What is Tendinopathy?![]()
How do we manage tendinopathy?
![]() Addittional treatment
Bath Physio & Shockwave
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​If you have any further questions, or would like to find out if chiropractic care is a suitable
form of treatment for you, give us a call on 01225 683007.
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Bath Chiropractic
A chiropractic adjustment, also known as spinal manipulation when applied to the neck or
back, will vary in nature depending on the area of the body being treated.
When treating the neck, spinal manipulation is a process whereby your chiropractor will
apply a quick but gentle movement to your head and/or neck, this may or may not produce
an audible clicking sensation known as an audible release.
Adjustments throughout the midback and low back are achieved through a quick and firm
impulse applied to the area, similarly to neck adjustments this may or may not produce an
audible clicking.
Adjustments can also be applied to a number of joints in the arms or legs, whereby this
similar quick and firm impulse can be utilised to manage pain in these regions.
The adjustment itself isn’t painful, although some individuals do experience a muscular
pulling sensation in surrounding regions to the adjustment site whilst your practitioner is
getting you into position prior to performing an adjustment. This is common and nothing to
be concerned about, although important that you let your clinician know if you do
experience this, so they can change your positioning to ensure your comfort throughout.
If you and your practitioner have deemed chiropractic adjustments as an appropriate form
of management, they could help you gain benefits such as:
- Decreasing pain within your joints and surrounding muscles
- Increasing your range of movement of your neck or back, to reduce sensations ofstiffness and restricted movement
- Some individuals have been shown to obtain improved posture with a tailoredchiropractic treatment plan
- Some studies have shown adjustments to help improve athletic performance
- Many also find that chiropractic adjustments reduce their need to rely on pain medications
or from home, facilitating recovery
What common conditions can a chiropractor help treat?
Chiropractors treat conditions or pain arising from the musculoskeletal and peripheral
nervous system, meaning they treat the joints, muscles, tendons, ligaments and nerves
throughout the whole body. This means chiropractors can treat a vast variety of conditions
which involve these areas of the body, however common conditions that chiropractors
regularly see and treat in clinic include:
- Neck pain
- Headaches and migraines
- Pain in the arms or associated joints
- Midback pain
- Low back pain
- Sciatica
- Leg pain or pain in the joints of the legs or feet
- Sports injuries
to massage and soft tissue release techniques, there’s a broad spectrum of conditions
they’re able to help you manage.
Bath Chiropractic 01225 683007
References for above –
Pain management = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6112063/
(Mann et al,2018),
https://www.nice.org.uk/guidance/ng59/chapter/Recommendations
(NICE, 2016),
Evidence based evaluation & management of common spinal conditions: A guide for the
manual practitioner (Browning, 2021). Orthopaedic Conditions (Vizniak, 2016).
Increasing ROM - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3487906/systematic
review by (Millian et al, 2012).
Posture -https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5574330/
Athletic performance -
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6555009/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3154064/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5843672/
– Evidence based evaluation & management of common spinal
conditions: A guide for the manual practitioner (Browning, 2021) and NICE guidelines
(2016).
Sciatica is a term used to describe pain which starts in the low back or buttock and travels
down the leg into the foot. It occurs when a large nerve which travels from the low back
into the foot, called the sciatic nerve, is compressed or irritated. This compression can come
from a variety of sources in the back and can be identified by seeking help from one of our experienced Bath Chiropractor and Physiotherapy team.
It’s also important to note that there are a variety of causes of low back, buttock and leg
pain other than sciatica. If you’re unsure of what’s causing your pain, our clinicians at
Physioimpulse can help in identifying the cause of your discomfort.
What symptoms could suggest sciatica?
- Pain which originates in the low back or buttock and travels into the foot
- Numbness or tingling in the leg or foot
- Loss of muscle strength in the lower part of the leg or foot
How will my Bath Chiropractor diagnose sciatica?
Typically, a chiropractor will be able to determine the presence of sciatica through your
symptoms and testing of the nerves, joints and muscles in the lower limb. These tests are
non-invasive, and your clinician will explain what they’re doing as they go. In some cases a
clinician may decide to refer you for a scan, however recent evidence has proved that a scan
isn’t always essential for an accurate diagnosis of sciatica.
How can sciatica be treated in clinic?
- Manual therapy techniques administered by your chiropractor or physiotherapist to reduce discomfort and stiffness
- Tailored advice on how you can adapt your activities of daily living to reduce theimpact sciatica has on your daily life
- Exercise rehabilitation to support your body’s recovery
- Education on the associated risk factors to aid recovery and reduce the risk of reoccurrence
What can I do in the meantime to reduce my chance of developing back pain and sciatica?
The latest evidence tells us that keeping active, eating a varied and balanced diet to
promote overall health, and abstaining from smoking are some of the key factors in
reducing our chances of suffering with low back pain or sciatica.
Interestingly, we’ve also learnt through research that walking appears to be the gold
standard exercise type in preventing and treating generalised low back pain. However, if
you’re unsure of what other types of exercise can help treat low back pain or sciatica, or
have any additional questions or concerns with your low back pain, give us a call and one of
our clinician’s will happily help guide you.
Bath Chiropractic
01225 683007
The impact of tennis injuries can be reduced by careful management of swelling, protection of the injured structures from further injury, and by enlisting the support of one of our Bath chartered physiotherapist or our sports chiropractor or osteopath.
Collateral tissue damage can be minimised by following the POLICE or PRICE guidelines, standing for protection, optimal loading/rest, ice, compression and elevation.
Current evidence as published by the Association of Chartered Physiotherapists in Sports & Exercise Medicine (ACPSEM) should be followed to minimise collateral tissue damage.
- Protection: splints, taping, crutches, modifying activity
- Optimal loading/rest: load the tissues relative to their state of injury and repair
- Ice: cold compress, cold water immersion
- Compression: strapping, compression garments
- Elevation: place injured part higher than the heart
Anti-inflammatories are not recommended in the first 5-7 days after injury, as inflammation is the body’s way of healing.
Swelling needs to be managed, but stopping inflammation from occurring at all is not advised.
A chartered physio will perform a thorough assessment to evaluate how well joints and muscles are functioning.
In addition the physio will assess muscle power, strength and endurance as well as balance, co-ordination and joint position awareness.
Injured players will be guided from the initial phase after the injury to the end phase of return-to-play testing.
It is important to rehabilitate fully after any injury as failure to do so often leads to re-injury often resulting in a longer period off play.
Rotator cuff tear
What is it? The rotator muscle complex provides stability and controls movement of the shoulder joint. Tears may be due to overuse or acute trauma.
How does physiotherapy treat rotator cuff tears? Acute soft tissue management as evidenced by the PRICE guidelines (above) should be undertaken to reduce secondary damage from swelling. Simple painkillers may be taken but anti-inflammatories should be avoided at this stage.
Once again a thorough examination will guide the treatment plan which may include mobilisations, soft tissue techniques, taping, acupuncture and other physiotherapy modalities.
The physiotherapist will write a graded rehabilitation plan including return to play testing.
Shoulder injuries: famous tennis examples Maria Sharapova had surgery to repair two rotator cuff tears in 2008 and has since suffered other problems with her shoulder.
Lower back pain
What is it?This is very common among tennis players because of the repetitive nature of the game and the demands of the strokes, especially serving. Acute pain may result from a sudden stretch or fall or ongoing ache may be experienced.
Physical conditioning is very important to minimise the risk of low back pain in recreational as well as elite tennis players.
How does physiotherapy treat lower back pain?A full assessment of movement control, flexibility, strength and endurance will guide the treatment and rehabilitation plans.
Our Team may use hands-on techniques for joints and soft-tissues, taping, acupuncture, exercise prescription, and practical advice.
Back injuries: famous tennis examples Roger Federer has suffered long-term issues with his back that he manages with core strength training and by playing fewer tournaments, while Andy Murray underwent surgery last year to address a long-standing problem.
Wrist sprain
What is it? The wrist contains many small joints and ligaments and has a cartilage structure, TFCC, like the knee meniscus, which can be injured.
How does physiotherapy treat wrist sprain?The physiotherapist will follow the PRICE guidelines (above) and may protect the joint with a splint or strapping. A full examination will be undertaken to determine which structures are involved.
A graded exercise program, including return to play testing, will be undertaken alongside hands-on treatments.
Carpal tunnel syndrome
What is it? This condition occurs when the median nerve that passes through the wrist is compressed, causing pain throughout the hand, wrist and forearm.
How does physiotherapy treat carpal tunnel syndrome? The first priority is to reduce any swelling in the carpal tunnel region and ensure the forearm muscles are functioning properly.
An assessment of the neck and neural system will be done to rule out any problems further up the movement chain.
An assessment of racquet grip and tennis stroke may help to identify any technical issues.
Wrist injuries: famous tennis examples Juan Martin Del Potro has suffered serious injuries to both wrists that have been reported as career-threatening. Nikolay Davydenko is another player to have struggled with a wrist injury.
Patella tendonopathy
What is it? This injury involves pain in the tendon that connects the kneecap (patella) to the top of one of the shin bones (tibia) and is usually caused by overuse. It can be either acute or chronic in nature.
How does physiotherapy treat patella tendonopathy? Management of inflammation and restoration of movement range and control are key factors in this condition early on then a graded loading rehab programme is key.
This condition need not stop a tennis player from playing, but the physiotherapist may suggest modifications to the amount or intensity of play.
Medial collateral ligament (MCL) sprain
What is it?This ligament limits excessive sideways movement of the inner side of the knee joint.
It has close links with the knee meniscus (cartilage) and the anterior cruciate ligament. The Unhappy Triad is the name given when all three structures are injured together.
MCL injuries can vary from overuse strains to full ruptures. A ruptured MCL may be managed conservatively or surgically.
How does physiotherapy treat medial collateral ligament sprain?Immediate treatment involves the PRICE guidelines (above). Protection may be offered in the form of bracing and / or use of crutches. Painkillers can be used but anti-inflammatories should be avoided in the immediate aftermath of the injury.
Restoration of normal range of motion is one of the first targets even if weight bearing is still reduced. Movement control including balance and co-ordination skills will form part of the rehabilitation plan along with hands-on techniques and strengthening.
The physiotherapist will guide the patient through graded exercises from squatting and lunging type exercises to jumping, hopping and landing skills.
Knee injuries: famous tennis examples Rafa Nadal suffers knee tendonitis that requires ongoing management, while Richard Krajceck battled back from a severe knee ligament injury to win further tournaments.
Calf strain
What is it?Injuries to the calf complex can affect the deep and superficial calf muscles, the Achilles Tendon and the Plantar Fascia of the foot.
How does physiotherapy treat calf strain? Immediate treatment involves the PRICE guidelines (above). Protection may be offered in the form of bracing and / or use of crutches. Painkillers can be used but anti-inflammatories should be avoided in the immediate aftermath of the injury.
Restoration of normal range of motion is one of the first targets even if weight bearing is still reduced. Movement control including balance and co-ordination skills will form part of the rehabilitation plan along with hands-on techniques and strengthening.
The physiotherapist will guide the patient through graded exercises from squatting and lunging type exercises to jumping, hopping and landing skills.
Sprained ankle
What is it?The most common injury is a strain to the lateral (outside) ligament but the deltoid ligament on the inside/medial side of the ankle can also be injured. Excessive strain on the ankle where it ‘rolls out’ can cause the lateral ligament to stretch or rupture and medial ligament to compress and get squashed.
How do physiotherapists treat sprained ankle?I mmediate treatment involves the PRICE guidelines (above). Protection may be offered in the form of bracing such as a walking boot, and / or use of crutches. Painkillers can be used but anti-inflammatories should be avoided in the immediate aftermath of the injury.
Restoration of normal range of motion is one of the first targets even if weight bearing is still reduced. Movement control including balance and co-ordination skills will form part of the rehabilitation plan along with hands-on techniques and strengthening.
The physiotherapist will guide the patient through graded exercises from squatting and lunging type exercises to jumping, hopping and landing skills.
If you are suffering with any of these injuries or any others just call for help and support getting you back to your best!
Dislocated shoulder
What is it?This occurs when a player’s arm is pulled or forced from its joint in the shoulder, most commonly in a fall or a collision with another player.
How does physiotherapy treat a dislocated shoulder?The shoulder will be reduced and depending on the severity of the dislocation, can be surgically stabilised. Intensive physiotherapy treatment will follow, working on flexibility, muscle strengthening and confidence, to ensure the shoulder does not dislocate again.
How long is the recovery?There are several different types of shoulder dislocation, relating to the direction of the dislocation. Anterior dislocations make up around 95% of all dislocations. Recovery will take around 2-6 months, depending on the severity and whether surgery is necessary.
Dislocated shoulder: famous football examples England winger Theo Walcott suffered a series of dislocations earlier in his career, and Chelsea keeper Petr Cech dislocated his shoulder in a Champion’s League semi-final.
Groin strain
What is it?This is a strain of the adductor muscles on the inside of the thigh and occurs when they are stretched beyond their limits and the muscle tissue tears. This can happen when players are stretching for the ball or side-stepping.
How does physiotherapy treat groin strain?Immediate treatment will involve the ‘PRICE’ protocol (protection, rest, ice, compression and elevation). The aim here is to reduce the bleeding and swelling from the injury site. This will also help with pain and can last for around three days.
Following this, the rehabilitation period will include gentle stretching, soft tissue work and muscle strengthening. Once properly healed, the player can start football specific drills, including jumping, running and sprinting.
For safety and to reduce the risk of re-injury, players should complete rehabilitation under the guidance of a chartered physiotherapist.
How long is the recovery?Muscle strains can be categorised into three grades. A grade one adductor strain involves 5-10% of the muscle fibres. This will tend to require 1-2 weeks rest before a player can return. A grade two strain is more extensive, including a greater number of muscle fibres.
Players will tend to be out for 3-6 weeks in this case. A grade three muscle strain is a severe tear involving most or all (rupture) of the muscle fibres. These players may require surgery and could be out for 3-4 months.
Groin strain: famous football examples former Liverpool and England captain Steven Gerrard recovered from a mild groin injury leading into the World Cup.
Hamstring strain
What is it?The hamstrings are a group of four muscles found at the back of the thigh. These muscles bend the knee. When they are overstretched the muscle fibres can tear leading to a strain. These muscles tend to tear during explosive or rapid movements such as sprinting.
How does physiotherapy treat hamstring strain?Immediate treatment will involve the ‘PRICE’ protocol (protection, rest, ice, compression and elevation). The aim here is to reduce the bleeding and swelling from the injury site. This will also help with pain and can last for around three days.
Following this, the rehabilitation period will include gentle stretching, soft tissue work and muscle strengthening. Once properly healed, the player can start football specific drills, including jumping, running and sprinting.
For safety and to reduce the risk of re-injury, players should complete rehabilitation under the guidance of a chartered physiotherapist.
How long is the recovery?Muscle strains can be categorised into three grades. A grade one hamstring strain will involve around 5-10% of the muscle fibres. This will tend to require 1-2 weeks rest before a player can return.
A grade two strain is more extensive, including a greater number of muscle fibres. Players will tend to be out for 3-6 weeks in this case. A grade three muscle strain is a severe tear involving most or all (rupture) of the muscle fibres. These players may require surgery and could be out for 3-4 months.
Hamstring strain: famous football examples
Michael Owen suffered multiple severe hamstring injuries throughout his career
Thigh (quadriceps) strain
What is it?This is where a tear occurs in the quadriceps group of muscles found on the front of the thigh that are responsible for straightening the leg, ie, when kicking a ball.
How does physiotherapy treat thigh (quad) strain?Immediate treatment will involve the ‘PRICE’ protocol (protection, rest, ice, compression and elevation). The aim here is to reduce the bleeding and swelling from the injury site. This will also help with pain and can last for around three days.
Following this, the rehabilitation period will include gentle stretching, soft tissue work and muscle strengthening. Once properly healed, the player can start football specific drills, including jumping, running and sprinting.
For safety and to reduce the risk of re-injury, players should complete rehabilitation under the guidance of a chartered physiotherapist.
How long is the recovery?Muscle strains can be categorised into three grades. A grade one thigh strain will involve around 5-10% of the muscle fibres. This will tend to require 2-3 weeks rest before a player can return. A grade two strain is more extensive, including a greater number of muscle fibres.
Players will tend to be out for 3-6 weeks in this case. A grade three muscle strain is a severe tear involving most or all (rupture) of the muscle fibres. These players may require surgery and could be out for 3-4 months.
Meniscus injury
What is it?There are two meniscus (a type of cartilage) in the knee. Kidney shaped, they provide a cushion between the upper and lower leg bones and can be pinched and torn under pressure. This tends to happen during twisting movements.
There are many different types of meniscal tear, including a ‘bucket handle’, ‘radial’, ‘parrot beak’ and ‘horizontal cleavage’ tear. Each tear will alter the biomechanics of the knee and therefore can cause irritation, swelling and pain.
How does physiotherapy treat meniscus injury?Dependent on the severity of the tear, it can irritate or cause the knee joint to lock. Sometimes following the initial swelling symptoms resolve with targeted strengthening work with a physio, and other times surgery is required. In this case, the meniscus is either repaired or trimmed.
Following surgery, the player will have intensive physiotherapy in order to control swelling, pain and increase muscle activation. This may include hydrotherapy and anti-gravity treadmill training initially, before starting football specific drills.
It is important that the rehabilitation is supervised by a chartered physiotherapist to reduce the risk of re-injury.
How long is the recovery?A player may be expected to return to play within 4-6 weeks, depending on the severity of injury and the surgery.
Meniscus injury: famous football examples ex Liverpool Uruguayan striker Luis Suarez underwent intensive physiotherapy to get fit in time to knock England out of the World Cup.
Anterior cruciate ligament (ACL) injury
What is it?This is the supporting ligament in the knee joint that enables twisting and turning movements. It can tear or completely rupture during an awkward landing or fall, or under impact of a tackle.
How does physiotherapy treat anterior cruciate ligament injury? Rehabilitation following ACL injury is long and intensive whether the ligament is repaired or a patient decides to manage the injury with rehab. It is a staged process to ensure the repair (graft) does not fail from early stressors if a reconstruction has taken place.. Initial treatment can include hydrotherapy, and graded strengthening
Football specific drills will be introduced later, starting with straight line running. Pivoting and quick turns will be introduced towards the latter stages of rehab, as these put the newly repaired ligament under the most stress. It is crucial that the player’s rehabilitation is closely monitored and progressed by a chartered physiotherapist to reduce the risk of re-injury.
How long is the recovery? You could expect a player to be sidelined for 9-12 months with an ACL injury. The intensive rehabilitation a player receives may lead to a quicker return than expected.
Medial collateral ligament (MCL) sprain
What is it?This is the ligament that joins the thigh bone and the shin bone and is found on the inner side of the knee joint. As with the ACL, it can be torn through twisting or impact.
How does physiotherapy treat medial collateral ligament sprain?Immediate treatment will involve the ‘PRICE’ protocol (protection, rest, ice, compression and elevation). The aim here is to reduce the bleeding and swelling from the injury site. This will also help with pain and can last for around three days.
As the ligaments start to heal, the player will be encouraged to put more weight through the ankle joint. The physio will then work with the player on their balance, co-ordination and muscle strength to get them back to match fitness and football specific drills.
They may use bracing techniques to support the joint during rehabilitation. It is important that the rehabilitation is guided by a chartered physiotherapist to reduce risk of re-injury.
How long is the recovery?MCL sprains can be categorised into three types. A grade one sprain is categorised as a mild sprain of the ligaments. Grade two is a partial tear of the ligament(s) and may result in some ‘looseness’ at the joint.
Grade three is a complete tear of the ligament which results in gross instability and may require surgery. Dependent on the type and grade of sprain, a player may be out for up to 6 months.
Calf strain
What is it?The calf is at the back of the lower leg and is made up of two key muscles which enable players to push off and run. Like other muscles, the calf can be torn and strained when stretched beyond its limits.
How does physiotherapy treat calf strain?Immediate treatment will involve the ‘PRICE’ protocol (protection, rest, ice, compression and elevation). The aim here is to reduce the bleeding and swelling from the injury site. This will also help with pain and can last for around three days.
Following this, the rehabilitation period will include gentle stretching, soft tissue work and muscle strengthening. Once properly healed, the player can start football specific drills, including jumping, running and sprinting.
For safety and to reduce the risk of re-injury, players should complete rehabilitation under the guidance of a chartered physiotherapist.
How long is the recovery?Muscle strains can be categorised into three grades. A grade one calf strain will involve around 5-10% of the muscle fibres. This will tend to require 2-3 weeks rest before a player can return.
A grade two strain is more extensive, including a greater number of muscle fibres. Players will tend to be out for 3-6 weeks in this case.
A grade three muscle strain is a severe tear involving most or all (rupture) of the muscle fibres. These players may require surgery and could be out for 3-4 months.
Sprained ankle
What is it?A sprained ankle occurs when there is soft tissue damage to the ligaments in the ankle joint. Around 70-85% of ankle sprains are ‘inversion’ sprains.
This occurs when you roll the ankle outward and the sole of the foot faces in and up. This can happen during a tackle, by running on uneven ground or landing awkwardly.
How do physiotherapists treat sprained ankle?Immediate treatment will involve the ‘PRICE’ protocol (protection, rest, ice, compression and elevation). The aim here is to reduce the bleeding and swelling from the injury site. This will also help with pain and can last for around three days.
As the ligaments start to heal, the player will be encouraged to put more weight through the ankle joint. The physio will then work with the player on their balance, co-ordination and muscle strength to get them back to match fitness and football specific drills.
It is important that the rehabilitation is guided by a chartered physiotherapist to reduce risk of re-injury.
How long is the recovery?Ankle sprains can be categorised into three types. A grade one sprain is categorised as a mild sprain of the ligaments. Grade two is a partial tear of the ligament(s) and may result in some ‘looseness’ at the joint.
Grade three is a complete tear of the ligament which results in gross instability at the ankle joint and may require surgery. Dependent on the type and grade of sprain, a player may be out for around 3-6 months.
Broken metatarsal
What is it?This is a bone in the foot that can be broken through contact, excessive rotational force or simply overuse.
How does physiotherapy treat a broken metatarsal? Initially the player will be encouraged to take weight off the foot by wearing an aircast boot. Once the medical team are happy that the bone has healed sufficiently, the player will gradually return to play.
The physiotherapist will specifically work on maintaining fitness, muscle strength/length, balance and co-ordination.
How long is the recovery?Dependent on the severity of the injury, recovery can take between 4-8 weeks. If surgery is required, this could be longer.
Broken metatarsal: famous football examples David Beckham and Wayne Rooney suffered high-profile metatarsal injuries before major tournaments for England, although both went on to play in the 2002 and 2006 World Cups respectively.
Rooney has suffered the injury on three occasions.
Clinical pilates consists of a series of exercises in various different body positions which have been adapted by physiotherapists to make them more suitable for use with patients groups. Essentially I prescribe exercises based on an individuals’ clinical need, taking into consideration factors such as their injury or pain, their posture, areas of muscle weakness or over activity, and movement dissociation.
I teach clinical pilates underpinned by the Australian Physiotherapy and Pilates Institute. The APPI has modified the original 34 Pilates matwork exercises to incorporate the recent research on lumbar instability, muscle imbalance and adverse neural tension. This makes the exercises highly versatile and accessible to a broad range of individuals, of any age and any physical ability.
I feel that there is a large emphasis on not only what the exercise is, but also how the exercise is performed, i.e. having the correct technique; using the correct muscles; and utilising the appropriate amount of energy in order to work effectively and efficiently. This makes clinical pilates a gentle form of exercise and ensures optimal gains whilst minimising the likelihood of injury aggravation. However, this doesn’t mean that I can’t put you through your paces if that’s what you are after!
Key benefits of Clinical Pilates include retraining:
* Neutral lumbo-pelvic alignment and activation of the key lumbo-pelvic stabilising muscles
* Correct ribcage/thoracic alignment
* Scapulo-thoracic stabilisation
* Deep neck flexor retraining to stabilise the cervical spine
* Balance
* Spinal mobility
* Flexibility of the key trunk and lower limb muscles groups
* Body awareness/postural awareness.
* Normal movement patterns, which is especially important in the case of injury or pain as this aids rehabilitation & reduces the risk of re-injury
Pilates Principles
1. Concentration: Focus on correct performance of each Pilates exercise and the specific muscles involved.
2. Centering: Focus on achieving neutral spine and activating the core stabilising muscles (pelvic floor and transversus abdominus) to support the lower back and pelvis
3. Control: Maintain optimal posture and control with all movements.
4. Flowing Movement: Work smoothly and efficiently with all movements.
5. Precision: Perform each Pilates exercise with attention to detail to ensure correct technique.
6. Breathing: Maintain relaxed, normal breathing throughout all pilates exercises. Do not hold your breath.
Recent research advocates the retraining of the deep stabilising muscles for patients with low back pain. Clinical pilates focuses on the retraining and recruitment of these stabilising muscles (core stability) as well as improving posture, strength and flexibility. Pilates can therefore help to prevent the recurrence of back pain in combination with correct back care and advice, and gentle aerobic activity.
I have lots of experience working with patients of all ages (children to the elderly) who present with back pain, acute and chronic. I have found a combined approach of clinical pilates, hands-on physiotherapy (especially myofascial release techniques) and advice/support to be a very effective program of treatment. In many cases I have worked with people who have had back pain for many many years, in some cases 20+ years! I couldn’t fix them over night but we worked hard together and had excellent results where people can feel better than ever, but it does take effort on both parts. So don’t be put off if you have had your pain for a long time.
Do I have to be pain-free/injury-free before I can start?
No. Many patients find that pilates is a useful form of exercise, helping them to return to their normal day to day activities/hobbies/sports following pain or injury.
What does it involve?
I would need to ask a few questions about your health and well-being, and what has motivated you to come see me. I will assess your posture and look at certain aspects of your joint/spinal mobility and muscle strength. I will work with you to address your specific needs and tailor a program to your individual requirements.
If you have any additional queries please not hesitate to contact us.
2/ Bike Equipment: ensure your bike is regularly serviced so a mechanical doesn’t spoil your ride, or even worse your race. Keep moving parts clean and lubricated and check for wear and tear in the chain, rear cassette and chain rings. Make sure the brakes work well and you have some spare pads to change when required. A good saddle is also key. They are like shoes, some fit, some don’t so do try a few before settling on one. Most good bike shops will let you do this. ALWAYS wear a helmet, it may just save your life one day. Don’t have it hanging on the bars, that only prevents scratches to the bike, not to your head and brain.
3/ Be Seen: yes darker colours absorb the sun keeping you warm but they are difficult to see so try and brighten it up with some light arm and ankle bands or buy clothing that is lighter, even with bright stripes or something similar. If you’re riding on duller days or early morning/late evenings, ensure you have a set of bright lights that work.
4/ Hydrate: start the ride well hydrated and aim to keep it this way. Generally 750-1000ml per hour especially now it’s getting warmer. As little as a 2% drop in hydration can reduce your mental and physical performance by 10-30% and don’t rely on thirst as you’re already dehydrated. Keep sipping your fluid (water, electrolyte drink, juice) every 10-15mins or so and aim to pee pale yellow! Unfortunately great coffee doesn’t count so offset with a glass of water with it on the coffee stop.
5/ Fuel: you should be well fuelled before each ride and this starts during your previous ride/training session so don’t “wait till I’m home” as this will not only make you more likely to overeat when you’re done but also impact on following training sessions. Aim to have something decent about an hour before you start e.g. porridge, yogurt and fruit with same cereal, wholegrain toast with nut butters, smoothie made with yogurt/milk fruit and nuts so it has time to digest and provide you with energy. Avoid anything 20-30minutes before as you’ll go straight to burning this off and into the sugar stores rather than the fat stores which may make you need more fuel during the ride, plus if you’re trying to lean down a little, it’ll impact on that.
If the session is less than one hour you should be fine with just water if you’re fuelled. If it is longer then start taking a carbohydrate drink/food at about 1-1 1/2hours and have small amounts but regularly so as to avoid stomach discomfort. What you have is very personal but sports drinks, cordial with small amount of salt, banana, fruit bread with honey/jam nut butter sandwiches, Jaffa cakes or muesli bars. If it is an intense session you may just stick with water and a sports drink as it’s easier to digest and you may need more than just water to keep energy and effort levels up.
After training try and have a snack especially if you are not eating for some time so fruit smoothie, milkshake, banana and yogurt, pancake with honey and nut butter and obviously fluid. Then within two hours try and have a meal that includes protein, carbohydrate and essential fats so grilled fish or chicken with sweet potatoes and salad, chick pea stir fry or bean and vegetable soup with bread.
Snack between meals to keep energy levels up especially if you’re training more than you have been and again this will help prevent overeating at meal times and energy levels up for work and training. Ideas are a Handful of nuts, seeds and dried fruit, fruit and yogurt, crumpets with nut butters, fruit breads, granola with yogurt, muesli bars etc. Try to avoid the biscuit tin and chocolate but everything in moderation! These will have a slightly adverse effect on your blood sugar giving you an initial high and then a slump leaving you craving yet more sugar.
The use of caffeine is becoming increasingly popular and it has been proven to enhance performance but beware of its effect on heart rate as some people are very sensitive making the heart give extra beats which may be a little alarming. Most caffeinated drinks that people tend to use are the energy drinks but these also contain high amounts of sugar so if you have one just before you set off be mindful of the effects on blood sugar and the fuel you will initially be burning. Stick to black coffee/tea with no sugar if you are leaving it until the last 10-15minutes.
Small amounts of caffeine towards the second half of a long session do help to mobilise the fat stores thus providing you with energy when the glycogen stores are running out and this practice is used a lot in endurance events. It also gives you a lift in and reduces effort level.
One thing to remember, play around with what you have and when so you know what you can tolerate before the event. Do not try anything new during the event because it’s there unless you are desperate as it may impact on the rest of the race. If it is a hilly event, aim to eat after climbing the hill, not just before or during as you’ll be working harder and thus it’ll be more difficult to digest. Wait until you’re at the top.
Most importantly is to practice what you want to eat, have a look at what is provided during the event and try those so you know what you can have and to plan how much you need. A general equation is 1g of carbohydrate (liquid or solid) let kg of bodyweight per hour but this does vary. Another way is about 250-400kcal per hour depending on intensity of effort and body size. Again, it is all about practice to see what you need and can tolerate.
6/ Skills, drills and technique: do spend time on how to handle the bike so as to be safer and also reduce losing time in any races/events. Simple things like practice taking water bottle in and out, reaching into pockets for food and eating on the go. Plan a specific drills session where you make a mini circuit that involves tight corners and practice going in both directions. As a general rule, if turning right, left foot is pressing into the left pedal and leg straight, the left hand is pressing into the left handle bars and straightish. The right leg is bent as is the arm with little weight on it. The extent of both is corner angle dependant. Practice taking the right line so you slow going into it but can speed away as you come out of the corner. Think about gearing too so you will need to change down into easier gears going in so you do not grind a big gear, thus losing momentum and speed coming out of the turn. Then there is descending. Again practice. Similar rules apply as to cornering.
7/ Train to race/complete the event: once you enter a key event/race have a look at the profile and try to train on as similar terrain as possible i.e. if it is flat train mainly on the flat, if it’s hilly train hilly and do try and be in the position you hope to race in as much as possible so if you plan to be on the drops or aero bars then be in that position in training so you train the muscles in that position. There is no point doing most of your training on the hoods to then expect yourself to do well on aero bars for several hours. Not only will you feel uncomfortable but you and your muscles will not be efficient and strong in this position as it is relatively new for you. Make exceptions for long club rides but key sessions do try and be in the race position as much as possible, or at least when you’re doing efforts/intervals.
Include strength work, so over gear hill reps in the saddle.e.g 6x5min at 65-70rpm in big gear. If you can’t find a hill long enough do somewhere that has an incline or on the flat but put in the biggest gear. Then have a few mins easy or descend freely with little effort focusing on technique and bike handling.
If you’re racing more road races and criteriums then include power surge work.e.g 10x10 sec out the saddle max effort with 1.50 easy. Spin for 5mins and repeat 2-3times. In group rides include some chain gang work going through and off work and understanding where you need to be to get the most shelter and in what side the through and offs should be in regards to wind direction and corners.
For long endurance races, include longer and longer intervals at race pace effort depending on the distance e.g. in a 3hour ride have 30min warm up then for the next 2hours include 10-30mins at race pace with 5mins spin between and do for the remainder of the ride but do a decent warm down.
8/ Functional fitness: this is the bit everyone forgets. It’s the small bits that count in enhancing performance and reducing injury risk to ensure you are using the correct muscles as the correct time and they are strong enough to maintain their work. People may have heard of “core stability” but it is more of a functional stability according to what you are doing and aiming to achieve, so yes it is about the lower transabdominal muscles but also about your gluteal (bum), lower back and shoulders and how they connect together to give you a stable platform to work from.
9/ Flexibility: this is very important. A tight muscle is a weak muscle so do spend time on stretching after your ride. Doesn’t have to be immediately but definitely that day. Focus on hip flexor and quadriceps and gluteal but do not forget hamstrings, calves, neck, shoulders and back. Hold each stretch for 30sec and ideally do 2-3times. A foam roller is also good for self massage before stretching as is finding a good yoga class to enhance your flexibility, stability and breathing. Many sports people are turning to yoga to enhance their performance and reduce injury risk.
10/ Bike fit: this is imperative in reducing injury, enhancing performance and maximising your efficiency and comfort. When you buy a bike you should have it fitted to you at the shop and this is great but you then having it looked at closer, so it fits you and your biomechanics, flexibility, stability and functional stability together will give you the perfect ride. Here at Physio Impulse our Bike fitter and Osteopath Jasper will do exactly that and offer advice re exercises, stretches and training so as to help you achieve your goals and limit injury.
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Physioimpulse Chartered Physiotherapists
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