OC Physio, Author

PRP Injections

Platelet Rich Plasma (PRP) injections are a type of therapy that involves using the patients own blood constituents to create an injectable product that helps with various soft tissue and joint problems. It can give long lasting reduction in pain associated with tendon, ligament and joint degeneration. As the process involves using no other products apart from the patients own platelets and growth factors to help healing in the tissue, it is popular for those who want to avoid artificial interventions or surgery. It is also a popular option if you have tried a range of other therapies but are still struggling. It is important to stress that it is still paramount that it accompanies a structured rehabilitation strengthening plan to achieve the best results.

Research in this field is growing and shows promising results of pain relief of approximately 1 year for arthritic knee pain. It has also become popular for the treatment of tendon and ligament injuries in elite sports where it is seen as a way to accelerate the bodies natural healing processes.

OSTEOARTHRITIS AND PRP INJECTIONS

There are many stages to osteoarthritis and PRP injections have shown to be useful to help relieve symptoms and does not cause further deterioration of the joint surface.

If your joint has severe arthritis already and you are in significant pain it would be sensible to consider a steroid injection to help settle the pain and inflammation as PRP injections can take a few weeks to take effect. You can read more about steroid injections here

WHAT TO EXPECT AT A PRP INJECTION APPOINTMENT

The first step is to draw blood from the patient (usually a vein in the arm). This is exactly like having a blood test. The blood is then spun very quickly using a specialist piece of equipment known as a centrifuge. This process causes the various constituents in the blood to separate into separate layers. One specific layer of the separated blood is plasma which will contain 2-5 times the usual number of platelets for a similar sample of normal blood. This layer is then extracted into a syringe ready to be injected back into the damaged area to stimulate healing. Over the last 10 years research has consistently demonstrated that this enriched plasma has a regenerative effect on the tissues of the body by triggering natural healing processes.

The PRP injection will always be delivered under ultrasound guidance to ensure we target exactly the right area.

Most research shows that a series of 3 PRP injections each 1-2 weeks apart gives the best outcome for Knee Osteoarthritis. However we also offer PRP and Hyaluronic Acid combination injection which gives the added benefit of Hyaluronic Acid in the same syringe as the PRP injection, hopefully delivering an even more successful treatment.

Treatment options will vary depending on your injury. Options include a single PRP injection, a series of 3 PRP injections or a combination PRP-Hyaluronic Acid injection.

HOW WILL I KNOW IF A PRP INJECTION IS RIGHT FOR ME?

Your initial assessment will involve diagnosing your condition. This will include a physical assessment and ultrasound scan. Once we have discussed your injury with you, we will then discuss your various treatment options. We will need to know about your medical history including current medications you are taking to see if the treatment is right for you. We may liaise with your GP if there are any concerns regarding your general medical condition to ensure your safety.

WHAT HAPPENS ON THE DAY OF THE INJECTION?

The appointment will last around 30 minutes. You should keep yourself well hydrated on the day of the appointment as this will make drawing the blood out of your arm easier. Once we have prepared the injection, we will use an ultrasound scanner to guide the injection to the damaged area. We will usually not use local anaesthetic for a PRP injection to ensure we do not alter the natural healing benefits of the PRP. As a result it can be a little sore after the injection for a day or two. It can also be common to experience a “post injection flare” which is a general pain at the injury site due to the local inflammation and may last for a week or so. This is nothing to be concerned about. We would encourage you to not take anti-inflammatory medication for the pain but instead use paracetamol or ice if required.

WHAT HAPPENS AFTER THE INJECTION?

You will be emailed instructions on things to look out for and avoid after your injection. We usually recommend that you avoid loading the area for a few days. You should give the body a chance to start the regenerative process by avoiding heavy loading of the area for 5 days. If the injection is in or around a tendon, we may ask you to avoid heavy loading for 2-3 weeks to avoid aggravating the post injection flare.

On the day of the procedure you may wish to consider arrangements for getting home after your injection because the joint or tendon can be painful to walk long distances, cycle or drive with.

WILL I NEED ANOTHER INJECTION?

If you get relief from PRP injections, then the treatment may be safely repeated when required. In the treatment of osteoarthritis in the knee, the benefits of PRP have been shown to last around 1 year.

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GTN patches for Tendinopathy

GTN (glyceryl trinitrate) patches have become a non invasive alternative treatment for persistent tendon pain. Other adjuncts such as Shockwave Therapy have been shown to be effective, but sometimes tendons can be stubborn. Injection therapy can also be useful but is more invasive and can pose risks to the tendon.

GTN patches are non invasive and were traditionally used for the treatment of angina which occurs in heart disease. The GTN is absorbed through the skin into the small blood vessels which then dilate and allows increased blood flow.

When using a GTN patch in the treatment of a painful tendon, we place the patch directly over the painful site to have an affect on tendon healing.

How does GTN improve tendon pain?

The mechanisims are not fully understood however researchers think GTN increases levels of a molecule called nitric oxide. We know that nitric oxide opens the blood vessels but we think it also stimulates collagen and tendon healing.

Recent studies show that using a GTN patch over a painful tendon alongside an exercise routine helped improve patients pain.

It’s important to remember NOTHING replaces the need to do your Physiotherapy exercises as well!

How do you use GTN patches in the treatment of your tendon pain?

The most important thing is getting the right diagnosis first. GTN patches will only work with tendinopathy. If your tendon is swollen and “creaking” its likely to be a different diagnosis. If you felt a ‘snap’ or ‘pop’ just prior to your pain starting, again we need to make sure your diagnosis is tendinopathy and not a tear of some sort.

If we haven’t performed an ultrasound scan of your tendon, we suggest you get one in the first instance to confirm the diagnosis.

The next most important thing to note is that it will work best when the tendon is just under the skin i.e superficial. That means it’s most appropriate for the achilles tendon, tennis elbow, patellar tendon and lateral ankle tendons.

GTN patch application advice.

Once we have identified where to place the patch you should start with half a patch. This is to reduce the chances of side effects you might get. Cut the patch in half and place half a patch onto the skin over the most tender part of the tendon. Dont use the other half of the patch. Throw it away!

Put the patch on in the morning and take it off at night to rest the area and prevent overloading the area with GTN. You should always take the patch off overnight.

You can exercise and shower with the patch on through the day but stop if you notice any skin irritation that is not settling overnight. If you are tolerating half a patch after a few days you can progress up to 1 patch per day.

We suggest using a patch for 2-3 months to help with pain alongside your exercise plan. Some studies looked at using the patch for much longer in severe cases for up to 6 months.

Are there side effects when using a GTN patch?

The most common side effect is a headache. This is due to the effects on the blood vessels mentioned earlier. Paracetamol may help alleviate this and your body is likely to acclimatise to the patch so the headaches should reduce. You could also reduce the dose by only using 1/4 of a patch and progress up from there.

Skin rash can be common too. Move the patch slightly each administration to give the irritated area some respite. Don’t stray too far from the tender part of the tendon or it may not have the desired effect.

There could be interactions with other medications that you currently take, so please check with your GP before using.

Key facts from the studies:

Using the topical patch for up to 6 months is superior to placebo
Useful adjunct for non-responders to other treatments in chronic tendon pain
Side effects include headaches due to cerebral vasodilation (Increased blood flow to the head)

Please contact us for further advice regarding your tendon pain if you have any questions.

Tennis Elbow Treatment

What is Tennis Elbow?

Lateral epicondylalgia or lateral epicondyle tendinopathy, formerly and commonly referred to as tennis elbow, is a condition which causes dysfunction within the origin of the tendons on the outside of the elbow.

This is caused by overuse and repetitive loading of the wrist extensor muscles, usually during manual labour, housework and hobbies (For example: racquet sports, typing and playing an instrument). It can come on acutely as a result of a strenuous activity that you do not normally do.

Repetitive use of the forearm muscles can lead to microscopic tears within the tendon origin, collagen disruption and an in growth of blood vessels. It also leads to muscle dysfunction and changes in the pain systems.

Risk Factors:

Smoking
Obesity
Repetitive wrist extension which is carried out for more than 2 hours per day
Vigorous activity (managing loads of over 20kg at least x10 a day)
Handling tools heavier than 1kg.

Common symptoms include:

Pain on the outside of your elbow.
Pain from your elbow down into the forearm.
Difficulty with gripping activities due to pain.
Difficulty with twisting movements such as opening jars.

What you can do to help yourself

Avoiding aggravating activities and activity modification

Turning palm up while lifting
Racquet sports – avoid using a heavy racquet or with a too small grip size
Using lighter tools at work
Counter force brace – some people get relief from using a counterforce brace to offload the tendon when using their arm.

Address ergonomics

Mouse – ensure your mouse is within close reach. It should be positioned at your side with your arm close to your body and a straight line between your hand and your forearm. The mouse should fit your hand, as if it is too small then this can cause your finger, hand and wrist muscles to remain tense.
Keyboard – your wrists should be straight and not bent up or down. Do not raise the back of your keyboard as this can increase the strain on your wrists. If your hands are not level with the keyboard you can use a wrist pad.
Maintain a 90 degree angle between forearms and upper arm. If your forearms are too high or too low, adjust the height of your chair.
Ambidextrous vertical mouse – reduces exaggerated movements at the wrist joint to reduce stress on muscles and tendons. It can be used in the left and right hand to share the workload.
Split Keyboard – can help keep your hands in a more neutral position.

Reduce / Quit Smoking

Smoking has been found to reduce circulation. If circulation is poor, tendons may take longer to heal and therefore will increase the risk of injury. Previous smokers are also at increased risk of tennis elbow due to the previous exposure and effects of tobacco on the vascular system. You can find help to reduce or quit smoking here – here

Weight Loss

Being overweight can increase the inflammatory molecules in the body which can lead to local and systemic inflammation within the body and therefore poorer healing and resolution of pain. You can calculate your BMI here to find out if you are a healthy weight.

Physiotherapy

The majority of patients (80-95%) with this condition will resolve with conservative treatment.

For lateral epicondylalgia there is no quick fix. There is no substitute for a thorough examination to allow for a specifically tailored treatment approach.

Physiotherapy will include:

Specialise strengthening program and load management.
Manual therapy – which may include joint mobilisations, soft tissue release and acupuncture to settle pain.

ESWT

Extracorporeal Shock-Wave Therapy (ESWT) is a treatment method which sends sound waves into the tissue which initiates a pro inflammatory response to the affected tissue. This increases blood circulation and metabolism in the affected area to accelerate the body’s own healing process.

For further information about ESWT – please click here

Ultrasound Guided Dry Needling

If conservative treatment is failing then “dry needling” of the tendon may help stimulate an inflammatory reaction within the tendon to kick start the healing process. We do this using ultrasound guidance to ensure we target the exact tissue.

PRP and Hyaluronic acid Injections

There is research to suggest that using a steroid injection to treat this condition will give temporary relief but at 3 months post injection, things are usually worse. PRP (Platelet Rich Plasma) injections may be a more suitable alternative as it is considered a regenerative medicine and more likely to give better long-term symptomatic relief than a steroid injection. It involves using your own blood constituents and separating the plasma out of the blood to re-inject back into the damaged tissue. This is usually done in combination with the dry needling mentioned above to help stimulate healing.

Hyaluronic acid can also be injected around the tendon origin to stimulate healing. It also does not have any potential negative effects that cortisone can have in this location.

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Knee Osteoarthritis Treatment

What is Osteoarthritis?

Running icon Osteoarthritis, is is often referred to as ‘wear-and-tear’ or ‘degenerative joint disease’, is a condition in which the surfaces within your joints become damaged so the joint doesn’t move as smoothly as it should. The natural cushioning between the joints called ‘cartilage’ wears away and therefore the bones of the joints rub more closely against one another.

The rubbing can result in pain, swelling, stiffness, reduced mobility and sometimes the bone at the edge of the joint may grow outwards, forming bony spurs called osteophytes.

This can happen over the main surface of your knee joint and behind the kneecap.

Symptoms:

Pain. Knee pain that tends to get worse when moving the joint and towards the end of the day. Certain movements that are commonly affected are going up and downstairs.
Stiffness. Sometimes, you may feel stiffness in the knee at certain times, often in the morning or after a period of rest.
Creaking or grinding sensation when the joint moves.
Swelling. You may notice hard swelling (caused by osteophytes) or soft swelling (caused by extra fluid in the joint).

What causes it?

As part of normal life, your joints are exposed to a constant low level of damage. In most cases, your body repairs itself and you do not experience any symptoms. Almost everyone will eventually develop some degree of osteoarthritis. One common myth is that exercise like running will “wear out your knees”. In actual fact research shows that people who run are less likely to develop arthritis in the knee!

However, several factors increase the risk of developing significant arthritis at an earlier age:

Risk factors include:

Age. Osteoarthritis usually starts from late 40s onwards. This could be due to the weakening of the muscles, the body being less able to heal itself and the gradual wearing out of the joint with time.
Obesity. Weight increases the pressure in all the joints. One pound of body weight results in 4 pounds of pressure on the knee joint.
Gender. Osteoarthritis in the knee is twice as likely in women than men.
Genetics. If your parents or siblings have had osteoarthritis, you are more likely to develop osteoarthritis.
Joint Injury. Injuries to the knee such as a torn meniscus or ligament injury can increase the risk in later life.
Joint Disease. If the knee has been previously damaged by another joint disease, such as rheumatoid arthritis or gout.

Treatment

There is no cure for osteoarthritis, however, there are a lot of things you can do to improve your pain and symptoms.

Weight Management

Being overweight increases your risk of developing osteoarthritis and also makes it more likely the arthritis will get worse over time. When you walk, run or go up and down stairs the knee can take up to five to six times your body weight. Therefore, even losing a small amount of weight can have a big difference to the strain on your knees. If you need to lose weight, you should follow a balanced, reduced-calorie diet combined with regular exercise.

Other ways you can reduce the strain on your knees

Pace activities.
Wear low-heeled shoes with soft, thick soles (such as trainers).
Avoid keeping your knee still in a bent position for too long.

Physiotherapy

The muscles surrounding your knee joint is like scaffolding. Strengthening the muscles around your knee can help stabilise and protect the joint. It’s also been shown to reduce pain and will prevent your knee giving way and therefore reducing the tendency to fall.

Aerobic exercise can reduce pain by stimulating the release of pain-relieving hormones called endorphins. It can also help you sleep easier, which is important for general health and well-being.

Our physiotherapists can advise on the best exercises to help build strength and fitness, whilst addressing each individual’s needs. It is important to have the right balance between rest and exercise, as too much activity can increase pain, whilst too little can cause the joints to stiffen up and deteriorate further.

Steroid Injections

A steroid injection given directly into the painful knee joint can start to work within a day or so. This has a strong anti-inflammatory effect and can help very painful swollen knees. For further information on steroid injections, please click here

Hyaluronic acid Injections

Hyaluronic acid is injected into the space in the joint that contains synovial fluid (joint fluid) and works by restoring the normal balance between the breakdown and production of hyaluronic acid. This can help improve lubrication and shock absorption of the knee joint as well as reducing pain and inflammation. For further information on Hyaluronic acid injections, please click here

Ultrasound guided baker’s cyst aspiration

Osteoarthritis can cause baker’s cysts in the knee, which are often painless, but you may be able to feel a soft-to-firm lump at the back of your knee. The cysts can cause aching or tenderness when you exercise. A cyst may not need treatment, but if it does, it can be treated by drawing off the extra fluid from your knee using a syringe (known as aspiration). For further information on aspirations, please click here

If you would like to book an appointment for a physiotherapy assessment and treatment or to discuss your painful knee or another joint, please click the button below.

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What is a Frozen Shoulder?

What is it?

Adhesive capsulitis, often referred to as frozen shoulder, is a condition which causes pain and stiffness in the shoulder joint due to the capsule that encloses the shoulder joint becoming thicker, contracted and tighter than it should be.

Frozen Shoulder Symptoms include:

A dull or aching pain in your shoulder, which tends to be worse at night or when you move your shoulder joint.
Stiffness around your shoulder joint that may stop you from moving your shoulder normally. This can make it difficult to do everyday tasks such as driving or dressing yourself. The below movements are mostly affected.

What causes it?

Onset of this pathology is usually idiopathic (comes on for no particular reason), however there are certain conditions and factors which have been linked to increased occurrence of frozen shoulder.

Such as:

Female population
Aged over 40
Diabetes
Underactive or overactive thyroid
Metabolic Syndrome
Post shoulder surgery or injury

Frozen Shoulder Treatment

Although the majority of the time frozen shoulder will eventually resolve by itself, the current research found that effective treatments which shorten the duration of the symptoms have a significant impact on reducing long term problems.

The latest evidence has found that the most effective treatment for frozen shoulder is the combination of physiotherapy and a steroid injection into the shoulder joint. The Ultra Sound Guided steroid injection is used to reduce inflammation and pain in the shoulder, which is particularly beneficial in the early stages where pain is a greater issue than stiffness.

This injection can also be performed as a hydrodistension – where the shoulder joint is also injected with saline to stretch the tight joint capsule and allow movement. Having a course of intense physiotherapy shortly afterward will then maximise recovery and improve the range of movement of the shoulder.

Physiotherapy treatment will involve manual therapy including mobilisation of the joint and an independent exercise program to assist a speedy recovery.

For more information about ultrasound guided cortisone injection and hydrodistension treatments that we offer at oxford circus physiotherapy please contact us.

If you are experiencing shoulder pain or stiffness and would like to find out why:

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Recovering after COVID-19

Rehabilitation Following Covid-19

Louisa England is one of our Physiotherapists and in this blog she provides us with information and what to do to aid your recovery and return to daily activity after Covid-19.

It is important to note that if you experience any cardiac symptoms during the illness such as palpitations, chest pain and severe breathlessness, you should speak to your GP before a phased return to activity.

COVID-19 is a new type of CoronaVirus which can affect the airways. This can cause shortness of breath, coughing and sometimes the level of oxygen in the blood is reduced. It is commonly passed between people via airborne droplets from coughing or sneezing.

After recovering from COVID-19 you may still experience some symptoms related to the illness and this may present as breathlessness and/or excessive mucus in the lungs.

Breathing Technique

The following may help with clearing mucus from your lungs.

The Active Cycle of Breathing Technique – ACBT

ACBT can be done anytime. ACBT is a set of breathing techniques used to relax and open your airways. These breathing exercises make your cough work better and help clear mucus out of your airways and lungs.

Breathlessness:

The following may be useful to help minimise breathlessness

Positioning

Use the below positions when feeling breathless, or recovering from exercise and during your breathing exercises.

https://www.guysandstthomas.nhs.uk/resources/patient-information/acute/positions-for-breathlessness.pdf

Check your Breathing – Activity log

You can use this BORG scale below to monitor your breathlessness whilst you exercise. This can be a useful tool to track your recovery. You should aim to be exercising within zones 3 and 5 on the below scale.

Modified BORG Scale Assessment of Breathlessness.

Remember: It is normal to get out of breath when exercising and for your heart rate to increase with exercise and walking but should return to normal within 5 minutes after finishing. You can keep a track of your scores and activity on the below table. You should notice improvements as time goes by

Below is a phased return to physical activity plan. Each phase should last at least 7 days and should only be progressed once progression criteria has been met. Drop back a phase if you are finding it too difficult. Rating of perceived exertion (RPE) is used to monitor how hard you are working in each phase. The ratings are in the below table:

Pacing (The 6 P’s):

Prioritise your activities
Plan your day within limits
Pace yourself – slow and steady, don’t rush
Position your body and arrange your environment to reduce shortness of breath- sit down if possible, avoid raising your arms or bending for too long and awkward positions
Use Pursed lip breathing when doing activities requiring effort.
Keep a Positive attitude – focus on what you can do!

If you would like any further advice with this or to book an appointment to discuss a different injury please click below.

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What is Femoral Acetabular Impingement?

Femoral acetabular impingement (FAI) is a condition in which there is abnormal contact (impingement) between the ball and socket of the hip joint (femoral head and acetabulum respectively).

Symptoms often include:

Stiffness and pain in the hip/groin area. This can refer to thigh, buttock or low back.
Aggravated by prolonged sitting, squatting and accelerating sports.
May also experience stiffness, restricted range of movement in hip, pinching, clicking or catching.

There are two main types of hip impingement. Individuals may have either type or a combination of both. The two types of FAI are as follows:

Cam Impingement – this is caused when excessive bone grows at the edge of the femoral head, where it meets a part of the femur called the femoral neck. The excessive bone growth forms a bump which impacts onto the socket during certain hip movements. Most commonly seen in young men.

Pincer Impingement – this is caused when excessive bone grows at the edge of the hip’s socket and creates an overhang, making the socket too deep in certain places.

FAI is important for two reasons. First, it is a common cause of groin pain in young adults. Because FAI has only recently been understood, in the past such patients may have been misdiagnosed and not managed appropriately.

It is important the condition is diagnosed early as they may be managed conservatively and individuals can continue with exercise, for example by modifying the way they do a squat and the load that they put through their hip.

At Portland Physiotherapy, your physiotherapist can help to identify the diagnosis and examine and treat the factors that may contribute to such pain or injury.

Ways to help settle symptoms

Resting from aggravating activities such as deep squats and prolonged sitting particularly in low chairs.

Strengthening and gradual loading is a massive part of treating this condition. Below are some examples of ways of strengthening the hip

Single Leg Elevated Bridge

Banded Glute Bridge

Hip Thrust

If you are experiencing hip or groin pain and want to find out what is causing your symptoms, please get in touch and one of the team will assess, diagnose and advise on the best treatment option for you.

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Hyaluronic Acid Injections

Hyaluronic Acid injections are becoming increasingly popular for individuals with joint pain. The benefits of Hyaluronic Acid is that it has less harmful effects than cortisone to joint surfaces and tendons, and symptom relief can last a lot longer.

This is important for individuals experiencing pain in a joint that is not responding to conservative treatment. A Hyaluronic acid injection is a quick and simple procedure, that can also be repeated without long term detrimental effects to a joint like cortisone can have.

So what is it?

Hyaluronic Acid (HA) is a Gel like substance that is naturally present throughout the human body. Its role is to retain water and keep tissues moist and well lubricated. The skin is made up of up to 55% of Hyaluronic Acid. It is also a natural part of the fluid that lubricates your joints.

Here are 3 key reasons why you should consider an HA injection for your painful joint.

Lubrication. Hyaluronic acid binds well to water, producing a viscous, jelly-like consistency. This viscous fluid provides lubrication and also acts as a shock absorber within the joint.
Transport medium for nutrients into the joint
Reducing inflammation. Hyaluronic acid plays an important role in reducing joint inflammation and pain caused by injury or tissue degeneration.

One of the more popular Hyaluronic acid injections is Ostenill Plus.

This requires only 1 injection which can give patients relief for up to 9-12 months. There are other products on the market like Durolane which is also a popular Hyaluronic acid injection. The most appropriate HA for you can be discussed with your Physiotherapist. If you would like more information about how HA may help you, please get in touch.

Why is it important to strengthen your glutes?

Glutes are the biggest muscle group in the body and are made up of the gluteus maximus, gluteus medius and gluteus minimus.

The role of the glutes is to stabilise the pelvis and hip. They work together to provide proper pelvic alignment when moving and when balancing on one leg. As a result, weakness of the glutes has a significant impact on your body’s biomechanics during everyday activities like walking, going downstairs and lifting. The compensation for this weakness and change of biomechanics then commonly results in injuries – particularly to the lower back, knees and feet.

The gluteus maximus and hamstrings are the primary muscles that extend the hip and provides the power for propulsion when running, jumping and even heavy lifting. When the gluteus maximus is weak, the hamstrings end up doing more of the work and therefore lead to tight or injured hamstrings.

What causes weak glutes?

When we are sat down the glutes are lengthened and inactive, therefore the longer we sit the weaker our glutes become. Unfortunately, modern lifestyles involve a lot of sitting, whether that’s at a desk, in a car or on the sofa.

How to strengthen the glutes at home?

Exercise is the key to strengthening your glutes.

Below are 5 key exercises that you can do at home using a miniband to help build up strength and control of your glutes.

Glute Bridge with band

Lying with knees bent and arms across your chest with a resistance band around the knees
Engage trunk muscles to stiffen the spine and pull knees apart slightly
Clench buttocks together and tuck your tailbone under to engage your glutes and raise hips off floor until knee hip and shoulder are in a straight line
Keep the knees pulled apart and hold for 2 seconds
Exhale and return to start position
Do not overextend your low back.

Fire hydrants with band

Place a resistance band around the lower thighs
Start on hands and knees with hands below shoulders and knees below hips
Engage the trunk muscles to stiffen the spine
Lift the knee out to the side without twisting through the trunk
Pause and top and slowly return to start position

Side Plank Clam

Lying on side with resistance band around the lower thigh and knees bent to 90 degrees
Elbow directly below shoulder
Engage trunk muscles to stiffen the spine
Lift hips off floor to bring spine into neutral
Squeeze heels together lift the top knee without rolling the hip back

Monster Walks

Place a resistance band around the legs at the ankles
Perform a small squat keeping the legs apart and knees in line with the 2nd toe
Lift 1 leg to the side to take up the tension on the band
Keeping the legs apart and in squat stance, walk forward, then backwards

Glute Taps

Place a resistance band around the legs at the ankles
Perform a small squat keeping the legs apart and knees in line with the 2nd toe
Place all your weight through the supporting leg.
Slowly tap to the side, then diagnonally backwards.
Keep your hips level and maintain a shallow squat on the supporting leg

Minibands

Minibands are light and don’t take up much space which means they are great to store or take away when travelling.

Bands vary in different resistance, therefore start on the lightest resistance and you can work your way up to make the exercise harder. It is important to progress the exercises to ensure continuous strengthening of the glutes.

By Louisa England.

If you would like more information or to book an appointment with Louisa, please click below

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Top tips for working from home

Top tips for working from home. Read our advice to help you stay healthy and injury free.

1. Establish a routine

Not travelling into the office can easily cause you to fall into bad habits. Research shows that effective sleep is produced by having a consistent time of getting up and going to bed. Decide on a set time to go to bed and wake up, plan your daily exercise and work diary in advance and don’t forget to plan a lunch break.

2. Create a designated work space

Work can quickly blend into home life and you can find yourself sitting on the sofa in front of the TV still working on the laptop after dinner. Adopting a regular routine will help get you into “work mode”. If you can do this in a set space it will help you switch off once you end your official day and you shut the computer down. If you are furloughed and unable to work try and find something ‘life or career enhancing’ and put that into your diary for example learn a language or go for a virtual tour of a museum.

3. Ergonomics

This is a difficult subject to cover as there is no 1 answer from everyone. The key is to keep moving regularly. Its ok to slouch (some of the time) and you don’t have to sit up straight all day long. Having an expensive chair is equally not all that important. The key is to feel comfortable and adjust portions regularly. Spending some time in standing at the kitchen counter or walking around the room as you take a phone call is a great way to break up the sitting time. If you are working on a laptop, we suggest using a laptop stand, external keyboard and mouse so you are not looking down all day long. Here are 2 affordable products on amazon that can help.

Keyboard Laptop stand

4. Don’t watch the news all day!

At present, the constant talk about Coronavirus is overwhelming and can get you down.There is a benefit to staying up to date with current developments, but too much information can take a toll on our mental wellbeing. Avoid checking news stories before bed and try to only check in periodically rather than keeping it on in the background all day. The most correct and updated information can be found here

5. Eat well

Don’t use food as a source of comfort, try to maintain the discipline of regular meal times and avoid too many carbohydrates like biscuits and muesli bars. Ensure you are getting plenty of protein in your diet and keep hydrated. It will keep your hunger cravings at bay and ensure you maintain energy levels.

6. Stay in touch

Zoom, WhatsApp, FaceTime, Skype your friends and family regularly. Arrange a group or family chat online to stay connected with those you would normally see regularly. It will help break up the days and having social interaction is an important part of your mental health.

7. Mental health

With stress and anxiety levels high it can impact on your overall health and sleep. Applications like “Headspace” and other meditation apps can help relax the senses. It’s important for everyone to have a little “me time” and it’s increasingly hard with everyone at home all the time. Set aside time daily to either meditate, listen to music or read a book to escape a little from all the craziness and remember at some point life will eventually return to some normality.

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