Over the course of 20+ years as a physio, working with everyone from teenagers, to stressed-out lawyers, to stay-at-home parents, to Special Forces soldiers, to athletes, to world champions, to centenarians – I’ve learned that there are some basic principles that underpin all our health. And when we ignore them, we are much more likely to get sick or injured. This is why I created the Health & Performance Pyramid, which looks not only at your joints and muscles, but also more holistically at your overall health, as this impacts on your ability to heal and to get back to full strength and function.
The importance of this came home to me in 2014 when I went on the holiday of a lifetime (for a tennis geek like me!) – a trip to Croatia, to train with Goran Ivanisevic himself at his academy. Before the trip, however, I was in the middle of trying to relocate my physio practice, as the lease on our old place was ending and I was desperately trying to find a new and bigger space for my expanding therapy team. I had spent months working and arguing with lawyers and planning officers, and I was pretty stressed-out, not looking after myself as I usually do. I was being inconsistent about drinking enough water, drinking too much coffee, eating on the run too often, and generally burning the candle at both ends – but I was really looking forward to my holiday!
On the first day, I stepped on court, warmed up properly, and started training. I was hitting the ball well, my adrenaline was flowing; I was moving well and with good control. And then, two hours in, I bent to hit a low volley – and disaster struck. Out of the blue, I felt a ripping sensation in my left leg, and it gave way as the gastrocnemius muscle in my calf tore. I couldn’t put any weight through my left leg, and had to be helped to a chair.
I knew instantly that it was a bad strain – known technically as a grade II, where fibres are torn but the whole muscle hasn’t ruptured. It was bad enough though: I could put my finger into a hole in my calf muscle, and I couldn’t walk.
This type of injury normally takes around 6 weeks to heal, but (admittedly after a couple of hours of feeling sorry for myself!) I decided to put my knowledge of the Health and Performance Pyramid to the test, effectively to use myself as a case study and see if I could get back on court with Goran by the end of the week – and while I wasn’t fully fit by that point, after 5 days I managed to jog 1km on the treadmill and get back on court, finishing the week – you guessed it – hitting a basket of forehands from the lovely Goran.
So – what is the Health & Performance Pyramid?
The concept that underpins all my work is the Health & Performance Pyramid. It’s my diagrammatic representation of how your health works, and if you have all these building blocks in place, then I believe you should have normal, pain-free function.
Let’s start at the bottom layer, the red Foundation Layer. This is all about the health of the cells that form your tissues and organs. Effectively, if you have the right nutrients going in, and metabolites being effectively flushed out, then the environment within your cells will be healthy, and you will be more robust – more resilient against injury or illness, and quicker to heal should you become sick or injured. But if you aren’t on top of the Big Four – hydration, nutrition, sleep and stress – then your cell environment will be less healthy than it should be, and you will respond less effectively to injury treatment or fitness training. When you come to see me, this is something we will discuss during your assessment session.
The next layer is the magenta Health Layer. This is about pain, which occurs when your movement is compromised (either for cumulative reasons such as dodgy posture, or traumatic reasons such as a fall or a car crash). As you’ve already found, in the assessment session, I aim to work out the underlying cause of your pain – and if appropriate, we’ll then create a package of physiotherapy to help you restore and then build up normal movement patterns through my unique RSM Model, so that not only do we retrain your nervous system into new and more functional patterns, but that the retraining is robust and long-lasting. If you need anything I don’t provide, I also work with a variety of doctors and other healthcare professionals and will be happy to refer you on.
After this, we have the purple Performance Layer. This is about becoming even stronger and more functional, so that you remain pain free, improve your athletic performance and reduce your risk of future injuries – even if you challenge yourself to do something out of the ordinary! If your plan is to get fitter or stronger after you finish with physio and rehabilitation, either because you want to reduce your injury risk for the future, or because you want to do something more challenging (eg sports), we’ll discuss your goals for the future, analyse your current situation (flexibility, strength, endurance, movement patterns, body composition) and work out the best option for you, whether that’s a programme of yoga, Pilates, core, sports flexibility and/or conditioning training, to help you get from your current state to where you want to go.
Finally, we have the blue Sport Specific Layer. This is where we start looking beyond the flexibility, strength and endurance (which you should have by this point!) to more technical aspects of whichever sport you choose to undertake, should you want to. At this point I’ll want to liaise with your own coach to provide you with specific, technical movement patterning drills to help you reach your peak.
Over the next few weeks, I’m going to drill down a bit deeper and explain exactly why the individual building blocks are so important, layer by layer. But if you’d rather experience it rather than read about it – why not call us on 0207 175 0150 to arrange a physio assessment and see how the Health & Performance Pyramid can help you?