Is it a problem if your baby learns to walk before they have learnt to crawl? Is there something odd about your baby or is it something odd about ‘milestones’?
Do you suffer from 'not stretching' guilt?
Do you ever feel sore after exercise and think...'if only I did more stretching!'...
So many of us have been taught the importance of stretching from a young age... but is stretching really the must do that we believe it is?
Check out Jasleigh's short and sharp blog on the impact of stretching on injury prevention, performance, recovery and sporting technique...
The Movement Team offer a specific Paediatric Physiotherapy service, it is rarely obvious though when and why a baby or child should see a Physio. Below are some basic and general guidelines. We are also very happy to take questions, jump on the phone or chat in clinic to help you understand when we might be able to help and we we aren't the best people to see!
“I keep getting injured this season; I just can’t catch a break”
This is, firstly, not uncommon and, secondly, unlikely luck related, though you may feel that way.
A fairly recent article in the BJSM (the preeminent sports medicine journal) has highlighted well that standard reloading protocols used are probably over ambitious in their prescription. This seems to be increasing injury risk, during and just after return to sport protocols.
This is through no fault of clinicians in their intent but rather more related to new information and understanding regarding injury risk.
This may seem like good news, which it is for injury risk, but many athletes reading this may be disappointed to hear it means a longer return to sport protocol (which means more time without playing).
This new understanding has collateral implications for general loading and more importantly in this situation deloading. Previously time off and deloading were seen as protective in nature with respect to injury risk, particularly with regards to ‘overuse’ type of injuries (see below for a better term for these and a better understanding of them). Better understanding of loading now indicates that underloading may be as big a risk factor as overloading for injury risk, but more on this later.
What is this new information and understanding? See the next classic statement.
“You are training too much”
There have been calls to do away with the term ‘overuse injury’ in favour of ‘loading error’ and, to be honest, this seems more logical to me when these injuries are often in people not doing a great deal.
So why the change and how does this happen in people who are not doing a great deal?
The last few years have yielded a significant number of scientific papers looking into this area of injury and the prevailing picture is remarkably consistent (it rarely is in science) and very helpful to those ‘on the ground’ (often not the case in science) by putting paradigm to some of the intuitive things coaches had thought and felt for a long time.
The new paradigm that is being proposed is the ‘Acute to Chronic Workload Ratio’ (ACWR).
Let’s break this down and explain its implications.
Acute workload; generally considered the training load of the last week (or microcycle if you must)
Chronic workload; recent articles focus this on the average training load of the last month (or mesocycle if you must) but this is often extended out to 10 weeks or beyond.
Acute:Chronic workload ratio(ACWR): This is the ratio of the workload in the last week to the average workload of the last month (or more).
“So what is the story with ACWR?”
It seems the story coming out of the research is fairly consistent and boils down to the ‘Goldilocks’ principle ie you need not too much but importantly not too LITTLE loading.
The sweet spot of loading is a little variable between sports (as suggested in an article released in the last month or so in the BJSM pertaining to football/soccer specifically) but generally it is suggested an ACWR of 0.8-1.1 is considered optimal. Outside of this the injury risk starts to rise, this rise looks a little variable but is almost exponential. Just to reiterate here, this is injury RISK NOT injury RATE or incidence. So you may well ignore this advice (or have been doing so inadvertently to this point) without issue, but limiting RISK of injury is the business we are in in the sports medicine community as we cannot possibly eliminate it.
Thinking about this you can see that any spikes or troughs in loading carry through for a month or more and thus should be dealt with appropriately or avoided as best as possible. This has implications much beyond any given month of the season and in the peri-injurious period.
Increased preseason participation has been shown to be protective for injury, with this effect being more significant when examined at differing running speeds. In short; the more preseasons sessions you do the less likely you are to be injured, conversely, those who have done fewer sessions are at greater risk of injury, with this effect magnified with increasing running speeds.
The QUT/ACU hamstring group have done great work over many years pertaining to one of the most hated of all injuries in sports, the hamstring strain. Their more recent work suggests that ACWR is likely implicated in hamstring injury! This is particularly interesting as this was formerly NOT seen as a loading related injury!
“How do you measure load? “
This is a really good question with answers that are far reaching and probably a bit beyond this article. But here are some considerations. Load can be measured intrinsically or extrinsically and either objectively or subjectively.
Most in the industry quantitatively measure at least extrinsic load (think GPS data) and potentially intrinsic load also (think heart rate).
Usually this is correlated with subjective measure of intrinsic loading (rating of perceived exertion).
Interestingly talking to coaches, their anecdotal experience seems to indicate that often times intangible and more informal, subjective wellness monitoring of their athletes is more useful to them. This was recently confirmed in some research suggesting that wellness questionnaires (which are fairly standard in elite sport) are a better predictor of training status/overtraining in athletes.
This is probably a good indicator that the ‘load of life’ so to speak and/or suboptimal recovery is a factor that is an effect modifier in training. For more on this see below in the article.
“He’s so good and he never seems to get injured”
Interesting that… I wonder if the two are related. Turns out there is some good data that this is indeed the case.
So even if you are more focused on performance than injury prevention (I don’t even want to know why that would be the case) there is now an associative (at least) relationship between remaining injury free and performing.
This probably doesn’t surprise a number of readers, it stands to reason that more time spent on pure training stimulus rather than recovery and reloading stimulus has a more potent effect on performance.
“I do everything I can to prevent injuries”
I’m not going into the fact that this could be called into question of itself.
Instead I will talk about things that I believe many would not be doing/things that will aid people in this endeavour which are not necessarily standard practice.
The first point is probably most important for endurance athletes and recreationally active people. It is the concept of training monotony. There is some fairly significant indication that training monotony is a large risk factor in injuries related to loading errors. What is monotony? Monotony is the LACK of variety ie running the same route, pace and in the same footwear weekly or even daily. This must be avoided at all costs and is hugely common in the aforementioned populations, though is relatively rare in team sports.
Somewhat inversely related to this is ‘bulletproofing’ yourself so to speak. This requires a high, diverse chronic workload. Alright, I will breakdown all the buzzwords in that phrase. As mentioned previously chronic workload is accumulated over the last month (or longer to be honest, including total lifetime). Having a chronic workload is important, ensuring it is diverse is crucial too. What does that diversity entail? Strength work is probably the first issue and should come as no surprise (for ALL athletes, endurance included!!!) beyond that cross training aids this too, particularly moving in different planes of motion and in different ways. As part of this, the load of ‘life’ is important to consider and optimise too. For instance; active commuting to work, leisure time physical activity and the likes.
There is some suggestion from many coaches that loading is definitely a huge issue but there are other factors that play a role in this often not considered when thinking about athletes. This includes the load from life so to speak, for instance, work stress (physical and psychological). The other aspect or another side of this coin is recovery. I have definitely heard the opinion that overtraining is non-existent and that the issue is under-recovery. Irrelevant of its pure accuracy the statement points to an important fact; recovery is crucial. Appropriate sleep, nutrition and relaxation is of the utmost importance when training and loading the body. I personally believe our society, and as a result sports as a microcosm thereof, underemphasises anything that isn’t vigorously active and subsequently recovery and regeneration is under emphasised and poorly executed by many athletes.
“Oops, I probably did a bit much”
We have all been there. How do mitigate some of the risk here?
There has been quite a bit of research in the past 5 years or so into performance enhancement/recovery augmentation. It seems to be a bit of a case of ‘groundhog day’ so to speak, with the moral being that life is a null sum. OR phrased differently, you are robbing Peter to pay Paul. The overarching take away from research on things like antioxidant supplementation, use of compression garments and ice baths seems to be that whilst they may augment recovery they also seem to blunt response to training stimulus. Again if we use some logic, this probably makes sense, the response to stimulus causing the fatigue, if blunted, would then blunt the stimulus itself.
The specifics of when, how and what regarding the use of these modalities are beyond the scope of this article.
That said, the question remains when to use these modalities if they are seemingly negative?
This may well end of being a matter of personal preference and/or coaching staff preference.
But my advice to athletes/coaches is usually that these modalities should be used when loading has been a little excessive and recovery is of a premium even at the cost of performance gain.
This usually occurs;
- Between weeks in team sports, with or without short turnarounds, usually from mid-season onwards
- When you do a bit much in training (read; don’t listen to your coach)
- When you have competed and been stretched a bit further than you thought you would be ie overtime etc
“So what are the take home messages?”
- Loading and consistency thereof, using the Goldilocks principle was, until recently, not very well appreciated in the research, hopefully this translates into practice particularly pertaining to spikes and troughs in workload as well as return to sport protocols.
- ACWR is more useful that total load and loading related injuries are probably more of a product of change in loading rather than pure amount of loading.
- ACWR of 0.8-1.1 seems to be ideal (with some caveats around different sports and individuals).
- Measuring load is hard, it is probably a matter of trial and error to find what is ‘signal’ (meaningful information) and what is ‘noise’ (useless information). But it is definitely worthwhile to monitor wellness measures in your athletes.
- Injury prevention is important for performance; lower rates of injury are associated with better performance in both team and individual sports.
- Avoid monotony in training and develop a high chronic workload to help protect yourself/your athletes from injuries.
- Ensure you optimise recovery and manage load during periods of high ‘life load’.
- If you are overstretched during competition or need to augment recovery, techniques like compression garments and cryotherapy/ice baths may be used, but understand they may blunt adaptive stimulus.
David Lipman is a medical doctor, podiatrist and exercise physiologist. He should know better, but still runs too much and often too hard, lifts much too heavy for his goals and probably drinks too much coffee (if that’s a thing). But now he tracks his acute to chronic workload ratio and it looks like it is working.
Avoid over-doing it - Too many times I see people who have decided to carry all their groceries in one trip, or pick up a huge box of something on their own or dive straight into a 20km run after 6 months off. It always seems silly to decide to do those things in retrospect, but making two trips or getting a mate to help you lift something can save you weeks of pain, discomfort and inconvenience. Prevention is better than a cure!
Avoid being still for too long - As animals, we didn’t evolve to sit behind a desk. Our bodies are designed to move, lift, run, jump, climb and swim. Prolonged sitting or standing means our muscles stiffen up, so when we ask them to perform a task they can falter and tear. So make sure you’re balancing your desk job with plenty of scenic walks to the printer/bathroom/break room!
Strengthen your muscles - Resistance training is a sure fire way to prime your muscles to withstand the forces of day to day life. Being strong and flexible means that they can handle anything you throw at them. The weaker a muscle is, the easier it is for it to be overloaded and tear. It’s all about starting small and being consistent with what you lift, so you don’t over do it (see point number 1!)
Recover well - Muscles, like any parts of our bodies, need some time off every once in a while. Challenge them with strength training, move them through their movements with mobility and stretching exercises, but then remember to care for them as well. Plenty of sleep and de-stress techniques like meditation can relieve muscle tension. Ensure you’re rehydrating with both water and wholefoods containing electrolytes to avoid cramping and fatigue. Chat to your physio/coach/trainer and make sure you’re employing rest days and de-load weeks into a training program to make sure you’re not going to crash and burn in a few weeks time.
Isabelle is currently the 1st Team Physio for Samford Rangers. Isabelle has worked in private practice around Brisbane before finding her way to Samford and The Movement Team.
Travelling is a wonderful luxury that many of us get to experience a few times throughout our lives. I see many people who are about to travel who are worried about what their trip will do to their body, or people who have injured themselves doing something they don’t normally do in their day to day lives whilst away.
Moderation is key - even for movement
The most common issues I see tend to surround prolonged sitting - planes, trains, buses, ferries - they almost always require you to stay seated for a really long time. Our bodies are designed to move, bend, twist and lift, so when you cramp it into a small space and stay really still for a long time, it’s going to let you know about it one way or another!
The best way to get around this is to take movement breaks, much like when you’re at home, uni or work. Get up and move around when you feel stiff. Don’t feel bad about bugging the person next to you! Your back/legs/neck/hips will thank you when you get to your destination and can comfortably walk off the plane, pain-free.
You’ll definitely catch me standing up, doing calf raises and lunges in the aisle and maybe even a few back stretches if it’s starting to bother me.
It’s good to moderate lots of forward bending with some backward bending, to keep your back happy.
In contrast, to too little movement whilst sitting, I also see plenty of injuries where people take on too much at once. Many people who go from couch potatoes and desk jockeys straight onto the ski fields, whitewater rafts and bungee cords often find that their body isn’t ready to handle the extreme loads that those sports require. Even those who don’t walk more than a few thousand steps a day find that their leisurely walks through new cities day after day are very tiresome on their legs. It’s often much safer to do some targeted exercise or training in the 12 weeks leading up to your holiday to prepare your body for what it’s about to experience. Pacing is key!
Choose Your Bag Wisely
Not all suitcases are created equal! Choose one that rolls smoothly, has a light but sturdy frame and avoid over-packing and making your suitcase too heavy. Keep in mind your travel destination - are there a lot of stairs? Will there be paved paths to wheel your suitcase down? If not, you might want to consider choosing a bag that can be put on like a backpack in case you run a path that isn’t accommodating, like the subway stairs of Japan or the steps over the bridges of Venice. Don’t be afraid to ask for help if you need it to load bags into overhead lockers, vehicles or suitcase lockers at the station - that’s what the attendants are there for.
When packing a backpack, try to put the heaviest items closest to your back. This keeps that weight close to your centre of gravity and means you don’t have to spend as much energy holding it up. Get an expert to fit your pack to you (with and without stuff in it!), and adjust the straps to your size to make sure you’ve got the best fit for you and the load you’re carrying. Again, avoid overpacking! Packing well, and wearing your pack well can avoid a whole stack of neck, shoulder, back and leg injuries.
Pack For The Holiday You Are Taking
If you’re going for a hiking holiday, it’s a great idea to invest in a decent pair of sturdy hiking boots before you go. Talk to an expert about the hikes you’re taking and they should recommend a boot style for you. Don’t forget to train your body for those boots! It pays to do your 12 weeks of training beforehand in those boots to wear them in. Your legs will adapt to the weight of the boots, you will discover any blisters before you’re away from home and you can experiment with the best ways to tie the laces.
Other holiday sports and activities might require special equipment as well. Make sure you chat to the rental attendant and source something that is right for you body size and shape. Skill level can also impact on this. For example, if you’re learning to surf it’s a great idea to choose a bigger rather than smaller board. It could mean a few less times getting dumped by waves, which is pretty hard on the body. The same goes for the snow. Depending on who you talk to, some say that snowboarding is easier than skiing (or vice versa!). It might be worthwhile to stick to something easier for longer, instead of stacking it into the snow and having to sit out nursing an injury while you watch everyone else enjoy!
If you’ve got any prescribed tools for your movement or health, like orthotics, walking aids or small equipment for a hotel-room physio exercise routine (!) make sure you take them with you. Continuing your normal self-care routine goes a long way to avoiding preventable injuries.
Pay Attention To Your General Health
What’s a holiday without a cold? A lack of movement isn’t the only reason that you’re probably feeling achy. Illness and inflammation can make joints and muscles tender. To avoid getting sick, make sure you’re eating a variety of wholesome foods, moving around during your day and getting some solid sleep at night. Sleeping in unfamiliar beds can be tricky, so do whatever you need to do to make yourself comfortable. Bring your own pillow, use an eye mask or ear plugs, or meditate before bed. Some people find melatonin helpful for combatting jetlag, to make sure they start their holiday on the right foot (or for coming home again, depending on your direction of travel around the globe). Good quality rest is essential to ensure you’ve got enough energy for your adventures during the day.
Holidays Are For Deloading Exercise, Not Stopping Altogether
Just because you don’t have access to the gym, doesn’t mean you can’t exercise! If you’re not off on an adventure holiday, you can get your 30 minutes of physical activity in for the day in other ways. You could walk to see the sights instead of catching an Uber. If you feel safe in the area you’re staying in, you could always go for a run, or find some stairs to jog up and down. Other more leisurely activities count as well, like snorkelling or walking along the beach or in the snow. Even a shopping spree counts towards getting your steps for the day in!
For those who are off on a more physical holiday, like hiking, snowboarding, or cycling tours, you probably don’t need to schedule too much formal exercise in, but doing the same leisurely activities can soothe sore muscles, by using them gently.
Isabelle Kelly- Physiotherapist
Isabelle is currently the 1st Team Physio for Samford Rangers. Isabelle is currently taking a 6 week trip around South East Asia!
We we talk about Physiotherapy in society, like a bunch of other professions, you can get good physio’s and not so good physio’s. Here at The Movement Team, we like the fact we are different from most physiotherapy practices out there. But before explaining how we are different, I want to highlight some things that most physiotherapist’s have in their ‘toolbox’ to help treat a patient.
We we arrive fresh faced at Physiotherapy School, we get taught the standard Anatomy, Physiology, Biochemistry, but then also how to assess an area of the body, and also how to treat an area of the body. For the purpose of this blog, I’m going to be talking about Musculoskeletal Physiotherapy as this is what you will mostly likely find in private practice (as opposed to other branches of physiotherapy e.g. paediatric, cardiothoracic, Neurorehababilitation).
When it comes to treatment options, there are a variety of things that a Physiotherapist can do to help with treating a patient. The most common of these is Manual Therapy.
In the Physio world, manual therapy is any technique where the therapists hands are on your body. This includes massage, joint/muscle stretches, joint mobilisations (the art of pushing on a joint to make it move), joint manipulations (usual quick high velocity mobilisations which usually cause an audible cavitation or ‘click’ or ‘crack’ sound), and muscle energy techniques (using muscles to help mobilise a joint) to name a few.
Now when patients present at the clinic with pain, manual therapy techniques are for the most part symptoms relievers. This is why: We have neurons that receive information from our sensory organs and transmit this input to the central nervous system (CNS) which are called afferent neurons. These afferent neurons are what tells our brains that something is painful. On the other side neurons that send impulses from the central nervous system to your limbs and joints to make things move or gain/release tension are called efferent neurons. Manual techniques like those stated above are designed to modulate the afferent input to our CNS. This is why you can get pain relief from a Physiotherapist pushing around on your joint for a while, or from a massage therapist working on your muscles. This input modulation can then also have an efferent effect on that area from the CNS. This change might be muscle relaxation or tension reduction or increased movement in the joint as an example. This may further improve afferent pain levels, and so a cycle can begin.
Sounds great right?! However, as most people would know, this effect may only last a few hours, a few days, or a week, and things usually start to tighten up again at some point. Did we fix the issue? Unlikely. But it helped you feel better while it lasted. Then how do we get the effects to last? I’ll touch more on this further down…
Electrotherapy encompasses the use of a machine which is placed on a patients body. These include but aren’t limited to: ultrasound therapy, TENS, and interferential which are probably the most used in Physiotherapy private practices.
Therapeutic ultrasound involves applying a round-headed instrument to the skin of the painful area, to deliver ultra sound waves that are absorbed by the underlying tissues, in the effort to help relieve pain and lessen disability. Any sports people out there might have had a physio use ultrasound on their ankle sprain or other ligament sprain in the past. I must admit that earlier in my career, I have used it on people also. To the patient it probably didn't feel like it was doing much, and that is probably because it is likely not making a difference! To date, there is still very little evidence to explain how ultrasound causes a therapeutic effect in injured tissue. Research of clinical trials into the use of ultrasound for a variety of musculoskeletal injuries conclude “no support for the existence of therapeutic effects” or “insufficient biophysical evidence” or “no high quality evidence available” or “potential treatment effects of ultrasound appear to be very small”. Which is interesting because A LOT of practices still use this machine!
The basic principle of Interferential Therapy (IT) is to utilise the significant physiological effects of low frequency (<250pps) electrical stimulation of nerves via the use of typically 4 pads surrounding the painful joint. Usually, you connect the electrodes from the machine to your skin, which passes an electrical current into the area. There is evidence that IT can help with reducing swelling and therefore lead to reduction pain and improved movement in those joints immediately post trauma or surgery. The effect is therefore usually only beneficial in the very early stages of rehab.
In Trans-Electrical Nerve Stimulation (TENS), two electrodes are often placed directly on the area of pain. In using it you will feel a ‘buzzing’ sensation and an intensity which is comfortable for you. TENS is used to reduce pain levels by way of electricity stimulating the nerves in a painful area. This stimulation then sends signals to the brain that block or "scramble" normal pain signals, that area is producing. The theory is called the “Pain Gate Mechanism” - which is similar to the pain relieving effect of wanting to rub your elbow when you hit your funny bone. It almost ‘distracts’ the brain of the pain for a short time. It shows evidence in temporary pain relief only, and it mainly used in those with chronic pain as an alternative to medication. It will not fix your injured area!
So what do these things have in common? They all (probably besides ultrasound) have a pain relieving effect. In my opinion, electrotherapy devices get overused in most clinical practices because the effect and evidence for use is usually small. I’ve worked in places where every session would require placing one of the machines on a patient, regardless of what they were there for, or the stage of recovery. Now think what you like about that fact, but there is a reason we don't have these machines in our clinic for regular use.
Here at The Movement Team we are more likely to use our hands as the therapy over machines because besides the symptoms relieving effects, it aids us in ‘feeling’ how your body moves, how your tissues and joints respond to manual therapy as we are treating you, and the effects seem to be almost immediate.
However as I have said above, manual therapy (and electrotherapy) are symptoms relievers only! They alone are unlikely to fix your issue, but will make you feel better in the short term. Which is fine if that is what you want, however if you want longer term effects then the best way to ensure that the issue is less likely to return is…….. exercise and movement!
With a name like The Movement Team, that should be no surprise! And this is likely what sets us apart from your more typical Physiotherapy clinic. We have a big gym area which is equal to the size of our four treatment rooms combined for a reason. It is also likely that when seeing us, you will be heading into that area at some stage. It might be the first session, it might be the 5th session, but its usually inevitable!
Now this is not to say that manual therapy (and to a lesser degree electrotherapy) does not have a place at all. These techniques have a place in allowing enough pain relief or muscles relaxation to occur which then allows you to begin movement and exercise therapy more comfortably. But that is also the key! “Allows you to begin movement and exercise therapy more comfortably”, not all Physio practices will use them in this way. If your practitioner is only doing manual therapy or electrotherapy without the addition of giving you exercises or movement plan, just have a think about whether feel you are progressing, or do you feel that you always seem to be coming back again and again for another round…
At The Movement Team we will use a combination of manual and exercise therapy to help with whatever issue you require, but in the end, the treatment plan will always be heading towards a more movement and exercise based solution in order to sort you out for the long term.
Now in saying that, I’ve had a few patients that have flat out said they didn't want to progress to an exercise based plan, or that they are happy to keep coming back every month for whatever reason. Now this is absolutely your choice and is fine as long as you know that the long term changes happen with movement and exercise.
B.Phty, PGD Health Sc, M.Phty (Sports)
Chari has 9 years of Physiotherapy experience, across 2 countries, has completed 2 post graduate degrees including a Masters of Physiotherapy (Sports) and works with the Queensland Academy of Sport and Queensland Rugby Union.
Tendinopathies- What You May Not Know
There are lots of different names that often get used in relation to tendon pain, while their meanings indicate what is going on at a scientific level, they are often used as umbrella terms, used differently in different medical professions or misused.
Tendonitis = was once used to describe all tendon pain, the suffix ‘itis’ indicates inflammation. True tendonitis does occur, however is much less common than tendinopathy, it tends to be a more sudden onset of pain due to a large change in load and generally resolves quickly with appropriate treatment.
Tendinosis = this term indicates a non-inflammatory degenerateon of the tendon, often resulting from repetitive micro-traumas. This term is not used as much as tendonitis or tendinopathy
Paratenonitis = some tensions, like the Achilles tendon, are surrounded by a thin sheath, called a paratenon. Paratenonitis occurs when this paratenon becomes inflamed. This is not commonly diagnosed, however as you need a biopsy for a clinical diagnosis.
Tendinopathy = ‘pathy’ indicates disease or disorder. Is the latest term used within physiotherapy to describe a non-inflammatory overuse injury, however some professionals also use this as an umbrella term for tendon pain.
Tendons are engineered according to their function and because of that tendons from different parts of the body have different structure, composition, cell types and metabolism.
Tendinopathies are most commonly caused by excessive loading and tensile strain on the tendon. This often occurs with, a sometimes obvious, but not always, change in activity. It is also thought that compression can play a role in altering the tendon matrix, this isn’t necessarily compression from an outside source (e.g. shoe on achilles tendon) but most commonly from the compression on the tendon from the bone it attaches to. The compression loads tend to be highest when the tendon is lengthened, for this reason, stretching is often ill-advised and massage is recommended if the muscles feel tight.
4 Load reduction Not Rest
While it is important to modify the load of the tendon, complete rest decreases the ability of the tendon to take load. It also affects the muscle attached to the tendon, reducing their strength capacity also. So while you should not ignore the pain as it is which is guiding you on what loads are too much, movement, particularly specific loading of the tendon is important.
While passive treatments (like electrotherapy and ice) may feel good in the short term, they do not address the need to increase the tendons ability to take load. Loading the tenon in a specific tendon protocol is essential for long term pain and functional improvements.
6 Most commonly affected area
The most commonly affected tendons are the rotator cuff (particularly the supraspinatus), biceps tendon, forearm flexor and extensor tendons, patella tendon, achilles and tibialis posterior tendon.
Samford Support Network and Holly's Story.
We were blown away when we first heard about some of the work the Samford Support Network and loved how they work with people in the local community.
Barbara Kienast is one of the most driven and beautiful souls in the Samford Valley area, and works day and night to ensure the Samford Support Network gets help to those who need it.
When Barbara asked us if we would like to support some of the local community members we were stoked! This is where we were introduced to Holly and her story. Below is an excerpt from an article her mum wrote for the Samford Support Network.
Holly was 23 when she decided to work as a groom in Germany, it was a decision she did not make lightly. She loved the life she was living in Australia, riding, training and competing her horse, Pierre, working locally as a chef, attending TAFE to qualify as a pastry chef, breeding pure bred chickens and ducks, caring for her pet dogs, cat and budgies. Holly had a close group of fun loving friends and a boyfriend she was madly in love with. It was hard for her to think of leaving Australia.
Holly was a high achiever, willing to sacrifice sleep and social life to reach her goals.
Into the short life she enjoyed before her accident Holly packed a lot of living. She worked as a chef, trained apprentices, cared for, rode and competed five horses, trained ponies for others, worked for a polo club and groomed for 6 months for one of Australia's top dressage riders. Holly worked for six months for the local business Natureworks, creating fibreglass sculptures. She also worked creating book illustrations Holly volunteered as a camp councillor for Edmond Rice Camps, caring for disabled children in respite care. She also volunteered time to the Samford Equestrian Group, helping out at competitions and, for a short time, on the committee. All of this she achieved with a smile on her face, Holly found joy in all that she did. The memories she created then still warm her heart today.
Holly left for Germany 2 days after completing her studies to become a pastry chef, the family she was to work for needed help urgently. It was the 8th December 2008, Holly was 23. As we waved her off at the airport I didn't realise it was the last time I would see her as she was. It is a moment that is now etched into my heart, the sad smile, desperate hug and clear blue eyes swimming with tears and excitement.
Once in Germany Holly enjoyed being in a new country, meeting new friends. She loved the horses she cared for and gave each one of them names after her old Australian work colleagues. It was very cold, often below -10, her first experience of real snow and ice. She lived in a tiny upstairs “apartment” (single room) in a house in Burgau, Bavaria, and rode a bicycle to and from work on the icy roads.
Holly was kicked in the head on the morning of the 28/12/2008, she had just turned 24. A trauma team arrived within 10 minutes, she was airlifted to hospital and operated on 20 minutes later. Holly was given a 1% chance of survival by surgeons at the Ulm Military Hospital, a hospital that specialises in head trauma cases for soldiers serving in the Middle East.
Holly was lying in Intensive Care in a coma, she could not move a muscle. She had wires and tubes all over her connected to drips and machines. I read her books by her favourite author, Terry Pratchett, hoping she could still hear. There was relief all around during her 2nd week in ICU when it was found she could breathe on her own for a short time, she was slowly weaned off the ventilator. Weeks passed with no change, Holly was unresponsive and totally paralysed, a tube was put in her stomach for food and water and a tracheostomy performed on her throat. Doctors transferred her to a brain injury clinic 50 km away in Burgau, it specialised in waking coma patients. She spent 5 short weeks of therapy there before being flown back to Australia, during those 5 weeks the hard work began. Holly had many therapies every day, some to help her wake gently, others to keep her body moving. Her left eye opened, the first movement of any body part since her accident. Holly would sometimes blink when asked, she was still in there Holly was sent back to Australia, the next 3 months were hard for Holly, she suffered further brain damage in hospital, gains made in Germany were lost, there was a lot of pain and little to indicate Holly was conscious. Back in Germany 5 months after her accident Holly fought hard and gained some movement in her left arm, foot and leg. The whole clinic celebrated the day Holly was finally able to communicate “yes” or “no” answers with a special buzzer near her left elbow, the therapists and I danced in the corridors! Holly progressed slowly to answer “yes” or “no” with her left big toe, then used an alphabet board, spelling single words with her left foot, it took months for the foot movement to return. The first sentence she put together was “I love Adam”
Every single day was full of pain and fear for Holly, she was terrified of falling, even when lying flat in bed, movement often made her fear overwhelming Return of movement also had a price, it meant horrible debilitating pain in the area affected as nerves misfired to muscles before creating correct pathways. Holly's skin would feel “electric shocks” every time she was touched. Her life was exhausting, still, she found pleasure in what was around her. She loved the therapy rabbits and dog, enjoyed the gardens and developed strong relationships with her therapists and nurses. Her smile returned, a bit lopsided, but.... a smile, what a wonderful day that was!
Often there were setbacks, progress was painfully slow, 2 steps forward, 1 step back. Holly could not eat or drink, she was fed via a tube, she missed food so much. To stand or “walk” Holly's legs were strapped to splints, made using a plaster cast of her whole leg. Her therapists would then create the movement of walking for her, after months of this Holly could take small steps herself if supported. She climbed stairs with 3 people supporting her, then climbed more stairs, then even more, each step made with leaden legs. Holly never missed a therapy, always tried hard, worked through her pain and fear and managed a smile every time I got the camera out. She had physiotherapy, speech therapy, occupational therapy, animal therapy, music therapy, neurotherapy, group therapy, art therapy, cooking therapy, movement therapy and hour after hour of retraining by nursing staff, who taught her to dress herself, wash herself, clean her teeth, brush her hair. Holly had to relearn how to live, step by step, thousands of repetitions were needed to create the nerve pathways necessary for a new task.
By March 2010 Holly was homesick. Every day for 6 months she asked to go home. Holly lost her ability to cry the day of her accident, but I believed her when she said she was crying inside. Being away from family, friends, horses and pets was taking its toll. She missed the sun and wanted to be somewhere familiar. She was desperate to be home before Christmas.
Holly arrived back in Australia a few days before Christmas 2010. She had a new walker, a cup she could “drink” from, a communication device, splint for her right leg, special shoes, and the will to do whatever it took to live at home. Holly had relearned how to eat soft food 13 months after her accident, but because of facial muscle damage Holly had difficulty drinking, and still “drank” via the tube inserted in her stomach. She would practice drinking whenever she could, and persisted for months at home until she was able to drink enough each day to have the tube removed. After the operation Holly enjoyed every second of watching that tube burn in a fire. Drinking is painful for Holly, every swallow hurts, she rarely complains.
Holly continues to improve, attends therapy in Australia and has 2 months of intensive therapy annually in a small town called Gailingen, in Germany. Her progress is remarkable. Holly is determined to live a full life, plans to walk on her own, talk, compete her horse and trail ride, breed and show poultry, and much, much more.
Holly loves living in Samford, every day she enjoys the beauty around her, she grows flowers and vegetables, cares for chickens and birds, plays with her dogs, spends time with her horse, paints and draws. She loves cooking pancakes (and eating them) Holly never takes the small moments for granted, she always remembers to smell the flowers and listen to the birds. Holly makes sure she enjoys each moment with the people she loves, as she says “In seconds your life can change and never be the same, so it is important to enjoy what is around you and appreciate what you have all the time”
We were taken aback by the drive and passion this young lady had, despite suffering a horrific brain injury miles from home. Holy has big goals and aspirations and we wanted to make sure we could help, so when the SSN asked us if we could work with Holly we jumped at the chance.
Mike, our exercise physiologist has a huge special interest in working with Neurological and Brain Injuries. So Mike was eager to get to work with Holly to support her goal of getting to the Paralympics in the sport of Equestrian Riding.
Whilst we understand Holly’s therapy will be ongoing, we are stoked to see her in our rehab space every week and lets say Mike and her may need to be kept apart as they are both exceptionally “good” at telling Dad jokes!
Holly is a great example of what the SSN does on a day to day basis and we will always be huge supporters of this brilliant organisation.
Please Consider making a donation to the Samford Support Network by clicking on their paypal link below.
Don't get me wrong....it is impressive! I can appreciate the dedication that is required to master this asana/posture, it is ascetially beautiful and she may be a great yogi but don't let the visual fool you or discourage you. Don't look at this and think Yoga isn't for me, I could never do that! Because really not many people could and 'this is not yoga'!
I have been practicing various forms of yoga for over twenty years and nailing scorpion
has never been my goal. Which is just as well really because it isn't going to happen.
My yoga practice does however gives me the opportunity to improve my proprioception (body awareness), to became aware of my energetic self, to develop concentration, to experience presence. It is a moving meditation, a dance (sometimes a clumsy un coordinated one)
with my body, mind and breathe.
It is a non judgemental personal journey where sometimes the most powerful adjustments
can't be seen but are powerfully felt. Changes may happen swiftly and slowly over time.
Let me share with you the most important lesson I have learnt.....Yoga is turning up.
It is sitting in your chair being aware of your breath, it is spending time on your mat moving gently or it can be going to a yoga class (not once but every week or twice a week if you feel like it or not).
There are many wonderful yoga teachers and many styles of yoga adapted from the ancient lineage. My humble advice is discover one that suits you and commit yourself to a term at least. Please don't do one class and decide it isn't for you because that is a judgement my friends & not a reflective valid decision.
Now where was I going with this....oh that's right I am leading (not teaching, you are your own teacher) a yoga class at The Movement Team Monday & Thursday mornings at 6.30am starting
Leisha Du Bois
Remedial Massage Therapist
Leisha is a Remedial Massage Therapist with 15 years experience. Leisha has studied modalities including Myofacial Release, Deep Tissue, Lymphatic Drainage, Pregnancy, Oncology and Swedish Massage.
So it’s January and no doubt there are New Year’s resoluters everywhere. I was going to take this opportunity write about New Year’s resolutions and how we can keep on track. But there are hundreds of blogs out there regarding this subject matter, and considering the crazy temperatures of the last week, I thought it would be important to address hydration to allow you to keep on track with your exercise goals in the safest possible manner.
When we exercise the body increases in temperature. The way that the body seeks to mitigate this increase in temperature is to sweat, which evaporates off the skin cooling the body. Like heart rate, typically there is a linear increase in sweat rates with an increase in exercise intensity. So the harder you go the more you sweat. Problem being is the potential to become dehydrated quite easily if the exercise intensity and (in light of the past week) temperatures are high.
Dehydration in a worse-case scenario can lead to fainting, fits, seizures, is one of the main causes of heat stroke and if unattended, death. Best case scenario dizzy spells (due to low blood pressure from low blood volume), lethargy, swollen tongue, dry mouth etc. So even if you’re not dangerously dehydrated, you will still underperform.
It’s important to bear in mind that we cannot rehydrate as quickly or easily as we lose water during exercise. Gastric emptying times are significantly reduced during a bout of exercise. So you can only absorb roughly 250ml per 15mins at best, when you can easily lose up to 3L an hour of water through sweat, especially considering the aforementioned factors. You may be able to drink more than this when you have a rest beak, but it will still only absorb at that rate, and it’ll be slushing around in your stomach until then.
Also, if you take into consideration that you may not have consumed enough water to satisfy your daily requirements to begin with (roughly 2L per day), and you’re on the back foot from the get go.
So here are some tips for adequate hydration for exercise and rest:
- Firstly, ensure that you’re drinking about 2-2.5L of water per day. On a hot day this may be more.
- About an hour before a bout of exercise, try to drink about 1-1.5L of water. This time frame allows time for water absorption the need for urination before, not during exercise.
- Speaking of urination, check your wee. The darker the wee, the more fluid you require. Dark orange? You’re in a bit of trouble.
- During exercise, only drink about 250ml per 15mins.
- Weigh yourself before and after training. For every kg of weight lost replenish with 1.5L of water. The extra 0.5L accommodates for the higher metabolic rate that your body is in post exercise, as it takes a little while for it to reduce to resting.
Easy? No sweat (sweat pun…. get it?)
B.ExSci&Nut, M.ClinExPhys, AEP, ESSAM
Michael is a masters qualified Exercise Physiologist with 5 years of clinical experience. During this time he has successfully applied exercise protocols to treat neurological, metabolic and cardiopulmonary disease. Michael is also a Ju Jitsu coach and Tai Chi/Qi Gong instructor.
In addition to our Lungs in Action class, individual sessions, small group training and other targeted classes, The Movement Team now offers a new weekly Tai Chi/Qi Gong class. For bookings or questions please contact the clinic.
As an adult you may have worked out a great way of running, but you probably have not.
Yesterday we had the pleasure of being involved in the Samford Fun Run! It was a great event for an excellent cause and it was so wonderful to see well over 400 people running and walking their way around Samford!! Running an event like this might be fun for some, but it is definitely not easy. In this article we ask the question... do we need to think more about how we run?
Running as an activity has a wide following. Almost 250,000 Australians are registered runners for Parkrun, a network of free weekly 5km events across the country. Major fun run events continue to grow in participants and number. Conversely in a 2015 Australian study of over 9000 people, almost 80% of adults were classified as having ‘low-sedentary’ activity lifestyles (1.2.3).
While running is only one form of physical activity, it is a cheap, accessible, and generally safe. Unfortunately though for those who don’t run regularly, it is often intensely unpopular.
It is remarkable how often you will hear people say “oh but I’m not a runner” or more simply “I don’t run”.
So are people actually ‘runners’ or 'not runners’?
There is no doubt that in the adult population some people find running much easier than others. Sometimes this is to do with the amount of actual running they have practiced and their general cardiovascular fitness, but for others it might be because of a bio-mechanical advantage they gain (or miss out on) from some combination of physical structure, muscle strength and motor pattern efficiency.
The good news is that many of these factors are not set in stone by our genetics!
Running is actually a skill!
We are not born knowing how to run. As young children we gradually learn to control our own body. Genetic features, like being particularly tall or short influence how we learn to move, but so do many many environmental features. In this early phase of life we learn to run more by trial and error than by some idealistic design.
Most running athletes spend huge amounts of time and effort focussing on improving their running technique and form. To maintain this form while running they need to build strength, body awareness and tissue resilience.
In the study mentioned above, only a dismal 18.6% of people met the recommendations for muscle-strengthening activities. Not many people are able to get better at running by just running more. The quickest and most significant improvements in running ability are often a result of technique and strength improvements. A planned and gradual increase in training load is then required to build up your cardiovascular fitness and your bodies ability to recover quickly.
Regular running with poor biomechanics or rapidly increasing training volume can have significant consequences. 'Overuse injuries' associated with running are very high, injuries are frequently the reason people quit running, and if not picked up quickly these injuries can be frustrating to recover from. Additionally, evidence for choosing footwear correctly is slim and awareness of running technique is generally poor.
So it can be helpful then to think of running as a skill rather than a genetic right. It is not feasible or really even possible to identify a 'recipe like' list of what you need to do to be a better runner. The key to your improvement might be to do with your technique, strength, mobility, training practices, footwear, medical conditions or very likely a combination of a number of factors. So if you want to improve your running (from whatever level you are currently) it may well be worth talking to your local Physiotherapist, Medical Professional or Running Expert to help identify your potential areas for improvement in this wonderful skill!
B.Phty (Hons), G.D. Paed. Neuro. Rehab.
Tim has 9 years of Physiotherapy experience and is an expert in Paediatric (Baby’s and Children’s) Physiotherapy. Tim’s the person to see if you have any concerns about your baby or child’s movement skills or development.
Tim is co-owner and director of The Movement Team. Tim also holds an Advanced Physiotherapist position within a Child Development Service in the public health sector.
Tim has worked across the breadth of paediatric health (acute hospital, disability care, developmental, community and private clinics) and has completed numerous national and internationally recognised education courses in topics including developmental orthopaedics, high risk infant management, respiratory functioning and infant movement.
Tim's formal training consists of:
Bachelor Physiotherapy (Hons) - University of Queensland
Graduate Diploma Paediatric Neurological Rehabilitation - University of Western Australia
Tim additionally holds the following positions and memberships:
Chairperson of the Queensland Paediatric Physiotherapy Clinical Network 2013 - present
National Paediatric Group Member - Australian Physiotherapy Association
The clinical information included in this article is of a general nature and might not apply to every family. Please see your local health professional for individualised developmental advice.
- http://link.springer.com/article/10.1007/s40279-015-0331-x What are the Differences in Injury Proportions Between Different Populations of Runners? A Systematic Review and Meta-Analysis Bas Kluitenberg et al.
- http://onlinelibrary.wiley.com/doi/10.1111/sms.12346/full The NLstart2run study: Incidence and risk factors of running-related injuries in novice runnersB. Kluitenberg et al.
- http://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-016-2736-3 The descriptive epidemiology of total physical activity, muscle-strengthening exercises and sedentary behaviour among Australian adults – results from the National Nutrition and Physical Activity Survey. Bennie et al.
Detox is a popular buzzword in the world of health and wellness. These diets claim to clear toxins from our body, increase energy, boost immunity, improve digestion and facilitate rapid weight loss. Sounds too good to be true, right? That's because it is.
Healthy adults have amazing inbuilt mechanisms to remove toxins from our bodies each day. Our liver, gastrointestinal tract, kidneys, lungs, skin and immune system are constantly working to remove unwanted substances. It's fair to say detox products and regimes are largely a marketing gimmick, seeking profit for a process your body can manage solo.
These diets involve fasting, elimination of entire food groups and reliance on commercially prepared detox products. Due to the restrictive nature of these diets it is difficult to meet nutritional needs when detoxing, which may compromise our immune system and digestive processes over time. There's also no scientific evidence to suggest these regimes will increase energy levels, in fact many people experience lethargy due to inadequate nutrition. Finally, we know any weight lost via these programs will return, and long term engagement in dieting behaviour is the biggest predictors of weight gain.
If you're looking for a way to feel more energised and healthy, skip the detox diet; instead, honour your appetite, choose a variety of food across and within the key food groups, hydrate, cut down on alcohol, participate in activity you enjoy, make time for self-care, and rest as needed.
By now I’m sure you’ve heard of the newest craze in mobile gaming, Pokémon Go. If not, here’s the scoop: It’s an augmented-reality game where you use your smartphone as a window into the Pokémon universe, and you search for Pokémon to capture and train. Then, you can battle them against Pokémon’s from other players.
Pokémon are geo-tagged. Meaning they hang out at certain real-life locations, waiting to be captured by roving Pokémon Trainers (players). That means that keen players have to get themselves between locations to discover new Pokémon.
This need to get from location to location was not an accidental feature of the game. In fact, the game was designed with exercise in mind. According to John Hanke who is the founder of the company who developed the game, exercise was one of the main goals of the game.
To hatch virtual Poké-eggs you have to walk a certain real-life distance to help them incubate. These eggs require distances of 2km, 5km and even 10km of walking to hatch. If fact there is very little you can do in the game while you are sitting still. This means that players often wander for hours looking for Pokémon to catch, landmarks to get objects and sites to battle. Just this week, a patient mentioned to me that he had accidentally walked 22km searching for Pokémon on the weekend. That’s a half marathon!
So what’s the big deal?
It’s brilliant that people are moving more! The human body is designed for lots of long slow walks, with short bursts of activity for running from predators or hunting dinner. So if you use Pokemon and look at it in an interval training and primitive training sense, the game can actually be a good thing!
There are even reports that Pokémon has brought some autistic, depressed and anxious people out of their shells and given them a reason to socialise, exercise and interact with the outside world more than they normally would. The effects of positive human interaction and exercise for mental health concerns are well documented and powerful.
However, there have been plenty of reports already that people are not only getting themselves into mischief trying to capture elusive Pokémon, but are hurting themselves. Twitter is alive with users complaining of swollen and sore legs, exhaustion and sore necks.
By having your head down, you actually increase the amount of force on your neck by double or more. Sometimes referred to in the media as ‘tech neck’, this is an ailment of the modern era. Not to say that you should never put your head down, but holding it in prolonged stare at your smart device will lead to more problems than the Pokemon game is working on. Physiotherapists including our team see the issues with this on a regular if not daily basis and unfortunately the average age of the patient is also getting younger due to young people spending lots more time on their devices.
If you also consider the increased rate the injuries from normally-sedentary folks jumping fences, exploring through dangerous territory (think landmine fields, construction sites and abandoned buildings) and traffic accidents from people walking with their nose on their phones.
What we would recommend at the Movement Team is that you make sure you check all of the pre requisites and also grade up on your exercise. If you view Pokemon Go as an Movement Session you would never go from not looking at your smartphone to spending 2+ hours doing the same activity. So what you would need to do here is simply build your time on the game slowly. Start with 20 minutes first and then build it up slowly as you get fitter and more adapted to the task.
Another thing to consider is do you have all of the Movement Pre Requisites to complete a task? Do you have great Thoracic and Cervical (Middle back and Neck) range of movement? Do you have enough strength and power to be able to jump over a fence to go Battle with the Pokemon hiding in the field? If you haven't sprinted for 10 years perhaps look at practicing 10 m first and then building up!
All of us here at The Movement Team love the idea of people getting out more and exploring using natural movement patterns where possible. However simply going from nothing to 2 hours plus per day of exercise is going to have a physiological response- be that a favourable one or one where your legs are sore for days post exercise!
Isabelle is currently the 1st Team Physio for Samford Rangers. Isabelle has worked in private practice around Brisbane before finding her way to Samford and The Movement Team. Isabelle is a qualified pilates instructor and also has a huge passion for dance and all things movement.
Hi this is Yanek here doing my bit for the Movement Team's Blog. We have had a great selection of blogs recently from the team and I must admit I was initially a bit stumped as what to write about next. The quality of the previous blogs has definitely set a high standard!
So I thought I would talk about something that I am exceptionally passionate about: Results-based Physiotherapy.
I am now 11 years into my Physiotherapy career which has spanned 2 continents and also a variety of Physiotherapy environments. I have worked in private practices, in sports clubs (from grass roots all the way up to the English Premier League) and in the complex rehabilitation environment with tri-service personnel in the British Armed Forces.
I am very proud of all of my previous work, though I must admit that the place where I have seen the most problems in terms of how Physiotherapy services are provided (and thus the results that clients get) is within private practice.
The Movement Team journey really started nearly 2 years ago now when Tim and I sat down and discussed both the problems we saw with Physiotherapy and also where it worked best.
It was our insights that Physiotherapy works best when:
- a clinician spends a good amount of time with a patient,
- the Physio and client are working towards a specific goal that is driven by the patient, and not something vague like "to feel better",
- the Physio has access to a wide range of equipment and space, and has the flexibility to utilise the full spectrum of physiotherapy interventions, and
- when the entire service and team is focussed on creating change for the patient.
When a Physiotherapy service is not working well, we do see some common issues, for example often the patient:
- has little idea what is wrong with them and they don’t understand what is going on.
- is not an active participant in the treatment process.
- does not have a good plan and doesn't know an expected time-frame to get improvement.
What Physiotherapy Isn't
Physiotherapists have a wide ranging set of skills to help a variety of problems. We have been taught a wide breadth of skills across key areas of the human body including Neurological, Cardiothoracic, Musculoskeletal, Paediatrics, Geriatrics and a variety of subsets within.
In private practice most consultations take place within a clinical setting (i.e. in a room). Perhaps when therapists are limited to a small space they have difficulty using the breadth of our true skills and this has contributed to a perception that:
For me, to simply equate physiotherapy to hands on soft tissue work is simply incorrect. Physiotherapists have a wide spectrum of skills that range from education, to hands on soft tissue work, to teaching motor skills, to direct manual therapy...all the way through to high-end strength and conditioning. Additionally we have a huge range of assessment and treatment skills specific to various conditions and presentations.
An individuals expectation of Physiotherapy depends largely on their previous experiences. It is not uncommon for people coming to see our team to have an expectation that they will simply lay down, get treated and then be fixed. This is very rarely true and if this expectation is held, it can lead to some of the most frustrating sessions for both Physio’s and their patients.
A hands on approach is a great way to get things moving and also to alleviate short term pain- however a single hands on session is never going to create long term change and results for patients.
From a business perspective it's great for practice owners to have lots of patients coming back week on week getting “treated” despite the fact they are not making significant progress. Along with a nice health fund rebate this creates a great system of simply processing people, but it rarely has clients progressing well towards what they want: to be better, functionally improved and stronger.
Physiotherapy should be far beyond having a therapist place electrotherapy machines on someone, a heat pack and 10 minute massage and being told to come back next week. As Physiotherapists we have a great ability to help change peoples lives. We can help people be better at and do more of what they want and with less pain or risk of injury. I'm more than happy to admit that no one wants to spend more time than they need to at a physio practice, doctors surgery or hospital - regardless of how nice I think our clinic is!
The Acceptance of Lower Standards.
So why is it ok to accept a standard of practice below what we know is possible. Especially when we know that there are models where it works really well (think of athletes and soldiers who can receive top level care that is goal based and progressive).
From a Physio's point of view, the ability to make the right decision for the right client is an extremely important skill to develop. When I was working at Tottenham Hotspur in the English Premier League (EPL), if my boss at the time asked me for a treatment plan for any of our players and I said “What I would like to see them a few times a week for 3 weeks and predominantly to focus on electrotherapy and massage. Then I'll see how things go...” I would simply have been out of a job within a few minutes and told politely to never come back.
When working with infantry soldiers wanting to get on the next tour of Afghanistan (who had to carry 40-80kg packs whilst taking enemy fire) if my Officer in charge asked how they were progressing and I said “well I have done some soft tissue work with them over 4 weeks” I would be endangering that soldiers career and also I would have a size 8 boot firmly placed somewhere on my anatomy and would swiftly be told “please make sure they are moving better and getting better” (The threat of endless burpees from the PTI’s would also be very scary!).
So if this is the expectation for athletes and soldiers, why do we sometimes accept a far lower standard for private patents? Is it just because we don't know we can expect better? I can guarantee that everybody would benefit and feel great for 6-12 hours after a hands on session with a Physiotherapist, and if thats what the patients need then that's great. But when we have the ability to help create significant and long lasting change (on top of feeling good for short periods)... shouldn't we do that!?
By taking this approach, you can visit a Physiotherapist who is an expert in movement and they can both treat your acute symptoms and take you all the way through to helping you with achieve great goals. Want to set a personal best with your squat and deadlift? Want to finish a work day pain free, or perhaps you want to improve your running technique so you can take part in the “Bridge to Brisbane”.
Proactive treatment instead of passive treatment can help a mother of 4 with a bad back and instead of simply settling her acute symptoms, it can address the cause of her back pain and avoid future flare ups! You could even take that further and help her build strength so she can out lift her husband.
So What Is Physiotherapy?
Physiotherapy is one of the best ways to help people progress towards their movement goals. Those goals may be anything...they may be about reducing pain and symptoms from injury, preparing for an event, getting stronger, addressing secondary impacts of other health conditions, avoiding injuries, or even helping a child learn to move for the first time. A Physio then might be your initial treatment, your goal achievement coach, your chance to train with a true movement and exercise expert, or simply your chance to improve your physical being.
Physiotherapy is in the industry of creating change for our clients and patients. Its having a specific working hypothesis thats agreed with the patient who is fully involved with treatment and fully understands what's wrong with them.
We have several key things in place at The Movement Team to ensure this happens.
- Our physio's are in charge of their own time with no time limits or patient limits set on them by the management. This allows each patient interaction to be treatment and result based, not one of a financial/business need. Your physio wont be telling you to come back to see them unless its absolutely needed.
- We do not treat more than 1 patient at a time.
- You will be hard pushed to find a TEN”s, Ultrasound or any other electrotherapy machine used at the clinic unless it has a clear an obvious goal attached to it. (There are many applications of electrotherapy which a very valid, however 90% of patients will benefit another type of intervention more!).
- We have a fully stocked gym where you can do both early stage exercises all the way through to high end strength and conditioning and all equipment is from the best manufacturers in Australia who work with elite sports teams and cross fit gyms. For me a swiss/gym ball and pilates reformer doesn't cut it as a rehabilitation gym.
- We do small training groups based on function- these are low cost and simple to get into and are led by our team.
- We work one on one with people specifically to train for strength and performance improvements. I have 8 clients who solely see me for one on one training as they move towards a high level goal. Your health insurance can be used with a physiotherapist in our gym to help work towards your goals.
So in answer to my blog post headline, Physiotherapy isn’t simply a hands on massage that hurts, its not a 20 minute electrotherapy session, its not being given “stretches”, its not being treated along with 2/3/4/5 other people at the same time (whilst you still pay $70 plus), its not having no end point in treatment, nor is it being one of 20 clients your Physio is simply processing to help achieve the clinics “income and revenue targets”.
We pride ourselves at The Movement Team on thinking differently. We constantly challenge what we do and will not settle for the average or the status quo. Our belief is that our results are the only thing that keeps us busy and are the reason why people will refer to us.
Yanek has 10 years of Physiotherapy experience, across 2 countries, including invaluable experience working in the English Premier League (EPL), military rehab centres and private clinics.
Joint replacement surgery is becoming more and more common. With an ageing population and 1.8 million Australians suffering from osteoarthritis in 2013, it’s fair to say that the number of people getting joint replacement surgery is likely continuing to rise.
Physiotherapy assists people suffering with osteoarthritis with prehabilitation. Prehabilitation is just rehabilitation, pre-surgery! Prehab is a general term that describes three months of moderately intense exercise immediately prior to joint-replacement surgery with the aim of improving outcomes after the surgery.
After surgery, there are a few options for rehabilitation. One is to stay in the hospital and do your rehabilitation in a specialised rehab wing. Alternatively, if you’re deemed safe enough (i.e. steady enough on your feet) to go home with family or friends, you can complete the rehabilitation as an out-patient with a physiotherapist in the community. Completing a course of prehabilitation has been shown to decrease the number of people needing in-patient rehabilitation post-operatively, and to decrease the amount of rehabilitation input needed.
The prehabilitation or rehabilitation comes in various forms. Common types of exercises used are strength training, aerobic/cardiovascular training and hydrotherapy (exercise in the pool). Recently, exercises with slow deliberate movements, like yoga and Tai Chi, have also been shown to be effective in treating osteoarthritis. Exercise has been shown to improve pain levels, improve muscular strength of the hips, knees and back, improve the efficiency of the walking pattern & other functional tasks and improve quality of life for people who suffer from osteoarthritis3.
For years, surgeons have had rules about who they are willing to operate on. Usually, you’ll hear terms thrown around like ‘medically stable’ and ‘low risk’ (hopefully this is you!). This means consistently taking medications effectively to control other conditions like high blood pressure or diabetes. Surgeons are increasingly incorporating weight limits on their patients prior to surgery as well, as increased body weight has been shown to be a causative factor in osteoarthritis, particularly of the knee3. To do this, surgeons are suggesting that their patients try a course of prehabilitation to decrease their weight, improve their pain and function before considering surgical treatment options.
The Movement Team now has knee-specific and shoulder-specific prehabilitation training groups operating in addition to our general training groups. Essentially, we see a lot of the same injuries and conditions so we have created some small groups of (4-6) people who need guidance on similar injuries or conditions.
You don’t need to have a surgery lined up to join in!
Prehabiliation is a classic example of asking the question “What can I do?” when injured. So ask yourself- despite any limitations- what can you do today?
Isabelle is currently the 1st Team Physio for Samford Rangers. Isabelle has worked in private practice around Brisbane before finding her way to Samford and The Movement Team. Isabelle is a qualified pilates instructor and also has a huge passion for dance and all things movement.
When thinking about injured body parts, bones and muscles often get all the attention. A different type of structure exists all over our body and is often the actual cause of our pain. This structure is a tendon. Tendons attaches our muscles to our bones and are absolutely key in allowing us to move as they transmit the force our muscles create onto our skeleton!
When tendons get injured however they are probably one of the hardest structures to treat. This is mainly due to a lack of understanding about how tendon’s adapt and respond to change.
As well as just transferring force from muscles to bones, tendons are actually able to store and release elastic energy. This function is especially important in athletic performance. Tendons (very large versions) are what allow a kangaroo to spring along so efficiently!
How to know if it is a tendon that you hurt?
Tendons adapt very slowly to new loads, so if you have developed pain associated with a recent increase (or new) activity, it is possible that your tendon rather than your muscles are the structure that is struggling with your new activities! To be sure that your tendon is what is at fault takes close questioning and assessment. Often tendon pain is one that seems to come back over and over again and I’m guessing quite a few of you have experienced this or at least know someone who has!
Patients often get frustrated in the process when it comes to returning to pain free activity, because your tendon injury either hasn’t been explained well enough, or the practitioner doesn't quite understand tendon pathology well enough to best assist you. I’m hoping today to bridge that understanding gap and give an insight into the treatment of tendinopathies.
Please Note! The next section is going to get a bit technical. If you have previously had or currently do have a tendon injury (or you are a health professional) this section is well worth reading. If you would like to skip the details and just see how to get things fixed… jump to the bottom!
Tendinopathy is a broad term that encompasses painful conditions occurring in and around tendons in response to overuse. The previous term tendinitis worked on a old paradigm that inflammation was involved in tendon injury however more recent studies show painful tendons are devoid of inflammatory cells. What that means is that dysfunction here doesn't follow normal inflammatory/histological processes that we may find with muscle or bony injury and has no clear end-point. Instead, the pathology involves complex and ongoing non-inflammatory alterations in the tendon matrix and cells. It is essential to understand this, as it underpins how we choose to treat and assess the injury.
Loading changes are the primary stimulus that appears to drive the tendon response towards pathology. Repetitive energy storage and release and excessive tendon compression appear to induce pathology.
Most tendinopathies in the body usually occur at what we call the enthesis - this is the point at which the tendon inserts onto the bone. The only exception to this is a mid-portion achilles tendinopathy. At the enthesis, there are two main factors which influence the amount of stress that happens at the tendon:
1) tensile load from the loading through collagen fibres of the tendon when there is muscle use and 2) compression load around a bony insertion point (as most insertions work around a bony pulley - e.g. heel bone of the achilles).
In mid-portion achilles tendinopathy - tensile load is the biggest factor leading to tendon pathology - mainly the stretch-shorten storage and release of energy (e.g. jumping).
Loading a tendon causes matrix and cell deformation, and depending on the type and amount of load, the cell responds by producing matrix proteins (mainly collagen). Exercise increases collagen production that may contribute to increased tensile strength of a tendon however, there appears to be a fine line between load that stimulates a positive tendon response and load that triggers a negative response. Due to this, tendons are SLOW TO ADAPT TO CHANGE!! This is critical to understand why tendon rehabilitation takes so long, and also why a sudden change in training can cause pain in the first place. Tendons take up to 3 days after a bout of loading to respond to that load. If we load it too quickly before that point, then we can easily send the tendon over the edge.
Researcher Physiotherapist Jill Cook and colleague Craig Purdam have done extensive research into tendon pathology and rehabilitation. Just google their names with ‘tendinopathy’ and you’ll find pages and pages of research on the topic by these two. After overload in a tendon they propose a three stage tendon pathology continuum:
1) reactive phase - this is an acutely overloaded tendon. At this early stage, the tendon can revert to normal if the overload is discontinued or there is sufficient time between loads for the tendon to recover.
2) disrepair phase - this is essential failed healing and results from ongoing load to a reactive tendon, causing structural disorganization of the internal tendon substances resulting in some separation of the collagen and reducing its loading capacity.
3) degenerative phase - progression to extreme changes to a disordered internal structure, cell death and little collagen. These patients will usually have times when are pain free and will continuously recur over and over again.
Figure 1 from Cook & Purdam (2009)
STOP NOW IF YOU SKIPPED THE GOOD BIT!
So what can we do if you come in to see us?
Firstly lots of questions will be asked to find out what increased loading has placed the tendon over the edge. We will also try and figure out whether it is more a compression or tensile loading issue in your case. This allows us to guide treatment and create conditions in which to create comfort and allow relative de-loading of the tendon. We also need to find out a bit about your previous history, current training loads, previous training loads etc, which allows us to ascertain whether there are other intrinsic factors at play they may need to be addressed concurrently. A good Physio will ask a lot of questions! So be patient with us, as this will assist us in helping you!
Now it is important to note that research has shown the gold standard treatment option to return to function is through exercise intervention. This will get you 80% of the improvement. Remember there is no inflammation component so things designed to treat inflammation may not be helpful.
Other treatments like massage, dry needling, joint mobilisation etc, are usually adjunctive and help the remaining 20% but only will not improve the condition alone! Specific exercises need to be done for this to get better. And the process will be slow! People managing this themselves usually progress too quickly or they go the complete other end by stopping all activity.
Now when we say de-load, this does not mean stop everything! Completely unloading a tendon is actually more detrimental than good because tensile load stimulates collagen production and directs its alignment as well as preserves muscular and whole body functional capacity. There are numerous ways to reduce load without stopping all activities. Relative rest means that the person may be able to continue playing or training if it is possible to reduce the amount of stretch-shortening happening or the total weekly training hours performed etc.
Your Physio will know what constitutes low, medium and high tendon loading activities and can guide you appropriately in this area. Because tendons do not like change and are slow to adapt we can only change one factor at a time in your rehabilitation progressions. Whilst it is easy to get frustrated with the slowness of these progressions, it is important to remember that when something takes some time to come on, it will also take some time to come right also.
Pathology on medical imaging is not related to pain! A lot of people have pathology on imaging but have never had pain - this is one reason some people can get tendon ruptures without ever getting pain in that tendon! Conversely some people have severe pain without any changes on imaging. Therefore imagining isn’t always of benefit for us a practitioner, but your history is likely to be more of benefit and will guide treatment more.
Research is still unclear on what causes pain in tendinopathy. Tendon pain can be easily changed without a change in tendon pathology. Physiotherapy techniques can improve your pain symptoms in one session which is great, however this is not enough time for a change in pathology to happen. Physiotherapy therefore can provide a great window of opportunity to use that time to increase the loading capacity of the tendon. For example, when leading up to an event, this may assist in providing pain free or at least pain reduced training sessions as guided by your Physiotherapist.
Another point to note is that patients usually don't present at the clinic until they are in the disrepair and degenerative stages. In these stages because tendon structural changes are already taking place we are unlikely to change the underlying pathology. We can still get your tendon loading capacity up and improve your pain and function, however in the early stages we have greater chance of returning the tendon back to normal structure.
So my advice would be if you have tendon pain - get in early! It may save you months of hard work and future pain episodes! Know the process will be slow, and that graduated exercise program is the only way to improve your tendon function.
Nutrition science is not without controversy, and the conversation surrounding dietary fat is no different. Let's chew the fat...
Firstly, a brief overview. We refer to fats in three general categories; saturated fat, trans fat and unsaturated fat. Intake of saturated fat (red meat, whole milk dairy and many commercially prepared foods) has long been associated with increased risk of heart disease. Trans fats (predominately found in processed foods) are also known to elicit negative cardiovascular effects. A diet rich in unsaturated fats (nuts, seeds, avocado, olive oil and salmon), however, is linked to improved blood lipid profiles and reduced cardiovascular risk. Fat is also extremely energy, or calorie, dense so it is often targeted for individuals seeking weight loss.
In our quest for a healthier, leaner population a generalised low-fat diet gained traction over past decades. This shift away from excessive fat intake sought to reduce rates of overweight, obesity and cardiovascular disease. While the sentiment was there the general public were not equipped with suitable low fat alternatives, and because fat is a haven for flavour our diets lacked without it. This gave way to diets high in refined carbohydrates, which included the likes of white bread, pasta, processed snack foods and added sugar.
As nutrition science evolved we learnt a lot more about the specific effects of dietary fat, and the health implications associated with excessive intake of refined carbohydrates. We now know refined carbohydrates generate an equal, if not greater, burden of disease when consumed in excess. We determined trans fats to be definitively unhealthy, and as a result significantly reduced these within the food supply. Saturated fats have been somewhat vindicated in recent years with evidence indicating some varieties (stearic acid and lauric acid specifically) have neutral effects on cardiovascular risk, although we still lack convincing evidence that they are helpful. Finally, we know eating unsaturated fats in place of saturated fats or highly refined carbohydrates improves blood lipid profile, and is a staple among some of the world's healthiest regions.
The bottom line? Fats are in. Prioritise olive oils, avocado, nuts and fatty fish, but don't demonise a great piece of steak and whole milk dairy products. Remember though, fats are simply one element of a healthy diet and lifestyle. Focussing on specific nutrients is not the key to a nutritious, health-promoting diet. Emphasise a diet of wholesome foods in sensible combinations instead. When we get the foods right, the nutrients take care of themselves!