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As Australians we are no strangers to extreme heat but what do we do about our exercise regimes? Heat acclimation is key to building and maintaining exercise regimes through the summer months!

Physiological Adaptations:

Understand the physiological changes that occur during heat acclimatisation. Your body adapts by increasing sweat rate, improving blood flow to the skin, and enhancing thermoregulation. This results in a more efficient cooling mechanism during exercise.

Structured Exposure Protocol:

Implement a systematic approach to heat exposure. Initiate training during cooler periods, progressively extending duration and intensity. This gradual process allows your body to adapt to higher temperatures without compromising performance or safety.

Hydration Strategies:

Consider your hydration plan as a cornerstone. Optimal fluid balance is crucial for maintaining performance and preventing dehydration. Tailor your fluid intake based on individual sweat rates and electrolyte needs. Precision matters.

Strategic Timing:

Time your workouts intelligently. Leverage cooler times of the day to optimize training conditions. This strategic scheduling minimises heat stress and enhances the efficiency of your acclimatisation process.

Tech for Performance Monitoring:

If you have made the investment, monitor key metrics like heart rate, core body temperature, and sweat rate during acclimatisation. Data-driven insights allow for personalised adjustments, ensuring a finely tuned adaptation process.

Nutritional Considerations:

Fuel your body strategically. Adequate nutrition and a balanced diet support the energy demands of heat acclimatisation.

Lets talk Tendinopathy!

When you think physio, you think bones and muscles…. But what about our tendons? Tendinopathies are a super common injury and correct management is crucial to getting you back out there!

What is a tendinopathy?

Tendinopathy is a condition characterised by the deterioration, inflammation, or irritation of tendons which is the fibrous tissues connecting muscles to bones. It usually develops due to repetitive strain/ overload, stretching or trauma to the tendon. 

The do’s of tendinopathy management 

✅Do seek professional guidence from your physio if you suspect you are dealing with tendinopathy. We can provide personalised advice and treatment options tailored to your specific needs.
https://tinyurl.com/NUMoves

✅Do Manage Pain Levels: During and after exercise, aim to keep your pain levels at a manageable intensity, preferably below 4 out of 10.

✅Beware of Provocative Activities: Activities that involve faster movements, plyometrics (jumping exercises), or excessive stretching can be more provocative for tendinopathy.

The don’ts of tendinopathy management

❌Don’t Stretch a Painful Tendon: Stretching can aggravate the condition and potentially worsen the pain. Instead, focus on gentle movements that promote mobility in the surrounding muscles and joints.

❌Don’t Poke or Rub the Tendon: It’s crucial to avoid direct pressure or rubbing on the tendon as this can further irritate the condition.

❌ Don’t Completely Rest the Tendon: While it may be tempting to rest the affected tendon entirely, it’s important to note that complete rest won’t promote healing or recovery.

Let’s talk tendinopathy today!

1. Rest completely

Tendon pain stems from the tendon not coping with a given load. Complete rest will only decrease the tendon’s capacity to tolerate load even further. Rather than completely resting, you should continue to place the tendon under a small amount of load that you know it will tolerate, and then slowly and progressively increase it over time.

2. Have ongoing passive treatments

Passive treatment such as massage, dry needling, ice, heat, TENS, ultrasound and interferential do not improve the tendon’s capacity to tolerate load, and therefore will usually not provide long lasting benefit. Some of these treatments can be helpful in the short term for pain relief if you aren’t coping, however it is understood that these treatments aren’t curative.

3. Have injection therapies

Injections directly into tendon tissues has not been shown to be effective in good clinical trials. In some cases, particular injections can actually have a detrimental effect to the tendon’s health long term. They should only be considered if the tendon has not responded to a well designed and implemented exercise-based program.

4. Ignore your pain

Once you have tendon pain, it is normal to expect some pain when you place load on the tendon. Just as you shouldn’t rest completely, you also shouldn’t push through large amounts of pain. A general guide is that pain more than 4/10 pain might indicate that the tendon isn’t coping with the load and it may make the condition worse over time. If pain is kept below a 4/10 during and after exercises and the pain is allowed to settle between bouts of exercise, the tendon will likely adapt, get stronger and tolerate more activity with less pain in the future.

5. Stretch your tendon

Stretching your tendon places it under high compressive load. We now know that compressive load can be harmful to a painful tendon and may slow down its recovery. There is also no published evidence to support stretching as a useful intervention in tendon pain.

6. Massage your tendon

An overloaded and irritated tendon is often further aggravated by the compressive load of massage. Massage, like other passive therapies is not usually helpful in the long term, though may provide short term pain relief.

7. Be worried about the images of your tendon

Tendon imaging (ultrasound or MRI) and medical terms such as ‘degeneration’ and ‘tear’ can create some fear around loading a tendon. The concern is that loading may make the tear worse and cause further degeneration. There is actually evidence demonstrating that problematic tendons can eventually tolerate quite significant load without pain, especially when load is incrementally increased. Interestingly, the amount of changes identified on imaging is actually poorly associated with the load capacity in a tendon.

8. Be worried about rupture

Pain is a protective mechanism that makes you unload a tendon – therefore you are actually less likely to rupture a tendon which is painful. Most tendons that rupture are pain-free, despite having substantial pathology when subjected to medical imaging (see point 7 – imaging is not a reliable indicator of a tendons capacity!)

9.  Take short cuts with rehabilitation

Time is required to develop strength and increase a tendon’s capacity. Although this time can seem long (sometimes 3-6 months or longer), the long-term outcomes are good if rehabilitation is completed. Things that are often promised as immediate fixes (see points 2 and 3) may provide short term pain improvements with no positive effect on long term tendon loading capacity and function.

10. Not understand tasks requiring high tendon loads

As a general rule, painful tendons hate being compressed and contracted forcefully from a stretched position. For the achilles and patella tendon, this involves spring like tasks, such as jumping, sprinting and changing direction. Early tendon rehab involves slow resistance exercises with gradual increases in load. As your tendon adapts to rehab, you should progress towards faster, spring like actions to prepare you for the functional demands of the muscle-tendon unit.

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So what does this mean for you?

The current best evidence for rehabilitating painful tendons is an exercise-based program which is progressive and guided by a physiotherapist with an understanding of these tendon loading principles. An individual’s pain and function need to be considered, and loads adjusted accordingly to ensure that tendons are being appropriately challenged.

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This blog is an adaptation of the work of Professor Jill Cook – a world leader in tendon pain management – and you can find her original article, along with an accompanying video at http://semrc.blogs.latrobe.edu.au/10-things-not-to-do-if-you-have-lower-limb-tendon-pain/.

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Stay tuned for more information about tendinopathy in our upcoming tendon series.

If you or someone you know is suffering from tendon pain, contact us:

Ph: (02) 49216879

E: admin@numovesphysiotherapy.com.au

 

The benefits of a high-quality individualised rehabilitation program after having ACL surgery are clear, but what should individuals be doing immediately after their ACL injury? Well, current best practice guidelines¹ advise gentle pain-free range of motion exercises within the first few days, followed by commencement of early ACL physiotherapy. The physiotherapist will take some measurements of swelling and range of movement as well as strength on the un-injured side. Early goals of physio are to reduce pain and swelling and restore normal range of movement. Following a significant knee injury it is common to experience poor activation and wasting of the muscles in the thigh, particularly the quadriceps. A large component of physio following knee injury is to get these muscles firing again and rebuild strength back up towards normal.

Together with an orthopaedic surgeon or sports physician, the physiotherapist can help guide the decision when to have the ACL reconstructed. It is generally accepted that patients should have their ACL reconstructed as soon as possible following injury. However, if the knee is still significantly swollen, painful and has poor function, it is likely to be in a worse state following surgery and take longer to return to normal. Ideally, before having surgery, the knee should have minimal swelling, good range of movement, muscle strength and balance. Studies have identified that pre-operative quads strength predicts outcome 2 years after surgery. This means that if someone doesn’t regain good quads strength before surgery, they have to work very hard for a longer time after surgery to get their strength back.

Depending on the type of injury, how an athlete is progressing with their rehab, and their sporting or functional goals, surgical intervention might not be necessary at this point. Regardless of whether an individual has surgery – undergoing a physiotherapist guided rehabilitation program immediately following ACL injury has been found to improve outcomes both pre- and post- surgery³.

One study found 50% of patients who delayed their operation and underwent rehabilitation avoided the need for surgery at all. Interestingly, over the following 6 years there was no negative consequences of delaying surgery. In fact, early surgery, and delayed (optional) surgical groups had no significant difference in the following outcomes:

• Participation in sport
• Quality of life scores
• Evidence of arthritis on scans
• Future surgery

If you’re interested in finding out more about ACL rehabilitation or seeking guidance regarding the best time to have your ACL reconstructed, contact us on 49216879.

1. https://bestpractice.bmj.com/topics/en-gb/589/management-approach BMJ Best practice guidelines
2. https://www.bmj.com/content/bmj/346/bmj.f232.full.pdf 2013 Study
3. https://www.ncbi.nlm.nih.gov/pubmed/26879746 2017 Systematic review