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.
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:
Foam rolling is an extremely popular form of self-massage, with a huge number of athletes from almost all sports using it in one way or another as a part of their preparation for either training or competition.
Here at Central Performance, we get a great number of new clients asking about foam rolling, and whether it will be helpful to them not only as a part of their training, but in their everyday injury maintenance. We encourage our clients to utilise the foam rollers in their gym or homes every day, as they are a great way to not only help prepare for exercise, but also recover from it!
Foam rolling is a fantastic tool to use as a part of rehabilitation because they enable you to release tight areas of the body on a daily basis, leading to improved movement and performance. These tissues can be tight due to injury from regular training, or even sustained postures throughout everyday activities e.g. desk-based workers often experience tight hip flexors from having their hips in a constantly flexed position at their desk all day.
Foam rolling is also extremely useful when recovering from exercise. Evidence shows that Delayed Onset of Muscle Soreness (DOMS) is significantly reduced when performed immediately following exercise, and then both 24 and 48 hours on muscle groups that were the main focus of the exercise session. Enhanced recovery leads to a greater level of ability and performance, hence why elite athletes everywhere are using it!
1. Quads: rolling is very helpful for reducing tightness is your thigh. Runners find this especially useful, and it can help prevent or manage patellofemoral (kneecap or runners knee pain) and quads strains. To do it, lie on your front with a foam roller under one leg and slowly roll up and down the length of your quad.
2. Calf: excellent for runners with tight calves, place a foam roller under one calf and lift off the floor with your hands, rolling up and down the length of your calf.
3. Lateral (outer) thigh: great for reducing soreness on the outside of the hips or knees, lie on your side with a foam roller under the outside of your leg and roll up and down the length of your thigh.
So if you are feeling a bit tight and sore with running, training at the gym, netball or whatever, give these a try and let us know if you need any help!
For more tips on training, mobility, strength and rehab make sure to follow us on Instagram (@centralperformance, #centralperformance), Facebook (@centralphysioandperformancefitness), or Twitter (@centralphysio). And keep an eye out over the coming weeks for more great recovery tips!
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.
When it comes to choosing which exercises to use in your strength training program, we encourage trainees to approach exercise selection with a balance of both pushing and pulling movements for the upper and lower body. This gives you a more complete development and greater overall balance and movement proficiency in a variety of different movement demands.
This usually involves targeting movements and body parts from multiple angles which, aside from symmetry also helps to:
1. Accumulate needed training volume, which is an important factor for building muscle size and strength.
2. Sculpt and shape the body towards ones desired proportions if training goals are more aesthetic driven.
3. Target unpractised or lagging movements and strengthen specific contributing muscles.
We’ll often have new clients show us the strength programs they’ve been using and have put together themselves to get some feedback. Often we’ll see included almost every known exercise variation for a body part that you can imagine in an attempt to cover all angles. This is a fine idea in theory, however, there are a few things to consider when trying to cover all possible angles and one of those considerations is something that I like to call variation preservation.
If you use all of the most productive or favourite exercises in your program, you will have too few exercise variations to choose from or to progress towards once you’ve reached training a plateau and are no longer making the kind of progress you used to on those exercises. The human body is an amazingly efficient and adaptive organism and certainly will, over a short period of time adapt to a given training plan, and this is where you’ll begin to see your progress slow and eventually stop altogether. When this happens, you will need some strategic deviation and a variant go-to exercise that still gives you similar qualities, while offering a fresh stimulus again, and all without losing any of the progress you have built up to this point.
Another more obvious problem with this ‘do everything’ approach is that you may end up doing way more than you need with potentially overlapping and redundant exercises, and subsequently using up more of your valuable recovery ability, that could go towards repair and building.
One of the possible solutions that I often suggest is to do fewer total exercises and more total sets of those exercises. Specifically, pick fewer exercises, but make sure that you use mostly your high return movements and keep a few of them in your back pocket for a later program. Doing more total sets of fewer exercises allows greater focus to be had, and for the beginner lifter in particular, more high-quality technique rehearsal.
You’ll notice that with option 2, you can manage the same total weekly training volume and focus it towards fewer exercises. Option B also offers a complete pressing program and leaves you with plenty of effective variations to utilise once progress begins to slow or stops.
It has been well documented that strength adaptations can drop off at around the 3-4 week mark using the same schedule. From here you may try changing the grip that you use, the set & rep scheme, the rep speed, and even the rest period between sets. Any of these as well an intermittent deload week can provide enough of a small change and a fresh stimulus, and still be fairly consistent enough to make continued improvement. After approximately 2-3 training cycles, however, it may then be a good idea to swap out those exercises and bring in the reserves.
In closing, try not to do every exercise possible – leave some high-return favourite exercises on the bench for variation preservation, to call in when you need fresh options to go to and for continued success in your training.
Do less and do it better.
If you like us to take a look at your training programming or would like some help with building one, reach out to one of our performance specialists and we’ll point you in the right direction.
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.
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.
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.
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.
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.
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.