Radio presenter Rachel Horne on her journey to dry running with the help of physio Emma James.

Rachel Horne, newsreader and Chris Evan’s co-presenter on Virgin Radio UK. 

“My friend Jools recommended I visit Emma James Physio, a specialist pelvic floor physiotherapist at her clinic at Champneys, Tring after I announced I was going to do The London Marathon. (Rachel was cajoled live on the Virgin Radio breakfast show by Vassos, Chris and the team back in November 2019!).

I’d never attempted a long run without desperately needing the loo.

“As soon as I’d said yes to the marathon, I panicked that my weak pelvic floor wasn’t up to it and was going to stop me from running the 26 miles. I’d done the odd bit of cross country before at school and outdoor fitness boot camps but never attempted such a distance or gone for a long run without desperately needing the loo!

“In fact, I used to dread it in summer when I did the Boot Camps and would always wear an incontinence pad, tie my hoodie around my waist and take a towel to sit on in the car on the way home in case the inevitable happened.

“I had three children in just over three years; carrying them put extra pressure on my pelvic floor and then I had complicated births giving me second and third-degree tears which weakened my pelvic floor further and the reason I leak when I run. 

“I hadn’t got round to doing anything about it mainly because as one of many 30 and 40-something women who are always busy looking after other people, fixing ourselves goes right down the list of priorities.

It’s almost a badge of honour for women to say they leak.

“I think I’d also just fallen into the trap of just accepting bladder leakage was normal. It’s almost a badge of honour for women to say they leak whether that’s when they run, get on a trampoline with the kids, or sneeze. Everyone laughs about it. You see it on TV adverts where women laugh about having the condition and it’s so normalised that women think they should say nothing and just use an incontinence pad whenever we leave the house.

Emma is a force for good.

“Emma is a force for good. My first visit to her was almost like a therapy session. She took the time to ask me about myself and encouraged me to tell her my story, giving me a safe space to open up. When she said she could fix my bladder leakage I felt like a weight had been lifted off my shoulders. She was wonderful.

“She helped me to realise it’s NOT OK to leak and made me see that unless I took steps to strengthen my pelvic floor, my leakage would just get worse, particularly as I approached the perimenopause and menopause.

“Because of the challenge I was facing, training for the marathon in a little over five months, Emma suggested a multi-pronged attack although I was relieved to hear I didn’t need to have an internal exam, which I know puts many women off sorting out their bladder problems, as I don’t have a prolapse.

“Through Emma’s clinic, I’ve used a combination of pelvic floor strengthening exercises, tried pelvic floor trainer Pelviva, had sessions on the PelviPower chair, and used Secret Whispers and my bladder leakage has dramatically reduced.

Leaking has definitely improved my general wellbeing.

“After just six weeks of support, I was dry after the first mile which was never the case before as I always leaked just after I started to run. Recently, I managed 5km (3.5 miles) over hilly terrain and was completely dry at the end of the run which felt like such a massive, massive achievement. Leaking less has definitely improved my general wellbeing too as I feel more like myself again. I now no longer need to wear a pad EVERY SINGLE DAY and only keep one on for exercise in the unlikely case I might leak. 

I no longer need to wear a pad every day.

“Now due to the Coronavirus, The London Marathon is rightly postponed but I do hope to run it later in the year. Once I’ve done that, I don’t think I’ll ever do another marathon ever again! However, I’m planning to continue running between 5 and 10km on a regular basis to get that time to think, feel energised, enjoy the fresh air, and release those endorphins and will be able to do so without always leaking which is just amazing!”

 

 

Tendon Pain Treatment and Management

The best part about tendon rehab is you need to facilitate your load to optimal levels, so it doesn’t mean complete cessation of exercise! Tendon rehab is fundamentally based around loading the affected musculotendon unit, so strengthening exercises are key. Research shows best outcomes are associated with a long term (average 12 weeks), progressive and individualised loading programme. So as long as you put the hard graft into your rehab; you’ll go the extra mile!

There are other significant factors that will contribute to your management; such as foot and ankle biomechanics, BMI, psychosocial factors as well as other co-morbidities. As Kelvin stated in our previous blog post, each case of tendon pain is unique and is tailored to you as the individual.

So, what is the norm for Tendon Pain?

Due to the makeup of the tendon fibres and what their role is, it takes either a dramatic change in your load or a build up in load that exceeds your capacity over time to elicit a painful response. This may cause an inflammatory response for an acute change and/or structural change in a more chronic period of excessive loading. Either way, there will be an element of pain that is overriding in either your day-day activities or exercise-based activities.

So, What do we do?

You stop doing what hurts, dur? Well, with tendon pain it isn’t as straight forward, and that’s good news for you! Why? Because it doesn’t mean you have to completely stop all forms of activity. Our aim is to keep the healthy or injured part of the tendon active within our desirable limits and with suitable progressions in activity and exercise; our tolerance will improve over time!

So now we come onto the million-dollar question, what is the right amount of pain?

The criteria for tendon related acceptable pain is really straight forward, we take a subjective interpretation of your pain and provide scores of optimal, acceptable and undesirable intensities of pain. The presence and/or duration of symptoms after a reaction are also monitored and fall into the same categories. Remember, your pain is unique to you, as well as your exercise tolerance – this is all considered when your therapist constructs your rehabilitation programme.

So don’t panic, tendon pain isn’t as debilitating as it seems. With patience and commitment, we will get you back to your goals, and back even stronger than before!

Adam

Blog post by Adam
Senior Physiotherapist at Emma James Physio

The upward surge in sports injuries around this time of the year

As the winter months slowly start to take over our skies, the balmy holidays in July and August already feel like a distant memory; what that also means for a lot of us is that we’re back in full swing with our gym routines, running trails, contact sport training and games – casual and professional athletes alike – and perhaps preparing for our next marathon/half-marathon.

Interestingly, we as Sports Physios tend to see an upward surge in sports injuries around this time of the year. And sometimes, as a figure of speech, we can even predict certain months being more “hip/knee/ankle injury dominant”, depending on whether there is a prominent sports events coming up e.g. London Marathon, or a finals series. In those months, we are bound to see and treat a few people with sore ankle tendons or painful knee tendons.

…but why is that?

Today I’m hoping to provide you with a little insight to how we as physios answer that question.

Tendons mostly are the thick, fibrous connective tissue that links a particular muscle to a bone, and is the main structure that converts a muscle contraction into an actual body movement. It is primarily made up of collagen tissue, and this tissue can be an incredibly robust, “workhorse” structure – being able to absorb impact, withstand multi-directional forces, convert muscle energy into movement, and generate power + velocity pertaining to our chosen sport.

However, tendons do have a major character flaw: they are very, very sensitive to change. Which means any drastic changes to one’s training routine – simply termed as Load in Sports Science – can have an irritating effect on the tendon structure, eventually leading to pain. Load, as we know, can be measured in a few ways:

• Frequency: How often the training takes place e.g. How many runs per week?
• Intensity: How hard the training session(s) is, e.g. How fast you’re running
• Volume: How much the person is doing in a particular session, e.g. How far you’re running

When there is a sudden, drastic increase in load – or an “upward spike” – the collagen structure of the tendon is unable to cope with these changes, and can often begin an inflammatory process, leading to collagen/tendon breakdown, and in severe cases, loss of structural integrity. Broadly speaking, this is when the person begins to feel a persistent pain during and/or after the training, and the performance/output is no longer as well as before. Conversely, tendons also adapt to a decrease in load – or we refer to as “deloading” – whereby the collagen structure adapts to a lesser training load/regime, and in time is no longer at the capacity of its previous training intensity. So if we were to put two and two together: a deloading phase during our summer holidays/off-season followed by an upward spike around this time of the year…it’s not hard to see why some of us are getting aches and pains!

Luckily, most of the time these changes are not permanent, and tendons generally do respond well to treatment and rehabilitation. This is where the expertise of your physio comes in – we can determine the extent/severity of your presenting tendon injury, provide any immediate treatment that is necessary, but more importantly go through the details of your training routine and carefully making adjustments to it. This ensures that we are gradually rebuilding your tendon strength properly, as well as preventing it from further irritation and breakdown. Such is the nature of tendon injuries, there is no one-size-fits-all, and each case is treated in accordance to its specific needs.

All the physios at Emma James have had the privilege to work with (and currently so) athletes at various levels, and therefore are very experienced in dealing with tendon injuries.

Should you have any doubts about your training, be sure to contact us as we would love to help. Just imagine: us making your marathon training (actually) enjoyable!

Kelvin
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Blog post by Kelvin
Senior Physiotherapist at Emma James Physio

Benefits of working with a Personal Trainer

There are many reasons why having a Personal Trainer (PT) can benefit you, people of all ages and abilities. See better results by living a happier more active lifestyle.

A Personal Trainer will help build a unique training plan for each individual, which can easily be adapted and adjusted. Exercises can be regressed or progressed depending on the level of fitness, injury, results driven, time and if having an ‘off day’.

Top 5 Benefits

1. Faster and Better results

Having a Personal Trainer will make sure you stick to your programme and push you to your limits during a workout session. Often when you work out solo you can become distracted and don’t push yourself as much. Time is always an excuse as not to work out but having a PT can adjust programs so they are just as affective no matter what the length of time you have available.
By pushing your boundaries, you will see faster results, this could be weight loss, toning up, cardio/fitness level or strength.

2. Fat loss and Muscle Gain
This is not everyone’s main goal but for 80% off people hitting the gym it is. Having a Personal Trainer, they know the right exercise each individual should be doing to achieve their goals. A mixture of weight training to gain muscles and become stronger and cardio to get fitter and leaner

3. Reduce chance of injury
A Personal Trainer will teach proper form and technique, which will prevent injury. Injuries can easily occur from not warming up properly or doing exercises incorrectly.

4. Establish a lifestyle habit and routine
A Personal Trainer can help motivate and encourage to create new habits. Once a routine is established it is easier to stick to, making it part of your lifestyle will make it easier to achieve results. Exercise and diet are all about consistency if you want to see those results.

5. They fit into your schedule
We all have busy lives and lots going on the beauty of a Personal Trainer is that they will adapt their time to fit in with you. So if you need an early morning or late evening workout a PT will be there.

6. Flexibility on Location
Many do not like working out in a gym as it can be crowded and over whelming. A Personal Trainer can change the location of any workout from either the gym, a home work out or even outside.

7. They can help with specific goals – an Event
As well helping set realistic goals a Personal Trainer can help set a training plan and train for specific event whether this be a run, triathlon, swim or a sporting event etc. With events you need to reach a certain level of fitness to be able to compete and stay injury free.

8. Mentor / Mental Health
Exercise realises endorphins which are ‘happy hormones’ they can help make you feel good physically and mentally. A Personal Trainer can help motivate you when you are suffering from mental health issues, they can help keep you on course to release the greatest number of endorphins. This in turn helps with a person’s overall wellbeing. A PT cares about how stressed you are, they will listen to you, they want to give you the best results which can be impacted on how you are feeling.

If this sounds interesting and you need that extra push why not call or email Emma James Physio to find out more….
reception@ejphysio.co.uk
01442 870686

Pippa
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Blog Post by Pippa
FCO Gym Manager & Personal Trainer
Emma James Physio

 

“I’ve got that Plantar Fa…something”

At some point, we’ve all experienced some kind of pain in the foot, or know of someone who is currently experiencing/complaining about persistent foot pain. Perhaps it was around the time we decided to get back to the gym for six weeks. Perhaps it was after a major hike up in the Lake District. Perhaps it is just the nature of our job has a bartender. Quite often, we then get told – or even self diagnose – that it’s something called Plantar fasciitis. But what exactly is Plantar fasciitis?

The Plantar Fascia is a thick, strong band of connective tissue in the base of the foot, roughly spanning from the heel to just before our toes. Because of its structure, it acts as a shock absorber, provides structural supports for our arches; and mechanically acts as a spring when we walk and run. Plantar Fasci-itis is the name of the condition when this structure is irritated and inflammed, thus causing the persistent, and often flagrant pain.

What causes plantar fasciitis?

Plantar fasciitis often occurs with a combination of physical, environmental, and social/work factors all impacting on the structure of the foot. Some of these are listed below:

• Altered/poor gait (walking) biomechanics
• Weakness in hip, knee, and/or foot muscles
• Repetitive strain on the soft tissue
• Recent change in physical workload (Predominantly overloading)
• Poor/uncomfortable footwear

Treatment and Management

The initial goal in managing plantar fasciitis is to reduce pain and inflammation. Your physiotherapist would be able to provide some manual treatment to help begin the recovery process. But it is also important to then assess and examine all these factors mentioned above in order to get to the root of the issue, and being able to prescribe the most appropriate management plan. This may include some stretching/strengthening exercises, modifications to your activities/daily schedule, and in some cases recommending extra assistance, such as an orthotic.

All our physiotherapists at Emma James are trained to assess any biomechanical issues, whilst the clinic is also equipped with purpose-specific pressure pads to perform a detailed gait analysis.

If this is something that you needed help with to get back to your work, your training, or even just to be pain-free, come and see our team of experts at Emma James Physio and we would love to help you!

Kelvin

Kelvin Leung, Sports Physiotherapist
Emma James Physio

Knee Injury and risk of Osteoarthritis

A recent study published in the BMJ analysing the risk of developing knee osteoarthritis (OA) after knee trauma analysed over 1 million patients.

The risk of developing knee OA after ACL injury was 4 x higher compared to the non- injured knee or non- injured knee.

A meniscal (cartilage) injury and combined ACL/ meniscal injury as associated with 6x higher risk of developing OA.

Key messages:
1. The IMPORTANCE OF KNEE INJURY PREVENTION PROGRAMMES (strengthening).

2. The IMPORTANCE OF STRENGTHENING AFTER INJURY TO PREVENT or DELAY KNEE OA DEVELOPING.

If conventional physiotherapy alone is not being effective at reducing pain and improving function apos therapy is the next non- surgical option- customised and calibrated footwear to reduce pain and improve muscle control.

You can also book a free consultation, to see if Apos Therapy could work for you.

More Information:

• What is Apos Therapy?
• Gait Scan
• What people are saying about Apos Therapy
• Apos Therapy Website

Lisa
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Blog post by Lisa
Senior Physiotherapist
MSc MACP MHCPC MCSP 
Emma James Physio

 

Ralf – My Apos Story

I have been an amateur runner throughout my life. However I hadn’t actually participated in races up to about 5 years ago. Approaching my 70th birthday also saw me running 10 km and even a semi-marathon in 2017.

In November 2017, training for my first dash of a full marathon I experienced terrible pain on my left knee. It did not come about suddenly but gradually grew over a few days. I stopped running since I was unable to make even a few hundred meters without feeling atrocious stabbings on my lower leg. Even walking became horribly difficult.
Not only my running life seems to have ended but daily chores involving my legs would preoccupy my thoughts for years to come.

The conclusion was evident: left knee arthritis. ‘’You have to alter your whole lifestyle. If you feel that this state affects only a quarter of your daily activity you are not ready for knee surgery. However a few more years of lowered energy and you definitely need one’’.

I was against surgery as I had heard of many cases of unsuccessful results. In May 2018, my sister, who is also a runner but definitely better than me, advised me to look into AposTherapy. She had witnessed the positive results in many of her friends who came back to run after years of forced inactivity.

The therapy started in May and went throughout the summer months, growing from 30 to 60 minutes a day. Some days when I did not find time to walk, I just put the computer on a high table and wrote standing.

In October my first baby runs took place: Only half kilometer or so. I was rejoiced by the fact that the pounding reduced although it came back after some distance. I continued every day with the therapy, even going out to the supermarket with my Apos shoes.
In November my weekly runs were up to 6 km although excruciatingly slow, taking me 1 hour when during that period previously I would have run a full 10 km.
My clearest objective for a nice start to the New Year was a Parkrun. These 5 km courses on Saturdays in parks all around Britain are great introductions for people of any age, who want to change their lifestyles by short runs.
I consistently delayed my first parkrun since even the slowest runner will finish in 45 minutes (9 minutes/km) and I was not sure the volunteers will wait for me, at about 50 – 55 minutes.

Therefore I was astounded when my first Parkrun was completed in 35 minutes. The 400 participants had probably created a magnetic field that just carried me to the end.
This was the most worthwhile gift for the New Year. I could run, respectfully. Of course there still was slight pain afterwards but the progress was evident.

It was nothing short of miraculous for me. I have to admit that Apos was not alone in this marvel. The open sea swims in summer and weekly strength exercises in my local gym were evidently helpful in reinforcing body and legs.

However first award goes to Apos. I am thoroughly happy and naturally reflect it on family and friends.

Blog post by Ralf
Apos Therapy customer

• Hear Ralf talk about his Apos Therapy  treatment on our You Tube channel
• For more information on Apos Therapy please visit https://www.ejphysio.co.uk/