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
In our post on compression garments and recovery, we brought up the potential role of the placebo effect which sparked some questions and commentary.
Adding a little more to the placebo/recovery discussion, in a new study from Wilson, et al. 2019 compared the effects of cold water immersion (CWI), whole body cryotherapy (WBC) or a placebo (PL) intervention on recovery markers after a resistance training session.
Although a single training session does not reflect the everyday workload demands placed upon competitive athletes, there was substantial enough effect on the recovery markers used following the single training session to directly compare the three interventions.
What did they do?
24 males with a minimum training age of 12 months were matched into CWI (10mins at 10 degrees Celcius), WBC ( 3 and 4 mins at – 85 degrees Celcius) or PL group and performed a high volume lower body resistance training session at 80% of predicted 1RM.
Recovery markers were assessed before and after at 24, 48, and up to 72 hours post-exercise including ”Perceptions of soreness and training stress, markers of muscle function, inflammation and efflux of intracellular proteins.”
The single training session did cause the expected perceptual soreness and muscle function disturbance with WBC managing to attenuate soreness at 24hrs and positively influencing peak force at 48 hrs post, greater than in CWI pr PL group. This has been a consistent finding in the literature to date: Stanley et al. 2012; Leeder et al. 2011; Versey et al. 2013; andRoberts et al. 2014.
It should be noted however that the WBC temperatures used in the study (- 85 degrees Celcius) were higher than those typically suggested (-110 to 140 degrees Celcius) possibly influencing results.
Aside from this small difference, it appears that ”many of the remaining outcomes were trivial, unclear or favoured the PL condition.”
Readers should be aware that we are still not aware of the chronic effects of cold water therapies and that some research has suggested it can negatively interfere with vascular and muscular adaptations from resistance and endurance training while CWI has shown some small benefits for recovery from endurance protocols.
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. firstname.lastname@example.org
Although a relatively recent addition in Australia, Compression Garments (CG) have rapidly become quite the fashion statement, initially designed to promote recovery from hard training and competition and subsequently to help improve performance.
Compression Garments are a type of tight-fitting form of clothing made from elastic material providing a gentle compression of the limbs. Some of the reported positive outcomes include:
There is also the possible placebo effect and psychological aid of wearing CG and perceived recovery and performance improvements to be factored in, as anecdotally athletes often speak positively of their helpful effects. The magnitude of physiological recovery improvements observed in the literature are similar to what has been seen with cold-water therapies or light exercise.
While the research currently has shown some recovery benefits from wearing CG it should also be noted that a great deal of the research is of poor quality and clouded with inconsistencies.
It should be added that there is also the risk of bias due to
While there have been some benefits shown and no observed adverse effects on performance or recovery with their use, there is still also no reliable criteria for best practice.
It is therefore suggested that if CG are used they should be used as an adjunct to more proven and reliable recovery enhancing modalities such as enough quality food, good sleep hygiene, as well as fatigue and stress management strategies. Currently, the research is not strong enough to provide conclusive recommendations.
Getting a coach involved with your training program can be a huge help in lots of different ways, but there are a few things to consider before taking the plunge. Whether your thinking of hiring a personal trainer, run coach, or whatever other sport you’re in to, here are a few questions you should ask yourself:
It’s inevitable when you decide to employ a coach they’ll implement some changes to your current plan. If you’re someone that’s resistant to change or struggles to put your faith in someone, the relationship has a high chance of breaking down. Without a foundation of trust between athlete and coach it doesn’t matter how good the training plan is the results won’t follow. If you want to succeed using a coach you need to be open to change.
After sitting down with your coach you need to ask yourself whether what they’re asking of you is realistic. If you believe you’ll struggle to fit their plan in around the other commitments in your life you need to be open with them. Good coaches modify plans to suit the demands of the athletes they work with. However, there is still a minimum body of work that needs to be done to achieve certain results so you need to be prepared to commit to that.
Perhaps the most important part of any coach/athlete relationship is that of trust. The more important your goals are to you the more important the trust in the relationship is. There is no perfect training program and despite their best intentions a coach cannot guarantee their program will work for you. However, if you both trust each other and form a deep bond you’ll be able to see out any hardships along the way and ultimately find the right path to achieving your goals.
If you do decide a coach is right for you and go about employing one, you’re about to develop a new number one fan! You’ll have someone who is as committed to your goals as you are, someone who’ll be there to celebrate the successes with you as well as share in your disappointments. You’ll be held accountable to the process but most importantly you’ll develop a bond that you’ll will carry through the entire process. A coach/athlete relationship can be very special and if you’re lucky enough, you’ll have this relationship for life.
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.
Headaches 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.
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.
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.
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.
Most cervicogenic headaches start from the back of the skull & then radiate forwards to the temples, cheek, forehead, eye or jaw area.
The pain is normally on one side or at least worse on one side, & rarely swaps sides.
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.
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.
There is extensive evidence showing that physiotherapy is effective in 3 key areas of management for these patients;
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.
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.
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.
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.
The 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.
At 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.
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
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.
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.
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
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 Test
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:
– 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!
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