Let's see how the running goes....

My new running shoes! 

When I first tore my meniscus back in December 2016 I initially had a very successful return to running. I did lots of rehab right from the start, and in late spring 2017 I began a couch to 5km plan that combined varied running with cross training, taking care to listen to my body rather than follow the plan rigidly, with the pleasing result that I ran my fastest ever 5km and carried on progressing to 10km. Then a rather over enthusiastic physiotherapist session caused my meniscus to tear again, and this time I couldn't rehab it (it's likely there was an underlying issue with the meniscus before the physio session, so it probably would have torn at some point anyway; it turned out later that I have discoid shaped meniscus that tear easily). I ended up having surgery in 2018 to repair and trim two tears, but it continued to be easily aggravated with the knee frequently swelling up and after an attempt to return to running in 2019 didn't go well I decided to knock it on the head and focus on improving the underlying function of the leg in the context of the whole of me. I have really missed my running but the most important exercise for me is long walks so I concentrated on this instead. I am no longer climbing as it's too much temptation to put torque through the knee, which I was warned off doing by the surgeon.

So, lots of somatic style exercises and JEMS exercises to restore the natural movement I had lost through chronic injury. I also tend to overly focus on my knee - understandably - which amplifies negative sensation leading to tension and anxiety. I am now aiming to widen my focus away from how the knee is feeling.

Endless squats and lunges with increasingly heavy weights have strengthened up my legs but there is still muscle wasting on the vastus medialis (partly because the knee has often had some swelling present) so I am including other functional movement exercises. I noticed that I lose optimal movement when I am moving down steep ground so I need to practice vertical hip release and incorporate this into my exercises. I need to improve my one leg dips on the injured side and I continue to work on foot sensitivity and propriocetion. I introduced exercises to encourage the return of spring and bounce to absorb forces and be energy efficient.

Last week I went for a tentative short run, a standard walk 30 seconds, run one minute for ten minutes. It went ok, no problems 24 or 48 hours later so I ordered some new shoes online (on the sale, hurrah!) from a favourite outdoor shop that I want to support whilst it is closed to visitors during the lockdown. New shoes felt important as my current ones have been shaped by my gait since surgery and so have negative connotations for me; they are also wearing out. Of course I went for a run the morning they arrived: a short, gentle 3km where I walked the steepest bits (I need to acclimatise my Achilles tendon on the uphills and get better control for the downhills before I run them), and slowed down or walked for 30 seconds to a minute when I got very breathless. I visualised the helium balloon supporting my central longitudinal axis, and kept my stride short. It felt great! Now lets see how it feels 24 hours later, then 48 hours....

I did notice that I wasn't rotating freely with my trunk so as well as thigh slides and greyhounds (an exercise I haven't posted about yet) I will be doing a couple of simple Muscle Energy Technique stretches as follows (please be responsible for your own comfort and safety when doing these, don't force the stretch):

Lie on your side on the floor or your bed. Keep your bottom leg straight and bend your top leg so the knee comes towards your chest but is still able to rest comfortably on the surface - you can use a pillow to support it, especially if you have irritable hamstring tendons. Position your bottom arm straight out in front of you so it is at right angles to your torso and let your top shoulder roll back, taking the top arm and your upper back with it. Now really stretch out that bottom arm and hold for ten seconds before taking a deep breath and relaxing. As you breath out see if you can let your shoulders and back roll back a little more; relax and breath easily in this new position. Now press your top knee gently into the surface it is resting on and sustain for ten seconds before relaxing and again letting your back roll back as far as it can do comfortably. Relax in this position for thirty seconds, then roll back and bring yourself slowly back up. Repeat on your other side.

Half moon stretch, one that I like to do pretty much anywhere - against a wall, lamp post, tree.... I began to describe this but really, it is easier for you to google how to do it as it is a yoga pose. It's often shown with no support but I like to lean my hands against something so I can really relax. Stand sideways on to the structure you are going to lean against, make sure it will take your weight. Your chest and pelvis must face straight forward through the whole exercise, at right angles to the support. In my experience if people aren't feeling the stretch it is because they are turning their chest and pelvis inwards. I always hold the stretch for at least 45 seconds on each side. I find it a very relaxing stretch that restores the sensation of connection through the body whilst also releasing tension.  

Core stability

What comes to mind when you think about core stability? For many, it conjures up strength and being able to hold the plank forever, and certainly strength is a useful aspect of core stability that provides endurance. However, it is helpful to consider function: what does core stability give us, why would we want it?  

I would like you to consider core stability as responsive and adaptive. Many muscles and other connective tissues work together with our nervous system to absorb forces, recover and adapt, so that we can maintain our trunk where we need it to be; providing a connection between our head, arms and legs. Like a spring, this works with movement, dampening forces rather than just blocking. 

The core muscles are found in our trunk and provide the connection between our legs and arms. When I hit a tennis ball, reach for a saucepan or use a fork to stir the compost pile, I am powering from the feet and legs as well as the shoulders and a steady, responsive trunk provides a stable and adaptive platform to transmit that power. You can feel this connection for yourself when you do push ups against a wall. If you let your trunk collapse, you lose both power and control. However, if we concentrate on bracing the trunk we lose an important aspect of core stability: the ability to note and respond rapidly to challenges such as a push or pull.  

Stability is adaptive and responsive. If you think about everyday life, would it be helpful to walk about braced, as if your body is a suit of armour? How would it affect your ability to react to someone throwing a ball at you, or if you slipped on mud? The trunk is most resilient to challenges when it uses a range of mechanisms. At the foundation of core stability are the local stabilisers: postural muscles such as the diaphragm, the transversus abdominus and the multifidus. These work continuously to stabilise the joint that they cross: before, during and after an action that other muscles such as global stabilisers and prime movers are providing the power for. Through nervous system training, these local muscles activate before we even need them, anticipating the perturbation that is about to happen. This is why we need to practice activities until we can focus on what we want to achieve rather than micromanaging how we are going to do the movement. Our core stability kicks in without us even having to think about it – although if we see a huge impact coming our way we may consciously brace a bit more. This is fine if we release again afterwards, but if we are always consciously holding ourselves the global muscles that are activated can override the local stabilisers and we lose the fine control that those local muscles provide. Rather than thinking on/off, it is helpful to think of the core muscles continuously monitoring the situation (via the nervous system) at low effort and making small adjustments. 

People with back pain are often concerned with improving their core stability. Investigations have found that they are often protectively activating muscles to protect their spine, which is a natural reaction. This corset like activation has the effect of limiting movement which has the counterproductive effect of putting more stress on a limited area instead of sharing the load by involving more of the body in the movement. You can try this out for yourself by comparing reaching your arm up for something first with your back and abdomen tensed up; then with your torso relaxed feel the ground with your feet and let the movement come from there. Your foot provides neuromuscular feedback that helps the core muscles to engage and react appropriately to stabilise you, your torso is able to lengthen and the effort is shared. Now repeat tensing/relaxing but this time seeing how it affects turning your torso; it should feel much easier when you keep relaxed and allow the movement to initiate from your feet and feel that connection through the body. 

Pain, even anticipated, and injury can cause the postural muscles to switch off, and to remain switched off even once you have recovered. In these cases, it is beneficial to explore movement in a safe, relaxed way that helps the neuromuscular system to engage again and to let go of the protective tension. Again, think of the postural stability muscles as springs, that bring you back to where you need to be. If the feedback system is not performing optimally, then there will be a loss in anticipation, adaption and recovery – in other words, stability - that will be further exacerbated by protective tensing. 

Developing resilient core stability involves vestibular, visual and sensory feedback as well as that from the muscle spindles and joints. Often the best way to train this is through varied challenges, as we want to be able to maintain stability through a variety of situations that are often unpredictable. The correct level of challenge will depend on your starting point, but examples could include: keeping your balance sitting on a swiss ball or standing on a wobble board whilst catching and throwing a ball; keeping your balance on both or one leg: with your eyes shut, or whilst moving your arms around, or maybe whilst performing lunges, or whilst someone pulls you gently in different directions using a band around your waist. You can explore different ways of engaging with the activity and see what feels most efficient and easy; notice what is happening with your body and what it is feeling. You will be generating feedback that will improve your anticipation and response, and hence your stability resilience. You will be helping the local postural muscles to activate so that you get smooth control and support; without those, no matter how strong you get the movement will lack that solid foundation and precision. If you are doing core muscle exercises such as the kneeling superman, please do ensure that you are not tensing and overusing your back muscles - as before, if you can feel two mountain ridges appearing either side of your spine that has itself disappeared into the valley, you are overusing your back. Instead, think of lengthening through the body, pressing out through the crown of your head (your face should be looking down so that your neck is aligned with your spine) and the heel of your foot; continue that lengthening sensation through your leg and arm as they extend away from each other in alignment with your spine. Some videos will instruct you to tense your gluts and abdominals before moving; maybe experiment with doing this, then release and experiment with the strategies I have discussed above and explore how it feels. 

Part of moving well is developing a range of options that your body, including nervous system, can choose from. Selecting only strength limits our potential. We need responsiveness, adaptability, endurance and robustness. 

You can read more about this, including useful exercises to explore, on the JEMS blog page:

http://www.jemsmovement.com/category/public/

For instance, the post on (not) all about the gluts; golf swing, skiing and dancing the tango; posts about the foot - all so useful even if you never play golf, ski or go dancing!

Walking freely

As you may know I have been having problems with my knee since 2016; most of the time it feels like it is in a straitjacket and it's not uncommon for it to swell up.

On my morning walk today I really focused on allowing my inner support for my trunk to engage, feeling my body extend gently upwards whilst keeping its adaptive bounce. I felt my trunk begin to sit nicely over my pelvis (let the pelvis carry the trunk) and a pleasing counter rotation established itself between my hips and my trunk as I walked. This allowed my gluteal muscles to engage and my legs to swing freely from the hip joint, and must have improved what goes on with my tibiofemoral joint as the straitjacket sensation vanished. All through visualising a helium balloon supporting me from the crown of my head. And listening foot, lots of listening foot!

Forward bend (video)

This forward bend exercise builds on the trunk tilt videos in the previous post, and also the spinal elasticizer exercise which encourages the spinal vertebrae to work together in sequence to facilitate flexion. 

As always, as I am not present when you are doing this exercise do take appropriate care for yourself - especially if you have a medical condition that affects balance, such as Meniere's disease or benign positional vertigo - as you are responsible for your own safety. Take it slow; only bend forward as far as you feel comfortable; then press through the feet and uncurl slowly beginning from the bottom of your spine with your head coming up last. 

The image I show comes from The Power and the Grace by Joanne Elphinston (2019).

 Please note that due to the Covid-19 lockdown the video was made in my home rather than the Clinic.

Trunk tilt (video)

This exercise looks at how you are using your pelvis to carry your trunk forward. This is a wonderful foundation for doing a forward bend, which will be the next blog video, but it also explores sharing the forward bend movement with more of the body rather than asking just our spine to do all the work. One video explores the basic movement, the second one explores asking your spine and legs to join in. A practical use for this ability to bend from the hips, taking the sacrum with you rather than leaving it behind, is when we are walking or running uphill; it is more effective movement than curving forward from our midback as you see so many people doing.

As with all these videos, you are responsible for your own safety when doing these exercises so do be self aware. 

Please note that due to Covid-19 lockdown the video was made in my home rather than the Clinic.

From early to late spring in the woods.

I thought I would share some of the photos that I take on my phone when out with the dog; these were taken from when the lockdown began and I was limited to the morning dog walk, when the sun was often still hiding.

 The first wood anemones and lesser celandine begin to appear in early spring, I look out for these every day. First there are only a few, but in seemingly no time they are forming huge spreads of white, green and yellow everywhere you look. I love the delicate centre of the wood anemone.

 Wood sorrel is a delicate plant that you have to look for; it grows beside the stream in our local wood. People used to eat the leaves but they do contain oxalic acid so be careful and only eat small amounts if you do want to try it. I prefer to leave it where it is.

 Garlic mustard lines the path as spring advances and I love its vibrant green and cheerful white flowers. It is in the mustard family and is edible, as are nettles (when the latter are cooked to destroy the acid). These would have been a welcome source of Vitamin C and other nutrients after the winter. 

 Marsh marigolds grow around the old Beauchief Abbey ponds. Their large yellow flowers really stand out.

 White dead nettle (Lamium album) is still used by some herbalists as an astringent and is also edible.

 Ground ivy, (Glechoma hederacea), another herb used by herbalists

 Cherry blossom and a hedgerow full of different species - and Tammy investigating them!

 As the blackthorn flowers finish, the hawthorn blossom begins. Also known as Mayflower and a valuable plant in herbal medicine (leaves, flowers and fruit are used). 

 A path lined by wild garlic, also called ramsons. I love eating the flowers as well as the leaves. There are many recipes online. 

I love the way hawthorn flowers seem to pour down the tree, following the drape of the branches. The rowan (also known as mountain ash) is still in flower and the elderflower will soon be out; I always feel the countryside looks like it is going to a wedding at this time of year!

 Stitchwort finally appears to keep the bluebells company.

 Cow parsley arrives and grows rapidly to line the paths, with wood forget-me-not at its feet.

 Sweet woodruff, growing in the shade under the trees.

 As spring advances towards summer the grass leaps up and the wood anemones and lesser celandine disappear, to be replaced by plants such as cuckoo flower and creeping buttercup. Vetches begin to appear.

 Red campion.

 Yellow pimpernel appearing in the shady areas near the brook.

 There are many more plants to see than this, but I hope you have enjoyed this taste of springtime.

Connecting the feet to the body when we turn (full body turn video).

Here is another JEMS video, building on the Listening Foot one. 
The intention is to practice integrating movement through the body, so as we turn the upper body we feel the connection with the feet travelling up through the leg and facilitating the turn. This makes for a smoother movement, and shares the effort across a larger area.

As well as foot sensitivity and mobility, this also integrates the movement from Thigh Slides; as you turn as well as awareness of your feet and legs, feel for the movement coming from your ribs as they rotate into the space behind you. Explore how the movement feels for you as it travels from your feet up into your shoulders and out through the crown of your head.

Due to Covid-19 lockdown the video was made at my home rather than the Clinic.



full body turn video link

Some useful links and a spring walk.

Some links to sites that may be helpful at this time:
Mind:
https://www.mind.org.uk/coronavirus-we-are-here-for-you/https://www.mind.org.uk/coronavirus-we-are-here-for-you/
Sheffield Community Helpline:
https://www.sheffield.gov.uk/home/your-city-council/coronavirus-support-for-people
NHS Every mind matters:
https://www.nhs.uk/oneyou/every-mind-matters/anxiety/?WT.tsrc=Paid_Social&WT.mc_id=Respond&fbclid=IwAR1e2YnQt_mXo5g1BtlZp1NDq8W2aITcf_uFfYx4Gh4dnT5eTXEqWSuKGOU

I love immersing myself in the sense of place when I walk in our local woodland, taking time to absorb the colours, textures, scents and sounds. I find it grounding, deeply relaxing, a release from stress, anxiety and unhelpful recurrent thought patterns. If I have a mild headache I sometimes find it is gone soon after entering the woods; when living in London I found working in the community walled herb garden in Brockwell Park had a similar benefit. Often I have the woods to myself but at this present time there are more people around as they are limited in where they can go for exercise so I try to get out early when it is quieter and I am more likely to spot wildlife.

I love the white flowered stitchwort that is now appearing alongside the bluebells, and the new beech leaves hanging soft from the branches before they fill out and stiffen. 

The paths are lined with cow parsley, sometimes reaching my shoulder height. I passed a big patch of comfrey in flower on Saturday, a herb that I used to use together with other herbs such as Calendula officinalis, lavender and Hypericum perforatum to make a healing ointment  for the skin because of its allantoin content. Herbalists decided a long time ago not to use comfrey internally and are now discouraged from using externally as well because of its pyrrolizidine alkaloids that are toxic in large or accumulated doses. I still enjoy seeing it, it is a handsome plant and wonderful for bees. 

A gorgeously vibrant green is everywhere with the new growth and many of these plants used to be part of our diet in the days when the new season for farmed vegetables was only just beginning and we would often be suffering from mild scurvy after the winter months. Chickweed, nettles, cleavers (wash then stand overnight to infuse in cold water for a delicious drink), ramsons, hawthorn and linden leaves, garlic mustard (or Jack-by-the-hedge, as my partner calls it), cuckoo flower, dandelion leaves.... it's a list that just goes on and on and I enjoy welcoming them all back. I sometimes wonder if we are hardwired to love that green because it draws our attention to plants containing beneficial nutrients. If you would like to try them for yourself there are plenty of recipes out there, beginning with Food for Free by Richard Mabey. Do check carefully that you have identified plants correctly before you eat them! There have been a number of cases of poisoning due to mistaken identity, from people making tea from foxglove leaves instead of comfrey to picking and eating deadly nightshade berries mistaken for bilberries. It is also best to avoid the Umbelifferae family; as with mushrooms the poisonous ones can be easily confused with the non-poisonous unless you know what you are doing. However, many plants can be picked with confidence so enjoy a little bit of food for free, and the connection with nature that comes with them.

Moving the spine to share the load (spinal elasticizer video).

This is a lovely, gentle exercise to encourage movement to travel through the whole spine, segment by segment, so all the vertebrae are joining in to support each other. I am sitting on a Swiss ball but this is very suited to doing whilst seated on any firm surface. If you feel protective about your back due to a history of injury and/or pain, you can keep to a very minimal, gentle movement whilst sitting on a chair. Please note that whilst these exercises are gentle you are responsible for yourself when doing them in your own environment. Explore, be gentle with yourself and enjoy.
Spinal elasticizer

 Please note that due to the Covid-19 lockdown the video was made in my home rather than the Clinic.

Get that upper body rotating... (thigh slides video)

This exercise is called Thigh Slides and is an excellent way to explore the alternating forward motion as our torso counter rotates above our legs when walking or running. This elastic movement generates energy that is released into the forward propulsion and so takes some of the effort away from muscles such as the calves. It is an example of parts of the body moving independently of each other whilst maintaining a connection and collaborating to achieve efficient movement.

It is also an excellent way to relax the back and help restore ease after long hours spent sitting.

Please note that due to Covid-19 lockdown the video was made in my home rather than the Clinic.
Thigh slides link

Breathing exercise (video)

Here is a video I made around week six of the Covid-19 lockdown (hence my leisure clothes and a band to hide the hair!). Times of stress can cause the chest to feel tight and change our breathing. This exercise may be helpful in promoting relaxation together with a sense of being grounded and reconnecting with your body.

There is also a video by Joanne Elphinston on YouTube, made during the lockdown:
https://www.youtube.com/watch?v=RmgHaprWFF0&fbclid=IwAR2twV32h-TWFFU_2TYnk_fnfqmBtI6uH9eXNVHUCxFyFZVrn646CJFcNr4

Listening foot exercise (video)

Seeing how uploading a video direct to blogger works. This is a learning process for me! Listening Foot is a fundamental exercise for movement, literally giving you a foot to stand on that will affect how the rest of your body interprets and responds to the environment and activity. This video was made during Covid-19 lockdown so I am not in the Clinic.

....and now it is May.

First of all, the link below is for a dance class: disco funk! Ten minutes that will get you both moving and smiling :-) Just skip the ads after the first few seconds to get straight to the class.

https://www.youtube.com/watch?v=cgDppkLnImI&list=PL0f7PvMpTH07hlhoritKpOjPx2Yc_WEWz&index=27&fbclid=IwAR08zEMmW0K3nhh9q6CW5CFOqrx1LYlNB1jsNNWBIbTFMRQ7NNloyanjDlg

I am working on getting some videos up on here demonstrating some beneficial JEMS exercises to help keep you in touch with your body and moving beautifully. I have been sending the ones I have made so far to some willing guinea pigs and had very useful as well as favourable feedback so it shouldn't be much longer before they are here! Main issue is my lack of IT competence.

You may not be able to book in for a massage treatment anytime soon as social distancing continues but I am still available through email, text or telephone if you need someone to talk to in confidence, whether to voice anxieties or vent frustrations. Please do feel that you can contact me.

I have been using my daily exercise to walk our elderly dog in the local woods which are changing so rapidly now. First there was the cheery yellow of the lesser celandine and the grellow of wood spurge, followed swiftly by the beautiful wood anemones, more every day, and then the first few tentative bluebells became a glorious carpet of shimmering purple blue.

The yellow archangels appeared together with wood forget-me-not and wood sorrel; as the earlier spring flowers faded back the creeping buttercup, fool's parsley and pink campion came springing up in their place. I picked wild garlic leaves to make pesto (delicious spread on toast accompanied by mushrooms and Swiss chard cooked in butter, plus scrambled eggs) and now their flowers (also delicious)  are filling the woodland with their aroma. The open space of the winter woodland has transformed into an enclosed green world as the leaves open to form the tree canopy, obscuring the architecture of branches and trunks. The birdsong is at its most impressive at this time of year. I always find the woods a calming, restorative space but I am missing my brisk walks to work and back. On the days when the hound wants only a short, slow amble I grab my touring bike after dropping her back home and cycle up and down the local streets for twenty minutes to get my heart rate up and strengthen my legs. Here is the view from our house so you can see we are quite high up; some evenings I just cycle up and down our road a few times!

Do stay safe and take care of yourself.