Posts Tagged assessment

Can Strength Training Help You Run Faster?

Run Faster For Longer With Less Chance Of Injury

The right strength program can improve your performance as well as reduce your risk of injury.

At Central Performance we see a lot of runners coming in either for physio treatment or running training with our running coach/physio superstar Ben Liddy. We know that runners love to run and can be like a bear with a sore head when they can’t run due to injury. One great, and often overlooked, way to both improve running performance as well as reduce the risk of injury is to add some strength training to your running training.

Traditionally it was believed that strength training won’t improve running performance as lifting weights will make people bulky and slow. However there is now good evidence that strength training improves running performance by increasing running efficiency. An increase in running efficiency means you to use less energy while running.

Strength training helps improve running efficiency by increasing the rate of force development (RFD) of a muscle. RFD is how quickly a muscle can produce force. The higher the RFD the quicker a runner is able to spring off the ground, reducing the ground contact time and therefore reducing the amount of energy they use.

What Type Of Strength Training Is Best For Runners?

Training needs to be personalAlso contrary to popular belief, the best form of strength training for runners is not light weights with high reps to build endurance. Research shows that the most effective form of resistance training for runners is heavy weights with low reps and plyometric (power) training. Using heavy weights for low reps helps to increase neural drive to the muscle which helps to improve RFD. Plyometrics also help to improve RFD and power development. Plyometrics involve jumping exercises and help teach the body to use muscles and tendons like springs, reducing ground contact time and thereby improving running efficiency.

The best types of resistance exercises for running are compound exercises such as deadlifts, squats and lunges. These exercises use almost all the lower body muscles in a coordinated fashion. 

Research shows that weight training twice per week causes significant improvements in running efficiency and performance. It has also shown that for competitive runners reducing weight training to once per week during the competitive season maintains the improvements made with twice per week.

Can Strength Training Also Reduce My Injury Risk?

Strength training also helps to reduce the risk of injury to runners and all other athletes. A recent review in the British Journal of Sports Medicine showed that resistance training can lead to a 66% decrease in sports injuries and a 50% decrease in overuse injuries. The below picture does a good job illustrating why strength training is important injury prevention for runners.

As you can see the soleus muscle, one of the muscles in the calf, needs to handle between 6.5-8.0 times bodyweight on ground contact during running. Having to tolerate such huge forces obviously requires a lot of strength otherwise the rsk of injury is greatly increased. A good guide for having adequate strength in the calf muscles is to be able to confidently do 30 single leg heel raises on each leg.

Tendinopathies are a very common type of running injury. They occur when the amount of load going through a tendon overloads the tendon’s ability to recover from it. Commonly occurring tendinopathies for runners are hamstring and achilles tendinopathies as both the hamstrings and calf muscles are extremely important in running. One of the best ways to improve a tendon’s capacity to handle load is by resistance training. Heavy resistance training provides a beneficial stimulus to tendons to help them build strength, remodel and allow them to adapt to high volumes of load put through them during running.


We’ve Got Runners Covered

The Central Performance Running Centre helps runners of all abilities improve their performance and reduce their risk of injury. Our strength coaches and exercise physiologists can get you on a personalised program that is effective, efficient and tailored just right for you. 

You can book online or call us on 9280 2322 for more info. 

This post was written by Hugh Campbell, our senior Exercise Physiologist. He has extensive experience and has attended numerous post-graduate courses on running biomechanics and the role of strength training in runners. 

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Shoulder Impingement Is A Common Cause OF Shoulder Pain

Shoulder Impingement

Shoulder Impingement Is One Of The Most Common Types Of Shoulder Pain

One of the most common complaints we see as physio’s is shoulder pain, and it doesn’t just affect athletes. While acute shoulder injuries often happen in collision sports or because of a sporting accident, people performing overhead activities such as lifting in the gym, throwing, racquet sports or swimming are also prone to shoulder pain.

What Causes Shoulder Pain?

Shoulder Impingement Syndrome is the most common cause of shoulder pain in the general population & with many types of sports activities. It can be very debilitating for people such as swimmers, racquet sports players and gym-goers. Throwing, bowling or pitching sports like cricket, baseball and softball are also common places to find shoulder impingement injuries.

Some occupations that involve lifting, carrying, and other repetitive tasks, especially if they are performed with the arm away from the side of the body, are also common causes of shoulder impingement. Even some common DIY tasks like painting walls or ceilings, repetitive drilling at shoulder height or above, and digging in the garden can bring on the pain.
 

How Does Shoulder Impingement Happen?

The shoulder is made up of three bones: the scapula (shoulder blade), the humerus (arm bone) and the clavicle (collar bone). The joint itself is a ball-and-socket joint, and the tendons of four muscles called the rotator cuff muscles are very important to hold the ball in the centre of the socket. The supraspinatus tendon is the most common tendon to get impinged.

As the arm is raised, the rotator cuff muscles keep the ball of the humerus tightly in the centre of the socket of the scapula. If this position is not maintained well, the tendons of the rotator cuff may be pinched between the top of the arm bone & the bony “roof” of the scapula. This can cause irritation of the tendon which can lead to inflammation, weakness and pain. Eventually it can lead to more significant problems like tearing of the tendon. 

How Do You Know If Your Shoulder Is Getting Impinged?

The classic presentation is a painful arc, which is when you feel pain as you lift your arm away from your side and up to your ear. This corresponds with the narrowing of the sub-acromial space, which is where the tendon gets pinched.

Many people also feel pain with twisting movements such as putting on a jacket or when reaching behind your back. When the inflammation is active you may feel pain at night and be unable to sleep comfortably on that side, and your shoulder can ache even when your arm is resting. Sometimes people describe a ‘locking’ sensation in the arm on certain movements.

What can you do to fix shoulder impingement?

Initially, avoiding painful activities to help settle your symptoms is important. If you have recently started or significantly increased your exercise regime you may just need to progress more slowly once your pain has resolved. However because most shoulder impingement is caused by an imbalance in muscle length &/or strength around the shoulder, you need to fix the underlying cause of your pain otherwise it is likely to return again in the future. This is especially true if you have had more than one episode of pain because recurrent pain strongly indicates an underlying imbalance within your shoulder, often within the rotator cuff muscles or the muscles that control your shoulder blade.

Keeping correct shoulder alignment relies a lot on keeping the right balance of length and strength within your shoulder muscles. Having a balanced gym program of pulling and pushing exercises is a great way to help achieve this. If you don’t normally go to the gym then you may need to do some extra strengthening for the muscles at the back of your shoulder, especially if you are an office worker and tend to hunch over your desk a lot. Shoulder and pec/chest stretching can also help.

If you have had a significant episode of pain, or several mild-to-moderate episodes recently, then you should get it checked out by a physio because you are very likely to have an underlying imbalance that will keep giving you problems in the future. Treating the pain when it is only recent and relatively mild is usually fairly simple. However, recurrent episodes can lead to more tendon damage requiring prolonged treatment, costly investigations such as an MRI, potentially more invasive management like cortisone, and much more time away from doing the things that you love.


If you have shoulder pain then we can help. You can speak to one of our friendly physios by calling us on 9280 2322.  We also have a dedicated Shoulder Program and you can  book an appointment online or contact us for more information. 

 

 

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Runners Knee

Runner’s Knee – Patellofemoral Pain

Sydney-siders love a good run! And with the Blackmores running festival coming up, beautiful scenery & awesome weather it’s easy to see why. So today we look at the most common type of knee pain that can affect runners as well as people playing many other sports that involve running and jumping.

 

The knee is the most common site for pain in runners, but it’s not just “runners” that are at risk. Many other sports that involve running &/or jumping have a relatively high risk of knee injuries. One very common cause of knee pain is Patellofemoral Pain Syndrome, which accounts for up to 40% of all knee problems in sports medicine centres. The pain is felt around or behind the kneecap & occurs when the kneecap (patella) does not align correctly into the groove on the end of the thigh bone (femur). It is common in young people, & affects more women than men.

 

 


Symptoms Of Patellofemoral Pain Syndrome

Pain is either felt around the front part of the knee or along one or both sides of the kneecap. It can sometimes be hard to find a specific spot where the pain is felt the most, especially because sometimes it feels like it is hidden away behind the kneecap. Your knee may be making some grinding or clicking noises, & there may be some swelling.

Often there is no specific cause (eg a fall or twist) of patellofemoral pain. Sometimes you may be able to relate it back to an increase in running or jumping volume, or things like new shoes or more hill running. It often begins as a niggle then gradually gets worse if you continue to exercise on it, eventually stopping you doing your normal training. It usually settles temporarily if you stop exercising but keeps coming back when you return.

Patellofemoral pain is usually made worse with anything that increases the load within your knee, eg taking your weight in a bent-knee position. Examples of painful activities can include;

  •    •  squatting, lunging & kneeling
  •    •  going up & down stairs or hills
  •    •  jogging or running, especially on hills or slopes

Some people also get pain from sitting in a bent-knee position for long periods of time, eg working at a desk or sitting in a movie theatre. This is because this position squashes the inflamed back surface the kneecap onto the end of the thigh bone, causing pain after a while.


Causes Of Patellofemoral Pain Syndrome

The main cause of patellofemoral pain is when the kneecap doesn’t “track” properly in the femoral groove when we bend our knee. It can get pulled out to the side of the groove, meaning that it rubs on the wrong places & becomes inflamed. Excessive or rapid increases in loading, usually due to increasing training or running volumes too fast, are also common factors that contribute to patellofemoral pain.

Poor biomechanics (i.e. the way our body controls movement) is the major factor that contributes to incorrect tracking of the kneecap in the femoral groove. Common biomechanical problems include:

  1.    1.  your pelvis drops to one side, increasing the tension on the outside of the leg & pulling the knee cap outwards
  2.    2.  poor glutes (hip muscle) strength means that your knee collapses inwards & rolls inside past the line of your big toe
  3.    3.  there may be an imbalance between the muscles on the inside of your quads (VMO) versus the outside (VL).
  4.    4.  you foot rolls in too much (pronation), causing the knee to collapse inwards so that your quads muscles have an outwards angle of pull on your kneecap.

Females are more likely to develop patellofemoral pain than males (3:2). This is due to women having a bigger “Q Angle”, which is where the quads muscles have a more outwards pull on the kneecap because women’s hips tend to be wider than mens.


What Can I Do About My Knee Pain?

Assessing & correcting your biomechanics is a big part of getting your knee pain resolved. You need to release any tight muscles on your outer thigh & hip, usually by using a foam roller or spikey ball. You will also need to strengthen muscles that are not keeping your leg and knee in the right alignment. The usual problem is that your knee rolls inwards over your big toe too much, so strengthening your glutes muscles to correct this is critical. Making sure that your inner quads muscle (your VMO) is strong enough to balance your outer quads muscle (VL) is also important. 

Your foot position also needs to be checked. The most common foot problem is over-pronation, where your inner arch collapses & rotates your shin and knee inwards too much. You will need to ensure that you have the right shoes for your foot type, eg if you are an over-pronator then pronation control shoes or orthotics are likely to help you. However as physio’s we always find that shoe type or orthotics alone are not the full solution – they are only one component. You must correct your other biomechanical factors like hip control as well.


We can help you beat your knee pain

Every day our friendly & experienced physio’s work with runners & athletes at all levels, from weekend warriors to national champions. We can help you with fast relief & get you back out there on the road, track, field or court. We specialise in finding & fixing the underlying cause of your problems so that once we’ve got you feeling good, you stay feeling good. 

If you need help with your knee pain then you can book an appointment online or contact us for more info, or give us a call on 9280 2322 to chat to one of our friendly team. 

 

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Low Back Pain – Keeping A Neutral Spine Posture

A Neutral Spine Is Important For Your Recovery

Lower back or “lumbar” disc injuries are a common type of back injury we see here at Central Performance. Our dedicated team of physiotherapists do a fantastic job of reducing pain & restoring the range of motion that can be lost as a result of a disc injury. Extensive research consistently shows that exercise plays a vital role in recovering from an episode of low back pain, but we find that many clients are unsure about how to begin or restart an exercise program. Many are not confident about getting back to even light or moderate exercise, fearing that they may re-injure their back. So today our Exercise Physiologists share a tip on how to avoid re-injury whilst exercising following a low back disc injury:

Keep a neutral Spine

Many people who exercise with lower back pain do so whilst holding their spine in positions that can increase their pain. Increased muscle tension due to recent pain can change both your resting posture & your movement patterns. For example focusing too much on not bending your spine (remember the old saying of “keep your back straight and bend your knees”?) can mean that your spine stays locked into extension (a deeper hollow in your low back than normal). This increases compression through some spinal joints, and if this is maintained as you go back to the gym this can cause ongoing pain. Alternatively, having hamstrings that are too tight can cause too much flexion (bending forwards) in your low back as you bend down, potentially increasing pressure on your spinal discs and causing more pain. 

A golden rule of exercising as you recover from a lower back injury, particularly disc injuries, is to maintain a neutral spine! A neutral spine is the term used for the position of the spine when all three curves of the spine (cervical, thoracic and lumbar) are in proper alignment with each other. It’s the most comfortable, stable position for the spine to be in whilst performing any activity, and you should aim to keep you spine neutral as you get back to exercise. Neutral Spinal Posture

Keeping a neutral spine is very important whilst exercising, as it distributes your weight evenly throughout the discs and joints in your back, as well as cushioning impact and other forces present throughout exercise. This allows clients with low back disc injuries to progress to performing more complex exercises and movements, which enables them to recover from their injury quicker and get back to doing the things they love!

Initial supervision and instruction on how to achieve and maintain a neutral spinal posture is an important first step to getting back to exercise safely and early following an episode of back pain. Contact us for more information on how our exercise physiologists and physiotherapists can help you with this, and stay tuned for upcoming posts about how to progress your exercises to give you the fastest an most complete recovery possible. 

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Do I Need a Physio, an Exercise Physiologist (EP) or a Personal Trainer (PT)?

So what actually is the difference between Physiotherapy, Exercise Physiology and Personal Training?

At Central Performance our physiotherapists, exercise physiologists & personal trainers all work side-by-side to care for our clients. Our  aim is to perfectly match our clients with the right program whatever their level of physical health, injury & performance. The flowchart below shows how it all fits together.


Central Performance Client Pathway


3 questions we often get asked by clients are; 

1. What does an exercise physiologist do?
2. How is exercise physiology different from physiotherapy?
3. How is exercise physiology different from personal training?

Firstly, exercise physiologists use exercise to treat chronic health conditions. The most common types of problems that our exercise physiologists treat are;

• Musculoskeletal Injuries, eg back & neck pain, osteoarthritis, sports injuries/sprains & strains, post-operative recovery like ACL knee reconstruction, shoulder & knee problems

• Cardiovascular & metabolic problems, eg high blood pressure (hypertension), heart problems, to reduce bad cholesterol (LDL & total) & increase good (HDL) cholesterol, &  diabetes management

• Mental health, eg depression & anxiety

Similar to how a doctor prescribes medicine, exercise physiologists prescribe exercise programs. When deciding on the correct program to prescribe they consider a range of factors about the client’s condition, any other unrelated conditions, previous injuries or health problems, & the client’s previous exercise experience. For example, a young male who presents with 6 months of back pain but no other injuries or medical conditions will receive a different ‘dose’ of exercise to a post-menopausal woman with a 10 year history of back pain who also has hypertension (high blood pressure). The goal is to match the client with the right type & amount of exercise, as well as to make the exercise interesting so that the client is much more likely to be consistent in their sessions.

Shoulder physiotherapyFor question 2 above, there are a few distinct differences between an exercise physiologist & a physiotherapist. Firstly, exercise physiologists specialise in treating chronic conditions while physiotherapists are more likely to see people with acute & sub-acute injuries. A chronic health condition is one that has lasted for longer than 6 months & can be musculoskeletal, metabolic or cardiovascular. By contrast acute & sub-acute injuries are within the first 3-6 months of when they began, although they also may be recurrent – where each episode is only short, but episodes may occur repeatedly over months or years.

The second difference is that physiotherapists are able to diagnose injuries & order some types of medical imaging, whilst exercise physiologists are not. If someone presents to a physio with a ‘tweaked’ hamstring after football on the weekend a physio is able to diagnose if they have a hamstring strain & what grade the hamstring strain is. By contrast an exercise physiologist isn’t allowed to give a client a diagnosis in that fashion & this is linked to exercise physiologists specialising in chronic health conditions rather than acute injuries. Similarly, physiotherapists can refer clients for some investigations such as x-rays while an exercise physiologist can’t.

Thirdly, exercise physiologists receive extensive training & education in the physiology of metabolic & cardiovascular health conditions. This gives them the skills & expertise necessary to prescribe exercise for people suffering from metabolic & cardiovascular health conditions. Physiotherapists don’t receive training to the same level in these conditions unless they have a special interest  in them & pursue further study.

Ball rollout for core stabilityRegarding the last question, there is a lot of overlap between exercise physiologists & personal trainers when it comes to musculoskeletal health. Exercise physiologists can be thought of as focusing more on corrective exercise for injury recovery, whereas personal trainers focus more on performance exercise where there are not significant restrictions imposed by injury or disease.

Personal trainers do not receive such extensive education or training in physiology, biochemistry or pathology to treat chronic health conditions. As a result they are not eligible for private health fund rebates or referrals from GPs under the Chronic Disease Management plan. Exercise physiologists however are eligible for private health fund rebates & most health insurers cover exercise physiology. Similarly, MediCare will also provide rebates for exercise physiology when referred by a GP under the Chronic Disease Management plan.

Exercise physiology rather than personal training may also be suitable for people who have no experience with exercise or gyms. Because exercise physiologists primarily treat people with chronic health conditions they receive training in cognitive behavioural approaches to help clients feel comfortable & confident while exercising. A similar cognitive behavioural approach can benefit those who have little to no experience with exercise & are therefore nervous to start exercise.

As you can see physiotherapy, exercise physiology & personal training all have different areas of specialisation. At Central Performance we believe in integrating all three in our multidisciplinary approach to provide you with a perfect pathway from pain to full performance, whatever your goals may be. For example a back pain client may initially see our physio’s for diagnosis & hands-on treatment to settle their pain & return to gentle movement. Then they may progress to exercise physiology for initial correction of movement biomechanics plus a return of baseline stability & strength. Once this is achieved they can progress to personal training to really build their strength & endurance, or train to achieve any other sporting or health goals they have.


Contact Us for More Info: For more information or help deciding which service would be the best for you to start, please contact us on 9280 2322 or via email. There is also lots more information on the webpage for each of the services – see physiotherapy, exercise physiology or personal training


 

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4 Quick Tests To See If Your Headache Is Coming From Your Neck

Woman With HeadacheHeadaches can really affect your lifestyle. You may find it hard to concentrate at work, & it can make you feel like not socialising so much because lots of noise or bright lights make it feel worse. Exercise is not very appealing & can make the pain worse, & many people become a bit short-tempered when they have a headache. You may also start to catch yourself taking regular painkillers as if it’s become a normal thing to do. If this sounds like you then there are 4 simple checks you can do yourself to see if your neck may be part of the problem.

Are neck-related headaches common?

Headache is the world’s most common pain disorder & affects 66% of the global population. Research shows that up to 22% of headaches are either partly or fully driven by problems in the neck. When the neck, which is officially called the cervical spine, is producing your headache it is called a cervicogenic headache. Studies also show that assessment & treatment by an appropriately trained physiotherapist is effective for treating these neck-related or cervicogenic headaches.

How can my problems in my neck give me a headache?

Several structures in the neck, primarily those in the upper neck or “sub occipital (C1-3)” region can produce cervicogenic headaches. They include the spinal joints (facet or zygapophyseal joints), muscles, & discs (especially the C2/3 disc). Restriction, tightness or inflammation in any of these areas can affect neural processing in an area called the trigeminocervical nucleus (TCN) & cause pain referral along the trigeminal nerve to the head & face area.

It is important to remember that many people with neck-related headaches do not have a history of neck trauma or even significant isolated neck pain. At Central Performance we treat a large number of headache sufferers & we find that mostly it is related to their posture, with no specific separate neck issues. Often people have tried regular painkillers, heat/cold or massage, but have only found temporary relief.

How can I tell if my headaches are coming from my neck?

Diagnosing different types of headache can be tricky because people may have more than one type of headache at any given time. However cervicogenic headaches do have some common patterns & features, so if you know what to look for you can quickly get an idea of whether your neck is likely to be part of your problems. Use these 4 simple tests to help you decide if you should get your neck checked out to see if it is causing some or all of your headaches.


Test 1: back-to-front radiation

Most cervicogenic headaches start from the back of the skull & then radiate forwards to the temples, cheek, forehead, eye or jaw area.

Test 2: the pain is worse on one side, & doesn’t swap sides

The pain is normally on one side or at least worse on one side, & rarely swaps sides.

Test 3: neck posture or position can increase or reduce the headache

Often gentle movement or stretching of the neck will at least temporarily ease the headache.  Sustained poor postures such as looking down at a screen, iPad or phone will usually increase the headache.

Test 4: upper neck pressure can increase or reduce the headache

Firm pressure around the upper neck & base of the skull can temporarily increase or relieve the headache.


Using these 4 tests will help you quickly screen if your neck is likely to be contributing to your headaches. If these tests indicate that your neck is involved, seeing a physiotherapist who is trained & experienced in treating cervicogenic headaches is the best front-line management. At Central Performance our physio’s have all of the knowledge & experience required to help you. One of our Director’s, Chris Jackson, has a Master’s degree in Manipulative Physiotherapy which focusses heavily on spinal problems including upper neck pain & headaches, & has been treating cervicogenic patients for over 23 years.

How can physiotherapy help neck-related headaches?

There is extensive evidence showing that physiotherapy is effective in 3 key areas of management for these patients;

1. Accurate diagnosis & localisation of joint dysfunction

If you are unsure whether your headaches are coming from your neck we can assess you to confirm or rule out your neck as a cause of your problems. If we do not feel that your neck is the main cause of your problems we can discuss other possible causes, & can liaise with your GP if other investigation or management is required.Physiotherapy neck mobilisation

2. Manual therapy is effective for acute symptom relief

We can often bring patients fast relief from headache pain by using tailored hands-on treatment techniques including joint mobilisations, soft tissue releases, mobilisations-with-movement & trigger point releases. We also start to put you back in control of your symptoms by providing you with a home exercise program designed to re-inforce & build on the improvements made with hands-on treatment in the clinic. Another goal in the early stage is to allow you to significantly reduce or eliminate your medication use.

3. Clinical Pilates: Structured exercise to strengthen the spinal stabilisers & deep neck flexor muscles for effective long-term relief from headache symptoms

As your pain settles you get access to our great research-driven exercise programs for effective long-term symptom relief. Our Clinical Pilates program includes private & small-group sessions using individualised exercise programming specifically designed to strengthen the spinal stabiliser muscles. Restoring balance to your spinal mobility & stability systems is critical & effective in keeping you free of headaches into the future. Click for more info on Clinical Pilates or watch the video below.


Mixed Headaches

You may have headaches from different mechanisms at different times, & even different types of headaches occurring at the same time. Often one mechanism can set-off or aggravate another, so seeing a physiotherapist to effectively resolve the cervicogenic component of your headaches can provide significant relief even if some other mechanisms are involved as well.

Clinical Pilates Studio ClassThe key to effective headache treatment lies in the accurate diagnosis of what type of headache you have. We regularly get clients who have had headaches for years & have taken a significant amount of medication that may have been unnecessary because they never really considered their neck as a source of much of their pain. A skilled physiotherapist can effectively assess if your neck is involved, & give you effective & proven treatment to get you feeling better. When this is matched with a tailored spinal mobility & stability exercise program like our Clinical Pilates program you can realistically look forwards to a future without headaches, or at least with greatly reduced symptoms.

Lastly, please remember that whilst headaches are very largely due to relatively benign causes, if you are experiencing lots more severe or frequent headaches, or if they have come on or increased very suddenly, you should definitely get them checked out ASAP. Your GP can help you, or if you are screened by one of our physio’s & we think you need further investigation we can refer you on to see the best person for you.

 


For bookings or more information please call Central Performance on 9280 2322 to speak to one of our physios or contact us online.
We’re happy to discuss whether a physiotherapy assessment is the right choice for your headaches.

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Lower Back Pain in Golfers

Lower back pain is by far the most common complaint for golfers of all ages and ability levels. Data collected from the Titleist Performance Institute (TPI) show that 28.1% of all players have lower back pain after every round. The most common trend is for trail-sided back pain, ie. pain on the right side of the lower back for a right-handed golfer or left sided back pain for a left-handed golfer.

In actual fact the lower back is generally not the cause of the injury but is the area of the body that is overloaded the most and eventually suffers from the pain. Most of the time it is the fault of the body segments above or below the lower back that are dysfunctional. If the hips, upper back, shoulders or ankles do not move correctly it puts more pressure through the lower back than it is supposed to cope with and it subsequently breaks down. For example, if you are tight through your upper back or hips, the rotation required to bring you to the correct position at the top of your backswing is unable to occur in the upper back and hips. This forces your lower back to compensate and attempt to rotate further. Your back is then repeatedly loaded with more force than it can take, ultimately resulting in the facet joint injuries we see so commonly in golf. It may be an injury that comes on all of a sudden during a swing, or it can be a gradually stiffening/tightening of the back or soreness that is present after a round.

There are 3 aspects within a golf swing that have a strong relationship with lower back pain. The first is an S-posture at initial setup position. As you can see in the picture below on the left, the S-posture creates increased compression forces through the lower back due to the excessive lumbar lordosis (curve). This compression puts heavier load through our facet joints and with repetition this can result in an acute irritation of the facet joints or gradual degenerative changes through these joints.

Instead of the S-posture set-up, we ideally need a straighter line through the lumbar spine. This requires core stability to draw the spine out of the large curve and maintain a stable lower back position throughout the swing. If you have an S-posture, you can begin to correct this by practising basic motor pattern and core exercises, sometimes beginning in lying or kneeling positions, then progressing into more relevant standing golf positions.

The second major feature of the golf swing that correlates with lower back pain is the “Reverse Spine Angle”. At the top of the backswing the line between our head and centre of the pelvis should point away from the target. A “Reverse Spine Angle” is where this line of the spine is tilted towards the target. In this position the facet joints of our lower back are in an open position so as we move into the downswing and ball contact there is a rapid compression onto the facet joints as we close down onto them. People may develop a “Reverse Spine Angle” because of an inability to separate the movement of the upper body from the movement of the lower body, such as restricted rotation at the upper back or tightness through the latissimus dorsi muscle (the lats). It can also be caused by restriction in trail hip range of motion or weak gluteals and core muscles.

“Early Extension” is the third characteristic of the golf swing which can result in lower back pain. This is the movement of the hips and/or spine straightening up too early in the downswing. It can be seen on the second image below where the buttocks moves forwards away from the back line, when it should actually remain in contact as the hips rotate rather than straighten. “Early extension” again jams down and compresses onto the facet joints of the lower back. The physical causes for this can be reduced hip rotation of the lead hip, poor rotational mobility in the upper back, tightness/shortness in the lats, poor gluteal or core strength and overall a poor overhead deep squat movement.

As well as assessing the golf swing to determine if these swing characteristics are present, a golf assessment must also include a physical screen. TPI teach a Physical Screen consisting of 16 tests, ranging from hip range of motion, upper back rotational range, overhead squat patterns and even to wrist range of motion. All of these body segments need to be working together as a unit to achieve a successful, safe and reproducible golf swing.

TPI’s philosophy of the golf swing is this:
“We do not believe in one way to swing a club, rather in an infinite number of swing styles. But, we do believe there is one EFFICIENT way for every player to swing and it is based on what the player can physically do.”

At Central Performance we have two practitioners who are TPI Certified to assess the golf swing and perform your golfing physical screen.
Helen Hathaway – Physiotherapist
Danny James – Strength and Conditioning Coach
We are by no means golf coaches who are the experts at swing analysis, but would love to work with you and your golf coach (if you have one) to ensure that the mechanics of your body allow for the most efficient and safe swing for you.

Our physiotherapist, Helen, and strength and conditioning coach, Danny, run Golf Biomechanical Assessments consisting of a Physical Screen and a Golf Swing Analysis. They piece together the information gathered from these tests and establish a plan to help you get the most out of your body to improve your golf game. For some, the goal may be to get through a round of golf without feeling stiff in the back for two days following. This may mean manual treatment with Helen to improve joint range of motion and muscle length, as well as a program of corrective exercises to restore normal function. For others, it may be that they want to improve the power in their swing and could benefit from strength and power development with Danny. If you are having pain or discomfort with your golf, or feel that your game could be improved by improving your body’s mechanics, feel free to call and chat, or email helen@centralperformance.com.au

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From Pain To Performance

client-performance-pathway-rooms-26-10-16At Central Performance we believe that clients in the 21st century are looking for a new model of health & fitness. In our view the line between “rehab” & “fitness” is blurred if not fully broken down. Our goal is to allow our clients to progress seamlessly from acute injury management right through to exercise for life-long fitness & sports performance, all guided by an expert team within one great location.

We find that our clients expect much more than just short-term symptom relief. Of course fast pain relief is still a crucial first step, but these days people want (& deserve) much more. They also want to know what implications their current problem has for their future health, & what they can do to prevent future injuries. Many people also want to know about options to improve their overall health & wellbeing, & for some they are looking for programs to improve their sports performance. Meeting these expectations requires a multi-disciplinary approach that focuses on each individual’s goals, lifestyle, history, exercise preferences & sporting aspirations.

These expanded needs & expectations demand a much broader view of “healthcare”. The line between injury rehabilitation & physical fitness is now very blurred, meaning that treating an injury is only the first stage in the “rehab” process. Once the pain is settled, what then? Should clients just be discharged back to their pre-injury lifestyle, bearing in mind that for most injuries the client’s pre-injury lifestyle was a big contributing factor to their injury! Think back pain in sedentary desk workers, hamstring tears for weekend-warriors who don’t get a chance to exercise during the week, OA knee pain in overweight individuals.

If a client’s “rehab” stops when their current pain episode settles down, we believe they’re just setting themselves up for more problems. These days most people realise this & are looking for a different approach, however they often don’t quite know how to go about fixing the situation. Central Performance now provides you with an effective & convenient solution, with a team of experts all working together in a single location.

OLD MUSCULOSKELETAL MODEL – Triage Care

In this model musculoskeletal services had a short-term focus on the diagnosis & relief from a specific episode of pain or injury, eg an episode of back pain or an ankle sprain. Once this episode was relieved patients were discharged, usually with some exercises to keep going with (which we all know almost no-one actually did!) & advised to make some lifestyle changes.
Working with this model there was almost an assumption of “I’ll see you next time something goes wrong” – whether it was the same problem recurring or something new.

Essentially, this paradigm focused on treating pain & then returning people back to their pre-injury lifestyle & level of function. But they became symptomatic in their pre-injury level of function, so if they just return to this level the chances of them becoming symptomatic again are very high.

The solution? People often find it hard to improve their overall health & fitness by implementing lasting lifestyle changes, but our new model of care at Central Performance is having great success in removing the physical, social & psychological barriers to make it much easier.


Old Model                                         →               New Model

Triage & symptom relief               →              Effective short term & long-term management

Isolated injury focus                      →              Whole-body health & fitness management

One or two main providers         →              Team approach; an expert in each area


THE NEW MUSCULOSKELETAL MODEL OF CARE: Patient-Centred Pain to Performance Model

When seen graphically in the pathway chart below it is easy to see that the “rehab” phase, i.e. the symptom relief phase, is just the start of our client’s patient’s path to sustained better health. In fact injury management & performance improvement are really just opposite ends of the same spectrum. There is no true dividing line between when exercise for rehab finishes & exercise for performance improvement begins.

Central Performance Client Pathway

It is crucial to note that our definition of “Performance” is completely individual. For one person performance may mean being able to play with the kids in the back yard, for another it may be elite sport. For some it may be staying mobile enough to keep living independently, for others it may be using exercise to combat depression. A desk worker may define performance as being able to do long hours without neck pain, another may define it as recovering from ACL reconstruction to return to the rugby field. Whatever each client’s definition of performance is, our services focus squarely on helping them achieve it.

It is also important to see that given the much broader scope of healthcare this model encompasses, it is impossible for one provider to be an expert in all areas. This is critical to the Central Performance care philosophy which states that:

At Central Performance we bring together a team of experts in each area of your program, all combining & working together in one convenient location.

The ability to provide all these services at one location is important because it removes many barriers that often hold people back. Convenience & time-efficiency are two aspects, but trust & familiarity are really the most important. For example if a client has been receiving physio & is now ready to progress on to more exercise-based management they are always much more comfortable knowing that they can still come to the same familiar place, they know the reception team, & whenever possible we have already introduced them to the person who they will be seeing for the next part of their program. Often there is a period of co-treatment, where clients may still have some physio sessions mixed in with their exercise sessions.

Most importantly we find that our clients will have built trust in their physio, & they know that their physio will have communicated closely with their exercise provider, so they know & trust that this next phase of their program will be at the same high standard as their physio program. This is vital as it greatly increases the number of clients who successfully make the transition from low-level injury-related exercise to exercise for sustained health, fitness & performance.

The same seamless integrated care happens at every stage of each client’s program. We help & support you right from initial recovery through to reaching your goals & making real & lasting improvements in your all-round health, fitness & lifestyle. Our clients have the real confidence of knowing that they will always see the right person at the right time, every step of the way.

For more information on how this new model of health & performance can help you reach your goals please contact us or call the clinic on 9280 2322.

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Two quick tests to help you avoid Shin Splints this Summer!

running

As we’ve just ticked over into summer, you may have been looking to return to those warmer early morning or late evening runs, so we thought we would help you out and give you a couple of quick and easy tests to help avoid one of the most common injuries – shin splints, or medically referred to as medial tibial stress syndrome.

A recent study of military recruits (Newman, 2012) looked over 5 years worth of data and subsequently have shown that if you’re positive for both these tests, you could be almost 8 times more likely to develop the condition. On the contrary, if you’re negative for both these two tests, you’re unlikely to have any problems (LR- >0.001)

 

Test #1 Shin Palpation

Instructions:shintest1

1)      Press down on the shin bone, two thirds down and on the inside, including all muscles on both your left and right leg!

2)      Press enough to squeeze out a wet sponge!

Positive test is recorded if there is any pain present

 

 

Test #2 Shin Oedema Testshintest2

Instructions:

1)      Press and hold down for FIVE SECONDS on the shin bone, two thirds down and on the inside.

Positive test is recorded if there is pitting oedema (a dent lasting on your shin!)

 

Here is what else you need to know!

1)      Common symptoms involve:pittingoedema

– Dull, aching pain on the front and inside of the shin
– Tender to touch shin bone

2)      Depending on the severity of your shin splints, symptoms may occur:

– Only during the warm-up
– Only during the warm up and the cool down components
– During the warm-up and continues to get worse
– All the time, disturbing sleep

3)      Some of the common risk factors to shin splints include the following:

– Increasing running speed or distance
– Running on hard or angled surfaces
– Flat feet (excessive pronation)
– Inappropriate footwear/fatigue
– Lack of ankle mobility (tight calf) or tight hamstrings
– Poor gluteal or intrinsic foot muscle strength / control

4)      Females are more likely to develop the syndrome (up to 3x!) (Burne et al., 2004)

5)      Healing time can take a while, up to 6 weeks, but this is dependent on the severity.

6)      Untreated shin splints with persistent overuse can increase risk of stress fracture, meaning that we’ll be needing to find you other alternatives to exercise!

Treatment for shin splints covers six main phases here at Central Performance including correct diagnosis, symptom control, addressing background biomechanical factors, tissue lengthening, tissue strengthening and advanced sport specific strengthening prior to your complete return to pre-injury level!

Click here for a PDF about SHIN SPLINTS. Feel free to forward this on to your friends!

 

Seb is the newest addition to the Physiotherapy team at Central Physio and Performance Fitness. He completed a Doctor of Physiotherapy post-graduate degree at Macquarie University, and is here to help transform your pain into performance! Feel free to contact Seb at Seb@centralperformance.com.au

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