Stretching Your Hamstrings - 9 different variations for you.

We often get asked at the clinic about how best to stretch the hamstrings. 

The truth is there is not a single method that is 'best' for all people and all injuries. 

Some stretches work better for certain problems. This is largely due to the fact that different stretches will bias (or target) different aspects of the muscle and different methods change the 'type' of stretch you get. 

In addition any experienced therapist will know that some individuals 'feel' a better stretch with one method when compared to another. This can vary from person to person. For that reason it's often best to try a few different methods of stretching, before deciding on which one to stick with.

Below are 9 different ways to stretch your hamstrings, try a few of them a 'feel' what works best for you:

For a full size printable copy of the stretches click here.

P.s. There are many more methods for stretching the hamstrings that are not included above, however this should be a good starting point.

P.p.s I have a couple of stretches that are my personal favourites. For example, the No1 stretch that I use is the second one from the bottom. There are a few reasons I prefer this stretch, but the reasons are a bit lengthy to go into on this blog post. Again this one doesn't work well for all people but it's one I use often. 

The best way(s) to ice an injury

So you have just injured yourself - you know you must ice the injured area, but have you ever thought about the best way to do that?

There are several ways to ice an injury, certain circumstances make some methods more appropriate than others. For that reason this blog post will outline a few of the best icing methods and give you some examples of when they are most appropriate to use.

Ice baths

This method is largely used after activity where it is believed that there has been wide spread micro-trauma to the muscle tissues of the legs (or lower limbs). I.e. running (distance), cycling, rugby, football, hockey, squash etc. This is a very general icing method, all areas of your legs will be iced equally, because of that this application is best used where there in not a specific injury.   

Micro-trauma, or tiny tears in the muscles, usually occur after intense or prolonged bouts of exercise. Everyone from elite athletes to your average gym goer can make use of this type of icing. The primary benefits of ice bathing include reduced muscular soreness, reduced metabolic activity (swelling) and flushing of 'waste' products in the muscles.

How to apply this type of icing (time required: 5-15mins)

Step 1. Fill your bath up to waist height with cold water (10-12°c). Depending on where you are and the time of the year your bath may run out at this temperature with the cold tap only, if not you'll have to add ice to get the temperature cold enough.
Step 2. Sit in the cold water, yes it will be chilly! From experience the first couple of minutes will be the most uncomfortable.  

Ice cube massage

This is a very direct method and one of the most aggressive forms of icing that can be used. It is great for use on small areas of inflammation (or tendinitis type injuries). Some examples of the type of injuries I'll often prescribe this for are Achilles tendinitis, golfer elbow, tennis elbow, patella tendinitis, plantar fasciitis and ankle sprains. If the area that needs to be iced is no more than about 3x the size of a 50pence piece this method is perfect.

How to apply this type of icing (time required: 5-7mins)

Step 1. Take an ice cube and grip it with a piece of kitchen towel (or something similar) leaving part of the ice cube exposed.
Step 2. Massage the inflamed area working in a figure of eight or circular fashion.

Gel ice packs (or a bag of peas) - available to buy here
Most people will be familiar with the method of icing. As with the other methods the primary reason for icing in this way is to limit localised swelling and to control pain levels. This type of icing is best used when the injury site is larger and more diffuse. The type of injuries you will want to use this method of icing with will be injuries such as a bruised quadriceps (thigh) muscle or a tear to the hamstring.

How to apply this type of icing (time required: 10-15mins) 

Step 1. Take your ice pack or peas out of the freezer and wrap them with a thin kitchen cloth or towel.
Step 2. Place the ice pack over the injury site, you can use tape or a bandage to lightly hold it in position. 

Instant ice packs - available to buy here
This application is essentially the same a using a standard ice pack or peas. These instant ice packs are more convenient because they do not need to be stored in a freezer. The can be stored anywhere and as their name suggests they can be used instantly. They do not start off cold, they contain to chemicals within the bag and once the two chemical are mixed the ice bag goes cold within a couple of seconds.

These are the ice packs I use if I'm working with a sports team on the touch line. They are useful as it means I have an instant 'ice' treatment available to me when I need it, without the need of having access to a freezer. These are ideal for putting in the boot of your car for a 'just in case' scenario. Although they are very useful there are two draw backs with these ice packs. Firstly they don't get quite as cold as gel ice packs - though they are cold enough in an emergency. The second problem is they can only be used once, after which they must be thrown away. As I said they are really only for use when there is no other option.

How to apply this type of icing (time required: 10-15mins)

Step 1. Squeeze ice pack and shake to mix the chemicals.
Step 2. Place the ice pack over the injury site, you can use tape or a bandage to lightly hold it in position. 

As always if you have any questions regarding this post please feel free to email us...

All You Need To Know About Lateral Ankle Sprains!

Ankle sprains are very common in sport. The most common type of injury to the ankle is damage to the ligamentous structures. The four most commonly injured ligaments are the anterior talofibular (ATFL), calcaneofibular (CFL), posterior talofibular (PTFL) and the anterior inferior tibiofibular (AiTFL). Out of those, the most frequently injured in sport is the ATFL.

The names of the ligaments sound complicated but they just describe the bones that the ligaments attach onto, for example the anterior talofibular is the ligament that joins the talus (*) and the fibula (∆) together and is called anterior because it sits more forward than its posterior counterpart!

The usual way of injuring the ATFL is by pointing your foot (plantarflexion) and twisting it inwards (inversion).  Once an ankle sprain is suspected, rest, ice, compression and elevation should be applied immediately. If possible, place the ankle in a bucket of icy water for 1 minute, take it out for 1 minute and repeat 10 times. This should be done every hour or as often as possible for the first 48 hours. This will help to keep the swelling down and will help with diagnosis when you go to see a sports therapist/physiotherapist.

The sprain should be graded from 1-3; 1 being only a partial tear of the ligament with next to no swelling and grade 3 being a complete rupture of the ligament with a lot of swelling.

Once you have pain free non-weightbearing movement, exercises can start to be prescribed by your therapist. These should continually be progressed which is why it is important to see your therapist at least on a weekly basis to make sure the exercises you are doing are safe and effective and to ensure you aren’t doing anything too strenuous too soon!

If you want some more advice on your ankle sprain then I am contactable via my email address.. sara.theringwoodclinic@gmail.com or you can book an appointment with us by visiting our website www.theringwoodclinic.co.uk or phoning us on 01425 480030.

Kinesiology Tape - What is it?

Have you seen the brightly coloured tape that lots of athletes are wearing at the Olympics this summer and wondered what it is? It is called Kinesiology tape and comes in a variety of colours – blue, black, pink, beige and also in a variety of designs including a union jack one that has been worn by some of the GB volleyball squad and also by runner Dwain Chambers. Kinesiology tape was founded about 25 years ago by Dr Kenzo Kase and has become increasingly popular with other brands now being introduced including Rock Tape. All different types of kinesiology tape are very similar but vary on the application strategies that are taught on their courses.

What Does It Do and How Does It Work?

Kinesio tape is not restrictive like normal athletic tape, and plays a different role entirely. Kinesio is designed to support muscles and joints without preventing movement. The tape has patterns on the adhesive side (see fig. 1) that can help to lift the skin in different areas to assist with lymph drainage during inflammation and can relieve pressure on nerve endings, decreasing pain.  Also, because the tape is non-restrictive it allows athletes to fully engage in their sport and not focus on painful areas.

Fig. 1. This picture shows the adhesive side of some pink Kinesio tape. The lines wave horizontally along the tape.  

Kinesio UK suggest the tape can be worn for up to 3-5 days but should be applied an hour before exercise or showering.  There is limited research to show the effectiveness of the tape up to 5 days after the application date and in my experience, no matter how well I stick the tape down it usually starts to peel off and fray after the second or third day.

It can be used for injury prevention and relief from muscle tightness to allow freedom of movement during sporting or everyday activities.  Additionally it can be used to assist in the treatment of muscular strains, shoulder pain (see fig.2) and to reduce swelling by using a variety of application techniques.

Fig. 2. This picture shows how the tape can be applied to help treat biceps tendonitis.

In order to apply it effectively, practitioners need to go on a course which is run by the Kinesio Taping Association. Both myself and Alex have been on such courses that allow us apply the tape effectively to gain maximum benefits.

If you would like to know more about kinesiology taping visit www.kinesiotaping.co.uk or comment on this blog and we would be happy to answer any of your questions. Additionally, you can visit our facebook page www.facebook.com/theringwoodclinic and write on our wall!

Sever's Disease - Achilles Heel Pain (Children 8-15 years old)

Sever's disease affects growing adolescents in the 8-15 age category. A child suffering with Sever's will complain of pain around the back / base of the heel bone (called the calcaneus).

The basics 

Put simply the Achilles tendon, at it's attachment to the heel, becomes inflamed. This can occur for a few reasons however normally the primary issue is that the growth plates in children at this age are yet to full develop and are therefore more susceptible to 'overuse' type injuries. In a growing child weight bearing activity will generally aggravate the injury. This occurs because there is too much force being placed on the tendon attachment during weight bearing activity.

Risk factors

Sever's disease is a very similar issue, in nature, to Osgood Schlatters (OSD) and is effected by many of the same risk factors, e.g. increased activity, leg length discrepancies, recent growth spurts, poor bio-mechanics in sporting activities, tight calf musculature or being over weight / obese.

|| Osgood Schlatters occurs at the knee ||

|| Severs Disease occurs at the Achilles heel ||

Treatment / Management

The good news is that most children will 'grow out' of this injury within 2 week - 6 months. It is important it's managed carefully in the mean time though. If managed incorrectly there is the possibility of a calcification (permanent bony deposit) developing at the base of heel.

Generally decreased activity will be required. This is usually on a the basis of pain free activity, meaning that pain free activity is fine, painful activity is not. 

As with OSD the same treatment options are applicable for Sever's Disease: 

Treatment for Sever's will involve:

1. Rest (or relative rest) - by 'relative rest' I mean that ALL activity must be pain free. If an activity causes pain then rest must be enforced. 
2. Soft tissue techniques (massage) to free up the tight muscular tissue. 
3. Bio-mechanical screening - to make sure no unnecessary force is being generated at the foot, ankle or heel. 
4. Light stretching - only when appropriate. 
5. Ice / cold treatment - to help manage the inflammation. 

Two things you must not allow your child to do if they have Sever's disease:

1. Train / play through pain. 
2. Stretch heavily if it causes pain.

25 Random Facts about Sara...

Sara is a graduate of University of Hertfordshire and a member of the Society of Sports Therapists.

Sara has experience working a season at Brumbies RFC (Super 15 rugby team) and with competitors at the Virgin London Marathon.

Sara's full profile is up on the main website's 'about us' page.

Below is a less formal introduction - Sara has written a similar blog post to this one that I wrote in early 2011, 25 random facts about me.

So with out further ado here are the 25 random facts that Sara wanted to share with us...

1) I have a younger sister called Helen and a younger brother called David 

2) My degree in Sports Therapy was 4 years instead of 3 because I did a placement year in my 3rd year in Australia with the Brumbies

3) For my education - I went to a private primary school in Eastleigh; Bournemouth School for Girls for secondary school and sixth form and went to the University of Hertfordshire to get my degree

4) My favourite subject at school was PE and my least favourite were English and Science. Ironically, my best subject in pub quizzes is now the science round!

5) I have completed Bronze, Silver and the majority of my Gold Duke of Edinburgh Awards

6) I have been horse riding from the age of 4

7) I have two horses called Jaffa and Nutmeg

8) I have visited, on holiday, places including the East and West coasts of the USA, Canada, Mauritius, Zante, Corfu, Menorca, Portugal, France, Malta, Ireland and Australia, however I have never been to Scotland

9) I used to have a bad phobia of snakes, however I forced myself to watch TV programs such as 'Venom Hunter' before going to Australia as I thought I would be coming across snakes regularly...however I didn't see a single one! It did make me less scared of snakes.. but I still don't like them very much

10) I was born with little toes that crossed over the top of my 4th toes and didn't have this rectified by surgery until I was 18

11) I was born in Poole Hospital and have lived in the same house with my parents for my whole life (except for when I'm at uni)

12) I love the countryside and when I'm in London can't wait to get back home again!

13) My favourite film is Love Actually, although I can only watch it at Christmas time!

14) I joined the kayaking club at uni and enjoy paddling on white water/rivers (however I don't have a boat so can't paddle very easily currently!)

15) I own a yellow mini which is called 'Custard'

16) I love to bake cakes and other sweet treats in my spare time - some are more successful than others!

17) If I had a super power I would be able to fly because I hate sitting in traffic jams (especially on hot days!)

18) I met my boyfriend Matt at the kayaking club at uni and we have been together ever since

19) I like playing netball and have played in the Northern and Southern Hemisphere!

20) My favourite sport to watch is rugby

21) My favourite colour is pink but I love all pastel colours!

22) Christmas is my favourite time of the year

23) I am still really close to my friends from secondary school even though we all went to different universities across England and Wales

24) I love talking about injuries to other therapists or to members of the public - I find it really interesting and could talk for hours

25) My favourite ride at Thorpe Park is 'Saw' and at Alton Towers is 'Air'!

If you would like to book in with Sara please either call 01425 480030 or use our online booking system. 

Online Booking - Now Available

You can now book your appointments online...

The system is very simple to use.

Just go to the main website www.TheRingwoodClinic.co.uk  and click the book online tab which is in the right hand column of the website.

IMPORTANT

1) Enter your current email as this will be used to send you an immediate confirmation of your appointment

2) If you have a mobile number enter that too - this allows the system to send you an automatic text reminder the day before your appointment.

3) If the appointment slot that you need is not available call in on 01425 480030 as occasionally there may be additional time slots available that are not displayed.

Finally watch the video below showing you how it works:

N/b The video has no sound

3 things you must never do to an ACUTE injury

This post will be short and sweet but please take 30 seconds to read it.

Avoiding the three things below will save you much time in recovery.

1. Never put HEAT on an acute injury

If you have just had an acute injury the area will immediately go into an inflammatory response.

If the area around the injury is hot, red, swollen or painful you must avoid putting heat on it.

Heat will only increase the inflammatory response along with any bleeding or bruising in the area. Avoid heat at this stage! Including hot baths.

2. Never MASSAGE an acute injury

This is for exactly the same reasons as I set out above.

Massage on an acute injury will only increase blood flow which in turn will increase the inflammatory response. Avoid massage on a 'new' injury!

3. Never try to 'RUN OFF ' an acute injury

This rule really falls into the common sense category. If you've just sprained an ankle, twisted a knee or pulled a hamstring you must stop exercising if it's causing you pain.

If you keep running on a painful joint or muscle then you will be creating additional trauma to the muscle fibers or joint surfaces.

To add to this, these type of injuries can feel less severe while the muscles are still warm it's only when you stop and cool down when the joint or muscle begins to 'stiffen up'. This is the point when you realise the full extent of your injury.

STOP if you are in pain to avoid causing more damage.

Physiotherapy Software (Preview Video)

Alongside working as a Sports Therapist at the clinic I run two other companies Physio Images and Rehab Software Pro.

Below is a video that I recently had produced for Rehab Software Pro.

The software allows Physiotherapists and Sports Therapists to produce rehabilitation handouts for their clients.

If you are interested in seeing how the software works then hit 'play' on the video below (video length 2.20).

Client Email (back, neck & shoulder pain)

Below is an email exchange with a client on his back pain.

At the time he was unable to to come and see me at the clinic, but the advice I've given him is likely to be of use to some individuals that suffer from 'posture based' back pain.

Initial client email

Hey Alex,

Long time.

Just wanted to ask a question about back pain.

I've had back pain for last couple years and it seems like I've been doing everything right.

What should I do next? What type of person should I look to visit in Southampton?

Thanks...

Additional details

I then asked him for a few additional details so I could give him better interim advice. We exchanged a couple emails. Alongside other things he informed me of the following details:

• No acute incident caused his pain, his discomfort has built in over time.
• He's had lots of Sports Massage / Chiropractic adjustment on his back and neck.
• He's in his early 20's.
• He's a writer / Blogger so spends ALOT of time at the computer.
• The main advice he's had from the Physio / Chiro has been to improve his posture and strength his back.
• He is seeing a personal trainer twice a week and has been working on the strength in his back.

My email response

Hi *********,

No worries.

On the face of it, it does sound largely that you have been doing all the right things - which I understand will be frustrating!

From what you have described is sounds alot like you have some postural issues through the spine / upper trunk. Which is likely to be causing the pain. Obviously I'm making a few assumptions here.

The symptoms you have described all for into the category of poor work (or other) posture. A good clue to this is that after improving your desk set up things have improved, if only slightly.

The type of issue you have described falls very much into 'upper cross syndrome' (Google it!). Again I'm sure you know this is the issue already.

In basic terms you need to STRENGTHEN up your weak / lengthened back muscles (which you're doing) and STRETCH your chest / biceps / anterior deltiod muscles (which you may also be doing).

The problem I find with this sort of issue is that many people, on the face of it, are doing the right things to improve the problem. However they are doing nowhere near enough volume of the rehab exercises to improve the problem.

Bear in mind if you are spending 8 hours+ per day with poor postureworking, then only doing 3x one hour in the gym per week and 10 mins stretching per day is not going to make enough of a difference.

If you want to fix this you will need to really put some time into it.

These are some of the things I would recommend:

1) In the gym, for the short term, minimise pressing movements (e.g. Over head press, bench press etc). Maximise Pulling movements (E.g. Bent over rows, seated rows etc). Focus on retracting the scapula with the pulling movements, as if you're trying to trap a pen between them. This will help address the imbalance between chest / back muscle groups

2) Do face pulls every time you're in the gym: http://www.youtube.com/watch?v=uQS-tXL1CLg

3) Do YTWLs every time you're in the gym: http://www.youtube.com/watch?v=Jj3NdjH1NSk / http://www.youtube.com/watch?v=hjIHVuV673k

4) Foam roll the back every day (10-15mins min) - looking to create extension in the thoracic spine / stretch the chest + shoulders. See pdf attached.

5) Stretch your chest / deltoids as often as possible. Long 30sec holds needed! See pdf attached.

6) Be truly aware of your posture while at your desk - you've got to work at breaking poor posture. This will take a bit of time.

Try these for 4 weeks and really work hard at them. Show the exercises to your trainer so he can go over them with you to make sure you do them with good form.

If you work really hard at these for 4 weeks and it doesn't make any change you can come down and see me and we can go through a proper consultation to get to the bottom of it.

I hope this helps.

Let me know if you want anything clarified.

Catch up soon.

Summary

The type of problem discussed here is something I see over and over again if you suffer from this type of problem have a detailed read over the post as some of the tips and exercises are likely to help you!

As always email me directly if you need any further advice.

Ankle Sprains - Video Presentation

If you have sprained your ankle please take 5 minutes to watch this video on ankle sprains.

You will learn:

1. What type of sprain is the most common - approx 90% of all ankle sprains are this type.
2. Two things you must do initially to improve the outcome of your ankle sprain.
3. Why it is important to work on the balance and strength of the ankle after injury.

A - Z of Sport Therapy

A fun post here with some common terms that Sports Therapists, Physiotherapists and other musculoskeletal therapists regularly use.

A = Achilles Rupture - for a complete rupture surgical repair of the tendon will be required in most active patients.

B = Bursitis - Bursas are small, fluid filled sacks that protect a tendon where it attaches to the bone. If the bursa becomes injuried and inflammed you have a condition called Bursitis.

C = Calcaneus - also know as the heel bone.

D = Draw Test. A test for damage (rupture) to the Anterior Cruciate Ligament of the knee - see this link for a video of the Draw Test.

E = Electromyography - is used for recording the work produced by a muscle. The technique measures the amount of electrical activity that is produced by a muscle.

F = Facet joint - the small joints between each vertebrae. There are two joints at each segment of the spine.

G = Gait - refers to the movement patterns of our limb, however Sports Therapist's will most often be talking about the movement at the foot and ankle, when talking about your gait.

H = Hemarthrosis - is bleeding into the joint spaces. This many occur due to a traumatic injury for example a heavy twisting injury to the knee.

I = Inguinal hernia - is a type of hernia found in the lower part of the abdomen. Treatment of this will often be surgical.

J = Jumpers Knee - is more accurately known as a patella tendinopathy. If you suffer from this pain will be present just below the knee cap when exercising.

K = Kyphosis - refers to the curvature of the thoracic spine. Over kyphosis will lead to a rounded posture in the upper back.

L = Lumbar spine - the lower 5 vertebrae in the spine (lower back).

M = Meniscus - the cartilage that acts as shock absorbers in the knee. Unfortunately this cartilage can be torn relatively easily.

N = Navicular - is one of the tarsal bones found in the foot. It is the 'key stone' bone on the inside arch of your foot.

O = Osgood-Schlatters disease - a problem found in active children between the age of 10-16. See my blog post on it here.

P = Patellofemoral Joint Pain - joint pain at the front of the knee. Pain found just underneath the knee cap can indicate Patellofemoral Joint Pain.

Q = Q-angle - is the angle from the hip to the knee. It's important as individuals with a large Q-angle are more susceptible to certain types of knee pain.

R = Rotator cuff muscles - are 4 muscles that act to stablise the shoulder joint. Rotator Cuff Impingement Syndrome is a common injury.

S = Sciatica - the sciatic nerve is the largest nerve in the body. Sciatica is caused by injury to or pressure on the nerve.

T = Tendinitis - is inflammation of a tendon. Examples are Achilles Tendinitis & Patella Tendinitis.

U = Ultrasound therapy - used to enhance cell repair during inflammation.

V = Venous Thrombosis - a blood clot that forms in a vein. There will be a higher risk of this down wind of surgery.

W = Wry neck - also known as Torticollis, is a deep spasm of the neck (side) flexors.

X = X-ray - Used to image 'boney' injuries.

Y = Yellow Elastic Tissue - is one of 3 forms of dense connective tissue.

Z = Zygomatic arch - is more commonly known as the cheek bone.

Muscle Strains - The Facts

The Facts:

1) A muscle strain is simply where muscle fibers are torn (or ripped). Ouch!

2) You cannot sprain a muscle. Ligaments are SPRAINED, muscles are STRAINED. Simple hey!

3) A muscle can be torn under the power of it's own contraction. Think of a sprinter powering out of the block and 'pulling up' - that will be a muscle strain.

4) A muscle strain will be painful AND weak at the same time.

5) Muscle strains are often confused with other issues such as muscle spasms, cramps or even DOMS (delay onset muscle soreness).

6) With more severe muscle strains there is often a palpable depression or lump in the muscle [*an experienced therapist will be able to tell you if there has been a tear or not].

---- ---- ----

Muscle strains are arguably one of the most misdiagnosed injuries I come across.

I see muscle strains several times a week in the clinic, however people often come to me thinking they have a muscle strain when in fact it's something different altogether.

Usually they have a muscle spasm, cramp or even DOMS (delay onset muscle soreness).

However there are others who come in with a genuine muscle strain. It's important to know what we've got because they need to be dealt with in slightly different ways.

A genuine muscle strain will have the following characteristics:

1) It's onset will be acute. What I mean by this is you won't get a muscle strain being inactive i.e. sleeping overnight or sitting at a desk for a long period. A true muscle strain involve tearing muscle fibers so most often a fast powerful movement will be involved.

You will normally be aware of the incident that caused the injury!

2) The muscle will be painful AND weak at the same time. A muscle that is weak but not painful is still a concern but will indicate something else!

11 things I learnt in 2011

At the end of each year I like to spend a bit of time to reflect on how my year has gone. As always I would like to have 'achieved' more than I did, but none the less I'm always surprised at how much I DID get done.

Reaching January 2012 means that I have completed one full year in my new clinic. This is obviously a significant mile stone to me and I thought it would be a shame not to mark it here on my blog.

2011 will be a special year to me for a number of reasons but most significantly it's the year I got engaged to my girlfriend Gemma. We're getting married this year (2012) in early November which we're both very excited about.

Along with reflecting on my previous 'achievements' I also like to write down some of the things I've learnt.

Here are 11 'Sports Therapy' related things I learnt (or have been reminded of) in 2011:

1) Everyones body is unique and will respond to treatments differently. For example one stretch may work well with 7 out of 10 people, however the other 3 out of 10 will require a very different approach.

2) The most common 'problem' I see in the clinic is related to shoulder and neck tension (or stiffness). The majority of this is due to poor posture. Fix your posture!

3) Writing this blog is enjoyable AND a useful tool for attracting new clients. I've had a number of people book in after reading one of my blog posts. Remarkably I had a mother bring her daughter on a 7 hour round trip from Suffolk after they read this blog post. Incredible!

4) Increasing your mobility, range of motion or flexibility in many cases is easier than most people think. It just takes a consistent (daily) approach with the right exercises or stretches.

5) Look after your body, because there are some structures and tissues that once damaged cannot be put back to 'normal'.

6) Deal with your injuries as early as possible - This really is important. Doing nothing and leaving an injury to 'settle down for a few weeks' is not a good approach.

7) When injured the majority of my clients don't know when to use ice vs when to use heat.

8) Normal people can complete extraordinary things with the right dedication. I've had a number of 'normal' clients do some extraordinary things from endurance horse riding events (100 miles) to first time iron man events. Very inspiring.

9) If you have an on going knee problem you MUST look at the joints above and below the knee (i.e. the hip and ankle).

10) The foam roller is a great self massage and treatment tool.

11) If you work in a desk job you must take time to stretch - see point 2.

And one bonus: Many people have very weak and under-active glutes that are causing back pain.