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

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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RECENT POSTS

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• GLA:D (Good Life with Arthritis from Denmark) Program at Clifton Hill Physiotherapy

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.

 

An exercise and education program for people with hip or knee osteoarthritis (OA) symptoms.

 

The GLA:D program is an exercise and education program developed by researchers in Denmark for people with hip or knee osteoarthritis symptoms.

Results from the GLA:D program in Denmark have shown:

• Symptom progression reduction of 32%
• Less pain
• Reduced use of joint related pain killers
• Less people on sick leave
• High levels of satisfaction with the program
• Increased levels of physical activity 12 months after starting the program

 On the success of the GLA:D program in Denmark, this program has been implemented in other countries, and most recently it has been launched in Australia.

The GLA:D Australia program consists of:

• Two education session which teach you about OA, how the GLA:D Australia exercises improve joint stability, and how to retain this improved joint stability outside of the program
• Collection data on your current functional ability
• Group neuromuscular training sessions twice a week for six weeks to improve muscle control of the joint which leads to a reduction in symptoms and improved quality of life

OA is the most common lifestyle disease in individuals 65 years of age and older, but can also affect individuals as young as 30 years of age. Current national and international clinical guidelines recommend patient education, exercise and weight loss as the first line of treatment for OA. In Australia, treatment usually focuses on surgery. The GLA:D Australia program offers a better and safer alternative. The GLA:D program is unique in that the education and exercises provided can be applied to everyday activities. By strengthening and correcting daily movement patterns, participants will train their bodies to move more effectively, prevent symptom progression and reduce pain.

At Clifton Hill Physiotherapy and Pilates and Rehab we were one of the first practices in the country to implement this program which reflects the latest evidence in OA research. We have now been offering the program for more than two years and have had more than 30 participants complete the program. Our graduates have consistently achieved good gains in their physical functioning, high levels of satisfaction with the program. Preliminary analysis of the outcome measures collected from our cohort doing the program at Clifton Hill Physiotherapy have shown the following improvements 3 months after starting the program:

• A reduction in pain levels
• Mean improvement of 7% in walking speed
• Mean improvement of 20% in sit to stand functional test performance
• Significant improvements in quality of life measures

We have also been very pleased to see that our graduates have made active steps towards maintaining their gains and setting new goals either by continuing with the GLA:D sessions as an ongoing program, or by adherence to a progressive home exercise program of both specific neuromuscular control exercises as well as general exercise.

We have also had a few participants complete the GLA:D program at our center as a result of being referred via the trial currently being conducted by La Trobe University on the delivery of the GLA:D program. This trial is still actively recruiting participants, and if you are interested be sure to check out the following link:

http://semrc.blogs.latrobe.edu.au/knee-pain-clinical-trial/

At Clifton Hill Pilates we are currently running the exercise sessions for this program at the following times:

• Mondays at 10.30am
• Tuesdays at 3pm
• Thursdays at 10.30am
• Fridays at 11am

All GLA:D sessions at Clifton Hill Physiotherapy are currently run by Physiotherapists who have officially trained in the GLA:D program including Cathy Derham, Billy Williams, and Adriane Khablyuk.

Be sure to get in touch with our team at Clifton Hill Physiotherapy to find out more about the program if you experience any hip and/ or knee osteoarthritis symptoms, regardless of severity.

 

Cathy Derham