This week we have learnt assessment and treatment techniques for joint restrictions. A valuable assessment tool is to place the limb in a one plane position, Drive in another plane and tweak in another plane. By Tweaking in another plane, I can find which plane position is successful, drive the relative joint motion, and as motion is gained in the joint, slowly tweak out to the unsuccessful plane position. I can then convert the assessment to a treatment technique.
The learning opportunity highlighted the difference between driving the body to achieve a specific motion at a joint as opposed to driving for authenticity of gait. If the goal is to drive the body to get a specific joint to move, it is not necessary to drive in an authentic gait motion.
The learning opportunity also highlighted assessing the knee. If driving with bilateral hands, look at the effect on the knee in each plane to determine its compression with in the knee joint. Consider the gravity, centre of gravity and mass and momentum.
The hamstrings will be influenced by the motion of the tibia. If there is relative internal rotation of the knee, the lateral hamstrings are recruited. It is vice versa for external rotation of the tibia.
The course is creating a clinical reasoning process for assessment and treatment. Everything we have learnt is now coming together. We have looked at the role of proprioceptors. What types of proprioceptors exist in the body, and how we want to stimulate them in our treatment exercises.
It appears the Saggital, Frontal and Transverse tweaks must be understood to progress further in this course.
This week we covered the techniques to mobilise the subtalar joint and mid tarsal joint on the treatment table. These joints were mobilised by understanding how these joints connect and influence each other in weight bearing. These techniques were easy to use, and performed in as close to the normal hip and knee position as possible.
Using techniques on the treatment table fail to include the forces of gravity, ground reaction forces, mass and momentum when in weight bearing positions. We can use environmental aids and in standing positons to best replicate normal funciton, and then mobilise the joints of the foot.
To be able to select the best position to place the body and then drive the body to get the desired chain reaction we can use TRAZMA analysis. In this analysis we look at what the bones are doing and what the relative joint motion will be. This is a key analysis to help confirm the correct drivers and body positions are used to get the desired chain reaction.
This week we covered balance and how we can mobilise the joints to get better stability with motion. There are many positions to use to test balance and they all involve movement, instead of standing still on one leg.
We are one week away from Gift Gathering 1. There is a good build up of skill before the gathering. Time to test it out.
Week 6 has completed and it was great to learn more about the hip joints and muscles. This region has some of the biggest muscles in the body and is the powerhouse for movement. The way the body moves from the feet to head, or the head to the feet, loads the hip joints (eccentric) in preparation for an explosive (concentric) unload. The triplane motion of this joint and, in particular the transverse plane internal rotation in gait, enables the buttock muscles to perform ecocentrically. This means the muscle uses its eccentric lengthening to perform concentric shortening, both at the same time.
The primary movement assessed this week was gait. We looked at the front hip and back hip in gait. We took our knowledge of what happens at the foot in gait and learnt the chain reaction up to the pelvis. It was clear that the movements through the chain reaction prepare the buttock muscles to load and then unload powerfully. We also looked at golf and how both hips are loaded in the back swing, in preparation for an unloading powerful stroke.
The webcasts on 3D squat looked at the various combinations of bilateral squat movements using combinations of saggital, frontal and transverse plane positions. (There are 27 possible combinations).
We also added in arm motions and also did triplane motion using single leg balance positions.
We grew our understanding of nomenclature using the SaFTey syntax. The key to assessment is to make the tweaks small at the start and see the clients response and then make the tweaks bigger later. We know the most powerful tweaks can be those planes of motion which are not the primary plane of motion of the joint.
We increased out understanding of nomenclature by learning how to describe exercise movements and how movements are done in reference to a common point called a Tripost.
In AFS Strategies we learnt about the desire of the body for success, to have fun, to be avoid pain. If we can have all these elements in our approach the body will unconsciously want to do the movement.
We finished the Sign language alphabet. It was not that difficult to learn and I look forward to learning some great new phrases.
Overall this week took the concepts of AFS and put it into the function of gait. Great week to consolidate some key principles in tweaking for success
Physical Edge sent Rhys Chong to Tunbridge Wells, to attend the Jenny McConnell 2013 edition of gait analysis and lower limb course. Jenny is a world leader in the treatment of knee pain and based in Sydney, Australia (www.mcconnell-institute.com).
Jenny McConnell believes in the KISS principle. She has identified common gait analysis issues over many years of practice, and can provide evidence from scientific research to support her ideologies. She keeps the work her clients do at home to 5mins per day and knows “little and often” is the key to success. In her practice in Sydney, she works on a managing pain over a clients life time. It is like having an MOT for your car. She has MOT’s for the body and prevents pain before it happens.
The course looked at how the entire body compensates for dysfunction in the movement system. The hips are an area which is not treated well, and it was highlighted on the course. The course looked at the role of orthotics and shoes in supporting the body. McConnell has a new orthotic for high heeled shoes and sandles, a much needed invention (right ladies).
Physical Edge will be introducing orthotic prescription as an addition to its services. There will be MOT sessions to help people manage pain over their lifetime. Physical Edge hopes to build strong relationships with clients, by learning over the long term how to help clients live healthy and painfree lives.
In professional sport the ‘off season’ offers an athlete the opportunity to rest, recover and mentally prepare for the following season. In the off season an athlete will do strength training and fitness training so that they are in peak condition when the new season starts. In tennis the fitness and strengthening will carry them through the season, and allows them to focus more on match play and technique.
In the amateur we can see that the off season either never occurs, or that the athlete decides to increase the intensity of their training – and injuries occur. The off season needs to be structured to maximise the benefits for the following season.
The off season also offers an opportunity for injuries to be treated sensibly and for the body to be rested to allow natural healing processes to occur. The powers of rest cannot be underestimated. This will include having plenty of sleep; it will also include having ‘active recovery’ whereby the body continues to exercise, but in a much lower intensity so that injuries can respond to treatment and heal.
Structure your year to peak for your events and also to have an off season. Your physiotherapist and trainer can work closely together to design an off season which will help heal your injuries and also maximise your potential for the following season OR for achieving an extra goal.
Some athletes are bloody minded and will do anything to win. Some clients only see the goal at the end but don’t think about the process of getting there. In physiotherapy I see many people who have trained incorrectly because they focus only on the event they are racing and not on how to train to get there.
Having a personal trainer and a physiotherapist work with you can vastly improve your chances of reaching your goal, with minimal to no injuries. The training process can be designed specifically for the goal and the exercises required to achieve the goal can be taught correctly.
When designing a training programme there are many variables to consider such as: exercise technique, timing of training, intensity of training, the environment of training, progressions of training, and even what is happening in an individual’s life. Having a team to work with you takes away the need to think. The professionals also have the experience and the knowledge to give you the best training advice.
When working with a physiotherapist and trainer you can contact them at any time. They can talk to you when you get injured, when you have questions about your training, and when you want to know what to do if you get injured. Having this team is like being a professional athlete, and provides the greatest chance of success.
I have seen amateur athletes start training, and progress doing extremely well without any help; then they reach a certain mileage in training and their body starts to break down. At this point it is too late to change technique and training regime because the race is within a few weeks. Treatment is then about first aid care – doing everything possible to keep that person training despite the risk of increased injury, and the fact that the race is now in jeopardy. There are many emotions which accompany being in a position of unknown at race time. A person with injuries does not know how the body will react during the race; the target or goals in that race no longer apply; and all those weeks / months of training have been put at risk. To cross the finish line is often the goal after an injury has occurred. A plan then needs to be made to race the following year with correct training principles, guided by the personal trainer and physiotherapist.
It helps to get the right advice to train. Speak to your physiotherapist – who works closely with a personal trainer – to create a winning team.
Health is an area in many people’s lives which is neglected. To live a healthy life requires taking action, as with other areas of your life, to get results. There is a wealth of information from professionals and websites offering the know-how to live a healthy life. So why are we not all healthy?
I have found – as with other areas of my life – that you need coaches. Coaches not only motivate you and keep you on track; they also provide you with the most recent information about living a healthy lifestyle. A coach can put a plan in place which is easy to follow, adaptable to your lifestyle, and is measurable over time.
In today’s world, you can approach many different types of professionals to get this help, but I have found that it works best if just one person takes overriding responsibility for you achieving your results. Generally the coach who can help you is the one who lives the life they teach. In health there is a holistic approach and there is a Western medical approach, and I think a combination of the two is needed. The areas that may be included in assessment of your health are: your medical history; your lifestyle habits; your physical training habits; and your mental approach.
I am a physiotherapist and I work closely with personal trainers developing healthy lifestyles for clients. I am able to draw on the help of medical professionals, such as doctors and surgeons, and also holistic professionals, such as Pilates instructors, homeopaths and counsellors. Personal trainers have a wealth of skills which they can use with their clients including lifestyle coaching, physical training, nutrition and exercise goal setting.
This series of blogs is designed to give my perspective, as a physiotherapist and someone who lives a healthy lifestyle, on how you can avoid injury when working with a trainer. The blogs are separated into common scenarios I see as a physiotherapist in my clinic. The aim is to assess those clients we see and to learn more about injury prevention when working with a personal trainer.
In the following weeks there will be 20 blogs which will give a comprehensive outline of how you can work best with a personal trainer and a physiotherapist. Please call or contact us via email with any questions you may have about these blogs.
The human body has a pain sensing system. This system is designed to preserve the body and prevent long term damage. In training the body responds to stimuli and training pain needs to be overcome. However, there is a limit, and it is important to understand for your own body what that limit is.
I saw a documentary on television where a young boy had no pain sensing system. He would go to school and ask his friends to punch him in the stomach; he pretended he was superman because he felt no pain. One day his parents noticed bruising and swelling around his legs and abdomen, and took him to hospital. The doctors discovered he had severe internal haemorrhaging from being punched too much. This young boy’s lack of a pain sensing system could have led to his death.
Another documentary showed scientists trying to reproduce the pain sensing system in the body because it is so important for preserving life. With all the technology and advances in science today they were unable to replicate the system. It is highly complex and adapts to its changing environment. We need it to learn what not to do, what we can do, and what is dangerous.
In training, if we ignore pain completely then injuries often occur. It is important to put in perspective what you are doing, the experience you’ve had in training, and what you think your body can do – you must have realistic limitations as to how much pain you will withstand.
Be sensible and listen to your body. Focus on gradual increase in loading in training, and be happy with steady progress in your training goals. Aim long term rather than short term. Keep in touch with your physiotherapist and trainer to guide you through this process and avoid injury.
It is not much fun being injured and in the long run ignoring pain from an injury will make your training time longer. Get your body assessed by a physiotherapist and work with a personal trainer to prevent injury and to enjoy your training.
In physiotherapy I see many sports injuries. Often I will see injuries which have been present for several weeks, months or even years. Clients tell me they were never told by their doctors or specialists to see a physiotherapist and that they decided to leave time for the injury to heal by itself. By the time they come to physiotherapy the injuries have set in to the body; the central nervous system has adapted to the pain and now can prolong pain. The musculoskeletal system has weakened or become tight, or moves incorrectly.
If you get injured call your physiotherapist to get advice straight away. Why wait? If you can’t see the physiotherapist, the physiotherapist can advise you over the phone what to do for your acute injury. It is in the phase just after inflammation that training can be very effective. Training in this time allows the body to adapt to load in a positive manner. The body becomes stronger, stiffer and moves correctly.
Starting treatment when an injury has been present for weeks, months or years will take longer. The amount of input the client has to put in outside of the physiotherapy clinic is also increased. What you are trying to do is to tell the body a new way of moving and being, and it takes time for the body to adapt to this new stimulus. The stimulus has to be applied frequently and regularly. Sometimes 100% resolution of the injury is unrealistic; in some cases it is more realistic to teach a person how to manage their pain rather than cure the pain completely.
It is obvious that it is important to treat acute injuries immediately and to seek medical care. Being proactive at the start avoids a tedious recovery time, which is likely to be the case if treatment is sought much later.
Once the physiotherapist has seen you through the acute phase of your injury, he can work with a personal trainer to design a training programme which is appropriate for your goals. The exercises given to you may have to be adapted for the injury, and these can be changed as the injury heals. Having a personal trainer watch you during the training process ensures that you do not do anything wrong, and risk reinjuring the body part.
The physiotherapist will know when your body is ready to train at full intensity again. The close relationship between the trainer and the physiotherapist is beneficial because the professionals know each other, talk the same language and can progress you through your training at the appropriate times. If you have physiotherapy questions, do contact us as http://www.physical-edge.com.
A patient came to me from training one on one with a trainer. She’d achieved many of her training goals in the gym, and therefore decided she wanted a new challenge. She asked the trainer to set a new challenge; and so the trainer decided to make her an Olympic weight lifter. This client was 5 foot tall, of medium build, and had never done heavy weight training before. The trainer gave her a deadlift to do, and in the process she felt a sudden sharp pain in her lower back and dropped the weights. She was in agony, could not sleep and noticed the pain whenever she was sitting for prolonged periods of time. On assessment she had significantly damaged ligaments around her sacro-iliac joint and it was now hypermobile. The treatment for this condition required regular physiotherapy, Pilates, and a modification of her training.
The above story is an example of an inexperienced trainer pushing the client beyond what should be expected of him / her (in this case a 5 foot tall medium built woman). The client has stopped going to that trainer and now requires more low level exercise training, rather than high level training such as running and weight training – which is what she originally desired.
When a physiotherapist and a trainer work closely together this situation can be avoided. The physiotherapist and trainer will assess whether an exercise programme is appropriate to give to the client, then find an alternative training method or set a different and more realistic goal if necessary. The client benefits from avoiding injury, continuing training, and having constant surveillance of how his / her progress is going. This is an example of why a physiotherapist and a personal trainer working together with a client makes a great team.