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Physio in the City clients will continue to receive the same high standards of care from our lovely therapists but will now benefit from Capital Physio's expansive network of clinics that can be found across the capital.

To find out more, visit or have a chat with our client care team on 033 0333 0435.

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Physiotherapy, Spinal, Sports and Complementary Care Clinics in London





By Greg Savides, Senior Physiotherapist, Clinical Manager, BSc(Hons), MCSP HCPC


For most non-league players, summer is a great time to get out into the sun with your mates and a few beers for a social game of cricket. Not much thought is given to warming up or conditioning other than exposing the legs to the sun.

Cricket has always been seen as a bit of a 'soft' game and as a result not much effort is put into preparation and fitness for a season.

A study conducted in South Africa showed that 49% of all provincial and national players will suffer injury in a season. These are generally fit seasoned professionals - so what hope do our weekend heroes have???

Injuries can occur in all areas of the game - batting, bowling, fielding and even the odd umpire.


The 2 types of trauma commonly seen are:

  • Direct trauma and
  • Musculo-skeletal strain

Direct trauma:

This is usually as a result of ball striking body. Depending on which area is hit will determine the severity of injury - stomach vs. jaw. Often this will be as a result of the batsmen's reactions being on the slow side. With players who do not practice regularly, the "eye" may not be "in" resulting in miss timing the stroke or playing down the wrong line resulting in ball hitting body rather than willow. The damage can be avoided in 2 ways: wearing sufficient protection for the conditions one is playing in e.g. using a helmet if you happen to know the opposition has an ex league quick on a dodgy pitch. The other is to not get hit.ones chances of this not occurring improve with faster reaction times and "seeing" the ball. This can be trained in the pre-season period doing hand-eye co-ordination exercises, playing a racquet sport or getting into the nets for some batting practice.


This is usually as a result of a sudden forceful activity as in playing a stroke or running between wickets. Because of the various shots in different positions the whole body is at risk of injury. Shot play requires sudden change of direction usually with force and injury can be minimised by conditioning the body to these loads, practicing the strokes and playing measured strokes rather than trying to smash the leather off the ball.

Running related injuries again can occur- taking off, running or turning. Keeping in reasonable shape during the off season; practicing activities with short swift running helps, including change of direction. Warm up prior to batting is also good-this usually involves a bit of a jog, some light stretching and knocking up (having someone throw some balls to you to get a feel of bat on ball). This is especially important for the team opening the batting as you have not been exercising out in the field.


Backs and the legs (muscles and joints) are most at risk here. These two areas take the brunt of the force during delivery which requires significant twist and bend under load (approximately 3-5 times body weight on front leg). At this stage of a social cricketer's career, a bowling style change is probably out of the question, so we have to look at ways of managing what we have. There is an obvious difference between spin and quick bowling so our focus will be on the "quicks". Probably the most significant fault with most social bowlers is their desire to be Brett Lee or the next Essex Express. Trying to bowl too quickly too early on in a game or a season is a great way to put an end to the season. Some preseason bowling concentrating on line and length with a gradual build-up in pace is recommended. If you are unable to get to the nets for a bowl, any sporting activity that involves running and twisting turning e.g. squash, hockey, frisbee could all help to prepare the body for the trauma of bowling. Stretching and warming up areas related to bowling prior to play are recommended. This would include the legs, back and bowling arm. Simple mimicry of the bowling action helps getting these areas prepared.

One consideration we take into account with bowling injuries is - the action. For a quick this can be front on, side on or mixed. See along side for brief explanation.


The two aspects of fielding that lead to injury in the social cricketer are throwing and running. However if your name is Jonty Rhodes then landing after launch is significant. At the start of a season the throwing arm is not particularly flexible and ready for the force required too hurl ball from boundary and this can often lead to a tear in the shoulder complex. As in bowling a gradual build up of throwing power is advised. Technique is often looked at when dealing with a shoulder injury. Typically there are two main throwing actions, side arm and overhead. Much work has been done over the last few years to promote the over-arm throw (think of baseball pitcher) as a way of reducing injury. Running in the outfield can also lead to injury and here again general conditioning should see you through the season. The other alternative is to spend the day in the slips!!

As a recap these are the key areas to think of this summer:

  • 1. Pre-season conditioning
  • 2. Sport specific training
  • 3. Warm up
  • 4. Play within your capabilities
  • 5. Deal with injuries/niggles early
  • 6. Have fun

There is a lot of information on the internet with regards to cricket training and preparation but if you do require any advice on the above issues, please contact us and discuss this with one of our physios.

Greg Savides MCSP SRP
works at our City Clinic

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Acupuncture & Physiotherapy

By Julie Gear

  • Did you know acupuncture can be used in conjunction with physiotherapy treatment to alleviate pain and aid recovery?
  • Acupuncture can help with most musculoskeletal conditions including: muscle aches, joint problems, arthritis, headaches, neck and back pain.
    There are written records of acupuncture dating back to 2500 years ago, but it is believed to be at least 4000 years old, making it one of the worlds oldest healing systems. Acupuncture is an essential component of Traditional Chinese Medicine (TCM).

Traditional Chinese Medicine (TCM)

According to Traditional Chinese Medicine, all things in nature are seen as a delicate balance of two equal, dynamically opposing and inseparable forces; Yin and Yang. Yin is the cold, slow and passive principle. Yang is the hot, excited and active principle. An imbalance of Yin and Yang leads to disruption or obstruction in our body's vital energy (Qi - pronounced "Chi") along the meridians (energy pathways). This manifests in our body as dysfunction or pain or illness in some way. Placing needles into certain acupuncture points along these meridians helps to restore the Yin/Yang balance and a healthy state or general well being.

Acupuncture in the Western World

Acupuncture was brought to Europe in the 17th century, and is becoming increasingly popular in the western world. This has lead to large numbers of clinical studies proving its efficacy for a wide range of conditions and injuries. The World Health Organisation has endorsed Acupuncture for the treatment of over 60 conditions. Many of the modern clinical studies involve careful analysis of our body's physiology, measuring the effect of acupuncture on specific hormones and chemicals in the body such as endorphins, serotonin and cortisol. Studies have shown that acupuncture may alter neurotransmitters and neurohormones, which can influence parts of the central nervous system (CNS) relating to sensation in involuntary body functions such as blood pressure, temperature and immune function.

There are a number of different "forms" of acupuncture practiced in the west. Solid (but very fine!) sterile surgical steel needles are used that are disposed of after each use. These needles may be manipulated manually or electrically stimulated.

Traditional Chinese Medicine (TCM) involves inserting the needles into the traditional acupuncture points, with the aim of restoring the balance in Qi or vital energy.

Intramuscular Stimulation (IMS)

Involves placing the needles into the tight bands and knots in the muscles, releasing energy and reducing muscle spasm. This can be more painful than other forms of acupuncture.

Dry needling involves placing the needles into particular points in the body (usually muscular trigger points) that are not necessarily in the traditional acupuncture points.

Japanese style acupuncture involves placing needles into the body to a very shallow depth just below the skin surface in the traditional acupuncture points.

Various forms of acupuncture are offered at physio in the city. It can be especially helpful when used in conjunction with other treatment techniques. Your physiotherapist will be happy to discuss if acupuncture would be suitable for you.

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Training for the marathon

By Helen Smith

The London Marathon is not far away, so all of you that are competing should be well into training!

Training for the marathon is very important and there are several considerations:


The weather is especially cold at the moment and the last thing you want to do is get a cold or any other illness. It is important to wear lots of layers. It is better to remove a layer than to get too hot while training. Get out of your damp training clothes and warm up as soon as you get home. Remember to stretch so that you do not get stiff. If you have a sore throat or your resting heart rate is elevated by more than 5 beats do not train, as it may put a strain on your immune system. In order to find your resting heart rate use a heart rate monitor and take your pulse whilst in bed, when you are truly relaxed.

Over training

Most people now feel that they have to increase their mileage with each training session. It is good to do a long run (over half a marathon distance) to give you confidence, but it is not advisable to go further than 20 miles as this puts a lot of stress on your system and you may not recover in time for the big day. Do your last long run at least two weeks before the race as it will take you at least 10 days to recover. During the last two weeks you need to decrease your distance and the amount of runs you do, so that you can peak while doing the marathon. Remember rest days are just as important as training days as they allow your body to recover, muscles to regenerate and you can use your rest days to stretch and improve your core stability. Core stability is very important as it will help you maintain your style as you fatigue. You can improve your core stability with abdominal or Pilates-based exercises. If you are unsure of what stretches or exercise you should be doing it is advisable to see a physiotherapist.

Running with injuries

Running with injuries is never recommended but especially not when you are going to be running 26 miles. It is better to see a physiotherapist as soon as the problem occurs, this way you have the maximum time for rehabilitation and the more likely you will be able to get to the starting line pain free.


  • Runners knee: Caused by inflammation of the ilio-tibial band. Pain is normally felt on the outside of the knee.
  • Shin splints: Pain occurs along the inside border of the tibial bone and tightness in the calves.

Both these injuries can be treated with ultrasound, acupuncture, stretches, biomechanical correction and soft tissue mobilisation.

Food & Hydration

As you will be training more than you are maybe used to, it is important to keep your carbohydrates and proteins intake slightly higher than normal, especially within an hour of training so that you can replenish your energy stores, which will help to repair your muscle tissue. During the run up to the marathon increase your carbohydrates to 'carbo load' but do not each too much the day before the marathon as you may feel sick and/or bloated. It is very important to drink whilst training as you will need to do this during the run. It would be advisable to find out what drink will be offered on the day so that you are comfortable with it. It is important to keep yourself hydrated during the whole period up to the run. You should never feel thirsty, as this is a sign of dehydration. Your urine should be a pale straw colour, which is a good indicator of your hydration levels.

It is very important to run pain free. If you are experiencing any pain or discomfort it is advisable to see a physiotherapist as soon as possible.

Enjoy the last few weeks of your training and the run will be a day you will never forget! All of us at physio in the city would like to wish you all the best on the big day!

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Snow boarder's' Ankle

Snowboarding and alpine skiing injuries vary greatly - where skiers injure thumbs and knees, snowboarders injure wrists and ankles. It may occur due to the different equipment used, the different movements involved and therefore the different stresses that are placed on the body.

Ankles are more vulnerable in freestyle snowboarding as the soft boots worn tend to provide inadequate lateral ankle support, which can lead to ankle sprains during falls, jumps or just riding.

Snowboarders ankle and severe ankle sprains present with similar symptoms, causing confusion when diagnosing and rehabilitating.

What is it?

Snowboarders ankle is defined as a fracture of the lateral process of the talus, a small bone that sits in the ankle. They are usually quite small fractures and are often difficult to feel by touching therefore making instant diagnosis difficult.

When does it occur?

When the foot is planted and the leg moves forward with speed and force, often twisting the ankle, putting greater force through the talus and chipping off a small bit of the bone. Often it occurs after a poor landing, for example missing the transition and 'flat landing' or simply catching an edge.

Who gets it?

Snowboarders who have had ankle injuries in the past or spend a lot of time in the terrain park as the ligaments may be weakened due to injury or repeated stress. This allows more movement in the ankle and puts more pressure on the talus.

What are the symptoms?

Snowboarders Ankle will feel like a badly sprained ankle. We begin to suspect it if recovery is slow, with or without treatment.

The symptoms are:

  • Pain around the ankle/foot, specifically on the outside
  • Swelling around the ankle/foot
  • Bruising in the foot
  • Difficulty walking - pain/stiffness
  • Difficulty getting into your boots and bindings
  • Overnight ache
  • Poor balance/unsteadiness

Why should I be worried about it?

If left untreated ongoing problems such as osteoarthritis, ankle degeneration, and chronic pain may occur, which could lead to no more snowboarding.

What can I do about it?

You should consult a health professional (Physiotherapist/Podiatrist/Sports Doctor) and tell them:

  • What happened, how and when
  • If it has happened before
  • If you have had an x-ray/or not
  • Where you spend most of your time on the snowboard

If you had an x-ray when it happened and it was clear, this is not unusual. The small fracture does not always show up on standard x-rays. Therefore, it may be necessary to have another one done in a different position. Your health professional may want to scan your ankle to rule out a fracture, if the x-ray results are not definite.

What happens if I have Snowboarders Ankle?
If a fracture is found, the immediate management may be a plaster cast or if the fracture is not simple you may need surgery to correct it. You are likely to be off the foot for 4 weeks and then have 2 weeks gradually increasing your weight bearing, whilst still in a cast. After this point, it would be wise to start a rehab program with the aims of:

  • Decreasing pain
  • Increasing strength in the leg
  • Increasing range of motion in the foot and ankle
  • Increasing stability, balance and ankle awareness
  • Providing advice on equipment
  • Returning to snowboarding as soon as possible

How can prevent Snowboarders Ankle?

  • Get fitter - do some form of exercise before your season starts
  • Snowboard where you're comfortable
  • If you're in the park, work your way through the levels
  • Consider your boots - should you have more support, perhaps try a hybrid boot if you have had injuries in the past
  • Make sure your board is set up to suit you and the way you ride

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Swimmer's Shoulder

Whatever your distance, whatever your stroke, whatever your ambition, there's always a way to improve your splash!

"Swimmer's shoulder" is probably the most non-specific description of a shoulder injury that you will ever hear! However, the term gains some merit with the knowledge that shoulder injuries are rarely simple - there is usually more than one anatomical structure that becomes painful, and also more than one causative factor.

The shoulder joint is inherently unstable; that is, it consists of a large ball (top of the humerus) resting against a small, flat, pear-shaped socket. The ligaments around the joint are also very loose to allow the arm a full arc of movement. The main thing that provides stability and therefore correct functioning of the shoulder are the rotator cuff muscles. They act to 'squeeze' the ball against the socket and control rotation of the arm.

There are numerous factors that can disturb this process:

1. "Born loose"

Many people have genetically loose ligaments, leaving the shoulder more prone to 'moving around' in the socket.

2. "Worn loose"

Swimming requires the shoulder to move through a large range of motion repeatedly, and over time the ligaments can become looser.

3. Dysfunctional rotator cuff

The rotator cuff muscles may simply not be strong enough to meet the demands you are placing on it.

These scenarios leave the rotator cuff muscles with a more difficult task of stabilising the joint, and it becomes prone to soreness, overuse or acute injury. Once the rotator cuff becomes painful or injured, it does not perform its job efficiently, allowing the ball to move excessively or 'slip forward' in the socket, and the downward cycle will continue.

The most important point to establish is that this scenario will not fix itself. Pro-active measures are needed in order to interrupt the cycle - soreness itself needs treatment and attention, and a structured program to ensure the rotator cuff has the strength to meet the demand is required. The best professional to assist with this process is your physiotherapist, who is specially trained in diagnosis and management of injuries.

A common misconception is that 'generally strengthening' the shoulder will assist its resistance to injury, when in fact quite the opposite can be true. Larger muscles such as the deltoid, pectorals (pecs) and latissimus dorsi (lats) are referred to as 'prime movers' as their function is to move the arm in a particular direction. If these muscles are able to move the arm powerfully and quickly, the rotator cuff must also be able to maintain their stabilising role under these more challenging circumstances. Very often there is a disparity in the strength between these two muscle groups, which once again leads into the spiral of an overloaded or inadequate rotator cuff leading to increased movement within the joint.

In summary:

the stronger you are or the more power you are capable of generating in your sport, the more you may need to strengthen your rotator cuff to maintain the muscle balance. It is sometimes tricky to isolate the rotator cuff from the prime movers in order to preferentially strengthen it, and once again a consultation with your physiotherapist is the ideal way to set you on the right track.

Below is a list of common circumstances arising in swimmers, which leads into the cycle of 'swimmer's shoulder', along with some simple solutions. More individual advice and specific assistance from your physiotherapist may be necessary.

  • Tight pectoral muscles pulls the shoulder forwards into a position that leaves the rotator cuff at a mechanical disadvantage.


    stretch your pecs!
  • Stiff thoracic spine (upper back), particularly an increased flexion curvature will also result in the shoulder being pushed into a forward position.


    include upper back extension and rotation stretches in your training.
  • Weak scapula retractors, these are the muscles between your shoulder blades. Again this contributes to the shoulder sitting forwards and places the rotator cuff at a disadvantage. The shoulder blades also tend to move around, making it near impossible for efficient rotator cuff function.


    practice squeezing your shoulder blades together at the back.
  • Decreased endurance of the rotator cuff. Your shoulder needs stability throughout your workout, not just for the first few strokes or the first 10 minutes.


    endurance retraining is as important as actual strength.

Swimming technique

This is another topic within itself and individual analysis is required to provide the best advice, but key issues can be your body roll and breathing technique. Too little body roll increases the movement required from the shoulder as the arm comes out of the water. To much body roll (i.e. a big breath) leaves the opposite arm in a stretched position as it pulls through the water. Both these scenarios place the rotator cuff at a mechanical disadvantage and stretches out the front of the shoulder predisposing you to the 'worn loose' scenario. Both your coach and physiotherapist will be able to provide further technique advice.

The moral of the story is to be kind to your rotator cuff'! A little time and investment in the right advice will keep you paddling happily and injury free throughout the season and in future years.

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Ergonomics in the workplace

By Julie Gear

Almost half the adult UK population (49%) reported episodes of low back pain that lasted for at least 24 hours. [1] Much of this could be potentially avoided with better posture at work correct lifting techniques.

We at physio in the city frequently treat injuries and conditions relating to the workplace e.g. Neck and shoulder pain, lower back pain, RSI (Repetitive Strain Injury, or also known as Upper Limb Disorder), headaches and muscle stiffness.

Workstations and sedentary lifestyles are a sign of the times; 40 years ago physiotherapists were frequently treating conditions associated with sustained standing e.g., factory floors. Now we are treating more conditions associated with sustained sitting e.g. sitting at a desk. This may be compounded by sitting on a train to get to work, and then sitting on the sofa at home watching TV in the evenings!

Unfortunately some of these conditions are difficult to treat, especially if the person has had the problem for some time before seeking treatment. The human body is amazing at developing compensatory mechanisms, and these all need to be dealt with. Fortunately a large majority of them can easily be prevented or easily treated when dealt with early on!

Prevention of poor posture related conditions

  • Sitting and working in good posture. You may have a designated health and safety person in your workplace that can assess you and your workstation. Alternatively your workplace may be able to hire an independent assessor to come and assess your workstation. We at physio in the city are able to do this. Please contact us for more information. Click here!
  • Use suitable equipment. Do not hold the phone to your ear with your shoulder- get a headset. Use a laptop docking station with a separate keyboard.
  • Get moving. Take lots of regular breaks. Leave your desk for lunch. Deliver a message personally instead of sending an email. Stretch regularly throughout the day when you are sitting at your desk. Other forms of exercise at some point during the day such as swimming, gym, walking or cycling to and from work can help break up the period of sitting. Pilates is excellent for improving posture for people with sedentary jobs.
  • Get adequate rest. Lack of sleep can also increase muscle tension and discomfort. Try not to sleep scrunched up into a ball.
  • Try to minimise stress. Easier said than done! Being aware of sources of stress is a start. There are many counsellors and stress management practitioners who can help with dealing with stressful situations.

Specialist office equipment suppliers

Our society is becoming more aware of how important good posture and ergonomics are in our lives, both at work and at home. (The advertisements for "orthopaedic" beds and equipment are now one of their biggest selling points!)

There are an increasing number of companies that supply specialist equipment for offices, schools and homes. These include chairs and stools, desks, footrests, armrests, keyboards, mice, document holders, headsets, laptop docking stations and bags, writing slopes etc.

Some companies that we frequently deal with are:

Advance seating designs (chairs)

Osmond Group LTD

Posturite (UK) LTD

Status Seating (chairs)

Vitra (chairs)

Dealing with Problems/Aches/Pains

  • Report problems early so that appropriate treatment and suitable rehabilitation can be arranged. This may be in the form of heat, ice, massage, exercise therapy, physiotherapy, acupuncture or a number of other therapies.
  • This is to prevent problems becoming long standing or chronic, which are harder to resolve, and can lead to long-term problems such as the early onset of osteoarthritis.
  • Don't ignore pain. Remember our bodies give us the sensation of pain for a reason - our bodies are telling us that something is not right, and we must try to correct this before the problem becomes irreversible.

[1] Palmer KT, Walsh K, Bendall H,
Cooper C, & Coggon D
Back Pain in Britain two prevalence surveys at interval of 10 years BMJ2000

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Did you know?

There are 58,185 netball participants registered with England Netball.Statistics courtesy of Castle, England Netball

The sport is notorious in social circles for pleated skirts, a challenge to the fitness, team rivalry, a rising international profile....and knee injuries.

What is Netball?

Netball is classified as a 'non contact' sport, although it may sometimes be more accurately described as a 'non tackling' sport. Each team has seven players on the court who play in positions that designate their role as a defender, attacker, goal shooter or centre. The aim is to pass the ball among team-mates to your attacking end, where a goaler can shoot the ball through a free standing net to score a goal, worth one point. It entails application of a number of physical skills and co-ordination, which without adequate levels of fitness and strength, can increase the risk of sustaining an injury.

Netball matches are of 40-60 minutes duration, during which time players in most positions will cover a significant mileage at speeds ranging from a full pace sprint to a jog recovery. Aerobically this is quite demanding and as muscles fatigue they may become more susceptible to tearing or straining. The addition of jumping, sprinting and change of direction to the aerobic challenge can provide great variety to the workout, however to a body unaccustomed to such increased impact loads and agility can create a recipe for injury. Excessive landing forces can result in overuse injuries such as tendonitis, shin splints and knee pain.

So what can you do to help reduce the risk of injury?

There are a number of considerations that can be made to reduce the risk of sustaining this kind of acute or overuse injury:
? Maintain an appropriate amount of aerobic fitness. If each quarter of netball lasts for 10mins, the ability to jog continuously for 20mins correlates approximately to half a game.
? Priorities time 2-3 times a week for a strength and conditioning program. This can take the form of a basic weights or equivalent resistance routine. It should also include a comprehensive stretching program and core stability.
? Include sport specific training in your workout. Proprioception or balance exercises should be included in the strength and conditioning routine, while some faster running and agility should be incorporated with aerobic activity.
? Wear appropriate footwear. A range of quality trainers have been developed specifically for netball, combining a court shoe sole with shock absorbing capacity in the forefoot and heel. Running shoes are not recommended as they are not built to provide optimum support in a lateral direction.

Other Common Injuries

Inversion ankle sprains or 'rolled ankles', soreness in the throwing shoulder and injuries resultant from collisions are also commonplace on the netball court.
? Prophylactic ankle bracing or strapping is recommended to prevent ankle sprains - if you play netball it is only a matter of time before it WILL happen to you. An ankle brace may be the difference between serious or minor damage to the ankle if you land on someone's foot. This is unquestionably essential if there has been a previous ankle injury. A physiotherapist can recommend and fit appropriate braces.
? Scapular and rotator cuff strengthening exercises (internal and external rotation with the shoulder blades squeezed together) should be included in the strength and conditioning program.
? Avoid collisions. Someone will always come off second best!

Are you tired just thinking about all these considerations? Look on the bright side - there are many measures that can be taken to prevent injury and if one or two of these suggestions can be implemented then you have reduced your risk! Oh, and don't forget to warm up, hydrate well and cool down!

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By Helen Smith

The triathlon season is well on its way and thousands of people will be training to swim, bike and run at the London Triathlon. This is one of the worlds biggest triathlons and takes place at the beginning on August over two days.

So what is a triathlon?

The most common race is an Olympic distance comprising of 1500m swim, 40km bike and a 10km run. You are timed from the start of your swim to the end of your run and therefore any time in between, also know as transition, must be kept to a minimum. You will have to not only master the swim, bike and run but also master the skill of changing from a wet suit into your biking/running outfit.

It is a multi-discipline sport and therefore involves cross training, which is very good for you physically however injury issues can still arise.


When competing in a triathlon you will normally do an open water swim. This differs from swimming in a pool, firstly, because you will have to wear a wet suit.

  • It is important that you swim in your wet suit before race day.
  • The wet suit should fit properly. It can feel very claustrophobic if it is too small and if it is too big it may slow you down.
  • Use a lubricant around the neck, underarms and in-between the legs to prevent chaffing, and it will also help the wet suit to come off quickly when you have completed your swim. It is better to use a natural base lubricant and it is advisable not to use Vaseline as it will eat into the fabric.

Secondly swimming in a lake, river or sea can be scary if you have never done it before especially if there are several people flailing their arms about, which tends to happen in a race. It is advisable to attend an open water swim before you race. There are several lakes that you can swim in and prepare yourself for an open water swim.

Thirdly it is vital that you have a good technique as swimming is a very common cause of shoulder injuries. If you develop pain during swimming, which remains persistent or presents every time you swim then you should see a physiotherapist as they can limit the pain, reduce the risk of further injury and offer preventative advice.


This is the longest part of the race and it is therefore important that you get a bike that is comfortable. It is important to practice on your bike in your racing clothes to make sure that you feel comfortable. Most importantly you must concentrate on your technique. When pedaling you must push and pull in a circular motion so that you don't put too much stress on any one muscles group. Pain will stop you from performing so if you experience any pain whilst cycling see a physiotherapist to get advice. The pain may be caused by a muscle imbalance or tightness, which can easily be corrected through exercises which will also prevent any further problems.


Running is the final event and a common cause of all injuries, aches and pains. Correct footwear is essential if you are thinking of running any distance. It is advisable to visit a store that specialises in running so that they can advise you on choosing the correct shoe and also watch you running in the trainer. Physio in the city is now able to analyse your running style using video analysis which is more effective to pick up any problems or faults that may be causing pain or could cause injury in the future.

The triathlon is a great sport but there is no pleasure in competing with pain so if in doubt visit a physiotherapist for more advice.
Helen was the winner of the London Triathlon for her age group and has been selected to represent Great Britain in the World Triathlon in Honolulu in October 2005.

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By Helen Smith

The Tour de France is now imminent. Lance Armstrong is competing to win his last and record breaking 7/8 tour. Over the time that he won these tours he has fought cancer and remained relatively injury free. How has he managed this? Training, healthy eating, rest together with a support team of physiotherapists, coach, masseuse, sports psychologist. the list goes on! Few people have the opportunity to such a team of experts to keep themselves fit and injury free.

However here are some helpful cycling tips:

  • Set Up - It does not matter what type of bike you ride, you have to feel comfortable when riding.
    1. Check your seat height: The leg should be straight when the heel is pushed down towards the floor on the peddle.
    2. Check the handle bar position: When reaching forward to the handle bars your back needs to be as flat as possible. This means you may need to adjust your seat back or the handle bars either up or down.
    3. If you experience any pain during your time on the bike it is worth taking it to a cycling shop so that they can check the setup for you.
  • Clothing - Wearing the right clothing is very important if you are intending to spend any length of time on your bike.
    1. Weather: If it looked rainy outside you would not normally leave the house without an umbrella or raincoat. When cycling make sure you are wearing breathable clothing and padded shorts otherwise your cycling experience could be very uncomfortable.
    2. Shoes: Shoes should be well fitted. If using pedals that require cleats have them fitted at a shop. If the cleat is in the incorrect position it could cause buttock, hip and/or knee pain.
  • Technique - It is vital to pay attention to your cycling technique to reduce the risk of injury.
    1. Gears: If you are new to cycling there is a likelihood that you will use too high a gear. This will mean that you are putting lots of stress onto your knees. If you are using a high gear, you may feel like you are working harder and are able to go faster, sadly this is not true. If you watch Lance Armstrong you will see that his legs are constantly spinning over 100 revolutions per minute. Try to lower your gear and make your legs do a quick smooth circle. This will ensure the pressure will remain even throughout therefore it will prevent you from overloading your muscular system.

If you experience pain whilst cycling and your bike set up is correct, then it is advisable to see a physiotherapist. The pain may be caused by something simple like a tight muscle that needs releasing or it could be caused by poor bio-mechanics, meaning you may be overloading certain muscles. Do not continue to cycle with pain if in doubt have it checked out.

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Unlike many other physically demanding activities, gardening is usually something people don't spend a lot of time preparing for. This is mirrored in the official (2003) figures, showing that an astonishing 337,000 people had to seek acute care at Accident & Emergency departments due to mishaps in the garden.

Many gardening activities are carried out in awkward positions, often including twisting and bending. For many people with a sedentary lifestyle, gardening is the only source of exercise, which naturally makes them more prone to injuries. However, even for people who exercise regularly, it is advisable to be careful and plan the tasks in the garden. The strength of your muscles, for example in the thigh, does not necessarily translate to how heavy a load your spine can manage when lifting something. The load that you lift does not only go through your knees and thigh muscles but also through all the structures of your spine. Thus, your ligaments, joints and discs in the spine may not cope as well with the load as your thigh muscles do.

Here are a few tips on how to prepare for gardening, which should reduce the risk of injuries:

  • Ensure that the tools are the right size and length for your height, allowing you to keep a straight posture.
  • Avoid bending down to work at ground level instead work from a kneeling position as this improves the overall impact on your body, provided that you are using sufficient support for your knees (knee-pads or kneeling cushion).
  • Remember to bend your knees and keep your back straight when lifting. Also remember to bring the load close to you, especially for bigger loads. The pressure through your spine is already significantly increased merely by the forward bending position of your body, so any weight added onto that will undoubtedly have an impact on your joints, muscles, ligaments and discs.
  • Try lifting many small loads rather than a few big ones. It might take you slightly longer to carry out your task but it pays off in the long run as you will reduce the risk of injury. If you cannot divide the load - ask someone to help you!
  • When carrying out repetitive work alternate hands or sides. Most of us tend to use our dominant side extensively even if it is not necessary for the precision of the task. Alternating sides will allow the muscles to relax and have sufficient blood circulation, and you will be much less likely to suffer a repetitive strain injury.
  • Take regular breaks when you work and try to avoid staying in one position for too long. It is generally better to do a little gardening regularly than overdoing it over the weekends.

If you should injure your back, joints or muscles whilst gardening and there is no improvement within the first 48 hours, you should seek help from a chartered physiotherapist. Your physiotherapist will assess what structure is affected and suggest the most suitable treatment and advice for your injury to recover more quickly.

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Reasons to see a physiotherapist

By Greg Savides MCSP SRP

Published in the March 2005 issue of RUNNERS FITNESS

How often have we heard this at physio in the city: 'I am running the Marathon this year, I have been trying to train but each time I go out it hurts, I rest a while, it gets better, I try run again and its back! What should i do?'

'The important thing', we urge, 'is to have the problem assessed, from there we can decide on the appropriate treatment and get you back out there safely!'

That is what physio in the city is about, but we stress physiotherapists are also heavily involved in preventing injuries. At our practice we like to get runners working on a home programme but also then coming back routinely for assessment and treatment so that we can catch injuries before they become a problem.

Physiotherapy is not just about a bit of massage and ultrasound. We have so much more to offer. No longer is it just about taking the pain away but about getting the athlete as a whole right. A good assessment of an athlete, not just the injury, will provide us with a diagnosis but more importantly the causes of the problem. By dealing effectively with the causes through a treatment and rehabilitation programme hopefully there will be no repeat of the same injury. This is a huge benefit to the runner not only physically but mentally as well.

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Olympic Involvement

By Mark Edmonds LSSM Dip. (Hons)

Olympic olympic

I was lucky enough to get selected by LOCOG as a Sports Massage Practitioner at the London 2012 Olympic Games. I've been a huge Olympics fan since the 1984 Games in Los Angeles and so having the opportunity to be play a hands-on role in London 2012 was a dream come true for me and a very exciting professional opportunity also. I was even more fortunate in that my placement was to be working solely on Track and Field Athletics… my favourite sport!

After nearly 1.5 years of the application/selection process from start to finish I found out I was one of approximately 100 Sports Massage Practitioners across all sports to be given a role.

It was made clear from the outset that it was very unlikely that I would be working on any athletes from First World countries such as Team GB, USA, Australia etc… but much more likely that I would be providing a service for the smaller countries that did not have the money to provide a full medical support team for their athletes competing. To me, this was not a problem… in my book, any athlete who made it to the Olympics was already a winner and a superstar!

I was due to work at 2 venues: The warm-up track adjacent to the main Olympic stadium where there was a treatment facility with around 10-12 physiotherapists and massage practitioners working every shift. Also at a designated training track in East London called Mayesbrook Park. This also doubled up as the main training facility for the Handball teams. I was given 9 shifts at each facility, so 18 shifts in total.

Alas the Mayesbrook Park facility proved to be very quiet and under-utilised by the athletes as a training facility and so all my shifts there were very quiet. Athletes seemed to prefer the close proximity of the warm-up track, adjacent to the stadium as it was only 5 mins away on the team bus from the Athletes Village. Also the atmosphere was much livelier and conducive for training there.

During my 9 days at the track I worked on athletes from countries such as Burundi, American Samoa, Tonga, Lesotho, Nigeria, Rwanda, Cambodia and Colombia amongst others, so a real test on my World geography knowledge! I also worked on people from a mixture of events ranging from 100 metres sprint to the marathon as well as throwers! They came in all shapes and sizes from about 50kgs to 100+ kgs! They also came in various levels of ability from those very unlikely to make it through the qualifying heats… thru to medal winners!

The highlight of my massage work was being lucky enough to massage 2 medal winners. Taoufik Makhloufi from Algeria won a Gold medal in the Mens 1500 metres and Hansle Parchment from Jamaica won a Bronze medal in the Mens 110 metres Hurdles. It was a real thrill to have got to know these athletes a little bit and I gave them both a big hug of congratulations after their amazing medal winning performances! Hopefully I played a small part in their successes in their events?

As well as the massage work, I was ideally placed on the warm-up track to see and speak to many of the stars of the Games. I treated it as a once in a lifetime opportunity and so was lucky enough to shake hands with the likes of Mo Farah, Yohan Blake, Adam Gemili and Jo Pavey as well as speak to Jessica Ennis, Asafa Powell, Dwain Chambers, Perri Shakes Drayton and Usain Bolt's Coach amongst others… almost too many to mention! Just being able to watch the athletes training for their various events was inspiring and to be able to mingle amongst them really made the whole Olympic experience for me a truly wonderful time.

I felt so privileged to have been given this opportunity. It is something I will never forget. A dream come true! So lots of great memories to take away from my time at the Olympics. Such a shame that it had to come to an end at some point. But I guess thats what partly makes the Olympics so special. At least I can say I was there and played my small part contributing to the undoubted success of the 30th Olympic Games in London 2012.

Team GB done a spectacular job across all the sports and built on the success of Beijing to finish in 3rd place in the medal table… a pretty good effort for a small country Id say.

Cant wait for Rio in 2016, when hopefully we can keep the ball rolling for future success. This time I will be watching from the comfort of my lounge howeveron the TV!

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Acupuncture without needles

Deborah Jones - Shiatsu Massage therapist


Debbie Malina investigates Shiatsu Massage,
and looks at why it is especially beneficial for dancers

Shiatsu Massage has been widely used in the UK since the late 1970s and its popularity continues to grow. Often termed “Acupuncture without needles”, Shiatsu’s benefits are recognised by a surprisingly diverse assortment of people ranging from athletes and dancers to accountants, bankers and lawyers. Dancers in particular are drawn to this non-invasive treatment, indeed many Shiatsu practitioners come to the technique from a background in dance, movement or theatre.

Interest in the use of Shiatsu as a form of therapy has been developing steadily throughout the medical world; within the NHS it is usually included as part of a programme of physiotherapy, coronary or cancer care. Shiatsu has also been beneficial in helping people with addictions.

The origins of the technique lie in Traditional Chinese Medicine, which was introduced into Japan some 1,500 years ago. For hundreds of years the most widely used form of massage in Japan was Anma, closely related to Chinese Tuina massage. Practitioners continued to use Anma for therapeutic relaxation until the early part of the 20th century when therapist Tamai Tempaku developed it into a form of bodywork, calling his treatment Shiatsu, meaning “finger pressure”. His method was a combination of traditional eastern techniques amalgamated with an element of physiology and anatomy derived from western medicine.

Schools were established to teach and promote Shiatsu across Japan, and it was given official recognition by the country’s government in 1964. The technique was further developed during the 1970s by Professor Shizuto Masunaga, who integrated Shiatsu with psychology and Traditional Chinese Medicine creating Zen Shiatsu – popular in the UK and US. There are now many styles of Shiatsu, all of which can trace their roots to the technique developed during the early 20th century. 

Based upon the same principles as a number of other eastern therapies, Shiatsu Massage works on the premise that energy travels around the body along specific channels, or meridians, which can be influenced at particular points of the body or acupoints. Stimulation of these is thought to balance out the flow of energy, either by unblocking energy or reducing it where it is overactive, and restoring levels when they have become depleted.

Treatment involves a variety of hands-on techniques to improve the flow of energy, or Qi, through the body. Approaches may vary between practitioners, some preferring to focus on specific points while others use a more general massage to stimulate the meridians. During a session the practitioner may place their hands on the abdomen, or Hara, considered to be the body’s energy centre; some therapists use this area to assess the flow of Qi through major organs and their meridians, enabling them to make a diagnosis of their patient’s needs.

This form of bodywork promotes the release of toxins through the stimulation of blood and lymphatic fluid. It is also able to help balance the hormone system, increase vitality and well-being, improve posture and flexibility while relaxing the nervous system.

Many conditions may be helped through using Shiatsu: headaches, insomnia, digestive upsets, stress and anxiety, back pain and some gynaecological problems. Dancers need to be aware that joint or muscle tears should only be treated when the healing process is under way. One of the benefits of Shiatsu Massage is that the treatment is able to help the entire body, rather than only addressing an individual problem, thereby assisting the overall healing process. 

Shiatsu is less aggressive than some forms of deep tissue massage; practitioners press along meridians with their fingers, gently stretching problem areas. When they have to apply more pressure on particular points of the body, as well as using their fingers practitioners also employ palms, elbows, knees and sometimes feet. Therapists may include rocking, stretching and massage techniques as part of their treatment, helping ease tension in muscles and mobilising joints. Where required, practitioners are able to correct structural imbalances, encouraging greater flexibility and re-aligning posture.

Although Shiatsu is safe and effective for most conditions, it should not be used where there are open wounds, immediately after surgery, when there is heart disease, osteoporosis or a skin condition. Check with your GP if you have a history of blood clots. While it is not recommended to receive Shiatsu during the first trimester of pregnancy, it is beneficial after that time and postpartum. Let the practitioner know if you are pregnant, as there are several pressure points that need to be avoided during pregnancy.

Therapists usually like to encourage feedback from their clients, either during or after the session; if something feels uncomfortable or painful let them know! Once treatment has been completed, you will be given a few minutes to rest and the practitioner will then discuss your treatment. You may experience a reaction either immediately afterwards or over the next few hours. This could be a feeling of relaxation or sometimes muscle soreness, headache and tiredness due to the unblocking of energy and the release of toxins; these should pass shortly.

The therapy has a cumulative effect and a full course of treatment, where possible, is generally recommended. After two or three treatments, discuss your progress with the practitioner to see how many more may be needed. Although dancers sometimes find it difficult to make time for regular treatment, even individual sessions can be beneficial. Patients often continue to receive Shiatsu massage long after any condition has healed. You do not need to be unwell to benefit from the treatment; people use it for relaxation, improving their overall health and well-being as well as increasing resistance to illness and injury.

Shiatsu is carried out in a peaceful environment on a futon or floor mat, although it is possible to receive treatment while seated on a chair. Other than wearing loose clothing, no special equipment is required. Pressure may be applied to your stomach during the session, so it is not advisable to eat a heavy meal beforehand.

Each visit lasts between 60 to 90 minutes, while the first may take slightly longer as your medical history will be taken by the practitioner. Although Shiatsu is used within the NHS, it is rare to be referred by a doctor. Treatments cost from £30 to £60 an hour, and block bookings are usually cheaper than individual sessions. Dancers may sometimes be offered reduced rates – ask if this is not evident. 

Shiatsu practitioner Deborah Jones spent the first part of her career as a professional dancer. She performed with The Royal Ballet and was an independent dancer for ten years. Deciding on a change of direction,Deborah felt drawn to bodywork, seeing this to be a means of using the knowledge she had accumulated over the years while honing her technique.

In 2003 she qualified as a Shiatsu practitioner and now runs her own bodywork practice. Deborah's interest in the world of dance has continued and she has taught workshops in Shiatsu to students at Laban, the Northern School of Contemporary Dance and London Contemporary Dance School.

“Having trained at The Royal Ballet Upper School for two years, I went on to join The Royal Ballet in 1984; eight years later I left the company to work with Jonathan Burrows. As a freelance artist, I performed with Michael Clark, Rosemary Butcher, Fin Walker and Rahel Vonmoos, and in Europe with Paul Selwyn Norton, Amanda Miller and Nik Haffner.

“During my mid-thirties, I was seeking a career change. When I had a Shiatsu session for a back problem, I found it significantly helpful, as well as feeling fantastic. Intrigued, I started to research the subject. At the same time, I was exploring Contact Improvisation with Kirstie Simson and this resonated with Shiatsu principles; I took the plunge and trained as a Shiatsu practitioner.

“The technique works to balance the Yin and Yang of energetic forces mentally, physically and emotionally. Yang relates to activity and Yin to rest and restoration of energy reserves. Dancers work hard, pushing beyond their limits in a competitive and judgemental environment. Shiatsu is a supportive treatment that can inform your self-awareness, helping you understand better how to support yourself. Knowing how and when to rest and re-energise is a valuable skill that Shiatsu can help develop.

“While Shiatsu releases muscular tension in much the same way as massage or osteopathy, its touch is directed to sensing the flow of Qi, requiring a different focus akin to meditation. This approach encourages the fascia system to respond, and connective tissue around the joints, as well as any organ, can be released. This feels very satisfying to dancers, who are used to sensing subtle flow and movement through their bodies. I find dancers often detect these energetic blockages without necessarily knowing how to release them.

“In my experience, dancers respond quickly to treatment as they are fit and active, with a high level of self-awareness. Usually, I can help a problem following two or three sessions, and if not I refer them on to another form of therapy. After resolving the initial issue, I encourage regular follow-ups each month or six weeks, this is gradually spread out to twice a year, depending on the individual.

“Primarily, dancers come to me if they have a specific problem or injury. They may attend sessions sporadically, due to the nature of their lifestyles, and also because of a lack of resources. Until Shiatsu becomes recognised as a mode of treatment that can be claimed for through insurance, like osteopathy and physiotherapy, it will be a luxury few dancers can afford on a regular basis.

“Dancers need skilled body workers; I feel Shiatsu is particularly effective for them, as it is centred on quality of touch and empathetic listening to the needs of the receiver [patient]. Through their training, dancers’ bodies are specifically adapted and developed, sometimes becoming unbalanced in terms of natural movement patterns. Such patterns tend to emerge as a dancer advances in their career, or at times of stress. The Shiatsu practitioner’s skill is to reintegrate these aspects of their receiver that no longer respond effectively. This can feel tremendously relieving.

“Within the dance community, I believe curiosity about Shiatsu is growing. This is a wonderful form of bodywork and deserves more recognition. Although I do see a lot of dancers, I am always keen to work with more of them, particularly through workshops where they can experience the benefits of Shiatsu touch – giving and receiving – as well as appreciating some of the philosophy behind it.”    


Shiatsu is not currently regulated within the UK, consequently anyone is able to call themselves a practitioner. Before making an appointment with a therapist, ensure they are registered with the Shiatsu Society or have membership of an approved association, such as the Complementary and Natural Healthcare Council.

Set up in 1981, the Shiatsu Society is the UK’s leading professional Shiatsu organisation and is part of the European Shiatsu Federation. It has taken on the role of self-regulation, as well as being a professional association for Shiatsu practitioners. Visit:,

More information on Deborah Jones’ Shiatsu workshops can be found at:

Published in Dancing Times, April 2012 and reproduced here with permission.

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FINA World Championship Involvement

By Gareth Ziyambi


Barcelona pool

The FINA World championships for the aquatic sports take place every 2 years. The stunning venue for this year’s edition was Barcelona. I had the pleasure to accompany the British Diving team as the team physio for what was a memorable Championships. The year after the Olympics is not always the easiest year to compete, especially after the sheer spectacle and the fulfilment of many athletes dreams competing in London.

The Diving venue was the refurbished pool used at the 1992 Olympic Games. It is simply a breath-taking setting, high up on a hill with a full view of Barcelona. Certainly the best backdrop for my physio bed I’ve ever had!

We had a 10-strong team of divers and full medical team including a Doctor and sports massage therapist. Personally it is always a pleasure to work as part of a unit, we are all able to concentrate specifically on our roles and pay attention to every detail within our respective fields than when operating on our own. And this means the divers can perform at their limits knowing that they have a complete medical team behind them. And perform they did! The standout performance is undoubtedly Sarah Barrow, whose 4th place finish was the highest ever finish by a British female diver at a world championship. Two other performances were remarkable as well, Hannah Starling made her first world final in the way only Hannah does, with a big smile on her face every time she get on the board to dive. For someone as young as she is, it was a pleasure to watch her stand up and be counted as a force to be reckoned with in the future.

The other standout performance was one of sheer grit and determination in the aftermath of injury. These are the sort of moments that define the human spirit, the never-say-die attitude when the chips are down. Tom Daley typified this with his performance. It is never ideal to get injured, more so the day before competition! Our job was simply to get him to the start line, and he would do the rest. For 48 hours, diver, coach, and medical team lived in the moment, never daring to think beyond the next round and working to ensure he could get to the next round. It is these moments professionally that one rather didn’t happen, but for which we are there when they do and ultimately get to “perform” to our limits. Success then is getting our charges to the start line and seeing competing against all others as if they are 100% fit. Any other way of thinking ends in defeat.

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Sports Massage for Triathletes

By Mark Edmonds Sports massage therapist

Triathletes racing at a novice/intermediate standard often train between 5-15 hours per week with professionals racking up 15-40hpw. This is a lot of training in anyone's book and as such the importance to be able to physically and mentally recover between training sessions is all the more vital.

Good nutrition, hydration, a well planned out training plan and the use of ice baths and compression clothing all have a big part to play in reducing an athletes recovery time. The other missing element that makes a massive difference is the correct use of sports massage to aid recovery.

All three triathlon disciplines are tough of the cardiovascular system which in itself places a stress on all of the main respiratory related muscles, however each of the individual sports has its own key areas which are placed under the greatest stress:

Swimming: Primarily shoulders, arms and the neck (from breathing)

Cycling: Lower back and legs, especially quadriceps, gluteals and hamstrings.

Running: Legs, primarily gluteals, quadriceps, hamstrings and calves.

Of the three sports, running tends to cause the greatest physical damage due to the high impact nature of the sport. Left unchecked, areas of hardness can develop within the muscles that in time can spread and eventually lead to muscular imbalances to develop which in turn can result in inefficient technique and at worst, over-use injuries such as muscle pulls or tendon strains. Tight muscles are also at greater risk of cramping, especially when fatigued, as in a triathlon race. They also use up a lot more precious energy in fighting their own internal tension during movement. This can lead to premature fatigue.

Sports massage can really assist the recovery rate from training sessions so that increased quantity and/or quality of training sessions can be achieved, leading to improved performance on race day!

Improved flexibility will also help athletes to achieve a more efficient style and improvements in a riders aerodynamics on the bike will be possible if the athlete is flexible enough to maintain a lower upper body profile, thus cutting down on wind resistance (improved speed for less energy!)

Within a typical 1 hour sports massage session athletes can focus the session onto areas that they feel need more help with. This will vary between athletes depending on factors such as sporting background, body composition, phase of training they are in, and any present or historic injury sites.

The depth of the massage will again vary depending on the athletes individual pain tolerance level, when the massage is performed relative to a training session or competition and the overall aim of the massage.

In brief, this may consist of warming, flushing and kneading techniques (effleurage and petrissage) to help to clear metabolic waste products away more speedily and also to encourage fresh oxygenated blood and nutritional supplies to speed up the rebuilding and recovery of the tissues.

Friction may be used on old injury sites or stubborn, persistent tight areas. Various targeted stretching techniques such as MET (muscle energy technique) and STR (soft tissue release) maybe employed to get the best possible results. These can lead to improved posture, reduce the stress on points of weakness and to generally aid flexibility as a whole.

Although sports massage is not inexpensive these days and is often regarded as a luxury item by many, it is an essential component to aid recovery and to vastly reduce the chances of sustaining over-use related injuries. It can also improve the psychological state of an athlete post training and pre-competition, which in itself could be the difference between winning and losing!

Athletes should aim to get a massage anywhere from twice a week to once a month, depending on the frequency, intensity and duration of training that is being performed.

Mark Edmonds was a GB Elite Team triathlete from 1989-97, having represented GB on over a dozen occasions. He was 2x runner-up in the British Middle Distance Championships in 1993-4 and has competed in 7 Ironman triathlons including the 2004 World Championships in Hawaii.

He has been a Sports Massage Therapist for over 22 years and has worked with the GB Triathlon Team and also at the 2012 London Olympic Games within Track and Field Athletics.

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By Adam White, MSPC HCPC, Senior Physiotherapist

We have all been told thousands of times that poor posture leads to neck and shoulder pain, but what causes this and can we do to stop the process?

With an increase in working hours spent in front of a computer, the incidence of neck and shoulder pain is also rising. Unfortunately for the modern worker, our body is not designed for hours and hours of sitting at a desk. We are made to move. Standing, walking and running is much more natural for us than staring at a computer screen. Not to mention the repetitive striking of computer keys and clicking on a mouse.

This change in our daily habits is causing discomfort and pain. But how?


The average human head weighs in at about 5kg. And in perfect posture, the passive structures such as the cervical joints, discs and ligaments can cope with this load with a little help from the active, muscular structures. However, once we move out of a normal alignment, we increase the amount of force going through these neck structures. This is where we see the familiar slump forward, rounded shoulders and forward head posture.

The muscles need to switch on (and hold on) to compensate. Due to the length of time in this poor posture, the neck muscles are in a sustained isometric contraction and become shortened and tight. Other muscles become stretched and inhibited due to the new posture, further increasing the strain on few still working!

Once this process begins, it can quickly get out of control. Abnormal muscle activation can lead to increases in force and tension in neck joints

and discs. This has the potential to impingement nerve as they exit the spinal cord. Further postural compensation is likely through the shoulder and back posture, causing more pain and abnormal movement patterns.

So what can we do?

  • Firstly, sit up straight!! Behaviour and changing bad habits can go a long way to limit the damage and restore normal biomechanics. The longer you can stay in a correct sitting posture, the more your good habit will replace your bad one
  • Move!! We are designed to move so take regular postural breaks at work to limit the repetitive issues caused by desk work.
  • Check your desk set-up is appropriate and not causing some of your bad postural habits.
  • See a health professional to restore normal movement patterns and strength.

Discomfort and pain caused by poor posture can be debilitating. But there are many things you can do to reverse this modern pain pattern. At the very least, you will be sitting up straight as you read this article!!

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What is a Gait?

By Denzil Trebilcock, B.Sc. (Hons), MChS


The human body is a remarkable piece of engineering.  From a very early age our neuro-muscular system is advanced enough to allow us to stand and walk bipedally.  Our system develops in line with increasing muscular strength and skeletal maturity enabling us to produce a locomotive system capable of crossing large distances, variable terrains and at different velocities. By analysing an individual’s gait and considering a number of temporal and spatial factors we are able to assess the quality of an individual’s movement.  This type of assessment can be used in a variety of ways from improving the efficiency of an elite athlete to assisting an individual in taking some pain-free steps.

What is gait?

If you have ever experienced lower limb pain and gone to see someone about it; then it is very likely that your practitioner would have wanted to assess the way in which you stand, walk or run.  Watching your movements within a controlled environment allows them to focus on any areas that might be regarded as ‘abnormal’ – be it the positioning of your foot at initial contact with the ground, the timing of a particular stage of your gait pattern, or the way in which you stabilise your foot placement.  This process of self-propulsion is referred to as our ‘gait’ or ‘gait pattern’ and is generally regarded as a sequence of activities that permits the most energy efficient progression of our bodies. The action begins in your central nervous system and is carried through to your voluntary skeletal muscles and is finally translated into movement across your joints. Any one of these basic elements may have a disruption, weakness or restriction that could ultimately affect your gait.

When assessing a patient’s dynamic gait we try to look at the body in its entirety. Starting from the top and working down we look to see if there are any postural changes in the position of the head, shoulders and spine. Is the arc of the arms swing symmetrical? The pelvic level is assessed for any signs of being tilted or twisted. Are the legs raised to the same height through each step? Is the stride length the same on both sides? Progressing to the ankle and foot we assess if there are any restrictions in the range of movement of the ankle joint. We assess the angle with which the heel makes initial contact with the ground and the speed with which the forefoot lowers to make contact with the ground. At the mid-way point of the gait pattern, when the individual is standing on one leg, we assess the angle the heel makes with the back of the leg and finally we look at the position of the foot in relation to the leg and knee as the heel rises off the floor in order to propel the leg forward. At each point we look for the quality and range of movement through the joints.

What is gait analysis?

We’ve given you a brief run down on the aspects of what makes up a dynamic gait cycle. As you can see there are a number of elements that must be considered and so the process of gait analysis is the accurate assessment of each of the elements mentioned above. It should also be noted that a gait analysis is not only an assessment of your dynamic movement but also an examination of your static balance, passive joint range of movement and postural structure, including such factors as the length of your legs. From a podiatry viewpoint we also look at the non-weight bearing orientation of the heel in relation to the forefoot. 

The process of analysing someone’s gait in a clinical setting means that a patient can be monitored in a controlled environment. Using a treadmill allows for a known speed whilst digital high-speed recording equipment can be used to capture each of the gait parameters. This can then be replayed and the necessary measurements made to assess if there are any abnormalities. In-shoe pressure analysis equipment also provides another insight into the loading patterns of an individual’s gait. This is particularly useful in seeing pressure differences between one foot and the other. 

What effect does hardcore training have on feet?

The classic problems are associated with overwork syndromes related to the soft tissue structures of the feet, i.e. tendons and ligaments. If an excessive degree of movement is noted through the gait cycle, most commonly excessive pronation, then it is very likely that the soft tissues will have to over compensate in order to maintain joint stability. If exercise schedules or loads increase suddenly then the possibility of injury dramatically increases. Poor biomechanical control will also increase the tensile stresses through the bones, which can give rise to stress fractures. The same poor biomechanical control can also lead to over loading of the joints, leading to acute bouts of capsulitis, bursitis or sesamoiditis in the first toe joint. The increased stress placed on the internal structures of the foot can also affect the nerves leading to neuroma formation. If an individual has a high arched foot they may suffer with very high pressure loading patterns at particular points in the foot due to increased ground reaction forces, which in turn can lead to pressure lesion formations in the skin and ultimately a change in the gait pattern.

With each of the cases above, gait analysis would highlight the abnormality causing the symptom and allow for implementation of therapy thus hopefully limiting time lost out to injury and away from training.

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Cervicogenic Headaches

By Fiona Holzberger, Senior Physiotherapist

Most people will experience a headache at some stage of their life. Unfortunately for some people these headaches can be recurring and intensely painful. These episodes may then start to impair their work productivity and their quality of lifestyle.

There are many causes for headaches and many reasons why headaches can bother some people more than others. There have been 14 different types and sub-categories of headaches identified to date. It is not uncommon for more than 1 type of headache to be the source of the patient’s symptoms. This can lead to difficulty with diagnosing the underlying cause of any headache episode.

Cervicogenic headaches is one such classification of headaches that is defined as any pain in the head that is originating from the cervical spine, or more commonly known as the neck. This pain may result from dysfunction of the spinal joints, nerves, muscle and soft tissue systems. No single structure in the neck is solely responsible for the development of cervicogenic headaches, but rather a combination of structures contribute to the overall presentation. This type of headache always presents with some pain or disorder in the neck. 

Where does physiotherapy fit in?

Physiotherapy treatment for cervicogenic headaches is dependent on what the Physiotherapist finds in the assessment, and so treatment for each individual will vary. Treatment may include:

  • Spinal mobilisation
  • Spinal manipulation
  • Muscle release techniques, including trigger pointing and myofascial release
  • Acupuncture
  • Techniques for improving the movement of the nervous system and normalising its signalling
  • Provide you with an individualised rehabilitation program targeting the key areas that are limiting your ability to move optimally without pain
  • Assessment and assistance with workplace set up
  • Biomechanical analysis of your technique for work and sporting skills

Headache Physio

What can you do when experiencing recurrent headaches?

  • If you haven’t had your eye sight tested for over 1 year, make an appointment to have them re-tested if you suspect that your vision is degenerating.
  • If you have an occupational health supervisor in your workplace and you haven’t had your work station assessed, ask for an assessment and advice on how you can make it more ergonomically friendly. Your Physiotherapist can also provide you with advice on workplace ergonomics.
  • Check that you are well hydrated during the day and that you are eating a balanced diet. A dietitian may help you identify any areas where your diet may need to be altered.
  • Make an appointment with a Physiotherapist for a complete assessment. Inform them of any patterns in your pain you may have noticed associated with activities, time of day, stress for example.

What symptoms to be aware of:

If you suspect that the symptoms that you or someone you know is experiencing is related to a medical emergency, you should 999 immediately. Some of the symptoms which may indicate serious pathology include, but are not restricted to:

  • Severe head pain with a sudden onset, unlike any head pain experienced before
  • Numbness or weakness affecting one side of the body
  • Facial weakness
  • Dizziness
  • Visual disturbance
  • Difficulties with swallowing or speech
  • Lack of balance or coordination
  • Blacking out
  • Neck stiffness

While some of these symptoms can be associated with headaches, anything that you are uncertain about should not be ignored and should be assessed by the hospital.

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Elbow Pain - Tennis Elbow

By Fiona Holzberger, Senior Physiotherapist

What is it?

Tennis elbow, or lateral epicondylalgia, is frequently seen in Physiotherapy and doctor clinics.  For some, it may start out as just a bothersome pain but left ignored, it can make even the simplest tasks using your arms unbearable. Unlike the name tennis elbow suggests, it is not confined to tennis players, or athletes in that case either. In fact, it is more often seen in the workplace and parenting circles.

So what causes it? Who is most at risk?

It is an overuse injury caused by repetitive and sustained loading of the upper limb. So basically, anybody who uses their arms to perform repetitive or prolonged tasks is at risk. This can include gardening, picking up your children, using the mouse or keyboard.

It starts with an overload on the body that it can’t cope with, which leads to trauma to some tissues. Continued exposure to the overloading task leads to further trauma, and the result, an imbalance in the system. As you can imagine, most people continue with their daily chores and routine, so the cycle continues and the condition deteriorates. For this reason it can be better understood why those that don’t play sports are still at risk of a traditionally believed-to-be sporting injury. I have never met anybody who trains and conditions their body specifically for sitting in front of a computer for hours, yet the demands placed on the upper body during this activity can be significant.  

Elbow physio

How to fix it?

Looking for a quick fix? Well, unfortunately tennis elbow is a very complex injury and is generally not easy to resolve. Some people complain of pain and disability in their arm for years to come. Despite this, there are a lot of treatment options available that can be extremely effective. Treatment generally requires a multifaceted approach including a close look at the person’s lifestyle and work, advice regarding how to modify activities to minimise the strain on the already burdened tissues, a thorough physical assessment, and a range of treatment techniques. A multifaceted approach is necessary for a successful recovery.

As always, prevention is the best cure. So if you have any concerns with a frequent task you perform whether it be occupational, sporting or social; an assessment with a Physio to identify any areas of weakness may be valuable.

Lastly, seeking help early in the injury can lead to faster and more complete recovery. So if you feel pain, don’t delay. 

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In House Physiotherapy

By Luke Kellaway, Senior Physiotherapist

The human body has evolved over millions of years into something that is able to run the 100 metres in less than 10 seconds, jump over 2 metres high and run a sub 2hr 10minute marathon. It is therefore easy to conclude that humans are designed to move.
Physio in the city have seen an ever increasing amount of postural neck and back pain patients since they first opened. The majority of these patients work at desks and in more recent years a large proportion of these have even had ergonomic assessments.
The cost to employers in provision of ergonomic equipment is considerable. However, not everybody is in need of this equipment which some could be seen as an expensive luxury. Especially, as it will need replacing at some point. Physio in the city strongly believe in In-house physiotherapy. We feel it is a far better, more cost effective alternative to providing a whole workforce with ergonomic equipment. Undoubtedly, ergonomic equipment helps maintain suitable posture whilst at work. However, the employee must be able to control this position, achieve the range of movement and endure the desired position for 8+hours a day.
Recently Physio in the City has started working with Statoil to provide their workforce with physiotherapy and sports massage. The service runs once a month at present but the demand of this 300+ London based workforce is substantial. The feedback received so far has been very positive. The monthly clinic is fully booked every month and the waiting list is as long as the clinic list.
The most common problem is neck and back pain. We have found the majority of patients have stiffness through the joints in their spine and have very overactive tender muscles surrounding the spinal column. This undoubtedly is as a result of posture at work and something physiotherapy and sports massage can help with.
We feel with frequent intervention and advice the patient will be able to manage their aches and pains effectively. Those that need more support may need ergonomic provision. The benefits of In-house physiotherapy to the company are that expense on ergonomic equipment is spared, less days of sick, less time lost for the patient travelling to appointments and a happy more productive workforce.
If you would like to talk to us about the services we offer or would like some extra info please contact us at or call 033 0333 0227, and it would be our pleasure to provide more information or discuss this further.

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Tips and Training Advice for Runners

By Ni'ia Hothersall, Senior Physiotheripist

Important considerations when taking up running

Fitness base.- Assess where your fitness is in the beginning. If you are planning that first big marathon or race but you can’t run 5 km yet, starting on that 3 month programme until race day may not be the best idea. Think about trying a gentle walk/jog programme, couch to 5km or even just generally exercising regularly for 1-2 months before embarking on an actual training programme. Give yourself time to train!

Footwear.- Ensure you replace any old shoes with new before you get started. The most structured and cushioned shoes won’t necessarily suit you so speak to someone with expertise in the area about finding the right shoe for you.

Which training programme? - Get some good advice based on your current fitness level for the type of training programme you should follow. The biggest mistake beginners and intermediate runners make is choosing a training programme that is too short or is too advanced for their fitness level.

Strength and conditioning – Do not underestimate the importance of strength required when running. Before you begin your training programme start some strength conditioning exercise and continue this throughout your training. Running is a very repetitive and high load type of exercise which places a large amount of strain on your musculoskeletal system. If it is weak and likely to fatigue quickly, this can lead to injury.

A general strengthening programme that incorporates your core, hips, legs and some upper body would be ideal.

Carrying injuries before you start? - If you have any recurrent or new injuries before starting a new programme, get them seen to! Seeing a health professional such as a physiotherapist pre initiation of a programme can help heal any existing injuries and also give you a wealth of information for exercises and advice on running.

Tips on avoiding over training

Increasing your speed or distance with each run is an easy way to over train and cause over-use type running injuries.

A basic training programme focuses on 3-4 sessions per week. One long run every 7-10days, a medium run, short run and/or maybe some form of tempo/hills or interval training sessions for the intermediate to advanced runners. Distance per week will increase gradually.

Cross training (e.g. cycling, swimming, yoga etc.) is a great way to keep the fitness up, but also give your body an active rest from running.

Remember, rest days are just as important as your training days. Your body uses these rest days to recover, adapt and build strength.

Flexibility should not be forgotten! Now that you are placing further strain on your muscles, remember they need some regular stretching to keep them mobile and in good condition.

Important areas to stretch are the glutes, quadriceps, hamstrings and calf muscles.

What happens if you develop an injury during your training?

Running with injuries is never recommended but especially not when you are training for that important race. It is better to see a physiotherapist as soon as the problem occurs. This way you can get an accurate diagnosis and have the maximum time for rehabilitation.

This will make it more likely you will make it to the start line pain free.

Most common running injuries

  • Runners knee: Caused by inflammation of the ilio-tibial band attachment on the outside of your knee. Pain is normally felt on the outside of the knee.
  • Shin splints: Caused by inflammation of the muscles along the inside of your shin and their attachment to your bone. Pain occurs along the inside border of the tibial bone and general tightness can be felt in the lower limb.
  • Gluteal tendinitis – caused by inflammation of the gluteal muscle tendons as they attach to your femur. Pain can be felt around the side of the hip, in the glutes or down the upper thigh.

Firstly, all of these injuries need to be accurately diagnosed, and all can be treated with a mixture of activity modification, soft tissue work, joint mobilisations and biomechanical correction.

Still unsure if you are doing the right thing?

Get a run screening assessment!

Our physiotherapists are trained at running assessments to properly assess your running style on a treadmill. Using real time video footage they can review and analyse your running technique to see if there are any imbalances that may need correcting.

A biomechanical assessment will follow with tips and advice to help you run as efficiently as possible for your body type.

Happy training!

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Lateral Knee Pain, Iliotibial Band Syndrome (ITB)

By Hayley Mepham, Senior Physiotherapist

What is Iliotibial band syndrome? Iliotibial Band

Arrow to ITB pain

ITB syndrome is ultimately an overuse friction injury that is frequently aggravated by cycling, running or the increased repetitive motion of the knee of flexion and extension. Symptoms normally present with lateral knee pain that sharpens with activity.

Lateral femoral epicondyle

aspect of the knee where excessive rubbing of the iliotibial band against a bony prominence at the outer aspect of the knee (the femoral epicondyle). This causes irritation and inflammation to the ITB and local tissue.

What causes it? Who is most at risk?

There are many biomechanical risks and environmental factors considered to cause this common lateral knee pain injury:

  • Excessive or inappropriate training or activity
  • Not allowing enough recovery periods from sport or activity
  • Inadequate warm up
  • A sudden change in training volume, duration, intensity, conditions or surfaces
  • Poor footwear
  • Inadequate rehabilitation following a previous lower limb injury
  • Abnormal running biomechanics and technique
  • Over pronation (i.e. flat feet can alter biomechanics angles of lower limb)
  • Muscle weakness or tightness  or imbalances (especially gluteal muscles, quads and calves)
  • Poor core stability
  • Tightness in specific joints (hip, knee or ankle)
  • Excessively tight ITB

How to fix it?

A physiotherapist can assess and identify any of the above contributing factors that could be causing your lateral knee pain, with a thorough lower limb physical assessment of your biomechanics and a running gait analysis to check to your technique. Once these contributing factors have been identified, there are many treatment options available that can be extremely effective for ITB pain. Here at Physio in the city, we adopt a multifaceted approach to focus on your individual lifestyle needs and goals.

Seeking physiotherapy in the early acute stages of this lateral knee pain can usually settle your ITB pain within a few weeks, to speed up the heeling process and reduce the likelihood of reoccurrence.

If you’re feeling pain in your training, don’t let it affect your goals and hold you back, seek physio advice to lead to a faster and complete recovery today!

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When should low back problems be referred for an MRI

As physiotherapists we are often the initial contact for an injury so it is paramount that we know when it is necessary to refer for a scan. This article is to help the patient understand when a clinician would refer lower back pain for an MRI.

When we are referring for a scan it is to prove or to rule out any serious injury. We have guidelines that we follow to decide whether a particular patient meets these criteria.

For low back pain to be referred for a scan immediately there needs to be referral pain down the leg. To understand how a physiotherapist decides what pain is serious and which isn’t, you need to know the two different types of referred pain.

Somatic pain:

The nerves in the lower back innervate the lower limbs. So when any structure in the lower back region gets aggravated the pain can sometimes present in parts of the lower limb. In somatic pain the nerve itself is unaffected; instead the pain is coming from other structures like discs and muscles.

Another example of this is when people feel pain down the left arm during a heart attack.

Radicular pain:

Direct aggravation of the nerves in the lower back, most commonly from a prolapsed disc. This is the type of pain that is potentially more serious and which physiotherapy may not resolve.  

When we understand the two types of pain it is easier to then decide whether a patient is presenting with somatic pain or radicular pain. Below are the guidelines we follow to compare one to the other.



Pain site:

Somatic – pain will be worse in the back compared to the leg. Pain can be on both sides

Radicular – pain will be worse in just one leg

Pain quality:

Somatic - typically described as having a dull, deep ache or pressure quality

Radicular - described as tingling, P&Ns shooting or electric quality, deep or superficial. Pain is generally constant

Pain location in leg:

Somatic – pain location is vague and changes over time. Often hard to define

Radicular – pain is in a specific area (that area is where that specific nerve that is affected innervates)

Paraesthesia (Pins and needles or numbness)

Somatic – may be present but is poorly defined

Radicular – numbness or pins and needles in a specific area of the leg (just like the pain site)

Bladder and bowel:

If you lose control of your bladder or bowel it may mean that something is pressing against the spinal cord – this would be an emergency scan. You may also present with numbness or pins and needles in the ‘saddle area’ (in between the thighs).




Somatic – should have full strength unless inhibited by pain

Radicular – may be loss of strength


Somatic – reflexes normal

Radicular – reflexes may be reduced or absent.

Neural tension tests:

A nerve cannot be stretched (like a bit of string) so we can do movements that test how well the nerve moves by pulling on it. This would tell us if the nerve is caught or being pressed on at any point.

Somatic – neural tension tests will be normal

Radicular – may be a decrease in the movement. For example when lifting the leg straight up while the patient is lying on their back.

Once the therapist has gone through the assessment he/she can judge whether a scan is worthwhile. After reading this article most back patients will feel more relaxed about their back injury as radicular pain is less common than somatic. However if you have read this and think your pain may be more serious, please book an appointment and let a professional assess your back.    

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