How can I reduce fatigue?

Fatigue is both a physiological and psychological response to exercise, so how can we help prevent it? Fatigue comes in two forms central and peripheral. Central starts in the central nervous system and works to reduce bodily harm and peripheral is the failure to maintain output such as a depletion in glycogen and occurs in the muscle itself. However, the exact chain of events leading to both is not determined. For most athletes’ fatigue is fatigue no matter where it originates and will affect performance if not managed properly.

How to we prevent fatigue?

First, having a good training program with appropriate periodization is a good start. Factoring in the individual, prep phase, specific prep, competition, travel, injury and personal beliefs. If you are an athlete who has a “season” this is fairly simple. If you’re an athlete with various events throughout the year, it’s a little more complicated. My advice with training is to seek the advice of a coach. This doesn’t always have to be in person, there are many coaches online (especially running ones) who can put together training plans and help you reach your goals.

Second, make the most of your post exercise routine. This is where things can get complicated. With regards to fatigue there are a variety of ways to help from active recovery, massage, cryotherapy, compression garments etc. In this systematic review it was found that all of those reduced perceived fatigue. Inflammation was best combat with massage and cold exposure.  Note, please, that there have also been studies stating the opposite. For instance in this study it notes that cryotherapy is no better than active recovery for reducing inflammation, this could save you a few quid in the long run.

As a note, it has been found that active recovery at a moderate intensity is likely better than just resting. This is due to better blood flow and lactate distribution.

In my opinion, active recovery is the best place to start, for instance, after a long run or hard session have a brisk walk or brisk bike ride. No pressure, no clocks, nothing. Just you and the open air. This also works after a difficult event as well, I find if I walk after a marathon I’m not as sore as I am when I don’t. If that doesn’t help, sit in a cool tub (10C) for ten minutes, another cheap option to try.

If you still feel sore or tired book in for a massage. Obviously, prices range on location and experience, but booking in for a one-hour session will at least help you decide if it’s for you. Compression garments may also be a good investment. I won’t lie, I use mine after long runs and after marathons. Yes, this is likely only reducing perceived fatigue and therefor may not work for everyone.

Fatigue can also stem from stress or a lack of sleep, so if you’re not sleeping properly, you’re not going to recover from training properly. If you are having trouble sleeping you can try a variety of  methods to see if they help. If not, speak to your GP and get appropriate advice. 

And don't forget the importance of nutrition. If you are not eating enough to eat you will not have the energy to compete. This has been a focus recently in the news, so make sure you are eating appropriately and if you are not sure, seek the advice of a dietician.

Recovery can be a very personal thing for each athlete and it is important to find what works for you.

Is whole body cryotherapy worth the hype?

Short answer, Not really. I’ll explain further.

Cryotherapy is a method of recovery which is done by lowering the skin temperature of the body. Some of the most common modalities are ice packs, ice massages, gels and cooling creams. Recently whole-body cryotherapy (WBC) chambers have been introduced to high level foot ball and rugby teams. But is this new, and costly, method really the best way to enhance recovery through cryotherapy?

I hit the research hard. One of the first studies I found from Hausswirth, el al (2011) claims the benefits of WBC on highly trained runners. One large flaw in this study is that the other modalities involved were far-infrared (not a highly reliable modality) and basically sitting in a chair for ten minutes. These two “sham” modalities would, of course, show that WBC is a reliable way to recover after running.  It’s studies like this that make me angry. They manipulate the data by introducing two modalities they know won’t work to “prove” that WBC is reliable.

Other research I won’t even mention here were studies paid for and sponsored by companies that make WBC chambers. I don’t give research like this the time of day. Many involve manipulated data to sell a product to teams that can afford it.

A more recent study by Viera, et al (2015) studied the effect of WBC on a vertical jump after high intensity training by placing participants in a chamber at the suggested -110 degrees for 3 minutes and a control temperature of 21 degrees for the same time. In this study there was no significant difference between the WBC and control group. Thus, suggesting that some of the “benefits” of WBC are possibly due to the placebo effect. 

One of the better studies from Holmes & Willoughby (2016) looked at previous studies and compared WBC to cold water immersion on recovery and skin temperature. One of the claims of WBC is that the extremely cold temperature is more effective at lowering the skin temperature than other modalities. In this study participants used a WBC chamber at -110 to -120 degrees for 2-4 minutes and cold-water immersion at 8-14 degrees for 5-10 minutes. The results showed that using cold water immersion lowers the skin, muscle and core temperature more effectively than WBC. The study suggests that further high-level studies on WBC be performed to confirm their claims.

My personal opinion is that WBC is very expensive and some of the membership rates are well over £100 a month. Most people would not use the WBC more than once or twice a week, making it a very expensive means of recovery. Plus, it means coming home from your run or workout, getting in the car, driving to a centre, going in a chamber for 3 whole minutes then driving back home. A lot of effort when you can simply fill your tub with cool water once you get home and sit and chill in it. Studies are not conclusive of its claims, and with that kind of cost, you may be better off buying a gym membership or hiring a personal trainer.

However,  saying that, its definitely worth trying. I will admit though getting a snapshot of yourself in the mittens, slippers and headband in a chamber is pretty cool, but unless it works for you, it’s just a lot of money for cold air.

If you have any questions about sports therapy, sports injuries and cryotherapy please feel free to email me sara@prestigesportinjury.co.uk

Who do I see, a graduate Sports Therapist or a Sports Massage Therapist?

Often as a graduate sports therapist I get mistaken for being a Sports Massage Therapist. It’s a tad frustrating as having completed a three-year BSc it’s safe to say I’ve had a significant more amount of educational and in-clinic training than a Sports Massage Therapist/Soft Tissue Therapist.

So, what’s the difference?

Sports Massage Therapist/Soft Tissue Therapist:

A Sports Massage/Soft Tissue Therapists will have the scientific knowledge of and manual therapy skills to address specific of soft tissue injuries, their function, and the result of manual therapy on injured and uninjured tissues. They will have experience in anatomy, principles of health & fitness, principles of soft tissue dysfunction, sports massage treatment

Sports Massage is a Level 3 course focusing on injury prevention and performance enhancement through manipulation of the muscles, ligaments and fascia (debatable – will blog about next year).

Most high-quality Sports massage courses will be ITEC/BTEC/VTEC Level. Many Sport Massage/Soft Tissue Therapists are registered with the Sports Massage Association of as part of the Complimentary and Natural Healthcare Council. However, there are other bodies they can be members of, and there is no statutory requirement.

It is also important for the therapist to have attended a course approved by a professional body above, as there are many "fast track" courses out there which are not always providing quality courses.

Here is a brief summary of ITEC/BTEC/VTEC Levels:

3: Sports Massage Therapist - qualified to work on non-injured tissue.
4: Sports Massage Therapist - qualified to work on injured tissue
5: Sports Therapist/Massage Therapist - qualified to work on injured tissue, recognise sports injuries and prescribe rehabilitation exercises
6: Sports Therapist (can be diploma or graduate) - qualified to do all the above and diagnose soft tissue injuries using clinical reasoning.

Graduate Sports Therapist:

First, the title of sports therapist is not a protected title, so you’ll find most of us who are graduates us the term “graduate sports therapist” or put our degree qualifications on all our paperwork.

I’m not going to get into the nitty gritty of who is better a  diploma or a graduate sports therapist as it depends on the practitioner not the qualification.

Diploma level 5 sports therapists often do courses on the weekend with coursework and exams during the course process and graduates spend 3 years developing the required skills while being assessed throughout.

A graduate Sports Therapist will have an undergraduate diploma and would have completed a course verified by one of the sports therapist professional bodies: Sports Therapy Association, Society of Sports Therapists or the Sports Therapist Organisation. There is no statutory requirement for regulation, but it’s best to find someone who is registered with one of these professional bodies to ensure they are practising at the correct level and attending CPD courses.

Graduate Sport Therapists focus on the assessment, diagnosis and rehabilitation of soft tissue injuries. While courses may vary, a graduate Sport Therapist will have courses in anatomy, ethics, biomechanics & gait assessment, fitness testing, injury prevention, sports massage, clinical assessment and decision making, advanced manual therapy, sports nutrition and first aid/sports trauma skills.

Both professions are helpful for people who participate in sport and need to have appropriate insurance for their profession. Both can provide sports massage for recovery, but only Level 6/Graduate Sport Therapists can assess and diagnose injuries using clinical reasoning, and Level 5's can recognise sports injuries and prescribe appropriate rehabilitation exercises. This becomes very important if you have an injury as Level 3 Sports Massage/Soft Tissue Therapists should not be working with injured tissue, diagnosing injuries or prescribing exercises.

Sadly, many CPD providers are teaching techniques which are beyond the remit of lower level qualifications. This can cause problems for the therapist as they will likely not be insured for those techniques, and therefore, should not be using them in their practice or advertising them on their website.

It is important to know the qualifications of your therapist, if you're not sure just ask them. They are not always noted on their website and some therapists may be advertising abilities beyond their qualification level. If you're looking for a non-injury related sports massage a Level 3 will be suitable, however if you are having pain or are injured you should book in with a Graduate/Level 6 Sports Therapist for an assessment and rehab program. 

If you have any questions about sports massage and sports therapy, please do not hesitate to email me: sara@prestigesportinjury.co.uk

Are the "Jack of all trades" all they're made out to be?

So what's better someone who is a "jack of all trades" or a specialist?

I began asking myself this question as I pondered over the variety of CPD courses I could take over the next year. Do I expand my portfolio into coaching or perhaps a personal training qualification? There are many options for sports therapists and other therapists out there to choose from. But what is best?

My dad used to say he could fix anything except the crack of dawn and a broken heart. And I reckon he could, except for a vacuum cleaner once. He was a skilled mechanic and, even though he had no degree, an excellent engineer. He used his decades of experience to fix cars, planes and pretty much anything with an engine. He had skills that could translate to other areas without changing his occupation. And for me his advice led me to the decision to expand my sports therapist skill set rather than take on a new skill.

I have a tiny aversion to people who try to do everything all the time. I think it's great that they're ambitious, but to me it just means that some skills may be lacking or not fully developed. For example, if you train to do osteopathic techniques, hypnotherapy and personal training is it possible to stay highly skilled in all those areas without letting one slip? We are all allotted the same 24 hours in a day, but I can't imagine anyone is using all their skills all the time or even giving each skill the same amount of work.

Some skills work well together such as sports massage, acupuncture, mobilisations/manipulations, strength & conditioning and rehabilitation exercises. Those are skills that can be used in a variety of settings and can be honed, in some cases, at the same time. But other skills would require a different setting or in some cases could cause a conflict of interest.

I once came across a rugby club whose coach was also their physio. To me this is a blatant conflict of interest as he had no way to separate his desire for his players to play and his need to think of their health and welfare. There were many players that should not have been playing that day, but still did even after suffering concussions. I feel the same way about personal trainers who also do sports massage or sports therapy, and continue to be a personal trainer. Is it not feasible that one could make their clients work out harder than prescribed so they're sore and then suggest they see them for a sports massage? I'm not saying these things happen, but these are the things I think about when deciding my own CPD pathway. Could my clients perceive a conflict of interest in what I do?

For me the welfare of my clients is the most important part of my clinic. This means providing them with quality, knowledgeable information with regards to sports injuries and ways to treat their injuries. So this is where I will focus my future CPD endeavours.

I have already attended a Movement Screening & Strength Training for Runners course in order to provide my running clients with better analysis and techniques for their rehabilitation. And the best part about this course is that the instructors (both physios) had specialisms. One is a hip/running specialist and the other is a strength & conditioning specialist.

I am also a firm believer in the referral. If a client comes in and I feel acupuncture might help or perhaps they would like advise on a personal trainer I am happy to refer to other professions. I think it's important to collaborate with other sport injury professionals so that we can all provide the best care with the best techniques for our clients. If an injury is out of my skill set I have a responsibility to refer onwards.

So, why be a "jack of all trades, master of none" when you can be the best sports therapist, osteopath, chiropractor, physiotherapist, sports massage therapist or personal trainer that you can be for your clients!

If you have any questions on CPD, sports therapy or conflict of interests  please feel free to email me on sara@prestigesportinjury.co.uk

Can sports injuries really be prevented?

As a sports therapist reducing the likelihood of an injury is just as important as injury diagnosis and rehabilitation. As stated above, no injury is 100% preventable there are guidelines that we can follow to attempt to reduce the likelihood of an injury occurring in any given sport.

The first rule is to know your sport. This seems like a no brainer, but it is important to understand the biomechanical, external and internal factors that exist within any given sport. For instance, I work with a local rugby team so a variety of players will be sprinting, tackling, scrummaging and rucking on an outdoor surface in a variety of weather conditions.

When identifying risk factors, we must first look at the athlete(s) internal risk factors such as age, gender, body composition and fitness level. In my sport the risk factors associated with a forward will be very different when compared with a back. There are modifiable (body composition, fitness level) and non-modifiable (age, gender) risk factors. When targeting any intervention, we need to look at both factors. Modifiable risk factors such as fitness level can be improved, and thus keep the player from sustaining injuries due to exhaustion. Non-modifiable risk factors such as age, cannot be changed, however, we can use methods to help reduce the risk of injury (see later below).

The next risk factors to identify are external risk factors such as playing outdoors or on a court. If participating in sport out on a pitch when it’s been very dry can be very different then when it is very wet. Knowing how to adjust your interventions will help keep your players safe. In my experience I’ve had players sprain their ankles on hard ground more than soft. And the likelihood of injury when tackling or jumping is increased.

The final piece is knowing the mechanism of injury (MOI). This is learned through experience and research. For a sports therapist it is often the MOI that is the key to what the injury likely is. As before with ankle sprains the key note is a plyer will tell me “I rolled over on my ankle”. I then perform the normal ankle joint, muscle, ligament and special tests to confirm my diagnosis. But this is also useful with overuse injuries. For instance, an athlete might tell you “The pain has become worse over time” or they’ll not no actual injury incident occurred.

As a sports therapist involved with team sports we need to map all the risk factors and MOI’s and use a variety of techniques to reduce the likelihood of injury, which may include the following:

Warm up: A simple warm up plan may reduce risk to injury by 50%. And while there is little research on the duration or intensity of a warm up it is best to allow the players to determine it individually. Some benefits of a warm up include increase ROM of joints, relaxation and concentration and speed of nerve impulses and a decrease of muscle stiffness. All those factors that can potentially reduce the risk of injury, especially in older players. A very good example of this is the FIFA 11+ program which uses a structured warm up of 10 exercises 1-2 times per week and has been proven to reduce injuries in football.

Taping/Bracing: In rugby we use tape frequently. It is often used to restrict undesired movement such as inversion of an ankle or to protect the acromial clavicular joint from injury during tackles. This often applies to players returning from an injury after a thorough rehabilitation program.

Protective equipment: This includes helmets for cycling or horse-riding and mouth guards for collision sports, common sense really!

Suitable equipment: It is imperative that your athletes are wearing appropriate equipment, even for running. A trail runner will not be wearing the same trainers as a road runner or sprinter. It also includes ensuring racquets for tennis or squash are of the right grip size otherwise an athlete may over grip the racquet and incur an overuse injury.

Recovery: This is the biggest issue I see in my clients. It is important to allow your muscles to recovery after any strenuous activity. The can include using active recovery and walking for ten minutes after a hard run, using cold water immersion, massage and eating properly after exercise.

When starting a new training program, it is advised to get appropriate advice from your GP first, then a professional such as a sports therapist or personal trainer for exercise guidance. Graduate sports therapists can perform an injury prevention screening which uses functional tests to measure any biomechanical dysfunction and if any adjustments are required, will issue you exercises, stretching or other methods to help improve any dysfunction. After a screening it would be advisable to see a personal trainer to introduce you to exercises at the proper level of your fitness.

Sports therapists can also perform sports massage which is an excellent way to recover after hard training sessions.

If you have any questions about injury prevention or other services that sports therapist can provide, please do not hesitate to contact me.

Sara Green, Sports therapist, BSc (Hons)

sara@prestigesportinjury.co.uk

www.prestigesportinjury.co.uk

Don't let back pain be a pain in the you know what!

Low back pain is one of the highest complaints I get in the clinic. Sometimes from my rugby players, sometimes from new clients. Many clients think that they need to rest, but, mobility is what will keep back pain at bay. If one stops moving the muscles will weaken and tighten, restricting movement further.

Below are some ways to help ease your back pain:

Get those endorphins going! Natural endorphins in the body can be as strong as pain medication and help block pain signals from reaching the brain. Endorphins also help ease anxiety, stress and depression. Some great ways to release your endorphins is to participate in cardio exercise, massage therapy or meditation.

Sleep. Yes, I know that back pain can help cause sleeplessness, but this same lack of sleep can make pain and make treating pain difficult. To help get you to sleep be sure the room is quiet, turn off all the lights and put your phone away from you. Quiet meditation before bed can then be added to help you drift off to sleep. I recommend the head space app to help you on your meditation journey.

Strengthening your back and “core”. Now I hate the word “core”, mainly because most people just think of their abs. But the “core” is also you low back muscles. You can start working on it very simply by sitting upright on a stability ball, the key is to start off gently then progress further. Pilates is also very good for strengthening the low back and abs.

Ice/Cold therapy. Use cold for inflammation, as the cold will slow down the nerve impulses and stop spasming. Use heat to stimulate blood flow and reduce the pain messages being sent to the brain. You can use a hot bath or hot water bottle to ease the pain.

Get those hamstrings stretched! Sometimes the cause of back pain is tight hamstrings which can cause tightness in the entire posterior line. I have a video on my you tube channel to help you ease hamstring tightness.

Keep the back moving. Easy slow paced exercises to continue mobility are a must and should not be painful.

Participate in activities that make you happy. This might be a slow walk in the woods or a nice cup of tea.

When it comes to back pain the first rule of thumb is to seek some form of treatment. It is important to have your back pain assessed to ensure it is not a serious condition, so a visit to a sports therapist or physio is imperative. If your pain is not serious and can be managed through exercise, as approved by NICE, then a mobility and strengthening program will be a great way to start. If you find your pain has become chronic, there are pain coaches who may also be able to help.

If you have questions about back pain or have any questions about how mobility and exercise can help please email me at sara@prestigesportinjury.co.uk