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The tragic passing of Mike Ho

The tragic passing of Mike Ho

We received the tragic news of the passing of our friend and former colleague, Mike Ho, who died on Monday 18th March. No doubt those who knew Mike over his years at Bodybalance will be deeply upset at this news.

Mike was a popular and well liked part of the Bodybalance team from 2011 – 2018, helping thousands of patients over his 7 years of employment at our clinics in Hatfield and Mil Hill, including working with Saracens Mavericks, EIS and TASS athletes, and many other elite athlete programmes. Mike was also a guest lecturer to the physiotherapy students at University of Hertfordshire and volunteered each year to help out at the finish line of the London Marathon.

We will remember Mike for his great love for physiotherapy as a profession and his strident desire to always achieve the best outcome possible for his patients. He was one of those people who always genuinely cared for the patient’s interests, and who wanted to give all he could to help them get over their injury and get back to doing whatever was their goal. Mike was also a friend, supporter and mentor to so many of our team over the years, both at work and outside of work. His example always encouraged us to do better.

Unfortunately, like so many other young men in the UK, Mike also struggled with his mental health. We ask that anyone struggling with their own mental health or with the circumstances of a loss such as this, please speak to someone.

Samaritans and Mind both offer free, unbiased support to anyone who needs help.

Samaritanswww.samaritans.org – Ph 116 123

Mindwww.mind.org.uk – Ph 0300 123 3393

Back pain, physiotherapy and the two week ‘critical’ window…..

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The conclusion of a new piece of research into back pain management and physiotherapy has found that patients should receive physiotherapy within two weeks of onset to optimise their clinical benefits.

The study published in 2012 in the medical journal, Spine, was conducted by physiotherapist, Julie Fritz at the University of Utah. A major review of over 32,000 people with newly diagnosed low back pain found that those referred by their GP to physiotherapy within 14 days were half as likely to need surgery or steroid injections as part of their management. The additional economic benefits of the two week window highlighted the reduction of costs with recurring visits and other associated costs (both individually and on the public health system).

Currently the NICE (National Institute for Clinical Excellence) guidelines for the management of back pain recommend manual therapy treatment, structured exercise, acupuncture and the use of painkillers; however there are no suggested timescales or recommendations for when a patient should be seen by a physiotherapist.

This new research has added a valuable piece to the jigsaw of back pain management puzzle by highlighting the significant impact of early intervention physiotherapy in the management of back pain patients.

So if you are experiencing back pain, why wait to see a physiotherapist? Optimise your recovery and long term prognosis and book your appointment now!

Hanging out with Team GB at the Freestyle World Championships

Our TASS physiotherapist, George Labor, shares his experience of working with Team GB at the Half-pipe competition of the Freestyle World Championships in Oslo, Norway.

It had been a long time since I was this excited opening a parcel! Within it was my first bit of National team kit. Inside was a bright red jacket with “Great Britain” on the back – amazing! I had been chosen to work with the Great Britain Half-pipe skiing team at the World Championships in Oslo!

George and the Half Pipe

The trip to Oslo started with a very early taxi at 4.00am. The amount of kit I had looked like I was going away for 6 weeks, not 6 days. By the time we arrived in Oslo and had settled in it was lunchtime so we decided to go for something to eat in the hotel restaurant. I had been warned that Oslo was expensive but £20 for a cheese burger and £9 for a coke (ignore my unhealthy choices) was unbelievable! It was a good burger – but not £20 worth.

Later that evening I met the squad, screened everyone and together we discussed a few areas to work on over the next few days.

The next morning we had a short drive to the slopes where I got to see a full Half-pipe for the first time; they are even longer and steeper than they look on the TV.  I introduced myself to the Sports Doctor and the Consultant Anaesthetist who were very calm and laid-back. They were used to covering ski jumping and they thought that this event was pretty run of the mill in comparison.

I spent the next two days of training getting accustomed to the Half-pipe. I was allowed to walk up the side and sit by the edge which proved a fantastic vantage point but was even more worrying watching the riders performed tricks above your head. Every time a GB rider came down I stood holding my breath. Thankfully it wasn’t for too long or I may have passed out!

The qualifying and finals take place in the evening so leading up to it there is lots of nervous energy around the hotel meaning the days can feel a bit prolonged. But it does allow plenty of time to prepare the athletes for their competition

Unfortunately none of the GB riders made the finals, however one rider did place high enough to get a spot for Great Britain at the Sochi 2014 Winter Olympics, which was brilliant. This was the big aim of the competition so all the coaches and athletes were very pleased. Thankfully all of the GB riders came through unscathed.

Hang time in Osloe

With finals not taking place until evening and none of the squad involved, I was invited to join them on the last day for a session of “leisurely skiing”.  Spending a day skiing with the GB Half-pipe team is not the usual “leisurely skiing” I normally do. We headed straight for the ski park. There were people flying through the air in all directions doing jumps and flips and riding the rails!!  For some reason your brain tells you that you should be able to do this, forgetting, of course, that these guys are talented athletes who have been doing it for years.

Half way up the mini half pipe, completely out of control on a wall of ice, I did remember that I was a physio and not a professional athlete, and had not trained for this; but it was too late. The next thing I knew I was sliding down the middle of the pipe, face first, with everyone laughing at me. I can now say I have skied a half pipe (well sort of) and done a few small jumps, but for the rest of the day I decided it best that I should stick to going around things.

It was a great experience and my jacket has pride of place in my wardrobe.  I look forward to watching at least one athlete that I have worked with during the Sochi 2014 Winter Olympics.

Challenge Barcelona 2013 (part 2)

Nicki Combarro’s second installment in her blog series on training for an endurance triathlon. She is participating in a study at the University of Hertfordshire investigating the effects of training for an ironman distance triathlon.

Nicki on treadmill

So the weeks are ticking by and I am almost half way through my challenge of a lifetime!

Over the past few months I’ve been completing what’s called ‘base’ training – which ensures you have a good grounding in all 3 disciplines before the harder training starts!

My base training is going well, despite my having to spend 3 hours on the turbo trainer (static bike) in my dining room as the road conditions were too dangerous for me to attempt a road session.

After another batch of testing I was really pleased to see that the hard work is paying off; my skin folds and body weight were down and my lactate threshold had increased. (Your lactate threshold is the value your heart rate reaches before your body starts anaerobic respiration… this is a point of no return and cannot be sustained for long, so the aim of our training was to try and delay this point as much as possible).

The excitement of being a guinea pig continued in March and I was subjected to a Dexabody scan – this is (thankfully) a painless full body bone density scan and involves laying on a slab in your pants whilst a machine scans you. The only effort was getting to Middlesex University with 6 inches of snow on the roads! In addition to bone density, the scan was able to give accurate information on body composition – fat and muscle mass. This is something that is going to be redone later in the study to see what improvements have been made!

Nicki on the DEXA scanner (in her pants!)

Over the past month I’ve overcome my irrational fear of cleats and have actually managed to get my road bike on the road! Unfortunately I haven’t yet mastered the ability to take my hands off the handle bars without wiggling in the road terribly, so as a result my hydration and nutritional strategy on the bike is not going so well. I must also apologise to the other road users as my hand signals are not very confident and I tend to hog country lanes – but I am sure with more practice this will improve!

I’ve fixed my first puncture (although it took 3 of us to muster the strength to pull the tyre leavers!) and upgraded my saddle to something a little more comfortable! If only I could transfer my power generation from the turbo trainer onto the road – I would be awesome!

Nicki sharing her expertise in the field of puncture repair

Current training is now in 3 week blocks with the weeks being medium, hard and then a recovery week. After a bit of guidance from Nick Juba, coach at Hatfield Swimming Club, my swimming is also going pretty well and I can now comfortably manage to swim 3km in 1hr10. My technique is still not the best but after being told that the swim part of an ironman requires 9000-10000kj of energy and with you only retaining 3000kj in your body normally, I’m trying to work on energy preservation so that I can get out of the water and still have something left in my legs for the bike and run!

With all this hard graft I’m starting to notice little niggles, especially in my knees as a result of my tight ITB’s. I’ve made friends with a foam roller and now spend many a night rolling around on it in my living room – often with tears rolling down my cheeks! I even had my first ever Sports Massage session with one of the Bodybalance massage therapists; an experience that I’ll never forget!

So what ‘s next…?

Basically, the distances start getting longer over the next few months:

  • Swimming increasing from 3km – 3.8km with the additional excitement of open water and another irrational fear I need to conquer….. JAWS!
  • Bike increasing from 80km (4hrs) to 150km (6-7hrs)
  • Run increasing from 15km to 30km.

Challenge Barcelona 2013 (part 1)

Nicki Combarro has signed up to take part in a research project to investigate the effects of training for an endurance triathlon. Here is the first installment of her experience.

Challenge Barcelona 2013

The count down has begun…..

With 7 days left before I start the biggest challenge of my life, I am beginning to ask myself why?

Why, when I am a working mum with 2 young kids, did I think it would be a good idea to take on the challenge of an endurance triathlon? I have moderate fitness and am a competent swimmer however the challenge of swimming 2.4 miles, cycling 112 miles and running 26.2 miles had obviously not sunk in when I volunteered to be part of the Challenge Barcelona research study at the University of Hertfordshire. Why?

When I first heard about the research project of Sport, Health and Exercise Research Group at the University of Hertfordshire, I was genuinely very interested. Lead by Dr Justin Roberts, the group are conducting numerous studies on a volunteer group of 80 amateur athletes training for an endurance event (the Challenge Barcelona endurance triathlon). The project will put the participants though a specially designed training program and will investigate the training effects, nutritional impact, immunological changes and incidence of injury in the cohort.

My husband had already signed up for the challenge and my interest was growing the more he talked about it. But do I have the physical ability to cope with the training? Will I have the mental strength to complete all the training? Will I be able to manage my body and stay injury free? I’ve worked with elite athletes for years, but how will it feel to be the athlete for once?

So, in a moment of weakness I signed on the dotted line and sold my soul in the name of scientific research!

Nicki on treadmill

With the start date of the training program being 21st Jan, I spent 4 hours last week in the physiology testing lab at Hertfordshire University having my baseline measurements taken. In summary this involved fasting overnight prior to having some blood samples taken and a resting ECG to check that my heart was up to the challenge, followed by skin fold testing. (Having your skin folds tested and measured 3 weeks after an indulgent Christmas, was not a pleasant experience).

My morning continued with functional screening, tests to look at my jumping ability and strength and then some running analysis on a treadmill looking at my oxygen uptake during exercise.  I thought this was going to be quite easy, however it involved running with a face mask on and that proved to be harder than I had anticipated. Due to the mask and the enforced mouth breathing, my mouth went from really dry and uncomfortable to sweaty and uncomfortable, feeling like the mask was going to slide off my face at any time. Just when I thought the testing couldn’t get any worse I was put onto a static road bike, given a facemask again, then asked to pedal hard while little pin prick blood samples were taken to look at the lactic acid in my blood. I am not sure what hurt most….my legs, lungs or fingers!

To top it all off, I was then put through a VO2 max test on the bike (again with the facemask). Needless to say, I didn’t last very long before my legs gave up!

Nicki Combarro - VO2 max baseline testing on bike

Feeling a little disheartened at my morning’s performance, it was pointed out to me that this was baseline testing and therefore any result was good and will only get better with all my training! Loving this positive spin on my efforts, I left the lab feeling quite upbeat and looking forward to the challenge ahead.

Having completed my psychology profile questionnaire and a current injury questionnaire, I am now eagerly awaiting my first months training plan that starts on the 21st Jan… but first I’m off to Sydney for the Australian Youth Olympics Festival….some sunshine before the hard work commences!

A bobsleigh sprint training camp… IN TEXAS?

Kessie Soper shares her experience of travelling with the British Bobsleigh team to their sprint training camp at the Michael Johnson Performance Centre in Texas.

As part of my role working with TASS (Talented Athlete Scholarship Scheme), I accompanied the British Bobsleigh development squad on a training camp to the Michael Johnson Performance Centre in Dallas, Texas.

You might wonder what the British Bobsleigh team was doing in Dallas in September, where the temperature rarely fell below 30 degrees? So did most of the locals. Pretty much everywhere we went, we were met by a perplexed expression and a surprised exclamation of ‘British Bobsled?!’…

The purpose of the trip was for the athletes to work with the expert team at the Michael Johnson Performance Centre on improving their speed and acceleration. The push start is an essential component of performance in Bobsleigh; the speed at which the sled accelerates at the top of the track is a crucial influence on the final finish time. This is why so many bobsleigh athletes come from the world of track sprinting, and why the British Bobsleigh team travelled to such a centre of excellence in Texas for a sprint training camp.

So after a long and boring flight, everyone was excited to arrive at the hotel and get settled in. My first experience of the local cuisine was quite fittingly the biggest burger, fries and diet coke possibly imaginable! Training started the very next day; the first day consisting mainly of meeting the team, orientation and screening. Screening aims to enhance performance and prevent injuries by identifying areas to improve in flexibility and strength. After the first day, all the athletes had plenty to work on and were eager to get going. The following 10 days involved an intensive training programme. Each day we arrived at the centre early in the morning for pre training preparation. The athletes who needed it came for physio, whilst the others warmed up with the hot tub and completed their injury prevention exercises. The morning session consisted of sprinting sessions, working on the start, running technique, video analysis and plyometrics. The athletes were then encouraged to complete a lengthy recovery regime including contrast bathing, physio and foam rolling. After lunch and a power nap, the athletes completed the same routine, but replacing the sprinting sessions for a weights session.

The centre provided state of the art facilities including an underwater treadmill, outdoor pool, indoor running track, indoor turf and large weight room. It is owned and run by the sprinting legend Michael Johnson. On the second week of the camp, Michael Johnson was at the centre and really inspired the athletes by watching their sessions and providing tips and advice. I admit to being a little star struck after his contribution to the London Olympic Games! The rest of the staff at the centre were amazingly enthusiastic and motivational. There was also a variety of American athletes who train there and also provided a great deal of inspiration to the team.

The trip was intensely scheduled with training, so there wasn’t much ‘down time’. However, we did get to go to an American Football match which was an amazing experience and gave us a real taste of American sport. The hotel was also very conveniently located opposite a shopping village and it would have been rude not to sample the local retail facilities! For me, the trip was a fantastic experience to learn about the intricacies of sprinting technique and to visit a world class centre with such amazing facilities and organisation.

Kessie Soper with British Bobsleigh at the Michael Johnson Performance Centre

Runners Knee: what it is, how to treat it, and how to prevent it!

Treatment for Runners Knee

Runner’s Knee is the common name for “Ilio-Tibial Band Friction Syndrome.” The Ilio-Tibial Band (ITB) is a long band of very strong tissue that runs from the lateral crest of the hip down the side of the thigh, attaching just below the knee joint (you can feel it on the outer side of the knee, just above the joint). Pain is caused when the IT Band rubs across the bony prominence on the outer side of the knee. This causes inflammation and pain; and commonly also local swelling and stiffness.

The ITB has a small muscle component called Tensor Fascia Lata (TFL). TFL sits high in the band near the hip and contracts to pull on the ITB. In doing so it controls the position of the foot as it hits the ground. TFL can also assist to stabilise the trunk and pelvis over the leg as we land in running (but it isn’t very good at doing this on its own). Stability of the trunk is a product of many muscles including the gluteals (gluteus maximus, medius and minimus) and hip rotators. When these muscles don’t work effectively, the trunk and pelvis shift sideways which increases the tension in the ITB. This tension causes friction over the bony part at the side of the knee, resulting in pain and inflammation.

There is some controversy surrounding the anatomy involved but what is certain is that Runner’s Knee is painful and relates to your biomechanics.    Common in running, Runner’s Knee can also manifest in cycling, football and hockey. The symptoms usually come on gradually and can be related to an increase in training volume or hill sessions. Sometimes the symptoms come on more acutely with speed sessions, changes of direction or plyometrics.

Runner’s Knee usually presents as a localised tenderness and swelling over the side of the knee. The knee is stiff and painful at the start of an exercise session before then settling as you get going. The pain returns later on in the session. When more irritated, pain can be more constant. Pain is often worse in the mornings and when moving after periods of rest.

When should I seek help?

There are many different knee problems that affect runners and these need varying amounts of attention. It is important that you always seek medical assistance if an injury occurs from trauma (such as with a specific twisting action) or if the knee gives way or swells in the joint.

With Runner’s Knee, it is possible that the pain may settle on its own with a little rest, ice and stretching, but when the pain persists for more than a few runs, or if it is getting worse, you should seek the assistance of a sports physiotherapist or other medical professional. There are many members of the sports medicine team that are able to help, and a good professional will advise you how other members of the sports medicine team may be able to help you individually.

A good Sports Physiotherapist is usually the best person to see first. They will be able to diagnose and treat your injury as well as give you exercises to help you manage the injury and prevent recurrence. Treatment of runner’s knee is usually fairly straight forward, although can take quite some time to settle down.

How do you treat ITB problems?

The best advice for initial self-treatment is to avoid the aggravating activity and to ice the area every few hours when painful. You can also try anti-inflammatory gels or anti-inflammatory medications such as Ibuprofen which may also help (we recommend you seek your pharmacist’s or doctor’s advice).

The physiotherapist will massage and mobilise the area to reduce the stiffness, as well as show you exercises to strengthen and re-train the muscles that stabilise the pelvis and trunk. The main muscles to strengthen are the gluteals – these can be worked with exercises such as clams, standing hip abduction, step ups and bridging.

Although often recommended, stretching the ITB is difficult and not particularly useful. Stretching the ITB is not as helpful as many people suggest. The ITB has tensile properties similar to Kevlar, so it is unlikely that traditional ITB stretches are not much benefit. It is a good idea, though, to stretch the muscle groups around the thigh (gluteals, quadriceps and hamstrings). Rolling on a foam roller for regular self-massage is a better idea, and Sports Massage can also be helpful.

When the symptoms of Runners Knee take too long to improve or don’t improve, you should seek further advice and management from a Sports Doctor or Orthopaedic Consultant who specialises in knee injuries. A Specialist may request an MRI to confirm the diagnosis or rule out other problems in the knee. In some cases the Specialist may suggest an injection of corticosteroid. Cortisone is a very strong anti-inflammatory drug that acts locally and can settle the pain quite quickly, but should only be used in special circumstances. Where the pain doesn’t improve despite all other interventions, an Orthopaedic Surgeon may recommend an operation to release the ITB, but this is only ever the case for a very small number of people.

Getting back to running.

When not able to run; swimming, cycling and the elliptical trainer are good ways to keep up your fitness. Once the pain settles enough, the stepper can also be a good way to build your fitness whilst also strengthening the important gluteal muscles. Rowing is another way to keep up your conditioning, but can be aggravating to some whilst not to others, so that will be up to the individual.

A sports physiotherapist will also be able to give you individual advice on cross training to maintain your conditioning and how and when to return to running. A graduated plan for getting back to running will usually involve starting with small amount sand increasing the volume before the speed. The exact advice on how to plan such a programme will depend on the intensity of your symptoms and the specific activity you are training for.

Prevention

To prevent Runner’s Knee, the most important thing to consider is suitable planning of training loads. Increasing loads too quickly, or adding in too many hills or speed sessions without building up to it, can be the most common precursor to ITB problems.

As with most sports, a small amount of strength training can help with both performance and prevention of injury. Exercises targeting the gluteals and general trunk stability, done 2 or 3 times a week, can build strength and endurance, and help control the trunk and pelvis movement over the knee. Stretching may not necessarily prevent Runners Knee, but keeping good flexibility around the hip and thigh will help with your performance.

Correct footwear is really important. Different amounts of support are needed for different people, and the right amount of support can help to control movement about the knee and pelvis by helping the position of the foot as it strikes the ground. A podiatrist may also be able to help, especially with the biomechanical contributions. For some people, custom-made orthotics can be necessary to help control the foot’s positioning.

An Olympic effort: Nicki Combarro’s 83 day long Summer of Sport

Nicki with Victoria Pendleton

Looking back through the diary, my summer of sport consisted of 83 days! London 2012 was a fantastic experience that is hard to put into words and one that many of us will never forget being involved in; however I am secretly relieved that it is all over and normality can resume!

My Olympic journey started towards the end of 2011 when I was asked to start planning the medical provision required by Team GB for their preparation camp that was to be held at the University of Loughborough in June 2012, immediately prior to the Olympics.

The Prep camp opened on June 18th 2012 and was a residential camp where all the Team GB athletes and support staff passed through for a period of time prior to the Olympics. The camp was designed to provide training facilities for the athletes whilst they started to bond as ‘One Team GB’. It was at this preparation camp that they were given all their Team GB kit and did lots of interviews for the media. During their stay the athletes had access to physiotherapy, sports massage, medical support, strength and conditioning support and a recovery suite (ice baths and cryospas).

It was really great to see all the GB athletes prior to the games – full of excitement and hopeful of what they might achieve after years of hard work. With a number of high profile British athletes all in one place, we were a very popular hangout for the media, as well as being visited by VIP’s such as HRH Princess Anne, the Prime Minister, Sir Steve Redgrave and Dame Kelly Holmes.

Nicki with Dame Kelly Holmes

The prep camp was great but long days and living away from my children was difficult. However I won’t pretend that it was all hard work, we did have some down time! The HQ staff (me included) fielded a mean 5 a side football team that took on the University’s Police force and won! On a nice sunny afternoon we managed to get in a bike ride around Leicestershire on Team GB bikes and I even managed an 11mile run along the canal tow paths with two of the Met Police officers who were in charge of security at the camp. Well I had to do some form of exercise to counteract all the Cadbury’s chocolate that we were being given as they were one of the official sponsors of the Games!

Nicki at preperation camp

Once the Games were in full flow I changed my clothes to become one of the ‘Purple People’ and went into London as a Physio Games maker! My role during the Games was to be part of the Medical team at the Velodrome and BMX track. At the venues we ran a physiotherapy service for the athletes prior to and during their training, to keep them on top form prior to their competitions.

Then during the excitement of the events I had the best view in the house! For cycling I was in the middle of the track – ready to go with the Doctors and paramedics in the event that an athlete might fall off their bike doing 50mph! For the BMX I was one of 6 medical emergency teams stationed around the dangerous course, again ready to extract them from the course in the event of a serious crash. The course was amazing and prior to the event we climbed up to the top of the start ramp to experience for ourselves the sheer drop that propelled the bikes into the first ramp! The athletes that compete in this sport must be wired very differently, the danger that they face during training and racing is significant, but makes the sport so exciting to watch!

Despite having covered a variety of sporting events in the past, I can honestly say that I have never experienced an atmosphere quite like that at the Velopark! I was inside the track when Sir Chris Hoy won his Gold medal in the Keirin, everybody screaming and shouting as his bike crossed the finish line, the crowd so loud that you couldn’t hear the person next to you. I was there when Vikki Pendleton made her last unsuccessful efforts to win a gold medal and came away with a silver.

As a Games maker we were supposed to remain neutral and support all countries equally… but in those final races how could I not cheer for Team GB! And cheer I did! After the celebrations of the closing ceremony and the feeling of Olympic fever being over, the build-up to the Paralympics began!

Back in the purple outfit again I restarted my commutes into Stratford; however this time required a little more will-power… with 6:30am shift start times I had to get up at 4:45am every day!

Those early mornings were sure worth it though! Although I was based in the medical polyclinic in the athletes’ village, my role required that I went out to different venues to cover a variety of events. My early morning starts meant that by 8am on some occasions I had seen the sun come up over the Olympic Stadium whilst practising medical scenarios with the Doctors, treating athletes and then watching the events with a trackside seat! The Paralympians were truly inspirational to watch and it was at times a very humbling experience being involved in their medical care.

My summer of sport ended on Monday 10th September when I was invited to attend the athletes’ parade in London as part of Team GB. It was amazing… thousands of people lined the streets to celebrate the success of Team GB with marching bands, Chinese Lions, all topped off with a fly past by the Red Arrows.   These athletes really had moved a country to tears over the course of 6 weeks with their stories of survival, successes and sometimes failures. They had inspired me, they inspired my children and I am sure that they had inspired whole generations.

Even now, weeks after the torch has been extinguished, my children still play ‘Olympics’ with one wanting to be Bolt and the other one wanting to be Jess Ennis… it definitely makes for an interesting competition!

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IN BALANCE, Volume 1, issue 2, Autumn 2012.

Bodyabalance newsletter Autumn 2012: The newsletter of Bodybalance Physiotherapy & Sports Injury Clinic

Featuring:

  • What we did this summer
  • Introducing Alan Barbero
  • Rolling out our online booking
  • All you need to know about the calf muscle

Click on the link above to be taken to a pdf version of our newsletter.