I put a post up on social media a while ago about how physios get injured too, and how I, personally, was needing to stay on top of my own rehab and treatment for a shoulder injury I have.  This was so that I could make the most of the plethora of sports available to me at the resort I was staying at at the time. Unfortunately, as we get older, it becomes more and more important for us to engage in and perform other types of exercise to enable us to continue doing the specific sports and activities we love. I often call this ‘homework’ to my patients – the tasks they need to do in order to achieve their goal.

Cross-training

There was once a time that I could do a backflip at the drop of a hat, regardless of where I was or what I was wearing. But it is fair to say that those days are long gone. All that would happen now is an injury, and probably a bruised ego as well. If I did want to do this however, I would need to perform a number of warm up stretches and exercises, break down the task into sections to practice individually first, and then put them together, preferably with a coach next to me… over a period of weeks to months! My body is not as malleable or resilient as it once was. Therefore, I need to train to be able to keep doing the things I want to do. And by ‘train’, I mean perform a combination of strength work, control or balance work, stretches and self-mobilisation or massage (for flexibility), and maybe a run, cycle or swim (aerobic exercise). I mean ‘cross-train’.

Cross training is essentially adding different types of training into your routine to achieve a more rounded set of skills that your body can call upon when needed. This is especially important in the hypermobility world, because we must make sure that our bodies can tolerate the stresses that seemingly ‘menial’ tasks pose, thereby reducing the risk of injury. But how do we decide what cross-training activities are most appropriate for our own bodies? Well, it comes down to what you are trying to achieve, and what condition your body is currently in. Do you tend to struggle more with tightness-related issues, like pulled muscles? Do you tend to struggle with more frequent sprains and strains, indicating a lack of stability or control perhaps? Or do you struggle to generate speed or power?

If you answered yes to any of the above, here are some examples of cross-training activities that could benefit you in the long-run:

1.      Strength training

Strength training is a key component of overall health and fitness for everyone. Lean muscle mass naturally diminishes with age. Your body fat percentage will increase over time if you don't do anything to replace the lean muscle you lose. Strength training can help you preserve and enhance your muscle mass at any age, develop strong bones, and manage your weight.

Strength training is such a huge topic in itself, but choosing how you strengthen ultimately comes down to what structure(s) has been identified (by a health professional) as being ‘weaker’, and what your goal is – what do you want to be able to do? Different types of strength training include body-weight (with little or no equipment), resistance bands, free weights, weight machines, and cable suspension training. There are also different types of specific strength exercises you can perform, all of which serve slightly different purposes and can yield slightly different results. Examples of these are isometric exercises, where the muscle length does not change throughout the contraction (it is a held contraction), and isotonic exercises, where tension remains unchanged but the muscle’s length changes (the limb/body part is moving against resistance). Isotonic exercises are then broken down into concentric contractions, which focus on the shortening phase, and eccentric contractions, which focus on the lengthening phase.

It is important to choose the right kind of strength exercises for you, so always seek help or guidance from a health or fitness professional.

2.      Stretching

The most commonly talked about forms of stretching are dynamic stretching, where joints and muscles go through a full range of motion, normally with an emphasis placed on preparing the body with movements required in the activity or sport you are about to undertake, and static stretching, where you hold a sustained stretch position. The research continues to present mixed views on stretching, mainly how and even if we should be doing it. Static stretching, for example, has been reported to reduce muscle power, however these reductions were shown to be minimal and not noticed at all if the stretches were held for less than 45 seconds.  It has also been found that stretching does improve flexibility but only for a short period of time. A few minutes after stretching, your joints move further, and with less resistance, so you may have improved flexibility. This could then be a good time to exercise, as your joints and tissues have more range of movement. And yes, this even goes for those with Hypermobility/connective tissue disorders, as often it is the joints themselves that are hypermobile whilst the muscles themselves remain tight.  

One thing that is undeniable is that stretching feels great. Many people feel more relaxed and report a rush of endorphins after a good stretching session. From a research point of view, it is difficult to test the long-term effects of stretching specific muscles that show abnormal tightness. Nevertheless, what we do know is that a long-term static stretching routine will improve your overall flexibility, which could, in turn, help to prevent injuries.

3.      Soft-tissue release / self-massage

Soft tissue therapy is the management, manipulation, and rehabilitation of soft tissues of the body including muscles, tendons and ligaments. It is applicable not just to sports people, but to anybody wishing to prevent or recover from a soft tissue injury.

Soft tissue therapy uses a large variety of treatments, one of which is massage. There are a number of other different types of soft-tissue therapy, including trigger point therapy, myofascial release and soft-tissue release. These are generally passive forms of treatment, ie. someone else is performing them on you. However, there are many different ways that we can achieve the same or similar effects simply through performing these techniques on ourselves. Self-massage is using your hands, tools, or objects to work on your own sore or tight muscles, instead of going to see a massage therapist or health professional. Examples of this would be using a foam roller, a spikey massage ball or a tennis ball, or a massage ‘gun’.

By stimulating blood flow and circulation, and requiring you to focus on a specific thing, like massage in general, self-massage may help ease stress; anxiety; headaches; muscle strain and tension; joint stiffness; pain; and digestive disorders. With self-massage you can also hone in on the areas of your body that are causing you pain, giving you the control to put as much or as little pressure as you like on an area. Afterall, you know your body best! And considering most of us can’t afford weekly massages, learning a few self-massage techniques can help you to ease pain and tension between professional massages. When included as part of a comprehensive treatment plan or exercise/activity regime, self-massage can often help manage chronic conditions like Hypermobility and connective tissue disorders, Fibromyalgia, and Arthritis.

4.      Balance / control work

Balance is your ability to control your body in space, distributing your weight evenly in a way that allows you to remain upright. Balance is divided into two types: static and dynamic.

• Dynamic balance: The ability to move outside the body’s base of support while maintaining posture control.

• Static balance: The ability to maintain the body’s centre of mass within its base of support.

Both types of balance are essential, and you can improve both with targeted exercises. Many of us take balance for granted, but everyone can benefit from improving it. Balance training exercises help to prevent falls and injury, as well as improve posture, strength, confidence, control and proprioception (your body-position sense, or awareness of where that body part is/what position it’s in). Balance training can be anything from standing on one leg, to using a Bosu or balance board, to Tai Chi, Yoga and Pilates. It aims to strengthen from ‘the inside out’ by improving the strength of your deeper stabilising muscles, and providing more control and intention with your everyday movements.

Balance training can help anyone at any age. Athletes find it can make them more powerful. Seniors use it to prevent injuries from falls and maintain independence. Fitness lovers know it helps improve workouts and performance. And my ‘hypermobiles’ really feel the difference in their everyday life, their quality of movement, and the reduced injury rate (rolling their ankle, for example). In fact, for any of us to just move around efficiently in life requires healthy postural alignment and good balance.

Conclusion

Ideally, we should all be incorporating some form of strength training, balance exercise, stretching and aerobic activity into our weekly exercise regime. Variety is key in staying strong and healthy and reducing the risk of injury. As Ben Cormac from Cor-Kinetic said, we should consider our exercise regime like our food – ‘a balanced diet’ – a bit of everything. Of course the specific type, the quantity, the duration etc will vary for all of us. This is why it is so important to seek guidance from a professional first. As a physiotherapist, these are some of the things that I consider with every patient that I see when establishing their management and treatment plan. If you would like to discuss any of the above further in relation to you, an injury, or a goal, please feel free to contact me here or email me at thegreenphyso@outlook.com.