Nordic Walking Ticks a Lot of Boxes!

I’m always on the lookout for types of exercise that the people I work with, those with neurological conditions, might find particularly useful. It has to be something accessible, enjoyable and effective in helping specific problems caused by neurological issues. Amongst fatigue, mobility challenges and transport issues, going that extra mile to participate in exercise that is questionable in its effects in the Neuro community, sometimes just isn’t feasible.

So, it seems that there is a strong candidate in our midst…in the form of Nordic Walking! Originally invented as a summer time alternative for the keenest of Norway’s cross country skiers, the form of walking is now a common recreational sport worldwide.


Nordic Walking uses specially designed poles, which you plant on the ground at a 45̊ angle. This specialised technique results in you using the muscles of your arms and core during walking, making Nordic Walking a form of whole body exercise. The poles help to propel the walker along – therefore your body works harder, but the support given by the poles makes it feel easier.

Nordic Walking ticks a lot of boxes! It aims to get you outside, socialising, using your legs, arms, core and balance mechanisms. It’s been shown to promote good posture and improve gait speed, strengthen the back and abdominal muscles and foster better balance during walking.

Not only are these common features often faced by people living with a neurological condition, but studies show that over time, Nordic Walking can specifically improve postural stability and stride length in people with Parkinson’s Disease. On top of that it is great for your heart and lungs and burns up to 46% more calories than normal walking, so is brilliant if you’re trying to lose weight.

Muscles used in Nordic Walking

The absolute bonus of Nordic Walking in neuro conditions is that by involving your arms in the walking, your core is automatically used more. The core is vital for controlled and coordinated movements of the arms and legs, and in turn extremely important for balance.

And with less effort required, Nordic Walking may allow you to go further, challenge your balance for longer and work your core better. All this leads to fitness and more efficient, less effortful walking.

We’ve certainly become fans! There are Nordic Walking groups and instructors all over the country. It’s an excellent candidate in the race to find an all rounder on the exercise front, for people with neurological issues.

Our other front runners are swimming, adapted or traditional cycling, Pilates and exercise in the water such as walking and aqua aerobics. We’d love to know if you’ve had a go at any of these and what your other favourites are. People are always on the lookout for new ideas for fitness and sport to motivate, energise and enjoy!

For details about Nordic Walking and how to find an instructor or group near you visit:

Keeping afloat with a neuro condition: Swimming and water-based exercise

This week the water has caught my attention. Always a fan of a splash about on holiday and some lengths for fitness I often encourage my clients to dive in for a therapeutic swim too. But not everyone with a neurological condition is capable of that and a recent discussion with a young lady with MS made me question my recommendations. Her MS symptoms are worsening and she is finding it difficult to walk. In addition she’s decided she wants to turn her life around for the better: eat more healthily, quit smoking and do more exercise. I asked if she’d consider swimming. Her concern: that she’d only be able to swim one length. She saw this as not only an embarrassment, but a waste of time. Quite by chance, the same afternoon I stumbled upon an Multiple Sclerosis Association of America advert for their ‘Swim for MS Online Aquatics Centre’. This part of their website is dedicated to raising awareness of water-based exercise as a wellness opportunity for those with MS, and comes complete with tip sheets and video case studies to inspire people with MS to dive in and have a go at exercising in the water too. Although on first impressions the site was pasted with pictures of healthy, sprightly looking young things, watching the videos on offer was uplifting and refreshing.

People with neurological conditions often find it difficult to find a way of keeping fit that works with their lifestyle, levels of fatigue and their abilities. But all of the ladies featured in the ‘Why I Swim’ section had found their own way of making the most of the water. Kristen, a mum of two, must be pretty good as she trains regularly and swims for a masters swimming club. Mary from Pennsylvania, on the other hand likes simply being in the water – the first time she went to her water exercise class she says “I marveled at what my body would do, that it hadn’t done in years on dry land”. She tells us about how being in the supportive pool allows her to walk in a straight line, stand on one leg and even dance – all things she couldn’t dream of doing out of the water.

But do we actually know that swimming and water therapy are good for you if you have a neurological condition? Physiotherapists have long used the hydrotherapy pool as a pain relieving environment for treatment for a multitude of joint and muscle related problems. In the water you are able to strengthen and stretch, improve the amount a joint can move, and partially weight bear through say, a broken leg, because the water makes you so buoyant.

On a closer look, after stroke, for example, research shows that exercise in water can improve both strength and the ability to do day to day tasks. Studies show that in people with MS exercise in water can improve flexibility and strength but it also improves walking, fatigue and stamina when on land again. These are commonly the areas that people with a neuro condition want to improve on. This sounds great! So what’s the catch?

I think with water, people are often concerned that if they are not a strong swimmer, alongside a neurological condition it might be difficult to keep afloat. But the joy of the water is that swimming isn’t the only option. If you’re shoulder deep in water about the buoyancy removes about 90% of your body weight, taking stress off joints and meaning you can probably move more than out of the pool.

Marching on the spot, walking widths, kicking holding the side rail or swinging your arms underwater all count as exercise. The resistance of the water means you’ll be working your muscles hard, so any movement in the pool is great. And it doesn’t have to stop there.

Going back to the MSAA videos, Ginny from North Carolina found she couldn’t swim as ‘normal’ so just went ahead and invented her own strokes. And why not? She’s “62 years young”, was diagnosed with MS 26 years ago and walks with a four wheeled walking frame. She tells us that the pool brought her “joy, clarity…endorphins, freedom. It’s amazing”.

When she started swimming she could only do a few laps. Two years later she does 45 minutes of lengths four or five days a week, and has become a certified fitness trainer, helping other people get into exercise. She looks to be a great inspiration and is often told by her clients “I see you doing it and think to myself, ‘if she can do it, I have absolutely no excuse’”. She started small, and worked her way up the fitness ladder. It was great to see Ginny, with her significant mobility problems, enjoying the water as much as her younger, more able counterparts.

In a neurorehabilitation unit I used to work at we re-introduced hydrotherapy sessions, and people at both ends of the ability spectrum saw the benefits. The soothing effect of floating for someone with lots of spasms was visible. The excitement and relief of standing, supported by the water, for someone with a spinal injury was fantastic to be a part of.

One thing is for sure: anecdotal evidence shows us that people with neurological conditions love being in the water. You don’t even need to be able to swim to enjoy the benefits as part of your neurorehabilitation program. Mary, who goes to the water exercise class says “the water has helped me with my confidence, has helped me feel safer on land, more sure of myself”.

So when I see the young lady with MS again I will once again encourage her to give the pool a go. It seems especially for people with MS who may have difficulty regulating their temperature, the coolness of a pool makes it a perfect environment to exercise and continue rehab. She could do her one length, and then some exercises standing at the edge. She could start small and build up, as the start to her new healthy lifestyle.  

Visit the Multiple Sclerosis Association of America to watch the inspirational videos and find resources on aquatic exercise:

We’d love to meet you on twitter here: @activeneuro

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So how DO you physio the brain? Neuro Physiotherapy and how it works

When you tell people you’re a Neuro Physiotherapist who works with people with problems of the brain or spine, the most common response is ‘So how DO you physio the brain?’. I imagine they’ve conjured up a great gory image of me getting my talons out to give these brains I’m working with a good heavy handed massage. Alas, no. Instead of getting stuck right in and manipulating the brain itself, Neuro Physiotherapists utilise the brain’s incredible ability to reorganise itself to help our patients move around more easily, and function more independently day to day.

Neuro Physiotherapists work solely with people who have suffered damage or trauma to their brain, spinal cord or nerves. This includes a vast array of both common and rare conditions including multiple sclerosis (where damage to the nerve coating in the brain and spine affects muscle movement, balance and vision), Parkinson’s Disease (where loss of nerve cells deep in the brain slow down movements and speech) and spinal cord injury (where trauma and inflammation of the spinal cord results in loss of feeling and movement lower down the body).

These different conditions affect young and old, rich and poor, women and men from all cultural backgrounds. It is thought that around 10 million people in England are living with a neurological conditionand Neuro Physiotherapy is one approach used to help improve their quality of life.

But how is it done? To help explain I’ll use the example of somebody who has had a stroke. About 150,000 people suffer a stroke in England every year, and brain damage caused by stroke means that they are the largest cause of adult disability in the UK. When someone has a stroke, the damage is caused by either a blockage in a vessel, stopping blood reaching some areas of the brain (known as an ischemic stroke, the most common type), or a bleed in the brain, which again means the blood can’t reach all areas of the brain it should do (known as a haemorrhagic stroke). In either scenario blood, and therefore oxygen, can’t move around the brain in the way it should, and without oxygen brain cells die.

Depending on where these cells were, they might have been responsible for moving the arm, coordinating the movements needed for speech or generating the thought processes needed to plan out how to make breakfast. Whichever it was, that function will now be impaired, and the person may struggle with the most basic of day to day tasks. The difficulties the person has will be entirely dependent on the extent and location of damage in the brain.

But research and anecdotal evidence shows us that those impairments and difficulties don’t necessarily last a lifetime. We now know that when nerves in the brain are killed, by an ischemic stroke for example, other brain cells may take over their job. Just like when a main road is blocked off, we can often still get to where we need to go by taking the side streets, other cells can sometimes do some extra work to compensate for lost functions.

Taking the ‘diversion’ might be slower and more effortful – and in the brain it might even take some time for that route to be available – but there is hope that you might reach the same end result. This process of reorganisation is called neuroplasticity, and it is the basis of Neuro Physiotherapy. We know that these new connections can be made - but it takes some work.

If our stroke survivor has a very weak leg and a target to walk again, the patient and the Neuro Physiotherapist must work together to jostle the brain into making the new connections required for walking. Strengthening the leg with weights or getting fitter using an exercise bike will help to an extent, but the one most important cog in the wheel of re- learning to walk again, is to practice walking. The patient may need hands on assistance, splints, a treadmill or all of these things, but the Neuro Physiotherapist helping the patient practice the correct movements of walking will encourage the brain to ‘re-learn’ the movement pattern.

Physiotherapist facilitates gait pattern

Gait re-education using a body-weight support treadmill

And as with anything, learning takes time. Think of the process of learning to juggle. The extremely difficult coordination and control required gets easier and easier as we continue to practice and our brain learns the movement pattern. Neuroplasticity means new connections are made, just as they are in our stroke survivor re-learning to walk.

And so, Neuro Physiotherapy aims to take people through correct movements, guide limbs and facilitate people doing day to day tasks, to encourage the brain to ‘re-learn’ normal movement. If people with a neurological problem are given the opportunity to practice the things they want to improve at, with facilitation to move in the right way, over time new connections can be made in the brain. Neuroplasticity is thought to occur mainly in the weeks and months following a stroke or a new neurological problem. However, new connections have been known to occur years and years down the line.

Introducing Active Neuro Physiotherapy

Welcome to the Active Neuro Blog!

We will be posting snippets that have caught our interest, and might catch yours, in the world of Neuro Physiotherapy and neurorehabilitaion – information on neurological conditions, developments in treatment techniques, exercise advice and ideas on how to get more active when living with a neurological condition. But first, here’s a bit about us…

Active Neuro is a Neuro Physiotherapy service that offers hands-on, evidence-based rehabilitation and practical advice on the types of activity that can benefit people living with a neurological condition. We work throughout London and carry out therapy sessions in our clients own homes, keeping their goals at the centre of everything we do. Our mission is to help our clients move more efficiently, enable them to be more independent and to empower them to try new activities and sports, whatever their abilities.

How can we help?

When a client has decided on their rehabilitation targets, we work closely with them to set a rehabilitation plan focused on these targets and their individual needs. Areas that we commonly cover are:

  • Making every day tasks easier by improving strength and stamina
  • Building core stability
  • Walking – be it faster, further or more steadily
  • Pacing and using energy efficiently
  • Building regular activity into daily routine – we aim to introduce people to activities they enjoy and might not even know existed!

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