Get moving with a recovery massage

Some still think of massage as a luxury reserved for pampered ladies with time on their hands, or a quick 10 minute shoulder rub at your desk.

These are both equally valid and enjoyable, however at UFIT we know that the right massage is an essential part of your recovery when training hard.

And what harder, more intense way to train than at CrossFit and MetCon. The combination of intensity and power required for short bursts of activity is exhilarating, achieves results fast and is addictive very quickly.

However, if you don’t supplement that intensity with recovery for your muscles, then man do they ache. And if you’re aching, then when you’re next at the Box you won’t squat so low, jump so high, or snatch your 1 rep max.

A UFIT sports massage includes a full consultation on your body and your lifestyle. Our recovery specialists themselves do CrossFit and MetCon, so are best placed to assess flexibility, restrictions and where function needs to be restored. It can be full body for a general treatment to prevent DOMs or focus on one area of scar tissue recovery.

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For example, you’ve been thrusting kettle bells all week, overhead squatting like a demon and throw in a few box jumps and your glutes are on fire. The gluteus medius and gluteus maximus are 2 major power muscles in your bum. Because they are big muscles we put a lot of pressure on them and often don’t realize the pivotal role they play in most functional movements. Often people comment that they didn’t realize there was any problem, until they are massaged. A warm-up and a few trigger points later and the contracted fibres relax, gliding happily and restriction free.

Some key areas where massage can help:

  • Promote efficient scar formation, by laying down the new fibres in an orderly manner
  • Reduce excessive adhesion aiding range of motion
  • Reduce excessive fascial thickening
  • Reduce spasm
  • Improve cardiovascular delivery of oxygen and nutrients to your muscles
  • Aid concentration and focus

At CrossFit, whether new or seasoned, you will be pushing yourself to new levels constantly. It’s your responsibility to your amazing body to give it the support it needs to get there.

 Recover Rehab Recharge

About the Author, Lynsey Keyes 

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Lynsey Keyes is a UK trained massage therapist and certified in both ITEC and BTEC level 4 Massage and Anatomy and Physiology. Having spent 15 years working in high-pressure marketing roles, Lynsey embraced her ultimate passion in bodywork and uses her experience to help people overcome the physical and mental stresses of modern life.

She is a passionate believer that massage should be a part of our everyday lives to support our bodies in whatever challenge we put upon them; whether you are a professional sports person, have a sore back from carrying your baby, or simply need to release some tension from a day in the office.

Pre-habilitation for runners with Mok Ying Rong

Meet Mok Ying Rong, our new physiotherapist at the UFIT one-north Clinic. A competitive runner and Nike Sponsored elite athlete, Ying is Singapore’s Half-Marathon record holder,  and well placed to help clients recover from sporting-relating issues!

She’s joined up with #ROCKrunners in the lead-up to the Singapore Standard Chartered Marathon, where she’ll be giving talks on one of her passions – running pre-habilitation!

Tell us about your sporting and running background

I’ve always been too active! I started competitive swimming in primary school and represented my swimming club and school at national and club levels. I moved on to triathlons in high school before running seriously at 16 and representing my school, Raffles Girls Secondary, at national meets. I was getting on the podium at these and decided to try national level events.

At first, it was intimidating running with the giants but as I ramped up my training and became more systematic, found myself winning more and more races. I’ve always been self-coached, I feel very tuned-in with my body, and pretty soon, found myself knowing what works and what doesn’t. My first race representing Singapore was the Asian Cross Country in Bahrain when I was 16.

What have been your career highlights?

Signing a contract with Nike when I was in high school and representing Singapore in the 2016 World Cross Country Championships. The partnership with Nike really boosted my confidence in my training and racing, and I’ve been representing them for almost 7 years and am simply thankful for their unwavering support.

My most significant career highlight is definitely winning the 2016 Gyeongju Cherry Blossom Half Marathon, breaking the Singapore Half Marathon record by 2 seconds! My time was 1:23:14 and I vividly remember it to be one of the most painful and intense race I have ever done.

How do you train for your races?

I select the main races I’ll do at the start of the year and then periodise my training phases. Some overseas races pop up and I take them in my stride. I’ve always believed in the journey, rather than an end-goal as running is my passion, and always make sure I do my conditioning and prehab work so I can progress my running fitness safely.

What got you into physiotherapy?

I was getting my fair share of injuries, my most tragic moment being having 5 stress fractures at one time over my left foot. I also had multiple shoulder issues from swimming. I started to do my own research to understand why I was getting injured which sparked my interest in physio and I knew this was the career for me.

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What is pre-habilitation?

As a physiotherapy student, I did workshops with companies and small interest groups, spreading my passion for pre-habilitation (prevention instead of rehabilitation) for runners. I initiated a project called ‘RunFree’ when I was in my 3rd year, which believed that running should be free for all, made possible if people can run free from injuries. I’ve run sessions for anyone wanting to progress their running safely, including a movement screen based on research and running biomechanics, followed by guidance with these runners on a safe running program.

What’s in your head before a race?

I’m still bad at this – always getting nervous before a race! But my favourite mantra for myself would be – just run! Just get out and run. No fear! ☺

Come and meet her at the UFIT one-north Clinic or within the UFIT running community very soon.

Precious new life: Getting ready for the big day

Friends Jodie and Steph share their experience of how the UFIT Pre-Natal Program kept them in great mental and physical shape throughout their labour and into the delivery room. Each Saturday over 7 weeks they and other expecting mums were guided by UFIT specialists on everything relating to pre-natal fitness, nutrition, and meditation. Here is how it helped them.

What were your favourite parts of the program?

Steph: I liked the variety of sessions. I wouldn’t have taken myself to see a nutritionist or learnt how to meditate in pregnancy if it weren’t for the program. I didn’t appreciate or understand the importance of these areas and of some of the other topics covered until learning about them.

Jodie: I also liked the variety of topics and practical components covered in the course. I didn’t know what my limits were when exercising in pregnancy so it was good to go through that and things like proper technique when lifting and doing gym exercises with Holly.

Steph: Life is so busy. I would spend 5 days of the week carrying on as normal and working hard. It was nice to take the time out every weekend to focus on my pregnancy. It was a great way to connect with the baby and to meet other like-minded individuals in their pregnancies.

Was there anything you were surprised to learn?

Jodie: I found the talks on nutrition really interesting as I hadn’t realised there were certain foods that could prevent that feeling of nausea that comes with morning sickness.

Noa provided us with some great recipes that I continue to use.

Steph: I was surprised to learn what Women’s Health Physiotherapists do both during pregnancy to alleviate pelvic pain and immediately after delivery. It was good to know the service was there if we needed it.

Jodie, you’re a second-time mum – did you still find the UFIT Prenatal Program Beneficial?

Jodie: Yes! Firstly, it was a reminder of how the body changes in pregnancy and of the postpartum recovery. Secondly, I felt this program had a very different focus compared to the Antenatal classes that I attended in my first pregnancy. Other programs focus on the delivery, breastfeeding and how to care for your baby whereas this was more about the mother and how to maintain your health and fitness throughout your pregnancy.

Steph: The UFIT Program was unique in the sense it was very holistic – it was more about how to look after yourself which in turn will help your baby.

Have you kept in contact with the other participants from the course?

Steph: Yes, we see each other fairly often for walks.

Jodie: Most of the girls have posted a photo of their newborns on our Facebook group once they’ve had the baby which has been really nice.  

Would you recommend the UFIT Prenatal Program to others?

Jodie: Definitely. It is very different from other Antenatal courses out there and it was great that it incorporated both theory as well as practical sessions in areas such as yoga and meditation.

Steph: I have already recommended it to friends who have since participated in it and loved it! The information presented was relevant and concise and the presenters are all pre and postnatal experts – I wouldn’t have had access to this information and to these presenters if I hadn’t have signed up for the course.

The UFIT Pre-Natal program is a 7 week program by UFIT's pre-natal experts who will prepare you for a safe and comfortable pregnancy and delivery, and includes:

* weekly seminars from experts in nutrition, exercise science, physiotherapy and psychology

* weekly exercise classes by our physios, yoga teachers and trainers

* a pre-natal personal training session

* a pre-natal massage session

* a meditation session

* a pelvic floor muscle assessment 

* meeting others on the same journey as you. 

 

 

 

 

Foot pain: To treat or not to treat?

When we exercise frequently it's inevitable we'll get aches IN OUR ANKLES AND FEET FROM TIME TO TIME.

In the case of UFIT Clinic client Evy Theunis, a trip to senior physio Declan Halpin was definitely worthwhile after she experienced an extended period of foot pain.

FIND OUT about her steps to a solid recovery after an achilles tendonitis diagnosis ... 

"At the end of my pregnancy, my left achilles started to hurt. I didn’t think much of it, and assumed it would just disappear after delivery.

Little Alexander came, but the pain in my left foot stayed! Short walks would still really hurt, so I decided to go see a doctor who referred me to a physio – and there came UFIT Clinic's Declan Halpin!

Apparently I had developed Achilles Tendinitis, and was in for a couple of months of recovery. No running, no tennis, no cycling outside, no lunges, no step ups, NO HEELS, no nothing, HELP!!!!

My plan to get back in shape before I would go back to work went out the window - or so I thought. Let alone do the Spartan race I had planned for in November.

But thanks to my weekly appointments where Declan stretched and massaged my Achilles (we did accupuncture as well), and thanks to the new exercises he gave me to strengthen my heel muscles, we quickly started seeing progress.

(An important point to note: when your physio gives you exercises, do them - sounds logical right - but most people apparently don’t. And it makes a huge difference).

As I was on a mission, Declan really worked with me to help me get as much variation in my training possible without jeopardizing or slowing down my recovery. I negotiated a lot :-)

All in all, it took us about 6 months to get me completely back to normal, AND, with the help of Declan’s magic hands, I made it to Bintan and finished my first Spartan!".

The award-winning UFIT Clinic is Singapore’s leading exercise rehab, injury recovery and women's health clinic. It's holistic approach and full range of physiotherapy and massage-related services by its experienced and friendly specialists can help you prevent injuries before they happen, or get you back on track as soon as possible once you're injured. 

The lesser known benefits of massage

OK, so we are mostly aware of the obvious reasons to get a massage; relaxation, stress relief, easing muscle soreness, injury prevention and management. All of these are fantastic and very well documented ways in which massage therapy could and should be a part of our lives on a regular basis.

But as more and more people are pushing their bodies to the extremes of their limits, (UltraRunning Magazine saw a jump of 10% in participation in 2013 on the previous year) and occasionally suffering a little for it, how else can one of the oldest manual therapies in the world play its part in preparing us for the long haul? UFIT Clinic one-north's massage therapist Lynsey Keynes uncovers the five lesser-known benefits:

Increased range of motion

Whether you’re engaged in five UFIT bootcamps a week and not stretching out properly (naughty naughty), or whether you're stuck under a laptop all week and suffering from carpal tunnel syndrome, your muscles are getting used and abused on a daily basis. Building regular massages into your routine can help soften, open up, stretch, release and allow extra, oxygenated blood to flow into those muscles and joints enabling you to reach and push further than before.

Balance improvement

Racket sports, driving, carrying kids on one side, generally just not being ambidextrous (who actually is?), all have an effect on the shortening of our muscles, and therefore tightening on one side. In a sporting environment, achieving good balance is key, and with a good massage to realign the posture, you could be well on your way to equilibrium.

Decrease migraine frequency

Exercise can be a migraine trigger (which presents a bit of a conundrum). Massage can help relieve muscle spasms, improve circulation, enhance sleep quality and increase serotonin, all of which can play a part in preventing not just tension headaches, but vascular headaches. Any migraine sufferer knows an attack can happen any time, so begin by pre-empting the threat and having a massage once a week to keep them at bay.

Boosts immunity

Having just one massage can boost your immunity. How? Massage interacts with the hormone system and decreases levels of cortisol, the stress hormone in the body. When you’re stressed, you probably notice you get more colds, sleep less well, just don’t feel 100%. Massage manages that cortisol away, and encourages the production of white blood cells, which defend your body against illness. So no more excuses not to get out for that run!

Eases symptoms of depression

Massage releases dopamine and serotonin, eases physical pain, calms the mind, decreases anxiety, soothes tense muscles and the sheer act of touch can simply be enough to lift your spirits. So use massage therapy alongside regular exercise, to help stabilise moods and tackle those challenges whether they be physical, emotional or mental.


Lynsey is a UK trained massage therapist and certified in both ITEC and BTEC level 4 Massage and Anatomy and Physiology. Having spent 15 years working in high-pressure marketing roles, Lynsey decided to embrace her ultimate passion in bodywork and use her experience to help people overcome the physical and mental stresses that modern life puts upon us.

She is a passionate believer that massage and sports massage should be a part of our everyday lives to support our bodies in whatever challenge we put upon them; whether you are a professional sports person, have a sore back from carrying your baby, or simply need to release some tension from a day in the office.

Moving well again with Rolfing

Muscular pain, poor mobility, bad posture - there are many ways to treat these issues. Here is how Rolfing has helped hundreds of UFIT clients move freely and comfortably again. 

Rolfing is a hands-on therapy that takes a holistic, full body approach to let you move more easily and comfortably. Through manipulation of connective tissue, Rolfers improve postural alignment and structure over the long-term. Unlike massage, which often focuses on relaxation and relief of muscle discomfort, Rolfing focuses on improving body alignment and functioning.

Also known as structural integration, Rolfing has been used by many professional athletes to rehabilitate injuries, break up scar tissue, and increase range of motion to improve performance and avoid future injuries. Dancers and musicians often use it to increase comfort in their bodies while performing, as well as avoid repetitive stress injuries.

In the UFIT Clinic, Rolfing has helped clients needing postural corrections after weight loss or pregnancy, office workers with repetitive strain from sitting too long, and others with injuries or tightness from their training.

When you first visit Maria Hussain, UFIT's Rolfing specialist, she will get you to stand while she checks your posture and how your joints are positioned. While you may go to see her with a knee issue, she will quickly seek any imbalances in other parts of the body which may cause the knee pain - such as a lack of ankle mobility - and treat that first. 

Says Maria "Walking is the most functional exercise of the body yet often we don't walk correctly which can cause postural issues, joint immobility and pain as we place pressure on other parts of the body". 

ROLFING WORKS HOLISTICally BY TREATING CONNECTIVE TISSUE

Rolfing embraces a wide range of approaches including osteopathy, chiropractic medicine, yoga and the Alexander Technique. It manipulates the body’s Myofascial system - the connective tissue (fascia) - which is the biological fabric that holds us together and enables stability of muscles and bones while allowing movement, and is crucial in high performance and central in recovery from injury.

Says Maria: "My objective is to lengthen, stretch and soften affected tissue to improve posture and bring the body’s natural structure into proper balance, alignment and integration".

Injury, stress, exercise, and work related repetitive movements can cause fascia to lose its elasticity and become shorter, tighter and denser. Tightened fascia pulls our muscles and skeleton out of proper alignment which can cause pain, discomfort and fatigue. By fascial manipulation remarkable changes in posture and structure can be achieved.

Rachel Flynn, who visited Maria for treatment after a car accident shares her experience:

"At my first appointment I was hunched over and my entire body was in a state of shock. I wasn't aware of how I was carrying myself. Maria’s knowledge of the effect of a road traffic accident on the body has been key to my recovery. She explained what was going on with the myofascial tissue, which helped me gain confidence to start moving normally again. I'm exercising again and Maria continues to assist me by identifying movements I need to get my normal gait back and minimise pain. Aside from that, Maria is such a helpful person and has been a great support on getting me the best results in recovery".

An aligned and balanced body can ease strain patterns in the entire system and improve breathing and increase energy, boost self-confidence and relieve physical and mental stress. Rolfing has also been shown to reduce spinal curvature in people with lordosis (sway back), and enhance neurological functioning.

WHO IS ROLFING FOR?

Rolfing is beneficial for everyone - for pain management, to enhance athletic performance, to facilitate injury rehabilitation and anyone who just wants to move better and feel more co-ordinated and aligned in their body.

ABOUT MARIA HUSSAIN

I’ve been been practicing bodywork for more than 10 years and I’m a qualified Structural Integration practitioner, studying with Tom Myers the author of Anatomy Trains and the founder of KMI Structural Integration, Meyers is an advanced Rolfer with more than 40 years’ experience. For more information on Rolfing visit www.anatomytrains.com/at/kmi/experience/

Maria is based at the UFIT Clinic, at both 6 Raffles Quay and one-north. 

 

 

 

How to get back on track after injury: UFIT Clinic

An ACL rupture is one of the most dreaded injuries in sport – not only is it painful, the rehab process is long and difficult, and tests the determination of even the most committed patient.

But like with many other types of injury - it is not all doom and gloom... 

Thanks to advances in rehabilitation and improvements in surgical techniques, it's not the career-ending injury that sports people once feared. With proper guidance, patience, and a large dose of motivation, it is definitely possible to make a full and complete recovery.

Marie De Place is a perfect example of someone who overcame such a major setback, and is now stronger and fitter than ever. She had her first appointment at the UFIT Clinic in March 2016, after a skiing accident. A year later she has just done her first Olympic distance triathlon. Here she shares with us her road to recovery with senior physio Declan Halpin, and the ups and downs along the way.

Marie’s initial reaction wasn’t what you might expect:

“My first thought was ‘I'd better be skiing again soon as I just bought a nice brand new ski jacket yesterday’ (typical girl thinking I guess). My second thought was "Good news! I will not have to train for that stupid triathlon that my friends convinced me to join". My third thought was "Hey, I will finally experience going down a ski slope in a sleigh pushed by the rescue guys".

She really had no idea at that time that an ACL injury would lead to ten months of rehab before she would be able to ski again! Typical recovery from an ACL rupture can be anywhere between nine and twelve months, depending on the type of repair performed, the fitness of the patient, and how quickly their body responds to the treatment program. It is usually broken down into four phases:

1. Acute Phase - Where the focus is on reducing the pain and swelling and improving range of movement.

2. Activation Phase - Returning the knee to full range of movement, strengthening key muscles such as your hamstrings, developing knee stability with balance exercises, and introducing body weight exercises such as air squats, bear crawls and lunges.

3. Strengthening Phase -  Building strength back into the leg to make sure both sides are equally strong. This usually means picking up some weights and doing lots of squats, deadlifts, step-ups, and other lower limb exercises.

4. Power Phase - Your leg can’t just be strong – it needs to be fast and powerful as well! In this phase we get you to hop, jump, skip, and run (in a straight line). This is often when the patient feels like they are really making good progress!

5. Return to Play - The final part of the rehab process is the most fun. Lots of side to side movements, agility runs, ladder work, and jumping around on wobbly surfaces!

So how did Marie find the process?

“Long, for sure. I did not expect it to last for 10 months but, as you get back to an (almost) normal life after a couple of months, the remaining eight months were more like cherries on the cake. Boring? Sometimes, especially when ending up in the same gym every night or so. Thank god, the exercises are not always the same. Fun? Yes, some good laughs, when I was wondering whether "crab walk", "bear crawling" and other weird animals jumps or moves were real physio movements or just Declan making fun of me.” [Declan: A little bit of both Marie!]

However, she reports that you get a real sense of achievement as you slowly return to full function:

"Beyond that, there is the satisfaction to feel that you are getting better and better and you can again do stuff you couldn't the week before.”

It is not just up to the surgeon and the physio to get you better – it takes a lot of commitment and hard work from the patient themselves. As Marie says,

“Motivation and commitment are key to recovery. Fortunately, you have your physio by your side, to support you and relieve the pain when necessary. However, when it it comes to leaving the office and going to the (so boring) gym to do difficult or quite painful exercise, only you can make it work.”

Finding the right physio and physio clinic is key – after all, you are going to spend the majority of a year working together, seeing each other weekly throughout the time period! Marie felt she made the right choice: 

"At UFIT, Declan and the team have been supporting me along the recovery journey, giving me confidence I can do it, that I will recover and practice all the sports I like again. And this is not as easy as it sounds for sometimes I did not progress as fast as I expected, some other times I felt pain again and had to slow down or even go back to the previous month program. It would have been so discouraging without their support.”

Creating a supportive atmosphere is key, but Marie believes it is more than this, it also requires trust.

“I had a great experience at UFIT. Everyone, from the receptionist to the physio team is welcoming, positive and attentive to your needs. They are great professionals providing an efficient recovery plan, prescribing relevant exercises, executing targeted massage and treatment.
But they do much more: they build trust. The best technical skills are not worth much if you don't trust your physio and you don't trust yourself. When someone tells you "drop your crutches and walk to the end of the corridor", believe me, you need to trust that person to do it. Recovering from an injury is a challenge. As any challenge, it requires you to be confident that you can succeed.”

Marie’s recovery led her to committing and achieving an incredible goal:

“I have just run my first Olympic Distance triathlon. I was more motivated than ever. I trained intensively for the last 3 months, starting as soon as my recovery at UFIT ended. And believe me, I am nothing like an athlete! Yet, along my recovery journey, I learned how to strive for progress, endure long, sometimes boring exercise sessions and a reasonable amount of pain. A beneficial experience in many aspects.”

The process is definitely a two way street, and requires both the patient and the therapist to collaborate and work hard to get the best results. The UFIT Clinic Senior Physio, Declan Halpin enjoyed working with Marie,

“My job is easy when a patient like Marie comes in. From day one she was determined and motivated to succeed, and never backed down from a challenge, or said ‘No’ when I asked her for another rep or set. It is easy to see when patient’s aren’t sticking to their rehab program – their progress is slow, and they fall behind in their recovery. This was never the case with Marie, and you can see this from what she has achieved in less than a year after such a serious injury.”

Marie says there is nothing she would have changed in her rehab process, and has given the UFIT Clinic the best compliment that anyone can give – referring her friends and family to come and see the team.

I would like to recommend the UFIT physio team and especially Declan to whom I owe a lot, but be patient when trying to get an appointment as they are some of the most recommended physiotherapists across the Island (actually I am sending all my friends, husband and sons to UFIT).

Thank you Marie – congratulations on your recovery and your Triathlon, and hopefully see you soon (but not too soon)!!

If you have suffered from an ACL or other injury, or have questions about your own recovery, please do not hesitate to contact the UFIT Clinic at +65 6532 2025, or find us at www.ufitclinic.com 

Recovering from post-exercise muscle ache

Anyone and everyone who has exercised at one point or another in their life has experienced Delayed Onset Muscle Soreness, or DOMS for short. It’s that achey feeling you feel in your muscles 2-3 days post exercise, and it can often be quite painful – limiting your movement to a point where stairs seems like Everest, or you find yourself looking for a toilet with grab rails to help you into position!

Some people actively look for DOMS, and feel they haven’t worked hard enough unless they experience it. Other people, on the other hand, refuse to workout for the next week if they get any soreness after a workout. So who is right – is DOMS something to be afraid of or encouraged? And what the hell is it anyway? And what is the best way to get over it so that we can go again?

The science behind what exactly causes DOMS is not 100% clear, but most people agree that it is caused by microtears to the muscles, which leads to inflammation as they heal, causing the pain. What we know for certain is that DOMS arises in the first 24 hours post-exercise, and typically peaks 48 hours after exercise. It leads to a temporary decrease in force production for the first 48 hours post-exercise. What is clear is that lactic acid accumulation is not a component of this process, and should not be blamed for your DOMS. Eccentric training (lengthening the muscle with tension applied - for example the lowering phase of a bicep curl or on the way down in a squat) definitely leads to a lot more DOMS than fast, concentric weight training.  

So is it bad for you? In a word, no. However, it will limit your effectiveness in any subsequent exercise or sport sessions over the next two to three days, which will limit the amount of work you can get through. Importantly, it has been linked with an increased chance of injury within this 48 period, through its inhibition of certain muscles and reduction in range of movement - so try to avoid playing a football match the day after doing a heavy legs squatting session!

Recent research coming out of Japan (Murase et al, 2010) actually points to the ‘repair’ process your muscles are undergoing as the source of the pain. As your muscles are repairing themselves, they release a substance called bradykinin along with other enzymes to create growth, which causes blood vessels to enlarge and nerves to become more sensitive. The combination of the sensitized nerve endings and the increased fluid in the area lead to the pain and ‘stiffness’ felt within the muscles.

The good news is that this ‘pain’ you feel is a sign you are getting stronger, and you are getting some benefits from the training you are doing as the body goes through the damage-repair cycle. A word of caution – more DOMS does not necessarily mean you are working harder, it can just mean that you are not training very smartly, and have overloaded a particularly weak area.

So what can you do to reduce DOMS quickly to get back into the gym? Here are a few tips:

  1. Warm-up and cool down before and after your session. Having an effective warmup and cool down has been shown to reduce DOMS in untrained individuals versus individuals who received neither. Your warmup should include the areas of your body you are about to workout, and you should be at least breathless by the end of it. Cool down should involve stretching, and a lot of:

  2. Foam Rolling: If you don’t know what a foam roller is, find out. Buy one, and make it your friend. Foam rolling has consistently shown to be effective at improving range of movement in tight athletes the day after high intensity workouts, and reduce DOMS. The more recent research points to a neuro-physiological affect on your muscles (desensitization of the nerve endings in your muscles) as the mechanism behind foam rolling, which may be why it is effective on DOMS.

  3. Manual therapy/Massage/Acupuncture: If your DOMS is particularly bad, speak to your friendly local physio about manual treatment and acupuncture to hasten your recovery. Both are effective.

  4. Active Recovery: Research has shown that lightly exercising the area the day after a heavy session can reduce the recovery time. For example, after a heavy squatting day, jump on a stationary bike the next day for a gentle 20minute cycle. Your legs will thank you!

  5. Nutrition and Hydration: Being well hydrated, and feeding your working muscles with good fuel should be the cornerstone of any workout program. Don’t waste your time in the gym if you are not paying attention to this outside of the gym. You will recover quicker, and you will make more progress if you do!

Final Word

It is unlikely you will avoid DOMS altogether when you start a new strength program. It is not something that you should be afraid of, or that should keep you away from the gym. However, pain does not need to be present in order for you to achieve progress in your conditioning. If anything, intentionally causing DOMS will only limit the amount of work that you can do in subsequent sessions, potentially slowing down your progress.

The ultimate goal of any training program is to find the optimal balance between work and recovery. The key to a great training program is to find that sweet spot where you are doing enough micro ‘damage’ to create a muscle adaptation, without crippling you for the next two days and making you miss your next session!

Recover well!

Declan


About the author

Declan is Clinic Director for the UFIT Clinic and a fully qualified, registered physiotherapist. He is passionate about helping his patients achieve their long term goals through identifying their weaknesses and imbalances, and developing a strategy to eradicate them. 

Find out more about Declan right here.

Swimmer’s shoulder: Preventing and treating injuries

Did you know?

  • The average high school swimmer performs 1 to 2 million strokes annually with each arm
  • Over 1/3 of top level swimmers experience shoulder pain that prevents them from normal training
  • 90% of complaints by swimmers that bring them to the doctor and/or osteopath/physiotherapist are related to shoulder problems.

Shoulder anatomy

The shoulder complex is designed to achieve the greatest range of motion (ROM) with the most degrees of freedom of any joint system in the body.

Your shoulder is a ball and socket joint, with a rim of cartilage that goes around the socket to make it deeper and more stable. Surrounding the joint is your joint capsule, a fibrous material, with thicker parts of the capsule forming ligaments.

A number of muscles, and the tendons from these muscles run around and over your joint. The muscles that have the most effect on your joint stability are called the rotator cuff. The ‘cuff’ is made up of 4 muscles which work together to help keep your shoulder centred in the socket:

 
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What is a swimmer shoulder?

Swimmer’s shoulder is an umbrella term covering a range of painful shoulder overuse injuries that occur in swimmers. Because there are various parts of your shoulder that can be injured from your swimming stroke, your pain can be anything from a local pain near the shoulder joint, to a spreading pain that travels up your shoulder and neck or down into your arm. Being an overuse injury, it is caused by repeated trauma rather than a specific incident.

Swimmer's shoulder has the following characteristics:

  1. Inflammation of the supraspinatus and biceps tendon within the subacromial space leading to a shoulder impingement syndrome.
  2. The onset of symptoms is often associated with altered posture, glenohumeral (shoulder) joint mobility, neuromuscular control, or muscle performance
  3. Training errors such as overtraining, overloading, and especially poor stroke technique may also contribute to this condition.

Many swimmers have inherent ligamentous laxity and often will have multidirectional shoulder instability - essentially, more movement in the joint.

However, all swimmers develop muscle imbalances where the adductors and internal rotators of the arm over-develop (due to the nature of swimming). Unfortunately, this leaves a relative weakness of the external rotators and scapular stabilisers - simply because they don’t get used as much. Consequently, this muscle imbalance overuse and/or poor technique results in an anterior capsule laxity. These all culminate and allow the humeral head to move forward and up thereby, compromising the subacromial space (where the supraspinatus and biceps tendons run through) causing an irritation/impingement.

What goes wrong in swimmer’s shoulder?

The shoulder is a very mobile joint, and being so mobile, it needs to be well controlled by the muscles and ligaments that surround the joint. Over-training, fatigue, hypermobility, poor technique, weakness, tightness, previous shoulder injury or use of too large hand paddles can lead to your muscles and ligaments being overworked. If this goes on, injuries such as rotator cuff impingement and tendonitis, rotator cuff tears, bursitis, capsule and ligament damage, or cartilage damage can occur.

 

Prevention of swimmer’s shoulder

9 times out of 10, a poor stroke technique is causing shoulder pain in the first place in swimming. Correcting your technique is not actually that difficult, but you do need to know what to look out for and, just as importantly, work diligently to improve in these areas. Video analysis is a great tool for this because it really helps you identify what you personally need to work on.

 

The following 3 simple tips will ensure you avoid developing a shoulder injury from your swimming:

1. Body rotation

Developing a good, symmetrical body rotation through the development of an efficient bilateral breathing pattern is key to removing shoulder injury.

Swimming with a flat body in the water with limited rotation along the long axis of the spine causes the arms to swing around the side during the recovery phase.

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Bad body rotation

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Good body rotation

This swinging action results in large amounts of internal rotation at the shoulder joint which is the major source of impingement and rotator cuff issues. By using several key technique drills this can be easily addressed and fixed.

2. Hand placement into water

A hand pitch outwards with a thumb first entry into the water leads to excessive internal rotation which, from approx 3200 strokes per hour, can eventually lead to acute pain in the shoulder as an 'over‐use' injury. Instead of entering the thumb first, change your technique to enter with a flat hand, finger tip first

 

3. High elbow catch

Without the use of video analysis, many swimmers are unaware of how they pull through under the water. Typically swimmers will pull through with either a dropped elbow or with a very straight arm. Doing so loads the shoulder muscles excessively as the majority of the pull through phase is spent pushing down, rather than pressing back. Working to develop a ‘high elbow catch’ technique with enhanced swimming posture will really help you utilise the larger, more powerful muscle groups of your chest and upper back, rather than rely upon the shoulders.


Treatment for swimmer’s shoulder

Researchers have concluded that there are essentially 7 stages that need to be covered to effectively rehabilitate these injuries and prevent recurrence.

 

Phase 1: Pain relief & anti-inflammatory tips

As with most soft tissue injuries the initial treatment is RICE - Rest, Ice, Compression and Elevation.

In the early phase you’ll most likely be unable to fully lift your arm or sleep comfortably. You should stop doing the movement or activity that provoked the shoulder pain in the first place and avoid doing anything that causes pain in your shoulder.

You may need to wear a sling or have your shoulder taped to provide pain relief. In some cases it may mean that you need to sleep relatively upright or with pillow support.

Ice is a simple and effective modality to reduce your pain and swelling. Apply for 20-30 minutes every 2 to 4 hours during the initial phase, or when you notice that your injury is warm or hot.

Anti-inflammatory medication (if tolerated) and natural substances (eg arnica) may help reduce your pain and swelling. However, it is best to avoid anti-inflammatory drugs during the initial 48 to 72 hours when they may encourage additional bleeding. Most people can tolerate paracetamol as a pain reducing medication.

As you improve, supportive taping will help to both support the injured soft tissue and reduce excessive swelling.

Your osteopath will utilise a range of pain relief techniques including joint mobilisations and massage to assist you during this painful phase.

 

Phase 2: Regain full Range Of Motion (ROM)

If you protect your injured rotator cuff structures appropriately the injured tissues will heal. Inflammed structures eg (tendonitis, bursitis) will settle when protected from additional damage.

Symptoms related to swimmers shoulder may take several weeks to improve. During this time it is important to create an environment that allows you to return to normal use quickly and prevent a recurrence.

It is important to lengthen and orientate your healing scar tissue via joint mobilisations, massage, shoulder muscle stretches and light active-assisted and active exercises.

Researchers have concluded that osteopathic treatment will improve your range of motion quicker and, in the long-term, improve your functional outcome.

In most cases, you will also have developed short or long-term protective tightness of your joint capsule (usually posterior) and some compensatory muscles. These structures need to be stretched to allow normal movement.

Signs that you have full soft tissue extensibility include being able to move your shoulder through a full range of motion. In the early stage, this may need to be passively (by someone else) eg your osteopath. As you improve you will be able to do this under your own muscle power.

Phase 3: Restore scapular control

Your shoulder blade (scapular) is the base of your shoulder and arm movements.

Normal shoulder blade-shoulder movement - known as scapulo-humeral rhythm is required for a pain-free and powerful shoulder function. Alteration of this movement pattern results in impingement and subsequent injury.

Researchers have identified poor scapulo-humeral rhythm as a major cause of rotator cuff impingement. Any deficiencies will be an important component of your rehabilitation. Plus, they have identified scapular stabilisation exercises as a key ingredient for a successful rehabilitation.

Phase 4: Restore normal Neck-Scapulo-Thoracic-Shoulder function

It may be difficult to comprehend, but your neck and upper back (thoracic spine) are very important in the rehabilitation of shoulder pain and injury.

Neck or spine dysfunction can not only refer pain directly to your shoulder, but it can affect a nerve’s electrical energy, causing weakness and altered movement patterns.

Plus, painful spinal structures form poor posture or injury do not provide your shoulder or scapular muscles with a solid pain-free base to act upon.

In most cases, especially chronic shoulders, some treatment directed at your neck or upper back will be required to ease your pain, improve your shoulder movement and stop the pain or injury returning.

Phase 5: Restore rotator cuff strength

It may seem odd that you don’t attempt to restore the strength of your rotator cuff until a later stage in the rehabilitation. However, if a structure is injured we need to provide nature with an opportunity to undertake primary healing before we load the structures with anti-gravity and resistance exercises.

Having said that, researchers have discovered the importance of strengthening the rotator cuff muscles with a successful rehabilitation program. These exercises need to be progressed in both load and position to accommodate for which specific rotator cuff tendons are injured and whether or not you have a secondary condition such as bursitis.

 

Phase 6: Restore technique, speed, power & agility

Swimming requires repetitive arm actions, which place enormous forces on your body (contractile and non-contractile).

In order to prevent a recurrence as you return to swimming, your osteopath will guide you with exercises to address these important components of rehabilitation to both prevent a recurrence and improve your sporting performance.

Depending on what your training or competitive program entails, a speed, agility, technique correction and power program will be customised to prepare you for swimming-specific training.

 

Phase 7: Return to swimming

Depending on the demands of your swimming season, you will require individual exercises and a progressed training regime to enable a safe and injury-free return to swimming. 

Your osteopath will discuss your goals, time frames and training schedules with you to optimise you for a complete return to swimming.

The perfect outcome will have you performing at full speed, power, agility and function with the added knowledge that a through rehabilitation program has minimised your chance of future injury.


ABOUT THE AUTHOR

 

Sebastien is a qualified Osteopath from France and graduated with a MSc in Osteopathy from Ecole d’Osteopathie Paris. Prior to this, he obtained a BSc in Sport & Exercise Science from the University of Rouen. He is also a certified Personal Trainer and Swimming Coach.

Before relocating to Singapore, Sebastien worked as a Sports and Health Manager for a luxury Parisian spa and launched his own Osteopathy clinic in 2014.

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Have a RAD six pack? Not as cool as you may think!

Information on abdominal separation for pregnant women and new mums

So, what is RAD?

RAD or rectus abdominis diastasis refers to the separation of the rectus abdominis muscles (otherwise known as ‘the six pack muscles’) from the midline of the abdominal wall. During the later stages of pregnancy, it is common for the six pack muscles and the connective tissue between them to separate. This is due to the increased stretch placed on the muscles by the growing bub and as a result of pregnancy hormones that weaken soft tissues throughout the body. 

 
 
Image credit: Pelvic Pain, www.pelvicpaindifferentiation.weebly.com
 

Am I at risk of RAD?

The risk factors include:

·       Large babies

·       Excessive weight gain in pregnancy

·       Caesarean section

·       Multiple pregnancies

·       Excessive amniotic fluid

·       A long second stage of labour

Is it common?

Yes!! We expect your belly to grow during your pregnancy so it is not surprising that studies have found that over 66% of women will have a RAD immediately after delivery.

How do I know if I have a RAD?

A RAD can be checked by your nurse, obstetrician or physiotherapist in hospital. The test for a RAD is fairly simple and involves the clinician placing one or multiple fingers on your abdomen between the six pack muscles to feel for separation. You may even be asked to lift your head off the bed to assess the gap further. You will need to be lying on your back with your knees bent to get an accurate measure of the abdominal separation.

If you are not assessed in hospital you can check your own abdominals with the same test or you can have it checked by a physiotherapist with experience in Women’s health.

What should I look for?

It is extremely common (and almost expected) to feel a gap between the six pack muscles after having a baby. It can even be present in women and men who haven’t been through pregnancy!! It is only when a RAD in considered ‘significant’ that you need to modify your everyday activities and perform exercises to reduce it.

A significant diastasis is when:

  • The separation is more than 2 ½ finger widths
  • The gap does not reduce in size when you lift your head (and therefore use your abdominal muscles)
  • A raised mound or a large dip appears in the midline of your abdomen when you lift your head.

So I have a RAD, will it go away on its own?

RADs can spontaneously improve as your stomach reduces in size after pregnancy. Usually, the greatest improvements are seen in the first 8 weeks following delivery.  After 8 weeks, this progress tends to plateau unless you do specific exercises to reduce the gap.  

Previously it was thought that diastases were nothing more than a cosmetic issue but recent research has found that significant diastases may be linked to pelvic girdle instability, lower back and pelvic pain and uro-gynaecological conditions such as prolapse.

Management

Conservative management is usually the first line of intervention.

  • Your nurse may provide you with tubigrip, an elasticated bandage that is to be worn for the first 6 weeks after childbirth
  • Posture!
  • Avoid having a large arch in your lower back as this will stretch the abdominal muscles further. Aim to sit and stand up tall with your tailbone tucked under.
  • Activity modification
  • Avoid activities that increase intra-abdominal pressure such as lifting and straining. Try to perform a gentle lower tummy tuck with a pelvic floor contraction to increase trunk stability when lifting your baby, capsules, prams, etc.
  • Avoid sit ups (this includes the sit up action to get out of bed) and abdominal exercises such as planks and bridges
  • Exercises- prescribed by a health professional
  • Exercises are aimed at strengthening the deep stabilising muscles of the pelvis, abdomen and spine such as the pelvic floor and transverse abdominis muscles. 

Unfortunately the research tells us that only 50% of post-natal women know how to do a correct pelvic floor contraction, even if they have researched how to do it! That is an alarming statistic!!

If you are unsure whether or not you have a significant RAD or you don’t know whether you’ve got your pelvic floor contraction right it is worth a consult with a physio with Women’s Health experience. Your recovery will be much speedier as a result!


ABOUT THE AUTHOR

Kelly graduated with a Bachelor of Physiotherapy from The University of Notre Dame, Western Australia in 2007. After a short stint in the public health sector, Kelly began working in a highly reputable Sports and Musculoskeletal Physiotherapy Clinic. Kelly’s caseload included a variety of sports, musculoskeletal, gender health and continence and post-surgical patients. Kelly was also the senior physiotherapist that managed the inpatients on a busy maternity ward which is where her passion for obstetrics and women’s health began.