Grip Strength

Whenever I open my door to a new customer*, I always like to shake their hand as an introduction. Whilst I am not one to base my initial opinion on the handshake, it is always notable when you come across a bone-crusher. Is it led by ego, or is there more to it?

Have you ever had to put down heavy shopping when carrying it to the car from the shop – and not because you lacked the strength to carry it, but simply because you couldn’t maintain your grip? How many day to day activities (DIY, opening doors, opening jars) benefit from a strong grip?

Activities such as CrossFit, Powerlifting, Weightlifting, even Obstacle Course Racing, would all arguably benefit from grip strength training – but would all of us benefit, regardless of our chosen activity?

In the health and fitness world, grip strength is vital, and loss of grip strength can be scary; I’ve seen many a person in clinic not so much in pain, as feeling fragile because they no longer feel safe holding a cup of tea, or a kettle.

Grip strength is also known to be a reliable test for risk assessment for various health issues such as cardiovascular disease and other causes of mortality  – Grip strength was a stronger predictor of all-cause and cardiovascular mortality than systolic blood pressure.” (1).

But the main reason grip strength is tested here is due to its strong association with shoulder strength, and so – often – shoulder injury – “We have shown for the first time that propriospinal pathways may connect the hand to the rotator cuff of the shoulder. The modulation of facilitation/suppression during the grip-lift task suggests that inhibition of propriospinal premotoneurons is down-regulated in a task-dependent manner to increase the gain in the feedback reflex loop from forearm and hand muscles as required.” (2)

Several factors influence grip strength: age, sex, hand size and grip span, posture, and position of the shoulder, forearm, and wrist.

Using equipment such as wrist straps may allow you to improve your lifting capacity, but are we masking a potential lack of grip strength?

To discuss a grip strengthening programme, please contact Dan@DC-InjuryClinic.co.uk

*HATE this word

REFERENCES

  1. https://www.thelancet.com/…/PIIS0140-6736(14)62000…/fulltext

2. https://www.ncbi.nlm.nih.gov/pubmed/18715892 

N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldn’t be seen as such. They are merely guides to a better understanding of how our bodies work.

For more information please visit www.dc-injuryclinic.co.uk

Shoulders: Mobility vs Stability

The shoulder joint has the greatest range of MOBILITY of any joint in the body; at the expense of this, can be the STABILITY of the joint. Its hard to think of many times throughout the day where you are not using your shoulder joint to some level. Your shoulder is a slave to your hand, so if you are using your hands, you are using your shoulder.

The shoulder joint is stabilised by a labrum (cartilage type soft tissue, drawing the arm into the socket; its capsule (compromising a series of ligaments that connects the arm to the socket) ;and of course the surrounding muscles. Many people who present with shoulder pain blame the “rotator cuff”, and whilst not all shoulder issues are caused by the rotator cuff, there is always a rotator cuff involvement, and – despite the name – this group of 4 muscles (supraspinatus, infraspinatus, teres minor, and the subscapularis muscle) are major stabilisers of the joint. Its very rare – in my opinion – that these muscle need lengthening.

Severe shoulder instability means the shoulder can dislocate (or subluxate) repeatedly during active movement or exercise. The most common dislocation – thought to be around  90-95% – would be an anterior dislocation, where the head of the humerus comes forwards out of the socket.

Subluxate means the joint moves more than it should do in normal circumstances but doesn’t actually come out of joint.

If you have history of previous subluxation or dislocation there is a strong chance of a secondary condition; either a bankart lesion or – more commonly – a hills-sachs lesion.

Bankart Lesion is a lesion of the front part of the labrum of the shoulder, and is caused by repeated anterior shoulder subluxations. This dislocation of the shoulder joint can damage the connective tissue ring around the glenoid labrum.,…

Hills-Sachs Lesion is a compression fracture or “dent” of the humeral head, associated with instability or dislocation at the front of joint. This lesion is caused by an anterior shoulder dislocation which causes the aforementioned dent. A study found Hill-Sachs lesions in 65% of acute dislocations and 93% in patients with recurrent instability (Ref 1)

Both of these lesions can cause further instability, meaning future dislocations are more likely; many people will know what this feels like – “my shoulder always pops out”!

Strong shoulder muscles are our best defence against shoulder dislocation and subluxation caused by instability. The key is to balance the muscles around the shoulder; imagine the head of your arm being on a pulley – front to back. We spend a vast proportion of our day with our arms in front of us; driving, writing, at the laptop, swimming, cycling, bench-pressing. We need to ensure that it is not just the muscles we see in the mirror that are strong.

REFERENCES:

  1. http://www.orthosurgery.gr/dimosieusis/AComparisonoftheSpectrumofIntra-articularLesionsinAcuteandChronicAnteriorShoulderInstability.pdf

Hip Pain

The hip joint is a ball-and-socket joint formed between the hip bone (pelvis) and the thigh bone (femur). After the shoulder, the hip displays the greatest range of motion of any joint in the body. Alongside this, it is hugely weight-bearing and so is pulled on by many strong opposing muscles during walking, running, jumping etc.

Normal hip joint
Source: Basic anatomical knowledge

Similar to groin pain, when we examine people with hip pain, the area that is painful or tender isn’t necessarily the area that is causing the problem. There may be pain referring from other structures; areas creating compensations which overload other tissues, making the hip area the victim, or symptom. Also, there is often more than one pathology at play – the groin/hip/lower back area is incredibly complex anatomically and biomechanically, with nothing working in isolation.

There is also a huge amount of confusion about hip/groin/lower back pathologies.

Gluteal Tendinopathy usually causes pain towards the outside of the hip. Also attributed to this condition are muscular stiffness, and/or loss of strength in the hip musculature. Click on link for more information.

Iliopsoas Bursitis (or Iliopsoas tendon inflammation) is – despite the iliopsoas being a deep hip muscle complex – often felt as deep groin pain.  A bursa is a small sack of fluid which reduces friction between tendon and bone. Symptoms can include a snapping/clicking/catching sensation may be felt in the hip. Pain and stiffness ( which can be front of the hip, groin, gluteal or even knee) may be worse in the morning, and sometimes eases as the body gets warmed up, but then worsens as activity increases.

Tronchanteric Bursitis is another lateral (outer) hip pathology, where inflammation of a sac filled with lubricating fluid, located between tissues such as bone, muscle, tendons, and skin, that decreases rubbing, friction, and irritation”. Often, but not always, associated with an acute incident such as a fall. It is considered a compression issue, and so traditional stretches may be antagonistic.

Femoroacetabular impingement (F.A.I.) is a hip condition that will often give you pain deep in the hip socket, and it’s typically made achy after activity. It is caused by a bony deformity of the hip socket, such as a Cam or Pincer (see image). It often reports fairly non-specific – it can cause pain in the groin, front of thigh/hip, and gluteal area. You might also feel a pinching/clicking sensation in your groin, and it can be uncomfortable getting up from a seat – anecdotally, an almost ever-present complaint seems to be moving the leg out of a car.  These – and labral tears, see below – are very often misdiagnosed, or missed, with the average time of successful diagnosis being nearly 3 years (1), which is surprising as there are a range of specific, and sensitive, tests.

Hip Labral Tear. The acetabular labrum is cartilage that runs around the rim of your hip joint socket. Its purpose is to make the hip socket deeper and more stable. The labrum can be torn from its attachment, or irritated, and cause pain, clicking or catching. Often, but not always, associated with an F.A.I.

Osteoarthritis (OA) Arthritis is “joint inflammation.” Osteoarthritis occurs when inflammation and injury to a joint cause a breaking down of cartilage tissue. Pain can appear in different locations, making it another difficult diagnosis – it is not unusual to have groin, thigh, gluteal, or knee pain. The pain can be stabbing and sharp or it can be a dull ache, and there is often stiffness. It was previously though that running was causal for OA, but research shows that actually, the opposite is true – “no evidence that running increases the risk of OA, including participation in marathon races, and, in fact, subjects that ran ≥1.8 METhr/d (≥12.4 km/wk) were at significantly lower risk for both OA and hip replacement”.

Osteoporosis is a the weakening of bones, making them more fragile and so more likely to break. It develops slowly – over several years – and is often only diagnosed when a minor fall or acute incident causes a bone fracture.

So as you can see, lots of cross-overs and symptoms which are very similar in a number of pathologies.

As always, when in doubt, seek professional assistance.

REFERENCES

  1. Time and Cost of Diagnosis for Symptomatic Femoroacetabular Impingement | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4555566/
  2. Effects of Running and Walking on Osteoarthritic and Hip Replacement Risk | http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3756679/

N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldn’t be seen as such. They are merely guides to a better understanding of how our bodies work.

For more information please visit www.dc-injuryclinic.co.uk

 

Panaceas & Unicorns

The Oxford dictionary describes a panacea as A solution or remedy for all difficulties or diseases.”

Or, put another way, a;

There is a common theme throughout all of my blogs, the theme being that there is very, very rarely a single cause of injury. There are, of course, exceptions to this, such as being punched in the face, or standing on lego, or even falling off a curb and spraining your ankle. Acute injuries with obvious cause.

However, pain is nearly always a multifactorial experience, with many layers, particularly if the pain has been insidious (with gradual effect over time).

So, of course, the flip side of that same coin, is that there is very, very rarely a single cure for any injury, pain, discomfort or illness.

Now, as someone who works all day every day with people in pain, this sucks! What a world it would be if every time someone walked into my clinic with lower back pain I could just insert a home-made orthoses; if every one with sore shoulders could just foam-roll the pain away; if every headache could just be a quick C-3 high velocity manipulation; if every “tight” hamstring could just be massaged better; if every foot injury just bought new shoes; if every running injury was just given strengthening exercises.

Alas, its never that simple, and so I have to be – see my blog on Evidence Based Practices – cynical of anything that claims to be a miracle cure.

For any intervention to be offered, I fully believe that we must be able to stipulate exactly why this will be beneficial. There are limitations to most treatment modalities and interventions, and so to offer any service, the research must show benefit to the client, or else we get into the realms of an ethical debate; can a service be offered if the research does not support its use?

And why does the research matter?

I met a flat-earther. They told me that the earth was flat.

I said that ‘science’ (studies) believes the earth to be spherical, because we can show this by empirical evidence (level 1 evidence acquired by experimentation), so that is what my beliefs are aligned with.

The flat-earther said that “studies aren’t important” because the earth “feels” flat.

And we got on like a house on fire, because that’s cool!

I do not seek to change anyone’s belief system – see my blog on Placebo – but that does not mean that I wish to advise on anything that isn’t proven to be beneficial.

So, yeah, panaceas are – unfortunately – as real as*

Recovery happens through clinical reasoning; diagnosis as close to correct as physically possible; the most relevant treatment and/or interventions; hard work; and consistency.

* if my daughters are reading this, Unicorns are totally real

N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldn’t be seen as such. They are merely guides to a better understanding of how our bodies work.

For more information please visit www.dc-injuryclinic.co.uk

GUEST BLOG: Do you have time for time? by John Lewis

Nietzsche once said, “He who has a why …. can bear almost any how”.

I spend a lot of time as a Therapist explaining the ‘why’ – but to what extent are people prepared to endure the how? What are the barriers to their adherence? Often, “time” will be one such barrier…

John Lewis is a Life & Performance Coach. He is a member of the Association for Neuro Linguistic Programming, the Association for Coaching and the UK College of Personal Development, taking you on a journey, from where you are to where you truly want to be. 

 

 

 

 

 

 

Here is an abstract from his latest blog, where he expertly looks at the importance of finding time for change;

How often have you heard yourself say that you are short on time? Probably more than you realise. It is no secret that our lives are busy and that we have lots of things on our minds, but does this mean that we are short on time?

We all have 24 hours a day.

It sounds like the most obvious statement in the world, but we all have exactly the same amount of hours in our day. No matter where you live in the world, no matter whether or not you have children, no matter what type of job you have and what hours you work. There is always going to be 24 hours in each and every day.

Sure, some people have more “spare time” than others, depending on their own personal or professional choices. However, it is what you do with the 24 hours within your day that will really make a difference to what you can achieve.

You might not like the idea of getting up early or perhaps using your lunch break or weekends to reach your own personal goals, but if this is the spare time that is open to you, then perhaps that means this time is your window to achieving your goals?

A lack of time is the perfect excuse…

Please click here to read the full article!

You can contact John via his website – www.jlmindsetperformance.co.uk – or via his Facebook page; JL Mindset Performance.

Understanding Your Iron Levels

The nervous system works in two parts; the sympathetic nervous system works primarily in “fight or flight” mode. The parasympathetic nervous system focusses on “rest and digest”.

So, opposites, to a point. You can’t run away whilst resting!

When exercising (or running away!) blood flow is directed to muscles – often screaming for oxygen to keep you going – and so the blood flow to the stomach lining decreases. The body requires iron to transport oxygen from the lungs throughout the body and to muscle tissue, which uses oxygen to create energy. Without adequate iron stores, athlete’s performance suffers.

Iron deficiency is a common cause of tiredness, or overtraining syndrome, particularly in endurance athletes – runners, cyclists, swimmers. Active people are susceptible to iron deficiency for a number of reasons; primarily, iron intake, increased iron loss, inadequate iron absorption. Other factors to consider include menstruation, and internal bleeding.

Absorption
Iron, when eaten, is absorbed (in a state called ferrous) in the first & second section of the small intestine (duodenum and proximal jejunum).

Circulation
In the blood, iron moves about bound to a molecule called transferrin. Transferrin carries iron (in its ferrous state) to the bone marrow and to other organs.

Distribution
Most iron in the body is found in hemoglobin (in the adult male that accounts for approx.2300 mg; in the female, approx.1750 mg). Hemoglobin is the iron rich red blood cells, which carry oxygen from the lungs to the rest of the body (i.e. the muscles, organs, tissues). Once at its destination, it releases the oxygen to permit aerobic respiration to provide energy to power the required activity or function, in a process called metabolism.

Metabolism
Most of this circulating iron is taken up by red cell precursors and incorporated into heme (which is then combined with globin chains to make hemoglobin!).  85% of heme molecules are synthesized in bone marrow, the rest mostly in liver, but almost all body cells possess the ability to synthesize heme (Reference 1)

Storage
There are two storage forms of iron: ferritin and hemosiderin.

  • Ferritin is the main storage form of iron. It is a protein which is released, and it is a useful measure of the tissue stores of iron (in other words, if you are iron rich in your tissues, your ferritin levels will be high). Iron can transfer in and out of this form quickly, which makes it easily accessible, but also means that it goes up in certain conditions, like chronic inflammation.
  • Hemosiderin – made up of ferritin and cell debris – is a  more stable form of iron storage, but is less readily accessible.

Measuring levels is a bit of a minefield, with lots of different markers indicating lots of different levels;

Haemoglobin is a protein responsible for transportation of oxygen in the blood. Normal male levels being between 13.5 and 17.5 grams per decilitre of blood, and normal female levels are 12.0 to 15.5 grams per decilitre of blood.

Haematocrit; this is the volume of red blood cells in blood. It is normally recorded as a percentage; 47% ±5% for men, 42% ±5% for women. The higher the ‘better’.

REFERENCES:

  1. http://fblt.cz/en/skripta/vi-dychaci-soustava/4-metabolismus-hemoglobinu-a-transport-krevnich-plynu/

Achilles Tendinopathy

The Achilles Tendon is a very common area of pain or discomfort. Going back, everything tendon related seemed to be considered “tendonitis” – ‘..itis’ being latin for inflammation. Often, we simply don’t know if the condition is inflammatory or not, and so it is considered a tendinopathy, where the suffix “…pathy” is derived from Greek, indicating a disorder,which is typically used to describe any problem involving a tendon.

The most common cause of Achilles tendinopathy is continually putting too much load on the tendon and not allowing enough time for the tendon to recover and adapt. This can be via;

Training Error – such as an increase in volume, frequency, intensity.

A Biomechanical issue – leg length difference, over pronation, or poor mobility in the foot, ankle and lower leg could be causal factors. Running “form” can also play a role here.

A flexibility issue – When your foot hits the ground the ankle moves the foot up – called dorsiflexion. Any loss of range can increase stress on the Achilles. Dorsiflexion range is commonly lost after ankle injury/sprain or due to calf muscle tightness

A strength discrepancy – Dr Ida Rolf once said where the pain is, the problem isn’t. Whilst the most common villains are usually the 2 calf muscles – gastrocnemius and soleus – something further up the kinetic chain could also be causing compensatory issues.

Symptoms usually begin gradually with onset of achilles pain during or after exercise/running. Over time, the pain becomes more frequent and can even begin to be a problem at rest. Usually the tendon itself is painful if you squeeze it, and you may become aware of swelling or thickening of the tendon. Some report pain first thing in the morning.

However, it can be aggravated by the simplest of things due to its weight-bearing location, and due to the various possible casues; using the stairs, walking uphill, squats, running fast or uphill, and lastly, some massage techniques and stretching! Yes, you read those last two correctly; if you have a tendinopathy that is compressive in nature, stretching will not help (Reference 1)… if you have an inflammatory response, having your sports masseur rub it/friction it for 30 minutes will not help.

Tendinopathy is usually divided into stages – reactive, disrepair, and degenerative.  Depending on which stage you are at, the most important treatment can be load management. This means reducing both tensile and compressive load on the tendon, much like proximal hamstring tendinopathy. Tendons connect muscle to bone and as a result are placed under a great deal of tension during activities that involve the muscle contracting or resisting a stretching force. Every time your foot contacts the ground during walking or running, the body has to deal with an impact force many times your body weight. Strength endurance seems key here (Ref 2).

The P.O.L.I.C.E protocol is useful, but as the condition can persist, ideally a structured, graded rehabilitation procedure of strengthening and stretching the relevant tissues will be discussed, with (potentially) a return-to-play plan put in place.

For more information, please contact Dan@DC-InjuryClinic.co.uk

REFERENCES

  1. https://www.ncbi.nlm.nih.gov/pubmed/22113234
  2. http://yaroslavvb.com/papers/alfredson-heavy.pdf

N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldn’t be seen as such. They are merely guides to a better understanding of how our bodies work.

For more information please visit www.dc-injuryclinic.co.uk

 

Gluteal Tendinopathy

Having written a couple of blogs on “Pain in the Bum”, (see #1 and #2) gluteal pain (gluteal; pertaining to the buttock muscles or the buttocks) is an interesting one as – generally speaking – despite the name, this usually reports, initially at least, as a hip condition…

Gluteal tendinopathy usually causes pain towards the outside of the hip. Also attributed to this condition are muscular stiffness, and/or loss of strength in the hip musculature. Other symptoms can include;

  • pain that is worse when you use the tendon e.g. running, jumping or hopping.
  • pain and stiffness that may be worse during the night or first thing in the morning.
  • pain that is often worse when you lie on your affected hip.
  • The outside of the hip may have tenderness, redness, warmth, or even visible swelling if there is inflammation of the hip bursa (sack of fluid).

Risk factors of the Gluteal Tendinopathy include being female(!) – as females are more at risk in the region of 4:1 – a high BMI, weak hip ABduction (the ability to take the leg away from the bodies midline) and excessive hip ADDuction (the movement of the leg across the bodies midline). It is also seen in high explosive sports and/or a rapid increase in explosive movements, such as plyometrics or HIIT workouts.

It is often mis-diagnosed as Tronchanteric Bursitis, which is an inflammation of a sac filled with lubricating fluid, located between tissues such as bone, muscle, tendons, and skin, that decreases rubbing, friction, and irritation”. The actual cause of the pain is thought to be a combination of pathology between gluteus medius and minimus (Ref 1)

Gluteus Medius (GM) is an important muscle in controlling the level of the hips. The role of the GM during activities such as walking and running is to dynamically stabilize the pelvis in a neutral position during single leg stance. Weaknesses often results in a trendelenburg sign, which is an abnormal walking/running gait where the hip of the swinging leg drops down, rather than raises up. On my Strength & Conditioning for Runners Workshop we spend a good portion talking about the ability to ABduct the hip, and the importance of the smaller gluteal muscles in not only the ability to achieve their primary function, but also to reduce the effects of their opposite movements. We spend a long time looking at effective ways of strengthening this potentially weak link – and it is way more simplistic than the well outdated method of doing hundreds of Clams….

Treating an aggravated tendon such as this is a great example of how stretching and or foam rolling is not the answer. Stretching the glutes can increase tendon compression and in doing so delay recovery and even make symptoms worse. Massage can help relax muscles but we should avoid allowing anyone or anything from applying direct pressure to the painful area. Successful treatment of GT includes, in ascending order, Education, Isometric Loading, Isontonic loading (without compression), Isotonic Loading (with compression) and, finally, graded exposure to explosive, plyometric based loading. This approach was found to have a 78.6% success rate at just 8 weeks (2), whereas corticosteroid injection was less effective (57%).

As always, when I doubt, get it checked out.

REFERENCES

Ref 1 Long et al, 2013 Sonography of greater tronchanteric pain syndrome and the rarity of primary bursitis

Ref 2 Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial, Melloret al, 2018, https://www.bmj.com/content/361/bmj.k1662

N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldn’t be seen as such. They are merely guides to a better understanding of how our bodies work.

For more information please visit www.dc-injuryclinic.co.uk

Elite Athletes ≠ Elite Treatments

Early last year my website lost a Page –  “Electrotherapies”. It would have gone largely unnoticed as, despite my training, qualification and insurance to carry out such treatments, I have never felt comfortable with their efficacy, and so very, very few people will have even realised it was a treatment modality that was on offer. It was far more likely that someone had asked for that specific treatment, and I had gently talked us out of it, in favour of a more effective, and so cost-effective, treatment plan.

This is a good article, by physiotherapist Adam Meakins, looking at where these modalities sit;

“To try and help with this issue Connect Health shared their traffic light system they use to help their physios focus on what should, could, and doesn’t need to be done with patients. A GREEN LIGHT means there is strong evidence that this intervention SHOULD always be done. An AMBER LIGHT means ambiguous evidence so this intervention COULD occasionally be done. And a RED LIGHT means this intervention has no strong evidence of effectiveness and so DOESN’T need to be done”.

The article continues to say that ultrasound has been “red lighted and now removed as an intervention for all MSK conditions”

But wait, here’s a picture of the most expensive footballer in the world having ultrasound treatment on his injured foot. So if you have foot pain, this MUST be the best treatment, right…?

A quick scan of some research;

“There was little evidence that active therapeutic ultrasound is more effective than placebo ultrasound for treating people with pain or a range of musculoskeletal injuries or for promoting soft tissue healing”

https://www.ncbi.nlm.nih.gov/m/pubmed/11444997/

——————————

“No high quality evidence was found to support the use of ultrasound for improving pain or quality of life in patients with non-specific chronic LBP.”

https://www.ncbi.nlm.nih.gov/m/pubmed/24627326/

——————————

This is an interesting one which found;

“A significant improvement was noted when the effect of continuous ultrasound was compared with rest, but continuous ultrasound treatment was not significantly better than placebo ultrasound.”

https://www.researchgate.net/…/19967762_A_comparative_study…

…..where “continuous” ultrasound was 2 appointments per week for 6 weeks, and still no better than placebo!

That’s gonna cost.

——————————-

Which is where I sit in conclusion; I understand why elite sports teams use these modalities, as money is – seemingly – no object and there are a lot of hours to fill in the life of an injured athlete, so why not? There seems to be no negative effect…

At least not for the athlete – the negative effect can be that weekend warriors, gym goers, even chronic pain sufferers can get caught up in expensive, long term treatment plans that simply don’t make sense, because we correlate elite athletes with elite treatments. Taking into consideration hugely important factors such as time constraints, money available, psychological and sociological factors there is always a better option.

Here is another article looking at why exactly you will see these treatments carried out in elite sport, but why that doesn’t make it the correct treatment for us, non-full time athletes;

Thoughts welcome

N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldn’t be seen as such. They are merely guides to a better understanding of how our bodies work.

For more information please visit www.dc-injuryclinic.co.uk

Sportive Bike Riding

Based here in Swindon, on the edge of the Cotswolds, we are blessed locally with numerous annual Sportives, over a wide range of distances and terrains – from road to cyclo-cross. Sportives are great ways to ride new roads without having to spend hours route-planning (or risking getting lost, inadvertently turning your 20 miler into a 40 miler!), and they are great fun for those looking to ride in a big group – and of course there’s also the huge sense of achievement at the end!

Depending on your goals, there are a few ways to make your long hours on your bike more comfortable. Incorporating other forms of training (cross-training) will be beneficial to your cycling, but naturally you will want to spend the majority of training in the saddle. There are plenty of good, generic strength and conditioning for cyclists articles to be found, such as this one on the TrainingPeaks website. Ideally, knowing your current strengths and weaknesses can isolate a more specific approach.

Phil Burt, Lead Physiotherapist for Great Britain Cycling Team advocates sports massage as part of the training protocol saying “A regular, say monthly, appointment with an experienced soft tissue therapist can be useful as a body MOT and can help identify areas of tightness or concern”, which in turn can lead to a more specific approach to your training.

It is a good idea to get your bike checked over, pre-event, to ensure it is in working order and so there is less chance of you having mechanical issues on the day. Whilst there may be mechanics on course, it will effect your enjoyment of the day, so learning the very basics (such as how to use your puncture repair kit) can be beneficial. Locally, I can recommend Run&Repair for bike maintenance.

A big factor effecting your enjoyment on the bike is of course how comfortable you are on the bike; this is effected by your bike position, the clothing you are wearing and your cycling history. I advocate a 3-step integrated process, devised to harmonise Man and Machine.

STEP 1 – Musculoskeletal Screening: Identify common musculoskeletal and biomechanical deficits and imbalances highly prevalent in cyclists.

STEP 2 – Rehabilitation and/or S&C Plan: Address aforementioned musculoskeletal and biomechanical deficits, with tailored, bespoke exercises and stretches.

STEP 3 – Discipline Specific Bike-fit: Incorporating the aforementioned musculoskeletal and biomechanical deficits, discipline specific adjustments of the bike take place, designed to maximise your position within the ‘3 Pillars’;

For many years, bike fitting has been the domain of the bike mechanic, but research suggests time and time again that it is in fact the clinicians perspective which can be most valuable. For full details of what I offer – see here.

The keys to successful training are like in any other sport;

  •  try to increase the amount you are doing gradually.
  • The sooner you start your training and more time you have to train, the greater the progression you will make before your event.
  • Try and incorporate some group rides into your training, as riding in a group is a good skill to learn before an event with people around you.

Let me know how you get on!

N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldn’t be seen as such. They are merely guides to a better understanding of how our bodies work.

For more information please visit www.dc-injuryclinic.co.uk