Eccentric Exercise for Tendon Pain

Tendon pain (tendonitis) is a very common condition of both younger people who exercise on a regular basis and older people who live a more sedentary life.  Essentially tendonitis is caused by minor rips, tears and disorganisation of the tendonous tissue.  These injuries can occur as the result of sudden trauma (eg lifting a heavier weight than normal) or over a long period of time due to repetitive movements.

Typical areas of tendonitis includes the achilles/lower calf, the elbow, knee and shoulder.

Tendonitis is usually a dull ache that is made worse on movement.  Often there is a cracking or grating sound.

What are the tendons?  Well tendons are the anchors at the end of muscles that connect them to bones and have high levels of collagen to provide strength – unlike muscles which have low levels of collagen, but far more stretch.

Fixing the Problem

One of the most effective ways to treat tendonitis, after initially resting, icing, compressing and elevating (RICE) is the use of ECCENTRIC exercises.  Eccentric muscle action is an overall lengthening of a muscle as it develops tension – typically putting down a load with control.

Eccentric exercises work on the tendonous part of the muscle-tendon unit (concentric exercises work on the muscular part).  Muscles are divided into two sections, 1. the contractile (red) muscle belly and 2. the (white) tendon and non-contractile components.

Active muscle lengthening (eccentric contraction) stresses and thereby strengthens the (white) tendon tissue more.

Attached is a list of Eccentric Exercises for Tendonopathy, however please note all serious pain or debility should be seen by a qualified medical practitioner.

Yoga and Ayurveda

Ayurveda is the ancient Indian science and wellbeing and is often seen as the sister discipline of Yoga (Ayurvedic practitioners often see Yoga as the exercise arm of their own therapy!).  Ayurveda has much to say about wellness, disease and how these affect the different constitutional or dosha types.  Ayurveda offers lifestyle advice, dietary advice, herbal prescriptions, surgery (very few modern practitioners offer this now!!!) and of course Yoga

It could even be argued that Yoga therapy began as an arm of Ayurveda.

Ayurvedic physicians often prescribe the practices of Yoga to both maintain health or treat illness or disability.  An Ayurvedic physician will often prescribe Yoga both for the illness AND the constitutional type of the patient – so let’s have a quick look at the general principles of Yoga as Ayurvedic therapy.

If you don’t know what your constitutional type is why not take our quick dosha quiz? Without knowing a person’s dosha it is said to be almost impossible to use Yoga as a healing tool.

Yoga for the Doshas

In Ayurveda there are three basic constitutions (we all have a mixture, but one or two doshas tend to predominate) – these being vata (wind), pitta (fire) and kapha (earth).  All the doshas benefit from a good balanced Yoga practice, however when we feel our mental and physical balance is being lost the following tips may be of help in fine tuning our practice.

Yoga for Vata

Vata is the dosha that is most easily disturbed mentally and physically, but also tends to recover well from imbalance.  A typical vata person tends to be long and slender – just the type of student who is often seen in a Yoga studio.  This constitution often suffers from mental disorders and problems with the joints.

All postures relating to the pelvis, asanas which involve pressure to the abdomen and balancing postures are recommended.  Vata Yoga practitioners should feel grounded all the time and should avoid extremes of temperature when practicing.

Classic posture for vata = trikonasana

Yoga for Pitta

Pittas love intensity and fire and are often drawn to an intense heating practice or one done is a hot environment.

However as pitta is situated at the navel, Yoga practice should look at keeping their digestive in good health and the navel area calm.  Spinal twists, inversions, meditation postures and meditation all ease pitta.  Benefit may also be obtained by resting between postures or even practicing with the eyes closed.

Classic posture for pitta = Matsyandrasana

Yoga for Kapha

The innate sluggishness of this constitution mean that the more energising postures and practices are brilliant to balance kaphas – such as backbends, sun salutations, inversions and the forceful pranayama of kaphalabhati and bhastrika.  Practicing in a heated room may be very advantageous to kaphas.

Classic posture for kapha = Matsyasana

 

Swara Yoga

Yogis thousands of years ago discovered two kinds of energy within the human being – a positive solar (male) energy and a negative lunar (female) energy – together they govern the whole of our being and when in balance, they provide for harmonious functioning of our mind and body and all its systems.

Energy and consciousness, permeate the whole of our being through the network of energy channels, called nadis which converge into two main channels ida and pingala which travel up the body on either side of the spine, – the lunar energy flows through ida and the solar energy through pingala, and they move upward through the body from the perineum to the crown of the head.

When the flow of energy in ida and pingala is in harmony with each other, a third channel opens within the spinal canal in the centre of the spinal cord, called sushumna, manifesting as an equal flow of breath in both nostrils. An active sushumna expresses itself as a state of deep harmony in body, mind and spirit promoting health and well being.

A pranayama technique called Nadi Shodana (alternate nostril breathing) may be practised and used as a tool for rebalancing the nervous system as it is one of the simple, safe pranayama (breathing) exercises with numerous health benefits.

To live life fully and evolve in a harmonious way we must practice, achieve and maintain balance between the right and left brain, between ida and pingala, as this will have very real implications in our daily life, in the way we function, interact, grow and evolve.  The science and practice of working to balance the energies of Ida and Pingala is known as SWARA YOGA.

Ancient Yogis noted that every 60 to 90 minutes one of the channels becomes dominant and the other passive (this is called NOSTRIL DOMINANCE) – the dominant nostril becomes clear and the passive nostril becomes partially or fully blocked.  Certain attributes, characteristics  and traits are traditionally associated with nostril dominance and these would affect the behaviour, desire and abilities of the Yogi.  Below is a short list of the effects of the changing balance of energy in the body as seen via nostril dominance –

LEFT NOSTRIL DOMINANCE        

  • Receptiveness
  • Body Coolness
  • Elimination of Toxins
  • Thirst
  • Expending energy in a slow sustained way
  • Nourishing
  • Imaginative pursuits
  • Playing music and singing
  • Reciting mantras
  • Initiating sustaining relationships
  • Drinking liquids
  • Intuitive, holistic thinking
  • Subjective decision making

RIGHT NOSTRIL DOMINANCE

  • Activity
  • Increased body heat
  • Strength
  • Hunger
  • Eating and digesting food
  • Short term intense effort
  • Expending energy in a vigorous way
  • Aggressive, negative acts
  • Intellectual pursuits
  • Deductive rational reasoning
  • Hunting and fighting
  • Attention to detail

What is Ageing?

Aging is not a simple business.

After all – if it were that simple – humankind would have already worked things out and average life expectancy would be around 200 years and rising.  Understanding why we age is a question that keeps some of the best scientific brains in the world fully occupied – and there is still no definitive answer.

Why do you need to know?

If your concern is looking good as you get older – you may wonder why you need to make your brain ache with ageing theory.

More and more scientific studies are discovering promising new skin care ingredients, warning us about dangerous lifestyle choices, focusing our attention on what to eat and drink for protection from premature aging.  Sometimes the theories seem to contradict one another or offer too many choices.

Simplified Theories of Ageing

  1. Free radical theory

The oldest (since 1956) and most well known and accepted theory of aging – most of us by now have heard of free radicals and the damage they do. The simple explanation of a free radical is a molecule with a free electron which then reacts with healthy molecules in a destructive way producing disease, cell aging and death.

You must have read lifestyle advice based on free radical theory – poor diet, alcohol, smoking, sun exposure – cause free radical build up in the body and result in ill health and premature aging. What you may not have known is that apart from the bad choices you make – just breathing in oxygen and generating energy to move or eat produces natural free radicals which are equally as bad for you.

What we all need is plenty of “free radical scavengers” – or as we now call them antioxidants – which include vitamin C, vitamin E, Betacarotene, green tea catechins and others.

Antioxidants are freely promoted in products like supplements and as anti aging ingredients in skin care based on this theory of aging.

  1. DNA and genetics

Based on the fact that we all have a pre-determined genetic tendency to function in certain ways including how and when we age. Research around this theory shows that genetics isn’t everything. In spite of DNA – rates of aging can still be greatly influenced by our lifestyle choices and by pollutants and toxins we encounter (as in the Free Radical Theory above) – these affect what is called “gene expression”.

  1. Rates of cell division or the Hayflick Theory

Named after the scientist who first outlined the theory in 1961 – Dr Hayflick. The suggestion is that human cells are limited in their ability to divide and reproduce themselves. Hayflick estimated that after 50 cell divisions they die leading to ill health, decay and eventually death. Longer life (anti aging) depends on slowing down the rate of cell division. The way we do this is largely through diet and lifestyle choices as described in the free radical theory before although some drug interventions are being studied.

One discover to emerge from this line of study is that over fed cells divide quicker and restricting calories extends life in lab experiments with mice. As a result calorie restriction (CR) has emerged as an anti aging programme in its own right closely connected to the Hayflick theory.

  1. Cross-linking or glycosylation

A relatively new (1990’s) theory which is becoming increasingly accepted with the work of Dr Robert H Lustig and others. Cross-linking theory is based on the damage to health caused by the presence of simple (added) sugars in the modern diet. Simple sugars bind to proteins in a process called Glycation which results in the formation of AGE’s (Advanced Glycation End Products). Resulting health problems include: Alzheimers, diabetes, cancer, sight loss, deafness and heart failure.

Fructose in the form of High Fructose Corn Syrup or HFCS emerges as the main villain in this theory largely because in many ways it acts as a toxin in the body and has ten times the glycation activity of glucose – the body’s main fuel source.

Glycation is also directly linked to collagen deterioration and skin aging.

Recommended antidotes to AGE’s include vitamin E, Alpha Lipoic Acid and flavonoids (plant chemicals in highly coloured fruit and vegetables) used in both diet and skin care.

  1. Mitochondrial decline

Mitochondria are the powerhouses of cells where energy is produced for everything we do, say and think in the form of ATP (Adenosine Triphosphate) which cannot be stored and has to be continually renewed.

The mitochondria make use of some essential nutrients to produce this energy including: CoQ10, Acetyl L Carnitine and B vitamins. Both mitochondria and ATP production decline with age and this is linked in part to free radical damage.

This theory of aging focuses on the need to protect and increase ATP production by repairing mitochondrial damage. Antioxidants play a part in limiting free radical damage but supplementation with the key nutrients needed to form ATP – in particular Acetyl L Carnitine, CoQ10 (idebenone) and CoQH (ubiquinone).

Summary – what matters?

Free radical damage is a common theme and the role of antioxidants is key. Focusing on lifestyle choices – boosting your diet with antioxidants (vitamin C, E, Betacarotene, green tea catechins, omega 3) and cutting out the damage from smoking, photoaging (UV) and alcohol will make a real difference to how well you age. Some supplements emerge as winners – CoQH (ubiquinone), Acetyl L Carnetine are two to focus on.

For the future – The movement is rightly focussing on sugar damage (from fructose in particular) as a significant cause of disease and premature aging. Cutting down on added sugar and eliminating fructose is something you can start doing now if you value your looks and health.

 

High Intensity Interval Training (HIIT)

There has been a huge amount of publicity on the benefits of high intensity interval training (HIIT) lately – it’s protective against virtually the major diseases of affluence and lifestyle (heart disease, cancer, diabetes and dementia), great as rehab if you are already suffering or poorly, easy to fit into a day (10 to 15 minutes a day) and cheap or free!

So what is not to love about HIIT?  Well what about a few ideas on what to do – so here goes.

Note – it is safer to start and finish all exercise programmes with 2 to 3 minutes of warming up and cooling down.

Sample HIIT Programmes

Programme 1

Cardio – 3 minutes jog, 30 seconds sprint, 3 minutes jog, 30 seconds sprint, 3 minutes jog.

Frequency: twice weekly

Programme 2 

Strength – 20 x push ups/three quarter push ups, 20 x tricep dips, 20 x shoulder presses (use weights/bands), 20 x bicep curls, plank x 20 seconds, side plank x 40 seconds (each side) and 5 lunges or squats.

30 second rest between exercises.

Frequency: twice weekly

Programme 3

Cardio + Strength:  2 minutes moderate walking, 1 minute vigorous power walking, 2 minutes moderate walking, 1 minute vigorous power walking, 2 minutes moderate walking, 1 minute vigorous power walking,  2 minutes moderate walking.  THEN, push ups  (30 seconds), wall squat (30 seconds), curl ups (30 seconds), step ups (30 seconds), lunges (60 seconds), high knee running (30 seconds) and reverse curls (30 seconds).

Allow up to 30 seconds between strength exercises.

Frequency: twice weekly

Gastric Reflux

Some of the most prescribed medicines in the Britain (and the rest of the western world) are for drugs that help gastric reflux or heartburn (sometimes called dyspepsia).  The shelves of the average chemist are weighed down with over the counter medicines.

Heartburn or reflux is where the acid of the stomach makes it’s way back into the foodpipe (or oesophagus), creating the typical burning feeling of this condition.  The stomach is protected against the acids it holds, but the foodpipe can be easily damaged by the presence of gastric acids.

Acids can re-enter the foodpipe where the lower oesophageal sphincter (a muscular ring at the entrance to the stomach)  becomes weak or “incompetent” – this can happen for many reasons including hiatus hernia.  However most cases of reflux are idiopathic or of unknown origin.

Most people have suffered from reflux at some point in their lives, but what can we do if it becomes regular and for some people this condition can dominate their lives?  Well yes there is – however first we should check with our doctor to check there is nothing more serious happening.

If there is no serious underlying condition, try these simple self help tips –

  • Diaphragmatic breathing (also known as full body breathing or complete breathing) – a toned diaphragm can aid the oesophageal sphincter in “pinching” the lower foodpipe closed.  Try Yoga for these exercises!
  • Wear looser clothes, try not to wear “shapewear”, tight belts, skirts or trousers/jeans.
  • Avoid bending at the waist.
  • Try to avoid large meals, have smaller portions.  Also keep a food diary to see if certain foods make the condition worse.
  • Eat simple foods – dense proteins and fatty foods stimulate acid production and churning/squeezing of the stomach.
  • Allow yourself a few times a day when the stomach is empty.
  • If overweight, try to lose weight.
  • If a smoker, cut down or stop (if will help lots of other things as well).
  • Learn to relax – a nervous stomach is an active stomach – again Yoga is brilliant for this.
  • Acupuncture can help, although this can be very subjective.
  • Never exercise immediately after a large meal.
  • Some people find bio live yoghurts, kefir and Symprove can help their symptoms.  These products can also help with irritable  bowel syndrome.

As with all things experiment to find what works for you.

Fat, Low Fat Diets and Health

Since the 1970s the message from government and public health bodies has been that dietary fats (especially saturated fats) need to be reduced in the nation’s diets.  Even today the general public health message is that dietary fat is associated with weight gain, cardio vascular disease and possibly a whole range of other problems such as diabetes and certain cancers – however there is an increasing body of science that casts doubt on these claims.

The government watchdog that assesses and advises on the efficacy of medical interventions and public health initiatives (NICE) still advises that at least 50% of our energy from food should come from carbohydrates (sugars), no more than 35% should come from fats (saturated fats should form no more than 10% of dietary energy intake) and 10% to 15% should come from protein sources.

Weight management is still generally promoted through restriction of fats as these are very energy dense foods.  Indeed since the 1980s the food industry in particular has promoted low fat (high carbohydrate) meals and foodstuffs.  Yes still the nation gets bigger, type II diabetes is increasing rapidly and coronary heart disease shows no sign of becoming less prevalent!

However since the millennium researchers have been looking at alternative approaches to a healthier diet. Recent evidence from 2002 onwards (see especially Westman et al, 2007) suggests that a carbohydrate restricted, moderate protein and higher fat diet may be more effective in weight loss, managing diabetes, reducing cholesterol and even high blood pressure than the historic low fat/high carbohydrate diets.

This superficially would make no sense, as fats are far more “energy dense” than carbohydrate.  However higher fat/low carb diets have been shown to  –

  • Lead to reduced amounts of processed food in the diet
  • Perform better at reducing weight loss – especially central obesity
  • Provide increased satiety/satisfaction from food
  • Improve HDL levels (good cholesterol)
  • Reduce plasma levels of fats
  • Reduce blood pressure

Indeed the benefits of higher fat/low carbohydrates diets would appear to be higher for people with insulin resistance.  The Swedish government now recommends high fat/low carbohydrate approaches to tackling overweight and obesity.

So are all fats good?  Well probably not, so it would still be wise to avoid trans fats/hydrogenated fats (man made fats) as these are associated with inflammation in the body.  It is also probably wise to increase our levels of unsaturated fats (from plants or oily fish) more than natural saturated fats (such as butter, cheese, cream, fats in meat etc).

Sugar and Ageing

High sugar diets are not only implicated with heart disease, cancer, diabetes and dementia – scientists now believe that they can cause the skin to prematurely age.  Indeed many scientists now argue that high sugar consumption is as aging for the skin as smoking.

All the evidence indicates that Britons love sugary treats and we consume roughly 3 times the recommended daily amount – government guidelines indicate that no more than 5% or 30g should be consumed.

So how is sugar guilty for not only making us fat and unwell, but also looking older?

There are two important proteins in our skin – Elastin (which gives it stretch) and Collagen (which plumps it out).  Both of these proteins are gradually lost over time resulting in wrinkles and saggy skin, however high sugar diets massively speed this process up.

Sugar “spikes” during the day, as we eat our cakes and biscuits, causes the release of insulin into the blood – this causes inflammation under the skin and eventually leads to the degradation of elastin and collagen, through a process called glycation.

The safest and easiest way to avoid the ravages of sugar (and time) is simply to reduce the amount of free sugars consumed by trying to eat low GI foods and keeping the chocolate cake as an occasional treat!!

Pilates and Lower Back Pain

Do you have lower back pain and have tried everything, but still got no relief? Have you read newspaper articles that have given curl ups and twists for lower back pain and ended up in even worse pain?

Lower back pain is endemic in our society (it is estimated that 80% of all adults will suffer at least one episode of “severe” lower back pain in their lifetime (the true figure could be closer to 100%). Well our sedentary lifestyle, posture and limited movement patterns all contribute.

Well below I have listed 7 Pilates based exercises that in my experience have really helped clients.

  • Pelvic Tilts (1 minute) 
  • Knee Folds (2 minutes)
  • Swimming from Kneeling (1 minute)
  • Side Bend/lateral lift (3 reps on each side)
  • Shoulder Bridge (10 reps)
  • Supine Hamstring Stretch with Belt (hold for minimum of 1 minute)
  • Kneeling Hip Flexor Stretch (hold for minimum of 1 minute)

Really important is to remember what NOT to do when you have back pain.  Avoid forward flexion, straight leg lifts and all twists.

Difficult Ground

It is estimated that the average Briton walks approximately 2.2 miles per day (the Government advice is 5 miles a day or equivalent activity) and the average citizen of the USA only walks 0.6 miles per day.

As human beings we evolved to move, specifically as hunter gatherers it is believed our ancestors would cover 3.5 to 10 miles per day.  Moreover is it also believed that the development of the human brain was (at least in part) due to deal with these walking and running behaviours (walking over difficult ground requires more eye-brain coordination, quick decision making and quicker reflexes).  Some scientists also believe the “S shaped” curve of our spines developed due to our bipedal movement on challenging ground.  Also it should be borne in mind early humans would be traversing uneven and often difficult surfaces – all of which are now known to stimulate brain activity, brain development and physical development.

However in the 21st century our reduced levels of activity and the presence of smooth surfaces in towns and cities, means that our joints and brains are less challenged.  Our movements now tend to be linear with little or no rotation or lateral movement.  Limited movement patterns will obviously lead to accelerated joint wear via soft tissue imbalances, but it is also theorised that they can –

  • increase mental decline
  • damage the cardio vascular system by increasing blood pressure
  • reduce muscle tone
  • lead to weight gain via reduced calorie expenditure
  • decrease balance
  • reduce proprioception

To put it crudely walking on “nice safe surfaces” may lead to accelerated aging.

Research in China has also shown that walking/running on difficult ground reduced blood pressure, improved balance, helped restful sleep and improved mood.  People suffering chronic pain reported reduced pain scores.

So if possible take yourself “off path” – in a park, walk on cobbles/uneven surfaces in towns, go for a hike in the countryside.  Start slowly and if you have a health problem speak to your health practitioner before starting your “off road challenge”.

Good luck.