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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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Dynamic Pilates Comes To CSSM

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Introducing PilatesFIT, Camberwell Sports & Spinal Medicine’s Dynamic Pilates program. Read to the bottom to find out about our special introductory offer.

Like traditional Pilates, Dynamic Pilates aims to increase the body’s strength and flexibility through a series of controlled and specific movements. Both classes will typically focus on exercises to improve postural awareness, balance and muscle control. Dynamic Pilates however, uses a principle known as ‘Isolate, Fatigue, Stretch’ which combines the traditional, with a circuit based program that reaps all the benefits of classic Pilates, as well as improving cardiovascular conditioning. You can think of Dynamic Pilates as being like your usual class with an extra kick!

Dynamic Pilates classes cater for beginner to advanced levels, with all classes providing thorough support and guidance from your instructor. With a maximum of 8 per session, there is strong attention to detail, and you can be sure you are performing each exercise safely and correctly. Currently we have Level 1 classes to cater for beginners and those returning to exercise. For the more advanced, we have Level 2 classes which involves a higher level of intensity.

Classes will be conducted by experienced Pilates Practitioners Danielle Thomas and Kim Van Hoorn. Currently the following timetable is available.

Dynamic Pilates Timetable

Level 1 : Beginner

Wednesday 2pm

Thursday 7am

Friday 7am, 10:30 am

Level 2: Intermediate

Thursday 6am, 9:10am

Friday 6am, 2pm

Sign up to class can be done online via the website, and sessions can be purchased in single or bulk packs of up to 10 sessions at a time. :!paragraph

The availability of sessions will grow, with sessions to be run at various times throughout the week, including early mornings, later evenings, and weekends.

Further information can be found on our website.


We are excited about the introduction of our PilatesFIT sessions and want you to try it. To get you motivated we are running an introductory offer of your first 5 sessions for $50.

Regular pricing will be $250 for 10 sessions or $35 for a single sessions.

We are sure you have lots of questions like “How is this different to my regular Pilates?” To get the answers to these questions and more. Download our FAQ page.

Spinal Manipulation - Help Or Hazard

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In recent weeks, joint manipulation or in lay terms ‘cracking’ or “popping” the spine, has been the topic of much discussion in the media. It is a technique common to Osteopathy, Physiotherapy and Chiropractic but has attracted somewhat negative attention across all professions who use the technique. Today I will discuss why, as Osteopaths, we may use the technique during our treatments and give you all the information you need to make an informed decision as to whether it may suit you at your next visit.

High Velocity Low Amplitude (HVLA), typically known as joint manipulation, is commonly applied during Osteopathic treatment. It is a specific technique which aims to achieve an increase in range of motion and a reduction in pain in a given area, typically in the spine. Rather than achieving movement at all joints in the area, your practitioner will adjust the technique in order to positively impact the joints with the primary issue. Rather than the notion of ‘getting cracked from head to toe’ or ‘getting cracked back into alignment’ it is a technique ideally applied as locally and to as few spinal segments as possible . Further, it is one of many techniques employed by Osteopaths to treat your injury or pain, and subsequently will never be used in isolation during your appointment.

The audible cavitation or ‘crack’ that you may hear is not your bones breaking or grinding together. Studies have hypothesised that it is due to the release of a gas bubble from the joint capsule when the ‘thrust’ is applied. Although this noise can be loud, it is not of concern.

Symptomatic relief following joint manipulation will vary from patient to patient. Generally an immediate sense of more movement is expected. Some temporary side effects may include local pain/discomfort, stiffness, dizziness or light headedness, and are likely to subside within 24 hours of treatment. This can also be as a result of the treatment itself rather than the manipulation in isolation.

Most people do not experience significant adverse events following HVLA. The risk despite being very minimal is important to note when making your decision. The incidence of a significant vascular incident (stroke) was found to be 1 in 2,000,000 with joint manipulation (Terrett, A.G, 2001). Comparatively, when taking the oral contraceptive pill the risk of stroke is 83 times higher (Gillium et al, 2000) than joint manipulation, and taking anti-inflammatory medications increases that risk to a substantial 1,666 times higher (Tramer et al, 2000).

With these figures in mind, while it puts it into perspective, your Osteopath will always ensure that the technique is safe for you. At each appointment a thorough clinical history and assessment will be completed. This will govern as to whether joint manipulation is an appropriate technique for you or your presentation as manipulation is appropriate in many but not all situations or injuries. It is also important to note that your practitioner has undertaken 5 years of study at a university level, and is highly trained to identify when you are not able to receive this technique.

In light of recent debate querying the application of spinal manipulation in the general population, patients can be assured that it is the policy of Osteopaths at Camberwell Sports and Spinal Medicine to never use spinal manipulation on children or infants.

If you have any further questions, your Osteopath will be happy to answer them for you at your next visit.

Stoke incidence following spinal manipulation is 1 in 2,000,000 Terret AG. Current Concepts In Vertebrobasilar Complications following Spinal Manipulation. Des Moines, Iowa: National Chiropractic Mutual Insurance Company, 2001.

Stroke related to birth control pill is 1 in 24,000 (83 times higher) Gillium LA, Mamidipudi AK, Johnston, SC. Ischemic Stroke Risk with Oral Contraceptives, a Meta-analysis. Journal of the American medical Association 2000; (84)1

Stroke related to use of NSAIDs (aspirin, ibuprofen) is 1 in 1,200 (1,666 times higher) Tramer MR, Moore RA, Reynolds JAM, McQuay HJ. Quantitative Estimation of Rare Adverse Events Which Follow a Biological Progression: A New Model Applied to Chornic NSAIDs Use. Pain 2000; 85: 169-182

Posted 25th May 2016

Make Your Move

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With Mother's Day just around the corner we thought it timely to discuss the Australian Governments Girls make your move campaign. Whilst this campaign is targeted at girls aged between 15-18 years, the significance of improving levels of physical activity for all women is highlighted. Promoting well-being and health for our next generation of mums.

Women face a unique set of barriers to participating in physical activity when compared to men. These barriers are particularly highlighted in young women who can feel they're not fit enough to participate, they may be anxious about not looking the part, they may perceive themselves as not 'attractive enough' to exercise and they often exhibit anxiety about being ridiculed when exercising.

There are a multitude of mental-health benefits related to regular exercise including improving mood and self-esteem, reducing levels of stress and anxiety, socialisation and then of course there are the physical benefits and the long term health benefits such as reducing the risk of some chronic diseases.

The stats in Australia suggest that 9 in ten young people just don't move enough. Younger women are generally less active than their male counterparts, exercise less intensely and are more likely to be sedentary than young males. With the Australian guidelines for young adults set at 1hour of moderate to vigorous exercise per day, what can mums do to get their young daughters moving?

Research suggests that finding an activity that a young women enjoys is one of the key factors to keeping her active. Not into netball? Why not try an 80's dance class! Exercise should be fun and exercising with peers has been identified as an important factor for regular participation. Why not start a sports team with friends? Or take a group of friends to the gym. Family role modelling can have also have a really positive effect on young women. Setting a good example and participating in physical activity will likely have a positive effect on your children's attitude towards physical activity.

So this May in honour of mother's day, women everywhere set yourself a goal to get out, have fun and get moving.

Australia's Physical Activity and Sedentary Behaviour Guidelines for Young People (13-17 years), Commonwealth of Australia 2014 Bauman A, Bellow B, Vita P, Brown W, Owen N 2002. Getting Australia Active: towards better practice for the promotion of physical activity, National Public Health Partnership, Melbourne, Australia in ABS Australian Health Survey; Physical Activity, 2011-12 Van Bueren D, Elliott S, Farnam C 2016. 2016 Physical activity and sport participation campaign insight's report. Department of Health, Commonwealth of Australia.

All About Osteopathy

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Osteopathy Awareness Week 
Caroline Sanguinetti

Did you know?? 1 in 7 Australians have back pain 3.3 million Australians take medication for headaches 28% have arthritis and other musculoskeletal conditions

Over 50,000 Australians see an Osteopath each week. With these statistics in mind, Osteopathy Awareness Week kicks off to a great start in order to get our name out there as one of the leading health services in Australia.

An Osteopath is an Allied Health Professional who specialises in treatment of the musculoskeletal system, as well as taking into consideration the influences of the vascular, nervous and visceral systems.

Underlying principles developed in 1874 focus on the ability of the body to heal itself with the appropriate treatment and management. Such treatment may include soft tissue massage, stretching, muscle energy technique (MET), joint articulation as well as manipulation (HVLA). Using a holistic approach, the aim is to restore the normal functioning of the body as opposed to the injury or problem area in isolation.

Common conditions that we treat include:

Neck and back pain

Sports injuries



Postural problems

Occupational injuries

Carpal Tunnel Syndrome

Tennis Elbow


Our treatment is versatile and tailored to suit our patient, from children to the elderly, pregnant women, and even those suffering from chronic conditions. Osteopaths encourage individuals to proactively manage their injury while preventing future episodes - providing advice on diet, exercise, stress reduction and posture. Long-term this means better health and well-being, as well as less time and money invested in hands on treatment.

According to statistics, Osteopathy is the fastest growing health profession in Australia. From only 300 registered Osteopaths a mere 10 years ago, we currently have 2000 osteopaths practicing.

Currently Osteopathy is offered as a Bachelor of Clinical Sciences and a Masters degree of Osteopathy of 5 years duration in total. With higher intakes each year, we can expect the profession to make consistent improvement in overall awareness in the community, and thus make a large impact in the private health sector.

Despite an increase in overall patient numbers, there is still a degree of misunderstanding of the profession among the public and other health practitioners. While being considered the ‘underdog’ among manual therapy, techniques that are specific to Osteopathy, as well as a ‘combined’ approach is quickly becoming the preferred way to manage and treat aches and pains.

Osteopathy Awareness Week (April 19-25th) aims to voice our principles and beliefs, and promote our profession as a competitive, successful approach to health care.

Walking The Trail Foot Care For The Oxfam Trail Walk

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Oxfam trailwalker is a challenging, life-changing event. This event is a tough physical and mental challenge, but also highly rewarding as it raises money to help fight poverty around the world. During this 100km walk, there are many challenges that you may face, some of which include blisters, chafing, rolled ankles and sore muscles and joints.

Prior to the walk

The number one reason for people not finishing the Oxfam Trailwalk is due to blisters. Prior to the walk, you can ‘prepare’ your feet so they are in optimal condition for the walk. This includes cutting your toe-nails to prevent pressure and bruising, having excess callus removed by a podiatrist and moisturising your feet daily to improve skin elasticity and minimise hardening.

During the walk

It is also important to recognise ‘hot spots’ whilst you are walking. Hot spots are slightly warm or sore patches of skin and are often the beginning of a blister. They are often caused by rubbing or pressure. If you think you notice a hot spot, get it attended to as soon as possible or tape the area with non-allergenic tape (hypafix) to prevent a blister from occurring.

Below are some tips that can help keep your feet happy throughout the walk and prevent blisters. Blisters are caused from an increase in moisture and friction so keeping your feet dry is the best way to avoid the likelihood of blisters.

Shoes: Ensure that you have at least two comfortable pairs of walking shoes or hiking boots. You should have a spare pair to change over every so often to reduce pressure or rubbing on the same spot for the entire 100km. Do not wear brand new shoes during the event as they have not been worn in properly and may rub more than usual.

Socks: Wear high quality moisture-wicking socks that are a wool blend or a synthetic/cotton blend. Do not wear pure cotton or pure wool socks as these hold in moisture and increase your chance of getting blisters! It is also recommended that you change your socks regularly during the walk to provide your feet with some relief.

Tape: Taping your feet with non-allergenic tape (such as hypafix) can help reduce friction when walking. To prevent the edges of the tape rolling when you put your socks on, round the edges of the tape instead of leaving the corners square. There are many different taping techniques that walkers use, so practice taping your feet prior to the event so you know what you like. It is recommended that you cover your feet with hypoallergenic tape where you know they are prone to getting blisters or hot spots.

Moisture control: Some people spray their feet with anti-perspirant deodorant during the event to prevent moisture build-up. Avoid applying Vaseline or pawpaw ointment to the feet as they can actually increase friction between the skin when walking for long periods of time. Socks are a useful tool for controlling moisture.

Come and see one of our friendly Podiatrists in the lead up to the Oxfam Trailwalker for pre-walk taping, footwear advice or any other queries or concerns you may have.

After the walk

Put your feet up and relax, you have just completed 100km so it is well deserved! Try soaking your feet in an Epsom salt bath for relief. It may also feel nice if you roll your feet on a spikey massage ball to release the tension in your feet. If you have any niggles or pains that persist after the walk, ensure to seek professional medical advice from a Podiatrist or another health professional.

Dane Swans Lisfranc Injury

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Lisfranc Injury

The term “LisFranc Injury” has been in the news a lot this week after speculation into the injury of Collingwood Star Dane Swan in the opening round of the AFL season. It was a gruesome injury with many of the initial reports indicating a fractured fibula. Those in the know however, could see that a fractured fibula was potentially the least of Swan’s concerns.

The foot is a complex arrangement of bony arches and supporting ligaments that underpin many of the foot’s functions. Named after a surgeon from Napoleonatic times, a Lisfranc Injury refers to an injury to any of the nine bones or supporting ligaments of the mid foot (fun fact: there are 26 bones in the foot).

These injuries can be purely ligamentous damage, or they can involve bony structures in the foot in a similar manner to the Swan injury. If bony structures are involved, they are classified as fracture-dislocations. Which explains the concern that this injury may be season-ending for Swan. Most often, Lisfranc joint injuries are high energy injuries that occur when a rotational force is placed on a plantarflexed (toes pointing down) foot but other causes can be more subtle.

Diagnosis of a Lisfranc Injury is not always straight forward and often symptom presentation can be delayed. A Lisfranc injury should be considered when there is mid foot pain and difficulty weight bearing after an acute injury or pain when weight bearing through the forefoot when pushing off or performing calf raises in a more chronic presentation.


The management of a LisFranc injury doesn’t always require surgery and depends on the degree of instability present. There are a range of treatment options that can be utilised to treat a Lisfranc joint injury, including footwear advice, strengthening exercises, mobilisation, immobilisation, taping or orthoses can all be options in less severe injuries before considering surgery.

Whatever the cause, a mid foot injury always needs to be thoroughly assessed and managed as a priority. Here at CSSM, we have a strong team that can assess your injury and advise you of the recommended treatment pathway for you. If you think you are suffering from a Lisfranc joint injury please don’t hesitate to book an appointment with one of our friendly practitioners – we can help you!

CSSM Gets Ready For A Winter Of Footy, Running, Basketball, Soccer, Skiing ….

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One of the triggers for foot pain is often a change in activity or a change in footwear as we evolve from our summer beach wear to the winter slog.


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

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

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

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

The Free Foot Checks are available until the end of April. Sessions are by appointment only, with only limited spaces available each day. Appointments for Free Foot Checks can only be made by calling the clinic on 9889 1078. Free Foot Check Appointments cannot be made online.


Posted 30th March 2017


Health By Chocolate - Is Chocolate The New Super Food?

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Easter is the time of year for friends, family and slight over indulging. Chocolate is a major weakness of mine and Easter eggs are of no exception. But, is chocolate really that bad for you? Read on and rid yourself of the Easter guilt.

Recent studies have found that chocolate may improve your brain power and mental health. The New England Journal of Medicine in 2012, established a loose relationship between that of countries with high Nobel Prize winners and country’s with high chocolate intake. Whilst I’d like to believe chocolate is increasing my intelligence, unfortunately there was no strong cause-effect relationship established. Ever wondered why chocolate makes you feel so good? It stimulates the release of endorphins, which is a natural hormone produced by the brain that generates a sense of well-being. Furthermore, chocolate contains tryptophan, an essential amino acid needed by the brain to produce serotonin. Serotonin is a mood modulating neurotransmitter that gives us the feeling of happiness. (Benton et al, 1999)

Chocolate has also been known to provide great benefits to the cardiovascular system. Dark chocolate contains flavanols which have an anti-oxidant effect, improve endothelial function, improve platelet function and reduce blood clots as well as decreasing hypertension and reducing the risk of heart disease. (3 - 5) Perhaps, a square of dark chocolate a day could keep the cardiologist away. Unfortunately, chocolate high in sugar and fat can contribute to cardiovascular disease, so choose wisely whilst in the supermarket aisle. Dark chocolate with greater than 80% cocoa and low in sugar, is the best for you.

Recent evidence has suggested that chocolate milk is an excellent recovery drink following endurance events. It has been proven to be an affordable recovery drink for many athletes, replacing our common commercialised sports drinks. Low in fat chocolate milk has the same ratios of carbohydrates to protein (4:1) as popular recovery beverages. It also offers fluids and sodium to optimise the athletes’ post-workout recovery. It is recommended to consume the milk immediately after exercise and again 2 hours later to ensure peak recovery and potentially a reduction in muscle damage (Pritchett & Pritchett, 2013). Sound crazy? Follow this link for the full article: …

Pritchett K, Pritchett R. 2013. Chocolate milk: a post-exercise recovery beverage for endurance sports. Med Sport Sci. (59): 127 – 34.


As I eluded too earlier, the type and amount of chocolate you consume is essential. The benefits of chocolate are found in cocoa and very few chocolates on the market are rich in pure cocoa. Cocoa has been mixed with other ingredients to make it more attractive to our taste buds. Chocolate high in sugar and fat provides the body with significant calories, if not burned, these calories can be the cause of obesity. Similarly, highly processed chocolate reduces the concentration of flavanols in turn reducing its cardiovascular benefits.

This Easter, I recommend you enjoy your chocolate, for some types have great health benefits, but always eat in moderation and balance with a healthy, active lifestyle.

Resources: 2. Messerli FH. 2012. Chocolate consumption, cognitive function, and Nobel laureates. N Engl JMed. Oct 18:367(16): 1562 – 4. 3. Benton D, Donohoe RT. 1999. The effects of nutrients on mood. Public Health Nutr. Sep;2(3A):403-9. 4. Hollenberg NK, Schmitz H, Macdonald I, Poulter N. 2004. Cocoa, Flavanols and Cardiovascular Risk. Br J Cardiol 11 (5):379-386. 5. Keen CL, Holt RR, Oteiza PI, Fraga CG, Schmitz HH. 2005. Cocoa antioxidants and cardiovascular health. Am J Clin Nutr. Jan;81(1 Suppl):298S-303S. 6. Lee KW, Lee YJ, Lee HJ, Lee CY. 2003. Cocoa Has More Phenolic Phytochemicals and a Higher Antioxidant Capacity than Teas and Red Wine. J. of Agric. Food Chem. 51 (25): 7292-7295. 7. Fisher ND, Hughes M, Gerhard-Herman M, Hollenberg NK. 2003. Flavanol-rich cocoa induces nitric-oxide-dependent vasodilation in healthy humans. J Hypertens. Dec;21(12):2281-6. 8. Pritchett K, Pritchett R. 2013. Chocolate milk: a post-exercise recovery beverage for endurance sports. Med Sport Sci. (59): 127 – 34.

Prepare To Win With Andrew Russell

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We at CSSM were lucky enough to have Andrew Russell join us as a guest presenter at our recent Run Long Run Strong information evening. As Hawthorn’s Elite Performance Manager, Andrew has played a major role in Hawthorn’s premiership three-peat and has a track record of 4 premierships in 11 years at Hawthorn.

His wealth of knowledge in the areas of maximising performance, strength and conditioning as well as the psychological aspects of elite sport was showcased throughout his captivating presentation.

Some of the very interesting and thought-provoking topics Andrew discussed were:

1) The way you perform on the training track makes only a small contribution towards your overall success as an athlete. The sacrifices you make outside of training (diet/lifestyle) increase your emotional commitment to success and play a much greater role.

2) The way you think influences your actions, your actions then develop into habits, and your habits harden into character.

3) Stress has a negative effect on the mind and the body. The most important factor in decreasing your stress response is having a sense of control over all parts of your life. Create strong social support networks.

An inspirational and hair-tingling video of Stephen Curry’s journey towards being one of the best shooters in the NBA was used to demonstrate the power of sacrifice, commitment and pure determination. A quote from this video that has stuck with me was, “Are the habits that you have today, on par with the dreams that you have for tomorrow?” …. Are they?

As Elite Performance Manager, Andrew ensures all players know exactly what is ahead of them at each training. He does not believe in throwing in any unexpected “lemon twisters”, valuing the trust that the players have in him each day. The players train hard, but recover even harder.

In pre-season Andrew designs the programs to have more extreme variations in training loads, with importance placed on pure speed and pure endurance early on, funnelling towards repeat efforts as the weeks progress. The importance of a strong preseason was portrayed in a ‘Games played vs % pre-season’ graph. The players that completed an average of 87% of the pre-season program, played on average 23 games with no injuries. Those who completed an average of 65% of the pre-season, played on average 16 or fewer games. The average group percentage of pre-season completed in 2008, and 2013-2015 was over 80%. These same years Hawthorn went on to win the AFL Premiership. Need any more motivation for a solid pre-season?

The Run Long, Run Strong education evenings are held to support CSSM’s preferred charity the Indigenous Marathon Foundation anf their Indigenous Marathon Project. CSSM was proud to donate $520 as the proceeds of this event.

Posted February 17th

Getting Your Groove Back - Find Your Motivation

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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.

1. 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.

2. Set a goal & 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 & 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.

3. Prepare & 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.

4. 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.

5. Don’t procrastinate & 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.

6. 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 state 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.

7. 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. Goodluck!

About The Author – Megan Dickinson is a physiotherapist and a keen runner herself. Having completed distances up to the marathon, she has an in depth understanding of sports injury and injury prevention.

Posted 5th November 2015

Are You Fit To Sit - An Examination Of The 21st Century Posture

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How much time do you spend inactive each day?

According to the most recent survey conducted by the Australian Bureau of Statistics (2013), the typical Australian adult spends an average of 39 hours a week performing sedentary activities. Furthermore, those employed in administrative and office jobs spent an average of 22 hours a week sitting. This doesn’t include the time spent commuting to and from their place of work!

Further evidence of sedentary behaviour is observed with the Australian Bureau of Statistics (2013) finding that less than one in five Australian’s were reaching the recommended daily 10,000 steps. A study by Gibson et al. (2013) on academic and administrative employees across Australia, USA, Canada and the UK found that the average daily step count was only a measly 3,783.

Office workers are not alone when it comes to these issues. High school and university students are also at risk, spending large quantities of time studying seated at a desk. Prolonged sitting in a poor seated posture can lead to injury or aggravation of an existing injury.

But what is all this time spent sitting down doing to our bodies? Across the coming months, this series of blogs will be dissecting multiple regions of the body and how our current sedentary lifestyles are affecting it. Each region will look into which muscles are becoming weak and lengthened, contracted and short and how our joints can be sitting in positions that can predispose us to pain or injury.


Australian Bureau of Statistics (2013). Australian Health Survey: Physical Activity, 2011-12. Retrieved from: (May 16, 2015)

Gibson, N., Faulkner, G., Murphy, M., Umstattd Meyer, M., Washington, T., Ryde, G., Arbour-Nicitpopoulos, K., Dillon, K. (2013). Walk@Work: An automated intervention to increase walking in university employees not achieving 10,000 daily steps, Preventative Medicine, Vol 56(5), p283-287

Posted 20th October 2015

Headache Or Heartache: Is Your Headache Treatable?

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As the days get longer and the weather gets warmer, the hay fever season will inevitably spring (pun intended) into action.

Up to 1 in 4 people in Australia and New Zealand are effected by hay fever, which causes inflammation of the nose and/or eyes (ASCIA). Melbourne, in particular, recorded some of the highest levels of pollen last year and resorted to injecting the London Plane tree (making up 75% of Melbourne’s trees) with hormones in the bid to stop the tree from producing seed pods! Fun fact for the day: Lygon Street was found to be a highly effected area, steer clear!

Now, you might be asking what this has to do with us at CSSM. Studies have shown that hay fever sufferers, as well as other conditions such as upper respiratory tract infections (the common cold), sinus infection and also asthma, can cause a headache. Both migraine and non-migranous type headaches were approximately 1.5 times more likely when suffering from one or a combination of these conditions (Aamodt et al, 2006).

Your osteopath at CSSM is experienced in treating through various structures with the aim to reduce the severity and frequency of these headaches where possible.

When it comes to seeing your Osteopath, we can assist in treating your headache in many ways.

Treating the simplest form of headache, originating from structures within your neck and upper back (Cervicogenic Headache) treatment may involve:

Soft tissue massage, joint mobilisation and stretching to offload structures in cervical and thoracic regions, as well as treating accessory muscles of respiration (Sternocleidomastoid and Scalenes to name a few, for the anatomy gurus out there)


When there is a sinus or allergy component to your headache treatment may involve:

As above with additional focus through frontal/forehead areas, temples and base of the skull


When there is a resolving upper respiratory tract infection or other respiratory condition such as asthma contributing to your headache treatment may involve:

As above with additional focus through the ribs, and possible lymphatic/sinus drainage to assist with the recovery process


If you are experiencing headaches, be sure to see one of our therapists at CSSM – we are here to help you!



ASCIA: The Australasian Society of Clinical Immunology and Allergy.


Aamodt et al. (2006), Is Headache related to Asthma, Hay Fever and Chronic Bronchitis? The Head-HUNT Study.


774 ABC Melbourne (October 2014), Hay fever hope: Melbourne tree injections trial aims to reduce allergens.


Body and Soul Melbourne (October 2014), Hay fever misery prediction: some to get off lightly, others to suffer.

Posted 1st October 2015

What Does Your Hamstring Tightness Tell Us About You?

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Hamstring injuries are one of the most common injuries in sports that demand high speed, power, or agility. In fact, Australian Rules football boasts an average of 3 to 4 new hamstring injuries per club per season! Hamstring injuries are said to represent 12% to 16% of all injuries in soccer and AFL (Warren et al., 2010). You only have to look at the top 8 finals contenders to see 7 players are missing finals matches due to hamstring injuries.

In order to strain a hamstring, you usually have to be sprinting hard, slowing down fast, changing direction sharply, or kicking. Overstretching is also a common mechanism which can occur at slower speeds. As the hamstrings simultaneously control of both the hip and knee joints, they are deemed more at risk of injury than those muscles acting on a single joint.

There are a multitude of factors contributing to injury of the hamstrings. I often hear patients report of tightness in the hamstrings, or an inability to touch their toes, but do you really just have tight hamstrings? Contrary to popular belief, hamstring tightness is only a small contributor to hamstring strains, there are many other more prevalent factors.

• Poor co-ordination and eccentric strength This is probably one of the most typical causes of hamstring injuries. Inadequate activation patterns of certain muscles cause increased load to be placed on the hamstring. For example, poor gluteal contraction forces the hamstrings to become the prime mover in hip extension, on top of its usual role, causing fatigue to set in more quickly.

• Poor shock absorption Shock absorption is achieved through eccentric contraction of the hamstring muscles. A lack of “stiffness” and elastic recoil in the hamstring group during foot impact increases the amount of force travelling up the lower limb.

• Poor running mechanics Overstriding or poor pelvic control, puts the hamstring in a lengthened and loaded position at initial contact.

• Inappropriate training loads / fatigue The hamstring muscle group consist of a greater percentage of fast twitch (type II) muscle fibres which are easily fatigable. High intensity or speed work should be performed early in the session, to prevent fatigue related injuries.

• Neural tension Neural tension refers to the amount of strain on a nerve with rest and movement. An abnormal increase in neural tension in the sciatic nerve can occur if the nerve becomes caught or restricted anywhere along its path, preceding the hamstring such as, the intervertebral foramen or gluteal muscles.

• Muscle imbalances For example, hip flexor tightness causes the pelvis to rest in an anterior pelvic tilt, maintaining the hamstring in a lengthened position.

• Low back pain Lumbar disc issues or stiffness often present with referred pain, tightens, or numbness / tingling into the legs, especially within hamstrings.

• Playing surfaces For example, a wet, slippery surface will put more strain on the hamstring due to instability and slipping.

The above is by no means a comprehensive list of all factors contributing to the incidence of hamstring injuries, but cover the majority of modifiable risk factors found in the research.

Remember that one of the most conclusive risk factors is a history of previous hamstring injury (Hagglund et al., 2013). Those in this category need to address as many of the modifiable risk factors present, to reduce their risk.


Hagglund, M., Walden, M., & Ekstrand, J. (2013). Risk factors for lower extremity muscle injury in professional soccer: The UEFA injury study. American Journal of Sports Medicine, 41 (2), 327-335.

Warren, P., Gabbe, B.J., Schneider-Kolsky, M., & Bennell, K.L. (2010) Clinical predictors of time to return to competition and of recurrence following hamstring strain in elite Australian footballers. British Journal of Sports Medicine, 44, 415-419.

Managing Training Loads

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The news this week has been dominated by Australian cricketer Ryan Harris’ announcement of his exit from the 2015 Ashes tour and his subsequent retirement from cricket. This was following the decline of a chronic knee injury he sustained in the tour match against Kent. In the wake of this announcement, it would seem fitting to talk about training loads and their effect on injury risk. Many studies have shown a strong relationship between training loads and injury rates, with increases in load resulting in an increase in the rate of injury (Rogalski et al., 2013). Despite this, emerging evidence is indicating that high training loads may not be the cause of injury, but rather spikes in training loads are the real culprit. Calculating training load Training load = training volume x training intensity For example, consider Sally, an amateur runner who trains 4 times per week, for 10km at 70% effort. In order to calculate Sally’s training load: Training load = training volume x training intensity Training load = 40km x 70% Training load = 2800 What does this mean for you? In order to decrease your risk of injury, it is important to avoid spikes in training load and ensure that you are increasing your load in a safe and effective manner. 1. As a general rule, training loads should not exceed more than 10% per week. This percentage tends to lower as your training load increases. If, from the above example, Sally wished to start increasing her training load, she should be aiming of a training load of 3080; 10% of training load = 2800 x 0.1 = 280 Total training load = 2800 + 280 = 3080 Sally can do this by either increasing her distance OR intensity but not both. 2. You need to be especially careful following periods of rest (or enforced rest due to injury) as this is when your training load can spike significantly, putting you more at risk of injury. 3. Listen to your body, the presence of pain can be an indication that the workload is too high. Managing training loads is as much an art as it is a science. Although the above formula provides an accurate way of measuring training loads, it is important to consider that each individual will respond differently. In the case of Ryan Harris, and his decision to retire from cricket, it can be safely assumed that the demanding training loads of international cricket, in conjunction with an underlying knee condition will have been an influencing factor.


Rogalski, B., Dawson, B., Heasman, J., & Gabbett, T. (2013). Training and game loads and injury risk in elite Australian footballers. Journal of Science and Medicine in Sport, 16, 499-503.

No Pain, No Gain? Delayed Onset Muscle Soreness (DOMS) Explained

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After the decision to start a new health routine or change your usual loading, you may have experienced the familiar soreness whilst trying to get out of bed and find yourself struggling to walk. This phenomenon is known as delayed onset muscle soreness, more commonly referred to as DOMS.

DOMS is related to eccentric muscle contractions, when the muscle in under tension, whilst being lengthened, particularly following unfamiliar or strenuous activity. This results in microscopic damage to the muscle fibres. Delayed onset muscle soreness is typically characterised by reversible pain that peaks 1-2 days after the activity and a decrease in strength, which typically lasts for 3-4 days. Delayed onset muscle soreness is relatively benign as there is less soreness and tissue damage with repeated bouts of the unfamiliar exercise. This indicates a degree of muscle adaptation, allowing your muscles to better perform that activity again.

The pathophysiology of DOMS is still not fully known and therefore many different strategies to combat the negative effects of DOMS (pain and weakness) have been proposed. Most have centred around the notion that DOMS is associated with tissue oedema (inflammation) that can be seen clinically and is evident on magnetic resonance (MR) imaging. To support this, there is some evidence that anti-inflammatory methods are effective in reducing pain and improving function following DOMS. For example, the use of ice immersion, anti-inflammatory medications and Omega 3 supplements have been shown to be effective in reducing the effect of DOMS.

There are, however times when you wonder whether it is more than just DOMS. When should you be concerned?

  • If your soreness is still present 96 hours post exercise
  • If your pain is debilitating and not improving
  • If you experience significant swelling or redness

Injuries may also present during workouts as little niggles or increased awareness of a particular area. A true injury will often limit range of motion and last beyond the time frame of DOMS. This is the time to see a professional.


Lee, J.C., Mitchell, A.W.M. & Healy, J.C. (2012) Imaging of muscle injury in the elite athlete. The British Journal of Radiology. 85 (1016).

Tartibian, B., B. H. Maleki and A. Abbasi (2011). "Omega-3 fatty acids supplementation attenuates inflammatory markers after eccentric exercise in untrained men." Clincal Journal of Sport Medicine 21(2): 131-137.

Cortisone Vs. Platelet-Rich Plasma (PRP) For Tendinopathies

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Cortisone was discovered in the late 1940s as a revolutionary means of treating the pain and inflammation associated with overuse injuries, particularly tendinopathies, such as tennis elbow or achilles pain. More recent evidence however, expresses serious doubts over the efficacy of cortisone in the long-term treatment of tendinopathies and suggests the consideration of other treatments such PRP as a viable treatment option.

What is the difference between cortisone and PRP?

Corticosteroid injections stop the inflammatory process cold. If the goal is to remove pain, swelling and inflammation, cortisone injections are the perfect instrument. The danger is if there is a tear in the tissue, this needs to heal, and you have in essence stopped that healing process.

The other issue with corticosteroid injections is their predisposition to breaking up collagen bonds. As tendons are made up of 70- 80% collagen, corticosteroid injections (particularly prolonged use) can weaken the tendon and make it more likely to rupture or completely tear.

In a recent systematic review of tennis elbow sufferers, cortisone was successful in bringing about fast and significant pain relief in the short term, for up to several weeks. However, after 12 months, the cortisone group had 63% higher chance of relapse when compared to those sought physiotherapy or tried the wait-and-see approach.

PRP injections on the other hand, work in the opposite way. The growth factors that are present in the blood stream are concentrated many times, then injected directly into the injured tissue. This stimulates fresh blood flow, unlocking the bodys natural healing response, stimulating healing of the injured tissue.

Cortisone and PRP are both very effective at reducing pain but for conflicting reasons. In short, one injection switches off the inflammatory process whilst the other switches on the healing process. Each treatment method has its place however, specifically for the treatment of tendinopathies, PRP is far superior long term.

Finally, it is important to remember that the management of tendinopathies is not as simple as choosing which injection to undergo. It involves diligence and commitment to the rehabilitation process in order to ensure full recovery.


Coombes, B.K., Bisset, L. & Vicenzino, B. (2010) Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: A systematic review of randomised controlled trials. The Lancet. 376 (9754), pp. 1751-1767.

Harmon, K., Drezner, J. & Rao, A. (2013) Platelet rich plasma for chronic tendinopathy. British Journal of Sports Medicine. 47 (9), e2

Stress Injuries: Who Is To Blame Your Body Or Your Coach?

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It's the time of year that many athletes are starting pre-season and trying to create a base of fitness for the upcoming season or adding an extra dimension of endurance to their competitive performance.

Recreational athletes are preparing for the summer swim classics and runs whilst beach goers are looking to shed some well-earned winter kilos.

Commonly, at CSSM we see a number of frequent stress (or overuse) injuries. Below is a list of common stress injuries from varying sports:

  • Medial Tibial Stress Syndrome (running)
  • Navicular Stress Fracture (running)
  • Patellar Tendinopathy (jumping sports - basketball, volleyball)
  • Proximal ITB (Ilio-Tibial Band) Friction Syndrome (cycling)
  • Suprapinatus Tendinopathy (swimming)

These are generally caused by overloading the body's tissues, causing failure (or injury) due to poorly managed training volumes or workloads.

Workload involves four components - mode, frequency, intensity and duration. The ability of an athlete to tolerate a specific workload will be completely different for each person in each sport.

Mode refers to the type of activity that is conducted. This may be a particular leg (eg. - cycle) for multi-sport events (triathlon) or it might a skills, weights or fitness sessions for skill based sports (ie. - netball or football).

Frequency describes the number of sessions that are undertaken in a week.

Intensity is purely how hard an athlete works in a session. Quite often this is monitored by the amount of time that you spend training above a specified percentage of your maximum heart rate. One of the most reliable measures has been shown to be an athlete's Perceived Rate of Exertion. Rated on a Borg or Visual Analogue Scale. This is a measure that anyone can perform.

Duration is our final descriptor, which depicts how long a workout will go for.

There are two extra components that we should elaborate on before we answer the title question!

Volume and specificity

Volume is the amount of training completed over a specified period of time whilst specificity is a reference to how closely the training replicates the sport or activity the athlete is training for.

So, all of these factors will relate in some way to overuse or stress injuries. Generally, the key factors that will put an athlete at risk of injury is inadequate recovery from training sessions through:

  • Not enough recovery between training sessions (or too greater frequency)
  • Excessive intensity of a training session
  • Prolonged endurance

The last two points are more to do with increasing the training load inappropriately.

The fundamental point of the above descriptors of training workload is to monitor and gradually increase training demands of an athlete without risk of injury.

Alternatively, periodise an athlete's training program to accommodate high competition loads or high training loads.

This realm of training workloads and determining the appropriate breakdown of mode, intensity, frequency, duration, specificity and volume belongs to coaches and sports physiologists or sports physiotherapists.

So unless you have your coaching accreditation or Sports Physiology/Master of Sports Physiotherapy degree then the blame for stress injury resides with those setting your programs.

Feel free to pop in sometime to discuss your training workload here at CSSM.

Happy training,

Luke Pickett.

Sports Physiotherapist.

A Fresh Perspective On Persistent Back Pain

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Persistent back pain is one of the most costly health problems and one of the most poorly understood. The old approach ‘fix the back’, ‘strengthen your core’ or ‘get a new office chair with lumbar support’ gives short term relief but doesn't address the true cause of persistent pain. By treating the symptom and not the underlying cause you're missing the point. In many cases it is possible to resolve persistent back pain instead of simply managing it.

The key to solving the problem is to understand it.

The very first step in your journey out of persistent back pain is to understand that it's not so much a back problem as it is a pain problem. Pain acts like our body's alarm system that alerts us to something potentially dangerous happening. Persistent or recurrent pain is like the alarm being continually triggered in the nervous system. Pain is not all in your head and it's not all in your body either, it's an altered 'state' of the nervous system as a whole.

One of the tricky concepts on this journey of discovery about pain is that whilst all pain is real - ‘your pain is what you say it is’ pain is also a perception that is open to interpretation. Your pain is not the same as my pain or anyone else's. Your pain is your brain's interpretation of what's going on.

Think about a rainbow. It's an example of a visual perception. Is it real? You can see it but it's not a physical thing. It requires sun and rain and when the conditions change it disappears. Pain is a sensory perception, you feel it but it's not a physical thing. A key skill in relieving persistent back pain is to disassociate it from a physical structure. Changing the belief from ‘my disc is worn out’ or ‘it's bone on bone’ to understanding pain is a 'state' of the nervous system. Our ultimate aim with pain relief is to change the conditions in the nervous system so that pain disappears like the rainbow does and the alarm is not continually triggered.

Pain relief is as much about looking after the physical health of the nervous system as it is about changing the way you perceive it. Here are my top 5 tips on how you can nurture your nervous system for pain relief:

  1. Move, stretch and exercise
  2. Nourish nerves with good nutrition
  3. De-stress and learn how to relax
  4. Improve the quality of your sleep
  5. Understand how pain works


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Patellofemoral joint (PFJ) pain is one of the most common knee complaints in runners and the highest presenting knee pathology to physiotherapists. Patients may commonly describe pain at the front of the knee aggravated by stairs and weight bearing or jarring activities that involve knee bending.

PFJ pain is commonly caused by poor kneecap alignment - where the kneecap does not glide freely through the femoral groove. This causes joint irritation and sometimes degeneration behind the kneecap as the kneecap rubs against the femur.

The malalignment or maltracking of the patella as we bend the knee is caused by a number of factors, the most common causes being a muscle imbalance and poor biomechanics.

Below is a breakdown of the contributing risk factors.


  • Structural abnormalities - femoral ante-version, shallow femoral groove, genu valgus (knock knees), patella alta (high sitting patella), leg length discrepancy.
  • Poor foot and hip biomechanics - flat feet, high arches, increased Q angle.
  • Muscle weakness - gluteals, VMO.
  • Hip and ankle muscle tightness and/or joint stiffness - such as tight ITB and decreased ankle dorsi flexion.
  • Poor balance and coordination.
  • Poor shock absorption when landing.
  • Gender - more likely in females.
  • Previous lower limb injuries.


  • High impact sports.
  • Training/playing surfaces.
  • Training load.
  • Equipment.
  • Footwear.

Common sports where PFJ pain is typically seen includes those with excessive running, jumping and squatting such as long distance running, netball, football, tennis, volleyball, basketball and skiing.

Untreated PFJ pain can result in patella tendonitis or other biomechanical related injures of the lower limb. Physiotherapy treatment to enable a patient to return to their chosen sport may involve:

  • Ice and anti-inflammatories
  • Regaining full range of movement
  • Restoring muscle length
  • Normalising quadriceps muscle control
  • Correcting hip and foot biomechanics
  • Retraining sport specific movement patterns by adding power, speed and agility


(Crossley., Collins., Beller., 2008)., (Brukner & Khan., 2005)., (McConnell., 2000)

Running And Hydration

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Be it for event training or just general fitness - hydration is something that is often poorly managed in runners especially when the weather gets warmer.

When I completed my first Melbourne Marathon, the temperatures in October were considered above average with race day reaching 29 degrees.

Endurance -based activity requires optimal nutrition and hydration to ensure your body is able to achieve maximum potential. The last thing you need after doing all that training is for your body to fail on you due to a lack of fuel. Not only can severe dehydration have physical side effects but it can be as disheartening as running out of petrol in your car only kilometres from the petrol station and having to push yourself to the finish.

A marathon or any distance run as an elite or beginner is as much mental as it is physical and doing your research on food intake and hydration is an important aspect of your training.

Here's a little about Hydration from the pros.

  • Keep up your nutrition/hydration during training just like you would on race day to avoid gastrointestinal upsets (Murray., 1998)
  • Don't increase or change your eating habits, just substitute for the appropriate foods.
  • Do your research - your body needs certain levels of energy stores pre, during and post race (Brukner & Khan., 2005)
  • Water is not enough - you need adequate carbohydrates/sugars (Murray, 1998)
  • Match carbohydrate intake to body weight ratio - endurance athletes undertaking greater than 90 minutes of exercise require a daily carbohydrate intake of between 8 and 10g/kg of body weight required to replenish glycogen stores. (Brukner & Khan., 2005)
  • The most accurate way to determine your adequate fluid intake is to take a ‘sweat rate test.’ Weigh yourself before and after a 1hour run luid intake must be matched with weight loss.
  • Only a small decrement in hydration has been shown to impact body functioning and performance running in the heat (Casa, Stearns & Lopez et al., 2010)

Race preparation

72 hours leading up to a race is when you should be starting to hydrate correctly.

  • Increase your fluid intake by sipping on sports drinks, not just water throughout the day.
  • Everyone is different depending on body weight but as a general rule of thumb - you know you are well hydrated if you void large volumes of pale coloured urine at least 6 times a day (Maharam & Lewis et al., 2006).
  • Drink to thirst - thirst is the physiological feedback that protects athletes from over or under drinking (Maharam & Lewis et al., 2006).

Race day

  • Be educated - wear appropriate clothing for weather conditions.
  • Drink approximately 500ml of fluids the morning of the run, but cease drinking 1 hour prior to give your bladder a rest.
  • Every 15-20mins during the race consume fluids at the drinks stations. Try to consume energy gels with water and consume electrolyte drinks separately to avoid gastrointestinal upsets (Kreiter., 2014).
  • External water helps to cool your body temperature down.

Post race hydration

  • You should slowly consume 750ml fluid (carbohydrate drinks such as Powerade) as soon as you cross the finish line and continue to do so for every kilogram lost. Eat protein and carbohydrates within 1 hour of race completion to allow replenishment of glycogen stores and for muscle repair (Kreiter., 2014).
  • A weight loss or weight gain of more than 2% is a warning sign of drinking improperly and justifies a medical consultation (Maharam & Lewis et al., 2006).

My Hot Tip for first time marathoners

  • Walking through the drink stations only takes approximately 10 seconds. With drink stations every 3-5km this will only add around 2 mins to your overall time - for adequate hydration it is worth the walk!

Overuse Injuries In Young Athletes

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There is a trend in youth sport to push our young athletes hard. At CSSM we often see young athletes who participate in sport between 6-8 times per week. There is an emphasis on sporting competitiveness from a young age, which sometimes comes at the price of overuse injuries.

An overuse injury can be defined as ‘an injury occurring as the result of repetitive submaximal loading of the musculoskeletal system when rest in not adequate to allow for structural adaptation to take place’ (2).

These injuries do not occur as the result of a single acute event, rather they occur more insidiously over a period of time when repeated stress and load is placed on the body. These injuries can affect any part of the musculoskeletal system including joints, muscles, bone and cartilage. Some overuse injuries are lower risk than others (but still sore!). Common low risk examples include Osgood-Schlatter disease and Sever's disease. Others are higher risk including stress fractures to the lower back (pars fractures) and femoral neck stress fractures.

Young athletes are at high risk of overuse injuries for a number of reasons:

  • Prior injury to the area is a strong predictor of future overuse injury
  • They have a higher rate of sports participation compared with an adult population (1)
  • They are more likely to have high training volumes and high training workloads
  • They are vulnerable during adolescent growth spurts
  • Their immature bones are less resistant to compressive and tensile forces
  • They may be over-scheduled in regards to training load
  • They are more likely to out grow sports and training equipment
  • They often have a lack of lean tissue mass

What can parents, coaches and young athletes do to reduce the risk of overuse injury?

A position statement by from the American Medical Society for Sports Medicine regarding overuse injuries in sport recommends:

  • Placing time limits on participation in sports. This relates to weekly and yearly participation.
  • Ensuring that young athletes get enough down time between sporting sessions for their body to recover.
  • Scheduled rest periods from high intensity sports should be encouraged.
  • Monitoring and if necessary reducing high intensity sport specific repetitive movement.
  • Modifying each young athletes training load taking into account their injury history, age and growth rate.
  • Closely monitoring young athletes training regimes at times of rapid growth.
  • Ensure equipment is well fitted.
  • Monitored strength and conditioning training including pre-season conditioning programs can be a good way of preparing young athletes for the season ahead.
  • Sport diversification should be encouraged rather than sports specialisation from an early age.

It is important for persistent ‘niggles’ in young athletes to be assessed by an appropriate clinician. These niggles can sometimes be serious underlying overuse injuries that may hinder long-term sports involvement. If these injuries are assessed, diagnosed and appropriately managed early on, the young athlete has far better prospects of a pain free return to sport.



(2) DiFioroi, J.P., Benjamin, H.J., Brenner, J., Gergory, A., Jaynthi, N., Landry, G., Luke., A. Over use injuries and burnout in youth sports: a position statement from the American Medical society for sports medicine. British Journal of Sports Medicine 2014; 48:287-288.

Pars Interarticularis Stress Fractures

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Following on from my last blog on overuse injuries in young athletes and leading into cricket season, I thought I'd examine one of the higher risk overuse injuries more closely. Let's focus on stress fractures of the pars interarticularis (spondylolysis).

These stress fractures are a fairly common cause of persistent lower back pain in the young athlete population (1). These stress fractures are most commonly located in the lower lumbar spine, most typically occurring at the level of L4/5. They can be unilateral or bilateral fractures.

Young athletes that compete in sports which require their lower back to move into repetitive extension and rotation such as cricket, rowing, diving, dancing, gymnastics, athletic throwing sports and some foot ball positions are at increased risk of developing these fractures (2). Young athletes are especially vulnerable to this stress in growth phases (2).

Compared to the adult population, young athletes are far less likely to experience lower back pain as the result of disc pathology, muscle-tendon strain or osteoarthritis (3). In one study, comparing lower back pain in 100 young athletes with 100 symptomatic adults, 47 out of the 100 young athletes were shown to have pars fractures. Compare this with just 5% of the adults from the sample (3).

So when should you as a parent be suspicious that your child has this condition? Generally speaking, if an active child or adolescent complains of lower back pain for a period of two weeks or more this pain should be investigated, especially if they play one of the above mentioned sports and have experienced a recent growth spurt. Often the pain will start insidiously and the young athlete may complain of an aching back which is worse for back extension, running and sore after sport. Often the pain will improve with rest. They may also complain of pain in their back at nighttime.

If it is suspected by your clinician that your young athlete has a pars fracture they will be sent for imaging to confirm this diagnosis. This usually involves a plain film x-ray first and if necessary will be followed up with an MRI.

Rest from strenuous exercise is the best treatment option for Pars fractures. Most young athletes will have to take time off sport for a minimum of 12 weeks and then commence a graduated return. Each athlete is individual however and the time frame for healing will be variable. Taking time out to rest may reduce the likelihood of non-union of the fracture and may reduce the likelihood of surgical intervention.

Importantly, young athletes shouldn't be complaining about persistent lower back pain! They are not likely to have the same cause of lower back complaints as adults and therefore their lower back pain needs to be promptly investigated. The sooner a pars fracture is identified, the sooner if can be well managed.

(1) DiFioroi, J.P., Benjamin, H.J., Brenner, J., Gergory, A., Jaynthi, N., Landry, G., Luke., A. Over use injuries and burnout in youth sports: a position statement from the American Medical society for sports medicine. British Journal of Sports Medicine 2014; 48:287-288.

(2) Iwamoto, J., Sato, Y., Takeda, T., Matumotomo, H. Return to sports activity by athletes after treatment of spondylolysis. World Journal of Orthopedics, November 18, 2010; 1 (1): 26-30.

(3) Micheli, L., Wood, R. Back pain in young athletes, significant differences from adults in causes and patterns. Archives of pediatric and adolescent medicine, 1995; 149 (1): 15-18.

Jaw, Neck And Head Related Pain

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Do you suffer from chronic headaches and/or neck pain, and struggle to gain long-term symptomatic relief from various treatment modalities? The answer to your pain may lie in the function of your jaw.

The Temporomandibular Joint (TMJ) is a joint located just in front of your ears, which connects your jawbone to your skull. It's used continuously throughout the day when you eat, talk and even breathe. This joint is closely related not only anatomically, but also in its overall function and biomechanics to the upper part of your neck, also known as your cervical spine.

Looking specifically at headaches, a study by Ciancaglini (2001) concluded that there was a distinct association between general headaches as reported by subjects, and symptoms of TMJ disorder. It is therefore vital that overall assessment includes these areas, and subsequent treatment is provided so that the presenting complaint, whether it be the headache or jaw pain, is resolved.

Some symptoms that may indicate a TMJ dysfunction are: pain when chewing or yawning, clicking, tension over the area, inability to fully open your jaw, and in more severe cases, locking. You may also experience ringing in the ears and other auditory problems due to the close proximity with the ear canal.

Currently there is much discussion about the cause of TMJ disorders. Some problems within the joint itself include arthritis, injury, and dislocation of the joint (either from direct trauma, extensive dental work (think wisdom teeth removal!), or general laxity). Bruxism, more commonly referred to as clenching or grinding, can also put significant stress on the area, often occurring when we are stressed, anxious, and even when we are thought to be at our most relaxed - when sleeping. Interestingly enough, it has been found that TMJ related symptoms are more associated with work-related psychosocial factors rather than the actual type of work itself! (Mikko et al, 2003)

Treatment of the neck will be similar to what you may have previously experienced, employing techniques directed at the joints, muscles, fascia and ligaments. Treatment of the jaw itself however is likely to include addressing tight muscles that support and coordinate jaw movement, and correcting any structural or biomechanical compensations present. Be warned - this may involve intra-oral work with a glove! A holistic approach is likely to be taken to also incorporate reduction in stress and anxiety and improvement in breathing technique to prevent reoccurrence if this is in fact the cause of your TMJ pain.

If you feel like you may be experiencing jaw pain, or are suffering from long term chronic headaches, book an appointment with one of the practitioners at CSSM - we can help you.


Ciancaglini and Radaelli, 2001. The relationship between headache and symptoms of temporomandibular disorder in the general population

Mikko et al, 2003. Temporomandibular joint related painless symptoms, orofacial pain, neck pain, headache, and psychosocial factors among non-patient

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.