Dynamic Neuromuscular Stabilisation (DNS): An 'origin-al' route to rehabilitation

At Rebalance we’re always keen to expand our knowledge and understand new concepts in rehabilitation, especially for athletes and active sports people. Tom’s been learning about Dynamic neuromuscular stabilisation (DNS) and gives us a rundown of how it can help you here.

"DNS is an effective method of rehabilitation that aims to restore structural and postural alignment of the body. It is based on developmental kinesiology ie, human movement during early development, from birth until the start of walking.

DNS in action

DNS in action

We often see patients with dysfunctional movement patterns and loss of postural control. It’s common that one dysfunctional muscle can destabilise whole body function, compromising the quality of purposeful movement.

The body always seeks to compensate for dysfunction; here this can lead to overload of spinal joints and discs, muscle overuse and postural strain. Rehabilitation by training muscles in isolation can sometimes be ineffective due to a lack of integration into a global motor/movement patterns. Movements do not become automatic and therefore offer little help to the patient.

DNS treats movement dysfunction by integrating the corrected movement within body positions taken from our early developmental postures. This has been shown to encourage the correct movement to become automatic, allowing the patient to engage the muscle without thinking. Going back to positions from the very beginning of our life might sound strange, however it allows us to invoke the potential of ideal movement patterns genetically encoded in our central nervous system.

DNS is suitable for patients with variety of acute and chronic conditions as well as for athletes/sports people trying to improve performance, prevent or recover from an injury. Book in for a session with Tom if you’re interested in learning more.


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London Marathon countdown: 8 weeks to go

The end of February should be a welcome time for those training for the London Marathon. The earlier sunrise allows for a morning run for those inclined, and the warmer weather means less layers and easier breathing. 

 

 

Here at Rebalance we're keen to for you to consider your body as a whole (the underpinning principle of osteopathy!) For runners specifically this can be applied in a number of ways. Here's a few things to think about:

CORE TRAINING 
Some core training is invaluable because your core strength gives power to your body. Engaging your core muscles supports your limbs and ultimately allows for a more powerful running style with a high arm swing, and greater stride.  

LEAD FROM THE BODY
Try to avoid leading with your head. Driving your run from the hips, and your upper limbs via connective tissue lines that connect into your back creates a strong yet relaxed running style. 

BODY POSITION
When running think about your body position, torso over your pelvis, relaxed fluid shoulders, and easy swinging rotation through the upper back. Visualising a flowing style can help some runners put it into practice. 

 

At the '8 weeks to go' point, most running plans suggest a few half-marathon type distances in your training schedule. Make sure your prepared physically, physiologically and mentally for this! We advise keeping a check on your hydration (water/caffeine) intake, restorative sleep (early to bed!) and stretching regime (little and often). Take care not to forget about stretching your upper body and lower ribs and abdominals which can give you better propulsion and more efficient in-exercise breathing.

Not long now....

Enjoy the journey!

Louise Camp
Osteopath  |  Sports Massage Therapist
The Rebalance Clinic 

 

 

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Pre-event nutrition: How to fuel your body before a race

Whether you take on a running, cycling or trekking challenge, we're here to help you understand how to fuel your body in preparation for your big day.

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The basics

The three compounds that the body converts into energy which allow us to move are fats, proteins and carbohydrates. Protein's main function is growth and tissue repair, and is only really used as energy when other sources are depleted, so its contribution to energy production in race conditions is relatively low. It is carbohydrates and fats which are the main sources of energy, with most energy produced by the metabolism of carbohydrates. The body uses these primarily and fats when their storage is depleted. For this reason carbohydrates should feature most in your pre-event nutrition.

There are two main types of carbohydrate: simple and complex. Simple carbs (sugars) such as glucose or fructose are quick sources of “fuel” for the body. Complex carbohydrates are more complicated compounds which take longer for the body to break down. A limited amount of carbohydrate can be stored in the muscles and liver in the form of glycogen. When muscle cells have a high demand for glucose, glycogen is broken down and when the demand is low, they absorb it from the bloodstream rebuilding the glycogen reserves.

One week to go

All your long training runs/cycles/treks are finished and it's time to take it easy. You won't hear "train less, eat more" very often but that's what you need to do to top up your glycogen storage. Depletion of glycogen levels is associated with muscle fatigue during prolonged exercise so the idea is to optimise and prolong your performance to avoid “hitting the wall”.

If you are training for an endurance event such as ironman or marathon, you need to start topping up your glycogen levels up at least a week before the event. If you are training for a sprint event such as 10K, 1-2 days may be sufficient. 

Easy-to-digest foods that will increase your glycogen levels include rice, tortillas, porridge, bread, pancakes, waffles, bagels, baked potatoes, yoghurt, and fruit juice. Watch out though, as many fruits are high in carbohydrates and fibre which can upset your stomach. Choose a low-fibre option like a banana or peel fruit such as apples, pears and peaches to reduced the fibre content. 

Your pre-event breakfast

The goal is to top up your glycogen stores which will have been depleted during your previous night’s sleep.

Your pre-event breakfast should be consumed 3-4 hours before to ensure the carbohydrates eaten have been both digested and absorbed. It should be rich in complex carbohydrates as they facilitate a gradual rise in blood glucose level and thus help to maintain steady energy levels for a longer period of time. Fat and protein metabolism takes longer than that of carbohydrates, plus they are not as effective as a source of energy during exercise and can remain in the stomach for longer which may cause discomfort. Keep the levels of fat and protein in your breakfast low. Fat can be used as an energy source towards the end of longer events; however, there is enough fat stored in your body so no need to consume extra fat before the event!

Great pre-event breakfast foods would be: porridge; cereals with low fat milk; banana; dried fruit; low fat yoghurt; rice pudding, baked beans on toast; toast with low fat jam, honey or marmalade; boiled eggs; lean grilled bacon and fruit juice.

Additionally, a light snack in the form of a cereal bar will be beneficial to competitors 1-2 hours before an event.

During your event

The most suitable form of carbohydrates to take on during an event are simple sugars in the form of a sports drink or gel. They provide a fast source of energy and help to decrease the glycogen to glucose conversion rate and hence provide energy for the latter stages. Most big events are well organised with water and sports gel stations along the way. We recommend you try gels before the day to avoid any unpleasant reactions or surprises!  

Hydration

It is vital to keep hydrated during any event to keep all body functions working well. It is generally advised that 400-600ml of water should be consumed 3-4 hours before an event (together with your pre-event breakfast). This allows time to excrete any possible excess. Up to 300ml should be consumed 20 minutes before the start and you should drink regularly throughout to prevent dehydration.

Hope you've found our whistle-stop tour of pre-event nutrition helpful... to find out more about race/event nutrition, we recommend these articles:

How to carb load for marathon week

Carb loading diet

Carbohydrate Loading: 3 Effective Methods to Increase Your Chances of Marathon Success

 

Tomas Bittner
Osteopath  |  Sports Massage Therapist
The Rebalance Clinic 

 

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RIDE100 Pt 2. Thrill ride through rain, hail, wind, sunshine, standing water and the beautiful Surrey fields and London sights

The actual day can be summed up in one word: epic! Thinking back on the Prudential London to Surrey RIDE100 just gone brings a deserved smile to my face and a feeling of validation & achievement. A first for me in many respects, first cycle event, first time to ride more than 60 miles, first time in padded underwear!, first week in cleats and first medal! 

If you were in and around London Sunday August 10th you'll probably will have noticed the crazy weather that no one sensible would have been out in! Having looked forward to the event for months there was a deep-seated 'British' determination to see it through and not only that - enjoy it! Despite the rain, headwind and cold, surrender or self-pity never entered my head over the course of the morning/afternoon and, despite the evidence of my event photos, I still believe I smiled throughout! 

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My overly conservative estimate of 8 hours to complete the course meant I was one of the last waves to go, starting just after 8.30am under an ominous grey sky amongst optimistic and waterproof clad cyclist allies. The news of the shortened course (down to 86 miles for safety reasons) was met with mixed emotions. My last minute panic-buy purchases of waterproof iPhone case/battery and waterproof bike frame bag filled me with girl guide pride:  'Be prepared'! 

After crossing the start line, I set off on a novice full-on, fast pace of ~3 minute miles, with avid (but safe and polite!) overtaking, determined to catch up with my friend who had set off in an earlier wave. 

An hour in, the rain started to come down in biblical proportions! Lashing into my face, pouring from my helmet, spraying up from the bikes in front - the wet was unrelenting. A forced marshal stop in Richmond park, due to a horrible accident, led to a bottleneck and the resulting 25 minutes off the bike added insult to injury with rapid loss of body temperature and stiffening muscles!

I was so glad to get back on my 2 wheels. Cheered on by some brave and much appreciated supporters I soon warmed up and got back to clocking up the miles. Reminding myself - as I had been advised by friends and patients who were marathon participators: 'Try to enjoy it!' 

At the 47 mile mark I was re-united with my friend who had (like so many others) had suffered a puncture. Trip to the mechanics centre done, we got back on the road with newfound determination and energy. Riding duo made for a new experience and with my earlier efforts made me keep to a good pace. The rain stopped and the sun peeked from the clouds!

The second half of the race made a little more time for contemplation, a chance to dry off, appreciate the countryside and more time to breathe and take it in. My bike (and new shoes/cleats) really came into their own and I felt good on the bike pushing a great pace around 18 miles/hour on the open stretches and the climbs, downhills and close corners were brilliant!

The last 10 miles really stand out for me: Sunshine, cheering and the knowledge that the finish (and my lovely Mum and Dad) was not far away. The power of the mind in sporting challenges was really brought home to me - I feel I have had some insight into pre & post-event psychology, which will certainly inform my practice when treating the athletes who grace our doors. I distinctly remember seeing the 99-mile mark (read 85 mile!) just after Westminster and a surge of reserved energy pushed me on. Taking the corner before Admiralty Arch 'like a pro' I sped onto the Mall and finished strong and smiling! 

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I did the course in 5.53.51 and calculating actual 'moving time' I did the distance in just over 5 hours! Which if I don't mind saying... I'm pretty pleased with! and… I’ll have raised £1000+ for the Mental Health Foundation, which I’m very proud of.

The RIDE Highlights were definitely car free roads, no traffic light stops, sour patch kids, cow-bells, supporters, sunshine and the Mall finish!

Ultimately, just loved it! Ride of my life! (so far...) The ballot for RIDE100 2015 opening Monday 18th August is already marked in my diary!

Louise Camp
Osteopath  |  Sports Massage Therapist
The Rebalance Clinic 


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RIDE100 Pt 1. Getting on my bike and staying there - with a little help from my friends!

I’ve been an all-weather cycle commuter for some years now and I took the exciting graduation step from my trusty TREK hybrid boy's bike to a Women's road bike this Spring...  and LOVED it! I’d previously picked up a RIDE100 leaflet (which somehow had remained stuck on the fridge) and when I became romanced by the new found speed of my bike and started developing a sense of being a 'more serious' cyclist, well, the wheels were in motion to actually take part! 


I proudly opted to ride for the Mental Health Foundation - a very worthwhile charity which promotes a very important yet overlooked issue. I registered, and with that my fundraising and training journey began in earnest.


As I already cycle some 80 miles/week my general fitness was already pretty good. But nonetheless, journeys to and from work became training runs, powering up all the hills to work out the legs and get the heart rate going. The odd weekend visit to Alexander Palace and the Heath in Hampstead made for some slightly longer rides. And a 52 mile weekender Surrey visit which took in Box Hill (in both directions) and the steeper West Humble bolstered my confidence and belief in 'I can really do this! '

 

But then… potential disaster! My rising excitement and confidence took a literal tumble some 3 weeks prior to the event, when I sustained a left calf strain.  Not during a power ride up a steep incline but after an innocent trot down some steps in Angel. Typical! The strain to my soleus was bearable on the bike but hugely painful in walking and I became worried that it wouldn’t stand up to a long endurance race in just a couple of weeks... Never have I felt so lucky to be part of the Rebalance team with expert care on tap. Having the team diagnose what was going on and support me through what might have been a race ending injury was amazing. Sincere and wonderful thanks to go both Andrew and Tom for all their hands on care: deep tissue massage, laser and kinesiotaping, which got me ready for the event.  It was right down to the wire boys but you got me there! xx

 

Patched up and repaired... with 5 days to go, I went all out 'pro' getting road bike pedals, shoes and cleats. What do they say:  ‘All the gear?!’... 

 

Full of anticipation, I was ready to go...

Louise Camp
Osteopath |  Sports Massage Therapist
The Rebalance Team

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