Secret of the Pyramid

Over the past 4 months, we've had something of a dramatic time at Victory: we were flooded by the Starbucks upstairs, and sustained a lot of damage and interruption. We continued to work around it but it's all been a bit of an effort, with a certain amount of playing "musical rooms" as we didn't have enough undamaged space to provide our usual services! However - they've now fixed the damage and we are back on track, rising like a "phoenix from the flood" as it were!

As part of our relaunch, this week I want to explain the concept that underpins all the work we do at Victory: the Health & Performance Pyramid. It’s our diagrammatic representation of how your health works, and if you have all these building blocks in place, then we believe you should have normal, pain-free function.

(c) Nell Mead 2014

Let's start at the bottom layer, the red Foundation Layer. This is all about the health of the cells that form your tissues and organs. Effectively, if you have the right nutrients going in, and metabolites being effectively flushed out, then the environment within your cells will be healthy, and you will be more robust - more resilient against injury or illness, and quicker to heal should you become sick or injured. But if you aren't on top of the Big Four - hydration, nutrition, sleep and stress - then your cell environment will be less healthy than it should be, and you will respond less effectively to injury treatment or fitness training. I’ll write more about this next week.

The next layer is the magenta Health Layer. This is about pain, which occurs when your movement is compromised (either for cumulative reasons such as dodgy posture, or traumatic reasons such as a fall or a car crash). When you come to see us with pain, we'll bring you in for a Health Assessment to work out the underlying cause of your pain - and if appropriate, we'll then create a package of physiotherapy and/or exercise rehabilitation to help you restore and then build up normal movement patterns through our unique RSM Model, so that not only do we retrain your nervous system into new and more functional patterns, but that the retraining is robust and long-lasting. If you need anything we don't provide in-house, we also work with a variety of doctors and other healthcare professionals and will be happy to refer you on.

After this, we have the purple Performance Layer. This is about becoming even stronger and more functional, so that you remain pain free, improve your athletic performance and reduce your risk of future injuries - even if you challenge yourself to do something out of the ordinary! During your Performance Assessment, the team will ask you about your goals for the future, analyse your current situation (flexibility, strength, endurance, movement patterns, body composition) and work out a programme of physio-led yoga and/or conditioning training to help you get from your current state to where you want to go.

Finally, we have the blue Sport Specific Layer. This is where we start looking beyond the flexibility, strength and endurance (which you should have by this point!) to more technical aspects of whichever sport you choose to undertake, should you want to. We can work in-house (our team have experience in a wide variety of sports!) and/or with your own coach to provide you with specific, technical movement patterning drills to help you reach your peak.

So don't wait until you're broken! Whether you're in pain right now, or simply want to improve your health and fitness, give us a call NOW on 0207 175 0150 and find out how we can help you to get better!
  

What causes injuries: overuse or misuse?

I love this image taken from swimmingscience.net

At Victory, we see a lot of people who've had specific, traumatic incidents which have caused their pain: fractures from traffic accidents, ligament ruptures from skiing accidents, joint replacements and other major surgery.  But we also see an awful lot of people whose injuries would traditionally be termed "overuse" injuries: tennis elbow, shoulder impingement syndrome, tendinitis of the Achilles or patellar tendons, acute low back pain...

The problem with labelling these injuries as "overuse" is that people naturally assume that they can be cured with less use - also known as rest. So they stop doing the activity that brings on the pain - running, playing tennis, ironing - under the misguided belief that once they've "healed", or once the "inflammation has subsided" that they'll be able to go back to doing exactly what they want to do.

Unfortunately, this approach is just like being a yo-yo dieter (if you aren't one of these, I'm sure you know a few!) Yes, if you give up cakes or wine for a few weeks, your tummy will get flatter. But once you come off the diet and return to your old habits, you'll put the weight right back on again - and probably a bit more too! Similarly, people on the the exercise-injury-rest-exercise pattern tend to find that each new injury is slightly more painful or takes a bit longer to recover from than the last.

The thing that we as physios don't shout loudly enough is that the cause of these "overuse" injuries isn't "overuse" nearly as often as it is "misuse" - bad movement habits or poor exercise technique, which may have a multitude of different roots.

As one example last year, a surgeon referred me a delightful middle Eastern woman who'd had chronic pain in both knees for 12 years. There was nothing structurally wrong with her knees: as I assessed her, it quickly became obvious that she wasn't using her gluteal (buttock) muscles as she walked and ran - a vital factor in knee control, as I've blogged before. When I asked her about this, she told me she had deliberately stopped using her glutes because of sexual harassment she'd been subject to, when walking around her home town! Once we'd realised this and retrained her glutes, her knee pain resolved within 2 months.

Another example I saw was a stock market trader who has 3 large computer screens constantly on the go over his desk. Over time, he developed severe back pain and came to me to work out why. We realised that his habit of sitting in a twisted position for long hours, staring at the screen to his left, had caused uneven pressure concentrations on his spinal discs, leading initially to backache and stiffness - and then, when he ignored it for long enough, to an acute locked back. Unfortunately for him, restoring disc metabolism is a slow business, but again, once the cause of his issue was unearthed, we were able to help him to retrain his sitting posture and then go through a course of hands-on treatment and exercises to give him not just pain relief, but normal movement patterns.

In my view, the most important thing we do as physiotherapists is to coach you in retraining your habits and movement patterns.

When a poor movement pattern is ingrained - for example, if you twist every time you put weight through your left foot, or every time you sit down - it can lead to compensatory habits: dysfunctional patterns of excessively high and low muscle tone, which in turn leads to even worse movement patterns and eventually to pain.

Our first job is to work out where it all started - and then to coach you to change your bad habits for good ones, much like a tennis coach trains you to swing your arm properly until you can hit a great backhand even under pressure.  But much like learning a backhand, good patterns don't come overnight, and that's why we only work with people who are prepared to sign up to a course of treatment, and who are prepared to put the work in. Retraining physical habits takes time, effort and consistency - but the reward is getting out of that cycle of exercise/injury/rest/exercise/worse injury and achieving long term results.

Want to find out more? Contact us now on 0207 175 0150 to arrange your health assessment.

What can I eat and when should I eat it?

If you're on our mailing list or follow Victory on social media (Facebook or Twitter), you'll know that over the past week or so we've been asking you to send us your questions about the Foundation layer of our Health & Performance Pyramid, which encompasses sleep, stress, hydration and nutrition. It's been really interesting to read all the questions we've received, and I'm hoping that this series of posts will start to answer them... this time, I'm focusing on good nutrition.

Why do I need to watch what I eat?  Every single cell in your body is created out of the things you ingest - you really are what you eat. Good nutrition doesn’t necessarily mean never eating a treat, ever, and it doesn’t have to mean calorie counting (more on that later) but it means concentrating on long term habits that will have a positive impact on your health.

Are carbs still bad for me? When it comes to carbs, it’s all about type and quantity. Having mashed potatoes with every meal certainly won’t do you any good (sadly!) but a completely carb free diet isn’t the answer either. Carbohydrates do play a major role in energy storage and transportation, so if you cut them out entirely you may lose weight to begin with, but many people will also notice themselves becoming sluggish and tired.  I did the Atkins diet many years ago, and while I certainly lost weight, I found that after a couple of hours on the tennis court, I was starting to cramp up. When you eat carbs, try to focus on your portion size (so that’s one fist sized serving for women and two fist sized servings for men) and the type of carb. Simple carbs (like white rice, white bread or pasta) will be broken down by the body quickly and converted into sugar. Complex carbs (like sweet potatoes, wild rice, whole grains) will give you prolonged energy and help you feel fuller for longer.

Should I be counting calories? Well, you could – but they aren’t the be all and end all! Calorie data can be very imprecise, depending on where the food was grown or raised, what cooking methods were used, how long it’s been stored for… It will give you a rough guide, but it definitely won’t be exact. What’s more important is concentrating on ‘whole foods’ – or, as our trainer Jess, puts it, “Mainline on anything that grew in the ground or used to have a face.”

What should I eat when I exercise? When you put your muscles under strain by working out, the muscle tissue sustains very tiny tears. This is nothing to be worried about, and is actually the reason your muscles get bigger and stronger after you exercise, but you can help them along the way by eating protein after your workout. Most people automatically think of meat when they think about protein, and things like chicken, beef or tuna are all good sources. Protein shakes can be useful; but don't worry, veggies - it's not all about meat: lots of vegetables and grains are good sources too – try dark, leafy vegetables (like spinach or broccoli) or things like lentils, quinoa or pumpkin seeds. You can use your hand size as a guide to this one too – a protein portion for women is the size of your palm, and for men, the size of two palms (see the picture above from Precision Nutrition).

The newspaper says that fat is good for me – is this true? Yes!  We need fats for our body to work properly – they’re used to balance hormones and lubricate joints, not to mention making up a good portion of your brain! Try to eat unsaturated fats (fish, nuts, olive oil, avocadoes etc) and saturated fats (butter, lard, etc) but steer clear of trans fats (anything that lists ‘partially hydrogenated fat/oil’ on the label). Use your rule of thumb – a portion of fat should be the size of one thumb (for women) or two thumbs (for men.)

Now that I’ve made myself hungry, I’ll leave this with you… I’ll be back soon to talk to you a little bit about stress (argh!) - but if you're interested in more information, please leave a comment below, check out our Online Foundation Programme - or contact us to ask questions!

Water, water, everywhere - how much should I drink?

If you're on our mailing list or follow Victory on social media (Facebook or Twitter), you'll know that over the past week or so we've been asking you to send us your questions about the Foundation layer of our Health & Performance Pyramid, which encompasses sleep, stress, hydration and nutrition. It's been really interesting to read all the questions we've received, and I'm hoping that this series of posts will start to answer them... this time, I'm focusing on hydration.

So... why do we need water? Well, our bodies consist of anywhere from 53% to 65% water (in general, the people with 53% water have more body fat). Our brains are made of around 70% water, and our lungs up to 90% water.  This water helps us carry vital nutrients to our cells, to flush out metabolic waste products from our muscles and organs, and enables us to take in air effectively by providing a moist environment in our mouths, noses and throats.

What happens if we don't have enough? If this level drops by even a percentage point or two, you start to become dehydrated – and this can affect the way your organs (especially your liver, kidneys and brain) function.  It'll also give you bad breath, dry skin, muscle cramps and sugar cravings - and chronic dehydration can result in kidney stones and types of bowel disorder. Given that we sweat up to a litre of water per day (men more than women; athletes more than sedentary folks) and also urinate approximately a litre per day, we need to keep topping ourselves up!

How should I take on water? Official guidelines still say that men should drink around 3 litres of water per day, and women 2.2 litres.  However, recent (and not so recent!) research suggests that while this amount is broadly correct for relatively sedentary people in temperate climates, we can - and should - actually get a lot of our water intake from other liquids (even tea and coffee count, though sadly gin doesn't) and from our food (most fruit and vegetables have a high water content).  And if we're getting enough, then our bodies will do what they do best and regulate our systems effectively to make sure it's suitably distributed, used and disposed of.

Should I drink more when I exercise? In general - yes. That's because you'll sweat more when you exercise, so you'll lose water through your skin; you'll lose it hrough respiration because you'll breathe harder; and you'll also be using more water to carry nutrients to your cells and flush out the by-products of increased metabolism, and any water used here will flow to your bladder.  But how much extra you should drink really depends on how much you're sweating.  Sports water bottle company CamelBak have produced a handy online sweat rate calculator which you may find useful to calculate your extra water needs.

How do I know if I'm getting enough? The first and most obvious sign of not getting enough water is that start to get a dry mouth.  Saliva is 99% water, and if that starts to deplete, you'll hopefully notice.  The next sign is lowered blood pressure, headaches and dizziness - because your blood is around 80% water.  If you still don't drink, your muscles will start to fatigue, you'll feel thirsty, and you'll stop urinating. Urine colour is actually a pretty good measure of hydration levels (assuming you're not overdosing on asparagus or antibiotics) as is frequency - if you are well hydrated, your urine should be clear or pale, and you should need to go at least 3-4 times per day.

Can I get too much? Yes, this is also a thing, though much less common than dehydration.  It gets most publicity when marathon runners overdose on water and become sick or die; but it also occurs in people who've drunk too much water to cure their hangovers and can't work out why they're feeling worse - and with some nasty medical conditions such as kidney failure, congestive heart failure, or sustained diarrhoea and vomiting.  Hyponatraemia is the name for what happens when your body is out of balance and you have too much water relative to sodium (salt).  When sodium levels are low, water tends to flood into your cells, causing them to swell.  This is a real problem when the cells concerned are brain cells, because there's only so much space in your skull - so swelling of the brain cells can lead to brain damage or even death, but this is extremely rare.

And on that cheerful note... drink up folks!  I'll be back soon to talk about stress and food - yum!  But in the mean time, if you'd like any more information, you can comment below or on our Facebook page, check out our Online Foundation Programme or contact us with a question.

What's so great about sleep, anyway?

If you're on our mailing list or follow Victory on social media (Facebook or Twitter), you'll know that over the past week or so we've been asking you to send us your questions about the Foundation layer of our Health & Performance Pyramid, which encompasses sleep, stress, hydration and nutrition.  It's been really interesting to read all the questions we've received, and I'm hoping the next few blog posts will start to answer them... this time, I'm focusing on sleep.

Why do we need sleep?  Well, we tend to think of sleeping as being a period when the brain and body are in "idle mode", but research is increasingly showing that this just isn't the case.  In fact, it's a period when we actively process our day, store memories, grow muscle, repair tissue and synthesize hormones.

What happens if we don't get enough sleep?  I'm sure you know how you feel after a poor night's sleep. You tend to feel groggy and slow.  You make mistakes at work.  Your coordination is affected, you become less agile and your anticipation and reaction times become slower (hence the signs on the motorway which remind you not to drive when tired).  Multiple that by lots of nights though, and it can become a real health risk, with studies showing correlation between chronic sleep deprivation and increased risk of obesity, diabetes and heart disease.

Does it matter when I sleep? Whether you're a night owl, or a lark, or a hummingbird (in the middle), the reason for it is partly genetic.  In one study done at Stanford University, volunteers were given questionnaires to determine when they were most productive, and were then given blood tests to look at a particular gene called the clock gene which is known to affect biological rhythms.  According to their questionnaires, owls preferred to do their activities and go to sleep between 10 and 44 minutes later than the larks; and there was a consistent difference in the makeup of their clock genes too.  However, it isn't quite that simple, as in general, younger people tend towards the owl and older people are more likely to be larks.

What's the deal with sleep cycles? There are two main types of sleep: NREM (non-rapid eye movement) and REM (rapid eye movement) and we cycle through them in order. Over the three stages of NREM sleep (transition to sleep, light sleep and deep sleep), we gradually fall deeper and deeper asleep; and by the time we hit REM sleep (after around 70 minutes) we are ready to dream and are effectively paralyzed.  A full sleep cycle takes around 90 minutes, and at the end of it, we return to light sleep again, which is the best time to wake.  So if you want to wake up easily, think about your sleep in 90-minute chunks.  If you want to sleep once a day, work back from the time you want to wake up, and try to go to sleep 7.5 hours (5 cycles) or 9 hours (6 cycles) before; or if you prefer to nap, try to arrange your sleeps in blocks of 90 minutes.

How much sleep do I need? This is the biggest question we hear, and the truth is that it varies from person to person so there's no one-size-fits-all solution.  According to the National Sleep Foundation, most adults do best on around 7-9 hours of sleep per night, with teenagers needing up to 2 hours more, and over 65s an hour or so less. But this doesn't all have to be in one go: before the industrial revolution, many of our ancestors naturally gravitated towards a polyphasic sleeping pattern, where they would have two or more shorter sleeps during a 24 hour cycle. One such pattern is still quite commonly seen in the Mediterranean where afternoon siestas are the norm - or for other patterns, have a look at this website from the Polyphasic Society.

But how do I know if I'm getting enough?  Probably the most important comment about sleep has to go to Jim Horne, from the Loughborough University Sleep Centre, who says "the amount of sleep we require is what we need not to be sleepy in the daytime.”  However, if you're still not sure, popular psychologist Richard Wiseman has just written a fantastic book about sleep called Night School, and his website has a nice little self-test. And if you want to know how to sleep better... well, why not check out our Online Foundation Programme - or contact us to find out more about it?

Parkour physio

Three months ago, I said goodbye to my friend and former patient, parkour athlete Naomi Honey, as she disappeared for a 6 month trip to South America.

Two months ago, Naomi contacted me to tell me she'd fallen while surfing and seriously damaged her knee.

We corresponded for a few days, she sending me her scans and doctors' reports, me responding with advice on self-care and exercises.  But it quickly became clear that she needed expert physiotherapy.

Naomi's been home for six weeks now.  When I first saw her, she couldn't fully bend or straighten her knee, was wearing a brace and walking with difficulty.  She had a grade 2 ligament sprain and was - understandably - pretty miserable.

But since then, she's had a course of physio with me, and has been attending Helen's knee classes - and has been practising her exercises at home.  Naomi is desperate to get back to Brazil next week, and so she's been really dedicated to getting better.

She's just made me the most amazing thank-you video  (above), simply called "Moving Again".  The results speak for themselves - can you tell which knee she damaged?

If you're have a sports injury, the sooner you come in for an assessment the better - call us on 0207 175 0150 and let's get you up and moving again!  And Naomi - we hope you have a fantastic time in Brazil!