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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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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
With the Eagles having snuck into the finals for the 2017 AFL season, there has been a lot of speculation about the possible return of star ruckman Nic Naitanui for a run at the finals. Naitanui has missed the 2017 AFL season following a late season ACL injury in 2016.
There has been a lot of evidence around suggesting that “NicNat” has made good progress with his knee rehabilitation, including this video from a US rehab camp in July, which has fed much of this speculation. Eagles coach Adam Simpson has put this speculation to bed during the week by ruling Naitanui out for the season, however with some players over recent years returning from ACL reconstructions in less than 6 months, many are asking, Why so long?
It is a good question and it is a question that we get a lot in the clinic when dealing with injured athletes at a local level. Whilst I do not pretend to have any inside knowledge of NicNat’s progress, nor would I dare second guess the judgement of the Eagles medical team, I do believe that Naitanui’s situation is a perfect example of the old saying, 'just because you can, doesn’t mean that you should.'
We know after many years of following the progress of athletes returning from knee reconstructions that the risk of re-injury increases substantially by a premature return to sport. Much of this knowledge was reinforced by a 2016 study that found that athletes who return to high level sport have a four fold increase in re-injury compared to athletes who do not return to sport1. In fact almost 1 in 3 athletes who returned to high level sports sustain a re-injury within 2 years1. An alarming statistic - but what is most interesting is that this re-injury rate decreased by 51% for each month return to sport was delayed up until 9 months after surgery1.
It seems that 9 months is the magical number – so is it a matter of just waiting? The answer is a resounding no! If wishing to return to sport at any level, effective and specific rehab is important. This rehabilitation program works towards regaining symmetry of muscular strength in the muscle groups around the knee. Effectively retraining the nervous system to build co-ordination and proprioception which increases agility, body awareness and reduces the chances of reinjury2. The rehabilitation program is best designed by your treating practitioner, be it an Osteopath or Physiotherapist in consultation with your orthopedic surgeon.
Return to sport should not be attempted until a criteria of sports specific performance goals are achieved. It is likely that this is an area where the West Coast medical team are at with Naitanui. They will have set performance goals for Nic to achieve at the start of the rehabilitation phase and it may be that he is not quite there yet. Good management can reduce re-injury risk by 84% after ACL reconstruction1. It is unlikely that they will release Nic Naitanui to return to play if there is any doubt about his ability to sustain the load. A re-injury now would potentially risk Nic’s ongoing career.
ACL injuries are distressing and the rehabilitation process is a long one. However, a positive outcome is achievable with careful management and patience.
Should you have any queries about a knee injury you have sustained, feel free to contact the team at CSSM.
About the Author.
Travis Bateman is an Osteopath, trail runner, mountain biker, habitual back of the pack finisher and founder of Camberwell Sports & Spinal Medicine. His clinical interest is in movement analysis and its relationship to injury management, pain and sports performance
Published 1st September 2017
Tendon overuse pain
With the Melbourne Marathon fast approaching and the weather improving we are starting to see more runners out pounding the pavements. Because of this I thought it would be good to address the topic of tendon pain. Tendon overuse injuries or pain account for a large proportion of a sporting clinician’s case load. In other words, we see it a lot. More specifically for runners, Achilles tendinopathies.
Typically, tendon pain tends to be worse on the morning after exercise or activity, is usually pain free at rest, becomes painful with use, and is painful to touch on the effected tendon.
During exercise or training you might experience pain with the first few steps, then warm up with activity to the point of comfort, then it may or may not reappear towards the end of training.
Tendon pain can be broken down into three categories:
The best management for the “reactive” tendon is relative rest, ice and commencing an isometric loading program which your physiotherapist can help you with. Anyone who has suddenly increased their load or training volume can experience this pain, but when identified and addressed early, this type of tendon pain can be relatively easy to settle down.
The disrepair or degenerative tendon rehabilitation requires a little more patience. This tends to be a step-by-step process whereby you would commence a weight based strength program guided by your physiotherapist, work towards gaining full range of motion at the effected joint, and then graduate through a guided walk/jog program. From here your physiotherapist would then introduce power/dynamic loading prior to progressing to sport specific tasks and eventually a full return to sport.
If you are looking to get back into running, or are starting to experience the above described pain, get in touch with one of our physiotherapists and we will help guide you through the process!
References:
Brukner, P. (2012). Brukner & Khan's clinical sports medicine. North Ryde: McGraw-Hill.
Cook, J. (2011). Tendinopathy: no longer a ‘one size fits all’diagnosis.
Cook, J. L., & Purdam, C. R. (2009). Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. British journal of sports medicine, 43(6), 409-416.
We’ve just wrapped up our 4th Run Long, Run Strong forum here at CSSM with all participants loving the opportunity to pick the brain of one of Australia’s most iconic long distance runners, Steve Moneghetti. A key focus of the evening was how important load management is to managing your running program, and how to prevent injury.
Steve’s a big believer in setting yourself a goal and working towards it, and we could not agree more. Signing yourself up for a running challenge can be daunting, but extremely rewarding if it’s done in the correct manor. Loading up gradually is extremely important, and it’s the number one mistake runners make when commencing a training program. Trying too much, too quickly can often lead to the body breaking down and the onset of injury becoming a reality.
From a planning approach, when training load exceeds load capacity is the moment where we are at risk of developing a load induced injury. Our load capacity will increase and improve with our training program, but researching and implementing other training modalities will improve our running performance.
Through the use of supplementary training you can continue to build not only your cardiovascular fitness but your muscular strength, endurance and power if you utilise the correct formats. Activities such as swimming, deep water running, weights training and Pilates are all great ways of improving your base level of fitness and reducing your chance of load induced injury!
We also spoke on the importance of recovery and allowing time for the body to rejuvenate from training load. From a biological level, allowing time for adaptation to occur is important for good muscular development. Not allowing a rest day in a full training week could allow for an overload on the tissues, and prevent muscles developing to their optimal level.
After another great forum we are already looking towards the next opportunity to help our #teamCSSM runners, so if you have any ideas from who you’d like to hear from in the future, let us know!
About the author.
James Unkles is a Podiatrist who has also completed his Bachelor degree in Exercise and Sport Science, and loves running every week! He can provide expert assistance with managing your running program, gait analysis or explain how the lower limb reacts to aerobic or anaerobic training.
References
Konopka, A. R., & Harber, M. P. (2014). Skeletal Muscle Hypertrophy after Aerobic Exercise Training. Exercise and Sport Sciences Reviews, 42(2), 53–61. http://doi.org/10.1249/JES.0000000000000007
It is “Severs Season” across Melbourne! As kids are getting involved in winter sport and as training loads increase, we are starting to see some common injuries hindering participation across many different sports. One particular concern for pre-teen athletes is the onset of heel pain, particularly in high impact running sports such as Hockey, Soccer, Basketball, Netball and Australian Rules.
By far the most common cause of heel pain in the early teens is Severs disease or “calcaneal apophysitis”. It is most common in children between the ages of 8-14 and it is generally sporting kids that can suffer from the condition.
As kids go through periods of significant growth, it is not uncommon for the growth plate at the back of the heel to be grabbed, pulled and irritated through the Achilles tendon and related posterior leg muscles. This pain can be so severe that walking can become a challenge and no activity can be completed at all. Pain will normally be felt on the side of heel and in the Achilles tendon.
This condition tends not to affect populations past 14 years old, as the growth plate becomes fully ossified within the calcaneus (heel bone) by that time. Factors that predispose a child to developing Severs include a flat or high-arched foot, tight posterior muscles particularly if they are actively engaging in high impact sports.
What should I do if my child has heel pain?
Heel pain is common in children, and most causes of pain are benign and self-limiting however all pain in children should be assessed. So if your child has heel pain you should:
Severs is something that does resolve with time, and generally does not require any type of surgical intervention. There are simple strategies that can help manage Severs disease, which usually have great results with pain reduction and increased mobility. Kids who show dedication to the treatment program improve rapidly and can be back participating in activity pain free after slight delay and with minimal repercussions.
If you think your child may be suffering from Severs, or other complex foot pain, come and see the Podiatry team at CSSM to help them perform at their best.
About the author – Jim Unkles is a podiatrist at Camberwell Sports and Spinal Medicine. He understands the demands of competitive sport in children through personal experience in representative Hockey and Cricket. He is currently managing several sporting kids experiencing Severs.
References
Marchick, M., Young, H. and Ryan, M.F. (2015) Sever’s Disease: An Underdiagnosed Foot Injury in the Pediatric Emergency Department. Open Journal of Emergency Medicine, 3, 38-40. http://dx.doi.org/10.4236/ojem.2015.34007
Motivation to exercise during winter can be tough - but sometimes it's easier to get out the door if you are going to meet a friend. From now until the end of winter, CSSM is giving you the chance to "bring a friend for free" to try one of our PilatesFIT or PilatesFIT EXPRESS classes!
PilatesFIT is a dynamic form of Pilates designed for those who are looking to improve their strength, conditioning, flexibility and fitness. Great for everyone of all ages, from beginners, to those more advanced and wanting to try a new, fun and effective form of exercise. Pilates can be an excellent form of general exercise in its own right or can complement other sports and activity perfectly.
We have classes right throughout the week, so find a friend and bring them along to a class and spread the word!
What you have to do
If you’re an existing PilatesFIT client, simply log in to your Mindbody account and book yourself into a class - then phone CSSM to reserve a place for your friend and we will do the rest! Your friend(s) must be booked in prior to attending the class
Fine print:
*Valid for all existing clients. Only valid when friend attending the same class as existing client. 1 free class per friend, can bring up to 3 friends per class. Can be used multiple times for multiple friends! Please contact CSSM if you or your friend is unable to make the class you’ve reserved to ensure someone else is able to attend*
Hawthorn football player James Frawley is out for 8 weeks with a Turf Toe Injury. So, what is turf toe and why does it take so long to heal?
Turf toe is a sprain of the 1st MPJ or the joint where the big toe attaches to the foot. It usually occurs when the big toe is hyperextended or forced upwards. This can occur as the toes push off the ground but can also result from another person stepping on the toes as the foot is moving. Turf toe can be classified as grade 1, 2 or 3 which indicate severity. In the worst cases, the ligament under the toe is torn. Pain is felt each time the toes bend, which is obviously difficult to avoid as this occurs with each step we take. Foot injuries are therefore difficult and can take long periods to heal properly for this very reason. It is very difficult to rest a foot completely unless a plaster cast or a cam boot walker is used.
If a turf toe injury is suspected, treatment should initially involve rest, ice and elevation. Consultation with a podiatrist will ascertain the extent of the injury and guide further treatment. A variety of treatments may be implemented ranging from taping; which can be very effective, right through to surgery in some cases.
If correct treatment is not undertaken there can be a permanent loss of flexibility at this joint. This will cause altered biomechanics and most likely predispose this joint to arthritis and pain in the long term. Correct diagnosis, treatment and adequate rest from sport will reduce the likelihood of long term complications.
We wish James Frawley a speedy recovery.
REFERENCES
Clinical Sports Medicines Brukner and Khan 4th edition 2012 McGraw-Hill Education
Podiatry Today: http://www.podiatrytoday.com/article/9063
http://www.medicinenet.com/turf_toe_symptoms_causes_and_treatments/article.htm
R.I.C.E. or M.E.T.H.?
By Lisa McInnes
I’ll never forget when one of my lecturers asked, “Isn’t Meth the new Ice?” After a few chuckles he was met with confused faces and a collective "huh?" I didn’t investigate this any further until my interest was recently triggered by seeing a journal article titled “The effects of cold water immersion and active recovery on inflammation and cell stress responses in human skeletal muscle after resistance exercise.” Working with a football club, I was interested and curious as to the practice of icing an injury and the use of ice baths post game for recovery and also as a nurse with occasionally post-operatively applying ice packs to orthopaedic surgical sites (surgeon dependent of course).
The study investigated the current belief of cold water immersion (ice baths) after exercise and its effect on skeletal muscle. It’s believed this reduced inflammation, compared with active recovery such as resistance exercise. Interestingly, the study found there was no human data available to support the theory of cold water immersion after exercise and that it is no more effective than active recovery for minimising the inflammatory and stress responses in muscle after resistance exercise.
So why has it been drummed into us as consumers and practitioners to use ice, even on acute injuries? Most of us are aware of the acronym R.I.C.E. (or R.I.C.E.R.) which stands for Rest, Ice, Compression, Elevation, (Rehab/Referral).
Have you heard of M.E.T.H.? This stands for Movement, Elevation, Traction and Heat and brings us back to the old debate....heat or ice? Does this newer acronym not contradict our current practice and beliefs? Of course it does! So what do we do? I believe the most important question to ask at this point is WHY? Why are we applying heat or ice? What are we actually trying to achieve? What is our purpose? Are we using ice as an attempt to numb the injured area or to reduce the swelling as a direct effect from inflammation?
What were we trying to achieve using ice? For years, with first aid and an acute injury we rested the area so as not to worsen or aggravate the injury further, applied ice to reduce inflammation thereby reducing swelling as this was considered counterproductive. Compression for support and to reduce swelling, elevation to reduce swelling, then rehab to strengthen the injured area. But why do we want to reduce inflammation? The body has an astounding capacity for healing and multiple buffer systems to maintain homeostasis, eg pH levels, water retention and of course conducive environments for healing. Will we really effect it?
So why use M.E.T.H? How does this work in the setting of an acute injury? Mobilising an injury or the tissues around it, with traction, will provide support whilst assisting lymphatic drainage as the muscles compress the lymph nodes moving lymphatic fluid back to the subclavian veins thereby reducing swelling. Elevation helps this process and heat will also increase blood flow enhancing the healing environment.
There are three phases of healing - inflammation, proliferation and maturation or remodelling (Physiopaedia.com). Without inflammation, the next two phases of healing are affected and impeded, the body cannot skip a stage. If this is so, then why are we trying to prevent it?
Current practice is slowly changing and is starting to gain momentum. As Elle’s blog ‘Ankle Sprains: Is Rest Really Best?’ explains, the benefits and importance of early implementation of therapeutic exercise in the successful rehabilitation of ankle sprains. Rest is not really best! Ice is following this path…
Gary Reinl, author of Iced: The Illusionary Treatment Option discusses there can be inflammation without healing but there cannot be healing without inflammation.
Have a look at the video below featuring Kelly Starrett and Gary Reinl about the change in culture for the elite sportsperson in America and their move away from the use of ice with improved outcomes for those athletes.
Very importantly, Gary mentions we need to keep in mind our purpose for using ice. If we want to numb the area to assist with pain relief then by all means use ice, but if our purpose is to reduce inflammation then we need to reassess our practices.
So what should we do from here? There are many blog posts and opinions on moving away from ice and using heat but what we really need are further clinical studies and research evidence so as practitioners we are using best practice to ensure our clients are receiving the best treatment to help them reach their goals and potential. Remember, if you have any questions contact your practitioner for further advice.
Further reading:
Reinl, Gary Iced: The illusionary treatment option. 2nd edn
References:
Peake J, Roberts L, Figueiredo V, Egner I, Krog S, Aas S, Suzuki K, Markworth J, Coombes J, Cameron-Smith D, Raastad T, The effects of cold water immersion and active recovery on inflammation and cell stress responses in human skeletal muscle after resistance exercise. The Journal of Physiology, 2013 Nov, Vol 595 (3), p695-711
http://www.physio-pedia.com/Soft_Tissue_Healing
For a long time running has received a lot of bad press with regards to its relationship with back pain and other “wear and tear” injuries such as knee osteoarthritis.
It does seem to make logical sense that the cumulative effects of high intensity activity, where forces of up to four times the normal body weight are driven through the joints of the body, would have a detrimental effect on those joints. It is certainly a theme that sports shoe companies have perpetuated and made billions from each time they advertise their latest advance in shock absorbing footwear, be it airTM gelTM or even the - you couldn’t make up if you tried - BioMoGoTM - not sure what happened to that.
The concept that “high impact” equals “bad” is certainly one that has penetrated the mindset of many of the patients that I see. Many of these patients I see as an Osteopath, who frequently have back pain of some sort, have either stopped running as a result or are considering changing the type of activity they do.
My response to these patients is on several levels.
The first is that maintaining some sort of activity when suffering back pain is vital. Both for the recovery and rehabilitation of the current injury and for the prevention of further injury.
Secondly, notwithstanding the common consensus and the logical connection, there is little quality evidence to suggest that running is bad for backs (or knees or ankles for that matter). In fact there is a growing body of research and knowledge that suggests the complete opposite. It is a counterintuitive position that reminds me of one of my favorite quotes:
"For every complex problem there is an answer that is clear, simple, and wrong." H. L. Mencken
It is a growing belief that running is in no way detrimental to the health of joints and the spine and in fact may enhance spinal health. A report of research conducted by Deakin University published just this month online at www.nature.com adds weight to this argument.
This is perhaps the first scientific evidence that exercise can be beneficial for the intervertabral disc (IVD) in the spine. This research identified that running programs, over extended periods of time, had positive effects on the composition of the disc. It also showed that higher intensity activity such as fast walking and slow running had more positive effects than slow walking or static positions.
If you are currently suffering back pain, this is not a recommendation to throw the shoes on (even if they are BioMoGoTM equipped) and go out for a run. You should always make these decisions in consultation with your Osteopath or Physio.
What this research does do (and it is certainly not conclusive evidence at this point), is give us reason to change the way we look at moderating our activity with the long term view to preventing spinal injury and back pain. We will keep abreast of what changes this and similar research directs the way we do things. Until then keep running, keep moving and enjoy yourself.
About the Author.
Travis Bateman is an Osteopath, trail runner, mountain biker, habitual back of the pack finisher and founder of Camberwell Sports & Spinal Medicine. His clinical interest is in movement analysis and its relationship to injury, pain and sports performance.
Research Reference:
Belavý, D. L. et al. Running exercise strengthens the intervertebral disc. Sci. Rep. 7, 45975; doi: 10.1038/srep45975 (2017).
I rolled my ankle, AGAIN!
Ankle sprains are the most common type of ankle injury and can account for up to 20% of all sporting injuries (Fong, Hong, Chan, Yung, & Chan, 2007). Poor management and insufficient rehabilitation can lead to recurrent ankle sprains, impairment of athletic performance (Yeung, Chan, So, & Yuan, 1994) and persistent disability (Petersen et al., 2013).
What happens when you roll your ankle?
An ankle sprain occurs when the foot rolls inwards, causing over stretching or tearing to the ligaments on the outside of the ankle.
Fig 1 Inversion injury of the ankle showing damage to the lateral ankle ligaments.
(ref: https://gymnasticsinjuries.files.wordpress.com/2012/10/anklesprainimage.jpg)
How bad is it?
There are 3 types of sprains which are defined by the extent of damage to the ligaments.
Grade 1: Stretched ligaments
Ligaments are stretched during a slight ankle roll. Common versions of this occur when running onto a patch of uneven grass or during an over step in tennis. You may immediately experience mild pain and a small limp. After a few minutes of rest, most people are usually able to continue their activity. Some swelling may occur within 24 hours and with appropriate management, you can expect return to preinjury state within 1-2 weeks.
Grade 2: Partial thickness tear of ligament
Ligament tearing occurs when the ankle rolls further than the ligaments can stretch. You may experience moderate pain, a limp and usually cannot continue to play. Swelling and bruising may occur within 24 hrs and weight baring is particularly painful. If you experience these symptoms, you should seek medical advice to determine the extent of damage. Depending on this, recovery can take between 2 - 6 weeks.
Grade 3: Complete rupture of ligament
Complete ligament rupture is a progression of grade two and occurs when the ankle has rolled beyond its normal limits. Initially, individuals are unable to walk on the effected ankle and can complain of it feeling “unstable”. Excess swelling and dark bruising would be expected 24 hours after injury. On a case by case basis, grade 3 sprains may require surgical intervention or up to 12 weeks of rehabilitation.
So you’ve sprained your ankle, what to do now?
After following the basic “RICE” principles (rest, ice, compress and elevation), you should seek medical advice from a physiotherapist as soon as possible. Physiotherapists are highly trained health professions who specialise in the assessment, diagnosis and management of ankle injuries.
What to expect when your see the physio?
Your physiotherapist will ask you questions regarding your injury and what symptoms you are experiencing. If pain allows, an assessment will be performed to diagnose your injury and explain the extent of damage. An accurate diagnosis is crucial in ensuring appropriate management and treatment can be provided. (Wolfe, Uhl, Mattacola, & McCluskey, 2001).
Firstly, pain and swelling management is commenced. This may involve icing, taping, bracing, crutches or a moon boot. Secondly, your physiotherapist will discuss your diagnosis and expected recovery time, as well as appropriate activity modification. Thirdly, pain free range of motion and strength exercises can commence. Fourthly, an individualised rehabilitation program will be developed and implemented. Goals and sport specific tasks will be incorporated once adequate function has been regained. Completion of your rehabilitation program results in positive outcome measures, optimal recovery and reduced risk of chronic ankle instability (Mattacola & Dwyer, 2002).
But don’t I need an x-ray?
Physiotherapists follow a set of guidelines called the Ottawa Ankle Rules that are used to determine whether a fracture is suspected (Ivins, 2006). These guidelines have an extremely high sensitivity and are used to reduce the number of unnecessary radiographs by 30-40% (Bachmann, Kolb, Koller, Steurer, & ter Riet, 2003) (Dowling et al., 2009). If your physiotherapist suspects a fracture, an x-ray will be organised.
Can I stop this from happening again?
Extensive research demonstrates that individuals who adhered to a rehabilitation program involving balance and proprioceptive training were significantly less likely to experience a recurrent ankle sprain (Petersen et al., 2013) (Hupperets, Verhagen, & van Mechelen, 2009) (Postle, Pak, & Smith, 2012). While the risk of re-injury can be reduced, unfortunately accidents can still happen.
Reference List
Bachmann, L. M., Kolb, E., Koller, M. T., Steurer, J., & ter Riet, G. (2003). Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review. BMJ, 326(7386), 417. doi:10.1136/bmj.326.7386.417
Dowling, S., Spooner, C. H., Liang, Y., Dryden, D. M., Friesen, C., Klassen, T. P., & Wright, R. B. (2009). Accuracy of Ottawa Ankle Rules to exclude fractures of the ankle and midfoot in children: a meta-analysis. Acad Emerg Med, 16(4), 277-287. doi:10.1111/j.1553-2712.2008.00333.x
Fong, D. T., Hong, Y., Chan, L. K., Yung, P. S., & Chan, K. M. (2007). A systematic review on ankle injury and ankle sprain in sports. Sports Med, 37(1), 73-94.
Hupperets, M. D., Verhagen, E. A., & van Mechelen, W. (2009). Effect of unsupervised home based proprioceptive training on recurrences of ankle sprain: randomised controlled trial. BMJ, 339, b2684. doi:10.1136/bmj.b2684
Ivins, D. (2006). Acute ankle sprain: an update. Am Fam Physician, 74(10), 1714-1720.
Mattacola, C. G., & Dwyer, M. K. (2002). Rehabilitation of the Ankle After Acute Sprain or Chronic Instability. J Athl Train, 37(4), 413-429.
Petersen, W., Rembitzki, I. V., Koppenburg, A. G., Ellermann, A., Liebau, C., Bruggemann, G. P., & Best, R. (2013). Treatment of acute ankle ligament injuries: a systematic review. Arch Orthop Trauma Surg, 133(8), 1129-1141. doi:10.1007/s00402-013-1742-5
Postle, K., Pak, D., & Smith, T. O. (2012). Effectiveness of proprioceptive exercises for ankle ligament injury in adults: a systematic literature and meta-analysis. Man Ther, 17(4), 285-291. doi:10.1016/j.math.2012.02.016
Wolfe, M. W., Uhl, T. L., Mattacola, C. G., & McCluskey, L. C. (2001). Management of ankle sprains. Am Fam Physician, 63(1), 93-104.
Yeung, M. S., Chan, K. M., So, C. H., & Yuan, W. Y. (1994). An epidemiological survey on ankle sprain. Br J Sports Med, 28(2), 112-116.
The Benefits of Early Morning Exercise
Who doesn’t love the idea of being an early riser? You’re up before sunrise, into the clinic, Pilates class done, and then home in time for a quick shower and breakfast before work.
But when the alarm goes off at 5.30am, there’s easy temptation to stay under the doona. So how can you motivate yourself to get up and going before the crack of dawn? Is there any additional benefit to exercise in the morning, as opposed to late evening after work? If you’re looking to decrease stress, increase quality of sleep and boost your energy levels then read on.
We all know the importance of a good night’s sleep. But we don’t often associate the connection between exercise and sleep behaviours. A study in the US from Appalachian State University found participants who exercised early in the morning had increased levels of mental alertness and felt more energised than their evening counterparts. The same study looked at participant’s sleeping patterns. It found participants who exercised regularly at 7am or earlier, reduced their blood pressure by an average of 10% which carried through the remainder of the day. They also had an average 25% dip in blood pressure at night, slept longer and had better quality sleep cycles than those participants who exercised later in the day. Morning movers are also at an advantage over their evening counterparts as some forms of high intensity exercise 2-3 hours before bedtime is known to disrupt sleep. Simply said, the early risers were more energised during the day, and slept better at night.
One of the most important benefits of exercise, is the role it plays with our Endocrine (Hormonal) System. Our Endocrine system is responsible for the regulation of stress hormones, appetite control and immune function. The primary hormone responsible for stress is cortisol. Cortisol is secreted from the adrenal gland and is known for increasing heart rate & blood pressure, storing fat, increasing appetite, breaking down muscle tissue and suppressing immune function. We can’t always remove the factors that cause stress, but we can control how we respond to these triggers. It’s commonly known that exercise increases our endorphins. Endorphins are released from the pituitary gland and are commonly known as that ‘rush’ of energy and satisfaction post exercise. The effect of endorphins can counteract the effects of cortisol, by decreasing appetite, and reducing tension & anxiety. Endorphins also interact with the receptors in our brain that control our perception of pain, which is why exercise is known to improve our moods. Making time for exercise in the morning, means we feel these benefits throughout the day, when we need them most.
Morning exercises are also at a greater advantage as testosterone levels are typically higher in the morning than they are in the evening. Testosterone is essential for optimal bone health, as well as being responsible for muscle growth and health. Exercising in the morning means you are using this natural fluctuation of testosterone to your advantage.
As we move past holidays and summer social events, setting goals for the year ahead becomes more crucial. We are often setting intentions to improve our physical and mental health, without the proper commitment or motivation to ensure these goals are met. Making time for a morning workout means you are setting aside time at the start of your day, ensuring that the rest of your day is free for other responsibilities. With any goal, consistency is key. Why not set yourself a new goal for the year, and see why the early birds really do get the worm!
The shoulder joint is a complex ball and socket joint that allows 180 degrees of movement. Shoulder impingement occurs when the rotator cuff tendons or bursa (a fluid filled sack) are repetitively compressed in the subacromial space (see image below).
This compression can cause localised inflammation and results in painful movements of the shoulder. It is one of the most common conditions we see in the clinic, especially coming into tennis and cricket season.
The impingement can be “primary” resulting from a structural narrowing of the space or “secondary” due to poor biomechanics and movement patterns of the shoulder. Some of us are born with smaller subacromial spaces or develop bony spurs over time. Secondary impingement can be a result of impaired scapula control, poor posture, or increased mobility in the shoulder joint (Holmgren et al, 2012).
Patients with subacromial impingement may experience pain when sleeping on the effected side, weakness when reaching and lifting and/or an ache referring from the shoulder down the outside of the arm.
Shoulder impingement is classified as a symptom, with many causative factors, rather than a diagnosis (Kibler et al, 2013). It is essential that your physiotherapist acknowledges the concepts of mechanical, movement-related impingement which may in hand prevent the potential for inappropriate surgical interventions (Braman et al, 2014).
The scapula is controlled by a pulley system comprised of muscles attaching to the spine, thorax and arm. Optimal shoulder posture, movement, stability and muscular control are heavily dependent on scapula performance (Kibler et al, 2013). Each muscle has a specific role in helping to tilt and rotate the shoulder blade to allow movements of the arm. The 2013 scapula summit defined altered scapula movement and position as “scapula dyskinesis”. If taping or gentle manual assistance to correct your scapula dyskinesis relieves your shoulder pain this is a fabulous indicator that you are an ideal candidate for rehabilitation and can avoid going under the knife.
As discussed, impingement is caused by a myriad of factors. Traditional treatment involved corticosteroid injections and surgical subacromial decompressions.
Recent evidence has found that exercise management for subacromial impingement is as effective as surgery at 1, 2, 4 and 5 year follow ups (Haahr et al. 2005, Haahr & Andersen (2006), Ketola et al. 2009 and Ketola et al. 2013). This is an exciting revelation in shoulder treatment, showing that a specific exercise program focusing on scapula muscle control, is effective in reducing shoulder pain and improving shoulder function (Holmgren et al, 2012). Exercise management has reduced the need for sub-acromial impingement surgery by up to 80% (Holmgren et al, 2012).
If you are experiencing shoulder pain we recommend you seek a thorough assessment to determine whether your injury will respond to a specific, personalised exercise program to avoid the need for surgical intervention.
References:
Braman, J.P., Zhau, K.D., Lawrence, R.L., Harrison, A. K., & Ludewig, P. M. (2014). Shoulder impingement revisited: evidence of diagnostic understanding in orthopaedic surgery and physical therapy. Medical & biological engineering & computing, 52(3), 211 – 219.
Haahr, J.P., Ostergaard, S., Dalsgaard, J., Norup, K., Frost, P., Lausen, S., Holm, E.A., & Anderson, J.H. (2005). Exercises versus arthroscopic decompression in patients with subacromial impingement: a randomised, controlled study in 90 cases with a one year follow up. Ann Rheum Dis, 64(5), 760 – 764.
Haahr, J.P., Andersen, J.H. (2006). Exercise may be as efficient as subacromial decompression in patients with subacromial stage II impingement: 4 –8- years’ follow-up in a prospective, randomized study. Scand J Rheumato, 35(3), 224-8.
Holmgren, T., Hallgren, H.B., Oberg, B., Adolfsson, L. (2012). Effect of specific exercise strategy on need for surgery in patients with subacromial impingement syndrome: randomised controlled study. British Journal of sports medicine, bjsports-2012.
Ketola, S., Lehtinen, J., Arnala, I., Nissinan, M., Westenius, H., … & Rousi, T. (2009). Does arthroscopic acromioplasty provide any additional value in the treatment of shoulder impingement syndrome?: a two-year randomised controlled trial. J Bone Joint Surg Br, 91(10), 1326-34.
Ketola, S., Lehtinen, J., Rousi, T., Nissinen, M., Huhtala, H., Konttinen, Y. T., & Arnala, I. (2013). No evidence of long-term benefits of arthroscopic acromioplasty in the treatment of shoulder impingement syndrome. Bone and Joint Research, 2(7),132-139.
Kibler, W. B., Sciascia, A.D., Bak, K., Ebaugh, D., Ludewig, P., Kuhn, J., … & Cote, M. (2013). Clinical implications of scapula dyskinesis in shoulder injury: the 2013 consensus statement from the ‘scapular summit’ report of 2013. British Journal of sports medicine, bjsports-2013.
There is a large amount of evidence surrounding the importance of gluteal strength as a protective factor for many musculoskeletal conditions.
A significant weakness in hip abduction (movement out to the side), extension (movement backwards) and external rotation (movement turning out away from the body), with associated hip adduction and internal rotation during functional tasks has been identified in people with patellofemoral pain compared to pain free individuals (Selkowitz et al., 2013).
In other words, people with anterior knee pain were found to have weaker gluteal muscles compared to people without any pain.
Abnormal hip mechanics has also been linked with Iliotibial Band Syndrome (ITBS). As the gluteus medius muscle is the prime hip abductor, weakness in this muscle can lead to greater angles of hip adduction therefore potentially increasing the strain placed on the ITB. It was found that runners with ITBS had greater deficits in gluteal muscle strength on the side of the affected limb, compared to the unaffected limb (Fredericson et al., 2000; Niemuth et al., 2005).
Additionally, poor neuromuscular control of the lower limb, in particular excessive dynamic valgus (knee dropping inwards when landing) is one of the primary risk factors for ACL rupture (Hewett, Myer & Ford, 2005). What causes your knee to drop in during landing you ask? The simple answer, weakness in your gluteal muscles.
Due to this apparent association between gluteal muscle weakness or dysfunction and lower extremity injury, there has been an increased focus on gluteal strengthening as part of injury rehabilitation or prevention programs prescribed by Physiotherapists.
As a practitioner prescribing exercises, it is important that we choose the most effective three to five exercises on an individual needs approach. Generally speaking, when doing gluteal strengthening exercises it is not uncommon to experience overactivity of the Tensor Facia Lata (TFL) muscle. The TFL works similar to the middle fibres of the gluteus medius and upper fibres of the gluteus maximum in that they all abduct the hip (movement out to the side). However, the TFL also acts to internally rotate the hip (rotates it inwards) which can exert forces onto the outside of the knee leading to conditions such as patella femoral pain. Due to this it is important we choose exercises that optimise gluteal activation whilst minimising TFL activation.
Selkowitz and colleagues in 2013 used fine wire electode EMG on the TFL and gluteal muscles to measure muscle activation during various commonly used gluteal strengthening exercises.
The clam [1], crab walk (or side step) [2], four-point kneeling hip extension with a straight knee [3], four-point kneeling hip extensions with a bent knee [4], bilateral bridge [5], and squat [6] all showed statistically significant higher gluteal muscle activation than the TFL. The gluteus medius was preferentially recruited during the side-lying hip abduction [7] and hip hitching [8], and the superior fibres of gluteus maximus was recruited best during the clam [1] and unilateral bridge [9]
If the goal is to preferentially activate the gluteal muscles whilst minimising TFL activation these nine exercises can now be prescribed with confidence, on an individual needs basis.
References:
Fredericson, M., Cookingham, C. L., Chaudhari, A. M., Dowdell, B. C., Oestreicher, N., & Sahrmann, S. A. (2000). Hip abductor weakness in distance runners with iliotibial band syndrome. Clinical Journal of Sport Medicine, 10(3), 169-175.
Hewett, T. E., Myer, G. D., Ford, K. R., Heidt, R. S., Colosimo, A. J., McLean, S. G., ... & Succop, P. (2005). Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes a prospective study. The American journal of sports medicine, 33(4), 492-501.
Niemuth, P. E., Johnson, R. J., Myers, M. J., & Thieman, T. J. (2005). Hip muscle weakness and overuse injuries in recreational runners. Clinical Journal of Sport Medicine, 15(1), 14-21.
Selkowitz, D. M., Beneck, G. J., & Powers, C. M. (2013). Which exercises target the gluteal muscles while minimizing activation of the tensor fascia lata? Electromyographic assessment using fine-wire electrodes. journal of orthopaedic & sports physical therapy, 43(2), 54-64.
You may be familiar with the term ‘Fascia’ in relation to a common injury known as ‘Plantar Fasciitis’. However what some people may not know, is that fascia is not only located in the foot but rather, right throughout the body.
Fascia is a strong connective tissue that serves many purposes, mainly compartmentalizing and connecting your muscles forming a body-wide tensional network of fascial continuity (Wilke, J). As with other structures within the body; for example soft tissue, joints and ligaments, fascia can also impact your body and be a source of pain.
For example, lower back pain is a very common complaint that we see every day at CSSM. Injury and subsequent immobility in the area can lead to decreased movement of the thoracolumbar fascia (a term given to the broad, thick diamond-shaped fascia spanning the middle and lower back regions). If this is a chronic problem, adhesions within the fascia can develop leading to long-term issues in the area, meaning that your back may feel ‘stiff and tight’ and therefore be influencing your pain.
Over many years, many physical therapists have started to incorporate assessment and treatment of fascia leading to positive results in terms of symptomatic relief, and injury prevention. You will also be interested to note that some of these techniques can be utilised on a daily basis at home using a foam roller!
A recent study has showed a positive relationship between using the foam roller on the thoracolumbar fascia (Griefahn A, et al). You may be more familiar with the techniques used on your upper back by lying on the roller vertically (along your spine as well) and horizontally, using your legs to push your body back and forth. This in turn will not only help to increase movement in the joints locally, but also reduce tension in the thoracolumbar fascia, therefore having a positive effect throughout the spine.
These treatment principles can also be applied throughout the body with other common conditions such as ‘runner’s knee’, jaw/TMJ pain and more. If you have any questions regarding fascia then do not hesitate to ask your treating practitioner.
References:
Wilke J. 2016, Myofascial Chains Revisited: A Review of Several Suggested Force Transmission Lines from an Evidence-Oriented Perspective with Special Focus on Low Back Stability.
Griefahn A, et Al. 2016, Do Exercises with the Foam Roller have a short impact on the Thoracolumbar Fascia? – A randomized controlled trial
The TGA (Therapeutic Goods Administrator), Australia’s drug regulator has issued a warning to women about the use of anti-inflammatories during pregnancy.
Whilst pregnant women should always speak to their health professional before taking any medication, many women consider anti-inflammatories “harmless” like other drugs such as paracetamol. Anti-inflammatories are marketed as a common remedy for headaches, period pain and other general pains; and many women may take them before they are even aware that they might be pregnant.
Taking anti-inflammatories during early pregnancy has been linked with increased risk of miscarriage.
The TGA is warning all women thinking of conceiving to avoid these popular drugs including Voltaren, Naprosyn and Nurofen; and are in discussion with drug companies to make sure they display obvious warnings on the packaging. The TGA has stated “The data suggests that the risk is greatest when the medicine is taken close to the time of conception."
American researchers interviewed more than 1000 recently pregnant women and found that use of NSAIDs increased the risk of miscarriage by 80 per cent.
There are many studies relating to the use of non-steroidal anti-inflammtory drugs (NSAID) during pregnancy. Antonucci et al outline “Increased risks of miscarriage and malformations are associated with NSAID use in early pregnancy. Conversely, exposure to NSAIDs after 30 weeks' gestation is associated with an increased risk of premature closure of the fetal ductus arteriosus” (part of the developing heart). “Fetal and neonatal adverse effects affecting the brain, kidney, lung, skeleton, gastrointestinal tract and cardiovascular system have also been reported after prenatal exposure to NSAIDs.”
A study by Wiley et al identified “Many pregnant women get prescriptions for NSAIDs during their first trimester, and even more--up to 15 percent--take over-the-counter versions of these drugs.”
The current advice from the TGA is “If you are pregnant, think you may be pregnant or are trying to become pregnant, consult a health professional before using these products and consider using an alternative medicine.”
References
“TGA pregnancy warning for popular over-the-counter painkillers” The Age Newspaper. October 11, 2016.
Use of non-steroidal anti-inflammatory drugs in pregnancy: impact on the fetus and newborn. NCBI. Antonucci et al. May 2012
First Trimester Use Of NSAIDs Is Associated With Cardiac Abnormalities In Babies. Wiley, John et al. Science Daily. August 25, 2006
Tension headaches are the most common type of headache and affect 36% of men and 42% of women - that's 7 million Australians. Tension headaches usually present with some of the following characteristics:
The causes of tension type headaches are multiple and include different muscular conditions. Excessive muscle contraction such as jaw-clenching and active trigger points or “knots” can induce one. Poor posture, be it at work, in front of the computer or driving, are the other main culprits. Other causes include stress, anxiety and fatigue.
Our myotherapists here at CSSM can help you with a variety of treatments.
Ressources
Moraska AF, Stenerson L, Butryn N, Krutsch JP, Schmiege SJ, Mann JD. Myofascial trigger point-focused head and neck massage for recurrent tension-type headache: A randomized, placebo-controlled clinical trial. The Clinical journal of pain. 2015;31(2):159-168.
http://www.headache.com.au/
The excitement is building in the lead up to the 2016 AFL grand final. But we should spare a thought for the players who have been recently injured and will be watching from the sidelines like the rest of us.
Sports injuries can affect a variety of tissues including muscles, ligaments, tendons and bones. Interestingly, it is estimated that greater than 60% of all sports injuries occur to the lower limb.
For our top four AFL teams this year, of the players who are excluded due to injury, 67% are suffering a lower limb injury and 6% have an injury specifically affecting the foot.
Due to the fact that feet carry all our body weight, foot injuries unfortunately can take extended periods to fully heal and returning to sport too soon can be detrimental long term.
Sydney Swans defender Michael Talia has a partial tear to the LisFranc ligament with bone displacement which may take a least three months to heal. Sam Reid also from the Swans has an achilles injury which should be ok in a few weeks.
Marcus Adams from the Western Bulldogs will be in a moon boot for at least two weeks after spraining his midfoot.
A Lisfranc injury sustained by forward Jarrod Pickett from GWS may take up to six months to heal. Jarrod will need surgery and then rehab before returning to full fitness. Midfielder Jack Steele also from GWS has sustained a foot injury during training which has prematurely ended his season.
Cory Gregson from Geelong has a stress fracture in the navicular for which he has had surgery and will take about 10 weeks to heal.
We wish all these players the best for their recovery.
You don't have to be an athlete to suffer a sports injury. At Camberwell Sports and Spinal Medicine we treat all types of sports injuries for both professionals and amateurs. It is estimated that in Australia, one million sports injuries occur each year. It is important to realise that up to 50% are preventable. Prevention can begin with the right advice regarding footwear, technique, training frequency, intensity and duration. Regular check-ups are recommended to alter training appropriately and address injuries when they occur.
Sport injuries can result in time spent off work or school as well as significant medical costs which sometimes involve hospitalisation. Visit CSSM today to book in your running gait assessment to optimise your gait, have your footwear and training regime assessed.
REFERENCES
Caroline Finch, leading sports epidemiologist. Injury prevention and the promotion of physical activity: what is the nexus?, Caroline Finch and Neville Owen, Sports injury Prevention Research Unit, School of Health Sciences, Deakin University and Faculty of Health and Behavioural Sciences, University of Wollongong NSW. HAZARD, Edition number 8, Autumn 1991, Victorian Injury Surveillance and Applied Research System (VISAR), p.1
1. D F Murphy1,
2. D A J Connolly2,
3. B D Beynnon1
Beginning a new exercise program can be overwhelming. There is so much choice and variety, but not a lot of information about different programs and what works for different bodies.
Crossfit, yoga, spin class, body pump- just to name a few. What’s a fad, and what will actually benefit your body?
How is Pilates different to the rest?
Pilates is a series of controlled, isolated movements that looks to lengthen and strengthen the muscles of the body. Pilates typically focuses on your ‘core’ abdominals. Your core is not just your ‘6 pack’ it’s the muscles that attach to the trunk of the body (your spine and pelvis) and includes abdominals, glutes and erector spinae (back) muscles.
The idea is to strengthen these trunk muscles to improve your posture and mobility so that your limbs move more effectively.
In a gym setting, you would typically work your global muscles (like quadriceps in your legs) or deltoids (in your shoulders). While this is great strength training, in terms of improving posture and spinal mobility, we need to focus on the intrinsic muscles- which is where Pilates is better.
Pilates is also one of the only forms of exercise that compliments other training. For example if you are a runner, you could combine Pilates training to assist with recovery and to strengthen your gluteal (bum) muscles, which will improve your running. This principle can then also be applied to a variety of other sports or activities
In fact, studies have shown that for those who attended two 45 minute Pilates training sessions a week - after 8 weeks their flexibility and lumbo-pelvic stability had improved significantly. (ncbi.nlm.nih.gov Asian J Sports Med 2011)
Pilates exercises are also easily adapted to a variety of levels and capabilities. Pilates can be safely performed pre and post pregnancy and post surgery (clinical Pilates). As well as this, Pilates is supervised by a trained practitioner, meaning you know you are performing each exercise safely - something that lacks in a typical gym setting.
A concern from many clients is that they believe they aren’t flexible and can’t do Pilates. But that is exactly why we come to Pilates, to increase our flexibility and to improve our posture. You don’t need to be flexible or strong to start, you just need to have the desire to improve.
If you have a pre existing injury, we recommend you chat to your practitioner before commencing a Pilates program, because in that instance clinical may be more beneficial to you (clinical is supervised by a physio and is rehabilitation based).
Your first Pilates Fit class is free, you have nothing to lose, and everything to gain!
We’ve all been there – whether it be post-Christmas, post winter, post injury or even post baby – finding the motivation again after a period of time off can be hard. Here’s a few things to help you bounce back into your exercise routine.
Don’t be hard on yourself – Get rid of the guilt, stop setting high expectations that are unrealistic to achieve – this only leads to negativity and punishment. If you have been feeling bad for missing out on exercise, turn it into excitement and confidence about starting again and reaching your goals.
Set a goal and write it down – Going into anything without a plan is a sure way to increase your chances of failing. Have it clear in your mind & put in down on paper. Think about both short and long term goals and make it specific – Eg; how many days do you want to run, what distances/duration you want to achieve and ultimately the long term goal might be completing a fun run on a set date. If it’s written down and in a place you regularly sight it, it will make you accountable for your actions and is often the best form of motivation.
Prepare and set yourself up for success – Plan or allow adequate time for what you want to achieve in your running session or workout. Take note of your progress by ticking or crossing or recording what you have achieved beside your list of goals. Prepare yourself by packing your lunch or gym gear the night before to allow yourself a better night sleep to wake up fresh and lastly if you have good self-control you will spend less time resisting desires against exercise and you are more likely to achieve you goals if everything is prepared.
Start out slow – If you’ve had a break from exercise due to injury or just simply not having the time, it is important to start out slow to reduce the likelihood of re-injury or a new injury from overloading your muscles and joints too quickly. It is also important to allow time to warm up and cool down properly with exercise to best avoid muscle soreness the next day.
Don’t procrastinate and never give up – Whilst it’s easy to procrastinate in life, it is bad for our will power, only making us more stressed as a result. Our willpower can be overused and weakened just like our muscles, but it can also be strengthened by making positive choices. So bite the bullet and stop making excuses, you will feel better for it in the long run.
Try something new – Sometimes routine can become mundane and after a period of time doing the same thing causes a loss of motivation. Stop it in its tracks and make your exercise routine a variety. If it’s running – include some steady runs with some interval/speed or hill running. If you are a gym goer – try exercising outdoors, if you struggle flying solo – try a team sport or recruit a friend to exercise with. Don’t make exercise a chore, for you to be successful at achieving your goals you must enjoy what you are doing.
Reward yourself – Starting anything new is hard, it takes willpower to adopt a change in behaviour, so make sure you reward yourself along the way to further drive your motivation to keep going. It might be little rewards along the way such as a new item of clothing or a massage or even a bigger reward like a holiday once the final goal is achieved.
Remember the important thing is to have a positive outlook on starting a fresh, don’t beat yourself up if you miss a session here or there, recognise you are doing well for having started and keep moving forward. Good luck!
As a physio I prescribe and encourage movement as therapy. I use my hands to mobilise, stretch, massage and move body parts; I use my voice to educate, encourage, plan and prescribe movement strategies; I use my body to demonstrate and visually communicate movement patterns. Movement really is a metaphorical feast for the senses and it’s also highly therapeutic.
Movement therapy………yes I’ve moved on (pardon the pun) from the term exercise. Patients don’t necessarily want to exercise better, they want to MOVE better and FEEL better and PERFORM better. Maybe even HEAL better.
Movement is widely prescribed as a therapy for most disease states of the body - from pain and stiffness in our muscles and joints to diabetes, asthma, heart disease, cancer and autoimmune disease to name a few. So what is it about movement that is so therapeutic across such a wide variety of conditions?
The common link to all disease in the body is chronic, low grade inflammation. It’s the body’s neuro-immune system attempting to restore balance. Our nervous system and immune system working together, releasing inflammatory chemicals like cytokines and hormones like cortisol. Driven by an overactive autonomic nervous system and exacerbated by stress and modern lifestyle choices.
The prescribed antidote to this modern day chronic disease dilemma is movement. Why? Because the physical organ that is our nervous system moves and stretches as WE MOVE. It glides and slides as we bend and flex and extend. Movement obviously keeps the nervous system physically healthy, infusing it with blood and oxygen. But movement is also highly anti-inflammatory, it changes the balance of the chemicals in the neuro-immune system, calming the inflammatory response.
So movement therapy is really immunotherapy. It balances the immune response by balancing the pro and anti-inflammatory chemicals in the nervous system. Ultimately health and well-being.. FEELING well and MOVING well and PERFORMING well…. is all about achieving the right chemical balance in our nervous system by creating a balance between movement and stillness.
And as for the prescription of movement…. well, I’ve moved on from numbers too. 10 reps 3 times a day is arbitrary. It really depends on the chemical balance in your nervous system. If your inflammatory profile is reasonably low then you can move more vigorously, more often. If your inflammatory profile is high then go gently with less repetitions and adopt the ‘little and often’ rule. Skilled therapists are terrific at judging from your history and examination where you sit along the inflammatory spectrum.
Set a goal and start moving. Find the right balance for you. Your immune system will do the rest.
Special Event - Wednesday 7th September 2016 @ 7:15pm
Camberwell Sports & Spinal Medicine welcomes four-time Olympian Craig Mottram to a special evening talk-fest on running - whatever the distance!
As the days start to become longer we find that we are only a few weeks out from the Melbourne Marathon, the traditional start to the Spring/Summer Running Season.
Our Run Long Run Strong evenings are targeted towards runners of every level and ability with a view to educating participants about training injury free, improving performance, and being the best you can be. Previous speakers have included Olympian Jess Trengove and Hawthorn High Performance coach Andrew Russell.
No one has more knowledge about what it takes to toe the line than Craig Mottram who first represented Australia at the Sydney 2000 Olympics. Craig will join the panel with his wife Krystine (a psychologist) alongside members of CSSM's expert team to bring you an entertaining and informative evening. Providing advice on training and preparation, injury prevention, injury management, strength and conditioning, and more.
Tickets
Spaces are limited to only 50 guests for this event. Our previous Run Strong events have sold out very quickly so we encourage you to purchase your tickets as soon as possible. Tickets can be purchased for $20 with 100% of proceeds of the evening going to CSSM's preferred charity, The Indigenous Marathon Foundation.
Ten Tips for the Ski Season
The snowflakes are falling and soon Melbourne will be migrating to the mountains for weekends of skiing and tobogganing!
Here are my top ten tips to ensure you make the most of your ski trip and be as prepared as possible.
Equipment
Check your equipment well before you depart for your trip. Consider buying new equipment as newer light weight equipment will have more bounce in it and make your skiing much more enjoyable. Try on your boots and make sure they fit correctly, wear them around before your holiday to make sure they are comfortable.
2. Fitness
Increase your base fitness level and you will be able to make the most of your costly lift pass. Cardio respiratory fitness is essential for skiing so try something like cycling as a great work out that won’t over load your knees. Furthermore, do a ski fitness program to target specific muscle groups you require for skiing (see tip #10).
3. Stretch
Rest is the most underrated performance enhancer. Whilst it is essential to strengthen in preparation for skiing it is just as important to provide the body with rest and stretching. Focus on stretching quadriceps, glutes and hip flexors to maximise your flexibility and muscle function.
4. Chill (Pardon the pun)
Take it easy! Start slowly and build the intensity and difficulty of your runs. Train yourself on the groomers to get use to your skis and boots and slowly progress. It’s easy to arrive at the mountain all amped up but try to save yourself from burning out on day one.
5. Learn
Take a lesson. Yes, they are expensive but at the same time a half day of expert tips doesn’t go astray whether you’re a novice or experienced. An instructor will help you make the most of your new equipment, give you specific skills to work on and provide advice on the best runs for you.
6. Drills
Just like a netballer practices throwing drills and a swimmer practices high elbows – a skier should perform drills to improve technique. It is recommended that you find a gentle run and practice long radius and short radius turning as well as identifying your centre of balance by leaning too far forwards and too far backwards. Once you’ve nailed this try progressing to some steeper runs.
7. Plan
It pays to plan out your goals and what you’d like to achieve by the end of the week. Perhaps, this is something you could discuss with your instructor.
8. Drink
Swap the wine for water; it easy to overdo it on the first night when you’re 10,000 feet higher than normal. Alcohol can exacerbate symptoms of high altitude sickness, including headaches and nausea. Never the less, a celebration at the end of a week well skied is always warranted.
9. Rest
When you’re fatigued and running out of gas, back off. It’s always the skiers who keep hurtling down the black runs that end up calling the rescue toboggan. As a physio, I see tonnes of skiing injuries, from broken wrists to ruptures ACLs. When required, rest and rejuvenate, take a day sitting by the fire and return to skiing when your body is back at its best.
10. Strengthen
Skiing is a fantastic workout for your body as it requires the use of all muscles. Here are some specific muscles to target and strengthen in the lead up to your trip:
Quadriceps: the most vital muscles required for skiing are your quads. These muscles hold you in position and help you steer and stop. Fabulous exercises for your quads are squats and lunges.
Hamstrings and Glutes: As you are skiing downhill you typically will hold your trunk in a flexed position, this requires strong eccentric (contraction on length) strength from your hamstrings and glutes. Good exercises for this are; bridges, single legged dead lifts and step ups.
Inner and Outer thighs: Your outer thighs help keep your body stable and enable you to steer whilst your inner thighs work like crazy to keep your skis together. Work these muscles with side lunges, side leg lifts, inner thigh squeezes and side leg squats.
Calves: Because your knees are bent as you ski, your calves (in particular your soleus) help you stay up right so you don’t fall over. Strengthen your calves by performing calf raises off the edge of a step.
Abs and Back: To maintain a forward flexed position through your trunk whilst skiing your abs and back must have great endurance. It is essential to strengthen these muscles in order to protect your spine. Work these muscles with exercises like toe taps, planks, back extensions and dumbbell rows.
Arms: Arms help push off with your skis and balance you. Make sure you work your biceps and triceps along with the rest of your body.
These days it seems there are a lot of trends in the fitness industry. Spin classes, Yoga, Crossfit, Pilates. It can all be a little overwhelming. But it can also be difficult to know what is going to benefit your health, and what is just a fad.
Pilates has always been the go-to exercise choice for physiotherapists and health-care practitioners alike. It is safe, challenging and an enjoyable way to restore strength and alignment through the body. It is also one of few exercise programs that can be easily applied to a variety of ages and abilities. But did you know there are different kinds of Pilates?
If you have been to the clinic before, no doubt you would have seen or experienced the clinical Pilates program. Designed for its rehabilitative purposes, clinical Pilates is personalised and tailored to an individual, depending on their specific needs and the nature of their injury. You would generally consult with your physiotherapist before commencing, and would then undertake a 4-5 week program depending on your goals and the severity of your ailment.
But what happens after clinical Pilates? Or what if you are not injured, or your ailment is not restricting you in day-to-day activities? That is where Dynamic Pilates enters.
Dynamic Pilates is a fitness based program, which looks to strengthen, tone and stretch the muscles of the body. Classes involve both body weight and resistance based exercises, which is highly effective in reducing muscular imbalances and improving general posture. It is the perfect program for those looking to challenge their bodies, without risk of further injury.
Classes are taught using both reformer and mat based exercises. Each class will incorporate exercises designed to strengthen generally weaker muscle groups, such as glutes, and release generally restricted muscle groups, such as hip flexors. Classes are also a fantastic way to cross-train, when combining with another sport or exercise program.
Dynamic Pilates is the perfect compliment to your current exercise schedule. From the athlete to the weekend warrior, and everything in between, Dynamic Pilates can cater to a variety of ages and abilities. If you are looking to improve your strength, flexibility and posture, we have the program for you.
For further information please contact the clinic.
The Perfect Pointe
When is the right time for a ballet dance student to progress to pointe work? Many students wonder at what age they might get their first pair of pointe shoes.
The dancer must first undertake a detailed assessment with a podiatrist or physiotherapist experienced in performing pre-pointe assessments. It is important to determine a dancer’s readiness in order to avoid potential injuries and the development of bad habits.
Dancing en pointe requires significant strength, athleticism and discipline. Beginning too young or when the body is not strong enough can be detrimental in the long term.
The en pointe position places significant pressure on the bones and soft tissues of the foot and ankle, up to ten times the dancers body weight on her toes and feet. Some bones in the feet are still growing until age 16 or even 25 years of age. And damage can occur in the growth plates causing malformed bones if a dancer is not strong enough. Damage can also occur to other joints such as the knees and hips; which may not become apparent until years later.
Many dancers begin pointe work at approximately 12 to 14 years of age; although age alone is not an adequate predictor of growth and maturity. When deciding if a student is ready to begin pointe work the practitioner will consider the number of years and hours per week the dancer undertakes. The practitioner will perform a detailed assessment which includes tests of strength, flexibility, neuromuscular control, balance, alignment and ballet technique. The body as a whole will be evaluated, not just the foot and ankle. The dancer must be able to perform all tests maintaining balance, control and alignment to be considered ready.
It must be recognised that pointe work is the end result of slow and gradual training of the whole body, back, hips, leg and feet in perfect balance and alignment. This will naturally occur at different ages for different dancers and should not be rushed. Practitioners will also expect a good attitude and work ethic which is required to dance at an advanced level.
Podiatrists Gen and Sarah at CSSM enjoy the opportunity to work with dancers; both for undertaking a pre-pointe assessment and in the prevention and management of injuries associated with dance.
References
Richardson M, Liederbach M, Sandow E. Functional Criteria for Assessing Pointe Readiness. J Dance Med Sci. 2010; 14 (3): 82-88. Weiss et al. When Can I Start Pointe Work? Guidelines for Initiating Pointe Training. Journal of Dance Medicine and Science. 2009; 13(3)). IADMS
Physiotherapists have been trained to treat a variety of conditions. We are commonly known for our expertise in treating musculoskeletal conditions and sports injuries, however we also work in conjunction with other medical professionals to help manage various neurological, cardiovascular and genetic disorders.
Parkinsons Disease Boxing legend Muhammad Ali was perhaps the most well known Parkinsons Disease (PD) patient, but approximately 70,000 Australians are living with Parkinsons (Parkinson’s Australia, 2015). Parkinsonism is characterised by a disorder of movement consisting of tremor, rigidity or increased stiffness in joints, slowness of movement, slowness in initiating movement and freezing while moving (Carr and Shepherd, 2010). The role of physiotherapy in the early stages of PD is promoting physical activity as a means of maintaining an active lifestyle, a flexible neuromusculoskeletal system, cardiorespiratory fitness, muscle strength and balance. In the middle stage of the disease, cueing and cognitive strategies are of greatest importance for optimising the performance of everyday tasks. The appropriate prescription of gait aids is also necessary when moving from the middle to later stages of the disease (Carr and Shepherd, 2010).
Walking The benefits of walking practice have been well established for people with PD (Carr and Shepherd, 2010). The aim of walking practice is to increase the stride length in order to increase overall walking speed, as opposed to increasing the cadence (amount of steps). In the early to middle stages of PD, moderate to high intensity walking may also have positive effects on maintaining muscle length and cardiovascular fitness. Given that in PD walking speed and stride length is most greatly affected under more complex walking conditions, incorporating backwards walking, dual tasking and negotiating obstacles is recommended.
Treadmill walking has been found to have an immediate effect of promoting a walking consistency significantly greater than that for normal overground walking (Frenkel-Toledo et al 2005; Bello et al 2008). Upon the completion of a treadmill-walking programme, several studies have found people with PD have gained the ability to walk faster and further (Miyai et al 2000, 2002; Cakit et al 2007).
Balance Training to improve balance involves methods that safely challenge a persons ability to make postural adjustments. Since impairment of reactive postural adjustments is a problem for people with PD, specific training is recommended in order to decrease the occurrence of falls. This type of training is however difficult to do at home without the supervision of physiotherapists due to safety concerns.
:paragraph!Standing up and sitting down People with PD are slow to stand up from sitting. Physiotherapists help people with PD use cognitive strategies and cues to train a more effective motor pattern. Improvements in time to stand up, peak horizontal and vertical speeds have been found in PD patients who participate in motor skill therapy with cueing (Mak & Hui-Chan 2008).References
http://www.parkinsons.org.au/what-is-parkinsons Bello, O., Sanchez, J. A., & Fernandez‐del‐Olmo, M. (2008). Treadmill walking in Parkinsons disease patients: adaptation and generalization effect. Movement Disorders, 23(9), 1243-1249. Carr, J. H. (2010). Neurological Rehabilitation, Optimizing motor performance. Elsevier India. Cakit, B. D., Saracoglu, M., Genc, H., Erdem, H. R., & Inan, L. (2007). The effects of incremental speed-dependent treadmill training on postural instability and fear of falling in Parkinsons disease. Clinical Rehabilitation, 21(8), 698-705. Frenkel‐Toledo, S., Giladi, N., Peretz, C., Herman, T., Gruendlinger, L., & Hausdorff, J. M. (2005). Treadmill walking as an external pacemaker to improve gait rhythm and stability in Parkinsons disease. Movement Disorders, 20(9), 1109-1114. Mak, M. K., & Hui‐Chan, C. W. (2008). Cued task‐specific training is better than exercise in improving sit‐to‐stand in patients with Parkinsons disease: A randomized controlled trial. Movement Disorders, 23(4), 501-509. Miyai, I., Fujimoto, Y., Ueda, Y., Yamamoto, H., Nozaki, S., Saito, T., & Kang, J. (2000). Treadmill training with body weight support: its effect on Parkinsons disease. Archives of physical medicine and rehabilitation, 81(7), 849-852. Miyai, I., Fujimoto, Y., Yamamoto, H., Ueda, Y., Saito, T., Nozaki, S., & Kang, J. (2002). Long-term effect of body weight–supported treadmill training in Parkinsons disease: A randomized controlled trial. Archives of physical medicine and rehabilitation, 83(10), 1370-1373.
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