Posts Tagged Surry Hills

How does Pilates help with my low back pain?

Low back pain is one of the world’s most common conditions and is a leading causes of disability and work absence worldwide. It affects over 80% of the world population and can result in a significant personal, social and financial burden.1 Low back pain usually settles down within 4-6 weeks but has an 80% chance of reoccurring within 12 months of the initial injury. Exercise therapy is the most common form of treatment for low back pain. It is low cost, easy to access, has a positive biological affect on the body and is recommended in most clinical practice guidelines.2

The Pilates method aims to improve posture and body awareness while building strength. The six basic principle of Pilates includes tightening the ‘powerhouse’ (trunk and gluteal muscles), concentration (cognitive attention), control (postural management), precision (accuracy), flow (smooth transition) and breathing while performing a range of exercises.2
It is a great way to get people moving in a smooth and controlled way. At Central Performance we use the reformer, wunda chair and mat-based exercises in a circuit style approach so that the exercises are varied and fun. These exercises use springs and body weight as resistance and can be adjusted to your ability. Our initial assessment involves a history of your injury and a physical examination to determine your exercise program. Than we get started! Starting on four 1-on-1 sessions to get used to the various exercises on your program. From there the choice is yours. Continue with 1-on-1 sessions or move to our group classes (max 4 people).

But how does this help with low back pain?

Just move! Our backs love movement. The worst thing to do when you have low back pain is to stop moving and stop exercising. Pilates allows you to move and exercise in a nice controlled and monitored way without using heavy weights. It can be a way of progressing your exercise tolerance or to transitions back into gym-based exercise.

I need a stronger core to get rid of my back pain!

This is often a very common perception in today’s society. We are often told to strengthen our core to prevent low back pain. However, if you have had ongoing or episodic low back pain than you may already bracing and overusing your core subconsciously to help ‘protect’ your back. Before strengthening your core it is important to regain normal relaxed movement of the spine. This relaxed spinal movement can fundamentally change the way your back behaves day to day. Pilates is a good way of starting off this process, using controlled movement of the spine before progressing to more progressive strengthening exercises, whether it be at the gym or harder Pilates exercises.

  1. 1. Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2163-2196
  2. 2. Yamato TP, Maher CG, Saragiotto BT, Hancock MJ, Ostelo RWJG, Cabral CMN, Menezes Costa LC,Costa LOP Pilates for low back pain. Cochrane Database of Systematic Reviews 2015, Issue 7

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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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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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Recovery (part 4): Compression Garments

Although a relatively recent addition in Australia, Compression Garments (CG) have rapidly become quite the fashion statement, initially designed to promote recovery from hard training and competition and subsequently to help improve performance.

Compression Garments are a type of tight-fitting form of clothing made from elastic material providing a gentle compression of the limbs. Some of the reported positive outcomes include:

  • Help Thermoregulatory control (maintaining correct body temperature)
  • Provides greater joint-position awareness
  • Enhanced local blood blow
  • Enhanced removal of post-exercise waste products
  • Enhanced muscle oxygenation
  • Reduced muscle oscillations
  • Reduced swelling
  • Reduced creatine kinase concentrations 
  • Reduced perception of post-exercise muscle soreness and fatigue

There is also the possible placebo effect and psychological aid of wearing CG and perceived recovery and performance improvements to be factored in, as anecdotally athletes often speak positively of their helpful effects. The magnitude of physiological recovery improvements observed in the literature are similar to what has been seen with cold-water therapies or light exercise.

While the research currently has shown some recovery benefits from wearing CG it should also be noted that a great deal of the research is of poor quality and clouded with inconsistencies.

It should be added that there is also the risk of bias due to sponsorshipship and potential financial gain.

While there have been some benefits shown and no observed adverse effects on performance or recovery with their use, there is still also no reliable criteria for best practice.  

It is therefore suggested that if CG are used they should be used as an adjunct to more proven and reliable recovery enhancing modalities such as enough quality food, good sleep hygiene, as well as fatigue and stress management strategies. Currently, the research is not strong enough to provide conclusive recommendations.

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Recovery (part 3): Stretching

Stretching has been tied to performance since the very beginning and currently, there is some evidence to suggest that there are small recovery benefits to be gained from post-exercise stretching.

For this instalment, we’ll be looking at some of the current evidence on stretching for recovery. Stretching to increase flexibility or as part of a warm-up will be covered in more detail another time.



The most common reasons for post-exercise stretching are to reduce soreness, help recovery and to regain pre-training flexibility, and while stretching is still common practice, much of the initial supporting theory has been debunked. 

Type

There are many types of stretching but the two categories most often subscribed to for recovery are static and dynamic. 

Static:(Self-administered, in place/no movement) 

Passive:(Partner administered) 

Dynamic:Active (movement based) 

Ballistic: Active / fast bouncy actions at end range)


Effects on Muscle Soreness 

A dig through the current literature will show that while there is some research suggesting positive results from post-exercise stretching on muscle soreness, much of it is low quality. While there is also widespread anecdotal observation of reduced muscle soreness with post-exercise stretching, there appears to be very little or no effect on muscle soreness reflected in the current body of evidence.


Blood Flow 

Static stretching appears to temporarily constrict the blood vessels through compression reducing blood flow, oxygenation and red blood cell delivery to the muscle. Shortly after the applied stretch, however, there appears to be a sudden and enhanced surge of blood flow greater than in pre-stretch conditions. This short-lived shunting effect may assist the recovery process through enhanced nutrient delivery and waste removal although this has not been firmly established in the literature.


Enhanced Parasympathetic Activity 

The PSNS is the branch of the Autonomic Nervous System associated with a ”rest and digest” response. Essentially, it slows the system down, reduces neural excitability and helps facilitate the recovery and adaptation process.
Static stretching has been shown to influence PSNS modulation, acutely (same day) and across several weeks after a consistent application over 28 days. This was demonstrated by positive changes to heart rate variability, which in recent times has become a popular metric for measuring ANS status and training readiness. 


Flexibility 

More research in recent times has pointed to static stretching leading to an improved stretch tolerance, rather than increased tissue flexibility. Some research has also suggested that improvements in flexibility may occur due to a temporary decrease in neural excitability or resting tone as a result of static stretching. Some newer evidence suggests that flexibility improvements may also be the result of change to the mechanical properties of the muscle-tendon unit through stretching.

In summary: 
. Static stretching has little to no effect on post-exercise muscle soreness

. Following post-exercise static stretching, a ‘shunting’ effect occurs resulting in a temporary increase in blood flow and waste removal.

. Static stretching promotes relaxation by enhancing PSNS activity.

. Static stretching creates short-term improvements in flexibility, and reduced neural drive.

While it appears that there are a few mechanisms through which static stretching can influence recovery, these changes are not meaningful enough to warrant using static stretching as a stand-alone, or primary method of recovery. 

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Recovery (part 2): Sleep

Following our introduction to recovery, we’re going to continue the series looking at some of the research around many popular recovery methods and offer some practical take-aways that you can begin to apply right away.

First up on the list is sleep – one of the most important influences on recovery, one of the simplest to address and yet is often the most overlooked of all performance variables.


Sleep is a needed resource for psychological and physiological wellbeing, during which time many of the bodies more potent repair and recovery processes are kicked into overdrive.  It is generally accepted that the primary purpose of sleep is restoration – To recover from previous wake-period operations and/or prepare for functioning in the subsequent wakefulness period. 

Sleep is also vitally important for memory consolidation and metabolic healthby potentially modifying energy intake and expenditure which can undermine dietary efforts.

An individual’s recent sleep history (consisting of both duration and quality) can have a dramatic influence on daytime functioning. Research has firmly established that sleeping less than 6 hours per night for four or more consecutive nights can: 

1. Impair cognitive performance and mood

2. Heighten risk of illness and injury

3. Disturb metabolic health, appetite regulation and immune function

There are many reasons why sleep habits may be negatively affected, some of which include:

Stress, nervousness, thinking, worrying, planning.

Illness

Sudden change to routine

Unsuitable diet/nutrient deficiency

Poor sleep habits and environment (eg noise, lighting, temperature, late television watching, late caffeine use, late activity). 

In addition to the above, Erlacher et al. 2011 asked 632 german athletes from various sports about their sleep habits leading up to important events or competitions, with the results showing that: 

  • 66% slept worse than normal at least once prior to an important competition
  • 80% reported problems falling asleep
  • 43% reported waking early, and
  • 32% reported waking up through the night

Factors identified as reasons for poor sleep included:

  • Thoughts about competition (77%)
  • Nervousness about competition (60%)
  • Unusual surroundings (29%)
  • Noise in the room (17%) 

The value of quality sleep is clear and it is easy to see how it can be impacted by many of the above variables which we all face from time to time. What isn’t so easy though, is how best to mitigate these factors to ensure that you get a good night sleep and subsequently prevent the associated performance decline from sleep loss.

Suggestions for improving sleep:

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

Switch off tv, computers, tablets, and smartphones 1-2 hours before sleep time. These will disturb the production of hormones that prepare you for sleep. 

2. Develop a ‘Wind down’ routine before bed

Slow down and de-stress as much as possible before bed and try to establish consistent sleep and wake times. A shower before bedtime has been shown to improve sleep onset latency. Research has also shown that almost half of all insomnia cases are linked to stress or emotional upset. Avenues to reduce stress are highly individual and situation dependent, so finding ways to reduce stress are paramount to improving sleep, and long-term health and wellness. Some proven strategies include: 

  • Exercise 
  • Deep breathing exercises 
  • Meditation
  • Daily journaling 
  • Gratitude journaling
  • Taking a walk
  • Being outside/sun exposure
  • Social activities / being with friends and loved ones

Habits and Environment

3. A quiet sleep space is a key

If noise can’t be avoided try using headphones with instrumental music at a low volume, or keep a fan on for an acutely distracting ‘white noise.’

4. Temperature, darkness, and clothing

Approximately 18 degrees Celsius is a cool room temperature that has been shown to help comfortable sleep occurrence. Thick bedding and clothing must also be avoided if it causes overheating. A dark environment with limited lighting can also help the body recognise that it’s night time and time to begin the process of preparing for sleep. 

5. Coffee and heavy meals

Avoid caffeine, big meals and heavy amounts of liquid before bed. 

6. Take Naps Where You Can & Need To

Naps can be beneficial to catch up on lost sleep, however, avoid them later into the afternoon if it might impact your regular sleep time. Blanchfield et al. 2018 recently showed that a short afternoon nap improves endurance performance in runners that obtain less than 7 hrs of nighttime sleep. Napping might be an important strategy to optimise endurance exercise in other athletic and occupational scenarios when sleep is compromised (eg long-haul, intensified training etc).

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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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