Cricket is played globally and is the second-most popular spectated sport behind football (also known as soccer in Australia – sorry AFL and rugby fans!).

Cricket is quite a unique sport which is played across three main formats at a semi-professional and professional level – T20, one-day and test matches. T20 is the shortest format of cricket, and involves up to 20 overs (six balls per over) bowled by each team, compared to one-day matches where each team could bowl up to 50 overs each. Test matches are the longest format and can last five days with each team batting twice and 90 overs bowled each day.

The variety of different match formats, and a range of skills needed (running, throwing, catching, bowling, batting, jumping etc)  can increase a person’s risk of overuse and impact injuries.

What are the most common cricket injuries?

Injuries were most commonly sustained by bowlers (41.3%), followed by fielders and wicket keepers (28.6%). Injuries were more commonly reported at the start of the cricket season.

Players less than 24 years old were found more likely to sustain an overuse and bowling related injury, compared to an older or more experienced player.

Injuries to the lower body accounted for approximately 49.8% of all total injuries, followed by the back (22.8%), upper body (23.3%) and neck (4.1%) areas. The most common injuries sustained in cricket are:

Upper body injuries (most common in fielders and bowlers):

• Tendinopathy of the rotator cuff and biceps tendons most common around the shoulder.
• Lateral elbow epicondylalgia (or tennis elbow) is most commonly experienced by batsmen, and can be influenced by the player’s technique and the type of equipment (heaviness of bat). Other elbow complaints may include medial elbow epicondylalgia (or golfer’s elbow) and impingement of soft tissue and bone structures especially when throwing.
• The hand was more commonly injured than wrist, mostly contact related such as bruising and finger dislocation or injury.

Trunk injuries (most common in fast bowlers):

• Side and back chest wall muscle strains.
• Lower rib periostitis (overuse related, referred to ‘shin splints’ of the trunk).

Lower back injuries (most common in fast bowlers):

• Disc injury or degeneration.
• Bony changes such as stress reaction, stress fracture (most common seen on the side opposite to bowling arm). Bone stress injury occurred in 11-55% of young bowlers compared to 4-6% of the general population.

Lower body injuries:

• Strain of the hamstring and quadriceps muscle groups occurred most commonly.
• Hamstring and abdominal muscle strains found most common to occur on the non-bowling side compared to quadriceps and calf muscle strains on the bowling side.
• Common knee injuries include patellar tendinopathy, patellofemoral joint (knee cap), chondral degeneration and tibial (shin) and femoral (thigh) bone stress reactions and fractures.
• Injury to the foot and ankle accounts for approximately 11% of injuries sustained by fast bowlers. Common injuries include ankle ligament sprain and impingement between soft tissue and bone structures at the back of the ankle.

How can we prevent or manage injuries in cricket?

Involvement and communication between your health professional and coach staffing is very important to minimise risk of injury and for the management following an injury. A Physiotherapist will be able to assist to identify potential contributing factors that may increase your risk of injury and implement appropriate strategies to address these factors.

Strategies may include:

• Address muscle flexibility, strength and endurance as indicated by a thorough assessment
• Observe technique and movement patterns in training and match day performance such as when bowling, fielding and batting
• Provide appropriate feedback and advice working collaboratively with your coach, and to monitor training match day loads.
• For bowlers it is important to consider your bowling pattern or style, number of bowling sessions during a week/month/year, number of deliveries bowled each session and week and number of rest days during a week.

Need more help?

For further information on preventing and managing cricket related injuries please contact us. Our team of expert health professionals at Move for Better Health will be able to assist in developing a management plan to support your sporting goals.

References

Arora, M, Shetty, S & Dhillon, M 2015, ‘The shoulder in cricket: what’s causing all the painful shoulders?’, Journal of Arthroscopy and Joint Surgery, vol. 2, no. 2, pp. 57-61.

Dinshaw, P, Rao, N & Varshney, A 2018, ‘Injuries in cricket’, Sports Health, vol. 10, no. 3, pp. 217-222.

Orchard, J, Blanch, P, Paoloni, J, Kountouris, A, Sims, K, Orchard, J & Brukner, P 2015, ‘Cricket fast bowling workload patterns as risk factors for tendon, muscle, bone and joint injuries’, British Journal of Sports Medicine, vol. 49, no. 16, pp. 1-6.

The post Most Common Cricket Injuries appeared first on Move for Better Health™.

We frequently treat patients with lateral hip pain and understand the effect that pain in this region have on daily life and sleep. Lateral hip pain can make everyday activities such as walking, climbing steps or stairs, sitting, or even lying on your side difficult and painful. To effectively manage lateral hip pain, a good understanding of the underlying anatomy is required (firstly through obtaining an accurate diagnosis by your Physiotherapist), and through a combination of treatment approaches including education, activity modification and specific exercise therapy, significant improvements can be achieved over time.

In this blog we’ll discuss the most common cause of ‘Gluteal Tendinopathy’, with a specific focus on the most evidence-based approach to rehabilitation following a recent research paper by several experts in this area (Mellor et al 2016).

What is lateral hip pain?

Lateral hip pain (e.g. pain located over the outside of your hip) is common, persistent and can be extremely debilitating. Lateral hip pain generally presents in the form of an underlying Gluteal Tendinopathy and is most common in women aged 40-60 years, but also effects a substantial proportion of the general population, with reports ranging from 10-25% (up to 1 in 4 people!).

Historically, lateral hip pain was often called to ‘Bursitis’ (referring to ‘Trochanteric Bursitis’) where by inflammation of the bursa (a small fluid filled sack that functions to reduce friction between the tendons and bones) was thought to be the primary source of lateral hip pain.

With increased research in this area alongside advances in medical imaging (e.g. MRI findings), we now know that most commonly, the source of lateral hip pain is tendon changes to the Gluteus Medius and/or Minimus Tendon, right where the tendons insert onto the hip bone. While inflammation of the bursa may or may not be present, this is often a secondary result of the underlying Gluteal Tendinopathy.

How do you treat hip pain?

The differences in the pathology of the underlying condition are noteworthy, with ‘bursitis’ (‘itis’) referring to tissue inflammation: a process of increased tissue sensitivity and healing, while a ‘tendinopathy’ refers to structural disorganisation of the tendon and therefore reduced capacity to bear load (e.g. force).

This changes the treatment approach from passive therapies like ice, massage, rest and anti-inflammatory medications (to name a few), to more active approaches including education on condition management and modification of everyday activities (e.g. avoiding activities that consistently increase your pain) and a targeted exercise programme to strengthen weak gluteal muscles, which is a common finding in people with a Gluteal Tendinopathy. While the exact mechanisms are not fully understood, resistance training exercises (e.g. in this case specific to the gluteal muscles) is believed to stimulate tendon remodelling and therefore increase the ability to tolerate load.

Recently, a key research paper compared the effectiveness of three management approaches for individuals with a Gluteal Tendinopathy (Mellor et al. 2016). The researchers recruited 204 people diagnosed with a Gluteal Tendinopathy and randomised them to three groups, receiving either:

• 1) A programme consisting of education, load management (e.g. exercise modification) and exercise therapy over an 8-week period (EDX)
• 2) A single corticosteroid injection (Ultrasound guided into the trochanteric bursa by a specialist) (CSI)
• or 3) A ‘Wait and see approach’ (e.g. No active care) (WS)

See a summary of the study results here (BMJ 2018;361:k1662):

Findings revealed after both eight weeks and 12 months (short and long term respectively), greatest improvements in overall condition outcome (‘GROC’) and pain reduction (‘Pain’) were found in the group receiving education, load management advice and exercise therapy (EDX), compared to both corticosteroid injection (CSI) or the wait and see (WS) control group.

The results of this study tell us a few things.

Firstly, in the patients studied (diagnosed with a Gluteal Tendinopathy) active management is effective in both the short and long term at reducing pain and improving overall condition outcomes (as rated by you), and that active management appears to be more effective than corticosteroid injection or simply waiting for the condition to improve over time.

Most importantly, education and load management advice were delivered by a Physiotherapist with knowledge in this area, while exercises were prescribed specifically to strengthen the gluteal muscles and tendons and progressed gradually over time.

At Move for Better Health, we understand that lateral hip pain can be complex, and that a detailed assessment, accurate diagnosis and long-term management plan (specific for you) is required to get you back to living your best and most active life. If you do indeed have Gluteal Tendinopathy, a management plan consisting of education, load management and supervised exercise therapy is considered evidence-based and best practice. Of course, each pain presentation is unique to the individual, so discussion of other treatment options (such as corticosteroid injection) with your physiotherapist is always encouraged.

To assist in recovery, Move for Better Health offer a range of supervised exercise classes allowing you to complete your tailored exercise programme under direct supervision. For further information on exercise options and tendinopathy treatment, click here.

References

Mellor, R, Bennell, K, Grimaldi, A, Nicolson, P, Kasza, J, Hodges, P, Wajswelner, H & Vicenzino, B 2018, ‘Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial’, BMJ, 361, k1662. doi:10.1136/bmj.k1662.

Allison, K, Vicenzino, B, Wrigley, TV, Grimaldi, A, Hodges, PW & Bennell, KL 2016, ‘Hip Abductor Muscle Weakness in Individuals with Gluteal Tendinopathy’, Medicine and Science in Sports and Exercise, vol. 48, no. 3, 346-352. doi:10.1249/MSS.0000000000000781.

Grimaldi, A, Mellor, R, Hodges, P, Bennell, K, Wajswelner, H & Vicenzino, B 2015, ‘Gluteal Tendinopathy: A Review of Mechanisms, Assessment and Management’, Sports Medicine, vol. 45, no. 8, 1107-1119. doi:10.1007/s40279-015-0336-5.

The post Hip Pain: What Treatments Work? appeared first on Move for Better Health™.

Interestingly, most hypermobile people do not develop any problems from their loose joints, in fact some people – such as ballet dancers and gymnasts, may even benefit from the increased flexibility!

Some people, however, can develop unpleasant symptoms due to their joint hypermobility. This can include recurring pain in multiple joints, pain in their muscles or fatigue (extreme tiredness). If hypermobility occurs alongside symptoms such as these, it is known as Joint Hypermobility Syndrome (JHS). This can include a diagnosis of hypermobile type Ehlers-Danlos Syndrome (h-EDS), the most common form of Ehlers-Danlos Syndrome (EDS).

This year, singer-songwriter Sia revealed to fans on twitter that she has EDS. The “Chandelier” singer is not alone in her diagnosis. Internationally, the syndrome is believed to affect 1 in every 2,500 to 5,000 people, although there are suggestions that it is actually much more common than this, with many people not reporting their symptoms, or receiving a diagnosis. So what is EDS and how can a Physiotherapist help?

What is Ehlers- Danlos Syndrome (EDS)?

EDS is an inherited disorder that affects the body’s connective tissue, the tissue that provides support to the skin, bones, tendons, ligaments and blood vessels. People with EDS have faults in their genes that cause problems with their collagen, the protein that acts as a “glue” to add strength and elasticity to connective tissue.  As a result, the connective tissue can be pulled beyond normal limits.

EDS is generally characterised by joint hypermobility, skin hyperextensibility (skin that can be stretched further than normal) and tissue fragility (skin that tears or bruises easily and wounds that take longer to heal). There are 13 types of EDS and each vary in their genetic causes. As a result, each person with EDS is affected differently and often in multiple ways.

What does EDS feel like?

The signs and symptoms of EDS are most often joint and skin related and can have a significant impact on daily function and quality of life.

Individuals with EDS may experience:

• Joint hypermobility
• Loose/unstable joints which are more likely to be sprained or dislocated
• Chronic joint pain and stiffness, most often in larger joints (neck, shoulders, back, hips, knees) as well as smaller joints (ankles, wrists, elbows)
• Early onset of osteoarthritis
• Soft velvety-like skin
• Fragile skin that tears or bruises easily
• Slow and poor wound healing

EDS can also branch out and affect other bodily systems that seem mysterious and unrelated. Other conditions that can occur include:

• Mitral valve prolapse, heart arrhythmias
• Uterine prolapse
• Hernias
• Gastroesophageal reflux disease (GERD)
• Irritable Bowel Syndrome
• Temporomandibular Joint Dysfunction
• Depression and anxiety
• Developmental Coordination Disorder (in children)
• Autonomic nervous system deregulation (low blood pressure, fainting)

As EDS can often masquerade as a variety of other illnesses, it remains misunderstood and underdiagnosed. In fact, most EDS patients spend an average of 20 years before finding a diagnosis!

How can Physio help manage EDS?

As EDS is a genetic disorder, it has no cure. Treatment is important however, to relieve the associated signs and symptoms and prevent serious complications.

A Physiotherapist can help by prescribing exercises that aim to increase muscle strength and provide stability to joints to avoid pain and improve function. Weight-bearing exercises in particular, are crucial to help maintain bone density and muscle tone. A Physiotherapist can also provide advice around how to stay active while minimizing stress on the body and where appropriate, direct patients to assistive devices such as braces and splints to help support joints and scooters and wheelchairs to aid mobility.

What other types of treatment can help manage EDS?

A patient with EDS may see a range of other health professionals to help manage their condition. A Doctor will monitor patients for associated complications and prescribe important medications. This may include pain-medication to relieve muscle or joint pain, blood-pressure-lowering medication to reduce stress on fragile blood vessels and supplements such as calcium and vitamin D to increase bone density.

Other health professionals might include a pain specialist, dermatologist, rheumatologist, occupational therapist and psychologist.

EDS in the Media

‘We live in constant fear’: the reality of life with Ehlers-Danlos syndromes, The Guardian, published 5th November 2019

Sia reveals she has rare Ehlers-Danlos Syndrome, ABC News, published 6th October 2019

Need help?

If you’d like to see one of our Physiotherapists, you can:

• Call us on 8373 5655
• Use our Online Booking Gateway (available 24/7) to choose your appointment time
• Drop in to see us in person
• Email us on info@moveforbetterhealth.com.au

References

2012, ‘Ehlers-Danlos Syndrome’, in H Chen (eds) Atlas of Genetic Diagnosis and Counselling, New York, NY, pp. 705–717.

Christophersen, C & Adams, JE 2014, ‘Ehlers-Danlos Syndrome’, Journal of Hand Surgery, vol. 39, no. 12, pp. 2542–2544.

Pocinki, AG, 2010, Joint Hypermobility, Washington.

Tinkle, B, Castori, M, Berglund, B, Cohen, H, Grahame, R, Kazkaz, H & Levy, H 2017, ‘Hypermobile Ehlers–Danlos syndrome (a.k.a. Ehlers–Danlos syndrome Type III and Ehlers–Danlos syndrome hypermobility type): Clinical description and natural history’, American Journal of Medical Genetics Part C: Seminars in Medical Genetics, vol. 175, no. 1, pp. 48–69.

U.S. National Library of Medicine 2019, Ehlers-Danlos syndrome, Genetic Home Reference, viewed 28 October 2019,   <https://ghr.nlm.nih.gov/condition/ehlers-danlos-syndrome>.

The post Joint Hypermobility and Ehlers-Danlos Syndrome  appeared first on Move for Better Health™.

The Chartered Society of Physiotherapy, a union group in the United Kingdom for Physiotherapists, have developed four common myth busters about lower back pain. They are based on what we know from the latest research evidence and clinical practice in the assessment and management of low back pain.

Low Back Pain Myths vs Facts

Myth #1: Moving will make my back pain worse.

Fact
People fear twisting and bending but it’s essential to keep moving. Gradually increase how much you are doing, and stay on the go.

#MotionIsLotion

Myth #2: I should avoid exercise, especially weight training.

Fact
Back pain shouldn’t stop you enjoying exercise or regular activities. In fact, studies found that continuing with these can help you get better sooner including using weights where appropriate.

#StrongerForLonger

Myth #3: A scan will show me exactly what is wrong.

Fact
Sometimes it will, but most often it won’t. Also, even people without back pain have changes in their spine so scans can cause fear that influences behaviour, making the problem worse.

#ThePlanNotTheScan

Myth #4: Pain equals damage

Fact
This was the established view but more recent research has changed our thinking. Modern physio takes a holistic approach that helps people understand why they are in pain, and the reason is often not because there is damage to the body.

#SoreButSafe

Want to know more?

For further information you can visit the Chartered Society of Physiotherapy’s website to view the supporting evidence behind each myth buster. Move Physio has years of experience in assessing and managing lower back pain. If you have or know someone with lower back pain and would like more information please don’t hesitate to contact us at Move for Better Health.

References:

Chartered Society of Physiotherapy, 2016, Back pain myth busters, Chartered Society of Physiotherapy, viewed 5^th November 2019, <https://www.csp.org.uk/conditions/back-pain/back-pain-myth-busters>

The post Back Pain Mythbusters appeared first on Move for Better Health™.

For example, compression of the rotator cuff tendons (most commonly the supraspinatus tendon) or bursa. In some people, repetitive and/or excessive compression over time may contribute to significant pain, loss of function and quality of life. Metaphorically speaking, you might consider the rotator cuff tendons or bursa being stuck between a rock and a hard place.

In medical terms, such symptomatic shoulder impingement is referred to as ‘subacromial impingement syndrome’ (SAIS) or more generally ‘subacromial pain syndrome’ (SAPS) and it accounts for up to 70% of shoulder pain presentations.

How Do You Manage Shoulder Impingement?

Like many conditions that we see at Move for Better Health, it is a misconception that surgery is the best management option, especially if the problem has been there a while and there are findings on x-ray or scans showing degenerative changes.

Historically, a commonly performed surgery in patients with SAPS is subacromial decompression surgery, a surgical procedure that involves removal of excess bone and any involved soft tissues through keyhole surgery. Theoretically, removing tissues responsible for narrowing the space where impingement occurs should reduce pain and improve function. Recovery from surgery can take months and importantly involves a graded exercise programme, guided by a physiotherapist, to reduce pain, mobilise and strengthen the shoulder.

A common alternative to surgery, and usually the first recommended management option for SAPS, is Physiotherapy.

Physiotherapy starts with a thorough assessment of the factors that affect your pain and function, but also factors that may have contributed to triggering your pain initially. Treatment can include a range of techniques aimed at reducing pain and improving function in the short-term, but importantly an exercise programme that gently and gradually progresses as your strength and function improves.

A typical treatment programme for shoulder rehabilitation takes 12-16 weeks, which can be less than the time it takes to recover from surgery.

So, Do I Need Surgery?

As always, each individual case needs to be judged on its merits, however Doctors, Physiotherapists and other Health Professionals should use the most current research evidence to guide recommendations on the most appropriate treatment.

In recent years, some high-quality scientific studies have investigated the effects of subacromial decompression surgery compared to placebo-surgery (arthroscopic investigation only) or a non-surgical intervention (e.g. no treatment or exercise therapy).

The common aim was to determine the most effective method of reducing shoulder pain and improving function in people with SAPS.

Currently, results suggest that both surgical groups (real and placebo) show marked improvements in pain and function from 6 months to 2 years following surgery, with differences between groups being insignificant.

These findings demonstrate that in some people, the surgical element of ‘decompression’ isn’t a big player, with authors concluding that there is no evidence that subacromial decompression is more beneficial than placebo.

To add to this, subacromial decompression surgery appears to show no greater clinically relevant benefits than exercise therapy alone, an important consideration when discussing management approaches between patient and therapist.

Current research tells us that the surgical benefits of decompression surgery are likely due to the correct dose of rest and tissue loading (e.g. exercise therapy prescribed by a physiotherapist) following surgery.

Additionally, it tells us that exercise therapy alone is just as effective in management of pain and function in the mid-long term. Given the inherent risk of surgery and the noted wide-spread benefits of exercise therapy, a conservative approach to SAPS at first instance appears to be the best option.

At Move for Better Health, our Physiotherapists take the time to thoroughly assess and diagnose your shoulder pain.  If you have SAPS, or other shoulder related problems (e.g. rotator cuff tendinopathy or rotator cuff tear), we can help you with an individualised management plan tailored towards achieving your goals, that is based on the best current research evidence.

If you’d like to speak to our team about shoulder pain, you can do so here or by calling us on 8373 5655.

References:

Beard, DJ, Rees, JL, Cook, JA, Rombach, I, Cooper, C, Merritt, N, Shirkey, BA, Donovan, JL, Gwilym, S, Savulescu, J, Moser, J, Gray, A, Jepson, M, Tracey, I, Judge, A, Wartolowska, K & Carr, AJ 2018, ‘Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial’, The Lancet, vol. 391, no. 10118, pp. 329-338. doi:https://doi.org/10.1016/S0140-6736(17)32457-1

Lähdeoja, T, Karjalainen, T, Jokihaara, J, Salamh, P, Kavaja, L, Agarwal, A, Winters, M, Buchbinder, R, Guyatt, G, Vandvik, PO & Ardern, CL 2019, ‘Subacromial decompression surgery for adults with shoulder pain: a systematic review with meta-analysis’, British Journal of Sports Medicine, vol. 7, no.1, pp. 1-10. bjsports-2018-100486. doi:10.1136/bjsports-2018-100486

Paavola, M, Malmivaara, A, Taimela, S, Kanto, K, Inkinen, J, Kalske, J, Sinisaari, I, Savolainen, V, Ranstam, J & Jarvinen, TLN 2018, ‘Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: randomised, placebo surgery controlled clinical trial’, BMJ, vol. 362, k2860. doi:10.1136/bmj.k2860

Steuri, R, Sattelmayer, M, Elsig, S, Kolly, C, Tal, A, Taeymans, J & Hilfiker, R 2017, ‘Effectiveness of conservative interventions including exercise, manual therapy and medical management in adults with shoulder impingement: a systematic review and meta-analysis of RCTs’, British Journal of Sports Medicine, vol. 51, no. 18, pp. 1340-1347. doi:10.1136/bjsports-2016-096515

The post Shoulder Impingement – A Painful Topic appeared first on Move for Better Health™.

We’ve combined the knowledge of our Physiotherapists, Exercise Physiologists & Podiatrists to give you a comprehensive overview of:

1. The most common running injuries & what causes them – Sam Campagnale, Physio
2. Gym training for running & how it can make you faster – Hunter Bennett, Exercise Physiologist
3. Running footwear myths explained – Steph Howard, Podiatrist

1. Most Common Running Injuries & What Causes Them

Almost a quarter of Australians participate in running, some just for fun and others competitively.

The knee was found to be the most common part of the body to be injured by running, and accounts for approximately 50% of all injuries. The most common knee-related conditions include:

• Patellofemoral pain syndrome (PFPS)
• Iliotibial band syndrome (ITBS)
• Meniscal injuries
• Patellar tendinopathy

Interestingly, while knees are often injured as a result of running, no evidence has been found to demonstrate a link between increased rates of knee and hip osteoarthritis (OA) and recreational running. Some research suggests that certain levels of running may actually be protective against OA, and help maintain the health of the cartilage of our joints.

Foot and ankle and lower leg conditions such as Achilles tendinopathy, plantar fasciopathy, and medial tibial stress syndrome (MTSS) (or also known as shin splints) accounted for approximately 40% of other running-related injuries.

The cause of running-related injuries is multifactorial and can be influenced by:

• Running and training factors (including the runner’s load management which may include how often they run, the training surface they run on, running intensity or speed, duration, and potentially any other types of training which are also occurring)
• Musculoskeletal issues (including previous history of injury)
• General health and lifestyle factors
• Running biomechanics

Although no ‘perfect’ running style exists, a health professional such as a Physiotherapist or Podiatrist is able to determine the relevance of a person’s running biomechanics, and identify whether modification of technique is required to maximise running efficiency and performance. 

If you have been injured while running, a Physiotherapist can assess the injury and figure out which of the above factors may be contributing to the issue.

After an initial assessment, Physiotherapists provide hands-on treatment (if applicable), supportive techniques (taping, for example) and prescribe a tailored graded return to running program to help you achieve your running goals.

To book an assessment with a Physiotherapist, you can call us on 8373 5655 or book online here.

2. Gym Training For Running & How It Can Make You Faster

When training to improve distance performance, the most typical method of training progression is to increase your training distance. I’d like to share with you how gym training for running can significantly improve many aspects of your performance, more-so than simply increasing the overall training distance.

Now, while I would be the first to admit that to get good at running (or cycling, or swimming etc. etc. etc.) long distances you do need to undertake some longer training sessions, but they aren’t necessarily the best or only way to improve endurance performance. In fact, I would go as far to suggest that increasing training distance is a somewhat illogical form of progression.

If we train by running a greater distance at the same speed (or possibly even slower) that we normally use during training, we are unlikely to get faster. For many, getting faster (and being able to maintain that faster speed) is the name of the game, right?! Fortunately for us there are other gym-based training methods that we can use to improve performance.

Strength and endurance training are often viewed at complete opposite ends of the training spectrum – where it is typically suggested that improvements in one will lead to subsequent reductions in the other. But in reality, it’s not that simple.

When we really consider endurance performance, we should be able to see that it is effectively the ability to maintain or repeat a given force output repeatedly – each step (or each pedal stroke) represents force being applied to the ground. Which is where getting stronger (or increasing the amount of force we can produce) comes into play.

You see, if someone gets stronger relative to their bodyweight, they can apply more force with each step of the foot, or stroke of the pedal. This means that they will require less relative force each step to maintain the same pace they did prior increasing their strength.

This in turn means that each step uses less energy, as it is at a lower percentage of their maximal force production. As a result, they now have the ability to move faster (and further) each step, despite using the exact same amount of energy.

So why does gym training make me faster?

Strength training has repeatedly shown to improve endurance performance in both recreational, and highly trained athletes. In fact, this research has actually shown that including strength training into an endurance training program will improve endurance performance to a much greater degree than endurance training alone.

These improvements have been measured by improvements in movement economy (also known as energy efficiency), increases in velocity at VO2max, and increases in maximal anaerobic running speed.

In short, it clearly demonstrates that strength training will make you faster at a given energy output – becoming easier!

These specific strength training interventions tend to result in substantial improvements in strength, with only small increases in lean mass – this actually suggests that the strength increases observed are mainly a result of improved neural efficiency, meaning that they result in significant improvements in relative force production, and you wont really get any heavier.

Additionally, this same training has been shown to cause a shift in muscle fibre type from type IIx (Super explosive muscle fibre type) to type IIa (less explosive, slightly greater endurance capacity) fibre types, which has been shown to further improve endurance capacity.

And to top it off, strength training has also been shown to causes an increase in musculotendinous unit stiffness (say that three times fast).

This increased stiffness results in an improved ability to store elastic energy during eccentric muscle actions (eg. landing each step), which in turn increases concentric muscle force (eg. Pushing off the ground). This results in less energy used per step, and a noticeable increase in movement economy.

So, if were to summarise the science – strength training makes you more efficient.Not to mention it also has the capacity to improve your ability to absorb force and therefore protect you from injuries (which is a topic I will save for another day).

If you are a runner who wants to improve their performance – whether that be speed, distance or overall fitness, then you can see an Exercise Physiologist for a individual assessment for a personalised gym-training program based around your goals.

Including two full-body strength sessions per week into your training would be a great place to start, and would be enough to stimulate improvement in strength, and therefore improvements in efficiency.

With this in mind, the focus should be on large compound movements such as squats, deadlifts and lunges to improve lower body strength, working within strength based rep ranges (such as 6×3, 5×4, 4×6). These rep ranges have been shown to elicit neural based strength adaptations, while minimising potential muscle growth – meaning they are the perfect way to maximise your strength without increasing your body weight.

I would also strongly recommend the inclusion of loaded carries, some pulling movements (inverted rows, dumbbell rows etc.), and some direct trunk stability work if time permits, as these can go a very long way to strengthening the muscles of the upper back and core, improving posture and preventing injuries.

If you are not sure where to start, have some questions around introducing strength training into your regime, or would like to see one of our Exercise Physiologists for a running exercise program, you can call us on 8373 5655 or book online here.

3. Running Footwear Myths Explained

There is a lot of information about as to how to protect your feet while running, and which shoes to wear. Here we’ll be addressing the two biggest running footwear myths, which relate to the affect a heel drop has in shoes, and the outcomes of barefoot/minimalist running.

Heel Drops

The myth: A higher heel drop (eg 10mm) is more advantageous than a smaller drop (eg 4mm).

A heel drop is the difference in the shoe between the height of the heel and the height of the toe. This can affect how your foot hits the ground.

A 10mm heel drop has been the ‘norm’ in running shoes over the last 30+ years, however there isn’t any research to say this is more advantageous than a smaller drop (e.g 4mm).

There are theories that a higher heel drop offers increased comfort on harder surfaces, based on anecdotal feedback from runners in terms of cushioning and comfort.

While a higher raise (10mm) is likely to protect the foot, ankle and lower leg, it also has the potential to increase forces at the knee joint (particularly in  those who over-stride).

So in summary, there is no evidence to suggest that it is more advantageous to have a higher heel drop (and in fact it can adversely affect the knee joint), but some anecdotal evidence suggests a higher heel drop may feel more comfortable to the wearer.

Barefoot/Minimalist Footwear

The myth: Barefoot or minimalist footwear will make your feet stronger and reduce the risk of injury.

As we know from the much publicised fall from grace of Vibram 5 fingers, this is not the case. These shoes worked for some but not for most.

As we see it, barefoot/ minimalist shoes sit at one end of a spectrum, with an ultra supportive/ cushioned shoe such as a HOKA on the other. Most people will find that something in the middle of this spectrum will suit them best. Quite often runners will get the best results when wearing footwear which is a combination of minimalistic performance-based racing flat and a more structured, cushioned training shoe.

The general agreement on studies looking at barefoot vs cushioned running shoes on economy is that the advantages associated with cushioning negate disadvantages of increased shoe weight. Studies conducted on the Nike Varporfly 4% (industry funded) have shown significant performance gains can be made through footwear design. 

One of the main arguments for barefoot shoes is that most elite runners mid-forefoot strike, negating the impact of heel height/cushioning. Research published in 2017 actually showed that out of 1843 runners in the Boston marathon 97%, were heel strikers, which highlights the importance of heel padding/ raises.

When should I see a Podiatrist?

Any runner with a foot or ankle injury should seek assessment from a podiatrist with strong biomechanical and running experience. Extensive knowledge of both structure (anatomy) and the forces impacting on the foot allow us to make an accurate diagnosis as well as identifying any contributing factors, leading to the formation of a treatment plan utilising the most effective evidence based treatments including improving the load capacity of the injured muscle, tendon or fascia rather than just focusing on decreasing loads via the use of foot orthoses.  

We can alter loads placed on the lower limb through 2 main avenues- intrinsically- strength and conditioning of muscle and tendon complexes & load/ training modifications. Extrinsically-via footwear, orthoses and braces. It is vital that we have a comprehensive knowledge of the potential affects of these and how they may work in combination to ensure the best results for an individual.

To see a Podiatrist for a running assessment, biomechanicial assessment or footwear advice/fitting, you can call us on 8373 5655 or book online here.

References

The most common running injuries & what causes them – written by Sam Campagnale, Physiotherapist

Ferber, R, Hreljac, A & Kendall, K 2009, ‘Suspected mechanisms in the cause of overuse running injuries: a clinical review’, Sports Health, vol. 1, no. 3, pp. 242-246.

Leech, R, Edwards, K & Batt, M 2015, ‘Does running protect against knee osteoarthritis? Or promote it? Assessing the current evidence’, British Journal of Sports Medicine, vol. 0, no. 0, pp. 1-3.

van Gent, R, Siem, D, van Middelkoop, M, van Os, A, Bierma-Zeinstra, S & Koes, B 2007, ‘Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review’, British Journal of Sports Medicine, vol. 41, no. 8, pp. 469-480.

Williams, P 2013, ‘Effects of running and walking on osteoarthritis and hip replacement risk’, Medicine & Science in Sports & Exercise, vol. 45, no. 7, pp. 1292-1297.

Gym training for running & how it can make you faster – written by Hunter Bennett, Exercise Physiologist

Hoff, Jan, Arne Gran, and Jan Helgerud. “Maximal strength training improves aerobic endurance performance.” Scandinavian journal of medicine & science in sports 12.5 (2002): 288-295.

Kraemer, WILLIAM J., et al. “Compatibility of high-intensity strength and endurance training on hormonal and skeletal muscle adaptations.” Journal of applied physiology. (1995). Vol 78, no.3.

Running footwear myths explained – written by Steph Howard, The Biomechanics Lab

Do Canto 2018, ‘Running Shoes: Myths and Disinformation: RT Chats with Podiatrist, Thomas Do Canto’, https://www.runnerstribe.com/features/running-shoes-myths-and-disinformation-rt-chats-with-podiatrist-thomas-do-canto/?fbclid=IwAR3bNXhPj_EnuS_bzJ7BwZfOBp0EFPpAzkBlC8EpuF8GzVl5Va2Znu0ExEE

The post A Multi-Disciplinary Insight into Running appeared first on Move for Better Health™.

• Reducing your risk of falls (reactive step training has been shown to reduce an older adults’ risk of falling by approximately 50%!)
• Improving your balance
• Increase sporting performance
• Preventing sporting injuries

The ‘Clock Yourself’ app is a fun, easy to use training method which has been developed by Australian Physiotherapists for this purpose.

This app is based on best clinical evidence and provides guidance and instruction on how you can train movement reaction time at home, and also gives you another way the brain and body.

Why is training movement reaction time and step training important?

Increasing age, low levels of physical activity and presence of multiple medical conditions all influence a person’s movement reaction time, mobility and balance. These factors can increase the risk of falling over.

However, with appropriate training, the influence of these risk factors can be reduced due to our body and brain’s incredible capacity to continue and learn new skills, and sharpen our ability to adapt in different environments.

What is Clock Yourself?

Clock Yourself was inspired by a familiar mental model – ‘a clockface’ – which serves as a foundation of 12 intuitive coordinates to begin our training, with no equipment required!

The complexity of training activities are continually progressed across five levels by modifying exercise intensity, and thought processing demands.

What is Clock Yourself used for?

Training activities are designed to work on stepping speed, physical and cognitive agility, and ability to adapt to varying situations in a fun and engaging environment for all age groups.

Clock Yourself can be used as a form of rehabilitation following injury, prehabilitation to prevent an injury or fall, or a warm up for athletic training. The possibilities are open to the creative mind!

How can we help?

For more information on this exciting training method feel free to talk to one of our friendly Physiotherapists at Move for Better Health, or you can visit the Clock Yourself website here.

Sam Campagnale is a Move Physiotherapist, and is familiar with Clock Yourself. He can help you to incorporate it into your exercise routine (at home or in our supervised Pilates or Gym classes), to ensure you’re safe and comfortable with setting up and using the app.

If you’d like to see Sam to set up the Clock Yourself app, or to refine your exercise routine, you can:

• Call us on 8373 5655
• Use our Online Booking Gateway to choose your appointment time
• Drop in to see us in person
• Email us on info@moveforbetterhealth.com.au

References

Nitz, J, Stock, L & Khan, A 2013, ‘Health-related predictors of falls and fractures in women over 40’, Osteoporosis International, vol. 24, no. 2, pp. 613-621.

Nolan, M, Nitz, J, Choy, N & Illing, S 2010, ‘Age-related changes in musculoskeletal function, balance and mobility measures in men aged 30-80 years’, The Aging Male, vol. 13, no. 3, pp. 194-201.

Okubo, Y, Schoene, D, Lord, S 2017, ‘Step training improve reaction time, gait and balance and reduces falls in older people: a systematic review and meta-analysis’, British Journal of Sports Medicine, vol. 51, no. 7, pp. 1-9.

The post ‘Clock Yourself’ One Step at a Time appeared first on Move for Better Health™.

Australian Journal of General Practice. Volume 47, No. 9, September 2018

In light of this recent article in the Australian Journal of General Practice regarding the use of imaging in the management of low back pain I was pleased to see the same messages and recommendations made to general practitioners in Australia as those recommended to physiotherapists.

The following tables outline the main recommendations:

With the proliferation of private radiology companies offering direct referral for allied health, it is important that these messages reach general practitioners, allied health professionals and the general public.

I was also pleased to see the recommendation of a referral to other health professionals to assist the GP in managing the patient’s low back pain episode. Given the need for careful education and advice on keeping active, including exercising within the patient’s abilities and confidence, I see general practitioners could struggle to have the time in a consultation to do this.

In my experience, doing this over the average episode of care (4 to 6 weeks of recovery time) requires several appointments with a physiotherapist who is skilled in the contemporary assessment and management of spinal pain.

During this time the physiotherapist will also be able to counsel the patient to exercise on a regular basis to further improve their general health and minimise risk factors for other health conditions.

It is common for people with pain related movement dysfunction such as low back pain to reduce their general activity through fear of aggravating the pain.  Physiotherapists are experts in helping people to find ways to stay active despite painful conditions.  We can help them identify and break down the barriers to an active lifestyle.

Physiotherapists at Move for Better Health use a pain education strategy based on the work of pain neuroscientists, and can offer supervised exercise sessions in a variety of formats such as gym, Pilates, hydrotherapy, yoga and home exercises.

To ensure that home exercises are easy to follow we use online software called Physitrack which allows us to prescribe specific exercises for the individual and monitor their progress.  The patient is able to use an app to follow instructions (on a smartphone or ipad) via video and also to provide feedback to the physiotherapist regarding the completion of the exercises and pain scores if appropriate.  We also use this app to deliver educational material in written and video format to help reinforce the important messages we know will contribute to more positive outcomes for patients. In certain cases we also use specific outcome measures via Physitrack to assist in identifying yellow flags and also to monitor progress for reporting to third-party funders.

If you would like more information in regards to our management of low back pain please contact us at Move for Better Health.

The post Low back pain: Can we mitigate the inadvertent psycho-behavioural harms of spinal imaging? appeared first on Move for Better Health™.

We’ve heard different answers to this question over the years, which often results in confusion about what we should or shouldn’t be doing. How do you know what information is backed up by up to date evidence and research, and what is out of date and no longer recommended?

At Move, our Physiotherapists use best practice guidelines established by the Australian Government’s Department of Health. These recommendations are widely trusted and implemented by medical professionals, and explain the ideal combination and amount of exercise for most individuals.

For exercise to work as a therapy the body’s tissues (muscles, tendons, ligaments, nerves and bones) must be exposed to certain amount of stimulus (exercise) for them to positively change (become more efficient, stronger, more resilient). This is why the national guidelines, and our guidelines, strongly recommend at least two strength training sessions per week.

Adults aged between 16 – 64 should:

• Be active on most (preferably all) days of the week
• Undertake a total of 2.5 to 5 hours of physical activity per week
• This should be made up of low to moderate exercise AND moderate to high intensity exercise
  • Ideally, moderate to high intensity exercise would make up 1 – 2.5 hours per week, and low to moderate exercise would make up the rest of your physical activity each week, totalling between 2.5 – 5 hours of exercise per week
  • This should also include at least 2 sessions of muscle strengthening per week. This can contribute to either the moderate to high or low to moderate intensity exercise sessions (depending on how hard you work!)

And for those of us 65 years or older, we should;

• Be active every day in as many ways as possible
• Take part in a range of physical activities that incorporate fitness, strength, balance and flexibility
• Try and continue to lead an active lifestyle even if you have some pain (a Physiotherapist can prescribe a tailored exercise programme which is appropriate for you. It’s very important to take your personal situation and medical history into consideration when deciding what types of exercises are appropriate)
• Accumulate at least 30 minutes of moderate intensity physical activity preferably every day

Your specific situation may not always benefit from these general recommendations, so before starting a new exercise routine it’s best to consult with your physiotherapist or GP prior to commencement.

How Do I Start?!

After reading the guidelines, some of you may be thinking “it’s all well and good to say we should be exercising between 2.5 to 5 hours per week, but how is that actually achievable?!”.

Many people experience the same barriers when it comes to exercise, including:

1. Not having enough time in the day!
2. Financial limitations
3. Lack of motivation
4. Unable to exercise with confidence due to existing pain or injuries

If you fall into one of these categories, here are some options which may help you get more from your exercise regime:

1. Not enough time

• Small group classes even once a week can allow you to exercise more efficiently and make better use of your time. Supervised classes can help ensure that you’re completing exercises correctly with proper technique, with Physios on hand ready to guide you
• Start small – Start with once per week and work up!
• Use a lunch break or short bursts of time in the morning to carry out low intensity exercise, a simple walk, hike or cycle will not only add up for your weekly total it will provide benefits to your energy and mood
• We offer a range of class times (including early mornings, evenings and weekends) to give you more options

2. Lack of motivation

• Build up your weekly programme by committing to one class or activity. It could be a Pilates or Gym class that you commit to on a weekly basis, or a team sport or training group where you’re committing to other people. This social commitment will increase the chances of you sticking with the routine
• Get a Physiotherapist to structure your exercise programme so you can consistently (but safety) increase the level of difficulty. These regular updates and challenges mean you don’t get bored as quickly
• Concentrate on the benefits of what you’re doing and how you’re helping your body! You can find more information on the wide-ranging positives of exercise here –
• We will support you!

3. Financial limitations

• If you’re unable to attend supervised classes or purchase a gym membership due to financial limitations, there are some other ways you can exercise while still having guidance from a health professional
• At Move, we use PhysiApp, which is exercise software that allows us to send exercise programmes straight to you. You can access your programme via a smartphone app or an internet browser. PhysiApp is complete with high quality videos and instructions, and also allows you to track which exercises are completed on a daily basis. We can create programmes which only include body-weight exercises (if you have no exercise equipment available to you) or they can include dumbbells, resistance bands or other gym equipment. A home exercise programme can be created for you by a Physio, and usually involves:
  • 1 x Assessment Consultation (45 minutes) – to go over your medical history, exercise goals and current physical situation
  • 1 – 2 x 1:1 Exercise Sessions (45 minutes) – so your Physio can teach you your exercise programme and make any necessary adjustments
  • 1:1 Exercise Review (45 minutes) – every 2 to 3 months to track your progress and increase difficulty
  • Access to PhysiApp for the entire duration of your exercise program

Need some more inspiration? Here are some FREE ways you can exercise around Adelaide:

• Hike at Morialta Conservation Park, Mount Lofty, Torrens River Walking Track, or Waterfall Gully
• Ethel Street Reserve Outdoor Gym at Goodwood
• CF Page Park Outdoor Gym at Cumberland Park
• Walk or run around the block
• Play basketball at a local park
• Ride a bike
• Swim at the beach

4. Unable to exercise with confidence due to existing pain or issues

• Physiotherapists are experts at working with injuries and conditions to create safe and effective exercise options that suit you and your circumstances
• If you have ongoing pain or niggles, your Physiotherapist will take this into consideration when putting together an exercise programme, to ensure it’s suitable for your individual needs

Our Exercise Options

Move offers a range of supervised exercise options or classes to help you achieve the ideal amount of exercise per week, including:

• Gym
• Pilates Equipment
• Pilates Reformer
• Pilates Mat
• Hydrotherapy
• Yoga

These all count towards the 2 strength training sessions that is recommended per week as well as contributing towards the total minutes of the low – moderate intensity exercise that should be completed each week.

When combined with a home exercise programme which provides a higher level of intensity, it may be easier than you think to get to the ideal 2.5 – 5 hours of recommended exercise per week that most of us require!

More Information?

You can read more about exercise & how to get started in some of our other blog posts here:

• Pilates: For the Everyday Person to Elite Athletes
• Recommended Treatment for Lower Back Pain
• My Hormones are Affecting My Weight: Exercise & Polycystic Ovarian Syndrome
• How an Active Lifestyle Can Fend Off the Flu
• Arthritis & Exercise
• Pilates for Neck Pain? It’s About More Than Just The Core!

About the Author

Tom Setchell is a Physiotherapist at Move for Better Health, and is passionate about helping his patients become stronger and more active. You can book in to see Tom or any of other other Physiotherapists online here, or by calling 8373 5655.

References

Department of Health, 2017, Australia’s Physical Activity and Sedentary Behaviour Guidelines, http://www.health.gov.au/internet/main/publishing.nsf/content/health-pubhlth-strateg-phys-act-guidelines, accessed 12/7/2018

The post Exercise Guidelines Made Easy appeared first on Move for Better Health™.

First, lets get back to basics. What are muscle injuries? How do you know if you have one? Why remember P.O.L.I.C.E. instead of R.I.C.E when it comes to managing them?

How do you know if you have a muscle injury?

Muscle injuries (strains) can happen to anyone, from athletes, weekend warriors to avid gardeners. If you’ve sustained a muscle injury, you are likely to experience:

• Immediate pain in the muscle following a quick movement or stretch of the muscle. This is because some muscle fibers have become so stretched that they stretch the surrounding nerves or a portion the muscle fibers have torn.
• Pain when you try to move the injured muscle. Moving torn or over stretched muscles activates the nerves in the area.
• Bruising at the painful area or down from the injury (i.e. the ankle for a thigh injury). A torn muscle will bleed, is it this blood that will turn into a bruise.

Muscle injuries can happen to any muscle but are most common in the hamstrings, calves and quadriceps.

How does an injury occur?

If you:

• Commence a physically intensive activity without warming up: A muscle that has warmed up is better able to contract (get shorter) and actively relax (lengthen with control), meaning it is more able to deal with the power required for the activity.
• Overstretch the muscle: A vigorous kick, tripping over, stretching a muscle beyond its limit will result in a strain.
• Contract a muscle vigorously: Lifting a heavy weight, especially if you are not conditioned to doing so, can cause an injury to occur.

What does the muscle injury look like?

A muscle injury can range from a severe stretch (Grade 1), minor tear (Grade 2) to major tearing of a muscle (Grade 3).

Source: Radiology Key – Image Analysis Fig. 3.8 Grading muscular injuries

The image above shows a Grade 1 tear, with part of the muscle aggravated and inflamed from the over stretch injury. This injury will hurt but you will still be able to move that part of the body without too much pain. A grade 2 injury will have a tear less than 50% of the muscle width and a grade 3 more than 30% the muscle width. All tears will be painful, but a grade 2 and 3 will affect how you move.

How do you best manage an acute muscle injury?

Forget R.I.C.E., call the P.O.L.I.C.E. and do no H.A.R.M.

R.I.C.E., has been a cornerstone of soft tissue injury for many years, however contemporary research shows that moving a muscle (mechanical loading) prompts the processes required for healing. This has led us to a new way to manage muscle injuries. Bring in the P.O.L.I.C.E.

• Protection: A brief period of reduced movement is necessary to minimise tissue injury.
• Optimal Loading: Early safe mobilisation encourages tissue healing and reduced chances of long term dysfunction (this will be explained in the rehabilitation section).
• Ice: Apply ice (cubes in a plastic bag are fine) for 15-20 minutes on the injured site then remove for 30 minutes before retuning ice to the injured site. Repeat as much as necessary in the first 24-48 hours.
• Compression: Apply compression bandage or garment to the injured area for the first 2-4 days to aid in moving swelling from the area.
• Elevation: Elevate the injured area (with respect to the heart) as much as possible in the first 2 days, again to aid in swelling management.

… and do no H.A.R.M. (these are some reminders to ensure no further damage is done to the injury)

• Heat and heat rubs – these will make the bleeding in the muscle worse and increase healing time
• Alcohol – is an anti coagulant and will make it harder for the body to form a clot in the injured muscle (the clot is required for the tear to heal)
• Running or moderate activity – initially only gentle activity is recommended and should be decided by your physio.
• Massage or soft tissue therapy – this will injure the healing tissue, but it will likely heap tissue surrounding the injury site

Rehabilitation (optimal loading)

After the injury the muscle will begin to heal and develop scar tissue. Management and rehabilitation should begin as soon as possible following the injury.

Source: Muscle Injury Tissue Progression – MendMeShop 2012

The image above shows a muscle before injury, after an injury and the scar tissue that forms once the injury is healed. This scar tissue causes a weak point in the muscle and makes it more likely to be injured again.

Effective rehabilitation can make this scar tissue more like muscle again and reduce the chance of further injury. Optimal rehabilitation is specific to you and your injury, a physiotherapist is an expert in diagnosing, managing and setting up rehabilitation for your specific injury.

Do you think you have suffered a muscle strain? Contact us for a full assessment of your injury and to set up your rehabilitation program.

About the Author

Tom Setchell is a Physiotherapist at Move for Better Health, and has an interest in acute and chronic musculoskeletal injuries. He has great skills in the use of exercise therapy for the management of these conditions. You can book in to see Tom online here, or by calling 8373 5655.

References

Bleakley C, Glasgow P, MacAuley D. PRICE needs updating, should we call the POLICE?. British Journal of Sports Medicine. 2011 Sep 7

The post Forget RICE, Remember POLICE! appeared first on Move for Better Health™.