The problem with leg raises

Posted by Nell Mead at 09:50 on 3 Aug 2011

I went to my usual circuit training session the other day, run by British Military Fitness.  It's a lot of fun: a fairly tough workout with a lot of cameraderie and competition, and outwardly no-nonsense (but actually very humorous) instructors.  They will push you as hard as you want to be pushed, and often very slightly harder.

I love the sessions; but as a punter, you have to remember that most instructors aren't psychic. They will always ask if you have an injury, and will always offer alternative exercises, but they can only help you if you tell them that there is a problem.  This is something that can be tricky unless you are quite confident in your own body and its capabilities (not something I generally struggle with too much, but I've had a lot of practice!).  It's easy to let your competitive side take over, and to start competing in exercises you're not familiar with.  Consequently your form can go to pot as you try to complete that 20th rep before the guy next to you: if you're doing a demanding exercise, that's an easy way to get injured.

One of the exercises I really dislike in that situation is the leg raise, where you lie on your back with your feet together and wave your legs in the air, with an obtuse angle at the hips.  It's an exercise that's supposed to work the lower abdominals and tone the tummy.

The reason I dislike this exercise so much is that the majority of people find it tough to control their torsos in this position.  I have a strong back and good awareness of trunk control, but in this position I find it really hard to stop my low back from arching.  That's because the hip flexor muscle psoas major is being put under a lot of stress to control the momevent of your legs at the hips.  Psoas starts at the sides of your lumbar vertebrae (T12 to L5 to be precise) and goes down to the lesser trochanter of the femur.  When it contracts, these bones are pulled together.

When your back is being correctly stabilised (by, among other muscles, lumbar multifidus and the deep abdominals), the spine is braced to pull your femur forwards and up, so your hip flexes and your legs move up and down.  That's the plan; so far, so good. 

But when your back isn't correctly stabilised - either because of weakness or pain around the low back, or because you're focusing on banging the numbers out rather than on protecting your back properly - your low back can arch and the vertebrae shear forwards towards your hip rather than your hip moving towards your spine in a controlled manner.  I've mentioned forward shear as a bad thing before, when I talked about spondylolisthesis.  So with 80% of the population suffering from back pain at some point during their lives, I'd suggest avoiding this exercise if possible, not because it is intrinsically bad but because many people will do it badly, particularly in a competitive setting.

A good alternative exercise, which will strengthen the deep abdominals safely, is the reverse curl.  Lie on your back with your hips flexed to 90 degrees.  Your knees can be bent or straight, but your hips must not drop below 90 degrees throughout the exercise.  Using your abdominal muscles, pull your legs towards you so that your bottom lifts off the ground.  Hold for a second, then lower it slowly back to the starting position.  If you feel that your back wants to arch as you return to the start, try putting your hands or fists under your bottom (not your back) as this will encourage you to keep your low back in contact with the ground at all times.  This way you will still be working your lower abdominals and your psoas, but there will be no risk of a shearing force damaging your back.

I should mention that after quietly explaining my concerns about this exercise to the excellent BMF instructor, she asked me to show the class and to post about it on the BMF Facebook page.  So Annie, this one's for you!

Victory at The Foundry

Posted by Nell Mead at 08:00 on 8 Aug 2011

For us at Victory - well, ok, maybe just for me - today is a hugely exiting and momentous day.  And why, might you ask, would that be?  Well, partly because I left the Army exactly a year ago today.  But also because the lovely directors of The Foundry, Dave, Helen and Graeme, asked me a little while ago if I'd like to set up a proper rehabilitation centre in their premises.  So from today, Victory is officially a full-time entity, with two therapy rooms, in the one location - hurrah!

I, my dad and my lovely friends Claire and Jono have spent the weekend repainting the therapy rooms, and you'll also see logos appearing over the next few weeks and a bit more clinic furniture.  Dave's also suggested holding a launch party - definitely something to think about in the near future!

In the mean time, I'd like to introduce you briefly to a few of the characters you might meet when you come to Victory.  When I get a chance, I'll blog properly about each of them - this really is just a very brief hello.

Sarah Harvey is my lovely PA.  She keeps me on track with all the myriad things I'm supposed to do but keep forgetting.  She organises the team's diaries and makes sure I don't double book myself and do remember to pay bills and invoice clients.  If you ever need to contact anyone about the administrative side of Victory, or to arrange an appointment, Sarah's your girl - e-mail her here.

Dr Victor Thompson is a clinical psychologist who specialises in sports and performance.  I met Victor nearly ten years ago when I became interested in sports psychology as a way of improving my results on the tennis court.  After four hours with Victor I won 20 tennis matches in a row, and I've been recommending him ever since.  At the moment, he consults with me on clients who have an emotional, psychological or stress-related component to their physical pain; so far this has been very successful and I look forward to being able to offer this service more frequently in the future.

Jake Thackray is a former Physical Training Instructor in the Royal Navy and is still a serving policeman.  He's been working at The Foundry for some time now as a specialist in sports massage and remedial therapy, and will continue his sports massage work with Victory.  At the moment he is mainly available on Monday evenings but over the next few months he will hopefully be around more regularly.

Busy bee Sarah Franklin is - by day - a fitness manager at Virgin Active Moorgate; but she is also qualified in sports massage therapy, and is available to see clients at Victory some evenings and weekends.  Although she has been working at The Foundry for some time, Sarah and I haven't yet swapped treatments (something I like to do regularly with all the Victory therapists) but I hear great things and am really looking forward to it.

Flight Sergeant Paul "Spot" Leppard leads the multidisciplinary Spines Team at the Defence Medical Rehabilitation Centre, Headley Court.  A qualified Exercise Rehabilitation Instructor (ERI), he also received his BSc in Sports Studies from the University of Wolverhampton in 2003.  He is available in the evenings and at weekends to provide exercise therapy for clients with back pain and spinal injuries.

Graduate Sports Rehabilitator Cat Cornwell is also currently working at Headley Court as a civilian ERI specialising in complex trauma.  She holds bachelors degrees in Sports Rehabilitation and Sports & Exercise Science, and is currently working towards an MSc in Neuromusculoskeletal Healthcare.  Last month she was also part of the Team True Spirit squad of Headley Court patients and staff to complete the Iron Man UK Triathlon.  With a very solid history of working with high level sportspeople including GB Women's Basketball squad, Cat is definitely the girl to take you from getting over an injury to being ready to start full-on personal training.  She is available in the evenings and at weekends.

Ryan Walsh is a former member of the Parachute Regiment and of the Army Rugby team - and is now a professional boxer - see him in action here.  He's a qualified Personal Trainer who has worked with Bath Rugby and was seen on the 2010/11 School of Hard Knocks series on Sky Sports One.  I've known Ryan since he was 17 and was surprised when he called to tell me he had qualified as a sports massage therapist; but even more surprised when he proved to be really rather good at it, with a good range of techniques and an instinctive touch.  You really can't teach someone to have good hands!

Former Royal Marine Phil McDougall is currently in the process of completing his Level 5 Sports Massage qualification at the London School of Sports Massage, and is due to start training at the British School of Osteopathy in September.  A thoughtful and instinctive therapist who is keen to learn, Phil will be available on Friday afternoons, and on other days by prior arrangement.  Given the famed rivalry between the Paras and the Marines, I'm intrigued to see how Phil gets on with Ryan...!

Capt Harold Ackroyd and Maj William Allen were the first two members of the Royal Army Medical Corps to be awarded the Victoria Cross.  Sarah suggested that we should name our therapy rooms in their honour - so we have.  For those who are familiar with Victory's layout, Ackroyd faces you when you reach the bottom of the stairs, and Allen is on the left.

Finally, there's Starvin' Marvin (on the right) - the leanest member of Victory.  He was named on 2 Feb after The Foundry held a Facebook competition.  He hangs around generally looking like a bit of a cool dude, and is always available to show you what bones look like and how joints should work.

The only down side to this is that - with not enough hours in the day - I'm having to give up my clinic at The Back Shop.  But the staff are great, and I still really rate the equipment they sell (particularly the Mobiliser!) and their ergonomic assessments, so I have no intention of losing touch with them completely.

Right - that's it, I've said enough.  You've met the gang: what are you waiting for? Come on in and meet us: get in touch to book that appointment you've been needing for ages....!

Victory's Flexible Friends

Posted by Nell Mead at 08:00 on 17 Aug 2011

For the past few weeks, as I’ve been working to turn Victory into a larger and more interdisciplinary practice, I’ve been having fun doing some “quality control” – making sure that the practitioners I want to be associated with Victory are at the top of their game. So, all in the name of benefiting you, the client, (naturally!), I’ve been swapping treatment sessions with Victory’s sports massage therapists, and with The Foundry’s trainers. I’ve not yet been disappointed, and I’m quite sure you won’t be either.

This past week, I’ve branched out a bit. Pilates teacher Laura Hogg used to work at The Foundry but has now set up her own, more spacious, centre just a few minutes away in Shoreditch. I’d been wanting to meet her for ages, so grabbed the opportunity when she rang to request some physio treatment, to ask if she’d be happy to swap sessions with me.

I’ve never really done much formal Pilates or yoga, though I’ve learned some of the basic exercises over the years as I’ve expanded my knowledge of physiotherapy and core control. But last week I Laura gave me my first Pilates lesson (which was excellent – highly recommended!); and this morning I also met her colleague Jo Lawson, a yoga teacher from New Zealand.

Both Laura and Jo are very bendy, which makes the shapes they can contort their bodies into really rather lovely to look at, and inspirational to try to replicate. But they’re also both very encouraging and sympathetic to those of us who are not quite as flexible. And – somehow – after repeating the moves a few times, I gradually felt myself becoming, if not quite graceful, then slightly less rusty!

One of Jo’s stretches, which we did when I mentioned an old shoulder injury, was completely new to me, and I thought it was brilliant so with her permission I’d like to share it with you. You may well need some assistance with this at first (I did!) but after a bit of practice it should get easier.

• To stretch your right shoulder, sit on the floor with your legs out straight in front of you and toes pointing at the ceiling. Pull your right foot all the way into your groin.

• Then reach your right arm out towards your left foot, making sure your right shoulder is inside your right knee.

• Next, twist your shoulder inwards so that your right thumb rotates anticlockwise towards the floor. Lean your upper body forward and reach your arm around your raised right knee, so that your hand reaches as far round your back as you can manage. You should feel an agreeable pull between your right shoulder blade and your spine, as your shoulder blade is pulled forward to accommodate your knee.

• Your next move is to reach round behind your back with your left hand, and try to grasp the fingers of your right hand with your left.

• Seen from behind, the stretch should ideally look like this.

• However, most of us won’t be quite that flexible, especially at first. So if your fingers can’t reach each other, you can hold a towel or strap in your hands, and gradually work your fingers closer together. At first you may need a helpful someone to place the strap or towel into your hands behind you.

Relax into the stretch for a couple of breaths, focusing on allowing your muscles to relax and lengthen. Then let go of your fingers, unwind and repeat on the other side.

When people ask me – as they frequently do – whether they should choose yoga or Pilates, I often respond somewhat glibly (and generally, I think, truthfully) that it doesn’t really matter which you do as long as you find a good teacher. Now, with Shoreditch Pilates and Primal Yoga round the corner, I’m delighted to be able to say that I think I’ve found excellent teachers for both disciplines, and I’ll definitely be going back for more: see you in class!

*Thanks to Jo for kindly agreeing to model at a moment's notice!

Phil's Sports Massage

Posted by Nell Mead at 16:33 on 26 Aug 2011

Hi everyone! I’m Phil – I used to be a Royal Marine, but now I’m just about to qualify as a sports massage therapist, and this is my first blog post for Victory. As a keen bean student, I’m turning into a bit of a sports massage geek and for my first post I thought I’d share some of the things I’m learning on my sports massage course. So, here we go: one crash course in sports and remedial massage therapy coming up!

What is it? It’s just massage. It’s been practiced and documented since the beginning of time. It’s still about because it works. As researchers have learned more and more about anatomy and general science, they’ve been able to tell us more about why it works – which has helped massage practitioners to develop a range of different techniques. Here are some of the techniques I apply here at Victory:

• Effleurage – large area strokes for warm up, prepping the soft tissues for deeper work
• Petrissage – kneading, further softening up a more specific area
• Friction – very deep technique used on a single point of scar tissue and adhesions
• Neuromuscular technique (NMT) – an extension of deep friction to release trigger points and other tension caused by the nervous system
• Muscle energy techniques (METs) – using the client’s own muscle energy to release tension and lengthen muscle fibres
• Tapotement – chopping and clapping for a pre-event wake up and energising
• Soft tissue release (STR) – a hybrid containing several other techniques for quick and effective release of soft tissue tension

Later in my course, I’m looking forward to learning more techniques such as connective tissue manipulation, strain-counter-strain and acupressure.

So why is it called *sports* massage? You don’t have to be an active sportsperson to have a sports massage. It’s just a phrase we use to distinguish the deeper, more treatment-based massage from a more superficial “relaxation” or “beauty” massage. Everybody uses their muscles and moves, and everybody has micro-traumas, tension, scarring, adhesions and trigger points in their tissues that can be released by the correct application of the techniques I’ve mentioned. Nine out of ten “sports injuries” are, after all, not as a direct result of the respective sport. They are a result of postural imbalances and pre-existing soft tissue problems in the participants’ bodies. The uncontrolled nature of many sports just turns these problems into acute injuries.

And why should I have a sports massage? Virtually every professional sportsperson incorporates regular sports massages into their training regime because it helps their performance, helps to prevent injury by maintaining soft tissue compliance, and improves their recovery. So if you’re serious about your training, maybe you should learn from the professionals. And if you’re not working hard in the gym, I’ll bet you’re working hard in the office. Humans really aren’t designed to sit on chairs and poke at computers all day, and our bodies develop tension and imbalances as a result. Sports massage – particularly when it’s combined with activities like yoga – can help to redress the balance and to keep you on top form for longer.

How is a Victory sports massage different from a spa massage? It’s easy to give a ‘nice relaxing’ pamper. On request, I’ll happily play ‘crashing waves’ on the iPod and leave you feeling sleepy and without a care in the world. However, I get my job satisfaction when a client stands up and the end of a treatment in a physically better state than when they walked in. You might well feel some discomfort when I’m applying deep friction and NMT, and I won’t give you a cup of green tea and a fuzzy robe at the end of it – but once I’m done with you, you’ll feel great, and I’ll recommend the most amazingly large burrito around the corner at Poncho’s.

Phil is available to provide sports massage at Victory on Friday afternoons, and at other times on request. You can follow his adventures on Twitter, and you can book an appointment with him here.