Basic Pilates position. Table Top
Lye on the mat on your back with you knees bent and feet on the floor (Crook lying) Pull in lower abdominals . Pulling your belly button towards your spine. While maintaining your spinal position lift one leg up with 90 deg at the hip and 90 deg at the knee then the other leg up slowly. This is Table Top. Lower your legs back down again one at a time while maintaining your spinal position.
Calf pain in runners is quite common and can become a persistent nuisance. Fortunately it usually responds well to treatment and there are a lot of simple exercises you can do to help it recover. This is the first of a series of pieces on calf injury and will guide you through early management of a calf tear. Later pieces will examine non-traumatic calf pain and rehab of strength and flexibility.
The calf is made up of 2 large muscles – gastrocnemius and soleus and a smaller muscle called plantaris. Gastrocnemius is the more superficial of the muscles with soleus sitting beneath it. Gastroc. has two heads to it and crosses both the ankle and knee joints – this makes it somewhat vulnerable to injury. Injuries to soleus are far more rare. In one study of 141 cases referred for ultrasound after calf strain just 1 had a soleus tear while 94 had gastroc injuries.
Traumatic calf injury
The calf is usually injured with sudden movements that dorsiflex the ankle (bend it up) while weightbearing. With the gastroc this often happens with the knee straight as the muscle is then stretched over 2 joints. Activities like rapid lunges (common during racquet sports) or acceleration to sprint when running are common causes of calf injury. It may also occur when the muscle is fatigued after distance running.
During a calf injury many people describe a sudden sensation of being struck on the back of the leg. Swelling is common and it can be difficult to walk initially. In more minor calf injuries people can sometimes continue with their sport at the time of the injury but the pain becomes more severe after. Of the two heads of the muscle the medial head (on the inside of the calf) is more commonly injured than the lateral head (on the outside).
Management of acute calf injury involves POLICE (formerly RICE). With muscle injuries anti-inflammatory medications are not currently recommended, especially in the first 48 hours as they are thought to delay healing. As with all injuries RunningPhysio recommends seeing an appropriate health professional. In the case of calf injuries this is especially important as there is a risk of Deep Vein Thrombosis (DVT).
Symptoms of DVT include pain, swelling and tenderness in the calf often accompanied by warmth and redness of the skin. Unfortunately these are often common symptoms after a calf injury even without DVT. In many cases people sent for investigation of suspected DVT are found not to have one, however if in doubt get it checked out as a DVT is a serious condition and can lead to pulmonary embolism which is potentially life threatening.
Treatment of a calf injury depends largely on severity (timescales detailed below are approximate and may vary considerably between individuals) but I follow these principles of treatment for calf injuries;
With a minor calf injury symptoms will be mild with minimal swelling, you will be able to walk unaided with slight discomfort but sudden movements that stretch or work the calf may cause an increase in pain. Initial treatment involves rest for 2-3 days after which you can often resume gentle cross training, providing it’s pain free. This might include swimming, or cycling (with low resistance) but should avoid impact, heavy resistance or sudden movements. Once symptoms settle you can start some light jogging on a treadmill and see how it feels before gradually returning to training. The timeframe for this varies from around 1-4 weeks depending on the injury and the individual. When you do return to running avoid hill training and speed work initially as this places a greater stress on the calf muscle.
Moderately severe calf injuries need to be treated with a little more caution. In the early stages there will be noticeable swelling and discomfort. You will be able to walk unaided but with some difficulty and pain. Any movements that place even a small stress or load on the calf are likely to be painful. This might include going up or down stairs, moving the ankle or pressure on the calf area.
The first 2-3 days are likely to involve bleeding within the muscle and significant swelling. In these acute stages you’ll need to be more attentive to rest, elevation and ice and I wouldn’t recommend cross training. You may benefit from offloading the calf a little. This can be done by putting a heel wedge in your shoe, strapping the calf or even wearing shoes with a heel (although probably something stable rather than stilettos!). This should be a short term strategy and you should aim to walk in normal shoes or barefoot as soon as comfortable to do so.
By days 4-7 you may find you’re comfortable enough to start very gentle exercises for the calf. Simply move the foot up and down, first with the knee bent, then with it straight. Move only as far as comfortable – don’t push through pain. Little and often is usually best – around 10-15 reps 3 times per day. The aim is to encourage the muscle to contract and relax, this should help clear swelling and maintain flexibility.
After day 7 you’re usually in the sub-acute phase of injury. The muscle is still healing and that new tissue will be vulnerable so you want to avoid excessive stress on it. The body is amazing when it comes to healing and it’s worth respecting that. We often aim to accelerate things but perhaps, in truth, our aim is more to promote the best environment to allow things to heal at their normal rate. It’s important to maintain flexibility and strength in the calf muscle as things heal, but this shouldn’t come at the expense of the healing process.
From approximately day 7 to 21 post injury scar tissue is still developing but isn’t usually strength enough to handle large loads. As a result I would avoid static stretches during this period, instead use the 2 traditional calf stretches (pictured below) but do them dynamically. Rather than moving until you feel a stretch and holding it, just focus on controlled, gentle movement in pain free range. Alternatively a minisquat is a simple way to maintain ankle mobility. You can also start some supported calf raises if able – do on both feet (rather than just 1) – push up onto your toes and slowly lower. You can usually resume cross training from 2-3 weeks post injury but keep it pain free and avoid impact and resistance work.
It is coming to the end of the season in many sports now and the ground is starting to firm up and I am seeing more and hamstring problems in my clinic. Here is a graphic of good hamstring exercises you can do to strengthen for the end of the season or next season to come.
Your "hamstring" issue many be little more complicated then you first thought then come and see me MId Cornwall Physio for a full diagnosis and rehab.
Do exercises 4 times each week, repeat each exercises 10 times. As the program gets easier over time increase the depth of your squats or add some weights into your hands to make it more difficult.
1. Feet shoulder width apart. Hands out in front of you. Squat down until you knees are at least 60 degrees and stand back up again.
2. Same as exercise 1. With your hands above your head in a “v” shape.
3. Split your legs so one is forward the other back (still shoulder width), hands out in front of you and bend your back knee so you squat down.
4. Repeat 3 with opposite leg
5. Squat down with a chair behind you. Just touch the chair with your bum and come back up again.
6. Same as exercise 5 but with one leg. Use your other leg to balance with in front or behind you.
7. Same as 6 but swap to the other leg.
It’s important to know that squatting polarises not only medical and science staff but also the public. Historically linked to damaging your knees or back, people have been scared about squatting due to sensationalised views reported in the media or told to them by their GP.
I can tell you now this is false, well, like anything if done without good form, considered programming or adequate timing, it could be detrimental. But with a graded exposure to load, good well practised form, appropriately timed within your week, and when required, a spotter, squatting can be very very useful!
Here are a few variations to consider:
Back squat
Hugely underestimated lift that requires a number of technical points to maintain control and share the stress along the kinetic chain. What’s often overlooked in the back squat is your structure! Foot positions will vary depending on your hip shape, with the retroverted among us often finding a narrower stance tricky! Those with a long femur also find the form tricky to execute and therefore maybe better using the front squat or overhead squat. As well documented, a wider stance inceases gluteus maximus activation (Paoli, et al. 2009) as does squat depth (Caterisano, et al., 2002).
Overall lower limb recruitment is extremely high, creating stiffness via co-contraction of lower limb muscles with especially high peak force created compared with an overhead squat (Aspe & Swinton, 2014). Initially quads are dominant but as hip flexion excedes 60 degrees a greater contribution of force is provided by the hamstrings, gluteus maximus (Caterisano, et al., 2002) and adductor magnus. When the hips passes 90 degrees the gluteus maximus and adductor magnus really take the majority of load and initiate the triple extension require to stand.
Front squat
Great alternative for those who struggle getting the adequate shoulder and thoracic angle of motion. This variation will apply greater load to the thoracic region due to increasing the distance between the load (bar) and the back musculature. Due to the pattern required to lift the weight more load will be placed onto the quads and away from the gluteals, however Gullet et al (2009) suggested overall muscle activation did not differ from the back squat, but with less compressive forces at the knee and a small knee extension moment this variation may be better for those with a history of knee joint issues. Maintaining the high elbow position is an adequate way to ensure control of the vertebrae throughout the lift although some find this difficult, a cross variation may be a nice alternative.
Overhead squat
As you can see by the weight I’m lifting in the video (stop laughing at the back there) it’s a pretty stressful lift. Aspe and Swinton (2014) showed a significantly greater activation of anterior trunk musculature over the back squat (only 2-7% greater force magnitude). The increased demands on the shoulder girdle and trunk equate to large gains in strength (probably isometric) through this region. This is also a good alternative to the back squat for those of us with relatively long femurs compared to the lower leg.
It’s important to note good control is vital here so I’d recommend learning the pattern with a piece of theraband stretched between your hands first. It’ll help you get used to engaging the muscles surrounding your scapular and stabilising your shoulder as you move through range.
Sumo squat
A nice alternative to the back squat, but you can also tweak the front squat in the same way. Putting the feet wide and turning them out will increased the demand placed upon the adductor and medial hamstrings, good to note adductor magnus’ vertical fibres and the medial hamstrings sit in the same posterior compartment of the thigh, hence restrictions in this movement due to soft tissue tightness may be a result of either.
This stance maybe useful for those retroverted hips due to opening out of the hip joints from the abducted and laterally rotated leg position. The large stress in this movement comes at the greater depths when the hips drop below the knee joint. Getting to this depth during this movement is the goal for larger hip loading.
Conclusion
The squat pattern certainly looks like a pattern adapted during many sports and strengthening this range has been linked to performance gains. Form is king so get good quality movement before adding extra load. If your feet aren’t perfectly position for each rep, or you slightly deviate during reps.. Do not fear! This type of variety is normal and is actually helpful as it exposes the system to slightly different stress. Just like running or sport.
Have a look at the runners and riders in this years National. I don't think you can look past number 1 The last Samuritrained by Kim Bailey
. http://www.bbc.co.uk/sport/horse-racing/39428608
Do exercises 4 times each week, repeat each exercises 10 times. As the program gets easier over time increase the depth of your squats or add some weights into your hands to make it more difficult. Any problems please call me.
1. Feet shoulder width apart. Hands out in front of you. Squat down until you knees are at least 60 degrees and stand back up again.
2. Same as exercise 1. With your hands above your head in a “v” shape.
3. Split your legs so one is forward the other back (still shoulder width), hands out in front of you and bend your back knee so you squat down.
4. Repeat 3 with opposite leg
5.Squat down with a chair behind you. Just touch the chair with your bum and come back up again.
6. Same as exercise 5 but with one leg. Use your other leg to balance with in front or behind you.
7. Same as 6 but swap to the other leg.
8. Proprioception exercises
There has been a lot written by both S and C coaches and physiotherapist about the "Core" Muscles and how they interact and how best to stimulate them post injury. By stimulate I mean strengthen or restrengthen them.
I am of the school of thought that post back injury the "Core" muscles and Trans Abs in-particular need active restrengthening in order to maintain a pain free back I do not believe they will "self strengthen" they need active participation from the injured party.
I also believe the best way to strengthen them is with active exercises such as Swiss ball work. This is not always possible due to the condition of the injured person. So below I an going to give an explanation of a static Trans Abs exercise I have used to good effect in the past.
This will help your lower back pain management for the rest of your life if you can maser this skill. It is always best to go and see a physio such as Mid Cornwall physio for your first tutorial in this skill but after that you can self manage.
I hope this has been helpful if you wish to call me for further discussion on the topic do not hesitate to use the number on the website. Many thanks
This exercise program is idea for riders with weak posterior glue med and glue min problems, otern you will feel lobs - sided in your pelvis when riding with increased pressure on one Iron or the other. Give this a try. 3-4 times a week in the evening or after riding. for a couple of moths and you will be amazed at the difference it makes. As always contact me for more information.
Do each exercise for 30 sec. Then immediately onto the next so the whole routine should take 4 mins each glute. And yes it does burn.
Clam – Side lying, feet together raise upper knee as if your knees were making the mouth of a clam.
Raised Clam – As above without you feet together the upper foot is free in the air and you must try to keep it still as you do the exercise.
Leg lift – Onto all fours the leg you are exercising extend behind you and raise it the air and pulse it there.
Pissing dog – On all fours abduct your leg out to the side with a bent knee as if your were a dog cocking his leg then back down again. Repeat.
Mid hold – Side lying working leg upper most and straight . Lift leg and externally rotate foot and hold.
Mid Pulse – As above but turn foot back to neutral and pulse up and down but not touching so no rest.
Post Pulse – As above but extend leg behind you and pulse.
In Today's Blog I will write about the modifiable risk factors in hamstring injuries, that is factors you can do something about, such as go and see your physiotherapist to help you reduce these risks to prevent injury or to reduce the risk of re-injury.
All of these factor can be helped by a sports specialist charted physiotherapist. Go and see one and they can help prevent and reduce your risk of hamstring injury.
I am blogging about the risk factors in hamstring injuries so you; the athlete can take measures to prevent them. In this Blog I will write about non-modifiable factors that cause hamstring injuries, theses are obviously harder to avoid but they may still be some areas where you can minimize your risk.
My next Blog I will discuss the modifiable risk factors in hamstring injuries. As you can see most factors can be helped by seeing an appropriate sports specialist physio so do come and see me. If you have any questions please email or call me.
Further to my Blog on ankle proprioception, this blog is a guide to Shoulder proprioception. Exercises are best supervised by a chartered physiotherapist. Very important after a shoulder insult to significantly reduce the risk of re- injury.
The Shoulder joint is the most mobile joint in the human body but conversely can be the most unstable. Therefore it is vital that the brain relearns where the shoulder is in space post injury. The following exercises are to done at the end of the rehabilitation process, all when the chartered physiotherapist says you are ready.
6. One arm press up position on a BOSU round side down.
7. Statue of liberty with a Swiss ball . Standing with a Swiss ball in one hand above your head and balance it there for 1 minute.
8. Walking statue of liberty. As for 7. but while walking around.
9. Lunging statue of liberty. As for 8. but lunging on alternate legs as your walk around.
10. Swiss ball Throw and catch. As for 7. but throw the ball against a wall or to a partner and catch it above your head as much as possible.
All exercises can be advanced by shutting your eyes.
Any questions please email me on info@midcornwallphysio.co.uk
Part two of my proprioception guide will involve a BOSU. This is an excellent bit of gym kit that can provide an unstable surface for you to stand, jump and exercise on. This is obviously very good for your balance but also helps your core stability as well. you can find BOSU's on websites such as Physique medical and other gym products websites.
11. Stand on BOSU on one foot Round Side Down (RSD) and throw a ball to a friend or against a wall.
12. Stand on BOSU on one foot Flat Side Down (FSD) and throw a ball to a friend or against a wall.
13. Hop up onto BOSU ( Not step up) FSD
14. Hop up onto BOSU eyes shut. Land and hold for 5 secs FSD.
15. Stand on one foot on BOSU and do a deep pistol squat RSD.
16. Stand on BOSU on one foot and do a deep pistol squat FSD
17. Standing on the BOSU on one leg FSD and do 20 deg hops in a circle twice round one way and twice back the other way.
18. Same exercise as 16. but 90 deg hops.
19. Hop up onto BOSU doing a 180 deg jump, land and hold for 5 secs.
The list of exercises can continue endlessly please contact me for more info@midcornwallphysio.co.uk
You can get more and more inventive and add in more BOSU's. Just remember to make an exercise just a little bit harder shut your eyes.
Proprioception is the technical term physiotherapists and health professionals use to describe balance and co-ordination of a part of your body - Or knowing where your limb is in space.
In this Blog I will go through the first half of a guide to a progressive proprioceptive program following ankle or foot injury from a grade 1 sprain to full reconstruction the progression will be different but the basics are the same.
Once you are comfortable on each phase( Not Wobbly) you can move to the next one. All exercises should be done with a slightly bent knee. These should be done every day for a minimum of 3 mins to a maximum of 20.
The progression will continue in next weeks blog for people who are keen to return to competitive sports.
The minimum return to sport is 10 days. Follow the program and don't skip a step no matter how good you feel. You will a strengthening program for your hamstrings after wards which your physio will provide.
P= Protection
O.L. = Optimum Loading
I = Ice
C = Compression
E = Elevate
For further information go to Websites www.csp.org.uk or www.sportex.net
