Covid-19 update

There was a possibility that I would be returning to my massage practice at the 919 Clinic in July, but the latest government update on businesses allowed to reopen does not include massage therapists. This is understandable as it is a close contact treatment. My professional association is asking for more clarity on when we are likely to be able to return to practice. If you were hoping for a treatment, I am so sorry that you will have to wait longer but it is with the aim of keeping you safe. John is available for physiotherapy treatment if you are in pain.

Meanwhile I am making plans for when I do return to practice. I will be putting away everything that is not required for the treatment, so the room will seem much barer - indeed, more clinical! I am replacing my usual bolsters and headrest with vinyl covered ones that I can clean thoroughly between appointments, and I have bought disposable face coverings so I can supply one to clients who do not bring their own (although I would encourage clients to do this). The photo above shows two of the new bolsters, a pack of disposable face masks, some hand sanitiser I am trying out (I already use hand sanitiser in between clients in addition to hand washing but as I will now be applying it far more frequently I want to make sure I get on with a brand before buying in bulk) - and a wobble cushion! This last item is an excellent way to engage the nervous system and wake up the muscles to improve adaptability and balance, and I can clean it in between clients.

I will post again with all the provisions I will be making for client safety once I have a date to return to practice. At present, guidance includes alongside other recommendations: 

• required questions asked to check the client's health and risk of exposure to Covid-19 on making the appointment and again on day of appointment; this will determine if the treatment can go ahead. 
•  asking the client to wait outside the Clinic, for instance in their car, until it is the correct time for their appointment.
• meeting the client outside the Clinic to sanitise their hands and ensure they are wearing a face covering (which will be kept on the whole time they are in the Clinic).
• providing a plastic box for the client's possessions including clothes; the box will be sanitised after they have collected them.
•  cleaning all surfaces in communal areas and the treatment room before and after the treatment.
• stripping and sanitising the couch after each treatment and placing couch cover and towels in a bag that will then be kept closed until they are washed.
• airing the room for fifteen minutes after each treatment.
• ensuring that there is only one client at a time in shared Clinic spaces such as reception.
• payment should be contactless.
• cleaning my own hands before and after treatments and after cleaning the room.
• I am to wear a face covering at all times. (Update 03/06/2020: latest guidance suggests that a visor will be required).

Some of these precautions you will be pleased to read that I was doing already, for instance the hand washing. Some are very new and will take getting used to, for instance the face covering, but I am sure this will seem routine very quickly. 

Aches and pains from desk work? A run through of postural tips and simple exercises (video)

When you are working from home and can't get a massage, self care becomes even more important.
The video begins with some postural tips, then goes through some exercises that may be helpful. I have covered all the exercises in separate videos on my blog but thought it would be useful to put them all together for you as an overview for desk related aches and pains. Please note that due to Covid-19 lockdown the video was made in my home rather than the Clinic.


video link for desk related aches and pains tips

The exercises include: thigh slides, spinal elasticiser, breathing, full body rotation and forward bend plus a bit about the feet. Hope it's helpful! 

Rolling the pelvis to relax the back (video)

Modern life can result in tension building up in the back and reducing mobility in both the spine and pelvis. This can affect ease of movement in many ways, and the sacral rock and pelvic clock exercise is a gentle and relaxing way to address it. The aim is to make the movement as smooth and slow as possible, exploring the subtleties that are lost through tension or forceful movement. This is a great exercise to do several times a week, especially if you have been sitting down a great deal.

If you feel you wish to take the movement further the video shows how to move into a bridge that engages all the spine as you bring your hips up and then lower them down again. As you do this, check that your back is staying relaxed and maintain a firm, even contact between your feet and the ground.

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

Lifting the knees without overusing that back (video)

This video explores being able to move your legs independently of your trunk whilst still keeping a connection. So often when people lift their knees up they collapse the back forward or tilt to one side; this loses the power we get from the gluteal muscles and affects a huge range of activities from running and climbing through to hill walking and going up stairs. 

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

knee raise video link

919 Clinic update

First of all, physiotherapists are now allowed to practice so John is available for appointments. If you go to the 919 Clinic website you can find out more information about this on the Covid Form link, including the new safety and hygiene protocol https://www.919clinic.co.uk/. He is encouraging people to opt for Zoom consultations where possible to minimise risk, but will see you for an in-person treatment if it is essential and you are not needing to self isolate. 

As you would expect with the current risk of Covid-19 transmission, massage therapists are not allowed to practice at present. The earliest provisional date for return to work we have been given is July, but it may well end up being later. I am acting on advice from my professional body which in turn is following guidance from the government, and am looking at the PPE that I will need to have in place before I resume practice. I will not return to practice until given the go ahead by my professional body. I want to keep you safe. 

I know that many people are really missing their treatments, and indeed I am missing the regular massage that I received prior to lockdown. As well as the exercise videos I have been posting to help keep you mobilised, I will be putting up some simple and safe self treatment videos. John also demonstrates useful exercises and stretches on the 919 Clinic website.
https://www.919clinic.co.uk/exercises

I hope you are all managing to stay safe and well during this difficult time. As ever, if you need someone to talk in confidence, as you would during a massage treatment, do feel that you can contact me; I am here to listen.

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!