Tall and strong at a young age, I was good at contact sports, particularly rugby and field athletics – running at someone, throwing anything and jumping were all fun for me. It was all about strength, condition and being bullet proof.

Dislocated left shoulder – shrug it off!        Torn right knee cartilage – move on!        Concussion – shake your head and get back up again.

Then, work and career started to get in the way. I married. We started a family. Professional training.  Change of career. More qualifications.  Walking with the kids and dog don’t really count, do they? Sport and exercise got put aside.

Twenty years pass. Sporadic attempts at gym, squash, circuits, and the rest. The kids grow up. Then, “40 years old” arrives and passes. Time to get rid of the growing belly. Back to the gym in earnest.

Boring, boring, boring! Too many ‘beautiful people’ who put me off and seemed so judgemental at my lack of focus and progress. Looking back, the problem was me not knowing what I wanted.

Next? A chance conversation and I was introduced to mountain biking. Now, this presses the right buttons! Wonderful and refreshing in its freedom and variability. Expensive, mind you! Great for aerobic fitness, balance and stamina – but ultimately, you get fit for what you are doing.

The activity doesn’t matter; tennis, running, rugby, and the rest – all wonderful but something was missing – I could bike a steep hill with the best and the rest, but couldn’t run up the street without puffing. The fitness was too specific, too focused.

It took another injury, severe this time, to make, no, force me to think about what I was doing. In my case, I came across kettlebell and body weight training and this works for me, physically and, more importantly, mentally. I enjoyed it and continue to enjoy it. Total body workout, flexible, aerobic and balanced. You can go heavy or light, hard or gentle.

Frankly,what works for me doesn’t matter – at my age so many people are searching for a specific or magical regime or principle that they can work to, a set of rules that they can follow. Well, let me spell it out – THERE IS NO SUCH THING! Human beings are just too variable, we all have the baggage of our particular genetics, history, fears and wants.

This means that even when we exercise in a group, there is a huge range of variability and you have a responsibility to look at what is both good and safe for you to engage in. If this wasn’t true we wouldn’t have specialist participants, (who ‘play to their strength’), in every team sport that I can think of!  Why, then do we imagine that synchronised mass step aerobics, for example, is suiting everyone and yet you don’t see anyone doing their own thing. Peer pressure – think for yourselves!

Most, if not all of this more mature age group, carry injuries. Most will have arthritic changes. The fast, twitch muscle fibres are fast disappearing. Recovery times are longer even just after each training session, let alone injuries!

Then, if that is not enough, even those who manage to get to a class, (of whatever type), are so often greeted by these lovely specimens of male and female beauty and physical perfection!

It’s enough to make you run a mile.

BUT DON’T, please don’t. Don’t blame the trainers for your lack of success in class or even for putting you off from taking up a class.

As an Osteopath, I mostly deal with illness and the effects of injury. Personal Trainers deal with wellness and do their best to avoid injury during training. This is an important distinction, especially as we age and I believe we should keep this in mind when we are choosing our direction.

What I think we should do is to ask,  “WHERE ARE ALL THE MIDDLE AGED TRAINERS?” Why aren’t trainers  staying in the business into their middle years? Why aren’t people of my age taking up training as physical trainers?

Plenty are training as therapists. Why? Perhaps because there are so many people who need treatment and therapy! Why not try and prevent rather than treat?

Let’s face it, these skilled but youthful trainers are wonderful. I have absolutely no criticism other than one that they simply cannot help, and that is their lack of experience in FEELING what I feel.

Most are sympathetic to the middle aged groaning, but aren’t generally empathetic. How can they be?

So, where do trainers go when they get to 35? Why does there seem to be a gap until the emergence of the 65 year old yoga teacher who leads sit-down, ‘aerobics’ in a Care Home?

OK, so I’m going over the top a bit, but I believe that most 40-60 year olds will recognise what I am saying. I try, in my professional life, to encourage exercise, movements, stretching and flexibility to my clients.

Within reason, clinically speaking, I don’t care what they do – If you hate swimming, don’t do it – very good for you but you won’t keep it up. Find your level, use advisors of course, but do what you are going to continue.

Squats or lunges while brushing your teeth. Sumo squats when you stand at the sink. Pull up your pelvic floor and lower abs when weeding the flower bed. Whatever works. Now, this chimes with me with the philosophy that Rannoch Donald is espousing with the 100 Rep Challenge. I strongly recommend you take a little of your valuable time and look at the site and Face Book page and you will see loads of examples of 100 rep sequences. Sure, the macho, the hardened, ‘no pain, no gainers’, the fab abs lot and many more are represented. But you will also find something for you. It’s not how hard you are or even how hard you do it, but that you do it.

Whatever it is!

Find something that fits your life, health state, age and desires. Your motivation doesn’t really matter to anyone other than you, better health, flatter belly, serenity, a better sex life – No one else’s business, but your own – my advice, if anyone cares, is to get your starting premise right and then design your own regime.

Rannoch Donald, Jonathan Lewis, Christian Vila, Steve Cotter, Mark Stroud and many others have great ideas about fitness and can give you a fantastic programme, but, (and I think they would all agree), they will all tell you to be clear about your objectives, don’t just follow the latest trends – think about how their method and advice will fit for you and your lifestyle.

So, what do I want from my exercise regime? None of your business. You have to work out what suits you and do what it takes to achieve it, (with a bit of professional help and guidance, of course).

Good luck.

SHOULDER EXERCISE – MOBILIZATION USING FIT BALL

References;

Wikipedia defines  the general population that use personal/physical trainers “as an age range of 18 to about 50 (45 and younger for males, 55 and younger for females)”. One internet thread I found asked, ‘what is the average age of trainers?’ and was full of well intentioned individuals with great mission statements, but not one of them was over 31!

There are a few certification courses for older trainers and for those training older individuals, but they seem mainly to be in the US.

Interesting article on STRENGTH TRAINING FOR THE OVER FIFTIES

First, I am a Registered Osteopath and must state that my interest in this opinion piece is for the relevance of Kettlebell for people who already have back problems and more specifically for the chronic or long term sufferers. Also, this is quite a long rant, but please bear with me because the general issue of how we tackle chronic back pain in this country is a serious one and often badly tackled.

Anyone with an acute back problem should avoid strenuous exercise until they have been properly assessed by a Registered Osteopath, physiotherapist or appropriate medical practitioner.

Second, you may well ask, what on earth is Kettlebell? This dynamic exercise and training form is currently making itself felt throughout the fitness industry and claims the patronage of many celebrities, (Jennifer Lopez, Matthew McConaughey, Gerri Halliwell and Penelope Cruz are often mentioned), Russian Special Forces, boxers, cross-fit trainers, MMA* fighters and football clubs.

Raging through the US for the last decade with crossfit trainers and fitness adherents, the discipline has been in the UK for the last few years and it has now reached a prominence that is hard to ignore.

Its origins are not entirely clear but lifting weights to improve strength and fitness goes back as long as boys have wanted to show off . Kettlebells have been claimed by the Russians, Turks and Scots, (who apparently trained with small church bells!). The kettlebell or Girya resembles a cannonball with a handle. Incidentally, they do not ring. The only sound created is the heavy breathing of the user and the occasional clang as the bell finds the floor early!

Weights vary from 4Kg to 60kg, although typically 8kg, 12kg, 16kg and 20kg are used by normal mortals. The more capable and ambitious ‘kettlebellers’ are called Gireviks, Russian for weightlifter.

Now, it is not my business to promote Kettlebell as a practise, there are plenty of more able people out there who can do that, but must declare that I am an enthusiastic participant who has benefited, and has done so at a number of levels.

What is the technique?

A good whole body mobilisation is essential. Some moderate aerobic exercise such as jogging, star jumps, squats and arm swinging,  shoulder, neck and quads stretches take place over several minutes. Now I know that the evidence for stretching before exercise is now felt not to help in preventing injury, but you will need 6-10 minutes of cardiovascular ‘warm-up’ for the session that follows.

For the chronic back pain sufferer, I think this gives hope. All too often, rehab programmes concentrate on passive stretching and mobilisation, rather than a return to CV health and strength. Personal and professional experience tells me that someone with a 20 year history of back pain is afraid of the consequences.

The attitude is ‘better the devil we know’ and all that. Maintaining the staus quo is better, in the minds of many, than ’stirring things up’, which is often the experience they have starting a new exercise programme. It takes a lot of courage to start a regime knowing that it may well make things feel worse to begin with.

However,the important word there is FEEL. I spend much of my clinical time agreeing with patients when they say, “but won’t that exercise make it hurt more?”. They don’t expect me to agree, because previous advice will often have been about caution and ‘don’t do too much’.

Being frank about what will happen is often more to do with the therapist making their own life easier; management of the patient rather than management of the condition. Both are needed, but it’s the emphasis that may need looking at! Please remember, hurting more does not necessarily equate to damage!

Of course, there are risks, but with proper guidance from your Osteopath, Physiotherapist or health advisor and in conjunction with your trainer, doing damage or causing any permanent worsening of symptoms is unlikely.

The trick is to take the right amount of time for the individual and this is where group classes can be weak – frankly, even the best trainers can’t be expected to tailor programmes for each person in a class of 20+. Don’t blame the class leader though, take personal control and think of how you get around the issue.

So, what is the answer? Well, one answer is to take personal tuition to begin with. Yes it can be expensive, but at say £35 to £40 per session over say 4 weeks, it’s cheaper than an overnight stay in London. Put bluntly, I know plenty of my chronic back pain patients do that fairly regularly ‘as a treat’. So treat yourself to being well and it may improve your mood and mental well being as well – radical stuff, eh?

Probably sounds smug, but it’s what I did. I took a couple of 1-1 lessons and was joined by a friend for a further 2, (price went down for 2 by the way), then another friend for two last sessions. Then I felt ready to join a group class. Let’s face it, most blokes don’t want to look like they don’t know what they are doing and most women don’t like to be stared at!! No doubt that sounds somehow sexist, but I hope you know what I am getting at.

The basic form is the TWO HANDED KETTLEBELL SWING. I won’t describe each exercise in detail, but the kettlebell swing is where it all starts and the technique must be good to both protect your back and get the most out of the exercise.

The swing mainly targets  the legs and abdominal muscles, the back, (BUT NOT WHILE BENT),the hip rotators and increases cardiovascular endurance. The swing element comes from contact with the inner arm as it meets the inner thigh and the thrust generated by a crisp forward thrust of the hips/pelvis.

The aerobic nature of the exercise is what startled me most when I started.

The next technique to master is the CLEAN.

Clean 1st Pos - Photo Christian Vila

Clean 2nd Pos - Photo Christian Vila

The kettlebell design allows for the weight to roll around the hand and wrist as you lift into the clean, keeping it balanced and ‘close packed’.

Once again, the power is coming from the thighs, abdomen and to some extent the lower back, dynamic, fluid and using the whole body to distribute any stresses. However, you can see that the back is held in a neutral or slightly extended position.

The lifting arm is held close to the body to protect the joints in the arm and shoulder. This is crucial, as injuries to the rotator cuff are common when weights are used with the arms extended or stretched out.  The loose arm is used for balance and seems to help focus the dynamic nature of the move.

PRESS - Photo Christian Vila

The next move is a continuation of the CLEAN; the PRESS can be seen in the image here. Particularly good for shoulder, shoulder blade and upper back muscles, it is once again using the whole body, flowing from one structure to another and while the joints are used throughout their range.  There are few static moments during kettlebell moves, the time when soft and bony structures are most stressed, and so helps in reducing the risk of damage.

While excellent for promoting mobility in the joints at each end of the collar bone, the upper ribs and neck, this exercise needs to be done with good technique. This often means using an approriate weight. I have seen people struggling with too much weight, the technique suffers with the consequent risk of neck strain.

I should also say that the leaders of the class that I attend are very hot on this and encourage swapping weights during a set – the emphasis is on keeping going safely rather than emulating Atlas.

The static presses and exertions of  ‘regular’ gym weights, fixed or free, do, in my view, carry the risk of overextension of the joints and point pressure on vulnerable structures such as the rotator cuff insertion, acromio-claviclular joint,  knee and shoulder cartilages.

There are plenty of other basic forms, but check those out on the kettlebell sites, (see examples below), as there are variations and styles that should suit most needs.

So, after all that, is it good for your back? Please remember that the back, (or spine), to physical therapists also includes the neck.

Succinctly, if you are well but unfit and want to become so, then yes. If you have back problems, then proceed with some caution!

However, as with all exercise forms, make sure that you seek out well qualified trainers and yet be strong enough in yourself to proceed at your own pace. Their job, in my view, is to provide the knowledge, support and skills, plus the encouragement to keep going and to draw out your motivation.

In conclusion, I like this regime because it is dynamic, relatively low impact and uses the joints through their whole range. It flows, is as much about balance and technique as it is about strength, yet improves power.

Kettlebell is an excellent mix of aerobic exercise and fat-burning, with muscle toning that doesn’t produce too much bulk.

It is egalitarian and friendly. My experience is that the men and women who go are not there just to look wonderful, but to improve themselves generally. Sounds a bit twee, but I mean it. Posers are at an absolute minimum and overt testosterone is low. There is a good mix of abilities, ages and, lets say, weight categories and there is an old-fashioned helpfulness, at least in the class I attend.

Go on, give it a go. As previously stated, check with someone qualified to judge but you may well be suprised by how much you will benefit!

Andrew Bellamy

Training in the Brighton, East & West Sussex area.

http://www.brightonkettlebells.co.uk/

http://thebrightongirevik.blogspot.com/

Influential figures in Kettlebell:

http://en.wikipedia.org/wiki/Pavel_Tsatsouline

http://en.wikipedia.org/wiki/File:Valery_Fedorenko.jpg

*MMA – Mixed Martial Arts

I sometimes feel that there is a gap in the way that we as therapists and trainers handle the recovery and rehabilitation phase of shoulder injury; that the categories are sub-divided too starkly into black and white, passive and active, low-stress mobilising and strength building. It seems to me that we should more often look at what the individual needs and build in an intermediate phase, where act as guide but let the injured individual be inventive and therefore participatory in their own recovery. They improve faster as a result. Encourage them to clean windows, polish floors, bounce balls against a wall – all low, (or at least controllable), effort activities that help to distract from the discomfort but also gives a sense of achievement.

This is not revolutionary thinking by any means as business management techniques are always telling us that if the employee ‘buys in’, then productivity and contentment rise! Why should patients and sports people be any different?

Each individual is just that, individual, and has different physical structure, varying levels of physical activity, abilities, age, expectations and needs. It seems intuitive, therefore, that while those who are professionals endeavour to tailor recovery regimes, that they should, in part at least, be led by the recipient.

I am a great fan of The Rotater and, increasingly, of Kettlebell workouts, but they have very different ‘points of entry’ in the timeline of recovery – the Rotater can be used fairly early in the recovery phase – gently at first, ramping up the intensity as pain reduces and range of motion increases and until it becomes an integral part of any workout, prehab or sporting event. Kettlebell is fantastic as a total body workout that is low impact and wonderful as shoulder mobiliser, BUT is only appropriate rather further down the recovery road!

The following video tries to outline a fairly ‘loose’ approach to mobilising the shoulder – be inventive, work within your means to start with, gradually increasing range and intensity, trust your therapist or trainer, but trust yourself as well.

As with all advice on medical conditions, check with your doctor, osteopath, physiotherapist, chiropractor or trainer before embarking on any new regime.

KITESURFING & WINDSURFING INJURIES by Andrew Bellamy

Please note that the comments in this blog come from many years of clinical experience and practice, combined with details and opinions taken from various sources, including open-source internet articles. Where relevant, links are provided.

Please also note that we cannot comment on individual cases without taking a proper history and conducting a full examination.

SO, HOW DANGEROUS IS IT to go windsurfing and kite surfing? Well, a quick search of the internet will throw up various reports of serious and even occasionally fatal events involving, in particular, kitesurfers.  However, these events are still rare and are no more frequent than other ‘dangerous or extreme sports’.

What sorts of injuries do we, as osteopaths and physiotherapists, see as a result of these now popular sports?

Here in Shoreham-by-Sea there is a particularly active group of surfers that range mainly from mid-teens to mid-fifty’s and who spend as much of their free time on the water as they can. Great fun with lots of adrenaline, wonderful exercise and what a way to get away from the mobile and other distractions!

However, where there is pleasure there is often pain and these sports are no exception. One of my best friends, who is almost messianic when it comes to windsurfing, tells me that he never has any injuries! Except, that is, for the bruised ribs caused by his harness as he came to a sudden stop recently, the neck strain and stiffness and foot and shin pain from doing too much for too long.

This is fairly typical from what I hear at the Adur Osteopathic Clinic and remember that those comments are from an experienced windsurfer!

Our Osteopathic and Physiotherapy Practitioners are frequently asked to help with treating injuries sustained while doing water sports such as windsurfing and kitesurfing.

NOVICES & LEARNERS typically suffer forearm muscle problems from gripping too hard until they learn to relax as well as shin and foot strains for much the same reasons.

Back strains from rigging and up-hauling tend to happen more in the early stages, but no one should be complacent about them as potential risks.

• As is often the case, prevention is the better path to tread.
• Take up Pilates to gain core strength and make you fitter before problems start.
• To ease backache while sailing, try tilting you pelvis back and forth in the quieter moments.
• Many of these problems can be overcome simply by practice and good coaching in the early days.

What are the common injuries in these sports?

Where I, as a Registered Osteopath and my colleagues come in is when it goes beyond a ‘bit of a strain’ and becomes a proper injury.

Listed below are some of the most common types of injury and where they occur on the body.

TYPE                                                                        TREATMENT

• Sprains, (26%)                                              Osteo/Physio Treatment
• Cuts, (21%)                                                   Self Treat/A&E is more serious
• Bruises, (16%)                                               Self Treat or Osteo/Physio Treatment
• Fractures, (14%)                                            A&E, but may initially be diagnosed by an Osteopath.

Where on the body do they happen?

• Lower extremities, (approx. 45%).
• Upper extremities, (approx. 18%).
• Head & Neck, (approx. 18%).
• Trunk, (approx. 16%).

Data kindly from http://physsportsmed.com/issues/2002/05­02/rosenbaum.htm

The Knee & Below.

How?

Being thrown from your board, while the foot remains in the strap is the most likely cause. This is especially likely if you are thrown backward and sideways off the board.

Ankles and feet are the most often injured and almost half are severe enough for fractures or ligament damage. 75% of fracture and ligament injuries in the foot are caused by getting caught in the foot straps.

The resulting effects can be long lasting if not dealt with adequately in the early stages. Fractures, of course, need to be properly diagnosed and treated in hospital.

What to look for?

The ‘classic’ fracture injury for these sports is the LISFRANC Fracture-Dislocation and may need surgery.

There will be pain and swelling over the front half of the foot. It may be difficult to put weight on the foot, especially once you get your boot off.

If it hurts to twist the front of the foot inwards and then bend it outwards to the side, you may have this fracture.

Suffice to say that the bone sticking up in the middle of the foot, as seen in this X-ray, is not natural!!

First aid includes R.I.C.E. This stands for Rest, Ice, Compression (strapping/support) & Elevation.

• So, take the weight off.
• Lift the leg above heart level and support it, i.e. lie on the sofa or bed.
• Get a gel ice pack on ASAP, (5-10 minutes initially and don’t apply directly to the skin).
• Apply strapping or a bandage. (The last element is in my view the least important in some ways. If you get it wrong, you can do more harm than good. It also may be too painful and can obstruct natural swelling – use with care and get some professional advice as soon as possible).

NB. If the foot swells very quickly, (in a few minutes), this suggests bleeding and will result in bruising.

Slow swelling over several hours suggests more of a strain/sprain, but these aren’t hard and fast rules.

If in doubt, go to A&E for advice. X-ray diagnosis is helpful but will miss fractures in as many as 20% of cases that turn up at A&E.

So, even if you get the all clear for any fracture, if there is still significant swelling after 3 to 5 days after the injury and it is difficult to put your weight on the foot, get a further opinion.

The Arm, Elbow & Wrist.

Nowadays generally called Upper Limb Disorders, ‘simple’ arm problems in sport tend to fall into the ‘overuse’ category – gripping too hard or for too long, especially if your hands are too small, (or large), for the boom or grips.

Knocks and blows over the side of the elbow are another common cause.

Strain of the insertions of the tendons into the elbow joint typically present to the osteopath or physiotherapist as Tennis or Golfer’s Elbow, (tennis elbow on the outside, lateral epicondylitis and golfers elbow, medial epicondylitis, inside the elbow).

• This shows up as sharp tenderness over the bony knobs either side of the elbow.

• You may have difficulty in gripping, handshaking, opening doors, changing gear and picking things up at stretch.
• Early morning stiffness and pain is common.
• Eventually can cause pain and stiffness in the shoulder and neck, especially as you start to compensate.
• Can take from two months to two years to get better, even with good treatment and if you keep doing the thing that causes it.

Other injuries include dislocations or subluxations, particularly fingers. Injuries where the thumb is forced backwards are variously called Skier’s, Poacher’s or Gamekeeper’s Thumb, (which are all basically the same injury). Dislocation of the shoulders is an important injury to resolve professionally.

Shoulder dislocations are a serious injury and are usually caused by blows from front or back, i.e., landing heavily onto a wave, board or even beach – backward dislocations seem to be more common. Forwards, or anterior, dislocations may occur if the boom is wrenched out of your hands unexpectedly.

A true dislocation must be seen at an A & E Department. The arm will usually be longer than normal, an odd shape at the shoulder, (dropped), and effectively useless! They may reduce the dislocation, or put the shoulder back in, there and then. The procedure is straightforward in uncomplicated cases, but not comfortable!

Your therapist will advise you on the initial treatment, recovery and rehabilitation stages. This is really important as recurrence rates for dislocation are fairly high and if you want to safely carry on with your sports, then strengthening of the rotator cuff muscles of the shoulder, (Subscapularis, Supraspinatus, Infraspinatus and Teres minor), is essential.

• Rehabilitation with an osteopath or physiotherapist should be started as soon as possible, but overhead movements should be avoided for about six weeks.
• Rotator cuff muscles should be rehabilitated asap. The use of Resistance Bands is widely recommended, especially for the home exercise phase.

Less serious are subluxations, where the ball is not fully separated from the socket and can easily is treated by experienced osteopaths and physiotherapists. However, the damage to the muscles and tendons can still be significant.

I see lots of people who tell me that they have dislocated joints – most haven’t and most of those telling me are blokey sorts!

Joking apart, while guys all like to brag a little after the event don’t treat things too lightly, as either type can leave you with permanent injuries and limitations.

My left shoulder, subluxed twice during one rugby game at age 17, (because they couldn’t do without me), still gives me jip. I didn’t get it fixed at the time because I knew better, of course!

In those days sports injury care was much less developed, but that has changed. Get it looked at as soon as it happens and you will benefit later.

Some excellent rehabilitation exercises can be found here.

Head & Neck injuries fall essentially two categories; blows to the head and strains and whiplash to the neck.

The first category should not need much explaining. Hit your head hard under any circumstances, see someone in the know!

Any blackouts, unconsciousness, dizziness, double vision, lacerations, contusions or odd behaviour that is at all unusual should be taken seriously and mean a trip to A & E straight away, please.

Neck injuries can be strains from overuse of the shoulder and neck muscles or whiplash from sudden stops or being flung from the board. I suspect that this is rather more likely to be relevant to kitesurfers, but let me know if that’s not your experience.

Injuries in these categories are just the sort of problems that osteopaths and physiotherapists are trained for and I’m proud to say that we have the experience at the Adur Osteopathic Clinic.

This article doesn’t cover all the possible injuries that wind and kitesurfers might suffer, but let me know if I you would like me to cover anything in particular.

Conclusion: Kitesurfing should be considered a high-risk sport.  Most Authorities that have investigated and researched this area have come to the same conclusion.

Some Key Words: Pilates, Lisfranc Fracture-Dislocation, A & E, R.I.C.E, First Aid, Upper limb disorders, Tennis elbow, Golfer’s elbow, Lateral epicondylitis, head & neck injuries, blackouts, whiplash

Many thanks to those websites that images were copied from.

A Prospective Study of Kitesurfing Injuries

Christoph Nickel, MD^*, Oliver Zernial, MD, Volker Musahl, MD, Ute Hansen, MD, Thore Zantop, MD^|| and Wolf Petersen, MD^||,¶

http://ajs.sagepub.com/cgi/content/abstract/32/4/921