Sunday, 11 July 2021

How to help your knees when walking downhill...

Image: Frantisek Duris

I often hear from my clients that they experience pain at the front of the knee when walking downhill, especially steep slopes. It's worth having someone look at you when this is happening, to see if you are leaning backwards; this pushes your weight through the knee and puts it under pressure. It also makes it harder for your gluteal muscles to do their share of the work, and you're more likely to slip as your weight is not over your feet.

These two videos from Joanne Elphinston, a wonderful physiotherapist and movement coach, demonstrate and explain this beautifully (the first link is to a post on her website, but if you read through you will find the link to the video; the second is an instagram post). She shows how to flex at your hip so that your torso stays up and over your hips and feet, allowing the gluts to do their work whilst the hip, knee and ankle joints flex to absorb the load.

JEMS knee pain walking downhill

You can also find my own video on Vertical Hip Release on my website, if you scroll down this page:

Saturday, 26 June 2021

Hours update and a useful link for runners looking for home exercises.

I hope you are well and enjoying the long June days. 

First, a quick update: I am now working Mondays as well as Tuesday - Friday (early closing on Wednesday). I am continuing to arrange my own bookings so please use the contact details on my website to book an appointment:

I am often asked about exercises; I do give these as part of my treatment plan for my clients but I thought I would include this link to a blog post by Mike James, a physiotherapist specialising in endurance sport, where he looks at the value of strength training for runners, and then gives six exercises you can do at home with no or minimal equipment:

Wednesday, 9 June 2021

Are you getting enough Magnesium?

Photo by HowToGym on Unsplash

 Some professional literature dropped through my letterbox, including an article on magnesium. This is an essential mineral for us humans, used in a large number of ways including metabolism and energy production, synthesis of fatty acids and proteins and the transmission of nerve impulses; the article quotes it is used in 300 enzymatic reactions, and gives seventeen clinical uses for magnesium. Magnesium supports bone health as well as being involved in heart, nerve and muscle function and blood sugar regulation.

Surveys have found that many people in the UK are deficient to a varying extent in this important mineral; causes of this may be insufficient levels in the diet together with the tendency for levels to be depleted by common factors such as stress, caffeine and alcohol consumption, sweating or menstruating heavily, or poor digestive function. The challenges of the last year may have caused an increase in these factors for many of us! Some chronic health conditions may also cause deficiency. 

As with so many health issues it isn't easy to know if you are deficient but possible signs to look out for include fatigue; brain fog/lack of concentration; restless leg syndrome; muscle cramps/twitches; palpitations; PMS and/or menstrual cramps; anxiety; headaches/migraines; insomnia; feeling easily startled; vertigo; poor coordination; constipation/IBS symptoms; cravings for salt and/or caffeine. If you are experiencing these, are concerned and are not sure of the cause you may wish to consult a health professional.

I notice that I get some of these symptoms when I drink too much coffee or am stressed; reducing my caffeine intake, doing some self care and increasing my dietary sources of magnesium usually resolves most of the issues quickly. I have now developed a feeling for which foods help me and what I need to cut back on (although I still drink tea and one cup of coffee every day - some habits are very hard to change!) 

Dietary sources of magnesium include:

  • legumes (such as chickpeas, peas, lentils, beans)
  • dark green leafy vegetables (such as kale, broccoli, spinach) 
  • fruit (such as bananas)
  • Nuts and seeds
  • Fish (such as mackerel and salmon)
  • Whole grains (such as oatmeal, whole wheat, barley, buckwheat, quinoa)
  • Dark chocolate :-)
There are also magnesium supplements available although I would always recommend looking to obtain through the diet first and then supplement if there is still a need. Magnesium citrate is generally thought to be the easiest absorbed. I don't give advice on how much to take other than to aim to eat a range of foods from the above list every day and maybe take a supplement, following the manufacturer's recommendations; I leave more detailed prescription to those more qualified than myself in nutrition. 

The BBC Good Food website has a useful article on magnesium:

Information obtained from:
'Magnesium - the most essential mineral for your practice' by Lamberts Healthcare 
'Human Nutrition, a health perspective' by Mary E Barasi 

Monday, 24 May 2021

More thoughts on running easier...

 I have been avoiding running for the last few weeks as breathing deeply whilst I ran through the woods was bringing on hayfever symptoms - not great when you do close contact work! Next year I will have my herbal remedy made up in advance but this year I just opted for long, brisk walks instead as I didn't want to miss out on the beautiful displays of wild flowers.

Today I noted that the pollen count was low and with the day off I decided to go for a morning run; a gentle run a bit, walk a bit to see how my irritable Achilles was doing whilst covering enough distance to see the bluebells in four nearby woods. As I ran I wanted to keep my upper body relaxed and rotating easily, and my posture optimal. This helps to distribute the effort more evenly rather than over-working certain muscle groups. I aimed for a running pace where I could still keep up a conversation if I had a companion. What worked for me:

  • Checking what my neck was up to. When I am putting in effort my chin tends to go forwards, causing my neck to go into cervical lordosis. Stick your chin forward and experiment with rotating your torso whilst looking forward; now bring your chin back to a neutral, relaxed position and repeat the movement. Which one feels easier? For me, neutral gives more movement so I use various visualisations to help bring me into that position, for instance imagining being lifted gently by the scruff of my neck, or my spine expanding upwards as if being pumped up with air like a bike tire. Others like to visualise a helium balloon supporting them from the crown of the head. Bringing my neck into this position also helps improve my centre of gravity as well as effortlessly bringing my shoulders back and opening my chest; have a go and see what you notice. Make a note too of what the back of your neck feels like when the chin is forward compared to neutral - you may notice that the spine disappears into a steep sided valley when the chin is forward!
  • Shortening my stride so that my centre of gravity is over my footstrike - this is less effortful than over-striding so I am less likely to stick my chin forward!
  • Ensuring that my palms are turned in to face my sides. I find this opens my shoulders and frees up my rotation compared to palms down towards the ground.
  • Visualising that my elbows are connected by a band to my ribs so that as my elbows move back my ribs follow and I get more torso counter-rotation which helps make me more energy efficient compared to if just my shoulders are moving whilst my torso stays put. 
I had a lovely run, such a great feeling! After a couple of hours I noticed that my right hamstrings were feeling tight followed by the sole of my right foot so I eased off and walked the rest of the way - I had a wind proof with me in case this happened as I knew I was pushing the distance, but it was such a sunny morning that I didn't need it. The tight hamstring is linked to a back/pelvis issue that Pilates helps with - a reminder to do some exercises....


Tuesday, 11 May 2021

How are you right now?

Photo by S Migaj on Unsplash

Take a moment; how are you right now? Look around you, what can you see, hear, feel, smell; what do you notice? How are you feeling?

A recurrent theme in a lot of the professional reading I am coming across is our mental and emotional state and how it affects our experiences and perception. Tom Goom of The Running Physio explored a recent study looking at the effects of worrying about the worst possible outcomes and being constantly aware of pain, and how mindfulness may help with managing knee pain in runners: Research into pain has noticed that we can train our brain: if we focus on and worry about the pain our perception of it becomes magnified as the brain is on high alert; if we can divert our attention onto other things or engage calmly with the sensation (for instance by understanding what is happening and so dampening anxiety) the brain may tone down the pain message. Pain is a sensation; it can be a response to our emotional situation as well as to physical injury - the brain does not distinguish between the two - and how we respond to pain influences our sensation.

How we communicate with people experiencing pain is important. People may worry that if their pain sensation is reduced then their other symptoms will not be taken seriously; this may cause them to focus on their pain. The fact that pain is controlled by the brain may cause people to worry that they will be told 'that it's all in their head' and not be taken seriously. Pain is our brain warning us about something; once the warning signal has been acknowledged we can ask it to turn down the signal whilst we explore what caused the alarm. Whilst pain can be triggered by physical damage, it does not always mean that there is injury; sometimes pain sensation is triggered by the brain recognising a scenario that it associates with danger and injury and this needs to be taken seriously too. 

Our past history can have a major effect (see my previous blog post linking to Lorimer Moseley's research, Back in 2018 I began to experience debilitating, increasingly intense sciatic pain; it became so intense that I began to experience panic sensations. I didn't understand what was happening and the pain episodes became more frequent. I eventually realised that the cause was the effect my knee injury was having on my back; once I understood that I felt the return of some control and the pain became less intense and eventually after treatment went altogether. Recently some of the early signs began to reoccur and I noticed that my nervous system was going on high alert; I was experiencing fear in anticipation of the pain returning. What could I do? First, I acknowledged it; this calms the amygdala down in favour of the cerebral cortex. Next I put it into context; because I experienced pain in the past does not automatically mean that I will again and this time I understand it better. I then encouraged my body to relax - it had tensed in fear - whilst reminding myself that relaxing will encourage better movement and help my back and knee. I then initiated helpful exercises and self-treatment and looked for improvement in how I was feeling rather than focusing on negatives. The feeling of panic retreated and two weeks on the underlying issue is still there but I am feeling ok. I am mindful that fear can cause me to avoid certain movements and that this is not always necessary or helpful; it is beneficial for me to explore movement in a context where I feel safe so that I can expand my boundaries rather than be increasingly constricted.

So, why ask how you are feeling right now? I began with a link to Tom Goom's post on a mindfulness trial that sought to address the tendency when injured to dwell on the injury and worst case scenarios and to be overly protective. Mindfulness aims to take us away from worrying about the past or the future - what has happened, what may happen - and instead notice our immediate surroundings and how we are right now. It places us in the present and allows us to relax as we take in what we can see, feel, hear, taste and smell. From there we can check in on how and what we are feeling and see if we can influence this. Mindfulness encourages us to reflect on some positives; think of three positive things that have happened today. They don't have to be major things; it is restorative to take pleasure in small things. Examples could be a bird or plant you noticed, or enjoying a cup of tea or a book, or looking at the clouds in the sky, wearing a favourite item of clothing or someone saying thank you or smiling at you. Katie Sheen in her course on mindfulness (free at present) describes how she played a game with herself of creating stories around what she could see on her windowsill from her hospital bed to help her cope with her cancer treatment can retrain the brain to look for positives rather than negatives and this can help us with our pain perception. 

Another way of managing pain is to take time to allow the brain to process what is happening. Often when we feel pain we very naturally flinch away and avoid repeating the movement or action we associate with triggering it - this is very helpful in learning to avoid burning ourselves, for instance. However sometimes, if we take a moment, the brain can process more information and maybe realise that in certain situations we don't always need such a strong pain response, or any at all. An example would be when we stumble; if this happened whilst we were recovering from an injury and there was inflammation this would initiate a pain response as part of protecting the injury. This may continue to happen even after the inflammation has gone - the brain has learnt to give a pain warning whenever it senses a stumble; pain can be initiated by the brain's perception of threat rather than actual damage. By taking a moment to process the situation and be curious about how we are feeling the brain can learn that it no longer needs to give the protective pain signal when we stumble. In some cases a conditioned pain response may be having a profound impact on how we move and hold ourselves; taking time to explore this in a safe environment can be transformative as the brain is reassured and lets go of perceived threats. 

Pain is real, it should be acknowledged; we can also engage with and understand it. Recovering from injury is not just a physical process, we need to check in with the mental and emotional side too.


Tuesday, 6 April 2021

Surviving and thriving by supporting others.

As many of my clients know I am a keen knitter. A very keen knitter, totally obsessed with wool. I like to know the provenance of my yarn, that it has been produced sustainably from animals that are well treated; much of my wool comes from small organic farms or sheep used for conservation grazing. I also seek out yarn with low mileage, produced from sheep to mill in the UK - sometimes entirely in Yorkshire. It is often difficult to find this information and I often buy directly from the small farm or croft that raised the sheep. Another place I can find it is from small independent yarn shops that share my ethics. Already vulnerable to high street pressures, all of these yarn shops had to close their doors during the lockdowns and due to their small size remain closed or use an appointment only system when lockdowns were lifted. Online sales continued but what else could they do during such a stressful time? Seven of them got together to form a group where they could share ideas and expertise, organise online events for the knitting community and generally support each other, iKnit7. Their different strengths enabled them to come up with a new website and raise their profile on social media, and they have run week long events featuring interesting interviews with designers and producers as well as promotional offers and competitions. As well as supporting each other and sharing their customer base, they have engaged and supported the knitting community by lifting our spirits. 

When I left BresMed my lovely colleagues gave me a generous gift in the form of vouchers for one of the iKnit7 yarn shops that I like to visit when I am in London so that I can indulge myself in my favourite yarns and other wool related purchases. My first purchase (online due to the pandemic restrictions) was some skeins of Dile from Uist Wool, a very special yarn I had been longing to knit a jumper with but was out of my price range until I received my vouchers. Uist Wool is a community project that takes in wool from local crofts and spins beautiful yarns using antique machinery that they salvaged and restored. I used it to knit the pattern Sian written by an independent designer who was inspired by her visit to Uist. I love my jumper; not only is it a beautiful pattern that evokes a landscape I love, making it has supported three other small businesses: the yarn shop, the designer and the wool mill - not to mention indirectly supporting the crofters the mill buys the fleeces from. Now my jumper is finished I have the fun of deciding what to buy next with my vouchers!

Together we thrive!

Sunday, 28 March 2021

Waiting for a green light...

Spring flowers: lesser celandine and wood anemones

 *UPDATE: Following on from the announcement on 5th April, I will be reopening from the 12th April. I am very much looking forward to resuming appointments!*

I hope everyone reading this is well and that your family and friends are too. 

I have been receiving enquiries about when I am allowed to return to work. I am waiting for the 5th April when we will be told if massage therapists are to be given the green light to return to work from the 12th. I am keeping a waiting list so if you would like to be on it do contact me by text, email or phone call and I will be in touch once I have a date to reopen. I have been reluctant to book people in on a provisional basis in case I have to postpone appointments once again. 

Meanwhile, I am here if you need someone to listen or if you would like some advice on aches and pains. My website also has links to the exercise videos I have made to help keep you moving well. A year in I know many more of us are beginning to struggle with the challenges this time has brought. Do consider contacting charities such as Mind, and Turn2Us if you are struggling with your mental health or financial and housing situation; they are there to help and support.

Take care, I hope to see you soon.