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Exercise during Pregnancy

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Exercise during Pregnancy
pregnancy physio

Exercising during pregnancy is good for both Mother and baby

Exercising regularly during pregnancy at a moderate level can improve posture, reduce pregnancy related musculoskeletal aches and pains such as back, rib and pelvic pain.  It can also help build the stamina required for labour and help aid physical recovery post delivery.

It is advised that women who have been previously physically active can continue to exercise throughout pregnancy at a moderate level. If you wish to take up exercise that you previously haven’t performed you should consult  a specialist pregnancy exercise Physiotherapist or an advanced exercise instructor who has done training to safely advise on which forms of exercise are safe to commence specific to your needs.

What is Relaxin?

The hormone relaxin is essential during pregnancy to allow ligament / joint laxity so the body can adapt to the growing baby. This does however leave the body a little more vulnerable to aches and pains especially with high impact exercise as the soft tissues are less supportive of the joints leaving them less stable and at higher risk of injury than normal. Therefore women shouldn’t perform high impact exercise during pregnancy.

Relaxin also regulates the mother’s cardiovascular and renal systems to help them adapt to the pregnant mother’s body’s increased demand for oxygen and nutrients. It does this by relaxing the walls of the blood vessels. This increases their ability to transport blood around the body and to the placenta. The higher quantity of waste products are more easily transported to the kidneys where they can then be filtered and expelled.

How exercise will impact my baby?

Recent research has shown that moderate exercise during pregnancy can improve the blood supply to the placenta by increasing the efficiency of the heart’s ability to pump blood. This improved blood supply has been shown to improve the size of the placenta and hence the blood flow and nutrition to the fetus. This may reduce the risk of full term low birth weight as improved nutrition to the fetus via the placenta during gestation has been shown to improve growth and weight of the fetus.

Forms of moderate exercise include brisk walking, low impact aerobics (taken by instructor with pregnancy exercise qualification), swimming and indoor cycling. Jogging is considered safe if you are having a healthy low risk pregnancy and have previously been a regular jogger. It is advised to avoid activities where there is an increased risk of falling such as skiing, climbing or horse riding. It is recommended that moderate exercise can be performed for 30-45mins 5-7 days a week.

Exercises such as pregnancy appropriate Pilates or Yoga which improve posture, muscle tone and strength of the spine, abdominal musculature and pelvic floor are advisable to help support the weight of the growing fetus and stresses on necessary changes to posture and soft tissue tone during pregnancy.

Importantly always listen to your body and don’t exercise if tired or unwell and stop any exercise immediately which causes any pain.

If in doubt always consult a pregnancy specialist Physiotherapist, midwife or Obstetrician.

Tips to Aid Recovery post Marathon

post marathon recovery
With race day fast approaching hopefully the stars are aligned and all your pre race preparation will allow you to produce a PB on the day.

Your marathon training will have taken you towards the 21-22 mile mark. So coming Monday you will be adding about 15% more distance to your longest run.

Your legs will be pushed to the limit so how can you best recover following your big run??


1- Be like Andy Murray!!

It’s widely known that Andy Murray soaks in a chilled bath after competing. Research shows that immersing the body in freezing cold water speeds up recovery after exercise. By reducing temperature, blood flow and inflammation in tissues of the muscles. 8-10 degrees Celsius is the temperature to achieve this. The soak needs to last around 8 minutes.

2- Avoid running in the early stages but do get up and move.

In the next 24-48 hours a brisk walk, light cycle or swim / aqua jog will increase blood flow to the recovering muscles. Providing oxygen and protein to boost muscle recovery.

3- Recovery massage.

If there are therapists about straight after the marathon then jump on their table and get a gentle effleurage massage to help drain the lactic acid from those tired muscles.
After that it might be 48-72 hours before you could bear someone touching those aching legs. Be sure to inform your physio of how you are feeling, previous response to massage and most importantly if you feel the massage is relieving the pain.

4- Listen to your body.

After the run you won’t know if the many aches and pains are an injury or just the result of the stress from the marathon. So let it settle early stages and if a pain isn’t reducing after 2-3 days consult a physio before starting to run again.

5- Get your nutrition right.

The endurance run you have completed will deplete your glycogen stores, so ensure plenty of carbs over the first few days post race. Increased protein consumption is also very beneficial to aid muscle recovery and rebuilding. Obviously hydration is essential although you might just deserve a pint of “ The Black Stuff” after the run, sure it’s full of iron apparently!!!!

Tips for Tapering for a Marathon

The big day is approaching to Deep river rock Belfast marathon and for many runners the big question is when do you taper?

Start to early and you will lose the fitness levels you have worked so hard to achieve.

Start to late and a long run won’t give your body time to recover prior to the big day. ( it takes about 7-10 days after your last long run for your muscles to recover!)

One of the biggest things to remember in marathon training is that there is no way to bluff it or cram at the last minute like you would for an exam. If the hard work isn’t done by 2-3 weeks out it won’t be!!! The taper is purely about refining your training.

Firstly, what is a taper?

It is a runner cutting their mileage of training significantly in the days/ weeks preceding the big event. It doesn’t necessarily mean slowing the pace down when running but shortening the length of runs to allow body recovery prior to the marathon.

Why taper?

When we train hard and consistently we push our muscles to the limit causing micro trauma of the muscle fibers. (please note, this is due to overloading the muscles in training not an acute muscle tear like feeling a sharp pain in your hamstring). When your muscles are damaged, your body will recruit amino acids. (the building blocks of proteins) to come and repair your muscle. However, as a coastal city might build a mightier dam after a flood, the body recognizes that this muscle will be subject to this type of damage and rebuilds the muscle bigger and stronger to adapt to this new stimulus.
In the last 6 weeks leading up to a marathon the stress on the muscles is increased weekly with less recovery time for the body to repair these micro-tears. This is were the taper is essential in the last few weeks to reduce the load and allow the muscle to repair stronger.

Aims of your taper:

1- Allow muscles time to heal and rebuild stronger
2- Let your body restock its glycogen stores
3- Minimise accumulated fatigue and allow your immune system to recover.

When to taper?

The majority of runners aim to complete their last big run 3 weeks prior to the marathon. So anyone running Belfast should hopefully have that complete. Although for more experienced marathon runners sometimes 2 week is sufficient but that would be the absolute minimum.

How to taper effectively:
From 3 weeks out cut the mileage to around 80% of maximum week but keep intensity of runs aiming a lot for marathon pace runs to get used to the speed. Plenty of rest days and stretching to aid muscle recovery. If you are planning on changing trainers for race day this must be done now to allow adequate break in time.

From 2 weeks out cutting miles to around 50% maximum but again keep running at marathon pace or slightly above it. At this stage beginning to carb load steadily to boost the now depleted glycogen stores. Steady carb loading is recommended rather than eating 14 bowls of pasta in the last 48hours

The week of the race, a steady run 6 days out is excellent to avoid staleness over the 3 week taper. A 12-18min easy run the day before can get you ready for the off on race day. Plenty of sleep, hydration and carb loading are essential. Whilst forming your plan for refueling on race day.
Most importantly on the day of the race don’t do something you have never done before. ( like eating 500 jelly babies) and repeat as close as possible the routine and plan you followed on the days of your long runs!

Now the only thing to do is try not to hit the wall!!!

Headaches? How Do The Physio Group Clinic’s Treat Headaches

chronic headaches, sports injury, physiotherapy


At The Physio Group Clinic we are seeing an increased number of clients suffering from chronic headaches.

There are many different types of headache such as : tension, migraine, cluster, vascular and hormone induced; these will be managed from a medical perspective.

Within our scope of practice it is the CERVICOGENIC headache that we can assess and treat effectively.

A cervicogenic headache is one that starts in the neck and refers up to the head. The upper neck contains joints, muscles, ligaments and nerves which if irritated can cause the headache.

The cause varies from poor posture to repetitive activities such as lifting and carrying. Significant use of phones, laptops and computers in poor positions also increases the load on your upper neck. Whiplash injuries are also common aggravating factors.

A true cervicogenic headache will always originate from the neck either during or after an activity And presents as a dull ache which spreads up the back of the head towards the temple, usually affecting one side rather than both.

headachesOn our physical examination we expect to find:

– reduction of normal cervical movement

– tenderness and or headache referral on pressing the upper neck joints

– muscular trigger points around the upper neck which refer to the head

– poor posture often with a rounded back and a poking chin.


Once  we at The Physio Group Clinic feel the headache is of cervical origin our treatment consists of:

-soft tissue massage to release the muscles

-joint mobilisation or manipulation to improve joint mobility

-postural and mobility exercises

-advice on computer set up etc


-postural taping if needed


A course of treatment yields high success rates for the true CERVICOGENIC headache so feel free to enquire whether Physiotherapy at The Physio Group Clinic can help you!!



sports injury, physiotherapy

Welsh rugby captain Sam Warburton faces a race against time to recover from injury to face Ireland in the Six Nations on Saturday.

In a bid to speed up the healing process he has been on an intensive ice machine to get rid of inflammation. This new High Tech bit of kit ” The Game Ready”  has also been endorsed by Rory McIlroy.


But what is the difference  between this and a bag of frozen peas from your freezer?

And what ultimately are we trying to achieve?


What these athletes are following is the PRICE regime for an acute injury:

Protection – Aim to prevent further injury e.g. using crutches

Rest – Allow healing by preventing further aggravating activities

Ice – Reduces pain, swelling and inflammation

Compression – A pressure strap such as tubi-grip to limit the swelling

Elevation – By raising the injured area above the level of the heart excessive swelling can allow swelling to drain away.


When we look at the outcome of an injury  we need inflammation to occur to facilitate the body healing itself, it is the excessive inflammation which as therapists we aim to minimise as this ultimately slows the recovery process.

This has led to an extensive array of treatment options using ice/cryo therapy all claiming to speed up the reduction of swelling and ultimately the recovery of injury.

So what are the options available????

Hyperbarbic Gaseous Cryotherapy

This technique consists in applying for a short time on the skin up to the painful area, carbon dioxide at −78 °C with a pressure of 50 bars and a frequency of 400 Hz. Sessions can be repeated at will. Unlike ice packs, the usage of carbon dioxide does not produce pain. Even if not as dangerous as liquid nitrogen used in cryosurgery, the low temperature could cause burns.

The Ice Bath

The theory behind ice baths is related the fact that intense exercise actually causes microtrauma, or tiny tears in muscle fibers. This muscle damage not only stimulates muscle cell activity and helps repair the damage and strengthen the muscles ( muscle hypertrophy ), but it is also linked with delayed onset muscle pain and soreness (DOMS) , which occurs between 24 and 72 hours after exercise.

The ice bath is thought to:

  • Constrict blood vessels and flush waste products, like lactic acid, out of the affected tissues
  • Decrease metabolic activity and slow down physiological processes
  • Reduce swelling and tissue breakdown

Then, with rewarming, the increased blood flow speeds circulation, and in turn, improves the healing process. Although there is no current protocol regarding the ideal time and temperature for cold immersion routines, most athletes or trainers who use them recommend a water temperature between 12 to 15 degrees Celsius and immersion times of 5 to 10 and sometimes up to 20 minutes.

The Game Ready

As modelled by Rory McIlroy below the Game Ready System continuously circulates cold water from the control unit’s ice reservoir, via a connector hose, through an inner chamber of the anatomical wrap  (this chamber is located closest to the body) before returning to the ice reservoir.

As a complete loop, the cold water is refreshed through the ice before returning through the anatomical wrap, thus delivering continuous cold therapy to the body part, allowing heat to be removed from the treatment site.

Simultaneously, the control unit pumps air into the separate, outer chamber of the anatomical wrap, intermittently inflating and deflating according to the pressure setting that is selected.

The compression not only assists in preventing/ limiting swelling, but also conforms the Anatomical Wrap to the contours of the body.  This increases the surface contact and aids the delivery of the circumferential cold therapy.

rory game ready

The Ice Pack 

Ice packs can be made from ice cubes in a plastic bag or wet tea towel. A packet of frozen peas may also be used as they mould nicely and can go in and out of the freezer. Purpose-made cold packs can also be bought which are reusable.  They can be applied for 15-20minutes and repeated every 2 hours. However care should be taken to protect the skin to prevent an ice burn.


Within our clinic we see trends towards a new type of ice therapy on a regular basis, with half a football team heading to cold baths in County Meath, or to an ice chamber in Portadown. Ultimately if the time spent travelling to these places was spent focusing on the PRICE regime with rest and ice packing maintained religiously, the same outcome would be achieved almost all of the time. So hold onto those peas for a little longer !!




Pilates is an exercise based therapy which is designed to strengthen, elongate and restore the body’s muscular Skelton system into balance.

The origins of pilates stem from early part of 1900 from its inventor ‘Joseph Pilates’ who as a child had been very frail but developed a technique of physical fitness using experiences from classical Roman to body building to martial arts.

He developed his own approach to exercise and body conditioning which gained popularity as athletes found it the best way to recover from injuries and prevent recurrence.

Over the years it has been developed and from the 1970’s on has become increasingly popular with the public.


It is a gentle, non-aerobic exercise method designed to strengthen weak muscles, lengthen tight muscles and improve general posture. The aim is for a properly balanced body which results in improved joint mobility, firm musculature and a good natural posture. It is a very specific form of exercise which is safe and controlled as well as low impact and works on the principle of ‘gain with no pain’.


Anyone can benefit from Pilates as it is a very gentle form of exercise. Traditionally the classes tend to be female dominated and there is still a tendency for Pilates to be avoided by men, however top premiership footballer Steven Gerrard is joining the growing list of sportsmen who are extending their career through incorporating it into their regime  so we encourage everyone to the class.


Although if attending for a specific ailment or injury it is best to inform the teacher prior to starting the class to ensure they can tailor certain exercises to specific needs.


Pilates is a complete exercise method developed by its founder Joseph Pilates over the course of a lifetime dedicated to improving physical and mental health. Pilates focuses on building your body’s core strength and improving your posture through a series of low repetition low impact stretching and conditioning exercises.

By core strength, we are talking about your back, abdominal and pelvic muscles. Through pilates, you will be able to develop these muscles without adding bulk, increasing your flexibility and agility and at the same time toning your stomach and thigh muscles.

Pilates goes far beyond your core muscles however and not only provides a complete body workout (you will be working muscles you didn’t even know you had!), but also helps you develop an awareness of how your body works, helping your mind and body to work in harmony.


Pilates is based on eight principles:

  1. Relaxation
  2. Alignment
  3. Control
  4. Precision
  5. Routine
  6. Breathing
  7. Centring
  8. Flowing movement

Should you wish to find out anymore about the benefits of pilates do not hesitate to contact our main office on 02830269733


achilles tendon, achilles heel, sports injuryAchilles Heel!

The term Achilles heel derives from Greek mythology when a great warrior Achilles was dipped in water as a baby which was supposed to make him invincible, unfortunately as his mother dipped him in, she held him by the heel Which wasn’t washed over. This became his weak spot and ultimately led to his downfall.

Unfortunately for most runners and triathletes who suffer from Achilles pain the duration can also be EPIC!

It is one of the most common weak spots in the body for overuse injuries and will usually be classified as one of 3 diagnosis’s

– Achilles tendonosis : this involves degeneration and some inflammation of the tendon itself. Its shape changes from that of a thin pencil like shape to an overall thickening along the tendon.

– Achilles paratendonitis : the paratendon is a sheath that encloses the tendon and should provide protection and allow fluid movement of the tendon. Unfortunately symptoms of inflammation and swelling can develop between the tendon and the sheath this can cause scar tissue and reduces the tendon mobility.

– A combination of the 2 above.

Very often with this the key to recovery is not just physiotherapy assessment and treatment but also evaluating the causes of it. These may include:

Biomechanical faults ( usually over-pronation)
Poor footwear ( digging into heel)
Direct injury or previous unresolved injury
Changes of running surface
Tight and or weak calf muscles

Commonly when athletes self diagnose and treat they get stuck into copious amounts of eccentric exercises ( heel drops with a gorilla on their back) and can often aggravate the complaint.

That is not to say eccentrics are not appropriate, just they need to be added to a rehabilitation program when appropriate i.e. when the basic calf mobility and strength is returning and the tight calf muscles have been released. Along with specific soft tissue treatment to the tendon.

Occasionally these injuries require a full podiatry assessment and orthotic prescription and if they fail to recover an ultrasound scan via a radiologist who may administer high volume saline injections to break up scar tissue between the para-tendon and the tendon.

Bridging Exercise

A common exercise prescribed by our therapists as well as in our Pilates class is: The Bridge.

The Bridge is an excellent stability exercise. This means that one of your goals is to keep your pelvis very still during the exercise. This exercise strengthens the gluteals and the lower abdominals promoting core stability.

It’s a safe exercise for those with a weak or injured back which starts at a low level but can be progressed as control allows into a high level stability exercise.

Kinesio Tape all for Show?

Kinesio Tape - The Physio GroupAs I watched the World Cup opener last night I wondered how much money Croatia had spent on the colourful Kinesio tape and could they have fielded if their tape hadn’t made it through customs!

The tape was invented by Japanese chiropractor Kenzo Kase in the 1970s. The U.K. web site for Kinesio tape claims it can alleviate pain, reduce inflammation, and supporting muscles during a sporting event.

The theory is that the tape pulls the skin away from the underlying muscle. The space created is believed to relieve pressure on the lymph channels in the area between the muscle and the dermis, creating more space for lymph flow and thus better lymph drainage through an affected area.

But does it work?

There is little evidence barring anecdotal and the director of Lilleshall Sports Rehabilitation suggests it’s benefits could be placebo.

When applying tape for a sporting event our clinic generally recommends subtle taping so as not to advertise any areas of potential weakness.

In stark contrast Kinesio taping seems to be worn as a badge of honour. Could it be a way for an athlete to explain away a potentially poor performance??

Certainly whatever the benefits or placebo the highly coloured visible colours has led to a phenomenal commercial success.

However at The Physio Group Clinic the jury is still out!

Pre Marathon Tips

Pre Marathon Tips - The Physio GroupWith Belfast marathon only 3 weeks away and Newry marathon 5 weeks away we thought it would be a good idea to give some advice to those who are running their first marathon.

For most first timers it’s all about crossing the finish line and not personal bests! From a physical point of view we would recommend you manage to get up to 25 or 26 miles somewhere in your training so at least mentally you know you have the physical capabilities of completing on the day!

There is a widespread notion that running the full 26 miles during training is a bad idea, that you are somehow weakening yourself. On the contrary, we tend to think that tackling the full distance for the first time while pushing a race pace is much riskier, you have to train the distance to race the distance!!

This is going to sound absurd compared to the advice you have been given by experienced runners and coaches but remember if you are a 1st timer you are not an experienced marathon runner! If your longest run is 20 miles remember you have still have about 25% left to complete! This doesn’t sound much, but the slower you run this equates to a lot longer on your legs than you are used to.

We see a lot of injuries that occur in the latter part of the race so we feel having the miles in the legs is essential. Just leave yourself enough time to taper and recover for the race!!

Foam Rolling – What are you trying to achieve?

Foam Roller Exercise - The Physio GroupAfter our Perfect Squat article the natural follow on is to mention the foam roller.

In recent times this has become as important a piece of equipment to athletes as running shoes or football boots.

But how do you use it? What are you trying to achieve? And what should you be feeling??

Read this interesting article below as it hits most of the key points!!


The Perfect Squat

Squatting - The Physio GroupOne of the most commonly performed lower limb exercises, yet often it isn’t being performed correctly. When this is the case your best case scenario is that you are inefficient in your training. Worst case there is potential to hurt yourself. 

Technique in our eyes is the key before thinking about loading up with weight!! This may involve improving your mobility, practicing technique, working on your stability, or perhaps
all 3!

Stretching for Runners

Stretching for Runners - Newry and Belfast PhysioWith the Belfast marathon on the near horizon and weekly 5k, 10k and half marathons we are constantly asked by runners about stretching. How, when and why? 

The current research pre run has massively come away from the Static stretch and moved towards a more dynamic warm-up to improve functional mobility for your run and we would agree with this approach for the majority of runners. 

The time to statically stretch, we feel, is after your run when the muscles are warm and extensible. The stretch should be felt but never sharply painful. 

The other point to remember is that if you spend time improving your muscle flexibility you then need to strengthen it so that you have strength through your full range of movement, but we will cover the strengthening exercises for runners in another post.

Barefoot Running or Minimalist Running

Barefoot Running - Newry and Belfast PhysioSince the explosion of the barefoot running and five fingers phenomenon, we have an increasing number of our clients asking us if they should be trying it.

There are a lot of claims made of the benefits of this style of running such as increased foot strengthen and reduced injuries. Unfortunately a lot of these claims aren’t backed up by scientific evidence and major manufacturer Vibram are paying the price in compensation to disgruntled customers.

So what do you?

In theory if you are a forefoot striker you may think your gait may be more tailored to the five fingers but does this work in the real world? The most important element runners must evaluate what terrain you run on and is the shoe fit for purpose for you? Also how many elite runners wear these types of shoes?

I would be very interested to get some feedback from those who have experience of the barefoot/ minimalist running. So please Pure Running NI,Born 2 RunNewry & Mourne RunnersNewry City RunnersDub Runners of Belfast, post up any comments below.

It’s Okay, It’s Only a Muscle Strain

Muscle Strain Injuries - PhysiotherapyThere is a popular misconception among athletes and managers that a muscle strain is nothing more than a cramp. They think this will settle in a few days and they will be fit for the following week.

However a strain is a muscle tear i.e. there is some disruption of the muscle fibres no matter how many or few.

When a strain/tear occurs, muscle fibres are damaged and the body sets about healing itself and lays down scar tissue which with appropriate rest and rehabilitation will reorganise to become functioning tissue. Even a mild strain or grade 1 tear of the hamstring will usually take 2-3 weeks to rehabilitate even when everything is done to maximise the healing process!

On occasions a strain occurs prior to a major event such as Diego Costas before the Champions League Final. I’m sure the Atletico Madrid medical team explained it was a few weeks injury, hence players will go with the latest “quick fix” to get someone to tell them they can outsmart nature. In Costa’s case it was horse placenta therapy in Serbia.

Inevitably these wacky fad treatments usually give the same result. Costas lasted 9 minutes into the final before pulling up and he has now put the World Cup in jeopardy.

Our clinic has seen many fads come and go and many interpretations of what a strain is and how you can return quicker.

What is consistent is that the tear has to heal! And if healing time is fast tracked, re-injury usually occurs.