Rectus abdominis diastasis (or otherwise known as abdominal separation) refers to the separation of the 6-pack muscles from the midline of the abdominal wall. This commonly happens during the later stages of pregnancy, and if left untreated may lead to post childbirth issues such as pelvic girdle instability, lower back and pelvic pain.
Whether you are a seasoned marathon runner or a beginner jogger, time and time again you've probably heard this: RUNNING TOO MUCH IS BAD FOR YOUR KNEES.
As a Physiotherapist who runs frequently, I'd be a millionaire if I was given a dollar every time I was asked the question, “Will running damage my knees?" or being told, "You're a Physio, you should know that running damages your knees!"
FACT: RUNNING IMPROVES YOUR JOINT HEALTH
A 2016 research done with more than 2500 Osteoarthritis Initiative participants shows that running has no correlation with knee damage. Another study also found that running decreases inflammatory markers correlated with knee pain and degeneration. The study discovered that the cyclical loading of the knee joint during running promotes healthy cartilage turnover in the knees. The bending and straightening of the knee, along with the loading and unloading of the knee during running, circulates the joint fluid and provides nourishment to the surrounding tissues.
(Disclaimer: Current studies on running and knee degeneration are limited to recreational runners with no existing knee issues. Research is inconclusive for runners with previous injury history. However, excessive long distance running can result in a situation where the knee is overwhelmed. When this happens, the knee joint is no longer able to counter the inflammation effectively, risking the potential for joint degeneration.)
So is it okay for you to run ten marathons one after another then? The answer is NO. If performed in the wrong manner, running can injure you, just like any other sport!
What are the 3 main causes for running injuries in Singapore?
1. LOADING ON AN IMBALANCED STRUCTURE
Running is a sport that involves symmetrical weight bearing. Ultimately our running speed is only as fast as our stronger leg can work. In my experience as a physiotherapist, identifying the areas of muscular strength and length imbalances appear to be the most straightforward way of pain reduction and injury prevention.
I can often get my patients to run without pain by simply identifying and tackling their weak and tight muscles. If the weaker leg begins to lag, the stronger leg starts to take on more responsibility in moving the body forward. Muscular strength imbalances put you at a risk of overworking the stronger leg. Otherwise, the weaker leg simply ends up working way beyond what it can manage. It is crucial to have symmetrical strength so that both your legs are working together to propel the body forwards.
Overtraining – or overloading the capacity of your muscles is another common cause of running injuries. During a hard training session, your muscle fibres break down, and for that period, your body is temporarily weaker. At this stage, you must rest to allow your muscles to repair and heal, after which it is stronger.
A sudden increase in mileage or accumulation of high mileage without adequately resting can prevent the healing process of your muscles. Excessive loading can eventually exceed your muscles’ loading capacity. This is when injury occurs.
3. OVERLOADING ON AN IMBALANCED STRUCTURE
This is the most common cause of exercise related injuries in our modern-day society. Running is an efficient sport to raise our heart rates and burn calories, so it is no surprise that it is the go to exercise for the "weekend warriors". These people are generally inactive during the work week, and then come weekend, switch gears from zero to five and do a marathon-distance run.
These runners are essentially overloading onto an imbalanced muscular system – a result of accumulated sitting from Monday to Friday. Muscles can change its length tension if you stay in the same position over a period of time. Therefore, sitting for too long can lead to certain muscular imbalances such as tight hip flexors, weak glutes, weak abdominals, tight lower back muscles…just to name a few.
If you are a weekend warrior, you should consider incorporating a couple of short pre-habilitative exercises during the weekdays, to minimise the number of imbalances before you begin any heavy training regime on the weekends.
How can Physiotherapy help prevent overloading injuries?
- Ensure that your muscles have adequate loading capacity to take on your current training load.
- Use different functional testing to make sure your muscles can tolerate and sustain loads relative to your training level.
- By analysing your movement patterns – such as running hard on the treadmill, a Physio can gather clues as to whether your muscles have adequate capacity to load well at higher running speeds.
- The Physio can then prescribe you with the right type of exercises to do to complement your training regime.
Remember not to bump up your running volume too fast and too soon. Happy running!
ABOUT THE AUTHOR
Mok Ying Rong is a Physiotherapist at UFIT Clinic. With an intense passion in the musculoskeletal field, she utilises a holistic manual approach alongside an energetic desire to get people back to a pain-free status. Ying's niche is in analysing and treating issues related to the running biomechanics.
Ying is also an avid sportswoman. She started off as a competitive swimmer before transiting towards triathlons, and finally establishing herself in the run scene. Her more memorable achievements include breaking the Singapore National Half-Marathon record in the 2016 Gyeongju Half Marathon, and representing the nation in the 2015 World Cross Country.
Ying's first hand sporting experiences allows her to relate better to people who are passionate about sports.
Ever heard the expression: “Age is just a number.”?
When it comes to health and fitness, this expression is 100% true. A 40 or 50-year-old who trains regularly and looks after their nutrition will likely to be in a lot better shape than a 20-year-old living a sedate lifestyle and eating a diet of junk food and fizzy drinks.
Take a look at the image below comparing the MRI scans of the quadriceps of 3 different individuals:
The amazing thing is that these legs may even look quite similar on the outside, but notice the difference once we look into the scans!
As you can see, it is not the age that makes the difference, but the lifestyle. (Never let anyone tell you that you are too old to do something!) Those who maintain an active lifestyle and eat clean, nutritious food is more likely to be healthy, whereas those who are not as active will lose fitness and function more quickly as you age. Losing fitness and function is a huge issue for the elderly, as it will lead to a sharp decline in independence.
As we get older, the cells in our body don’t regenerate as fast or as well as they once did, which results in a longer recovery time. A hamstring strain in a teenager should heal faster than someone in their 40s (presuming they’ve done their rehab correctly). One reason for this physiologically is that elastin – the component that allows tissues to stretch – slows down in production considerably after 40.
As well as having less flexible tissues, lubricant in your joints (known as the synovial fluid) lessens, which reduces the shock-absorbing capacity, increasing the chances of developing Osteoarthritis. Unfortunately, there is no way of reversing the loss of synovial fluid production, it is simply part and parcel of the aging process.
One of the most common issues we see in the clinics is Knee Arthritis, and best way to treat this is to reduce the stress on your joints. This doesn’t mean sitting down all day. On the contrary, it means modifying the exercises you do, and correctly loading the joints by strengthening the surrounding muscles. By strengthening the muscles around your legs, they are capable of accepting a greater load, meaning that less force will go onto the knee.
The American College of Sports Medicine states that the population who benefit the most from exercise are post-menopausal women. Exercise helps to fight against Osteoporosis by reducing the breakdown of bone density, which many post-menopausal women tend to suffer from.
As with all things, prevention is better than cure. So it is essential that you maintain a strong foundation of fitness and health. Rather than playing catch up on your health trying to fight off the effects of an unhealthy lifestyle, it is better and easier to look after yourself throughout your life by maintaining a good level of fitness.
As a rule of thumb, the most important muscles to look after as you get older are your quadriceps at the front of your thighs. They are important to strengthen in order to reduce the risk of arthritic pain as you reach middle age, and for the elderly past their 60s - the strength to stand up and walk independently.
For the “weekend warriors” with desk-bound jobs (which applies to most readers), it is essential that you stretch and mobilise your back before every training. If you are not warming up properly prior to your workouts after sitting for prolonged periods, you will likely be too stiff and immobile, which can lead to compensations and injuries in the upper and lower back, hips, shoulders, and neck.
Here are some simple exercises you can do at home regularly to maintain your strength and mobility:
Aging (and the body aches and deterioration that comes with it) is a part of nature’s process that unfortunately cannot be reversed. However, staying fit and healthy is a choice that you can make. Keeping strong and mobile is the key to injury and illness prevention, allowing you to live your life to the fullest even as you get older!
For a customised and extensive assessment of your physical well-being and muscle health, book a consultation with a Physiotherapist.
About the Author
Kieran Sasiadek is a UK trained Physiotherapist with extensive clinical experience at UK’s NHS hospitals and clinics, as well as with professional football club Burnley FC. In Singapore, Kieran spent three years with Jurong Health Services working with the Intensive Care, General Medicine, Orthopaedics, and Sports Rehabilitation units. He also presented published research in that time. Subsequently, he was the Head of Physiotherapy at a private clinic before joining UFIT Clinic.
Kieran is an avid sportsman, active in rugby, touch rugby, soccer, Gaelic football, and basketball. His love of sports compliments his passion in treating sports injuries in amateur and professional athletes. His main ethos is to provide his clients with the independence to take control of their rehabilitation program, and enjoy the process of recovery.
As much as we love getting away, quite often a long flight can cause us aches and pains, and more than a little discomfort. The environment and conditions on the plane itself can cause some physiological changes in the body, and can get especially obvious on long-haul flights.
Warming up prior to physical performance is believed to facilitate mental and physical readiness, prevent injuries, and improve performance. Static stretching – once strictly adhered to has since been thought to impair performance and have no impact on injury prevention. As such, static stretching has been replaced with dynamic stretching. But is it wise to cease static stretching altogether?
Whether you’re in the saddle to commute, training to compete, or just for fun, cycling is an excellent exercise as well as a fantastic way to get around.
Being an Osteopath as well as an amateur cyclist myself, I know that cycling injuries do occur and often re-occur. In my experience, injuries are usually caused by overuse or poor riding form. The resulting pain and physical limitations can be particularly debilitating for cyclists, impeding performance or preventing you from continue to cycle altogether. Luckily, most injuries can be resolved fairly quickly with some simple bike set-up tweaks, and some manual therapy such as Osteopathy for persistent pain.
1. LOWER BACK PAIN
This is largely caused by the sustained flexed forward position in cycling which can put excessive pressure through the joints and discs of your low back.
- Raise your handlebars to reduce the amount of flexion going through your lower back.
- Daily stretches and exercises to improve hip and lumbar flexibility - an Osteopath or other manual therapist can advise on the best stretches for you.
2. NECK PAIN AND HEADACHES
Neck pain and headaches can also be due to a flexed forward cycling posture. This in turn causes your neck to over-extend, especially when you are looking up and around. Long periods of neck extension can lead to muscle tightness, joint pain, and associated headaches.
- Raise your handlebars to decrease the extension curve in your neck.
- Alter your cycling position so you are sitting in a more upright position for short periods.
- Do regular neck flexion and side-bending stretches to ease neck and shoulder tension – consult an Osteopath or other manual therapist on the best stretches for you.
3. KNEE PAIN
Knee pain is commonly caused by your saddle being too low, or your cleats not in an optimal position. A saddle that is too low means that your knee and leg never straighten out fully. This leads to shortened hamstrings, sustained tension on the knee cap, and weakening of the muscle controlling the last 10 degrees of knee extension (known as the vastus medialis). All of these can lead to knee problems such as patella mal-tracking, patellar tendonitis, and overuse injuries.
Many road cyclists use cleats to connect their shoes to the pedals. Whilst cleats improve performance, they can also result in persistent knee pain if they are not optimally positioned.
- Raise your saddle.
- Optimise cleat position.
- Cycle in a lower gear to decrease the amount of stress through your knee on each pedal stroke.
- Consider getting a professional bike-fit done.
4. HAND AND WRIST PAIN
Leaning forwards during cycling puts a lot of tension through forearms and hands, which can be exacerbated by gripping the handlebars too tightly and not varying your hands position. This can lead to repetitive strain injury (RSI) with pain and tightness in the wrists, forearms and elbows.
Some cyclists also experience tingling and numbness into their hands and fingers, most commonly on the pinkie and ring fingers. This is caused by compression of the ulnar or median nerves due to the sustained wrist and hand position on the handlebars. It can be made worse from the bike vibration if you are cycling on rough terrain.
- Change your hand position on the handlebars regularly.
- Ensure that your wrists are straight and not over-extended.
5. MUSCLE STRAINS AND TEARS
Hamstrings and calves are the most common muscle injuries amongst cyclists. This is because these muscle groups get particularly tight, making them more vulnerable to tears and tendon injuries.
- Warm up before a ride, and stretch afterwards to keep your muscles healthy and flexible. Using a foam roller after a ride for myofascial release can help with this too.
- Check saddle height. A saddle that is too high can put a strain on the hamstring tendons.
- Check cleat position as cleats too far forward may put a strain through the achilles tendon.
- Pace your training program. Build up gradually to longer-distance cycling.
WHEN SHOULD YOU SEEK PROFESSIONAL HELP?
If you are experiencing the pain only when you are riding, then hopefully the above tips can help alleviate the issues. However, if the pain persists even when you are off the bike, you may need to get professional help.
An Osteopath will be able to provide relief by releasing restrictions, improving flexibility, and releasing muscle tensions. Osteopathy can also give you the best chance of staying pain-free by maintaining joint health, mobility, and muscle flexibility, as well as provide you with an individualised exercise advice.
You may also want to consider getting a professional bike fitting done. This will ensure that no particular part of your body is under excessive strain, which should also help to improve performance.
ABOUT THE AUTHOR
Sebastien Bodet is a qualified Osteopath from France with a MSc in Osteopathy from Ecole d’Osteopathie Paris. He is also a certified Personal Trainer and Swimming Coach.
Sebastien is a former Olympic swimmer who represented France in the 2008 Beijing Olympic Games. He was a member of the University of Michigan Elite swimming team, and to this day remains an Olympic Sports Ambassador in France.
Sebastien's area of specialty is sports injuries, rehabilitation, and pain management. As a former professional athlete, he understands what it takes to maintain and rehabilitate the body for a high level of sporting performance. He takes a holistic approach to injury treatment, not limiting the treatment plan to only the pain area, but accounting for the entire body structure and lifestyle habits to create a fully customised treatment plan.
Sebastien's priority with every patient is to ensure safety and efficacy of their treatment plan. He is passionate about restoring body fitness and function to its optimum so that all of his patients can live life to the fullest potential.
With increasing affordability and accessibility to horse-riding in Singapore, there is growing interest in horse-riding as a sport and hobby, and a rise in participation in local competitions such as the recent National Dressage Championships, and the National Jumping Championships.
For some people, hopping onto the back of a majestic horse that weighs many times our body weight may be a scary thought. Horse-riding requires not just physical skills, but also a good understanding of your mount. However, there are many health benefits associated with horse-riding – aside from getting a good physical workout, it can also be an incredibly healing experience. As an avid rider growing up, I want to share with you not just the obvious benefits, but also some of the more unknown ones.
TOP 9 HEALTH BENEFITS OF HORSE RIDING
1. BALANCE A necessary skill to be able to stay on the horse, especially if it turns quickly. It doesn’t mean that if you don’t typically have ‘good balance’ you can’t ride – you can hold the front of the saddle to begin with and as you improve you will be able to stay upright and balanced without holding on.
Balance Test: Many of us don’t realise how bad our balance is unless you have done any lower limb rehab. Try standing on one leg, close your eyes and balance for 30seconds. Too easy? Try balancing on tip-toes while staying super still. Not so easy? Balance is one of the easiest things to improve and quickly – we can show you how.
2. CARDIOVASCULAR SYSTEM BOOST Trotting and riding associated activities such as mucking out are considered a moderate exercise for the rider. The longer and faster you go, the higher the intensity and the more calories you burn.
3. COORDINATION Your arms and legs are your communication to the horse. There are certain arm positions and squeezes that you perform to indicate a command and often at the same time. Your body awareness will flourish.
4. INTERNAL ORGANS STIMULATION This is the same when walking on foot, which is why it is one of the many reasons it is fantastic for sedentary or wheelchair bound people; it aids in liver function and digestion.
5. MOTOR FUNCTION The whole body has to work both independently and together to develop riding skills. As it is unlike most other sports your body can develop and improve new motor skills.
6. REFLEXES AND ALERTNESS As the horse moves, you must instantly and continuously react to it and be aware of any environmental considerations. We will keep you on your toes and develop your responses.
7. SELF-CONFIDENCE Responsibility, patience, overcoming fears, self-control and relationship building with the horse; an unbiased and non-judgemental partner that is only responsive to your intent and behaviour (which studies have found to be highly beneficial for those with ADHD, depression, anxiety and mental health disorders).
8. SEROTONIN PRODUCTION Doubling up on this mood-enhancing hormone by exercising and spending time with animals.
9. SENSORY INTEGRATION STIMULATION Riding well means ‘feeling’ your way with the horse, which is unlike most sports which is sight reliant (you can’t play the easiest version of racquet, team or ball sports if you can’t see the ball), but you can ride with very limited vision.
WHAT IS PREHAB?
“Prehab” is a proactive approach to building strength and stability, and improving mobility, balance, and joint functions to decrease the potential for injuries. Prehab is extremely beneficial when you are considering getting back to any sport after a break.
HOW PREHAB CAN IMPROVE YOUR RIDING PERFORMANCE
RIDING FOR STRENGTH TRAINING
Horse riding is an isometric exercise, where specific muscles are targeted to stay in a certain position without contracting the muscle. One of the best features of this sport is that whether you’re trying to or not, you DO engage all the right muscles. Over time as they improve in strength, so will the transfer of this strength to other positions such as standing or sitting, and other forms of exercise.
Walking and trotting (like a light jog) are the two most common speeds that you will be doing as a beginner in horse riding. To try to understand the number of muscles involved, imagine trying to balance and coordinate your movements with the horse as you squat up and down continuously. Your quads, hamstrings, glutes, and adductors will certainly be sore the next day! Any old ankle, knee, or hip injury that has not been fully rehabilitated may start to rear its ugly head as you will rely more on your better side, and the imbalance will only become greater.
While riding, your arms are either pulling the reins or held statically in a raised position. This can create beautifully sculpted shoulders – provided you don’t have chronically tight shoulders from sitting at the desk all day. Your Physiotherapist can teach you how to open them up and get your shoulder blades stronger, so that you can hold them correctly and much more comfortably, and not exacerbate any niggling shoulder problems.
DEVELOP STRONG CORE MUSCLES
If you are looking for a core of steel, then look no further! Your core muscles are in overdrive to balance and stabilise your upper body on an unpredictable and ever-changing base of support; slouching or over extending the back will affect your ability to stay on the horse as it turns one way, you need to counterbalance with those obliques. Your centre of gravity and body weight are constantly shifting, but you must remain as central on the saddle as you can, or you might cause yourself or even the horse to go off balance. The core is the foundation of our body, and if it isn’t working optimally, then how can we expect it to provide the base for our limbs?
A strong pelvic floor is critical in horse riding. If you’re unsure that your pelvic floor muscles are strong enough to tolerate this type of exercise, then you must get assessed before you try horse riding. (Come in to see UFIT’s Women’s Health Physiotherapists Kelly McGinnity or Lucie Lamprey)
Horse riding is a wonderful hobby for both adults and children looking for a new and extremely fulfilling experience. It fosters a wide range of skills that many of us would get huge benefits from but a certain level of body awareness and improvements would be ideal to maximise these benefits.
Physiotherapy can identify areas of weakness, potential problems, and imbalances in the body, and create a customised sport-specific prehab plan to achieve your goals. The aim is not to be “perfect”, but prevention is better (and less painful) than cure. Speak to a Physiotherapist and take the first steps to create the foundations for a long, injury-free, and healthy hobby.
ABOUT THE AUTHOR
Lucie Lamprey is a Senior Physiotherapist at UFIT Clinic. She has a B.Sc. (Hons) in Physiotherapy from the University of Southampton, as well as a Masters of Manual Therapy from The University of Western Australia. Lucie has worked with a wide range of clients, including people who are new to exercise, those with pre-existing medical conditions, to recreational and competitive elite athletes.
Lucie specialises in sports injury rehabilitation and injury prevention, with a focus on the spine, pelvis, and lower limbs. She is a certified Clinical Exercise Specialist from the American College of Sports Medicine (ACSM), with extensive exercise knowledge to develop exercise programs for athletes with comorbidities. Other areas of expertise include managing acute or chronic pre and post-natal conditions, incontinence and pelvic organ prolapse, and dry-needling for musculoskeletal conditions.
Do you spend long days in the office behind your desk? Do you find your body getting increasingly stiff, fidgety, or uncomfortable as the day progresses? The cause could be due to a weak core stability – the foundation of your body.
HIGH-RISE AND BODY-WISE
Think of your body like one of the skyscrapers in CBD. Your deep core muscles are like the foundations, beams and pillars which hold it upright. Should this internal scaffolding become weak or damaged, your body becomes an unstable structure, ready to break at any time. High-rise buildings of course have many supportive structures internally, externally and underground to allow for error (thank goodness) so that they can withstand the elements.
Our bodies are somewhat clever in that we too, have a back-up system. We have muscles that are ready to help out should our main structural system fail. However, these muscles simply aren't designed for this role of anti-gravity and postural support, so when they get tired and tight, this is where injury occurs.
Sitting at a desk all day causes our internal scaffolding to become ineffective, and our deep core in turn becomes weak and under-active. Aside from a weak core, we often find that our upper back and hips can become stiff. Our joints produce lubrication through movement. With long periods of immobility, the production of the fluid that oils our joints slows.
KEEP THINGS TICKING
Studies into lower back pain have proven that the muscles that support the trunk and pelvis become weak through a process called pain inhibition, i.e. a painful area becomes a weak area as the adjacent muscles just don't want to work. Seeing a Physio can help to put you on the right path through an assessment of your posture and functional movements, and subsequently a specific treatment plan to help target those weak or stiff bits.
General exercise and maintaining an active lifestyle will help to keep things ticking over. Or working with a personal trainer to have some specific guidance with your training can really help to build general or specific strength and endurance, depending on your individual goals.
BUILD THAT 'POWERHOUSE'
One form of exercise that is perhaps a little more targeted towards the core and our 'internal scaffolding' is Pilates. Pilates aids the activation and development of the deep core muscles, which are crucial for pain-free daily function, optimal performance during sports, and injury prevention. Through its extensive repertoire and targeting of very specific muscle groups, Pilates will make you 'feel' muscles you never knew you had, and also increase your body awareness significantly. So when you start to notice that your posture is off alignment and causing unnecessary stress on your body, you can correct and reposition yourself.
Pilates also helps to improve flexibility by encouraging you to counter-balance those positions that you find yourself stuck in for long periods of time – such as rounding forward over your keyboard, or slumping towards your computer screen.
Pilates can be done on a mat or with a specialist equipment, the most popular of the equipment being the reformer. Pilates is best taught by a qualified physiotherapist, or someone who has extensive experience within a rehabilitation setting. This allows them to scrutinise your every move to ensure you're doing the movements perfectly, thus eliminating the room for error to achieve the best results.
Regular activation and strengthening of these crucial deep core muscles with Pilates is important, whether you're experiencing physical pain or not. We all know that having an effective core or 'powerhouse' muscles is a recipe for success. The general rule is that after six weeks of twice-weekly Pilates sessions, your body will start to FEEL different, aside from looking more toned. And the best part about Pilates - ANYONE can do it!
The newest UFIT Clinic outlet at Orchard Central offers small group Physio-led Pilates Reformer classes. While there are other Pilates Reformer classes in Singapore, this will be the only class that offers an individually tailored program led by a physiotherapist who will pick from an extensive repertoire of exercises to best achieve your specific goals.
Align yourself mentally and physically from 24 February to 31 March, as UFIT Clinic Orchard will be offering 3 Pilates classes for $180!
This promotion includes 1 package per person and is open to new and existing clients. New clients will be required to attend a Pilates Assessment at $150 which includes a free class.
Sign up now with the form below:
About the author
Lucy Warren is a Physiotherapist and Pilates specialist from the UK. She has a first-class honours degree in Physiotherapy from Cardiff University, and is also an APPI-trained matwork instructor. Lucy has extensive sports experience with professional and semi-professional teams and athletes, having provided pitch-side physiotherapy for multiple elite sport teams in the UK. She has also worked for the British Army for two years, assessing and treating infantry soldiers and helping them to rehabilitate to peak fitness.
Lucy taught matwork Pilates for several years before making the transition across to Reformer Pilates. Lucy loves using the Reformer and other Pilates equipment with her clients in order to achieve their specific rehabilitation goals. She believes that it is an incredibly versatile tool which can lead to daily life improvements like better posture and more efficient movement, as well as relief from pain associated with physical imbalances.
In her own time Lucy is a keen netballer, skier, and loves to travel to new places.
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 is the best way to get over it so that we can get active again?
The science behind what exactly causes DOMS is not 100% clear, but most people agree that it is caused by micro-tears 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 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:
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:
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.
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.
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!
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!
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!
About the author
Declan Halpin is our UFIT Team Director 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.
It's so annoying to be injured. It stops you from doing what you want to do and brings a lot of discomfort with it. That niggling pain that bothers you every time you exercise, or the discomfort you have when sitting at your desk for hours on end. A lot of us will try to ignore the pain, hoping that it will go away with time or rest. Sometimes this works. You listened to your body telling you to take some time out to recover and HOORAY, you're back in the game. But sometimes this approach just won't kick it.
Understanding why you feel pain is the most important thing to do if you want to get rid of it effectively. One thing that's important to know is that PAINFUL doesn't necessarily mean HARMFUL. This doesn't mean to say that you should keep pushing yourself through the pain hoping it will just go away. What it means is that there may not be anything structurally damaged, but there is something happening biomechanically that your body just does not like. Injury can occur when there is altered stress on the body's tissues. The pain you feel in the body is your brain's way of telling you that something isn't right, like an early warning system.
How can we overcome pain? Rehabilitation is usually multi-faceted but to put it simply; we need to get the stiff bits moving and the bendy bits more stable.
The thoracic spine is just one part of the body that we frequently see as being 'stiff' - this is likely to be due to the modern day lifestyle of sitting too much and spending too much time in poor postures. Doing regular thoracic mobility exercises and foam rolling the upper back will help to increase range and free your upper back up so that the lower back doesn't have to do all the work.
Hips and ankles are two other common 'stiff bits', below are a few ideas of how to get them moving.
Increasing stability and control in the relatively 'bendy' bits is equally important. This may involve increasing core and gluteal activation, strength and endurance of the deep postural muscles in order to create a strong and stable foundation from which to move. Combining the two approaches is a recipe for success, as long as you do your homework.
This is just a little snapshot into what your rehabilitation may involve. So if you've got a niggling pain that just won't go away, or you think you could get a little more out of your training if only you could move a little better, book in a session with one of our physiotherapists for a full body check-up.
For now though, consider these three steps to help you stay injury-free:
1. Progress gradually
Don’t ramp up your training too quickly, it’s just not worth it. Our bodies take time to change and adapt so be consistent and avoid loading spikes. For example, if you've had a week of rest from exercise, don’t expect to do more than you previously did, as large fluctuations increase the load on our joints and soft tissues. Follow the 10 percent rule: add mileage OR intensity by 10 percent or less a week, and do not increase both at the same time. Monitor yourself with a training App to show what you have done each week. Also remember overload can be brought about by a combination of lifestyle and training. If you have been overloaded at work, this will affect your training too.
2. Recover well
Listen to your body. It needs time to recover, both mentally and physically. The micro trauma that occurs to the muscles and tendons stimulates further healing and growth, and this can only happen if they’re given a chance to rest and recover. If you start to feel a niggling pain, give yourself time to recover. Do not be afraid to adapt your training schedule to your needs. You won't lose fitness from taking one day off. Ensure your training programme includes recovery sessions - this can be swimming, pilates, yoga, or foam rolling sessions.
3. Strength and conditioning
We all have areas of weaknesses. An important component of any training plan is to make sure we have good flexibility, core stability, and strength. A dynamic strength and conditioning programme will target specific areas to help stabilise joints, promote postural balance, and improve muscle performance and efficiency. It helps the body tissues to become used to higher levels of loading, enabling them to deal with the increased demands of training and competing, therefore minimising the risk of injury. In essence - get the stiff bits moving and control the bendy bits!
When you have an injury that just won't seem to go away, see a physiotherapist who can assess different predisposing factors such as your biomechanics, alignment, muscle strength, muscle length, and motion control. Get this – often the source of your pain may not be where you feel it. At UFIT Clinic we don't just prod and poke the bit that hurts in the hope that the pain will go away. Our physiotherapists are highly skilled in assessing body biomechanics in order to fully understand how your body moves and why certain activities or postures are causing you pain. Book an assessment with us to find out more!
ABOUT THE AUTHOR
Lucy Warren is a Physiotherapist and Pilates specialist from the UK and is the Clinic Manager at UFIT Clinic Orchard. She has a first-class honours degree in Physiotherapy from Cardiff University, and is also an APPI-trained matwork instructor. Lucy has extensive sports experience with professional and semi-professional teams and athletes, having provided pitch-side physiotherapy for multiple elite sport teams in the UK. She has also worked for the British Army for two years, assessing and treating infantry soldiers and helping them to rehabilitate to peak fitness.
In her own time Lucy is a keen netballer, skier, and loves to travel to new places.
Over the years, school sports in Singapore are becoming more and more challenging and demanding. No longer just a social event, the competitions are now extremely competitive. Either this is because schools are putting more focus on competitive sports as a way of raising their profile, or parents are seduced by the notion of nurturing the next Olympic champion, the reality is that school kids in Singapore are training harder than ever, for longer, more intense sessions.
Overtraining is an issue for two reasons:
Paediatric burnout, or ‘overtraining syndrome’ is more than just being tired. It is the body's physiological and psychological response to chronic stress. This can happen when excessive demand is placed on the young athletes – either in volume (too many sessions in a week) or intensity (too much pressure to perform).
What are the signs of burnout from overtraining?
Fatigue: Does your child wakes up in the morning and still complains about being tired? Or do their teachers comment about them being sleepy at school?
Low self-esteem: Is your kid suddenly telling you that they are ‘not good’ at a particular sport, or want to drop out of the competition because it's not fun anymore?
Low immune system: Has your child been falling sick easily and frequently?
Irritability: Has your once-happy child suddenly become withdrawn and snappy with you and his coaches? This is a natural response to chronic stress.
- Depression: In extreme cases, athletic burnout can trigger bouts of depression in kids as young as 12 if they are pressured by high expectations to perform.
2) Overuse Injuries:
At the UFIT Clinic here in Singapore, we are seeing more and more ‘overuse injuries’ in young kids. What are we referring to? Inflammation of tendons and ligaments, issues such as Osgood-Schlatters, or Sever’s syndrome, and even stress fractures in developing bones. These are most commonly seen in young athletes who participate in two or more sports. Coaches are usually aware of not overworking their athletes. However, when your child goes from session to session, and coach to coach, the cumulative effect of all that physical work can lead to a burnout, constant muscle fatigue, or worse, forcing your child to sit out of the sport due to injuries.
The Good News? Both Burnout and Overuse Injuries are entirely preventable!
Review your child's weekly schedule for sports training, including all school-based activities (PE classes, etc). You might be surprised by the amount of time your child spends on physical activities! Ask your child if they are happy with the amount of physical training they are participating in - do they feel pressured to train? You can also consider speaking to your child’s coaches if you feel that their training schedule is too demanding. Show them your child’s physical activity schedule – they might also be surprised!
We recommend that your child should have at least one full day of rest in a week, and no more than two days a week with two scheduled training sessions. This will certainly prevent the possibility of burnout and overuse injuries. With your child happier and more relaxed, that will actually lead to better sporting performance!
About the Author
Declan has always maintained a strong interest in sports, and has previously worked as an Academy Physiotherapist for Crystal Palace Football Club (a professional football club in London, England), He was also the Rehabilitation Coach for the Western Province Stormers Academy (a professional rugby club in Cape Town, South Africa). Within Asia, he consults for the Indonesian Athletics Association as a Performance coach and physiotherapist for their Olympic athletes and Elite Development Squad.
In the age of Instagram and Facebook, and with celebrities like Miranda Kerr and Gisele Bundchen flaunting their post baby bodies on social media, there seems to be increasing pressure on new mums to get back into exercise soon after childbirth.
But did you know that participating in sport, running and other high-impact exercise too early after childbirth can reduce pelvic floor strength and cause long-term bladder and bowel problems or pelvic organ prolapse?!
There are however, many benefits to postpartum exercise for both mum and baby. Here are some tips for new mums or soon-to-be mummas on how to return to their normal exercise regime safely.
Benefits of postpartum exercise
- Facilitates recovery after delivery
- Increases cardiovascular fitness
- Facilitates postpartum weight loss
- Improves energy levels
- Improves mood
- Reduces anxiety and depression
- Improves muscle strength and posture
- Increases joint and muscle flexibility.
Pregnancy and childbirth place enormous physical stress on the body. Your pelvic floor muscles weaken during pregnancy and are further stretched during childbirth, your muscles and ligaments are looser due to the effect of Relaxin and your abdominal muscles are stretched due to your expanding belly.
All of these changes have occurred over 9 months and it is likely to take at least that long before your body gets back into its pre-pregnancy form. It is therefore important to be patient and realistic about your return to a fitness regime.
Please consider the following factors prior to getting back into exercise. Failure to address these issues before returning to moderate-to-high intensity exercise can cause incontinence, pelvic organ prolapse, abdominal hernias and back pain:
- Pelvic floor muscle dysfunction- signs and symptoms of this include difficulty getting to the toilet on time, frequent urination, leakage of urine or stool when you cough, sneeze and/or laugh, a sensation of heaviness or dragging in the vagina or lower pelvis, painful intercourse
- Musculoskeletal aches and pains such as lower back pain, coccyx pain and pubic pain
- Abdominal separation- otherwise known as Rectus Abdominis Diastasis.
It is also important to consider the time since your delivery, the type of delivery that you had and how you have recovery since your delivery before deciding when to return to exercise. If you have had a Caesarean section, the assistance of forceps or a vacuum in your delivery or a tear or episiotomy, your recovery is likely to be slower, therefore delaying your return to exercise.
Pelvic Floor First Australia’s recommended exercise guidelines
- Pelvic floor exercises - commence 24 hours after a vaginal delivery and 3 days after a Caesarean section
- Gentle abdominal bracing - this involves very gently engaging your deepest abdominal muscle by drawing in your lower tummy just above your pubic bone. Commence 24 hours after a vaginal delivery and 3 days after a Caesarean section
- Walking - when your body feels ready. Start with short walks on a flat surface without a pram and slowly increase the distance and difficulty as your body allows
- Swimming (once bleeding has stopped).
- Low impact exercise - walking on increasingly challenging terrain, cycling, cross-trainer (if no low back pain or pelvic pain)
- Light resistance - light hand weights or Therabands/tubes but nothing that causes you to hold your breath or strain, body weighted exercise, low intensity water aerobics
- Continue with pelvic floor exercises and abdominal bracing
- Be aware of good posture, form and quality of the exercise
- Invest in a supportive bra!
- Consider visiting a physio for an abdominal muscle check and pelvic floor muscle testing before returning to high impact exercise, running, sport or abdominal exercise programs
- Slowly increase resistance, intensity and impact of exercise.
You can return to your previous activity levels if your pelvic floor muscles have returned to normal and you are not experiencing back pain or signs of pelvic floor weakness such as incontinence or a sense of heaviness in the vagina during or after exercise. If your symptoms persist, seek the advice of your obstetrician or a physiotherapist with experience in Women’s health and continence.
Remember that everyone’s birth experience is unique and we all recover at different rates. Return to exercise only when you feel ready - it should be an enjoyable experience so there is no point pushing yourself when you’re sleep deprived or achy and sore!!
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.
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.
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.
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 massage therapist Lynsey Keynes shares 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.
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.
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.
About the author
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.
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.
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:
What is swimmer’s 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:
Inflammation of the supraspinatus and biceps tendon within the subacromial space leading to a shoulder impingement syndrome.
The onset of symptoms is often associated with altered posture, glenohumeral (shoulder) joint mobility, neuromuscular control, or muscle performance
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 hand paddles that are too large 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.
Bad body rotation
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 approximately 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 helped (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.
A revolution in patient recovery and rehabilitation in Singapore – Manual Therapists, Movement Specialists, Psychologists and Nutritionists working together to help you achieve your goals.
Singapore's only clinic that combines an international team of experts from multi-disciplinary backgrounds to ensure that your health is always at the forefront.
Book your consultation today at www.ufitclinic.com with one of our specialists.
Maybe you should see a Women’s Health and Continence Physio!
What does a women’s health and continence (WH &C) physiotherapist do?
A WH & C Physio is a physiotherapist that has done additional study at University to specialise in the areas of continence and women’s health. They can treat every day aches and pains and sports injuries but are also able to treat conditions related to pregnancy and pelvic floor muscle dysfunction.
What does an assessment with a women’s health and continence physiotherapist involve?
Initial assessments are usually between 45 minutes and an hour long. The physiotherapist will spend most of the first session asking questions to determine the source of your symptoms. If the pelvic floor muscles need to be examined, the initial and follow up assessments may involve the use of real-time ultrasound over the lower abdomen, to providing visual biofeedback during pelvic floor muscle training.
What conditions do women’s health and continence physiotherapists treat?
WH & C physiotherapists treat a diverse range of conditions related to pregnancy and the postnatal period as well as conditions related to pelvic floor muscle deficiency in men and women at any point in their lifespan, including:
1. Antenatal services
- Management of musculoskeletal complaints such as back and pelvic pain, pubic symphysis disorder and carpal tunnel syndrome
- Advice on exercise in pregnancy
- Pelvic floor muscle assessments.
2. Postnatal services
- Management of musculoskeletal conditions such as back and pelvic pain and
de Quervain’s tenosynovitis
- Assessment and management of abdominal separation
- Pelvic floor muscle assessments
- Advice on return to exercise
- Treatment of blocked milk ducts
- Treatment of perineal pain and swelling after delivery
- Pelvic floor muscle rehabilitation after obstetric tears
- Assessment of altered bladder sensation.
3. Other conditions treated by a women’s health and continence physiotherapist
- Urinary incontinence
- Faecal incontinence
- Pelvic organ prolapse
- Painful intercourse
- Provoked vestibulodynia
- Coccyx pain.
If you would like further information on the services or if you would like to book an appointment please contact UFIT clinic.
About the author
After spending the first part of her career juggling work, athletics and travel, Kelly decided to pursue her passion for Women’s Health and completed a Graduate Certificate in Continence and Women's Health at Curtin University. Upon completion of her course, Kelly worked for a specialist Women’s and Men’s Health and Continence Clinic where she gained further experience in the assessment and management of ante-natal and post-natal conditions, incontinence, post prostatectomy complications and pelvic pain disorders. Read more
A trip down memory lane for Kelly Latimer and her time spent with Declan, Head Physio at the UFIT Clinic so far. In Kelly's words...
I first saw Declan a couple of years ago after he reached out to me via social media. He had heard of an issue I was having that was initially diagnosed by another physio as a hamstring problem and said he would like to take a look at it. As my last physio was utterly useless, I agreed. A proper diagnosis and a few weeks of treatment later, I was back up and functioning like before, if not even better. His multi-pronged approach of manipulation, massage and strengthening exercises was exactly what I needed.
It was at that point I decided to start training with Declan too. We assessed my goals and he came up with routines for me that kept me safe and helped me reach new levels of fitness. We trained to prep my body for pregnancy, so that I could train through pregnancy. I’m happy to say that I’ve managed to escape a lot of pregnancy issues like trapped nerves in my back, back aches and excessive weight gain. I couldn’t have done it without Declan’s assistance and guidance.
I wouldn’t hesitate to recommend Declan’s services to anyone. He is brilliant. Open-minded and always eager to learn more to help his patients, he’s now increasingly harder to get hold of. However I also know that he has cultivated the creme de la creme of rehabilitation specialists in Singapore (and likely South East Asia) at the UFIT Clinic, so whoever you see will be sure to get you back on the road to recovery - providing you do your exercises.
Thank you, Declan. And thank you, UFIT.
I have been practicing yoga for over 12 years and have slowly transitioned from a practice focused on dynamic, sweat inducing yoga to being able to understand and appreciate the benefits of slowing down the practice and the mind. When my husband and I found out we were pregnant with our first child in August last year, the benefits of this transition really came to fruition as prenatal yoga became more than just a “yoga class”, but also a place for relaxation, mindfulness and birth preparation.
There are many benefits of practicing yoga while you are pregnant, here are just 5;
1. Yoga develops strength, flexibility and stamina
Pregnancy and labour is most certainly a marathon not a sprint and as your baby grows inside your belly more energy and strength is required to help carry the extra weight. Yoga helps you strengthen your hips, back, arms and shoulders. A woman who is in the best possible shape for the challenge of labour and beyond, both mentally and physically, will also most likely recover faster after the bub has arrived.
2. Promotes emotional well being, relaxation and stress management
Through deep breathing the nervous system goes into parasympathetic mode, which promotes relaxation. Learning how to control your breath during yoga can be challenging however; this awareness and control is not only an effective tool during pregnancy to help calm and reduce anxiety, it is also a technique to help with pain management, allowing you to focus and relax during labour.
3. Important birth muscles are toned
Prenatal yoga encourages deep toning of the pelvic floor, hip and transverse abdominal muscles. Building and maintaining this muscle tone through out your pregnancy can not only alleviate muscle aches and pains throughout the 9 months but also facilitate a speedy postnatal recovery.
4. Connection with your Bubba
A prenatal yoga practice at least once a week allows you to take some time out of your busy schedule to bond with your growing baby. Slowing down, breathing deeply and connecting with your baby as your pregnancy progresses allows you to focus on how your body responds differently to the changes that are happening week to week.
5. Relief from common pregnancy complaints
A regular prenatal yoga practice can help to reduce or alleviate common pregnancy complaints such as easing heartburn, fluid retention and muscle cramps to name a few. By stretching and toning your muscles you can also help blood circulate through the body in a healthy way as well as alleviate back, neck and hip pain which is often caused by the increasing stress from the growing weight of the baby.
You certainly don’t have to have been practicing yoga for 12 years to gain these benefits. If you have some experience in practicing yoga prior to your pregnancy, with your drs consent, you can commence prenatal practice. If you’ve had little to no yoga experience that’s also fine; following the all clear from your dr at 12 weeks.
Most runners run because they love running. They love getting out on the road or the track, they love the time to reset, to reflect, and they love the feeling of achievement after every run – from a competitive race to a slow jog around the park! But what if I told you that there was a way to make your running smoother and faster, to avoid running injuries, and therefore to get more enjoyment out of it!
Running is essentially a series of one legged hops in a row. In order to improve this, you need to develop the strength and the stability of the movement. The best way to do this is to Squat.
There really is not a better exercise to focus on your core, hips, glutes, and leg strength. Any runner who does not squat is missing out on all the benefits this exercise brings in terms of strength and stability. It can also help to erase any muscle imbalances you have, where one side of your body is doing all the work! Start off just doing body weight squats, ensuring your knees are in line with your toes, and do not extend over your toes. If you can manage this, add a small weight like a medicine ball. Aim for a high volume of reps in order to mimic more closely the requirements of running! You will very soon start feeling the benefit in your muscles, and see the benefits in your running times!
Once you have mastered the squat you can progress to exercises on a single leg.
If you are unsure if you are doing it correctly, or if the squatting movement causes you pain, speak to a good sports trainer or physiotherapist about assessing the movement before you add weigh to it!
See your UFIT Clinic Physiotherapist to get you back to full health today!