RHP Physiotherapy Blog
The latest from RHP Physiotherapy
RHP Physiotherapy is one of Brisbane’s premier physiotherapy practices. We’ve started this blog in order to provide an informed and authoritative discourse on a range of health related topics.
Our hope is that we can provide you with up to date information and events associated with a range of health topics not limited to sports injuries and musculoskeletal problems as may be associated with traditional ‘physio’ or physiotherapy.
Our sports physiotherapists are amongst the country’s elite but we have worked hard to establish a culture of excellence across a range of health related issues. Many of these topics we hope to discuss in coming blogs.
On the 3rd of December RHP physiotherapists supported by physio students embarked on the task of screening 50+ female football (a.k.a. soccer) players from The Gap Football Club.
The women’s arm of The Gap Football Club is perhaps the premier women’s club in Qld, and has a terrific culture of player development and support that contributes to its success. This has been under the stewardship of head coach Rob Askew and club captain Bec Price for a number of successful seasons.
Screening is a process of individual player assessment with the goal of discovering any deficiencies in strength, co-ordination, flexibility, or dynamic movement skill that might be contributing to increased injury risk. The players that took part were from the U13, U15, U20 and Open age groups.
A large body of research has occurred in the last 5 + years investigating lower limb injuries in football players, and also strategies to minimise their occurrence. Most of this research has focussed on anterior cruciate ligament injuries in the knee. It shows that women are approximately 4 times more likely to sustain this injury than men, and occurrence in teenagers is becoming more common. This is mostly due to weakness in gluteals, hamstrings and trunk muscles, and dynamic movement skill deficits that present in the post-pubescent female player.
Thus one of the primary goals of our pre-season injury screening is to identify the players who are performing least well on our tests, and intervene early with specific strengthening, education, and skill development strategies. All players will receive a report, and advice on any areas that they need to improve. Appropriate exercises and drills specific to their needs will be provided, with reviews planned during the coming season to monitor progress.
RHP Physiotherapy is a proud sponsor of The Gap Football Club, and pleased to instigate these injury prevention strategies based on the most recent research.
Good luck for the 2016 season Rob and Bec, and we hope your players stay on the pitch.
New Year Resolution – Avoid injury and illness in January
With the Christmas and new year period fast approaching, many athletes, organised sports and regular exercisers are planning a few weeks off from there normal routine. A break or a rest is just what the body and mind needs, but..
There is significant risk of injury and illness if you get back to normal training too fast after a break, taper, or time off after injury, and therefore reduced performance can occur. If an athlete completes >80% of planned training weeks in the 6-months before a major championship their chance of reaching their performance goal increases by 7 times. Avoid missing training time to recover after injury from resuming training too quickly. View the study
January is one of the busiest months for injuries as we get back into normal training. Add to this those of us that decide to take up a new activity, or start running again and get fitter in the new year.
Now we have solid guidelines from the Australian Institute of Sport as to the recommended time it takes to return to normal and full training load after a period of rest or a break. This data is based on long term injury surveillance through the Athlete Management System (AMS) combined over 25 or more sports.
You can use this table to work out the recommended time. For example if we plan to rest for 2 weeks (column on the far left of table), and do 40% of our normal training load (choose from the bottom row), it should take a further 2.5 weeks to return to full training load. Therefore, we would be at modified or reduced training for a total of 4.5 weeks.
If you do 60% of your normal training load for the 2-week period, the return to training period is now only 1.4 weeks, a total of 3.4 weeks at modified or reduced training.
The numbers provided in this table are a guideline and make no accommodation for the age of the athlete or prior injuries or risk factors. If you have any questions, or would like some help in planning your return to training and how to monitor it, catch up with one of RHP Physiotherapy’s highly experienced physiotherapists.
Source – Purdam et al. 2015 AIS White paper: Training troughs’ are a risk to performance: Tapering, rest periods, injury/illness; A planning tool to minimize risk of injury/illness during the return to training. Version 1, 23 June 2015.
Sedentary Behaviour and Physical Inactivity
In light of the Australian Physiotherapy Association joining forces with MOvember foundation’s initiative of “MOVEmber” aiming to encourage people to move every day of November and gain the benefits of physical activity (specifically in relation to prostate cancer), today we will be looking at the current physical activity guidelines we should all be meeting to improve our health and quality of life – and the small things we can do to try to meet them.
What is Physical Activity?
The World Health Organisation (WHO) defines physical activity as any bodily movement produced by skeletal muscles that requires energy expenditure – including activities undertaken while working, playing, carrying out household chores, and engaging in recreational pursuits.
- Physical inactivity (low levels of physical activity) is the fourth leading cause of death due to non-communicable disease (NCDs) worldwide (heart disease, stroke, diabetes and cancers) – contributing to over three million preventable deaths annually (6% of deaths globally).
- Physical inactivity is estimated to be the main cause for approximately 21–25% of breast and colon cancers, 27% of diabetes and approximately 30% of ischaemic heart disease burden.
- Physical inactivity is the second greatest contributor, behind tobacco smoking, to the cancer burden in Australia.
- Physical activity has significant health benefits and contributes to prevent NCDs.
Source: Global Health Risks: mortality ad burden of disease attributable to selected major risks. World Health Organization, 2009.
How much physical activity is recommended?
The Australian Government’s current guidelines for adults are:
- Doing any physical activity is better than doing none. If you currently do no physical activity, start by doing some, and gradually build up to the recommended amount.
- Accumulate 150 to 300 minutes of moderate intensity physical activity or 75 to 150 minutes of vigorous intensity physical activity, or an equivalent combination of both moderate and vigorous activities, each week.
- Be active on most, preferably all, days every week.
- Do muscle strengthening activities on at least two days each week.
- Minimise the amount of time spent in prolonged sitting. Break up long periods of sitting as often as possible.
- Those over 65 or with poor mobility should perform physical activity to enhance balance and prevent falls, 3 or more days per week
The intensity of different forms of physical activity varies between people. In order to be beneficial for cardiorespiratory health, all activity should be performed in bouts of at least 10 minutes duration.
Benefits of physical activity
improve muscular and cardiorespiratory fitness;
improve bone and functional health;
reduce the risk of hypertension, coronary heart disease, stroke, diabetes, breast and colon cancer and depression;
reduce the risk of falls as well as hip or vertebral fractures; and
fundamental to energy balance and weight control.
However, current research is showing that even if you do meet the physical activity guidelines – if you are sedentary you will still have risks to your health…
What is ‘sedentary behaviour’?
Being ‘sedentary’ means sitting or lying down for long periods (not including sleeping). So, a person can do enough physical activity to meet the guidelines and still be considered sedentary if they spend a large amount of their day sitting or lying down at work, at home, for study, for travel or during their leisure time. This can have impacts on health such as an increased risk of cardiovascular disease and type 2 diabetes.
Experts say we’re sedentary on average for 7-10 hours a day. While researchers are still trying to understand exactly why sedentary behaviour has such a negative effect on our health, it appears to be related to how our bodies process fats and sugars.Professor Wendy Brown from the University of Queensland’s School of Human Movement Studies in an interview with ABC news explained that when muscles are not moving, metabolites – especially fats – are not cleared from the bloodstream as quickly. High circulating levels of fats eventually lead to metabolic illnesses like diabetes and cardiovascular disease. The latest evidence is that the effects worsen when daily sitting time is more than seven hours.
So what can we do about it?
In essence, the guidelines recommend that if we can break up sitting with two minutes of standing/walking at least every twenty minutes this will significantly reduce our sedentary time and improve our health, productivity and energy levels. If we can limit our screen time at home in front of the computer and TV to less than 2 hours a day this will also greatly benefit us – and this also goes for adolescents and children. Standing desks and alternating sit to stand desks are becoming increasingly popular for people who are at their desks for majority of the day, this is another effective way to reduce sedentary time.
Please find below some great tips and advice to try to limit sedentary behaviour and physical inactivity at home and at work; just remember – any activity is better than no activity so get out there and start moving.
Clicking on the age groups below find out the Australian Physical Activity and Sedentry Behaviour Guidlines.
Also, a national campaign “This Girl Can” by Sports England resulted in an amazing and inspirational video to encourage women to get off the couch and start exercising – to watch one of my favourite videos of all time see the video below!
We all do it, but how well do you breathe?
· Our diaphragm is the primary breathing muscle. It bisects our trunk separating our lungs/chest from our abdomen/belly.
· When our diaphragm contracts it descends towards our pelvis. This creates a larger volume of space in our chest, lowering the air pressure which in turn draws air into our lungs (inspiration).
· When our diaphragm relaxes, it ascends, pressure in the lungs is increased and subsequently air is pushed out of our lungs (exhalation).
· Other muscles between our ribs (the intercostals) support this process by helping to elevate the ribs during inspiration.
Requirements for efficient and relaxed breathing
1. Appropriate abdominal muscle activity. Not too much, and not too little, and the correct balance between all of the abdominal muscles.
a. Excessive upper abdominal muscle activity can lead to an ‘hourglass’ like shape, restricting lower rib and diaphragm excursion.
b. Weak abdominals can allow poor anchoring of the lower ribs which then can flare upwards during inhalation. This creates difficulty for the diaphragm.
2. Appropriate pelvic floor activity. The pelvic floor has an important relationship with the diaphragm and abdominal muscles. During inspiration the abdominal contents move downwards, and the pelvic floor muscles need to allow this descent to occur while offering some support. The pelvic floor muscles work with the abdominals to modulate pressure in our abdominal cavity (intra-abdominal pressure) according to the amount of exertion we are doing. The amount of activity will vary, from being very quiet whilst we are idle, to increasing with walking/ talking/ singing, and significantly increasing with sport and exertion.
a. Weakness, or poor neuromuscular firing of the pelvic floor muscles will impair the cohesion of this system, and contribute to diaphragm tension and breathing dysfunction.
b. Excessive tension in the pelvic floor muscles can contribute to restrictions on diaphragm excursion during relaxed breathing.
a. A rounded upper back will restrict normal rib cage movements and increase incorrect breathing patterns.
b. Sway back or forward tilted pelvis postures will cause a “scissored” position fault between diaphragm and pelvic floor. This impairs their reciprocal relationship, and promotes dysfunction.
c. Forward head posture can cause cervical spine dysfunction. 2/3rds of the nerve input to the diaphragm comes from the phrenic nerve which arises from the mid cervical spine. Good neck posture will assist with nerve control of the diaphragm.
Non-ideal breathing mechanics
Poor breathing mechanics often leads to “upper airway breathing”, which is less efficient and results in excessive use of neck and shoulder muscles. If this occurs you are more likely:
· To experience neck pain and headaches
· Have restricted endurance capability
· To experience lower back pain due to interruptions in core stability.
Breathing is an integral part of everything we do, and influences our function, strength, endurance, immune system, core stability, injuries, and happiness. It is a complicated movement that is influenced by the whole body.
If you believe that your breathing system is not functioning at its best, then it is well worth having a skilled physiotherapist assess you. At RHP Physio your posture, gait, muscle balance, neuromuscular activity, muscle tone, biomechanics, and co-ordination is all taken into account when analysing your breathing.
To make an appointment with one of our skilled physiotherapists call us on 07 3856 5566
Rehabilitation after ACL reconstruction surgery.
The ACL (Anterior Cruciate Ligament) rehabilitation protocol I use to guide rehabilitation for my patients is a goal based progression. We can move through the ACL protocol at our own pace, and let the criteria govern how quickly we go, rather than a traditional pre-determined timeline. This is really helpful for setting goals and determining the appropriate exercises for each patient at each stage. Rehabilitation after ACL surgery must be individu alised and requires clinical reasoning that the experienced therapists at RHP Physiotherapy can provide.
Image from www.ihealthsphere.com.au
This simple and elegant protocol was designed by Randall Cooper, a specialist sports physiotherapist from Melbourne, and is broken down into 5 phases. There is a list of goals and outcome measures that need to be satisfied at the end of each phase to move onto the next one. The five phases are:
• Phase 1: Recovery from surgery
• Phase 2: Strength & neuromuscular control
• Phase 3: Running, agility, and landings
• Phase 4: Return to sport
• Phase 5: Prevention of re-injury
Interestingly the rate of return to same level sport after ACL reconstruction may not be as high as you would think, and certainly not what we see reported in the media of quick returns to high level sport by high level athletes. A recent Australian study revealed that of 314 participants, less than 50% of the study sample had returned to playing sport at their preinjury level or returned to participating in competitive sport when surveyed at 2 to 7 years after ACL reconstruction surgery. Return to the preinjury level of sport at 12 months after surgery was not predictive of participation at the preinjury level in the medium term, which suggests that people who return to sport within 12 months may not maintain their sports participation. At follow-up, 45% were playing sport at their preinjury level and 29% were playing competitive sport. Ninety-three percent of the study sample had attempted sport at some time after their ACL reconstruction surgery. Long term effects after reconstruction are being investigated by researchers at UQ now with Steph Filbay and her colleagues.
So, taking your time, progressing at your own pace, and being mentally and physically prepared for return to sport could maximise our success of returning to sport.
Here are a few tips on how to progress through an ACL rehab protocol with minimal problems:
* Get the knee straight early (within the first 2-3 weeks), and keep it straight. Flexion (bending) can progress gradually. If you have had meniscus repair, this may happen after you are allowed out of a brace as recommended by your surgeon.
* Use knee pain and knee swelling as a guide. Listen to your knee. If either or both are increasing, the knee isn’t tolerating what you’re doing to it.
* Build high impact forces gradually. The articular structures in the knee joint will take time to adapt to a resumption of running, jumping and landing.
* Complete your ACL rehabilitation. Once people are back running with no knee pain it’s easy to think that it’s all done. But the last 1/3 of the protocol is the most important – to help reduce the chance of re-injury, increase the chance of a successful return to sport, and possibly to reduce the likelihood of osteoarthritis down the track.
* Technique is everything. Compensation patterns develop after an ACL tear, so focusing on correct muscle and movement/ biomechanical patterns is paramount. A copy of the complete ACL Rehabiltation Guide from Randall Cooper can be downloaded from the Thermoskin website.
A copy of the complete ACL Rehabiltation Guide from Randall Cooper can be downloaded from the Thermoskin website.
In the next of my blogs I will explain how we use the Melbourne Return To Sports Score at the end of Phase 4 to determine readiness for return to training and sport.