Welcome to our site. We provide musculoskeletal therapy, rehabilitation, performance training and education to members of the public and health and fitness professionals via one-to-one appointments and both formal and informal group workshops. Start here if this is your first visit.

Fit for LIFE

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Feeling well begins with being as fit for life as possible, as life is the foundation that everything else is built upon. It is quality before quantity. It is the efficient, fundamental function of your body. It is well aligned posture and movement competency. It is balance and control. It is resilience to the day-to-day tasks and the stresses and loads life places upon your body. Develop a better functioning body and you'll become better at whatever you choose to use that body for!

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Fit to MOVE

Fit to move builds upon a sound foundation by placing increased demands upon the body to develop enhanced levels of control, strength and endurance across more demanding and complex movement patterns. It is increased resilience and the capacity to master control of oneself. Fit to move is tuning the high performance human.

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Fit for PERFORMANCE

Fit for performance focuses on the development of high level activity-specific attributes. Be it for your sport, the physical demands of work or that challenging event you've signed up for. Injury typically increases with activity specificity, particularly when combined with repetition. Fit for performance provides the capacity to perform at extremes whilst minimising any compromise of technique, control and subsequent risk of injury.

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Good days and bad days with chronic pain. Identifying triggers of pain.

by websitebuilder • 1 September 2021
** usual opening caveat: it is well beyond the scope of this short piece to address myriad pretexts and contexts and as such this represents one opinion aimed at ‘most people, most of the time’. Just a short one today and here’s the good news first; if you have good and bad days with your pain you almost certainly have the capacity to influence those days to increase the good days and reduce, if not totally eradicate, the bad days. Whilst this may feel like it doesn’t apply to you if you’re in pain right now, something is making those days better and worse and the likelihood that those things are both identifiable and modifiable is fairly high. It will of course require accurate diagnosis and most certainly take considerable effort and consistent dedication to the good cause to make a change but – and this deserves repeating - if you have good and bad days you’re likely to have the capacity to take control of the factors which cause the bad ones. This is a pertinent place to draw attention to the opening caveat with a reminder that if you have non-mechanical pain this may not apply to you in quite the same way. Although don’t forget that trapped nerves, bulging discs and similar may have a neural element to them but they can still be considered mechanical by virtue of whatever is trapping or aggravating them. It is also worth mentioning that just because pain is long-term does not mean it isn’t intermittent or modifiable. If you have good days and bad days…… The first step in identifying triggers of intermittent pain is self-awareness, in order that we can identify specific combinations of motions, postures and loads which cause pain. The tricky thing is to narrow these pain triggers down to precisely which combinations are troublesome. A painful posture at work may not be painful at home when load or other subtle motions may be absent. For instance, bending forward to tie your shoe may not be painful; bending forward whilst stretching to reach something with one hand may be painful. In addition to this, the pain may not occur at the time of the trigger. But, pain always has a cause. Always. Here are some suggestions for a starting point to identify pain triggers: · Identify specifically what hurts e.g precisely which muscle/tendon etc (not just ‘shoulder’) · Identify, if possible, specific motions/activities which aggravate your pain (consider during and after) · Identify postural deviations (not just static posture but your ability to maintain form during motion) · Identify imbalance e.g left-right difference in joint range of motion · Identify strength imbalances (side-to-side, top-to-bottom, front to back) · Identify excessive movement behaviours e.g sport or work-based repetition · Identify how varying loads affect the above This list is of course far from comprehensive but provides a decent starting point to developing awareness of factors which may contribute to your ongoing painful problem. It is worth mentioning of course, that you could identify significant factors from the list above and have no pain, but these factors help form a picture from which to make a diagnosis and at the very least give you a head start in tackling your problem. Remember: pain doesn't always mean STOP but it's a good idea to PAUSE until you find out what it does mean, just in case.

Does bad posture, asymmetry and imbalance really matter?

by websitebuilder • 1 September 2021
** usual opening caveat: it is well beyond the scope of this short piece to address myriad pretexts and contexts and as such this represents one opinion aimed at ‘most people, most of the time’. For many years we were told that bad posture would send us into a downward spiral of pain, increased risk of injury and ruined performance. Fast forward to today and we have a plethora of resources insisting bad posture does non of those things. What changed? As with many things in the health and fitness industry trends and ideas are often quick to come and go. We are after all, a relatively new and evolving industry and what starts out as a nice idea for one person on one day quickly becomes all things to all men and it takes the confusing passage of time – read; experience – for us to realise that general rules do not always apply to specific circumstances and vice versa. And so with a full swing of the pendulum we throw the baby out with the bath water and many trainers and therapists who would once have assessed you to within an inch of your life now pay total disregard to posture and movement symmetry. It is of course true that many people live for many decades with bad posture, movement dysfunction and imbalance without any ill effects whatsoever. It is equally true however that for others, two days of unusual slouching can cause tremendous discomfort. Most of us of course, are somewhere between these extremes and this is just one reason why posture, movement dysfunction and asymmetry should always play an important role in assessment but should never get the blame for every ache and pain simply because they are present and we don’t have any other answers. So, are posture, asymmetry and imbalance really important? Or more specifically, when are they important and why? Firstly, let’s consider when they are not as important. To be clear, I still believe these factors should be assessed and considered even if they will likely be deemed to present no significant, immediate detriment. High level athletes. As a general rule, high level athletes experience asymmetry and imbalance as a direct result of getting great at their chosen activity. An obvious example being significantly increased strength, endurance and range of motion in the dominant arm of squash players when compared with their non-playing arm. If this extra performance is developed appropriately and alongside a relevant care plan this increased capacity is likely to be not only perfectly healthy and risk-free but indeed absolutely necessary. Now let’s consider a more recreational squash player who is largely sedentary off-court and presents with less-than-optimal range of motion across several joints but has greater than normal range of motion in only their playing arm. Whilst this does not necessarily predict injury it most certainly needs to be considered when developing a training program as they will often have developed their increased motion via sub-optimal biomechanics and have a lower level of general fitness and therefore are potentially less resilient to the stresses they are exposing themselves to on court. Add to that, the fatigue from a full-time job which also adds stressful load to the dominant shoulder and the risk of injury increases considerably. This is not due to any single risk factor but to the accumulation of several factors. The removal of bad posture or workload or low resilience or general tightness could reduce this individual’s overall risk of injury to below their tolerance threshold. Equally, 8 hours overtime at work next week could be enough to tip the scales the opposite way. The fact that we typically only learn our threshold retrospectively is why all things should be considered prospectively.  Short version: · Bad posture does NOT necessarily mean pain or predict injury · Asymmetry and imbalance does NOT necessarily mean pain or predict injury · All lifestyle factors combine to establish overall risk level · Bad posture, asymmetry and imbalance can disproportionately load and fatigue tissues which may also be relied upon for full-speed recreational/work activities · We often only realise our threshold for injury when we cross over it! · Don’t ignore bad posture, asymmetry and imbalance just because they may not be the cause of your pain and may not increase your risk of injury because they also could do! Remember: pain doesn't always mean STOP but it's a good idea to PAUSE until you find out what it does mean, just in case. I hope that helps.

Low back pain

by websitebuilder • 1 September 2021
** usual opening caveat: it is well beyond the scope of this short piece to address myriad pretexts and contexts and as such this represents one opinion aimed at ‘most people, most of the time’. It is estimated that around 85% of us will experience pain in our low back at some point during our lives with around 40% of the population visiting a healthcare provider for treatment. This comes at an annual cost of over £1 Billion. This combination is something unequaled by other conditions. In addition to this, the overwhelming majority of these cases are described as chronic and 'non-specific', with this type of pain typically being attributed to life's general aches and pains. However, low back pain is often far more debilitating than pain experienced elsewhere in the body. Low back pain is often a highly complex, multi-factorial condition which rarely receives an early diagnosis (we typically don't stop until we have to) and as such, this increases the complexity of reliable diagnoses. What we DON’T know about low back pain: · most things. What we DO KNOW about low back pain: · surgery, injections and medication is rarely a solution. · pain with movement isn't always bad. · MRI scans rarely show the cause of back pain. · 'flare ups' do not necessarily mean more tissue damage. · ‘getting old’ is NOT a cause of low back pain. · complete rest is neither necessary nor a solution. · lifestyle and movement retraining is crucial. · most people fail to properly engage with movement-based interventions. · most back pain comes back. The overwhelming consensus is very clear; medication, cortisone injections and surgery are not solutions to ongoing back pain. That is not to suggest that these things are never helpful or that they do not represent a potential element of treatment for some people, some of the time! It is important to be aware however that even in cases where surgery, for instance, is necessary - that all other conservative interventions should be adhered to, and exhausted, prior to surgery becoming an option. Here, adherence is key. It's true, exercises for back pain can be boring and may take some time to take effect even with dedicated consistency but given the amount of literature available which clearly outlines the need for therapeutic exercise interventions even after surgery in order for surgery to be fully effective it is impossible to ignore the benefits of improving stability, movement quality and habitual movement strategies. At the very least, it will increase your resilience to surgery and put you ahead of the game recovery-wise if more invasive interventions are eventually necessary and in many cases the preparation negates the need for these other interventions altogether. In short, dedicating yourself to a properly supervised program of suitable movement retraining is a no-lose situation. Exercise-based interventions One of the most often overlooked factors in habilitative exercise programming is that strength and stability are not the same thing. We need to be stable before we are strong. Not only can excessive 'bracing, squeezing and clenching' often exacerbate symptoms but such effort can simply not be maintained for long periods. There are 168 hours in each week and your body needs to be properly supported and pain-free for all of them. That's a lot of bracing, squeezing and clenching! Appropriate stability then is more often the answer although strength and endurance must clearly also play a role. Whilst the exercise interventions for low back care are as vastly varied as low backs themselves, there are a number of exercises which have been consistently shown to help most people, most of the time, including three exercises which are almost always helpful in offering quality stability in a relatively spine-sparing manner. So much so that Professor Stuart McGill, world renowned low back specialist, refers to them as 'The Big 3'. These are the bird dog/superman, side plank and modified curl-up; of course they come in many guises, progressions and regressions. Lifestyle modifications Lastly, modifications to the ways in which we move daily can play a huge role in the way we manage long term back pain. Stuart McGill has published an amazing resource called Back Mechanic aimed at the lay person, to be used in conjunction with a suitable professional and in it he offers many methods of self-evaluation and modification of daily tasks in order to avoid and manage painful movements. I have recommended this book many times and have yet to receive bad feedback from anyone who has purchased it. In summary; surgery is sometimes, but very rarely the answer and is not intended to be a stand-alone solution for low back pain. Back pain can mostly be managed via adjustments made to habitual lifestyle choices, movement strategies and an appropriate exercise program. This strategy should always be included in low back care, whether as a stand-alone intervention or as a precursor to surgery or as a conclusion to surgery. It should focus on improved motor patterns, function and stability with strength and endurance being developed once these have been achieved. It takes dedication and consistency. That is easy to say although often difficult to maintain but it is never wasted effort! I hope this helps. Remember: pain doesn't always mean STOP but it's a good idea to PAUSE until you find out what it does mean, just in case.
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Testimonials

Prehabilitation to rehabilitation

I value Zak not only as someone who looks after my wellbeing but as a friend who puts himself before others. Zak managed my transition from a worn out hip to a shiny new one. He prepared me for the hip replacement and helped with a faster recovery. His holistic approach is backed up by his skills in many areas. My wife and I had already been his clients for years before.  We had benefited from his skills of diagnosis, treatment and analysis of outcomes. As I was getting worse waiting for a hip replacement, he slowed my decline.  He gave me exercises to keep me mobile, strengthening muscles around my hip.  This reduced the pain I experienced. He did therapy on leg muscles which were working harder. He used Kinesio tape to support muscles around back and knees. The benefits of his work were demonstrated on the day after my operation.  I was able to impress the hospital physio and the NHS wanted to send me home that evening. After the operation, he concentrated on making me walk properly.  This impressed the post op NHS physio who thought my movement and my response to new exercise was really good. Zak is to blame for both of these.

I would recommend Zak not only as a PT, but as a therapist, his dietary advice, and councillor.  He sees you not as a body part with a problem but a whole person.


A A. Sheffield

I have worked with Zak for a few years now, having seen him work with clients for many years before that. I began 121s for core and alignment. What I didn't realise was how much more I would gain! I learn so much in every session, not just about anatomy and my body but also from Zak as a wise and wonderful human being. I've gained confidence in body movement when Zak challenges me which has given me the confidence to try new things. He has an amazing understanding of movement and the body and is keen to help me understand this too. I say that everyone needs a bit of Zak in their lives. As a wellness coach and personal trainer myself, I refer my own clients to Zak and would recommend his services to anyone. Even if your goals are to simply move better, prevent injury, have someone review how you move, you will find you get your money's worth time and time again and who doesn't want to live to their 80s and 90s and still be as active as ever? I certainly do! Thank you Zak for your part in that.


HF, Health and Fitness Professional

I originally attended a workshop relating to movement hosted by Zak in my local gym and was genuinely staggered by the quality of the information. Having spoken to many therapists, doctors and consultants I asked a question about an existing knee issue and I was given information and advice I had only ever received once before by my final consultant who was reputed to be the UK’s top knee specialist and who’s status was definitely reflected in his fees. I would highly recommend Zak as a first port of call for such consultations. If I'd found him sooner I would have saved hundreds and hundreds of pounds and have gotten to the bottom of my problem much sooner!


RG, Workshop Attendee 
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