In our increasingly sedentary modern lifestyles, we often end our days feeling stiff and the sensation of “tightness” in our muscles. We speak to Dan Arthur, Physiotherapist at UFIT Clinic one-north, as he shows us a few mobility drills you can do to iron out any kinks you might have.
The UFIT team comprising Dave Lee (Physiotherapist at UFIT Clinic Orchard) and Simon Porter (Head of UFIT Performance) have worked closely with the team at Visa Singapore to perform desk assessment demonstrations and provided education on correct sitting posture and desk set-ups to stay pain free.
Here are the exercises and stretches that work best performed at the desk. A handful of these exercises you can do at home or at the gym to help bulletproof your back, neck and hips against being seated all day.
Dave Lee, Physiotherapist at UFIT Clinic Orchard and triathlete, gives us insight into the world of triathlon competitions and some common injuries and issues that may occur. If you are participating in the Metasprint Series Singapore Bike-Run Duathlon on 10 March 2019, Dave’s knowledge of injuries that affect endurance athletes, especially cyclists, can help you gain better understanding and nip any issues in the bud before problems arise.
Being active in sports, UFIT Clinic Orchard’s Senior Physiotherapist and competitive Muay Thai fighter Nada Khalid listens to her body and is aware of any issues that might arise. She would be able to take the necessary actions and precautions as needed. That being said, this will not always be the case when it comes to children who are active in sports.
Jade Sarsero, Physiotherapist at UFIT Clinic and CrossFitter at UFIT Tanjong Pagar gets ready for the CrossFit Open talks about why it’s a great sport and how becoming friends with your physical therapists can really help you improve your performance and get the most out of your competition in 2019.
Preparing to take part in an obstacle course or an endurance race? Here are some tips from a Physiotherapist to help you in the build-up, pre-race, and post-race to ensure you stay in top condition and injury-free.
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.
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.
Modern lifestyles are increasingly leading us towards a highly sedentary lifestyle. For many of us, our days are mostly spent in a seated position. We sit in the commute. We sit behind the desk at work. And to relax at home, we sit in front of the TV for a few hours at a stretch. Imagine the compounded effects of all that sitting!
We have all heard the phrase “Use it, or lose it.” It is repeated for a reason, because it is true! Those of you who exercises regularly know just how quickly you can lose your strength and fitness when you take just a week off regular training. Sitting doesn’t engage much of your muscles. All it does is to poorly load them, which lead to stresses, strains, pain, and loss of muscle mass.
It is well known that exercise produces the “happy hormones” endorphin. Simply moving more produces the same results too. When you are stationary for too long, guess what – your endorphins level drops too.
Now the really bad news: Just as exercise doesn’t counteract the effects of eating junk food, exercise also doesn’t counteract the effects of sitting! This means that although you are likely to reduce some of the negative effects by exercising regularly, it doesn’t mean you can sit the rest of the day because the negative effects of sitting increase in proportion to the amount of time you sit.
Not convinced yet? Here’s a list of some common side effects of sitting for an extended period of time, and how it can impact on your fitness training!
side effects of sitting for too long
Looking in one direction (i.e. at the computer screen, the TV, or your mobile phone) for a prolonged period can reduce your range of movement. This can lead to tight muscles especially when turning your neck, and affect your performance in team sports, swimming, driving, and even sleeping. The constant “pain in the neck” or headache is a common ailment affecting many people in our society – the next time you are on the MRT, just look around to see how many people are looking down at their phones! Muscle tightness limits your body’s range of movement, and impact on your ability to generate maximum force in weights training.
SHOULDER PAIN AND/OR "CLICKING"
Rounding and pushing your shoulders forward as you type on your keyboard makes the muscles at the front of your body tighter, which worsens your slouching even more. Most people will get stiffness and pain on the outside of the shoulders, or around the shoulder blades as they are constantly being pulled forwards. Your shoulders eventually get weaker and go out of position. You know that feeling when you sleep awkwardly and wake up stiff? Well that is what you are doing to your body when sitting poorly.
ELBOW AND WRIST ACHES AND FATIGUE
In today’s modern age we are constantly engaged on our electronic and mobile devices. We are typing on the keyboard, scrolling social media on the phone, or playing games on the tablet. The wrists and elbows are being used more than ever in these limited positions that constantly engage the hand and wrist muscles. No wonder they are such a common area to have a repetitive strain injury!
3 simple ways to make a change
Now that we know how long hours of sitting poorly can affect us physically and mentally, what can be done instead?
- Stand up and move every 45 minutes. You know the feeling when you feel like wriggling in your chair, or perhaps lean your body to one side– that is your body telling you to GET UP! Don’t just shift in your chair, get up and stretch or go for a walk. If you are short on time, even just standing up and down again in your seat helps to give your body a quick reset. Set an alarm or reminder to get up from your seat regularly.
- Consider a standing desk. As companies are placing more importance on staff wellness, many are open to the idea of improving ergonomics. There are many types of standing desks available on the market that allows you to adjust the height of the desk with a touch of a button. You don’t have to work standing up all day, changing it up is the key.
- Make sure you are sitting properly. If a standing desk isn’t an option for now, use the following steps as a guide on how to sit properly:
- Sit right to the back of your chair (ideally maintain a 2-inch gap between the edge of the seat and the back of your knees)
- Raise your chair to an appropriate height so that when you are tucked in, you are able to use the keyboard with your elbows relaxed at a 90-degrees angle on the armrests. If your feet are dangling, deter the urge to sit forward to plant your feet on the floor. Because as soon as you sit forward, you lose the back support and will soon slouch. Instead, you can place a low box as a footrest below your feet to create the ideal 90-degrees bend at your knees.
- Pull yourself close in to the desk. At this position, your chair’s armrests slip underneath the desk. If you are too far away, you will constantly be leaning your body forward in an unbalanced angle to use the keyboard.
- Bring your monitor closer! Stop leaving a nice clear space in front of you that is rarely needed – bring your keyboard and monitor closer to you, so you don’t end up leaning your body and neck closer to the screen as you concentrate or become tired.
If you spend a good part of your day seated behind a desk, and am experiencing constant aches and and muscle tightness, you might want to visit a physiotherapist to do an in-depth ergonomic assessment to find out if imbalances in your posture and balance are causing these issues.
ABOUT THE AUTHOR
Lucie Lamprey is 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.
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.
Lower back pain is common. Over 80% of us will suffer from it. Unfortunately, there is a long-held view that lower back pain is usually caused by something mechanical, and can only be resolved with surgery. In most cases this is not true. There are many things that you can do on your own to alleviate the pain, without having to go under the knife. Our body is a remarkable instrument that is capable of recovering on its own, given sufficient time.
Physiotherapy and rehabilitation can help you manage and recover from lower back pain, through a mixture of mobility and strengthening exercises.
If you have been experiencing intense lower back pain regularly, manual therapy and soft tissue release can help to reduce pain and facilitate movement. It will not be an easy journey. There will be sweat (lots of it), there may be tears (I can’t promise they won't be mine!), and there will likely be setbacks. These are normal, recovery is usually not linear and pain is not predictable. But at the end of that journey, you can be satisfied that you have earned your recovery. Not only that, you will become fitter, stronger, and better equipped with practical and effective knowledge to avert pain in future.
An MRI scan is not always necessary
An MRI scan is useful if you are planning a surgery, as it gives the doctor a good overview of your anatomy. It is also useful if you are displaying certain neurological symptoms, such as progressive leg weakness or a loss of bowel control. Your doctor and physiotherapist will screen for these conditions, which may indicate certain pathologies. In the absence of these, your MRI is just a very expensive “selfie”. It gives little to no value in helping the doctor come up with a treatment plan, or predict how you will respond to conservative treatment.
A good physiotherapist will base your treatment on your symptoms, thoughts, feelings, response to movement, and tests results. There are also numerous studies comparing the MRI results of people who have back pain, with those who doesn't have pain. In both groups, there is a remarkable similarity in the number of people with disc bulges and other degeneration symptoms. If these conditions are present in people who are not experiencing back pain, maybe they are not the main issues that are causing the pain.
Tips for Beating the Pain
- Stay active. People who remain active recover more quickly. It can be as simple as including a 20-minute walk each morning and evening.
- Change postures regularly. Your back becomes sensitised by prolonged stationary posture & awkward movements - your best posture is your next posture.
- Do regular spine-strengthening exercises. Don’t be afraid of any particular movements, even if they don't feel comfortable right now.
- Practice, practice, practice. The exercises may leave you feeling sore at first, but you will get better with regular practice.
- Be patient. Sometimes the pain can get worse for no reason at all. Be proactive and optimistic about treating it, but don’t blame yourself for making it worse.
- Stay optimistic. The more you worry about your pain, the worse it might become - your brain acts like an amplifier.
- Make sure you are getting a good night's sleep. This might mean making adjustments to the pillows you use, or your sleep posture.
- Get strong. Strong supporting muscles can help to alleviate back pain, and also provide a whole host of other benefits.
About the author
Kyle Wild completed his physiotherapy training in Leeds, UK and worked briefly in the NHS before combining roles between private practice and sport. He has extensive experience in contact sports, from initial injury management to post-injury rehabilitation . His passions lie in preparing people to perform within their chosen sports, with an emphasis on performance throughout the rehab process. You have to prepare your body for the stress and strains of what you enjoy doing, especially if you don't want to end up in the clinic because of it!
Plantar Fasciitis is often a dreaded foot disease - but with persistent and consistent treatment it can be overcome! Mok Ying Rong - UFIT Clinic physiotherapist, Nike Sponsored elite athlete, Singapore’s Half-Marathon record holder and winner of the 2017 Great Eastern Womens' Half Marathon - shares her advice on overcoming Plantar Fasciitis right here ...
What is plantar fasciitis?
It is a clinical condition characterised by sharp pain in the middle of the heel and along the arch area. Pain is often worse with the initial few steps after prolonged inactivity such as the first step you take in the morning. Pain gets better with some movement but increases with further loading. Pain is often worse at the end of the day.
Who gets it?
Athletes who engage in repetitive weight-bearing sports such as distance running, basketball. Weekend warriors who engage in a sudden increase in sports coming from a level of sedentary desk work throughout the week. There is also some evidence linking ageing with plantar fasciitis. People with occupations requiring prolonged standing and walking.
What contributes to the development of plantar fasciitis?
Intrinsic and extrinsic factors both play a contributing role. Intrinsic factors include arch height, hypomobility of the ankle, tight calf muscles etc. Extrinsic factors consist of factors such as inappropriate footwear, uneven ground surfaces, increased in weight-bearing activities, sudden increased in mileage and increased Body Mass Index. Alteration of ankle-foot biomechanics resulting from previous injuries and soft tissue or joint limitation can contribute to the development of PF. For example, tight calves can limit the mobility of the ankle which can subsequently result in excessive compensatory pronation, leading to a strain at the plantar fascia.
How does physiotherapy help plantar fasciitis?
Your physiotherapist will help to manage and reduce your symptoms by utilising a variety of techniques according to your specific needs. Techniques include joint mobilisation, soft tissue releases, gait and footwear analysis. If you engage in sports such as distance running, your physiotherapist may also discuss with you on appropriate progressing of training loads. The physio will also assess for other factors that can put you at risk of symptom recurrence. Throughout the whole process, you will also need to play a part by doing the exercises that your physiotherapist will teach you.
If necessary, you will be prescribed orthotics and night splints. Orthotics can help to minimise excessive pronation which causes additional strain to the plantar fascia. Wearing a night splint at night allows the fascia to be placed in a more optimal and relaxed position.
Running and plantar fasciitis
Plantar fasciitis can be very persisting which gets increasingly difficult to treat the longer it is present. The best way to go about it is to prevent it. Try running on soft surfaces, increase your running mileage by no more than 10% per week, perform regular stretches for your calves after each run and wear the proper shoes for your foot type and gait.
Here are 3 activities to try out :
1. Assess the flexibility of your big toe
Can your big toe be raised up to an angle of 50 degrees when your knee is positioned above your foot (as in the diagram)? The flexibility of the big toe allows the ‘windlass mechanism’ to occur. This windlass mechanism is the winding of the plantar fascia to elevate the medial longitudinal arch. Without this mechanism, the foot loses its stability and the foot’s stability muscles cannot function well. The plantar fascia is then subjected to great amounts of strain.
2. Stretch your calves
Here are two variations of calf stretches. For both variations, you can alternate between doing it with a straight knee and a bent knee. The former focuses on stretching of the gastrocnemius while the latter focuses on the soleus (the deeper of the two calf muscles).
a. Wall stretches
b. Hang off an edge
c. Self-mobilisation of the plantar fascia
With one hand, pull the toes of the foot back to place the fascia on a stretch. With the other hand, massage the fascia by applying gentle but firm pressure across the fascia along the arch. Do this for 5-10minutes, 2 times a day.
About The Author
Ying is a physiotherapist 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 started off her career as a physiotherapist in the private sector. During her period here, she found her niche in analysing and treating issues related to the running biomechanics.
Ying is also an avid sportswoman. Ying started off as a competitive swimmer before transiting towards triathlons and finally establishing herself in the running domain. 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.
- BsC Physiotherapy (Queen Margaret University)
- Dip Physiotherapy (Nanyang Polytechnic)
- National Coaching Accreditation Programme (NCAP) theory level 1
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.
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.
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.
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.
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
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.
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