The Benefits of Massage

By Dom Walker

As a cyclist and sports massage therapist who has been treating cyclists and runners for a number of years, I am often asked whether a regular massage can be a beneficial component to a training program.

The simple answer is absolutely! A regular massage will help improve your movement, increase circulation and promote recovery and in turn improve performance however, the key word here is REGULAR.

Massage shouldn’t be seen as a luxury or indulgence and only used when every muscle and tendon in your body has seized up but, as an integral part of your training with a therapist who understands sports massage and your body.

Here’s the reason why…..

One of the great benefits of massage is that it relaxes tense muscles, improves joint range of motion and reduces the potential for injury.

Cycling and running requires sustained, repetitive muscle contractions, the greater these contractions, the more force is generated and in turn the more muscle fibres are recruited and therefore shortened. Whilst all this translates into increased power, speed and distance, it also means adhesions and minor scar tissue forms between the muscle and the surrounding fascia. Left untreated, it is these adhesions and unwanted muscle tightness which can restrict movement and joint range of motion which over time can lead to abnormal movement patterns that can cause overuse injuries.

Recovery is another benefit of massage. Regular massage can help reduce pain and the intensity of muscle soreness following a big run, ride or swim. Pain can alter how we move and even inhibit healing so, a well timed massage can help us get out of that stress dominated response of our nervous system and into a more relaxed state.

Massage can also improve the circulatory system delivering increased oxygen and nutrients to muscles. Better circulation means better recovery however, one thing to keep in mind and contrary to popular belief, massage won’t clear out the lactate or lactic acid build up in your muscles. Lactate is cleared from your system fairly quickly once stopped and is not the reason for muscle soreness which is actually caused by cell damage in your muscles.

Cycling and running go hand in hand with massage but it is important to remember that the benefits are cumulative. A one off massage here and there will provide some relief for a short time but won’t give you the same benefits when used as part of your training plan – quicker recovery, injury prevention and the benefit we all want, improved performance.

Dom Walker is a Remedial Massage Therapist and leads the massage team at Physiosports Brighton. See his full bio here http://physiosports.com.au/physio_staff/dom-walker/

Mastering Load 3 : Training Load and Injury – A Cycling Coach Perspective

In the first blog of this series it was mentioned that when it comes to fit there has been more of a focus on performance than injury prevention. This is also true for the load modeling that occurs in the sport of cycling; training load is managed more to optimize performance than prevent non-traumatic injury. In this blog we will investigate the potential that properly managed training load has the serendipitous effect of also helping to prevent non-traumatic and overuse injuries in cyclists.

Performance load modeling was first developed by Banister et al in 1975. Their model was based on heart rate (HR) during training bouts. Later, training load models that used power as a metric to determine training stress were developed and used Banister’s model as a base. This method of modeling training load for cyclists via power data vs. HR became viable mainly due to two factors:

1) HR correlates with the power output for an individual at a given training status and

2) the advent of portable power meters that cyclists could utilize to track power output during training and racing scenarios- outside of a lab setting.

Power based training load models have attributes that could be argued advantageous in modeling for injury prevention. 1) While not scientifically validated in most cases, these training load models are commercially available for cyclists and coaches to use and can be easily accessed via the internet. Couple this with the automated data upload that many cycling computers offer and data management becomes very easy. 2) Modeling training load with power better represents overall mechanical load vs. using HR which more a measure of internal stress.

Of the commercial training load models, Performance Management Chart (PMC) developed by Dr. Andrew Coggan and marketed via Peaksware is one of the most popular.

Figure 1. shows the training load modeling for an athlete over the time span of one year.
PM

Figure 1- Training load modeling for a cyclist for one year. Each red dot represents a workout and its corresponding training stress. The blue line represents fitness, the purple line represents fatigue, and the yellow represents freshness.

The Coggan method of modeling training load relies on some basic sport science ideas that have rebranded. The first idea is the idea of “threshold”. With the Coggan method “threshold” is defined as the maximum power output an athlete can maintain for 60 minutes. It is officially named Functional Threshold Power (FTP). Another concept unique to the Coggan model is the idea of normalized power. Normalized power (NP) was developed mainly because the average power (and kjs of work) for a ride or race doesn’t necessarily correlate to its physiological stress. This is especially true with rides/races that have high amounts of intermittent bursts of power. NP and FTP, along with workout duration are used to calculate an athlete’s training stress score (TSS) for a particular workout/day. TSS is the underlying data point that is compiled and utilized in the Coggan model and used to calculate Fitness, Freshness, and Fatigue for an athlete.

Fitness, know as Chronic Training Load (CTL), is calculated by an exponentially weighted rolling average of the last 42 days’ TSS. It shows up as a blue line in PMC. An athlete’s fatigue is known as Acute Training Load (ATL) and is again calculated with an exponentially weighted rolling average, but instead it defaults to the last 7 days. ATL is a purple line in PMC.  Freshness is calculated by subtracting ATL from CTL. This is called Training Stress Balance (TSB) and is illustrated with a yellow line in PMC.

Training load modeling has allowed for coaches and athletes to break away from classical and block periodization and still see gains. When these schemes are often employed an athlete can go a whole or multiple microcycles of training (e.g. a week or more) without returning to a “fresh” state. One could argue this might lead to a higher chance of overtraining syndrome and illness. On the other hand, cyclists utilizing a functional non-linear periodization scheme (as seen above in Figure 1) coupled with training load modeling, can potentially be in a “fresh” state once or twice a microcycle and still see gains. This helps to ensure that stress from training load is not too high too soon or for too long.  This is especially important for cyclists who are building back fitness after coming back from time off of the bike (e.g. after traumatic injury, health issues, seasonal breaks).

In Figure 1 notice that there is a quick and drastic decline in CTL in the middle of the graph. Also note that there are a group of TSS data points clustered around zero on the x-axis. In reality this athlete had a bad crash in a race that forced them off of the bike. You can see their CTL dropped to the levels they had in January. Interestingly, their interval power numbers matched the numbers they were putting out during that time. You see the athlete’s return to fitness over the course of the next month or so. One thing to also point out about this particular incident is that the athlete’s FTP was not retested/reentered into PMC after the crash/loss of fitness. This would have decreased the accuracy of the model. But, as many practitioners know, best practice for an athlete does not always include testing them. In many cases it is better for the overall scenario if testing can be avoided.

In rugby, cricket (Gabbett 2016) and athletics (Raysmith 2016), an increase in injury risk has been shown with spikes of increased load, troughs of unloading (Drew 2015), or unloading due to an initial injury, and inadequate chronic load (pre-season training). It has been suggested that the chronic load (long-term): acute load (short-term) relationship is extremely important in training load injury management.

In conclusion, at this time the idea that training load modeling can help prevent cycling injury is merely a hypothesis based on evidence from other sports, anecdote and reasoning (and some may say it is actually more conjecture). We do not believe this is problematic for the obvious reason that anecdote drives research questions and therefore our understanding of sport.

Cycling coaches are in the unique position to have the data required to monitor training load at their fingertips, so in recording data there is no cost or burden to the cyclist above and beyond something they would normally do to increase performance. If injury prevention is an unexpected side effect of training load modeling for performance then we might already have the answer to mastering load in cyclists.

 

Jason Boynton, M.S.
Postgraduate Student– Exercise and Health Science
School of Exercise and Health Sciences
Edith Cowan University

j.boynton@ecu.edu.au
http://www.boyntoncoaching.com/about/

How do we analyse loading in cycling: Part 2

The cycling kinetic chain

In part 1 of this series, we introduced the concept of “Mastering Load” in cycling, essential knowledge for treatment and injury management, with its inherent requirements being a knowledge of:

  • tissue reaction to load,
  • tissue pathology,
  • the mechanics of cycling,
  • cycling kinetic chain deficits,
  • how to analyse and reason the findings of local, entire kinetic chain and whole body assessment
  • interpretation of training loads and wellness measures

Whilst we have touched upon the lack of ‘conversation’ regarding the cycling kinetic chain and its relationship with injury, there have been informed commentaries in the past eschewing a kinetic chain approach:

Gregor, in his classic review paper of 1996, commented “knowledge of….load sharing among all segments responsible for the co-ordination of energy delivery to the crank is important..”

In that same review he quoted Van Ingen Schenau, 1989,

“…uniarticular muscles are power producers and bi-articular power distributors….”.

FACT: The kinetic chain approach to analysing pedalling is a viable construct

As a background I think we must explore the “Perfect” vs “Imperfect” technique of pedalling, and how this imperfect technique can be a source of pain or injury. And what the measures are which guide us in assessing that a pedal stroke is imperfect – kinematics, muscle activation, co-ordination, strength, length-tension relationships, force, power, posture?

ACTIVATION

In the area of normal muscle activation in the pedal stroke, the historical perspective was simplistic, with the more realistic pattern represented in figure 1

 Figure1FIGURE 1 – MUSCLE ACTIVATION in the CYCLING PEDAL STROKE

(TDC = top of pedal stroke; BDC = bottom of pedal stroke)

 

 

 

 

 

 

 

 

 

 

 

And whilst the gluteals and quadriceps are seen as the main muscles for power production, co-ordination of the pedal stroke utilizing the hamstrings and calves seems an important feature of “perfect” pedaling (Blake 2012).

Note the extensive range of hamstring activation, as well as the calf, especially in the power phase, in an agonist/antagonist relationship to control the pedal stroke.  Also the activation of tibialis anterior, and vastus lateralis and medialis, at the end of the recovery to prepare to push over the top of the pedal stroke.

The most efficient pedaling needs to maintain power at the top and bottom of the pedal stroke (Dead Centres – Leirdal 2011). Given that the peak of power is at 3 o’çlock on the clock-face, maintaining power at the Top Dead Centre (TDC) and Bottom Dead Centre (BDC) becomes a challenge of co-ordination/activation.

CO-ORDINATION

Blake (2012) looked at muscle co-ordination patterns in cycling, finding that peak efficiency occurred at 55% VO2 max, with efficiency being the relationship between power output and metabolic cost. At optimal efficiency there was an even spread of activation levels between the muscle groups, but as the workload increases, there was a greater emphasis upon the power muscles (GMx, VL, VM), and less efficiency (least at 90% VO2 Max), with a higher level of variation in the timing of the co-ordination muscles (Hamstrings, RF, Gastrocnemius).

EMG Intensity Maxiums

 

 

 

 

 

 

 

 

 

 

 

 

Blake showed that the GMx and VL/VM are the power muscles acting vertically, but with the VL/VM activating earlier in the pedal stroke at higher workloads, and GMx increasing the most relatively, as workload increases. An increase in the work done by the power muscles relative to the co-ordination muscles is a common theme with increased workload and fatigue states (Dingwell 2008, Bini 2010).

Periods of high workload (hills/powering) and fatigue have a relationship with the clinical presentation of pain in the cycling community. Rarely does pain present in “easy” riding.

The GMx has the greatest potential for increased power as it functions at low MVC at maximum efficiency. One can imagine it, and the VL/VM being the gears, and the co-ordination muscles the clutch, allowing for synchronous change in gears and timing of activation. So the “gears/power muscles” increase their activation level significantly with increased workload, whilst the co-ordination muscles don’t increase their activation for power, but they function for smooth transmission of the power, especially in the TDC/BDC positions.

The idea that the hamstrings and calf muscles work synergistically with the power muscles to co-ordinate the fast and powerful moments of hip, knee and ankle extension resonates well from a movement analysis perspective, with early activation of quadriceps and tibialis anterior at TDC to gain a good angle for the horizontal vector component, also a notion that makes sense. Add the strong and smooth transmission of force to the pedal through ball of foot contact and good foot and ankle range and position, and the proposed model of power and co-ordination presented by Blake is highly usable for the physiotherapist in optimising efficiency and injury prevention in cycling.

The co-ordination correlate on the bike is high cadence pedaling (100RPM+), with riders who struggle with their co-ordinative muscle activation finding it difficult to maintain a smooth pedal stroke and “bouncing” around on the seat. Practice of high cadence pedaling is common in well-trained cyclists – therefore the practice of optimising co-ordinative patterns exists.

So the higher the workload, the more dominant the power muscles become, with a less efficient and more vertical pedal stroke. If the power muscles are deficient other muscles must fill the gap as workload and fatigue increase. Riders with poorer co-ordination will use the power muscles more at lower loads, with earlier fatigue, less efficiency and greater potential for adverse kinematics.

FACT: There is a “more perfect” way to pedal which may influence injury risk.

KINETIC CHAIN

As a clinician analyzing the cycling kinetic chain for a relationship between pain/injury and a posture, movement or strength parameter, one soon realizes that the evidence is minimal and not strong.

We look to use the evidence base, to extrapolate from “on-land” activity theory, to use performance based knowledge, and clinically reason the findings of a thorough assessment in best practice management.

Evidence

  • Lower back pain if there is Increased Lumbar Spine Flexion (Van Hoof 2012, Salai 1999, Burnett 2004, Schulz 2010)
  • Knee pain is associated with increases in knee abduction and ankle dorsiflexion (Bailey 2003), as well as hamstring muscle inco-ordination (Dieter 2014)
  • Cycling volume (Andersen 1997, Akuthota 2005) is associated with neuropathies of the hands, feet and saddle area
  • Handlebars lower than saddle (Partin 2014) is associated with saddle neuropathy

Extrapolation to Land based presentations:

  • Gluteal Deficit is associated with patella-femoral pain syndrome (PFPS) (Souza and Powers 2009) and patterns of “anterior hip overload” (Lewis and Sahrmann 2008)
  • The ankle joint is required for load dissipation – a first order worker (Zhang 2000)
  • Quadriceps weakness is a risk factor for PFPS (Langhorst 2012)
  • Dynamic Knee Valgus is associated with PFPS and ITBFS (Powers 2009, Fairclough 2009)

Performance based parameters:

  • Knee Angle at Bottom Dead Centre (BDC) STATIC 25-35 degrees (Peveller 2007); DYNAMIC 33-43 degrees (Fonda 2014)
  • Force Transfer foot-pedal is mainly ‘ball of foot’ (Gregor 1996)
  • Fatigue/High VO2 leads to increased use of POWER muscles (Blake 2012), increased DF (Bini 2010) and Knee Splay (Dingwell 2012), increased lumbar and pelvic lateral flexion (Sauer 2007, Chapman 2008)
  • The gluteals and quadriceps are important for power; hamstrings and calf for co-ordination (Blake 2012)

FACT: Plumb Line measures and fore-aft seat measures are not represented in the evidence.

SUMMARY

It would seem that key features of the CYCLING KINETIC CHAIN are lumbar spine position, degree of lateral pelvic tilt, gluteal and quadriceps muscle ability, degree of knee valgus (splay), the ability to be smooth and co-ordinated in the pedal stroke, knee angle at BDC, ankle DF angle and ankle joint ability and the point of force application foot to pedal.

CONCLUSION

Pain and injury in the athletic population is complex in its aetiology. Clinical reasoning is essential to optimising management, and in cycling understanding the knowledge base regarding the interaction between the body and the bike is an important cornerstone to expert practice. The kinetic chain approach to analysis of cycling injury is a valid pathway and will bring cycling injury management to a level similar to other high performance sports.

 

Paul Visentini is a Specialist Sports Physiotherapist, with his awarded sub-specialty in the area of lower limb tendinopathy.

Paul is a keen recreational cyclist and is highly involved in teaching and management in the area of Cycling Injury, ‘PhysioBikeSetUp’ and ‘Mastering Load’. He has been involved in Cycling Injury Management at both elite and recreational level, and is undertaking his Doctorate in Physiotherapy, investigating “Clinical Measures of the Closed Kinetic Chain in Cycling”.

Paul will be presenting at the Mastering Load Symposium 3 & 4 June 2017 in Melbourne visit physiosports.com.au/courses/ for more information. Email laura@physiosports.com.au for a registration form.

Stay tuned for:
PART 3: Training Load and Injury : A coaches perspective

CYCLING Mastering Load – How do we analyse loading in cycling: Part 1

 

compressedCYCLING Mastering Load is not a hot topic of discussion in journal articles or blog spots, not-withstanding the significant levels of
non-traumatic injury or pain suffered by cyclists both recreational and elite (DeBernardo 2012, Clarsen 2010, Dannenberg 1986).

Mastering Load implies a detailed understanding of the features and characteristics which can influence non-traumatic injury.  More recently there has been strong emphasis upon training load and its influence upon injury, from thought leaders such as Tim Gabbett, Yann LeMeur and Michael Drew, but mainly related to rugby, cricket and Australian football.

Historically, injury management practitioners have analysed mechanical components of movement such as kinematics, vertical ground reaction forces and muscle activation to predict and/or explain tissue overload.  Jumping and landing theory gives evidence of the ability to change mechanical loading characteristics during activity, and current concepts in the management of patellofemoral pain syndrome (PFPS) and anterior cruciate ligament (ACL) rupture also have mechanical deficiency and subsequent rehabilitation as key tenets (Hewett 2006).

FACT: We can change mechanical loading AND it is important in injury management.

What about cycling?

The Mastering Load conversation is not quite as evolved in cycling, and is complicated by the nature of cycling, which of course involves a bike.  The emphasis regarding the mechanics of cycling has always been focused upon bike geometry and rider set-up to the bike.  There is little or no discussion of the mechanical ability of the body, as there is in PFPS or ACL injury.

Power production, VO2 max, joint moments, seat height, knee angle, fore-aft seat position are all parameters measured in cycling research, but a recent systematic review of cycling non-traumatic injury  related research (Visentini 2015, in press) found no evidence that these parameters are related to injury.  The emphasis in research has been upon performance.

FACT: Most bike set-up theory is not based upon injury data but performance data.

There is some evidence that excess lumbar flexion is related to lumbar pain (Van Hoof 2012), and that volume in cycling relates to altered nerve conduction (Akuthota 2005, Anderson 1997).  There is softer evidence that excessive dorsiflexion in the pedal stroke as well as knee valgus in the frontal plane could be related to knee pain.

FACT: Body related parameters have a relationship with cycling injury/pain.

What if?

Taking on board the theory of mechanotransduction being a cellular reaction to mechanical load (Khan and Scott 2009), what if a cyclist suffers a fall and subsequent back pain, which can affect gluteal muscle activation.  At times of peak power the cyclist has been shown to maintain power levels regardless of the activation pattern.  In this case the gluteals may be deficient and the other power group, the quadriceps, need to work 15% harder.  What effect on the articular cartilage matrix of the retropatellar surface with this increase in patella-femoral compression force (PFCF) due to an increase in the quadriceps moment arm (McLean and Blanche 1994).  Isn’t this like a training load error – increasing local loading by 15% as compared to the same session the previous week?

FACT: All non-traumatic pain or injury in cycling is essentially an error in loading which causes a cellular and matrix response.

The clinical reasoning process in cycling injury management requires a knowledge of the cycling body, bike set-up, pedaling mechanics and activation, training load measurement and analysis, and tissue response characteristics.  In essence a “mastery of loading” is required to best manage the cyclist in-clinic.

 

Paul Visentini is a Specialist Sports Physiotherapist, with his awarded sub-specialty in the area of lower limb tendinopathy.

Paul is a keen recreational cyclist and is highly involved in teaching and management in the area of Cycling Injury, ‘PhysioBikeSetUp’ and ‘Mastering Load’. He has been involved in Cycling Injury Management at both elite and recreational level, and is undertaking his Doctorate in Physiotherapy, investigating “Clinical Measures of the Closed Kinetic Chain in Cycling”.

Paul will be presenting at the Mastering Load Symposium 3 &4 June 2017 in Melbourne visit physiosports.com.au/courses/ for more information. Email laura@physiosports.com.au for a registration form.

Stay tuned for
Part 2: Breaking down the cycling kinetic chain
Part 3: Measuring Cycling Training Load

Ice Ice Maybe?

A lot has changed in sports medicine over the last few decades. With an obvious shift towards evidence based practice, treatment modalities that were once the foundations of our injury management are being investigated and replaced when research cannot support their use. This is evident again with the role of icing, or its scientific name cryotherapy, in injury management.

Dr Gabe Mirkin coined the acronym RICE (rest, ice, compression, elevation) in 1978 advocating the use of ice to reduce swelling and inflammation in the acute stage of injury management. The rationale for the use of ice was that cooling the injured area results in reduced blood flow and limits inflammation and swelling leading to improved tissue healing.

But inflammation is a vital component of healing cascade, the increased blood flow to the area supplying the injured tissue with oxygen, inflammatory cells and hormones to clean up the area and trigger a proliferative phase that leads to tissue regeneration.  On today’s evidence, inhibiting the body’s inflammatory response may actually lead to incomplete healing. This has been scientifically proven with regard to the use of non-steroidal anti-inflammatories in acute injury management, maybe its time we consider the effects of cryotherapy in the same way.

The flip side of this argument is that an uncontrolled inflammatory response may lead to excessive swelling and pain. POLICE (protection, optimal loading, ice, compression, elevation) is the new acronym for acute injury management protection with optimal loading being considered the most important elements of the program. Optimal loading encompasses the principle of mechanotherapy where tissue loading results in a cellular response leading to positive structural change. Excessive pain and swelling may diminish the individual’s ability to load the injured area effectively. In this case ice may play a role as an analgesic or to limit excess swelling allowing for controlled early loading.

How long does ice need to be applied for to have a positive analgesic effect without having a negative impact on the tissue healing process? Unfortunately there is no clear answer for this. The impact that ice will have on cooling injured tissues will be dependent on the depth of the injured structure, surrounding adipose tissue and muscle bulk.

There is a lack of evidence either way, which is largely the point. We have used ice in injury management as dogma but maybe its time to start using our clinical experience and knowledge of physiology and tissue healing to determine when cryotherapy is appropriate and in what dosages. Even Dr Mirkin, the man behind RICE, has changed his mind and thinks that excessive icing after injury has a negative effect on tissue healing.

Ice is not the enemy of tissue healing. Inflammation and pain are a normal and a required physiological response to injury. The evidence is not calling for ice to be banned from our acute injury management. The advice we give our patients should encompass the facts that a controlled inflammatory response is vital for good tissue healing and that ice can be used to reduce pain and excessive swelling to allow for early protected loading.

A delicate balance exists between protection to prevent further insult to damaged tissues and our interventions to speed up recovery. Every patient should be assessed and considered on their merits and our intervention, even acute injury management, should be tailored to their specific injury.

As the title of this blog says – Ice Ice Maybe?

References:

  1. Bizzini M. Ice and modern sports physiotherapy: still cool? Br J Sports Med 2012;46:219
  2. Bleakley CM, Glasgow P, MacAuley DC. PRICE needs updating, should we call the POLICE?
Br J Sports Med 2012;46:220–1.
  3. Bleakley CM, Glasgow P, Webb MJ. Cooling an acute muscle injury: can basic scientific theory translate into the clinical setting?
Br J Sports Med 2012;46:296–8.
  4. Khan KM, Scott A. Mechanotherapy: how physical therapists’ prescription of exercise promotes tissue repair. Br J Sports Med 2009;43:247–52.
  5. Mirkin G – http://drmirkin.com/fitness/why-ice-delays-recovery.html
Steve Whytcross (FACP)
Steve Whytcross (FACP)

Steve Whytcross is Specialist Sports Physiotherapist (awarded 2015) with a special interest in lower limb overuse injuries and load management strategies. Over the last 16 years, Steve has worked extensively in both Australia and the UK and has previously worked in elite soccer, tennis and Australian Rules Football. With an ongoing dedication to professional education, Steve has co-developed and delivered the “Mastering Load” series (2008-present) and Science of Cycling course (2013-present). Steve has presented for the APA on the use of new technology in physiotherapy, and has a special interest in bike set-up and the integration of technology in assessment, rehabilitation and feedback.

Common Rowing Injuries and Prevention

Rowing is a fantastic sport to undertake in both a social and competitive way. Rowing programs are a large part of many school sport curricular, especially in Melbourne.
Rowing is a great sport for strength, cardiovascular fitness and general well being. However, because of the nature of the sport and time spent training, there are many injuries that can, and do occur.

Common Areas of Injury in Rowing:

  • Lower Back – The force going through the lower back and the constant movement through the area makes this the most common injury to sustain. These back injuries range from muscle and joint overload, disc injury and stress fractures
  • Knees – Especially knee cap alignment injuries with the consistent workload going through the legs both in the boat and in the gym
  • Ribs – In elite and sub elite rowers, rib stress fractures are prevalent, caused by the constant pull of the muscles in the area associated with the rowing stroke
  • Shoulders and Upper Back – a common area of overload with technique and work load
  • Wrists – Swelling around the tendons of the wrist due to repetitive “feathering” or movement of the wrist with the oar.

Main risk factors for injury

  • Poor rowing and gym technique
  • Lack of strength and flexibility
  • Over training
  • Poor posture

How to prevent Injury

  • Work closely with coaches on technique
  • Undertake a Rowing Specific Assessment at Physiosports Brighton in order to identify any physical deficiencies that are present
  • Stretch and warm up well
  • Maintain general fitness levels

The ideal scenario is to prevent injuries. If you are involved in rowing and wish to have a Specific Rowing Assessment please contact Physiosports to arrange a time with one of our Rowing Physiotherapists. If you experience any of the above injuries, early diagnosis and treatment is the best way to ensure the least amount of time is lost on the water.

Happy Rowing!!!!

Michael McCloskey
Physiotherapist
Director, Physiosports Brighton
 

Load, Load, Load.. Blah, Blah, Blah!

I have enjoyed the recent papers and the more recent twitter-fest discussing LOAD MANAGEMENT.

A great conversation for sports injury managers and practitioners to be having. Do we need to prove that it works? Can we prove that it works? Has it been proven by authors such as Gabbett (BJSM 2016, 50: 273-280), by analysing training loads?

The best practitioners have one thing in common – they are experts in clinical reasoning – the ability to analyse and problem solve.  Clinical reasoning is immeasurable, like the art in our science, or the science in our art. Load management is similar – there are so many factors and variables that it might be impossible to isolate, and control for, in any type of meaningful research. With so many variables, taking a single aspect of load management or a collection as per many scoring systems, may ignore another more important component.

Perhaps the only way to research load management would be the pragmatic intervention, of the expert vs novice practitioners managing randomised groups….who has the better outcomes?

So many components to consider: volume, frequency, intensity, type of activity, periodization in/out of season, pre-season training volume and quality, type of force, direction of local loading ( ie tendon compression vs tensile), stress, sleep, fatigue, diet, abdominal adiposity, hormones, systemic disease, local and global forces and mechanics, the cellular response, the local tissue response, the response of a joint or an entire closed kinetic chain, fear, catastrophizing, motivation and other psychosocial components, central sensitisation, peripheral sensitisation, genetic differences……

Think about the many things that may potentially effect the function of the cell and related tissue – this is what the expert practitioner does.

Perhaps we ought to conceive that load management is not an intervention like the use of blood products to enhance tissue change.  Load management can be viewed as the product of an analytical process within the clinical reasoning framework.

Load management, or “mastering Load” includes mechanotherapy, pain management, education, strength, activation, mobilising, fitness training, relative resting, and nearly any other intervention utilised by injury managers.

Whilst difficulty in researching shouldn’t preclude us from the attempt, perhaps we are best served educating our practitioners in load management, in all its complexity. We should encourage engagement via publications from Cook and Purdam (BJSM 2014; 48: 506-509), and from Glasgow et al (BJSM 2015;49:278-279), and others, as well as in the tweets and editorials.

We should all be MASTERS of LOAD, and in doing so, help patients to master their injuries.

 

Paul Visentini (FACP)Physiosports049

Paul Visentini is a Specialist Sports Physiotherapist, with his awarded sub-speciality in the area of lower limb tendinopathy. He also completed post graduate studies in Manipulative Physiotherapy in 1994, and designed the “VISA Score”, a widely used functional outcome measure for Patellar Tendinopathy.

Paul is a keen recreational cyclist and is highly involved in teaching and management in the area of Bike Set-Up and ‘Mastering Load’. He has been involved in Cycling Injury Management at both elite and recreational level, having consulted to the AIS in Varese, and is undertaking his Doctorate in Physiotherapy, investigating “Clinical Measures of the Closed Kinetic Chain in Cycling”.

Paul has a special interest in muscle activation and load sharing in the closed kinetic chain, especially in cycling.  He is a leading clinician in Melbourne, Australia, and has a passion for cycling injury management, the evidence base involved, and the clinical reasoning process required to achieve the best result.

The ‘ScienceOfCycling-Injury Prevention’ is a platform for the education of Cycling Injury Practitioners world-wide, and the associated course has now been presented by Paul in Melbourne, Varese and Newcastle.

The ACL Conundrum

By Steven Whytcross

One of the issues I have with the sports medicine community is our habit of following trends, especially in the case of jumping on the back of the latest research article to justify our “evidenced based practice”.

Over the last few years some fascinating and potentially game changing research has emerged regarding ACL injuries. The evidence shows that

  • Not all ACL injuries require surgery to return to sport
  • ACL reconstruction does not reduce osteoarthritis in the knee
  • Almost half of the people who have an ACL reconstruction stop participating in their competitive sport after surgery

Continue reading “The ACL Conundrum”

Kids’ Heel Pain: The Sever’s “Epidemic”

Heel pain in active children is incredibly common, and one often hears the question as to why it seems that half a team suffers from pain in this area.
The likely cause in 8-14 year old boys more than girls is Sever’s disease. Sounds worse than it is.
In physio speak, it is a traction apophysitis of the calcaneal attachment of the Achilles tendon. In layman’s terms, the Achilles attachment to the heel bone in young children is cartilage. Through the growth phase into puberty, this cartilage attachment is transitioning into a tendon-bone attachment, but through different stages of development can be weaker than others. Those ‘weaker’ stages coincide with growth and poorer mechanics, as well as increasing amounts of sport for children. So the ‘weaker’ attachment is overloaded and becomes inflamed.apophysis
Eventually, the attachment matures at anything from 12-14 years of age but, in the interim, what can be done to help?
First and foremost, rest is rarely a great fix for active boys and girls.
Treat the inflammation with regular ice after activity and find a load (amount of sport) that one can tolerate.
Most importantly, improve the mechanics of the entire leg. The better the mechanics, the less overload. This may include better shoes or boots, heel raises, calf strength, calf extensibility (massage and stretch) and other management strategies.
A good assessment and a management plan is essential.
The message is – Sever’s disease can be improved! You can have less pain and better function with the right management!  Make sure you see a practitioner who is a physiotherapist or podiatrist who is involved in sports. At Physiosports our management of poor mechanics is second to none, and our podiatrists have ASIC and NIKE shoes on-site, to trial in a FOOTWEAR ASSESSMENT, to help you find the best shoe for your children (size 6 upwards).

Paul Visentini (FACP)
Director Physiosports Brighton