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Acupuncture & Physiotherapy


Training for the Marathon


Snowboarder's Ankle


Swimmer's Shoulder


Ergonomics in the Workplace

In aid of Back Pain Awareness Week: 17th - 23rd October 2005










Reasons to see a physiotherapist

As published in RUNNERS FITNESS March 2005



By Greg Savides

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 in 1993 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.

Musculo-skeletal: 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 (approxiamtely 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 pre-season 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 works at our City Clinic


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.

For more information about the acupuncture services we offer click here.

Julie Gear works at our City Clinic


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:

• Weather
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!

Helen Smith MCSP SRP works at our City Clinic


Snowboarder's Ankle

By Miffy Edlund

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

Miffy Edlund MCSP SRP works at our West End Clinic


Swimmer's Shoulder

By Sonya Crowe

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. Solution: 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. Solution: 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. Solution: 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. Solution: 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.

Sonya Crowe is a physiotherapist at our City Clinic.


Ergonomics in the Workplace

By Julie Gear

In the year 2000 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!


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 counselors and stress management practitioners who can help with dealing with stressful situations.


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:

o Advance seating designs (chairs) www.asd.co.uk

o Osmond Group LTD www.ergonomics.co.uk

o Posturite (UK) LTD www.posturite.co.uk

o Status Seating (chairs) www.statusseating.co.uk

o Vitra (chairs) www.vitra.com


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

Julie Gear MCSP SRP works at our City Clinic



By Sonya Crowe

Did you know?
There are 58,185 netball participants registered with England Netball
Statistics courtesy of Sam Castle, England Netball. www.englandnetball.co.uk

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.
* Prioritise 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.

Preventing knee injuries …
Much research has been conducted into preventing knee injuries in netball, including changing of the ‘stepping rule’ to allow players an additional step before stopping abruptly, which was not found to effectively reduce forces about the knee joint. Co-contraction of the quadriceps and hamstring muscles may also assist in increasing knee joint stability. Recommendations currently made by health professionals and experienced coaches to avoid knee injuries are as follows:
* Develop and maintain adequate eccentric leg strength. This can be done using simple ‘closed chain’ exercises at home or in the gym. Examples are 1/3 depth squats, lunges and step downs, which should be performed with foot angled straight ahead, the knee lowering in line with the 3rd toe and not going past the foot.
* Always pivot ‘outwards’ as catching the ball. Try this: running to the left, land and ground the left foot, running to the right, land and pivot on the right foot. This reduces the ‘valgus’ or ‘inward’ forces on the bent knee, thereby reducing the risk of injury to the cruciate and medial ligaments.

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!

Sonya Crowe is a physiotherapist at our City Clinic.




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 wetsuit.
* It is important that you swim in your wetsuit before race day.
* The wetsuit 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 wetsuit 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.

Helen Smith works at our City clinic

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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.

Helen Smith works at our City Clinic

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By Therese Nilsson

It is springtime again and for many people this means it is high time to start working in their garden. 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.

Therese Nilsson works at our clinic in Cheam

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Reasons to see a physiotherapist

By Greg Savides MCSP SRP

As published in the March 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.

Greg Savides works at our City clinic

As published in the March issue of RUNNERS FITNESS


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