Teaching on Zoom: A Glance Behind the Scenes


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

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

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

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

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

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

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

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

Andrew Firth

Pilates Instructor

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

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

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

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

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

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

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

Type

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

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

Time

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

Tenacity 

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

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

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

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

Osgood-Schlatter Disease – Let’s Get Proactive!

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

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

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

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

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

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

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

Dónal Ahern

Sports Physiotherapist

References:

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

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

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

A warm welcome to Dónal Ahern, Physiotherapist and Pilates instructor

We are excited to welcome Dónal, a very experienced sports and musculoskeletal physio, to our teams.

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

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

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

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

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

TIPS TO RETURN SAFELY TO THE GYM

Sonja is one of our physiotherapists and pilates instructors, with a special interest in exercise-based rehab and functional strength. Here she give you a step-by-step guide as venture back to the training room. Sonja has a very cute cat called Kimchi.

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

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

(Haas et al, 2001).

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

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

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

References:

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

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

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

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

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

PREPARING FOR A NEW-LOOK SPORTING SEASON

Billy is one of pilates instructors and a 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

Physiotherapist and Pilates Instructor

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

Telehealth appointments available and a guide to covid -19 for our special pregnant clients – stay well and be kind everyone

Please find attached a (17.3.2020) guide on Covid-19 from rcog (Royal College of Obstetricians and Gynaecologists) for our treasured pregnant clients. Our best wishes to you all.

Please note Telehealth appointments are available to anyone who needs an appointment but is unable to attend the clinics.

Call INP 90896666 CHP 94861918 CHP&R 9481 2955 for more information

Keep being kind to each other and looking out for those around you who may need your help, or a few loo rolls. We will be limiting our social media presence in the immediate future to allow essential info to be disseminated. We wish you and your loved ones all good health and calm through this process we are all in together.

https://www.rcog.org.uk/globalassets/documents/guidelines/coronavirus-covid-19-infection-in-pregnancy-v2-20-03-13.pdf

Medial tibial stress syndrome-an update with Adriane

February 24, 2020/in Uncategorized /

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

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Choosing your running footwear- all you need to know !

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

Your feet and diabetes

The Australian Bureau of Statistics stated in 2018, that 5% of Australians have type 2 Diabetes mellitus. That is equal to one million Australians. Diabetes in fact, is the fastest growing disease in Australia. Currently two hundred and eighty Australians are diagnosed every day. How does this relate to Podiatry, you may well ask?

Type two Diabetes mellitus is a progressive disease. As the pancreas fails to produce sufficient amounts of insulin, blood glucose rises. It also causes a lowering of the good cholesterol (HDL) and a rise in the bad cholesterol (LDL) and triglycerides. This leads to a hardening and narrowing of blood vessels in the legs, compromising blood supply to your feet. Both high blood glucose and high levels of bad cholesterol plus the toxic effects of their metabolic by-products they generate, damages nerves in your feet.

The combined effect can result in numbness, tingling and painful feet.
Also, an increased risk of bacterial infections, delayed healing and ulceration. In fact, Diabetes Australia quotes four thousand four hundred foot amputations occur every year due to diabetes. There are ten thousand Hospital admissions annually due to diabetes and foot ulcerations.

There is no denying the seriousness of this disease adversely affecting your feet. It is not just a touch of sugar.

Prevention is always better than cure.
So, if you are over fifty five years of age, have diabetes in your family, are of Chinese, Indian, Aboriginal or Pacific Island background or if you had gestational diabetes, you are at a high level of risk in developing type two Diabetes mellitus.

If you smoke cigarettes, have high blood pressure, if your waist circumference is greater than one hundred and two Cm if you are male or greater than eighty eight Cm for a female or if your Body Mass Index is greater than twenty five, you too are at a high risk of diagnosis.

If you are always tired, always hungry, put on weight easily especially around your waist, are slow to heal, have blurred vision and are thirsty, these are the symptoms of type two Diabetes mellitus.

So, see your GP for a test. Eat well, exercise and lose weight. See your Podiatrist, Erica Michaelson at

CHP + R, to assess your foot health or provide a comprehensive diabetic assessment.

Erica Michaelson

Podiatrist

 

Erica consults on all aspects of foot care and lower limb biomechanics, including advice on footwear, running shoes, the assessment of foot posture and orthotic prescription and treatment of foot and lower limb pain. Erica has a special interest in children’s feet, diabetic foot care, skin and nail conditions of the feet and sports and dance injuries.

Erica is very experienced with difficult foot problems and is one of the very few podiatrists endorsed by the Australian Health Practitioners Registration Agency to prescribe medications such as anti-inflammatories, anti-fungals and anti-biotics and to perform pain-relieving foot injections.