapy!

I am often appalled at how quickly people opt for surgery. Surgeons do a great job they save lives and they make lives bearable however it's important to remember that they have been trained to do a particular job and that makes them good at that job and only that job. To use an old fashioned analogy...If  you take a problem to a joiner he'll tackle it with hammer and screwdriver a mechanic will tackle it with a wrench a tailor will reach for needle and thread. The surgeon is not different. The skill and indeed the difficulty for the person with the ailment is knowing which tradesperson to go to with your issue.

Surgery is deeply invasive and traumatic,  A surgical intervention may fix the problem but it does so by damaging the body and then relies on the healing capacity of that body. More damage trauma and healing might seem a bit counter-intuitive as a method of counteracting damage and trauma and healing. 

Our bodies are self healing and we are so good at healing and adapting that this ability is what causes many of our ailments.  Inflammation is one of the bodies healing mechanisms and it causes illnesses that include allergies, arthritis, Alzheimer's, Crohn's diseaseMultiple Sclerosis and oh so many more. Cancer is an over development of the cell division that is supposed to repair us. Arterioscloros that is responsible for heart disease and stroke is another failed attempt at healing. Physically our bodies adapt very quickly to injury, e.g. we soon learn to hobble very effectively if we have a damaged foot but all the other structural stresses caused by that adaptation may lead to many other pains. 

It makes sense to give our own healing system a bit of support and a decent chance at doing what it was designed for.
I see bodies as supercharged healing machines that sometimes just need a push in the right direction. Therapists offering structural re-balancing techniques, natural medicines, nutritional support or personal development techniques are all part of the support team. That team often only get called for help when the effect of the surgery is as bad as the original complaint, making their job harder.

Thursday 2 October 2014

Broken not Injured

I feel that it is important to point out that there is a difference between broken and injured, at least to me, from a clinical point of view.

When someone falls over a root, they get injured, when another player bangs into them during a game, they get injured. When someone trains foolishly and become imbalanced and their body stops functioning properly, they get broken!

There are a lot of good (and some not so good) qualified people out there to give advice. There are industry standards and guidelines on all kinds of sport and strength and conditioning techniques. These qualifications and guidelines provide an assurance of good form and good technique they are not senseless job creation or a way of getting money from you.

I see too many broken people who have taken themselves on a get fit campaign with too little research and poor technique, they have started in the wrong place and ended up broken. I also see those who have gone a long with advice from a coach or teacher who is not qualified in that specific field, this can result in long term and chronic injury.

Invest in yourself by using the professionals, you'll learn a lot about your body that will last a lifetime.

Thursday 18 September 2014

Low back pain and movement- I did something most doctors would not recommend,

I WANTED TO SHARE THIS WITH YOU. It’s from a Facebook page that I often interact with.

As I was doing my best to keep up with the Dangerous Brothers as they pegged it to school on their scooters this morning I found the harder I walked (in my trusty Reef flip flops - accept no substitute!) the more Pounds PSI I was putting on my heel. This was because - duh - I was lengthening my stride and heel striking. Normally in those shoes things that I sometimes have to wear you don't really notice this, but now, with my injury, it's screamingly obvious. All the pressure is shooting up my straight leg and into the base of my spine. How could I remedy this? I did something most doctors would not recommend, I shortened my stride and started (VERY DELICATELY) to 'run'. Landing on my forefoot and just allowing my heel to 'kiss' the pavement - and guess what? no. pain. at. all. Then I stopped cuz I was scared I'd screw myself up again. Something to think about though, it showed me that when your body is very receptive to pain, you notice what you're doing wrong and how you can maybe help things along. Anyway, I would NEVER recommend people start running when they're injured but it certainly highlighted a few things for me.

Thank you to TH for your observations.

I tell people this all the time. Shorten the stride, take off the heel, wear something that lets you feel the ground and you'll move differently and reduce impact. It’s not rocket science..natural movement is better because it’s easier - it’s what the design intended!!!!!!!

Wednesday 4 June 2014

Plantar fasciitis....confusion

Plantar Fasciitis is a frustrating ailment to be troubled with. There is no quick fix and it takes ages to heal.

Plantar Fasciitis is simply swollen, damaged and stressed tendon

Muscle injuries heal relatively quickly. There is a good blood and lymph supply to the muscles and the body has a mechanism for building a quick temporary repair and the getting the details perfected later. But with tendons the process is much slower.

The body has a 2 phase healing system, quick fix then full repair. This is a bit like putting a board over a broken window. It might not be perfect but it keeps out the elements, keeps in the heat and keeps out intruders until a glazier can replace the window. However tendons - particularly plantar fasciitis - are more comparable with cracks appearing in the walls of your house. You can keep injecting them with fillers and you can keep filling the plaster and redecorating but ultimately, if the foundations have gone wrong then, you need to attend to that if you want the cracks to stop appearing.

Clients come to me confused having had conflicting advice from different health professionals.

Normally one of the following:

1. Giving the foot more support, thereby reducing the stress - a technique often prescribed by podiatrists.

2. Injecting the foot with hydrocortisone to remove the inflammation - a technique often prescribed by doctors.

3. Reducing activity levels/rest then slowly increasing exercise - doctors and physios often go for this

4. Massaging the calf and foot to reduce tension on the plantar fascia - massage therapists will offer this.

All of these work to some extent.

1.Increasing support works very well, but the problem may reappear disguised as knee pain or hip pain (a new crack).

2. Hyrdocortisone works brilliantly sometimes and fails dismally other times. Often, the plantar fasciitis returns after a few months. (different crack on a different wall, same problem)

3. Rest normally only works if the injury was the result of an unusual trauma or workload that isn't repeated. So if your wall crack was due to a one time stress like tree falling on the house.

4. Massage will reduce the discomfort and improve function (reduces the number of cracks appearing) but it still doesn't solve the problem.

~ It's not what you do but the way that you are doing it.~

We need to ask ourselves "What is causing this condition”

You need to look at form and not function.There is normally a specific set of dysfunctional movement patterns unnecessarily stressing the tendon.

Clients come to me completely confused and frustrated by all this different advice and all of it looks at relieving the symptoms, which is nice, but it does not address the cause.

It's the way you move and how you are using the foot that is stressing out these structures.

You will need to stretch and strengthen the feet legs and hips, wear shoes that that allow your feet to absorb impact and function correctly and you will need to re-learn how to move naturally in those shoes. But that, is a rant for another day!

Sunday 27 April 2014

Do your shoes fit? -The Falling Lady-.

I help out at a remedial exercise class - Access Parkour -  where we work on restoring natural movement patterns using Parkour teaching techniques. This involves a lot of squats and hip work as well as stretches, quadripedal movement and balance.
One of our clients, a lovely middle aged lady, lets call her Silvie, kept falling off to the right whenever she stood up from her squat. I wondered if her glut medius was hypertonic, perhaps abductors or somehow her tensor fasciae latae was inactive and not supporting her. This continued for a few classes without improvement  - and then I noticed that her foot was supinating, falling over the lateral edge of her shoe as if it was trying to get to the floor. I asked her to take off her shoes and try the move again. Hey presto! perfect squat.

Feet need the floor. My belief is that Silvie's foot wasn't getting proprioceptive feedback because the sole was so cushioned and because the sole of the shoe is narrower than her foot is when it was working.

So my advice, make sure that the sole of your shoe is bigger than your foot and work off the floor whenever possible rather than off a cushioned sole. Alternatively buy thin soled or minimalist shoes for gym work and make sure that they are big enough!

Friday 4 April 2014

Barefoot Transition Period


The transition to minimalist shoes, takes time. Not just weeks but many months and for some a year or two.

Once you take the heelstrike out of your gait, straighten up your posture, learn to move softly absorbing the load with your feet ankles and knees, and you have built up the strength in all these structures, you will never want to go back. Once you have tuned the soles of your feet in and they start feeling the world below you, you will feel a certain joy of movement that you have not experienced before.  But be aware that once you have made those changes in strength and flexibility you will no longer be comfortable in the old shoes. Your big straight feet will not be going into pointy shoes any more! You will not want to suffer a shoe that dulls your senses.  This is a commitment.

I warn my clients of this all the time. You do need to change to minimalist shoes because you just can't re-learn to walk in your old shoes - all that support, strapping, heels and engineering makes it impossible to get the feel for the new gait and posture - and the transition models don't give the feedback that you need to make the changes.

You will need protection from the cold, and from the threat of damage and you will want protection from the dirt. So in the meantime minimalist shoes are the best bet. I've played around with a few shoes and the starting point for me is Vivo. Beginners can't do socks and they don't offer the protection you need in the early stages. Fingered varieties I found gave too much weird feedback and I've seen a lot of people still heelstrike in them, also I found that I personally supinated in them - an old habit - and I also found them cold, perhaps the large surface area contributes to this. However some very experienced runners seem to have gotten the hang of all of these and love them. If all of that is too much of a commitment or expense get some old fashioned gutties (like those some of us wore to gym classes). Make sure the sole of the shoe is larger than your foot and is completely flat and you are off to a good start.

I'm not sure if an older individual - sorry to be ageist - can make all the muscle tendon and flexibility changes that are required to go all the way minimalist all the time. But it is the only way to make the postural and biomechanical changes that are required for better posture, ease of movement and dynamic efficiency.

Read all the stuff you can. It's worth paying for a session with a professional. This is your health, it's worth the price of one dinner out to get it right. Then take your time, do the exercises and ramp up the walking and the running over time. Your back and your knees will thank you, your calves and your ankles will complain for a while. You can't undo a lifetime's poor habit but slow and steady really does win this race.

Saturday 22 February 2014

Do your shoes wear unevenly?

Do your shoes wear unevenly? Is the heel more worn at one side ? Does your foot slide of the edge of the shoe? 
Do you know that this might be a symptom of a bigger problem?

It might explain a lot of the aches and pains that you suffer.

Pronation, supination, inversion, eversion, fallen arches...

These words are all terms used to describe a malfunction of the foot. People take this news about themselves and just accept it without really appreciating that it can have long range consequences.

If your foot doesn't hit the ground properly there is a chain reaction of consequences.- a sort of cascade of damage-.  In a healthy gait (walking or running) the compression forces from the impact with the ground do not damage the joints in fact studies have shown that they even increase cell regeneration, keeping the joints healthy.  Conversely forces at abnormal angles and shear forces that are a result of biomechanical malfunction damage the joints and stress the system.  Such forces cause a cascade of symptoms as the brain tries to compensate and correct the body. This leads to pain, inflammation fatigue and even, sometime down the road, joint replacement… It is impossible to correct issues with ankles, knee, hip, lower back or disc conditions without attending to the weakness in the body’s biomechanical system that is causing the stresses.

The imbalances causing this stress are just as likely to be caused by inactivity as over activity. Adaptive movement pattern caused by repetitive movement - including participation in sports- can play a part in causing this structural imbalance. 

Some will choose the  support offered by orthotics or specialised sports shoes, but ultimately strengthening and correcting the system is what will put it right.

If you have functional joint or muscular discomfort it can be tempting to go for painkillers, anti inflammatory medication  or orthotic inserts but ultimately you will get relief from fixing the problem not masking the symptoms.

Get it assessed, take responsibility for your health, do the exercises  strengthen and balance your body then choose minimalist shoes.

                                                                    GET IT FIXED

Tuesday 4 February 2014

The Squat and it's Relevance for Barefoot Runners

30 mins squatting per day for 30 days...

This is a challenge currently on the go in the PARKOUR community. What’s the point?

The squat is a natural human movement. Due to our early introduction and ongoing addiction to the chair, it’s a movement that has been all too soon lost to us. The squat, as an exercise, practices a movement pattern the industry likes to call the ‘hip drive’. It’s that straightening out action of the hip from bent to upright. It involves a posterior chain of muscles, the gluteals, the hamstrings and the adductors.
It’s the movement from which we derive most of our power whether it’s for sport or just lifting groceries.

But why sit in this position for a prolonged time?

I lived in India for some time and would watch the gardeners attending to their tasks sitting in this position for hours at a time then easily stand straight up collect their lunch and squat again. Many of the eastern cultures sit in this position to rest. What the squat does is maintain the mobility, flexibility and power to use the big muscles for big jobs. It maintains the power to drive up through the pelvis without putting any lateral strain on the back. That’s important because as a therapist what I often find is that I am working with conditions caused by small muscles doing the big jobs because the big ones are redundant from disuse.

Teaching and perfecting the squat is hard and getting it right hurts while the flexibility and power is built up. Once the work is done the reward is a strong, flexible hip knee and ankle and a system that can work and run produce power and absorb impact.

Learn to squat to learn to run.