NICE Guidelines for early management of persistent non-specific low back pain.

Guidelines for the early management of persistent non-specific low back pain have been released by The National Institute for Health and Clinical Excellence.

This focuses on patients who "have been in pain for longer than 6 weeks but less than one year, where pain may be linked to structures in the back such as joints, muscles and ligaments".

NICE recommends that clinicians trying to improve the management of persistent non-specific low back pain use manual therapy, as practised by osteopaths, which includes techniques using spinal manipulation, mobilisation, and massage/soft tissue work.

Further information concerning the full guidance and a summary of the guidelines, can be found at http://www.nice.org.uk/CG88


For further information or advice or to book an appointment then please call The Sporting Club on 0207 481 4107 or visit www.thesportingclub.co.uk

What is Osteopathy?

Osteopathy recognises the importance of the link between the structure of the human body and the way it functions. Osteopathy is an effective health care system which focuses mainly on the musculo-skeletal system (the muscles, joints, ligaments and connective tissues) and the way this inter-relates with the body as a whole.

Osteopaths use their hands to diagnose and treat the underlying cause of the problem utilising a highly developed sense of touch, to identify problem areas of the body.

We take a holistic view that the musculo-skeletal system is important in maintaining the health of other parts of the body such as the respiratory and digestive systems. Osteopathy encourages the body to work as efficiently as possible, allowing the body to restore itself to normal function. Treatment is carried out using a wide variety of techniques to suit the patient and the condition being treated, thus making it suitable for the whole family.

Osteopaths train for 4 – 5 years at recognised specialist colleges where there skills and understanding are developed. Once graduated Osteopaths are registered with the General Osteopathic council (GosC) and become members of the British Osteopathic Association (BOA).

Our Osteopath James, studied at the British School of Osteopathy and found particular interests in respiratory conditions sports injuries. James has since worked in private practice for over 4 years and is a member of BackCare (a registered charity).

For appointment call James directly on 07877 711 492 or 0207 481 4107 or email us on info@thesportingclub.co.uk. Visit us at www.thesportingclub.co.uk for further details and health advice.

Time for a change?

Updating or changing your programs regularly is a key aspect to achieving your training goals. People who stick to the same routine for months and sometimes years on end, will rarely get the results they are after.

The basic premise is this. When you do a new workout consisting of different exercises and movement patterns, the body is forced to recruit different motor units. The body's response to the workout is to adapt and be stronger than before. Every time you do the same workout, the motor unit response can diminish somewhat, until eventually your body figures out what's going on. The body will then become more and more efficient, thus using less energy to get through the workout.

Considering that we workout to burn more energy, the last thing we want is for the body to become efficient in its energy expenditure. The goal is to burn more energy in less time.

How often you need to change depends on your experience. If you are a relative beginner, then a program can deliver results for up to 8-10 workouts. If you're a high level athlete, you may need to change programs weekly. As a general rule of thumb, I would never stick to the same program for longer than 5 weeks.

The good news is that you don't need to massively overhaul your programs to elicit change for the body. Here are some small changes you can make to deliver big results:

• Instead of doing back squats, switch to a front or overhead squat.
• Change the hand position of the exercise. Most times we use a pronated grip (palms facing away from body) so switch to a neutral or underhand grip.
• Change your rest times. If you're used to having 90 seconds rest between exercises, then decrease it to 60 seconds to improve your lactate threshold, or increase it to 2 minutes to improve your strength levels.
• Change the speed at which you move. Adding a pause at the hardest part of the movement can help improve motor unit activation, e.g on your squats, hold for 1 second at the bottom.
• Use FatGripz on dumbbell and barbell exercises (www.fatgripz.com).
• Do exercises in supersets or circuits to improve your CV fitness whilst also improving your strength

In order to maximise results and avoid becoming one of those regular gym goers, you must keep your programs fresh.

Pre and post natal

A friend of mine recently asked for some advice on good post natal exercises to do. Although it is hard to generalise, here are some tips that will apply to most pregnant women, and those who have recently given birth:

1. During the 1st 3 months of pregnancy, make sure you do not go overboard with strenuous exercise where you are struggling to find your breathe. There is an increased risk of miscarriage if the womb becomes overheated, so I would stick to resistance exercises, keeping the workouts around 40 minutes in length, with 90-120 secs rest between sets.

2. After 3 months has passed, you can largley resume your normal routine - EXCEPT - avoid exercises where you lie on your back.

3. You will probably find that exercises such as back squats (or anything where a bar will load the spine) become quite uncomfortable. I think squats are a great pregnancy exercise, so rather than remove them completely, switch to an exercise such as a dumbbell squat where you hold dumbbells beside the body.

4. Once you have given birth, it depends on what type of birth you had - natural or c-section when deciding when to resume. If you were doing regular exercise throughout your pregnancy, then you may be able to resume low level exercises, such as horse stance versions, after 2 weeks. If you had a c-section, then you need to have more time off to allow the scarring to heal. After 6 weeks, a horse stance horizontal would be a great first exercise to start, as it will recruit your core and gluteal muscles without placing too much load.

5. Running would be one of the LAST things I advise you to resume. Your pelvic area will become quite loose and flexible during pregnancy, and will continue to be relatively unstable in the weeks following birth. I usually work for at least 3-4 weeks on strength exercises before allowing my clients to resume running.

6. Because of the demanding physical nature of raising a small child, you shouldn't avoid doing 'big' exercises that load the muscles and joints. Here is a sample program that I used with a client 6-8 weeks after she gave birth to her 3rd child. I kept it rather short (35-40 minutes), mixing both strength exercises with CV exercises that were not too demanding. I took into account that her sleep patterns were still disrupted, and she had 2 other young children to take care of. She trained with me up until 8 months into pregnancy:

B	Exercise	Sets	Reps	Intensity	Rest	Tempo
A	Dumbbell Squats	3	15-20	6kg+	60	2010
B	Rower	1		450-500m	90	Fast
C	Lunge Stance Single Arm High Cable Row	3	12-15	22.5kg+	60	2011
D	Stair Climbs - Alternating 1 Step/2 Step	1	10 Flights	Body	90	Med
E	Split Stance Squats	2	8-10	Body	60	20X0
F	Bike	1	2 Min	Moderate	90
G	Seated Bar Overhead Press	2	10-12	10kg+	60	2010
H	X-Trainer	1	2 Min	L7 / 130+	90	Med
I	Swiss Ball Back Extension - Arms at 45 degrees	2	10-12	Body	60	Med

Sample program to improve lean muscle mass

For most of my female clients, having nice lean muscles is one of their key training goals. And so it should be. Maintaining a healthy level of muscle is vital for everyone, especially women. The main benefit from an aesthetic standpoint, is that the more muscle you can maintain, the more energy your body will burn at rest.

Too many women in my gym are scared of moving off the 'coloured' dumbbells, and seem to lift the same small weight for months on end. My advice is don't be afraid of lifting heavier weights. Women will very rarely put on too much bulk, even under very heavy loads. I was recently watching the training protocols of Britain's top weightlifter in the lightweight category. In clothes she looked like a normal lean, 16 year old girl, with a figure that most women would desire. It's just that when you saw her in the gym, she could clean and jerk more than 100kg!.

My point is that for most women, putting on bulk is a near impossible task, even under very heavy load.

This is a sample program that I would use for people with at least 3-6 months of resistance training experience, who are keen to get lean!

Monday & Thursday
	Sets	Reps	Load	Rest	Tempo
A1 - Dumbbell Squats - Heels Raised	3	10-12	-3R	45s	31X0
A2 - Seated Bar Overhead Military Press	3	10-12	-3R	45s	31X0
(Rest 90 secs before moving onto B exercises)
B1 - High Block Step Ups - Back Bar	3	8-10	-3R	45s	2011
B2 - Lat Pulldowns - V Grip	3	10-12	-3R	45s	30X0
(Rest 90 secs before moving onto C exercises)
C1 - Single Arm Rows - Bench Support	3	10-12	-2R	30s	3011
C2 - Petersen Steps - Back Bar	3	10-12	-2R	30s	2011
C3 - Standing Single Arm Triceps Ext	3	10-12	-2R	60s	3010
Tuesday & Friday
	Sets	Reps	Load	Rest	Tempo
A1 - Bar Deadlifts - Stiff Leg	3	10-12	-3R	45s	3010
A2 - Incline Dumbbell Press	3	10-12	-3R	45s	30X0
(Rest 90 secs before moving onto B exercises)
B1 - Incline Back Extensions - DB on chest	3	8-10	-3R	45s	3011
B2 - Seated Alternate Dumbbell Curls	3	10-12	-3R	45s	3010
(Rest 90 secs before moving onto C exercises)
C1 - Flat Flyes	3	10-12	-2R	30s	3010
C2 - Reverse Low Cable Curls	3	10-12	-2R	30s	3010
C3 - Swiss Ball Crunch - Cable Resistance	3	10-12	-2R	60s	3020

These programs work in a pairing or superset format. So for example, you would do exercise A1, rest 45 secs and then do exercise A2. Rest another 45 secs, and then go back to A1, repeating this until you have done each exercise 3 times.

For the C exercises, you do exercise C1, rest 30 secs, exercise C2, rest 30 secs, exercise C3, rest 60 secs, then go back to exercise C1.

For load, a figure of -3R, means choose a weight for which you could do an extra 3 reps. You will probably find for the latter sets that you need to drop the weight due to fatigue setting in.

For tempo, I use a format of numbers that was originally designed by leading strength coach, Charles Poliquin.

Using the dumbbell squat as an example:

First number - speed in lowering or eccentric phase (i.e 3 second count lowering down)

Second number - count holding the position after lowering (i.e 1 second hold at bottom)

Third number - speed of contraction (i.e 'x' means standing tall at max speed)

Fourth number - count holding position after contraction

Give this program a go for 4-6 weeks and you will no doubt see some great results.

Cereal-ity

Good old cereal. Quick, convenient, nutritious. A great way to start the day.

Umm, if only this was true.

Our addiction to cereals may be one of the single biggest reasons why we are in the midst of an evergrowing obesity epidemic. And just to clarify - because I have been questioned a lot on this lately - cereal includes all grain breakfasts, even the humble porridge and muesli (which I call the classic 'best of a bad bunch').

One of the key reasons why we as a society are struggling with our weight is because we cannot control our insulin levels. It's relatively simple. When we eat carbohydrates, our blood sugar levels rise. If they rise above a certain point, our body releases insulin to combat the rise. When insulin is present in the bloodstream, we are primed to store fat, and/or metabolise sugar into fat.

So a simple solution is to eat foods that do not significantly raise our blood sugar levels. Meat, fish, nuts, eggs, full fat dairy, above ground vegetables, pulses, legumes, low sugar fruits. If these foods form the basis of your diet, then you will lose body fat and improve your concentration levels.

When we start the day with high sugar cereals (basically all cereals have a Glycaemic Index of 50+) our blood sugar levels are destined to rise, then fall very quickly. This will result in the classic mid-morning run for a coffee and muffin to bring the blood sugar levels up, and the whole process repeats itself.

If you start the day with a breakfast higher in protein and fat, it will regulate blood sugar levels, keep you satisifed for longer, and help you make smarter food choices for the rest of the day.

So do yourself a favour and ditch those colourful boxes taking up valuable space in the cupboard. Flip a steak instead.

To run or not to run?

Running is seen as the classic way to get fit and lose weight. The ultimate calorie burner. The only leg toner. That's why the streets in my neighbourhood get taken over by the weekend warriors, hogging the footpath.

But what if running is not all that it's cranked up to be? Could it be doing more harm than good?

With my new clients, if they tell me that they go running 2-3 times per week, I ask them why they run. If they say because they want to lose weight, I usually remove it from their program. If they say they really love to run, then I let them keep running, but with variations to their normal routine.

The reality is that long, continuous runs of more than 30 mins can cause undue stress to the body and its energy systems. Running by its very nature is not corrective and not strengthening, so if you have postural and muscular weaknesses in the body, running will find them and pick at them.

I think I should repeat this point - Running is NOT a strength exercise. So all those people who tell me that they have strong legs because they do lots of running, their squats in the gym usually tell a different story, i.e they struggle to do proper squats with just their own bodyweight.

Running the same distance at the same speed will also quickly lead to a plateau in your training. Even the most unfit people will stop gaining results from slow steady paced running in about 6-8 weeks. Given that any results in any training require the body to adapt to new stimulus, reaching a plateau and staying there is not what you want.

For a different take on running, I would highly recommend some sprint training. Sprint training forces you to work at a higher intensity for a shorter period of time. Numerous studies have shown that working at a higher intensity is the most effective way to burn calories and stay lean.

If you are new to sprint training, then it's very likely that you will only last a short period of time, even if you are a regular runner. It may also make you feel a little ill, but this will pass as your conditioning improves.

Here's a 20-25 minute moderate level program you could try in the park or on the track:

40m sprint (jog back to start point) and repeat 6 times.

60m sprint (walk back to start point) and repeat 5 times

80m sprint (rest 60 secs, sprint back) repeat 4 times

Improving your anaearobic fitness also has carryover effects to your aerobic conditioning. So sprint training will actually help with your longer runs as well, especially if you are training for a middle distance event such as a 5-10km run.

Try it out. Your body won't be disappointed