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In a previous interview with Alison McGregor from Chainsmith Bikes (which you can read here), physiotherapist Kenny from Physio K talks about how tightness in the body and repetitive movements can result in overuse and injuries. Aches and pain when cycling should not be ignored. At Physio K, we often deal with injuries or pain as a result from cycling. We know how your body acts and reacts to repetitive movements. Spending hours in the saddle in a similar position can accumulate into a series of problems. We are used to assess the body, search for different movement patterns, educate our clients and address their problems. But sometimes the body isn’t the problem, discomfort can also be caused by the positioning on the bike. Alison McGregor has a passion for women’s cycling and her aim is to encourage all new riders. She is co-owner of Chainsmith, a custom road bike specialist shop in Surry Hills. One of their services besides building custom bikes is specialised bike fitting, which can be key in injury prevention. Let’s delve into the world of a bike fitter who can make your comfort on the bike a whole lot different! THE INTERVIEW: Kenny Merlevede: You're specialised in custom built bikes. How much can you customise on a bike and how (much) could this impact the performance of the athlete? Alison McGregor: Years ago my business partner David Piacenti and I recognised common problems in the workshop. All these road bikes were turning up for services with all sorts of set-up issues. The stems were really short, saddles were pushed forward or the shifters and bars were arched back. Basically the riders were adjusting their bikes to relieve pain or discomfort. Numb hands, sore shoulders, saddle sores were the main problems they were trying to stop. When you're uncomfortable on the saddle, you deny yourself your best performance. It makes sense to think the problem is solved by adjusting parts here and there. But it often makes things worse. The fact is sometimes you just bought the wrong bike. Making too many changes negatively impacts your bike handling, your position and balance over the bike is changed. In extreme cases it can cause dreaded vibrations or speed wobbles, which is obviously dangerous and impedes both confidence and performance. The bottom line is that many riders buy a bike based on what their mates ride, or what the Pros ride. It can be an expensive mistake to follow others rather than look at yourself and celebrate what makes you unique. So we devised a very different approach to finding and building the right bike to achieve personal riding goals. Our clients already came to Chainsmith for consults, to choose high-end factory frames and components. Then we build the bike to suit their exact needs. This is one type of custom. It allows the client a proper position over the bike, enabling them more control in riding all sorts of terrain. With the feedback we received we knew when clients are well balanced on a purpose chosen bike they use muscles correctly, fatigue less, ride longer and faster. The second type of custom aligns the client with their bike even further. When a bike is made to measure, in true custom fashion, our experienced builders engineer a frame to perfectly balance the individual rider. The geometry and the tube measurements are developed in relation to a rider's bone lengths and flexibility. This means better comfort and better handling. When it comes to performance, the evidence shows that being aero is not the be all and end all. With good fitting practices there should be synergy created between your body, the machine, and the terrain. That's what full custom bikes afford you. Kenny Merlevede: You're working with the ID match bikefit lab. How (much) does that differ with other, classic bike fit systems? Why or how is it better? Alison McGregor: We were so relieved when IdMatch Bike Fit Lab arrived from Italy because we knew it would give our clients certainty. It saves them money and time, and ultimately helps them find their best bike. Chainsmith is the only one to have the system in Australia and it took a lot of Italian conversations to understand the incredible accuracy it would give. Now we've had time to use the Lab, we realise the efficiencies and capabilities are beyond other fit systems. There's so much technology! Measuring is done with 3d scanning. When you're seated on the smart bike it automatically adjusts as you're pedalling. It simulates a riders position on their current bike in seconds and then makes incremental changes to better the riders position and performance. The smart bike is different because it's effective for clients who own bikes, but also for clients wanting new bikes. There are thousands of bike models and components in the IdMatch program. So a client's frame size and components can be determined before they buy. Of course, you need to read the data and you need to understand geometry in the first place. So humans are never replaceable. But we are trained, and with this system being so efficient it's a powerful tool. Importantly, our custom clients have the opportunity to seamlessly assume their ideal position before a frame has even been created. That's a security our custom clients appreciate. Kenny Merlevede: You've had a few injuries and niggles yourself. Some got fixed with treatment but I'm sure your bike fit system has helped a lot as well. How did you experience the difference after making the bike changes? Alison McGregor: About 10 years ago I stopped running due to excruciating pain. I was diagnosed with stenosis. I was never competitive nor much good at it, but I was gutted because I loved it. But there wasn't much hope. Luckily being on the bike helped open up my back. So I took it up pretty aggressively. When I met you, I'd suffered three straight days of unrelated neck pain. You immediately relieved the pain with some incredible needle work. That day you taught me a valuable lesson. Being in the ride position for hours on end, several times a week, comes at a cost if you fail to support yourself with stretching or strength training. And even with the world's best bike fit, or custom bike, you can benefit from medical recommendations. When we received the IdMatch Bike Fit Lab we obviously tested ourselves. I'm a macro adjuster and I tend to have a high pain threshold, but when you're on the fit system and it's manually moving you as you pedal you can feel each incremental change to your position. Even though my fit was close with small adjustments I could literally feel my shoulders opening up and the access to air getting better. In another instance, if you look at my stance you'll notice my right toe naturally points outwards. It's no coincidence my older frames have marks on the chainstays and crank. I literally stripped the paint off my CX frame and started scraping through the carbon! Since my fit, I've adjusted all my cleats with slight changes to my saddle position. The float is no longer destructive but more importantly my stroke is smoother and with more power. Bike Fit starts at the cleat, so there are noticeable changes in comfort from that one change. At the same time I added strength training with shoulder, core and hip focus. Off road there's been obvious benefits - my improved position combined with strength work allows me to hold the front wheel down and avoid slipping out on really rocky climbs. My change in stability and balance is really noticeable. Kenny Merlevede: Have you had huge successes with a bike fit on athletes' aches and pains? Alison McGregor: Absolutely. For clients who own a bike and visit the lab to increase performance or comfort, the feedback reports show how we've helped. Since February we've done so many fits. Probably the most dramatic has been for several petite women who struggle to find a bike for their riding aspirations. One in particular suffered quite drastic injuries due to her position and saddle. She'd lacerated particularly sensitive areas. Obviously this is something that can stop your riding altogether. A change of ride position and saddle using the IdMatch Saddle Test has eliminated the problem and, in the meantime, she ordered a custom frame to cater for her size and race ambitions. Aching hands, neck and back aches and knee pain are usual issues we see. Burning feet or saddle pain are also common. Actually, a client recently came to us while working through piriformis syndrome. The bike fit adjusting his bars and saddle helped with notable improvements in his riding comfort. That means he can ride more, and ride endurance. Of course he's also working with a medical practitioner, which we always subscribe to. But the reduction of pain due to the bike fit has been a fantastic motivator considering his lengthy battle with injury. Kenny Merlevede: How can your bike fit system help riders with injury prevention? Alison McGregor: The IdMatch Bike Fit Lab is a fantastic tool for fit, but also programmed to provide the most ideal bike options. By introducing the Lab the idea was to offer pre purchase bike fit. It's the best way to select the right frame model, in the right size, with the correct components. The other day we'd a client wanting to purchase a brand we don't sell. The IdMatch program allowed us to look at all the options in an appropriate model and size, this includes the handlebar, stem, saddle and crank length. What quickly became apparent was his lack of flexibility. With our recommendations he realised his choice wasn't suitable. A handful of spacers could have helped his comfort, but it would have drastically and negatively affected his balance in the front end. We came up with a much better solution that aligned his body and cycling goals. Pain or injury prevention doesn't only come in the form of good position, but also in how a bike handles in relation to the rider's balance. Many cyclists don't realise that when you're not balanced correctly over the bike you can experience instability on corners and descents. Good performance isn't just about being fast, it's about riding confidently and trusting your equipment 100%. At the end of the day, with the right bike and ideal position you should feel synergy between yourself, the machine, and the terrain. It's exactly that unity that allows you to really commit to your best performance. You can learn more about the comprehensive bike fit system here ​​ To read the article about cycling performance and injury prevention with Kenny Merlevede, click here

Subacromial impingement syndrome. It’s quite a mouthful and a diagnosis that will make you fearful of ever using your shoulder and arm again. But what is it and what does it mean? Subacromial impingement is considered to be the most common musculoskeletal condition affecting the shoulder and is estimated to affect at least one in four people at some point in their lifetime. It is based upon the idea of tissues within the shoulder joint undergoing compression during certain functional movements, especially ones that involve the arm being raised above shoulder height. In essence this theory suggests that one of the muscles that contributes to the rotator cuff (supraspinatus) gets pinched underneath the bony roof of your shoulder blade (acromion process) resulting in pain and inflammation of the tendon and its surrounding tissues such as the bursa (a sac of fluid that protects the tendon from abrasion). But is this really the cause of your shoulder pain? After all, up until this point in your life you’ve never had an issue with this bone or this tendon so what’s changed? To answer this, we first must understand what tendons are and how they operate. Tendons are the connective tissues that help connect a muscle to a bone. It is made up of collagen fibres which are closely packed to give a tendon the strength it needs to transmit the forces produced by our muscles into the bones they attach to. In fact, tendons are so robust that gram for gram these tightly packed fibres are stronger than steel! If that’s the case, then you may be wondering how do they get damaged? Well, there are several lifestyle factors that contribute to tendon health and regeneration. Avoiding modifiable factors such as smoking, obesity, high intakes of fatty or processed foods and high cholesterol levels all contribute to maintaining healthy tendons. However, by far the most notable risk factor for tendon injury is SUDDEN CHANGES IN ACTIVTY LEVELS! Tendons do not like a sudden change in activity. If they go through a period of unaccustomed loading, especially above shoulder height, they will end up getting irritated and unhappy. When we work a tendon to fatigue (which happens quite easily when we first start moving after a period of inactivity) it induces swelling within that tendon. This is especially true in the case of the supraspinatus tendon, which is the main tissue implicated in this diagnosis. As a result of this fatigue and swelling there is a decrease in activation of the supraspinatus muscle which plays an important roll in stabilising the shoulder joint and preventing the unwanted rise of the humeral head (top of the arm bone). Therefore, the issue is not actually subacromial impingement but rather tilting more towards an irritation of the tendon due to overuse, also referred to as overuse tendinopathy or as rotator cuff related shoulder pain. So, what can you expect from physiotherapy management? Well typically when dealing with rotator cuff related shoulder pain there should be physiotherapy rehabilitation for the first 12 weeks, followed by self-management or independent rehabilitation from week 12 to 24. After week 24 you can then return to normal activity. Physiotherapy management may often include some manual therapy techniques in addition to a targeted home exercise program or work-related activity program. It is important to note that some of the exercises you will be asked to complete may bring on some discomfort or result in you working through pain. This is completely normal, but it should be tolerable and settle quickly upon completion of the exercise. The reality of the situation is that this theory of shoulder impingement is now considered outdated. The evidence now shows us that decompression surgery, which was and still is the surgical procedure for this injury to date, does not outperform either placebo surgery or physiotherapy treatment in the short-, medium- or long-term outcomes. So, we have to ask, why risk taking the surgical route if in 6-12 months-time the result will be the same with physiotherapy treatment. References Cuff, A., & Littlewood, C. (2018). Subacromial impingement syndrome – What does this mean to and for the patient? A qualitative study. Musculoskeletal Science And Practice, 33, 24-28. doi: 10.1016/j.msksp.2017.10.008 Lewis, J. (2009). Rotator cuff tendinopathy/subacromial impingement syndrome: is it time for a new method of assessment?. British Journal Of Sports Medicine, 43(4), 259-264. doi: 10.1136/bjsm.2008.052183 Lewis, J. (2011). Subacromial impingement syndrome: a musculoskeletal condition or a clinical illusion?. Physical Therapy Reviews, 16(5), 388-398. doi: 10.1179/1743288x11y.0000000027 Lewis, J. (2016). Rotator cuff related shoulder pain: Assessment, management and uncertainties. Manual Therapy, 23, 57-68. doi: 10.1016/j.math.2016.03.009 Lewis, J., McCreesh, K., Roy, J., & Ginn, K. (2015). Rotator Cuff Tendinopathy: Navigating the Diagnosis-Management Conundrum. Journal Of Orthopaedic & Sports Physical Therapy, 45(11), 923-937. doi: 10.2519/jospt.2015.5941 Löscher, S. (2018). 2013 Neer Award: Prädiktoren für das Versagen von nicht operativer Therapie bei chronischen, symptomatischen Rupturen der Rotatorenmanschette. Manuelletherapie, 22(04), 157-159. doi: 10.1055/a-0658-8975

Have you ever had recurring knee pain when walking, running or squatting? You're not alone: Thousands of people are suffering from the dreaded IT Band syndrome. We see and treat people with this kind of knee pain all the time, and have been able to get them back to the activities they love. In this article we'll guide you with the information you need to get rid of this annoying pain. What is an IT Band? ITB is short for iliotibial band. It's a thick band of fascia structure on the outside of your upper leg. It originates from a muscle on the side of your pelvis (the TFL or Tensor Fasciae Latae and some fibres of the gluteus maximus) and inserts just below your knee. It flexes and extends the hip and helps with rotation of the leg as well, and plays an important role in knee stabilisation. One of the most common and dreaded injuries associated with the ITB is called IT band syndrome What causes ITB tightness - what causes pain on the outside of the knee? IT band syndrome occurs when the IT band becomes painful due to irritation and overuse: flexing and bending the knee repetitively. When we repeatedly engage in a movement; like bending and extending the knee, this can cause friction and irritation of the area. This almost always happens when the IT band is too tight and causes friction on the outside of your knee. This can result in pain and / or inflammation and is very common in active people. When will you experience the most pain? The discomfort, irritation or pain from this issue will most likely be when moving: running, walking or squatting (with or without weights) will usually offset the symptoms due to the friction on the outside of the knee. Resting will normally ease these symptoms, although it may take a while before this annoying feeling disappears. Why does the IT band get tight? This is the most important question to answer in order to get the right treatment in place. In many cases, we see a biomechanical issue that's a big contributing part. It could be an issue with foot mechanics or lower leg dysfunction; where one of the bones in the lower leg isn't moving well. It could also be higher up the leg, or even in the lower back. When one of the lower vertebrae in your spine is stiff or when there is tightness in one of the muscles in the pelvis, this can cause the pelvis to tilt. Even if this tilt is slight, it will result in more tension in the IT band. The discomfort, irritation or pain from this issue will most likely be when moving. Running, walking or squatting (with or without weights) will usually offset the symptoms due to the friction on the outside of the knee. Resting will normally ease these symptoms, though it may take a while before this annoying feeling disappears. You’ll need one of these if you want to roll your IT band! :-) How to treat ITB pain? Let's start with explaining what will NOT resolve your problem. Many health practitioners focus on the symptoms and will give treatment on the painful spot: somewhere around the knee. This is unlikely to solve your issue because although this is the spot where your pain or tightness is, it is not necessarily the cause of the problem. Another unhelpful treatment option: foam rolling your ITB! We see so many active people foam rolling their ITB in the gym. Let me tell you: you cannot release your IT band with a foam roller. Whilst a foam roller is an amazing tool that can be used to release muscle tightness all over your body, the IT band is not one of them. Because the IT band is very strong connective tissue and not muscle, you would require far more pressure than you could generate with a foam roller to make the necessary impact. Foam rolling the gluteus maximus and the TFL muscle to ease IT band tightness The clue with treatment is finding out what is moving well in the body and what is not moving well. Foam rolling your glutes and TFL muscle can be a good start (find out how to do this correctly here ), but a proper assessment of the biomechanics at play is needed to address the underlying cause of your pain. At Physio K, we are experienced in finding and addressing the root cause of your problem and guiding you in your rehab, so you can get back to doing what you love. To book an appointment with one of our experienced practitioners: click here

WHAT IS SCIATICA? Sciatica is a term that tends to get thrown around quite a lot especially in reference to any nerve related pain in the lower extremity. Yet despite its common diagnosis, there are many misconceptions surrounding what it really is. It is a vague term used to describe pain that is associated with the compression or irritation of a nerve root located in the lumbosacral region of the spine (lower back). Now grasping that this pain originates from the lower back can be a touch more complicated, especially when factoring in that most symptoms are felt down the leg. However, this begins to make more sense when looking into the major anatomical structures involved. Sciatica derives its name from the condition’s involvement of the sciatic nerve which is the largest and longest nerve in the human body. Starting in the buttock and travelling down to the lower leg, this nerve is formed by a cluster of smaller nerve roots that can be traced back to the sacral plexus within the lower back. If these nerve roots are irritated in any way it can manifest in referring pain down the nerves pathway which can include the buttock, thigh, calf, and foot. HOW CAN THESE NERVE ROOTS BE IRRITATED? To understand how the nerve roots can be irritated we need to look at where these nerve roots are and what structures can influence them. As can be seen in the image below, the nerve roots are the yellow cords exiting either side of the spinal cord. These nerves send and receive information from the brain all the way down to the tips of the toes and are therefore a very important travel route for sensory (feeling) and motor (muscular) control. Another important structure to consider is the discs, depicted as the blue semi-circles. When it comes to nerve root pain there are two primary types: mechanical pressure and chemical irritation. The concept of mechanical pressure is relatively straightforward. It postulates that when a nerve root experiences compression, as can be seen in the image above on the right, this can limit the amount of blood flow to the nerve. Without the appropriate blood flow there is reduced oxygen being delivered meaning the nerve will not be able to perform its functions properly. Furthermore, if this reduced blood supply is prolonged it can lead to nerve degeneration and the development of abnormal impulses within the nerve. This is what can often be experienced as the burning, pins and needles or electric shock type of sensations down the leg. The chemical irritation system is slightly more complicated and has two additional schools of thought. The first is that the discs contain powerful chemicals that when spilled onto the nerve can lead to inflammation making the nerve angry and dysfunctional. Discs are very active tissues within the body. They are constantly laying down new cells and breaking down the old ones to ensure they are always healthy and functional. For the discs to be able to break down old cells they need to have powerful enzymes that can damage and discard them. Therefore, if a disc herniates and some of the chemicals spill onto the nerve roots, they can irritate the nerve and start an inflammatory response from the body. The second is that the disc can cause an autoimmune response which will often catch the nerve in the crossfire. Whilst it is very rare that a tissue in the human body has no nerve or blood supply, this is the case for the discs after the first few months of life (like the inside of the eyeballs!). As a result, the discs are quite foreign to the body’s immune system, to the point where it is unrecognizable. Therefore, when a disc herniates the immune system reacts to this as it would a foreign body, such as an infection or a virus. This means it attacks the disc tissue resulting in an inflammatory reaction which will end up affecting the nerve root given its proximity to the disc. WHAT ARE THE SYMPTOMS OF SCIATICA, WHO DOES IT AFFECT AND FOR HOW LONG? The most common symptoms associated with Sciatica is pain travelling down the back of the leg. Key areas include the buttocks, back of the thigh, calf, and foot. Some people can experience a burning, electric shock or pins and needles type pain or in rare cases a sensation of cold water running down the leg that may be associated with numbness or muscle weakness. The intensity of the symptoms can be quite broad ranging from mild, barely noticeable pain to severe pain, likened in some cases to childbirth. Sciatica can affect people of every age however it is mostly seen in the forties and fifties. Expected timeframes for recovery from a sciatica diagnosis can vary greatly however the pain is generally the worst for the first 2-4 weeks. At the 12-week mark 50% of those with sciatica will have nearly a complete resolution of initial symptoms. For a small group of people, pain may not improve at the rate normally expected however by the 12-month milestone over 75% of patients are asymptomatic. HOW TO MANAGE SCIATICA? When it comes to the management of Sciatica there are a range of treatment options available, including physiotherapy. The most important factor in most of these is allowing the appropriate amount of time for recovery. Other common non-surgical treatments include adjusting lifestyle factors such as smoking cessation and weight loss as well as introducing general exercises or specific spinal/ nerve movements targeted at mobilising the sciatic nerve. In extreme cases medications, specialist nerve injections or surgery may be used as a last resort however for most this is certainly avoidable! If you are unsure about what may work best for you then book an appointment with your health professional who can provide you with an accurate diagnosis and a suitable treatment plan that is built around you and your lifestyle! References Dower, A., Davies, M., & Ghahreman, A. (2019). Pathologic Basis of Lumbar Radicular Pain. World Neurosurgery, 128, 114-121. doi: 10.1016/j.wneu.2019.04.147 Goldsmith, R., Williams, N., & Wood, F. (2019). Understanding sciatica: illness and treatment beliefs in a lumbar radicular pain population. A qualitative interview study. BJGP Open, 3(3), bjgpopen19X101654. doi: 10.3399/bjgpopen19x101654 Jesson, T., Runge, N., & Schmid, A. (2020). Physiotherapy for people with painful peripheral neuropathies: a narrative review of its efficacy and safety. PAIN Reports, 5(5), 1-e834. doi: 10.1097/pr9.0000000000000834 Schmid, A., Hailey, L., & Tampin, B. (2018). Entrapment Neuropathies: Challenging Common Beliefs With Novel Evidence. Journal Of Orthopaedic & Sports Physical Therapy, 48(2), 58-62. doi: 10.2519/jospt.2018.0603. Background photo created by jcomp - www.freepik.com