Friday 10 April 2015

One of the hardest things about being a therapist is not having any sessions available

One of the hardest things about being a therapist is not having any sessions available when people come to you in pain and need of treatment.

And this happens all the time - and not just to me I imagine - my diary is typically about 75% full for the first two weeks of any month, before the month has even started.

There are many reasons for this. In no particular order:

1) People are busy and book in advance to fit in with their own schedules
2) People book a series of sessions in preparation for an event i.e. London Marathon, or to help alleviate/manage a painful injury or condition that requires ongoing treatment. It's quite normal for me to do a series of 6 sessions with someone, which obviously eats into my availability for other people.

3) I work across 3 locations - set days and hours in Streatham, Crystal Palace and the City (Moorgate), this does of course limit my availability for each location - but I will always offer you any sessions I have in any location, in case you are able to make them.

Where does that leave me if I want or need a session sooner rather than later?

If I don't have any same- or next-day appointments to offer, sometimes, I do squeeze in emergency sessions, especially for existing clients who are really in need.

This does mean I sacrifice some of my free time, where I already work usually 6 days a week, and late into the evening - an extra hour now and then won't hurt me. But, I draw the line now at working past 9pm in the evening, and like most people, I do need time off too - there's no point me putting everyone else's health and well-being before my own, and this is something I have learned from experience.

I'm also a part-time student at the British School of Osteopathy, which means I have to attend classes alternate Saturday and Sundays, and have to study in the weekdays in between, which is another commitment on top of my already busy schedule.

A normal month for me typically includes only having 2 proper days off - alternate Saturdays when not in school - but I am always trying to find ways in which to find, maintain and dare I say improve, that elusive work-life balance!

Working with local therapists

If I'm unable to squeeze anyone in, I have worked hard over the last couple of years to build up a good network of fellow therapists in all the locations I work at, so I can usually point people in the direction of a good therapist who may have more availability than me, and who I know will do a good job. These are practitioners I know personally, and often have either worked alongside ,or have tried out myself. The list of practitioners includes:

Streatham
Physio, Pregnancy massage/specialist, Acupuncturist, Massage therapists, Reflexologist, Cranio-sacral therapist, one on one and class Pilates and Yoga teachers.

Crystal Palace
Osteopaths, Acupuncturist, Nutritionist, Mindfulness/Meditation teachers, Massage therapists, Reflexologist, Yoga on-one one practitioner, Personal Trainer and Stott Pilates teachers (reformer and mat) one on one and class.

Moorgate
Osteopath, Massage/Myofascial therapist.

Similarly, I know many good remedial/sports massage/myofascial therapists in other parts of London, who I am happy to refer people on to, and regularly do.

So this is why I sometimes can't offer you same-day or next-day availability, and sometimes even same-week (Moorgate and Streatham clinics can often get booked up 2 weeks in advance) - but like most therapists, I will always try to help in some capacity - this may mean waiting for an appointment with me, coming to a different location than preferred, or being referred to a different practitioner who I think is suited to helping out and who most assuredly has my seal of approval :)

Friday 20 March 2015

What is Muscle Activation and why do you need it?

Muscle Activation essentially means restoring the natural firing sequence of muscles involved in movement

Why is this is important? Well, sometimes, the natural firing sequences of muscles that enable different types of movement in the body, becomes changed, and other muscles have to become involved to do the work of the muscle or muscles that are not firing, or are weak.


The prime example of this would be the Psoas (the body's main hip flexor). If Psoas is weak or inhibited, then the Quads and the Abs will take over - in addition to doing their own job - for the Quads, this is knee extension and the Abs are all about maintaining core stability and strength. After time, the Quads and Abs may weak or inhibited from doing the work of Psoas (hip flexion) as well as their own jobs, so other muscles further down the kinetic chain have to take over - and so on. These are called 'muscle compensations’, and they have a cascading effect throughout the entire body, which increases the risk of injury. And it because of this notion of kinetic chains and firing sequences, that we start to see how pain and dysfunction can materialise in the body but the underlying cause, and therefore where we should treat, are elsewhere

Could it be, that right arm problem that nothing has helped with, might actually be caused by the opposite side hip flexor not firing and disrupting the firing sequences of muscles in the kinetic chain, so the arm (and associated muscles) is actually involved in hip flexion (as well as doing their own job)? YES!

Could those always tight hamstrings that nothing has helped with, also actually be caused down the chain by Psoas not firing, which means the Glutes are also switched off (due to their reciprocal relationship), and the Hamstrings are having to do the job of the Glutes as well as their own job? YES!    

Muscle Activation gets muscles firing in the correct sequences, and strengthening weak/inhibited muscles. When this is achieved, all muscles that have been compensating for other muscles that are not firing or are weak/inhibited muscles, can now focus solely on doing their own job – which means they can relax! This reduces pain and dysfunction in compensating areas, and can also increase overall strength, mobility and performance.

Where does Muscle Activation come from?

This is fairly new to the UK; the technique and approach is more popular in the States, and increasingly worldwide. The originator is a South African physiotherapist called Douglas Heel, who developed the approach from working out what the body is trying to achieve, in order to start working out where and why things go wrong. Doug worked out that we need to look at the firing sequences of muscles in a kinetic chain in order to work out what needed to be activated - and for this reason, has much in common with Myofascial Release and 'fascial lines' in the body. More about Doug's approach can be found on his website, http://www.douglasheel.com/. Variations of this approach exist in other names and formats worldwide, such as Muscle Activation Technique (MAT) and NeuroKinetic Therapy in the States.

How does a session work?

This is a whole body treatment, so even if you come in with something like neck or shoulder pain, each session begins with hip flexion muscle assessments, and then we test and activate/restore the following muscles systems:

• Diaphragm
• Psoas, Glutes, Hamstrings
• Quads
• Gastrocnemius and Tibialis Anterior
• Adductors, Glute Medius and Minimus, Quadratus Lumborum (Lateral sling)
• Piriformis, Latissimus Dorsi
• Abdominals
• Shoulder thoracic
• Sternocleidomastoid. Masseter and pterygoids
• Supraspinatus (Central sling)


You can remain clothed during a session if you wish, as most of the techniques can be performed through or around clothes.

Does it hurt?

This is a very hands on technique, and activation points for a particular muscle can be very tender if the muscle in question is weak and inhibited, and needs to be activated. Although it can be fairly intense at times, the activation points do not need to be worked for too long. After activating each muscle, we re-test it and usually see dramatic results straight away - then as the session ends and you go about your daily business, expect a reduction in pain and dysfunction if this is the reason you came, or an increase in strength and performance in your next run or race!

How long is a session?

Each session is 60mins long, and may include some other Myofascial and Sports Massage techniques if required. Alternatively, book in for my Full Body MOT (available in 90mins and 2h versions) and receive a dynamic combination of Muscle Activation as described above, Myofascial Release, Sports Massage techniques. Literally leaving you feeling like a brand new person.


Friday 3 October 2014

What is Myofascial Bodywork and how can it help me?

Myofascial Bodywork is a bespoke style of clinical bodywork designed by me, which incorporates the best of advanced direct and indirect Myofascial Release and Sports Massage techniques, with joint mobilisations, articulations, manipulation and therapeutic stretching. 

No one session is the same - each session is tailored entirely to the individual, and draws upon my extensive skills and experience to get a good understand of what is going on, and how best to treat it. All designed to reduce pain, inflammation and restrictions in joints and soft tissue, and to restore balance to the body. Once the musculo-skeletal system is structurally balanced, all of the body's systems can better work together to function as one - restoring good health overall. 

Why is it important to get the musculo-skeletal system in good working order? So that 'compressive load' and gravity is distrubuted efficiently through the joints in the body. Any change to the way in which this is distributed can lead to knock on effects else where in the body. For example, it is said that:

“For every inch of Forward Head Posture, it can increase the
weight of the head on the spine by an additional 10 pounds.”
Kapandji, Physiology of Joints, Vol. 3




The aim of Myofascial Bodywork is thus to restore BALANCE in the body. Sometimes, this can mean working away from your area of pain, if it is thought that imbalance in other structures and areas are part of the cause. I look at the whole of the body. I look for the underlying causes of physical dysfunction, rather than just treating the symptoms.

Ever wondered why your right shoulder is sore, your right hip now I mention it can also be a bit painful sometimes, you had mild sciatica a couple of years ago but it cleared up and you forgot all about it, oh and yes now you ask I did badly sprain my right ankle 5 yrs ago but surely this didn't all start from an ankle sprain? Well, sometimes, things like this can be connected. You sprain your ankle, which means you have to walk in a different way - called a compensation pattern - the ankle healed but you didn't actually get treatment, so there is probably a build up of scar tissue which means the ankle is less flexible, the muscles are tighter, so you have continued to walk with that compensating pattern, which means the hip joints are moving differently than they used to, and you may be putting more weight on the other leg, so not moving the right hip as much as it has started to become sore when you do, and if the hip is sore, then you will unconsciously start to protect yourself by moving less in the back, you start to exercise less, the spinal muscles starts to become tight and you found yourself getting less flexible in your back, you start to wake upon with stiffness and/or pain in the lower back area, so you have to adjust the way you sit at your desk at work for 8hrs a day, and your body starts to rotate to ease the discomfort, and as muscles tighten they shorten, and before you know it your right shoulder is now sore also and it is starting to radiate up into your neck and now you're getting tension headaches from the stress of it all...

This is what makes the Myofascial Bodywork approach a longer lasting effect than other forms of bodywork. I want to know all about you, even the things you might have forgotten, to work out why your body has responded with pain and discomfort.

I use clinical assessment skills and a range of orthopaedic testing to try to identify the problem areas, which helps to put together a treatment plan. Usually, I will expect you to do some homework away from the treatment room, and have a good range of therapeutic exercises for lengthening short muscles, improving range and quality of joint movements, and can advise on ways in which to improve posture at your place of work.

Wednesday 2 July 2014

First year at Osteopathy school - how did it go?

So I have just reached the end of my first year at Osteopathy school, and it seems like a good time to look back over the year and think about how it all went.

Firstly, I can't believe how fast the year has gone! That's a good thing, right? As it's a 5yr Master's degree, so that means the remaining 4 years will be over before I know it and then I can start to earn back the £35k tuition fees...(let's not go there), but, strangely, thinking back to earlier in the year, there were times where the course was dragging horribly, and going in every other weekend for an entire weekend of classes, became a real chore. At times I wondered whether it was all worth it, as it the course seemed to take over my life. Now I have completed year one, despite all the challenges along the way, I have to say a resounding YES.

The good

I already feel like a better practitioner. I have a better understanding of health and dysfunction, and the context and ways in which they can manifest in the body. I wanted to ramp up my level of anatomy and physiology and I would say that box has most definitely been ticked. I wanted to feel more clinical, and I most definitely do. I have already experienced a shift in my approach, and the way in which I treat and deal with people, and of course have learned some great new techniques and applications.

I have met some wonderful, inspiring people among my fellow students, some of who I look forward to working with in the future. There has very much been an 'we are all in this together' vibe, which is so very helpful and motivating, especially when we're all mostly gasping for air in the last few weeks of term, struggling to revise into the early hours of the morning, on top of our jobs and life commitments. 

The bad

So this course, although part-time, takes over your entire life. That is not good, and I didn't realise the extent to which this would be the case. As someone who works in this industry already, alongside osteopaths and physios, I have found some elements of the course a little slow paced. I have found myself slightly resistant to having to learn things to such a high level of detail - Krebbs Cycle, I am talking about you - when a basic understanding is really all you need. Class sizes are a bit larger than I would like, and the introvert in me has struggled sometimes with this. 

Would I recommend the course to other people?

Well, yes. I would, and in fact, I have, and I think at least one of these recommendations is signing up for next year's course. But I am honest about what to expect, in terms of work-load and commitment, as it is vast.

So a whole summer off (after I have handed in one last essay on Friday), before classes re-commence in late September, I think I have earned a bit of a break! Oh, exams. I get my results mid July, I think, but I don't even care what I get (I have a fair idea), a pass is a pass, that is all that matters, second year here I come :) 

Tuesday 1 April 2014

Thai Yoga Massage photoshoot - this is what it's all about!

SO I trained in Thai Yoga Massage last year but, being so busy with all my other forms of bodywork (Myofascial Release, Sports Massage, Osteopathy training), I have only recently found (well, MADE!) the time to start to implement it into my practice. And I have realised all over again exactly what drew me to it in the first place. Here's an example... 



Stretching out the hamstrings and the muscles of the lumbar spine, and even the thoracic spine on people who are flexible enough!



Thai Yoga Massage is floor based work, and combines acupressure with some really strong and powerful stretches - working and releasing restrictions in muscles, tendons, ligaments, and fascia. An added bonus is that it is wonderful to give, as much as it is wonderful to receive - a Thai Yoga Massage session is relaxing, soothing and rhthymical, almost a dance around the person I am working on. It makes a really refreshing change to the more structural sessions that I do - everyone loves being stretched, and these days, everyone needs it - while still having a massive effect on the body - Thai Yoga Massage is still releasing physical tension and restrictions in joint, so it still helps promote improved range and quality of motion, and can still help reduce pain and inflammation. 

So I did a photoshoot at The Little Escape a few weeks ago, you may have seen some of the photos appearing on my Facebook and Twitter pages. Here are the results, all in one place, so you can get a flavour of what Thai Yoga Massage is all about. 

Stretching out the hamstrings while mobilising the hip joint


Stretching out the lumbar spine and tractioning the shoulders 



The supine spinal twist - a great one for releasing restrictions in muscles of the thoracic and lumbar spine

Stretching the main quad tendon while applying soft tissue to the glutes and muscles of the lower back 

The Cobra - encouraging the spine into Extension, something we all need to do more of, and stretching out the pecs


Another powerful stretch to the quads

Walking the spine - releasing tension and restrictions in the muscles of the upper lumbar and lower thoracic spine, plus more stretching of the pecs!



Stretching out the erector muscles of the lumbar and thoracic spine

A seated spinal twist, encouraging those lumbar erectors and side rotators and flexors to release


The Bridge, taking the back into a nice arc of extension.


If you like the look of it and would like a session, I am currently offering Thai Yoga Massage in Crystal Palace at The Little Escape, at my home treatment room in Streatham, and for mobile house calls in Streatham too. I hope to be offering Thai Yoga Massage at the Light Centre in the City too, soon! 

And most of all, I can't wait for the summer, when I can take my futon to a park or bring it to your garden, and we can hold the session outside basking in fresh air and sunshine! 


Many thanks to The Little Escape for the wonderful setting, thanks to @HarmiousShiatsu for the photographer and models. 

Tuesday 18 February 2014

Thai Yoga Massage - sounds cool, but what is it?!

Some people describe Thai Yoga Massage as 'lazy person's Yoga', as you get all the benefits of Yoga, without doing the work yourself.


Thai Yoga Massage is a wonderfully relaxing yet incredibly therapeutic form of traditional massage. It is Stretchtastic!

Unlike most other forms of massage, you keep your clothes on! You lie down on a comfortable futon on the floor, where you will be taken through a series of positions and stretches, together with lots of soothing acupressure, to help loosen up tight muscles and joints, release fascial restrictions, and stimulate the circulation of blood and lymph to promote healing, energy flow and relaxation. 

Each treatment is tailor made to the needs of the individual, so you will get stretched where you need it, and 

Being a Sports Massage therapist and an advanced Myofascial Release practitioner, you may also get a few bonus techniques to enhance some of the stretches and positions.

Thai Yoga Massage is for you if you want relaxation but your body needs attention too - some common ailments that Thai Yoga Massage can help with include:

  • Poor posture and associated issues
  • Tight shoulders 
  • Stiff neck
  • Headaches/tension
  • Sciatica
  • Low energy/Fatigue
  • Back pain
  • Stress
  • Hip/knee pain
  • Digestion

Thai Yoga Massage full body treatments are available for for 90min and 2 hour sessions in London - City (Moorgate), Crystal Palace Streatham, and house visits in Streatham and surrounding areas. See my website www.myofascial-bodywork.com for more details.

What to expect in a session of Myofascial Bodywork


Consultation
A session of Myofascial Bodywork starts with discussion - I find out as much as I can about what has brought you to see me today, how it affects you, what else you have tried - the more information you can provide, the better. 

Assessment
After this we usually move on to assessment. This is where I get to look at your presenting complaint in a little more anatomical and bio-mechanical detail, but it is not just limited to your main issue or symptom - as we are looking for the underlying causes, we will need to look ideally at the whole of you. I'm trained to a high level in Sports Massage and have done a lot of postgraduate advanced workshops in posture and assessment, plus of course I am a student at the British School of Osteopathy, so hopefully you will see that my observations skills when it comes to postural assessment at a detailed level are pretty good

Treatment
Treatment can take many different forms, depending on what we have determined is causing your issue, and thus what we need to do to help remedy the problem(s). This can range from oil-based massage based treatment to non-oil based soft tissue mobilisation and myofascial release, plus joint articulations and mobilisations, therapeutic stretching, and even medical acupuncture (and kinesio taping coming soon!). 

Dress
Expect to be undressed during a session, down to your underwear. If you are not comfortable being observed or treated in your underwear, you can wear shorts instead, but preferably a normal bra (ladies) instead of a sports bra, which tends to be a bit limiting as the back can't be unclasped while you are on the table face down and we need access to your thoracics or get behind your scapulae. Also, the less you wear, the more I can see when assessing your posture, gait and range/quality of movement. 

Positions
I move my patients about a lot! This enables me to apply different techniques in different planes, which therefore have different effects. I can often start with some chair based techniques, or have you lying on the table facing up. Sometimes, I may need you to lie on your side, and sometimes lying face down. Whichever position(s) you need to be placed in, I make sure you are comfortable and secure with pillows for support. 

Techniques
The main techniques I use are Sports Massage techniques and Myofascial Release. 

Myofascial Release is always applied skin on skin, without oil. With this technique, we are looking to release restrictions in your fascial system, which may be a cause of pain or dysfunction systemically as well as locally. More details on Myofascial Release can be found on my website www.myofascial-bodywork.com

There are many Sports Massage techniques that are non-oil based, which complement sessions of Myofascial Release well - these include Soft Tissue Release, Muscle Energy Techniques, Position Release/Strain Counterstrain - plus some extra mobilisations and joint articulations from further postgraduate training I have done. 

I tend to combine all of my different techniques into my signature treatment approach, and this I call Myofascial Bodywork. It is very normal for many sessions of Myofascial Bodywork to be 100% non-oil based, so although I am a Sports Massage therapist and can Deep Tissue with the very best of them, I think you can see that I am also so much more - and I don't generally consider myself a Massage Therapist these days, not even a Clinical one, as that does not really portray the wide range of treatment and techniques that I provide, nor, in reality, the treatment that you are likely to get if you come to see me.