Patellofemoral Pain Syndrome (PFPS) is a common complaint we see here in the clinic. This usually presents as a gradual onset of pain in the front of the knee which is generally vague and difficult to pinpoint. This knee pain usually progressively worsens over time and can interfere with your daily activities and overall function. There can be a number of contributing factors to PFPS and therefore it needs a thorough examination to identify the important factors for each individual patient. Factors such as load management, range of motion, strength and control of the hip, knee, ankle and foot can all play a part in the development of PFPS. It is important then, that we identify the contributors and target these factors with an individualised rehabilitation program. Let’s take a look at these factors in some more depth:
Load Management: As with many injuries we see here at Central Performance, the main contributing factor tends to be a sudden increase in activity (running or loading) e.g. getting back to running after a break but trying to do the same distances you were running before you stopped. Although PFPS often affects runners, it can also occur from other repetitive activities such as stair climbing, hiking or hill running as well as excessive compressive activities such as squatting and kneeling. Key to the successful rehabilitation of PFPS is to manage your load in an appropriate and graded way.
Knee Strength and Lateral Tightness: Research shows that people suffering from PFPS tend to have a weakness in the quadriceps muscles. We also see that the structures (eg the ITB) on the outside of the knee and hip are tight and this affects the position of the patella, pulling it laterally and causing increased wear and tear on the cartilage of the knee due to this sub-optimal tracking.
Hip Strength and Control : A lack of hip strength or control, particularly in the gluteal (“glutes”) muscles to the side of your hips, can result in a rolling inwards of the knee during single leg activities (e.g. walking, running, steps etc). This inward rolling (“valgus collapse”) also pulls the patella outwards, which causes further wear and tear on the under surface of the patella itself and on the contact points of the femur.
Ankle and Foot Factors: Stiffness or restriction of the ankle can transfer excess load up the leg and place more stress through the knee. Similarly, if there is a lack of strength in the calf complex, then this can result in an increase in load through the knee joint in order to compensate. Foot posture has also been linked to PFPS, with those people having flat or “pronated” feet more likely to present with patellofemoral pain.
As you can see, managing Patellofemoral Pain Syndrome is as complex as it is to spell it! It requires a thorough assessment and an individualised rehabilitation program addressing the factors that are specific to you and your pain experience – there is no “one size fits all” treatment recipe. So if you are experiencing anterior knee pain our talented team of physio’s can help!
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.
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.
Injuries are a common occurrence in sport, but no one wants to be sidelined for too long. We know that following your physio’s rehab program will help you recover, but nutrition is also an important part of your treatment plan. A good diet is essential for performance and recovery from physical activity, but when we get injured its easy to forget all the normal diet habits while focusing on recovering.
Food plays an important role outside of just fuelling your body. You may not know that food plays a significant role in inflammation, which is a key aspect of healing following an injury, so what you eat will impact your recovery. Food can also assist with rebuilding muscle, bone and repairing damaged tissue. So if you are currently injured or find yourself with constant niggles and aches, read below to learn more about the link between diet and your recovery.
When you are injured, your body produces inflammation. Pain, swelling, redness and heat draws healing chemicals to the injured area. The damaged tissue is removed, and a new blood supply and temporary tissue is built. Next remodelling occurs, where stronger, more permanent tissue replaces the temporary tissue. Inflammation is important in triggering the repair process during injury, but too much inflammation can delay healing and cause additional damage.
Strategies to help produce the right amount of inflammation can be extremely useful and this is where nutrition plays a big role. Choose anti-inflammatory fats such as;
At the same time, avoid a high intake of pro-inflammatory food such as;
Once the body begins the proliferation and remodelling stages of healing (building of new tissue), a balanced diet is necessary. Ensure you eat adequate;
It is common to reduce intake following an acute injury due to reduced activity levels and appetite, but energy expenditure may actually increase by 15-50% depending on the type and severity of injury. Reducing your intake could impact tissue healing and muscle wastage in the early stages of your injury, so guidance from a qualified sports dietitian can help you maximise your rehabilitation program by ensuring you are eating adequate protein, fat, carbohydrates and micronutrients.
It might sound like a cliché but a 2017 Scandinavian study found that a healthy diet with a variety of fruit, vegetables and fish reduced the odds of new injuries in adolescent athletes. Fruits and vegetables come in a range of colours which all have their own unique make-up of micronutrients essential for health and enhancing recovery between training sessions. Even if injuries sometimes seem out of your control, getting into the habit of eating a variety of fruit and vegetables in adequate amounts is not only beneficial for your general health, but could also play a role in reducing your risk of injury.
Tendons and ligaments in the body are made of collagen cross linkages. Several studies have looked at the link between gelatin ingestion and injury prevention. Supplementation with gelatin has been shown to improve connective tissue structure and function, potentially improve joint health, and reduce pain associated with strenuous activity. Ingesting gelatin with vitamin C increases the effectiveness as they work together to increase collagen synthesis and improve collagen crosslinking, e.g. in tendon tissue.
The most current recommendations are: ingest a gelatin supplement (such as 15g of Great Lakes Gelatin Collagen Hydrolysate) with at least 50mg of vitamin C one-hour before training to assist injury prevention. If injured, collagen can be consumed daily to aid recovery by increasing collagen and tissue strength.
These are general guidelines only, so more specific individualised advice, speak to Kelsey our Sports Dietitian.
Bone health is critical for everyone; we’re taught from a young age to include dairy products in the diet for their calcium content, but vitamin D is the other main nutrient that we need to build strong, healthy bones.
Runners particularly are at a high risk of bone stress injuries, as well as those in indoor sports (because they are away from sunlight/vitamin D opportunity), non-weight bearing sports such as swimming, or physique-sensitive sports such as diving, gymnastics and body building. Studies have found runners with higher vitamin D intake recover quicker from injury, and those with higher bone density have decreased frequency of bone stress injuries.
Vitamin D can be obtained mostly from safe exposure to the sun, and in smaller amounts from some margarines or milks fortified with vitamin D. You can also ingest it from mushrooms that have had sun exposure. Using a vitamin D supplement depends on your body’s levels of vitamin D, so this should be discussed with your doctor or sports dietitian before commencing.
Research in soccer matches found that injury risk increases towards the end of each half of the game. This is when players are fatigued, decision making and fine motor skills are impaired and running biomechanics are modified. The findings are transferrable to other sports – if you are fatigued towards the end of your game or race, you are more likely to injure yourself. Fuelling and hydrating adequately are the best measures to prevent injury by delaying onset of fatigue. Appropriate fuel and hydration plans that help you to maintain exercise intensity for longer and reduce fatigue need to be very personalised because they depend heavily on you, your body and the activity or sport that you are participating in.
Injuries are all too common in sport, exercise and even normal activities. Whether its rugby, running, swimming, gymnastics or even just DIY and gardening, injuries are a regular occurrence. Given the powerful effect of nutrition on our general health, its no surprise it also plays an important role in your recovery from injury. So if you have an injury, past or ongoing history of injuries, or even someone you know is constantly injured, make sure you book an appointment with our sports dietitian. Kelsey can provide you with a personalised injury management nutrition plan to assist your rehabilitation program and get you back into your sport, exercise and regular activity faster. Contact reception on 9280 2322 or head to our online bookings page to book in your first session with Kelsey. For more info you can also see our Dietitian’s page.
In Part 2 of this blog post series, we covered the hormone changes that occur in the first phase of the menstrual cycle, the follicular phase. This week we will go into the second phase of the cycle, the luteal phase.
The luteal phase occurs from day 14-28, assuming a 28-day cycle. We know this phase all too well as this is when PMS (pre-menstrual syndrome) symptoms occur! Be aware of food cravings, especially if your symptoms sideline you from your usual workouts.
This phase is the high hormone phase with progesterone at its peak. Progesterone increases the body’s core temperature, lessening tolerance to heat during workouts and increasing sweat which causes the body to lose more sodium. Because of this you need to really make sure you stay on top of your hydration when working out in the hotter months of the year in the second phase of your cycle!
During the luteal phase, the body uses carbohydrate less effectively for energy, instead utilising fat. If you are trying to reach high exercise intensities or need to perform at your best during this time, extra carbohydrates around training sessions may be necessary for you to be able to exercise at your best. Protein breakdown also increases, so its really important to make sure you are recovering adequately with protein sources after a workout.
Examples of high protein snacks to enjoy post-workout includes plain yoghurt with nuts, a fruit smoothie made with milk, yoghurt and fruit, or some boiled eggs.
Try having red meat or salmon for dinner post-workout to aid your recovery and help you get in your essential nutrients during this time of the month.
If you are looking for an effective periodised nutrition plan to suit your cycle and training demands, our sports dietitian Kelsey Hutton can give you everything you need. Your initial assessment with highlight your goals, current nutrition levels & areas to focus on. Your personalised plan gives you a practical & effective way to fuel your body with everything it needs for peak performance.
In part 1 of this blog post series, I talked about the concept of the female athlete triad. Menstrual dysfunction, low energy availability and low bone mass can affect active women without the right nutrition and exercise plan individualised to their needs. Now in part 2 & 3 of this blog post series, I will discuss hormonal changes across the menstrual cycle that can have an effect on exercise and nutrition.
Every females cycle will differ, but assuming a 28-day cycle, there are 2 phases – the follicular phase (day 1 -14) and the luteal phase (day 15 – 28). Day 1 of the cycle is when menstrual bleeding begins.
During the follicular phase (day 1-14), the hormones progesterone and estrogen are at their lowest, with estrogen slowly rising until ovulation occurs on day 14. Testosterone levels are also raised slightly, so muscle building is optimised. Energy levels are at their highest in this phase, and your body is able to effectively use carbohydrates as an energy source in this phase, so you can reach higher exercise intensities during training. As estrogen peaks towards the end of the follicular phase, changes in collagen structure means tendon and ligament tears are more likely to occur, so its important to ensure you are particularly careful with your exercise warm ups and technique.
Increases in strength and energy during the follicular phase means you can take advantage of your body being able to use carbohydrates more effectively as a fuel source and to aid muscle growth and recovery. Think about including carbohydrate foods as a pre-workout meal and including high fibre carbohydrate sources with your meals. Some examples include a banana smoothie before your workout, and brown rice with stir fried chicken and vegetables for dinner. Sleep is also a key consideration during this phase, make sure you are getting enough sleep after your big training sessions to aid recovery!
Stay tuned for Part 3 of this blog series which will go into the hormone changes across the second phase of the cycle and the impacts this can have on exercise performance.
If you are interested in a periodised nutrition plan to suit your cycle and training demands, our sports dietitian can provide individualised guidance. Contact reception on 9280 2322 or head to our online bookings page to book in a chat with Kelsey.
This is the first part of a 3-part series covering some nutrition considerations that relate specifically to women during exercise. For female athletes, weekend warriors and regular exercisers, hormone changes across the month can dampen motivation to exercise and can affect performance. This 3-week blog series will delve into the hormones that are impacted during the menstrual cycle, dietary strategies to assist performance at different stages of the cycle, and a concept known as the ‘female athlete triad’.
The female athlete triad is an interrelationship of menstrual dysfunction, low energy availability (with or without an eating disorder), and decreased bone mineral density.
Particularly common in young female athletes, amenorrhea, or the absence of menstruation for 3 months or longer, can lead to decreased bone health as bones lose calcium due to lower estrogen levels. Over time, this can lead to increased risk of fractures/breaks, bone mass loss, osteopenia and osteoporosis. A loss of menstruation often occurs when there is low energy availability. The body is using all its energy for metabolic processes and for training/exercise/competition, so may not have enough energy left to cover other daily demands such as menstruation. Low energy availability doesn’t just affect those with low body fat percentages or with diagnosed eating disorders, it can exist in those with adequate body fat levels! This can occur from an imbalance of training demands and food intake, especially when there are time constraints and other commitments involved.
If any of these signs or symptoms sound familiar to you, our sports dietitian can provide guidance on managing your health while fuelling exercise demands. Contact reception on 9280 2322 or head to our online bookings page to book in a chat with Kelsey.
Now that you know what the female athlete triad is, the next blog post will focus on hormone changes across the menstruation cycle and how this can impact performance. Luckily, there are dietary strategies that can be used to optimise performance at different times of the month. Stay tuned!