Strength or resistance training involves much more than simply going to the gym a couple times a week. To gain the most from strength training it’s crucial to understand the science behind exercise choice, dosage and planning. This is the foundation of designing a strength training program.
In fact, strength training is more about the design of the program than the exercises themselves. Recent evidence highlighting the significance of concepts such as load management and periodization emphasize this point. These concepts include progressively building your training volume and intensity, providing appropriate variety in the program and accounting for the physical profile and injury history of the patient.
The idea of strength training can make some people who’ve been previously or currently injured apprehensive. However, the risk of aggravating an injury must be balanced with the risk of staying in a deconditioned state and maintaining a higher re-injury risk. Which brings me to one of the most common questions I get asked by patients, ‘what can I do to prevent this happening again?’ Thankfully these days my answer is both simple and based on sound scientific evidence – improve your strength.
It would be wonderful if improving strength were an easy process. Though physical and mental effort is required to complete the actual strength program, it’s structure need not be complicated. With the guidance from an appropriately qualified Physiotherapist, a simple yet highly effective strength training program can be designed to progress your injury rehabilitation and reduce your injury risk.
In summary there are three main reasons you should strength train following an injury:
1. Resistance Training is a valid treatment option for musculoskeletal rehabilitation.
A recent systematic review using data from 1545 rehabilitation patients demonstrated that strength training improved outcomes in chronic low back pain, knee osteoarthritis, chronic tendinopathy and post hip replacement patients (Kristensen and Franklin-Miller, 2012. Other studies have shown that a structured resistance training program can reduce pain and improve function in neck pain (Gross, 2015), groin pain (Jensen, 2012), shoulder pain (Andersen, 2014) and also osteoporosis (Gomez-Cabello, 2012).
2. Strength training reduces sports injury risk
A recent systematic review using data from over 26000 patients showed that ‘strength training reduced sports injuries to less than a third’ and suggested that strength training may also halve overuse injuries (Lauersen et al, 2014).
3. Strength Training is easy to start
As most patients following injury are starting from a low base of fitness, strength training doesn’t need to involve large weights, squat racks, benches or sweaty mats in a gym with blaring music. In most cases to achieve an appropriate training stimulus simple bodyweight training is ideal.
IN SUMMARY, RESISTANCE TRAINING:
- is effective in treating a range of common musculoskeletal conditions
- is effective in reducing sports injury risk
- is easy to perform.
APA Sports Physiotherapist, S&C Coach, Pilates Instructor
Find out more about John’s Strength & Conditioning Essentials for Physiotherapists Course
With marathon and triathlon season fast approaching we often see an increase in injuries around the foot and ankle, in particular Achilles tendon pain. Last weekend Physiosports hosted a weekend conference for physios and sports doctors run by the world’s best tendon experts. Here are their 5 super important tips for anyone who thinks they have Achilles Tendinitis (although we call it Tendinopathy).
1. Ensure a correct diagnosis.
There are lots of tendons and other structures around the back of the ankle that can get sore with running. Given that management of tendon injuries is very different from injuries to joints and other structures, being sure it is your tendon that is the problem is vital before undertaking any treatment plan.
2. The findings of your scans are inconsequential to your recovery.
Often those with tendon complaints will have an MRI or ultrasound reporting partial tears or degeneration. The latest evidence suggests that these same findings often exist in pain-free tendons and is an expected tissue response. Furthermore, it has been found that these altered tissues can be rehabilitated back to normal function through exercise.
3. A specific loading program is vital.
Your Achilles tendon acts like a giant spring; this is why only performing calf raises for your exercise will not be enough to get you back to running and jumping sports. A carefully graduated exercise program, starting with low load activities (calf raises) and eventually progressing to dynamic jumping/hopping exercises are needed to prepare the tissue for the demands of your sport.
4. Complete rest and passive treatments (injections, needling etc) will not fix the issue.
As for point 3, tendons act like springs. Any treatment that stops you loading the tendon is ultimately making the tendon less capable of being a spring and this, in turn, makes it harder to rehabilitate the tendon back to normal strength. While sometimes injections and medications can reduce the pain, they do not ever help to restore the tendon’s strength or function and should be used very carefully.
5. Do not stretch the tendon.
Achilles tendon problems exist where the tendon wraps around the heel bone. The injury is a result of a combination of tensile (stretching) and compressive forces on the tendon that are too large for it to cope with; as a result the tendon makes itself stiffer through changing its cellular structure. Even though the tendon feels tight walking around (especially in the morning or when you start running) – remember this is a response in the tissue to protect itself. When you try and stretch the tendon to loosen it up you are actually placing a compressive and stretching force on the tendon and actually making it worse.
Professor Jill Cook – JC
Craig Purdam (FACP) – CP
Ebonie Rio - ER
Sean Docking – SD
MASTERCLASS – PRESENT EVIDENCE/LATEST RESEARCH
|7:30||Revisiting the continuum of tendinopathy…again? – CP/JC|
|7:50||Characteristics and evidence around pain in tendons – ER|
|8:30||How do tendons adapt to load? SD|
|8:50||Management of tendinopathy in season – ER/CP|
|9:10||What to do if it’s not working? – JC/CP|
Saturday 9:00am – 5:00pm
|9:00||Tendinopathy – basic science and clinical presentations– SD/CP|
|9:45||The pain of tendinopathy – bottom-up, top-down where are we at?– ER|
|11:00||Tendon imaging – SD|
|11:45||Understanding load – CP|
|1:30||Assessment of tendinopathy and differential diagnosis – JC/ ER|
|2:15||Phases of rehabilitation – JC/ER/CP|
|3:30||Adjunct therapies and adolescent tendons – JC/SD|
Sunday 9:00am – 4:00pm
Rotating 4 workshops:
1. JC – Achilles/Glut tendons
2. ER – Patella
3. CP – Hamstring
4. SD – Imaging – when, how, what does it tell us?
|11:45||Clinical presentations and other tendons|
|3:30||Q&A / concluding remarks|
Plantar Fasciitis is a condition causing tissue damage and pain at the attachment of the plantar fascia to the underside of the calcaneus (heel bone).
Plantar Fasciitis is the Latin term for “inflammation of the plantar fascia”. The plantar fascia is a thick, fibrous ligament that runs under the foot from the heel bone to the toes. It forms the arch of the foot and functions as our natural shock-absorbing mechanism. Unlike muscle tissue, the plantar fascia is not very elastic and therefore is very limited in its capacity to stretch or elongate. Herein lies the problem: when too much traction is placed on the plantar fascia (for various reasons) micro-tearing will occur, resulting in irritation, inflammation and pain.
In many cases, plantar fasciitis is associated with a heel spur. Surprisingly, the spur itself does not cause pain, and may often be found in the other foot without symptoms.
What is a Heel Spur?
A heel spur is a bony growth at the front/underside of the heel bone. This type of calcification is also referred to “calcaneal spur” (calcaneus is Latin for heel bone). The reason for the development of a spur is that the body ‘responds’ to the constant traction and pulling from the plantar fascia ligament away from the heel bone. The ligament itself cannot become any longer, so instead the bone will ‘assist’ the ligament and grow.
A heel spur will show clearly on an X-Ray of your foot. After diagnosis of the Plantar Fasciitis, some doctors will recommend you have X-Rays taken. However, it should be noted that calcaneal spurs are not painful. They are not the problem. Pain is only caused because of inflammation of the tissue surrounding the heel spur.
It is interesting to note that most people suffering from Plantar Fasciitis pain do not have a heel spur! And vice-versa, there are people with a spur under one or both heels, but they have never experienced any foot pain. Spurs take many years to develop, they can also be found at the back of the heel (near the Achilles Tendon) or in other parts of the body.
Risk Factors for Plantar Fasciitis
- Certain sports: Activities that place a lot of stress on the heel bone and attached tissue, i.e. running, dance and aerobics.
- Flat-feet or high arches: People with flat feet may have reduced shock absorption, increasing strain on the plantar fascia. High arched feet have tighter plantar tissue, leading to similar effects.
- Middle-aged or older: Heel pain tends to be more common with ageing as muscles supporting the arch of the foot become weaker, putting stress on the plantar fascia.
- Overweight: Weight places a greater mechanical load on the plantar fascia. There is evidence that overweight and inactivity lead to chemical damage to the plantar fascia, with a worsening of pain.
- Pregnancy: Weight gain, swelling and hormonal changes that accompany pregnancy may lead to mechanical overload of the plantar fascia.
- Being on your feet: People with occupations that require a lot of walking or standing on hard surfaces may suffer plantar fascia pain.
- Wearing shoes with poor arch support or stiff soles: Poorly designed shoes may contribute to problems.
- Maintaining a healthy weight to minimise the stress on the plantar fascia.
- Choosing supportive shoes. Avoiding stiletto heels and shoes with excessively low heels like ballet flats. Buying shoes with a low to moderate heel, good arch support and shock absorption. Reducing your time barefoot, especially on hard surfaces.
- Not wearing worn-out runners. Replacing old runners before they stop supporting and cushioning the feet. If a sport involves a lot of running, replacing shoes after about 650 kilometres of use.
- Starting activity slowly. Warming up before starting any activity or sport, and starting a new exercise program slowly.
- Undertaking training prior to competition to ensure readiness to play.
- Allowing adequate recovery time between workouts or training sessions.
- Drinking water before, during and after play.
- Avoiding activities that cause pain.
What are the symptoms, why is the pain worse in the morning or after sitting?
Heel pain is in most cases experienced in the centre of the underside of the heel, or at the front or sides of the underside of the heel. The pain is more intense with your first steps out of bed in the morning or after sitting for a while. The reason for this is that during rest our muscles and ligaments tend to shorten and tighten up. The tightening of the plantar fascia means more traction on the ligament making the tissue even more sensitive. With sudden weight-bearing the tissue is being traumatised, resulting in a stabbing pain.
After walking around for a while the ligament warms up, becomes a little bit more flexible and adapts itself, making the pain go way entirely or becoming more of a dull ache. However, after walking a long distance or standing for hours the pain will come back again.
To prevent the sudden sharp pain in the morning or after sitting, it is important to give the feet a little warm-up first with some simple exercises. Also, any barefoot walking should be avoided, especially first thing in the morning, as this will damage to the plantar fascia tissue.
Apart from pain in the heel or symptoms may include a mild swelling under the heel. In addition, heel pain is often associated with tightness in the calf muscles. Tight calf muscles are a major contributing factor to Plantar Fasciitis.
Initial treatment includes offloading the area, wearing supportive cushioned footwear with a slight raise at the heel and avoiding flip flops, ballet flats and un-supportive stiff soled shoes. By booking an appointment with your podiatrist as soon as possible they will be able to assess your foot and the causative factors. They are able to apply a specific taping technique to your foot to rest the plantar fascia long enough for it to heal and for you to continue walking. They will then guide you with appropriate home exercises including important and specific stretching and strengthening of the lower leg and foot. They may also prescribe a heel lift and advice on appropriate footwear and may look at other modalities if required. A reduction in weight is also beneficial in assisting healing if you have increased body weight recently.
Treatment – Ongoing if required
- Night splints/Strassburg Sock: Your podiatrist may recommend wearing a splint or sock fitted to the calf and foot while sleeping. This holds the plantar fascia and Achilles tendon in a lengthened position overnight.
- Orthotics. A Podiatrist is the most specifically trained health professional to assess your biomechanics and may prescribe off-the-shelf or custom-fitted arch supports (orthotics) to help distribute pressure to the feet more evenly, and to stimulate the small foot muscles.
- Physiotherapy. A physiotherapist can give instruction on a series of exercises to stretch the plantar fascia and Achilles tendon and to strengthen lower leg muscles, which stabilises the ankle and heel. A physiotherapist may also instruct how to apply athletic taping to support the bottom of the foot. Your podiatrist will refer you for this should you need it.
- Other Modalities – for the chronic case which can be discussed with your podiatrist are Acupuncture, Trigger point massage, ESWT (shock wave therapy), Cortisone Injections, Medication. These measures are for the most persistent cases, and do not replace the need for the treatment methods detailed above.
- Surgery – is the last resort once all of the above conservative treatment options have been exhausted.
Rehabilitation and return to play
Aims of rehabilitation
- Decrease initial pain and inflammation.
- Identify biomechanical dysfunction.
- Improve flexibility.
- Strengthen the plantar fascia, intrinsic foot muscles and lower limb
- Return to full fitness.
- Injury prevention.
Reducing pain and inflammation
- Reduce activities that cause pain.
- Maintain fitness by swimming or cycling. Take the opportunity to work on upper body strength.
- Taping gives excellent support while allowing the foot to heal.
- If taping is effective then it is likely that orthotics will also be effective in correcting foot biomechanics and helping to prevent the injury returning once normal training has resumed.
- Apply cold therapy. Ice massage for 10 minutes to the site of pain – several times a day if possible. A frozen drink bottle used like a rolling pin is an easy way of performing ice massage.
Return to play
- Follow the advice given by a sports medicine professional.
- After a week of no pain running can be started again.
- This should be a gradual process. If pain is felt at any time then go back a step.
- Running time should be gradually increased.
- Apply tape to the foot to support it for the first few runs, especially if orthotics are not being worn.
- Ensure the correct shoes for your type of running style or sport are worn. See our podiatrists for a personalised Footwear Assessment to determine the correct shoe.
- After every training session apply ice for about 10 minutes.
- Stretch properly before each training session and after. Hold stretches for about 30 seconds and repeat five times.
Always Consult a Trained Professional
The information above is general in nature and is only intended to provide a summary of the subject matter covered. It is not a substitute for medical advice and you should always consult a trained professional practising in the area of sports medicine in relation to any injury. You use or rely on the information above at your own risk and no party involved in the production of this resource accepts any responsibility for the information contained within it or your use of that information.
Our Podiatrist, and resident shoe guru Phil reviews the Mizuno Wave Ride 19
STYLE: Rider 19
CATEGORY: Neutral firm high mileage running shoe
SIZES: Men’s 7-14 in D and 2E width, Women’s 6-12 in B and D width
HEEL PITCH: 12mm
UPPER: Mizuno has used a new mesh with very little stitching or overlays to improve the fit of the shoe. The toe box has no restricting overlays, which dramatically reduces pressure over joint prominences and improves upper flexibility. The firm heel counter is padded but not excessively with thick memory foams as seen in other brands
MIDSOLE: A neutral wave plate finishing at the midfoot, provides equal amounts of medial and lateral support. The U4ic midsole that has been supplemented with the SRtouch cushioning compound in the heel gives this generation one of the softest rides of any Rider.
OUTSOLE: In areas of high wear the designers have utilised Mizuno’s X10 carbon rubber, this dramatically improves durability whilst not hindering grip. To reduce weight and improve grip the rest of the outsole is made up of G3 rubber.
- Forefoot: The open toe box and slight splay to the midsole creates a visual perception of width. The visual perception is matched when trialling the shoe as even in standard D width the Rider feels wider than comparable shoes.
- Midfoot: In comparison to the forefoot the midfoot fit is snug and secure. The minimally supported mesh wraps around the foot and any sense of width in the forefoot is forgotten with a secure feel through the shank of the shoe.
- Heel Counter: The firm heel counter and foam cushioning is a little harsher than other brands but therefore doesn’t choke the ankle. Overall it helps the streamline feeling of the shoe.
- Orthotics: This shoe has been well loved by podiatrists in the past and the current generation is no different. The firm heel counter, neutral wave plate and firm ride works well with any device.
RIDE: This is not Mizuno’s softest neutral shoe and therefore the ride is on the firm side. Therefore for runners who like a plush ride they are better suited to the Enigma 5. However the Rider does give a firm and responsive ride that is comparable to high mileage training shoes, high praise for a much more supportive shoe
CONCLUSION: The Mizuno Rider 19 continues a tradition built up my its predecessor for a shoe that functions like a heavy neutral running shoe but feels and performs like a lightweight racing flat. It works well for the runner with a neutral to mildly pronating foot or those with orthoses. Its ideal for the runner who wants a lighter shoe but requires more stability than the performance biased options.
- Runners with a reasonably neutral foot type
- Runners with orthoses
- Runners requiring support but looking for a lighter weight option
A native from the Netherlands Natalie van den Adel has joined the McKinnon Cougars State Championship Team. At 25 Natalie has already had a spectacular career.
Natalie started playing basketball at the age of 8,after winning back to back National Championships and receiving MVP honors at 17 for her hometown club, she left to play for Colorado State University, USA where she would stay for 2 years.
In 2012 & 2013 Natalie returned to her hometown club in the Netherlands, playing for the Senior Womens Team (highest level in the Netherlands), winning back to back Final Four Gold Medals and an MVP award.
After a season in France, one of the best leagues in Europe, Natalie moved to play in the Liga Femenina, the highest division in Spain. Finishing her second season with C.D. Zamarat in Zamora would lead her to Australia, where she is now a member of the McKinnon Cougars State Championship Team.
Since she was 15 Natalie has been a member of the National Team of the Netherlands. She has played 6 youth European Championships, winning a Gold medal with her U20 team. At the age of 20, Natalie made her debut in the Senior National Team and she has been a member since.
It is great to have Natalie here in Australia, she is a very welcome addition to the Cougars Championship team. We look forward to continuing working with Natalie and the rest of the team for the rest of the season.
- Allow your child to go barefoot as much aspossible, especially as they learn to walk, it enhances their balance, sensory ability and improves their muscle strength. Studies show that children with the healthiest and most supple feet are those who habitually go barefoot.
Common Finger Injuries
When playing ball sports such as football, basketball and netball, players are at risk of thumb and finger injuries. In particular basketball players often incur a sprained (jarred) finger or a more severe joint dislocation. Continue reading “Common Finger Injuries”
This is a warning for those runners who have been loyal to the Asics GT2000 model and have updated their shoes. The Asics GT2000-3 is significantly different to the Asics GT2000-2 and all previous GT2000 models. Asics have re-engineered the GT2000 a shoe that has been consistent for years. Similar stories can be read about the Kayano and Nimbus models. Continue reading “Asics GT2000 Update”