April is about Running – London Marathon and London HYROX.
The month of April sees London host not one but TWO Running events.
Obviously, we have the London Marathon but we also have HYROX London the week after.
London Marathon is Sunday 23rd of April
London HYROX is at Olympia 30th April and 1st of May
At Marylebone Physiotherapy and Sports Medicine we have been treating Athletes doing both of these amazing events.
We also know some amazing people doing BOTH!
So, we all have a good grasp of what the Marathon en tales. It’s 26.2 miles and it’s as fast as you can but more to do with a life-time achievement goal for most people and raising money for their favorite charity.
Last Month our resident Marathon Runner Julio gave us his tips on Marathon Running (See March 2023 BLOG).
But what about HYROX?
What even is it?
HYROX is a global fitness race for Every Body.
Participants from all around the world compete in the exact same format.
The race starts with a 1 km run, followed by 1 functional movement, which repeats 8 times, taking place in large indoor venues, creating a unique stadium like atmosphere for all participants.
52% of gym members now cite fitness as their primary sport.
Fitness is the largest sport in the world and HYROX is the first mass participation event that gives everyday gym-goers their own race to train for.
HYROX bridges the gap between traditional endurance events with functional fitness, to create a race format for Every Body.
Hyrox is truly accessible: with 4 different racing categories to choose from, HYROX is for everyone no matter the fitness level:
Open – take on the standard HYROX for a challenging but achievable race for everyone.
Pro – for the experienced racer, heavier weights make for a more challenging experience.
Doubles – find a partner and take on the challenge as a pair, running together but splitting the workload of the exercises.
Relay – come together with your friends or family and race the relay where each member of the team does 2 times 1 km and 2 workouts.
Well, HYROX is less running, only 8 km to be precise.
However, HYROX throws in events after each 1 km run.
This year’s event in 2023 consists of:
1 km Run
The first HYROX workout is 1000 metres on the Ski Erg.
1 km Run
Workout number two is the Sled Push for 50 m
1 km Run
Workout 3 is 50 metres on The Sled Pull.
1 km Run
Workout 4 is 80m of Burpee Broad Jumps
1 km Run
Workout number 5 is the second Ergometer in the competition. 1000 metres on the Concept 2 Row Erg marks the beginning of the second half of the HYROX workouts.
1 km Run
Workout 6 is a 200m Farmer’s Carry
1 km Run
Workout 7 is 100m of Sandbag Lunges
1 km Run
The event finishes with 75 or 100 Wall Balls.
Dale is our Resident HYROX advisor and he achieved a GOLD standard at HYROX this year.
Here are Dale’s tips for HYROX:
If you view the 1 km run as actually your recovery after each event then this is a great place to start. Rather than pumping your arms as you would normally, let them relax and dangle. This may look a bit strange but your upper body will thank you for this.
The Ski Erg is a very individual event where your technique determines everything. I like to use a forward arm circling motion rather than the classic pulling down motion that is going to over work your Triceps.
The Sled Push requires you to get your whole body behind it. The muscle of the calf working most is the Soleus. This calf muscle works when the knee is bent. Try doing some bent knee calf raises to build endurance in these muscles.
The Sled Pull is a whole body movement, not just a test for the arms. Lean back into each pull and use your body weight. Try strengthening your grip by simply hanging from a bar for as long as possible.
BURPEE BROAD JUMPS
Burpee Broad Jumps are the first event where I would pull up my knee sleeves. Make sure your technique is exact and you use the plyometric rebound from the Burpee into the jump. This is a complex movement requiring multiple planes of direction. The only way to practice this is to do the movement itself.
Rowing for 1,000 m is the next event. Rowing is quite technical and needs to be practiced before hand. This event does benefit the taller athlete and those who are technically better at Rowing. Practice Pulling slower and hard not faster is the first place to start. Remember to use your back, leaning forward to scoop the handles and leaning back to maximise your pull. Once your technique is cleaner, so can add the speed later.
The Farmer’s carry is the ultimate in grip strength and endurance. This is easy to train for as 200 m can seem along way. The better athletes will be able to do this in one or two goes because they have specifically trained their grip. It is also worth practicing fast walking with weight as this itself is also a skill to avoid constantly bashing the weights into your thighs. At Marylebone Physio we use grip dynonometry from VALD to precision measure your grip strength and training improvement.
The Sandbag Lunges are another event where I would pull up my knee pads to avoid unnecessary pain on the knee cap with a thin but very welcome neoprene pad. Try to stay as upright as possible and avoid leaning forward because of tight hip flexors.
The Wall Balls are the final event and this is a real test of endurance and co-ordination. Here the rest strategy becomes important as you don’t want to run out of energy so close to the finish.
You are not going to manage 100 Wall Balls in one go right at the end of the race so here is what I advise. 10 x 10 reps is a very simple but effective way to break this event down into manageable chunks.
Making every rep count by hitting the target and being as accurate as possible despite the fatigue. Catching the ball on the way down as you squat will also save time and keep you in a rhythm.
So, there you have it.
The two events are both equally epic and may require you to get some bodywork done to keep you going and stay injury free.
So whether you are doing the London Marathon or London HYROX, we at MARYLEBONE PHYSIO & SPORTS MEDICINE have got you covered.
So which one is more challenging?
It depends on how fast you are going and how much training you have done before hand.
Whatever you are training for, don’t train in pain, see a Physio.
Next Month is the London Marathon and we have been treating lots of clients in their preparation for Race Day.
Julio one of our Physio’s at Marylebone and East London Physiotherapy and Sports Medicine can his first Marathon last month.
In this Month’s Blog Julio shares his experience, how he prepared and what he did in terms of training.
“On the 5th of March I completed my first Marathon ever.
What I would like to share is the journey that lead to be one of the finishers.
The decision to complete a Marathon was double fold: First to set a personal goal for the winter months in order to keep motivated; long dark winter days can be tough for people who likes outdoors; Second I wanted to experience first-hand what some of our patients go through in order to be able to give as much as relevant advice as possible.
This is what we like to do at Marylebone Physiotherapy and Sports Medicine, practice what we preach!
PREPARATION The preparation started in November when I spoke with my running coach and asked if he would guide me through the journey. Even if I could potentially follow a plan or guide myself I felt that having a coach had significantly helped. And here my first advice. No matter who is. Local running club, a more expert friend, professional Coach I would discourage to follow just and solely a written plan that often you receive when signing up for such events. Pro: you interface your difficulties with a human being that can put into context and adapt plans accordingly. Cons: this can involve costs.
TRAINING After 3 weeks of training (Started with increasing my running load) I started to accuse lateral knee pain. Really common among runners. Frustration and hanger immediately started to be part of my day. I never had an injury before as a gymnast, as a swimmer, runner or triathlon athlete. I felt mental impact of not being able to exercise. I was upset as I always exercise thinking I should not impact badly in any way my body but furthermore enhance by the sport activity. Thanks to my coach and colleagues we focused on the causes that may have contributed to my injury and made the appropriate training changes. Such as resting, cross training, strengthening muscles. I found really helpful cross training such as swimming or cycling to continue to improve my overall fitness. An essential part of my training was Strength and Conditioning. Spending time working on body weights exercises was essential to get confidence towards my body back.
THE MARATHON The Race Day was really exciting and everything went well. I knew what to have for breakfast and my gear was ready and all prepared the day before in order to not to have any surprises. This is the most important thing for race day. Planning ahead. So in case things go wrong, you have probably already a plan.
REFLECTION Running my first Marathon was a success and it could have not been done without the support of friends, family, and colleagues. Remember you are going to collect so many memories during your training journey that will be vital to get you going on your Race Day. Running is about feeling your body step after step to reach the destination. It has been described as ‘type B fun’ which is enjoyable after the event. I feel a huge sens of achievement and was pleased with my time despite being only minutes away from my goal. However, there is always next time!”
Marylebone Physiotherapy and Sports Medicine wish all our clients and everyone else a safe and enjoyable London Marathon.
It is February and this month is dominated by Valentines day and so this is the month of love and we want to share the love of exercise with you.
If you have started a new fitness regime in January, then by February hopefully you have fallen in love with exercise. Meaning that you should now find some sort of joy for performing this type of physical activity. Whether it is the feeling of achievement afterwards or the physical challenge of completion there should be some enjoyment for participation in this type of behaviour.
The love of exercise can be polarising. Say “Exercise” to people and there are two common responses:
Great! I love exercise
Oh NO! I hate exercise
If you remember from out last post, exercise is Physical activity that is repeated, planned, purposeful and structured.
Exercise is a relatively new concept in terms of biology, because we are now performing physical activity for health reasons rather than working the land or hunting.
Love of our physical form comes from understanding our bodies from an evolutionary point of view. Because exercise is actually not a natural phenomena and is relatively new in terms of the human experience on Earth.
So, why do most people hate exercise when it is so good for us?
The key is in our biology and more particular viewed through the lens of evolutionary biology.
Where saving energy when we were hunter gatherers was the name of the game. This is also why we have evolved to be so energy efficient at walking and why you can’t walk your way to weight loss.
Here we would have been active most of the day with physical tasks. This is the same with the agricultural revolution, physical tasks were required for the farming of crops and livestock.
The use of Technology has been a game changer in terms of human physical exertion. We now work by sitting down all day which is a direct paradox to how our physical biology has evolved.
The other concept is the abundance of food, particularly very tasty high calorie food that we don’t have to hunt or forage for.
These days in order to be healthy we have to choose to move. However, this goes directly against your primeval drive to rest, relax and conserve energy. Or indeed take the route of least resistance. Increasing your Physical Activity might look like taking the lift/escalator rather than the stairs in a modern day environment.
To counter our natural instincts to conserve energy, “Smart” new buildings have deliberately changed their layouts so that stairs are at the front of a building and the lifts are at the back. Thus encouraging stair use and physical activity by making our environment more “physically friendly”
Moreover, we need to apply this logic to our entire lives in order to simply get more activity into our lives. Strategies such as active transport, which means walking or cycling to work, or at least getting off one stop earlier on the bus for example.
Most health advisors agree that 150 mins of moderate physical activity per week is the minimum investment of time for health purposes. Despite this recommendation, most adults struggle to achieve this, bearing in mind this is only 22 minutes per day.
Strangely, we have known about this in the UK since the 1950’s. But 80 years later we continue to repeat our learning of the old information.
Physical activity for health benefits is best explained by the London Buses study by Morris et al in the 1950’s. In this revolutionary study comparing the health of Bus Drivers against Bus conductors clear evidence can be seen that walking around the bus and climbing stairs is better for your health than sitting down for the same hours of work (See reference).
Physical activity has multiple benefits to both physical and mental health. It’s so good for you it should be prescribed to everyone. However, the medicine is not necessarily to everyone’ s taste.
So, this concept that we should “love exercise” perhaps needs a rethink.
We should be encouraged to exercise, but ultimately, this should be our decision based on what is good for our health, the health of our families, our nations and our world.
At Marylebone Physio and Sports Medicine we understand the importance of exercise. Whether you love it or not we can prescribe you the right exercise at the right time to get you back to loving whatever exercise is your preference.
Because, the best exercise for you is the one you love doing.
Thanks to Daniel Lieberman and his book “Exercised” as the inspiration behind this post.
Exercised: Why something We never evolved to do is healthy and rewarding By Daniel E. Lieberman, New York, NY: Knopf Doubleday Publishing Group, 2021. ISBN-13: 9781524746995
MORRIS JN, CRAWFORD MD. Coronary heart disease and physical activity of work; evidence of a national necropsy survey. Br Med J. 1958 Dec 20;2(5111):1485-96. doi: 10.1136/bmj.2.5111.1485. PMID: 13608027; PMCID: PMC2027542.
It’s January and the new year brings about the reflection of new year’s resolutions. This will no doubt involve some sort of new fitness regime We all know the benefits of regular exercise, but what are the 5 most common mistakes that new comers and those returning to the gym make?
The correct dose of exercise – The Goldilocks principle
Consistency is key – You can’t get fit in one workout
Dynamic Warm up – Save static stretching until the end
Train Movements NOT Muscles – Train the brain
Having a plan to your training – Let your plan be your guide
The correct dose of exercise – The Goldilocks principle
Exercise Prescribers here at Marylebone Physiotherapy, we are experts at getting the dosage of exercise correct for each client. Not too easy as to be ineffective and not too hard as to not be able to walk the next day. Not too cold, not too hot, but just right, is also known as the Goldilocks principle. Exercise can be defined as physical movement that is:
We can use the acronym RePPS to help us remember this
Repeating a movement is the very definition of exercise. You learn to master a particular movement, then you load it up with heavier weights or speed up the movement. You can also perform the movement under fatigue.
Planning your exercise is covered later on in this Blog.
Purposeful relates to your specific fitness goals. Remember that weight loss is a side effect of fitness training and not the desired goal.
Structured refers to the way your training session is broken down into its component parts
Below is an example of a typical gym session:
Dynamic Warm up Strength Metabolic conditioning Cool Down Stretch Use the RePPS principle for your next session.
Consistency is key – You can’t get fit in one workout
“You can’t drink the Ocean in one gulp!”
It is the same with exercise, you can’t get fit in one workout, just like you can’t live your life in one day.
The first six weeks of training you are unlikely to see any results. However, you are likely to feel better and have more energy. The best things come to those who wait, but in a society that wants instant gratification the wait can be frustrating.
Around 8 weeks the physical transformation becomes visible. We tend to lose body fat and gain lean muscle. Look forward to 12 weeks and things are looking even better
However, you will eventually plateau with your fitness gains and this is where you need to maintain it. Make time for exercise and be consistent.
Dynamic Warm up – save static stretching to the end
If you have not trained since your School, College or University days then things have changed. Wear warm layers and slowly strip them off as your body warms naturally with the heat generated from the movement.
We tend to favour a dynamic warm up in preference to static stretching. We can save that until the end of the workout. Because performing static stretches slows down your heart rate, lowers injury risk and helps reduce DOMS (Delayed Onset Muscle Soreness) we tend to leave it for after the workout. The other reason for this relates to studies where over stretching muscles in the warm up loses the protective effect of the tendon reflex that is designed to stop over stretching.
Dynamic as the name suggests means we are moving through a movement rather than holding a static posture. This could look like Squats and lunges or Press ups and toe touches. Starting with partial movements and building into full range, listening to the body and not pushing into pain or restriction.
Movement sequences that open the hips and rotate the body and examples of dynamic stretching.
Train Movements NOT Muscles – Train the Brain
Unless you are body building or focusing on particular muscles, then we at Marylebone Physiotherapy would encourage you to train movements not muscles. That’s why we have our own Movement Specialist, Katia.
Movement is a skill, and as such it needs to be practiced and challenged in order to not just make it better, but optimise the movement. The brain knows nothing of individual muscles, it knows only movement.
There are seven level 1 functional movements that you should be familiar with, these are: Push Pull Twist Hinge or bend Squat Lunge Walking (Gait)
These seven movements form the basis of all functional movements the body has to perform.
Examples of Level 2 functional movements are running jumping and throwing.
Level 3 functional movements are the highest level and these require proficiency at levels 1 and 2 before attempting. Level 3 includes multi-directional movements or combinations of movements linked together.
An example of this is a Burpee. This is a hip hinge into a press up, back into standing and then performing a jump at the top of the movement. The Burpee is normally completed at speed to add to the challenge of the movement.
Having a plan to your training – Let your plan be your guide
How do you get there if you don’t know where you’re going?
The answer is to have a plan. This will be based on your Fitness goals.
Are you doing a Couch to 5 km or Running a Marathon? Are you starting your first Boot-camp or competing at CrossFit?
Most Gym goers start with a “Push, Pull, Legs” Plan of three times a week
You could train one of the functional movements every day of the week. Or you could break the functional movements up into training each once during the week.
An example might be:
Monday – Push, Twist
Tuesday – Walk
Wednesday – Pull, Lunge
Thursday – Walk
Friday – Hinge, Squat
So, there you have it. The five most common Gym mistakes and how to avoid them happening to you.
Now it’s your turn to implement this new knowledge and have an injury free return to training.
This is your year to get fit, stay injury free and enjoy being healthy.
Pilates is an exercise method that aims to strengthen the body with an emphasis on the core and control.
It is almost unique in its suitability for all ages and abilities and research has demonstrated its positive impact on patients with non specific chronic low back pain, for which numerous treatments have been unsuccessful.
In our clinic at Marylebone we offer Pilates lead by qualified instructors and physiotherapists who are able to tailor an exercise programme to any individual need. For our beginners or those aiming for a more personalised experience we offer one to one sessions, where the therapist is able to listen to any concerns and make sure that every exercise is completed optimally.
Pilates was initially a mat based exercise programme and I spent time teaching this technique in NHS hospitals to those suffering from MSk conditions as well as post surgically and pre/post natal. Here at Marylebone we teach traditional mat based Pilates but also use the more modern reformers. Whilst daunting to look at, the reformers can provide a more challenging workout whilst focusing on those principals of core control central to the Pilates technique.
If you are unsure whether Pilates is right for you, then you can always come along and try one of our free 30 min taster sessions with a qualified therapist. The team and I have worked with a range of conditions and have seen people progress from acute pain to enjoying physical activity again; we would love to hear from you and hope to see you here at Marylebone soon!
TrailMed are bringing their Health and Performance Laboratory to London! And there is no better place for it as in our East London Physiotherapy and Sport Medicine clinic in the Lee Valley Velopark.
CardioPulmonary Exercise Testing
Dr Patrick Musto will be conducting Cardio Pulmonary Exercise Testing on Saturday the 23rd February 2019 at the Velodrome.
CPET is a test accurately measuring the funcion of your heart and lungs in response to exercise. The results of the test will give you more information about your health and exercise capacity and allow you to plan your training programs knowing your thresholds.
If that sounds interesting do not hesitate to book yourself in while there are spaces still available! To book yourself in follow the link below.
TrailMed will ask you to exercise on a bike while wearing a mask to set the protocol. The test will involve gradual increase in intensity of exercise to ensure your heart and lungs are stressed. Your breathing, blood pressure, and oxygen saturation will be recorded and monitored. The more you are able to do, the more information is gained from the test. The whole appointment will take up to an hour including explanations, consent, history, examination and testing. For further details visit TrailMed webpage.
If you are wondering what CPET and what benefits it brings but don't want to get tested yourself, Dr Musto will also be holding a CPET Talk and Demonstration on the same day. Express your interest by contacting TrailMed directly!
The CSP is currently promoting a campaign ‘Rehab Matters’ which is aimed at improving access to rehabilitation services across the UK. This is an idea that is shared by Marylebone Physiotherapy & Sports Medicine and we thought we would share the CSP’s provoking film about two fictional characters who have very different experiences after leaving hospital as one receives physiotherapy and the other does not. Enjoy.
We’ve all been there. Stuck in traffic and you’ve already been in the car for 2 hours. You start to feel that familiar discomfort forming in your lower back heading down your leg as you shift your weight in an attempt to relieve the feeling, or sit up straighter hoping you will last the next hour until you’re home.
It will come as no surprise that an epidemiological study looking at lower back pain in truck drivers found that over 50% of them reported lower back pain at one point over the duration of a month. Or, that the prevalence was significantly increased from both a ‘short resting time’ and ‘long driving time in the day’. A larger study of taxi drivers also found that over 50% had reported LBP in the last 12 months and that long driving time plus frequent bending/twisting activities whilst driving, alongside stress also increased prevalence.
Unfortunately, like it or not, we can’t escape the world of long drives or travel – unless you fancy being a hermit for the rest of life – so we’ve come up with some simple tips that aim to keep you on the highway to a pain-free journey!
Take the time before you set off to get comfortable. Research is limited on exact parameters as every person is different and what is comfortable for you may not be for someone else. Therefore, take the time to adjust what you can until you have the desired setup.
Adjust your mirrors: generally, you should only have to move your eyes to look in your mirrors; this reduces the strain on your neck. Sit up straight when doing this, when you slouch you will no longer be able to see - it will act as a reminder to maintain good posture.
Adjust your seat: you want to be sitting upright with only a slight recline (roughly 10-20 degrees). You may need to use a small lumbar support or a rolled-up towel to support the natural curve of your lower back. You may find a seat cushion useful to reduce the vibration and act as a shock absorber. Please see the links below for more information regarding driving ergonomics.
Stop or move regularly. Now I know that we’re all desperate to get home after a long day but you may need to schedule in regular stops – and who doesn’t love a service station? Especially when there’s an M&S! If you really can’t (and you have the bladder of a horse) then try regularly rolling your shoulders, arching and curling your spine and using traffic stops to stretch your legs – just remember to put it in neutral!
Get organised and think about taking either a cool or heat pack with you (whatever helps your pain).
Cruise Control? Yes please! Use this where possible, not only does it make your driving experience easier but you can place your feet flat on the floor which is a better position for your spine. But don’t get too comfortable, you will have to brake at some point!
Muscular effort in sitting has been shown to be greater than that of standing, so when you are out of the car ensure you are working hard with your physiotherapist to strengthen your back and core muscles and give yourself the best chance of preventing future pain that will ‘drive’ you crazy!
Miyamoto, M., Shirai, Y., Nakayama, Y., Gembun, Y. and Kaneda, K., 2000. An epidemiologic study of occupational low back pain in truck drivers. Journal of Nippon Medical School, 67(3), pp.186-190.
Chen, J.C., Chang, W.R., Chang, W. and Christiani, D., 2005. Occupational factors associated with low back pain in urban taxi drivers. Occupational Medicine, 55(7), pp.535-540.
There is a body of opinion that recommends not putting your hands in ski pole loops unless you are in fear of losing your poles, for example in deep powder snow, but this has always been a debate.
In the event of a fall, putting your hands inside ski pole loops greatly increases the risk of sustaining a Skier’s Thumb sprain. This common skiing injury is caused when the skier falls and lands on their hand or the ski pole, with the thumb in an extended position, spraining the Ulnar Collateral Ligament of the thumb. This is the ligament located in the web space in between the base of the thumb and the index finger.
This injury is also commonly seen in rugby players and goalkeepers. Immediately after injuring your UCL it is best to rest it for the first few days and apply ice for 15-20 minutes every 2-3 hours. It is wise to seek medical attention if the swelling and pain has failed to settle within the first week as this may be indicative of a more serious injury to the ligament like a partial or complete rupture, and you should rule out any associated fracture. Symptoms may include persistent pain and swelling and a sense of instability around the thumb during pinch activities. Wearing a thumb stabiliser if you have a previous history of this injury may be a good idea.
Proprioception is the sense of knowing where your body part is in space, without having to look. This can be a difficult concept to grasp until you lose it, because so much proprioception occurs subconsciously. It is important in all everyday movements but especially so in complicated sporting movements, where precise coordination is essential.
Your proprioception capabilities can be impaired when joints are injured, such as with ligament sprains. When you lose proprioception of your joint after a sprain, you may experience an unstable sensation of the joint. The most common symptom of reduced proprioception is poor balance.
The Proprioceptive System is made up of receptor nerves that are positioned in the muscles, joints and ligaments around joints. The receptors can sense tension and stretch and pass this information to the brain where it is processed. The brain then responds by signalling to muscles to contract or relax in order to produce the desired movement. Following injury to joints and ligaments the receptors are also damaged, which means the information that is usually sent to the brain is impaired. This can leave the person prone to re-injury, or decrease their coordination during sport.
Proprioceptive and balance exercises teach your body to control the position of a deficient or an injured joint. A common example of a proprioceptive or balance exercise is the use of a wobble board after an ankle sprain. The unpredictable movements of the wobble board re-educates your body to quickly react to the wobbly movements without having to think about these movements. That is, your natural balance and proprioceptive reactions make the transition from a conscious to a subconscious state. A quality subconscious proprioception and balance system is important in everyday life and particularly in sport.