Advice and exercises for preventing injuries and improving performance fr runners and tri-athletes.

​Here is some great advice from Andy Matson, our fitness expert and coach.

Runners and tri-athletes are always looking for a competitive edge and a desire to increase their knowledge for optimal performance. The tips and advice together with the exercise testing procedures mentioned in this information will provide an evaluation of an athlete’s strengths and weaknesses.

The evaluation can then be used to design a training programme that is specific to the athlete. Whether you are a seasoned athlete or returning from injury you will find some of this information beneficial to your overall fitness capabilities.    

Tips for optimal running style
This is a hot topic amongst the experts and of course runners/triathletes themselves. What constitutes to correct technique vary enormously depending on the professional you talk to and their speciality, so rather than striving for the perfect running style it’s far better to aim for optimal running style that’s right for you and works with your natural physique. So how do you know your optimal style, below are some questions to ask yourself first.

• Does it feel comfortable when you are out for an easy run?
• Are you seeing positive rewards from your hard work?
• Are you injury free and rarely pick up injuries especially when you increase your training.

If your answer to the questions is yes then you are on the right track, you still might want to re-evaluate your style frequently as most runners do become a little forgetful especially when they increase their training.  If the answer is no you may want to change things. There is some common ground that experts agree on in relation to good technique, please see below a few of their suggestions.

• The head- your eyes should be looking ahead and at the ground between 10-30 meters in front of you. Looking straight down will throw your spine out of alignment.
• The arms- imagine your arms as pistons and moving forwards & backwards. Keep them close to your sides and avoid excessive crossing over the centre of your torso. Arms should be bent close to 90 degrees.
• The core- this is an area that a lot of runners/triathletes neglect. A weak core will cause many injuries that could have easily been avoided. Try running tall and don’t arch your back and avoid sticking your buttocks out. Imagine your pelvic area is a bucket of water. Your aim is to stop the water from tipping out, so you need to keep it as level as possible. To do this you need to engage your core and glute muscles, so pull in your bellybutton and squeeze your butt tight to keep the bucket level.

• Over-striding- This is one of the most common injury-causing problems in running. Landing heel first with your foot well ahead of your body's center of gravity is the same as putting your brakes on in a car. Some runners assume that a longer stride will improve their speed or running efficiency, but that's not the case, it wastes vital energy needed for running economy. Make sure that you don't lunge forward with your feet. Focus on landing mid-sole, with your foot directly underneath your center of mass with every step. Try to keep your steps light and quick, as if you're stepping on hot coals.
• Breathing- proper breathing is just as important to your running economy as stride and posture. If you don’t take in enough oxygen, you will find it more difficult to keep a relaxed form and maintain your pace. Shallow breathing pattern will replace depleted oxygen, but one that is deep and rhythmic oxygenates your whole body and increases your endurance. 

​Assessing your core stability & balance. 
Below are two simple exercises you can do to test your core stability & balance.

Core stability test- stand with your back against a wall, feet hip-width apart. Lift one leg off the ground up to 90 degree angle without tipping or sliding sideways (relax and avoid tensing up). The more stable and upright you remain, the better your core stabilizers are working.
 
Single-leg reach- Place one cone (or similar object) about two feet in front of you, and stand on your left foot. Bending your knee, while keeping your core tight and your back straight, reach forward with your right arm to touch the cone (or come as close as possible). Stand up and repeat. Start with 8/10 reps, and work up to 30. As you become stronger, vary the cone positions—put one at 9 o'clock and one at 3 o'clock, for instance—and challenge yourself by going barefoot. "Make sure the whole foot stays in contact with the floor; don’t let it roll to the outside. Repeat for the right leg.
   
Benefit: This exercise strengthens major leg muscles—glutes, quads and calves—but doesn't allow you to favor your strong side. It also teaches balance on one foot while your knee is bent, and strengthens the stabilizing muscles in the foot so that when you land on each foot your body is ready for impact.

The warm-up (Dynamic)
The warm-up is not only used to increase the body temperature & heart rate, a good dynamic warm-up is a complete total body workout for runners & triathletes. If performed correctly a dynamic warm-up can result in positive training adaptations to improve performance, help prevent injuries and prepare the body for competition. This is time to focus on improving strength, power, speed & agility and should last for 10-20mins. Dynamic warm-up sessions should focus on stretching muscles and movement patterns that require a combination of muscles & joints that are specific to your sport.

The exercises:

• Toe & heel walking- for strength/stability and help reduce the likelihood of shin splints.
• Knee to chest walking- balance & postural control & stretching gluets.
• Walking quad stretch- flexibility in quads/hip flexors, also improving leg balance.
• Stork walk- balance & multi-limb coordination & hamstring strength.
• Hamstring walks (inchworm) - develops range of motion in hamstring & lower back, also good for core.
• Toy soldier’s march- develops hamstring & lower back flexibility- progress with a skip.
• Lunge walking with arms- range of motion in the hip flexors, strengthens quads, glutes & core.
• Counter-movement-jump (CMJ)- explosive power throughout the entire body.
• High knee running- improves the forward drive when running.
• Heel flick running- improves the recovery phase when running.
• Backpedal – strengthening quads & hamstrings and for balance also helps with range of motion through hips. This is a good exercise to do before a speed session. 

Exercise testing.
Why test?  The aim is to develop knowledge and understanding of exercise capabilities of the athlete. A practical outcome of the testing is enhanced performance of the athlete being tested. Testing should be an integral part of an athlete’s training program and should be conducted regularly and frequently.

The Tests
Try the following tests by Top End Sports

• Agility Shuttle Run Test (10m shuttle) 
• 20m Multistage Fitness Test (Beep Test) 

​VO2 Max
VO2max is a measure of a person's aerobic fitness. The table below categorizes VO2max scores for adult men and women of various ages. These are relative VO2max scores, in the units of mls of oxygen per kilogram of body weight per minute (ml.kg-1.min-1). Click here to see to VO2 norms for your age group.

• Reliability: The reliability of the beep test would depend on how strictly the test is run and the practice allowed for the subjects.
• Advantages: Large groups can perform this test all at once for minimal costs. Also, the test continues to maximum effort unlike many other tests of endurance capacity.
• Disadvantages: Practice and motivation levels can influence the score attained, and the scoring can be subjective. As the test is often conducted outside, the environmental conditions can affect the results.

One way to ensure that all athletes push themselves in the test is for them to wear a heart rate monitor. You can then compare their maximum heart rate during the test to their predicted or measured maximum to determine if they have 'maxed out'. 
Heart Rate ZonesIn order to structure training more accurately and to analyze sessions effectively, Heart Rate zones have been developed. The table below shows the 1-6 HR zones used by British Cycling (BC is one of the most highly regarded models for HR zones). There are alternative models that use more or less HR zones and arguably the three broad zones of basic, intensive and maximal would be sufficient for most ages up to regional level competition.

Table: Training Intensity Zones (Adapted from British Cycling Level 3 Coaching Handbook: Coaching for performance) This table also represents the relationship between %max heart-rate VO2max. thus, one only needs to monitor heart-rate to estimate the relative exercise domain or VO2max.

The ZONES

Recovery Zone – Purpose: Recovery
Adaptation: Increase blood flow to muscles to flush out waste products
Zone 1 – Purpose: Base endurance
Adaptation: Increase in cycling/running economy, improves fat metabolism i.e. fat is the main energy source.
Zone 2 – Purpose: Improve efficiency
Adaptation: Mainly fat burning, significant cardiovascular overload, improvements in biomechanical and physiological efficiency.
Zone 3 – Purpose: Improve aerobic power and endurance
Adaptation: Improves carbohydrate metabolism, some fast-twitch fibres change to slow-twitch fibres, increased cardiovascular efficiency.
Zone 4 – Purpose: Raise lactate threshold
Adaptation: Improves carbohydrate metabolism, develops lactate threshold, some fast-twitch fibres change to slow-twitch fibres.
Zone 5 – Purpose: Sustained maximal aerobic power
Adaptation: Develops cardiovascular system & VO2 max, improves anaerobic energy production and tolerance/removal of end products i.e. lactate shuttle.
Zone 6 – Purpose: Increase maximum muscle power
Adaptation: Increases maximum muscle power & resistance to fatigue, develops cardiovascular system & VO2 max.

Note: Should only be undertaken when fully recovered from previous sessions. Taking fluid/fuel between efforts helps avoid premature fatigue.

Aerobic capacity
Aerobic capacity improves if exercise intensity regularly maintains heart rate between 55 and 70 % of maximum. Clearly, achieving positive training adaptations does not require strenuous exercise. An exercise heart-rate of 70% maximum represents moderate exercise with no discomfort.
An alternative and equally effective method to establish your training zones is the karvonen method,  Kavonen method takes into account your resting heart rate. For more details on this method see www.topendsports.com or www.briancalkins.com

NOTE: You can also go onto topendsports website and calculate you actual Vo2max scores from the bleep test. Look under fitness testing calculators.
 
Rate of perceived effort (R.P.E.)
R.P.E = Rate of perceived effort: this R.P.E is based on a similar scale to the British cycling scale and the Borg scale. You can make up your own scale as long as it relates to your training zones. When training you should always refer to your perceived effort in addition to your heart rate monitor for feedback. Heart rate monitors are a guide only and do have a degree of error in predicting you HR.

R.P.E.  Is an effective way of measuring your effort levels and correlates highly with VO2max, HRmax and your training zones.

These are the level of effort you need to put into your sessions in relation to R.P.E.

• L1- very light with no effort, this is for recovery to bring heart rate back to normal.
• L 2-4 very easy gentle pace with little effort.
• L 5-6, is coming out of comfort zone but still able to hold a conversation with someone.
•  L 6-7 getting out of breath, can only speak two/three words before needing to take a breath.
•  L8 race pace, can’t talk & hard.
• L9-10 maximum effort, anaerobic energy system, example sprinting.

I hope you have found some of this information useful, all of the information above has come from reliable and valid data bases that are backed by scientific research. Remember that it is best to take a holistic approach to your training and listen to what your body is telling you. That balance, agility, strength and speed are all vital components of most sports including running, cycling and triathlons. Regular testing and assessment of your fitness is a vital component to stay injury free and maintain optimal performance, happy training.   

You can read more about Andy Matson here, or at his website AMActiv.co.uk

Plant and shovel without the back trouble! 

With the end of winter finally in sight, many people are itching to get back into their gardens to begin mowing, weeding and pruning, but while your garden may need some help getting back in to shape, don’t forget so do you! 

Many gardeners overdo it by throwing themselves straight into gardening without a warm up, forgetting that their bodies need, like the gardens, to be coaxed in gently and limbered up over a period of time.

By doing things the wrong way it’s easy to understand how back pain can arise from our pursuits in the garden, but most injuries are preventable if you do things the right way. 

Here are some tips for getting your spring garden green and beautiful again without injuring yourself in the process: 

LIFTING 

• Stand Close to the Load 
• Make sure your feet are shoulder width apart, head up, feet and body pointing in a straight line with the item you are lifting. Pivot with your feet; don’t twist your body whilst carrying the load. 

Knees Bent, Back Straight 

• Check the weight of what you are lifting. Use your leg and arm muscles to help you slowly lift.

Easy Does It 

• Bend your knees and slowly lower the load to its resting place. 
• Do not lift heavy objects above your waist. 
• Avoid heavy lifting immediately after prolonged bending and kneeling. 

THE RIGHT MOVES 
Using the right moves can go a long way to enabling you to plant and rake without the ache. 

• Warm up before starting to garden by gently stretching your muscles. If it’s cold, wait until later in the day when it’s warmer. 
• Never dig when the ground is wet or there is a heavy frost - it is difficult to do, making the soil heavier and also not good for the soil structure. 
• Positioning your body correctly reduces strain on muscles and joints: do not repetitively lift heavy loads - alternate it with lighter loads.

Changing Hands 

• Take the strain off by changing the position of your hands.

Check Your Position and Change it Often 

• Kneel then stand or simply sit and relax for a while, but don’t maintain any one position over a prolonged period.

Kneel to Plant 

• Use kneepads or a kneeling mat to reduce the strain whilst you plant and weed. Keep your back straight and stop frequently to take a break.

Rake Right 

• Ease the strain on your back by putting one leg in front, the other behind. Switch legs and hands from time to time, whilst it might feel strange it’s good to try and even up your movements.

Take the right precautions and your back will thank you for it and you can enjoy your garden all year long!

In January, I spent a rewarding day teaching The Alexander Technique to musicians at a sixth form in Bedford. The students are classed as high performers and all are looking to study at a music college on leaving school.

In the morning, I ran a group session with the lower sixth pupils working with each other to see how small changes to the posture can bring a huge reduction in muscle strain. And then in the afternoon I gave one-to-one lessons with the upper sixth students. These thirty-minute sessions allowed me to focus on them while playing their instruments and to suggest specific techniques relevant to them.

A musician is no different to an athlete training for the big event. Both require long hours practising to perfect their skills, and both have to perform well under pressure under the scrutiny of a knowledgeable audience. Unfortunately, they also share a propensity for injuries, and the aches and pains that come from longs hours of training. However, for musicians they can often be worse due to the stationary nature of playing an instrument.

And to continue to comparison to sport, competition for a place at a top music college is fierce, just like any sports team. To have a chance, students will be expected to practise for a minimum of two hours a day, and once at college this will rise to four or more just to keep pace. At Julliard in New York, anything less than six hours a day is frowned upon!

The common ailments a musician will experience are lower back pain, stiff necks and sore shoulders. Long periods sitting at a piano, twisting to play a violin, or holding a trombone, or worse a double bass, can put tremendous strain on the muscles. And when focusing on playing correctly, a musician may not notice they are tightening their neck, shoulders or lower back.

The Alexander Technique is taught at all top music colleges around the world. It is an essential skill to learn that enhances a musician’s ability to perform with poise and therefore less effort. The technique develops self-awareness and improved ‘body-knowledge’, or what Seb Coe calls ‘physical literacy’. It may be a cliché, but a musician is also an instrument, and one that is far more complex than the one that they play. If they are balanced and poised, it makes it easier to play. If they are tired and in discomfort, it’s not so simple and they will more likely make mistakes, and maybe even come to loathe their practice and instrument.

​Learning how to stand, sit and hold an instrument with minimal effort is one benefit of learning The Alexander Technique. The other is mental. The technique promotes the ability to focus and be mindful while playing a complex piece. This also helps with reducing the impact of performance anxiety – essential for auditions and the big occasions.

I really enjoyed working with the students. They are understandably enthusiastic about their music and have ambitions to make a career out of their passion. I hope the sessions will see them through to the next stage of their study, and prepare them for the exciting (and tough) times ahead.

Post by Roy Palmer our Alexander Technique teacher.

Many people with Raynaud’s do not have the full classic colour changes, but develop infrequent, mild bouts of uncomfortable, pale, cold fingers where symptoms only last a few minutes. Sometimes it is moderate with more frequent bouts of symptoms that last longer. Rarely, it is severe with repeated frequent bouts, with each bout lasting for longer periods of time.
 
Only the fingers are affected in most cases. Less commonly areas of the body such as the toes, earlobes, nose, nipples or tongue can be affected.
 
Raynaud’s is divided into two types:
 
Primary Raynaud’s – when the condition develops by itself and in most cases there is no known cause
Even mildly cool weather, or getting something out of the freezer, or being in windy conditions can trigger symptoms in some people. Strong emotion may also trigger symptoms in some cases. The small blood vessels in the fingers, toes, etc, just appear to be more sensitive than normal to cool temperatures. Usually, all fingers on both hands are affected in primary Raynaud’s. It also tends to run in some families; women are affected more often than men and it usually first develops before the age of 30.
 
The outlook for people with primary Raynaud’s is usually good. Most people have mild symptoms that do not interfere much with daily life. People with more severe symptoms often respond well to treatment with nifedipine. In some cases the condition remits (goes away) in time. In one study that followed up people with primary Raynaud’s over seven years, the condition had gone away in nearly 2 in 3 cases at some point over the study period.
 
Sometimes, someone who is thought to have primary Raynaud’s develops other symptoms several months or years later and the diagnosis is changed to secondary Raynaud’s. This is thought to occur in about 1 in 10 people who are initially diagnosed with primary Raynaud’s.
 
Secondary Raynaud’s – when it develops in association with another health condition.
Secondary Raynaud’s is less common and is usually associated with an underlying autoimmune condition affecting the blood vessels, joints, muscles, nerves or skin such as scleroderma, systemic lupus erythematosus and rheumatoid arthritis. Symptoms are often more severe and tend to respond less well to treatment.
 
If you have secondary Raynaud’s you will normally have other symptoms in addition to the symptoms of Raynaud’s. The Raynaud’s is just one feature of the condition. For example, you may also have joint pains, rashes, joint swelling, etc.
 
Often the underlying condition is already present, and you may develop Raynaud’s as a complication. Sometimes the symptoms of Raynaud’s occur first, and other symptoms of the underlying condition develop weeks, months or even years later.
 
In secondary Raynaud’s, symptoms may first begin in just one or two fingers on one hand. This is in contrast to primary Raynaud’s when all fingers on both hands are typically affected.
 
Hand-arm vibration syndrome (vibration white finger) is one common cause of secondary Raynaud’s. This is caused by using vibrating tools regularly over a long period of time. For example, it occurs in some shipyard workers, mine workers, road diggers, etc. It is thought that repeated vibrations over time may damage the small blood vessels or their nerve supply.
 
Medicines
Secondary Raynaud’s can also be a side effect of taking certain medicines, including:
 

• some types of anti-migraine medication, such as sumatriptan and ergotamine
• beta-blockers, which are used to treat high blood pressure and heart disease
• some chemotherapy medications
• decongestants
• the contraceptive pill
• medications used in hormone replacement therapy
• some types of medications used in the treatment of high blood pressure, such as angiotensin-converting enzyme (ACE) inhibitors and clonidine
• The illegal drugs cocaine and amphetamine can also cause secondary Raynaud’s.

 
Injury and overuse
Raynaud’s sometimes results from a physical injury to the affected area. It can also affect musicians, people who type a lot or other people who use their fingers and hands more than usual.
 
Are tests needed to confirm Raynaud’s?
Not in most cases. There is no test that confirms primary Raynaud’s. The diagnosis of primary Raynaud’s is made on the basis of the symptoms described above and there is no abnormality found that may suggest a secondary cause when a doctor examines you. Blood tests and other tests may be done if secondary Raynaud’s is suspected.
 
What are the complications of Raynaud’s?
In very severe cases of Raynaud’s the blood supply to an affected body part can become severely diminished, which normally only occurs in secondary, not primary, Raynaud’s. Without a constant supply of blood, the tissue in the body part will begin to die.
 
How is Raynaud’s phenomenon treated?
For the majority of us with mild Raynaud’s it’s about self-care:

• Keep the hands and feet warm. Warm gloves, socks and shoes are essential when outside in cool weather.
• Keep the whole body warm, symptoms are less likely to occur if the entire body is warm. For example, wear hats and scarves in addition to warm clothes.
• Buy portable heat packs and battery heated gloves and socks. The Raynaud’s and Scleroderma Association has a list of suppliers.
• Try not to touch cold objects. For example, use a towel or gloves when removing food from the freezer or working with cold food.
• Regular exercise is recommended by many experts. Exercise the hands and feet frequently to improve the circulation.
• Smoking can make symptoms worse, because the chemicals in tobacco can cause the small blood vessels to narrow.
• Avoid caffeine (in tea, coffee, cola and some painkillers) as it can trigger symptoms in some people.

 
However, sometimes medications are needed, and many options are available. These include blood pressure medications such as calcium channel blockers (amlodipine, nifedipine, felodipine, and others) and angiotensin-receptor blockers. These medications act by increasing blood flow to the fingers and toes. For patients with more severe symptoms or who have developed complications such as ulcers on the fingertips, other medications can be used including sildenafil or prostacyclins.
 
Sometimes, patients will also be prescribed other medications that can help improve symptoms, including topical creams, selective-serotonin-reuptake inhibitors (SSRIs), or cholesterol-lowering (statin) medications.
 
For more information about Raynaud’s phenomenon you can visit the Scleroderma & Raynaud’s UK website or download their factsheet HERE

What is tinnitus?
Tinnitus is the term for the sensation of hearing a sound in the absence of any external sound. The types of sounds range from ringing, buzzing, whooshing or humming and can be continuous or come and go. The tinnitus might seem like it’s in one ear or both, in the middle of the head or even be difficult to pinpoint.

Some people may even think the noise is coming from outside and try to locate where the sound is coming from before they realise it’s actually inside them! Occasionally people have tinnitus that has a musical quality, and can seem like a familiar tune or song. This generally occurs in older people who have hearing loss and a strong musical interest. This type of tinnitus is known as musical tinnitus or musical hallucination.

​Who gets tinnitus?
Tinnitus is very common and is reported in all age groups, even young children. About 30% of people will experience tinnitus at some point in their lives but the number of people who live with persistent tinnitus is approximately 10%. Tinnitus is more common in people who have hearing loss or other ear problems, but it can also be found in people with normal hearing.

The experience of tinnitus is different for different people. Most people find that they are able to continue their normal day-today activities. However, a small percentage of people with tinnitus report it as severely affecting them.

What causes tinnitus?
Whilst the exact causes of tinnitus isn’t known, we do know that it is not a disease or an illness. It is generally agreed that tinnitus results from some type of change, either mental or physical, but not necessarily related to hearing. When we hear, sound travels into the ear and then the hearing nerves take the signals to the brain. The brain is then responsible for putting it all together and making sense of the sound. Because the ears can’t distinguish what’s important and what’s not, they send a lot of information to the brain. This is too much information for us to process, so the brain filters out a lot of unnecessary ‘activity’ and background sound, such as clocks ticking or traffic noise.

If there is a change in the system, for example a hearing loss or ear infection, the amount of information being sent to the brain changes. The brain then responds to this change in levels by trying to get more information from the ear, and the extra information you may get is the sound we call tinnitus. The tinnitus is therefore actually brain activity and not the ear itself!

It is generally accepted that it isn’t only a change in the ear that can result in tinnitus, but it could be due to a change in our stress levels, for example, with tinnitus being noticed after periods of significant stress, a change in life circumstances or general well-being. People often say that they are aware of noises in the ears when they have a cold, an ear infection or wax blocking the ear. Sometimes people become aware of tinnitus following a really stressful event and once they’re aware of it, seem to notice it more and more, but this usually fades once these things have passed. However, some people continue to notice the tinnitus, for example after an infection has cleared up.

Fortunately, tinnitus is rarely an indication of a serious disorder and a doctor will be able to check this for you.

What should I do?
The first person to talk to is your GP. You may need to be referred to an Ear, Nose and Throat (ENT) Surgeon or an Audiovestibular Physician, who will rule out any medical factors, assess your hearing and probably give you some information about what tinnitus is and how best to manage it. Some hospitals have hearing therapists or specially trained audiologists who are available to offer more support, if you need it.

The most important thing to do is to keep doing the things you enjoy. If you start living your life differently to accommodate the tinnitus, it’s just going to seem more of a problem. You may need to do things differently, for example reading with some background music on, but it’s important that you do them nonetheless.

It does improve
When you first experience tinnitus, you may naturally be worried and very aware of this new sound. We constantly monitor our bodies and if anything changes, we become aware of the changes. Hearing tinnitus for the first time can be quite frightening if you think it means that something is wrong with you, or that it might change your life. It’s a new sensation and you need to give yourself time to adapt.
Most people find that their tinnitus does seem to settle down after this initial period, even without doing anything in particular.

You might hear this being referred to ashabituation. It’s a bit like walking into a room with a noisy fan or air conditioner.

Initially, it seems really loud and then after a while, you stop noticing it as much. Tinnitus can often be much the same – initially, it’s more noticeable but you gradually notice it less than you did. The first time you realise it’s in the background is a great moment – it confirms that there are times when it’s less noticeable, which means you should be able to keep doing the things that you enjoy doing.

Things that can help
Talking to someone People around you may not understand what tinnitus is and how it might affect you, so might not be able to give you the type of support you need. It can be really helpful to talk to someone who has experience of tinnitus.

Meeting people who have been through the same things you are going through right now can be very helpful. There are Tinnitus Support Groups around the country. Not only can you pick up tips from others, but you can gain (and give) support simply by sharing your story with people who understand because they’ve been there themselves.

Relaxation
It is quite common to feel anxious and afraid when you first experience tinnitus. By relaxing more, you may be able to feel less stressed and so notice your tinnitus less. Learning to relax is probably one of the most useful things you can do to help yourself. A really easy way to relax is to find somewhere peaceful and just slow your breathing down (feel free to have some sound on in the background). You can take a few slow deep breaths and pay full attention to the feeling of the breath entering your body, filling your lungs and leaving your body. When we use deep breathing to relax, we feel calmer and more able to manage the tinnitus, and often don’t notice it as much!

Using a hearing aid
Loss of hearing is often an unnoticeable and gradual process, and many people are surprised when they are told that they have a hearing loss. If you have hearing loss, using hearing aids can be helpful for tinnitus because they are restoring what you can’t otherwise hear.

Using sound
Tinnitus is usually more noticeable in a quiet environment. It’s a bit like candles on a birthday cake – in the lights, the candles aren’t very bright but if you turn the lights off, the candles seem much brighter. With tinnitus, when there is other sound, it doesn’t seem that loud, but when you turn all the other sound off, the tinnitus seems much more noticeable. A lot of people have found that using background sound helps them – this can be a radio, music, or using natural sounds.

People are really good at figuring out ways of making things better for themselves and you might already be aware that you generally don’t notice the tinnitus as much when there is background noise. By using sound at other times, you’re just using other ways of doing what you already know to be helpful.

Addressing sleep problems
People who live with tinnitus might have difficulty falling asleep or staying asleep. In order to sleep well, our bodies and our minds need to be relaxed. Worrying about the tinnitus, or worrying about how much sleep you’re getting (or missing out on), is unhelpful and will only make it more difficult to sleep. Most people with tinnitus sleep well and their tinnitus is no different from those who do not sleep well. 

People who have tinnitus and sleep poorly tend to worry more at night than people with tinnitus who sleep well. Working through problems during waking hours is better than in the middle of the night when you have nothing else to occupy you. It helps to make use of relaxation techniques to prepare the body for sleep. Once your body and mind are relaxed, sleep will come a bit easier.

Having some soft sound in the bedroom can help some people with tinnitus sleep better. The type of sound you use is up to you – as long as it is pleasant or neutral.

Professional support
If you are referred to a specialist tinnitus clinic, and your tinnitus is particularly troublesome, you will be introduced to more formal or structured ways of managing tinnitus. Most centres use a combination of approaches. You may come across some terms before, or hear them when you get there, and it helps to have some understanding of what these terms are.

Cognitive Behavioural Therapy (CBT) - this is one psychological approach that can be useful in managing tinnitus. The idea is that when you became aware of your tinnitus, you responded to it negatively. For example, you may have thought there was something seriously wrong with your hearing (a belief) and this led to you being anxious (an emotion), and you then tried to feel better, for example by avoiding silence (a behaviour). 

Some beliefs and behaviours are helpful and that’s great – keep doing them! But some beliefs and/or behaviours are unhelpful and CBT helps you to recognise them, and then you work together with the clinician (usually a psychologist, audiologist or hearing therapist) to find different ways of
responding to the tinnitus so it becomes less bothersome.

Mindfulness - this is a meditation technique that is used frequently for pain management, and more recently for tinnitus. The idea is that we tend to resist unpleasant sensations (eg hearing tinnitus). If we stop resisting and allow the unpleasant sensation, this alters our awareness to include more sensations. We start to notice that sensations become less dominant once our attention moves away from them and focuses on a different part of the body. All of this can change in a moment, simply by changing our awareness. If we use mindfulness effectively, we can create some space from the tinnitus and in that space, we can decide how we’re going to respond to it. It’s a wonderful way of achieving ‘peace and quiet’.

Tinnitus Retraining Therapy (TRT) - this is a very structured approach to managing tinnitus. Basically, TRT assumes that the tinnitus has been prioritised as an important signal. TRT uses sounds at a particular level to try to reduce the priority of the tinnitus so that you no longer hear it. It is based on the idea that we can get used to sounds, e.g. the sound of the fridge or air conditioner, so we can also get used to this sound of tinnitus. The process of getting used to the tinnitus sound is called habituation. 

TRT uses sound generators and counselling to attempt to retrain how the brain processes sound so that you habituate to the tinnitus. Most people working in the tinnitus field will use elements of TRT but the strict method is not frequently used because there is limited evidence for its effectiveness.

Take care of your hearing
Frequent, prolonged exposure to loud noise increases the risk of getting tinnitus, or of making it worse, so take care to avoid very loud sounds, or protect your ears against them. Wear proper ear protectors (not cotton wool) when hammering metal, using power tools or when you are near any noisy motors. Ear protection is also important if you watch live music or play in a band or orchestra. Ear protection should not be used if ordinary, everyday sounds are uncomfortable (this may be hyperacusis or oversensitivity to sound). If ear plugs are worn for blocking out such sounds, it can actually make hyperacusis worse.

Hyperacusis
Hyperacusis is an increased sensitivity to sound. If you find that everyday or ordinary sounds are uncomfortable, you may have hyperacusis. Whilst it might seem natural to want to block out as much sound as possible, avoiding sound can actually make hyperacusis worse. Talk to your GP about this and ask for a referral to either an ENT Surgeon or Audiovestibular Physician who will be able to suggest management options – often, using sound (in a very controlled way) can improve hyperacusis.

For more information about Tinnitus please contact the British Tinnitus Association
Email: info@tinnitus.org.uk Helpline: 0800 018 0527 Website: tinnitus.org.uk
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I can’t begin to count how often patients have asked me the differences between all three therapeutic modalities are. While the differences used to be more defined historically, it's now difficult to differentiate each therapy as there are quite a number of techniques and treatment approaches which we all share. Some of you will be aware of these, having perhaps been to manual therapists from all three. 

Some of you may only be aware of physiotherapy through the NHS, which is often quite different to the treatment protocol offered by private physiotherapists. In fact in my experience from attending continued professional development courses that  there are almost always a mixture of all three types of practitioners present on virtually all of the courses I have attended in the last 10 year period.

Osteopathy
Osteopathy in its most traditional form is a manual therapy which aims to reduce pain and return patients back to full function. It works with the structure and function of the body and is based on the principle that well-being of the individual is based on the neuro-musculo-skeletal system (nerves, muscles, skeleton and connective tissue) all working harmoniously together.

Osteopaths use touch, physical manipulation such as joint articulation and release (manipulation), stretching and a variety of soft tissue massage to increase the mobility of joints, to relieve muscle tension, to enhance the blood and nerve supply to tissues, and to help your body’s own healing mechanisms. They often provide advice on posture and exercise to aid recovery, promote health and prevent symptoms recurring. So osteopaths work to restore your body to a state of balance, where possible without the use of drugs or surgery.

All UK Osteopaths have completed a 4 year degree with rigorous clinical training after-which they have to be registered with the General Osteopathic Council (GosC). 30 hours of continued professional development (CPD) is required from us to enable us to remain on the register.

Physiotherapy
Physiotherapy [like Osteopathy] encompasses a range of interventions, services and advice aimed at restoring, maintaining and improving people's function and movement and thereby maximizing the quality of their lives, as defined by the CSP. Therefore much like osteopaths Physiotherapists help people affected by injury, illness or disability through movement and exercise, manual therapy, education and advice. They maintain health for people of all ages, helping patients to manage pain and prevent disease.

It is certainly my belief that there are subtle differences between physiotherapy in the NHS (where perhaps the emphasis due to time constraints, funding, resources etc.) are more focused around rehabilitation through education and exercises programmes, thereby empowering their patients to participate in and achieve their own recovery. Physiotherapists in private practice have more time to spend with their patients and therefore can employ a range of other skills in addition to further improve a patient’s movement and function.

Physiotherapy is a degree-based healthcare profession Physiotherapists practising in the UK must be regulated by the Health and Care Professions Council (HCPC) and complete CPD hours annually. All our physios here at the Centre are also registered with the Chartered Society of Physiotherapy (CSP).

Chiropractic
Again, as with Osteopathy, Chiropractic is a healthcare profession concerned with the diagnosis, treatment and prevention of disorders of the neuro-musculo-skeletal system and the effects of these disorders on general health. There is an emphasis on manual techniques including joint adjustment and/or manipulation with a typical focus on subluxations (misalignments of the spine). However they also address posture and lifestyle advice.

Chiropractic’s also study for 4 years, are regulated (by the General Chiropractic Council) and have to complete CPD hours each year.

There is a very short whistle stop tour through the three professions in a very simplistic and historic way. However, many of the manual techniques are now shared across the disciplines, as are the use of other techniques such as acupuncture in its various forms, from the traditional acupuncture perspective through to the very western dry needling type of acupuncture in its various guises.

If you're in need of treatment, it's really all about finding a practitioner and therapy and indeed their right skill set to best suit you. Sometimes that may come down to having a chat with a practitioner, looking online and ensuring that they are part of recognised regulatory body, getting recommendations from friends and family and, otherwise, going for an initial consultation.

I think the main point to take note of here is that each practitioner is an individual and is shaped by their own interests, experiences and the courses that they have undertaken since their undergraduate qualification. So it’s not only you - the patient as an individual, but the practitioner too and much less about the label that practitioner holds!
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If there's one thing we've lost in our high-tech way of life, it's rhythm. And I don't mean whether you can bust a move (I'm sure you can). I'm talking about cortisol rhythm.

Cortisol is a hormone, and one of the main stress response chemicals produced by the adrenal glands. It is responsible for maintaining the health of and proper communication between every cell in your body. When it is in a healthy rhythm, cortisol is highest in the morning to give us energy and kick start our day, keep inflammation low, and immune response at its peak. It is naturally lowest before bed allowing us to wind down into a rest-and-repair phase. 

Prolonged exposure to digital devices at night that emit high levels of blue light, Lowers Melatonin production an important hormone that controls the sleep-wake cycle and can raise Cortisol levels associated with stress. When this natural cycle is disrupted, we can end up with:

• Sleep problems (insomnia, waking in the night, waking up tired in the morning)
• Hormonal imbalances
• Anxiety and depression
• Blood sugar and metabolic problems (including sugar cravings, metabolic syndrome, PCOS, and diabetes)
• Weight challenges
• Decreased memory, focus, and willpower
• Immune system imbalances leading to more frequent infections, reactivation of old viruses, allergies, inflammation, and even autoimmune disease

In fact, most long-term chronic health problems can be traced to disturbances in the natural Cortisol pattern. For example, obesity, digestive problems, diabetes, and even cancer have been linked to disturbances in Cortisol rhythm. So resetting your Cortisol rhythm is one of the most important steps we can take to lower stress and promote balance in our lives now, and ensure our health for the long term.

Disruption to Our Natural Circadian Rhythm
Before the invention of the light bulb, our Circadian Rhythms were well in sync with the sun, because nighttime light disruption was minimal. 

Your Circadian Rhythm is basically a 24-hour internal clock that is running in the background of your brain and cycles between sleepiness and alertness at regular intervals. It's also known as your sleep/wake cycle.

Today our exposure to blue light naturally emitted from the sun, isn’t controlled by the sun alone and the prolonged use of electronic devices in the hours leading up to bedtime has significantly increased our daily exposure to blue light. 

Exposure to artificial blue light in the evening can really disrupt the Circadian Rhythm. This disruption likely leads to a lower quality and quantity of sleep - which can result in major depression, bipolar disorder, post-traumatic stress disorder, generalized anxiety and other mood disorders.

What You Can Do
When done consistently, limiting the time spent on electronic devices in the evening alone can transform your life by resetting your sleep and lowering your Cortisol levels. While the science behind how blue light affects our health is still being studied, there are easy steps you can take today to protect your health.

• Limit screen time. Perhaps the most important thing you can do to protect your health from the harmful effects of nighttime lighting is to limit screen time after the sun goes down.
• Remember the most significant environmental trigger to your Circadian Rhythm is light. The metabolic processes should follow roughly a 24-hour pattern, so exposure to lighting in longer intervals can be disruptive. Because digital screens emit a significant amount of Blue Light, limiting your exposure to these sources is a great first step. 

Try it tonight! Turn off your digital screens two hours before bed. It's likely that you’ll start sleeping better immediately and you’ll also begin to feel better over time.

• Wear Blue Light Glasses. Blue light glasses are a trending topic, because they offer so many health benefits. They work by blocking a portion of the blue light wavelength from reaching your eyes.
• Remember that blue light is particularly important in regulating your circadian rhythm, because it creates the strongest response from the ipRGC photoreceptors. These receptors play an important role in the circadian rhythm and mood regulation. When we are exposed to these wavelengths at the wrong time of day, it can confuse our bodies.
• Get Outside during the day and reset your circadian rhythm. Exposing yourself to sunlight will send a signal to your body and help regulate your circadian systems.
• Adjust screen brightness. Maybe you work the night shift, respond to after hours emails, or simply want to catch up on your favourite TV drama, sometimes avoiding screens at night is difficult. Blue light glasses will protect you from any source of the wavelength. However, many mobile phones and computers also offer the option to adjust your screen’s brightness. You may find that shifting your brightness down during the evening can help minimize light pollution in your home.
• Change your light bulbs. Many energy saving light bulbs contain LEDs, which tend to produce higher amounts of blue light. By switching your light bulbs to a warmer hue, you can reduce your exposure. 

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Diabetes is a disease in which your body cannot produce enough insulin, cannot use insulin, or a mix of both. In diabetes, sugar levels in the blood go up. This can cause complications if left uncontrolled. 

The two types of diabetes are – Type 1 diabetes is where people’s body do not produce insulin caused by an auto immune reaction, where the immune system attacks the cells producing insulin in the pancreas and is often diagnosed in younger age, and Type 2 diabetes is where the body often develops a resistance to insulin, i.e the body still produces it, but the body has an inability to react to it. Most of the increase in diabetes in the last 20 years is of Type 2.

Diabetes Symptoms
Early symptoms of diabetes are often undetected because they may not seem that serious. Some of the mildest early diabetes symptoms include:

• frequent urination
• unusual fatigue
• blurred vision
• weight loss, even without dieting
• tingling or numbness in hands and feet

The potential health consequences are often serious. Diabetes raises the risk of cardiovascular disease and can cause problems with your eyes, skin, kidneys, and nervous system (including nerve damage, or neuropathy). Diabetes can also cause erectile dysfunction (ED) and other urological problems such as inability to control urination, and urinary tract infections.

Fortunately, many of these complications are preventable or treatable with awareness and attention to your health.

Risk Factors 
Many factors can increase your risk for experiencing complications from diabetes, including:

• smoking
• being overweight
• avoiding physical activity
• having high blood pressure or high cholesterol
• being older than 40

Quitting or reducing smoking, exercising regularly, and maintaining a healthy weight are all highly effective ways to prevent the onset of diabetes. 

Lifestyle Changes

• Certain lifestyle choices can greatly impact your physical and mental well-being if you have diabetes:
• Balancing your meals with an even mixture of starches, fruits and veggies, fats and proteins can improve your bodily health and delay the onset of diabetes symptoms. 
• Avoid excess sugar, especially in carbonated drinks like soda and sweets. 
• Keep a regular exercise schedule and manage your blood sugar within your exercise regimen. This can allow you to get the full benefits of a workout without feeling shaky, tired, dizzy, or anxious. 

Could a Very Low Calorie Diet Reverse Type 2 Diabetes?

Scientists are busy researching a new weight management treatment, which includes a very low-calorie diet, to help people put their Type 2 diabetes into remission. The study is called DiRECT, short for Diabetes Remission Clinical Trial, and it could completely change the way Type 2 diabetes is treated in the future.

“Our findings suggest that even if you have had Type 2 diabetes for six years, putting the disease into remission is feasible”, says Prof Michael Lean from the University of Glasgow who co-led the study. “In contrast to other approaches, we focus on the need for long-term maintenance of weight loss through diet and exercise and encourage flexibility to optimise individual results.”

The first year results are hugely promising. They show that it’s possible for some people to put their Type 2 diabetes into remission using a low-calorie, diet-based, weight management programme, delivered by their GP. Almost half (45.6 per cent) of those who took part in the programme were in remission after a year.

The study found there was a close link between Type 2 diabetes remission and total weight loss. 86 per cent of people who lost more than 15kg on the programme were in remission after a year, as were 57 per cent of people who lost 10–15kg, and 34 per cent who lost 5–10kg.

In the comparison group, where people had the best diabetes care currently available, but didn't try the new weight management approach, only 4 per cent went into remission.

If you would like to read more about this ongoing research, please visit Diabetes UK to get all the facts http://www.diabetes.org.uk/direct

You can also find out your risk of developing Type 2 diabetes by taking the test: https://riskscore.diabetes.org.uk/start

WHAT IS CHOLESTEROL?

Cholesterol is found in every cell of the body and has important natural functions when it comes to digesting food, producing hormones, and generating vitamin D. It is manufactured by the body, but can also be taken in from food. It is waxy and fat-like in appearance.

There are two types of cholesterol - LDL (lowdensity lipoproteins, bad cholesterol) and HDL (high-density lipoproteins, good cholesterol). 

LDL (bad) cholesterol
LDL cholesterol is considered the “bad” cholesterol, because it contributes to fatty buildups in arteries (atherosclerosis). This condition narrows the arteries and increases the risk for heart attack, stroke and peripheral artery disease, or PAD.

HDL (good) cholesterol
HDL cholesterol can be thought of as the “good” cholesterol, because experts believe it acts as a scavenger, carrying some of the LDL (bad) cholesterol away from the arteries and back to the liver, where the LDL is broken down and passed from the body. 

A healthy HDL cholesterol level may protect against heart attack and stroke. Studies show that low levels of HDL cholesterol increase the risk of heart disease.

WHAT CAUSES HIGH CHOLESTEROL?

All of the below can either increase your cholesterol level or affect the ratio of good to bad cholesterol:

• eating a diet high in saturated fat
• smoking – a chemical found in cigarettes called acrolein stops HDL transporting cholesterol from fatty deposits to the liver, leading to narrowing of the arteries (atherosclerosis)
• having diabetes or high blood pressure (hypertension)
• having a family history of stroke or heart disease
• being over weight
• There’s also an inherited condition called familial hypercholesterolaemia, which can cause high cholesterol even in someone who eats healthily.

Sometimes the way we live our life can affect how our genetic makeup is expressed. For example a diet high in saturated fat or being overweight may help “switch on” certain genes which increase cholesterol levels.

By making significant changes to your diet, within a few weeks you should see a reasonable reduction in your cholesterol levels. It is important to maintain these changes and perhaps even build on them in order to keep your cholesterol consistently low.

WHEN SHOULD CHOLESTEROL LEVELS BE TESTED?
Your GP may recommend that you have your blood cholesterol levels tested if you:

• have been diagnosed with coronary heart disease, stroke or mini stroke (TIA), or peripheral arterial disease (PAD)
• have a family history of early cardiovascular disease
• have a close family member who has a cholesterol-related condition
• are overweight
• have high blood pressure, diabetes, or a health condition that can increase cholesterol levels

WHAT SHOULD MY CHOLESTEROL LEVELS BE?
Blood cholesterol is measured in units called millimoles per litre of blood, often shortened to mmol/L.

As a general guide, total cholesterol levels should be:

• 5mmol/L or less for healthy adults
• 4mmol/L or less for those at high risk 

As a general guide, LDL levels (bad) cholesterol should be:

• 3mmol/L or less for healthy adults
• 2mmol/L or less for those at high risk
• An ideal level of HDL is above 1mmol/L.  

A lower level of HDL can increase your risk of heart disease.

Your ratio of total cholesterol to HDL may also be calculated. This is your total cholesterol level divided by your HDL level. Generally, this ratio should be below 4, as a higher ratio increases your risk of heart disease.

However, cholesterol is only 1 risk factor and the level at which specific treatment is required will depend on whether other risk factors, such as smoking and high blood pressure, are also present.

HOW CAN I LOWER MY CHOLESTEROL LEVEL?
The first step in reducing your cholesterol is to maintain a healthy, balanced diet. It’s important to keep your diet low in fatty food.
Try to avoid or cut down on the following foods, which are high in saturated fat:

• fatty cuts of meat and meat products, such as sausages and pies
• butter, ghee and lard • cream, soured cream, crème fraîche and ice cream
• cheese, particularly hard cheese
• cakes and biscuits
• milk chocolate
• coconut oil, coconut cream and palm oil

You can swap food containing saturated fat for fruit, vegetables and wholegrain cereals. This will also help prevent high cholesterol returning.

The government recommends that a maximum of 11% of a person’s food energy should come from saturated fat. This equates to no more than:

• 30g of saturated fat a day for the average man
• 20g of saturated fat a day for the average woman
• Children should have less

Check the labels on the foods you’re eating to find out how much saturated fat you’re consuming. Many experts believe that the fats found in avocados and oily fish, such as mackerel, salmon and tuna, are good for you. These are known as omega-3 fatty acids and high doses can improve (lower) triglyceride levels in some people. However, too much omega-3 fatty acids can contribute to obesity.

Other lifestyle changes, such as taking regular exercise and giving up smoking, can also make a big difference in helping to lower your cholesterol.

If these measures don’t reduce your cholesterol and you continue to have a high risk of developing heart disease, your GP may prescribe a cholesterol-lowering medication, such as statins. Your GP will take into account the risk of any side effects from statins, and the benefit of lowering your cholesterol must outweigh any risks.

TREATMENT
If you’ve been diagnosed with high cholesterol, you’ll be advised to make changes to your diet and increase your level of exercise. If after a few months, your cholesterol level hasn’t improved, you may be advised to take cholesterol-lowering medication.

Changing your diet, cutting down on alcohol, stopping smoking and exercising more will also help to prevent high cholesterol developing.

Cholesterol-lowering medication
There are several different types of cholesterol-lowering medication that work in different ways. Your GP can advise you about the most suitable type of treatment, and may also prescribe medication to lower high blood pressure (hypertension) if it affects you.

The most commonly prescribed medications are:

Statins
Statins block the enzyme (a type of chemical) in your liver that helps to make cholesterol. This leads to a reduction in your blood cholesterol level. Statins are prescribed to people who are at high risk of heart disease, because they need to be taken for life, otherwise cholesterol levels start to rise again once you stop taking them.

You’ll usually be started on a medication called atorvastatin. Other statins include simvastatin and rosuvastatin.

Aspirin
In some cases, a low daily dose of aspirin may be prescribed, depending on your age (usually over 40 years old) and other risk factors.

Low-dose aspirin can help to prevent blood clots forming, particularly for someone who’s had a heart attack, has established vascular disease, or a high risk of developing cardiovascular disease (CVD).

You may also be advised to have periodic blood tests to ensure your liver is functioning well.

Ezetimibe
Ezetimibe is a medication that blocks the absorption of cholesterol from food and bile juices in your intestines into your blood. It’s generally not as effective as statins, but is less likely to cause side effects.

Bile acid sequestrants (resins) or fibrates
If statins or ezetimibe aren’t effective, you may be prescribed a bile acid sequestrant or a fibrate.

Bile acid sequestrants bind to bile acids in the intestine and stop them from being reabsorbed. The body has to use cholesterol to make more bile acid, which reduces cholesterol levels in the blood.

Fibrates help to slow or halt the build-up of cholesterol in the arteries to reduce the risk of heart problems. They are given to people who have high cholesterol levels because they have a raised level of triglycerides in their blood.
If you have concerns about your cholesterol levels then it’s probably best to talk to your GP and get tested, but in the meantime why not take the ONE YOU Heart Age Test, which estimates your heart age compared to your real age. It also explains why it’s important to know your blood pressure and cholesterol numbers and advice on how to reduce your heart age.

Take the test here>>>>