Posts Tagged strength

Exercise Physiology for hip and knee Osteoarthritis

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:

  1. Specific local strengthen exercises for muscles around the knee and/or hip.
  2. Increase ranges of motion of motion of the knee and/or hip.
  3. Progress exercises to full-body exercises to increase strength and confidence in movements that replicate activities of daily living such as stair climbing.

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.

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The Powerful Combination of Physio and Fitness When Coming Back From an Injury

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. 

Danny James, Head Strength & Conditioning Coach at Central Physio & Performance Fitness
Danny James, Head Strength & Conditioning Coach at Central Physio & Performance Fitness and can be reached at danny@centralperformance.com.au

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Should We Really Bother Foam Rolling So Much, Really?

For all the jazz around foam-rolling these days it may be surprising to know that the underlying mechanisms are still not well understood and there is a paucity of high-quality and well-designed studies available.

Some of the proposed mechanisms of effect may include:

1. Reflex neural inhibition

2. Increased stretch tolerance

3. Mediating pain-modulatory systems

What we do know is that foam-rolling appears to be effective for producing short-term gains in flexibility without reducing performance. And while the benefits to muscle function have not yet been established, there does seem to be a demonstrable reduction in post-exercise muscle soreness as a result of post-exercise rolling.

So, from the research that we do have, it’s safe to say that foam-rolling is perhaps not the miracle saviour for poor exercises choices or not moving enough that we once thought it was.

Reference:

1. A Meta-Analysis of the Effects of Foam Rolling on Performance and Recovery. Wiewelhove, et al. 2019

2. The Science and Physiology of Flexibility and Stretching : Implications and Applications in Sport Performance and Health. Behm, 2018.

Danny James, Head Strength & Conditioning Coach at Central Physio & Performance Fitness
Danny James, Head Strength & Conditioning Coach at Central Physio & Performance Fitness and can be reached at danny@centralperformance.com.au




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Why Should We Train Through A Full Range of Motion?

We’re often asked about the benefits of going through a full range of motion with your strength exercises. Here is why we recommend that you do and what it means for your training.

1. You get a more complete stimulus and development across the full length of the muscle. We know that muscle fibres don’t always run the entire muscle length from origin to insertion. We also know through the specificity principle that strength gains are specific to the joint angles that are trained so it is important to cover as much of the movement arc as you can. A full range of motion allows greater activation of as many fibres as possible and better strength and hypertrophy gains.

2. Technique standardisation. When you go through the same, top to bottom range for each and every rep, you can be sure when you are progressing and not simply changing form to accommodate the load.

3. Length and strength in long positions. Research has been piling high with the benefits of loading in long muscle lengths (such as in the bottom position of a squat or stiff-legged deadlift, pull up, or bench press where you feel the greatest stretch). This enables strength gains specifically in those ‘stretch’ positions where typically we are not able to produce as much force. Loading into lengthening (eccentric loading) also allows greater overload as well as flexibility improvements.

4. Less injury risk. There is a greater dispersal of stress across more joint systems and larger excursions of motion mean that less load is needed to provide an overload. This greatly reduces the likelihood of a training-related injury.

There certainly are circumstances were you might consider reducing range, such as:

1. To provide a greater overload in a particular joint position thereby effecting a specific muscle or group of muscles. Less range means more weight can be used so caution is advised here. This is to be used sparingly and mostly for the advanced lifter only.

2. Specific sport application – half squats have been shown to have carry-over to running and sprinting activities.

For the most part, the bulk of your training should emphasise taking the joint through as much pain-free range as is controllable and the muscle through full stretch to full contraction. It might mean you’re using a little less load however the benefits hugely outway the risks:

  1. Reduced risk of injury which can set your training back
  2. More complete development of a muscle and strength in weak positions.
  3. Consistent technique and clairty of progress.

References:

Altering the length-tension relationship with eccentric exercise : implications for performance and injury. h

Full Range of Motion Induces Greater Muscle Damage Than Partial Range of Motion in Elbow Flexion Exercise With Free Weights

Specificity of a limited range of motion variable resistance training

Why do full range of motion exercises not increase strength at all muscle lengths?

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Is Your Phone Ruining Your Sleep?

Are you having trouble falling asleep?

A tonne of research has shown us that the use of electronic devices prior to sleep time can wreak havoc on our ability to fall asleep.

It turns out that the short-wavelength blue light emitted from smartphones, tablets, and other devices disrupts proper melatonin production.

Melatonin is a hormone released primarily by the pineal gland that regulates sleep-wake cycles. It is released at night and in conditions of prolonged darkness as a signal to the body that its night time.

Figueiro et al. 2012 looked at a small sample size of 13 individuals who used self-luminous tablets to read, watch movies and play games prior to bed.

The study concluded that light from these self-luminous displays 2 hours prior to bedtime diminished melatonin production by about 22%, possibly affecting circadian rhythms and normal sleep cycles.

Some things you can do to help not only get a good night’s sleep but help get to sleep in the first place include:

1. Develop a ‘POWER-OFF POLICY’ before bed

Switch off your electronic devices at least 1-2 hours prior to bedtime.

2. Develop a ‘Wind down’ routine before bed

Slow down and de-stress as much as possible before bed. Some other suggestions include taking a walk, meditating, reading a book, gratitude journaling.

3. A quite, cool, and dark place

Reduce any distracting noise, avoid warm clothing or bedding and aim for a temperature of approximately 18 degrees Celsius.

4. Avoid coffee, heavy meals and liquids before bed

Limit feelings of fullness, digestive discomfort and sleep disturbances due to late-night bathroom trips.

Danny James is the Head of Personal Training and Strength and Conditioning services at Central Physio and Performance Fitness, located in Surry Hills in the Sydney CBD area. danny@centralperformance.com.au

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What’s Better For Recovery From Strength Training? Whole Body Cryotherapy, Cold Water Immersion, or Placebo.

In our post on compression garments and recovery, we brought up the potential role of the placebo effect which sparked some questions and commentary.

Adding a little more to the placebo/recovery discussion, in a new study from Wilson, et al. 2019 compared the effects of cold water immersion (CWI), whole body cryotherapy (WBC) or a placebo (PL) intervention on recovery markers after a resistance training session.

Although a single training session does not reflect the everyday workload demands placed upon competitive athletes, there was substantial enough effect on the recovery markers used following the single training session to directly compare the three interventions.

What did they do?
24 males with a minimum training age of 12 months were matched into CWI (10mins at 10 degrees Celcius), WBC ( 3 and 4 mins at – 85 degrees Celcius) or PL group and performed a high volume lower body resistance training session at 80% of predicted 1RM.

Recovery markers were assessed before and after at 24, 48, and up to 72 hours post-exercise including ”Perceptions of soreness and training stress, markers of muscle function, inflammation and efflux of intracellular proteins.”

What happened?
The single training session did cause the expected perceptual soreness and muscle function disturbance with WBC managing to attenuate soreness at 24hrs and positively influencing peak force at 48 hrs post, greater than in CWI pr PL group. This has been a consistent finding in the literature to date: Stanley et al. 2012; Leeder et al. 2011; Versey et al. 2013; andRoberts et al. 2014.
It should be noted however that the WBC temperatures used in the study (- 85 degrees Celcius) were higher than those typically suggested (-110 to 140 degrees Celcius) possibly influencing results.

Aside from this small difference, it appears that ”many of the remaining outcomes were trivial, unclear or favoured the PL condition.”

The study concluded that while WBC may perform slightly better on some recovery indices following a single resistance training session, overall neither WBC or CWI performed better than the placebo treatment at accelerating recovery.

Readers should be aware that we are still not aware of the chronic effects of cold water therapies and that some research has suggested it can negatively interfere with vascular and muscular adaptations from resistance and endurance training while CWI has shown some small benefits for recovery from endurance protocols.

Danny James is the Head of Personal Training and Strength and Conditioning services at Central Physio and Performance Fitness, located in Surry Hills in the Sydney CBD area. danny@centralperformance.com.au

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Effective Exercise Treatment For Hamstring Strains

Strength, Flexibility and Running Are Key Elements of Hamstring Rehab Programs

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!

 

The three main treatment avenues we use are: Strength, Flexibility and Running.

1. Strength

1 Leg Barbell DeadliftsStrength 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.

2. Flexibility

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.

3. Running

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.

 

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What To Do To Help Recovery

The four main components that we address when building a high-performance program are mindset, movement, nutrition, and recovery. With this post and the few to follow we are going to look at some things that you can do to influence an often overlooked but vital piece of the performance puzzle, recovery.
First up, here is a general overview.
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”Every training element has a point of diminishing returns. Our job (the coach’s job) is to find it shift emphasis and cycle back at the optimal point in time.” ~ Derek Hansen
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It’s important to understand that physical (and mental) exertion is a stress input that requires a recovery process and ultimately triggers a particular adaptation. Within the training realm, your workout is the stressor event. After a difficult session, there is an alarm reaction in the body caused by working out that results in a mobilising response, creates an inroad to your recovery and an acute performance decline. After this, a rebuilding period is required for the body to build back up to baseline and beyond in order to withstand future training inputs.
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The rebuilding or recovery stage is made up of the physiological events that occur between workouts and is helped along by good nutrition, enough sleep and various other activities that we’ll talk more about later.
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 If you’ve done enough to recover from your training inroads and adapted to a higher ceiling of resilience, you’ll notice a small increase in performance (faster time, longer distance, heavier weight etc). It can be said then that you’ve completed the cycle and gained a positive adaptation from your training.
You’ve gotten a little better, and so the cycle continues. Apply an appropriate and recoverable stimulus, and repeat.
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Stress + Recovery = Adaptation
…or 
Work + Rest = Success

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As you can see, improving performance is a delicate balance of measured training and healthy supporting habits to maximise the result of your efforts. Recovery is the necessary bridge between the work that you do and what you get out of it. You don’t progress from simply training alone.
 
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There are two parts to recovery: Rest and Regeneration.
Rest is an entirely passive strategy, involving a deliberate attempt to minimise planned movement and the mental and emotional duress associated with aiming one’s efforts at a long-term training plan.
Rest is aimed squarely on achieving physical and psychological recharge.
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Regeneration involves active, movement-based strategies used to minimise fatigue, replenish energy systems, encourage tissue healing and function, re-sensitise to the training stimulus, and speed up the recovery process.
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Some of these strategies include manual therapy, stretching, low-stress aerobic activity, and cold therapies to name a few.
 
We will discuss some of the strategies in the next instalment.
 
Stay tuned…
 

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Should You Be Starting A Pre-season training Program?

Pre- Season training: why is it important?

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!

Pre-season strength trainingA 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

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