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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

The month of March is the nominated month for raising awareness for endometriosis around the world.

Endo is a relatively common condition and statistically affects up to 1 in 10 women.

Did you know that physiotherapy can help improve your journey living with endometriosis?

Endometriosis is a condition where, for reasons still unclear to medical researchers, endometrial tissue starts to grow in other areas in the pelvis, and outside of the uterus (where it normally would be found). Some symptoms include pelvic and abdominal pain, sometimes described as very severe period cramps, and in some cases can affect fertility. Other associated symptoms can be bladder and bowel dysfunction and pain with sex.

Treatment of endometriosis is a case-by-case basis and requires a good team care involving the Gynaecologist and other healthcare practitioners including the physiotherapist.

The Physiotherapist can help by managing the contributions from the musculoskeletal system around the pelvis, abdomen and hips. Understanding and improving pelvic floor muscle function is essential for good bladder, bowel and sexual function, but can also make a change in how your body reacts to pain.

The diagnosis of endometriosis often mean that someone may have experienced chronic pain for several years. The physiotherapist can help educate to understand how pain works and what to do about it. It helps to retrain the way the brain connects to the involved areas and muscles in the abdomen and pelvis, towards more helpful neural pathways and pain management strategies – rather than the classic “brace against pain” and “fight or flight” responses our bodies often resort to.  Physiotherapy alongside medical management can help you build and implement effective strategies to manage and reduce the impact of endometriosis on daily function and enhance quality of life.

So, if you have been diagnosed with endometriosis, or know someone who suffers from endometriosis, call one of our wonderful Pelvic Health Physio’s to learn more.

Adriane Khablyuk  B Sc (Physio)  Post Grad Cert (Pelvic Floor Rehabilitation)

Adriane graduated from Curtin University (Perth WA) in 2013. She has worked in the private practice setting since and developed experience in treating a wide variety of musculoskeletal disorders.Adriane has a special interest in Women’s Health and completed her Postgraduate Certificate in Pelvic Floor Rehabilitation in 2018. She is passionate about helping women return safely to an active lifestyle post-natally. She loves treating pregnancy related musculoskeletal conditions, including pelvic girdle and SIJ pain, and pelvic floor dysfunction. She also has special interest in treating all continence issues, pelvic pain  and pelvic floor dysfunction in women of all ages.

Shin Pain – an insight into the condition and its rehabilitation.

Medial tibial stress syndrome presents as pain along the shin bone and is often referred to as “shin splints”. It is a relatively common injury and can affect athletes involved in impact sports, and up to 35% of runners.

The cause of shin pain is usually related to a sudden increase in load as one increases training intensity in view of an upcoming running event or game. This means an increase in either kilometer distance achieved, or pace and speed, or type of terrain (concrete vs grass vs soft sand etc), or tackling more hills or inclines. In some situations, it can even be caused by a sudden change in training shoes, which results in different biomechanics and way of loading the lower limb.

It is hypothesised that pathology of medial tibial stress syndrome involves dysfunction in the muscles that attach along the shin bone (tibia), namely posterior tibialis and flexor digitorum longus muscles. It is thought that that increase in load can result in increase in tension within these muscles, causing greater shear forces at the attachment sites of these muscles on the tibia. This in turn may result in symptoms such as pain, swelling and edema. In some severe cases, medial tibial stress syndrome can even lead to micro-fractures along the periosteum of the tibia if left untreated and aggravating triggers are not addressed.

Novice runners who have just picked up running as a new year resolution, for example, are particularly likely to develop this type of injury as their body has not conditioned and adapted to the demands of the new activity yet. Runners with higher body mass index (BMI), decreased hip strength and increased foot pronation were also found to be at higher risks. Females were also more prone to developing this type of injury due to having a larger pelvis and its implications on the biomechanical function of the lower limb.

So, what do I do if I have shin pain? – Does this mean I have to stop running?

Nope. Not necessarily…

Treatment of medial tibial stress syndrome involves an array of different approaches, including reducing load. This does not however mean that you should stop running altogether. It may be essential in some situations to have a temporary break from running until the acuteness and severity of your symptoms diminish to allow you to start a rehabilitation program towards starting to run again. But in most cases, it is a matter of allowing a relative reduction in load – run less distance, run smarter – and start a strengthening and conditioning program to address the biomechanical deficits identified by your physiotherapist.

In the early stages, the physiotherapist may treat the surrounding musculature to reduce any potential tension along the tibia and teach you some useful stretches and management techniques.

The physiotherapist will assess your biomechanics range of motion and strength, review your training volume (kilometers distance achieved per week), help you break down the intensity of your training and assess your running technique.

Overall, you will learn to train smarter, run better and understand how to work the fine line of challenging your body towards improving your performance, and also allowing adequate room for your body to strengthen, condition and adapt accordingly to prevent resurgence of injuries.

So, do not hesitate to see one of our friendly physiotherapists for an assessment and start your journey to fitness and wellness.

 Adriane Kabhlyuk , Physiotherapist and Pilates instructor

References:

Collins, N, Bisset, L, McPoil, T, Vicenzino, B. (2007). Foot orthoses in lower limb overuse conditions: a systematic review and meta-analysis. Foot & Ankle International; 28:396–412.

Geoffrey, J. (2014). Dynamic foot function as a risk factor for lower limb overuse injury: a systematic review. Journal of Foot & Ankle Research: 7: 53.

Janice and Reiman (2017). Lower Extremity Kinematics in Running Athletes with and without a History of Medial Shin Pain. International Journal of Sports Physical Therapy: 7(4): 356-364.

Luedke et al. (2016). Influence of Step Rate on Shin Injury and Anterior Knee Pain in High School Runners. Medicine and Science in Sports and Medicine; 48(7): 1244-50.

Newman, P, Witchalls, J. Waddington, G, Adams, R. (2013). Risk factors associated with medial tibial stress syndrome in runners: a systematic review and meta-analysis. Journal of Sports Medicine; 13(4): 229-241.

Saeki et al. (2017). Ankle and toe muscle strength characteristics in runners with a history of medial tibial stress syndrome. Journal of Foot and Ankle Research; 10: 16

Saeki et al. (2017). Muscle stiffness of posterior lower leg in runners with a history of medial tibial stress syndrome. Scandinavian Journal of Medicine & Science in Sports.

Winkelmann, Z.K. et al. (2016). Risk Factors for Medial Tibial Stress Syndrome in Active Individuals: An Evidence-Based Review. Journal of Athletic Training. Dec;51(12):1049-1052.

Zachary et al. (2016). Risk Factors for Medial Tibial Stress Syndrome in Active Individuals: An Evidence-Based Review. Journal of Athletic Training; 51(12):1049-1052

Did you know Josh trained as a Podiatrist before becoming a  Physio? 

Here are his expert tips on choosing your running footwear:

As Physiotherapists we are asked for advice on appropriate running footwear several times each day. Footwear companies often make exaggerated and misleading claims about the wondrous properties of their shoes, which can make it difficult to determine what type of running shoe is right for you.

In recent times ‘Barefoot’ or ‘Free’ running has gained popularity. Advocates will argue that because cavemen would have run barefoot this is a more natural way for our body to function when moving, and is more in line evolutionarily with how our foot and ankle are meant to be used.

The reality for present day adults is that a good degree of conditioning and adaptation is necessary for our bodies get used to running without footwear. Cavemen didn’t have to contend with surfaces such as hard bitumen or concrete. The right shoes play a critical role in reducing the shock caused to our bodies by these surfaces.

Numerous studies have demonstrated a marked change in loading patterns (how weight and pressure are distributed) through the feet and legs during running with and without shoes. Rapid change in any exercise training does not allow our bodies enough time to adapt, and adaptation is important for injury prevention. If you wish to trial barefoot running it should be a transition that is quite structured and measured so as to minimise the associated risk of injury. As this is a complicated process, it is best to seek the advice of a trained practitioner with specific knowledge and understanding of the biomechanics of running.

At the other end of the scale to bare feet, is footwear that does not permit normal functioning of the foot. Our feet and ankles are intricate in their design and function very well in normal situations to assist smooth and strain free patterns of movement through the body. Footwear that is rigid and does not accommodate foot motion can have equally detrimental effects to running without shoes.

So what does this all mean?

The long and short of this, if you’ll pardon the pun, is that there is no one-size-fits-all approach to selecting footwear. We each have distinctive running patterns and anatomical variations of the foot and ankle that mean we each need shoes with different features.

It is hard to know where to start with such a vast array of options available. When you walk into your local shoe store, even the staff may have little idea as to the features of each shoe, which is not to denigrate them, but shows how complex the technical components of shoe design and manufacture are.

Reputable brands and stores will have various styles with different features to enable selection of footwear that is appropriate to your own foot type and biomechanics. Remember that cost does not always equate with quality; the most expensive shoe may not work well for you personally. It is much more important that you have a shoe suitable to your foot type and your running regime than it is to spend a lot of money.

There are some common mistakes made when it comes to choosing running shoes.

Always measure shoe size while standing, and allow approximately the width of your thumbnail from your longest toe (which for some people is the second toe, not the big toe) to the end of the shoe. This allows for expansion of the foot during exercise, which is especially important in warmer weather. The width of the shoe is equally important. A good guide is to pinch the top of the shoe over the widest part of your foot. A small amount of the material should bunch between your index finger and thumb. A sign that the shoe is too big is that your whole foot will feel like it slides back and forth in the shoe.

If you wear orthotics, always ensure you wear them when fitting new shoes. You may find you need to go up a full size to accommodate the orthotic device.

Make sure the heel counter, the stiff part at the back of the shoe that covers your heel, is deep enough. If your heel feels like it loses contact with the sole of the shoe when you walk you may need to adjust the arrangement of the lacing of the shoe, or failing that, choose a different style of shoe that offers more depth. This is very important because the position of the back of your foot influences how well the front of your foot functions. Particularly with shoes that have in-built rear-foot control features, such as running shoes, it is essential that the heel sits right on the insole and snugly against the back of the shoe

Lastly, select a shoe that allows your mid-foot and fore-foot to move easily. To check this pick up the shoe with one hand cupping the heel, and the other cupping the toes. Twist the shoe gently between both hands. The first two-thirds of the shoe should twist under pressure and the heel should stay relatively stiff. The flex point of the shoe, where it bends most easily, should be where the ball of your foot would be, ideally around the first third of the shoe. It’s best to avoid shoes that bend in half, as your foot does not bend naturally at this point.

I hope this has provided some food for thought when it comes to running and footwear. Remember there can be a large degree of trial and error when choosing footwear, but a good retailer will have a more in-depth understanding of appropriate shoe types for you, so don’t be afraid to ask questions and do your homework.

 

—

Josh Neeft

M Physiotherapy (GE), B. Podiatry

Inner North Physiotherapy
734 High Street
Thornbury VIC 3071
P: (03) 9089 6666
F: (03) 9089 6644
E: josh@innernorthphysiotherapy.com.au
W: innernorthphysiotherapy.com.au

Clifton Hill Physiotherapy
111 Queens Pde
Clifton Hill VIC 3068
P: (03) 9486 1918
F: (03) 9486 5650
E: josh@innernorthphysiotherapy.com.au
W: cliftonhillphysiotherapy.com.au