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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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Don’t Let Muscle Cramps Cramp Your Style!

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Is your sporting performance being hindered by regular muscle cramping? You may be wondering why this is occurring and how you can manage and prevent them.

Muscle cramping is a common yet painful and involuntary contraction of a skeletal muscle, which can occur without warning or apparent cause (Bergeron, 2008). Put simply, when there is any disruption at any level within the central or peripheral nervous systems, the muscle fibres (known as the muscle spindles and golgi tendon organ proprioceptors) are affected, which consequently influence the length and tone of the muscle, which can result in the muscle cramp. Typically we see them in the calf muscle, hamstrings or quadriceps.

A study looking at the treatment and management of muscle cramping revealed that there are two distinct categories; skeletal muscle overload and fatigue, as well as exertional heat cramps.

Recovery and prevention of skeletal muscle overload cramps:

As soon as you feel a cramp come on, lower the intensity of exercise. Begin passively stretching and massaging the effected muscle group, provided you can do so within pain limits. You may also find that icing the area will provide some short term relief.

Long term, look at improving conditioning and range of motion through the particular area, as well as individual fitness and stretching programs. Adjustments to biomechanics, equipment set up (e.g. bicycle seat height) and relaxation techniques may also be of benefit. Our practitioners at CSSM are able to assist you with this.

Recovery and prevention of exertional heat cramps:

As these cramps typically occur during or after exertion and generally in conjunction with extensive sweat loss, the cause of this kind of cramping is due to electrolyte imbalance.

First port of call is to promptly replenish the deficit, typically with a high salt solution - which is likely to have an effect within a few minutes. A sports drink will also assist in replenishing electrolyte levels.

Dietary potassium intake is also proven to be beneficial - so think about incorporating yoghurt, salmon, avocado, mushrooms, bananas and dark leafy greens such as spinach into your meals.

If you have any further questions, speak to one of our experienced practitioners at CSSM.


Bergeron, M 2008. Muscle Cramps during Exercise is it fatigue or electrolyte deficit?

Knee’d Some Help With Your Running?

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The popularity of recreational running is sky rocketing with the number of runners coming through the CSSM doors higher than ever.

Iliotibial band syndrome is the most common injury to the outside of the knee in runners with an incidence rate between 5% and 14% (Van der Worp et al, 2014). The ITB is a long fibrous structure that extends from the hip to the knee. Iliotibial band syndrome is caused by friction between the ITB and the underlying bony process of the femur. The highest friction point is at 30 degrees of knee flexion during foot strike and the early stance phase of running. The cause of ITBS is multifactorial involving both intrinsic and extrinsic factors.

Risk factors

  • Downhill running
  • Poor footwear
  • Poor gluteal strength
  • Poor pelvic control
  • Uneven surfaces
  • Running biomechanics
  • Leg length discrepancy


  • An ache and/or tenderness over the outside of the knee
  • Pain onset at about the same time/distance on each run
  • Pain aggravated by running downhill
  • Pain descending stairs

Recent evidence

A recent systematic review has investigated the aetiology, diagnosis and treatment of ITBS in runners.

Iliotibial Band Syndrome in Runners A Systematic Review

Maarten P. van der Worp,1 Nick van der Horst,1 Anton de Wijer,1,2 Frank J.G. Backx3 and Maria W.G. Nijhuis-van der Sanden4

The main results of the study showed:

The studies of the aetiology of ITBS in runners provide limited or conflicting evidence and it is not clear whether hip abductor weakness has a major role in ITBS. The kinetics and kinematics of the hip, knee and/or ankle/foot appear to be considerably different in runners with ITBS to those without. While articles were inconsistent regarding the treatment of ITBS, hip/knee coordination and running style appear to be key factors in the treatment of ITBS. Runners might also benefit from mobilisation, exercises to strengthen the hip, and advice about running shoes and running surface.


Here at CSSM we can help!

Clearly the biomechanics of different running styles can contribute to ITBS. With our latest technology we are able to assess your running technique to help treat the cause of your pain. An appropriate rehabilitation program should be prescribed to strengthen and stretch the relevant pre-disposing structures. A podiatry appointment may be necessary to assess foot posture to ensure you are wearing the correct footwear.

If you are experiencing an ache in the outside of the knee, first line treatment is relative rest and ice. However, prevention is always the best cure. If you have any queries, contact any of the friendly practitioners at CSSM for an opinion or advice.

Is Rest Really Best?

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Ankle sprains are one of the most common lower limb injuries we see as physiotherapists. As children, we were taught the principles of R.I.C.E rest, ice, compression and elevation. Most people believe the best way to heal an ankle sprain is by resting it and keeping off it. However, recent evidence suggests otherwise!

The ankle joint helps to hold our body weight over our feet. It has a prime role in balance and coordination. There are three main ligaments that run along the outside of your ankle into your foot to help stabilize the joint.

There are many causes and contributing factors to ankle sprains. If you are an athlete involved in high impact sports with change of direction you are at risk of injuring these ligaments. Furthermore, if you are in poor footwear, have poor balance or exposed to uneven surfaces you are more likely to sprain your ankle.

So, you've rolled your ankle, its bruised and swollen and all you want to do is lie in bed with an ice pack. But, is rest really best?

An important study on ankle rehabilitation found ‘an accelerated exercise protocol during the first week after ankle sprain improved ankle function’ (Bleakely et al, 2010). The study compared two rehabilitation programs which both included ice and compression. One rehabilitation group performed therapeutic exercises in the first week post injury whilst the other simply rested. It was found that the group with early intervention had better overall outcomes and earlier return to activity - such as work and school.

This article challenges popular advice for rest and protection of minor to moderate ankle sprains. It highlights the importance of early management and implementation of therapeutic exercises in the successful rehabilitation of ankle sprains.

Rest is not really best! If you or a family member experiences an ankle injury please seek early medical advice. At CSSM, we specialize in the assessment and management of all sporting injuries.

The abstract of the article is outlined below, however if you're interested in reading the full study please click here.

Bleakley et al (2010) Effect of accelerated rehabilitation on function after ankle sprain; randomized controlled trial


Objective To compare an accelerated intervention incorporating early therapeutic exercise after acute ankle sprains with a standard protection, rest, ice, compression, and elevation intervention.

Design Randomised controlled trial with blinded outcome assessor. Setting Accident and emergency department and university based sports injury clinic. Participants101patientswithanacutegrade1or2ankle sprain.

Interventions Participants were randomised to an accelerated intervention with early therapeutic exercise (exercise group) or a standard protection, rest, ice, compression, and elevation intervention (standard group).

Main outcome measures The primary outcome was subjective ankle function (lower extremity functional scale). Secondary outcomes were pain at rest and on activity, swelling, and physical activity at baseline and at one, two, three, and four weeks after injury. Ankle function and rate of reinjury were assessed at 16 weeks. Results An overall treatment effect was in favour of the exercise group (P=0.0077); this was significant at both week 1 (baseline adjusted difference in treatment 5.28, 98.75% confidence interval 0.31 to 10.26; P=0.008) and week 2 (4.92, 0.27 to 9.57; P=0.0083). Activity level was significantly higher in the exercise group as measured by time spent walking (1.2 hours, 95% confidence interval 0.9 to 1.4 v 1.6, 1.3 to 1.9), step count (5621 steps, 95% confidence interval 4399 to 6843 v 7886, 6357 to 9416), and time spent in light intensity activity(53minutes,95% confidence interval 44 to 60 v 76, 58 to 95). The groups did not differ at any other time point for pain at rest, pain on activity, or swelling. The reinjury rate was 4% (two in each group).

Conclusion An accelerated exercise protocol during the first week after ankle sprain improved ankle function; the group receiving this intervention was more active during that week than the group receiving standard care.

Your Phone Is A Pain In The Neck

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It’s called ‘text neck’ - a typical texting stance: head down, hand holding the phone up, replying back to a text or reading your latest updates on Facebook, Instagram and Twitter.

A recent study found that people spend an average of two to four hours a day with their head tilted forward over their phones and devices. When we break that down, that’s 700-1400 hours a year of excess stresses to our cervical spine and that doesn’t include our work, school and everyday posture.

How many times do you check your phone or other gadgets in a day? Every morning, when you get to work, lunch breaks, after work and before bed?

Are you now thinking this may be the cause or contributing cause to your sore neck?

A 2014 study found that with the human head weighing between 4.5 and 5.5kg, adding a 60 degree tilt (which is the position our head moves to when we are texting) creates a 27kg strain through our neck. (Hansraj, 2014)

Straining the neck can cause many issues - migraines, headaches and poor posture. One of the most common stances for poor posture occurs when the head is tilted forward and our shoulders are slouched forward.

The cervical spine has seven vertebrae and has a natural backward ‘C’ shape much like our lumbars. When we are constantly in this poor ‘texting’ position, what can happen is muscle strain from stretched muscles being held in a position for too long, pinched nerves and over a course of time, a loss in the natural curve further adding stress to our cervical spine. These stresses may possibly lead to early wear and tear, degeneration of the discs and in severe conditions, surgery.

While you can say it’s merely impossible to stay away from technology as it is ever evolving, there are actions that can be taken to avoid these neck issues from arising. One would be to view your phone with your spine in a neutral position and avoid spending hours in the day hunched over the phone.

There are other factors throughout daily life which can most definitely affect your posture and tension through the neck - one being work - but by correcting your texting position this can help reduce your risk of neck pain.

No one wants a back like the hunchback of Notre Dame, no one wants ‘text neck’!


Hanraj, K 2014, Assessment of stressed in the Cervical Spine Caused by Posture and Position of the Head

Davies, M 2014, Have YOU got text neck? How hunching over your phone puts 60lbs of extra pressure on the spine, The Daily Mail, 19 November, viewed 24 November 2014,

Get Back Into Training Faster Quick Tips To Recover Post Exercise

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Congratulations! You’ve finished all your exercise and training, now what?

Athletes of all fitness levels can benefit from doing recovery after any type of exercise which includes training and events. All of these means of recovery encourage the removal of metabolites and waste products away from the muscles whilst also encouraging delivery of nutrients and oxygen to the muscles.

Just taking the time to include a few simple methods of recovery as part of your post marathon program can decrease recovery time, reduce muscle soreness and get you back to training faster.

These quick tips include:

  • Active recovery / warm down - Having completed your activity (training, event, sport) your warm down can be anywhere from 5-15 minutes of light activity such as jogging, riding or swimming - whichever suits you best.
  • Stretching - Once you have warmed down, stretch the muscles you have used in that training session. For the lower half of the body, you may include calf, hamstrings, glutes, quads and hip flexors. For the upper body, include arms, back and shoulders. If in doubt, it doesn’t hurt to do a good stretching session including all the major muscles from the upper and lower body. Foam rolling is also another way in which you can aid the major muscle groups.
  • Compression garments - Compression garments can be worn post training/event speeding up recovery time, reducing DOMS (delayed onset muscle soreness) and improving circulation. A good website to have a look at is the 2XU site:
  • Ice baths - Ice baths aid recovery by decreasing the temperature of tissues which constricts local blood vessels reducing inflammation. If followed by warm water, the blood vessels dilate allowing lactic acid and waste products to be flushed from the area which helps reduce DOMS. Here are two methods:
    1. Stand in an ice bath with waist deep water (2-10oC) for 1 minute followed by 1 minute out of the bath. Do 1-3 times.
    2. Alternate between cold (2-10oC) and hot (37-40oC) showers or baths for 1 minute each time. Complete 1-3 times.
    Athletes who are doing intense exercise such as marathons, triathlons, iron man, football or sports tournaments can benefit greatly from ice baths.
  • Soft tissue therapy - Myotherapy and remedial massage. Training can lead to increased tone (or tightness) in the muscles which can reduce your ability to deliver nutrients and oxygen to cells as well as remove waste. Regular soft tissue therapy helps reduce muscle tightness and any irregularities in the soft tissue. Usually about 2-3 days after an event is the best time to get treatment.


(Takahashi, 2002) Authors: Takahashi, Tatsuhisa; Okada, Akiyoshi; Hayano, Junichiro; Tamura, Toshiyo

Source: Frontiers of Medical & Biological Engineering, Volume 11, Number 4, 2001 , pp. 249-259(11)