Week 8: TZ1 and subtalar and midfoot joint motion

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. 

Physical Edge attends Jenny McConnell Course in Tunbridge Wells

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.

Maximising performance in the off season

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.

Personal Training Series: “Don’t care, get over the finish line”, can lead to injury

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.

Personal Training Series: Coaching your way to a healthy lifestyle

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.

Personal Training Series: Ignoring pain

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.

Personal Training Series: Putting the patient at risk

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.

Personal Training series: Setting goals too high

The danger of training can often be setting goals too high. It is very easy to decide that training with a trainer is the start of a whole new change of life. In some ways it is, but in other ways the goals that are set with the trainer need to be realistic for your body type and athletic ability. Of course, you can gradually build up to bigger and bigger goals, but at the start it helps to set achievable goals and test how your body adapts.

I have noticed that when clients come in with an injury they may suddenly decide to compete or race, where before the injury they had no desire to train. There is something about getting treatment or starting training which triggers within people a desire immediately to take part in races. I have had clients who injure their knees and yet suddenly want to do a marathon; this is a great example of setting goals which at the time are unrealistic. A more appropriate strategy may be to recover from the injury, build up strength, start looking at running technique, and slowly build the distance you run eg 10km, 15km, 21km and then a marathon.

I had another client who wanted to run a half marathon 3 months after giving birth; she reported pain in her body and required treatment which stopped her from training. 9 months down the track she completed the half marathon, and retrospectively acknowledged that she initially started training too early; she now knows  that her body needed the time to heal from the birth of her child before it was ready to withstand the impact of running and training. Her half marathon was a great success; she enjoyed the day and did not get injured. If you are going to do a half marathon for the first time, you want it to be an enjoyable experience. If she had done the race 3 months after giving birth, it would have been a painful experience and probably put her off running forever.

Having a physiotherapist and trainer work together can help you assess the current state of your body, and then help you set a plan to develop your strength, endurance and power. They can also look at your technique before helping you to set an appropriate goal. Having a trainer is hugely beneficial in overseeing your progression, and the physiotherapist can see how your body is improving and give you guidance as to how quickly training can progress. The physiotherapist also has the advantage of understanding medical conditions and the impact this will have on training.

Working progressively towards a goal often requires a change in a client’s mind-set. Patience is not everyone’s natural tendency; however if someone wants to achieve a goal there will be an element of patience required. If the goal is inappropriate – since the client does not want to wait to go through the training process – then a new goal needs to be set. At the end of the day the client will fail if the goal is set too high, and this reduces motivation for training in the future.

When a client sets goals or has ambitions which are too high we call these fantasies. Physiotherapist and trainer can put goals into perspective, set realistic targets, and make the process enjoyable

Rhys Chong talks about a winning team for success in sport and life

Winning a Gold Medal at the Olympics, winning the Tour de France or winning an Ironman are spared for the elite athletes of the world. Every sport has its unique demands but there is one goal all athletes strive for … to be the “best he/she can be”.

Whether you are a professional or an amateur there are aspects of training which can help you be the “best you can be”. The key is to have a team of specialists who work specifically for you. Bradley Wiggins, Chrissie Wellington, and Sir Chris Hoy all have a team of professionals guiding them to success.

 I completed my Ironman and had a team of professionals working with me. I knew if I wanted to be the “best I could be” I would need coaches for different parts of my training. In my team was a training coach, swim coach, bike mechanic, nutritionist, mental conditioning coach, massage therapist, physiotherapist, and pilates instructor.

 Each member of my coaching team had their role to play at various stages in my year of preparation for the Ironman. My training coach directed the overall training plan and as my strength and technique improved, with the help of other specialists, I focussed on work with my mental conditioning coach. I did have injuries during the year but they were minor. It helped to condition my body with gym work and pilates. The expert physiotherapy treatment and massage therapy I received allowed me to train 6 days a week.

 Elite athletes will train in cycles of 4 years in preparation for the Olympics. The focus of their team is to have them at peak performance for that one race on that one day that really counts. This could be your “A” race for the year when you want to set a PB (Personal Best time). 

 My advice is to plan your training with your coaches. Your entire physical and mental preparation will be for your “A” race. The synergy created by pinpoint focus on your “A” race will create incredible results. 

The benefits of having a team of coaches are far greater, when compared with a computer or book prescribed program. Your coaches are with you from the beginning of your journey through to crossing the finish line. They know how you “tick”, and can provide you with emotional guidance and motivation, in the good times and the bad. Your training can be adapted to fit with what is happening in your life. When it really matters we all want to talk to people and training is no different.

If you want to race an Ironman for the first time and want the right team of coaches to work with, see  www.physical-edge.com   

Rhys Chong

Author, Physiotherapist and Ironman

Interview: Rhys Chong about First Time Ironman book

First things first – completing an Ironman Challenge is no New Years Resolution. When did you suddenly realise that you wanted to become an Iron Man, after no prior training?

 

The Ironman had been a dream of mine for 10 years. The distances in an Ironman seem impossible but this made it more exciting. I saw athletes in there 70’s and 80’s complete the race, athletes with half a functioning kidney fight to the end, and amputee athletes limp over the finish line.  I keep videos of these hero’s on my website http://www.physical-edge.com They all inspired me and I decided it was time for me to step up and stop thinking about it. I had a friend who became my coach and he promised to help me. Knowing I had his support, I made the decision to do the Ironman and entered. 

 

What do you think planted the seed of the challenge in your mind?

 

I worked in a gym as a Physiotherapist and there were two personal trainers who did Ironman. I already wanted to do an Ironman, but with their coaxing and hearing their stories the idea grew more and more. The more questions I asked them the more I got excited about the idea.

 

Why did the Ironman challenge draw you in?

 

It was a challenge beyond my comprehension. It seemed totally irrational and inhuman to do, and yet by watching the youtube videos (www.physical-edge.com) I was captured by the enormity of the task. Watching  Ironman athletes cross the finish line in total euphoria was incredible. I wanted to do that and I wanted to be an Ironman.

 

You’ve had – and have – an amazing career in physiotherapy – you recently started your own physiotherapy business in 2007 Why that line of work?

 

I believe people are gifted with certain natural talents which do or do not fit with his/her chosen career. If you can find out what you do best and choose a career which matches your talent, then everyday you wake up and are excited about going to work. I had wanted to be a Physiotherapist since I was 12 years old. I naturally enjoy being around people and hearing how well they are doing in life. I have good sense of touch which is important in Physiotherapy and I love sport. These Olympics are dangerous as I find myself glued to the television all day.  I enjoy helping others and having my own business allows me to be creative in how I work as a Physiotherapist. I was going to be an Artist or a Physiotherapist, so having a creative outlet is even more fulfilling. You can see a video on http://www.physical-edge.com which gives more insight into my passion for Physiotherapy.

 

How did your line of work influence your decision (and success) in completing the Switzerland Ironman?

 

I have treated professional athletes in sport and work with amateur athletes. I have a passion for endurance events like the Ironman and Tour de France. In these events there are many injuries. I like the “buzz” of having an injury to heal in a tight time schedule, as happens when an event is coming up. Endurance athletes often get injured when they are doing their longest training sessions. This can be 3-4 weeks away from a big race. This is when the pressure is on to perform as a Physiotherapist. My contact with endurance athletes excited me and increased my desire to race an Ironman.

 

 

How did you stay focused and commit to the challenge once it had been finalised? 

 

The best way to commit to anything is “burn the bridge behind you”. Once I had made the decision to enter the Ironman I entered online immediately. I made the commitment by paying £450 and registering for my first Ironman. The bridge was burned and I could not go back. Once I was committed, all I could do was look forward and find a way to make it all happen. I think the greatest driver to keeping me focussed was the fear of not finishing the Ironman.  Everytime I thought about the race it frightened me and spurred me on to train and stay focussed.

 

What drove you to complete the challenge?

 

Every Ironman believes he/she will do anything to finish the race. I was committed 100% to get to the finish line no matter what happened. The pain was bad in the last 20km of the race but I was not going to stop running. I think this belief is developed in long hours of solo training in the cold and wet months of winter. I forced myself to train hard in these conditions and if I had made this sacrifice then I was going to get to the finish line of the Ironman.

 

What were you thinking from one stage to the next?! Did your mind wonder to what you were going to have dinner, or did it focus on the pain?!

 

My mind was focussed on my race plan. I had worked with a mental conditioning coach prior to the race. I had created a visualisation of my entire race, including breakfast and celebrating at the end. It is a type of hypnosis and I knew exactly what I had to do for each stage of the race. I only focussed on what I had to do next, so very short term. If I did have a moment to relax e.g. on the bike leg, I took the opportunity to enjoy the moment and really appreciate the fact I was actually racing the Ironman. I wanted to enjoy the race and capturing the scenery in Switzerland was breath taking.

 

Your words when you crossed the finish line?

 

YES!!!!!!! I was euphoric. I sounded like I was about to charge the enemy in war. The crowds were cheering and I was ecstatic. I screamed a war cry all the way down the finishers shoot to the finish line.

 

Was there ever a moment during the challenge when you worried about the lengths you were stretching your body?

 

At one stage on the bike my left knee kept subluxing, as the muscles on the outside of my leg had got so tight it was pulling my knee cap laterally with each stroke of the pedal. It was sharp pain and I had to keep my leg moving in a straight line to control the knee cap. I was worried about running the marathon next.

 

Your book ‘First Time Ironman’ launched this month – a tick in the box, life long ambition, or did you write it ‘just because…?’ 

 

I wrote the book because I now help business men and woman, entrepreneurs and celebrities train and complete an Ironman in 1 year. The book was designed to give first time Ironman athletes an appreciation of training for the race and the race itself. I wanted to know what it was like to train and race an Ironman and I know others would to.

 

What would you like your readers to gain from it? 

 

I want readers to see that racing an Ironman is achievable even with running your own business and having relationships. If you commit to racing the Ironman the rest will fall into place. It is key to have a great team of coaches and medical staff to help you. The book gives you an insight into how I used my team not only to have a great race but also a fantastic experience. 

 

How did you find running your business whilst simultaneously writing your book?

 

It was tough at times but being super planned made all the difference. I worked with my coach on a weekly basis to get the timing right and when my work got too much we altered it. 

 

It’s a pretty intense life you seem to lead! Hows the social life?!

 

Social life did take a back seat but when I did go out everyone wanted to hear about my training and were inspired by my plan. They wanted to donate to the charity I supported and in some ways I met people I never would have met without doing the Ironman. My coaching team are now great friends and they all came to my wedding.

 

What do you do to unwind in the evenings, or is unwinding unnecessary?

 

I will watch television or a movie and eat good food.  I enjoy life so I actually like doing things to relax to. I find working on my business and being creative or cycling 3-4 hours relaxing.

Your Ironman team helped Diccon Driver finish his Ironman challenge despite awaiting a kidney transplant.

 

How did it feel to a part of that monumental achievement?

 

Diccon is an inspiration to us all. His story is immense. I am proud to say I trained with Diccon and I think he will be the first Ironman who has had a kidney transplant. I am honoured to help Diccon and I am excited about his future race plans.

 

What are your plans for the future? Any more challenges?!

 

I have just had a baby so my new Ironman is taking care of her. This is an Ironman for life. I still go for bike rides and race team triathlons but my days of racing long distances have to take a back seat. I would love to do another Ironman with my children one day. Maybe when I am really old I will inspire them to race an Ironman.