The Subtle Art of … Listening

Theologist Professor Henri Nouwen once said that “anyone who willingly enters into the pain of a stranger is a truly remarkable person”. Whilst I wouldn’t take that plaudit too literally (did I just dislocate my shoulder patting myself on the back? *facepalm*) I do think that Healthcare professionals are a special breed.

We are helpers. We are carers. We are fixers.

The phrase “righting reflex” is sometimes used to describe something that happens quite commonly during traditional advice giving, particularly in the Therapy setting. It is the tendency to identify another person’s problem, and immediately try to fix it. There is a sad truth that people can sometimes be indifferent or ambivalent about change, regardless of current situation; they see the arguments both for and against change and have often heard the logical arguments in favour of change many times before. Have you ever started a sentence, or thought process, with “Yes, but…”?

With the best intentions of the Therapist always in mind, this “righting reflex” can inadvertently cause the person to focus on all the reasons not to change. This is called “sustain talk”.

Motivational interviewing (M.I) relies on using the other people’s own reasons to change. It suggests that ambivalence about change is a completely normal human reaction, and is often a necessary step in the process of change.

M.I encourages clinicians to work with patients’ ambivalence rather than viewing it as a problem. The more people hear themselves talk about change, the more likely they are to do it.

It also aims to encourage the patient’s autonomy in decision making

HOW DOES IT WORK?

There are a number of theories for how and why motivational interviewing works. Self-determination theory states that people are more likely to change if three basic needs are attended to;

  • Autonomy in making decisions – “do I want to do this?”
  • A sense of their own competence in making the change – “can I do this?”
  • Relatedness – are they being supported by key people around them (including healthcare professionals)

Another theory is that when patients hear themselves (as opposed to the therapist) speaking about change, then their motivation improves and outcomes are better.

LISTENING

Mary Lou Casey once said “What people really need is a good listening to.”  

Philosopher Albert Schweitzer stated “Each patient carries his own doctor inside him.  We (Therapists) are at our best when we give the doctor who resides within each patient a chance to go to work” 

How true these 2 statements are combined.

The intrinsic motivation to do something must be more than the perceived risk – it is the therapists job to find that motivation, not to simply criticise any lack of compliance.

As this paper – Barriers to treatment adherence in physiotherapy outpatient clinics: A systematic review – says; “…therapists should be concerned about the attitudes, beliefs and barriers facing their patients and act collaboratively with their patients to design realistic treatment plans which are customised to the patient’s life circumstances…”

I have always said to people in the room with me (be that 1 on 1, or 100 people at a seminar) that you always have all the pieces of the answer, you just, perhaps, don’t know how to order them yet.

What we Therapists do is rearrange those puzzle pieces into a coherent picture, which makes sense to you. But you complete the puzzle – it is your picture.

Once that picture makes sense, I cannot over-emphasise how empowering that is.

One more quote – as Psychologist Carl R. Rogers once said;

“The curious paradox is that when I accept myself just as I am, then I can change”

N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldnt 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

The Rise of The Video Consultation

What does a video consult include?

I realise that for many people who have been conditioned to ‘rely’ on manual therapies, the thought of a virtual appointment can seem almost laughable. How is someone going to rub your calf better for 6 weeks through a screen?

I have always believed – and openly stated in rooms full of large numbers – that the most important thing that we therapists do, is not

X the massage

or

X the manipulations

And, the truth is, your calf pain would have reduced over 6 weeks with or without the weekly rub down. It is a brutal, but necessary truth, and the reason I have never advocated this approach. 

That is not to say that it would have optimally healed without a Therapists interventions.

But the key to successful rehabilitation – of all pain –  is, and always has been:

⇒ Advice

⇒ Reassurance

⇒ Guidance

⇒ Empathy (and a listening ear)

and

⇒ Education

All of these things can be done via video or phone.

During a video call, I can see you move; I can see you locate your area of pain; I can see you recreate the pain (I do not need my elbow to do this 🙂 ). I can see first hand movements which you can, and can not do.

But more importantly, I can hear you describe your pain; allow you to tell me about your limitations and fears; listen to your history, and your story; and I can advise about what you shouldn’t and – more importantly – should be doing to self-manage.

By sharing screens, I can show you my exact thought process of what your symptoms sound consistent with. I can show you, through video links which I can talk you through, exactly how and why you will get better.

As soon as the call ends, you will receive a completely GDPR (confidentiality) compliant email, with your bespoke Rehab plan, with exercise videos, and individualised reps/sets etc.

Now, more than ever, physical activity is vital to maintain our health. There is no need to be at home frustrated, scared, or feeling at a loss because of your pain.

Movement is medicine.

Advice is key.

Please do contact me (Dan@DC-InjuryClinic.co.uk), or Share with someone who may be suffering. Your support at this time is very much appreciated.

 

Running Biomechanics Analysis

A running biomechanics analysis can form an integral part of evaluation – either for/of the injured runner or for screening for injury reduction – but should always be complemented by a physical examination and thorough history taking (1).

Research shows that for treadmill analysis, an acclimation period of 6 to 10 minutes should be used before video evaluation, as studies have identified changes in kinematics deviating from normal running mechanics with treadmill running up to an initial 6 minutes (1). It is also important consider the nature of symptom provocation in an injured runner. Essentially, if a runner experiences symptoms after a number of minutes or miles – for example between 2-4 miles – it may be necessary to acquire video with the runner in a fatigued state, after a period of running and consistent with their symptom history.

As is common with most things running related, the way in which we as runners adapt our gait patterns to run on a treadmill are entirely individual, and specific to the runner (2). Changes in posture (body position), cadence (leg turn-over), strike pattern (heel-forefoot-toe), upper body motion (rotation etc) are all fairly common when comparing an athlete running on a treadmill versus outdoor at the same pace (although it is worth saying that some runners will show no major change across the two surfaces!). Again, time is an important criteria here.

To combat these 2 hugely important points, running analysis sessions at DC Injury Clinic require a minimum of 30 minutes of running on a treadmill, at a series of paces (ranging from walking to 5K pace).

However, before you get on the treadmill (or ‘dreadmill’ 🙂 ), using years of biomechanical assessment experience, a series of running specific tests – both biomechanically and physiologically – should be carried out, designed to highlight areas where either restrictions in mobility (or more importantly, a lack of control over the available mobility) and/or strength could potentially be contributing to inefficient running and injury/pain. This part will look at:

  • Ankle & Lower Leg strength & mobility
  • Knee Assessment
  • Hip strength & mobility
  • Pelvic strength & mobility
  • Upper body mobility
  • Balance & coordination
  • Spirometry Test (used to help monitor lung condition and capacity)
  • Pulse Oximetry Test (measure of how much oxygen your blood is carrying. Having a very low blood oxygen level can put a strain on your heart and brain)
  • Blood Pressure Test

From here, we move on to the active assessment, on the treadmill!  Using the latest technology, this part looks at:

  • EMG (Electromyographical) testing seeing objectively which muscles you utilise – see below image
  • Initial contact point
  • Stride length/pattern
  • Upper/lower leg rotation and cross-over
  • Hip Extension & Pelvic Tilt
  • Hip drop &/or Hitching
  • Upper body & Arm Movement/Rotation
  • Cadence (step frequency)

EMG Data

This is a full body video gait assessment, and is a great opportunity to help find ways to reduce chance of injury risk and increase performance. Whilst there are no panaceas, this will provide us with clues as to how you can make yourself a stronger, faster and more resilient runner, and so is ideal for the new runner or the experienced runner.

Once we have accumulated all relevant data from the above 2 stages, we will discuss a bespoke plan to address any issues which may have been apparent. You will also receive this in writing after your appointment as this is fundamentally the most important part – what you can do.

Not your therapist. Not your coach. Not your equipment.

You.

For more information, or to book an analysis, please contact Dan@DC-InjuryClinic.co.uk

REFERENCES

  1. An Evidence-Based Videotaped Running Biomechanics Analysis | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4714754/
  2. A kinematic comparison of overground and treadmill running | http://www.ncbi.nlm.nih.gov/pubmed/7898346

N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldnt 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

Plyometrics, Instagram, and running before we can walk…

I am a relatively late-comer to the world of Instagram (DC_Injury_Clinic, if you’re asking), and it has taken a bit of getting used to. There is some brilliant stuff put out on there, and some – well, bat sh*t crazy stuff. Something that caught my eye very early on, was the huge number of PT’s and gym-goers showing off their amazing ability to box-jump. They can jump, like, really high!

If we are being strict, plyometrics are “a form of exercise that involves rapid and repeated stretching and contracting of the muscles, designed to increase strength” – so exercises that require you to jump, land and then rebound into another jump straight away. So box jumps aren’t technically plyometrics but are a graded exposure to plyometrics – albeit top-end in my opinion. This form of training is governed by the stretch-shortening cycle (SSC) of the muscles utilised – where the muscle undergoes an eccentric contraction (lengthening), followed by a transitional period prior to the concentric contraction (shortening). SSC exists in all forms of human motion and so is important as a training tool for most of us. The benefits include (1);

  • Improved storage and utilization of elastic strain energy
  • Increased active muscle working range
  • Enhanced involuntary nervous reflexes
  • Enhanced length-tension characteristics
  • Increased muscular pre-activity
  • Enhanced motor coordination

Improving these qualities will – somewhat counterintuitively for the stretchers out there – lead to an increase in leg stiffness during contact with the ground, and so force production during the concentric (shortening) contraction. This increase in both leg stiffness and force production will likely lead to improvements in athletic performance.

They are also a key component of latter stage rehabilitation, as rehab is about exposing you to greater challenges in a graded and controlled manner. Plyometrics could be seen as the bridge between rehab and performance – research showing that injury reduction programmes that include plyometrics can reduce lower limb injury by 56%. In comparison, those that didn’t utilise plyometric movements reduced injury by only 26% (2)

So why did I start this blog with Box Jumps? It has always intrigued me how much time we spend learning to explosively jump (bizarrely often sold as ‘functional’), when many of us haven’t yet mastered the ability to land – the ultimate functional movement (think of walking down the stairs, stepping off a curb, coming down a ladder, running!). Approximately 70% of ACL injuries result from situations that do not involve direct contact (3), but are more likely a result of manoeuvres that involve some form of deceleration – for example, landing (4).

I absolutely recommend graded exposure to plyometrics, but they should not be seen as a given for every PT session. I often talk about “earning the right” to perform certain exercise, and plyometrics certainly fit that bill.

If you are not ‘strong’, yet, then we should not be training ‘power’, where;

Strength is the amount of force a muscle, or group of muscles, can exert .

Power is the ability to generate that force as fast as possible.

Focus on the basics first – the fun, Instagram friendly stuff will come.

REFERENCES

  1. https://www.scienceforsport.com/plyometric-training/
  2. Rossler et al, 2014
  3. Boden et al. 2000; McNair, Marshall, and Matheson 1990
  4. Olsen et al. 2004; Cochrane et al. 2007

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

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 and nerves, 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.  If you are a victim of it and feel that prescription medication are not enough to ease the pain, then check out his source, which explains why nerve supplements are better than prescription medication.

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. The outer section of the muscle can be treated quite effectively by the muscle relaxant product from Gelliflex.com, its the inner section, which IS always tricks and requires a much more clinical look. 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 the muscles, often screaming for oxygen, to keep you going. Because of this, 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/