injury

Static vs dynamic stretching. What’s the difference and what should I be doing?

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When it comes to preparing your body for a workout, the notion of static stretching as a warm-up is facing a considerable challenge. Recent research is uncovering potential drawbacks, revealing that this traditional approach might not be the performance booster we once believed it to be. In fact, static stretching could have the counterintuitive effect of decreasing muscle power for hours post-stretch, potentially hindering your athletic performance.

The promise of injury prevention often associated with static stretching seems to fall short in the scientific realm. Studies are urging fitness enthusiasts to pivot toward dynamic exercises for a more effective warm-up routine. Dynamic exercises, such as proprioceptive training, strength workouts, and dynamic warm-ups, are emerging as champions in preserving performance levels and reducing the risk of injuries.

The shift from static to dynamic warm-ups has a growing evidence base. Dynamic exercises engage your muscles in a way that static stretching simply doesn’t. They prepare your body for the dynamic movements that lie ahead in your workout, enhancing flexibility, blood flow, and overall performance. As we bid adieu to the old-school static stretches, consider embracing a new era of warm-up routines that incorporate dynamic, agility, strength, and balance exercises for superior results.

So, before you settle into that long-held stretch pre-workout, take a moment to reassess. Your body might just thank you for the switch, unlocking a new realm of athletic potential and injury prevention. After all, in the dynamic world of fitness, adaptability is key. ????????

Sports injury management

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Sports injury management

When it comes to sports injury management, most people are familiar with the old acronym RICE (rest, ice, compression, elevation) for soft tissue injury management, but what is the evidence for it, and can we do better?

Complete rest is rarely necessary following simple soft tissue injuries. For example, following a simple ankle sprain, a person who continues to move the ankle and weight bear as tolerated will have accelerated recovery compared to someone who avoids weight bearing and keeps the ankle still.

Ice is often used immediately following a soft tissue injury. Ice does not reduce swelling. If applied correctly, ice can reduce the temperature of surrounding tissues enough to reduce the nerve’s ability to carry information back to the brain, thereby reducing pain. Unfortunately, ice can interrupt the natural inflammatory response following an injury and possibly delay the healing response. The consensus is: only ice following an injury if the pain is intolerable – then ice it properly by making a bag of crushed ice and water.

The new recommended acronym for soft tissue injury management. PEACE (Protect, Elevate, Avoid anti-inflammatories, Compress and Educate) refers to the steps immediately following injury. In the next few days, the injury needs a bit of LOVE (Load, Optimism, Vascularisation and Exercise). For more information on how to best manage your injury, contact us on 49216879 or admin@numoves.com.au

For the full article visit the BJSM editorial: https://bjsm.bmj.com/content/54/2/72

Winter Sports

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Winter Sports Physiotherapy Newcastle

Going skiing or snowboarding these holidays?

Remember to keep up your strength training before heading off on your trip. This will allow you to ski/board for longer without fatiguing. More importantly, strength training will also reduce your risk of injury. Great ways to improve strength and fitness indoors this winter include yoga, spin classes, weight training, rock climbing and more.

Another great way to improve your strength is through Pilates. Our Pilates classes run on 7am Mondays, 6:30pm Mondays, 7am Wednesdays and 12:15pm Fridays. Pilates helps to improve physical strength, flexibility, posture, and enhance mental awareness. All these benefits will allow you to be stronger and safer on the snow – these equal more fun!

Staying active throughout the winter can sometimes be difficult. No matter how choose to keep active and get stronger, something is better than nothing! Buy yourself some new exercise clothes. Remind yourself of your fitness goals, or make new goals.

For more information on sports preparation.

When is too much exercise a problem?

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exercise problemExercise plays an important role in assisting in the management of mental well-being. Research exists that agrees with the idea that if we are regularly active the symptoms of depression may improve (Click here to read our previous blog on exercise and depression). If we then exercise harder, it sometimes makes us feel even better and this good feeling can both mentally and physically become addictive.

A recent practice article from Heather Hausenblas and James Smoliga in the British medical journal discusses ‘addiction to exercise’, where exercise is an essential element to every day. The discussion surrounding the difference between healthy regular exercise and an addiction to exercise is important especially when injury occurs, as a reliance on exercise is difficult to overcome.

Having a physio practice in a gym based environment means we have seen clients with a reliance on exercise to the point of it being an addiction. As a general observation it is more common now than 10 years ago, but a greater number of people have a level of awareness of their need to exercise. The greatest time of concern with exercise addiction relates to when injury occurs and the ability to exercise has decreased.

Managing an unhealthy reliance on exercise involves starting with reflecting on the motivation or reasons for needing to exercise. What are your goals for exercising? If an exercise addiction is present, then we do not need to stop exercising, but rather understand the reasons and work towards a healthy exercise routine with less risk of injury and improved health benefits. Hausenblas refers to it as reducing the rigidity of an exercise routine. If you are over-reliant on running, then we may try to change the exercise routine initially and replace a run with a swim. Gradually work towards a healthy volume of exercise is the goal.

If you are reliant on exercise and don’t feel you can stop then discuss it with your GP or a psychologist. Alternatively give us a call and we can discuss your exercise routine. We will not ask you to stop but can assist with strategies to start moving towards a healthy exercise routine.

Housenblas H, Shreiber K, Smoliga J. (2017): Addiction to exercise. The British Medical Journal. http://www.bmj.com/content/357/bmj.j1745

The effect of static stretching on performance and preventing injury

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Stretching

Historically many people have used static stretching – a long hold and the end of available muscle length – as a part of a “warm up” routine before sport or exercise. But the research doesn’t back it up, and it may be detrimental.

Let’s talk about performance first. Static stretching actually decreases muscle power for a period of time – the period is debatable, but at least 5 minutes and up to 3 hours – after stretching is performed1,2. This also applies for contract-relax or proprioceptive neuromuscular facilitation (PNF) stretching. This could easily impair athletic performance, especially in sports where high force generation is required. Dynamic exercise/facilitation exercises do not seem to have this power loss effect.

What about injury prevention? Nope, no help there either. A very large study by Lauersen et al. (2014) which synthesises the best quality research surrounding injury prevention to date reported no reduction (or increase) in injury risk for people who performed static stretching3. What they did find was that proprioceptive training, strength training and a dynamic warmup did reduce the risk of acute and overuse type injuries4,5,6.

It’s hard to break old habits, but if static stretching can impair your performance and doesn’t make any difference to injury risk, it may be time to change it up. Athletes can derive a greater benefit by spending that time on a dynamic proprioceptive, agility, strength and balance training program warmup.

If you aren’t about to perform a physically demanding athletic activity and you enjoy stretching, go for it. There is no harm in stretching and if you haven’t got the mobility to perform a sport or task then both static and dynamic stretches are options to achieve this.

To read more about avoiding running injuries, click here and to read up on how to prevent injuries during pre- season click here.

  1. Marek, S. M., Cramer, J. T., Fincher, A. L., & Massey, L. L. (2005). Acute effects of static and proprioceptive neuromuscular facilitation stretching on muscle strength and power output. Journal of Athletic Training, 40(2), 94.
  2. Behm, D. G., Bambury, A., Cahill, F., & Power, K. (2004). Effect of acute static stretching on force, balance, reaction time, and movement time.Medicine and science in sports and exercise, 36, 1397-1402.
  3. Lauersen JB(1), Bertelsen DM, Andersen LB. Br J Sports Med. 2014 Jun;48(11):871-7. doi: 10.1136/bjsports-2013-092538. Epub 2013 Oct 7. The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials.
  4. Soligard, T., Nilstad, A., Steffen, K., Myklebust, G., Holme, I., Dvorak, J., … & Andersen, T. E. (2010). Compliance with a comprehensive  warm-up programme to prevent injuries in youth football. British journal of sports medicine, 44(11), 787-793.
  5. Soligard, T., Myklebust, G., Steffen, K., Holme, I., Silvers, H., Bizzini, M., … & Andersen, T. E. (2008). Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomised controlled trial. Bmj,337, a2469.
  6. Herman, K., Barton, C., Malliaras, P., & Morrissey, D. (2012). The effectiveness of neuromuscular warm-up strategies, that require no additional equipment, for preventing lower limb injuries during sports participation: a systematic review. BMC medicine, 10(1), 1.

Running injuries – How to avoid them

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running

There is a lot of expert opinion on running technique for performance and injury but its complex and sometimes contradictory. When we look at running without injury what helps one person often doesn’t for the next. Pain is not uncommon with running so for this article lets define an injury as when pain influences your running. This article is running advice that often does help get you running pain free …

Planning your approach to running is important but most of us just run when we get the time.

How often should I run is a great question with many possible answers. Let’s start with why you run? Having a goal is an important part of getting started. What do you want to achieve by running: increase fitness, lose weight, do a 5km park run, improve your time for running a set distance, complete a half or full marathon or simply feel better mentally and physically. Let’s aim to minimise or avoid muscle or joint pain that stops you from continuing to run.

How often (runs per week) and how long (distance)?

This depends on whether you have been running lately or not. If you haven’t run in the past 12 months then you need to start slower and less frequently then increase more gradually. There are apps such as couch to 5kms that can help guide you with graded increases. If you already have a base level of running fitness then you can progress more quickly.

Starting with 2 runs per week and working up to 4 per week is a good guide for frequency but it depends on how far you are running and you base running fitness. Starting with 3km walk / jog progressing to continuous jogging then working towards 5km (park run distance) is a good place for those who haven’t run recently.

One of the most common mistakes leading to joint or tendon pain is just doing too much too soon.

If you have had running injuries such as back or hip pain, shin splints or knee pain previously then a physio assessment is recommended before you start. This will identify stretches and strength exercises that will help and provide a guide to how often and how far you run when getting started.

What surface (grass, beach, cement, road)?

The surface you run on needs to be considered. If you want to do a half marathon on road and cement then we need to prepare your body for these surfaces. But if you are just getting started grass has the least impact and has most give to reduce impact stress through the legs. Road or tar is next then cement is the most stressful. Beach is obviously going to have less impact but be careful on the wet sand near the water if there is a reasonable side slope as this will quickly lead to pain. Soft sand level running is hard work, fantastic fitness and low impact but again don’t go too hard too soon. If you are prone to foot pain, then you should have shoes on even for beach runs.

What type of shoes?

There is a lot of research being done around shoe types and orthotics. You can read more detail in our running shoes blog but the only accurate advice is once you have found a type of shoe that allows you to run without pain then stay with it. Finding that shoe becomes more difficult and it is recommended that a physio assessment look at your foot type, muscle strength and running style to best advise a starting point.

How should I run (technique)?

There is lots of information about the ideal running technique (such as the ‘pose’ method) but what suits one body may not suit the next. To land on your heel first like when we walk is associated with increased pressure on the joints in our legs. Alternately to land on the forefoot increases loads on the achilles, calf and shin. If someone has a natural preference to one style and doesn’t have any complaints then you are best not to change your style. If you are trying to avoid knee pain by running more on your forefoot you might just develop an achilles problem and then not be able to run. If you do have joint pain and have been advised to change your running style then get advice and make the change very slowly.

If you have any questions in relation to preventing or treating running injuries let us know on admin@numovesphysiotherapy.com.au

 

Groin and adductor pain in sport

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Newcastle physiotherapy for groin and adductor pain in footballThe NU Moves Physio team has recently completed a masterclass debating the best approach to manage and treat adductor pain and tendon problems with footballers. Journal articles were found and discussed relative to the NU Moves approach to diagnosis and treatment.

The following is a summary of the NU Moves masterclass. The current best approach to assist a footballer with pain in the groin or adductor region:

  • Diagnosis is essential: There are many different possible sources of pain into the groin / hip area. Identifying the likelihood of each of these (e.g. osteitis pubis, stress fractures, avulsion fractures, bursitis, tendon strain, hernia, arthritis, lower back referral) via a thorough assessment is essential. Subsequently investigations (Xray, CT scan, MRI, Ultrasound) to confirm or negate are considered. The timing of investigations depends on the risks of the problems and whether treatment is altered because of the investigation findings.
  • Treatment of adductor tendon pathology:
    • Note that this requires consideration and exclusion of all the other potential causes of hip pain.
    • Don’t stretch the adductor muscle area – the right type of strength and functional return to sport exercises will assist recovery of flexibility and stretching is more likely to irritate the problem.
    • Stability is essential – becoming core stable in the pelvis by focussing on strengthening the gluteal and abdominal muscles in sport specific positions (i.e. one leg stand) is the starting point and can often be done very quickly after injury occurs.
    • Strengthening the adductor tendons – when commenced at the correct time after the injury, adductor strength exercise is useful in improving long term outcomes of full pain free return to sport. This could be a ball squeeze between the ankles / knees in lying or a band or cable resistance exercise in standing (as long as the pelvic stability stage has been achieved).
    • Graded return to running: graded return to jogging then running then change of direction exercises is essential. Once the tendon can cope with it and the pelvic / core stability is adequate then a terrific way to strengthen the area for running is to start jogging. The problem is when you go too hard too soon and create a flare-up of pain that lasts several days. Flare-ups are a set back to the eventual goal of return to playing again.
    • Sport specific exercise: kicking / striking / passing the ball in football can all be done lightly and gradually increased in a comparable way to jogging and running. Similarly, once pelvic / core stability and sufficient local strength of adductors is achieved, these are a great way to strength load the area for sport. Again, be wary of flare-ups by progressing too quickly.

The adductor tendon strain is a frequent problem in sport and particularly in football. The best advice is to get an accurate diagnosis first then an active exercise program including 3 parts: the pelvic / core stability, the adductor tendons themselves, and a sport specific program. Getting the right level of loads on the area during each phase of recovery is essential to the process. That is where we help the best.

If you want the best diagnosis and treatment then call us at NU Moves if you have groin pain or a known adductor problem. If you have a friend or family member needing advice to get back to sport then recommend us.

Prescribing running shoes – A guide through the fog of misinformation

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Running shoes are often prescribed based on arch height, degree of pronation they show when running and the latest trends like maximum cushioning and minimalist shoes. So how do you know what advice to follow and which shoes are right for you?

1. Arch Height
It is common practice to prescribe footwear based on the height of your foot arch, such as motion control shoes for people with flat feet and a cushioned shoe for people with high or stiff arches. This has previously been common practice but does not appear to affect the likelihood of sustaining an injury while running.

2. Pronation
Although over-pronation (too much rolling in) of the foot while running is often blamed for many running injuries, there is conflicting evidence to support this. It is unclear what a normal amount of pronation is and the difference between the movement of the shoe and the movement of the foot can be up to 20% while running, which makes measuring the amount of pronation difficult even with video analysis. If you cannot accurately measure pronation then fitting a shoe based on foot type becomes trial and error.

3. Trends
Over the years many trends regarding footwear have come and gone such as minimalist, anti-pronation and extreme cushioning shoes. It is important to consider that even people with the same foot type will respond differently to the same shoe. Therefore it is clear that one type of shoe will not suit everyone and buying shoes based on the latest trends can be erroneous.

So how should you choose what shoes to wear when you run?
1. Experienced Runners
Draw from experience, know what works for you and stick with it. Don’t be tempted by the latest trends and marketing, but if you are, incorporate the new shoe slowly and as an occasional change of pace.

2. New Runners
The most important thing to consider for a new runner is comfort. Try a few pairs on in the store and see how they feel. Initially staying away from extremes such as anti-pronation or extra cushioning shoes is a good place to start.

3. Runner with recurring injuries despite a change in shoes
Remember that shoes play a small role in sustaining most injuries and it is important to consider body mechanics, movement patterns and training habits when attempting to reduce injury risk.

If you are having recurring injuries while running, have a physio assessment to work out what is the best way to get you running pain free.

This blog is a summary of a great educational video from Kevin at Running reform http://www.runningreform.com/

Watch the original video at https://vimeo.com/126720173

Common training mistakes – how to avoid injury

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running and physiotherapy

Exercise and sports related injuries are common. Some sports such as rugby come with higher risks and frequency of injury. General exercise often has low risk of injury but that depends on how hard we push ourselves and the type of exercise we do. It doesn’t matter whether it is a team sport, an exercise class, a personal training session or an individual session, an injury will limit your participation for a period of time.

One common source of injury is ‘training error’. This is usually doing too much, too soon but can also be related to technique (e.g. squat, running) or equipment. Technique is the way you move relative to the load or complexity of the movement.

There is a fine balance between being challenged sufficiently to enjoy exercise and avoiding ‘training error’. A simple message is the more you know your body at each stage of life the less likely injury will occur. This means train at a level of load suited to your body; gradually increase the level of exercise over several weeks; listen and adjust to pain especially if it is in a joint or the spine; and use mirrors to watch how you perform a gym exercise to ensure the technique is correct. It’s simple advice but it works if you want to reduce the chance of injury.