Managing an acute injury

Knowing how to immediately look after an injury for the first few days can speed up its recovery. In this blog we look at a more up to date protocol on how to help you manage it.

Many of us are well versed on the R.I.C.E acronym (Rest, Ice, Compression, Elevation). Which eventually was upgraded to P.R.I.C.E (P = Protect). Over the last few decades the advice on the management of acute injuries has rarely been contested. However, with growing research there has been a change in the way clinicians deliver advice on acute injuries to patients. With more recent research there is a new acronym called P.O.L.I.C.E. Standing for Protect Optimal Loading Ice Compression Elevation.

What’s changed?

The term REST can be completely misinterpreted. While it’s important to have a balance of rest AND loading. Too much rest can lead to
deconditioning of tissues, stiffness and weakness. By OPTIMALLY LOADING tissue it provides the right levels of stress to encourage tissue healing, while assisting with the drainage of swelling.

What is the right amount of load?

Firstly, you must listen to the pain and not try to push through it. But if in doubt seek advice from a health professional, whether it be a Dr or Physio. Assessing the injury will help clear any serious problems, like fractures or ruptures. After having the serious issues cleared, you can be guided on the appropriate movements or weight bearing exercises to perform.

If in doubt seek advice from a Health professional

Additionally, to help provide the right loading you may require a moon boot, crutches, brace or strapping for support. Before being gradually weaned off.

Ice

I’ve previously questioned the value of applying ice for reducing swelling. There is growing evidence that shows that we need some swelling to aid in the healing process and  by using ice to minimise swelling, we could be slowing down the rate of tissue healing. 

See: hold the ice in RICE

But using the ice instead to reduce pain, by limiting nerve conduction and lowering tissue temperature. This can be effective within 5-10 minutes of application. Doing this every hour will bring pain levels down allowing you to move or load the tissue as tolerated.

Side note: Make sure you regularly check tissue quality while icing to avoid frost bite.

Compression and Elevation

These two are the least controversial in their benefit of recovery from acute injuries. Having compression helps maintain swelling to a manageable level and the area can still move normally. Making sure the compression is tight but not causing pain or numbness. You can use crape bandaging or a tubigrip.

Elevation, particularly for the lower limb helps again at minimising excessive swelling. While elevated it helps to be gently moving the
area, which also assists with tissue healing and swelling.

Anytime you’re dealing with a new injury it’s important follow the most up to date advice to help you recover as quickly and safely as possible. By seeking physio, we can offer you that guidance and support as you progress. At Fundamental Physio Newmarket, you’ll be thoroughly assessed to identify the extent of your injury, then put on the right treatment plan to help you return to normal activity. 


References

Bleakley et al 2012 PRICE needs updating, should we call the POLICE? Br J Sports Med 

Algafly et al. 2007. The effect of cryotherapy on nerve conduction velocity, pain threshold and pain tolerance. Br J Sports Med

Malanga et al 2015. Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgrad Med

Making your new years resolutions stick

The new years resolution are often dreams we wish to aim for. Often achievable, but without a plan of action we often see these ideas fade within the first month.

Happy new year to everyone. With the start of a new year comes the promise of something better. New year’s resolutions seem pretty cliché, but they do offer us the best time, if not the only time in the year to reflect on the previous year and a chance to set some personal goals to achieve in the coming year.

Whether its fitness goals of running a half marathon, a bigger lifting total or just getting up off the sofa and doing daily walks. Or weight loss, changing to whole food or starting fasting. Or mental goals, having more “me” time, doing mindfulness, meditation or being stricter with your work/life balance.

The list goes on, being able to achieve any of these goals won’t happen overnight but having the right strategy you should be able to achieve them.

Defining your Goal

Having a loose resolution with no direction or steps to achieve is not only disappointing if you fail but off putting to try again. Having goals instead of resolutions will give you structure, making it more likely for you to stick to and motivating once you hit your target. One of the best ways of structuring your goal is by making it SMART.

Specific – Clearly defining your goal. What do you want to achieve? Concentrate your efforts by making sure the goal is to the point.

Measurable – Track your journey along the way with milestones. If you cannot track it, you don’t know how you’re progressing.

Attainable – Realistic goals are important. Is there something else you must achieve before making the next step? 

Relevant – Make sure the goal matters to you in your current situation. Having goals that move in the same direction are more attainable.

Timely – Setting a deadline will make it more likely to be achieved and having the milestones along the way helps you get there.

Creating habits to achieve your goals

Goals are perfect to give us a sense of achievement. But for most of the common new year’s resolutions, they are huge life style changes and to achieve these it requires a change of habits.

Habits are only achieved through daily repetition before it becomes a normal part of life. If your resolution is to lose weight then creating new habits such as preparing healthy snacks and meals in the evening, regular sleep patterns 7-8 hrs per night, 1 litre of water per day, incorporate daily fitness that you enjoy whether its starting off with walking or a High Intensity workout.

Be prepared for road bumps and setbacks, but if you’ve seen progress focus on this to keep motivated. Let your family/friends know about your lifestyle changes, so they are prepared, and it holds you accountable.

Fundamental Physio Newmarket wants you to achieve both long and short-term goals. Whether it’s an injury free 2019, or that nagging injury you’ve been dealing with. The appointment schedule is open for the new year. 

Surviving the Silly Season

The Holidays are an easy time to let go, but when trying to get back to your regular routine can always be be an uphill climb.

The festive season has begun and it’s that time where normal routines spiral out of control. Making it harder to return to your normal once the dust settles in the new year. Here are some things to consider over the holidays to keep you on track!

exercise-icon-19 (1)Keep Moving

Taking time off over Christmas is perfect for doing something new and challenging. Get involved with the family and enjoy it all together. You might be away from home so getting more creative with what you can do.

Try things like…

  • Paddle boarding or kayaking
  • Going off for a hike in the bush
  • Taking up power walking or running
  • Beach cricket or Volleyball
  • Snorkeling
  • Take up swimming
  • Work on the garden

Make up your own HIIT workout with body weight movements. Last year I posted the Holiday WOD, this might give you some ideas.

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Try to fit in exercise of at least 30 minutes a day, this will have you feeling better for it.

Keep HydratedCircle-icons-water.svg

With the summer arriving, it can be hard to judge how hydrated you are. Plus, with the extra consumption of alcohol, hydration levels will deplete quicker.  Keep an eye on your pee! The darker the colour the more urgent you’ll need to up your H20.

meditation iconEnjoy Quality Food

It’s the time of year we “let loose” and then a week later set really high standards with new years resolutions. Pick and choose when you want to have the treats, just don’t make every meal a cheat meal.

Intersperse it with eating good quality food, then by New year you won’t feel so guilty and will be able to set a goal that is more realistic.

Finding Time To Relaxexercise-icon-19

The weeks before the actual holiday start can be extremely stressful with organising the family, work deadlines, Christmas parties etc.

Using the holidays as a time to regulate your stress levels. Try to think about yourself also during this time.

Some ideas…

  • Spa day
  • Work on a breathing practice
  • Meditation youtube/app
  • Take up a beginner’s yoga class
  • Relax on the beach

How often do you get time off work for this long? Having a balance of relaxation and play is important to recharge and be ready for the new year.

Have a merry Christmas and Healthy AND Happy New Year!

How young is “too young” to lift weights?

There’s still controversy with regards to when it’s safe to begin resistance training. Find out the benefits of weightlifting for your child’s development.

In my last blog I covered the misconceptions of lifting weights as we get older. Today we go to the other end of the spectrum, which is as equally misinformed with regards to children starting resistance training.

Across social media we see a growing trend of children involved in barbell training. Whether it’s supplementary training for their sport or weightlifting for competition. But there still remains a stigma or controversy towards children and weightlifting. This can make it extremely difficult for a parent to make an informed choice if they consider enrolling their child into a programme.

What are the concerns?

The most common worries for parents is injury risk and belief that lifting weights may stunt their growth by causing damage to the bone.

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Injury risk is always there, in any sport. But statistically weightlifting has a fairly low injury rate when compared to other sports. In one study, the overall injury rate per 100 participant hours was 1.92 for rugby and 6.2 for football and 0.0017 for weightlifting.

The biggest factor keeping injury risk so low is supervision and good coaching within a structured setting. Especially with children, keeping them focused on correct technique and giving appropriate programming to match their ability.

Another common myth of children weightlifting is that it causes damage to growth plates of the bone which could stunt healthy growth. There has actually been no scientific evidence or case studies to show that growth plates become damaged from weightlifting.  The most common cases of growth plate damage come from popular high impact sports like football, hockey, basketball and volleyball.

What are the benefits?

Weightlifting has been shown to decrease injury rates by increasing bone strength, tendon strength and improving the strength of stabiliser muscles to prevent injury during practice and competition.

During preadolescence we have heightened neural proliferation and central nervous system (CNS) maturation. With increased load and stress on the body with resistance training provides an additional stimulus to the already natural proliferation taking place. This results in a boost in neural development compared to youth who do not partake in resistance training.

How and where to start?

  • Firstly this does not mean your 7 year old will be throwing around heavy weights. There’s a process to building up a child’s competence with functional movement.
  • Finding a gym that offers a programme for kids, which can be adapted to the ability of each child and that they’re supervised by a qualified coach.

Development of trainingTo begin with, every child needs to learn functional movement patterns without any weights to have competency and understand the movement. With repeated exposure it develops whats called their “training age”. This is not their physical age, the years spent participating in their chosen sport/activity. A child at 7 years old, exposed regularly to a functional skill movements programme will have a higher training age by the time they reach puberty. This gives them a greater advantage to grasp the more complex tasks and see greater fitness gains in later stages of development.

Hopefully this will give you more confidence entering your child into a weightlifting programme. It is safe for children of all ages to lift weight as long as it’s supervised by an experienced trainer. Understand that the reward far greater than the risk.

References

  • Hamill B, 1994 Relative safety of weight lifting and weight training.
  • Legerlotz et al, 2016 Physiological Adaptations following Resistance Training in Youth Athletes-A Narrative Review
  • Malina RM, 2006 Weight training in youth-growth, maturation, and safety: an evidence-based review.
  • Powell et al, 1999 Injury patterns in selected high school sports: a review of the
  • Neurological benefits
  • Negra et al, 2016 Effects of High-Velocity Resistance Training on Athletic Performance in Prepuberal Male Soccer Athletes

Neck Pain – Wry Neck

Managing sudden neck pain on your own can be difficult. Whether you’ve had an injury or just woke up with it, physio can provide the right type treatment.

Have you ever just woke up with neck pain? Well you’re not alone. Up to 75% of the general population suffer with an episode of neck pain once in their lives.

Usually it comes on suddenly, from some non-traumatic event causing severe pain and stiffness of the neck. Which can be quite debilitating. Often occurring when waking up, if the head has been held in a prolonged position or turning the head quickly in a particular direction.

This can be particularly concerning when not being able function with your neck the normal way. The reassuring news is that it can be treated with physio and resolved using the right type of treatment, in a short period of time.

Wry Neck Symptoms

  • Neck stiffness – Your range of movement becomes severely limited. Usually locked up away from the site of pain.
  • Pain – Extreme pain localised to the centre or side of the affected area. Often radiates into the shoulder.
  • Muscle spasm – The injury usually leads to muscle spasm of the surrounding neck muscles and causes further restriction in neck movement.

Causes of Wry Neck

There are several theories of what causes a wry neck. The most common one being the small facet joints (two on each side of the vertebra) become irritated or injured when held in a prolonged position or moved quickly. This causes the increased pain, movement restrictions and muscle guarding.

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The other cause of a wry neck is an injury to the disc. Whether it be a bulge or strain of the disc wall, it can cause inflammation and place pressure on nerves that branch out of the neck. This may result in pain that radiates down the arm or cause altered sensation. If you experience this altered sensation it is important to seek professional advice. Discogenic neck pain might take longer to recover than a facet, but still responds well to physiotherapy.

Treatment Options

The good news is that a wry neck can be treated conservatively with physiotherapy treatment techniques and exercise. Physiotherapy can offer manual therapy techniques to loosen the stiff joints and soft tissue release for the muscle spasm. Dry needling may also help with reducing the muscle spasm and strapping can help during the acute pain.

Once the pain has gone and movement has returned, it will be important to consider prevention in the future. Strengthening and postural correction exercises for the neck, along with advice on ergonomics for your work environment may be needed.

Ideally seek treatment within the first 24 hours to start with the right advice for dealing with this injury. After a thorough assessment you will receive the best treatment and appropriate exercises to help you recover from your neck pain.

For an appointment, call on 095290990 

Training – Finding the Sweet Spot

Understanding your training load and tracking your acute:chronic ratio is a great tool of avoiding injury but seeing regular improvements when training.

Bourdon et al 2017

Understanding your abilities with training is a constant adaption. In the gym or on the training field, knowing your boundaries of training intensity will allow you get the best results and minimise risk of injury.

In 2016 there was conference in Doha, Qatar bringing many of the worlds leading sports science experts to discuss monitoring athletes training loads. This is Journal draws together the key points from the conference.

The importance of monitoring your training load is to get the best out of training and make improvements. But also tracking this figure helps minimise risk of injury.

Acute-Chronic Workload Ratio.jpg
Training loads of each session is referred to as ‘Acute’ workload, this is compared to each week throughout the year, it’s referred to as your ‘Chronic’ workload. The objective is to make sure there is no big spike in acute workload compared to chronic workload. A spike in acute workload will lead to fatigue, poor performance and increased risk of injury. As displayed in the diagram a ratio increase increase acute:chronic of more than 1.5 results puts you in the red zone that indicates a greater chance of injury. Also worth pointing out, taking your training level below 0.8 of your chronic workload, surprisingly showed a higher risk of injury.

Staying within the workload “sweet spot” is your goal to minimising injuries. It takes time to build up training load and this should be done gradually.

Measuring Training Load

To monitor your overall effort in your workout there is a simple method of combining:

Internal Load: These are the biological/psychological factors. This could be heart rate monitors, blood lactate levels or rate of perceived exertion.

External Load: Power output, speed and acceleration derived from GPS and accelerometer devices.

Tracking your training load is a great way of assessing your own capacity to handle the session. Over time this can provide information on training load adaptation.

Internal Road x External Road = Training Load

In CrossFit there’s too many variables to monitor with different workouts each day. Use your strength component to measure your external load, this will be a more consistent figure. Whether it’s a dead lift, back squat or strict press. Record internal load a rate of perceived exertion, using a visual analogue score, see below.

The acute:chronic workloads apply to all levels of athlete, not just beginners and people returning from injury. Even at the top level our training intensity needs to be tailored to our own individual needs.

Below is a summary of the journal.

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Bourdon et al. (2017) Monitoring Athlete Training Loads: Consensus Statement Int J Sports Physiol Perform Performance

Crossfit: Is it time to go Rx?

Are you at that point in your CrossFit training where you’re asking if it’s time to go Rx in a workout? Read on to make sure it’s safe and no risk of injury.

Have peace in the process and joy in the progress

For a seasoned athlete this question is almost a full gone conclusion in deciding to do the prescribed workout. But even then on any given day factors can play their part in deciding if they need to adjust the workout. For the newer athletes and the others that have just been plugging away and making progress on the scaled options, it can be tempting to move into the prescribed workouts.

What does “going Rx” really mean?

  • You can safely move with consistency even when under fatigue.
  • You understand the purpose of the workout and can complete it within or around the desired goal.
  • Your coach is confident with you doing the workout.

Safety and Consistency

It’s the main concern for anyone attempting to workout at a prescribed level for the first time. Developing your competency of individual skills in the strength phase of training is vitally important. But also being able to match it with consistency when doing multiple reps. It’s important to be honest with your ability.

Moving either your body or heavy weight inefficiently and inconsistently over multiple reps only increases the risk of injury. If it means you continue building strength with the scaled options, so be it. Most workouts will repeat 2-3 times per year, giving you another opportunity for the next one. 

Understand the purpose

Every time you walk into the gym and see the new workout on the board consider that there is a purpose to each one. Workouts are not just slapped together. The coach has programmed each workout to compliment the type of strength work you’re doing and the stage that you’re in, within the program.

Each individual workout is designed to expose your body to different metabolic demands. A workout designed to be a short 5-8 minutes is expectant for you to be able to train continuously during this time at a weight you can keep going. If you’re going Rx and taking long breaks, this defeats the object of the session.

The other side is doing a workout that’s meant to be long in duration testing stamina. If you’re scaling too low, this could get you through the workout much faster. While this looks good on the whiteboard you won’t get the intended aerobic demand to your body.

If you’re unsure about where your expected to finish or what weight would be appropriate….

Speak to the Coach

Coach has been watching you week by week and is aware of your abilities. They also understand the stimulus of each workout. So if you’re still unsure of what level you’re at, ask the coach. They’ll guide you on appropriate weight, pacing, expectation of finish time and offer scaling options if you’re injured or still not ready for a particular movement.

If the coaches decision is lower than your expectation, leave the ego at the door. This is for your own safety and you’ll still end up getting an effective workout.

Gradually you’ll find there’ll be days you can Rx and others you won’t. Remember that you can’t force the process. Keep working to your ability and progress will come.

Complex movements and a neutral spine

Being aware of what a neutral spine feels like is a good start. But when incorporating it into more difficult movements, it requires patience and consistency.

Let’s start simple before making it complicated

Moving with integrity is essential to getting the best output from your exercise and with that, understanding the principals of neutral spinal position play a primary role. You could be pushing off to sprint or jumping up to block a shot or preparing for an Olympic lift, finding a neutral spine provides your limbs with a stable base to engage.

Maintaining a neutral spine

What is a neutral spine?sPINE

The design spine provides a wide range of movement in different directions, helped by having 25 mobile vertebral segments. This allows you to be highly functional. But not all spinal positions are efficient. It’s a neutral spine that evenly distributes stress through the complex tissue structures of the spine. This reduces the risk of injury when challenged and provides a strong platform for the arms and legs to work from. It also provides the least amount of tension on the nervous system as it branches out from the spinal column.

Looking at the supportive network of the spine, it’s made up of 3 arches. A slight inward cervical arch (neck), an outward thoracic arch (mid back) and inward curve at the Lumbar (lower back). Underneath the lumbar is the sacrum connecting to the pelvis.

Cannons being fired from a battleship have more power, stability and accuracy than once fired from a canoe.

Why do we need a neutral spine?

Physically it’s the most efficient position, but it doesn’t mean we need to be fixed in this shape at all times.

It does however become important when we throw complex movements into the mix. A complex movement is something that requires speed, power and timing from multiple muscle groups across multiple joints. Lacking the coordination of maintaining this posture during difficult movements not only compromises the spine but offers poor performance output.

An easy example of poor spinal position can be the dead lift. Often people race to get a heavier lift while ignoring the potential risks to the tissues of the spine. Finding a neutral position will not only be safe, but will offer better outcomes in developing strength.

Another example I see is the pull up. Coming over the bar there is often excessive chin poke and neck extension to clear the head over the bar. This compromises the neck, shoulders and upper back.

If you’re struggling with maintaining this spinal shape when doing complex movements you might want to remove an element of difficulty, such as weight, speed or scaling the movement. Develop better body awareness before making it more more challenging.

How to find your neutral spine

On the floor – 

  • Lying down on your back with your knees bent and feet flat on the floor.
  • Tilt your pelvis up and down to feel the top and bottom of your sacrum, at the back of the pelvis.
  • Then you want to feel the middle of the sacrum, adjusting your pelvis, it will lie between the top and bottom of the tilt.
  • Then tuck your chin in without fully flattening your neck to the floor.Finding neutral spine

Once you’re confident with the shape, get up into standing and attempt to maintain it through movement. The video below, using a stick will provide feedback to keep you well positioned.

… and then once you’re confident with keeping this shape, slowly start incorporating it into heavier, faster movements. This will put you in a safer position and improve the results of your training.

 

Takeaways from the CrossFit Open

The Open has finally closed and with it comes a range of experiences at all levels. But using your results in training could help you become better athlete for next year.

The struggle you are in today is developing your strength for tomorrow.

The 2018 CrossFit Open has finally come to a close. From seasoned veteran to first timer, the last 5 weeks have physically pushed you to new limits. We have all gone through it together but each of you will have experienced it differently. The Open provides us with a milestone, a measure of our fitness from the past year and offers us with data moving into the new season of training.

Finding weak links

CrossFit HQ gets more creative every year with their programming. This exposes weakness of skills, abilities and fitness. Whether it’s strength and endurance or struggling with certain gymnastic movements. The aim of the open is to not only select the strongest in the pack and gain a sense of achievement, but also offer individuals an insight into their weaknesses.

Spending a bit of extra time on movements you’ve struggled with throughout the year will help you develop into a well rounded athlete and become more equipped for the following Open.

Developing a strategy

Running head first into a workout, like a bull in a china shop is not a great strategy for success. Understanding your abilities for each movement will help you form a strategy, like how many reps you’ll do before breaking? how long your break will be? etc.

This knowledge doesn’t come cheap. You’ll have to train through the year and learn your max reps for each movement and apply it to your training.

Overcoming your own doubt

For those entering the open for the first time, it can be quite daunting, with personal expectations and the competitive nature of the event. But when coach recommends you to go Rx, how many of you were surprised by the result? Who got their first pull up or handstand pushup?

Just going beyond those comfort zones gives you a glimpse of what’s possible for the rest of the year with regular training.

Small things can make the biggest difference

Looking after yourself during the open was crucial to getting the best result. How was your sleep quality? hydration? nutrition; pre and post workout? breath work? Did you spend time warming up and mobilising before the workout?

If any of these areas were neglected it will work to your advantage by making it a regular part of your regime in the new season.

Leaving the ego at the door

This years prescribed workouts got more technical from the 3rd week onward. For many who’ve just started CrossFit it’s important to know if your abilities lie within Rx or still need to be scaled. Coach might even advise you not to Rx if unable to maintain form or safely lift the weight. Try not to be discouraged by this, it was only to save you from the threat of injury, allowing you to carry on training following the Open.

If you struggled to reach Rx for a movement, use this as motivation to develop the strength or to practice the skill to be ready for the next open.

Having Fun

Isn’t this what it’s all about? Accept the suspense of waiting for the new workout to be announced. Enjoy the friendly competition between other members in the box and the drive that gives to achieving more than you thought possible. Enjoy the feeling of support from the community to get the best out of each other.

Well done with everyone that took part in the 2018 CrossFit Open and good luck with training for the new season.

Study: When is bending too much?

This recent study looked at sustained bending and the time it takes before our postural muscles give in and we begin to rely on our passive structures for support.

Alessa 2017

How long is too long, to be in a forward, bent posture? Many of us spend hours doing house chores; weeding, DIY, working on the car etc. Not to mention the time spent leaning over a computer desk or looking down at your phone.

Back pain

Your muscles play an amazing role of suspending us in these positions, but just like with exercise our muscles will reach a point of fatigue. When the postural muscles aren’t able to provide the support we then rely on “passive” structures like ligaments and fascia, which is not their primary role, eventually leading stress and increased risk of injury.

This study looked at 2 angles of the spine leaning forwards and found that within 40 seconds the participants transitioned from the support of postural muscles to the passive structures. While this was found to be a natural transition the prolonged strain on the passive structures has been shown to increase the risk of lower back pain as suggested in another study.

As mentioned in a previous blog, these positions are not “wrong” but it’s better for the overall health of the spine to regularly change position and break from sustained load on an individual structure to provide balance.

Abstract

Static trunk bending is an occupational risk factor for lower back pain (LBP). When assessing relative short duration trunk bending tasks, existing studies mostly assumed unchanged spine biomechanical responses during task performance. The purpose of the current study was to assess the biomechanical changes of lumbar spine during the performance of relatively short duration, sustained trunk bending tasks. Fifteen participants performed 40-s static trunk bending tasks in two different trunk angles (30° or 60°) with two different hand load levels (0 or 6.8 kg). Results of the current study revealed significantly increased lumbar flexion and lumbar passive moment during the 40 s of trunk bending. Significantly reduced lumbar and abdominal muscle activities were also observed in most conditions. These findings suggest that, during the performance of short duration, static trunk bending tasks, a shift of loading from lumbar active tissues to passive tissues occurs naturally. This mechanism is beneficial in reducing the accumulation of lumbar muscle fatigue; however, lumbar passive tissue creep could be introduced due to prolonged or repetitive exposure.

 

Alessaa F. et al (2017) Changes of lumbar posture and tissue loading during static trunk bending. Human Movement Science

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