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.
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
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.
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.
1. The push up is not only a foundational upper body strength exercise, it is also a dynamic core stability exercise.
2. If you cannot perform full-length push ups, there are better alternatives than the kneeling push up that are safer and have a much higher return.
3. Appropriate exercise selection + consistently excellent technique + smart work is key to progressing safely.
The push up is one of the most universally recognised bodyweight exercises around, which when performed correctly demonstrates not only fundamental upper body strength and stability, but also one’s ability to generate whole body tension and core stability.
That’s right, push-ups are essentially a core exercise too.
The function of the outer core muscles is to resist movement of the spine, and to transfer force. It provides a robust platform from which movement of the extremities, such as pulling, pushing, carrying, throwing, striking, jumping and catching, and running can occur. In the push up, the function of the core, particularly the anterior wall known as the rectus abdominis is to provide an anchor for expressing pushing force, and to resist movement of the spine into extension.
Unfortunately push ups are rarely performed correctly. This can often be the result of improper instruction and technique, inadequate upper body pushing strength and control, but more commonly the main culprit is a lack of sufficient core strength.
Firstly, here are some examples of improper push up technique:
One of the more traditional approaches to addressing the inability to execute a push up is to regress to a kneeling position, as you can see in pictures 1 and 3. This makes the exercise easier as this set-up cuts the body in half, shortens the lever and reduces the load. Unfortunately there are a few problems with this version of the staple exercise. Firstly, the kneeling position with knees slightly bent tensions the tissues at the front of the thigh that cross both the hip and knee joints, namely the rectus femoris muscle.
Much like a pulley system, in the bent knee set-up this increased stretch can pull at the attachment site of the pelvis and effectively pull it into an anterior tilt. This forward rotated pelvis reduces bracing and tension capabilities of the anterior core musculature and glutes. Since quality push up repetitions require the ability to generate a strong bracing strategy with your abs and glutes to maintain the position of your pelvis and spine, performing the push up from a kneeling position is not ideal.
Further, the sagging low back position at set up can cause compressive stress to the lumbar region of the spine as it is driven into excessive extension, which is exacerbated with the increase of pushing force through the arms. The shoulder could also be at risk due to the forward weight shift that can occur and subsequent increased support load if there is also poor scapulohumeral rhythm and stability to handle it. This could lead to some of the more delicate structures in the shoulder having to take up much more of the slack.
When you have all of these other areas of passive restraints take up the workload of mitigating forces, at best you fail to actually target the intended movement, make little progress if any and may simply have to recover more. At worst you might get hurt.
The push up is one way to challenge and develop the skill of whole body bracing and torso control, which helps to distribute load across more area, and performing them from a long lever position is how we do it.
Here are a couple of the progressions that we use, along the way to performing full-lever push-ups from the floor:
1.Hands Elevated Push Up (gradually lower the height of the bar as you progress)
2.Band Assisted Push Up (band thickness and tension while determine the amount of assistance offered)
3.Push Up (this was Gillian’s first ever set of full push ups)
While we are working our way through the push up progressions we will also supplement with direct pillar work. Here are some of the progressions that we use to enhance anti-extension strength of the anterior core:
1. Front Plank
As mentioned earlier, the key to training that improves movement quality and quality of life is appropriate exercise selection + consistently excellent technique + smart work.
If you are interested in our unique approach to training, feel free to call us any time and let us help you.
Ladies, if you are struggling to make the kind of progress you’ve been working towards and would like become a stronger, fitter, and more confident and capable version of yourself, you can join our all new Women’s Strength and Conditioning Program, commencing in April.
Registrations will close on April 15th so if you would like to reserve your place, call us at the clinic on 9280 2322, contact us via our website HERE or email Sophie directly at email@example.com.
We hope to see you soon.
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
In our Good Reads compilation for September:
10 Olympic Athletes’ Habits You Should Steal (That Don’t Involve the Gym)
Some helpful habit tips from some of the world’s top performers in sport.
Nutrition for Injury Recovery (Infographic)
By John Berardi, Ph.D.
Training Pregnant Clients – Avoid These Exercises
Sophie Drysdale returns to continue the discussion on safe training while pregnant.
As always, if there are any topics you would like to know more about please feel free to contact us.