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Rehabilitation of injury is not just about reducing pain levels. A full rehabilitation should involve a progressive strength and conditioning program and a progressive increase in activity/sport/work.
As physio’s we are always asked “how long will i be out?” and ” when i can play sport again?” or “can i go for a run tonight”?
Those questions can sometime be a little difficult to answer and it is not always as clear cut as you might think. We have a good idea on “average” timeframes for the body to heal, e.g. a moderate ankle sprain should take around 4-6 weeks to fully rehab and get back to a high level of performance. But we don’t always know how well a specific structure (e.g achilles tendon) will tolerate loading. So one important aspect of return to sport decision making is the fitness test. The classic fitness test 10 or 15 years ago might well have been a jog around the cricket pitch and a few “throw downs” in the nets. More modern day fitness testing will not only look at tolerance to quantity of exercise, but also assess the quality of movement.
Here is a very good lecture by Dr Andy Franklyn-Miller on the use of video analysis of functional movements as a clinical tool to assist with return to sport.
The take home message from this is that return to sport is not based purely on an average time frame of an injury or the strength of a specific muscle, but more based on the quality of functional movements and the bodies tolerance to it.
A recent study by Teyhen DS, et al. has found that back pain patients have decreased muscle thickness of the Transversus Abdominus(TrA) compared with non back pain paitients. This TrA is your deepest core muscle, underneath your obliques. The trouble with how deep it is, is that without the help of a real time ultrasound it’s very difficult to know how to activate or get these guys back up and running. Failing to get your TrA activating again is likely going to precipitate a further episode of back pain and so the cycle continues. So do your back a favour and get in to see a Physio to get your abdominals visualised via Ultrasound. Once you have been shown how to activate these muscles time to get in to Pilates where you will be using your TrA throughout!
Dysfunctional gluteal muscles can be the cause of many biomechanical strain injuries. It’s important that from the second we come into contact with the floor our lower limb transmits force effectively through to our pelvis (and hence spine)
Sometimes though in trying to work the gluteal muscles we accidentally develop tension in the front of our hips (a musle called tensor facia lata – or TFL). If you’re training and notice a cramping like sensation in the upper part of your outer thigh/hip region it may be that the muscles you think you are working are not the muscles that are actually being stressed.
Tight, overactive TFL’s can cause symptoms like runners knee (ITB friction syndrome) as the ITB is a fibrous extension of the TFL tendon.
So what can you do about it? Well recent evidence (see this study here) seems to show that exercises like the clam, sidestep, unilateral bridge and hip kickbacks (while on hands and knees) are the best exercises for avoiding TFL’s annoying contribution.
I also get people with overactive TFLs’ to use a foam roller like to knock the tone out of the TFL PRIOR to the exercises above.
Give it a go
Posted in Common Injuries, Physiotherapy, Pilates, Running, Stuart Baptist
Tagged biomechanics, Core Training, Exercise, Gluteal muscles, Gluteus Medius, injuries, Injury Prevention, ITBFS, Pain, pelvic floor muscles, physio sydney, physiotherapists, physiotherapy, re-training, Stuart Baptist, sydney CBD Physio, sydney physio, TFL overactivity, training
Because the Pelvic Floor muscles are not ones we can see contracting it can be a real battle to know how, let alone if, they are engaged. This is a hard one to correct, and I think the most common mistake people have is that rather than recruiting their Pelvic Floor they will instead squeeze their Glutes (Buttocks) as if their life depends on it, and end up with overactivity of the Gluteal muscles.
The result of this can mean that you end up with constant tension in your backside, and unfortunately you’re no closer to strengthening your Pelvic Floor Muscles than when you began. As your pelvic floor muscles attach to the pubic bone, the tailbone and the two sitting bones the contraction is more of a drawing inwards and upwards between the legs, as if you are trying to stop yourself from passing fluid or wind.
As with training any muscle, the pelvic floor muscles also need to relax between contractions, so do give yourself some recovery time as well.
Please contact SSOP to find out more about our Clinical Pilates Classes in Sydney CBD.
Pelvic Floor muscles
The Australian Physiotherapy Association released a link to this article relating to injury prevention through the eyes of a Singaporean physiotherapist. I love the principle – have your movement assessed, and corrected where appropriate, to minimize your risk of injury. The upshot is that your physical performance is usually enhanced too.
While this approach works in theory, the question must be asked as to why more people don’t utilize this preventative approach to keep themselves in shape. Most people don’t turn up to the physio until they’re suffering so much pain that horse tranquilizers would not have an effect. We all pay for gym memberships and fitness classes; we go to the GP for checkups. We even respond to the 12-monthly (or is it 6-monthly now?) reminders to go to the dentist. Curiously, when we get told that no treatment is required, we’re happy to hear it, we pay our money and we move on.
Why aren’t people visiting their physiotherapist for scheduled movement checkups when we know that such a large proportion of injuries can be prevented in the first place?
In my humble opinion, physiotherapy as a profession has not yet demonstrated to the public the merit in addressing movement problems before they become painful.
I am constantly encouraging my patients to take a proactive role in injury prevention. While this seed is usually planted following an injury, the end result is that smart patients maintain a personally relevant shortlist of key movements. They regularly check these movements (often during a warm-up) and work on some targeted exercise if those movements aren’t up to scratch. And it works. The end result is that I only need to see these patients every now and then, and only if they aren’t able to get on top of things themselves. It’s a far cry from the blowout injuries that take many months, and visits, to fix.
That familiar phrase is as applicable as always: prevention is better than cure. With that said if you would like to make an appointment with a physiotherapist please contact us.