Posts Tagged Sydney

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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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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Can Strength Training Help You Run Faster?

Run Faster For Longer With Less Chance Of Injury

The right strength program can improve your performance as well as reduce your risk of injury.

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.

What Type Of Strength Training Is Best For Runners?

Training needs to be personalAlso 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.

Can Strength Training Also Reduce My Injury Risk?

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.


We’ve Got Runners Covered

The Central Performance Running Centre helps runners of all abilities improve their performance and reduce their risk of injury. Our strength coaches and exercise physiologists can get you on a personalised program that is effective, efficient and tailored just right for you. 

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. 

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How Do I Manage A Tendon Injury?

Tendon Injuries

What are they? What should I do? What should I not do?

Tendinopathy is a common condition that results from overloading a tendon. It used to be called tendinitis however research shows that usually not much inflammation is involved, hence the name change. Lower limb tendinopathy is common in sports including running, basketball, netball & football. Upper limb tendinopathies occur frequently in tennis & other racquet sports, swimming, & throwing sports like cricket & baseball.


What is tendinopathy? And how did I get it? 

Tendinopathy occurs when the tendon’s main tissue, called collagen, becomes damaged because it is no longer able to cope with the load being put through it. This overloading usually happens when there is an increase in exercise frequency, volume or intensity. This may be someone starting the gym again after a break, when stepping up training in preparation for a race or fun-run, or when you start pre-season training after resting from your sport in the off-season.

As the tendon becomes overloaded it starts getting irritable and in some cases swollen. You will usually feel pain in the morning after waking up, when you move again after resting or sitting at your desk for a while during the day, and maybe at the start of exercise. Often in the early stages of tendinopathy your pain will disappear as you warm up, but usually comes back again after you cool down, rest or sleep. It will usually get worse over time if you keep overloading it. 


Ok, so what should I do?  

There is a lot of conflicting advice out there about how to deal with tendinopathies. Much of it is out-dated and we now know that old-style things like stretching and completely avoiding painful activities will actually slow or prevent your recovery.

For a great overview of tendon injury & management guidelines check out this video from Professor Jill Cook, a leading research expert in tendon management.


Here is a summary of the main Do’s and Don’ts for recovery from tendon injuries

 
DO:

•  Continue to exercise at a sustainable level. As a general rule a little bit of pain is acceptable during exercise in a tendon with tendinopathy. As a rule of thumb 3 or 4 out of 10 pain level during exercise is okay as long as the pain stops within an hour after finishing exercise and isn’t worse that night or the next morning

•  Get your tendon assessed and begin treatment early. Like many things the earlier you get on to it the faster your recovery, the less treatment you are likely to need, and you give yourself the best chance for a great recovery.

•  Start heavy, slow resistance exercise. Tendons need a load placed on them to allow them to repair themselves. The best way to start loading a tendon with a tendinopathy in a controlled fashion is with heavy, slow resistance exercise. Look for a tempo of approximately 3 seconds on the concentric (lifting) phase and 4 seconds on the eccentric (lowering) phase. Again a little bit of pain during heavy slow, resistance exercise is okay as long as it stays at a 3-4 out of 10 level and does not persist after stopping exercise.

•  Be consist with your exercise. Tendons prefer to be used consistently and performing your exercises regularly will help with your rehabilitation from a tendinopathy

 
DON’T

•  Stop exercising or using the muscle completely. Like we said earlier, tendons need consistent loads to be placed on them in order to repair themselves. Stopping exercise completely may temporarily stop the pain but that pain is likely to return when you return to exercise as very little healing will have taken place.

•  Stretch the tendon. Stretching a tendinopathy is similar to itching a mozzie bite, it might provide some short term relief for the pain in the long term it will likely slow the healing. This is because stretching a tendon will usually cause it the tendon to get squashed against the bone it attaches to. This compression against the bone will usually aggravate the tendon and slow down its healing.

•  Try and rush your rehab. Tendons do not have a good blood supply and therefore are slow to recover. In some tendinopathy cases it can take 12-18 months for the tendon to remodel and recover. Be patient and consistent with your rehab. If you rush it and try and increase your exercise and loading of the tendon too quickly you will likely aggravate the tendinopathy and slow down your recovery.

 

For more information call us on 9280 2322 or book online to get your tendon checked out by one of our friendly physios.

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3 Things You Must Have Before You Begin A Training Program

Spring usually marks the beginning of an increase in gym traffic as many people begin to shake off the winter dust and head into the gym ready to shape up for the summer.
Unfortunately, much of this enthusiasm will wain early and the majority of well-intentioned and under-prepared trainees will fall off the path and never achieve the things that they could have.
Here are three things that we suggest you explore with yourself honestly and objectively, and address, before you begin your fitness journey, in order dramatically increase the chances of success and having your efforts come to fruition.
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1. A Reason WHY: 
Having a specific and meaningful purpose behind your training can serve as a strong foundation, and a fallback reminder for when times get tough, of what you truly value and why it’s important to do all the little things that are necessary, inconvenient and oftentimes uncomfortable in order to reach your goals. This is particularly important during the initial (and most challenging) period of trying to establish new habits and lifestyle change.
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The things that we say to ourselves, matter.
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So make sure that you anchor all of your actions off of a clear and powerful purpose and you will dramatically increase your chances of staying the difficult course towards success. As Roy Disney once said: ”When your values are clear to you, making decisions becomes easier.”
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2. A Plan
This one would seem like common sense but surprisingly the majority of gym-goers are entering the gym with no clear goal or plan of action and often end up performing whatever exercises come to mind at the time. The problem with this approach, however, is that:
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Random training yields random results. Period. 
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The old ‘something is better than nothing’ response is no excuse either. Particular training goals will have a very specific set of requirements that are guided by proven scientific principles and practical application.
Simply doing what you feel like is a road that leads to nowhere in particular, very quickly.
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A plan will give you a direction to send your best efforts, guard-rails to keep you on track against the many options and distractions as well as feedback on results. Your program should also have both short and long-term considerations in mind, starting from where you want to be, working back to where you are now and broken up into smaller, more manageable chunks of training time.
This provides the flexibility to change course throughout the process based on results and offers many smaller, specific and more attainable goals along the way that inject a bolstered focus and motivation to your training that you wouldn’t have otherwise.
Remember, random training yields random results. If this is not an area of specialty for you, getting a plan built by an expert in the area of program design can save you significant time, effort and frustration.
The same way that we rely on a mechanic to oversee the safe and efficient running of our vehicles, a doctor to oversee and provide guidance on our health and well being, it’s also valuable to seek help from an exercise professional who can guide you in the right direction with a clear plan of action.
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Having the right plan will work far better than having no plan at all and leaving all of your progress to wishes and guesses. Ultimately, the benefit of having a plan is that it provides clarity and focus. Discovering your why will provide you with a vision of what you want to attain, a plan will provide you with the clarity of what needs to be done, and the focus to address the small daily actions that will add up over time.
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Wishes and guesses: the preferred strategy of every unsuccessful person you know.

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3. A Support Crew: 
A support network of people who care about you, respect your goals, and who genuinely want to see you succeed is a hugely underrated component to success in any endeavour. There are going to be challenges and you will likely stumble from time to time along the way and having good people around you who’ll lift you in those difficult times might just be the very thing you need at the time to keep going.
Having somebody to be accountable to also helps, and this can be a training buddy, a coach or a friend to whom you can announce your intentions to, and check in with on a regular basis to hold you to your word.
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Remember, nobody has to understand or agree with your goals, but it is important that you gather around you people who respect and support your choices. Your environment matters and mediocracy loves company. Choose your support crew of coaches, training partners, and friends wisely. Find people who will push you and pull you up on your excuses. People you can lean on without relying on, and who you genuinely enjoy being around.
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If you’re looking to get started and would like to do it right, reach out to us here.

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

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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When To Change Exercises And Why

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.

 

For example, a typical upper body pushing program might look like the following:
  • 5 total exercises per session,  3 sets of each exercise, 2 pushing sessions per week (30 total sets)
  • Combination of flat, incline, barbell and dumbbell exercises on both pressing days
You could instead try performing the following: 
  • 3 total exercises per session, 5 sets of each on each exercise  (30 total sets per week)
  • Flat or Incline exercises only for 2-3 training cycles
  • Barbell or dumbbell exercises only for 2-3 training cycles

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.

Have options.

Do less and do it better.

DJ

 

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. 

 

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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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