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

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.

Getting Started

When I was organising cards for my Sports & Remedial Massage business it seemed essential that I should have some sort of web presence. Rather than setting up a conventional web site, it seemed like it would be more fun and a lot more useful to use a blog format. So here it is. What I plan to do is post updates on my own activities and experiences, combined with useful information on how massage, the remedial techniques used by sports masseurs and exercise can help you to improve your quality of life as well as your sports performance.

I myself turned to sports massage to help me to deal with a chronic back problem, so I speak from personal experience when I say that it can make a dramatic difference, especially when complemented by the right exercise programme. I’ve also seen the positive effects on clients who have resigned themselves to coping with aches, pains and restrictions, only to have their mobility improved by a single treatment.

Recovering properly from injury (by that I mean getting back to how you were before it happened as opposed to settling for long-term problems), banishing those little niggling aches and pains that everyone just learns to live with, or improving the way your body works for you requires effort and determination. There are no wonder cures and no-one can do it all for you, but with the right help and motivation you can make a huge difference. If you are a client of mine, I can provide that help directly. Otherwise I hope I can at least inspire you to look after yourself and not to settle for a body that doesn’t do what you ask of it.