Osteoarthritis (OA) of the knee and hip is a very common condition associated with aging and something we see quite a bit of at Central Performance. OA is a condition that involves changes to a joint and breakdown of the cartilage inside the joint, this can then also affect the bones and ligaments within the joint. Approximately 2.1 million Australians are affected by OA, with approximately 25% of Australians over the age of 45 affected.
It is becoming more widely recognised that exercise should be a front line treatment for osteoarthritis, particularly for the hip and knee. The Royal Australia College of General Practitioners (RACGP) put out new guidelines for the treatment of knee and hip OA in 2018. Within these guidelines for the treatment of knee and hip OA exercise and weight-loss were the only treatments that were strongly recommended. There was better evidence for exercise than there was for medications or surgery.
While changes to the joint associated with OA cannot be reversed, exercise can help to alleviate or manage the symptoms, improve your ability to perform activities of daily living, reduce disability and improve quality of life. Exercise physiologists, who are trained to prescribe exercise for the treatment of chronic conditions such as OA, are well skilled to develop and prescribe exercise programs for patients who are suffering from OA of the knee and hip.
An exercise physiology treatment program for OA will be personalised depending on the results of your physical assessment, your current functional ability, your confidence with exercise and your goals. A exercise physiology program for a client with knee and hip OA will generally program through three stages:
Your treatment will usually begin with exercises to increase strength of the muscles surrounding the knee and hip joints to help stabilise the joints and improve your symptoms. As your strength and pain improve your treatment will progress to increase range of motion at the hip and knee. The final step of your exercise physiology program is to progress again to full-body exercises that will have great carry over to day-to-day activities. The whole program will be guided by your symptoms and measured against your goals.
Running is an extremely popular form of exercise with almost no cost and fantastic physical and mental benefits. I’m sure we’ve all met runners who are almost obsessive about their running and are like a bear with a sore head when they can’t run. We see lots of runners at Central Performance, from office workers who run a couple of times a week for the health benefits to our elite running group coached by physio and track coach Ben Liddy.
One thing most of our runners have in common is that they would like to run a little better. Whether that’s reducing aches and pains they feel when running, improving their City2Surf time or lowering their 1,500m PB everyone wants to improve somehow. An often-overlooked way to improve running performance is to include some weight training into your training. The classic opinion was the weight training made you heavy and slow however there is a lot of good research that shows that weight training can significantly improve endurance, running performance and running economy.
It used to be thought that to improve performance in endurance sports like running that it was more beneficial to use a light weight for lots of repetitions when performing weight training. The theory was that it better replicated how the muscle worked when running and therefore it would lead to greater improvements in running performance. We now know that low repetition, heavy weight training and plyometric training is better for improving running performance and economy. This might seem counter intuitive but there are some good reasons for why that is the case.
First of all, heavy weight training and plyometric training both improve what is called Rate of Force Development (RFD). RFD means how quickly a muscle can produce force, the higher the RFD the quicker a muscle is able to produce force. A high RFD is important when running because ground contact time with each stride is so short. If you are able to increase the RFD of the muscles in the legs then you are able to decrease your ground contact time and increase your running cadence. Increasing your running cadence improves your running economy, making you a more efficient runner.
Secondly, a stronger muscle means that each stride requires relatively less effort from the muscles in your leg. For example, the soleus muscle in the calf has to deal with between 6-8 times body weight with each stride. That is an awful lot of force to be dealing with for a sustained period of time. A strong soleus, strengthened with the help of weight training, will be better able to handle 6-8 times body weight for a 800m race, 5km fun run or full marathon.
Thirdly, heavy weight training and plyometric training help to strengthen and stiffen tendons. A stronger, stiffer tendon is better able to transmit the force produce by the muscles into the movement of bones required for running. Better force transmission by the tendons again improves running economy and efficiency. It also has the added benefit of helping to guard against the development of tendinopathies such as Achilles or hamstring tendinopathy. We see many runners with these injuries and heavy weight training is the starting point for their rehabilitation.
As you can see there are some very good reasons for including heavy weight training and plyometric training to improve your running performance. As simple as two sessions of weight and plyometric training per week can lead to significant improvements in running performance. Below is an example of a simple weight and plyometric training session for runners.
The goblet squat is a fantastic way to introduce the squat movement into your training program and it is the first version of the squat we use with our clients. The squat is one of the key movements in weight training programs we develop for runners as it is fantastic for developing quad strength. This is important as the quads take the second most load during running after the calf muscles.
Single leg deadlift:
Another key movement in the weight training programs for our runners, the single leg deadlift is great for developing strength in the hamstrings and muscles of the lateral hip, particularly the glute medius. The glute medius plays an important role in maintain lateral stability of the hip, helping to prevent hip drop and subsequent valgus collapse of the knee when your foot strikes the ground. We also aim to have a mix of double leg and single leg exercises in our programs and the single leg deadlift is one of our favourite single leg exercises.
Bent knee calf raises:
An often overlooked muscle group when weight training, the calf muscles have the highest demand on them of any muscle group when running. As stated earlier, the calf muscles must handle between 6-8 times body weight with each stride. Therefore, it is important to strengthen the muscles of the calf. The bent knee calf raise helps to prioritise loading on the soleus muscle and better replicates the ankle position during running.
Hurdle hops are one of our first plyometric progressions we introduce into our runners programs. It is a great exercise to help develop power on one leg and get our clients used to the landing forces associated with plyometric exercises. With a hurdle hop we emphasise ‘sticking’ the landing which requires our clients to be able to control the landing forces.
Patellofemoral pain syndrome (PFPS) is a condition typified by a vague, diffuse pain around the knee. It is often most noticeable during running and walking up and down stairs or hills and is a frustrating injury because it can severely limit a sufferer’s ability to partake in sports and activities they enjoy. While the pain usually isn’t associated with significant damage, the pain itself can be severely limiting. One of the first steps to getting back to activities pain-free is to reduce the aggravating activities to allow the pain to settle and to start a strength training program.
Traditionally it was thought that the most important muscles to help prevent and relieve PFPS were the VMO (one of the quadriceps muscles on the inside of the patella) and the gluteus medius (one the glute muscle on the outside of the hip). However, recent research shows that specific exercises for those muscles have no better outcomes than general exercises. Therefore, the goal of strength training for PFPS should be to have a comprehensive program to strengthen the whole lower body to not just rehab PFPS but improve performance and reduce the risk of other lower limb injuries.
Here is a sample of exercises we use for runners and other athletes recovering from PFPS:
A fantastic foundational exercise, split squats help develop strength in the quads, hamstrings and lateral (outside of the hip) glutes as well as develop balance in a split stance position. These place more emphasise on the quads and lateral hip muscles than the other exercises in the program.
Another fantastic foundational exercise, deadlifts are great for developing strength in the hamstring, glute max (the big, main glute muscle) and back muscles. Deadlifts particularly strengthen hip extension which is very important in running and athletic movements.
Surprisingly the calf muscles (gastrocnemius and soleus) are the muscles that receive the most load during running (6-8 x bodyweight), more than the quads (4-6 x bodyweight), hamstrings, glute medius (2.6-3.5 x bodyweight) or glute max (1.5-2.8 x bodyweight). Therefore, it is important to strengthen these muscles to improve their ability to cope with the loading they receive during running .
A great, simple exercise for the lateral core muscles which play an important role in helping keep the pelvis level during running.
These four exercises together provide a comprehensive strength program that strengthen almost all the muscle of the lower body. Together with a temporary reduction or modification to activity and exercise they can help get you back to what you want to do pain-free.
Running season is well and truly underway! With so many fun-runs, half marathons and marathons going on at the moment, we’re seeing a lot of clients come into the clinic with niggling injuries holding them back, be it in training, competing or just participating! The most common of these injuries is an Achilles tendinopathy (previously known as Achilles tendinitis), which occurs when the Achilles tendon is unable to adapt to an increase of strain being placed on it, leading to small amounts of damage within the tendon fibres themselves. This increase in strain commonly comes about in runners who have suddenly increased the distance they’re running, the amount of hill running they’re completing or the intensity they’re running at!
So, what can you do to help heal an Achilles tendinopathy? Here at Central Performance we love taking an active approach, believing that combining specific exercises with appropriate Physiotherapy techniques is the best treatment possible.
So, what exercises should you be doing? A loaded calf raise program is your best chance at getting back on track. It’s important to remember that initially, these exercises will likely increase your pain, but don’t worry, that soon settles!
Your initial loaded calf raise program should include:
For all these exercises, aim for 3 sets of 15 reps on alternating days. As their difficulty decreases, weight can be added to each of them to further progress the strengthening side of the rehab process.
We recommend following this program for at least 8-12 weeks, progressing from 15 reps max to 6 reps max towards the end of the program. You can still continue to run throughout this time, as long as your pain levels don’t exceed a 3/10 and your pain subsides following the run.
The final phase of your journey to full recovery incorporates ballistics and advanced strengthening exercises. Exercises based around advanced sport-specific strengthening and high- speed movements, combined with rapid change of direction drills are essential for getting you back to full fitness and preventing a recurrence of the injury!
Hamstring injuries can be tricky, and proper treatment is a definite must before testing them out again on the sporting field. Hamstring injuries are among the most common we see here in the clinic, and we believe in using a holistic treatment approach encompassing several areas to get those dodgy hamstrings healthy again!
Strength is a crucial part of keeping hamstrings healthy, and there are a number of exercises we like to use to increase hamstring strength. We use progressive overload in both hip and knee dominant exercises to ensure maximal strength levels are achieved. Some of these exercises include single leg bridges, Nordic curls, prone hamstring curls, single leg deadlifts and hamstring slider curls. Remember to mix up your exercises and give yourself plenty of rest between sessions.
Obviously, flexibility is a massive part of healthy hamstrings, however many people don’t release that flexibility of muscles other than the hamstrings also plays an important part of keeping those hamstrings healthy. Therefore it is important that flexibility components of hamstring rehab programs focus on glute, hip flexor, quadriceps and calf range of motion as well as the hamstrings themselves. Poor range or severe tightness in these muscles are an injury risk factor, so this should be a priority for anyone returning to sport from a hamstring injury.
Running can be a difficult part of hamstring rehab, as in many cases it was the mechanism of the injury! It is however an extremely useful tool in hamstring rehabilitation, and once you’re over the initial hesitancy is the trick to getting those hamstrings firing again. Changing up the style of running training you do is key. We use a mix of progressive speed exposures, max speed exposures, change of direction and deceleration training, and again suggest varying the type and intensity of running training you complete.
For many people who play winter sports like football, soccer, AFL, netball and hockey, pre-season training is just around the corner or may have even started already. Completing a whole pre-season program is not only vital for fitness levels and skill practice, it can be a massive component of preventing injuries throughout the season!
A 2016 study found that elite AFL players who completed <50% of their pre season training were 2x more likely to sustain an in- season injury than those who completed >85%. This isn’t just relevant for AFL though; it’s relevant for all sports at any level.
This is a telling stat, and one that needs to be at the front of all athletes’ minds whilst participating in pre-season training. Even if you’re injured, there is something you can do. Pre-season isn’t just about “getting fit again”, it can be used for rehabbing those niggly injuries still hanging around from last season. The is also lots of research showing that increasing strength can help prevent many common sports injuries including hamstring and adductor (groin) muscle tears, rotator cuff and other shoulder injuries, shin splints and other sprains and strains.
Research from the Australian Institute of Sport (AIS) also shows that avoiding rapid spikes in training load helps you avoid injury not only in pre-season, but during the season as well. Going straight in to in-season training and competition loads causes a huge spike in strain through your body and this dramatically increases your risk of injury during the season.
So make the most of your pre-season training. Get yourself to those sessions, and work on everything you can! Remember, the work you do now will pay off come start of season if you make the effort!
Not sure what to do for your pre-season training? Let one of our Strength & Conditioning coaches or Exercise Physiologists get you on the right program to boost your performance and reduce your risk of injury
Reference: Murray et.al 2016 Individual and combined effects of acute and chronic running loads on injury risk in elite Australian footballers
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.
Also 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.
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.
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.
If you’re looking for a great personal trainer in Surry Hills then Central Performance has you covered. Many people know us as a physio or rehab-oriented facility, however you should know that a large part of what we do every day is work with healthy individuals, who are completely free from injury, using tailored exercise programs to improve peoples overall health and sports performance.
Here are some key ingredients that set our exercise services apart;
• it’s all about you. Every exercise program we deliver is specific just for that client and is based on their individual goals, wants, needs, current fitness level and preferences
• exceptional trainers who really care about you. We really make the time and effort to get to know you, your likes and dislikes, what you want to achieve and what might be holding you back. We make sure your time with us is a real highlight of your day, not just just another exercise session.
• a warm and friendly environment where you feel you really belong, amongst a group of people who always want the best for you.
• a dedicated team working hand-in-hand around you to give you everything you need for success. Because our team of trainers and coaches work right alongside our phyiso’s, exercise physiologists and massage therapists, if you do have any injury concerns then help and advice is always on hand.
We work with people at every level of fitness and sports performance, from gym newbies to athletes competing at national and international levels. Whether your goal is weight loss, sports performance, getting your body back to the way you like it, or maybe you just feel sluggish and you know you’ve got to get moving again, we can tailor an exercise program just right for you. Spending too long at the desk and putting on some kilos, or maybe your doctor says you need to get your weight or blood pressure under control with regular exercise? We can help.
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.