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Physiotherapy Wigan George Morris physio
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Cycling Injuries
Lower back
While many aspects of bike fit can cause pain or injury in other parts of the body, if it is lower back pain you are experiencing then there is only one thing to consider.

“Lower back is dead simple,” “It’s all to do with the position of the saddle. If the saddle height is too high and you’re over-reaching to the front end, it will cause problems.

“The back is more a link, the legs are a source of power but the front end is just keeping you attached to the bike. Generally back pain is a function is of stack and reach.

“If your stack (the vertical length from the centre of the bottom bracket to the top of the headtube) and reach (the horizontal length from the centre of the bottom bracket to the centre of the headtube) is too low and long then it will cause lower back pain. The other extreme of that is that if your saddle is too low and you’re sat too upright, then you are taking all the shock of the road through your back. You actually can be too upright and have back pain.”

Your body also needs time to adapt to a riding position, and so work load should only be increased gradually over time – with periods of stability to adapt to the load in order to avoid back pain. Working life and the effect it may have your flexibility should also be taken into consideration with regard to your limitations and the position you can comfortably achieve on the bike.

Besides experiencing obvious back pain, there are other ways to identify a bad fit. For example if a rider finds themselves consistently holding the top of the handlebars rather than the hoods or drops for comfort.

“A classic one is riders who spend all of their time with their hands in the middle of the handlebars and not on the hoods or the drops,”

“Then probably the bike is too big or the position too long. In that situation, you need to shorten the stem. The hood is the most expensive ergonomic part of the bike and you’re deciding not to use it – that usually strikes a chord with most people!”
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Physiotherapist wigan- George Morris
Should I run on a treadmill or run outside.
Runners have always had a view on whether treadmill running is easier than doing it outdoors. Michael Mosley weighs up his options.
For those of us who rather optimistically made a New Year's resolution to do a bit more exercise, running is the obvious and popular option. But is it better to do your running outdoors, in the wind and rain, or to go down to your local gym and work up a sweat on the treadmill, while surreptitiously admiring your reflection in a giant mirror?
It's not something I've really thought much about before, possibly because I'm not that crazy about running, but it's certainly a topic that divides running enthusiasts. So what are the arguments, for and against?
Energy
Firstly, which of these approaches is likely to get you fitter? Those who are enthusiastic about running outdoors claim it uses up more energy. The main reason is wind resistance, which you don't get a lot of when you are a gym rat. But fans of the gym say this is not necessarily true. In a study conducted by Exeter University, Prof Andrew Jones took nine male runners and made them run along a road, measuring their energy expenditure. Then they got these volunteers to run at the same speed on a treadmill, but on different inclines. What they found is that runners could adequately compensate for the extra effort of running outdoors by setting the treadmill to a 1% gradient
Find out more
Michael Mosley
Trust Me I'm A Doctor is broadcast on BBC Two at 20:00 GMT on Wednesday 27 January - catch up afterwards on BBC iPlayer.
A cheat's guide to healthy living
Speed
It's worth knowing that when you run on a treadmill you tend to overestimate the pace at which you are going. A study carried out in Singapore which asked people to run outdoors and then match their speed on a treadmill, found that when people ran on a treadmill they went significantly slower, even though they thought they were going just as fast. The scientists behind this particular study suggest this is probably because when you are running indoors you don't get the same visual cues.
Close-up of running legs on a treadmillImage copyrightiStock
Or as they put it: "The unmatched perception of speed is likely due to the distortion of normal visual inputs resulting from the discrepancy between observed and expected optic flow."
Whatever the cause, it seems that when we run outside we unconsciously work harder.
Safety
If running outdoors edges indoors when it comes to work rate, which approach is safer? In the gym, of course, you are unlikely to be hit by falling branches, slip on dog poo or trip over a kerb. But when it comes to injuries there is a hazard which is commoner among treadmill runners - overuse injury due to unvarying repetition.
When you are on a treadmill the tendency is to plug away, like a hamster on a wheel, doing the same thing over and over again. For every mile you run your foot will hit the ground about 1,000 times. Repeating the same movement puts you at greater risk of joint or ligament damage. So if you use a treadmill it's a good idea to mix it up a bit by varying the speed and the incline.
Close-up of running legs on a road surfaceImage copyrightiStock
If you run outside, particularly if you go off-road, there is inevitably going to be more variety. Each step will be different from the one that went before, simply because you are running on an uneven and varied surface. Research suggests that this constant challenge not only strengthens the ligaments and activates a greater variety of muscles, but also improves your sense of balance.
That said, the belt of a treadmill can be more forgiving than a hard pavement, which is important if you are carrying an injury.
Well-being
It seems intuitively obvious that running in the great outdoors puts you closer to nature and has to be better than running in a confined space. But what's the proof?
Well, a few years ago scientists from the University of Exeter made a serious effort to properly evaluate the evidence and their conclusions were very clear.
Woman running down country roadImage copyrightiStock
Digging through the literature they found that exercising in natural environments, particularly in green spaces, "was associated with greater feelings of revitalisation and positive engagement, decreases in tension, confusion, anger and depression, and increased energy".
They also found that people who exercised outdoors claimed to enjoy it more, find it more satisfying and said they were more likely to do it again. Though whether they actually did is another matter.
One other advantage of exercising outdoors is that you've got a greater chance of being exposed to sunshine and therefore topping up your vitamin D, (although in UK, at this time of year, that is not a particularly convincing argument).
Conclusion
For me outdoor running has clear advantages. It's far more varied and I have yet to convince my dog that watching me on a treadmill is as much fun as running through the fields. But the best advice, especially if you're starting out, is to pick the kind of running that you enjoy and which you're likely to stick to. If that means heading to the nearest treadmill just remember to vary the speed and the incline.
Physiotherapist wigan- George Morris
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George morris physio and osteopath leigh & wigan
Calf strengthening for cruciate ligament injuries
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George Morris physiotherapist leigh and wigan

Anterior cruciate ligament injuries

One of the most common knee injuries is an anterior cruciate ligament sprain or tear.

Athletes who participate in high demand sports like soccer, football, and basketball are more likely to injure their anterior cruciate ligaments.

If you have injured your anterior cruciate ligament, you may require surgery to regain full function of your knee. This will depend on several factors, such as the severity of your injury and your activity level.

Anatomy

Normal knee anatomy, front view
Three bones meet to form your knee joint: your thighbone (femur), shinbone (tibia), and kneecap (patella). Your kneecap sits in front of the joint to provide some protection.
Bones are connected to other bones by ligaments. There are four primary ligaments in your knee. They act like strong ropes to hold the bones together and keep your knee stable.

Collateral Ligaments

These are found on the sides of your knee. The medial collateral ligament is on the inside and the lateral collateral ligament is on the outside. They control the sideways motion of your knee and brace it against unusual movement.

Cruciate Ligaments

These are found inside your knee joint. They cross each other to form an "X" with the anterior cruciate ligament in front and the posterior cruciate ligament in back. The cruciate ligaments control the back and forth motion of your knee.

The anterior cruciate ligament runs diagonally in the middle of the knee. It prevents the tibia from sliding out in front of the femur, as well as provides rotational stability to the knee. 

Description
About half of all injuries to the anterior cruciate ligament occur along with damage to other structures in the knee, such as articular cartilage, meniscus, or other ligaments. 

Injured ligaments are considered "sprains" and are graded on a severity scale.

Grade 1 Sprains. The ligament is mildly damaged in a Grade 1 Sprain. It has been slightly stretched, but is still able to help keep the knee joint stable.

Grade 2 Sprains. A Grade 2 Sprain stretches the ligament to the point where it becomes loose. This is often referred to as a partial tear of the ligament.

Grade 3 Sprains. This type of sprain is most commonly referred to as a complete tear of the ligament. The ligament has been split into two pieces, and the knee joint is unstable.


Partial tears of the anterior cruciate ligament are rare; most ACL injuries are complete or near complete tears.

Cause
The anterior cruciate ligament can be injured in several ways:

Changing direction rapidly
Stopping suddenly
Slowing down while running
Landing from a jump incorrectly
Direct contact or collision, such as a football tackle
Several studies have shown that female athletes have a higher incidence of ACL injury than male athletes in certain sports. It has been proposed that this is due to differences in physical conditioning, muscular strength, and neuromuscular control. Other suggested causes include differences in pelvis and lower extremity (leg) alignment, increased looseness in ligaments, and the effects of estrogen on ligament properties.


Symptoms
When you injure your anterior cruciate ligament, you might hear a "popping" noise and you may feel your knee give out from under you. Other typical symptoms include:

Pain with swelling. Within 24 hours, your knee will swell. If ignored, the swelling and pain may resolve on its own. However, if you attempt to return to sports, your knee will probably be unstable and you risk causing further damage to the cushioning cartilage (meniscus) of your knee.
Loss of full range of motion
Tenderness along the joint line
Discomfort while walking
Treatment
Treatment for an ACL tear will vary depending upon the patient's individual needs. For example, the young athlete involved in agility sports will most likely require surgery to safely return to sports. The less active, usually older, individual may be able to return to a quieter lifestyle without surgery.

Nonsurgical Treatment

A torn ACL will not heal without surgery. But nonsurgical treatment may be effective for patients who are elderly or have a very low activity level. If the overall stability of the knee is intact, your doctor may recommend simple, nonsurgical options.

Bracing. Your doctor may recommend a brace to protect your knee from instability. To further protect your knee, you may be given crutches to keep you from putting weight on your leg.

Physical therapy. As the swelling goes down, a careful rehabilitation program is started. Specific exercises will restore function to your knee and strengthen the leg muscles that support it. 

Surgical Treatment

Rebuilding the ligament. Most ACL tears cannot be sutured (stitched) back together. To surgically repair the ACL and restore knee stability, the ligament must be reconstructed. Your doctor will replace your torn ligament with a tissue graft. This graft acts as a scaffolding for a new ligament to grow on.

Grafts can be obtained from several sources. Often they are taken from the patellar tendon, which runs between the kneecap and the shinbone. Hamstring tendons at the back of the thigh are a common source of grafts. Sometimes a quadriceps tendon, which runs from the kneecap into the thigh, is used. Finally, cadaver graft (allograft) can be used.

There are advantages and disadvantages to all graft sources. You should discuss graft choices with your own orthopaedic surgeon to help determine which is best for you.

Because the regrowth takes time, it may be six months or more before an athlete can return to sports after surgery.

Procedure. Surgery to rebuild an anterior cruciate ligament is done with an arthroscope using small incisions. Arthroscopic surgery is less invasive. The benefits of less invasive techniques include less pain from surgery, less time spent in the hospital, and quicker recovery times.
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George Morris physio and osteopath leigh & wigan
cruciate ligament injuries
Quarter squats
Squat exerciseSquat down to about a quarter of the way down and return to the starting position.
Aim for 3 sets of 10 to 20 repetitions.
Progress this by going down to half way (Phase 3 of rehabilitation) and then full squats (to horizontal) in the sports specific stages.
Increase the intensity by adding weight.
Ensure stomach muscles are kept firm when performing squats.
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George morris physiotherapist leigh and wigan
Quads setting
Anterior cruciate ligament exercises
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George morris physio and osteopath leigh & wigan
cruciate ligament injuries
Step ups
Step up and down on a bench about 9 inches high.
Step up with the recovering leg and step down with the same leg.
Change round and do the same number of repetitions on the non injured leg.
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Lunge

Standing one leg in front of the other as shown.
Bend the front leg to lean forwards and return to standing.
Aim for 3 sets of 10 to 20 repetitions.
Increase intensity by adding weight.
Ensure stomach muscles are kept firm when performing this exercise
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George Morris physio and osteopath leigh & wigan
Cruciate ligament injuries
Leg press
Leg press machingPosition yourself on the seat with the feet hip width apart on the platform In the starting position there should be approximately a 90 degree angle at the knee.
Adjust the seat accordingly.
Push with the legs to straighten the knees (either the seat will move backwards or the platform will move forwards).
Do not lock the knees - leave a slight bend.
Slowly bend the knees back towards the starting position, although do not allow the weights in the stack to touch.
This maintains tension on the muscle.
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