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In today’s competitive sporting environment, children are being placed under increasing pressure to excel at their sport. Schools and clubs (not to mention parents) invest a lot of time and money developing their children into athletes, and it is quite common for youngsters to be exercising in excess of 20 hours per week!

Although exercise at an early age has numerous health benefits, it also involves the risk of injury, and in children, unique risk factors means unique injuries…

Due to the structure of growing bones, injuries in children differ from those of their adult counterparts. For example, due to the “elastic” nature of long bones in children, these bones tend to “bend” and split rather than break, resulting in what is known as a Greenstick fracture (see above). The end-plates of long bones (where the growth occurs) are susceptible to “shifting” under large loads or fractures, which given their location, often affects the overall growth of these bones.

Where an adult might develop a tendon problem with overuse, children are more likely to develop a traction apophysitis, whereby the bony attachment point of the tendon is “pulled’ away from the bone.

This usually occurs at the attachment site of large, powerful muscles such as: the elbow (Panner’s Lesion), the Hip, the knee (Osgood-Schlatter’s Lesion and Sinding-Larsen-Johansson Lesion) and the Ankle (Sever’s Lesion).

These injuries are usually due to the repetitive nature of some of the sports that children play (think about how many times a young, fast bowler, will practice his bowling action) leading to repetitive stress of specific tissues.

We commonly see shoulder and elbow overuse injuries in throwing sports (cricket, baseball, water polo etc), stress fractures of the spine (e.g. tennis, fast bowlers) and stress fractures of the lower legs (runners and dancers).

Faulty technique, lack of adequate recovery, poor flexibility and muscle weakness are some of the most common causes of these injuries and they can be prevented to a large extent. This highlights the need for Sports Injury Screening at schools, as it is often during such testing at schools and clubs that we have been able to identify and correct problems, before they become injuries…

Ric@PhysioPRO

Reached that training plateaux? Not improving on your personal bests? Well the answer may not be that you should train harder, it may be that you need not train at all…

Overtraining syndrome is a neuroendocrine syndrome that results from the process of overtraining, where the body is not allowed sufficient recovery time to adapt to the demands of high performance training.

A person suffering from overtraining usually complains of the following symptoms:

• Persistent Fatigue
• Performance decrease (despite continuing to train)
• More effort required for a task than previously experienced
• Frequent illness
• Lowered maximal heart rate
• Decreased body mass
• Persistent muscle soreness
• Sleep disturbances
• Mood changes (high stress levels and reduced motivation)

As I said above, these symptoms result from Intense training with INSUFFICIENT Recovery time, and the body fails to adapt to the excessive loads, thus it “burns out”. This condition can take months or years to recover from..quite alarming!!

Overtraining syndrome isn’t to be confused with the term “overreaching”. Overreaching is the term used to describe similar symptoms of fatigue, decreased performance and mood changes, however it is short lived (provided you allow yourself to recover) and usually resolves within a two week period.

Elite athletes actually use overreaching to enhance performance, through intense training followed by ADEQUATE rest. What happens is that the body “super-compensates” due to the intensity of the training and this results in enhanced performance.

The mistake a lot of athletes make is that when they start feeling the symptoms of overreaching, they think they need to train harder to get over the “slump” and in so doing they run the risk of developing overtraining syndrome.

Awareness of the fact that you are nearing the point of overreaching is the single most important factor in prevention of overtraining. A way of closely monitoring this is to keep a “training diary”, where you not only record your training details (distance, load, heart rate etc.), but also things like quality of sleep, general well-being, fatigue, stress and muscle soreness.

Hopefully all of the above has highlighted the importance of recovery in your training program. Recovery can be divided into short and long term recovery.

Short term recovery (also called active recovery) occurs in the hours immediately after intense exercise. For some tips on how to enhance this, see Andrew’s article on Recovery Rules.

Long-term recovery techniques refer to those that are built in to a seasonal training program. A well-designed training schedule should include recovery days and/or weeks that are built into the training schedule. Another important factor is to change your training program throughout the year, by modifying  workouts types and varying intensity, time, distance and all the other training variables.

Sometimes you need to take one step back to take two steps forward…

Ric@PhysioPRO

Training is the pursuit of any activity that will ultimately lead to an increase in performance in a specific sport. That’s what we mean when we talk about training!

So, training should be directed at bettering performance in an athlete’s chosen sport. As physiotherapists we should identify the most important components of fitness for each particular sport and tailor an athletes training toward improving these particular components.

Different training methods exist. These include aerobic training, anaerobic training, plyometric training, agility training, strength and power training – the list goes on. Today we are going to talk specifically about two of the most common types of training…. aerobic and anaerobic training.

Aerobic training or endurance training is performed to increase aerobic capacity or fitness. We measure aerobic capacity by measuring VO₂ Max or the maximum oxygen an individual is able to utilize in one minute, per kilogram of body weight. VO₂ Max can be measured in a fancy laboratory, but unfortunately most of us don’t train in this sort of setting, rather opting for the sports field or the gym. Luckily there is a simpler, albeit less exact method, known as predicted VO2 max which is estimated by measuring the heart rate at a specific workload which is a method commonly used.

It’s reported that aerobic training effects occur while maintaining a heart rate of between 70% and 85% of one’s maximum heart rate. Maximum heart rate is estimated by subtracting your age from 220. So it is pretty easy to do: for a 30 year old like me, max heart rate would be 220-30=190 beats per minute. And the ideal range of heart rate for me to produce an aerobic effect would be between 135 (70%) and 160 (85%) beats per minute.

 And you thought jocks didn’t do maths!

Many sportspeople find benefit in the endurance and fitness gains made by training aerobically as well as the health benefits of a stronger cardiovascular system and resultant weight loss.

Anaerobic training burns glucose as an energy source but does this without oxygen present, to produce energy. Oxygen is absent because this sort of training is typically high intensity for a short period of time and there isn’t time for full oxygen delivery to the muscle cells using the glucose. This pathway utilizes ATP as its energy substrate. The process produces less energy per molecule of glucose utilized than aerobic exercise does when burning up that glucose with oxygen present.

Anaerobic training improves the capacity to maintain a high rate of power production at very high intensities for short period of time. This type of training helps maintain muscle recruitment and muscle contractile function after training so that the onset of fatigue is delayed, as well as improving the body’s tolerance to lactic acid build up. Lactic acid is a by-product of training anaerobically and contributes to the discomfort felt while training.

Interval training or intermittent exercise is the most efficient method of increasing anaerobic fitness. Such training involves bouts of exercise separated by periods of rest or recovery. The principle behind this type of training is to achieve a level of lactic acidosis with one individual effort and then allow the body to recover from its effects before embarking on another bout of exercise. This is done to train the body to cope with higher levels of lactic acid before shutting down and to recover faster.

As mentioned, to obtain maximum gains from interval training it must be activity/sport specific. Also remember that because of its increased intensity, the potential for injury is a little higher than that presented by aerobic training. It’s therefore beneficial for athletes to use a variety of training methods to take advantage of the benefits offered by each and allow time for rest and recovery of the body.

Andrew@PhysioPRO

Following on from Andrew’s last article on joint laxity, I expect many of you would have felt that touching your toes was impossible due to the pull in your hamstrings. But was it your hamstrings…?

Just like muscles get placed on stretch during certain movements, so too do your nerves. Very often, what we perceive to be the “muscle” pulling tight during a stretch, is often the nerve being stretched or “tensioned”. The ability of your nerve to tension to its normal length is referred to as Neural Mobility. A trained Physio will often test your neural mobility to detect if your symptoms are due to reduced movement/tension of the nerve.

Now before you do this next quick test, PLEASE READ CAREFULLY: If you have back or posterior thigh pain (or both) at present then avoid this test as it may flare up your symptoms. Rather go see a trained Physio who can assess the appropriateness of this test for you.

The SLUMP TEST

1) Begin by sitting on the edge of a desk or chair with your thigh fully supported by the desk/chair (FIG 1.1).

2) Place your hands behind your back, sit badly (get your shoulders down towards your hips, thus curving your upper back) and drop your chin to your chest by flexing your neck (FIG 1.2) *At this point, if you already feel lower back or posterior thigh pain, then STOP. That would be considered a positive test and you definitely have NEURAL TENSION**

3) With your neck still flexed, try straightening your ONE knee until you feel the tension/pain in your posterior thigh develop (FIG 1.3).

4) Now bring your toes up towards your head, by moving your ankle (FIG 1.4)

5) Keeping your knee, ankle and back in that position, look up at the ceiling (i.e. ONLY move your neck backwards- FIG 1.5)

6) What happened?

If the tension/pain at the back of your thigh got better when you looked up, that would indicate you do have NEURAL TENSION. Think about it, we didn’t move your leg, so if the tension/pain got better, it could only be related to something else-your nerve.

If there was no change to the symptoms with the neck movement, then your hamstring is most likely the culprit.

Now try it with the other leg. There could be a side to side difference.

So you had a positive test and have neural tension, now what? Its advisable to go see your Physio at this point so he/she can assess the extent of your symptoms and advise an appropriate stretching program. One exercise we at PhysioPRO recommend to try “lengthen” or loosen up the nerve is neural flossing/sliding.  We use a similar setup as above, however, we don’t  “tension” the nerve, but rather “floss” the nerve.

So start as per steps 1 and 2 (see image below)

Then, as you straighten your leg (step 3), SIMULTANEOUSLY extend your neck (step 5).

Do 10-15 repetitions per side, 2-3 times per day. This “flossing” technique has been proved to result in the greatest tensioning of the sciatic nerve in recent research, and is an effective tool at improving your neural mobility.

Once you have done your flossing, try stand and touch your toes again. If you had neural tension, you should notice a significant improvement now…

Happy Flossing

Ric@PhysioPRO

Our bodies are all different. Some are tall, some short, some big, some small and the same variety is found when it comes to the tissues within. Some people have more collagen in their ligaments and tendons which means they tend towards being more rigid and stiff. Others have less collagen and are far more flexible. As with most things in life, problems can occur on either extreme.

Let’s deal with one side of the spectrum – being very flexible or ‘hypermobile’.  The problem here is that increased laxity or flexibility in the joints makes the joints more unstable and puts a person at a greater risk of injury, especially for those involved in contact sports. As we get older the body naturally stiffens up so hypermobile individuals that avoid injury early on in life are generally able to be more active older adults.

The Nine-Point Beighton Hypermobility Score is a quick and easy test to rate how hypermobile you are. It’s a simple 9 point system where the higher the score the higher the laxity. It is scored as follows:

Scoring high on the Beighton scale doesn’t necessarily mean you have Hypermobility syndrome as you could be hypermobile with no adverse symptoms (which include pain in the muscles and/or joints). Generally if you score either 4 or 5 out of 9 you are on the hypermobile end of the spectrum and should take precautions to prevent injury and work on stabilising and proprioceptive exercises, such as balancing on different surfaces while performing sports specific exercises, so that you can stay fit and healthy into your old age.

Andrew@PhysioPRO

With the Olympics currently in full swing, I’m sure many of you are enjoying all the top class sport showing on our televisions. Olympic athletes compete at the highest levels for consecutive days – sometimes even twice in the same day. How quickly and how well they RECOVER is vital for their optimal performance and could be the difference between going for Olympic gold and going home early.

The main aim of a post-game/event program is to enhance recovery, to maximize performance and minimize potential for injury at the next event. Recovery programmes have the following objectives:

• Restoration of function
• Neuromuscular recovery
• Tissue repair
• Resolution of muscle soreness
• Psychological recovery

A number of recovery methods are used by sportsmen and woman. Though there’s limited research in to the efficacy of most of them, let’s look at a few of the most popular techniques used:

Warm-down (active recovery)

Most athletes perform a warm-down of between 5 and 15 minutes after intense exercise followed by stretching of the muscles used in their specific sport. The warm down is also generally specific to the nature of their particular sport.

Cold Water Immersion (CWI)

As the name suggests, players immerse themselves in ice baths ranging from 5-15°C for up to 5 minutes at a time. This has a cooling effect on the body tissues. CWI is associated with a peripheral vasoconstrictive response, reduced perfusion, and a decrease in oedema (which all help control the inflammatory response). However sportsmen with a history of cardiac problems such as arrhythmias should avoid CWI as it results in “cold shock” with associated increase in heart rate, blood pressure, respiratory minute volume, and metabolism, thus placing extra stress on the cardiac system.

Massage

Intense training causes prolonged elevation of muscle tone in both resting and contracted states. This increased tone or “muscle tightness” limits the extensibility and shock absorbency of soft tissue and thus predisposes the tissue to strain. Active trigger points that result from heavy training may reduce muscle strength. All these problems can impair training and competition and can progress to injury if they are not resolved. Soft tissue therapy is thought to work by reducing excessive post-exercise muscle tone, increasing muscle range of motion, increasing the circulation and nutrition to damaged tissue, and deactivating symptomatic trigger points. It also helps to identify any soft tissue abnormalities, which if untreated could progress to injury.

Nutrition

Nutrition aids in the recovery from intense exercise by replenishing glycogen stores and providing necessary protein and water. Repetitive bouts of activity can cause profound glycogen depletion and substantial breakdown of muscle proteins which could lead to impaired sporting performance. Athletes are encouraged to consume a carbohydrate rich snack/meal that provides 1-1.2g of carbohydrate per kg of body weight as well as 10-20g of high-quality protein within the first hour post exercise, as this is when rates of glycogen synthesis are greatest. Glycogen is the major energy source for muscular activity in the body. Large amounts of fluid may be lost during exertion, especially with increased intensity and in hot conditions. Rehydration is vitally important to replace the lost fluid as well as electrolytes (especially sodium) lost through sweat.

Deep-water running

This recovery method involves running in the deep end of a swimming pool using a buoyancy vest. It is a form of cross-training that reduces the impact put on your joints and thus reduces overuse injuries.

Compression Garments

Lower limb tights and below-knee socks are advised for athletes soon after finishing their event. Athletes should leave them on for the next 24 hours. This aids in recovery from post-event muscle soreness.

Lifestyle factors such as adequate rest and sleep as well as the psychology of the athlete have also shown to influence recovery times.

As you can see what the athlete does off the track/field might be as important as what they do on it and coaches should be encouraged to incorporate recovery time into athletes’ schedules.

Andrew@PhysioPRO

Although this may seem trivial to some, the number of patients that are unaware of whether to apply hot or cold therapy to an area has prompted me to write this article.

Let’s start with a common scenario… A player feels a sudden sharp pain in the hamstrings whilst playing soccer. He finds it difficult to continue playing. Should he use ice or a hot water bottle?

The second scenario…. A few days after a heavy workout, a player feels strong discomfort in the hamstrings when walking or climbing stairs. What should he do??

Both these scenarios involve a muscular issue involving the hamstrings, however they should be handled very differently. To understand why, we need to understand the effects of heat and ice…

Heat:

• Increases blood flow to the area through dilating blood vessels, thus transporting proteins, nutrients, and oxygen for better healing
• Increases cell metabolism
• Increases the tissues ability to stretch (extensibility)
• Relieves muscular spasm

Cold:

• Reduces blood flow through constricting vessels, thus reducing internal bleeding
• Decreases cell metabolism which will slow down an inflammatory reaction
• Reduces pain (analgesia)

So, in cases of ACUTE INJURIES (where we are trying to reduce the inflammatory response), one should apply ICE to the area as soon as possible and continue for the first 72 hours. It is recommended to only apply ice for 10 minutes and then wait 50minutes before applying again (i.e. 10 minutes every hour). This is to prevent a reaction (known as the “Hunting response”) which will actually INCREASE blood flow to an area that gets too cold for too long.

On the other hand, HEAT is used to treat CHRONIC INJURIES where there is no swelling or bruising. Usually this is for sore, nagging muscular aches or stiff joints. It’s great for muscular tension and can be applied for 15-20 minutes at a time, taking care not to burn the skin. This can be in the form of a hot water bottle/heat packs or just a really hot bath.

So from the above it should be obvious that scenario number 1 needs to ICE his injury as he probably has a hamstrings muscle tear. He should also follow the PRICER principles – see this article

The athlete in scenario 2 should use HEAT and stretching to relieve his muscular pain as his is not an acute injury and most likely post training muscle stiffness (delayed onset muscle soreness – DOMS).

Hope that this helps you clear up when to apply which therapy.

Ric@PhysioPRO

“We don’t stop playing because we grow old….we grow old because we stop playing”

                                        George Bernard Shaw                 

I love this quote…maybe because I never want to stop playing and maybe because it’s so true. Numerous studies have shown that in addition to benefitting the psyche, physical activity benefits all of the body’s organs. They suggest that exercise may have an important role to play in aging well and remaining healthy, preventing and delaying disability and improving survival into older age.  

Benefits of physical activity:

• The Cardiovascular System – the most dramatic benefit of physical activity is seen in this system, with decreased morbidity, mortality, and symptoms of degeneration as well as reduced cardiac rehospitalisation.
• The Respiratory System – physical activity improves the condition and quality of life in older people with chronic obstructive pulmonary disease.
• Osteoarthritis – physical activity increases muscle strength and improves joint mobility.
• Bone Health – Resistance training and high impact activities help to maintain bone mass in the elderly. Balancing and strengthening exercises also reduce an older person’s risk of falling and injuring themselves.
• Psychological function – cognitive function, sleep and mood patterns may improve with physical activity. Benefits are also associated with muscle control and weight loss which may lead to improvements in body image and reverse an older person’s fear of physical activity.
• Diabetes – Exercise in combination with healthy dietary modifications reduce the risk of type 2 diabetes developing.

 As with most things in life, this issue has two sides. Although there are many benefits to the older population who are exercising they are unfortunately also at an increased risk that exercise could precipitate a significant cardiac event.

Many older people suffer from at least one chronic condition and as a result consume multiple medications. There are potential problems associated with exercise when combined with some of these drugs and these would need to be addressed before commencing an exercise programme. It is critical that before starting an exercise program, older people should consult their physician and undergo a physical exam to be given the thumbs up to start exercising.

Some contraindications to exercise outside of a monitored environment include:

• Myocardial infarction(heart attack) within 6 months
• Angina or physical signs and symptoms of congestive heart failure
• A resting systolic blood pressure(the top figure) of 200mmHg or higher

For older adults who have been very inactive the first step is simply to reduce sitting time. The best exercises to consider are ones that are functional, task specific, relevant and enjoyable to the individual. Start off slowly and work towards a goal to accumulate 30 minutes a day of moderately-intense physical activity on most days of the week.

For older people who are generally active, start by increasing the volume of aerobic and/or resistance exercise being done. Some examples of aerobic exercise could be stationary cycling, brisk walking and swimming. Always warm up for 5 minutes and gently stretch before exercising at a moderate level (one at which a conversation can be easily maintained).

While undertaking resistance training, proper breathing consists of exhaling during the lift for 2-3 seconds and inhaling during the lowering of the weights for 4-6 seconds. Holding your breath while lifting weights should be avoided, and if a weight causes strain when used drop to a lighter weight.

Keep on Playing 🙂

Andrew@physiopro.co.za

As physiotherapists we often deal with a lot of myofascial problems. Most people understand the first part of this word i.e. Myo-referring to the muscular system but I want to explain the second component of this word a little better – Fascia – and its relevance to how your body functions.

Firstly – what is Fascia?

Fascia is a slightly mobile connective tissue spread throughout the body in a three dimensional web. It surrounds every muscle, every fascicle, every fibril (fibre) and every microfibril that make up your muscles. It mainly consists of collagen and elastin.

Think of your body’s fascial system as a multi-layered body stocking, with fascial sheaths wrapping the muscles and weaving in layers throughout the body. Because of this, stress in any area of the body has an effect on every other part of the body. The Fascia basically connects everything!

What does the Fascia do?

Fascia plays an important role in supporting, stabilizing and protecting the structures it surrounds. In other words, it provides postural balance. The Fascial system conveys mechanical information via tension and compression and has a role in cellular nutrition. The deep fascia also provides a surface area for muscles attachment.

 In its optimal condition, fascia is a loose, moist tissue. When there is continual loose movement and balance in the body, the fascial body stocking stays loose and mobile, facilitating movement between different parts of the body.

However, under continual stress (caused by poor postures and mechanical forces exerting abnormal tension on muscles) as well as lack of movement, fascia becomes rigid and loses its fluidity causing muscle undernourishment. Layers of fascia begin to stick to one another, causing the “knots” you may have experienced in your muscles (trigger points). The sheaths of fascia stick in a systematic way, based on your habitual patterns of movement, or for some, lack of movement.

Therefore Myofascial release aims to reverse myofascial deformation and re-open the tissue to increase the fluid flow to affected areas (restore the viscosity of the tissue), muscle function and improve motor and sensory input. It is also very important to decrease the abnormal pull (stress) on the myofascia to correct altered joint alignments.

As you can see the fascial system plays a major role in muscular injuries and pain and if overlooked by your therapist could contribute to recurring and prolonged aches and pains.

Andrew@PhysioPRO