Making People Better
Making People Better
The Essential Cyclist's Guide to Preventing Pain and Protecting Joints
Get ready to pedal through the essentials of cycling safety and injury prevention with our distinguished guest, Charlie Bradford. Discover the vital strategies weekend cyclists need to adopt to keep their passion for pedaling pain-free. Charlie, an expert physiotherapist with a wealth of experience, shares his insights into the common mishaps that befall avid cyclists and how to sidestep these with smart preparation and a balanced lifestyle. We zero in on the art of cycling, emphasizing the importance of graduating activity levels to avoid injuries and the key role a physiotherapist can play in guiding you to a safer ride.
Find out why cycling could be your knee's new best friend, especially if you're battling against arthritis. We break down the benefits of this low-impact sport, discuss how a well-fitted bike can be a game-changer in preventing overuse injuries, and tackle the unique challenges hill-climbers face. Additionally, we delve into the exercises that can keep your knee joints in top form and why strength conditioning and weight-bearing exercises are non-negotiable companions to your cycling routine. Whether you're in it for the thrill of the race or a leisurely weekend jaunt, Charlie's expertise is geared towards helping you achieve a safer, more informed cycling journey.
Enjoy a moment of relaxing calm with the Vita Health Group Wellbeing Series of podcasts to make you feel good, keep you healthy, help you make changes to your life. Vita Health Group is an award-winning market leader and has been at the forefront of healthcare for the past 30 years. Vita Health Group making people better.
Speaker 2:Yes, hello, welcome. It's time for another of the Making People Better podcasts with Visa Health Group. The series explores the challenges of everyday life with a focus on mental and physical health and well-being. I'm Glenn Thompson, your host on these podcasts, which we hope you find useful and informative, and I'm joined on each episode by various experts in their chosen field. Well, today I'm joined by Charlie Bradford from something called Physio SW19. I wonder where that could be. His slogan is. You'll feel the difference, charlie. Welcome to the Evita Health podcast. Making People Better series. How are you doing? Very good, thank you for having me. Good to have you back on board with us, charlie, your team leader now SW19, phys physio sw19. I'm guessing you're in southwest london somewhere we almost certainly are.
Speaker 3:We're about as close to windward and station as you can get, but we're sort of adjunct to the vita health group so we're one of their private clinics okay, and uh, team leader.
Speaker 2:What does that mean exactly?
Speaker 3:you are literally, as it says on the can, the leader of the team yeah, we're a captain's armband some days, no, so I am the clinical lead, so I'm a physiotherapist that works inside the clinic. I've been here for, I think, about 10 years, and so I've kind of progressed up the rank, so to speak, and now I kind of run the clinical side of the actual business and how is business?
Speaker 2:is it booming?
Speaker 3:it's not too bad at the moment. It's been a good start to the year. We're just waiting for people to start falling off of ski slopes. That's usually the common thing we get before the marathon rush coming up to March and April.
Speaker 2:I was going to ask you about different times of the year, different seasons.
Speaker 3:You must see different times of injuries coming through the door Sometimes yeah, I think the classics are definitely skiing, with the knee injuries that come in related to that. And then yep the running with the marathon, where people are trying to kind of get physically fit and then they're pushing it a bit too hard, too close to the date, so we get people coming over how mary shot in sort of april going I've got to run a marathon in two weeks time, can you help me? It's like, yeah sure I'll work miracles. And then Christmas is the season for festive back pain, unfortunately. So it's not uncommon to have sort of that flare up at the end of the year.
Speaker 2:And, again, the treatment depends on what the injury is, I guess, but it can vary widely, can't it?
Speaker 3:It can, yeah. So obviously we try and take a sort of assessment focus based on that and see what we think is relevant for most patients. It can be anything from sort of manual techniques, but usually you would associate what we're doing with some exercise basis whether it be kind of strengthening or stretching, and that would then progress depending on patient needs with regards to their goals that we kind of set in the initial couple of sessions.
Speaker 2:So, in terms of your work itself, charlie, do they come? They come to you. Do you go to them? How does it work?
Speaker 3:Yeah, so they come to us. We sort of see varying different people from all age groups, from pediatrics so kids in English through to the elderly. But we seem to have a bit of a niche here in Wimbledon which is kind of the weekend warrior people, where they're busy at work during the week and then they're kind of doing sort of not extreme exercise but lots of exercise over the weekends. So we kind of try and put them back together again. We've had people from far as field as India and America come specifically to see us, which I think is mad. But you know, it's great that we're kind of that popular.
Speaker 2:And, as you say, the weekend warriors. People do that. They work all week in the office, maybe at home or literally at their place of work, and then work all week in the office, maybe at home or literally at their place of work, and then they go headstrong into that running, that cycling. We're going to focus on cycling today, but they just go headstrong into it, don't they, without any sort of gentle lead up, and I'm guessing that's where you see the problems yes, certainly.
Speaker 3:I think you'll find that a lot of patients when they come talk to you, that you're kind of going through their exercise regime and you're looking at the levels of what they're doing and thinking like you're you're at the same level as a same professional athlete or professional athlete who's getting paid to do this job, and so it's difficult for them to try and match the work-life balance and keep a kind of high exercise load about without creating injury. And that's where we come in to try and ground them a little bit but also guide to ensure that we reduce their injury risk yeah, and I guess they go head strong into it.
Speaker 2:You know, without any gentle lead up and they think I've been injured. Do I want to go through this again? They probably give up. They don't go back into that exercise routine or even worse, they keep going.
Speaker 3:Yeah, which is probably more common. In southwest london, we see a lot of those kind of headstrong people who just will not stop. Anything like you're, you know, you should really stop before you create a serious injury, but they just, they will plod on, even with our advice, okay.
Speaker 2:Well, we want to focus today on cycling, which is great because it's something I do myself. I'm not a serious cyclist. I am going to join a club this year down. I live down on the coast in kent, so there's a couple of good cycling clubs around here, but cycling generally a safe exercise, charlie yeah.
Speaker 3:So apart from other road users, it tends to be rather safe. It's all to do with kind of a cumulative load on the body. So if you take something such as running, you know you're putting quite a large amount of force through your joints as you're hitting that tarmac or hitting that trail, and you know some studies have shown that that can be anywhere between sort of 1.5 times your body weight to five times your body weight. So you know you're looking at a larger cumulative pressure going through those joints and with cycling you're not getting that. So it's it's probably what we would class as a non-weight bearing exercise, because the forces involved are much, much lower. Yes, it puts strain on other parts of your body, but it's not at the same level as you would get with something a bit more high impact and when you say high impact, you're thinking about running and that sort of exercise, I guess so many different sports you can have impact in different ways.
Speaker 3:I mean, you could look at somebody who plays high level squash and you know their shoulders under a lot of pressure. But yeah, running's the one we would probably compare it to, simply for the fact that it's one of the most popular kind of weekend sports or the things that people can fit in day to day, and that's where you know we tend to suggest that you know, actually, if your knees not in fantastic condition, have you considered cycling rather than running? Because you can. You can get away with higher level of exercise with less chance of injury.
Speaker 2:And, in terms of cycling, you mentioned the fact that you know it's a reasonably safe exercise. What repeating injuries, though, do you see with cycling coming through your doors?
Speaker 3:A lot of it's tied to your general fitness levels. So ie you're doing too much for the level that you are. You get overuse injuries. So tendon related problems where your muscle strength or your tendon quality, which is kind of linked to your muscle strength and your flexibility, is not in keeping with what you need in order to want to do the level of sport that you're trying to achieve. So like hamstrings will be a big example with cycling or something called your hip flexor, which is a really large muscle in the front of your groin region which brings your leg up towards your chest. So you think about the cycling action. It's kind of quite highly involved. But then it could be anything related to posture as well, and I know we're going to have a bit of a chat about bike fit later on, etc. Which is where most of our injuries will occur. Is that actually you're the bike you've got? It's not quite right for you, in which case you're creating again pressure and irritation and again with that.
Speaker 2:It's good to go to a proper cycling shop with proper trained staff and have a an expert fit for that bike that you're going to be on yeah, the bike.
Speaker 3:It's a dark art, I must admit. The science behind it is a little bit gray in some regards. Um, and it is all dependent on the skill of the person that's doing the bike. Fear, but also that kind of trial and error that you need because it's all about that subjective feedback how comfortable do you feel? How much training can you sustain in that position? You know most road bikes are. You know it's not something you want to sit on, not without wearing padded shorts and being in the right gear, because they're not comfortable I know that from experience yes, unfortunately same I have plenty of padded underwear and uh, and trousers and shorts and what have you.
Speaker 2:I'm lucky where I live because it's all fairly flat and I'm by the sea down here, so we've got all the sea walls and, uh, the romney marsh in kent is very flat. I've yet to master the art, charlie, of hill climbing. So any good tips practice?
Speaker 3:more it's. It's a. It's a really difficult one. I mean, there are no friends on a hill, so if you go with a group of people, they will leave you behind if you're a bit slow. So, yeah, practicing it, making sure you, if you want to be good at no sort of hill climbs, then you need to make sure your training is is suitable to do so. There's no point training on a lovely flat coastal path if you want to go up a hill, but then you learn how to use your gears properly. They are there to help you and ensure that you're maintaining a nice cadence. So the amount of revolutions, essentially, and the pace at which you're doing that when you're cycling, and if you can maintain a good cadence, then you'll get up it eventually. It still might not be much fun, but you'll get up it.
Speaker 2:We've got a couple of mean hills around here. I've got to master, I think Just a bit at a time, then come back down, then go back a bit further the next day, I think.
Speaker 3:I don't remember Kent being that flat, so I'm pretty sure it's quite hilly. Yeah, it is in places. Yeah.
Speaker 2:Talk to me about the arthritic knee joint then.
Speaker 3:I know you want to focus on one of those exercises that we would recommend for an arthritic knee joint. Usually you'll see if you've had an x-ray of a knee radiologists will talk in three languages which is mild, moderate and severe, depending on the level of degenerative change that's occurred inside that joint. And you know cycling is probably more your moderate to severe when we're using it in this, in this format which is it's the idea of trying to maximize range of motion and to keep that knee bending and straightening as much as it can and to kind of build up a little bit of strength but also reduce discomfort and pain. So it's it's very different to the cycling you might do to want to try and get fit. It's more to do with just actually your condition. So the recommendation would usually be sort of 20 to 30 minutes of low resistance cycling, normally on a static bike daily. But when we say low resistance I mean you don't even have to turn the thing on, it's just to kind of get the legs spinning and get it moving.
Speaker 3:And there's some really good kind of empirical medical evidence in this which the numbers kind of support that you know doing this consistently can be a real benefit to movement and comfort consistently can be a real benefit to you know movement and comfort. But you know, anecdotally I've seen it for years is that people's knees who have been clinging on you know waiting for replacement surgery and you know there might be reasons why they can't have it yet, so it's they're too young or, you know, they're a bit hospital phobic and essentially doing this cycling has prolonged that joint for much longer than the sell-by date and do you have, like um, material supports to put on the leg for an arthritic knee joint?
Speaker 2:if you're on a bike, you know, and you're having a bit of pain, is there something you can put on your knee for that?
Speaker 3:I would tend to try and avoid bracing it, so to speak. You kind of want the knee to move and, again, because it's a non-weight-bearing exercise, there isn't that much force going around it, it's just the angle at which you're creating. So, rather than wear a support, maybe try putting the seat up a level to actually mean you hate you. You're not going into such a deep knee bend, which you will find much more comfortable. There are products available for day-to-day use with regards to offloading a joint, but they're quite restrictive, so trying to do something a bit more active on them might be a bit uncomfortable, kind of bit of chafing and rubbing and and generally not not a very nice experience all right.
Speaker 2:Thanks a lot, charlie. Let's come back. We've touched on it before, but the importance of that correct bike fit, that is so important, isn't it?
Speaker 3:it is and it's like I said, it's a bit of a dark art, because, although there's good evidence to support you know what bits you should be looking at. Each person is is slightly different and so you need someone to look at it with you. I mean most people who kind of buy their first ever road bike, kind of give it a go themselves and quite quickly find out that it's not the most comfortable thing to be sitting on for four hours on a sunday. But there are some key things you should be looking at and I think if you're at a kind of a good level and you're thinking about using cleated shoes so shoes that you physically clip into the pedal the first thing you should check is what is that cleat doing? You know where is it pointing? Because if you've got a knee that naturally sits at 10 and 2, but yet you've fixed your cleat at 12 o'clock, you're now making the knee move in a different arc of movement that it's not used to.
Speaker 3:So having a look at that would be my number one thing and before you start changing anything else on the bike is see how that goes, because if you start fiddling about with one thing and then something else and something else. You don't know the effect of what you've actually done and those variables are too great in order to actually see if any benefit. I always think I describe it to my patients like trying to adjust the picture frame is that if you move one side and the other side too quickly, you'll never get it level. So you know, small, marginal changes are probably much more of benefit.
Speaker 3:The thing I would say is the probably the most important would be your saddle height as a second point and trying to measure that is again quite difficult, but just as a an arbitrary fix, just so people can try this at home, if you get your pedal so it's pointing down at six o'clock, so towards the ground, and you're sitting on your sitting, on your bike, sitting on your saddle, if your heel can touch the pedal and it's just about floating on it, then that's about right for you. If your knee is bent when your heel is on the pedal, when it's pointing at six o'clock, your saddle is too low, it's got to go up. And if you're floating in midair and your heel is nowhere near your pedal, then again your seat's got to go down, it's too high and it's just a kind of a rough, a rough guess, just without looking at it properly so those are the two main factors to bear in mind then when you want to get that correct bike fit.
Speaker 2:But if you're unsure, you know there's a plenty of cycle shops around. Just go in there, see the guys, see the girls in the shops to get some expert advice definitely.
Speaker 3:I mean we're blessed with, like, some really good independent bike shops in this country. I mean they're all like anybody who's into their cycling. If it's a bit of an addiction, unfortunately and it will you will hemorrhage money once you get into the sport. I do pre-warn you present company included, so it's. But I would always go and see those guys who work in independent bike shops. They know their stuff, they're so passionate about what they do and they've seen everything you can think of and they're going to give you a really nice bespoke look at what you need. I mean, and also some physio companies actually do provide bike fits. I do bike fits for my patients as well, where I can have a look and they can bring in their bike and we stick them on a little rolling road type bit of equipment and I have a look at how they're set up just to make sure that they are as comfortable as can be and, of course, as you say, once you get into it, you, you, it's, it's hard to give it up.
Speaker 2:It's uh and you do. You're right, you do hemorrhage money, uh, spending, spending on all sorts of bits and pieces for the uh, for the session on the bike. Talk to me about the need for strengthening and, you know, having a bit of a program for that, and also also the issue of bone density.
Speaker 3:I think in every kind of activity, in every sport, we tend to get so laser-focused into the thing that we like to do from running to cycling to badminton, whatever it may be is that we forget that that sport or that activity puts a degree of stress on your muscles and on your joints. You need to ensure you've got what we call a good conditioning programme in the background. So you need to ensure that you're not just maintaining your general fitness through the sport that you do, but you're ensuring that your muscles are strong enough to deal with what you're asking it to do. And cycling is no different to that, although it's non-weight-bearing. It's very important that you start to strengthen things such as your core muscles or your hamstrings to ensure that you're not creating injury with repetitive use.
Speaker 3:Going on to the bone density bit, again, there's kind of positives. With every activity. There's positives and negatives. Is that with cycling, if you're a complete cycling addict and all you do is cycle and you're not, you're not walking anywhere, that much you know. You're not doing any compound exercise where you're lifting weights or whatever it may be, is that you are not putting enough force through your, your skeleton, essentially to help with bone growth essentially, and if that force isn't going through you, you can find that some cyclists have a slightly lower bone density much more common in our female cyclists than our male cyclists or people, for example, have, like, significant IBS or something like Crohn's disease. They need to be really wary that their bone density will suffer if they're just doing this kind of form of non-weight-bearing exercise program.
Speaker 2:How does that differ? Then? I mean what happens to them?
Speaker 3:Yeah, so bone density generally changes with age. How does that differ then? I mean, what happens to them? Yeah, so bone density generally changes with age? Um, you'll find that you'll you'll probably have family members that have been described as osteoporotic or osteopenic these two different well-known bone diseases that seem that your bone density isn't isn't as good as it should be. So the more weight-bearing exercise you do as you get older, the better to maintain that structure, and the more force you put through the bone, essentially the more these little organisms inside the bone respond to that force and then start layering down this calcified tissue to ensure that they remain strong. And unfortunately for women with menopause is that you will find that hormonal changes change your bone density, and it's much more prevalent in our female cohort than our male cohort, and it's vital that they are doing some form of loading program to protect them from that and what about training at home, you know, on a static cycle, a static bike, would that help?
Speaker 2:would that help to increase that density?
Speaker 3:yeah. So because it's again non-weight bearing on the bike, I probably would say you need to still do something something else. So squat style exercises or something like a hamstring bridging exercise or you know, just picking up a couple of weights and, you know, doing some walking around the house can even be a benefit to you. With every sport you need variants. You can't just do this. The thing that you want to do, you know all the time, because essentially you're, it's an overuse activity. So the more you can vary what you're doing, the more benefit you'll have in maintaining your exercise capacity but also protecting you from injury and what about your core stability?
Speaker 2:the importance of that with the bike, yeah, so you're not really using your core.
Speaker 3:On the bike you've got, you're sitting on a, I would say, comfortable saddle, but that's not true. You're sitting on something, you're sitting on something and then you're you're supporting the rest of your weight on the handlebar, so your stomach will often kind of just drop forward. If you're lucky to frequent richmond park at any time and see some of the slightly older gentlemen cycling around, you might notice this and realize that their stomach might be slightly protruding in front of them because their cord's just not working in that position and because your back's at an angle on something like a road bike, that's, you know, actually not that great for your back to being in that kind of a slightly bent forward position. You need that strength in order to protect you. So working on your core muscles is a great benefit. How do you do that? What's the best way of doing? Yeah, people often go down the kind of the plank road, so that's one of the most horrible exercises in the world, I think I've got to say I'm pretty good on the plank at the moment.
Speaker 2:I'm doing all right on the plank that's good for you. It was, it was murder to start with, but I'm getting there no, I tried to avoid it like the plague, essentially.
Speaker 3:Um. So planks are good, they've got their place, but they're actually quite a high level exercise. So congratulations, glenn, for doing that. But you need to kind of start at a lower level.
Speaker 3:So the muscles that people think their core exists of, as they talk about what you would know, is your kind of six-pack muscles or the muscles on the outside of your abdomen called your obliques now, that's not what we mean by core. There's a deeper set of muscles that act a bit like a corset around the spine, called your transverse abdominal muscles, and they are usually a bit more tricky to get to activate and how to kind of load them properly. Pilates is is the way for that usually, or a form of that style of exercise, but you need someone to go through it with you just to ensure you're doing it correctly, because if you're starting in the wrong place or you're contracting the wrong muscles, it's unfortunately a little bit of a waste of time. So you've got to get a little bit of an assessment just to make sure that you know yes, you're doing it right Now you can start building up from here.
Speaker 2:All right, that's great. Thanks for that, charlie. It goes without saying, doesn't it? If you're out on that road bike regularly, it's good to get it checked over at least once a year. Isn't it a proper servicing bias? You know, if you know how to service a bike yourself, so be it. But I always take my cycle to the shop down the road not far from where I live, about three miles away. The guys there are great. They go through a little service program. It cost me about 30 quid to get it serviced. It's money well spent, isn't it?
Speaker 3:yeah. So getting your bike services like the same as you would service your car. It's vital you can be traveling at quite high speeds on a bike, especially if you're hurtling down a hill at 40 plus miles an hour. You don't want to find out that your brakes aren't working correctly or your tires aren't good enough. So definitely working on that. But my number one take home is wear a helmet, please. Partially, obviously, I work with Vita Health Group at Physio SW19, but I also work in the NHS still, and I work in trauma. So I often work in A&E essentially, and unfortunately there's some very nasty injuries that can be sustained without wearing a helmet. So if there is one tagline, the minimum thing you should be taking away from today is please, please, please, wear a helmet, and they are lifesavers.
Speaker 2:Great advice, charlie. If anybody wants more details about Physio, sw19 and also Vita Health Group on how they can help, maybe you know if you're a cyclist and you want a bit of help with some physio through your cycling activities, what's the best route of getting in touch with you?
Speaker 3:Yeah, so you can kind of look up our services. We've got our physiosw19.couk website or you can go to vit health group dot co dot uk to pick up some information around that as well. Or, if you know, if anyone's got any specific questions they want to ask me about what I've been talking about today, use my email address, which is c dot bradford at physio sw19.couk now I've got to ask you very quickly and finally are you a fair weather cyclist or do you go out all year round?
Speaker 2:what's, what do you do, charlie?
Speaker 3:no, I'm not a fairway cyclist. I I have no problem cycling the rain or the cold. The one thing I don't do is strong wind.
Speaker 2:We get plenty of that down here on the coast. Charlie, great to talk to you. Charlie bradford there from physio sw19, you'll feel the difference is their slogan. And, of course, charlie very much involved with vita as well. So if you'd like more details, head, head over to the respective websites Details coming up. But, charlie, thanks for joining us today on the podcast.
Speaker 3:Thanks, Glenn. Thank you for having me.
Speaker 1:Thank you for listening to this Making People Better podcast, part of the Wellbeing series from Vita Health Group. Improving your lives, physically and mentally, drives everything we do, and getting you back to doing what you love is our priority. Vita Health Group making people better wwwvitahealthgroupcouk.