Running Retraining for Exercise and Performance

Running Retraining for Exercise and Performance

(Read to the end of the article if you have a running injury and would like to have a free initial consultation with a physiotherapist)
Running is good for you. It boosts immune cells, heart and lung function, decreases insulin resistance and has been shown to decrease the rate of knee osteoarthritis. It has also been proven to decrease chronic systemic inflammation, not to mention preventing at least 25 other chronic conditions.

It’s no wonder then that lots of people run – but as physiotherapists we often see people who have injured themselves when they run the wrong way.
So what are the main things that runners do that lead to injury, and how do you avoid them? Here are the top three.

1. Technique
Most runners display one or two minor issues with their running technique that unchecked can lead to major issues, such as over- stride, excessive foot pronation or landing on a suboptimal part oftheir foot. Small technical problems can turn into big headaches when running over long distances or at a suboptimal pace. For example, runners who overstride often land on their heel, which can lead to injuries such as plantar fasciitis, patellofemoral pain and shin splints. Ouch!
An expert such as a physiotherapist can assess your running technique and give you the tips and advice you need to make small changes to your running technique that will make a big difference when it comes to potential injuries. Even something as simple as shortening your stride can help to reduce the ground reaction forces that ultimately lead to avoidable pain.

2. Match Fitness
As they say, you have to walk before you can run. Intrinsic factors in individual runners such as lack of flexibility or lack of strength in key stabilising and global muscles can decrease your capacity to employ proper running technique. If you’re just starting your running journey, chances are you will experience one or more of those issues.

For example, runners with tight anterior hip muscles which are the hallmarks of having a desk job and weak glutei (i.e. booty muscles) that simply aren’t worked enough frequently experience lower back
pain, hip impingement, patellofemoral pain and Achilles tendinopathy after running. Physiotherapists can assess your key “running muscles” and work out exactly what you need to do to improve your underlying capacity to ‘run, Forest, run!’ Just increasing your glutei and calf power by 10% can seriously increase your ease of propulsion and muscle power.

3. Power Load
Load management is key when running because all runners need to manage their training load to ensure they have capacity to handle the big forces being exerted on the muscles and bones in their legs. If these things aren’t managed well, it leads to avoidable pain. When you run with pain you inevitably adopt maladaptive (bad) behaviours leading to both physical and non-physical changes such as increased stress and decreased running capacity. It really is a vicious cycle.

A physiotherapist can assess and educate you on the best way to manage your training loads. Something as simple as adjusting your gait through specific, targeted exercise prescription can seriously improve muscle capacity and have you running better.
Book an appointment today with our specialist and passionate physios at Rozelle Physio and receive a gait analysis, muscle testing and a personalised exercise prescription to improve your running today.

 

What are the Deep Hip Muscles and Why are They Important for Hip Pain?

What are the Deep Hip Muscles and Why are They Important for Hip Pain?

What are the deep hip muscles and why are they important?

Many of us would have heard about the “core” muscles and how important they are for people with back pain, or about the “rotator cuff” muscles and their role in protecting the shoulder. But very few people, even those with hip pain, would have heard about the deep hip muscles and their role in protecting the hip joint.

A group of Australian physiotherapists and leading researches have proposed that the deep hip muscles (glute med, glute min, piriformis, illiacus, illiocapsularis, gemelli and obturator internus) play an important role in stabilising the hip joint. That is because these muscles are situated in a position very close to the hip joint and have a high proportion of type 1, slow twitch muscle fibres. This is the ideal combination for producing a stabilising force around a joint. EMG studies, also show that these muscles activate at times that could only serve to stabilise the hip joint.

So why is this important?

Many of the common hip injuries such as osteoarthritis, trochanteric bursitis, femoracetabular impingment (FAI) and labral tears can be the result of excessive movement or laxity in and around the hip joint. At the same time, research has shown that when we have pain in a joint, the muscles that stabilise that joint often stop working properly, they switch on too late or atrophy. So identifying these muscles in the hip joint gives options for rehabilitating these important muscles. If these muscles do play an important role in stability, then making sure they are strong and functioning well could help prevent hip problems.

How Can we Assess and Rehabilitate the Deep Hip Muscles?

Because the deep hip stabilisers are quite small and quite deep, we use real time ultrasound to identify these muscles in physiotherapy and check if they are functioning well. We can also prescribe exercises to target these muscles, again using real time ultrasound to check the exercises are being performed well. Once the patient is able to recruit and switch on these deep muscles well, we then move on to more functional exercises that recruit larger muscle groups too.

 

Heel Pain and Plantar Fasciitis Treatment

Heel Pain and Plantar Fasciitis Treatment

(Read to the end of the article if you have heel pain and would like to have a free initial consultation with a physiotherapist)

Heel pain caused by plantar fasciitis is a condition we commonly treat at Rozelle Physiotherapy.
The plantar fascia is a band of connective tissue that runs from the base of the heel to the toes. The plantar fascia supports the arch of the foot and acts like a spring during normal walking.

What Causes Plantar Fasciitis?

When there is too much load placed on the plantar fascia, such as an increase in exercise, walking on hard surfaces, poor footwear, abnormal biomechanics or an increase in body weight, then the plantar fascia can become painful. The pain is usually worst on the bottom of the heel and can be most severe with the first few steps in the morning or after spending a long time on your feet.

How Do Physios Treat Plantar Fasciitis?

Early treatment usually involves correcting the contributing factors by modifying load, improving the biomechanics of the foot and ankle, stretching tight muscles and improving the range of movement of the foot and ankle. We may also use soft tissue massage to improve the mobility of the calf muscles and plantar fascia, or dry needling of the plantar fascia.

Chronic Plantar Fasciitis and Shockwave Therapy

If the problem has been occurring for a long time, it can be particularly stubborn and difficult to treat. So as well as the above treatment, Rozelle Physiotherapy has recently started using extracorporeal shockwave therapy (ESWT) at the practice to help treat chronic plantar fasciitis. ESWT uses pressure waves to treat musculoskeletal conditions such as plantar fasciitis and tendinopathies. It is particularly useful when the condition is chronic.

Studies show that ESWT is safe and effective for reducing pain in chronic plantar fasciitis. Recent research comparing ESWT to corticosteroid injection for chronic plantar fasciitis found that ESWT had greater reduction in pain after 12 weeks compared to the corticosteroid injection group.
At Rozelle Physio we have also been finding that patients are having a good response to treatment with ESWT. Pain relief is often immediate after the session.
Usually treatment involves 1 session per week of 2000-3000 pulses for 4 weeks. At Rozelle Physio there is no additional charge for ESWT as part of physiotherapy treatment.

If you have had long term plantar fascia or tendon pain and would like to assess if Shockwave Treatment may be appropriate for you, use this link to click for a free initial consultation:

 

“That’s Tight Y’all”

“That’s Tight Y’all”

“I feel really tight…..it’s nice” – Said no one ever

I have lost count of the times I have had patients come in complaining that their muscles feel “tight” or that they feel “stiff”. This feeling may or may not be accompanied by pain and is generally a fairly constant thing that increases or decreases without rhyme or reason. Additionally, these people often tried everything under the sun; from stretching to heat to supplements, all to no avail. People will resort to “adjustments” from chiros, releases from massage therapist or hours on end of hot yoga, all to try to alleviate this tightness. I feel your pain (Tightness, as the case may be), I can fully empathize with this sensation of feeling stiff and tight. I can’t even remember a time when my hammies and upper traps haven’t felt tight. Let us try to delineate some of the possible causes for this annoying phenomenon.

We must first separate something important from the get-go. THIS IS NOT TO DO WITH YOUR MUSCLES LENGTH. Tightness/stiffness is very rarely a range of motion issue unless you have certain conditions e.g. Parkinson’s or brain injury. Interesting fact to prove my point – In a poll of hyper-mobile people 80% reported that they felt MORE stiff than the average person. The polar opposite being true as well – people with crappy range or flexibility can feel perfectly fine. So don’t assume that just because you feel tight that you are literally tight or shortened in those muscles.

“Normal” range doesn’t even truly exist anyway. Sure, we have averages out there for what we are generally looking for but what is “normal” is dependent purely the individual and what they need that joint or muscles to be able to do in their daily life. Case in point, swimmers and baseball throwers require huge ranges of shoulder motion that would be considered abnormal by any relevant measure. Although a cool trick to bring out at parties, being able to do the splits has no bearing on well, anything really.

Inflammation, a big word that gets thrown around a lot. Tissue inflammation can definitely cause tissue irritation and thus stiffness & tightness. “Inflammaging” ( I promise that’s a real term that I didn’t just make up right at this moment) is a combo of inflammation and aging. Put simply, it means is that as we age we get more inflamed and therefore a feeling of more stiffness. Just like with Arthritis, some people get it worse than others – blame the genetic lottery folks. However, this doesn’t answer the question of why many young people feel stiff. There are many possible causes but the most likely explanation is our good old friend muscle knots/trigger points.

Trigger points are super common pressure-sensitive soft patches of the muscle that may be active (acutely painful) or latent (hurts with pressure applied). Think of them as mini-cramps in the muscle giving that sensation that the muscle is “tight”. This explains why there is often not an actual tissue extensibility problem. Although we don’t know exactly why they appear, we do at least know what they respond to and they can be treated relatively well if the therapist knows what they are doing. I like to think we here at Rozelle Physio know what we are doing when treating these pesky spots 😉

Finally, we come to psychogenic stiffness. Those stressed at work know all too well this feeling of stress-induced “tightness” (the neck often feeling it worst). Amazingly, the mere fact that you believing you are stiff could result in feeling that way. A self perpetuating stiffness you might say. There may then, therefore, be some credence then in freeing up the mind to free the body. State of mind equals state of body – possibly……… can’t hurt to try think loose thought!

Key points:
– Your muscles are not chronically short
– Aging and inflammation have a role to play in the tight sensation
– Trigger points are also a biggie – Thankfully they can be treated!!
– Think loose thoughts 🙂

No more RICE, call the POLICE!!

No more RICE, call the POLICE!!

Physios love our acronyms, from ACL to VBI and every letter in between (unfortunately no acronyms begin with ‘Z’) we have acronyms for everything. The most well known of these is one thrown around in every sporting field in the country…..RICE. ). It’s easy,  every coach, player or parents knows; Rest, get the ICE, COMPRESS the area, and ELEVATE! That’s the correct thing to do right? RIGHT?  As soon as someone goes down with a sprain or strain “QUICK, get the ice” (as though ice has magical healing properties I was not aware of).  Alas, while ice can help numb the pain it does not speed up recovery (may actually hinder in some cases but that’s for another blog). With what the evidence tells us, it may be time for an update to this outdated practice.

We see soft tissues injuries from sports all the time in the clinic; whether it be muscular strains (Commonly hamstring) or ligament strain (ankle). It’s frustrating from a physio standpoint to see these relatively simple, common injuries managed so poorly in the acute stage. The blame lies primarily with ‘old school’ practitioners avoiding change to traditional methods that have been in place for decades. As the adage goes ‘you can’t teach an old dog new tricks’.

Fear not though, here comes the POLICE to the rescue. Another acronym I know ( I told you we love them) but one that actually aids the healing progress from minute one. You will notice that the ‘ICE’ remains the same…. ‘Phew I don’t need to remember 5 new words’.  The ‘P” = protect which is really just the same as the ‘R’ but it wouldn’t be right if our acronym didn’t form a cool word, ROLICE doesn’t have quite the same ring to it.

The critical point of difference here is the ‘OL’. Which lead us to this term of “Optimal load” which you may have heard if any of you have been to see us before in clinic. Sounds good, but what does this fancy term actually mean? Ahhhh you see, this is where you’re friendly neighbourhood physio comes in to guide you.

I call this the ‘Goldilocks principle’. Just like Goldilocks, we want to find Kellogg’s ‘Just Right’ (I may not have been paying attention in fairy tale class). That is, the adequate amount of load on the injured tissue that will aid tissue healing and recovery. Instead of playing a guessing game like goldilocks did, your physio can help guide you with finding that sweet spot. However if you decide to brave it alone, a good rule of thumb is to let pain guide you. *Unpopular pinion time – Pain is awesome (acute pain) because without it we don’t know when things hurt (duh).It’s surprisingly critical for our survival (ask anyone who can’t feel pain how day to day life feels). We use this important sense to determine what is a safe amount to ‘load’ things up. Think safe as anything that stays within 1-3/10. You WILL NOT damage to the tissues with this amount of pain. Pain DOES NOT equal damage.

So next time you go down with an injury optimally load that baby

Key points:

– No more RICE (stick to potatoes or pasta for your starchy carbs)

–  Call the POLICE (not literally, maybe call us instead)

–  Optimally load that injury (get into the clinic Goldilocks)

Ankle Sprains

Ankle Sprains

Hey I rolled my ankle….. It’s Achilling me

Poor jokes aside, it’s an injury we treat all the time…The dreaded ankle sprain. Almost everyone who’s played sport has felt the sting of an ankle sprain (70% of the entire population will have at least one in their lifetime!), especially those in jumping & landing sports. It’s not surprising that it’s one of the most one of the most common injuries we see at Rozelle Physiotherapy. We’ve heard all the weird and wonderful ways people have managed to sprain their ankle from rolling over it on the Bay run,  to falling down a flight of stairs a little worse for wear in heels. From the sportiest of the sporty  to your couch potato no one is completely immune to the lateral ankle sprain.

While extremely common, only 50% of sprainers seek specific treatment. This may be due to the supposed simplicity of such a common injury, but 85-95% of those not receiving treatment will go on to sprain their ankle again. Each time we sprain the ligaments around the outside of the ankle get looser leading to a negative cycle of spraining over and over.

It’s only logical then to seek out excellent treatment & rehabilitation in this early stage, especially if you’re a first time sprainer. This ensures a safe return to sport/exercise/work, minimising risk of recurrence and maximising performance.

When can I go back to sport/exercise/work?  is the question we most often hear.  It’s a very relevant question, but one that will generally require a thorough assessment and treatment plan from a physiotherapist.

In general, guidelines dictate:

Grade 1 sprain: 2-4 weeks
Grade 2 & 3 sprain: 6-8 weeks

However, general timeframes are just that….general and are not individualised to the level of strength, balance, functional control and demands of an individual’ssport/work. The decision to return to sport is a little more complex, with multiple factors that we take into account to help determine when it is safe to return to play.

“Can’t  pain just tell me when it’s fine to return to play?Unfortunately not, quite the opposite in fact. Pain is actually an extremely poor indicator of the state of the tissues and relying on pain to guide recovery leads to an increase in recurrence of ankle injuries due to returning to early.

“How can I tell when to go back then”  ….I’m glad you asked.  Fortunately,  we use various performance measures (not just pain) focused around strength, balance, &control we use in clinic that guide us in determining when you’re ready to go back and be your best on field or at work.

Key takeaways!!

Don’t just leave it
Early rehab for first sprain = back to sport quicker, safer and better
Pain = poor indicator of readiness
Let us help

Do you even lift?

Do you even lift?

Do you even lift?

Whether you’re a powerlifter, manual labourer or a new mum, I’m betting you probably need to lift things every day.
“Keep your back straight”, “use your legs”, “bend your knees” are phrases we hear all the time as conventional wisdom (unfortunately, from many physios too). Conventional wisdom is not always the ‘wisest’ of advice it seems, especially when it comes to backs.

 

Mythbusting

There is this huge misconception in the general population that backs are structures that need to be wrapped in cotton wool – protected to the point of not using them for what they were specifically designed to do i.e. bend and lift. Backs truly are a feat of incredible evolutionary engineering. Have a think of what we ask of our backs on a daily basis. Twisting, bending, lifting or even all three combined (imagine adding an unruly 2 year old to the mix!!), it’s no wonder that sometimes they can get a bit sensitive and painful.

Yet the advice above stays as prevalent as ever in manual handling training, trickling into public perception….Youtube every heavy deadlift video from present day to the advent of humankind and one common thing prevails…. a flexed lower back!!!!!……..”BUT, BUT people say you shouldn’t bend your back when lifting”. It’s interesting that the way these giants lift, bears a striking resemblance to how we are not supposed to lift, yet the sport is extremely safe – in actual fact approx 1-4 injuries /1000 hours, 3x safer than soccer and AFL. Riddle me that!!……If backs were fragile things in need of protection I doubt they could cope with lifting up to 500kg with a flexed spine – just a tad bit more than the average toddler 😉

 

Loading

What it comes down to then is not so much the HOW we actually lift, but how familiarised (or adapted) the back is to doing the task. Which brings us to one of my favourite words – ‘Loading’. We are adaptable creatures capable of doing amazing things if loaded in a paced way; adding little bits at a time. Just like you wouldn’t decide to climb Everest without preparing for the high altitude, you can’t expect to lift things (awkward, heavy or otherwise) without adequate preparation to adapt to the load.
As someone that likes to lift heavy things in the gym for the fun of it, I can attest to this awesome phenomenon of adaptation. We lift heavier and heavier things, in multiple ranges of spinal flexion and wallah, the back can cope with more load……..MEANING that it can handle all those awkward and/or heavy toddlers in everyday life without issue. A simple rule to follow for my own training and with every client: The body will allow you to cope with most of the stresses you place on it, provided you give it the time to adapt. Key word being TIME. Now, I’m not advocating for Granny to go out and start strongman training tomorrow – I AM advocating for people to go out and use their backs for what they were designed for…..bending baby!!

Take care of the muscles, ligaments and joints and they will take care of you. That is where your physio comes in! Optimal strategies to strengthen and load your back, individually tailored to your environment to ensure that risks to the back are minimised. At Rozelle Physio, This is what we excel in, so let us help you with that.

Key points:

– Unwrap that cotton wool
– Bend the back
– Graded load increase over TIME

What’s the benefit of taping for neck pain

What’s the benefit of taping for neck pain

Taping is thought to have more of a neuro-physiological effect versus a actual mechanical effect on tissues. K-tape can benefit patients due to increased proprioception and increased postural stability. Taping can also affect blood circulation to the area by providing continuous stimulation to the skin and subcutaneous tissues.

When we have a sore area what do we do? Generally we rub it.

The tactile pressure and stimulation of the receptors in our skin make us feel better. The tape provides gentle tissue-sheering all day therefore providing a beneficial analgesic effect on the area. In addition, the tape gives us feedback to prevent painful and/or improper posturing. Tape can also be used to facilitate a muscle, inhibit a muscle or provide structural support to the joint.

Depending on the goal of the physio, k-tape will be applied with a muscle in a stretched or shortened position, and different tension is applied on the tape during application. Many areas or body parts can be treated effectively with this tape. Taping an unstable ankle can increase reaction time and help with rehabilitation and prevention of re-injury.

Taping a shoulder can help with posture correction and awareness. The tape can help facilitate or inhibit muscles as deemed necessary by the therapist. The stretchy qualities of the tape will allow full range of motion and stimulate proprioceptive rehabilitation of weak muscles.

Back pain can also be effectively treated using this taping technique. Tape can provide an analgesic effect by stimulation of receptors in the skin as well as helping the client by providing feedback when the client goes into a poor position or incorrect posture. The tape can inhibit over-reactive muscles causing us pain including levator scapulae, trapezius, paraspinal and erector spinae muscles.

Postural Neck Pain

Postural Neck Pain

Postural correction may be necessary in patients who have had a neurological dysfunction, but it may also be helpful for persons who do not have a clinical complaint. Poor posture can contribute to breathing problems, back, neck and shoulder pain, fatigue, indigestion and sleep problems.

In other instances, poor posture may be the result of pain, for which the person is trying to compensate. Physiotherapists are very concerned about the posture of their patients, as it can make a huge difference in a person’s recovery.

Correct posture allows you to keep the head in midline, bear weight, weight shift in all directions and have proper balance. You are guided in exercises and imagery that will help you keep your head, neck and spine in correct alignment.

Abnormal postures will be addressed with a number of techniques to improve posture. In some instances where muscle tone is compromised as a result of illness, such as Parkinson’s or stroke, we may use bolsters, pillows or wedges to stretch the muscles and aid in posture correction. Taping is another means of correcting posture. Taping the body in the correct postural position makes it difficult for the person to deviate.

Poor posture is usually accompanied by pain, therefore we can address this first with manual therapy, massage, or manipulation. Trigger point dry needling therapy to get rid of trigger points has been proven helpful in relieving pain and relaxing muscles. The individual is taught a series of exercises to progressively the muscles and aid in correcting posture. Most see results in fewer than 4 sessions.

​Poor ergonomics can also contribute to poor posture which in turn can contribute to some of the problems listed above. We can assist with the design of your home or office to make it more efficient and less challenging to your health. In most cases only simple adjustments may be required to help improve your posture and alleviate back pain for good.

Is Bracing Effective?

Is Bracing Effective?

Lateral epicondylitis, or tennis elbow, is one of my least favorite injuries.  It can be disabling, nagging, and sometimes even relentless!  A commonly recommended treatment involves the use of a tennis elbow strap.  There has been some support in the literature regarding these orthotics, however results in the literature have varied.

A nice new study published in a recent issue of JOSPT assessed the efficacy of these devices in a group of 52 subjects with lateral epicondylitis.  The study examined the amount of pain-free grip strength and maximum grip strength is subjects with a variety of tennis elbow straps, including a placebo strap.

How Do Tennis Elbow Straps Work?

The theory behind counter-force bracing is similar to the mechanics of a guitar.  When a finger is placed on a string along the neck of the guitar, it reduces tension on the string distal to the fret where your fingers are located.  A counter-force tennis elbow strap can be thought of as your fingers on the neck of the guitar (your forearm) and the extensor muscles, especially the extensor carpi radialis brevis, would be the guitar string, thus reducing tension of the muscles as they attach to the lateral epicondyle.  The authors of the study review this concept well.

Counter-force Bracing is Effective

Results indicate that strapping was effective in allowing subjects to produce significantly more pain-free force.  Subjects were able to produce 16% more strength without pain using a strap.  There was no difference between two of the devices they used (a strap vs. a sleeve with a built in strap), indicating the strap itself is likely the significant factor.  The image below on the left is just the strap and the image on the right is the sleeve with a built in strap:

One of my original concerns with the study involved the rest time between repetitions of grip strength.  As anyone that routinely assesses grip strength knows, the amount of force produced can drop significantly if the rest time between repetitions is not adequate.  However, the study design used a mean of 4 repetitions for each device and allowed 5 minutes of rest between testing sessions.  This was adequate for me and I was happy to see this methodology.

Clinical Implications

  • I like this study because bracing is simple, cheap, and effective.
  • Counter-force tennis elbow straps are effective at allowing patients with lateral epicondylitis to produce more grip strength with less pain.
  • The strap should be placed around 2.5 cm distal to the lateral epicondyle.
  • While it is unclear if the size of the strap is important, the study used straps that were between 5-8cm in width.  Considering there is some conflicting results in the literature, I would recommend you try to replicate the width of the strap.  There are some straps on the market that are very skinny.
  • Straps can be an effective way to allow people with lateral epicondyltis to return to athletics or weight lifting when painful gripping can severely limit activities.