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.

 


Recent posts:

Posted by admin on May 5, 2014

Core Control Swimming: What is your core doing?

  • It allows more of the power produced by your kick to push you forward through the water.
  • Good body position in the water leading to a better “streamline” position and a more efficient stroke due to less drag.
  • A more stable attachment point for the powerful shoulder muscles to work from. This means that they can work more effectively and move your stable trunk through the water more easily.
  • Helps reduce over activity of some muscles. This means less general muscle tightness.
  • Less chance of injury.

Adding a couple of simple drills to your workout sessions can be enough to ensure you core is strong and stable throughout your entire training week.

FOCUS ON CORE CONTROL

Core Control Check

Instructions:

Stand facing a mirror with your finger tips on the bone at the front of your hips. Lift one leg off the ground so that the foot is held in the air near the opposite knee without touching. Bend the leg you are standing on so that you squat to 90 degrees and return to the starting position. Repeat 10 times on each leg.

Interpretation:

If you notice any of the following then you will benefit from some specific trunk and pelvic control work:

  • your knee buckles inwards toward the other leg as you squat
  • your hip moves outward so that it is not above the foot
  • the two points under your fingertips do not stay level as you squat
  • you cannot keep your body from bending sideways or twisting as you squat
  • if the left looks different from the right during the test

To improve swimming performance and reduce injury risk it is important to perform these exercises for 2-3sets x 1min at least 3-4 times per week. You might use them as part of your warm up before each training session.

Swiss Ball Bridging

Aim: To improve trunk and hip control.
Start: Lie as shown on the ball. Rest your head and shoulders on the ball and ensure knees are bent to right angles. Activate deep abdominals, and gluts.

Action: The key to this exercise is to use your buttock muscles Swiss_Ball_Bridgingto keep your thighs and pelvis in a straight line. Hold your arms directly above your head and then slowly bring one arm down to the side and then return to the start. Alternate left and right.

Abdominals

Aim: To isolate the deep abdominals whilst flexing / extending the hip. Stabilise pelvis and lower back.
Abdominals
Start: As shown. Feel for the deep abdominal muscle.

Action: Activate the deep abdominal. Relax the chest. Whilst maintaining muscle tension practice breathing evenly and then relax. Keeping the spine and pelvis level slide one heel out along the floor, half straightening your leg, and then bring it back to the starting position. Alternate left and right.

If you want to learn which other exercises will help improve your core call (07) 3856 5566 for an individual assessment with one of our physiotherapists.

Plus check out other info sheets for swimmers including:

“Shoulder blade stability” and “Flexibility for a better streamline”.

Posted by admin on May 5, 2014

Looking after your Lumbar Intervertebral Discs

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Injury to a disc can be quite painful and limit your ability to do everyday activities. Discs are most vulnerable when your spine is flexed and rotated, that is, when you bend forward and twist. When you sit your spine will also be in a flexed position so it is important to remember that sitting is like bending. These positions increase the pressure that your disc has to manage, which can lead to tears in the outer fibres of the disc and possible herniation.

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There are many ways to prevent injuring your back. Obviously keeping a good posture at all times is essential. This means keeping your spine in a neutral position and to avoid sustained positions (greater than 5-10 minutes), that don’t allow your spine to be in neutral. In the lumbar spine this position is referred to as a lordosis, or an inward curvature. It is important that your lumbar spine is maintained in a correct amount of lordosis, as too little or too much can lead to increased pressure in your discs. To maintain this position when lifting objects you must bend your knees and keep close to the object you are lifting.

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The core stabilising muscles include the deep abdominals, back muscles and buttock muscles. These support our neutral spine position and need to be strong with good endurance to hold our desired position for long periods. Flexibility at the hip joints is also very important so we are able to move adequately at the hips and not early or excessively at the lumbar spine.

The following are exercises to maintain flexibility around the hips and strength of our core to help minimise risk of back injury. Aim to do these exercises at least five days per week.

Stretches

Hold 30 seconds, repeat 3 times.
Gluteal stretch

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 Hip flexor stretch

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Hamstring stretch

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Control exercises

4 point kneel
Repeat 10 times, slowly.

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Cross-extension

Repeat 20 times. Build up to 50 times.

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Sit to Stand

Repeat 10 times, slowly.

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Posted by admin on May 5, 2014

Pre-season Injury Prevention Report

• Decreased exercise levels during the off-season lead to:

• A deterioration in the load tolerance of our tendons
• Reductions in muscle strength, endurance, and power.
• Reduced balance and co-ordination via a dampening down of the brain to muscle nerve pathways.
• Reduced aerobic fitness
• Loss of flexibility
Points to Consider with pre-season training:
• Begin early so there can be a gradual build up to full match fitness for the first game. Research shows that it can take several weeks for the collagen cells within your tendons to adapt to the increasing demands. Time will vary according to how much inactivity there was during the off-season, and the older athlete is generally more susceptible to tendon injuries.

• Include strength training specific to the sports requirements. For example:

1. Sports involving sprinting will require hamstring strengthening to decrease the risk of hamstring tears.
2. Sports requiring jumping will require calf, quadriceps, and gluteal strengthening
3. Sports involving lots of changing direction such as soccer will require adductor strengthening to minimise the risk of groin strains
4. All sports require strengthening of the “core” muscles. These are the muscles that provide stability to the pelvis and spine so the limbs work off a platform that is not moving excessively. I consider the pelvic floor, abdominals, diaphragm, deep back, and gluteal muscles make up the core.

• Include balance and co-ordination drills. This may include:

1. Foot speed drills
2. Single leg balance drills
3. Change of direction
4. Exercising on unstable platforms
5.Drills with training partners involving controlled body contact perturbations.

• For sports involving jumping and landing, include landing training and teach correct landing strategies. Research into ACL preventative strategies show that teaching deep landing strategies and improving lower limb and gluteal strengthening is very effective at reducing ACL injury rates.

• Sports specific training is crucial for development of higher-level movement skills and adaption of strength, coordination and flexibility into performance. Game situations are best performed earlier in training sessions before bodies are fatigued so injuries are less likely to occur during the most difficult training aspects.

• Static stretching is useful for maintaining or developing flexibility in our muscles. This is best at the end of a training session or away from training in the athlete’s own time. Tight regions need to be stretched daily in order to improve.

An example of a 20 minute warm up routine that has been advocated for football players can be found at www.fifa.com. It is called the “11+” program and includes many of the aspects mentioned above.

For more information or an introduction to specific exercises that can be incorporated please Contact Us.



If you are a coach or trainer and would like our skilled physiotherapists to provide or assist with your teams training session(s) please Contact Us.

Posted by admin on May 5, 2014

The Link Between Cortisol, DHEA and Insulin

As a consequence, excessive carbohydrate intake often leads to excessive cortisol secretion.  There are several causes of adrenal overload or fatigue, but if the gland has to continually produce excess cortisol due to carbohydrate overload, this will contribute.

Because DHEA and cortisol act to balance each other, and because there is a finite amount of DHEA available over a lifetime, reduced DHEA levels are a sign that too much has been used and, an early sign of adrenal exhaustion.

Because insulin also promotes fat storage, if there are large amounts of carbohydrates to be broken down, there will be high levels of insulin in the system and more fat being formed and stored.

As mentioned, when insulin is high, excess levels of cortisol are produced as a back-up mechanism to mobilise more blood sugar, which is done at the expense of the adrenal glands.

One way to counteract this process is to include more protein in the diet.  Protein is in part, broken down by glucagon from the pancreas.  Amongst its other functions, glucagon stimulates the production of glucose from amino acids (protein) and lactic acid in the liver.

Posted by admin on February 5, 2014

Rotator Cuff Injuries of the Shoulder

Function: The rotator cuff muscles originate from the various surfaces on the shoulder blade Rotator(scapula) and attach to the top of the arm bone, wrapping around what is called the head of humerus. Co-ordinated contraction of the rotator cuff muscles keeps the head of the humerus centred in the socket during arm movement. Without this action the shoulder becomes weak, the forces of arm movement are not well controlled, and injury and degeneration are likely. A secondary role of the rotator cuff is to assist movement of the arm into internal and external rotation (Wilk and Arrigo, 1993).

Injury: An injury to the rotator cuff might be indicated by symptoms such as an ache around the shoulder and down into the arm; a pinching feeling with movements over head; an arc of pain as you lift your arm up to the side (abduction): or a sharp catching pain with rapid or unusual movements of the arm. The time taken for these symptoms to develop depends on the mechanism of injury.

Injury to the rotator cuff can occur in a number of ways but usually involves one of two general mechanisms:

(A) Acute onset: High forces / trauma: eg. falls onto the shoulder crush the rotator cuff muscles between the humerus and tip of shoulder blade. Heavy unexpected loads / rapid loading of the rotator cuff muscles can strain the muscle fibres eg. catching a heavy object or having your arm pulled forcefully.
(B) Slow onset: A poor balance of strength between the different muscles of the rotator cuff allows the head of humerus (HOH) to move out of position and the rotator cuff muscles can be pinched between the HOH and tip of shoulder blade (Acromion). Additionally poor scapula control muscles, tightness of large muscles such as the pec and lat, and even poor posture, causes poor positioning of the scapula at rest and with movement.This again leads to pinching/increased stress on the rotator cuff fibres between the HOH and the Acromion.

Repair: Fixing this injury involves identifying and addressing the factors that caused the damage. At Red Hill physiotherapy we will use assessment of general posture, muscle length, strength of the rotator cuff, scapular stability and a number of other testing methods to determine the likely cause of your rotator cuff injury. We will also identify any contribution from the neck, thoracic cage, and pelvis.

In cases where the damage to the rotator cuff is minimal to moderate we will use hands-on methods of treatment for pain relief and to correct these issues. We also encourage, where possible, a program of self management involving rotator cuff/scapular exercises, stretches and postural changes specific to your problem. The management of your injury will progress as you begin to heal and will always incorporate functional / sport specific components.

In cases where severe damage is suspected you may be referred for an Ultrasound or MRI scan to help clarify the nature of the problem. If it is thought that you may require surgery an appointment with an Orthopaedic Specialist will be arranged. Information, explanation, and ‘prehabiliation’ exercises from your physiotherapist will be an important part of your preparation for surgery if it is to go ahead. Post operatively you will be managed in a number of different ways depending on the surgical methods used. Commonly there are strict limitations to your movement for the first 6 weeks as set by your surgeon. Also a number of rehabilitation drills will need to be done as set by your physiotherapist. Progression of these therapeutic exercises will help you return to full function in 6-12months.