How do you get shin splints from skiing?

Something came along that surprised me the other day – a ski instructor with shin splints. Now you’d imagine that with your feet and lower legs locked into a pair of ski boots, shin splints would be an unexpected eventuality. However, in this case the boots didn’t fit properly. They were brand new, top spec boots (Salomon) in November, but were basically too big for the occupant. Over the period of a few weeks of heavy training the inner boot began to disintegrate because of the amount of movement inside and things went downhill (forgive the pun) from there.

The person concerned felt the pain but pressed on, not really knowing what else to do, until she got to the point where she simply couldn’t ski any more and went to see a boot fitter who asked her how many years she’d had the boots for because they were so knackered! With the boots diagnosed, she still had no idea what was wrong with her lower legs (and lower back), hence we met. Basically, her poor tibialis anterior and posterior had been working so hard to stabilise her feet against the forces produced by her skis they were going the same way as the boot linings. Three weeks of rest and rehab and she’s now pretty much back to normal.

And the moral of the story is…you may prefer the feel of larger boots when you try them on in the shop with warm, relaxed feet, but ski boots must fit firmly. They are not meant to feel like slippers! Salomon replaced the boots with a brand new pair – of the correct size.

Get ready for skiing.

My partner will be heading off to Austria in about a month to start training as an Alpine ski instructor and asked me to help him out with an exercise programme. A good time then to write something that he can share with his fellow students, which is as relevant to anyone thinking of hitting the slopes for a holiday as it is for folk for whom the mountains are about to be their office. Skiing presents enormous challenges to our muscles, neurological system and cardiovascular system, so it’s not surprising that many people’s experiences of it are blighted by aching limbs, painful knees, exhaustion and injury, to say nothing of the frustration of having one’s ability to learn constrained by fitness. So why do we imagine that we can go from sitting a desk five days a week to engaging in such physically demanding exercise at high altitude for several hours a day without suffering?

Just like any other sport, because nothing else mimics the specific movements involved in skiing, you will only truly get fit for skiing by skiing. This is clearly impractical when you don’t have a snowy mountainside to hand; it’s also a recipe for developing functional adaptations that are in themselves likely to cause chronic pain (more on this later). However, by isolating some of the key demands of the sport, we can devise a fitness programme that both prepares the body appropriately as well as guarding against the development of imbalances in individuals who are skiing on a regular basis.

Knee alignment and stability.

The integrity of your knee joint is protected by the muscles of your thigh, the quadriceps, hamstrings and adductors, which must be in balance. It’s counter-productive to focus on developing your quadriceps whilst neglecting your hamstrings. Skiing naturally builds the quads and hip flexors (the psoas and iliacus muscles); the flexed body position adopted lends itself to over-emphasising these muscles and encourages them to shorten. In turn this inhibits contraction in the hamstrings and hip extensors, which can result in the lower back muscles being overloaded. Regular skiers (including instructors) should beware of this tendency, as it can lead to chronic knee pain and/or back problems by the end of a season. The hamstrings are partly responsible for stabilising the sacro-iliac joint between the pelvis and spine; essential to upright posture and one of the body’s three main centres of balance, instability in this joint is a frequent cause of back and hip pain.  Hip stability is crucial to the stability of the knee joint, so a good ski bum is really one with strong gluteals, especially the gluteus medius and smaller external hip rotators, rather than a person who wears a beanie hat indoors!

KNEE SUPPORT AND ALIGNMENT EXERCISES

Core strength.

Improving the strength of your abdominals as well as your gluteals helps to enhance the stability of your body core and reduces the load on your spine. Your body’s ability to generate stiffness here is the key to effective and efficient transfer of muscular force to your legs and arms. Good core strength will improve the efficiency of your leg drive and improve your postural control (in other words you will fall over less). An efficient core musculature will also allow your diaphragm to focus more on its breathing responsibilities rather than having to contribute so much to bracing your core, with the result that you will find breathing easier and be able to maintain a better body position for longer periods on variable terrain – especially useful for off-piste work.

Proprioception and balance.

Proprioception is a neurological function designed to enable your body to monitor where its moving parts are relative to the rest of it at any point in time. It plays a major part in the control of movement, balance and, as a direct consequence, in the prevention of injury. It helps to stop us falling over and protects us from joint degeneration. We get it from simply being active and doing things that involve balancing in particular. Children tend to have good proprioception because they’re always climbing on things, jumping, balancing on one leg and so on, but we tend to lose it as we become more sedentary. The good news is anything that involves exercising on an unstable surface, which is good for your core, will also improve your proprioception, so two birds with one stone!

Cardiovascular fitness.

Whilst Alpine (downhill) skiing is not especially demanding of the cardiovascular system, being active at relatively high altitude will soon make you breathe harder, even just walking up the steps to the bar. You don’t need to be able to run a marathon, but being able to run for the bus without the need for resuscitation will make huge difference to your enjoyment, not least because instead of working hard just to get oxygen into your lungs, the muscles which help you inhale will have the spare capacity to keep your core stable.

Even if you prefer to stick to the green and blue runs, you’ll find a bit of advance effort makes all the difference to your enjoyment and, most importantly, helps protect you from injury. If you’re an instructor, the same rules apply, only the focus is on maintaining balance in order to optimise the range that your body can perform over and prevent the development of chronic pain syndromes.

Below are a couple of exercise programmes that will help you to improve your postural stability (including your knee), core strength and proprioception. All you need is a mat (or the carpet), a gym ball and half an hour every other day to see a real difference. Throw in a bit of jogging, swimming or cycling two or three times a week and you’ll improve your skiing and consequently enjoy it a whole lot more. Your knees will also thank you for it afterwards.

PREPARATION FOR SKIING 1

PREPARATION FOR SKIING 2

How to be a Telemark hero: fitness for Telemark skiing.

Telemark skiing is a particularly physically demanding sport, especially on the quadriceps, hamstrings and gluteal muscles. If you’ve never heard of it, here’s a video clip of me in action or a brief introduction courtesy of the Telegraph. Not surprisingly, an internet search pulls up various recommendations of barbell squats and lunges as ways of recreating the appropriate muscle action and overload for gym training. However, there is a danger that conventional squats tend to favour the quadriceps and are thus prone to produce muscular imbalance.  Also, if your knees are not tracking straight to begin with (i.e. they tend to move outwards or inwards as they bend), any squat or lunge type exercise you do is going to reinforce your existing posture and could hasten your progress towards chronic or acute injury. One way to check this on yourself is to do a series of single leg squats each side in front of a mirror and watch what happens to your knee.

So, if you’re a Telemark skier who wants to improve, or someone who’d like to give it a go, here are a few thoughts on useful preparation.

1. Have your static and dynamic posture assessed by a suitably qualified person, preferably one who has experience of Telemark skiing. Everyone tends to favour one side of their body over the other and this can produce some pretty dramatic postural variations. To ski well, you need to be able to reproduce the same movement pattern evenly with both sides of your body and if you have a fundamental postural issue, no amount of lessons will correct it and training will tend to reinforce it; you may also be leaving yourself open to injury.

2. Aim for balance between your quadriceps and iliopsoas (knee extension and hip flexion) and your hamstrings and gluteals (knee flexion and hip extension). People tend to naturally over-use their hip flexors and quadriceps, which are also prone to shorten because we spend so much time sitting down. This encourages a level of muscle tension which causes their antagonists, the hamstrings and gluteals, to relax and in some cases become ineffective. Other muscles then have to take on a greater workload, which can cause issues such as knee or lower back pain.

3. Build strength and endurance for eccentric contraction (when the muscle is contracting yet lengthening rather than shortening). A lot of the time your muscles are in eccentric contraction as they act to control a movement: for example your quadriceps as you flex your knee and react against gravity pulling you downhill. Eccentric contraction is far more demanding, particularly when the muscle is pushed to the extremes of its length/tension relationship, and preparing your muscles for that unexpected slip off the edge of a mogul or going over a particularly steep drop could save you from damage. Plyometrics (essentially jumping, skipping, hopping type activities which can be intensified by including depth jumps off benches etc) are good for this, and if you’re doing weights, bear in mind that lowering the weight steadily and under control is doing as much good as picking it up in the first place.

4. Make sure your muscles are able to move with fluidity and efficiency. The quadriceps, hamstrings and gluteals are muscle groups consisting of a series of separate muscles, each of which exerts a subtly different directional force on the joints. They have a tendency to become literally ‘stuck’ together by fascial tissue meaning they lose their individual movement properties and work as a single unit instead. Good separation between the medial and lateral hamstrings for example, is particularly helpful for skiers as they control rotation in the flexed knee (think of your edging). A good sports and remedial masseur will release adhesions, and rehabilitate scar tissue that will hamper efficient muscular contraction. They may also be able to identify problems that could lead to injury if unresolved.

5. Work on building a strong core with good spinal and hip stability. The forces generated by powerful leg and arm movements need the firm support of your abdominal core and the deep postural muscles of your vertebral and hip joints. Telemarking involves a good deal of twisting and side bending, so the deep, short transversospinalis muscles and the multifidus must be effective at creating and moderating this. Your piriformis and other external hip rotators are stabilising your sacro-iliac (SI) joint on your inside ski side as you increase pressure on your outside ski and accelerate it when turning. If they’re not doing this effectively and evenly on both sides, you are set up for SI joint pain. Targeting some of these small postural muscles with some relatively innocuous looking exercises can make a big difference to your overall movement efficiency. Working with a gym ball also helps increase the percentage muscle fibre recruitment over the same exercise performed on a fixed surface because you have to control your balance at the same time.

PDF download: ALL ROUND EXERCISE PROGRAMME FOR POSTURAL STABILITY AND RANGE OF MOVEMENT

PDF download: ADVANCED CORE AND HIP STABILITY EXERCISES

6. Include multi-planar exercises in your training. Many of the exercises recommended for Telemarkers are single plane, such as squats and lunges. In reality though you ski over natural and varied terrain with your body constantly adjusting its balance and applying forces in all directions in order to accommodate bumps, dips, slope camber, changes in snow depth and condition etc. Here’s a nice variation on the lunge to add to your repertoire.

7. Take up yoga. You don’t have to get into the happy-clappy, meditative stuff to get a great deal of benefit from yoga. It’s great for balance, strength, flexibility and overall movement control. It will also help improve your awareness of any differences in strength and range of movement between one side of your body and the other. I recommend Sage Rowntree’s book ‘Yoga for Runners’ as the poses are just as appropriate for Telemark as they are for runners. I also like her phrase: “Comfort with the discomfort of intensity” – something to bear in mind next time you’re keeping the turns flowing when your thighs are burning!

Be positive – get your aches and pains fixed instead of putting up with them.

One of the most surprising things that I’ve noticed is how many niggling musculo-skeletal aches and pains people are prepared to put up with on a continual basis.  Not only this, they’re often willing to compromise movement function and activity patterns in order to get by. Why is this? It seems to me that we have a prevailing culture of acceptance of certain physical limitations, especially when age can be leant upon as an excuse.

A client of mine once called me the day after a hip mobility treatment, to announce that she’d ‘sprung out of the bath’ that morning whereas before she’d had to lever herself out using her arms and she’d played the best round of golf in ages. Some months previously she’d visited her GP about pain the pain and stiffness she was experiencing in her hips, only to be told ‘what did she expect at her age’. Sadly, that’s all too often the response and it had made her consider giving up golf for good.

The one thing that you can be sure about small, niggling aches and pains is that if ignored they will become bigger problems as time goes on. That stiffness in your shoulder when you try to look behind you when reversing the car or the twinge in your back when you get up off the sofa will not go away of its own accord. Instead, your body will find ways of compensating: adjusting your posture, de-activating a particular muscle or laying down more connective tissue for example. Your body is extremely adaptable, but unfortunately that adaptation can just as easily go in an unhelpful direction and become increasingly debilitating.

It can be quite hard to get your head around the fact that this adaptability works in reverse and that, even as you get older, your body is still renewing and rebuilding itself on a continual basis. However, it requires effort and discipline on your part, because changes that have occurred over what may be decades are not going to be fixed by half an hour on a treatment couch. Just like buying a ticket if you’re wishing you could win the lottery, visiting a therapist is a good way to start, but if you really want results it’s down to you to do your share by exercising, changing your habits if necessary and having a positive attitude.

Earlier this year I treated someone who had continual pain on the side of his left foot, to the point where he couldn’t walk properly and so was spending an increasing amount of time sitting down (like I said, it’s amazing what people will put up with). When I looked at his foot, it had become extremely supinated, with the sole facing inwards, and a line drawn down his Achilles tendon and through the centre of his heel bone went round about a 45 degree bend.

I worked on the fascia around his tendon and heel to begin repositioning it and showed him a stretch using a towel which he could do every day to encourage his foot back to a more normal position. I didn’t see him for a couple of months and when I did he explained that the pain had reduced and become more central on his foot the day after treatment, thereafter it went away completely…but he had been doing the stretching religiously every morning. He asked me to have a look at his foot to see if it had changed. I was amazed – I could now draw a perfectly straight line down his Achilles tendon and the centre of his heel bone. His foot was re-aligned, he was now weight bearing properly and walking without pain; his effort and persistence had paid off.

So, the message is: don’t give up your sport, lower your horizons generally and put up with pain – get to work and get it fixed. And if someone tells you to act your age, don’t listen to them.

Trail running: tips to help you crack it and avoid injury.

I love trail running. I started before it was invented – it’s basically cross-country but with a name that avoids connotations of schooldays torture on a cold, wet afternoon – and I hit the trails around my home in the south of France every other morning. It beats legging it round the roads and pavements hands down for variety, challenge and views; it also gives you a better work-out both physically and mentally.

The need to leap streams and ditches, climb steep rocky paths, brake downhill on gravel and jump over fallen trees introduces a whole plethora of athletic dimensions that you just don’t get on concrete and which you need to be prepared for. The risk of falling is far greater and you’re potentially falling onto rocks or into a hole; if you twist your ankle you can’t just get picked up in a car and your body has to be able to react quickly and strongly to maintain balance when loose ground gives way or you catch your foot on something. If you’re thinking of giving it a go, or want to get up those hills you think you can’t, here’s a few tips:

Get 4 x 4 footwear. You wouldn’t expect to put slicks on a Land Rover, so don’t expect ordinary running shoes to give you sufficient traction – you’ll be slipping all over the place, wasting a lot of energy with a very good chance of falling. And to me, ground covered in sharp rocks and potholes is no place to be in a pair of so called ‘barefoot’ running shoes; it makes for nice advertising photos, but off-roading demands better protection.

Learn to keep your focus. Be conscious of where you’re putting your feet and plan your route several steps ahead of where you are at that moment. Keep your sights on the horizon, but use your peripheral vision to constantly assess the terrain, because you can be sure that the times your concentration slips will be the ones when you do. This is especially true when running downhill, because it’s easier to let your mind wander in moments of less intense effort.

Improve your balance and proprioception. This will help you stay on your feet on uneven surfaces and improve your reactions when you skid or trip. Try practicing some yoga balance poses and exercising with a wobble board or inflatable disc.

Follow a strength & conditioning programme – just running isn’t enough. Running on uneven ground makes your peroneal muscles (on the side of your lower leg) work extra hard to stabilise your ankles. Your gluteal muscles (in your backside) play an essential role in supporting your hip and preventing your knees from collapsing inwards or outwards as each leg takes the weight of your body. It’s easy to develop an imbalance here if your quadriceps are overactive and tight, which could set you up for injury. And don’t neglect your upper body – your arms and shoulders will help you get up those hills.

Get a Swiss ball and learn to use it properly. Swiss balls are great for building core strength – essential for enabling you to fix your spine against the multidirectional forces you’ll be generating by jumping obstacles and counteracting cambers. Exercises such as abdominal curls performed correctly on a Swiss ball recruit more muscle fibres than the same exercise performed on the floor.

Believe you can run up the hill. Personally, I prefer to run slowly and increase my cadence (stride frequency) rather than walk; it keeps you in the right rhythm. Your body takes 2-3 minutes to adjust to changes in intensity, so slow down to help your oxygen intake keep pace with demand as the slope begins to increase and KEEP GOING; you’ll soon start to feel like you can sustain it. Whether you make it without stopping or walking has more to do with mental attitude than anything else.

Remember to enjoy the view: “It’s easier to go down a hill than up it, but the view is much better at the top.” – Arnold Bennet

Your bottom – not just for sitting on!

One thing that’s struck me over the past few months, is how many people suffer from chronic pain caused by neglecting their gluteals and external hip rotator muscles. This can be as diverse as lower back pain, particularly around the sacro-iliac joint at the base of the spine, anterior (front of) knee pain and sciatic pain.

The gluteus medius is a very important muscle, which until recently has been relatively misunderstood. Thought of typically as an external hip rotator and adductor, used to lift your leg sideways and rotate it outwards, it’s now known to have a key role in stabilising the hip joint during walking, running and hopping etc. In other words, whenever you need to balance on one leg whether you’re standing still or on the move. Because we spend so much time sitting on it, it’s rather inclined to get lazy and may even switch off altogether, forcing postural changes and pushing the work onto muscles such as the tensor fascia latae and the ilio-tibial band.

Even if you’re a regular runner and gym goer it’s possible that you have good gluteal strength in a squat or leg press, yet the same muscles may still not stabilise your hip effectively in a different position, such as with your hip extended. Effectiveness has more to do with multi-directional stability and, because your muscles never function in isolation, when that stability is lacking it can result in mechanical changes and, ultimately, pain elsewhere.

The piriformis is another demon waiting to cause discomfort. Often becoming very tight, but not necessarily strong, it can pressurise the sciatic nerve causing the same symptoms as sciatica, which we associate more commonly with nerve compression at the lumbar vertebrae. The position of the sciatic nerve relative to the piriformis varies between individuals: in some people it runs above the muscle, in others below and in some the nerve may actually pass through the belly of the muscle, so it’s easy to understand how muscular tightness can restrict it. Along with the gluteus maximus, biceps femoris and multifidus, the piriformis also contributes to the stability of the sacro-iliac joint by tensioning the sacrotuberous ligament. Remedial massage techniques can be used to reach this deep muscle and release tension. Combined with regular stretching and strengthening exercises this can improve it’s functionality, which in turn may relieve pain in the lower back, along the top of the iliac crest and around the sacro-iliac joint.

At the end of the ski season this year when I intensified my running, I began to feel pain in the front of my knees when coming down stairs. A winter of pretty intensive Telemark skiing had built up my quads and hip flexors to the point where they were dominating my hamstrings and gluteals,so I needed to redress the balance by strengthening these weaker muscles and stretching my quads, which had definitely shortened. A few weeks later, no knee pain! I’ve also been working on my running technique to use my gluteals and hamstrings more, lifting my heel higher and flexing my knees more. This reduces the length of the lever as you bring your leg forward making it easier on your quads and hip flexors.

My point is, with chronic injuries the pain is rarely in the same place as the problem. Unfortunately, our instinct is often to address the pain at the point where it occurs, ignoring the fact that our bodies are complex and interconnected systems where nothing acts in isolation. You might not have a pain in the butt, but it could be the source of a problem elsewhere!

Some useful resources:
Unbeatable Buttocks for injury free performance. Read my review at Peak Performance
Gluteals and Core workout with Tamsin Lewis
Gluteal inhibition or weakness by Kinetic Revolution

Backs and boats: the physical and environmental challenges of sailing.

I spent last week putting some of the fleet of sailing yachts that I manage back in the water and training our new crews who’re getting ready for the season. At the same time I had a book to review called ‘Beating Back Pain’, written by sports physio Mark Alexander, which caused me to reflect on just how bad for your back sailing can be.

There’s been quite a lot of research into back injuries caused by ‘hiking’ in dinghy sailing (that’s leaning out over the side of the dinghy to counteract the weight of the wind in the sails), but the issues faced by sailors of larger vessels are far less specific as the range of activities and movements is incredibly broad. Operating manual winches, lugging sails around, throwing and catching heavy mooring lines all pressure on backs, but these activities are often carried out in a confined space where it may be impossible to achieve a biomechanically efficient body position. On top of this, you’re working on a moving platform, sometimes in extremely boisterous sea conditions when holding your balance is difficult, there are lots of obstacles to fall against or be driven into with massive force by a wall of water coming over the deck. Below decks on a yacht in rough weather is like being in a washing machine and at its most extreme, ocean racing can be a bit like a game of rugby played on a power plate!

Less obvious are the issues caused by lack of activity. Sailors on long passages spend a huge proportion of their time sitting down; often in awkward or slouched positions trying to get comfortable or brace themselves against the motion of the yacht. Even during peak activity such as sail changes, the distances covered on foot are very short (maybe only a hundred feet or less), and in challenging conditions such as those that prevail for weeks on end in the Southern Ocean, you’ll be crawling on all fours! Over a period of several weeks, muscles begin to lose strength and endurance due to lack of use. This physical decline is exacerbated by the energy demands of sailing on a rough sea, which are so high it can be impossible to consume sufficient food to meet them; in response your body draws on its fat stores as well as sometimes metabolising muscle tissue that you’re underusing.

The muscles supporting your back and providing the core strength required to fix your spine against powerful movements such as winching, throwing, pulling and pushing, may begin wasting and are thus less able to provide the protection your back needs. If they’re barely up to it before you start, they’ll soon be doing a pretty poor job. Your hip and gluteal muscles can be similarly affected. Conversely, measurements taken from elite ocean race crews show that if muscles are in constant use, they may actually increase in size and strength, such as the quadriceps (from bracing to operate sail trimming winches). Combined with degeneration of the antagonistic and synergistic muscles this can initiate postural changes and muscle imbalances, further exposing the sailor to injury or chronic pain.

So, the physical and environmental demands of yachting present a double challenge to our bodies, amplifying the likelihood of injury, but how many yachties bother to do any strength and conditioning training in preparation? The answer is very few, unless you happen to be professional race crew for something like the Volvo. Rather than wait until you’ve hurt yourself, pay attention to your posture, maintain good flexibility especially in your hips, thoracic spine, hamstrings and quadriceps, build up your core strength and practice good technique for winching, lifting, throwing lines and so on. I recommend that anyone taking up sailing (especially if you’re doing it later in life), going on an ocean passage or becoming a professional sailor, gets their posture assessed and develops an exercise programme that they can follow even when at sea. Inform yourself – Mark’s book ‘Beating Back Pain’ gives a useful overview – and don’t settle for living with what initially may seem like minor problems. You can read my review on the Peak Performance web site along with details of how to order a copy.

Running – the things I see…

The way I see it, running has numerous benefits: as well as keeping you physically fit, it gives you the ideal opportunity to create a personal space that other folk can’t interfere with. You can be out the door and over the horizon without the need for a complicated excuse. It encourages discipline and self-dependence – how are you going to get home if you don’t go the distance? There’s time to think, chance to challenge yourself and… you don’t half see some interesting things along the way.

I’m very lucky, because I live in the south of France I get to run in some beautiful countryside. My running shoes also go wherever I do because it’s a great way to see a place in the freshness of early morning, before most folk are out and about. No matter how many times I see the sun rise over the sea, run along an empty beach or hear a hidden stream crashing through boulders, the joy of it never diminishes.

Running along Hammamet beach in Tunisia early one spring morning, I passed a local woman sitting close to the shoreline. Encumbered by clothing that covered everything apart from her hands and face, she was simply staring sadly at the horizon like a Muslim version of the French Lieutenant’s Woman. She smiled at me but there was a longing in her face that spoke of isolation and containment. It was a look that made me wonder whether for a moment she wished she were me. Freedom is another benefit of running – or is it the other way around?

On a more comical note, I was on one of my regular trails through the hills alongside the Bay of St Tropez when I heard a great deal of yapping and shouting in the distance. It was October and I assumed the local hunters had caught up with a wild boar, but the racket was clearly on the move and getting closer. A moment later, the most unlikely ensemble imaginable burst round the corner in a crescendo of canine enthusiasm and I found myself sharing my route with a team of Huskies towing a quad bike!

Yesterday, it being Sunday morning, I decided to tackle a 23k route I’d had my eye on for a while. It goes way off up into the hills and includes a pretty monumental climb, even by my standards. I was pretty surprised to round a corner on very long uphill section and see in front of me a very unlikely looking jogger who I soon caught up and overtook. I say unlikely because we were in the middle of nowhere and he looked like he shouldn’t be that far from a defibrillator, let alone from home or a vehicle of some kind. He had the sort of kit on that people wore on the high street in the 1980s, which was flapping about as he ran like someone hurrying for a bus. It was very surreal, as if he’d been beamed in by Scottie. I had to admire his ambitious choice of terrain, but couldn’t help thinking he’d make better progress with less wind resistance! It’s probable that he was equally surprised to be overtaken by a woman in what some would describe as a catsuit, who gave him the fright of his life by creeping up behind him and shouting bonjour!

 

Recover properly, don’t save your injuries for later.

Last week I was in Manchester where I have a group of extremely active clients in their 60s and 70s. Amongst them are golfers, skiers, walkers and swimmers; all have been extremely good athletes in the past, participating competitively to a high level. They are fit, but after a lifetime of sporting endeavour they’ve naturally picked up a few injuries along the way and it’s later in life that these really come back to bite.

When we’re in our teens, twenties or even thirties it can seem reasonably easy to recover from injuries such as sprains, strains and impacts. Sometimes we may not even notice much of a problem, so most of the time we just take a bit of a rest, maybe do the exercises prescribed by a physio and when the pain has gone we get back on with our activity. It may be some years before we start paying the price for this and the problem then is that often, as discovered by my older clients, the medical profession isn’t really interested, because they regard musculo-skeletal aches and pains as a standard feature of ageing.

For example, one culprit I see frequently is scar tissue. Following an injury the body lays down a repair quickly but randomly – a bit like a DIY bodge! Muscle fibres need to run in parallel in order to work effectively and they need assistance beyond remedial exercises to regain their proper structure and function. Deep transverse friction is a massage technique which breaks down random scar tissue and adhesions, enabling massage combined with stretching and strength work to realign fibres and restore full functionality. It’s painful, but effective and will save you from potentially bigger problems later. Scar tissue is prone to re-injury and repeated micro-tears mean it just keeps on accumulating over time without you even noticing – until one day something else starts to hurt. Often, it is something else because your body has adapted to the weakness by transferring the load elsewhere, creating postural changes and muscular imbalance.

If you’re an enthusiastic and talented amateur, the risks of carrying the legacies of your sporting mishaps forwards as your body ages are considerable. Whilst many of the resulting problems – restricted mobility, muscular weakness and pain – remain treatable, you’d be naive to expect state healthcare to come to your aid. Instead, you may well be hearing the phrase “What do you expect at your age”. So make sure your rehabilitation is complete, no matter what your age when the injury occurs, and don’t accept ageing as an excuse to put up with pain. Just bear in mind that when you reach your seventies and can’t exercise because of injury past or present, your feelings of frustration will be just the same as when you were younger.

‘ipad shoulder’ – does it exist?

A client came to see me recently complaining of a nagging shoulder problem. Her right shoulder ached ‘inside’ and she pointed to a spot in the middle of her deltoid muscle. It had been going on for some time and wasn’t showing any signs of getting better. We ran through some tests which were positive for a shoulder impingement (sometimes known as ‘swimmer’s shoulder’). Ironically, she’d first noticed it when swimming, although she’d be the first to admit that she’s no athlete!

Shoulder impingement typically affects athletes who make repetitive arm movements in or above the horizontal plane and is caused by trapping the soft tissues between the head of the humerus and the space under the acromion process and the coraco-acromial ligament.Lifting the arm forwards to an angle of 90 degrees to the body and rotating it inwards produces pain as the tendons of the rotator cuff muscles, the long tendon of the biceps and the bursa which overlies the supraspinatus tendon are compressed.

Forty five minutes of deep-tissue massage to the shoulder and scapula area, involving trigger point release within the infraspinatus and teres minor resulted in improved mobility and reduced pain over the following few days and treatment is still continuing. It’s not a debilitating problem, but shoulder issues such as this should be resolved as early as possible, as they can develop into tendinitis and bursitis as well as ‘frozen shoulder’. Part of that resolution is finding out what has caused the problem to arise and my client had an interesting theory; she thought it could be the result of the way in which she uses her ipad, propped up in front of her with her arm raised to touch the screen.

Not long afterwards, a report in the Daily Telegraph highlighted the problem of neck and shoulder pain caused by ipad users holding the devices in their lap or putting strain on hands and wrists if propped up too high. Whilst this wasn’t quite the same as my client’s experience, it does demonstrate the chronic effects of repetitive activity that we often don’t realise we are spending as much time on as we actually are. Scrolling down to the reader comments following the article, reveals an individual who himself complains that he is unable to raise his arm above halfway and puts it down to using his ipad. Coincidence, or might there be a connection between using an ipad propped up on a desk and shoulder impingement?

There are certain risk factors that may predispose an individual to shoulder impingement, such as age (typically more people over 40 are affected), imbalances in the scapular muscles, tightness or weakness of the posterior rotator cuff muscles and the biceps. Interestingly, my client is over 40 and has hypermobility of the shoulder joint, which is also a risk factor. At the end of the day it’s going to be a combination of such factors together with our uniquely individual ways of using our bodies that results in the onset of a chronic problem like this. However, it highlights the importance of being aware of our posture and how we maintain our bodies in order that they can cope not only with athletic activity, but also with activities that on the face of it appear unlikely to cause injury.