Runners! Should we rethink weekly kilometres as our measure for success?

While distance is an important variable to measure with running, not all kilometres are created equal. A recent viewpoint published in JOSPT (1) highlighted the need for analysis of more than just how far you run and highlights the value of rate of perceived exertion (RPE) to track your efforts. Let’s consider a 10km run and the different parameters that can be measured…

Firstly, I’ll answer the question as simply as I can. No. Distance alone is not a good enough measure of training for us to use as it doesn’t capture all the different variables that a single run can have. Let’s talk about what else is important.

Duration and pace

(circled in red in the table below)

The time we spend on our feet out is the first thing we want to know once we’ve finished a run. It’s how we compare ourselves to our mates and to compare to our previous results. The same distance travelled at a faster speed is going to be a higher stress on your body. No surprises here.

     

(table from: Paquette, Napier, Willy & Stellingwerff, 2020)

So, the next question is what happens with two runs of 10km, both run at the same pace/duration are they always equal? Is time and distance all we need to know?

Rate of Perceived Exertion (RPE):

(circled in blue in the table below)

      (table from: Paquette, Napier, Willy & Stellingwerff, 2020)

Measuring RPE gives a really good sense of what you have felt on the day of the run and can encompass a lot by simply using an ‘out of 10’ rating (0 being nil effort and 10 being the hardest) for the effort involved.

For example, when we are feeling “fresh” (RPE = 2/10) is very different to when we feel “tired” (RPE = 5/10) the same 10km feels a different stress on our bodies and RPE can captures this.

A word of caution

From the table referenced we can see in the table that there are numerous things to measure and to account for that we haven’t discussed today and this highlights how complex things can get. Looking at factors beyond just distance is important and highlights how we all cope with the stress of training differently. The goal of any tool like this is not to burden you with more worry but might give you a moment to reflect on why today’s 10km was different to the previous one. Happy running!

Tom West (APA Sports and Exercise Physiotherapist)

  • Paquette, M., Napier, C., Willy, R. & Stellingwerff, T. (2020). Moving Beyond Weekly ‘Distance’: Optimizing Quantification of Training Load in Runners. Journal of Orthopaedic & Sports Physical Therapy. 1, 1-20.

Exercise and technology – how can technology help me get enough exercise?

Paul is one of our physiotherapist with a special interest in exercise prescription to improve function. Here Paul chats about some of the program s we use to help you achieve your goals.

We have all asked ourselves; “how much exercise do I need to do to stay healthy?”. Well, if we go back to basics, the World Health Organisation has set out clear guidelines for us to follow.

While, in a perfect world, we would get enough exercise, sometimes trying to meet the daily requirements is hard and we find ourselves with muscle strains and joint sprains. If you’ve been in this position before, then technology can help.

Physitrack is an online exercise program used by Clifton Hill Physiotherapists. This is a free App that will have a personalised exercise program made for you by your physio. We try to go paperless, but of course if you prefer a hardcopy we can easily print your program for you. Lucky for me, my drawing of stick figures are a thing of the past.

Once you are progressing through your program, then there are other apps we can introduce which will continue to monitor your cardiovascular load and progress you safely through exercise.

References and Acknowledgements

https://www.nike.com/au/nrc-app

https://www.strava.com

https://apps.apple.com/au/app/c25k-5k-trainer/id485971733

Kaushal N, Langlois F, Desjardins-Crepeau L, Hagger M, Bherer L Investigating dose-response effects of multimodal exercise programs on health-related quality of life in older adults (2019).

Deep Vain Thrombosis or DVT-an update from Jodi Dribbin

Due to COVID-19, we are all sitting more and moving less, with decreased incidental exercise. This may increase your risk of developing a Deep Vein Thrombosis.

Do you know what a Deep Vein Thrombosis is?

Also known as a DVT, it is a blood clot that has developed in the deep veins. Most commonly found in the calf, but can also occur in the arm.

Signs include:
– Swelling
– Pain or tenderness not caused by a specific injury (most commonly felt in the calf)
– Heat, redness
– Discolouration of the skin.
**If you have any of these symptoms, it is important to alert your doctor ASAP.

It is also important to note that if you have any signs including chest pain, shortness of breath, increased heart-rate or coughing up blood, then you MUST alert your doctor ASAP as these could be signs of a blood clot that has travelled to the lung (AKA pulmonary embolism).

Blood clots are treated with anticoagulant medication (AKA blood thinners), and they slow the body’s ability to develop new clots and stop the existing clot from growing.

A clot either arises spontaneously or is caused by conditions including surgery, trauma, or prolonged bed rest.

Women tend to have a lower risk than men, but pregnancy or use of oral contraceptives (the pill) or hormone replacement therapy may represent important risk factors.

Other risk factors include:
– Family history of blood clots
– High BMI (overweight)
– Sitting too long/ confinement to bed or wheelchair
– Smoking
– Long term chronic lung or heart conditions
– Diabetes

Understanding your risk, and the decisions to help mitigate the occurrence of blood clots can help protect you from the potentially fatal consequences!

Therefore, make sure you get up regularly from your desk, go for a daily walk and try squeeze in some resistance or cardiovascular training! As always, don’t hesitate to come in and see one of our physio’s for any advice or recommendations.

References:
– Kyrle, P. A., & Eichinger, S. (2005). Deep vein thrombosis. The Lancet, 365(9465), 1163-1174.
– Stoptheclot.org

Jodi Dribbin

Physiotherpaist
B Physio, Post Grad Cert Pelvic Floor and Continence Physiotherapy (The University of Melbourne)
MAPA

Another original publication by one of our clever Physios

Brendon Haslam is at the 11th hour of a PhD…. no mean feat! He is contributing original and valuable research that will help Stroke survivors with Chronic Pain. He has another publication out this week. Great work Bren!

https://www.sciencedirect.com/science/article/abs/pii/S1936657420301023

Teaching on Zoom: A Glance Behind the Scenes

(This account by Andrew is a snapshot of how dedicated and hard working our team is. They have all gone to great lengths to continue to provide outstanding and safe healthcare. We thank them all and feel lucky to work with such a wonderful group of people)

Andrew Firth is Clifton Hill Pilates and Rehab’s Pilates Instructor and Personal Trainer. Andrew and his wife Emma recently welcomed their son Will into their lives. So, with a new baby at home, Andrew has adapted to the restrictions and runs all his classes live on Zoom. Here is a day in the life of Andrew:

With 2020 being what it is, the simple act of teaching Pilates has proven tricky to say the least. Restrictions, procedures and protocols have forced change on all of us – but sometimes, change can lead to innovation.

As many of you already know, Clifton Hill Pilates and Rehab has been teaching some of its classes online (using Zoom) since before the first lockdown. This service has evolved with each passing week, and every instructor has developed their own unique approach to teaching through a screen. For myself, I have found the task of crafting my own method to be an interesting and often entertaining one. Today, I thought I’d share the rigours and joys of teaching on Zoom.

First things first. This is – or rather, was – sweaty work. Teaching requires flexibility, and access to an enormous spread of exercises. Regressions for when your client is struggling, progressions for when they excel. A mixture of reliable, familiar movements for consistency, and then more varied movements to keep workouts interesting. When I began teaching online, it was quickly apparent that I could not hope to demonstrate every single exercise, for every single class, sometimes for five or six classes in a row, without suffering some sort of nervous (and physical) breakdown.

I took myself to the studio. The film studio, that is – formerly known as my living room. There I recorded myself performing exercise after exercise, variation after variation, often in arduous workouts lasting upward of two hours. I sweated. A lot. Fortunately, I enjoyed it, and the most difficult chore was trying to sweep an ocean of dog hair out of the carpet pre-recording.

With the recording done, I migrated to the computer. I taught myself the ins and outs of video software – how to slice, convert, loop and extend footage – and then I put these newfound skills to the test. As the only model in what would eventually become reference videos, I knew that only one thing truly mattered – every clip had to make me, the instructor, look excellent. Andrew Firth, top notch athlete, his flawless technique obvious at all times, always the consummate performer. And those parts of the recording where I stumbled, or forgot what I was doing? Hastily chopped away. That bit where I pulled my chair down on top of me? Sliced, diced and thrown in the trash. Those exercises where I had sweat dripping into my eyeballs? Delete everything, put on a fresh t-shirt, and return to the living room to re-record. It took me days to plan workouts, shoot them, edit them, arrange them into a workable format, and then chuck the One Ring into Mount Doom for laughs. But it was worth it.

Now, whenever I teach a CHPR Connect class, there is no need to flail wildly before the camera as I try to explain what clients should do next. Instead I just double-click the video called “High Bridge on Chair” or “Kneeling Cat Stretch”, and while that plays in the background I can give participants my full, undivided attention. With a library of over 220 different exercises now at my disposal, the classes have become concise and specific, with each 45 minute session typically boasting 30 exercises or more. It isn’t face-to-face Pilates, it isn’t in the studio, and the only equipment we use is a mat and a chair, but make no mistake: Pilates through a screen can be one helluva workout.  

Andrew Firth

Pilates Instructor

This delightful image is of Andrew dressed in his Christmas cheer, with some of the team celebrating Christmas in July last year

(of course the highly talented Andrew is an outstanding singer too!)

Daniel’s 3 principles for returning to exercise and sport in lockdown

Cracking under Covid, or prospering through pandemic? 3 principles for returning to exercise and sport in lockdown.

Most of us have this one same question right now: How do I get back to the level of fitness I had before the world went crazy (aka coronavirus)? We are all pining after those days of Tuesdsay night mixed netball, Thursday night footy training and all manner of sports over the weekend with a dash of pilates or yoga classes to round us out. And now we’re supposed to replace all that from within the confines of our lounge room or the over-crowded Merri Creek trail No doubt, we’re trying!

However, the question we all should be asking is: how do I maintain my exercise and sport safely? In recent weeks and months, it has been more common than usual in our physio rooms to see patients coming in with an achilles issue or a flared up shoulder due to people doing exercises that they’re not used to doing. For example, you may not have gone for a run in 10 years, but since the gyms are closed you feel that this is your only option. We all need a bit of guidance around this.

So here are my 3 ‘T’s for prospering through the pandemic:

Type

Exercise type is concerned with what you aim to improve with exercise. The main exercise types include aerobic (or endurance), resistance (or strength), flexibility and balance. The key here is, where possible, to start with a type of exercise that is most alike the kind of activity you did prior to lockdown. For example, just because you’re able to run 10km regularly doesn’t mean your lower back will automatically be able to cope with starting a HIIT (high intensity interval training) program – I’m speaking from experience here!

It’s great to experiment with new types of exercises, but know your limits. Ask yourself: has my body done this movement at this intensity before? Start small. Build from there.

Time

The recommendation from the Department of Health for 18-64 year olds is 5 hours of moderate intensity exercise per week – or 43mins per day. This does not have to be done all at once. For example, you might do a 20 minute online Pilates class in the morning and then go for a walk in the evening.

Tenacity 

Sure, it’s just so that this tip also starts with a ‘T’, but what I mean is: the best kind of exercise is the kind that gets done. So, to make sure those 43mins happen everyday:

  • Set your goal. Sign up to that 6 week challenge. Draw out your running / cycling goal on google maps.
  • Plan for it. Put it in your phone’s calendar. Lay out your exercise mat the night before. Put your runners at the front door.
  • Get support. You are far more likely to exercise if you know you have someone alongside you. Rope in your partner or housemate, or even the kids!

Make that exercise your own. Be smart about it, and your body and your brain will thank you for it.

Daniel Zeunert is a musculoskeletal physiotherapist at Inner North Physiotherapy and Clifton Hill Pilates and Rehab. He received his Masters of Physiotherapy Practice at La Trobe University in 2014, and has an interest in low back pain and returning to running after injury.

Osgood-Schlatter Disease: Let’s Get Proactive!

This might surprise you, but 1 in 10 adolescents experience knee pain that stops them taking part in the exercise they love. Most of these young people would struggle to tell you the name of their knee condition (it’s a mouthful), but what they can easily recall is the characteristic painful lump, and significant time out of their sport.

Osgood-Schlatter Disease (OSD) is that condition. OSD is caused by repeated stress at the point in your knee where the quadriceps muscle meets the bone. This is a potential point of weakness during the years in which kids are growing and participating in lots of exercise. Those who are very active – and particularly those that specialise in a single sport from a young age – are more likely to get it.

In the past, OSD was believed to improve once this growth period had finished – typically within 6-18 months of diagnosis, a frustratingly lengthy amount of time for a young person to give up their sport (and not dissimilar to the recovery timeframe for another bogeyman of the knee, the ACL injury). This timeframe however, is now not thought to be accurate. In reality, it has been shown that many people experience knee pain and reduced knee function for at least 4 years, and sometimes into adulthood.

Those that get back to sport often suffer from ongoing pain and weakness in their knee and hips muscles. Apart from the detrimental effect this can have on a young athlete’s performance levels, it may also predispose those with OSD to other injuries in the future.

Considering the impact this condition has on many young people’s lives and sporting aspirations, it seems OSD has been underestimated in the past. So, what is the best way to treat it? Recent research has begun to shed light on the answer.

Where previously “just rest it” was the main treatment on offer (with mixed results, as we have seen), researchers in Aalborg University in Denmark recently found that physiotherapy was effective in reducing pain and rebuilding knee strength in those with OSD. Contrary to past advice, exercise was also not completely stopped. Instead, coaching on how best to modify activity levels to facilitate recovery and stay fit was given to patients, in addition to a specific exercise program to help their knee strength.

Given the long-term consequences of OSD, and the promising results of this trial, it appears sensible to take a proactive approach to recovery from this injury. With physiotherapy-lead education on how to reduce pain while also staying fit and active, in addition to exercise programs targeting specific weaknesses after the injury, it is likely that young people will get back to their sport more quickly and have better knee health in the long term.

Dónal Ahern

Sports Physiotherapist

References:

1.         Holden S, Rathleff MS. Separating the myths from facts: time to take another look at Osgood Schlatter ‘disease’. British journal of sports medicine. 2019.

2.         Rathleff MS, Winiarski L, Krommes K, Graven-Nielsen T, Hölmich P, Olesen JL, et al. Pain, Sports Participation, and Physical Function in Adolescents With Patellofemoral Pain and Osgood-Schlatter Disease: A Matched Cross-sectional Study. The Journal of orthopaedic and sports physical therapy. 2020;50(3):149-57.

3.         Rathleff M, Winiarski L, Krommes K, Graven-Nielsen T, Holmich P, Olesen J, et al. Activity Modification and Knee Strengthening for Osgood-Schlatter Disease: A Prospective Cohort Study. Orthopaedic journal of sports medicine. 2020;8:232596712091110.

A warm welcome to Dónal Ahern, Physiotherapist

Some of you may have already heard a lovely Irish accent around the clinics… that belongs to Dónal and we are excited to have him join us. Dónal is a very experienced sports and musculoskeletal physiotherapist.

Initially trained in Dublin, Ireland, he then moved to New Zealand – working in club rugby and at ATP Tour tennis events in Auckland.

Since arriving in Melbourne, Dónal has continued to develop his understanding of the profound impact pain and injury has on peoples’ lives, and the best ways to help everyone – athletes and office-workers – overcome the challenges they face.

Dónal completed the Master of Sports Physiotherapy program at the University of Queensland, his thesis exploring the underlying causes of persistent kneecap pain. His interest in hamstring injury prevention lead to him presenting on the topic at the 2019 Sports Medicine Australia conference.

In addition to Clifton Hill Physiotherapy, Dónal is employed by Richmond Football Club as the VFL Rehabilitation Physiotherapist, where he focuses on integrating strength and conditioning principles into injury management – resulting in optimal recovery times and improved athletic performance.

Outside of work, when we are not as confined as we are now, Dónal spends his time exploring the many wonderful cafés in Melbourne and getting outside for games of 5-a-side soccer.

TIPS TO RETURN SAFELY TO THE GYM

Sonja is our physiotherapist with a special interest in exercise-based rehab and functional strength. Here she give you a step-by-step guide as venture back to the training room.

Sonja has a very cute cat called kimchi.

As we approach the long-awaited re-opening of gyms on 22nd June, some of us are very excited and enthusiastic to get back into strength training. Whether you have been able to maintain some type of strength program with limited equipment, found an alternative workout routine, or decided to take a break during the lockdown period, there are a few tips that you can follow to ensure steady progress and reduce your risk of injury.

  1. Adjust your expectations: Approaching your return to the gym with the right mindset is the first step. The reality is that your overall exercise routine has been impacted in the last few months and your expectations must therefore be lowered initially. This means you need to expect to be going back to previous exercise/activity with less strength and conditioning.  
  • Have an introduction week: There is no need to rush back into working out. Rushing back into things can lead to injury. When you are deconditioned, your body has a decreased capacity to tolerate load, and inappropriate loading increases your risk of injury, which can set you back even more (Bowen et al, 2017). Studies have shown that when your training load for a given week (acute load) spikes above what you have been doing on average over the past 4 weeks (chronic load), you are more likely to be injured (Blanch and Gabbett, 2019).
  • Use the first week to ease into the exercises, and use this to see where your new starting point is. Some parameters you can adjust are:
  • Reduce volume: Perform less sets per week than you were previously e.g. Reduce total sets per muscle group by 50%
  • Lower intensity: Use lighter weights that you previously have e.g. by 50%
  • Lower frequency: Start with less total workouts per week

(Haas et al, 2001).

  • Progress slowly: Allow a 4-6 week accumulation period where you focus on technique and getting back into the groove. Slowly increase the parameters listed above in this time, as large week-to-week changes in training load can increase your risk of injury (Cross et al, 2015).
  • Monitor your recovery: Following each session, you should monitor your recovery, in particular any soreness experienced. Excessive muscle soreness is likely to reflect an overload in your previous session and a reduction of the 3 parameters would be suitable (Cheung et al, 2003). On the other hand, if you are progressing well your training programs volume, intensity and frequency can be steadily increased towards your normal program.

If you have any existing niggles that you would like to sort out before your return to gym, or if you would like some guidance with exercises, book in with our physios and they can assist you.

And lastly! Be a great gym member and make sure you always bring a towel, wipe down your equipment and wash your hands at the end of your session.

References:

Blanch, P., Gabbett, T.J. (2016). Has the athlete trained enough to return to play safely? The acute:chronic workload ratio permits clinicians to quantify a player’s risk of subsequent injury. British Journal of Sports Medicine, 50:471-475.

Bowen, L., Gross, A.S., Gimpel, M., et al. (2017). Accumulated workloads and the acute:chronic workload ratio relate to injury risk in elite youth football players. British Journal of Sports Medicine, 51:452-459.

Cheung, K., Hume, P., Maxwell, L. (2003). Delayed onset muscle soreness : treatment strategies and performance factors. Sports Med, 33(2):145-164

Cross, MJ., Williams, S., Trewartha, G. et al. (2015). The influence of in-season training loads on injury risk in professional rugby union. Int J Sports Physiol Perform. doi:10.1123/ijspp.2015-0187

Hass, C.J., Feigenbuam, M.S., Franklin, B.A. (2001). Prescription of Resistance Training for Healthy Populations. Sports Med, 31(14): 953-964

PREPARING FOR THE NEW LOOK SPORTING SEASON

Billy is our physiotherapist with a keen interest in sport, especially football.

The influence of COVID-19 has been significant and far reaching across society and certainly includes the passionate world of community sport. However, with the easing of restrictions we are beginning to see some light at the end of the tunnel for the return of our favourite sporting codes!!

As exciting as this is, the abrupt return of sport involving restricted and modified training protocols poses a number of unique challenges for athletes, with respect to increased risks of injury. This is relevant to both weekend athletes and those at the elite level.

Firstly, it is worthwhile discussing why increased injury risk is relevant to the current sporting environment. Due to the pressing demand to get winter sporting codes started, to potential conflicts with the summer sport season, a smaller and more compact pre-season conditioning period is required. In other words, the spike in training loads between an initial training session and a match is much steeper than would normally be achieved with a routine preseason program. Physiotherapists and strength and conditioning team members use the term load management to describe this change in sporting demands.

An excessive spike or trough in training loads has been linked to increased injury risks, and considering the potentially increased burden of injury in a shortened playing season, this is a pivotal consideration in a team sport program (Windt & Gabbett, 2017).

To a certain degree, this spike in load is non-modifiable due to the exceptional circumstances. So, what can athlete be doing to positively change their risk of injury? Here are some simple and practical tips to assist in you getting the most out of your winter sport season;

1) Ensure any previous injuries are fully rehabilitated.

An unfortunate reality for many players who are participating in-season is that return to play is prioritised over full resolution of symptoms and full clinical rehabilitation. This can often result in weaknesses or deficiencies not being fully rectified. These weaker links can alter an athlete’s movement patterns and potentially present a ‘weak link’ when exposed to high relative sporting volumes.

The benefit of having no current games is that these deficiencies can be prioritised and corrected with a tailored rehabilitation program.

2) Include exposure to sport specific training.

This may sound obvious, but adequate training of sports specific volumes is pertinent to managing injury risks. In some circumstances, the antidote is the poison itself in adequate doses. For example, high speed running is a risk factor for hamstring injury, but completing appropriate volumes of high speed running in a graded way is actually a way to prevent hamstring injuries (Duhig et al., 2016). A spike in kicking volumes is often associated with quadriceps or hip flexor injuries, therefore exposing an athlete to appropriate, graded kicking volumes is a great way to minimise these injuries (Mendiguchia, Alentorn-Geli, Idoate, & Myer, 2013).

Understand your sport and its unique demands. If you play a hockey, make sure you hit enough balls. If you play rugby, make sure you’re practicing some tackling (when safe to do so…). If you’re a basketballer, be sure to train agility and change of direction. Exposure to these loads is pivotal to prevent an excessive spike when matches return.

3) Optimise recovery strategies

As athlete’s return to sport, it is certain that many of them will experience generalised delayed onset muscle soreness (or DOMS) following training. While literature advocating for or against specific recovery practices is inconsistent, it is widely accepted that taking an active role in recovery from exercise is a positive step for any athlete (Calleja-González et al., 2016).

Find what works for you, whether it be a light walk or bike ride on the day following training or a foam rolling or stretching session. Anything that you can do to help your body recover quickly will help you best prepare for the next training bout.

4) Understand and respect your body.

Despite strict adherence to all training load, recovery and rehabilitation practices, it is an unfortunate fact that some players are more prone to injury than others. Also, if you haven’t been active during the lockdown period, it is more than likely that you will need to be cautious about how much training you complete when you return to structured sessions.

It will be tempting to aim at a return to sport as soon as possible, like a Round 1 match. However, for someone with a significant injury history, or who is recovering from a long-term injury, it may best to make a conservative decision about delaying return to play. One size does not fit all and this decision should be based on a collaborative approach from the athlete, coach and healthcare stakeholders.

All in all, it’s exciting to be getting sport back in our lives. There is no better time to get any niggling injuries or weakness addressed. If you have any lingering issues that you would like professionally and thoroughly assessed, your physio can set you a structured and goal-orientated individualised plan.

Billy Williams

References;

Calleja-González, J., Terrados, N., Mielgo-Ayuso, J., Delextrat, A., Jukic, I., Vaquera, A., . . . Ostojic, S. M. (2016). Evidence-based post-exercise recovery strategies in basketball. Phys Sportsmed, 44(1), 74-78. doi:10.1080/00913847.2016.1102033

Duhig, S., Shield, A. J., Opar, D., Gabbett, T. J., Ferguson, C., & Williams, M. (2016). Effect of high-speed running on hamstring strain injury risk. British Journal of Sports Medicine, 50(24), 1536-1540. doi:10.1136/bjsports-2015-095679

Mendiguchia, J., Alentorn-Geli, E., Idoate, F., & Myer, G. D. (2013). Rectus femoris muscle injuries in football: a clinically relevant review of mechanisms of injury, risk factors and preventive strategies. British Journal of Sports Medicine, 47(6), 359-366. doi:10.1136/bjsports-2012-091250

Windt, J., & Gabbett, T. J. (2017). How do training and competition workloads relate to injury? The workload—injury aetiology model. British Journal of Sports Medicine, 51(5), 428-435. doi:10.1136/bjsports-2016-096040