Injuries: Bad luck or bad preparation?

When it comes to people who play sport you will find almost everyone has been injured at some point or another. Often, after sustaining these injuries we cite ‘bad luck’ as the main culprit, and think about how, ‘if we only hadn’t jumped in this way, landed in that way, moved in such a way, that we wouldn’t have sustained these injuries’. The truth is luck has little to do with it and the majority of injuries (particularly non-contact injuries) can be prevented with appropriate training and conditioning.

The vast majority of the time it’s not in the way in which we moved in a short period of time that caused our injury, but how we failed to move in various ways over long periods of time and it is this that stopped us from being able to protect ourselves and led us down the road to a place where the risk and likelihood of injury has been greatly increased.
A lack of strength and/or mobility in certain areas can leave us vulnerable to injury. The reason for ‘landing funny’ may be a lot less down to chance, and a lot more down to a lack of knee or ankle stability, someone who ‘has bad luck with their Hamstrings’, may not have had such bad luck if they had a better Quad:Hamstring ratio, stronger glutes, and performed eccentric hamstring training for example.
Combining muscular imbalances and bad posture with the high intensity demands of modern training and competition is a recipe for disaster. In fact over time it’s extremely likely that injury will occur at some point in that scenario, and unless the issue which caused the injury in the first place is dealt with, there is a strong chance of recurrence.

The South African Golfer Gary Player (winner of 9 Majors in his career) once famously said ‘‘The more I practice the luckier I get’’.  It may seem an unusual quote to use when talking about injury prevention, but in order to reduce injury risk (and therefore become ‘luckier’) it’s a must to practice in the right way and do so often.
Thankfully, injury prevention strategies, removing muscular imbalances and improving posture also have a carryover to improving performance.
This is where Strength & Conditioning (S&C) training shows its huge potential as a tool to not only reduce the likelihood of injury, but also improve performance simultaneously.
S&C practices can even be incorporated into a team or individuals warm-up to not only improve their performance and reduce injury for that specific session, but help them gradually improve and become more resistant to injury over time.

  Training to remove muscular imbalances, fixing faulty movement patterns and working on areas where mobility is poor are a must when trying to reduce an athlete’s (or even the average person’s) risk of injury.

S&C and Physiotherapy both have crossover benefits and goals when dealing with athletes and getting them from injury to return to play. Similarly the benefits of assessment and direction from both codes, has huge benefits to the recreational athlete in terms of problem identification and individual targeted conditioning.

S&C professionals and Physiotherapists have key roles in improving a team or individuals performance and reducing substantially the risk of injury.

The paradigm shift in training towards more evidence based functional strength and conditioning puts facilities, individuals and teams that employ S&C pro’s and Physiotherapists to design and implement their training at a huge advantage to those that do not. Training with the professionals who have specific knowledge are highly qualified and have relevant experience in this area is the obvious choice for anyone interested in performing better physically, reducing their chances of injury and looking for targeted results.

Our next few blogs will deal with common injuries, some of the common practices in S&C. 

You too can train in this type of high quality, professional environment, locally. Just contact us on 057 93 41657 now.

DOM DOM DOMMMMMMMMMMMMS...Sore muscles? But why..I thought I was doing good...:"(

The Feeling...

I've Just Started a New Exercise Program and Now I feel Like I've Spent an Hour in The Spin Cycle of the Washing Machine...again:o)...Why Am I Sore in Places that I Didn't even Know I Owned :"(

...sound familiar?

Dom Dom Dommmmmmmmmmm...

Delayed Onset Muscle Soreness...(DOMS) 

Someone asked me today about DOMS and I thought maybe I should write a few lines about it. 

God knows there are times when I've went back to 'legs day' after a lay off - probably booze related - and went lifting the same as I previously was. 
The outcome usually results in doing a good impression of March Of the Penguins for a solid 3/4days. 

So WHAT Are DOMS?

Any type of activity that places unaccustomed loads on the muscles may lead to the phenomenon know as delayed onset muscle soreness. This differs from acute soreness as it typically develops 12 - 24 hours after the exercise has been completed. The experienced pain however may not peak until 24 - 72 hours after the exercise has been completed.

WHO gets DOMS?

Everyone is susceptible to DOMS, even those exercising years. However, the soreness associated lessens as your body adapts to the work it regularly performs. A partial protective effect may develop after even one bout of soreness-producing exercise and reduces the chances of experiencing that same soreness for weeks/months into the future. 

WHY do I get DOMS?

The origins of the soreness and accompanying symptoms are complex. There is a general consensus that the soreness is related to microscopic damage to the muscle fibers involved in the exercise. 
This type of damage is owed to novel stresses being placed on muscles unaccustomed to excessive workloads. 

One common misconception related to DOMS is that the soreness is related to lactic acid accumulation, however, lactic acid is not a component of this process. 

Activities that cause DOMS are related to eccentric muscle action, i.e. when a muscle lengthens while force is applied, e.g. the lowering phase of a bicep curl, your legs controlling your momentum as you jog down hill.

The degree to which you experience DOMS will depend on the type of forces placed on your muscles, e.g. running downhill will place greater deleterious forces on the muscles than running uphill. High weight or repetitions will cause greater damage.  

I've Other Symptoms, does DOMS only produce SORENESS?

Local muscle pain is the predominant symptom of DOMS, however, there are also a number of common additional symptoms which present including:

Stiffness - accompanied by a reduced range of movement at the affected joints

Altered Gait - depending on the joints affected and the muscles involved, normal walking may be difficult

Tenderness - to the touch - 'OUCH....don't touch me'

Reduction in Strength - this is a temporary affect and last days at a maximum

Other more rarer symptoms may present in severe cases:

Muscle Breakdown - so severe that the kidneys may be placed at risk

Elevated Creatine Kinase (CK) - an enzyme in the blood signalling muscle tissue damage

Can I Avoid DOMS?

The single best way to avoid DOMS is to progress slowly into a new exercise program. Easier said than done for those impatient people like myself. 

Allowing your muscles to adapt to the new stress being placed on them will minimize the painful side effects. 

Allowing sufficient recovery time between the same exercises will help. Performance of exercises while enduring painful DOMS can make matters worse and lead to more severe injury.

Adequate warm up is also advisable although there is no good quality evidence to suggest that pre-exercise stretching can help prevent DOMS. Stretching AFTER exercise is much more important. Try 30-second static holds. Stretching won't prevent DOMS but it will help reduce the intensity of some symptoms.

Well I have it Now, How can I get Rid?

There is little conclusive evidence to suggest that many treatment modalities will hasten recovery and return to normal function.  

However, if the primary goal is to reduce symptoms then the following treatments may be beneficial at reducing the painful symptoms experienced:

Massage - nothing too heavy though as this can be very counter productive

Acupressure - once again avoiding excessive pain

Cryotherapy - ice/cold application

Pain Meds - best to avoid is possible, but helpful in severe cases

Light exercise - using the muscles that are sore but does not over-stress them.

Reduction of symptoms doesn't equate with full recovery. muscle damage may still exist and reduced function may still persist.

The Old NO Pain No Gain Principle?

I hear this on a daily basis. 

Pain does not need to be present in order to reach strength targets or fitness status. Pain may however indicate the need to reduce or even avoid certain activities. 
Any acute pain experienced signals a problem with that exercise. 

Any acute pain that persists after exercise should be assessed by an appropriate registered health professional. 

Unqualified 'therapists' will always tell you something, whether rightly or wrongly, and usually try and 'rub' it!!! It's your time, your money and your body at risk. 

A visit to your Chartered Physiotherapist will involve a thorough assessment and the best advice to follow will be given.

Physio Central                T: 057 9322720

Ardan Surgery                 E: info@physiocentral.ie

Ardan Rd                           W: www.physiocentral.ie

Tullamore

Co. Offaly

  

Happy Birthday to Us:o)

Hey guys,

So, Physio Central is approaching it's 1st Birthday this week. To celebrate and to say a thanks for making this venture a success thus far, there's a 20% discount on all new appointments and treatments for the next 2 weeks. WOWZA!!! If your needing some physiotherapy or toying with the idea of getting some physio done well this is a perfect opportunity to sample the benefits of getting some therapy by professionals at a reduced cost. Thanks to all who supported the clinic in the past year, it's been a pleasure and we sure appreciate your support and are grateful for your trust.

https://www.youtube.com/watch?v=anNRry5yfIQ

Custom Made Orthotics (Insoles)

Take care of your feet...they need to last a lifetime

Do you suffer from general lower limb pain? 
Abnormal foot biomechanics is often the root cause of pains, aches and fatigue within your feet, ankles, legs, knees, hips and/or lower back.
What is biomechanics?
Lower limb biomechanics is concerned with how your feet, ankles, knees, hips, pelvis and lower back work in conjunction to support your body-weight and allow you to stand and run. 

What happens if I have abnormal foot function?

Pain free walking and running is accommodated by finely tuned, orchestrated movements which require specific things to happen at precise moments in you lower limbs. When these movements are lacking or out of sync then a variety of problems can occur as the pictures above and to the right illustrate. The body is reactionary. So we know that any deviations e.g at the ankle, will trigger a series of events up the kinetic chain in order to compensate, i.e. knee, hip, pelvis, lower back changes.

How do I know if I have abnormal foot function?
Contrary to popular belief. Pain in the feet is not a normal process. If you suffer pains, aches, and/or fatigue in any of your joints from your feet, to your lower back it may be stemming from abnormal foot function. A good indication is to look at your the soles of your footwear and observe the wear marks. Your symptoms combined with certain wear marks can give a clear indication of abnormal biomechanics.

Normal Heel Wear:
Specifically, the outer border of the heel should have some normal signs of wearing. 















Abnormal Heel Wear:
If the area of wear seems excessive, or if the wear is on the opposite side of the heel then this can be an indication of abnormal foot function.










Normal Heel Cup:
Placing your shoes on the table and having a look at them from behind is another indication of abnormal wear. The shoes should sit level and vertical. 
Abnormal Heel Cup:
However, if they roll excessively to the inside or outside then this will indicate faulty mechanics.

Normal Sole Wear:
there should be normal wear marks under your shoe also. The main area of wear should be under the area of the ball of the big toe. This area of wear is normal due to the pressures encountered as your big toe propels you off the ground










Abnormal Sole Wear:
However, excessive wearing of this area can also indicate faulty biomechanics, i.e. wears thin over a short space of time. Also, no wear in this area can be an indicator aswell as any wearing over the area under the smaller toes of the foot.










:o( This looks like me....What can be done?
At Physio Central, we have developed extensive biomechanical knowledge from working and constantly training in this area. Through detailed history taking and an extensive biomechanical examination including looking at your current footwear a specific picture of how you support yourself on your feet will be developed. To correct any abnormality a Custom Foot Orthotic Device may be prescribed.

'Custom fit...the best fit...Always!!!'

So, What are Custom Foot Orthoses?
Commonly known as insoles, these orthoses are precision, prescription medical devices that are worn inside your shoes. They alter the way your foot contacts the ground and importantly provides specific support to the structures of your foot involved in the complex series of events that are required to allow you to stand, walk and run.

Why Custom Fit?
Custom made foot orthoses are prescribed for your individual condition. Custom prescription ensures your devices are medical prescription and follow the specific contours of your feet. They are long lasting meaning they accommodate your wear into the long term.

There are many cheaper alternatives on shop shelves, but these are merely cheap imitations.
1) They are not medical prescription grade and so, they are not made to fit your feet precisely and control your foot for your individual need. 
2) They also wear out quickly which can certainly lead to exacerbating symptoms in the long term making a bad problem worse. 
3) They are primarily developed to fit a certain shoe size and manufactured to a generic foot shape. 
Ultimately there is a very real chance of these devices causing your body more harm than good.

Importantly, there a number of techniques used to allow us to capture the foot as needed. Some processes and techniques, e.g. stepping in foam boxes to capture foot shape, are inferior to others. 

At Physio Central we use the techniques which follow current best practice guidelines to ensure you get the best device possible.

Sports Orthotics:
It is now well established in the sports medicine sector that custom foot orthoses are a vital part of treatment when dealing with sports related lower limb overuse injuries. They are also recognised to be a positive preventative measure in injury and performance management. Up to Olympic standard the improvement in performance, with decreased fatigue and greater comfort of using orthotics where neccesary is now well indicated.

Additionally:
Custom orthotics are a very effective tool in resolving many lower limb conditions. However, it is just one tool in a multi-modal approach and other treatments are often indicated also.
At Physio Central we work in close conjunction with Biomechanics Foot Laboratory who are one of Europe's precision made orthotic manufacturing companies. 

'Invest in your feet...they deserve it'

Through this valued link we bring you the very best quality products, individual to your needs and at competitive prices

Physio Central,        T: 057 9322720
Ardan Surgery,        E: info@physiocentral.ie
Ardan Rd,                 W: www.physiocentral.ie
Tullamore,
Co. Offaly

Rugby's Greatest

An Ode to the Great Man Himself,,,Down Under's Salute to BOD

Fair dinkum Aussies

Painful Shoulders giving you sleepless nights:o(

Painful Shoulders???

Why though??? Treatment is here...

Painful shoulders, one of the most chronic and debilitating conditions that people present to the clinic with. It happens to be the third most common presenting musculoskeletal condition seen in primary care (Parsons, 2007). Imagine over 54% of people have ongoing symptoms after 3years!!! (McFarlane et el, 1998).

More specifically, rotator cuff pathology is the most common cause of shoulder pain with the problem increasing with age.

What’s the Rotator Cuff?

The rotator cuff is a small group of muscles and tendons that act to stabilize the shoulder. They are deep to you big shoulder muscle the deltoid but have huge importance in stabilizing and accommodating full pain-free movement of the shoulder.

How do I know what problem I have in my shoulder?

There are over 150 specific tests prescribed for identifying shoulder conditions. Many of these are unreliable as Hegedus et al, 2013 confirmed, “Physical test of the shoulder are consistently found to be unreliable and poor predictors of structural pathology”. Unfortunately a lot of unqualified therapists out there try to use many non - specific tests leading to misdiagnosis and delayed healing etc.

However, with an excellent understanding of the anatomy of the shoulder and its biomechanics, your chartered physiotherapist has a number of specific pain provocation and movement tests that can be performed to identify the source of your pain. One of the biggest indicators of rotator cuff pathology is age.

How did I damage them?

Damage can of course arise from trauma to the shoulder but in the older patient, in the main, the rotator cuff is damaged through wear and tear. There are differing thoughts on why the various tendons deteriorate and especially as medical science has improved, previously held views on the mechanisms of injury are been questioned with justification e.g. shoulder impingent.

What to do?

Well there are three options:

                1) Conservative, i.e. physiotherapy, injections

                2) Surgery

                3) Do nothing and live in pain with disturbed sleep and all the other undesirable effects.

Surgery v Physio!!!

Effects of surgery, when compared to supervised physiotherapy are consistently unconvincing. Studies show that surgical intervention results are no better than conservative treatment for Shoulder Impingement Syndrome (SIS) (Dorrestijn et al 2009).

This is the case even considering the dramatic difference in costs. Surgical interventions roughly cost double that of a full course of supervised physiotherapy for the same shoulder condition. All the while results are similar or better (Ketola et al, 2009).

The results of surgery for SIS remain inconclusive with the best results being shown in younger patients.

Additionally, while preparing for surgery a patient may firstly rest. Then surgery is performed after which rest is again prescribed. This is followed by supervised physiotherapy with activity modification in the short term.

The question can be asked, which part of the process is responsible for the improvement in the shoulder condition?

The rest? The surgery? The activity modification? The physiotherapy? Is surgery providing relative rest? (Lewis, 2011)

What’s involved in Physiotherapy for my painful shoulder?

There are generally four stages of a physiotherapy programme for rotator cuff pathology. Your rehabilitation will be matched to the stage of the shoulder problem.

Physiotherapy will involve a multi-modal approach and could include the following:

1) Manual therapy: joint mobilisations, trigger point therapy, dry-needling, soft tissue mobilisation.

2) Exercise: strength, flexibility, endurance of the shoulder. Core stability work,

3) Posture, exercise to correct structural anomalies

4) Scapular control, altering the position/orientation of the scapula to allow for movement

5) Proprioceptive and neuromuscular control – towards end stage

How long will all this take?

The severity, nature and stage of the condition will ultimately dictate the duration of a successful programme, as will patient adherence to the programme.

Even severe conditions given the right rehabilitation should see resumption of normal activities after 12weeks.

Don’t live in pain. Call in and see your Chartered Physiotherapist today.

Physio Central

Ardan Rd,

Ardan Surgery,

Tullamore,

Co. Offaly

E:info@physiocentral.ie

T: (057)9322720

W:www.physiocentral.ie

Foam Rolling and the Mystery of the Trigger Point

Trigger Points and Foam Rolling: The very basics -

These things can get complicated so here's a quick overview:

Every muscle in our body is comprised of millions of fibres. These fibres are surrounded by a structure called fascia which surrounds the muscle like a membrane which we can call Myofascia.

Unfortunately this myofascia is prone to developing painful areas called Trigger Points (TrPs), the so-called knots..

There is a lack of information regarding Trigger Points and their how they occur. That said there are some commonly agreed basics such as:
1)They are tender areas in tight bands of hardened muscle potentially causing a host of symptoms.
2) Trigger Points always cause pain on compression.
3)They prevents full functioning and lengthening of a muscle, weakens the muscle and often results in local or referred pain areas.

How did I get them?
They can develop from muscle overuse, direct trauma to the muscle, muscle overload, stress, poor hydration, posture and/or poor movement patterns to name a few.

A visit to your Chartered Physiotherapist will highlight problem causing Trigger Points and through various techniques the painful symptoms can then be alleviated. Alternatively, between visits, use of a foam roller can help deal with these problem areas and possibly prevent there occurrence through a process of Self Myofascial Release.

Foam Rolling and Trigger Points:

Now that we know what the painful areas in our muscles are, how can a foam roller help?

Well what is a Foam Roller?

They come in many different sizes and materials. The standard foam roller is cylindrical in shape, 15cm, high density foam and either 45cm or 90 cm in length.

How do I use it?

Trigger Points can be found by a little self exploration. They are easy to find when using a foam roller.
1)Using your body-weight against the roller moderate pressure is applied to a specific muscle group.
2)As you move across the roller painful areas will become apparent.
3)On application of pressure to these areas you should stop and relax your muscle as much as possible. Often the experienced pain will begin to dissipate between 10 – 30 seconds.
4) Continue to roll your body against the roller, making slow progress across your targeted muscle group.

(Some areas may be too painful to apply direct pressure, if so you could work around those areas by shifting your weight and body alignment on the roller).
5) You should continue to roll as much as tolerable but avoiding any sharp pain.

In some body parts a more focal point of pressure is required, for these areas a small ball e.g. tennis ball may be helpful.

Avoid rolling directly over bony points and joints.

Then What?

After your foam rolling session you may feel a little sore. This will dissipate also and next session should be more tolerable.

It is extremely important to stretch after foam rolling. Having broken down adhesions, Trigger Points etc your muscles are in a prime position to lengthen. It is an optimal time to stretch and we’re all about doing the minimum to reap the maximum, so don’t loose this window:o).  

Applying a stretch of 30sec min to the muscle groups you targeted in your foam rolling session e.g. quads, calves, gltus etc will result in desirable cellular changes in your muscle fibres and ultimately increase the length of your tight muscles and reduce pain.

For more information or to order your foam roller give us a shout at Physio Central

Stay tuned for some videos of some useful foam roller techniques

Physio Central                                   T: 05793 22720

Adran Surgery,                                  E: info@physiocentral.ie

Ardan Rd,                                         W: www.physiocentral.ie

Tullamore,

Co. Offaly