ACL Injuries in Children

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Unfortunately, the number of ACL injuries in kids  (especially aged 10-14) is rising. This is likely due to increased participation in high-risk athletic activities, and a lack of early sport-specific training.

About the ACL

The ANTERIOR CRUCIATE L IGAMENT Arises from the lateral femoral condyle and inserts into the intercondyloid eminence of the tibia, blending into the medial meniscus (see below)

The ACL resists anterior tibial translation and is also a secondary restraint to knee hyperextension. Basically it holds your thigh bone on your leg bone!
It also prevents excessive rotation of the tibia during cutting and pivoting activities.

Mechanism of Injury

  • Commonly a non-contact injury where the athlete plants their foot on the ground to change directions, subsequently tearing and causing the knee to ”give way”
  • The ACL also can be torn if the knee is forcefully hyperextended while landing from a jump.
  • Although less common, contact ACL injuries can occur when an athlete is hit on the side of the knee with the foot planted on the ground. These injuries often involve more than one ligament.

So should kids have surgery or take a non-operative route?

ACL reconstruction in kids may be required when:

  1. The child has repairable associated injuries that require surgery (e.g., bucket-handle meniscus tear, repairable meniscal lesion or osteochondral defect)
  2. The child has recurrent, symptomatic knee giving way despite completing high-quality rehabilitation
  3. The child experiences unacceptable participation restrictions (i.e. an unacceptable modification of activity level to avoid knee giving way)

Non-surgical treatment is a viable and safe treatment option in skeletally immature patients who do not have associated injuries or major instability problems

So what now?

If your child has sustained an ACL injury, or acute knee injury, book in an appointment with one of our experienced physiotherapists who will guide your child through their comprehensive rehabilitation program. It is important that you as a parent come along to these appointments so we may involve you in their care, and we will all work together as a team, to get them back to their sporting goals.

Laura To

Physiotherapist and Pilates Instructor

We are excited about Dónal’s new STRENGTH AND CONDITIONING CLASSES

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Strength and Conditioning Classes 

Strength and Conditioning (SnC) classes at Clifton Hill Pilates and Rehab are aimed at people who are looking to improve their physical fitness and performance through high-intensity resistance and cardiovascular training. 

What is Strength and Conditioning? 

SnC improves your physical capacity and performance. We do this by consistently and progressively asking our bodies to adapt to an exercise stimulus. By performing these exercises in a particular way, we can achieve different goals – whether that’s improving your maximal strength, endurance, power or speed.  For example, lifting heavy weights slowly will improve your strength, but performing exercises quickly will be more likely to improve your speed. 

At CHPR, we train several types of physical capacity in each class using a variety of different exercises. 

This is done with individual goals in mind. For example, if you find it difficult to squat due to stiffness in your ankle, we can work on this while modifying your range of movement to ensure you feel comfortable and can gradually progress as your mobility improves. 

Why Should I Start SnC Classes? 

The benefits of being physically stronger and improving your overall fitness are well studied, with resistance training – at least twice per week – now part of the World Health Organisation’s recommendations for people of all ages. You can read more on some of the benefits here, and WHO recommendations here. 

Here are a few of the headline benefits: 

  • Improved muscle size and power 
  • Improved sports performance 
  • Reduced sports injury risk 
  • Improved bone strength 
  • Improved general health and reduced risk of chronic disease 
  • Helps to manage many existing chronic diseases and pain conditions 
  • Fat loss 

SnC Classes at CHPR – How It Works 

Key Features of SnC Classes at CHPR 

  1. Circuit-style class: train key movements and muscles 
  1. Individualised components to fit your goals, current fitness levels and training experience 
  1. Improve your muscle strength, power and mobility 
  1. Duration = 60 minutes 
  1. Designed and lead by expert Physios with additional SnC qualifications 
  1. Small groups – maximum of 4 people per class 

Before joining classes, you will first be assessed for mobility, technique, as well previous injuries and your current sporting or fitness goals. 

From there, depending on your experience level and confidence, you may initially require some further 1:1 instruction before joining classes. This is to ensure that you have consistently comfortable technique during the class, making it a more enjoyable experience for you! 

If you have specific goals (e.g. increasing your squatting weight, or improving your hip mobility), we can also schedule a periodic re-assessment to ensure you’re achieving these goals. 

Current Class Coach: 

Dónal Ahern is an APA Titled Sports and Exercise physiotherapist and ASCA Level 1 Coach. He has significant experience working with the community and athletes to improve their physical fitness and reduce injury risk. He has a special interest in Strength and Conditioning for improving athletic performance and general health. 

MAKE ADAPTATION YOUR FRIEND

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As we find ourselves back in lockdown, Victoria, we love these timely philosophical words of wisdom from the clever Andrew Firth.

Stay well everyone and keep moving.

‘As I write this, Melbourne has just gone into a 5-day snap lockdown. The hammer has struck, the knee is recovering from a sudden jerk response, and already we find ourselves adapting to this new (and yet strangely familiar) situation we’ve landed in.

Which got me thinking.

Adaptation. Just as Covid has proven itself frustratingly adaptable, developing new strains and thriving within numerous environments, so too has society been forced to exercise its own adaptation muscles. Muscles that had been – dare I say it – wasting away?

Amateur philosopher that I am, my mind quickly dragged me into deep reflection.

Exercise is, at its core, a process of adaptation. In order to get stronger, you must challenge your body’s limits. Send your focus (and your willingness to sweat) into those areas where you are weak, and load them up to create stress. Once suitably exposed to its own weakness, your body is forced to accept that it cannot meet the demands you’ve placed upon it. It is sorely lacking, and so it responds to this unhappy realisation by initiating a process of – you guessed it – adaptation.

Your body works while you sleep. It renovates your musculature, making your inner mechanics stronger, better, more efficient. Perhaps it rebuilds you as a more durable, more mobile, more relaxed version of yourself. Or maybe you’ve performed exercises that demand greater coordination, heightened balance, and improved activation sequences, so that your body has no choice but to upgrade its dexterity. That is the art of exercise selection – choosing movements that target a specific weakness and thereby exploit dysfunction, turning it on its head to bring about the improvements you desire. You could call it “calculated adaptation,” and if nobody else has laid claim to that little phrase before now then it belongs to me, it’s mine, you can’t have it.

Anyway. Returning to my original point.

Adaptation lies at the heart of everything. Historically, those things that have failed to adapt have also failed to survive, quickly outgrown by the world they inhabit. That is the struggle we face today, both on a global scale and also as individuals. My personal goal (and I encourage you to consider it for yourself) is to acknowledge that adaptation is upon us whether we like it or not. We cannot change this fact, but we can calculate our adaptations. Even in lockdown we can choose our individual challenges to achieve a desired result. Develop a new skill. Ply a new trade. Or, god forbid, get down on the floor and do an hour (yes, a whole hour) of exercise. Let adaptation be your friend, and reap the rewards’.

ANDREW FIRTH

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

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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?

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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

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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

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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

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(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

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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!

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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.