What are the Glutes and why are they so important?

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The glutes are a group of muscles around the back and side of your hip that make up your backside. They are responsible for creating some hip movements and for controlling your pelvis on your standing leg. There are 3 different glute muscles – glute maximus, glute medius and glute minimus – their names refer to their size.

The main hip movements they are responsible for are taking the leg out behind you, taking the leg out to the side, and turning the leg so the knee points out. They do also have other functional roles and are required for other more complex movements, and their role can vary slightly depending on what position the body is in to start with – but we’ll keep it simple.

Their role means they play a huge part in controlling the alignment of the lower limb when you land on it, and are a main generator of power in propelling you forwards over that leg. This makes them very useful for tasks such as running, jumping, stepping, lunging, squatting and getting up off the floor.

Glute max is the biggest of the group and is most responsible for generating power. It is responsible for strength and speed.

Glute med and Glute min are smaller and deeper muscles, they are designed to fine tune and control movements around the hip and pelvis.

They need to be able to pre-empt your next move and to have good endurance to ensure you can keep good form throughout periods of exercise.

Due to their complex role and to the affect they have on our efficiency and biomechanics the glutes are very often a key area to rehab to offload lower back and knee pain. When the glutes are not strong enough, or are not working optimally, the load that they are not controlling gets shifted to other areas of the body – such as the lower back and knees. Lower back pain and knee pain are the two most common things seen in a physiotherapy clinic and when both are reliant on a decent set of glutes it becomes a very common area addressed in rehab.

A test to try at home – stand in front of the mirror and relax, take a look at your knee caps in the mirror and see which way they point. Now try tensing your butt muscles – what happens to your knee caps? Then what happens when you totally relax your butt muscles?

This can be applied to things like squatting – if your knees roll in towards each other when you squat, try using your butt muscles to pull the knees out into better alignment. The knees should point in the same direction as your feet throughout the squat.

Also, if you lean forwards excessively through a squat movement, or only get a small way down before you feel like you’re going to topple over backwards – your glutes are not working properly.

The key to successful rehab is consistency

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A nice analogy that I have found useful when teaching someone to pace their training is to consider training load in terms of alcohol consumption…bear with me.

Imagine that you have been set a weekly target of drinking 14 pints of beer (or your favourite equivalent).

If you were to decide to drink all 14 of those pints on the first evening then you would end up very drunk and likely have a prolonged hangover that meant you didn’t feel like drinking for the rest of the week (or ever again). It would have also meant that after a certain amount of pints that evening you would have already been drunk and the rest of the pints were just pointless excess that are likely damaging.

If you decide to be a little more sensible and drink 7 pints on two evenings that week; the effects will be less dramatic than the first scenario but once again you were likely drinking in excess and would still have a hangover. If you continued to drink like this for too long you would cause your body harm.

The best way to succeed at this challenge, whilst giving your body a good chance to recover, would be to do 2 pints each day or a structured week of 4 days of 3 pints and 1 day of 2 pints with 2 rest days.

Shoulder Rehab

With this analogy the getting drunk from the effects of alcohol would be similar to the acute fatigue effects from exercise, and the hangover would be similar to the soreness and tissue healing that occurs after exercise.

Obviously, exercise is far better for you than beer and you should be doing the exercise version, not the drinking!

Once you have mastered the art of pacing exercise it is important to have a rehab schedule that is varied. This has 2 main benefits – it gives your body a good variety of exercise types to make sure you are covering all the bases, and it keeps it interesting for you.

The other aspect of consistency with rehab is keeping it up over a prolonged period. It takes time for tissues to adapt and muscles to strengthen. It takes 6-8 weeks of consistent exercise to build strength in your muscles, and even longer to get changes in your soft tissues and tendons. If you were to only stick at your rehab program for a few weeks and then find better things to do you would not have given your body a chance to adapt and benefit from the exercises you were doing.

Playing sports and even carrying out new or complex tasks in daily life requires skill. It is widely accepted that skills need to be developed and practised over time. Strength is also a skill, if you want to attain a high level of it, you need to do consistent practise, just like with anything else. We all go through phases where life seems to get in the way – but always remember “Something is always better than nothing”.

Rehab & Loading- The Traffic Light System Explained

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Your body adapts to the loads that it is put under on a regular basis. This ensures that your tissues regenerate in response to the stresses exerted on them to enable them to withstand the stress better in the future. This is how we get stronger. When this process goes wrong we end up with a tissue in disrepair – an injury – commonly this is due to sudden unaccustomed increases in load without the appropriate time for recovery and regeneration of tissue.

The Traffic Light System:

This is a system we teach patients in order to help them monitor their return to activity and gauge their progress. It is hard to know how to manage a new injury and how far you should push yourself. Your body is designed to adapt and change in response to stress and sometimes it is OK to feel discomfort when returning to activity. It is your in-built ability to heal and recover that will then decide how quickly you can push things.

Green

  • Monitor your symptoms – pain, swelling and movement – these should be noted DURING exercise, LATER that day, and the next MORNING.
  • It is OK to feel some pain DURING when trying out something new, we normally say working up to 4 out of 10 pain is acceptable.
  • If you do not experience problems during exercise but are struggling LATER that day; this could be a sign you have overdone it a bit.
  • The key time to monitor your progress is the next MORNING. This is where the traffic lights come in…

GREEN LIGHT – no increase in symptoms – you are fine to do the same activity again or try a little bit more.

AMBER LIGHT – Some increase in symptoms but able to move normally within 1 hour AND back to normal within 24 hours – proceed with caution. Try the same activity again after 48 hours and do not progress it until you have achieved a green light.

Red Light– Big increase in pain and/or pain that does not settle within 24 hours – you have done too much, give it 48 hours rest, get moving gently and go easier next time.

Keeping a written training diary can help you to follow your progress and notice any reoccurring patterns to your symptoms.

We usually advised that when introducing new activities or increasing training you have two days of low load to follow to allow recovery time. Hard sessions should be on every 3rd day.

If you are unable to achieve GREEN LIGHTS when doing new activities then it is advisable to contact a physiotherapist.

Acupuncture vs Dry Needling – What’s the difference?

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Acupuncture is the use of fine, flexible needles inserted into specific points of the body in order to stimulate the body’s natural healing. In many western circles the terms acupuncture and dry needling are interchangeable and are talking about the same thing, but their methodology and techniques are actually different. The term acupuncture comes from […]

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DOMS

Am I Injured?

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What is DOMS, am I injured?

DOMS stands for Delayed Onset Muscle Soreness, and it occurs as a result of exerting your muscles. When you do an activity that is new, or you are working harder or for longer than usual, the extra stress on the tissues of your body causes micro trauma. These are microscopic tears in the fibres and occur widespread throughout the muscle groups being used.

This usually results in widespread soreness in one or multiple areas of your body 1-3 days after the activity, and the soreness can last quite a few days. This is totally normal. As these tiny microscopic tears heal they create slightly stronger muscles. It is important that our muscles go through this process in order to allow us to adapt and change, so we get better able to withstand the stresses of a new task in the future.

However, it is not possible to predict when DOMS will strike. Not everybody gets it and some people seem to suffer more than others. As a general rule it is more likely when starting out doing exercise, when doing something new, or when working harder than normal. This means as you keep training it does get better, you won’t always feel like that after exercise. For some this is reassuring to know it is possible to exercise and not feel sore the next day, and for others a lack of DOMS means they are due an upgrade to their program and should be working harder!

Certain types of exercise are more likely to cause DOMS than others. Typically exercises with a high eccentric load are more likely to cause soreness. Eccentric is the lowering phase of a muscle (or the deceleration phase), for example when you bring the weight back down towards your chest in a chest press.

 

This means that things like speed work, explosive/plyometric tasks, and repetitive high speed change of direction, all have a higher likelihood of causing soreness the next day. Clear examples of exercises with an eccentric focus would be jumping off of a box, or catching a heavy medicine ball.

Generally exercises will always have an element of concentric and eccentric demands, with other muscles working isometrically to control the movement, but you can modify them to increase or decrease the bias accordingly. This knowledge can allow you to control the amount of soreness you are likely to have following exercise. This information is also useful if you do not like DOMS. Doing a graded program that starts with basic isometric and steady concentric exercises and builds up in intensity and speed of movements slowly is more suited to managing DOMS.

 

There have been lots of studies into what we can do to reduce the soreness that occurs after exercise. The majority of which have shown there is very little we can do to shorten the length of time the soreness lasts. But there are things that we can do to make sure it does not last longer than normal. These include basic things like keeping active and moving around lots despite the soreness, do not repeat a hard activity or workout that targets the same area until the soreness has calmed down, drink plenty of water and eat well, and use things that usually give you a feel good effect (such as a hot bath or some gentle stretches). Some people who are training hard and need to recover as quickly as possible could also look into using the Compex for improved recovery. You are able to hire a Compex unit from The Physio Clinic to try it out.

 

When DOMS goes too far:

It is possible to create too much DOMS. Sudden extreme exercise can cause Rhabdomyolysis. This is rare and unlikely but possible. It causes extreme levels of post exercise soreness, rigidity (loss of range of movement due to rigid muscles), lack of urine or urine that is very dark in colour, and this takes longer to recover from that just DOMS.

It is due to excessive levels of microtrauma that results in high levels of creatine kinase in the blood and puts excessive stress on your kidneys. Unlike DOMS, Rhabdomyolysis is a serious condition that requires medical attention.

You need all the symptoms for it to be Rhabdomyolysis, if you are just excessively stiff and sore after exercise … you just have bad DOMS, plan better next time.

What is shockwave treatment and how does it work. Why we choose to use it here at the clinic as a treatment method

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Shockwave therapy is a non-invasive treatment in which a device is used to pass acoustic shockwaves through the skin to the affected area. This will encourage neovascularisation (the formation of new blood vessels) and tissue regeneration, which are important during healing and recovery.

Shockwave Therapy can provide relief and advanced recovery in situations where the healing process has stalled or failed to respond to standard therapeutic intervention. Anyone who has suffered an injury knows that chronic pain can affect your quality of life, performance at work, enjoyment of regular exercise and ability to take part in sports.

Shockwave is able to provide relief and healing even in chronic cases where the body has previously demonstrated an unwillingness or inability to do so by itself. The use of Shockwave Therapy has been found to safely and successfully treat a range of musculoskeletal conditions. Its use is supported by a wealth of clinical experience and scientific evidence. Research has shown, a combination of Shockwave and Physiotherapy gets the best results as opposed to each in isolation.

At The Physio Clinic we most commonly use Shockwave Therapy to treat chronic tendinopathies and plantar fasciitis that have not responded to physiotherapy alone. It is a useful adjunct to the treatment of long standing tendon conditions as these are classically a hard tissue to rehab and a common cause of persistent pain.

Tendinopathies occur when a tissue remains in a persistent state of disrepair. This happens when there is a decrease in the efficiency of the body’s ability to heal, or when the demand on the tissue is too high with not enough time for recovery. The longer this state of disrepair continues the lower the tolerance of the tissue to withstand the stresses put upon it and the more likely it is to remain in a state of disrepair. In order to get the body to re-stimulate the healing process we need to introduce a new stress on the tissue.

This is done with the use of the Shockwave machine. Shockwave Therapy is designed to put the tissue in a fresh state of healing, when this is used appropriately alongside a personalised rehab program it gives the tissue the best chance at regenerating and returning to a functional state.

Injuries that runners face when the ground hardens and the heat increases

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Increased hardness of the ground, for runners that run off road, means increased ground reaction force and more strain for your body’s shock absorbers

These shock absorbers include structures like cartilage, tendons, fat pads, bursae etc.

The only way to take the stress off of these is with a preventative strike of your winter training containing lots of muscle strength work. Ground reaction force is absorbed by your body’s contractile tissues – your muscles. As per Sir Isaac Newton ‘Energy can neither be created nor destroyed’ – it has to be absorbed by the body.

If your muscles are not strong enough to deal with this increase in demand when the ground hardens then the passive structures listed above will bear the brunt of the force. It takes time (6-8 weeks) to build muscle strength. Therefore it is essential to have achieved this strengthening of your muscles prior to the ground hardening in order for you to be able to prevent injuries. If you are already running with a niggle then this increase could be the thing that tips it over the edge into an injury.

Increases in temperature pose a challenge on the body for regulating your temperature when running.

It is essential for your core body temperature to stay in and around 37 degrees C. An increase in the temperature around you will lead to higher demands on the systems that keep you cool and an increase in risk of dehydration.

Running in the heat physiologically slows the body down.

We are not as efficient at 25 to 30 degrees as we are in 10 to 15 degree temperatures. So don’t be afraid to slow things down if you have to, especially if you feel nauseous, light headed, sleepy, confused or even cold—all signs that you may be overheating.

To avoid this you may need to take regular walk breaks. Slowing down and walking are not signs of weakness. They are smart training that will pay off down the line. Three to five days of easier runs in the heat will give your body the time it needs to get ready for the added demands that heat will add.  Doing too much too soon is a good way to cause heat-related illnesses.

Stay hydrated

Hydration doesn’t mean just have a drink of water before or after a run. You need to get hydrated and stay hydrated throughout the course of the day, using not just water but fluid which has a source of electrolytes, such as sodium and potassium. And if you are out for over an hour you should plan a way to stay hydrated on route.

The difference between our Running Clinic (looking at the body as a whole) and a video assessment in a running shop (from the knee down)

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It is a common selling point when buying new trainers from a running shop to get your ‘gait assessed’ or your ‘foot posture checked’. These assessments vary depending on what equipment they have available. Some shops offer video analysis – this is a video of your feet whilst you are running to see what part of your foot you strike the floor with and whether your foot rolls in excessively whilst it is in contact with the floor. From this they will advise whether you need cushioned trainers or any arch support. Another form of running shop foot assessment is the use of a force plate and a computer program. This is where you walk or run over a force plate and the computer program predicts what style of trainers you need dependant on the footprint you create. Any running assessment done in a running shop is looking at just your feet for a basic check on some common types of technique and they will advise you accordingly on the brands of shoes they know match that style.

The Running Clinic, offered here at The Physio Clinic is a full body assessment completed by a professional Therapist’s who specialises in movement assessment and run technique retraining. The Running Clinic includes a full

Treadmill Gait

body video assessment, coupled with a movement screen, to assess how you walk, run, and move during basic tasks. This paints a whole picture of any areas you need to work on with your training schedule, running technique and strengthening exercises.

The sessions take you through a guided, gradual process of improving your strength and running technique with personalised one to one sessions and repeated re screening to see how you are improving. The video analysis tools used during the running clinic look at your body as a whole whilst you run and allows us to look in detail at what’s going on. The ability to see you in slow motion and calculate joint angles through your gait cycle means we get a more accurate idea of how you move. The Running Clinic is great

for improving your running efficiency and decreasing future injury risk.

In a nut shell a running shop assessment is done by a running shop assistant and is designed to pick out common basic running foot techniques and match them to a style of running shoe. The Running Clinic is an assessment and retraining program run by a rehab specialist to help you improve your running, whether you are just starting out or are striving for your next PB.

Buying Your New Trainer In Store

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Running Gait

Getting your gait assessed in store when buying trainers is no bad thing if you have no idea what type of runner you are.

But the rules they use to match you to a pair of shoes are very over simplified. They can guide you on what shoes may suit your running style but they have no knowledge on the underlying causes of why you run like that. You may be advised to wear a stability shoe due to flat feet or overpronation – but in fact if your foot shape and movement is down to skeletal structure as opposed to muscle function and you will find a stability shoe too aggressive and uncomfortable.

These people tend to say ‘I was advised to get a stability shoe to address my foot posture but I had to stop wearing them because they felt like the arches were poking into the soles of my feet.’ These shoes are therefore not appropriate. If it doesn’t feel totally perfect in store then they are not going to start to feel good once you’ve left the store.

Any shop selling you running trainers should have the availability for you to try the trainers whilst running. You will move in a totally different way when running compared to standing or walking and what feels good standing in a shop does not necessarily mean it feels good to run in.

 

When you get home with your new running trainers:

The key thing with any new running trainers is to break them in gradually. Even between brands and between models within brands there are variations in the technology and materials used. Changes in the amount of shock absorption or areas of stability/mobility will change how much stress goes through each area of your foot and ankle. Any sudden change in stressors will have the potential to overload tissues in the body and lead to injury.

Start with shorter runs and build up the time spent in new trainers gradually. Be guided by any ‘hot spots’ of soreness you feel after a run in them. If you run too far too soon you are more likely to miss these warning signs and get a full blown injury.

 

Lastly:

More expensive does not mean better. It also does not mean more comfortable or any less likely to cause you issues. The latest fashion new releases are also not always a great place to start. High fashion does not mean they will suit your needs. Also if they do end up feeling good and you want to buy more in the future you want a reliable line you know they will continue to reproduce. The elites get away with running events in the latest footwear because they are strong enough and well trained enough to tolerate regular changes in footwear, they factor this in to their training schedules. It is also likely in their contract that they have to wear them, whether they like them or not!

Buying Your New Trainers

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