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

Stay well everyone and keep moving.

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

Which got me thinking.

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

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

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

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

Anyway. Returning to my original point.

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

ANDREW FIRTH

Due to COVID-19, we are all sitting more and moving less, with decreased incidental exercise. This may increase your risk of developing a Deep Vein Thrombosis.

Do you know what a Deep Vein Thrombosis is?

Also known as a DVT, it is a blood clot that has developed in the deep veins. Most commonly found in the calf, but can also occur in the arm.

Signs include:
– Swelling
– Pain or tenderness not caused by a specific injury (most commonly felt in the calf)
– Heat, redness
– Discolouration of the skin.
**If you have any of these symptoms, it is important to alert your doctor ASAP.

It is also important to note that if you have any signs including chest pain, shortness of breath, increased heart-rate or coughing up blood, then you MUST alert your doctor ASAP as these could be signs of a blood clot that has travelled to the lung (AKA pulmonary embolism).

Blood clots are treated with anticoagulant medication (AKA blood thinners), and they slow the body’s ability to develop new clots and stop the existing clot from growing.

A clot either arises spontaneously or is caused by conditions including surgery, trauma, or prolonged bed rest.

Women tend to have a lower risk than men, but pregnancy or use of oral contraceptives (the pill) or hormone replacement therapy may represent important risk factors.

Other risk factors include:
– Family history of blood clots
– High BMI (overweight)
– Sitting too long/ confinement to bed or wheelchair
– Smoking
– Long term chronic lung or heart conditions
– Diabetes

Understanding your risk, and the decisions to help mitigate the occurrence of blood clots can help protect you from the potentially fatal consequences!

Therefore, make sure you get up regularly from your desk, go for a daily walk and try squeeze in some resistance or cardiovascular training! As always, don’t hesitate to come in and see one of our physio’s for any advice or recommendations.

References:
– Kyrle, P. A., & Eichinger, S. (2005). Deep vein thrombosis. The Lancet, 365(9465), 1163-1174.
– Stoptheclot.org

Jodi Dribbin MAPA
B Physio,

Post Grad Cert Pelvic Floor and Continence Physiotherapy (The University of Melbourne)

(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!)

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.

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 22^nd 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