http://www.worldrowingmagazine.com/worldrowingmagazine/200910?pg=14&search_term=baz%20moffat&search_term=baz%20moffat#pg15

Visit: http://www.hfs-clinics.co.uk/contact-us to make an appointment, or call 0844 264 0334

In today’s competitive corporate society, particularly in the City, women have become “superwomen”, with the ability to be successful in all areas of life – corporate employee, mother, lover, friend and independent individual. For many of us, one or more of theses areas suffers due to a lack of energy, time or physical strength due to pain or lack of exercise.

As a woman, one fundamental way to achieve success in all of these roles is by having correct posture. Sitting up properly will influence your core stability, in particular your pelvic floor muscles, enabling you to use a few endurance muscles instead of many power muscles which quickly fatigue.

Do you find it difficult to reach an orgasm, or does it lack intensity? Have you experienced pain during intercourse or do you lack confidence regarding your sexuality? Do you sit slumped at work? Do you visit the loo more than eight times a day? Do you leak when you cough or sneeze? If you answer yes to any of these questions, then your pelvic floor is an area you should be focusing on.

DON’T GO INTO A SLUMP

Recent evidence reveals that slumped sitting leads to pelvic floor musculature atrophy (muscle wasting).  Correct sitting allows these muscles to constantly support the pelvic girdle by maintaining a continual low tone. This prevents muscle wasting and thus pain in the lower back or urinary dysfunction and incontinence. Do some endurance training of your pelvic floor an other pelvic core muscles and you’ll eradicate lower back pain and need to visit the toilet less frequently. Not only will you be toned on the inside, those muscles will help you develop a flat stomach- without holding your breath! And the best side effect is an easier, more intense orgasm.

It’s a physiotherapist rather than a gynaecologist who can help you with developing your core muscles and their related problems. If you want to know more about the status of your pelvic floor or need any of the above areas treated, contact The Chartered Society of Physiotherapy and ask for a women’s heath physiotherapist in your local area, or contact the Continence Society for a local practitioner near you. If you are based in London, go to www.hfs-clinics.co.uk for the best quality Physio and related therapies in the City of London and on Harley Street.

GREAT SEX LIFE

A physiotherapist’s first line of approach is to take a detailed history of your signs and symptoms, then they will advise you on normal dietary, bladder, bowel and sexual function. Your physiotherapist will then guide you through core stability exercises for your pelvic girdle, tailored according to your muscle imbalance. These are simple but effective exercises that nobody can see you doing. Make them part of your daily routine and if you do them regularly you will notice amazing results in 4-6 weeks. You’ll have no lower back pain, no leakage and best of all, you’ll be rewarded with a vastly superior sex life.

This article was printed in City AM on 24th Oct 2006

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It’s all too easy for doctors to neglect their own health. Physiotherapist Kam Sowman explains how to reduce the likelihood of being dogged by musculoskeletal problems.

A hospital doctor doesn’t work a typical 40 hour week – most work between 50 and 80 hours. Generally speaking, there are no scheduled breaks for coffee or lunch- instead these are taken when work allows. In common with other professionals, long hours mean many doctors have little time for sport and as a result there is a general trend towards them becoming less fit.

Combine these long hours, poor diet due to eating convenience foods and lack of exercise, with time spent sitting on the edge of patients beds, writing up case notes on the lap, being hunched over a computer looking for blood results, being bent over for ten minutes at a time while examining patients (or for even longer while performing surgical procedures) and you have a recipe for disaster.

Extremely Common

Musculoskeletal pain, as a result of poor posture and poor movement habits, is extremely common throughout society and doesn’t exclude medical professionals.

Billions of pounds are lost annually through absence from work and law suits due to musculoskeletal pain caused by a poor working environment. Health and safety legislation means that companies are now responsible for providing safe working environments. This includes manual handling recommendations and minimum legal requirements for seating and desks, collectively known as a work station. For many large corporations, a considerable amount of money is spent on work stations. However in most hospitals this is overlooked.

Ergonomics is a term used to describe the applied science of equipment design for the workplace, and is intended to maximise productivity by reducing operator fatigue and discomfort.

Legal Specifications

There are minimum legal specifications for chairs, desks and screens in the office environment are now adjustable, allowing for the great degree of variance between humans. Unfortunately this is not the case with most hospital workstations.

Poor sitting posture is a major cause of back and neck pain. With correct seating and good desk height, problems can be avoided. Most office desks are a standard height of 700-720mm. However most people, if seated at the correct chair height, require a desk between 750-800mm. It is therefore obvious that most people sit at a desk that is too low for them.

A designated working area for paper and computer work with, where possible, adjustable chair, desk and screen height would allow staff to sit in a more ergonomically correct posture and reduce posturally- generated pain.

Sound ergonomics are important, but are a waste of time without good postural control. Such control applies to not only to sitting but also to standing, bending over patients, carrying notes and performing surgical procedures.

Poor posture or poor movement habits- such as being stooped over patients- cause mechanical stress and strain on articular, myofascial, neuro-meningeal and connective tissues. Over time this causes cumulative micro trauma which leads to pain and pathology.

The ‘ideal postural alignment’ concept, pioneered by Kendall et al, occurs where the head, vertebral segments, pelvis and lower limbs are aligned in their correct anatomical position. ‘Ideal’ alignment is not always possible due to bony and soft tissue restriction, therefore ‘neutral alignment’, a mid range joint position is sought, where there is minimal support from the passive osteo-ligamentous system.

It is the deep postural muscles that are then responsible for maintaining alignment, posture and joint stability in weight bearing positions. Maintaining an ideal or neutrol posture means less stress on joints and soft tissues and therefore less incidence of pain and pathology. Standing and sitting in neutral alignment needs to be learned and then practiced regularly until it becomes part of normal functioning.

Stooped Over

Improving work stations is one way to facilitate better posture and reduce pain , but other measures can help, too. Raising a patient’s bed height seems all too obvious but in many cases is overlooked. All too often doctors and other staff members are seen stooped over patients for long periods of time while conducting examinations.

By raising the bed and bending from the hips and not the spine, one can maintain a neutral spine alignment and drastically reduce the incidence of posturally – driven back pain.

Neck pain is another source of discomfort while at work and is also easily avoidable. Thinking about the posture you are in when taking a patients history can make a big difference.

Sitting slumped on the bed, twisting round to face the patient, is a very common scenario. Instead try to position yourself so that you sit in an upright, neutral posture, preferably in a chair facing the patient.

Try to avoid resting your notes on your knee and slumping over them; use a table or even write the notes up later on a suitable working surface. Writing slopes are extremely useful for bringing document up to the user to prevent excessive cervical flexion. These can be purchased in most furniture outlets.

Despite manual handling legislation, there are still instances when medical professionals are asked to lift items, whether this be moving heavy case notes around or examining a heavy leg belonging to a rather large prop forward.

It is important to try to carry or lift the object in question as close to the body as possible, in turn reducing the overall load on your spine. It may even be necessary to share the load between two people.

One final warning: absence of pain doesn’t necessarily mean that poor posture is not causing harm to tissues, which could lead to a painful condition in later years. And by that time it could be too late to do anything about it.

AVOID MUSCULOSKELTAL PROBLEMS

· Try to use a desk to write up notes. Don’t be tempted to use your knee.

· When using a computer, always adjust your chair and, if possible, desk and screen height to suit you.

· Adjust patients’ bed heights when examining them to avoid having to stoop

· When taking a patients’ history, try to sit correctly in a chair and always turn your body, and not your neck, to face the patient

· Take care when lifting patients’ case notes- they can be heavy. Keep them close to your body to reduce the load on your spine. If you have to carry several files, make two trips.

· Take regular breaks from static positions and if you are bent over for long periods, straighten your spine every few minutes to prevent muscle fatigue and subsequent tissue damage.

· See a physiotherapist who specialises in treatment of neuromusculoskeletal injuries and has an understanding of muscle balance.

Kam Sowman is a chartered physiotherapist at Health and Fitness Solutions

This was published in Hospital Doctor on 30th June 2005

Running shoe technology has come on in leaps and bounds since the days when they were only designed for competitive athletes, and with this has come a bewildering choice of shoes aimed at specific types of feet or running style.

RUNNING FORCES

Feet are complicated structures with 26 bones working together to absorb your body weight and transfer it efficiently forward in walking and running gait. The foot has to function as a shock absorber and then become a lever for effective propulsion and this needs to happen with precision timing. Running can be considered as a dosage of force we apply to our bodies, and as such the need for effective shock absorption is paramount. A good shoe needs to combine efficient force absorption, as the foot strikes the ground, with a stable platform over which to allow the body to pass in forward movement.

TEST FOR INJURIES

People have individual characteristics in their foot type that shoe manufacturers have discovered, and reputable running shoes can identify these using basic video analysis techniques. A pronated foot type tends to be one which has a flattened arch appearance and can give rise to rotations in the leg that can make the runner unstable when on one leg – which is most of the time when running. Try standing in front of the mirror and standing on one leg – look at what happens to the foot. Try bending your knee into a one-leg-squat position, and see if you can keep your kneecap over your foot as you bend- often with a pronating foot type you will become unstable. This exercise is one of the tests that physiotherapists and podiatrists use to check if you are predisposed to running injuries. If this happens with you, you will require a more supportive shoe and it would be beneficial to have a video gait analysis of your running style, including a foot examination. Highly arched feet tend to be more stable – but can be associated with type injuries. It is then advisable to look at a cushioning shoe.

STABILITY SHOE

As a running injury specialist the shoe we most often recommend is what is termed as a stability type shoe. Brooks Adrenaline GTS and New Balance Stability 745 are favoured for their durability and for the results seen as part of a programme of injury treatment carried out at our clinics. The range of shoes for cushioning includes Asics Gel and Brooks and for the very pronated foot we recommend the Brooks Beast shoe. Recommendations and further advice is available on the website www.hfs-clinics.co.uk

POSTURAL CONTROL

It is very important to remember that the foot is an integral part of a system in the lower limb that has to work effectively for runners to avoid common injuries and to achieve their goals. It is essential to consider the effect of your postural control system. A good pair of running shoes is very important, but they cannot alone solve injury issues. I strongly recommend video analysis of running where your whole body is analysed, rather than just from the knee down, to get the most from your choices in injury prevention and performance.

Wayne Edwards, Health & Fitness Solutions. Published in City AM 9th January 2007

- Greg Ryan, Health & Fitness Solutions

Fitness

The fitness industry has always been full of fads- remember The Abdominizer? – And one of the biggest and bounciest of them all is the gym ball. Or Swiss ball, or core stability ball. Whatever it’s called, if you go to a gym you probably have either used it or thought about using it. So is it any good?

Well, if you sit on it, it makes you work your ‘core’ – that part of your body you are told is important and needs to be strengthened in order to support your back, improve your posture and give you a flat stomach.

BODY ALIGNMENT

However, what they fail to tell you is that if you sit and stand correctly when exercising you are working your core – without a Swiss ball in sight. In fact, something as simple and functional as opening a door works your core, but the efficiency of how good you work it will depend on how good your body’s alignment is at the start of the activity; standing in a slouched position when pulling the door open is not as good as if you were standing properly.

However, not to disparage the Swiss ball too much, when used appropriately it can be a great way of challenging the core to work harder, but what most people need to learn first is how to sit correctly on a stable platform before being let loose on an unstable one like a gym ball. It all comes down to posture in the end.

MOVE YOUR ARMS AROUND

The core is important but, to get the most out of it, one has to think less about strength and more about control. If you are sitting reading this slouched over, think about sitting tall as if you’re being pulled by a piece of string attached to the top of your head, without holding your breadth.

Congratulations, you’ve just activated your core. If you now start moving your arms around, this will make your core work harder to keep your spine, pelvis and head still- the key elements of your core.

Sure, add some weights to your arms and strength becomes an issue, but ultimately your core is for life, not just for when you sit on a ball or for when you workout in a gym. So get a core workout everyday by “thinking tall” when you’re sitting, standing and moving. If you want to focus on your core to improve your body strength and performance, try video gait analysis. It’s a great way to look at your dynamic posture and can provide a view on how your core performs while undertaking exercise.

From this a tailored exercise programme can be put together to give you the edge in performance, as well as preventing injuries before they occur.

Greg Ryan is a consultant musculoskeletal physiotherapist at Health & Fitness Solutions

This article was published on 27.02.2007 in City AM

Essentially, what’s ergonomic for one person isn’t necessarily going to be ergonomic for someone else.

“You’re not going to be able to find one chair to fit all. When you take all the heights and sizes and body frames you’ll find in a company and try to fit it into one chair, you realise that even if various components of the chairs adjust, it still won’t fit the individual,” says Godfrey.

It’s worth considering what is meant by “ergonomic” in terms of chairs. The hollow of the back should be supported and the feet should rest comfortably on the ground or else a footrest. The elbows should be about level with the keyboard for comfortable typing and the top of the monitor should be at eye level. And that’s about it for beginners. It should be apparent from those components that the chair is only one element of the deal.

“A lot of people pay attention to the chair and forget that you need a good marriage between the chair and the desk,” says Godfrey. “Most desks are made to 700-720mm high. Unless you are 5ft 4in or shorter, 720mm is going to be too low for most people.” So you have a new ergonomic chair at the right height but sit too high and lean forward or compromise your sitting position by dropping the chair height.

The results can be complaining employees, which gets difficult because the people making the decisions about spending feel they’ve “done” ergonomics and it didn’t work. “When directors spend money on furniture and they don’t get the return on their investment that they’d hoped for, their perceptions of ergonomics have become negative,” says ergonomist Herman Bynke. “They are removed from the subject matter and they really don’t believe in ergonomics afterwards.” Bynke believes it isn’t enough to spend a lot on the state-of-the-art chairs. “Ergonomics is all about the fit between the human being and the equipment. It’s a big picture, and the ergonomics in the office environment is still focussed on the chair.

Godfrey agrees that people need to look further than the furniture. “People expect that good ergonomics are going to take their aches and pains away,” he says. “They need to understand that even when you’re sitting properly at a chair that’s been designed for you, with the right desk height and so on, you’re still sitting. We’re hunter gatherers, and the whole office environment has evolved over the last 20 years, while we haven’t evolved for many thousands. We like to be upright, we like to move about and the fact that you’re sitting well doesn’t take away the fact that you’re sitting.” People need to understand that they should get up for ten minutes an hour, and that staring at a screen for ages isn’t going to be a good idea, he says.

There is a lot that can be done without spending a lot of money. People make the mistake, says Bynke, of putting their screens to the side of the desk rather than looking straight at them – crick in the neck anyone? They put the documents on which they are working on the desk rather than at the same height as the monitor. Notebook users often seem to think that the monitor height rule doesn’t apply to them: stands for notebook computers are available though, for example the Notebook Station USB from Kensington.

“People forget that these products are designed for working on the move, not for sustained use, and therefore they sit hunched over their laptop for far too long,” says Phil O’Neill, director and business manager for Kensington Europe.

Lighting is also important. The Verilux Happy Eyes range is among those that imitates daylight, which is whiter than the yellowish artificial light to which most people have become accustomed. Overall, the way people make mistakes appears mostly to involve overlooking the basics. If you’re sitting badly, chances are you know you’re doing it, and if your staff are doing it so you’ll be able to spot it.

If you’re embarking on investigating the ergonomics of your environment for the first time, consider asking your staff whether they’re comfortable and educating them about the correct use of their equipment before spending a fortune – a high spend might prove unnecessary.

Article taken from The Guardian, 30^th June 2005

At first they may be quite worrying, but in fact only a very small percentage are actually caused by anything sinister. A doctor or neurologist will usually satisfy themselves quite quickly that there is nothing seriously wrong simply through routine examination. Quite often patients seem to need more than simple reassurance from a specialist and want to have a scan done before their minds are set at ease. The danger of this is that scans can show other things that whilst perhaps not anything to worry about actually have the opposite effect on the patient.

There are many different types of headaches that have been classified in the medical world but the exact mechanisms that cause most common headache types are still being researched and debated.

It is becoming increasingly obvious, however, that with lots of simple headaches there are also underlying disorders with the neck as well as head pain. These are often ignored because they are not of primary concern to the headache sufferer and often the symptoms in the neck are very minor and only perceived perhaps as stiffness. This association between the neck and the head is often overlooked by patients and clinicians alike.

Physiotherapists who treat headaches regularly are expert in identifying joint disorders and related soft tissue and muscle problems in the upper part of the neck. Regardless of where it is in a “chicken and egg” debate this relationship exists and physiotherapy has proven success in treating many headaches even when they have already been diagnosed as migraine or cluster headache for example.

We have many case studies where our patients have had daily headaches for many years that have been treated completely within weeks just by improving the condition the tissues in the neck and ensuring that the patient improves spinal posture and work habits.