As a cyclist you have many options when it comes to getting the right bike and making sure you are 
riding it comfortably. 

At the very start of the journey you hope to have selected the correct frame size and type of bike for your intended use. Most bike shops will be able to get this part of process right for the rider, though  some  are  better  than  others. We  are  lucky  in  Bath  to  have  a  couple  of  great  shops  with knowledgeable  staff   who  are  passionate  about  cycling  rather  than  some  of  the  larger  chains  with disinterested store assistants. 
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So  you’ve  got  the  bike  and  hopefully  all  is  well.  But  there  are  often  a  number  of  reasons  why things don’t go to plan and we may start to develop discomfort when we are riding or even start to aggravate or cause an injury. ​

Here are some of the reasons why riding that new bike may be causing you some issues:
• Changed frame geometry which can affect riding position
• Altered contact points relationship (e.g saddle to bar drop)
• New saddle
• Over-exuberance with the new bike leading to a drastic increase in ride mileage
• Different gearing from your previous or other bike
• Unsuitable crank length

If you start to develop some issues your first port of call may be to pop back to the bike shop. In 
some cases the solution to your problems may be beyond the shop’s remit and a bike fit may be 
recommended to address your problem. 

Bike  fitting  is  a  process  through  which  a  trained  professional  can  make  adjustments  to  the 
position  and  set  up  of  the  bike  to  best  match  the  rider’s  current  capacity  -  whether  that  be 
flexibility, strength, stability etc. 
Most bike fits will be offered by individuals who have undergone some training in how to deliver 
this  process  using  various  check  sheets,  average  values  for  joint  positions  and  possibly  motion 
capture systems that generate a ‘recommended’ set up. 

As  a  specialist  physiotherapist,  I  have  worked  with  cyclists  for  many  years  helping  them  to 
overcome various problems and injuries. It is this specific knowledge that allows me to go beyond 
a simple check-box formula based approach to bike fit. 

At Physioimpulse we ensure  each  rider  is  individually  screened  and  if  there  are  any  injuries  picked  up  these  form  an important  part  of  the  basis  of  the  bike  fitting  decisions  made  in  the  session  to achieve  the  best possible outcome.
In the case that injury is already established then it is most likely that the bike fit will not ‘cure’ the 
problem  as  a  stand  alone  intervention.  Once  again,  as  a  trained  specialist  physio,  I  can  offer 
guidance  on  the  importance  of  setting  up  a  comprehensive  rehabilitation  programme  to  ensure 
the problem is addressed both on and off  the bike. 

So,  if  you  are  out  riding  but  you  are  not  totally  comfortable,  or  you  have  been  picking  up  small 
injures here and there its time to consider having your bike fit re-assessed more comprehensively. 
Please feel free to get in touch if you have any questions about your bike fit or if you would like 
more information about our bike fitting service. I am always more than happy to answer questions.  

Bryan McCullough
Specialist Cycling Physio, MSCP
Bike Fitter - IBFI Level 2
bryan.mccullough@physioimpulse.co.uk

What is Sports Massage?
At Physioimpulse sports massage therapy is delivered as part of our interdisciplinary team approach and is utilised in many cases we see in clinic as a strategy for injury management and prevention. Cases of a stiff neck and upper back from professionals in a desk based occupation are one of the most common patient complaints we receive on a daily basis. Often the port of call is sports massage, where techniques such as deep tissue release combined with muscle lengthening techniques can go a long way towards restoring normal functionality. They work by releasing areas of increased tension from poor working posture or repetitive strain, and can help to break down areas of focal tone (commonly known as knots).
Specific uses of sports massage:
Maintenance:
After long bouts of exercise from activities such as resistance training or running, muscles are exposed to micro trauma in the form of small tears in the fibres they are made up of. This creates areas of swelling which can become irritable and often sore. Sports massage and rehabilitation can help to remove irritable substances such as lactate away from the site and can aid in the promotion of delivery of fresh and nutrient rich blood, providing the body with everything it needs for a speedy recovery process post exercise.
Injury Management:
Scar tissue is what the body uses to repair damaged areas in muscles. Sometimes scar tissue can be dysfunctional and form as unorganised and weak material which puts the area at risk for re-injury. Sports massage and rehab can help provide a framework to begin to remobilise this tissue, make it more pliable and less prone to re-tearing.
Healthy Body, Healthy Mind:
Stress is an emotion experienced by everyone on a daily basis. No matter what level of stress, or whether it be physical or mental stress, the implications can cause negative effects on the body. Relaxation techniques are often used by the therapists at Physioimpulse, they allow for the targeting of the body as a whole and ultimately resulting in an elevation of both mood and bodily function in many of the patients we see.
What Can You Do To Reduce Muscular Tension?
-Daily stretching routine
-Foam rolling and self-applied massage
-Work at a standing desk
-Incorporate adequate rest and sleep
-Receive regular sports massage therapy

We are receiving some great feedback on the pain relieving effects of our Ostenil Plus injections which enable people to return to their normal activities of daily living with greatly reduced reports of pain.
The study below outlines the benefits of these injections in delaying the need for major knee surgery

If you would like to know more about these injections read our Injection Therapy page or email matt.shepherd@physioimpulse.co.uk

​01225 683007

The use of intra-articular hyaluronic acid (HA) injections in patients with osteoarthritis (OA) of the knee has shown efficacy in delaying total knee replacement (TKR) surgery in a recent retrospective, longitudinal study published in PLoS One.

The investigators sought to compare the delay from diagnosis to TKR surgery in patients with knee OAwho received intra-articular HA injections vs those who did not. All patients studied were treated in France between 2006 and 2013. A second objective of the study was to compare direct medical costs associated with ambulatory care between the 2 groups.

A total of 14,782 patients were treated for knee OA (ages ≥50 years; mean age, 68±10 years; 67% women). Annual incidence rates of knee OA were estimated to be 0.52% in women and 0.92% in men. Of the 14,782 patients, 1662 individuals (11.2%) underwent TKR surgery before the end of 2013.

At each point evaluated, restricted mean survival time without TKR surgery was higher in the HA treatment vs no injection group (from 51 days at 1 year after diagnosis to 217 days at 7.5 years, respectively; P <.001). In the year before TKR, the means for total direct medical costs were similar between the 2 treatment groups (€744 for HA vs €805 for control). Intra-articular injections accounted for <10% of the total costs.
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This is the first retrospective longitudinal study involving patients with knee OA that used medico-administrative databases in France. The investigators concluded that “the results support the effectiveness of [HA] injections in delaying [TKR] surgery and show that patients treated with [HA] have similar direct medical costs for ambulatory care compared to patients treated with corticosteroids only.” Further cost-effective analyses are warranted to explore the ability of HA injections to delay TKR surgery for a longer period of time.


Reference

Delbarre A, Amor B, Bardoulat I, et al. Do intra-articular hyaluronic acid injections delay total knee replacement in patients with osteoarthritis – A Cox model analysis. PLoS One. 2017;12(11):e0187227.

Our top pilates trained physiotherapist Renu has put together this fantastic guide for postnatal runers.
Download and read the whole presentation below!
Having problems getting back to full strength and activity post partum? Renu specialises in getting you back to full health!

Did you know amongst other things, chiropractors frequently also treat the hips, knees and feet?
 
Amazingly in an average lifetime, our feet carry us an equivalent of five times around the Earth and in addition to this, the feet must take the strain of supporting the body’s weight even when just standing still. Given how often we use our feet, and the demands we make upon them on a day to day basis, it’s so important to look after them properly.
 
In each foot there is a total of 26 bones, and damage to any one of them, or even related muscles, ligaments or cartilage can result in problems with the foot that may need attention from a trained professional in order to prevent longer term damage.
 
Here are some simple tips for you to follow to keep your feet in good condition:

• You should inspect and feel your feet daily for cracks, corns and ulcers.
• Toenails should be cut straight across, not too close to the skin.
• Take extra care when walking barefoot.
• A well fitting shoe should not require a long and painful breaking in period.

 
Pay good attention to your feet; changes and/or pain in the feet and ankles could indicate a more serious foot ailment or circulatory problem, so if in doubt, check it out! If you think you might need support for your feet/arches then check out our biomechanics and orthotics service

​While fun and efficient, our much-loved technological devices could be the cause of bad posture and resulting back and neck pain…
 
Technology has become part of our everyday life. Everywhere you look people are surfing the net on their computers, writing a text message on their mobile phone or using a tablet to watch a video, which means a considerable amount of our time is being spent hunched over looking at a screen.
 
It goes without saying that our techno devices bring a lot of fun and efficiency into our lives, but they can also, unfortunately bring a multitude of problems for our backs and necks, which is why correct posture when you are spending a lot time in front of a screen is extremely important.

Our bodies are very robust to general postural stress but to reduce repetitive loads follow these simple Do's and Don’t's:
 
Do

• Try out new gadgets before you buy them to make sure they’re comfortable to use and spend time setting them up in a way that works well for you
• Take the time to break position on a regular basis and stretch your arms, shrug your shoulders and move your fingers around when using your mobile, smartphone, laptop or tablet, as this helps to keep the muscles more relaxed
• Ensure your chair has an adequate back support when sitting in front of a computer at a desk
• Take regular breaks to rest eyes, neck and shoulders
• Stand up and walk around at least once an hour
• Relax your wrists while typing.

 
Don’t

• Get too engrossed in what you are doing and forget how long you have been using your tech device in bed; if you are still planning to surf/text/play on your devices in bed, set an alarm to remind you to pack it away and get some much needed sleep
• Slouch, use a low table or cross your legs while sitting at a desk in front of your computer screen for long periods
• Sit in the same position while using your tech device for too long at a time
• Tense your neck, shoulders or wrist.

​Many people cringe at the sound of knuckles, elbows and other joints cracking. For years, experts have debated whether or not this common cracking could cause joint problems.
 
It has recently been confirmed that this ‘popping’ is due to a small bubble forming between your joints. The bubble forms when your joints move apart, forming a kind of vacuum in the synovial fluid, a slippery substance that lubricates your joints.
 
People who can deliberately make joints like knuckles pop usually do so by pushing or pulling the joint in such a way as to make an air bubble appear with a sudden pop. This is called joint cavitation. Once the bubble is there the joint will not pop again until all the air has been reabsorbed.
 
However, there are other cracking noises and sensations that may of concern. Snapping and cracking noises can be caused by osteoarthritis as a consequence of the natural ageing process, or following a trauma or disease in the joint. In this case the cartilage, which eases friction in the joint breaks down, so that movement causes painful friction and crunching noises.
 
Snapping noises and sensations, on the other hand, are likely to be caused by muscle or tendon moving across a bone. This happens when a tendon is slightly loose, and occurs most often in the hip, knee, ankle, wrist and shoulder. This could eventually lead to bursitis, or inflammation of the fluid-filled sac that allows muscle to move smoothly over bone.

Adhesive Capsulitis (AC), or Frozen Shoulder, is a common condition causing stiffness and pain in the shoulder. AC affects 2-5% of the population and up to 20% of people with diabetes. It may also be associated with high cholesterol, heart disease and rheumatic conditions.
AC is a condition in which the shoulder is completely or partially unmovable (stiff).  Along with often intense shoulder pain, AC presents with progressive limitations in both active range of motion (joint movement you can achieve alone) and passive range of motion (movement achieved when someone else moves the joint).
The cause of this debilitating condition is not fully understood. It is believed that the shoulder (glenohumeral) joint capsule, a band of connective tissue surrounding to head of the humerus, along with shoulder ligaments, become red, swollen and inflamed, leading to shortening and stiffness (contracture) and a loss of the capsules normal elastic quality.

​AC generally affects people aged 40 – 65 years, it can occur spontaneously, with mild injury, or secondary to another condition. Night pain is a common feature. X-ray investigation is often normal. Symptoms of AC can mimic other conditions such as osteoarthritis, for example, which can make diagnosis difficult, but physiotherapists are well placed to diagnose AC using a thorough history and physical assessment.
For some time it was believed by many that AC followed a natural history theory. If initially ‘frozen’ it would suggest it could thaw. The theory was that the condition moved from painful (freezing), stiff (frozen), through to (thawing) recovery / complete resolution. Furthermore, it was believed that the condition would improve over time (usually 2 – 3.5 years) without any intervention.
We can now confidently say that these theories have largely been disproven. No longitudinal evidence supports the natural history theory and there is moderate evidence stating that most improvement occurs early, not late; therefore, the key in AC is early diagnosis and early treatment. A delay in treatment may in fact lead to worse outcomes.

​Physiotherapy
The team here at PhysioImpulse can help identify many causes of shoulder pain and stiffness and support in the management of these debilitating conditions.
Treatment of AC is focused on restoring normal range of movement and returning the joint back to its previous function. Shoulder joint  injections are commonly used for AC and these injections aim to reduce inflammation and also act as pain relief. However, there is no ‘gold standard’ treatment regime; your physiotherapist will work with you to create a plan tailored to you.
Early mobilisation with physiotherapy is generally recommended as first-line treatment; a variety of techniques may be used. One of these is ‘hands-on’ physiotherapy using joint mobilisation techniques. These aim to gently stretch the joint capsule by performing passive mobilisations at varying points throughout the shoulder range. Your physiotherapist will support this with appropriate exercise therapy and activity management advice.

For Further information on Adhesive capsulitis or any other condition just call the number below or email therapists@physioimpulse.co.uk

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• The Achilles is the tendon found at the bottom of the calf and joins the calf muscles (Gastrocnemius and Soleus) to the heel bone. The Achilles tendon has to tolerate the highest loads in the body – up to 10 times your body weight during running and jumping.
• Achilles heel pain is now called Achilles tendinopathy. There are cellular changes to the tendon and to the arrangement of collagen fibres, as well as its supporting system, the matrix. With Achilles tendinopathy the tendon does not become weak, but it does make it difficult for the Achilles to tolerate loads. Correcting this that is at the heart of treatment.

You can get Achilles tendinopathy through a specific injury or by overuse. The tendon can deteriorate gradually over a period of time

​What are the symptoms?

• Classic features of Achilles tendinopathy are the gradual onset of morning stiffness, which may resolve within 5-10 minutes, and stiffness when walking after sitting for long periods. The morning stiffness is often worse on days after a run.
• You may also notice some swelling.
• Your Achilles tendon might feel tender when you touch it. There may be a grating noise or creaking feeling (crepitus) when you move your ankle.
• Sudden pain in your heel or calf, which quickly becomes swollen, bruised and sore, can mean you’ve torn the tendon. You may actually hear it snap. This is called an Achilles tendon rupture. You should get urgent medical attention if this happens.
• The pain/stiffness will typically “warm-up” during the first 5-10 minutes of a run. This often means people don’t seek help as they can initially run through the pain. But the earlier you seek help, the more likely you will be able to get away with adjusting your load rather than stopping running altogether.

 
 
 
What causes Achilles Tendinopathy?
 
There are certain risk factors that may lead some people to developing Achilles tendinopathy, many of which relate to changes in load through the tendon rather than to a person’s biomechanics.

• More men are affected than women
• It is more common in your 30s or 40s.
• Some individuals also have a genetic predisposition to developing tendon pain.
• Other risk factors can include changes to your exercise regime.

 
There are three questions that should be considered:

• What – Have I changed in my training/exercise in some way e.g. more hilly terrain for running/cycling, increased distance/speed?
• Where – Have I changed where I train e.g. cross country to road running?
• With – Have I changed what I train with e.g new footwear, altered bike set up etc?

How to treat it

• Diagnosis can occur at different points: the onset of pain may be quite sudden and a reaction to overload – referred to as a reactive tendinopathy and may be severely painful. Or it might be more chronic (longstanding as opposed to severe) – referred to as tendon disarray or degeneration. The treatment will therefore depend on the individual, but ultimately it involves improving the tendons tolerance to load.

 
Physiotherapy principles
 
The key areas that physiotherapy focuses on are as follows:

• Improving how well the tendon tolerates load
• Biomechanical correction read here about orthotics/insoles
• Manual therapy (Soft tissue and joint mobilisation to relax tight areas within the calf muscles and reduce any stiffness in surrounding joints)
• Strength training and correcting training errors

There may be a need to cut running initially, but the general consensus is that off-loading the tendon for too long is unhelpful. So the ideal is to calculate the amount of running that can be done without affecting the symptoms – which are mostly latent. So morning stiffness following a training day can be a good indication of how the tendon is coping with load.
There is good evidence that slow, heavy load-strength training can improve a tendon’s tolerance to load and this is one of the gold standards for treatment. It is important, though, to avoid overload through other aspects of training while strength training, otherwise it may fail.
 
While there may also be specific biomechanical factors feeding into the tendinopathy.
Your Physiotherapist will consider the whole chain when assessing, including looking at the hips and knees any spinal involvement.
 
More common than biomechanical problems are training errors. Most people we see present with Achilles tendon problems when they have radically changed their training load. All the evidence points towards load management as the best way to treat Achilles tendinopathy. And it is important to give it time before considering other options – we suggest three to six months.