2014 ‘Injury of the year’

Yep I’m calling it… a little early maybe but it’s hard to imagine anything knocking this injury out of its top spot. Lachie  is one of those people that always manages to outdo himself when it comes to injury. It’s never simple or straight forward, and this one was no different. I wasn’t there to witness the actual injury but the photos speak for themselves…. it really is the most unbelievable injury I have EVER seen so much so that it even had high profile sports surgeons running for the hills. (if you don’t like gory stuff I suggest you don’t look at the photo).lachie

We see a whole range of acute knee injuries that require surgery. Usually people tear one, maybe 2 ligaments or injure the cartilage in the knee. Not this guy though, he actually managed to tear the big 4. Yep that’s all 4 major ligaments that are basically responsible for holding the knee together.  ACL… gone. PCL… rutured… MCL.. split… LCL…torn.

Take a moment to process that. I didn’t believe it until I had the MRI report in my hands and could read for myself.

How? well its kind of funny you asked. It was ‘rugby related’.. but not exactly on the footy field but rather in the ‘tram tracks’. Tram Tracks is a one-on-one tackling battle that continues until someone taps out. Its probably the dumbest game in the world but rugby boys seem to love it (especially after one or two beers). Must be something to do with testosterone and a little ‘healthy’ competition.

So amidst a Saturday session in the ‘tram tracks’ Lachie managed to dislocate his knee, not his kneecap his knee.

He required a full open knee reconstruction where the surgeon used two donor ligaments to pretty much design him a new knee. Usually a knee reconstruction uses a ligament created using a tendon graft from your own hamstring, however  in this case donor tissue was used because the surgeon wouldn’t have wanted to compromise the stabilitylachie 2 of the knee any further. Taking a graft weakens the hamstring tendon in the short term and potentially could slow the recovery & rehabilitation.

Lachie is now 10 weeks post surgery and I’ll admit I’m very surprised with how well he is recovering. He’s back in the gym doing a full legs program (with light weights). The focus is primarily on developing good hamstring & quadriceps control. His rehab also includes proprioceptive training and balance exercises on a wobble board.

This week he will progress to jumping and hopping to prepare him for a return to running program. His surgeon is very happy with his progress and expects him to make a good recovery.

The bit I still don’t get…. I asked Lachie the other day if he wanted to play rugby again next year, he did hesitate a little but not as much as I would have expected, before saying ‘yeah probably’. I guess it’s one of the things I love about my job, these guys go through so much just to get themselves back on the field. For many it’s a play at all costs attitude. Is that just a guy thing? Or is rugby really that good of a game? Maybe that’s why they say rugby is the game they play in heaven, because these boys literally can’t get enough.

Lachie works for Adwords Management Australia and is available for interviews upon request…. or he can just help you with website marketing & design stuff, he’s pretty good at that too!

Hope this has helped you through the Wednesday afternoon slump!

Have a great day

Em 🙂

Are you running into problems?

Iliotibial band (ITB) Friction syndrome is one of the most common causes of lateral (outside) knee pain that we see, especially in runners. It’s also probably one of the most frustrating problems both for myself and for the patient. It is largely an overuse injury due to the repetitive nature of activities such as running. It often starts out as a little ‘niggle’ however gradually worsens & worsens until it quite literally will stop you in your tracks.index

The ITB is a band of connective tissue that spans the length of the outer thigh. It originates up at the hip from another structure called the TFL (tensor fascia lata) and inserts onto the tibia just below the knee. It plays a crucial role in stabilizing the outside of the knee during activity. ITB friction occurs when the ITB gets tight & inflamed (as a result of overuse) and begins to rub over the lateral femoral condyle on the outside of the knee joint producing acute, often sharp pain in this area.

Many of my patients ask WHY? There are some factors such as pronated feel, tight calves, poor pelvic stability, anterior hip inflexibility and poor lower limb control that can increase the likelihood of developing this problem. Other extrinsic factors such as footwear & training loads also need to be addressed and considered when looking into the management of this issue.

SYMPTOMS

  • Pain felt on the outside of the knee
  • Tenderness over the outside of the knee
  • Pain generally worsens with activities such as running, particularly downhills and downstairs
  • In more severe cases there may be swelling and or crepitus (creaking) over the side of the knee
  • Pain can extend up into the thigh along the length of the ITB

Often people suffering from ITB friction may be able to run a few hundred metres before the pain will kick in. It is not advisable to try and run through this pain, you will aggravate the tendon which can then take several days to settle down.

DIAGNOSIS: A skilled physiotherapist will be able to diagnose ITB friction from your clinical history and a thorough examination. There is usually no need for further investigation unless you do not improve with appropriate management.

TREATMENT & MANAGEMENT

Physiotherapy is a vital tool to manage ITB friction syndrome. In the initial stages rest from aggravating activities will be required to allow inflammation and pain to settle.

Physiotherapy treatment should involve a variety of the following:

  • Soft tissue releases to tight structures such as the ITB, TFL, gluteus medius, lateral quadriceps and lateral hamstring. This should then be complemented with use of a foam roller at home on a daily basis
  • Addressing bio-mechanical factors such as poor pelvic stability and anterior hip inflexibility
  • Advice regarding exercise modification, footwear & training loads. Some elements within training sessions should also be looked at such as the direction of running if using a track, if you are repeatedly running the same bend you will be overloading one side more than the other which can result in overuse injuries such as this.
  • Dry needling is an awesome way of releasing tight bands of muscle. Often with this problem I find these all around the outside of the hip and down the length of the thigh.
  • Electrophysical therapy such as TENS to help with pain & inflammation.
  • Icing & use of anti-inflammatory medication

With the correct treatment most people with ITB friction syndrome will make a full recovery, however rehabilitation can be a lengthy process in those patients who have had the condition for a while. In saying that it is so important that this problem is caught early. If you get on top of ITB issues in the first 48-72 hours you will drastically reduce the amount of time off running.

Can it be prevented? There are some exercises that I would advise runners do on a regular basis in an attempt to prevent excessive tightness of structures such as the ITB. Use of a foam roller is a great form of self massage, it’s a bit of a love / hate relationship but it is extremely effective. Hip flexor stretches, general pelvic stability exercises and bilateral calf strengthening are essential in the long term management plan. Chat to your physio if you want someone to go over such exercises more thoroughly.

Have a great week!

Ems

Dealing with stubborn tendon problems

Treating and managing ‘tendon’ problems one of the most frustrating group of injuries I encounter, mainly because their recovery often has no time frame, it’s never linear, instead they tend to be a 2 steps forward one step back kind of problem. If it’s frustrating for me, I can only imagine how my patients must feel.

Why?

The answer isn’t black & white (it never is in medicine). There are however a few anatomical and physiological factors that can help explain why tendon problems can be stubborn as all hell.

I’ll quickly given you a little anatomical insight as to what a tendon actually is, and no a tendon is not a ligament (I do kind of understand why people get this concept confused). Tendons are thin fibrous bands which connect a muscle to a bone. Their function is to transmit forces, essentially providing stability with no real ‘active’ work. Not all tendons function the same. Some are positional purely assisting with controlling the position of the joint (fingers) while some can actually store energy & work as springs to assist with basic movements of the body such as walking.

Tendon dysfunction is usually a result of overuse due to repetitive stress being placed through one particular area of the body. Common sites include the Achilles, the patella tendon, the rotator cuff, tennis elbow & the hamstring tendon. Problems can be categorized as either

TENDONITIS: inflammation of the tendon OR

TENDINOSIS: inflammation with additional micro tearing and wear & tear of the tendon fibres.

Many clinicians also now use the umbrella term ‘tendinopathy’ which encompasses aspects of both.

Anyone can suffer from tendinopathy if there is great enough forces transmitted through a tendon that may not be conditioned to deal with it. Take me for example when I was 22, no history of knee problems, started doing a lot of stair running & plyometric training (jumping lunges, squats etc) combined with running. Ended up with acute patella tendonitis.

Such cases in ‘younger’ athletes are easier to manage. Tendonitis is acute & generally we are dealing with inflammation which with rest from aggravating activities & appropriate rehab will clear up in a matter of weeks.knee

Tendinosis is a little different & this is where the frustration sets it. Athletes in the 35-40+ category who do a lot of activity are those we worry about here. At this age (which is by no means old) most tendons will be starting to show signs of wear and tear. Small degenerative fraying of the collagen fibres at a microscopic level which is usually asymptomatic. When you start to place a lot of load through that ‘weakened’ area problems begin to arise. It starts as a dull ache, which gradually gets worse. Often stiffest in the morning upon rising. The area may also be tender & swollen if inflammation is also present. In very acute cases there can be ‘crepitus’ or creaking in the tendon itself.

The longer you push through some of these seemingly minor symptoms the harder it will be to manage.

Why are they stubborn?

Well for one tendons don’t get a great blood supply in comparison to our muscles & organs which are constantly bathed in fresh blood filled with oxygen & other lovely nutrients. This contributes to a slightly slower healing process.

Microscopically tendinosis is due to the disruption of the collagen fibres of the tendon. Normal healthy tendon fibres line up side by side while inflamed injured fibres will bunch together & get a little ‘tangled’. It can take up to 100 days for our body to reestablish strong collagen fibres.

Is there any good news?

Yes. Kind of.

In the acute stages you will need to rest from aggravating activities whether it be running, weights, tennis, surfing. However some activity will actually be favourable to your rehabilitation by promoting remodeling of the tendon fibres, however this will normally need to be cross training of some sort so as to reduce the overall load through the tendon.

There will also be certain exercises depending on the tendon in question that will be required to strengthen the tendon for long term management. Such exercises are usually eccentric & focused on the negative phase of movement, this simply means loading the tendon as its lengthening. This has been show to encourage rebuilding of collagen.

The treatment course is always individualized & you and your physiotherapist should work together to develop a rehabilitation program that controls your symptoms whilst also incorporating appropriate strengthening.

There are also alternatives… such as injections, patches to promote blood flow & more recently the PRP (platelet rich plasma) which involves an injection of a concentrated solution made from your own blood to promote healing. (more to come on this in an upcoming blog). Such options can be discussed with your physio or doctor.

Have a great day!

Em

Yoga vs Pilates. Which is better?

I get asked this question ALL the time from my client and honestly I sometimes find myself not really knowing which to suggest as there is no straightforward absolutely correct answer. Both forms of exercise have many positives and from a clinical point of view I don’t think either is necessarily superior to the other.

Some would say it’s a head to head battle between strength & stretching BUT I tend to disagree. I’m certainly no yogi or a Pilates guru but I have done a little of both and I would say there is definitely a strength & flexibility component to both styles. The main difference I believe lies in what not only your body but your mind will get out of each session.untitled

Yoga is one of the most widely practiced exercise forms in the world, it’s said to help with uniting the mind, body & spirit to restore balance and harmony within the body. I would say it’s somewhat therapeutic for many, if done correctly it facilitates awareness about alignment, posture and imbalances within the body. There are many styles of yoga with choice purely a matter of personal preference.

Pilates has more of a focus on strength and stability throughout the entire body & incorporates floor based work with reformer machine work. The poses & exercise are targeted towards the hips, pelvis and legs using your body weight to create resistance and improve strength. There is a prime focus on engaging the deep abdominal muscles to support the spine & strengthen posture.

This is an important focus for me when discussing options with my clients. Chronic back & neck pain sufferers will gain huge benefits from Pilates where the focus is on core stability. Patients suffering ongoing episodes of back pain will most than likely have weakness through their core and pelvic stabilisers. The only solution in the long term is to develop a strengthening program for them which in terms of compliance and effectiveness is best done through proper structured Pilates classes.

I think when it comes down to choosing what is better for you, the breathing and spiritual side of things will be the deal breaker. Studies have shown a link between practicing yoga and improvements in mental & emotional well-being. Me, well I can’t sit still for more than 5 minutes. Focusing & engaging my mind is so challenging that I find yoga classes harder than a 14km run. That’s a pretty good indication that a certain area of my well-being that needs work.

In yoga the breathing is all about relaxation. The breathing cycles are performed in rhythm with movements & flow patterns. You inhale with certain movements and exhale with others; the aim being to relax  areas that may be holding stress within the body. There is a certain level of spiritual focus, finding your inner self & being at peace with it.

Pilates uses breathing to provide energy to working muscles. Concentrating on the breathing will help channel oxygen flow to the muscles that need it for that particular movement. Generally there is no spiritual connection in these classes, rather slow controlled movements focused on quality not quantity is the key.

Both styles have similar goals being to achieve control through balance of the mind & body. I won’t sway you with my personal preference as clearly both yoga & Pilates have exceptional merit.

If you want to escape from the stresses of everyday life, be calm & get zen go for yoga. Recovering from an injury or you have weak muscles / joints and you want something to strengthen and stabilise I would tend to say Pilates may be the choice for you.

At the end of the day it’s about what you WANT to do. Try both and make the decision by which one you get more out of.

Sometimes it’s not ‘just a cork’

Throughout winter my Saturdays are spent on the sidelines of a rugby field. I have been working with Easts for 7 years now and I still haven’t quite figured out how the boys do it…. They actually just go out there are smash themselves around for 80 minutes; its no wonder half of them can hardly walk come Sunday… Then they front up to training on Monday ready to do it all again.

We see alot of different injuries & they range hugely in severity; from dislocated shoulders to sprained ankles, concussion & head cuts to hamstring strains. Given that we are dealing with rugby as a sport here one very common injury we see is a ‘cork’ or more technically a ‘haematoma’ This is caused by a direct blow or impact to a muscle, causing bleeding within the muscle. The force of the blow will be reflected by the amount of bleeding and swelling within the muscle; you will suffer a loss of range of movement & pain as a result of this acute response.

Now this all sounds relatively innocent compared to some of the other traumatic injuries we see & hear about BUT unfortunately its ‘not just a cork’. This injury, if not managed properly can actually be a cause present an athlete with some significant frustration down the track.thigh-contusion180

Mild contusions can usually recover fully in 1-2 weeks often the player may not even miss a game.

Moderate to severe contusions can take 4-6 weeks to recover with a few weeks spent on the sidelines.

In some cases, often due to poor management or return to sport too soon players can develop a condition called myositis ossificans. This is a rare but exceptionally painful problem where bone growth or calcification begins within the traumatized muscle. Bony growth continues for 6 weeks before your body will begin to reabsorb the calcified material, making it a rather length rehabilitation period. The risk of developing this is higher in those players that return to playing early and receive another direct blow to the same spot causing the muscle to re-bleed.

The initial phase of management is immensely important. This first 72 hours should consist of:

  • Compression
  • Ice – best done in as much stretch as tolerated. For example when a player suffers a cork to their quadricep on a Saturday we apply the ice immediately with the knee in as much flexion as possible (bent). This puts the muscle in a lengthened position & if done straight away you can help to prevent significant loss of range of movement. This process should be continued the following day by the player
  • DO NOT TAKE ANTI INFLAMMATORY MEDICATION this will increase the amount of bleeding within the muscle
  • Avoid alcohol, heat & massage to the affected area. All of these will increase blood flow to the area which will contribute to excessive swelling.

Following the acute phase management focuses on restoring full pain free range of motion of the injured muscle and also strength. This is done via gentle active stretches, soft tissue massage & basic strengthening exercises.

For example: If we are dealing with a moderate quad contusion. On Monday / Tuesday the player should start basic range of movement exercises in the form of heel slides along a bed to get the muscle moving through its available range. Inner range quadriceps strengthening with body weight and also seated leg extension with body weight can also be commenced. As soon as there is enough range to ride an exercise bike this can be introduced. Start with the seat as high as possible and as the muscle loosens you can lower the seat as tolerated which results in greater flexion of the knee thus greater stretch through the injured muscle.

Gradually strengthening & rehabilitation exercises can be progressed and a return to running program introduced.

Players really shouldn’t go back to playing until they have full pan free range of motion & strength in that muscle.

Sometimes I don’t think I give these boys enough credit when it comes to what injuries they are willing to carry into a game. BUT in the case of a cork there really is nothing we can do as physios to prevent them from getting another blow to that area; it’s the nature of the sport. We can pad it & they can do the most thorough warm up in history, it’s not going to help the response of your muscle when a 120kg bag rower’s knee makes contact with your quad. The risks of developing complications with returning too early are minimal BUT they do exist. Be careful, sometimes its not ‘just a cork’.

Have you injured your meniscus?

The knee is of the most commonly injured areas in the body. Generally we see a pretty even spread between acute knee injuries sustained from a traumatic event such as during sport or from a trip or fall; on the other hand we have the overuse knee problems…. the runners that pump out a huge amount of km per week resulting to overload or inflammation of some of the structures in and around the knee.

The meniscus or menisci (we have two in each knee) and one of the internal cartilages within the knee joint that can be prone to injury both acutely and as a result of overuse.

The menisci are moon shaped cartilages that are located in the knee. They are the ‘shock absorbers’ which permit us to undertake such high intensity and high impact activities. We have one located on the inside and one on the outside of the knee.index

The signs & symptoms of a meniscal injury will vary significantly depending on the severity of the damage:

  • An inflamed or irritated meniscus will present with joint line tenderness, discomfort at end of range extension (straightening the knee) and a reproduction of pain at end of range flexion (bending). There may be a small amount of swelling present.
  • A meniscus that is torn will have swelling, joint line tenderness and potentially an inability to move the knee through full range of motion due to pain. In cases where the tear is large you may experience locking of the knee in certain positions.
  • A Baker’s cyst which is a pocket of swelling directly behind the knee may be present & can be an indication of a tear in the meniscus

A diagnosis can be made by a skilled physiotherapist based on your history & from a proper examination. There are special tests that assess the integrity of the meniscus. Further investigation, usually an MRI, may be warranted to confirm the diagnosis & make decisions regarding future management of your injury.

Management

Treatment of a meniscal injury will again depend on the severity. Being cartilage in nature these structures don’t receive a very good blood supply, making the healing process slightly slower.

An inflamed meniscus can take up to 6 weeks to settle down. A torn meniscus can be managed conservatively in some cases, however in others surgical intervention may be required. This will depend on the size & position of the tear and the degree to which it is affecting your function.

Physiotherapy treatment can include the following:

  • Soft tissue massage to tight, overactive muscles
  • Electrophysical therapy to assist with management of swelling & pain
  • Dry needling – targeted towards overactive tight muscles or to assist with management of swelling, pain & inflammation
  • Exercise prescription: stretching & strengthening exercises to target tight & weak muscles around the knee
  • Advice regarding activity modification

If surgical intervention is required your physiotherapist will prepare you for surgery and also be able to assist you with the post surgery rehabilitation.

Probably the most common question we get from clients is if and when can they go back to sport, whether it be running, soccer, netball. The time frame unfortunately isn’t that clear cut as it comes down to the severity of the injury. Generally speaking its at least 6 weeks before people get back into higher intensity exercise BUT that is very ball park. Those that end up in surgery take a little longer as many surgeons are in no rush to have you placing heavy loads through the knee.

I recently was working with a professional snowboarder who injured his knee. He ended up in surgery & its been about 9 weeks now and he is just beginning to become confident with jumping, running & high intensity exercise that puts alot of load through his knee. The good news this is just in time for him to hit the slopes for the Australian Ski Season…. that is if we actually get any snow this year!

If knee pain is holding you back from exercise or its just there irritating you throughout your day to day life I would suggest getting it checked out by your physiotherapist.

Are you hypermobile?

As physiotherapists we spend ALOT of time working with people who have stiff joints, tight muscles, reduced movement….. All of these things present as a lack of mobility, which is, in most cases, resulting in pain (hence why they are sitting in my waiting room).

BUT sometimes we forget about the other side of the coin….. The hypermobile ones, those that have TOO much movement, their joints have more range than required, their muscles are too flexible.

This is actually a problem that exists far more commonly than one may think, often it is asymptomatic & people won’t even be aware that their body is a little more like an elastic band than their best friends, BUT in some cases joint hypermobility syndrome can cause pain.

Joint hypermobility is usually inherited; if your mum is super super flexible, chances you will be too. There is nothing you can do to change it or prevent it, unfortunately its due to a gene representation in the connective tissue (the glue that holds our bodies together) causing it to become more pliable& more stretchy allowing for excessive movement at certain joints.

People with hypermobile joints have a higher incidence of dislocation and sprains of involved joints. The hypermobility tends to decrease with age as we naturally become less flexible.

When it comes to being hypermobility some people just live with it, other people may suffer from certain related medical conditions such as Ehlers-Danlos Syndrome (EDS), Marfan Syndrome and Osteogenesis Imperfecta BUT the purpose of this blog isn’t to overload you with information related to these issues but rather to give you a little insight into a more common presentation which is ‘hypermobility syndrome’ or HMS and when you may need to seek a little professional advice.

Do you have HMS?

There is a great little series of tests that you can do right no on your living room floor. Give yourself a score of 1 for each of the following that you CAN DO.

  • Touch the floor with your palms flat without bending your kneeshypermobile
  • Can you bend your left elbow back past straight
  • The same for your right elbow
  • When lying flat on floor with your left leg straight out in front of you can you lift your left heel off the floor approx 1-2 inches without lifting your knee or upper leg
  • The same for your right leg
  • Can you bend your left thumb under so that it touches your forearm
  • The same for your right thumb
  • Can you bend your left little finger back past 90 degrees
  • The same for your left little finger

For each one you are able to achieve give yourself a point.

What was your score out of 9? If you were able to do any of the above you have are classed as hypermobile BUT you don’t necessarily have HMS.

In a clinical setting your score along with the prevalence of certain symptoms would categories you into either minor or major hypermobility syndrome. Some symptoms include joint pain, history of subluxation or dislocation of joints, being particularly tall & slim. 

If your hypermobility is causing you joint pain make an appointment with a sports physiotherapist. They will be able to assess you and answer all your questions about what you can, can’t, should and shouldn’t be doing. There are exercises that can be done to help with the pain and also allow you to partake in all the activities you wish to. It’s also nice to be educated about the risks that certain sports may present to you as a ‘hypermobile’ individual; for example if you are desperate to play high intensity collision sports such as rugby you should be aware that the risk of you dislocating your shoulder is slightly higher than your team mates who are not hypermobile.

So you have HMS? DON’T PANIC. This doesn’t mean you need to start doing things differently. Yes you can exercise, in fact it’s recommended that you do; yes you can play sport (some may be advisable to avoid); yes you can go trampolining; yes you can ski; yes you can LIVE a normal life

Shoulder ‘impingement’ syndrome

It’s got many names…. rotator cuff tendinitis, swimmers shoulder, throwers shoulder, subacromial impingement or subacromial bursitis. These are all smart, intelligent sounding names for pain that occurs deep in the anterolateral shoulder (anterior meaning front & lateral meaning side… so to the front and side)

Lets do a little anatomy recap: The shoulder is a ball and socket joint; likened to a golf ball on a golf tee. The humerus or upper arm bone sits against a small socket called the glenoid. It’s an inherently unstable joint which is why we are able to perform all the weird & wacky movements with our arms.

The rotator cuff are a group of 4 muscles: supraspinatus, infraspinatus, subscapularis and teres minor. Their role? to depress the head of the humerus essentially assisting the joint capsule and shoulder ligaments to hold it snug in its socket.shoulder

The supraspinatus tendon is usually the one of interest when it comes to rotator cuff ‘impingement’. It passes between the acromion and head of the humerus in the ‘subacromial space’. This space is perfectly designed for the tendon with not a hell of a lot of ‘breathing space’. So when the tendon gets inflamed, irritated and swollen a pinching occurs as this space becomes a little too narrow!

This can be an overuse injury due to repetitive or prolonged strain on the rotator cuff tendons such as with overhead activities, pulling/pushing, lifting or repetitive reaching. It can also be the result of a direct blow or fall onto the point of the shoulder forcing the head of the humerus upwards into the subacromial space creating a pinching effect on the rotator cuff tendon.

Both outcomes result in a painful arc of movement of the arm that can begin to impact on simple activities of daily living such as reaching behind for your seat belt, doing up your bra (ladies) and overhead reaching tasks.

Patients will generally report feeling a deep ache deep inside their shoulder that they can’t quite pinpoint. The severity can vary enormously from a small niggle that is quite hard to replicate with testing to those that can barely lift their shoulder above shoulder height due to pain.

A few key symptoms that indicate ‘impingement’ syndrome include the inability to sleep to the affected shoulder; associated neck stiffness as a result of compensatory movement patterns and pain on repetitive overhead movements… often people will struggle with hanging out the clothes or unpacking the dishwasher.

How is it diagnosed?

A skilled physio need only listen to your history and do a few key clinical tests to know diagnose an impingement syndrome.

Further investigation such as ultrasound or MRI can be organised to confirm this diagnosis if required.

Is physio necessary?

The short answer is yes. Why?

In both presentations of impingement whether it is an overuse problem or as the result of acute trauma physiotherapy is a pretty important management tool.

Treatment can include:

Soft tissue massage: to tight overactive muscles particularly at the back of the shoulder. The upper trapezius found at the top of the shoulder is also tight.

Advice regarding activity modification in terms of training & exercise but also avoiding day to day tasks that may be aggravating their condition.

Dry needling & acupuncture: this is a really useful way to release tight muscles whilst also encouraging blood flow to the region. Fresh blood is packed full of oxygen and essential nutrients to assist with the healing process.

Rehabilitation: once the inflammation is under control most people need to undertake a rotator cuff strengthening program to restore correct shoulder biomechanics, improve posture and prevent ongoing pain and dysfunction. Some common exercises include internal and external rotation as well as lots & lots of upper back strengthening. Think seated row, high row, and prone row! Muscly backs are incredibly attractive boys….

What happens if ‘conservative’ management fails?

DON’T panic most cases don’t get to this stage but sometimes conservative management of impingement syndromes can fail. In these circumstances there are more aggressive forms of treatment that can be explored such as cortisone injections, platelet injections and in very severe non responsive cases surgical intervention maybe required.

Impingement syndrome can be a very very debilitating problem. When it’s chronic it’s a frustrating condition to suffer but also to treat. It’s stubborn and slow. If you’re noticing a niggle don’t ignore it, the sooner you get treatment & appropriate management strategies are employed the sooner you will be back in the surf, on the tennis court or in the pool.

Tibialis Posterior Tendonitis

Tibialis posterior dysfunction is one of the most common overuse injuries found in the foot & ankle.

The tibialis posterior muscle originates high in the shin from the back surfaces of the tibia and fibula. It tracks down along the inside border of the tibia, passes around the inside of the ankle and terminates via two attachments in the foot.  The main insertion (and that of interest to this particular injury) is into the tuberosittib posty of the navicular.

The tibialis posterior is an extremely important stabiliser of the foot & ankle. It functions to produce inversion at the ankle and also plays a major role in maintaining and supporting the medial arch.

Tibialis posterior tendonitis occurs when there is excessive strain put upon the tendon as it inserts into the navicular.

Why?

  • As an overuse injury through years of wear and tear associated with high impact activities such as running
  • Acutely as a result of sudden increase in training volume or intensity OR the use of inappropriate footwear

Athletes with poor foot biomechanics such as flat or pronated feet, tight calves and poor pelvic stability are at more risk of developing tibialis posterior dysfunction.

Signs & Symptoms:

  • Pain: felt along the inside of the foot
  • In acute cases there can be visible swelling on inside of the foot
  • Pain aggravated by high impact activities such as running & jumping
  • Crepitus may be felt along the length of the tendon.

A thorough physical examination by a physiotherapist will usually be sufficient to diagnose tibialis posterior tendonitis. In cases where diagnosis is in doubt an MRI may be required to rule out other potential pathologies.

Treatment:

Initial treatment must focus on unloading the tendon and allowing it to rest. In severe cases where simple weight bearing activities are painful a short period in a walking boot may be warranted. Icing and anti-inflammatory medications may also be suggested by your health care provider.

Physiotherapy management can involve:

  • Soft tissue massage to tight surrounding muscles, particularly the calf.
  • Electrophysical therapy to reduce inflammation & assist with pain relief.
  • Dry needling to reduce inflammation
  • Taping of the foot to unload the tendon
  • Advice regarding orthoses, shoe inserts & appropriate footwear
  • Activity modification
  • Exercise prescription of appropriate strengthening exercises

In chronic cases or those that have not responded to conservative therapy further intervention may be required. Options can include corticosteroid injections and surgery.

Have a wonderful week! 🙂

The road to becoming an Iron Man

Imagine the fittest person you know… and by fit I don’t just mean your mate who can run 20km with ease or your boyfriend who squats 100kg.. Now multiply that by 10 and you have Adam Becker. I’m not kidding this guy is on another level of fit. Mentally and physically he is the fittest person I know.

A few weeks ago he asked me if I wanted to do a running session with him. I considered it until I found out it was 100 x 100m efforts on the clock. The other option was 28 x 1km efforts. I’m not sure which is worse all I know was that there was no way I was attempting either session with this crazy kid!

I first met Adam when he playing footy down at East’s Rugby. He is now the manager of Parc Ftness, a small boutique gym chain in Bellevue Hill and Rose Bay, a personal trainer, Cranbrook rowing coach and IRON MAN.

I caught up with him following his first Iron Man in Japan a few weeks ago… (where he came 2nd in his age group I might add) to chat about his training scheduale and how he came to be the fittest human in the eastern suburbs.

When I first met you, you were running around playing hooker for Easts Rugby. What made you decide to start doing triathlons?

I had always wanted to have a crack at one. But never new how to get involved. I swam throughout school and always did the charity runs like the city2surf.
So when it came time to make the transition from Colts rugby to Grade. I thought it was a great time to chase another goal.

What would your typical days training involve?

Depending on the day, but during the week usually a shorter high intensity ride with a group and then a run off that early in the morning.
Depending on other commitments, a swim during the day and weights or run in the evening. Everyday is different sometimes it’s more and sometimes it’s less. It depends on what you’re trying to get out of the training

Did your training interfere with your job and social life?

The training didn’t interfere with my job too much, as I could schedule work around it. The big important sessions were on the weekends, so it did mean drinking became a problem.  I still made an effort to have a bit fun (just not till the early hours of the morning).

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How important do you think high intensity training and weight training are to preparing yourself for an event like Ironman?

All training has it place in the sport. But I learnt very quickly that your heart rate and brain are the keys to the race. Depending on how good you are, you could be racing from 8 to 17 hours, so having a high heart rate is only going to make your body pay in the last part of the race. During training you want to keep the high intensity, but having your body do the work it as easy as possible.
Weight training on the other hand is very important in my opinion. Of course trying to hit your 1 rep max is not ideal! But strength/endurance weights are great. Trying to put your body under stress for as long as possible is key. Especially to the major movers of the body like your ankles, knees, lower back and core. Putting exercises into a circuit is a great way to get everything done in a small amount of time.
Was there a particular person or people who were integral to your preparation for such an event?

I had previously completed a few half Ironman’s and Olympic distance races. As the Ironman distance was a completely new venture for me, I worked closely with a coach and then surrounded myself with a team of people whether they knew it or not, who were very good at what they do. From riders, runners, and, of course, my physio!!!
What was the greatest challenge you faced with the lead up to Ironman Japan?

The freezing cold winter training!!! And getting enough sleep!!!

Now that you have the luxury of hindsight would you do anything differently in the lead up to the event?

I wouldn’t change too much, but I would definitely focus more on the running leg, and do more open water swimming.

Did the race go as planned? Did you face any difficulties during the race?

I had the usual pre race nerves. I was thinking that the swim looks a lot further than I had realised.

Did the race go as planned? Did you face any difficulties during the race?

The race went pretty much to plan, I did the swim in the time I wanted, even though I couldn’t swim in a straight line. The ride went even better, catching up to the back of the pro men and coming off the bike in 25th place over all. The Marathon was just as imagined, the first 33kms felt as good as they were going to feel in the pouring rain. But it all came crashing down in the final few km’s. I think I may have taken on to much water at an aid station, This reduced my run to a slight jog until I got to the final 3ks into the town centre where I thought I better suck up the pain and run a bit faster for the crowds surrounding the finish line.0472_21283

Can you describe the feeling you had when you finally crossed the finish line?

Pure Happiness

What was the first thing you ate following the race?

Sushi and a beer back at the hotel.
What is your next venture?

The Coogee Stairs… and the Port Macquarie Half Ironman.

 

Adam works out of Parc Fitness in Bellevue Hill and Rose Bay. He is an AWESOME personal trainer if you are on the look out for one!

Happy Monday!