WARM UP EXERCISES FOR YOUR WINTER WORK OUT

A warm up generally consists of a gradual increase in intensity in physical activity , joint mobility exercise, and stretching, followed by the activity. Warming up brings the body to a condition at which it safely responds to nerve signals for quick and efficient action. 

Warm up exercises are needed regardless of the type of workout you choose. The warm up exercises will prevent sprains and strains. In winter, you need to increase the amount of time you spend on warm up exercises. This is due to the reduced temperatures and the fact that the muscles are tighter in the winter, so injuries are more common. There are a few warm up exercises you can choose from.

1. Static Stretches

When you are planning to walk or jog outside in the winter, it's imperative that you perform your leg, arm and back stretches. Take some extra time to stretch your entire body (i.e. 10 minutes). Don't forget to stretch the hamstrings, the quadriceps and the Achilles' tendon.

2. Arm Circles

Arm circles can be performed as warm up exercises if you are planning to ski or bike. Circle your arms from one side to the other, making sure to increase the tempo. You may also take some deep breaths raising your hands up in the air. When you exhale, bend over and quickly move your hands towards the ground.

3. Twist Your Upper Body

To stretch your upper body, place your hands on your hips and move your upper body from left to right, then from right to left. Try rotating your upper body clockwise and then counterclockwise.

4. Jumping Jacks

Jumping jacks can increase your heart rate, but make sure you perform a few stretching moves prior to these. The jumping jacks will ensure that the heart will start pumping more blood to the muscles, so that you won't be prone to injuries.

5. Walking

Prior to a longer run, you can take 5 minutes to walk and put your blood into motion. You can also perform the hands and upper body stretches while you walk.

6. Squats

Squats will work on your lower body and will warm up the muscles from this area. Make sure you perform the squats correctly. Hold your hands in front of you or put them at the back of your head; your back should be straight. Use your abdominal muscles to squat down and come back up. Try not to move your hands and upper body while you perform the squats.

7. Jumping Rope

Jumping rope is not a usual way to warm up, but it may be used if you prefer a more intensive type of warm up. This warm up exercise will increase your heart rate.

Unlike the other types of warm up exercises, jumping rope is only required for 3 to 5 minutes to prepare you for your winter workout. Ideally, you should perform this activity after stretching for a couple of minutes.

8. Imitate the Exercise Moves

You may also warm up by imitating the moves you are about to perform during your workout. In this manner, you will warm up the muscle groups that you will be using.

These are some of advisable warm exercises for your winter season. so do your workout with proper warm up exercises and keep fit your body....

IMPORTANCE OF COOL DOWN EXERCISES AFTER WORK OUT

The importance of a cool down immediately after a workout cannot be emphasized enough. After running, jumping or throwing, it is always a good idea to do some cool down excercises immediately. This will help to prevent any injuries or unnecessary soreness. Start with a light jog around the track and make sure to go at a slow pace. This will prevent your muscles from tightening up and becoming sore. Also, sprinting is an anaerobic excercise which builds up lactic acid. A slow jog will help to get  rid of the acid from the body. Do at least 2 laps after a work out and stretch again. It is important to get a good stretch on the quads, hamstrings, and calves which will be worked out the hardest.

Many people dismiss the cool down as a waste of time, or simply unimportant. In reality the cool down is just as important as the warm up, and if you want to stay injury free, it’s vital. It is necessary to take the tissues normal level

Purpose:

The main aim of the cool down is to promote recovery and return the body to a pre exercise, or pre work out level. During a strenuous work out your body goes through a number of stressful processes. Muscle fibers, tendons and ligaments get damaged, and waste products build up within your body. Lactic acid also present in the muscle fibres.

The cool down, performed properly, will assist your body in its repair process. One area the cool down will help with is relieving some of the effects of delayed-onset muscle soreness or DOMS. This soreness is caused by a number of things. Firstly, during exercise, tiny tears called micro tears develop within the muscle fibers. These micro tears cause swelling of the muscle tissues which in turn puts pressure on the nerve endings and results in pain. DOMS may occur due to dehydration also. Whatever the reason cool down activities help to reduce the occurrence of DOMS.

Secondly, when exercising, your heart is pumping large amount of blood to the working muscles. This blood is carrying both oxygen and nutrients that the working muscles need. When the blood reaches the muscles the oxygen and nutrients are used up. Then the force of the contracting (exercising) muscles pushes the blood back to the heart where it is re-oxygenated. It helps to reduce heart rate in normal way.

However, when the exercise stops, so does the force that pushes the blood back to the heart. This blood, as well as waste products like lactic acid, stays in the muscles, which in turn causes swelling and pain. This process is often referred to as “blood pooling.”

So, the cool down helps all this by keeping the blood circulating, which in turn helps to prevent blood pooling and also removes waste products from the muscles. This circulating blood also brings with it the oxygen and nutrients needed by the muscles, tendons and ligaments for repair.

So don't skip cool down activities while playing or doing work out. 

Key points for effective cool down

                     Gentle exercise and movement;

                     Low-intensity, long-hold static stretching; 

                     Re-fuel. 

Cool down routines:

             

                                         For the Professional

10 to 15 minutes of easy exercise. Be sure that the easy exercise resembles the type of exercise that was done during your work out. For example, if your workout involved a lot of running, cool down with easy jogging or walking. Include some deep breathing as part of your easy exercise to help oxygenate your system.

Follow with about 20 to 30 minutes of low-intensity, long-hold (30 to 60 seconds) static stretching. Many people make the mistake of stretching too hard or too vigorously during this part of the cool down. it is to gently lengthen out those muscles that have been constantly contracting during your game.

Re-fuel. This part of the cool down can be done as you perform the other two parts. Both fluid and food are important. Drink plenty of water, plus a good quality sports drink. The best type of food to eat straight after a work out is that which is easily digestible. Fruit is a good example. 

                                            For the Amateur

3 to 5 minutes of easy exercise. Be sure that the easy exercise resembles the type of exercise that was done during your work out. For example, if your workout involved a lot of running, cool down with easy jogging or walking. Include some deep breathing as part of your easy exercise to help oxygenate your system.

Follow with about 5 to 10 minutes of low-intensity, long-hold (30 to 60 seconds) static stretching. 

Re-fuel. This part of the cool down can be done as you perform the other two parts. Both fluid and food are important. Drink plenty of water, plus a good quality sport

WILLIAM'S FLEXION EXERCISES FOR BACK PAIN

Williams flexion exercises focus on placing the lumbar spine in a flexed position to reduce excessive lumbar lordotic stresses leads to tightness of hip flexor muscles and lengthen or weakening of hip extensor and abdominal muscles. Some of the postural changes like excessive lordotic curvatures, May lead to mechanical back pain( refer previous posts of mechanical back ache) . Exercises are designed to (1) strengthen the abdominal, gluteal, and quadriceps muscles, and (2) stretch the erector spinae, hamstring, and tensor fasciae latae muscles and iliofemoral ligament.

INTRODUCTION

Williams flexion exercises — also called Williams lumbar flexion exercises, Lumbar flexion exercises or simply Williams exercises — are a set or system of related physical exercises intended to enhance lumbar flexion, avoid lumbar extension, and strengthen the abdominal and gluteal musculature in an effort to manage low back pain non-surgically. The system was first devised in 1937 by Dr. Paul C. Williams(1900-1978). He strongly believed that lumbar flexion or abdominal strenthening exercises can give resolution for mechanical back pain condition.

GOALS OF WILLIAMS FLEXION EXERCISES

The goals of these exercises are to open the intravertebral foramina and stretch the back extensors, hip flexors, and facets; to strengthen the abdominal and gluteal muscles; and to mobilize the lumbosacral junctions. So one who have weakness in their abdominal muscles should do these exercises to get rid of back pain along with core strengthening exercises. 

CORE EXERCISES

Williams believed that the back pain was the result of human evolution in movement from a quadruped to an upright position, proposing that the standing position was the cause of back pain because it placed the low back in a lordotic curve. Williams advocated seven exercises to minimize the lumbar curve-

pelvic tilt exercises, partial sit-ups, single knee-to-chest and bilateral knee-to-chest, hamstring stretching, standing lunges, seated trunk flexion, and full squats. 

1- Pelvic tilt exercises: 

Lie on your back with knees bent, feet flat on floor. Flatten the small of your back against the floor, without pushing down with the legs. Hold for 5 to 10 seconds.

2- Partial sit-ups: 

The athlete lies in "hooklying" position (supine with knes bent and feet flat). With hands behind his or her head, the athlete elevates the upper torso until the scapulae clear the resting surface and stress is placed on the rectus abdominus. After returning to the start position, the sit-up is repeated for a prescribed number of repitions. 

3- Knee-to-chest:

Single Knee to chest. Lie on your back with knees bent and feet flat on the floor. Slowly pull your right knee toward your shoulder and hold 5 to 10 seconds. Lower the knee and repeat with the other knee. 

4- Hamstring stretch:

Lying supine, the athlete places both hands around the back of one knee. The athlete straightens his or her knee and pulls the thigh toward his or her head so the hip goes into flexion. we now know that tight hamstrings actually  tilt the pelvis posteriorly and promote trunk flexion.

5- Standing lunges:

This exercise actually results in some extension of the lumbar spine when performed properly. Nonetheless, it is a good stretching exercise for the entire lower extremity, especially the iliopsoas, which may be a perpetrator of low back pain if it is abnormally tight or in spasm.

The athlete begins the forward lunge in a standing position with the feet shoulder width apart. He or she then takes a big step forward with the right leg and plants the foot out front, keeping the body relatively straight. The knee should stay over your ankle and not extend out over the toes to minimize stress on the knee joint.

6- Seated trunk flexion:

This exercise is performed by sitting in a chair and flexing forward in a slumped position. Maximum trunk flexion is obtained and direct stretching of the lumbosacral soft tissue structures occurs. 

7- Full squat:

William's squat position is with the feet placed shoulder width apart, the hip and knees are flexed to the maximum available range of motion, and the lumbar spine is rounded into flexion. Upon reaching maximum depth, the athlete "bounces the buttocks up and down" 15 to 20 times, with 2 to 3 inches of excursion on each bounce, then repeats 3 to 4 times.

RATIONALE 

Williams believed that the basic cause of all pain is the stress induced on the inter-vertebral disc by poor posture. He theorized that the lordotic lumbar spine placed inordinate strain on the posterior elements of the inter-vertebral disc and caused its premature dysfunction. He was concerned about the lack of flexion in daily activities in the accumulation of extension forces that hurt the disc. This same concept has been proved by latest studies. Because before we believed , once get the back pain, physician or physiotherapists were advising to take complete bed rest. But these things changed or disproved by latest studies , they recommend early mobilization are giving better result in back pain.

PAIN GATE - PHYSIOTHERAPY TECHNIQUES FOR BLOCKING GATE

Peoples are usually thinking, what is pain? and How does it transmit and control ? Me also had the same feeling once upon a time. This post will give a suitable answer for  all of your questions.

Pain and Gate control theory of pain is an attempt to discuss about how pain sensation is transmitted. Pain is defined as the subjective sensation which accompany the activation of nociceptors and which signals the location and strength of actual or potential tissue damaging stimuli.

Various types of pain may range from mild irritation, through burning and prickling sensation to more intense stabbing and throbbing sensation and finally to agonizing and intractable pain which may be intolerable to many subjects.

Nociceptor afferent enters the spinal cord via dorsal root and makes synaptic connections with other neurons located in the dorsal horn of the spinal cord grey matter, which is the site of convergence of many inputs. The main reflexes involving nociceptor reflex are- Withdrawal reflex and Crossed extensor reflex.

Nociceptive efferent enter the spinal cord, terminate on the dorsal horn and make synaptic connections with-

• 1st- Inter neuron serving reflex.
• 2nd- second order neuron (T cell or transmission cell).

These second order neurons cross the mid line of the spinal cord to transmit the information to the higher center via lateral spinothalamic tract on the contra lateral side of the spinal cord. These ascending neurons reach ventrobasal nuclei of the thalamus where they terminate on the 3rd order neurons which convey the information to the cerebral cortex. Also the information is passed to higher centers via multisynaptic spinoreticular tract.

Modulation of pain transmission

At the level of spinal cord 

As noted before primary nociceptive afferent terminate at the 2nd order neuron or T cells. The excitability of this pathway can be altered by other inter neurons present in the dorsal horn. The cells of Substantia gelatinosa have an inhibitory influence on the transmission cell by Presynaptic Inhibition of the nociceptive afferent terminals at the point where they synapse with transmission cells.

Substantia Gelatinosa cells are inhibited when the nociceptive afferents are activated, this reduces the presynaptic inhibition and allows nociceptive information to be passed to higher center. Substantia Gelatinosa cells are stimulated by the activation of low threshold large diameter A beta mechanosensitive afferents. This leads to increase in presynaptic inhibition and prevents the transmission of nociceptive information to be passed to higher centers.

Pain modulation at Higher Centers: Gate control theory of pain

If the nociceptive information is allowed through the gate according to gate control theory of pain, then the traffic will continue up the lateral spinothalamic tract of the spinal cord through the thalamus and to the cerebral cortex. As the stimulus passes through brain stem, it may cause an interaction between Periaqueductal grey matter and the raphe nucleus in the mid brain.

These nuclei form part of the Descending pain suppression system and their neurons lead to the excitation of Substantia Gelatinosa cells and thus will cause inhibition of the pain transmission. The endogenous opioids the enkephelins, endorphins and dianorphins are involved in pain modulation at this level. They are thought to be associated to produce analgesia related only to prolonged pain rather than initial fast pain, produced when an injury first occurs. Therefore the inhibitory effect of higher centers influence the pain transmission mediated through C fibres.

So, according to Gate control theory of pain, Gate is open when Substantia Gelatinosa cells are inhibited as the cells allows nociceptive stimulation to be passed on higher center and the Gate is closed when SG cells are excited. Gate control theory of pain argues that human thoughts, beliefs and emotions affect the amount of pain felt from a given physical sensation. The basis of this theory is that both the psychological and physical factors guide the brain’s interpretation of painful sensations and subsequent response.

Modulation of pain by Physical Therapy

At the level of spinal cord: The large diameter mechanosensitive afferents can be stimulated by large number of modalities. They can be stimulated by direct simple mechanical stimulation of receptors in skin, muscles and joints. Techniques used include- massage, joint mobilisation, traction, compression, thermal stimulation, TENS, IFT, electrical stimulation of muscles.

At the level of Higher Centres: The Physio therapeutic agents which cause stimuli to flow along nociceptive fibres can stimulate the higher centers to inhibit to inhibit the pain transmission. Modalities used include- ice, friction, Ultrasonic therapy, UVR, low TENS, thermotherapy.

At the Periferal level:

i) Chemical released by the tissue injury may stimulate the nociceptive nerve ending. Degree of stimulation depends on the amount of chemical present. Therefore removal of these chemicals by the physio therapeutic agents affecting the circulation may help to reduce the level of nociceptive stimulation. Example- HEAT, ICE, CONTRAST BATH.

ii) Nociceptive fibres have a maximum frequency at which they can conduct. C fibres- 15 pulse/sec and A delta fibres- 40 pulse/sec. If higher frequency of stimulation is applied, a physiologic block to conduction might occur. Example- TENS and IFT.

PLANTAR FASCITIS

What is plantar fasciitis? Probably the most common cause of heel pain. Symptoms come on gradually and are often worse first thing in the morning. The plantar fascia is the tissue under the foot which forms the arch. Treatment includes rest, reducing pain and inflammation and stretching exercises. 

Causes

Plantar fasciitis is an overuse injury caused by repetitive over-stretching of the plantar fascia which is is thick band of tissue / tendon that runs under the foot leads to possible inflammation and thickening of the tendon. Through overuse the fascia can become inflamed and painful at its attachment to the heel bone or calcaneus. The condition is traditionally thought to be inflammation, however this is now believed to be incorrect due to the absence of actual inflammatory cells within the fascia and degeneration is thought to be a more likely cause.

It is more common in sports which involve running, dancing or jumping. Although overuse is ultimately the cause of injury, there are a number of factors which can increase the likelihood of developing it including overpronation, a high arched foot, tight calf muscles, poor footwear, being overweight and previous injury.

Symptoms

Symptoms of plantar fasciitis consist of a gradual onset of pain under the heel which may radiate forwards into the foot (foot arch pain). There may be tenderness under the sole of the foot and on the inside of the heel when pressing in. The pain can range from being slightly uncomfortable to very painful depending on how badly it is damaged. Pain is usually worse first in the morning because the foot has been in a relaxed position all night and the plantar fascia temporarily shortens. After walking around this usually eases as the tissues warm up and gradually stretch out. When the condition is present, similar periods of moving around following inactivity such as sitting for long periods can also trigger the pain.

Physiotherapy Treatment:

Contrast bath: 

This the good pain relieving method of application, which consists of alternative hot and cold water application for the period of 10 secs with the intermittent period of two secs.

Ultrasound therapy:

It gives more pain relieve and helps to heal the injured points or areas to recover rapidly.

Strength Training.  Similar to tendinopathy management, high-load strength training appears to be effective in the treatment of plantar fasciitis.  High-load strength training may aid in a quicker reduction in pain and improvements in function.

Stretching consists of the patient crossing the affected leg over the contralateral leg and using the fingers across to the base of the toes to apply pressure into toe extension until a stretch can be felt along the plantar fascia. Achilles tendon stretching can be performed in a standing position with the affected leg placed behind the contralateral leg with the toes pointed forward. The front knee was then bent, keeping the back knee straight and heel on the ground. The back knee could then be in a flexed position for more of a soleus stretch. In my experience frequent soleus stretching gives better relief the pain as well as plantar fascitis.

Toe Exercises for improving Plantar Fascitis.

Mobilizations and manipulations have also been shown to decrease pain and relieve symptoms in some cases.  Posterior talocrural joint mobs and subtalar joint distraction manipulation have been performed with the hypomobile talocrural joint. 

Posterior-night splints maintain ankle dorsiflexion and toe extension, allowing for a constant stretch on the plantar fascia.  Some evidence reports night splints to be beneficial but in a review reported that there was limited evidence to support the use of night splints to treat patients with pain lasting longer than six months, and patients treated with custom made night splints improved more than prefabricated night splints. It gives desired effects

Six treatments of acetic acid iontophoresis combined with taping gave greater relief from stiffness symptoms than, and equivalent relief from pain symptoms to, treatment with dexamethasone/taping. For the best clinical results at four weeks, taping combined with acetic acid is the preferred treatment option compared with taping combined with dexamethasone or saline iontophoresis.

Foot orthoses produce small short-term benefits in function and may also produce small reductions in pain for people with plantar fasciitis, but they do not have long-term beneficial effects compared with a sham device whether they are custom made or prefabricated. When used in conjunction with a stretching program, a prefabricated shoe insert is more likely to produce improvement in symptoms as part of the initial treatment of proximal plantar fasciitis than a custom polypropylene orthotic device.

Grostan technique :