the blog of balance performance physiotherapy

Balance is delighted to announce that we now have a Computrainer. Bring your bike down to Balance hook it up to the trainer and ride up the Alpe d’Huez!

The Ford Ironman World Championships in Hawaii provided fantastic results for CompuTrainer pro riders. For the second year in a row 8 of computrainer trained athletes made it into the top 10 (5 women and 3 men). Even more exciting was the fact that 3 of those ladies made it into the Top 4 – Mirinda Carfrae (2nd), Leanda Cave (3rd) and Rachel Joyce (4th).
Pete Jacobs from Austaralia is quoted to say:

“On the Computrainer, Your legs don’t get a break. It’s not like doing four hours on the road. You are not getting a break and you are doing constant wattage and when I feel good I pop the wattage up and when I feel lousy I just cruise but I’m still getting really good cadence and muscle memory. Much more than on the road. ”

Take your indoor bike training to a new level with the CompuTrainer – a state-of-the-art indoor bicycle training technology that improves cycling performance while keeping the indoor rider challenged and happy. The CompuTrainer is the leading electronic bicycle ergometer for maximum performance improvement, testing, and enjoyable indoor training.

Benefits of the CompuTrainer:

Increases your cycling power by 20 to 30% and your speed by 2 to 4 MPH. Whatever your starting point, you’ll improve significantly.

It sets the industry standard for accuracy (± 2.5%), power (1500 watts), quality, and service lifetime (10+ years).
Exclusive performance features like SpinScan™ electronic pedal stroke analysis and Adjustable Aerodynamic Drag Factor are unique to CompuTrainer.

Call Balance on 020 7627 2308 to inquire about using the Computrainer.

Graham Anderson our Clinical Director is among the key speakers at this years International Cycle Symposium (ICS). The inaugural ICS takes place over two days in the heart of Covent Garden in Central London at The Design Centre on January 25th-26th (Wed and Thurs).

The International Cyclefit Symposium is a two day forum into the relationship between the human body and a bicycle. The journey will by necessity draw from may disciplines:Bike fitting practitioners,Medical community, Academic community, Bicycle frame and component manufacturers, The international line-up of speakers have selected because they are all leaders in their particular field.

Each speaker will present for 45 minutes. There will then be a chaired Q & A session from the symposium to try and learn from each other and also establish ‘best practice’ for fitting and related disciplines.

Practical Sessions
At the end of each day there will be a demonstration/participation fitting by an experienced technician. Comments and general input from speakers and delegates will be encouraged!

Who Should Attend?
ICS will be a fascinating learning forum for anyone who has an interest performance cycling. Go to the website to learn more.

http://cyclefit.co.uk/lecturer-biographies

Sports injury and orthopaedic rehab at Balance Performance Physiotherapy

If you’re unfortunate enough to suffer an Anterior Cruciate Ligament (ACL) rupture as Lucas Leiva did last week – the Brazil international will miss the rest of the season having injured his left knee during Tuesday’s Carling Cup quarter-final victory at Chelsea – as a professional footballer reconstructive surgery is essential to return to the game.

If you’re not a pro but the injury results in your knee continuing to irregularly give way, an operation to reconstruct the ACL is really your only option, especially if you aspire to have an active lifestyle. At Balance of course we actively encourage you to ask for more and expect more from yourself. However whether pro athlete or not the operation is only effective if followed with quality rehabilitation executed with discipline and patience. Ensure your rehab guides you far enough down the road for you to achieve a complete recovery, give you absolute confidence to return to your sport and has provided you with resilience to future injury (either to the same knee or another structure that becomes vulnerable due to inadequate rehab). Of course there is no such thing as invulnerability in a human but to reiterate – you should be asking more of yourself and more of your physio or sports therapist. Do not pull up short!

Hamstring grafts are the grafts of choice these days but patella tendon grafts can also be used and do well.

Here’s the kind of schedule you’d expect going into rehab post operatively, which is initially quite straightforward:

Weeks 1-4 focussed on range of movement.

Return to sport at 5-6 months and contact sport soon afterwards.

This timeline is dependant on the quality of rehab, the individuals discipline and motivation, their unique circumstances and complications.

Most surgeons would like to see their work relatively protected for 9 months post op.

Balance got world class judo player Winnie Gordon competing in European champs at 5.5 months but that is rare. He went in to surgery on with a good level of preinjury knee strength which gave him a useful functional reserve.

Like every injury ones success is dependent on quality of training, movement, control and motivation.

At Balance we use tools that provide results, consequently we have a vast array of “toys” to work on specific weaknesses identified in our clients. There are some tools that we use over and over again, equipment that makes rehab more effective for a variety of reasons. one such reason is the ability to introduce something as early within the rehab process as possible to familiarise a client with the tool and also because we use equipment that is scalable – it can be used with more or less intensity depending on the stage of development a client has achieved.

For example Trigger Point Performance Therapy (TPT) and Alter-G partial weight bearing treadmill are used at very early stages in ACL rehab, CrossCore180 and kettlebells arent far behind. We make use of all of our available space: in Clapham and Fulham we have 1,000s of square feet of space to utilise and matted areas for essential ground work.

When an individual has focussed on prevention (prehab) prior to their current injury (remember there is no such thing as invulnerable) their subsequent recovery is much faster. Such prehab involves a mindful approach to movement skills, joint mobility, intelligent recovery following practice/training/competition: sports massage, self massage (Trigger Point Performance Therapy), hydration and nutrition, good quality sleep, stress management (mental and emotional).

As for Lucas, he and Liverpool are now considering when last season’s player of the year should undergo surgery.

The team at Balance are exceptionally experienced at treating ski and winter sports injuries. Not only do several members of the team ski but all are experienced in treating Orthopaedic injuries. So if you have hurt your knee and ruptured your ACL or torn your mensicus then we can help. Or you may simply want to know what exercises you do to strengthen you legs before go, book a session with one of our experienced personal trainers.

Ski boot or board shoes not fitting well? Come and see our Sports and Orthopaedic Podiatrist Mick Habgood to get your ski boots perfectly fitted.

Balance Performance Physiotherapy is now in Fulham SW6. Several members of our strong team are working from Fulham including our Clinical Director Graham Anderson and founding members Dr Lucy Goldby and Jonathan Lewis.

Our practice in Fulham is a large studio based in Fitrooms Gym on North End Road. It is easily accessible from Fulham Broadway, Earls Court and West Brompton tube and overground stations. It is also easily accessible if you are coming from Hammersmith, Shepherds Bush or West Kensington.

We have a fantastic studio which is a great space to move in. We also have access to the whole gym so it is a fantastic venue to complete your rehabilitation in.

To book into our Fulham practice call: 020 7627 2308

Balance Performance has worked alongside Pilates Sanctuary for 5 years now, its been a great relationship as they fully understand our concept of movement, function, performance and recovery. They guide the clients we refer to their equipment and mat studio within our site in Clapham to adopt improved active lifestyles based on a strong foundation of core and movement control. Alice and Agur are teachers of the highest calibre. See their latest news below:

Hello from everyone at Pilates Sanctuary,

As some of you may already know, Pilates Sanctuary is 5 this November and we would like to express our thanks to you for being one of our clients. Whether you are someone who has been with us since day one or if you have recently joined us, we would love you to help us celebrate this occasion.

Please join us on Friday 25 November between 6pm-8pm at the Pilates Sanctuary studio, Balance Physiotherapy, 113-115 Gauden Road, SW4 6LE. So that we have some idea of numbers, please would you email us on info@pilatessanctuary.co.uk by Monday 21 November if you are able to join us for these celebrations. It would be lovely to see you there!

Pilates Assessment

Agur and Alice went to a fantastic workshop led by Warrick McNeill,a physiotherapist and Pilates Foundation teacher, who belongs to an organisation called Performance Stability (www.performance-stability.com). We learnt how to use the Pilates Movement and Performance Screen; a series of tests which provide formal assessment tools and enables pilates teachers to see potential areas of injury. The results of the test are input into the Matrix software which then produces a detailed report highlighting the participant’s areas of strength and weakness . This is going to be very useful for anyone who wants to address any recurring problems, deepen their understanding of their own body and improve their performance in Pilates and other activities.

If you are interested in the assessment please speak to Alice or Agur directly either in class or contact us on alice@pilatessanctuary.co.uk 07881 953843 or on agur@pilatessanctuary.co.uk 07824901063.

Pilates Sanctuary Teachers

In other Pilates Sanctuary news, we said goodbye to Anja who is focusing on her work in North London and we welcome Rosalie who some of you have already met. Rosalie is a fantastic teacher and those of you working with her already, will have enjoyed her knowledge and experience of Pilates.

Rosalie Pastrana suffered from backache while growing up due to Scoliosis. She tried many different exercise programmes. In 1997, after completing a Degree in Advertising and PR in Spain, she moved to London in the hope that she would find a solution to her constant pain. She came across the Pilates Method while practicing Yoga in London. Within a short space of time, her back pain became more manageable. The sense of balance and wellbeing she felt encouraged her to study and develop this body movement discipline in depth.
She completed the British Wheel of Yoga Foundation Course with Barbara Joseph, going on to qualify as a Matwork and Equipment Pilates Foundation Teacher® with Anoushka Boone at Pilates in Motion.

Rosalie is committed to continuous professional development. She regularly attends Pilates and Anatomy workshops so that she can enhance both her teaching and personal practice.

Gift Vouchers

We are pleased to be able to offer Gift Vouchers for Christmas or other occasions. You can choose if you’d like to give someone some private or group sessions in the studio: a single private session is £55, a block of 5 private sessions is £250. A single group class is £24 and a block of 5 group classes is £110. Whether you are introducing someone to pilates or you want to give someone a gift they currently enjoy, we are sure you will agree, a pilates gift voucher will be well received.

The Balance team are very proud to have been working with Claire for a while now and have helped her come back from several problems. But don’t let us tell you about it, hear it straight from Claire. Follow the link to read the whole article on Famously Fit’s website.

<a href="http://www.famouslyfit.com/celebrity-fitness/claire-bennett-no-2-great-britain-fencer-injury-rehab-and-balance-performance"

Graham and Jonathan are both working all week at the ATP Tennis Finals at the O2 this week. Both Graham and Jonathan have been working in professional tennis for over a decade now. Yet their passion and commitment to working with high level athletes continues.

While Graham works all year on the ATP travelling the world, he continues to maintain a part time clinical list at Balance where he is able to share his knowledge with the team as Clinical Director and clients can benefit from his expertise when they see him in his capacity as a Consultant Physiotherapist. We wish Jonathan and Graham and all the players the best for the last tournament of the season.

The London Golf Show runs from November 11th-13th at Earls Court Exhibition Centre.

Balance Performance is taking a stand and delivering education at the Golf Show. The focus is on recovery and performance for golfers using Trigger Point Performance Therapy self-massage tools: TPT products have changed the way Balance Performance operates due to the sustainable health and sports performance it offers our clients through self-care. The Performance Golf Kit focuses specifically on the needs of golfers for improved performance and addressing problem areas.

Here’s the message we’re sending out to golfers and coaches alike:

TRIGGER POINT PERFORMANCE THERAPY – Attention Professionals, Coaches and Players

Making its UK debut into the golf world, Trigger Point Therapy Tools were highlighted as one of the coolest, “must-have” items of 2011 at PGA Merchandise Show in 2011.

Golf Digest’s Ashley Mayo reported – “It’s not feasible to get a deep tissue massage after every round of golf, but Trigger Point massage balls and self-care devices makes it possible to thoroughly rub down even those hard-to-get-to muscles in your shoulders, back, legs and feet. And Trigger Point’s foam roller has a grid designed to make you feel as though hands and fingers are giving you a massage.”

“TRIGGER POINT PERFROMANCE THERAPY operates in the same fashion as the Golf Swing – From the ground up…After learning how TP Therapy can improve swing economy in other critical areas, such as shoulder mobility, pelvic rotation and thoracic mobility, it was a no-brainer to integrate it into each of my programs” Trevor Anderson, CSCS, CGFI. Head of Golf Performance – IMG Academies, Florida

TRIGGER POINT THERAPY – IMPROVE YOUR GAME
Golf is a dynamic sport requiring optimal biomechanics to produce, reduce and stabilise force. The most efficient ball strikers have the same kinematic sequence of generating and transferring speed throughout their bodies, delivering energy from the lower body to the torso, to the lead arm and ultimately to the club head.

The most common swing flaws and golf related injuries are caused by physical limitations in one or more of the 8 areas of the body we have determined have the greatest influence on golf swing biomechanics. Tight or overactive muscles can disrupt the process, resulting in loss of distance and accuracy. TPT allows you to restore range of motion, lengthening tight muscles, allowing the body to produce a powerful, efficient and consistent swing.

The common postural distortion patterns we see are not created on the golf course, but rather during daily life. The way you stand and sit defines your ability to address the ball in a biomechanically sound position. Bad posture and lack of hydration create muscular adhesions and scar tissue, causing our bodies to ultimately lock up. In this state we can either choose to shorten the golf swing, compromise the golf swing or deal with pain and discomfort.

Let us show you how TRIGGER POINT THERAPY TOOLS can address the physical issues that affect your life and your game.

So if you’re in London on the weekend of Nov 11-13 be sure to come and visit our stand at The London Golf Show, try out Trigger Point Performance Therapy tools for yourself. Let your golfing friends or coach know about us too. If you’re going with a mind to test and try out golf clubs come to the stand and try out TPT and move easier before you go in search of a Callaway or Taylor Made.

Follow us @balancephysio for regular updates and @londongolfshow.

Tom Staniford has been kind enough to shares his thoughts on Trigger Point Performance Therapy and how it has helped him as an elite cyclist.

Tom came in to contact with Balance Performance via one of Europe’s high end cycle specialists based in London’s Covent Garden – Cycle Fit. Our podiatrist Mick Habgood, and cycle specialist physiotherapists got involved to help make the interface between Tom and his bike as pain free and efficient as possible. Mick produced custom fitted and very unique orthotics for Tom’s cycling shoes. After Fran explained Tom’s rare condition I knew that TPT had to be something worth considering. But given the pathology involved and the ongoing pain Tom experiences daily I wasn’t entirely sure how well received my suggestions would be. But it was an absolute pleasure to meet Tom down at Exeter University and some his team there that have been supporting the paracyclist for some time down in Devon with physiotherapy and strength and conditioning. Going through the the Ultimate 6 techniques aiming to reduce the tension in the key areas influencing toms movement quality we soon realised there was something in it for him. My only reservation was on how Tom would feel the next day after the TPT session…..

Below is Tom’s description of his Trigger Point Performance Therapy experiences:

TPT & Balance Performance Physiotherapy
Trigger Point Performance Therapy, you have to admit, is a pretty cool-sounding name for a brand. Especially one which claims the ability to help ‘unlock your body, release your strength, find your inspiration’.

I’ll be completely honest with you and say that in the past my attention-span for peripheral training focus, recovery methods and ‘miracle’ products has been somewhat lacklustre. However, a physio screening and bike fit with new sponsors Cyclefit and their partners Balance Performance in Covent Garden last year threw up some interesting physical feedback- some of which I was already aware of, and some of which I was not.

It was at this point that Jonathan, of Balance Performance, suggested I might benefit from some TPT therapy to address certain physical weaknesses which were holding me back not just on a performance level, but a personal level. I was initially dubious due to my aforementioned laziness/fear/complacency but resolved to give it a go.

This blog aims to pass on some of the thoughts, feelings and observations I’ve collected whilst using Trigger Point Performance Therapy products under Jonathan’s expert guidance. It should be stated from the outset that I’m not a qualified physio, Doctor or healthcare professional. I never have been. I can offer only my own opinions and explanations gleaned through rigorous testing of the products over the last year.

So who am I?

My name is Tom Staniford and I am a UCI C3-classified paracyclist. Last year I rode for British Cycling’s Paracycling Talent Team and Rapha Condor CC. For all of this season and next season I will be riding for Cyclefit in the UK. I am also, following a win in June 2011, the British National Paracycling Criterium Champion.

One of the main reasons I am supported so well by Cyclefit and Balance Performance (apart from my devastating blend of wit, intelligence and charisma), is that I present a fantastic opportunity for these experts to apply their skill to addressing how best to manage, and more importantly overcome, various physiological factors.

I have a rare genetic disorder known as Lipodystrophy. Very little is known about it due to its rarity, and it often presents itself differently in different individuals. My own condition (as yet the only known example of its type) means that I do not store fat subcutaneously (under the skin), yet I can store small amounts on my liver and other internal organs. Low body fat (generally between 2 and 4% on my arms and legs) means I do not have very much in the way of fat stores for endurance, my thermoregulation can be a bit hit-and-miss and I have quite a gaunt appearance.

On the bike, in addition to low fuel stores from fat, I struggle to build muscle due to the lack of immediate fuel under the skin and chronically low testosterone. Fat exists as a fuel source but also as a protective barrier around joints. With no such cushioning available, my muscles have tightened around my joints in order to protect them as best they can- leaving me with markedly poor flexibility. In some cases the lack of protective body fat or muscle has resulted in the partial fusion of bones such as in my wrists and ankles.
The lack of fat on the soles of my feet has also caused over a period of many years the bones the bones to grow crooked and fuse.

The fact I do not store fat subcutaneously has meant that the vast majority of fatty acids and triglycerides I eat from food are either stored on the liver or remain in the blood. This high fat content in my blood has tricked my body into thinking I have Type 2 Diabetes, thus making my metabolism of carbohydrates almost as tricky as my metabolism of fats. As an endurance athlete this presents some interesting fuel source conundrums!

As a diabetic I generally have poor circulation to my extremities (thus also limiting my recovery and muscle (re)growth capabilities) which is exacerbated by the fact that I have no fat stores for thermoregulation and encouraging an even blood flow across all my muscles.

So why TPT?
In a nutshell, because TPT encourages bloodflow. Better bloodflow means I can manage my diabetes better, my muscles receive the nutrients and oxygen they require to work and grow more efficiently. Better bloodflow will encourage the muscle to relax, improving my flexibility, and also work more efficiently when they are required to.

Observations
My first TPT session with Jonathan was on a rest day. Placing aside my doubts and any other obligations I had for the afternoon, we settled down to a brief hour-long session. And it hurt a great deal. In order to properly encourage bloodflow and the relaxation of the muscle you need to push them, so it does hurt a bit at first But it’s a strangely enjoyable pain- like a good massage from a proper sports masseur. The pain is not ‘oh my… I’m actually crying, please stop’. It’s more like a focussed pressure which you control and direct to certain key areas of tenderness of soreness. They important thing to remember is that however much or little pressure you apply is entirely up to you. The more you apply (within reason!) the more effective it will be, but everyone has their own threshold.

After the first session, however, I felt fantastic. Relaxed and balanced. Grounded and centred. It’s an odd feeling, as you do not realise the stresses or impostures you build up in your muscles through the routine and repetition of poor movement. However after that first session I did feel noticeably balanced. It was quite nice to just stand still. And just feel. No tight muscles or imbalances needing to be addressed or overcompensated for. To just stand, completely based and grounded and still. To ‘be’. Complete, with no adjustment or rectification necessary.

Following that initial session Jonathan encouraged me to experiment with pressures, the frequency with which I ‘rolled out’, and the timing: before a ride, after a ride, even during a ride. Regardless of what sport(s) you do, or to what level, the following observations may be useful. The best advice I can give is that you conduct your own experiments on your own body in order to analyse how best you can incorporate TPT into your daily lifestyle or training.

I find that more than 2 or 3 ‘full’ TPT workouts (ie- hitting each of the ‘ultimate 6’ zones) a week tends to leave me feeling sluggish and heavy. Like a really good massage, my muscles become so relaxed that they seem to exist in a state of constant sleepiness. This is okay if you enjoy the feeling, have few other obligations, or can afford a longer warm-up but I prefer to keep my muscles feeling a little bit livelier most days.

For the same reason, full TPT workouts before a ride tend to switch my muscles off and make them think ‘its recovery time’ rather than ‘wake up, we’re going training’. Having said that, though, I find that some brief attention to the soleus and calves (key areas where, for me, I build up a lot of tension, stress and inflexibility) 20-30 mins before a ride is worthwhile. The increase in bloodflow is enough to wake up my legs without sending them to sleep, and I find that the relaxation in my lower legs naturally makes my feet relax a little more- improving my warm-up and foot comfort for the ride. I feel the pre-exercise ‘wake-up’ technique is especially good in period of heavy or very regular training.

Similarly, I tend to keep post-ride TPT sessions quite focussed and short- especially if I am training again later in the day or over the following few days- in order to relax them enough to encourage good recovery, but not so much that they switch off entirely and take a long time to feel like they’re working again!

I sleep better with TPT just before bed, but recover better between sessions if I TPT straight after training. This presents you with a bit of a conundrum- and again, it is only through experimentation with your own TPT products and your own body that you can really work out what works for you. It’s perfectly plausible that you may be able to do multiple TPT sessions before and after training, and then another one before bed- but I just can’t handle that.

What works for me, then, is a short and focussed TPT session on either just my lower leg, or on all areas of the Ultimate 6- I choose what to do depending on how I feel after training. This generally helps me loosen up, warm down properly, refresh my mind and also enable me to do any admin or ‘normal life’ things I need to do later in the day.

If training was particularly hard, or my ongoing recovery is suffering due to stress, lack-of-sleep, forgetting a meal, or anything else which may crop up then I will normally do another short, focussed Ultimate 6 session before bed to enable me to sleep better.
I do a slightly longer version of this pre-bed session the evening before every rest/easy day so I can sleep well and my muscles can really switch off and enjoy moving into ‘rest day’ mode.

Breathing
The most important method of gauging, controlling, and encouraging the Trigger Point Performance Therapy is your breathing. In simple lay-man’s terms, we are manipulating the muscle to encourage a stronger bloodflow of nutrients and oxygen. If you’re not breathing properly, then you’re not really introducing fresh oxygen into the system.

The technique I use is quite simple- long deep, heavy breaths and motions with the TPT products for the ‘full’ ultimate 6 sessions and sessions before or on a rest day. Use shorter, shallower, faster breaths and manipulations for the pre-exercise sessions in order to encourage your muscles to wake up. As I said at the beginning of this blog, I am in no way a qualified expert, but if you’ve ever had access to an oxygen mask or oxygen tent you will note the drowsy/relaxed effect they can give. I liken this ‘dopey’ sensation of oxygen ‘high’ with overdoing the TPT and switching your muscles off- ideal for rest day sessions, but not really what you want immediately prior to training!

Effects
I think the best indication of how much benefit Trigger Point Performance Therapy has given me must come from a 3rd party or slightly independent source. My girlfriend Alice is, amongst other things, a pretty good masseuse and used to give me fairly regular leg massages during intense training periods. We agreed that she would not touch my legs during the TPT trial.

After 3 weeks of solely TPT and no leg massages she massaged my legs and, I know it sounds like a tremendous cliché, could not believe the difference in the looseness, flexibility, suppleness and feeling of my muscles- particularly the problem areas of my calves.
I’ve also noticed a marked difference in how my body feels, and I can also actually discern a visual difference in the looseness of my calves.
I’ve noticed my feet (huge problem area) are much happier- with a better blood flow. I’ve noticed that when my Calves/soleus tighten up, the stress passes down the biomechanic chain and affects the comfort of my feet. Focussing on those two key areas with TPT, then, helps reduce pain, improve my posture and encourage performance. I’ve also discovered it’s incredibly nice when working at a desk or watching a film on the sofa to use the small roller or footballer on my feet.

Conclusion
Just want to make it clear that I’m not an employee of Balance Performance or Trigger Point Performance Therapy. I don’t receive financial benefit or money in return for writing this, and have no connection to either company at this time beyond the fact that Jonathan is a great guy, sent some TPT products my way, and showed me how to use them.

The thing he has always stressed to me, and I hope I have also stressed to you, is to experiment. Go to a workshop, borrow a friend’s, or buy your own products. Use their advice or words above as a starting point, and explore your body. Find out what works. Find out how and when and why certain techniques or timings work best with your body and your training. Everybody (literally) is different, so what may work incredibly well for you may not be true for others. What is true, however, is that everybody can, with some experimentation, find something that is really beneficial for their health and performance.
END

thanks so much to Tom for putting the time into putting his thoughts down here. To see more about Tom read his profile on:
Jaguar Academy website: http://www.jaguaracademyofsport.co.uk/the-academy/rising-stars/2011/thomas-staniford.aspx

Also Toms own site: http://www.tom-staniford.co.uk/category/news

Follow Tom on Twitter @tomstaniford

To see the range of products on offer from Trigger Point Performance go to the Balance Performance Shop: http://balancephysio.com/blog/2011/10/paracyclist-tom-staniford-on-trigger-point-performance-therapy-and-balance-performance/