With the Tour De France setting off on July 1st, cycling fever has set in.

The 3,500km ride will see more than 150 cyclists make their way from the Grand Depart in Copenhagen, through northern France and take on a gruelling Alpe d’Huez climb.


What is the Tour De France?

The tour is the world’s biggest annual sporting event, made up of 21 stages over 23 days. It contains six mountain stages along with five altitude finishes.

But already, just over a week in, there has been crashes, chaos, and carnage on the cobbles with wet and slippery conditions forcing cyclists off their bikes.

“It’s been really interesting to watch the start of the tour,” keen cyclist and Osteopath Robin Kiashek says. “However, it’s always alarming to see people come off their bike. Seeing these accidents happen in real time got me thinking about the issues that might trouble cyclists while taking part in this sport and how, as an Osteopath, I could help.”


London to Brighton Cycle

Robin is currently training for the London to Brighton Cycle in September. He is taking part in the 55-mile ride with his son Joel in a bid to raise funds for Macmillan Cancer Support.

On 11th September, the pair will make their way through the country lanes of Mitcham, Banstead and Haywards Heath before taking on the challenge that is Ditchling Beacon.

Ahead of his own cycling event, Robin has pulled together some common issues experienced by cyclists in a bid to help avoid these injuries.


Be aware of back pain

Back pain can be a real problem – especially for cyclists who spend hours hunched over handlebars. Plus, when you add this to the working-from-home challenges of 2020, 2021 and 2022 – you’ve got yourself a recipe for poor posture.

But here’s the good news: “Our spine is made of solid, bony blocks reinforced by strong ligaments and muscles,” Robin says.” It is surprisingly difficult to damage. But if strained, the surrounding muscles and ligaments can cause discomfort and pain.”


How to prevent lower back pain when cycling

  1. Check your posture. Posture is key when it comes to keeping your back in tip top condition. And this applies as much to cycling as it does to when you’re working at a desk. According to British Cycling, the top of the handlebar should be around 5-6cm below the mid-point of the saddle.
  2. Take a stand. Take breaks from cycling to take some strain off your back, shoulders and neck. This will also help you reset the correct posture with your shoulders back, your head level in line with your body and an engaged core.
  3. Talking of cores – strengthen your abdominal muscles. It’s important to work out the muscles in your abs and back. Why? Your core muscles help you stand, move and go about your daily business. It’s also been proven that a strong core reinforces good form and prevents injury.


Watch your knees

On a day-to-day basis we expect great things from our knees. As the largest joint in the human body, the knee basically forms a sort of hinge where the thigh bone (femur) and shin bone (tibia) meet. This enables us to bend, straighten and in this case, cycle.

Cycling might not be a high impact sport. But unfortunately, when pedalling our knees can be a relatively easy mechanism to injure.

Robin explains: “For example, a sudden increase in intensity or duration of exercise can temporarily damage the bone, muscle or ligaments. Problem knees can lock, click, catch, give way or refuse to straighten.”


How to look after the health of our knees

  • Check your bike set-up. Is your saddle too high or low? Do you have the correct saddle tilt? Having an incorrect set up can place compression on the patella, it can overstretch your hamstrings and it can place undue pressure on your knees. Follow this handy step-by-step guide to get your saddle height right.
  • Build up knee strength. Calf raises, leg extensions, squats and hamstring stretches can all help. After all, strong muscles around your knee can help to support and protect your joints as propel you forward with each pedal.


How Osteopathy can help with these niggles

Robin qualified in Osteopathic Medicine more than 25 years ago. Since then, he has trained in various additional complementary disciplines including Western Acupuncture and Low Level Laser Therapy – both of which can be used to treat pain.

“Non-invasive methods like manual Osteopathy, Western Acupuncture and Low Level Laser Therapy all work towards helping with knee niggles and back pain,” Robin says.

“Gentle osteopathic techniques can help to increase the mobility of the joints and relieve muscle tension. While low level laser therapy stimulates your cells to repair tissue and reduce inflammation and pain.

“Acupuncture can help to enhance the blood supply to the tissues, which in turn promotes the body’s natural healing process.”

And Robin has one last tip for cyclists with a challenge in mind: “It’s well worth considering a bike fit session to make sure set up is as it should be.  These can vary greatly in price and content but there’s some good information in this Cycling Weekly article as a starting point.”


If you are suffering pain or discomfort and you would like further information on how Robin may help you, or you would like to book an Osteopathy appointment get in touch.

Pain Management

When in pain, most people tend to apply heat to the problem area rather than cold/ice compressions. Which is understandable – it feels more soothing.  And who wants to add being cold and uncomfortable to an already painful situation?

“In my 25 years of practicing osteopathy, I’ve only ever encountered one patient treating their pain by applying ice,” Osteopath Robin Kiashek tells us.

But actually, a hit of cold/ice therapy might be a better solution.

What is cold/ice therapy?

Cold water therapy is the practice of using water that’s around 15 degrees to treat health conditions or stimulate health benefits.  While ice therapy is the practice of using ice to do the exact same.

Despite the current buzz around this type of therapy – with the rise of the cold shower trend – this type of treatment has actually been used for thousands of years.

How does cold/ice therapy work?

Cold therapy, or in this case – ice therapy, is sometimes referred to as cold hydrotherapy or cryotherapy.  And it has the power to reduce inflammation in our body.

So, when we are hurt or are in pain, whether it’s through stubbing our toe, spraining our ankle or something more serious – ice therapy slows blood flow to the area by causing vasodilation of blood capillaries.  This expels blood from the surrounding area temporarily. Once the ice (wrapped in a wet tea towel) is removed after five minutes, fresh blood enters the injured area.

This in turn reduces inflammation and swelling that causes pain in the joint or tendon.

It is particularly effective for acute injuries and also if it is put into practice quickly after the injury occurs.

How does cold therapy compare to heat therapy?

Conversely, heat therapy causes blood vessels to dilate by arterial vasodilation which rushes blood flow to the area.  It can feel very soothing.

And heat therapy can definitely help with flexibility issues, tight muscles and damaged tissues. But it’s not a good idea where there is swelling.

The power of cold therapy

Robin saw the power of cold therapy first-hand when his son underwent surgery after tearing his anterior cruciate ligament (ACL). As part of the recovery process, he was given a Game Ready machine that pumps iced water every 30 minutes, for 30 minutes, around the injured knee.

Robin says: “Rest, ice, compression and elevation (RICE) have long been used to treat acute injury and to help the recovery and rehabilitation process after surgery. It’s something I tell my patients when they come to me in pain.”

But cold/ice therapy can be used for other holistic and physical outcomes.

What are the benefits of cold/ice therapy?

We’ve spoken before about the benefits of cold/ice therapy. But according to the science, cold/ice therapy can:

  • Give your immune system a boost.  A range of studies have proven that doses of cold therapy could bolster your immune system over a period of weeks or months.
  • Ease symptoms of depression.  Research has shown that cold open water swimming could help those suffering with anxiety and depression.
  • Help with muscle soreness.  In a 2011 study, cyclists who were immersed in cold water for 10 minutes had decreased soreness. And a later 2016 study reported the same results.

However, before you plunge yourself in an outdoor lake or ice bath, it’s important to discuss any sudden cold-water immersions with your doctor.  Just to make sure it’s safe for to do so.

Plus, you must never apply ice directly to the skin as it will burn and it should only be used under medical guidance.

If you’re in pain, don’t hesitate to get in touch with Robin.
Robin Kiashek treats patients suffering from all types of conditions.  Including sporting injuries, musculoskeletal issues and headaches.

Along with runner’s knee and Achilles tendinitis – shin splints are thought to be one of the most common health injuries runners incur.

Shin splints – which are often more formally referred to as medial tibial stress syndrome – are a very common overuse injury. The term refers to a pain that occurs in the front or inner parts of your lower legs, along your shinbone.

According to the latest data, shin splints account for around 11% of injuries in male runners and 17% of injuries in female runners. It’s also prevalent in dancers and those who work in the military.

What are the symptoms?

If you suffer from shin splints, you’ll most likely have a dull pain, ache or throbbing feeling along the front or inner part of your shinbone. But you might notice a few other symptoms including:

  • A pain that gets worse when you exercise
  • Tenderness to touch
  • In some cases, mild swelling can occur
  • The pain seems to go away when you rest

What is the cause of shin splints?

Shin splints are caused by repetitive stress on your shinbone and the tissues that attach your muscles to the bone.

They occur because you are putting too much stress and strain on your shin bone and the tissues around it.


Why do shin splints occur?

Usually, shin splints flare up because you have overexerted yourself or have pushed your usual exercise limits that little bit further. Generally speaking, you are more likely to get shin splints if you:

  • Have started exercising after not being active for some time
  • Run or jump on hard surfaces
  • Have a poor running technique
  • Are wearing shoes that don’t offer you enough cushioning and support
  • Don’t rest enough between your exercise sessions

How do you get rid of shin splints or prevent them?

In many cases, shin splints can go away with rest. According to the NHS, if you suffer from shin splints you could also try:

  • Wearing trainers that cushion and support your feet properly
  • Building up to the exercise intensity gradually
  • Warming up before any exercise and stretch after exercising
  • Putting an ice pack on your shin for up to 20 minutes every 2 to 3 hours
  • Switching to gentle exercise such as yoga or swimming whilst it is healing
  • Exercising on soft ground, if and when you are feeling better


How osteopathy can help with shin splints

Osteopathic treatment can help to reduce the tension deep in the muscle of the leg.

Osteopath Robin Kiashek, who has more than 25 years’ experience in the industry, said: “I take a holistic approach when it comes to assessing any problem my clients are suffering from. For shin splints, I would look to reduce the tension in the leg muscles and make sure there are no other underlying mechanical problems.

“You might be suffering from the pain in the shin, but other predisposing factors  – like your gait or posture – might be the root cause.  Only after a full biomechanical assessment can we come up with a treatment plan.  If left unchecked these pains might develop into something far more serious.”

Robin Kiashek has dealt with numerous running injuries – including shin splints. Get in touch if you would like to book a treatment or find out more.


Research published by Macmillan Cancer Support shows an estimated 7 million people across the country turned to running or jogging during the Covid-19 crisis to boost their mental health.

One in seven people in the UK (14%) said running had helped them deal with stress since the first lockdown in March.  And about a third said running helped them feel calmer and more positive.

All of which is great news.  But it’s important that these mental benefits don’t come at a physical cost. More research (!) show that, for every 1,000 hours of running, beginners get injured twice as often as experienced runners.

Among the most common problems to plague runners are Plantar Fasciitis – painful inflammation of the tissue along the bottom of the foot and Achilles Tendonitis. This manifests as pain and tenderness in the heel and along the Achilles tendon.  Which is the thickest tendon in the human body.

Responding to running injury

On a practical level, there are a couple of simple self-help measures that you can try:

  • First and foremost, take an immediate break from training.
  • Apply ice regularly to the painful area for the first 48-72 hours to reduce swelling.
  • Take a good look at your training footwear. Running shoes will generally need replacing after you’ve run 300-500 miles.
  • Consider gentle, stretching exercises, such as the heel drop (devised by Swedish sports doctor Dr Hakan Alfredson).  Try three sets of 15 heel drops twice daily over three months.

Give low-level laser therapy a try

Over time, most such treatments will provide some relief.  But what if you had access to a quicker, more effective and long-lasting therapy? Low-level laser therapy (LLLT) could be the answer. It’s a pain-free, non-invasive treatment that involves placing a low-power light beam on the injured area. The light stimulates repair by cellular organelles (specialised structures within a cell that carry out a particular function) called Mitochondria, This reduces pain and promotes a speedier, safer recovery.

Treatment times are relatively short and many patients report encouraging results within two or three sessions.

LLLT is used widely by osteopaths in the United States.  It is gaining ground here in the UK, alongside general osteopathic techniques, as a successful treatment for sports injuries.  Also, Plantar Fasciitis, Achilles Tendonitis, back pain, various types of arthritis and other conditions including strains and sprains.

Osteopath Robin Kiashek said: “I’ve been using LLLT as part of my treatment plans for over 10 years.  It sits nicely alongside the other therapies and patients frequently report great improvements to their symptoms.”

There is some useful information on the website about LLLT, including a video explaining how it works.

So, if pain has stopped play when it comes to your exercise regime then why not contact Robin to see if LLLT could get you back up and…well, running?

Western Acupuncture in London

As many of my patients already know, I frequently combine osteopathy with one or more other therapies, such as Western acupuncture, when seeking the best treatment outcome for a patient.

Acupuncture has been used in the Far East for over 2000 years, reaching the West during the 17th century. The medical profession now increasingly recognise and use it as an effective form of pain relief. One or more fine needles are inserted through the skin into specific points within the body and left in position for a short while. These can be manipulated by hand or via low-voltage electrical stimulation (known as electro acupuncture). Basically, acupuncture stimulates nerves within the skin and muscle. It releases endorphin and serotonin – the body’s own painkillers – into the pain pathways of the spinal cord and the brain. In this way it modifies how pain signals are received.

Eastern vs Western Acupuncture

In my practice we use Western acupuncture, also known as dry needling. This version of the therapy combines the use of the same acupuncture points and needles as Eastern (Chinese) acupuncture with a Western approach to evidence-based medicine and the latest scientific knowledge.

Traditional Chinese acupuncture seeks to balance opposites – yin and yang, hot and cold etc and facilitate the flow of the life force Qi – in the pursuit of general good health or to ward off illness. In contrast, Western acupuncture uses a ‘neuro-physiological’ approach to target specific issues.

How acupuncture can help you

In recent years, a growing body of research as reviewed by the Acupuncture Evidence Project* has shown that acupuncture can help by:

* Providing pain relief for tension headaches/migraine, TMJ, back, neck, shoulder, leg and knee pain and discomfort resulting from arthritis, rheumatism and operations

* Relieving trapped nerves, muscle strains, sports injuries and generally increasing the range of physical movement

* Reducing reliance on and side effects of medication

* Relieving nausea, including morning sickness in pregnancy

* Helping with infertility

* Dealing with sleep problems

* Promoting natural healing and well-being

Benefits of Western Acupuncture

The therapy offers several hugely important benefits, as it is:

* Largely (although not always) pain free, with a minimal risk of bruising or bleeding

* An effective painkiller, stimulating the release of the body’s own natural analgesics

* Safe, including during pregnancy – The British Medical Association has undertaken several studies regarding its safety

* Able to combine safely with osteopathy, and patients can usually benefit from both therapies during the same session

How I treat patients using Western Acupuncture

Once I have assessed a patient and I feel that acupuncture may benefit them, we discuss what it involves. Assuming they are happy we then agree a treatment plan. Initially, treatment might take place once a week to begin with, then at longer intervals as the patient feels better.

In the UK acupuncture is taught at post-graduate level to those with existing medical qualifications. I studied with The British Medical Acupuncture Society, qualifying in both Western acupuncture and related Electro-Acupuncture, offering both at my clinics. For more information on Western acupuncture or to book a consultation in one of my London clinics, please feel free to contact me.

*John McDonald and Stephen Janz, The Acupuncture Evidence Project, 2017