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

Top 5 Posts of 2017

Entering the new year here’s a look back at last years 5 most popular blogs.

Happy New Year – 2018 is already under way. Hope you all had a great break.

Last year was a busy year with the blogs. Here are the top 5 posts from last year in case you missed them.

5. The Office WOD

  • How many of us at work get stuck in the same position and forget to move?
  • This post was offering some general strengthening and postural awareness exercises to follow regularly at work.
  • Try getting into a routine with these types of exercises. It should help prepare you better for training.

4. Trigger Points – what are they?

  • Those knots felt in your traps after a busy day at work are more than likely trigger points.
  • This blog goes into explaining what they are, how they’re caused and how they’re treated.

3. Recovering from DOMS

  • This was a popular topic as we all love a bit of DOMS.
  • Understanding how to manage your recovery and training while in the DOMS phase will make it more tolerable.
  • Also knowing the difference of pain between DOMS and an injury will help avoid making anything worse.

2. Improving front rack position

  • After doing many mobility assessments, the front rack shape is what most people struggled to hold passively without a bar.
  • This was one of a 4 part series of shoulder shapes we should be achieving to help make movement more efficient.
  • It offered a range of mobility exercises to open the shoulder into the front rack.

1. Anterior knee pain in CrossFit

  • One of the most common injuries in sports and top 3 with CrossFit athletes is a knee injury.
  • This blog looked at anterior knee pain and the common causes. It offers some basic suggestions to self managing the injury.

The purpose of these blogs has been to provide a wider understanding of your body and give you more control of it. Wishing you all an injury free 2018 and keep checking for the new blogs.

What’s causing my muscle tightness?

Muscular tightness is one of the disruptions to normal movement and if not managed well can lead to possible injury. Identifying your tightness and using specific strategies will help relieve tension.

One of the main issues patients struggle with is muscular tightness. They get a feeling of pain or tightness and an inability to relax the muscle.

What is tightness?

When looking at patients I need to find out if they have mechanical stiffness or the “feeling” of tightness or a combination of both, as this would direct my treatment plan.

Is the range of movement limited? does it have a soft or hard end feel? Are movements a struggle at end range, feeling heavy? What’s the rest feeling like, is it a constant tightness?

While we can have mechanical tightness of a joint or muscle, there are also the “feelings” of tightness. You might get your hands to the floor with your legs straight and feel the hamstrings tightening. While another person could do the same, get to their knees and not have tightness.

What causes the feeling of tightness?

Tightness is a sensation like many others, including pain. What we understand from pain is that this is not always brought on physically, but also by the perception of threat.

pathway-of-a-pain-message-via-sensory-nerve-in-injured-muscle,2324600

So like pain, tightness is a protective mechanism from the central nervous system to avoid danger. On a number of levels it detects stressor’s that expose the whole body or specific region to threat.

Examples of this…..

  • Prolonged sitting, without movement we often notice tightness in certain areas, possibly through reduced oxygen supply and increased metabolic toxicity.
  • Stressful situations cause rising cortisol levels and increased activity of the Vagus nerve leading to muscular tightness.
  • Repetitive movement over a period of time causes increased tension.
  • Posture muscle tightnessInjury or pre-existing weakness can cause a guarding response from the nervous system.

Using tightness as a warning sign for these potential threats might allows us to acknowledge the situation and quickly act upon it.

What will help my tightness?

Like all movement patterns, we improve with practice. The same goes for muscle tightness. If we regularly bombard it with neural messages to remain tight we develop trigger points and chronic tightness through a process called central sensitisation. Which makes the tissues more sensitive to pain and tightness.

If we can regularly supply our nervous system with input that is non-threatening we can slowly help desensitise the muscle. But this takes time and regular repetition.

Stretching

Most people with tightness, especially after prolonged rest feel the need to stretch out. But depending on our intended goal there are different types of stretches.

  • Static stretches
  • Active stretches
  • Dynamic stretches
  • PNF (Contract-relax)

While these stretches will help, it might only be temporary without regular repetition and reinforcing the nervous system with good movement.

Strengthening

There is a misconception that resistance training causes our muscles to feel tighter. Mainly due to the effect of DOMS. That feeling of soreness you have the day after a hard workout. But some recent studies have shown that strengthening can be equally, if not more beneficial than stretching.

Improvements in flexibility coming from improved ability to handle higher levels of metabolic stress and lower levels of inflammation. By lowering the threat to the nervous system through increased strength, it allows you to work the muscle through a wider range, without getting a stretch reflex.

Massage and other soft tissue work

Another way to help desensitise these tight muscles is to apply pressure. This could be with the use of a foam roller/lacrosse ball or other manual therapy techniques like deep tissue massage, myofascial release, trigger point release, dry needling.

Relaxation techniques and breathing mechanics

Like in the previous blog, an overactive or dominant sympathetic nervous system can cause muscle tightness. Finding ways of breaking poor postures or shallow breathing using a range of methods like kapalbhati, wim-hof, meditation, yoga etc. Using these methods are just part of the process to lowering overall tightness.

Usually, just following one of these methods individually is not going to be as effective as combining them together. Try to deal with the tightness from all angles.

If guidance is required or manual therapy techniques feel free to call 09 5290990.

Iliotibial Band Syndrome

Whether your running, rowing cycling or lifting. Repeated knee flexion may irritate structures on the outer knee. It is important to get on top of this condition to stop it hindering your training.

Setbacks are the perfect opportunity to grow

Iliotibial band syndrome is most commonly experienced with runners. But also in all sports that require repetitive knee flexion under high load. Early signs and symptoms often go unnoticed (or ignored) until it’s blown up into a fully-fledged injury.

What is the Iliotibial Band?

Iliotibial band

The Iliotibial Band (ITB) is a thick fibrous band of strong connective tissue running down the lateral side of the thigh. Its attachment points at the hip are from the Glutes at the back and Tensor Fascia Latae at the front. The bottom connection feeds into the outer border of the knee and patella. It’s at this attachment point that pain and inflammation develops and would be classed as Iliotibial Band Syndrome (ITBS).

The role of the ITB is to provide the knee with stability and to abduct the hip outwards. When we walk, run or squat it’s working hard to keep the knee in the correct position and force is distributed evenly.

What are the symptoms of ITBS?

Problems arise when the lower limb moves in abnormal directions repeatedly, causing the band to flick over bony structures of the knee, leading to irritation. It may also get tighter than normal through shortening or over activity of the Glutes and Tensor Fascia Latae. This results in the ITB becoming a tighter band pulling more at its attachment and compressing other tissue around it.

ITBS usually is a sharp pain or burning sensation in the lateral knee. Generally, felt during exercise when the knee flexes repeatedly through mid-range. This range of 30-40 degrees is when pressure of the ITB against the bone is at its highest. If this movement is repeated enough, it causes friction and irritates the tissue.

What causes ITBS?

There are a number of factors that can cause a stir up of ITBS. Physically there could be a muscle imbalance, with tightness or weakness around the pelvis, hip or knee, reduced balance, and reduced ground reaction time. Mechanically, often due to the physical limitations that cause incorrect movement patterns, poor weight transferring and distribution of load.

On top of this are issues with training error. How quickly a programme is progressed, especially if it involves load or speed. From running to weight lifting, training loads need to be gradually increased to reduce the risk of injury.

Management of ITBS

Initially you may be restricted from doing the activity that caused your pain while your body recovers. An assessment will help you identify what factors are triggering your ITBS. Treatment will be multifaceted providing advice for tissue loading, gait retraining and specific muscle strengthening and stretches. Additionally, soft tissue manipulation, strapping and dry needling.

With the improved running form, increased strength and flexibility you will gradually be introduced back into the activity. This will make you overall better at your sport and reduce the risk of this problem returning.

Evidence shows that ITBS responds well to conservative management with a success rate as high as 92%.

If you’re struggling with recovering on your own contact me on 09 5290990

Strength Training for Endurance

This is a literature review of the benefits of including resistance training into your running or cycling training programme.

Rønnestad 2014

For recreational runners and cyclists, strength training is not always considered important when developing increased pace, endurance and mechanics. But this paper from 3 years supports the involvement of explosive strength training as part of a training program for endurance runners/cyclists. With benefits of improved endurance to muscle fibres when in an anaerobic state, increased tendon stiffness and greater explosive power.

The study went on to find numerous benefits with the addition of strength training. And provided these recommendations.

  1. To improve the chance of increased endurance performance following a strength training program, the resisted exercises should engage similar muscle groups and imitate sport specific movements. This will result in firing up the same neural pathways connected with the motion of running or cycling.
  2. Force output may increase the ground strike in runners or force velocity in cycling if an explosive focus is put on the concentric phase of the muscle. For example pushing fast out of the back squat.
  3. At least 2 sessions per week of strength training to develop maximal strength over a 12 week program. Beginning with lighter loads in the first 3 weeks to learn correct form before increasing load. Working within 8-12 reps and 2-3 sets.

Some beneficial lifts for runners and cyclists would include back squats, dead lifts, hip thrusters and bent over rows.

Abstract

Here we report on the effect of combining endurance training with heavy or explosive strength training on endurance performance in endurance-trained runners and cyclists. Running economy is improved by performing combined endurance training with either heavy or explosive strength training. However, heavy strength training is recommended for improving cycling economy. Equivocal findings exist regarding the effects on power output or velocity at the lactate threshold. Concurrent endurance and heavy strength training can increase running speed and power output at VO2max (Vmax and Wmax , respectively) or time to exhaustion at Vmax and Wmax . Combining endurance training with either explosive or heavy strength training can improve running performance, while there is most compelling evidence of an additive effect on cycling performance when heavy strength training is used. It is suggested that the improved endurance performance may relate to delayed activation of less efficient type II fibers, improved neuromuscular efficiency, conversion of fast-twitch type IIX fibers into more fatigue-resistant type IIA fibers, or improved musculo-tendinous stiffness.

Rønnestad et al (2014). Optimizing strength training for running and cycling endurance performance: A review. Scandinavian journal of medicine & science in sports

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Lunge Hip Mobility

The 2nd part of hip mobility focuses on your lunge shape. Having full access to hip extension will improve your running, throwing and kicking abilities.

This is the second part of the hip series. These hip shapes are positions that we should all be striving for to have confidence and feel safe to function if exposed to complex positions. 

Following on from the blog hip opener for the hinge shape is our next hip position we should try to achieve. The lunge shape is full extension and internal rotation of the hip with the knee positioned behind the hip and foot pointing forwards. This shape is most seen in lifters doing split jerks, kicking a football, ball throwing. But most commonly seeing this lack of range with runners, not utilising the full hip extension in the push off at the end of stance phase.

Over the years adaptive changes happen either through injury or more with positions we adhere to. The most common being sitting, which results in anterior structures of the hip becoming limited. Lacking the end range of this movement could mean we’re selling our self short of momentum, power or endurance.

Running-lunge

Using the picture of long distance runner Mo Farah, he demonstrates a great lunge shape at the hip. While maintaining a neutral spine he manages to reach full hip extension and toes are pointed forwards, maintaining the internal rotation of the hip. Lacking hip extension can compromise running form of the upper limb and spine. But as you can see he reaches a good press shape of the opposite shoulder in the arm swing making his running style extremely efficient and balanced.

Below are a series of stretches and mobility exercises to help improve your lunge shape.

Couch stretch

If hip flexors are tight this is one of the best stretches for improving length back. A long sustained hold of this stretch with full diaphragmatic breathing over 2 minutes is extremely effective.

Illiopsoas Trigger Point Release

This muscle sits within the abdominal cavity and if tight it will feel sore with pressure through the abdominal wall towards the muscle. At first the pain can be quite high but relaxing into the pressure overtime the pain subsides and will feel looser once released. Aim for 1-2 minutes hold.

Hip flexor stretch (with band)

Another hip flexor stretch with a joint mobilisation using a band. Position the knee behind the hip. Allow the band to pull the hip forwards, contract the glutes to get the best anterior hip stretch.

Quads and inner thigh release with LaX ball

A lacrosse ball is a great tool for isolating sections of tight muscle. Rolling on the ball like you would a foam roller will be more effective, if tolerated. Then opening up inner thigh/hip adductors using the kettle bell handle. The knee flexion/extension stretches the muscle through range while being tacked down.

Suspended split stretch

This is for the more adventurous. It will help your lunge go deeper while increase stretch through the hamstrings. Throughout this movement, it is important to keep the glutes switched on to avoid hanging of the hip capsules. Spend around a minute each direction.

Continue reading “Lunge Hip Mobility”

Hip Opener for Hinge Shapes

The hip hinge is an important movement in daily activities as well as in sports. Many people are unaware this movement exists and struggle with reaching their potential.

Many lifting injuries result from a lack of movement awareness and weakness of the posterior muscles. The hip hinge is a foundational movement for so many actions like deadlifts, squats, sprinting, jumping. Lacking an effective hip hinge is like racing a formula 1 car on flat tyres.

Developing a good hip hinge will improve the strength of the posterior chain. This includes muscles like the glutes, hamstrings and back extensors. The hinge movement is primarily coming from the hip. The goal is to maintain a neutral spine throughout the movement, the hips start to bend with your butt moving backwards and minimal flexion in the knee. This will increase the tension on the hamstrings and glutes.

The majority of people find this pattern of movement unnatural, as it’s rarely practiced and in most cases, are quad dominant. This quad dominant pattern causes weight to be distributed anteriorly, which is fine with some activities, but most actions we need to be more engaged with our posterior chain.

hip hinge movements.jpg

 

Below are a series of stretches and strengthening exercises to help Improve your hip hinging abilities.

Weighted Hip Hinge

This exercises is a great way to warm up and encourage the hip back movement while fighting the resistance to maintain a neutral spine.

Banded Hip Distractions

These two movements are also great for warming up. Both encourage release of the hamstrings but also the band provides a traction force on the hip socket. This should allow the joint to move free’er and help you access more range in the joint.

Dynamic Hamstring stretch

This is a deeper stretch of the hamstrings. Having more flexibility here will help you hinge better at the hip which will off load the knees.

Jefferson Curl

This movement is a great way of developing movement segmentally and will help build strength when maintaining a stable spine. It’s important to note if you have a spinal injury to avoid this movement until you have gone through the appropriate phases of rehab.

Continue reading “Hip Opener for Hinge Shapes”

Do your hips get the green Light?

Functionally the hip has certain positions that create stability and power. We should be looking at accessing its full range to ensure the health of the joint.

Healthy joints make difficult movements easier

Just like the shoulder, the hip has an important role in allowing us to function in various positions. It’s also a ball and socket joint, with both joints acting as catalysts for power, stability and accuracy of its connecting limb.

Unlike the shoulder as you may already know, the hip is held within a deeper socket, but still has a multitude of muscles surrounding the joint, including its own rotator cuff. The hip also has a ligamentous capsule with fibres angling in different directions. Using the capsule the joint can wind up into some very strong and stable positions. Accessing these ranges of tension puts the joint into a safe place to absorb load.

Gray339

These high torque shapes held by the hip are our start and finish points of most movements of the lower limb. Most of the time we can function well within the realms of the inner movement. But if we struggle to start from these positions it becomes difficult to transition and finish in a safe end shape. The goal should be to have full physiological capacity.

In the hip, there are 3 shapes we should all be able to achieve.


  1. The first movement is the squat/hinge a combination of flexion and external rotation at the hip. This movement takes all the glory, it’s all of our squat movements, it’s dead lifting, it’s rowing and the list goes on.
  1. Next is the Lunge/run which is full extension of the hip with internal rotation. This could be the bottom of a split Jerk, in running it would be your trailing leg before leaving the ground.
  1. Pistol is the last movement which alludes a lot of people (including myself), requiring full hip flexion but also full ankle dorsiflexion.

While the squat/hinge position is the most common hip shape used. We should also feel competent at the other 2 positions. Over the next few weeks I’ll go through the 3 movements and provide some ideas to achieve full depths.