Being injured and in pain is the worst. It holds you back from performing activities you enjoy and even everyday tasks can be tougher to do to the standards that you’re used to. There are often also mental hurdles to overcome when trying to come back to sports or the training that you love.
When you sustain an injury that needs physical therapy, this means that one or more of the body’s systems was not robust enough to handle a particular stressor it was up against at the time.
This could be because of an exercise choice, too much of a particular activity over time, not be ready for the particular activity or simply fatigue that leads to less than ideal movement quality. There can be many reasons. Either way, the body was not resilient enough to fend off the stressor and it broke down. The best way that we know to build up resilience against injury is through fitness.
One of the biggest challenges that we can face when trying to navigate an injury and resume regular movement or training is knowing exactly what’s appropriate to do. When can we begin to veer off the rehabilitation road and flow onto the training highway?
The answer lies in a connecting the various professions that have the most to offer at ALL stages of your journey. Specifically, your physiotherapist and your strength and conditioning coach or trainer.
For a long time there’s been a gap between physiotherapy and strength and conditioning when there is so much to gain when these worlds collide and there is a combined focus and collaborative effort towards not only getting you back to the activity that you most enjoy but also making sure that you are even more unbreakable in the future.
When you’ve been injured, you’ll need a physiotherapy lens at the site to examine the damage extent, get you out of pain and on the road back to function. Towards the end of treatment, your strength coach or trainer then merges into the game to deliver fitness strategies that should result in you needing fewer trips to the physiotherapist and the long term result of building resiliency against future damage.
The fact of the matter is, your physiotherapist can get you out of pain and back to normal, but they’re often not equipped with the tools to get you far stronger than you were and need. It may very well have been (and often is) a lack of strength and readiness for the activity that led to the injury in the first place.
Your strength coach can get you better than you were, stronger, faster, fitter and less damage prone, but they cannot directly apply the same healing and rehabilitation strategies.
Both of these skill sets have the same goal; to apply a certain stimulus and provoke a certain adaptation that results in you getting a little better. They just exist at different ends of the continuum.
Often, if you’ve been hurt what you need is some combination of the two skill sets working with you at the same time for best effect.
Are you having trouble falling asleep?
A tonne of research has shown us that the use of electronic devices prior to sleep time can wreak havoc on our ability to fall asleep.
It turns out that the short-wavelength blue light emitted from smartphones, tablets, and other devices disrupts proper melatonin production.
Melatonin is a hormone released primarily by the pineal gland that regulates sleep-wake cycles. It is released at night and in conditions of prolonged darkness as a signal to the body that its night time.
Figueiro et al. 2012 looked at a small sample size of 13 individuals who used self-luminous tablets to read, watch movies and play games prior to bed.
The study concluded that light from these self-luminous displays 2 hours prior to bedtime diminished melatonin production by about 22%, possibly affecting circadian rhythms and normal sleep cycles.
Some things you can do to help not only get a good night’s sleep but help get to sleep in the first place include:
1. Develop a ‘POWER-OFF POLICY’ before bed
Switch off your electronic devices at least 1-2 hours prior to bedtime.
2. Develop a ‘Wind down’ routine before bed
Slow down and de-stress as much as possible before bed. Some other suggestions include taking a walk, meditating, reading a book, gratitude journaling.
3. A quite, cool, and dark place
Reduce any distracting noise, avoid warm clothing or bedding and aim for a temperature of approximately 18 degrees Celsius.
4. Avoid coffee, heavy meals and liquids before bed
Limit feelings of fullness, digestive discomfort and sleep disturbances due to late-night bathroom trips.
Danny James is the Head of Personal Training and Strength and Conditioning services at Central Physio and Performance Fitness, located in Surry Hills in the Sydney CBD area. email@example.com
Following our introduction to recovery, we’re going to continue the series looking at some of the research around many popular recovery methods and offer some practical
First up on the list is sleep – one of the most important influences on recovery, one of the simplest to address and yet is often the most overlooked of all performance variables.
Sleep is a needed resource for psychological and physiological wellbeing, during which time many of the bodies more potent repair and recovery processes are kicked into overdrive. It is generally accepted that the primary purpose of sleep is restoration – To recover from previous wake-period operations and/or prepare for functioning in the subsequent wakefulness period.
An individual’s recent sleep history (consisting of both duration and quality) can have a dramatic influence on daytime functioning. Research has firmly established that sleeping less than 6 hours per night for four or more consecutive nights can:
1. Impair cognitive performance and mood
2. Heighten risk of illness and injury
3. Disturb metabolic health, appetite regulation and immune function
There are many reasons why sleep habits may be negatively affected, some of which include:
Stress, nervousness, thinking, worrying, planning.
Unsuitable diet/nutrient deficiency
Poor sleep habits and environment (eg noise, lighting, temperature, late television watching, late caffeine use, late activity).
In addition to the above, Erlacher et al. 2011 asked 632 german athletes from various sports about their sleep habits leading up to important events or competitions, with the results showing that:
Factors identified as reasons for poor sleep included:
The value of quality sleep is clear and it is easy to see how it can be impacted by many of the above variables which we all face from time to time. What isn’t so easy though, is how best to mitigate these factors to ensure that you get a good night sleep and subsequently prevent the associated performance decline from sleep loss.
Suggestions for improving sleep:
1. Develop a ‘POWER-OFF POLICY’ before bed
Switch off tv, computers, tablets, and smartphones 1-2 hours before sleep time. These will disturb the production of hormones that prepare you for sleep.
2. Develop a ‘Wind down’ routine before bed
Slow down and de-stress as much as possible before bed and try to establish consistent sleep and wake times. A shower before bedtime has been shown to improve sleep onset latency. Research has also shown that almost half of all insomnia cases are linked to stress or emotional upset. Avenues to reduce stress are highly individual and situation dependent, so finding ways to reduce stress are paramount to improving sleep, and long-term health and wellness. Some proven strategies include:
Habits and Environment
3. A quiet sleep space is a key
If noise can’t be avoided try using headphones with instrumental music at a low volume, or keep a fan on for an acutely distracting ‘white noise.’
4. Temperature, darkness, and clothing
Approximately 18 degrees Celsius is a cool room temperature that has been shown to help comfortable sleep occurrence. Thick bedding and clothing must also be avoided if it causes overheating. A dark environment with limited lighting can also help the body recognise that it’s night time and time to begin the process of preparing for sleep.
5. Coffee and heavy meals
Avoid caffeine, big meals and heavy amounts of liquid before bed.
6. Take Naps Where You Can & Need To
Naps can be beneficial to catch up on lost sleep, however, avoid them later into the afternoon if it might impact your regular sleep time. Blanchfield et al. 2018 recently showed that a short afternoon nap improves endurance performance in runners that obtain less than 7 hrs of nighttime sleep. Napping might be an important strategy to optimise endurance exercise in other athletic and occupational scenarios when sleep is compromised (eg long-haul, intensified training etc).
”Every training element has a point of diminishing returns. Our job (the coach’s job) is to find it shift emphasis and cycle back at the optimal point in time.” ~ Derek Hansen
Tendinopathy is a common condition that results from overloading a tendon. It used to be called tendinitis however research shows that usually not much inflammation is involved, hence the name change. Lower limb tendinopathy is common in sports including running, basketball, netball & football. Upper limb tendinopathies occur frequently in tennis & other racquet sports, swimming, & throwing sports like cricket & baseball.
Tendinopathy occurs when the tendon’s main tissue, called collagen, becomes damaged because it is no longer able to cope with the load being put through it. This overloading usually happens when there is an increase in exercise frequency, volume or intensity. This may be someone starting the gym again after a break, when stepping up training in preparation for a race or fun-run, or when you start pre-season training after resting from your sport in the off-season.
As the tendon becomes overloaded it starts getting irritable and in some cases swollen. You will usually feel pain in the morning after waking up, when you move again after resting or sitting at your desk for a while during the day, and maybe at the start of exercise. Often in the early stages of tendinopathy your pain will disappear as you warm up, but usually comes back again after you cool down, rest or sleep. It will usually get worse over time if you keep overloading it.
There is a lot of conflicting advice out there about how to deal with tendinopathies. Much of it is out-dated and we now know that old-style things like stretching and completely avoiding painful activities will actually slow or prevent your recovery.
For a great overview of tendon injury & management guidelines check out this video from Professor Jill Cook, a leading research expert in tendon management.
• Continue to exercise at a sustainable level. As a general rule a little bit of pain is acceptable during exercise in a tendon with tendinopathy. As a rule of thumb 3 or 4 out of 10 pain level during exercise is okay as long as the pain stops within an hour after finishing exercise and isn’t worse that night or the next morning
• Get your tendon assessed and begin treatment early. Like many things the earlier you get on to it the faster your recovery, the less treatment you are likely to need, and you give yourself the best chance for a great recovery.
• Start heavy, slow resistance exercise. Tendons need a load placed on them to allow them to repair themselves. The best way to start loading a tendon with a tendinopathy in a controlled fashion is with heavy, slow resistance exercise. Look for a tempo of approximately 3 seconds on the concentric (lifting) phase and 4 seconds on the eccentric (lowering) phase. Again a little bit of pain during heavy slow, resistance exercise is okay as long as it stays at a 3-4 out of 10 level and does not persist after stopping exercise.
• Be consist with your exercise. Tendons prefer to be used consistently and performing your exercises regularly will help with your rehabilitation from a tendinopathy
• Stop exercising or using the muscle completely. Like we said earlier, tendons need consistent loads to be placed on them in order to repair themselves. Stopping exercise completely may temporarily stop the pain but that pain is likely to return when you return to exercise as very little healing will have taken place.
• Stretch the tendon. Stretching a tendinopathy is similar to itching a mozzie bite, it might provide some short term relief for the pain in the long term it will likely slow the healing. This is because stretching a tendon will usually cause it the tendon to get squashed against the bone it attaches to. This compression against the bone will usually aggravate the tendon and slow down its healing.
• Try and rush your rehab. Tendons do not have a good blood supply and therefore are slow to recover. In some tendinopathy cases it can take 12-18 months for the tendon to remodel and recover. Be patient and consistent with your rehab. If you rush it and try and increase your exercise and loading of the tendon too quickly you will likely aggravate the tendinopathy and slow down your recovery.
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.
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.
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.
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.
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.
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.
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;
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.
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:
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.
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.
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.