Posts Tagged sports injury

Exercise physiology for Patellofemoral Pain Syndrome

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:

Split Squats:

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.

Deadlift:

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.

Calf Raises:

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 .

Suitcase carry:

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.

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Swimmers Shoulder

Swimmers shoulder is a generic term used for what is an overuse issue for the shoulder, particularly concerning the muscles and tendons of the rotator cuff. Despite the name, this painful shoulder issue isn’t specific to swimmers but is seen in a variety of people, from those who are highly active to people who are couch potatoes.

People with swimmers shoulder generally experience a dull pain in the morning which ‘warms up’ throughout the day but may not necessarily disappear completely. You may also feel a sharp pinching pain in the shoulder with overhead activities. As with most musculoskeletal injuries, swimmers shoulder can have a number of contributing factors including load management, muscle strength and endurance deficits, stiffness or tightness, and inadequate neuro-muscular control of the shoulder.

Load Management

Swimmers shoulder will often come on due to an increase in the use of the shoulder. For example a swimmer may have had a sudden increase in the amount of time they’ve been training per week, the intensity, or have been training a new stroke. In those who are less active, it may be due to things like giving the house a new coat of paint or doing some spring cleaning. The reason these rather innocuous activities may cause shoulder pain is not so much related to the activity itself but to the ability of the shoulder to tolerate what you’re asking it to do (i.e. having the strength and control of the shoulder and shoulder blade to perform the activity).

Muscle Strength and Endurance

In order for the upper limb to move freely and allow us to complete tasks like reaching up to the top shelf to grab something or to reach behind us to do up the zip on a skirt, the joint itself relies less on bony stability (like the deep ball and socket joint of the hip) and relies more heavily on active stability (muscles). When these muscles don’t have the strength and/or endurance to control the shoulder joint, we can get excess movement and aggravation of the structures surrounding the joint. Often there can be an underlying weakness, but you won’t know it until you ask the muscles to do something quite difficult or something you’re not used to, such as spring cleaning, painting or a sudden increase in training load.

Range of Motion and Control

Although a sudden increase in activity is usually the catalyst, there are other factors that can leave you more susceptible to this issue and these should be targeted in terms of treatment. Tightness at the front of the chest, weakness of your upper back muscles, thoracic cage mobility and shoulder blade control all may have some contribution to a swimmers shoulder issue. As with many musculoskeletal issues, swimmers shoulder is a complex pathology which requires thorough assessment in order to identify the contributing factors. Once these have been identified, a thorough rehabilitation plan targeting the contributing factors is paramount in achieving the best outcomes for you and your shoulder moving forward. If you think you have a case of the swimmers shoulder, come in and see one of our physiotherapists for a comprehensive assessment and treatment plan that targets your specific goals!


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Runner’s Knee – Patellofemoral Pain Syndrome


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.

Rolling in of the knee (“valgus collapse”) commonly causes Patellofemoral Pain in runners.


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!


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Shoulder Impingement Is A Common Cause OF Shoulder Pain

Shoulder Impingement

Shoulder Impingement Is One Of The Most Common Types Of Shoulder Pain

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.

What Causes 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.
 

How Does Shoulder Impingement Happen?

The shoulder is made up of three bones: the scapula (shoulder blade), the humerus (arm bone) and the clavicle (collar bone). The joint itself is a ball-and-socket joint, and the tendons of four muscles called the rotator cuff muscles are very important to hold the ball in the centre of the socket. The supraspinatus tendon is the most common tendon to get impinged.

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. 

How Do You Know If Your Shoulder Is Getting Impinged?

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.

What can you do to fix shoulder impingement?

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.


If you have shoulder pain then we can help. You can speak to one of our friendly physios by calling us on 9280 2322.  We also have a dedicated Shoulder Program and you can  book an appointment online or contact us for more information. 

 

 

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Runners Knee

Runner’s Knee – Patellofemoral Pain

Sydney-siders love a good run! And with the Blackmores running festival coming up, beautiful scenery & awesome weather it’s easy to see why. So today we look at the most common type of knee pain that can affect runners as well as people playing many other sports that involve running and jumping.

 

The knee is the most common site for pain in runners, but it’s not just “runners” that are at risk. Many other sports that involve running &/or jumping have a relatively high risk of knee injuries. One very common cause of knee pain is Patellofemoral Pain Syndrome, which accounts for up to 40% of all knee problems in sports medicine centres. The pain is felt around or behind the kneecap & occurs when the kneecap (patella) does not align correctly into the groove on the end of the thigh bone (femur). It is common in young people, & affects more women than men.

 

 


Symptoms Of Patellofemoral Pain Syndrome

Pain is either felt around the front part of the knee or along one or both sides of the kneecap. It can sometimes be hard to find a specific spot where the pain is felt the most, especially because sometimes it feels like it is hidden away behind the kneecap. Your knee may be making some grinding or clicking noises, & there may be some swelling.

Often there is no specific cause (eg a fall or twist) of patellofemoral pain. Sometimes you may be able to relate it back to an increase in running or jumping volume, or things like new shoes or more hill running. It often begins as a niggle then gradually gets worse if you continue to exercise on it, eventually stopping you doing your normal training. It usually settles temporarily if you stop exercising but keeps coming back when you return.

Patellofemoral pain is usually made worse with anything that increases the load within your knee, eg taking your weight in a bent-knee position. Examples of painful activities can include;

  •    •  squatting, lunging & kneeling
  •    •  going up & down stairs or hills
  •    •  jogging or running, especially on hills or slopes

Some people also get pain from sitting in a bent-knee position for long periods of time, eg working at a desk or sitting in a movie theatre. This is because this position squashes the inflamed back surface the kneecap onto the end of the thigh bone, causing pain after a while.


Causes Of Patellofemoral Pain Syndrome

The main cause of patellofemoral pain is when the kneecap doesn’t “track” properly in the femoral groove when we bend our knee. It can get pulled out to the side of the groove, meaning that it rubs on the wrong places & becomes inflamed. Excessive or rapid increases in loading, usually due to increasing training or running volumes too fast, are also common factors that contribute to patellofemoral pain.

Poor biomechanics (i.e. the way our body controls movement) is the major factor that contributes to incorrect tracking of the kneecap in the femoral groove. Common biomechanical problems include:

  1.    1.  your pelvis drops to one side, increasing the tension on the outside of the leg & pulling the knee cap outwards
  2.    2.  poor glutes (hip muscle) strength means that your knee collapses inwards & rolls inside past the line of your big toe
  3.    3.  there may be an imbalance between the muscles on the inside of your quads (VMO) versus the outside (VL).
  4.    4.  you foot rolls in too much (pronation), causing the knee to collapse inwards so that your quads muscles have an outwards angle of pull on your kneecap.

Females are more likely to develop patellofemoral pain than males (3:2). This is due to women having a bigger “Q Angle”, which is where the quads muscles have a more outwards pull on the kneecap because women’s hips tend to be wider than mens.


What Can I Do About My Knee Pain?

Assessing & correcting your biomechanics is a big part of getting your knee pain resolved. You need to release any tight muscles on your outer thigh & hip, usually by using a foam roller or spikey ball. You will also need to strengthen muscles that are not keeping your leg and knee in the right alignment. The usual problem is that your knee rolls inwards over your big toe too much, so strengthening your glutes muscles to correct this is critical. Making sure that your inner quads muscle (your VMO) is strong enough to balance your outer quads muscle (VL) is also important. 

Your foot position also needs to be checked. The most common foot problem is over-pronation, where your inner arch collapses & rotates your shin and knee inwards too much. You will need to ensure that you have the right shoes for your foot type, eg if you are an over-pronator then pronation control shoes or orthotics are likely to help you. However as physio’s we always find that shoe type or orthotics alone are not the full solution – they are only one component. You must correct your other biomechanical factors like hip control as well.


We can help you beat your knee pain

Every day our friendly & experienced physio’s work with runners & athletes at all levels, from weekend warriors to national champions. We can help you with fast relief & get you back out there on the road, track, field or court. We specialise in finding & fixing the underlying cause of your problems so that once we’ve got you feeling good, you stay feeling good. 

If you need help with your knee pain then you can book an appointment online or contact us for more info, or give us a call on 9280 2322 to chat to one of our friendly team. 

 

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What To Eat For Faster Injury Recovery

Nutrition for injury management and prevention

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.

Food and inflammation

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;

  •   •  olive oil
  •   •  avocado
  •   •  fish oil
  •   •  salmon
  •   •  sardines
  •   •  nuts and seeds,

At the same time, avoid a high intake of pro-inflammatory food such as;

  •   •  processed foods
  •   •  take-away foods
  •   •  vegetable oils (corn oil, sunflower, safflower and soybean oil)

Once the body begins the proliferation and remodelling stages of healing (building of new tissue), a balanced diet is necessary. Ensure you eat adequate;

  •   •  protein
  •   •  low saturated fats
  •   •  a diverse range of fruit and vegetables
  •   •  low-GI carbohydrates (you will need less carbohydrates than when you were training, but more than a sedentary day)

Energy intake

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.

Eat the rainbow for injury prevention

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.

 

 

Collagen and soft tissue injuries

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.  

 

Vitamin D and bone health

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.

Fatigue and injuries

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.

Get Your Personalised Diet Plan Now

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.

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Do I Need a Physio, an Exercise Physiologist (EP) or a Personal Trainer (PT)?

So what actually is the difference between Physiotherapy, Exercise Physiology and Personal Training?

At Central Performance our physiotherapists, exercise physiologists & personal trainers all work side-by-side to care for our clients. Our  aim is to perfectly match our clients with the right program whatever their level of physical health, injury & performance. The flowchart below shows how it all fits together.


Central Performance Client Pathway


3 questions we often get asked by clients are; 

1. What does an exercise physiologist do?
2. How is exercise physiology different from physiotherapy?
3. How is exercise physiology different from personal training?

Firstly, exercise physiologists use exercise to treat chronic health conditions. The most common types of problems that our exercise physiologists treat are;

• Musculoskeletal Injuries, eg back & neck pain, osteoarthritis, sports injuries/sprains & strains, post-operative recovery like ACL knee reconstruction, shoulder & knee problems

• Cardiovascular & metabolic problems, eg high blood pressure (hypertension), heart problems, to reduce bad cholesterol (LDL & total) & increase good (HDL) cholesterol, &  diabetes management

• Mental health, eg depression & anxiety

Similar to how a doctor prescribes medicine, exercise physiologists prescribe exercise programs. When deciding on the correct program to prescribe they consider a range of factors about the client’s condition, any other unrelated conditions, previous injuries or health problems, & the client’s previous exercise experience. For example, a young male who presents with 6 months of back pain but no other injuries or medical conditions will receive a different ‘dose’ of exercise to a post-menopausal woman with a 10 year history of back pain who also has hypertension (high blood pressure). The goal is to match the client with the right type & amount of exercise, as well as to make the exercise interesting so that the client is much more likely to be consistent in their sessions.

Shoulder physiotherapyFor question 2 above, there are a few distinct differences between an exercise physiologist & a physiotherapist. Firstly, exercise physiologists specialise in treating chronic conditions while physiotherapists are more likely to see people with acute & sub-acute injuries. A chronic health condition is one that has lasted for longer than 6 months & can be musculoskeletal, metabolic or cardiovascular. By contrast acute & sub-acute injuries are within the first 3-6 months of when they began, although they also may be recurrent – where each episode is only short, but episodes may occur repeatedly over months or years.

The second difference is that physiotherapists are able to diagnose injuries & order some types of medical imaging, whilst exercise physiologists are not. If someone presents to a physio with a ‘tweaked’ hamstring after football on the weekend a physio is able to diagnose if they have a hamstring strain & what grade the hamstring strain is. By contrast an exercise physiologist isn’t allowed to give a client a diagnosis in that fashion & this is linked to exercise physiologists specialising in chronic health conditions rather than acute injuries. Similarly, physiotherapists can refer clients for some investigations such as x-rays while an exercise physiologist can’t.

Thirdly, exercise physiologists receive extensive training & education in the physiology of metabolic & cardiovascular health conditions. This gives them the skills & expertise necessary to prescribe exercise for people suffering from metabolic & cardiovascular health conditions. Physiotherapists don’t receive training to the same level in these conditions unless they have a special interest  in them & pursue further study.

Ball rollout for core stabilityRegarding the last question, there is a lot of overlap between exercise physiologists & personal trainers when it comes to musculoskeletal health. Exercise physiologists can be thought of as focusing more on corrective exercise for injury recovery, whereas personal trainers focus more on performance exercise where there are not significant restrictions imposed by injury or disease.

Personal trainers do not receive such extensive education or training in physiology, biochemistry or pathology to treat chronic health conditions. As a result they are not eligible for private health fund rebates or referrals from GPs under the Chronic Disease Management plan. Exercise physiologists however are eligible for private health fund rebates & most health insurers cover exercise physiology. Similarly, MediCare will also provide rebates for exercise physiology when referred by a GP under the Chronic Disease Management plan.

Exercise physiology rather than personal training may also be suitable for people who have no experience with exercise or gyms. Because exercise physiologists primarily treat people with chronic health conditions they receive training in cognitive behavioural approaches to help clients feel comfortable & confident while exercising. A similar cognitive behavioural approach can benefit those who have little to no experience with exercise & are therefore nervous to start exercise.

As you can see physiotherapy, exercise physiology & personal training all have different areas of specialisation. At Central Performance we believe in integrating all three in our multidisciplinary approach to provide you with a perfect pathway from pain to full performance, whatever your goals may be. For example a back pain client may initially see our physio’s for diagnosis & hands-on treatment to settle their pain & return to gentle movement. Then they may progress to exercise physiology for initial correction of movement biomechanics plus a return of baseline stability & strength. Once this is achieved they can progress to personal training to really build their strength & endurance, or train to achieve any other sporting or health goals they have.


Contact Us for More Info: For more information or help deciding which service would be the best for you to start, please contact us on 9280 2322 or via email. There is also lots more information on the webpage for each of the services – see physiotherapy, exercise physiology or personal training


 

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From Pain To Performance

client-performance-pathway-rooms-26-10-16At 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.

OLD MUSCULOSKELETAL MODEL – Triage Care

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


THE NEW MUSCULOSKELETAL MODEL OF CARE: Patient-Centred Pain to Performance Model

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.

Central Performance Client Pathway

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.

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Two quick tests to help you avoid Shin Splints this Summer!

running

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

Instructions:shintest1

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 Testshintest2

Instructions:

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:pittingoedema

– 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!

Click here for a PDF about SHIN SPLINTS. Feel free to forward this on to your friends!

 

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

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