Tag Archives: rehabilitation

Sitting down to help reduce falls and fractures.

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Falls have been a big topic since people can have their lives change forever should they break a hip or dislocate a shoulder or anything similar.  Falls are the commonest cause of injury-related hospitalisation in persons aged over 65 years, accounting for about 30% of all medical emergency admissions. Women are 3x more likely to fall than men, and in the elderly, are also more likely to be osteoporotic making the chance of a fracture higher.  I find all this information concerning.

You can get advice on controlling falls that ranges from eating dietary supplements to performing balance training to wearing protective clothing to protect points where a fracture might occur.  One thing that I have noticed hasn’t been given that much attention is that often people lose the ability to sit with control at a relatively young age.  If you can’t control how you sit down then there is a bigger chance of slipping sideways off the chair or falling backwards than there would be if you sat with control.

The 1 minute squat test is a good way yo see how fit a person is but there is the assumption that the person is getting up and down correctly which might not always be the case.

1 MINUTE SQUAT TEST

Stand in front of a chair, feet shoulder-width apart and squat down to lightly touch the chair before standing again. See how many you can do in one minute. Make sure the chair is low enough so that it allows your hip bone to drop a fraction below your knee.

Superfit: More than 60
Fit: 40-60
Barely fit: 20-39
Unfit: Less than 20

Sometimes it’s better to start , without worrying about the time limit, and see if you can perform a chair squat with good form:

Chair Squats:

Stand about 2 feet in front of a chair, hinge forward at your hips, torso leaning slightly forward (45 degree angle), bend hips, knees (knee caps tracking over first and second toe) and ankles congruently, move hips back and down toward the seat pan (sit bones barely touch the edge of chair), arms crossed in front of chest, brace your core. Stand up fully (shoulders and hips level).

Now if you want to progress there are lots of variations but one that I like best is to start performing goblet squats which can be a precursor to performing back squats.

Goblet Squat 

The few coaching cues involved in the goblet squat more than suffice to get the job done:

  • Hold a weight against the chest.
  • Position your feet so your stance is a smidge outside shoulder-width, with your toes pointed slightly out. If you’re taller, you may need to widen the stance a little more.
  • Sit back and down between the knees, keeping your chest up the whole time. Make sure you’re not falling forward or rounding your back.
  • Go down as low as you can while keeping your feet flat on the floor. If your heels come up, your stance is still too narrow.
  • At the bottom, brush your elbows down the inside of your legs and push your knees out. This is what makes the goblet squat so special, so let me say that again: knees out, knees out, knees out.  This helps to engage your gluteal muscles more effectively.
  • Stand back up and stand tall at the top.

Simple enough, right? Make sure to not overthink it. Think less, squat more, and you will find yourself moving more confidently and getting stronger.

Now not everyone will want to or be able to do all these different squat variations  but each has the ability to help make your legs/thighs/hips stronger and help you to walk with more confidence and hopefully with less likelihood of feeling wobbly.  If you have an sort of medical condition please check with your health care provider before trying any of these exercises out but if you get the ok I am sure that there is some benefit waiting here for you.

Regards,

Ross

 

P.S. If you have trouble following these exercises you can certainly make an appointment with a local physical/physiotherapist, personal trainer or athletic therapist to help you work through these exercises.  If you are in the Leighton Buzzard area and want me to see you then you can book to see myself using the following link : https://form.jotformeu.com/42456841375359

 

Basics on progressing your stretches

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People  have an injury, it stops hurting and then they return to their normal activities. Ideally it would be this simple but often you are left with tightness/discomfort.  This happens partly due to the fact that tissues tighten and shorten as they heal.  There may also be sensitivity issues which affect how tight things feel when trying to get back to your ‘normal’ activity.  In the following section I am going to look at a basic simple progression on how to get back your knee flexion mobility following a resolved injury.

To start with the simplest thing to do is just repeat the movement that is tight. For example one could just repeat the tight movement and the anterior thigh muscles should loosen to a degree just from doing that same movement.  This is a basic stretch that you can see footballers doing on the side of the pitch before and after a soccer match-

If this basic stretch isn’t enough then you can progress the stretch as tolerated depending on how sensitive the knee is.  If the restriction appears to just be soft tissue tightness and not a problem within the joint, then this second stretch might allow you to progress to a pain free state.  To do this stretch you use a pillow to gap the knee joint so avoid joint compression while stretching the thigh muscles.  The joint might be painful simply because the soft tissues crossing the joint are tight. By using the pillow ,and external support, you may avoid joint pain and see whether the knee/thigh can be more comfortable once the soft tissue tightness is relieved-

Whatever you are stretching, you need to consider what factors might be in play that could be producing discomfort or restrictions.  I mentioned that sometimes as area can be tight because of external factors making the area sensitive.  Another factor that can affect tightness is whether there are any muscles involved that cross more than one joint. When a muscle crosses more than one joint then you need to adjust your stretches to make sure that both ends of the muscle are being stretched to get the soft tissues to fully relax and allow good extensibility.

In this last stretch there is an emphasis to get the rectus femoris muscle stretched. It is important to tighten the abdominal muscles to make sure the stretch isn’t being overly focused in the lumbar spine.  Be careful when doing this stretch that you don’t fall over.  You may need to do the stretch near a wall. You might also find that you can’t reach back fully so a towel or belt might be needed to allow you go get to the stretch you are capable of even if your arms won’t reach.

So a recap.  In this instance I have gone from an easy stretch, to a more difficult stretch to finally a specialised stretch to get full comfortable flexion of my thigh muscles.  As mentioned other procedures might be needed if the knee joint is affected. Sometimes you might need to use a foam roller or cross tissue massage to loosen any tightness that is in a direction unusual for the muscle being stretched.  If the joint is affected then you may need to apply pressures across the joint to allow better mobility.  Joint work is something you need to discuss with a professional before trying on your own.  Finally remember that once you regain your mobility you should be performing strength and co-ordination training to enable the limb to work normally. You might find that these last two procedures can be added into the mix earlier as tolerated and in fact may be necessary in order to regain full flexibility.

Lots to consider. I hope that this information at least gets you started in your quest to regain your function.  It is a bit artificial to separate things out but by doing so it might help to localise and identify where problems are occurring.  Please let me know if you have any suggestions or comments that might be useful in these endeavours.  Regards.

Ross

Planning for Recovery

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People often say to me ”I took a month off but when I returned to playing I got injured again”!  This is frustrating for many people but it occurs partly because people make the mistake of confusing ”this no longer hurting” with their body being completely healed and back to ”normal”.  There are a couple of things to consider that might help to make planning for recovery easier:

1)  Injuries often are healed fairly quickly but the tissue that has replaced/repaired has not been subjected to normal stresses and may well be locally stiffer, more sensitive and generally weaker than it originally was.

2)  Even when strength,sensitivity and mobility have returned to normal levels you will have lost the conditioning to the affected part of your body because you haven’t been able to train properly.  Even if you healed completely you still haven’t recovered your skills/co-ordination. You can often get by without much training before returning to competition if you aren’t hurt too badly or you are only doing things at a low activity level.  You do still run a higher risk of re-injury if you don’t do some prepatory training.

3)  Ok, you now have a healed injury and your co-ordination appears to be back to normal and you are ready to go!  Well almost.  The last consideration is that with a substantial lay off you also have the chance that you have lost some of the capacity you have built up over the years from participating in whatever activity you do. This isn’t a big factor if the injury has been recent and you have gone through a conditioning program before returning to what you do.  On the other hand, if you have had a long time off ( due to injury or just inactivity) your body has lost some of it’s built up ”toughness”. This means that you might find things get sore/injured again because you have less resilience.  Part of avoiding this would be to get back on a regular graded training program  before moving on to higher levels of participation or competition.  Adults who have played a sport for years and then stopped , say to have children, and then returned a decade later find that they seem to initially get injured relatively easily to what they expected.  This is partly due to the body naturally getting weaker/stiffer when not challenged to keep up optimum strength and flexibility.

To minimize problems each of these concerns need to be reviewed.  If you need help to check things find a health care practitioner to help you go through and see that strength, range and co-ordination are back to normal and comparable from side to side.  If you aren’t sure about your conditioning then either a health care practitioner or a personal trainer might help you check your fitness (strength and conditioning) levels.

So before rushing back onto the pitch, or even back to a hard labor intensive job, consider the things listed.  With a bit of planning and training you have a good chance of recovery with minimal problems.

Ross