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Maintaining the best results requires knowledge and expertise. Our athletes train and so do we, through our professional development program. Meaning that when a practitioner the treats you, they have the most advanced injury care knowledge. Read about what our practitioners are thinking in the injury blogs below.

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Athlete Sponsorship Program Andy White

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Andy White is part of CSSM's Athlete Sponsorship Program. Andy signed up for his first ironman in 2010 and has since completed 9 half ironman events and 3 ironman races.

 

I am currently training approximately 8 -10 times per week. I would like to train more as I'm sure most people would. I feel that any more than that is counterproductive for me as my ability to recover is diminished and my productivity in life and at work takes too much of a toll. It is not sustainable and also not fair to those who rely on me to be too exhausted to function. 

I have been running as part of my triathlon training for 8 years. Prior to this, I have been running for as long as I can remember. I raced cross country in my younger school days and always loved to run. I wanted to take my running further after receiving a qualifying spot for the 2017 Ironman World Championships in Kona last year. Since then I have progressed my regular running and included more run specific races of which I am really enjoying.

I have had two significant broken ankles in the last 10 years that both required surgery, along with countless other soft tissue injuries. I have done lots of work to re-strengthen the ankles and have no trouble with them at present. Running as many would know is very taxing on the body so battling injuries makes it difficult to be consistent over a long period of time.

I find remedial massage is great at reducing the built-up tension that your body maintains from the constant muscle contractions. After so much contracting (post a hard week of training) the muscles become tightened and shorten so popping in to see Julien, the CSSM remedial massage specialist is just what is needed. Remedial massage can help relieve that tension and thus improve the quality of your recovery. This is why I really see the benefits.

“Ride for show and run for dough.” This is a saying applicable to triathlon that my coach told me one day. The real race doesn’t start until the run so don’t burn all your matches on the bike. Just get through it with the least amount of energy expenditure. Then run for the money. However, I do admit I do not always follow this advice to the tee!

Battling mental barriers comes with the nature of any sport and long-distance triathlon is no exception. The way I break it down when struggling mentally is to focus on the present - the here and now. What can I do right now to make it more manageable? On my longer sessions I would often ride or run from one place to another - from A to B. Thus knowing that every pedal stroke or every step I took was actually getting me closer to where I wanted to go. I found that 'out and back' training sessions were mentally the toughest. I also found enlisting social support by running to meet someone or running to and from work was a great way to get myself training.    

My goal for the rest of 2018 is to run a sub 35min 10K. This may seem quite manageable for some. However, for an endurance specialist anything that involves speed is really challenging and involves lots of suffering. This is a goal I am working towards to improve my overall running, which will no doubt carry over into my endurance triathlon running down the line.

Muscle Energy Technique: What Is It?

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Muscle Energy Technique (MET) is one of the many manual therapy techniques that is commonly used by our Osteopaths at CSSM. 

It involves placing a joint or muscle in a specific position whereby the practitioner can feel resistance or a restriction. The patient is then required to gently resist the pressure of the contraction for a period of 3-5 seconds, with the relaxation phase following allowing for an increase in passive range of motion of the affected structure. This sequence can be repeated up to 3-5 times depending on how the tissue responds. Ultimately, we want to achieve a palpable change in the tone of the surrounding tissues, an increase in range of motion, both of which are likely to result in a reduction in the patient’s pain levels. 

MET, also known at Proprioceptive Neuromuscular Facilitation (PNF), works on the theory that agonistic and antagonistic muscles (for example the bicep and tricep muscles) cannot contract at the same time. Therefore, by contracting the antagonistic muscle, it ensures that the agonistic muscle can relax and return to its resting tone. Once the targeted muscle is able to relax, there is typically an improvement in its structure and function.

A study by Mahajan et al. in 2012, showed that MET is effective in decreasing pain intensity and increasing active neck range of motion in patients with mechanical neck pain. The same study found MET to be more effective than static stretching of the neck. 


When used correctly, MET can be one of the most effective, yet simplest ways to improve joint mobility and tightness in the muscles. It is a safe technique that can be applied to treat a broad range of injuries in patients of all ages, and is one of the many tools which our practitioners employ to ensure that our patients get the best results and care.

 

Here's a short video of Muscle Energy Technique (MET) in action: 

https://www.youtube.com/watch?v=mI4XSuEVfhs

 

References:

Mahajan, R., Kataria, C., & Bansal, K. (2012). Comparative Effectiveness of Muscle Energy Technique and Static Stretching for Treatment of Subacute Mechanical Neck Pain. International Journal Of Health And Rehabilitation Sciences (IJHRS), 1(1), 16. doi: 10.5455/ijhrs.00000004

Niel Asher Education. (2015). Trigger Point Therapy - Muscle Energy Techniques [Video]. Retrieved from https://www.youtube.com/watch?v=mI4XSuEVfhs

 

About the author

Lachlan White is a registered Osteopath. He has an interest in treating patients with acute and chronic pain conditions, including headaches, neck and back pain and assisting in the management of chronic and degenerative disease. 

Sophie Taylor: The Road To Tokyo 2020

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Sophie Taylor is part of CSSM's Athlete Sponsorship Program. Sophie talks about her goal to debut for the Senior Australian Hockey Team with her end goal the 2020 Tokyo Olympics.

 

Hockey is a fantastic sport to be involved in. I love the team sport aspect and the demands and challenges associated with the sport. 

Some of my best friends are hockey players who I have known since a very young age. It is always fun getting to train and play the sport you love with some great friends. Whilst hockey can be physically and mentally exhausting most sessions, I love the challenge of pushing through and digging deep when times get tough. I think the fact that you always have a group of girls at training is also really fun, I personally think I would find an individual sport challenging as I really enjoy the social side associated with hockey. I also like the variety of skills and attributes you need to play, you cant just be a good runner or really strong or really skilful, you need a mixture of these to compete in the modern game.  

Our club competition runs April to September. Then we have the Australian Hockey League this year - a four week tournament in October. And then the rest of the time is spent in pre season and preparing for any camps or tours we may have. 

My current week looks like this:

Monday AM: Gym, physio and massage

Monday PM: Hockey skills and running 

Tuesday PM: Hockey skills and running 

Wednesday AM: Gym

Thursday PM: Massage

Thursday PM: Hockey skills and running 

Friday AM: Hockey skills 

Saturday: Game!

Sunday: Rest day 

Recovery is also included post every session and usually again each day. Depending on the session recovery includes: ice bath, pool recovery, foam rolling, stretching. 

Also I make sure I am consuming the right type of food at the right times and drinking plenty of water. Oh and getting 8-10 hours sleep a night!

We won the Australia Hockey League last year (2017) after coming 3rd in 2014 and 2nd in 2015 and 2016. So that was a pretty amazing achievement and a massive highlight to date. 

Also, I was fortunate enough to be selected in the U/21 Junior World Cup team in 2016. We traveled to Chile to compete against the 16 best U/21 teams in the world. We won the Bronze medal which was the best result an Australian team had had since the early 2000s.

My goal is to debut for the Senior Australian Team with the big goal the 2020 Tokyo Olympics.

I'm actually studying to be a physio myself and am in my final years of study. 

Personally, I have been very fortunate with injuries to date, so I see a physio regularly for ongoing management and injury prevention. I think physio’s play a massive role in Injury prevention as well as treating injuries that have occurred. So I like to regularly book in to make sure I'm doing everything possible to prevent injuries from occurring. 

In hockey, we seem to have a lot of soft tissue injures - in particular, hamstrings. This is probably due to the position we are in when we are playing. We also have a fair amount of tendon and back injuries. In our gym program, we are always doing isometric holds on different muscle groups as there is a fair amount of evidence to show the benefit of static holds on tendons. We also make sure we are consistently in the gym a couple of times every week to ensure our bodies are strong and ready for the demands that a busy week has on our bodies. 

The best advice I've been given that has stuck with me is: Love the process not the destination! 

Women's Footy, Where's It Heading?

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Tash Rappos is one of CSSM's sponsored athletes. The 25 year old currently plays in the VFLW for St Kilda.

In this latest blog, Tash talks about being a part of the changing face of women's footy.

 

I love the team aspect and companionship that is involved in footy. Some of my best friends I met through football, and I’m talking back when I was 17 in youth girls, so over 8 years ago, we live across the state but still manage to make time for each other. 

I also love when you practice a certain play at training then watch it come together on the field, it is very rewarding to see all of our hard work pay off. 

All of these girls put in so much effort and watching us all gel together is something special. 

My predominant team at the moment is St Marys Salesian, which is based at Ferndale Park in Glen Iris. 

I am still currently signed on with St Kilda in the VFLW, but a few injury and illness setbacks have caused me to shift my focus from footy to my health. 

So I will be pushing hard with SMS for the rest of the season and reassess for next year. 

My best memories are from 2013 where the team I was playing for won the premiership, and I got the BOG for the match, and then I also managed to win league best and fairest for that year. That was pretty amazing. 

Although I think last years may top it. The inaugural season for SMS, with an abundance of first year players, making it to the grand final. And just watching how far we had all come as a team. We had lost to the opposition in the semi by just one point. But we managed to get on top in the grand final by just one point. I had actually thought we lost the match when the siren went. But I saw a sea of yellow (SMS team colour) come racing towards me as I was on my knees in a heap on the ground. And we had won! It was an amazing feeling. I also managed to get BOG for that match as well which was pretty special. That year I was also a part of the inaugural VAFA squad and came third in the league best and fairest too. Then to top it off I helped organise a very successful end of season football trip for the girls.

I've been playing footy for about 8-9 years. I started in the youth girls competition in the western district, and after graduating high school made the move over to the east for uni. I’ve had a few years off in there somewhere as well for work and travel. 

Right now, I’m taking it one day at a time. So my main goal at the moment is to play my best and help cap off another successful year for SMS.  

I’m hyperaware of the injuries that can occur so I am very diligent with my prehab and focusing on being strong and doing proper warm ups before trainings and games.  

As for future goals, I will reassess after the season is done. AFLW is indeed in the mix, but alas, life can get in the way. 

Two of my teammates did their ACL’s last year and another two of my friends have done them this year. 

I do a lot more training outside of footy trainings, a lot of gym, prehab, yoga, Pilates and F45. Having previous ankle and shoulder injuries last year brought me into Camberwell Sports and Spinal Medicine as a frequent client. My Physio’s (yes their were two, Jess and Alice), helped me rehab my ankle and shoulder and gave me extra exercises to strengthen my posterior chain to help prevent knee injuries, in particular, ligament tears. 

Before training and games I use therabands in my own activation warm ups, which involve squats, crabwalks, two legged and one legged hops, hip thrusts - just a lot of exercises that activate the glutes and wake up the stabilising muscles of the legs. And our warm ups have increased a lot from last year and include a lot of change of direction and lateral movements. 

Foam rolling and deep tissue massages also help a lot with releasing tension throughout my legs and my whole body. 

Monday’s: Lower body posterior at the gym, then football training 

Tuesday’s: F45 (their resistance day) so it’s normally full body resistance, taking it very easy on the legs, I would also ideally like to get a cardio session in, so a bike ride or run 

Wednesday: Pilates at CSSM

Thursday: Lower body anterior at the gym, and football training

Friday: I will either use as a rest day or upper body, depending on how I’m feeling

Saturday: game day 

Sunday: Yin yoga which really just feels like a good stretch session and some meditating 

I started off with seeing an osteo for a shoulder injury, who helped with that a lot before referring me to the physio to further the recovery and rehab. I also take full advantage of the myotherapists and podiatrists at the clinic. I like to look after my body holistically in that sense.  

When I was at the peak of my injuries, I was coming in weekly for check ups, treatments, and progressions for my rehab.

Since then, I haven’t actually had a biomechanical injury. I still use exercises that were prescribed to me for my injuries. And I’ve been through the physio Pilates program, just about to go into the Pilates FIT sessions. I also see a myo regularly which helps a lot with releasing tension in my upper back and legs especially. 

I think it certainly helps and has had a positive impact on my recovery. It has definitely put me at ease in terms of knowing my boundaries and how hard or far I can push myself when getting back out there.

The best advice I've been given is to do what you love and what you’re passionate about. Work hard and don’t expect change or progress overnight. It will come if you put in the effort. But make sure you love it, because if you don’t make it to the top, you need something else to drive you through the hard times. 

In 5 years it would be nice to see the AFLW up and about, inspiring future generations to jump on board from a younger age. I hope it will be running longer than the 8 weeks over summer, and that each team will have a VFLW team aligned with it. The pay for these girls ideally would be a lot higher so that they are able to dedicate the same amount of time to the training and program as the men do, instead of having to work part or full time jobs on the side. 

Women don’t get paid for footy, or if they do it’s very, very minimal, we all literally play for the fun and passion of it. We don’t have any incentives. When I was training with St Kilda full time, or Collingwood back in the day - both with amazing programs. We’d be training/playing 4 times a week. We’d be dedicating our time and energy and petrol money and literally everything we had to be a part of a team and the change in women’s footy. It was 20+ hours of our week we were giving to the club for purely the love of the game. 

So even if AFLW remains stagnant in its progression (which I doubt it will), there will always be girls willing to put in the effort to play the sport that they love. 

The more sponsors that jump on board and can help fund the sport, the bigger it will get. 

The next few years you will begin to see the girls who have been through the women’s academy since the age of 12, and they will be bringing in some real talent. I think the games will become more exciting to watch and there will be a whole new brand of women’s footy coming to light. 

Athlete Sponsor Sponsorship Program Georgia Hansen

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Georgia Hansen is our youngest athlete accepted into CSSM's Athlete Sponsorship Program. At 20, Georgia is a talented runner and is hoping to qualify for the World University Games in Italy next year.

 

I am currently training 6 days a week – 2 track sessions, 2 longer runs, 2 grass sessions, and 1 gym session.

I have been running since I was about 7 years old. I was an active member of my local little athletics club, and it was there where I found that I had a passion for running. Although I was competing in all sorts of events – from high jump, to 100m, to triple jump – I was naturally more talented at the longer (relative!) distance races (400m and 800m). Competing for the club in track relays, cross country, and individual track & field, bought out my competitiveness and determination, and it was here where I realised that I wanted to take it further.

I have been reasonably lucky injuries-wise. My most severe injuries would include severs disease, plantar fasciitis, and an inflamed sacroiliac joint!

Mobility exercises and seeing my physio have been key when dealing with injuries. My physio helps to remove any inflammation to the injured area, and mobility exercises help to strengthen parts of my body that are weak.

I’ve received so much advice so far in regards to running, it’s tough to pick a “best”! I would probably have to quote my coach, who always says to me, “it’s up to you as to how much you want to do well”. No one else can do the training for me. No one can complete the race for me. It’s up to me.

Every athlete constantly faces mental barriers. It is how you respond and deal with them that defines you as an athlete, because, if it were easy, everyone would do it. That’s what makes sport so unique, and differentiates elite athletes from the rest. If you want to succeed, you need to realise that it’s not going to be easy. There are going to be mental barriers. It’s inevitable. We face them every training session. Every rep. 

I am now focusing on preparing myself for the summer season at the end of the year. I want to put my body in the best possible shape for qualifying for the World University Games next year in Naples, Italy, where I can qualify at the start of next year. Putting in the hard work now will help me to be in the best possible position come trials early next year.

Sonia Dunne: Living With Rheumatoid Arthritis

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Sonia Dunne was diagnosed with Rheumatoid Arthritis while training for the 2014 Ironman Melbourne. Despite her diagnosis, she still competed the 3.8km swim, 180km bike ride and a 42.2km marathon! It’s this determination that saw her accepted into CSSM’S Athlete Sponsorship Program.

Sonia talks about how rheumatoid arthritis has affected her life and training and how she plans to achieve her goals for 2018.

 

Rheumatoid Arthritis is an autoimmune disorder that causes pain and swelling of the joints. For me to cross the Ironman Melbourne finish line in a very respectable 14 hours and 7 minutes was a HUGE accomplishment to say the least, especially given sufferers of RA at my level are rarely able to get out of bed in the morning and end up with severe depression from the pain associated with the disorder. I did actually end up in hospital at the completion of the event for a week and a half due to the fact that I pushed myself above and beyond in order to make the finish line and become an IRONMAN. Unfortunately, I have paid the price for my sheer determination to cross that finishing line and since then I have seen some very trying times.

I am not a quitter and I refuse to give up often to my own detriment. No matter how hard and crappy my RA is, I always manage to keep a positive attitude in all that I do, and I inspire others around me. The overwhelming symptom I have is pain and stiffness, sometimes it lasts 4 hrs and sometimes it last all day but the mornings are generally the worst. I remember once trying to get out of bed and the pain was so great that I collapsed and my body went into shock and I had a fit. That was probably the disease at its worst. Now, with the treatment I am receiving, I still get pain but it is far more manageable.

My knees, lower back, feet and hands are most effected. My knees of late are causing me the greatest about of pain, so much so that I rarely walk without pain anymore. It often takes me 30 seconds or so to stand up from a seated position and move making running pretty much impossible.

I receive treatment monthly in the form of a drug called Tocilizumab that requires admission to day oncology. In the next few weeks, I am also going to be admitted to hospital to have Yttrium Radio Synovectomy Therapy which is a treatment that destroys painful tissue, stops fluid secretion and reduces joint inflammation on the knees.

Strangely, exercise helps! I'm unclear as to whether that is mind related or mobility related but if I don’t exercise I find myself being very short and irritable. Does it help the pain? Probably not, although I like to say it does but the issue then becomes working out what is RA pain and what is general muscle soreness. The challenge you have with someone like me is that exercise is not going for a walk or an easy swim, exercise is  running 21kms or exercising to max capability for 45 min or riding for 4hrs + anyway you get the idea!

Exercise brings so much more benefit for me other than keeping fit, keeping the weight off etc….its an outlet. It’s something I use to clear my head, digest the day and make a plan for what's next. That is invaluable.

I have certainly not done another Ironman - but I will one day. I have done two ultra marathons, two half IM's and two half marathons and one Olympic distance triathlon over the past two years. Of late, I’ve taken up Functional 45 Training with F45 Oakleigh and this I really love. I am learning so much about the importance of balance as opposed to just run, ride, swim and the strive to beat yourself, I just love it. I have found myself participating in sports that are far less weight bearing on my joints, and shorter time span to avoid stress and fatigue on my body. I can't say I am convinced as I have been programmed for so long to do endurance.

I am also on the Triathlon Victoria Board - VP. This helps me remain connected to the sport I love and enables me to give back in a way that I can manage and that suits my skill set. It also helps me develop both personally and in my career. One day I will race again, but in the meantime this is a great compromise. There is so much that can be done and gained from volunteering in sport.

Diet - clean eating with my disease is a must. I feel it in myself and my body when I don’t eat well. Lots of fish for essential oils and lots of green vegetables and minimising sugar. F45 has also been a huge help with this, it has transformed the way I see food. I have also found wine to be a trigger.

Home - we have had to make a few modifications to make life a little more bearable. Pull taps instead of turn taps, walk in shower recesses as opposed to the old step over the bath style and importantly, we have a furry family member - Molly which I found also helped a lot as the focus shifts from you to her.

Lifestyle - bring back the flats and joggers! Unfortunately, I am not going to win awards for the "style master of the year " at work or heading out as I can only wear flat shoes or when the pain is unbearable, joggers but everyone is used to that now and it suits my lifestyle. The other big change I have made is to prioirtise sleep. Fatigue comes as a symptom of the disease but the more sleep you get the easier things are to bare so I try to get at least 8 hrs sleep a night.

I utilise Remedial Massage, Pilates and core and lower back strengthening exercises thanks to Kobe at CSSM. I had really not maintained my body proactively at all until I was lucky enough to be selected as an ambassador and now I do it all the time. More importantly, I understand why I'm doing it and what I am affecting. Looking after your body is so important. I now believe that if you are good to your body it will be good to you.

The best advice I’ve been given is stop and listen to your body. By nature, I just push and push and push I have learnt that there is only so much your body can take and that is why I am where I am today. Hopefully, others can learn from this.

I have a very supportive specialist who is very keen to support me in achieving my goals whilst also managing the impact on my body and the expectations that I have. At this stage, all I am doing is F45, focussing on strengthening my body through pilates and weights.

My goals for 2018:

Compete in the Kokoda Ultra Trial Marathon

Compete in the Noosa Triathlon

To get a 6 pack!

Pregnancy And Osteopathy

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During nine months of pregnancy, the female body undergoes several structural and physiological changes and this can lead to compensatory patterns in movement with the potential to cause restriction and pain. As Osteopaths we are trained to assist you in your overall movement and well-being.

The most common body adaptions that we see include, 

  • Exaggerated spinal curves with changes in pelvic tilt, causing some muscles to be ‘tight’ and weak, contributing to: 
    • Headaches 
    • Muscle pains 
    • Lower back pain 
    • Posterior pelvic pain 
    • Plantar fasciitis 

 

  • The presence of the hormone relaxin, and an increase in progesterone causing an increase in ligament laxity presenting as:
    • Posterior pelvic pain or instability 
    • General spinal pain 
    • Muscle spasm 

 

  • An increase in body weight due to the growing foetus and an increase in blood volume, adding further strain to the joints and connective tissue 

 

  • Interstitial fluid retention impacting lymphatic flow, causing: 
    • Thoracic Outlet Syndrome
    • Carpal Tunnel Syndrome 
    • Peripheral oedema/swelling in legs and/or arms 

 

  • An increase in baby size (especially in the third trimester), causing: 
    • Reflux (heartburn)
    • Shortness of breath 
    • Intercostal neuralgia (pain around the ribs)  

 

At CSSM, we ensure a careful selection of hands-on techniques to best suit your condition, as well as your stage of pregnancy for safe and effective management. This may involve soft tissue massage, joint articulation and stretching in order to address affected areas. Spinal manipulation can be utilised if your practitioner deems it safe and appropriate for your condition. Your Osteopath will then take time to educate you on ways to manage your pain for the remainder of the pregnancy and also following delivery when your newborn arrives. 

Osteopaths are Government registered allied health practitioners with five years of university education behind them studying anatomy, pathology, physiology, pharmacology and clinical application. If you want to find out how an Osteopath can make your pregnancy more comfortable, make an appointment at cssm.com.au.

 

Caroline Sanguinetti is an Osteopath who specilaises in pregnancy care. 

Patella Tendinopathy: Jumpers Knee

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Jumper’s knee

With winter just around the corner, the sporting seasons are now in full swing. Many teens and pre-teens are involved in multiple sports, both in school and club teams resulting in a surprisingly large training load. A particularly common complaint we are treating is knee pain, more specifically patella tendinopathy or “jumper’s knee”.

Patella tendinopathy is a condition that develops in adolescents, more commonly in boys who participate in sports such as basketball, volleyball, football, and other sports requiring repetitive jumping. Prior to puberty, the patella tendon is not fully attached to the knee cap and excessive load during this period can change some of the fundamental characteristics of the tendon. 

Girls have a mature patella tendon by the age of 12-13 years, generally prior to the increased training demands of high school. This puts them at a lower risk of patella tendinopathy. Unfortunately for the boys, they do not develop a mature tendon until 14-16 years. By this age, higher training loads have already commenced, stressing the patella tendon during its critical developmental period. 

How does patella tendinopathy present?

  • Localised pain at the base of the patella 
  • Increased pain with increased load such as running and jumping 
  • Pain may be bilateral, but often one side is worse 

What are the risk factors?

  • Male gender
  • Repetitive quadriceps contractions (jumping, running)
  • Rapid increase in training load 
  • Poor calf strength 

What should I do if I think my child has patella tendinopathy?

  • Address the pain initially through ice and decreased load (NOT complete rest)
  • Anti-inflammatory medication used as directed may be beneficial for your child if tolerated
  • See a physiotherapist for assessment and treatment which may include:
    • Soft tissue massage 
    • Taping 
    • Commencement of isometric exercises for pain relief 
    • Assessment of jumping/landing strategies to identify predisposing factors
    • Strengthening and stretching exercises to address the factors identified above

Patella tendinopathy can be a long-term injury that requires optimal load management and patience. There are some simple self-management strategies that can help control pain and improve function, so if you think your child may be suffering from patella tendinopathy come and see one of our physiotherapists here at CSSM to help get them back playing sport pain-free.

 

About the author

Kobi Phelan is a graduate of the Doctor of Physiotherapy program at the University of Melbourne and also holds a Bachelor of Exercise and Sport Science. Kobi places high importance on actively involving her patients in the design and implementation of their injury rehabilitation.

 

References: 

Mascaró, A., Cos, M. À., Morral, A., Roig, A., Purdam, C., & Cook, J. (2018). Load management in tendinopathy: Clinical progression for Achilles and patellar tendinopathy. Apunts. Medicina de l'Esport, 53(197), 19-27.

Coming Back From Injury - Peter Hutchings

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Getting back from injury can be a long and lonely road. No matter what sport you play or what kind of athlete you are, everyone has setbacks.

I had hip surgery in 2016 after tearing cartilage in my right hip while training for the Cairns Ironman.

It's been tough because I really enjoy the satisfaction that comes from competing in endurance events both from a physical and psychological perspective.

For me, surgery was inevitable. Even though I tried to avoid going under the knife by focusing on glute and core strength work, I was unable to run pain free. As if that wasn’t enough, I also suffered from a frozen shoulder during the same period.

Regular physio and massage has been part of my rehab program. I have worked on changing my running gait to a more mid-foot strike to reduce impact, increase running cadence and extensive core and glute strengthening work.

Rehab has been frustrating. The improvements have been very slow and I have had to manage my expectations carefully and listen to my body. But I believe early intervention has helped minimise the damage and get me active sooner.

I am currently training 6-7 days a week. Generally 2-3 swim sessions, 2 runs and 2-3 rides. This is supplemented by massage focused on my lower back and legs. Dry needling is also a part of the treatment.

The best advice given to me while I've been injured? "Be patient and don’t skip the rehab exercises even if they don’t seem to make a difference."

My goal is to complete a half marathon triathlon again. If you're injured, be patient, listen to your body, be consistent with training, don’t increase the training volume too quickly and utilise massage as a key rehab treatment.”

 

*Peter Hutchings is 54 and is sponsored by CSSM as part of the 2018 Athlete Sponsorship Program

He is currently 16 months post-surgery and one of our very determined athletes.

CSSM is proud to work with people like Peter to help them achieve their goals.

Reception & Practitioner Support Vacancy - 2 Positions

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Camberwell Sports & Spinal Medicine requires a Medical Receptionist to be part of our busy reception/administrative team. Be the smiling face that greets our clientele who come from a vast variety of backgrounds.  The role is a permanent part-time position.

We are seeking a person who thrives on a busy working environment. This person will be highly motivated to have a positive impact of the practice by being organised, proactive, and dedicated to providing patient services support to the highest level.   

The practice is open extended hours with this position including some mid-week evening and weekend commitment.

 Your responsibilities will include:

  • Front desk reception
  • Meeting and greeting patients – creating a great first impression
  • Working with a busy switchboard
  • Assisting with patient enquiries
  • Scheduling patient appointments
  • Prepare and receipt patient accounts
  • Data entry with a high level of accuracy
  • Filing - scanning (paperless office)
  • Organising and liaising with other practices and service providers.
  • General administration
  • Practitioner support
  • Back of house support – Organising linen etc.

 

To be successful in this role you must possess the following:

  • High-level computer literacy
  • Strong organisational and communication skills with the ability to manage competing demands
  • The ability to work within a large team environment and liaise with people on all levels
  • Excellent presentation skills
  • Professional telephone manner
  • A knowledge of Frontdesk Practice Management software would be highly advantageous

 

The position will commence May / June 2018.

 

Resume’s to:

 

Careers@cssm.com.au

 

Low Back Pain And Paracetamol

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Low back pain and paracetamol by Osteopath Lachlan White

It is expected that 70-90% of people will suffer from low back pain at some time in their lives. 

Low back pain can be a significantly debilitating experience and commonly affects a person’s ability to complete simple tasks, such as getting dressed, getting out of bed or walking a short distance. It also has the potential to burden those who care for low back pain sufferers. 

Paracetamol is one of the most commonly prescribed medications for relieving low back pain – but is it really effective?

Significant research has recently been conducted in this area and has revealed some surprising insights.  The British Medical Journal (BMJ) found paracetamol to be ineffective for reducing low back pain intensity and improving quality of life. Evidence also indicates that people consuming paracetamol are four times more likely to have altered liver function due to the body’s metabolism of the drug.

When compared to placebo (a dummy pill), paracetamol has been shown to have the same effects on pain, function, sleep and quality of life – no improvement. 

So as a sufferer of low back pain, where does this leave me?

In some cases, anti-inflammatories or other forms of pain medication are more likely to be effective. There are also many other self-management strategies which may assist in managing low back pain. 

Osteopathy is a form of manual therapy within the Allied Health profession which can help diagnose, treat and manage low back pain. By using a range of safe and clinically effective treatment techniques tailored to the individual, it can relieve pain, improve mobility and strength, and increase performance. Osteopaths are also able to prescribe rehabilitation programs, provide advice regarding common medications, prescribe other self-management strategies and assist with any other problems that you may be experiencing.

To discuss this further contact CSSM on 9889 1078.  

About the author:

Lachlan White is a registered Osteopath. He has an interest in treating patients with acute and chronic pain conditions, including headaches, neck and back pain and assisting in the management of chronic and degenerative disease.

References

Back problems. (2017). Australian Institute of Health and Welfare. Retrieved 20 March 2018, from https://www.aihw.gov.au/reports/arthritis-other-musculoskeletal-conditions/back-problems/what-are-back-problems

Machado, G., Maher, C., Ferreira, P., Pinheiro, M., Lin, C., & Day, R. et al. (2015). Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials. BMJ350(mar31 2), h1225-h1225. http://dx.doi.org/10.1136/bmj.h1225

Williams, C., Maher, C., Latimer, J., McLachlan, A., Hancock, M., Day, R., & Lin, C. (2014). Efficacy of paracetamol for acute low-back pain: a double-blind, randomised controlled trial. British Dental Journal217(4), 183-183. http://dx.doi.org/10.1038/sj.bdj.2014.732

Protecting Junior Athletes From Injury

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One of the most common questions we receive from concerned parents about their active children is, “how much is too much?” 

When a child has a healthy interest in sport and has the dedication to be the best that they can be, sometimes it can be difficult to get them off the court and the ball out of their hands.  As with many things in life, balance is important and parents are tasked with the role of trying to encourage the enthusiasm of youth whilst knowing that too much may be putting that child at risk of injury.

This issue becomes more apparent as the “professionalism” of sport filters into the junior ranks.  In some sports, athletes can now receive national rankings from the age of 10 and athletes are encouraged into single sport specialisation together with high intensities and volumes of training at increasingly younger ages.  

Undoubtably, the biggest consideration when dealing with junior athletes is injury prevention. With young age, sport specialisation and high training volumes - they are at high risk. 

An article from 2017 in the Strength and Conditioning Journal discussed this dilemma.  How much is too much?

Interestingly, the article concluded that junior athletes tolerate surprisingly high volumes of sport - but only if the load was tempered by significant rest periods between seasons and a limit on sports specialisation until the late teens.  

Of importance was the finding that injury prevention strategies and conditioning should form part of the training program.  

The recommendations of this study outline that a mixture of structured sports and unstructured play is very important in junior athletes. The study found the time spent playing structured sport should be no more than twice the time spent participating in unstructured play.  

In terms of the total volume of the number of hours spent playing structured sport (training plus match play) - it should be less than the child’s age in years and should not exceed 16 hours per week for late teens.  So a ten year old athlete can play up to 10 hours of structured sport a week, but an 18 year old should not exceed 16 hours.  

Time off is very important.  The recommendations within this research suggests that time off between seasons and time off through the year is vital.  The findings suggest that junior athletes should have at least 3 months away from structured sport each year (not necessarily in a row) and at least one month between seasons for the best outcomes with regard to injury prevention.  

When it comes to specialisation, the research suggests that this should be limited until the athlete reaches late teens. Athletes should participate in different sports throughout the year, but not necessarily more than one sport at a time.  

Clearly, the recommendations in the paper are one view and general in nature.  Recommendations will change based on numerous individual variables including gender, developmental progression and the actual sports involved.  Should you have any queries about your child’s participation in sport and injury prevention, please talk to our team at Camberwell Sports and Spinal Medicine.  

About the Author

Travis Bateman is an Osteopath, trail runner, mountain biker, habitual back of the pack finisher and founder of Camberwell Sports and Spinal Medicine.  His clinical interest is in movement analysis and its relationship to injury management, pain and sports performance.

 

Reference

Jayanthi, Neeru A. MD; Dugas, Lara R. PhD, MPH, 2017, The Risks of Sports Specialization in the Adolescent Female Athlete, Strength & Conditioning Journal: April 2017 - Volume 39 - Issue 2 - p 20–26

Sitting Vs Standing

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The jury is out on which is better. Standing all day is no better than sitting. This is because, by standing all day, a variety of new risk factors are introduced such as increasing compression through the spine which can lead to low back pain. It may also increase the risk of developing varicose veins and other cardiovascular problems as the body has to work against gravity to return blood flow back to the heart.

What experts do agree on is that the body was designed primarily for movement, so sitting or standing statically for extended periods is counterproductive.  Therefore, a combination of alternating between sitting and standing is most likely to be the healthiest option. So instead of forking out thousands of dollars on a sit-stand desk, try the obvious solution first –stand up and move as often as possible at work.

The term ‘ergonomics’ is derived from the Greek language and translates as ‘how to work according to nature’. Put simply, it is the interaction between a person and their environment.

In Australia, 45% of all employed adults work in a sedentary job where they spend most of their time sitting. Prolonged periods of sitting not only increases the risk of diabetes, heart disease and obesity, but may result in the development of numerous musculoskeletal disorders and discomfort. Ergonomic adjustment to the workplace environment may increase comfort and productivity, and decrease the risk of chronic injury and disease.

Some basic tips to improve desk ergonomics include:

  • Feet flat on the ground
  • Knees and hips at 90 degrees
  • Hips slightly above knee height
  • Hips positioned in the back of the chair
  • Backrest slightly reclined to 10-20 degrees from vertical 
  • Forearms approximately level with the desk, keyboard and mouse within close distance of each other
  • Computer screen is at arms length from the head, with eye line falling within the upper 1/3 of the screen
  • Sit up tall, chest out, shoulders back and remain upright.

 

Image sourced from: http://www.sittingergonomics.com/

 

Is there anything else I can do to assist my workplace health?

Yes there is. Movement is the key to rejuvenating the neurological system by activating fatigued and ineffective muscles, and allowing fluid movement to keep the spine healthy. Workers should be moving every 25-30 minutes. Get a drink of water at the water fountain, take the stairs instead of the lift or speak to a colleague face to face instead of using email!

Simple stretches can also be completed to assist with pain prevention. These are a few examples of stretches that can be completed whilst sitting: 

 

 

Image sourced from: https://equilibriumnaturalhealth.com/2016/12/01/seated-stretches/

For more information, contact one of our Osteopaths here.

About the author:

Lachlan White is a registered Osteopath. He has an interest in treating patients with acute and chronic pain conditions, including headaches, neck and back pain and assisting in the management of chronic and degenerative disease.

 

References

Australia Bureau of Statistics. (2011). 4835.0.55.001 - Physical Activity in Australia: A Snapshot, 2007-08. [online] Available at: http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/4835.0.55.001main+features32007-08 [Accessed 20 Mar. 2018].

Chu, A., Ng, S., Tan, C., Win, A., Koh, D. and Müller-Riemenschneider, F. (2016). A systematic review and meta-analysis of workplace intervention strategies to reduce sedentary time in white-collar workers. Obesity Reviews, [online] 17(5), pp.467-481. Available at: https://onlinelibrary.wiley.com/doi/abs/10.1111/obr.12388 [Accessed 20 Mar. 2018].

Free Foot Checks

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Feet are funny things.  26 Bones, 33 Joints, over 100 muscles, tendons and ligaments.  That is a lot that can go wrong. 

Too often at CSSM we see patients who present with long standing foot pain. Invariably this pain starts as a little niggle, which progresses to pain that doesn’t go away and eventually can become quite painful and disabling.

Now we understand when people say, “It didn’t seem too bad so I didn’t bother to get it checked out,” however identifying issues before they become a problem is a key philosophy of CSSM. With this in mind Camberwell Sports & Spinal Medicine is giving you the opportunity to quiz our experts and receive a free foot check. It is time to get those little niggles checked out!

The Free Foot Checks are conducted by our Podiatry team. The assessment involves a half hour session and will include a biomechanical and video gait analysis. Suitable for children and adults alike, these sessions are focussed on giving the participant a clear understanding of how their foot functions, outlining any evident biomechanical issues, the cause to these problems and suggestions on various management options all with a written report. Designed to answer any questions that you may have, we can also give other specific advice regarding shoe selection and self-management of foot conditions. This will all be provided free of charge with no obligation.

Servicing the general public and athletes from recreational to elite, our podiatrists pride themselves on providing services which have measurable outcomes.

The Free Foot Checks are available until April 15th 2018. Sessions are by appointment only, with only limited spaces available each day. 

Free Foot Check Appointments cannot be made online.

Find out more about the podiatry services available at CSSM on our website www.cssm.com.au/podiatry

*The Small Print:

  • This offer is obligation and commitment free.
  • This offer is available for a single use only and is open to both new and existing patients of Camberwell Sports & Spinal Medicine.
  • Free Foot Checks are a temporary service available from Camberwell Sports & Spinal Medicine until 15th April 2018.   
  • This offer can only be redeemed by calling Camberwell Sports & Spinal Medicine for an appointment on 03 9889 1078.  Free Foot Check Appointments cannot be made online. 
  • The purpose of this offer is to enable patients to access the Podiatry services of Camberwell Sports of Medicine and to experience our philosophy on injury management.
  • Camberwell Sports & Spinal Medicine reserves the right to amend these terms and conditions without prior notice.
  • In the event of any dispute, the decision of Camberwell Sports & Spinal Medicine is final.

Blisters

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It’s time to burst some bubbles, pop the stigma and talk about the really irritating problem of blisters. They’ve been in the news recently with South Korean tennis superstar Hyeon Chung having to retire from his Australian Open semi-final clash with Roger Federer (heard of him?). It has to be a serious blister to cause someone to retire from playing in a grand slam semi-final, but it goes to show how important blister prevention and management can be!

If blisters are left untreated and not offloaded they can eat away at the epidermis (the outermost layer of the skin) and reveal the dermis; a part of the skin that is easily prone to nasty infections. The last thing we want to happen after developing a blister, is to see an infection take over the region on the foot and lead to time off your feet.

With the new football season about to kick off (pun intended) and with events such as the 100km Oxfam Trailwalker happening soon there is a lot of blister talk around the clinic at the moment.  

As most people know, a blister can really ruin your day.  In fact for the Oxfam walkers, blisters are the most common reason that participants seek medical attention or even pull out of the walk, so managing them is super important if going ahead with the challenge.

Tips for Avoiding Blisters

  • Wear good quality socks: that form well to the foot and size well.
    In vigorous situations, having a sock too small can increase the area of pressure due to the seam contacting with the foot. Likewise, socks that are oversized can increase the friction over bony landmarks and cause a “hot spot.”
  • Wear in your footwear!
    Seems simple, but testing your shoes and gradually wearing them in before vigorous exercise is the best way to avoid blisters. Hiking, construction and leather boots are the main culprits. Preventative taping using sports tape or underwrap (Hypafix or Fixomull) will decrease the friction caused and leave your feet a lot happier.
  • Manage hotspots early.
    If you feel the blister starting to form, cease activity and inspect the area. If a fluid sac has not appeared, commence management involving a non-stick dressing over the area and tape it well. Your podiatrist can also help by applying felt offloading padding, particularly for those pesky blisters in the arch and under the big toe.

Managing Blisters Once Formed

  • Don’t pop the blister unless you can do in a sterile manner, apply an anti-bacterial agent (such as Betadine) and an appropriate bandage. If not, protect using blister packs for protection and reabsorption. 
  • If these can be achieved, create a small insertion to the fluid sac and the most distal point (lowest gravity point) using your sterile implement. Use gauze (or similar products) to absorb the fluid as you gently drain the blister. Once the region is inspected, apply Betadine and dress.
  • This is a great time to adjust the lacing on your shoes, or change shoes all-together to protect the area going forward.

Blisters can be detrimental to the best athletes and for the weekend warrior. If you have any further questions, or want advice and strategies to protect yourself in whatever challenge you face, pop in (pun intended) and chat to the Podiatry team at CSSM.

 

About the Author: James Unkles is a Podiatrist who has also completed his Bachelor degree in Exercise and Sport Science. He loves the finer details of running and how it effects the body. He hates blisters with a passion. 

Women '5 Times More Likely' To Rupture ACL

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The opening of the AFLW season has seen a spate of season ending knee injuries, including Carlton skipper Brianna Davey who ruptured her ACL against the giants last Friday.

Leading sports medico Peter Brukner says women are 5 times more likely to rupture an ACL. 

“The main reason is mechanics,” he says. “Females have a wide pelvis and therefore are more bow legged. There’s more of an inclination for their knees to fall in when they twist, so that makes them more susceptible.”

For women and men, an ACL injury can be devastating, writes Physiotherapist Kobi Phelan in her latest blog.

An ACL (Anterior Cruciate Ligament) rupture is one of the most debilitating sporting injuries that can see athletes sidelined from nine to 24 months and beyond. ACL injury occurs most commonly during sports that involve sudden changes in direction, sudden stops or jumping such as football, tennis, skiing or basketball.

For many years surgery has been seen as the best management for sufferers of ACL injuries wishing to return to physical activity. However recently there has been a lot of discussion about non-surgical pathways for ACL rehabilitation being equally as successful for certain people.

Surgery versus no surgery depends entirely on your functional requirements, goals and time for rehabilitation. Whatever your choice, it is a long and mentally tough rehabilitation period after ACL injury.  With around one in three people never returning to sport after ACL injury, a thorough rehab plan is essential for the best outcome. Regardless of the management strategy, achieving full knee extension, regaining quadriceps activation and reducing knee swelling precedes the all-important strengthening and conditioning phases.

For surgical patients, it has been shown that five weeks of intensive pre-operative rehabilitation with the aim of achieving 90% limb symmetry resulted in better knee function two years after surgery (Grindem et al., 2015). For those who are operated on sooner, it has been shown that completing some pre-op rehab results in a higher likelihood of returning to sport and having better knee function post-op (Mansson et al., 2013).

For both surgical and non-surgical patients, returning to sport should be criteria as opposed to time-based. This means, achieving key milestones before progressing to the next level. 

Returning to running is only a small component of the overall picture and requires adequate strength and single leg balance prior to being attempted. 

I follow a criteria based program by Randall Cooper because it ensures patients achieve Phase 1 functional goals prior to progressing to Phase 2, and so on. Results indicate that of those who met the key goals in Phase 3, only 5 per cent sustained a second ACL injury (Grindem et al., 2016) after returning to sport in Phase 4.

For the best outcomes after an ACL injury it is important to consult a physiotherapist and discuss the most appropriate pathway for you. If you have recently had an ACL injury, come in and see one of our physiotherapists. We will help guide you through your rehabilitation, whether it be pre-surgery, post-surgery or no surgery at all.

 

References:

Filbay, S. R., Ackerman, I. N., Russell, T. G., & Crossley, K. M. (2017). Return to sport matters—longer‐term quality of life after ACL reconstruction in people with knee difficulties. Scandinavian journal of medicine & science in sports, 27(5), 514-524.

Grindem, H., Granan, L. P., Risberg, M. A., Engebretsen, L., Snyder-Mackler, L., & Eitzen, I. (2015). How does a combined preoperative and postoperative rehabilitation programme influence the outcome of ACL reconstruction 2 years after surgery? A comparison between patients in the Delaware-Oslo ACL Cohort and the Norwegian National Knee Ligament Registry. Br J Sports Med, 49(6), 385-389.

Grindem, H., Snyder-Mackler, L., Moksnes, H., Engebretsen, L., & Risberg, M. A. (2016). Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med, 50(13), 804-808.

Månsson, O., Kartus, J., & Sernert, N. (2013). Pre‐operative factors predicting good outcome in terms of health‐related quality of life after ACL reconstruction. Scandinavian journal of medicine & science in sports, 23(1), 15-22.

Sanders, T. L., Maradit Kremers, H., Bryan, A. J., Larson, D. R., Dahm, D. L., Levy, B. A., ... & Krych, A. J. (2016). Incidence of anterior cruciate ligament tears and reconstruction: a 21-year population-based study. The American journal of sports medicine, 44(6), 1502-1507.

Waldén, M., Hägglund, M., Magnusson, H., & Ekstrand, J. (2016). ACL injuries in men9s professional football: a 15-year prospective study on time trends and return-to-play rates reveals only 65% of players still play at the top level 3 years after ACL rupture. Br J Sports Med, 50(12), 744-750. 

A Pain In The Backpack

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By Kobi Phelan

With textbooks, computers, lunch and sporting equipment, backpacks can be heavy. This is particularly concerning for junior students as the spine is at a critical stage of development between 12 and 14 years of age.

According to the Australian Physiotherapy Association, 70 per cent of children will suffer back pain because of heavy backpacks.

Backpacks should weigh no more than 10 per cent of a child’s weight. However, recent studies have shown that the school bags of more than half (61%) of school aged children exceed that.

Studies have reported the highest level of discomfort is in the shoulders and back as well as the neck.

In extreme cases, overloaded backpacks can cause headaches, pins and needles and numbness in the arms.

Ideally, you want to lower the backpack weight but here are a few things you can do to eliminate discomfort and injury: 

-Get organised. Only take the books you need for that day and leave the rest at school or in a locker.

-The ideal school bag is a backpack with wide shoulder straps that are comfortable and sit well on the shoulder and a padded back support that fits snugly on the back. 

-Parents should look for bags with compartments that allow you to pack the heaviest items at the base of the bag closest to the spine.

-Don’t make the mistake of thinking your child will grow into a backpack. The backpack shouldn’t sit higher than the child’s shoulders when sitting down.

-The straps should be shortened until the bottom of the backpack is just above the child’s waist, and not sitting on their buttocks.

Our team is more than happy to answer any questions or help to fit a backpack properly.

If The Shoe Fits

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It’s back to school time! Hard to believe the summer break is already over! Parents - it’s time to check up on all things uniform based, seeing how much kids have grown over the break and whether or not they still fit in their shoes!

Getting the right school shoe can be tricky, some are too heavy, some are too bulky and some are too expensive. We’re here to help put you on the right track, to not only get the best value for money, but to get the right fit for your child.

Before you purchase the shoes, ask your child:

-How much running do they do in their shoes?

-How many days per week do they wear them?

-And how old are their school shoes?

It’s important to ask these questions, as shoe technology has improved significantly over the previous couple of years. Companies such as Ascent are making school shoes with running shoe technology to increase movement efficiency and decrease the overall weight of the shoe, whilst still sticking to uniform guidelines. The only issue is with these shoes is that they do wear out in less time than traditional shoes. So be aware when purchasing.

It’s common for parents to purchase shoes so that children “will grow in to them” which is a big NO! Having a shoe that is too big can lead to blisters and musculoskeletal conditions of the foot and lower leg, which can lead to big problems going forward. A perfect shoe fit is 0.5-1 size on top of your measured foot size to allow for the foot to swell during activity without restricting motion.

Key Features:

  • Rigid “heel counter” enabling the rear foot to be locked in to the shoe and prevent slippage
  • Fixation through laces, or velcro to prevent midfoot movement
  • Nil flexibility through rotation of the midsole. In simple terms: not being able to scrunch the shoe in to a ball. A little bit of flex is good, but it should be free moving.
  • Width across the forefoot - should not rub on the foot.

Remember to take care of those shoes, get them fitted properly by the experts, and if there’s anything we can do to help, come and see the Podiatry team here at CSSM.

Blog Series Part 4: Crossing The Midline

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Here’s an exercise for you: head down to your local oval and use the boundary line and run directly along it. If you notice your feet crossing over the boundary line to the other side of your body, you are most likely crossing the midline of your body. This may be a result of muscle tightness/weakness across the pelvic and hip region or could be coming from your foot posture. Persistent crossing the midline in association with loading increases have shown to increase your chances of lower limb injury, and may require intervention.  

Crossing the midline is also referred to having a “narrow base of gait” which identifies that rather than having your feet strike the ground in alignment with your lower limb, you become more ‘adducted’ and have both feet strike the ground closer towards, or cross over the midline of your body (an imaginary line from the top of your head, dissecting the body in to two). Overloaded foot structure from pronation can be made worse for lower limb function if you have a narrow base of gait, and can lead to increases in the average vertical rate of force in the body (Napier et al., 2015).

Intervention programs can involve stretch and strengthening, dynamic exercise prescription, gait retraining or even the use of orthotic devices to prevent you overloading from midline infringements. 

Every runner is different. We all have different styles, strike patterns and muscular status. If you’re wanting to get the best out of your running to propel you to the next level, getting your technique analysed is the best way to get to the bottom of any issues and help your program for the future.

We offer a Running Gait Analysis’ at CSSM.

 

About the Author
James Unkles is a Podiatrist who has also completed his Bachelor degree in Exercise and Sport Science, and loves the finer details of running and how it effects the body.

References

Napier C, Cochrane CK, Taunton JE, et al. Gait modifications to change lower extremity gait biomechanics in runners: a systematic review. Br J Sports Med 2015;49:1382-1388.

Blog Series Part 3: Heavy Heel Striking

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Part 3: Heavy Heel Striking

Are you wearing out of the rear of your runners much more quickly than the rest of your shoe? You may have a heavy heel strike in your running style. This is commonly paired with a very “loud” running style, where you can commonly hear the contact that you make with the ground. So take out your headphones, and listen to your style! 

Heavy heel striking is not only unattractive to watch when observing gait, it is extremely taxing on the body. That large impact sends load through the posterior leg and can lead to longstanding conditions such as ankle instability, shin splints, muscular overload and even stress fractures. It even relates to the topic we covered in the last blog in this series - looking at how overstriding can affect your gait. If you are a chronic overstrider, you may also be contributing to your injury risk heavily loading on the rear-foot. 

Research conducted at Curtin University in Perth looked at the relationship between “running quietly” and vertical ground reaction forces (how much load is impacting the body during ground contact). Their study found, particularly with male participants, their peak loading rates and forces were reduced when asked to “run quietly.” This important piece of research backs up many coaches and health professional’s beliefs that potentially altering a runner away from a heavy heel striking gait, can help to prevent further injury.

This is not to say that heel striking is a terrible gait characteristic. A large percentage of the population do run with a heel strike style gait, and can be seen in many endurance athletes across the world. What is important to remember is that any type of instability associated with the rear foot can largely effect how we manage the increased load of running through the lower limbs. 

To assess the effect of this characteristic, having your running technique analysed by a running coach or health professional is the best way to prevent any injuries that may develop. 

About the Author

James Unkles is a Podiatrist at CSSM, who enjoys running as part of a balanced lifestyle. His passion in biomechanical analysis will help you get the most out of your running.

References
Xuan Phan, Tiffany L. Grisbrook, Kevin Wernli, Sarah M. Stearne , Paul Davey & Leo Ng (2017) Running quietly reduces ground reaction force and vertical loading rate and alters foot strike technique, Journal of Sports Sciences, 35:16, 1636-1642, DOI: 10.1080/02640414.2016.1227466

Blog Series Part 2: Overstriding

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BLOG SERIES: Part 2 Overstriding

Technique in running is something that is often overlooked in the casual competitive runner, and in many cases can lead to the development of an overuse injury. In terms of gait (running movement) patterns, maximising your efficiency during gait will prevent joint overloading and thus prevent the onset of load induced injury. In this blog series, we have already gone through running lingo - this week we look at overstriding.

As the term indicates, overstriding is where our stride length (the distance between the same feet contacting the ground in one stride) is influencing our ground contact. If there is excessive stride length and our ground contact is occurring well out in front of our body, by contacting the ground in front of our body, our ability to hold the load changes as we are unable to recruit the knee and the hip to manage the load and notoriously the muscles below the knee must take the load. 

This can cause overuse injuries such as Medial Tibial Stress Syndrome (MTSS-Shin Splints) as the anterior leg musculature overreacts to the load and can cause irritation to the tibia bone. Patella-femoral joint pain is also common with an over-strider not being able to utilise the upper leg complex to process the body weight load as it meets the ground reaction forces. Calf, achilles and hamstring injuries can all be related back to overstriding.

These conditions unfortunately are not quick fixes, and can take time to repair and rehabilitate. 

So how do you know if you're overstriding? The best way is through video analysis. Whether that be through a directed video gait analysis with a trained professional, or getting a mate to take a video on their smart phone of you running along from the side. You may also know by symptoms of pain just below or behind the knee cap, anterior leg soreness or inflammation of the lower leg. 

Treatment for overstriding involves including some gait retraining cues to decrease the impact of overstriding and look at greater efficiency, potentially soft tissue work depending on the health of your lower limb and occasionally orthotics to alter the mechanics. For something that can seem so miniscule, the reality of the situation is that it can cause chronic activity pain. By working through these difficulties we can get long term outcomes, which not only resolve your pain, but can keep you running for longer and help you hit your targets!

About the author

James Unkles is one of our Podiatrists here at Camberwell Sports & Spinal Medicine. A casual runner in his spare time, he understands the nature of the industry and how little imperfections can become big issues.  

Reference

Rowlands, A., Eston, R., & Tilzey, C. (2001). Effect of stride length manipulation on symptoms of exercise-induced muscle damage and the repeated bout effect. Journal of Sports Sciences, 19(5), 333-340.

Next week: Heavy heel striking. Stay tuned!

Blog Series Part 1: Running In Plain English

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Technique in running is something that is often overlooked in the casual competitive runner, and in many cases can lead to the development of an overuse injury. In gait (running movement) patterns, maximising your efficiency during gait will prevent joint overloading and thus prevent the onset of load induced injury.

Common technique habits that can increase your risk of injury include overstriding, heavy heel striking and crossing the mid line of your body. Those might all seem slightly complicated to diagnose when heading out for your daily run.

Over a four part series, we will look at some common running technique mistakes and how they can affect you putting one foot in front of the other!

It is quite common in the running game to use certain terms to describe your running pattern and the impact you have with your technique. All over the internet you will find running blogs which implement different terms and try and guide you in the right direction, but we’re here to help you understand and use this information to become a better runner.

Stride
The actual impact from one foot meeting the ground, transferring through the foot, taking off, swinging though and contacting the ground again.

Stride Length
The distance of one stride, generally measured from initial contact point to initial contact point on the same leg. 

Gait
In health terms, we use this term to describe your movement style. It encompasses both walking and running, both foot contact and flight time.

Midstance

The stage in your gait where your foot is flat on the ground, and taking the full weight of your body. This time in your gait cycle is commonly where compensations can occur through your foot, knee or hip.

Toe-Off

The propulsion phase where your foot leaves the ground.

Heel Strike

The initial ground contact generally made by rearfoot and midfoot runners. 

Load

Commonly referred as “training load” it refers to the forces coming through the body. 

 

Now you know the lingo, next week in Part 2 we will delve into Overstriding. Watch this space!

 

 

Exercise For Osteoporosis

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October has been World Osteoporosis Awareness Month. Most people understand what osteoporosis is and what it means in relation to bone health. However despite promising evidence, there is something of a knowledge gap amongst the general public in terms of what can be done through diet and exercise to minimize and prevent the risk of osteoporosis.

According to the Australian Bureau of Statistics as many as 4 out of 5 people with osteoporosis are unaware they have it, despite being at risk of fracture. 4.74 million Australians over the age of 50 either have osteopenia or osteoporosis.  And by 2022 it is anticipated that there will be a fracture every 2.9 minutes associated with poor bone health in Australia.

Osteoporosis is a condition affecting the structure and metabolic health of bones, in essence making bones weaker and decreasing their ability to absorb impacts. The spine, hip, and wrists are most commonly affected and are often sites of fractures for the elderly. This is important, because as we age, decreased bone mineral density predisposes an individual to an osteoporotic fracture. With fractures in this age group contributing significantly to morbidity and decreased quality of life, it highlights the importance of implementing strategies to successfully manage osteoporosis.

A randomized control trial by Bailey and Brooke-Wavell examined the effects of performing 50 hops per day in 61 premenopausal women. Over 6 months, those who performed 50 hops seven times per week increased their bone mineral density by 1.8%, whilst those performing 2 or fewer sessions a week showed no change or even a loss in bone mineral density. Similar results have also been replicated in post-menopausal women. These findings highlights that weight bearing impact exercises are effective in improving and minimizing the effect of age related bone mineral density loss. And that exercise is a powerful stimulus for good bone health in both young and older individuals irrespective of current bone health.

Whilst ‘impact’ exercise may seem counter-intuitive and perhaps harmful for those with weakened bones. It is important to understand that bone, like muscle, requires a level of stimulation to increase metabolic and cell activity. With muscle we can do this through resistance exercise, and this allows our muscles to grow stronger. The same can be done to bone through weight bearing exercise that stimulates bone remodeling and growth. Unlike muscles which adapt quickly, bones don’t have the same blood supply or cellular activity, and as a result bony adaptation is a longer and slower process, with complete skeletal remodeling taking 7+ years.  

Current consensus statements from Osteoporosis Australia and Cochrane Reviews support a combination of Vitamin D and calcium supplementation enhancing the effects of impact exercises performed 3-5 times per week, with 50-100 weight bearing impacts per session to create a meaningful improvement in bone mineral density. Supplementation alone is ineffective in creating positive changes in bone mineral density. Exercises can be as simple as step-ups, star jumps, side-side jumping, bounding or stomping. Further exercise including resistance exercise, aerobic exercise, and fall prevention strategies are also recommended to ameliorate and decrease risk of osteoporotic fractures. 

If you or someone you know has osteoporosis or are concerned, please speak with your GP to perform all the appropriate checks and discuss a management plan. For those who have osteoporosis, it is critical that advice regarding new exercises is obtained through a qualified health professional to ensure appropriate loading, progression, and safety. The team at CSSM are perfect for that!

For further reading and resources please see Osteoporosis Australia.

About The Author:

Trevor Spencer is a Physiotherapist with a strong interest in exercise rehabilitation for athletes and the general population.  In addition to his physiotherapy qualifications, Trevor has qualifications in Exercise and Sports Science.  

 

 

References:
- www.osteoporosis.org.au/sites/default/files/files/Burden%20of%20Disease%20Analysis%202012-2022.pdf

- Bailey, C. and Brooke-Wavell, K. (2010). Optimum frequency of exercise for bone health: Randomised controlled trial of a high-impact unilateral intervention. Bone, 46(4), pp.1043-1049.

- De Matos, O., Lopes da Silva, D., Martinez de Oliveira, J. and Castelo-Branco, C. (2009). Effect of specific exercise training on bone mineral density in women with postmenopausal osteopenia or osteoporosis. Gynecological Endocrinology, 25(9), pp.616-620.

- Sinaki M, Itoi E, Wahner HW, et al. Stronger back muscles reduce the incidence of vertebral fractures: a prospective10 year follow-up of postmenopausal women. Bone 2002;30:836-41.

- Maddalozzo GF, Snow CM. High intensity resistance training: effects on bone in older men and women. Calcified Tissue Int 2000;66:399-404.

-Howe TE, Shea B, Dawson LJ, et al. Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane DB Syst Rev 2011, Issue 7. Art. No.: CD000333. DOI: 10.1002/14651858.CD000333.pub2.

- Bass SL, Naughton G, Saxon L, et al. Exercise and calcium combined results in a greater osteogenic effect than either factor alone: a blinded randomized placebo-controlled trial in boys. J Bone Miner Res 2007;22:458-64.

- Allison, S., Folland, J., Rennie, W., Summers, G. and Brooke-Wavell, K. (2013). High impact exercise increased femoral neck bone mineral density in older men: A randomised unilateral intervention. Bone, 53(2), pp.321-328.
 

 

Rowing Injury Free

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Rowing is an incredible sport for many reasons: it is a great way to gain cardiovascular fitness, builds full body muscle strength, promotes weight loss and reduces stress. But due to the nature of rowing, it is also closely associated with a number of injuries. Most rowing injuries are related to overloading and poor biomechanics that can be due to incorrect technique, lack of experience and changing sides that the oar is on (if using a sweep boat).  

Why technique is so important: 

The rowing stroke is a continuous cycle that is divided into the catch, drive, finish and the recovery. The drive requires the rower to sequentially use their legs, followed by body and then arms while the recovery sequence is the reverse. Incorrect technique can therefore lead to overuse injuries as the rower is repeating incorrect movement patterns. For example, poor technique through the recovery such as lunging too far forward at the catch can put rowers in risk of shoulder and back injuries. While poor technique at the finish such as hunching through the shoulders and leaning too far back can increase pressure through spinal discs. 

Common injury sites for rowers:

  • Wrist and hand  
  • Forearm 
  • Shoulder
  • Rib stress fractures
  • Hip
  • Knee
  • Back

How to reduce/prevent injury from rowing: 

  • Maintain correct technique
  • Good general health
  • Make sure you warm up sufficiently 
  • Stretch afterwards – particularly hamstring and hip flexor muscle groups
  • Improve posture both during rowing and during study or work

Immediate management for your rowing injury: 

  • Stop what you are doing, rowing through pain can make your injury worse! 
  • For soft tissue injuries use RICE (rest, ice, compression, elevation) until you have the opportunity to see a healthcare professional. 
  • Seek treatment from a health care professional as soon as possible. Early management will help your condition heal quicker and reduce your time spent away from rowing. 
  • Correct any technique errors prior to graded return to rowing.
  • If you are experiencing discomfort in your chest and suspect a rib stress fracture in line with the Rowing Australia guidelines, 4 days of no water training is highly recommended. 

 

At CSSM we are able to assess and treat your rowing injuries as well as use our software to analyse your technique using the ergometer. 

 

References1-5

1. Rumball JS, Lebrun CM, Di Ciacca SR, Orlando K. Rowing injuries. Sports medicine. 2005;35(6):537-555.

2. Holden DL, Jackson DW. Stress fracture of the ribs in female rowers. The American journal of sports medicine. 1985;13(5):342-348.

3. Hosea TM, Hannafin JA. Rowing injuries. Sports Health. 2012;4(3):236-245.

4. Karlson KA. Rib stress fractures in elite rowers. The American Journal of Sports Medicine. 1998;26(4):516-519.

5. Smoljanovic T, Bojanic I, Hannafin JA, Hren D, Delimar D, Pecina M. Traumatic and overuse injuries among international elite junior rowers. The American journal of sports medicine. 2009;37(6):1193-1199.

When Should I Have An MRI, CT Scan Or Xray?

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Many patients with pain in their lower back are often after treatment and advice on ways to best to manage their condition. Osteopaths and other practitioners are trained in thoroughly assessing and examining someone’s body, and can determine a differential diagnosis that forms the treatment and management plan moving forward. 

Every day we are faced with patients wondering whether they should have some sort of investigation into their pain - x-ray, CT or MRI. In respect to the lower back, MRI can be gold standard for diagnostic value, and will therefore identify problems with the vertebrae, intervertebral discs and soft tissues. However what it is not capable of, is determining the structure that is responsible for YOUR pain. 

Studies in the field of back pain have revealed that imaging cannot reliably diagnose lower back pain, and often cause more false alarm. False alarms, or ‘Red Herrings’, are known as possible structural irregularities that MAY cause someone pain, however are not clinically diagnostic. This may be features of ‘wear and tear’ within the spine, having occurred over many years of an active or even sedentary life. 

While the idea of having an MRI to visualise structures in the back is valuable and extremely tempting, we also must understand the complex outcomes of unnecessary imaging or poor interpretation of results. This can in fact INCREASE patient apprehension and therefore indirectly affect quality of life and lead to a poorer prognosis.  It is important for practitioners in the medical industry to accurately relate the MRI findings to clinical symptoms and manage accordingly with treatment techniques and lifestyle advice (Graves et al, 2012). 

When your pain is not improving over a period of time, not responding to manual therapy, or if you present with any clinical red flag, then imaging is undoubtedly a valuable tool to use. This will change the way that your practitioner manages your condition, and may refer you on for further intervention or assessment as required. 

At CSSM, we encourage patients to discuss their condition with their practitioner. Ensure that you understand YOUR pain, and ways to manage it when conservative treatment is appropriate rather than seeking answers through imaging methods.  

 

Resources:
Graves et al, Early Lumbar MRI not associated with better outcomes, 2012.
Jensen 2010, Early MRI Use, COCA.
https://www.painscience.com/articles/mri-and-x-ray-almost-useless-for-back-pain.php