It’s not easy when you are facing 12 weeks of recovery before you can move freely again to focus on the positive. But thats precisely why its harder - because you have to do the work. In preparing for this, there are some stages of recovery that you should understand that go hand in hand with the physical therapy that you are about to endure.
Abdominal cramping is something that many of us have dealt with. You’ve had a big, rich, heavy meal, you’ve been not taking care of your intake over a period of indulgent celebration or you’ve been doing some self administration of pain medications and haven’t been aware of your diet. Cramping and bloating seems such a generic complaint that often we may dismiss simple things as indigestion, or a meal that ‘may not have been right’ from the dodgy street vendor at a music festival. But when is abdominal cramping something more that we should be worried about? There may be many different causes of concern for abdominal and intestinal pain but we shouldn’t dismiss or disregard what our ‘guts may be telling us’.
DIVERTICULOSIS is the formation of pouches inside the large intestine (diverticula). The pressure inside the intestine makes these pouches bulge out which results in the condition Diverticulosis. Irritable foodstuffs and issues with diet can contribute to the formation of pouches that sit inside the lining of the large intestine. Now many people can have diverticulosis and not have any presenting symptoms. DIVERTICULITIS is the more painful condition where these pouches become inflamed or infected and create painful abdominal irritation. The formation of Diverticula in the intestine tends to affect those over the age of 60, it is worth considering what our current habits may be doing to our system in our younger years so that when we begin to head towards our more senior years, we are well aware of what it is that can influence our health and more specifically our intestinal health later into life.
But what causes these pouches to become inflammed? There are varying theories and unfortunately these are still theories and there is still a consensus to be reached as to why diverticula progress through to the inflammatory diverticulitis. There are a number of causes that range from ingestion of foodstuffs, to ingestion of mediations and just plain irritation from not eating the right combinations of foods that contribute to this condition. It is wise to be aware of the influences and perhaps look at some of the claims in a more succinct fashion.
A recent medical journal in Harvard University in January 2017 suggested that unprocessed red meat (such as steak) can be a contributing factor to the development of diverticulosis. Researchers assert that c-reactive proteins and ferritin (blood cell protein that contains iron) are more prominent in a red meat heavy diet and that these elements can create irritation in the intestine which leads to increase risk of diverticulosis. There is also a theory that red meat consumption increases the levels of bacteria present in the gut which can influence the integrity of the gut lining and leads to the formation of the pouches.
Knowing that we have to eat enough fibre has long been a stalwart of dietitions in the contemporary era.. When it comes to irritation and diverticulosis, there is a myth that fibre plays an influential role in the development of the disease. However, when a flare of diverticulosis turns into diverticulitis fibre is definetly not going to be your friend. Fibre adds bulk to stools which stimulates peristalsis (muscular contractions) and colon contractions to move stools through the intestine. When you are in a ‘flare up’ of the condition this can create irritation and pain in the intestine and would be contrary to your condition at this time. Conversely fibre also helps to soften stools in the system and makes them less irritable to the intestine when the system is not in flare. So it may seem contrary that when you are experiencing a flare of the diverticula that you avoid fibre whereas to prevent it from occuring, you are encouraged to be fibre rich. This can cause some confusion for sufferers and should be discussed with your medical practitioner.
Whilst medical Research has not found any conclusive links between fibre and the onset of diverticulitis, as well as with certain foods such as red meat. the contemporary modern diet could have much more of a role in the onset. More people seem to be suffering from this condition now in the contemporary era and research currently suggests it is the over reliance on processed foods and particularly carbohydrates that is contributing to the increase. It is asserted that the “a diet that limits foods that are high in FODMAPs — fermentable oligosaccharides, disaccharides, monosaccharides, and polyols — can benefit people with irritable bowel syndrome. With these factors present in many of our processed foodstuffs it is not hard to make the leap between an increase in this condition and our over reliance on processed foods inside our dietary regimen.
The administration of NSAID’s and analgesics can also contribute to intestinal issues that may contribute to diverticulitis. It is known and documented that the ingestion of these medications creates issues with intestinal bleeding and influences the integrity of intestinal walls. Gastroenterologists from Universities and Medical Research Institutes in May 2011 in Washington and Boston cite the use of NSAID’s as a leading influence in the formation of diverticula and diverticulitis in both the upper and lower gastrointestinal tract. Subjects administering 2 tablets a day of aspirin were known to have consistent links with gastrointestinal bleeding and complications of intestinal walls due to the nature of the NSAID’s effect on intestinal integrity.
SO what to eat and what to avoid with this condition. There are some myths expoused and suggestions that certain foodstuffs contribute to this condition. We’ve talked about red meat. We’ve talked about additives in processed foods Avoiding small nuts and seeds is also said to be of benefit as these small items have been identified to create a flare of diverticulitis. Even tomoatoes can be an irritant it is suggested. Unfortunately the science doesn’t necessarily support these claims and cites them more as influences rather than definitive causes. Many medical professionals cite that each individual case needs to be addressed with care and consideration to the particulars of what is presenting. In essence, that what works for one may not work for all.
So whilst we may not have to be too concerned with the onset of diverticulitis or the irritation that comes with the formation of diverticula in our stomach now, as we get on in years it can be a consideration that we need to understand, particularly if we have been predisposed to elements such as heavy red meat diet, overuse of analgesics or even just in the unlucky percentage of sensitive gastro-intestinal issues. Being aware means understanding the warning signs and if abdominal cramping or pain in the andomen is present, best not o just put it down to a dodgy kebab or take out.
bicep curls - the exercise one should never do. Standing in a CrossFit gym and doing a bicep curl is usually the best way to lose instant credibility and imbibe questioning and dismissive, wry glances. However this opinion may be displaced as I discovered. The Curl actually has a function. Sure it is an isolation exercise and trains a single muscle. However as I discovered, it can also be utilised when you are working with a complex movement or trying to achieve some supporting strength for the shoulders.
So often in the clinic when faced with someone’s fear of the dreaded question - ‘How much exercise do you do’, I receive a confident and bold reply of “Oh I exercise 30min a day at least. I get my exercise on my walk to work.” I’ll be brutally honest here. Its an encouragement that someone is moving 30mins a day and being proactive in their approach to remaining mobile and remaining fit enough to engage in a 30min walk to work. However, too often in an approach to true exercise or ‘moveability’ of our body that keeps ALL our joint open, working and in reasonable shape - a walk is just not enough.
The predominant action associated with the arm muscles are elbow flexion along with supination and pronation of the forearm. In regards to elbow flexion, Biceps Brachii must give way to it’s more powerful brother the Brachialis, who lies deep to biceps brachii and generates up to 50% more power in the elbow flex. The other main Brachii brother is the Brachioradialis, which rotates the forearm against the humerus. It is involved in all three actions of flexion, supination and pronation but is most powerful when the forearm is in the midway position between supination/pronation.
It’s so much easier when you are maintaining behaviour because the momentum is with you. You are riding a wheel that is hurtling along. Generating the ball rolling is much harder and that means if you are starting from scratch - you got an uphill battle. Being honest with ourselves and not selling ourselves short is important. As is not allowing our self talk to convince us that we can’t be more proactive in these elements? Essentially, we can use these elements as excuses, convincing ourselves NOT to partake in changing behaviour. But it doesn’t take 5 min to have a quick stock check of the above elements and see what needs attention. It may just be the thing that makes you commit to changing your own health.
When we come back from an injury, there is always a process of trying to re-engage with the program that we were once connected. We are keen and eager to once again be back in the swing of activity after an enforced period of downtime. The eagerness and excitement is intoxicating and we have all the motivating forces at play that we can muster. But at times, our bodies are not exactly ready for what it is we want and need to do. So how best to return to the field after a rehabilitation.
The most important factor in returning to activity is a “Graduated Return” . This means a slow and measured return to the movement without overloading a freshly rehabilitated joint or muscle. The known actions are trained, intuitive and known to us are ready to be included in our regimen again yet we must consider the intensity of this return and adjust it accordingly. And this can be the most difficult part of returning to form.
We want to start out mimicking that which we did before. A runner will want to go back to running, a court player back to the action of swinging and shooting, a lifter back to doing the ‘composite’ lifts and getting the CNS (Central Nervous System) to re-engage with the movements. We all know the squat is a great exercise but it is also the one that is most difficult to get right. Such a complex and multi-dimensional movement needs action in all of the main joint spaces of the body all combined together in a synchronicity of trained action. You cannot create this type of synchronicity without actually performing the full lift in as complete action as possible.
Working on getting the co-ordination back of these movements is priority. Attempting the movement without load is important. Revisit the mechanics of the movement and perfect them. Now this does NOT mean breaking down the movement into separate parts. For example, a clean and jerk lift should not just be broken down into a squat and an overhead press separately. While this is valuable to refine motions and certain strength elements, research in sports science proves that breaking down a motor skill into it’s individual parts and perfecting them separate from each other does not translate to perfecting the combined movement itself. The elements of co-ordination and external stimulus needing adaption (such as fatigue, resting power to generating power, stability after stress etc) means that you need to create as great a ‘performance likeness’ as possible to truly train the required skill. Training motor skills in separate parts has been discarded in sports training in favour of ‘match like simulation’ and performing in as ‘real time’ an event as possible. Nothing beats match practice to create match fitness.
Using your movement co-ordinations and repetitive training to work form and function in a required movement is about training the CNS as much as training the muscles and joint spaces to perform an action. In this way, you have to remind your nervous system of the co-ordinated effort required to perform certain movements. In much the same way as the latter part of rehabilitation involves reintroducing small jumping and stimulated movement patterns, so to must this part of the process begin to bring into play the complete movement with external stimulus (read ball, racquet, bar, bat) as is needed in the game scenario. In short – work on your form again. Knowing how to co-ordinate and replicate the movement pattern without load is vital.
Once you have moved through this stage, the rebuilding of power and strength has to come at a slow, yet consistent pace. The scientific approach can be employed here and having a measure in place helps to give you an equation that can be applied to the rehabilitation. Working off a 1RM (one rep maximum) concept, this is your one rep maximum load point is a good place to start. For many of us, we haven’t yet figured out our one rep load maximum. Knowing what your 1RM load is means you can start to make calculated judgements of what you should and shouldn’t be lifting and this should be informing your weight or load resistance.
In terms of load, the suggested protocol for beginner lifters is what should be considered. This tends to come in at around the 70-80% 1RM loading. I would hazard that as a return to form you should drop this to 50-60% of 1RM loading. Working on form and function for the first week of training and then gradually increasing this to 70-80% of 1RM for the following week which then leads to 80-90% of 1RM for the consecutive 3rd week. Following this protocol, you should be able to work up to your maximum loading over a manner of 3-4 weeks. You could also take a more conservative approach of beginning at the 30-40% loading and then gradually increasing incrementally PER WORKOUT by the smaller increments (2-5kg depending on percentage of 1RM) to increase adequate muscular loading on the strength component.
If we are speaking in terms of an athlete involved in movement and on field experience I would suggest following a Gradual Linear Progression as proposed by Kelly Starret who proposes a 4 part system of loading in movement.
· Position – working with the movement progression, beginning to get full movement and angles of movement in respective joint spaces.
· Load – start by establishing a resistance level at the 30-40% of tension that was the previous maximum load of a client and progressing with linear progressions of 2-5kg per workout.
· Volume – working with a volume increase and increasing the sets and repetitions of sets going upwards from 2x5 to something like 3x8 to build resistance and capability
· Speed – lastly introducing speed and actions with fast twitch nature to replicate on court or on field experience. Increasing the time quotient of performing actions and building aerobic capacity through challenging time constraints and resistance under time.
With these measures in place you are more concerned with monitoring how an athlete or subject is able to move from one measure to the next. Staying ahead of pain and monitoring recovery after exercise means not pushing the body to that point where it has to fail to test the limit of the injury or movement.
Now it is very easy to transfer all this information and reloading formatting into another sporting situation. For example, a runner would have the same equations being applied but in terms of distance and intensity. If a regular run was a 14km load or a weekly load around the 50km mark, a graduated return would still be to apply the percentages of return to the weekly amount. Say 60% of 50km over 1 week. Then incremental increases would be the same until the desired full load was achieved.
You can also apply this to a ‘on field’ situation whereby time on field was reduced to quarters, halves or periodic times on field. Utilising positions as well would be advantageous in that a striker may play as a back for a period followed by moving up into the mid field or forward line until they were ready to be fully installed in their specialist position. All the while the supervised training regimen is built around keeping an eye on a returning player and ensuring that in training, they can begin to push into the realms of full load but without risking reinjury or overloading. This is the coaches responsibility as much as the players and coaches should be aware of injury reloading and have a program in place within the drills and skills to ensure that players are ‘managed back into’ play effectively.
These are but two examples of trying to keep an athlete back on track and being able to gradually increase the amount of load that they can endure without pushing them beyond what they are capable of enduring with the risk of re-injury or post acute injury. If the graduated approach is followed then the minimisation of re-injury is the result and the rebuilding of CNS conditioning along with muscular endurance and efficient joint mobility.
This all results in the least amount of chance of overloading an injury and risking further impairment of a structure post rehabilitation. It’s a slow process but it is about adhering to the principle of ‘starting from scratch’ to begin again. This essentially results in athletes being able to take the court or return to performance with the assurance that they can once again push forward into new regimes without the fear of injuring again or being at risk of over stimulating compromised structures.
When we encounter ‘eccentric’ minds we can find them quite difficult to relate to. Bombastic, crazed and ‘less ordinary’ people are difficult to tolerate at first and it is only upon out inkling to listen and perhaps entertain the idea of the less understood approach that we can even begin to connect with the genius that sometimes lies before us. It is hard work to meet someone when they are on a level that is not your own - not below or above - just not the same.
There are advocates out there who proport that training regimes that involve extreme mobility and manipulation of the body are at times necessary. However, there can be real and damaging long term issues that can arise from pushing too far into extremes. Damage to cartilage, lax tension in ligaments and bone deformations from extended extreme ranges of motion are some of the considerations to think of when considering delving into these exercise regimes.
At what point should we start being concerned about mobility and are there any signs that we should signal to ourselves? There are answers to this and one of the main points to consider is our ability to move without assistance. Simple feats of strength and balance are one of the first precursors to signal overall health. Our ability to move and stand, balance and lift (even the smallest items) all feed into our ability to maintain independent living and quality of life.
So if you are looking at recruiting strength and not just size, then you need to do more than lift heavy things and put them back down again. In fact, it’s the putting them down part that is actually more to the point. Eccentric loading is asking a muscle fibre to lengthen under load. Essentially the amount of force produced when a muscle lengthens.
Any movement that involves the overhead pitch action or throwing action is a multi-dimensional and complex combination of active muscles generating force, as well as stabilisers and then braking antagonists that all result in a powerful arc of motion. Throw into the mix the amount of times that athletes embark on this action in their chosen pursuits of athletic perfection and you can see that this action can be a great cause of strain and repetitive stress on a very flexible and ultimately unstable joint.
So you’ve sprained your ankle. You’re lying there in a tonne of pain, unable to get unbroken sleep, your foot is swollen, any movement hurts and your lateral malleolus looks like a baseball resembling a painters pallette of yellow, blue and purple tinges. Life sucks right about now as you can’t even make a cup of tea and walk to the lounge room. Instead you have to get on all 4’s, gradually pushing your teacup down the hallway towards the tv room. It’s most undignified.
It’s one of the most common injuries to occur in sporting fields and in athletes. The sprained ankle is an easily encountered injury as the ankle is subject to so much pressure in terms of stabilisation and effective balancing of the entire body as it launches from one foot to another and propels us forward, upward, sideways as well as ensuring even distribution of weight and softening shock upon landing from jumps and said propulsions. Thats a lot of work!
It’s a bit of a rude awakening when winter finally makes its presence felt and where once you were lazing lightly on the grassy knoll in the lovely 23 degree sunshine with a bottle of rose and a wedge of camembert gives way the next day to darkness and gloom in pelting rain where a thermal underlayer is not a consideration but a necessity.
Riding along on your bicycle in such inclement conditions is not the most appropriate of behaviour perhaps, but you’ve woken up and in full ‘glass half full’ mode have considered that surely the weather will clear and this is but a temporary climate change ridden hiccup of a weather pattern. Surely once you begin your morning commute in the sun will come out, rainbows will burst forth and you’ll be singing your DIsney tunes in your head as you pass by the traffic on your way to work.
The commiserate option however is the dreaded public transport system. The communal cocophany that in this weather takes on the identity of a bacteria laden cess pool, with people coughing, sneezing and even spluttering into soaked handkerchieves or tissues whilst you are all locked in a tightly sealed vacuum of shared space is not the most attractive option. The social responsibility of taking charge of your own bacterial infection spreading is often lost on our ‘deadlines driven’ work ethic society and sometimes it leaves one questioning whether we are really being socially responsible when we consider heading into a common workplace when we really should be taking a ‘work from home’ day. But i digress…
Deciding to jump on the public system at the first hint of a rainstorm is perhaps a little bit ‘lightweight’ in approach, but the comfort of arriving at work without a soggy wet bottom from the ride in is as much a luxury as that first morning coffee. But in treading the boards of the
So whilst we are contemplating what it is like to be flying down the hill in mid winter on a bicycle, you can be forgiven for thinking that you are in an arctic gale at times, the least of issues being that all of a sudden, tears start forming in your eyes and your nose becomes a veritable torrent of fluid. Its not exactly the Canadian Alps here in Sydney so it isn’t really necessary for arctic exercise gear, but last week It certainly felt like it. So what does cold air do to our system and how much of a threat is it?
Cold air coming in through our airways is not ideal. One of the jobs that our nose does is to humidify the air as it comes into our nasal passage and passes into our lungs. Cold and dry air irritates the mucous membrane in our nasal passage and makes the nasal lining produce more mucous in order to warm the air and keep the lining moist. This results in large droplets of water coming forth from our nose and even our eyes when we are exposed to cold air. Germs and bacteria thrive in dry air and so it is not surprising that as we find ourselves in dryer climates during the winter months as well as being indoors where we heat our air, bacteria is more prevalent and thus the risk of picking up colds and flus increases.
The nasal passages also have tiny micro-hairs called cilia that act like tiny oars, sweeping along mucous through our nasal passages. When it gets cold these cilia slow in their action and therefore the effectiveness and prevention of bacteria taking hold and creating illness in the winter months is reduced. The increase of mucous and fluid in these passages is the body’s way of creating another line of defence. This increased mucous is what results in runny noses and the sniffling during the cold, winter months.
Humidifying air is one the best things that we can do to help out our nasal passages. Creating warm and humid air is the best way to help our cavities do their normal job of warming the air and filtering bacteria and possible pathogens before they enter our body. Humid air is important as dry air is not good for our body and our lungs. The air needs to be humid when it reaches the lungs and so creating humid air in winter is important for keeping everything healthy and avoiding illness.
Humidifying the space can be done by creating sources of water in the room. Bowls of water on windowsills, near heat sources help to keep the warmer heated air from our domestic heating appliances. Having plants in a room also helps. You can purchase humidifiers that create this airflow in the house but there are many ways that you can naturally humidify the home without resorting to a humidifier itself. Even drying clothes inside near the heater can help to humidify the air. It can also be as simple as showering with the door open.
In the case of the adventurous person and my daily bike commute, preventing dry cool air from entering into the mouth and nose is perhaps the best choice and as i have come to realise, the mad bandana clad biker is the best way to prevent the sniffles on the activity run. Having a ski mask may not be the most practical of solutions, but something similar, say a scarf or headband that covers the nose and mouth can help to prevent too much cold air from getting inside your airways.
Whilst it may seem a little dramatic to be obsessing over humid vs dry air, it can make the difference to preventing diseases and bacteria from getting further into our bodies and causing havoc with our winter lurgies. Whilst we don’t have a bitter winter here in Sydney it is worth being conscious of all you can do to help keep the illnesses and winter colds at bay.
Neuroplasticity - the brains ability to reorganise itself and adapt by forming new neural connections is a vital part of the human body to continue to grow, thrive and live. It is so important that we not only develop this ability in early life but maintain it into later life. Continually asking our bodies and our brains to be challenged and solve problems that keep our neural connections alive and vibrant.
The vertical jump is in fact a combination of 3 main synergistic actions. The Triple Extension is something that is coined in the quest for the vertical jump and that is the combination of hip extension, knee flexion and ankle extension. These three movements when combined together have the capacity to create the synergistic eccentric and concentric actions required to perform the vertical leap.
when we injure those trained muscles through repetition or overuse, our body is quick to adapt to any changes. As a result of a weakness or injury we may create a small internal rotation in a major joint such as the shoulder, which then creates a small adaption further down the chain of the arm - say medially rotating the elbow. This change then creates a load or strain on other muscles (in this example the pronators of the forearm) which become more active in performing the motion.
Touch is communication, it is pleasure, it is compassion and it is also diagnostic. Without it we are denying the ability to understand the bigger, wider implications of a presenting issue or injury. Someone with a strong emotional link to an injury or more-so trauma, will require more than a heat pack to feel that they are being ‘treated’ in the best care and way.
Sleep deprivation is a conundrum of debate. How much sleep can you ‘lose’ before you actually begin to eat away at your well being? Can we regain lost sleep? Do we have to regain it before midnight? A few hours of lost sleep over a night or two is not too damaging and the idea of having a ‘sleep bank’ that we can make deposits and withdrawls from is not necessarily a truth.