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Muscle strains are the nemesis of running athletes such as footballers, soccer players and track and field athletes. Despite advancements in sports medicine, muscle strains continue to occur and frequently reoccur during the same season which can have a profound...read more
We don't often think about about what we did as kids and how it affects us later in life. but when it comes to reducing the risk of developing osteoporosis or preventing fractures as we get older, the things we did as kids can have a real impact. Adolescence provides...read more
Low back pain (LBP) is a common injury that many of us will suffer at some stage of our lives and unfortunately for some, it can have a real impact on their quality of life. There is lots of misconceptions and misleading information regarding back pain, what causes...read more
Welcome to the Peak Sports Physiotherapy blog!
I am excited about the launch of this blog as it coincides with the launch of Peak Sports Physiotherapy’s website and physiotherapy clinic which is operating in Wangaratta and Benalla.
This blog is designed to provide and share information about common injuries and conditions that we treat, with the aim of educating the reader’s so they can improve their health and performance.
Here is what you can look forward to in our blog:
- The latest evidence for managing musculoskeletal and sports injuries
- Tips and advice for improving running economy and performance
- Information about load management, strength and conditioning, and recovery
- How to improve physical health and wellbeing
Rules of Engagement:
We invite you to join in the conversation as we explore the different topics. As mentioned above, this blog aims to provide information and education to help others.
We welcome your thoughts and comments, but please ensure they are in the general interest of most readers. Please avoid any offensive language or disrespectful comments.
As this is a public forum, please don’t post any confidential or private information.
Finally, we are happy to answer any questions and welcome suggestions for future topics. If you have any queries, you can email us at firstname.lastname@example.org
Thanks for reading and I hope you enjoy the blog!
Director – Physiotherapist
Peak Sports Physiotherapy
Muscle strains are the nemesis of running athletes such as footballers, soccer players and track and field athletes. Despite advancements in sports medicine, muscle strains continue to occur and frequently reoccur during the same season which can have a profound effect on the fitness and form of the injured player.
Common muscle groups involved include the hamstrings, calves and quadriceps.
But why do they re-occur?
Here are some of factors that may influence the muscle susceptibility to re-injury:
Inadequate rehab following initial injury.
It makes sense that if you try to return to sport before you are ready, then you are a strong chance to re-injure. Rehab is designed to restore your pre-injury function and even improve it. Stretching and passive modalities such as massage and Dry needling can help reduce pain and stiffness temporarily, but it does nothing to address the structural performance of the muscle, therefore it won’t reduce the risk of re-injury.
Some of the key criteria that rehab addresses include:
- Restoring Strength – particularly eccentric muscle strength
- Restoring Power – which is the ability of the muscle to contract quickly (pretty important if your running). This is often neglected but is very important, as it has been shown that power deficits persist even after strength has been fully restored.
- Restoring running capacity – injured muscles have a greater propensity to fatigue with repeated running efforts compared to previously uninjured muscles.
Poor Eccentric Strength:
Eccentric strength training, which is the ability of a muscle to contact while it is lengthening, is an important component to injury rehab and prevention for 2 reasons.
- Most muscle injuries involve a high eccentric force. Eg: the hamstrings slowing the leg down in the terminal swing phase of running. Therefore, being able to tolerate high eccentric loads is a good thing.
- Eccentric exercise increases muscle fascicle length. Long muscle fascicles are associated with a reduced risk on injury
Central Tendon Injury:
The advent of MRI has allowed for more insight regarding muscle injury and severity. In particular, whether or not the muscle strain involves the central tendon within the muscle.
Most muscles, including the biceps femoris in the hamstrings, rectus femoris in the quadriceps and soleus in the calves have a ‘central tendon’ that runs along the length of the muscle (figure 1.)
When the injury involves the just the muscle fibres, the recovery tends to be a lot faster (usually 3-6 weeks). If the injury involves the central tendon, it becomes a different clinical entity. It’s essentially a ‘tendon-injury disguised as a muscle-injury” and takes a lot longer to heal (up to 12 weeks).
Muscle Healing Time-frames:
Just because you can be back playing sport within a couple of months following a muscle injury, it does mean that the muscle is fully healed. A study by Bayer et al. (2018) looked at MRI’s of injured muscles at 3 and 6 months post-injury. They found that the muscle was still far from fully healed 6 months after injury, even though most players were back playing at 2 months. They also found that 3 months after injury, the affected muscle had a reduced in size by about 10%, and this had not changed 6 months after injury.
It goes to show that just because you have returned to sport, it doesn’t mean that the rehab is done. it really does take months for the muscle to return to normal.
Unfortunately, there is a link between getting older and risk of muscle injury. I’m over 30 years old myself so I’m not going to harp on it! The key message is, if you are getting on in your sporting career and you’ve had a history of muscle injuries, it would be in you best interests to improve things like your eccentric muscle strength to reduce your risk of an early retirement.
Thanks for reading, if you have any questions or would like any further information please get in contact with us.
Peak Sports Physiotherapy Wangaratta and Benalla
Bayer et al. (2018). Role of tissue perfusion, muscle strength recovery, and pain in rehabilitation after acute muscle strain injury: A randomized controlled trial comparing early and delayed rehabilitation. Scandinavian Journal of Medical and Science in Sport, 28. 2579-2591
Prakash et al (2018). Connective tissue injury of calf muscle tears and return to play: MRI correlation. British Journal of Sports Medicine, 52, 929-933
Comin et al. (2013). Return to competitive play after hamstring injuries involving disruption of the central tendon. The American Journal of Sports Medicine. 41(1), 111-115.
Lord et al. (2019). Greater loss of horizontal force after a repeated-sprint test in footballers with a previous hamstring injury. Journal of Science and Medicine in Sport. 22, 16-21
Green, B., Pizzari, T. (2018). Calf muscle strains in sport: a systematic review of risk factors for injury. British Journal of Sports Medicine, 51, 1189-1194.
We don’t often think about about what we did as kids and how it affects us later in life. but when it comes to reducing the risk of developing osteoporosis or preventing fractures as we get older, the things we did as kids can have a real impact. Adolescence provides the best opportunity to develop strong bones that will last a lifetime, and even reduce the risk of fractures later in life.
We Reach our Peak Bone Mineral Density shortly after Maturity
During adolescence, it can seem as though kids grow 2 inches overnight. This growth spurt includes their bones as well. In fact, Adolescents develop 25% of their skeleton during this growth period, and by the time they’ve 20 years old, they’ve have developed over 95% of their peak bone mass.
After maturity, bone mass gradually decreases as we age (figure 1). In some cases, if it declines to a certain level, the diagnosis of osteoporosis can be made.
Exercise as Adolescents can help prevent Fractures later in Life.
So, if we develop more bone during adolescence, can it prevent sustaining a fracture or developing Osteoporosis late in life? Potentially yes**. For instance, A study that compared soccer players who had been retired for more than 30 years with aged matched controls (who weren’t particularly active during adolescence), found that those with the background of soccer not only had significantly stronger bones, but had also suffered far fewer fractures later in life.
**there are other factors including genetics/smoking/diet which all effect the rate of bone loss through adulthood.
It’s not just about how much bone we have, but where the bone develops that’s important
During adolescence, there are large numbers of bone-forming cells on the bone’s outer surface. This means that during adolescence, new bone preferentially gets laid down on the outside. This is important as it effectively increases the diameter of the bone, meaning it will be more resistant to bending and rotational forces (Figure 2.)
Imagine two pieces of poly pipe, one that is wide and the other which is narrow… which one is easier to bend?
The reason this is so important is because this really only occurs during adolescence. After maturation, bone growth occurs on the inner surface, which doesn’t provide the same resistance to bending or torsion.
So what exercise is good for developing bone strength?
Exercise that involves running and jumping are great for developing bone strength. Sports such as football, soccer, basketball and netball are all great as they all involve multi-directional movements that would stimulate bone development for different planes of movement.
The other form of exercise that is great for bone development is resistance training. In fact, there is a direct correlation between muscle mass and bone strength. So, getting adolescents lifting weights in the gym could be a very effective way of reducing the risk of fracture later in life.
What Exercise is Not so Good for Bone Development?
Swimming and cycling do not stimulate extra bone development in adolescents. Probably because they’re both non-impact sports that use a relatively small percentage of maximal muscle contraction per cycle. Similarly, walking does not appear to be rigorous enough to stimulate bone growth.
Don’t get me wrong – swimming, cycling and walking are all incredibly good for you, but if the focus is bone development, it would be best to supplement your training with some resistance training.
Thanks for reading, for more information give Peak Sports Physio a call on 03 5721 4162.
Bass, S.L., et al. (2002). The Effect of Mechanical Loading on the Size and Shape of Bone in Pre-, Peri-, and Postpubertal Girls: A Study in Tennis Players. Journal of Bone and Mineral Research, 17(12). 2274-2280.
Rizzoli, R., et al. (2010). Maximising bine mineral mass gain during growth for the prevention of fractures in adolescents and the elderly. Bone, 46. 294- 305.
Vlachopoulos, D., et al. (2018). The effect of 12-month participation in osteogenic and non-osteogenic sports on bone development in adolescent male athletes. The PRO BONE study. Journal of Science and Medicine in Sport, 21, 404-409.
Tvelt, M., et al. (2015). Exercise in youth: High bone mass, large bone size, and low fracture risk in old age. Scandinavian Journal of Medicine and Science in Sports, 25, 453-461.
Low back pain (LBP) is a common injury that many of us will suffer at some stage of our lives and unfortunately for some, it can have a real impact on their quality of life.
There is lots of misconceptions and misleading information regarding back pain, what causes it, and how you treat it. Sometimes, even advice given with the best intentions can create a degree fear which can have harmful effects. An example is the video below:
This is a Worksafe ad that ran a few years ago. The message is obvious and valid… don’t try and lift stupidly heavy things otherwise you might hurt yourself.
Why is this harmful?
We need to appreciate that this video is an extreme example of what might occur if we did do serious damage to our back. The reality is that over 95% of lifting injuries are nothing like this, they are usually just minor strains that will settle quickly with appropriate management.
Let’s say someone did experience a minor lifting injury after watching that clip, do you think the image of their disc exploding would cross their mind? Of course it would! they would be worried that this minor injury is something far more serious, and they will experience more pain because of it.
Bulging Discs are as Normal as Grey Hair!
Very often people presenting with LBP will be referred for an MRI or a CT scan to investigate the ‘source’ of their back pain. Very often, the results will report a bulging disc or disc degeneration etc… the trouble is that bulging discs and disc degeneration are also very common in people who have never had back pain before. The graph below (figure 1.) shows the prevalence of ‘injuries’ in people who have never had back pain. To put that in to some context, I’m 30 years old, and have never had back pain, but there is still a 40% chance I have at least one disc bulge
So what does this mean?
It means that if you have a bulging disc, there is a fair chance that it was there long before there was any pain. It could be completely unrelated, and more importantly, you don’t need to change you behaviour because you think it might make it worse.
But a disc bulge must be related, How else could it occur?
Well the answer could be pretty straight-forward. The intervertebral discs are made up of 3 main materials:
- Collagen – this acts as the structural netting or scaffolding that holds everything together
- Proteoglycans – these are protein cells situated inside the disc that attract water
- Water – water molecules bind to the proteoglycans
Imagine the intervertebral disc is a mesh bag full of balls (figure 2).
The mesh bag represents the collagen, each ball represents a proteoglycan that has a molecule of water attached to it. when we are young, we have a lot more proteoglycans in our discs, so there a lot more water content – our discs are well hydrated which makes the collagen framework very taught – a bit like a swiss ball that is fully pumped up.
As we get older, our bodies lose some of these proteoglycans, which also means there is less water molecules to ‘pump’ up the collagen framework – bit like a swiss ball that is half deflated. Because the disc has less water content to keep the collagen taught, the edges of the disc bulge out the sides. And there you have it – a bulging disc that is completely harmless, and as normal as the wrinkles on your face.
Myth 2: You’re Back can go ‘Out of place’ or you can ‘Slip’ a Disc
Another common misconception is that the spine or spinal joints can go out of place. This misleading term often arises from people trying to explain why their back keeps getting sore.
If you closed your eyes and imagined a spine, there is a fair chance it will look like the picture below (Figure 4). These models are everywhere and although they have their uses, they are very oversimplified and can mislead people to thinking the spine is inherently unstable and can slip in and out.
The next picture is what an actual spine looks like (figure 5). You’ll notice that you can barely make out the intervertebral bodies from the discs because there are so many ligaments surrounding them. There is no way it can go out of place!
So if your back suddenly locks up, you can best assured that everything is still where it should be, acute back pain undergoes the same healing process as rolled ankle, it’s normal for it to be acutely sore for 2-3 days then it will gradually settle
Your Back is not Fragile
Leading on from the last point, if people believe that their back is fragile and unstable, they will change their behaviour to avoid something bad happening. It’s not unusual for people with long-standing LBP to believe that they are not allowed to bend or lift or sneeze or laugh because they genuinely believe that they will hurt themselves. The unfortunate thing is that these beliefs often cause them to give up their favourite sports or hobbies.
Bending is a normal movement, just like bending your elbow. What would happen if you actively avoided bending you elbow? It would get stiff and it would get sore. The same thing happens to your back if it doesn’t move the way it is designed to.
The spine is a remarkably strong and well-designed structure. They can cop a flogging! As kids and young adults, most have fallen out of trees, crashed motorbikes, played contact sports etc.
It would be a real shame if you gave up something you enjoy because of a misguided belief that it was harmful. Back pain doesn’t need to be feared. Movement is good, do the things you enjoy and who knows, your back might even feel better!
If you have questions or would some advice regarding back pain, feel free to contact Peak Sports Physiotherapy on 03 5721 4162!
Thanks for reading,
Belavy et.al (2015). Can exercise positively influence the intervertebral disc? Sports Medicine, DOI 10.1007/s40279-015-0444-2
Brinjikji et.al (2014). Systematic Literature review of imaging features of spinal degeneration in asymptomatic populations. American journal of neuroradiology, 36, 811-816
Raj (2008). Intervertebral disc: Anatomy-Physiology-Pathophysiology-Treatment. Pain Practice, 8(1), 18-44
I’ve had a couple of people say recently that they’ve have been considering performing a strength program to help their running.
Whether the goal is injury prevention or simply wanting to run faster, adding a strength program to your routine could be one of the most effective training strategies you could employ. Even in highly trained and elite distance runners, those who supplement their running with strength training will notice improvements in running economy, and aerobic threshold.
Running doesn’t make you stronger
This obviously depends on your background strength and fitness, but the point I’m trying to make is that running is an aerobic exercise, not a strength exercise. The whole point of running is to be as efficient as possible so you don’t conk out half way through your run. When you run you rely on the elastic energy in your tendons for propulsion, not muscle contractions. The muscles job is to provide adequate tension in your tendons so the elastic energy can be utilised properly (Figure 1).
What is strength training?
Strength can be defined as the maximum weight you can lift once. This is often referred to as your 1 repetition maximum (1RM). To Build strength, it is recommended that you train at 65-75% of your 1RM, or >80% if you’re a trained individual. When you are working at this intensity, you should only be able to perform 8-12 repetitions before stopping due to fatigue.
For those who are interested, there are ways of estimating your 1RM that don’t involve performing a one rep-max test. The are plenty of phone apps that you can download which are pretty accurate. But at the end of the day, its not essential to know your 1RM to perform effective strength training. Just find a weight that you can lift 8-12 times but no more. If you can lift it more than 12 times, make it heavier!
Does this mean you need to join a gym?
Well, unless you have access to weights at home or at work, you probably should. Body weight exercises such as squats, lunges, bridges, calf raises without added resistance just aren’t heavy enough to produce the adaptations that strength training provides. These types of exercises, which can be performed more than 20 repetitions before fatiguing and are classified as activation exercises. They can be useful as part of a warm up or in the early stages of a rehabilitation program, however they are generally not hard enough to produce significant strength gains and you’ll plateau pretty quickly.
How does strength training help you run faster?
Strength training for running isn’t about getting massive, its about increasing the stiffness of the muscle-tendon unit so it can utilise elastic energy more effectively. This is done by:
Improving the contraction capabilities of the muscle – The tendons in your legs act like springs, stronger muscle can create tighter springs which are more effective at propelling you forwards.
Increasing tendon stiffness and cross-sectional area – Once again, stiffer springs lead to better performance.
Greater neuro-muscular activation – Even when you lift really heavy weights, your body only activates a portion of the muscle at once. Strength training increases the muscle’s ‘neural drive’. This improves the coordination and timing of muscle contractions and allows you recruit more muscle per rep. Effectively, your teaching your body to ‘switch on’ more muscle. This helps to make you more resistant to fatigue and reduces the strain on your bones and joints when you run.
The increased neural drive explains the strength improvements that are seen in the first 2-4 weeks of training, which is well before any physiological muscle adaptations have had time to occur.
Reduce time lay-off due to injury – I know this is technically not an adaptation of strength training, but I’m a physio so I had to throw in something about injury prevention. Coincidentally, the most effective treatment for tendinopathies such as Achilles tendinopathy, patella tendinopathy etc is heavy, slow strength training.
The only way you get these adaptations is with heavy strength training!
So the take home message is: Strength training will improve your running, but it’s got to be heavy enough!
If you would like more information about strength training for runners, please give us a call on 03 5721 4162.
Balsalobre-Fernadez et.al. (2016). Effects of strength training on running economy in highly trained runners: A systematic review and meta-analysis of controlled trials. Journal of Strength and Conditioning Research, 30(8), 2361-2368.
Bohm et.al. (2015). Human tendon adaption in response to mechanical loading: A systematic review and meta-analysis of exercise intervention studies on healthy adults. Sports Medicine.
Kraemer, W. et.al. (2002). Progression models for resistance training in healthy adults. Medicine and Science in Sports and Exercise. 34(2), 364-380
It’s summer and its bloody hot, but most football and netball clubs are starting their preseason training to prepare themselves for the 2019 season.
Preseason is not just about developing fitness for round one, it’s also about developing a level of conditioning that sees you through the season without breaking down. Because let’s face it, Injuries cost premierships.
Soft tissue injuries such as hamstring and quadriceps strains are common in field sports including football and soccer, and they can have a real impact on player performance particularly towards the end of the season.
CONSIDER THIS SCENARIO:
Its round 14 during the season, you’ve got plenty of games under your belt and have developed some good match-fitness. Then you strain your hamstring. Let’s say that you miss 3 weeks due to recovery, which includes 1-2 weeks of modified training. This means you’ll be back playing round 18, which just so happens to be the last round before finals start.
The trouble is, because of the lighter weeks on the track, you will have lost some of your conditioning. If you look at Table 1 below, you’ll see what I mean.
As you can see, 2 weeks training at 40% then takes a further 2.5 weeks of full training to get back up to speed. So really, it takes 4-5 weeks to get back to where you were pre-injury. Which essentially means you’ll be going into finals underdone. Now if you have a couple players in the same boat, it’s easy to understand how injuries can devastate a team.
WHO IS AT GREATER RISK?
Risk factors for soft tissue injuries do vary depending on the muscle group, however there are two risks factors that are common for all:
- Previous injury
- Age (>30)
Now obviously you can’t change you age or injury history. However, you can significantly reduce to risk of soft tissue injury with a couple of simple eccentric-strengthening exercises. The benefits of these exercises are listed here, and they can reduce the risk of injury by up to 51%.
REDUCE SOFT TISSUE INJURIES THIS SEASON
Try adding these exercises at the end of you training routine, They don’t require any equipment and don’t take long to perform. But don’t be fooled, they are quite tough! Start with 2 sets of 5 reps and build from there as you become accustomed to it.
Get a partner to stabilise your ankles, slowly lean forwards from your knees (you will feels your hamstrings tighten straight away). lean as far forward as you can, then fall to the ground catching yourself with your arms.
Reverse Nordic’s (Nordic Quadriceps)
Starting in a kneeling position, slowly lean backwards from your knees as far as you can control (you should feel this working your quads), then bring yourself back to the starting position. Try not to bend at the hip. You can also place or a roller or towel under you ankles to make it more comfortable.
Well done for all those who have started preseason, your effort now will pay dividends later the year!
For a pre-season fitness assessment, or for more information, give Peak Sports Physiotherapy a call on 03 5721 4162.
Frenkleton, G., Pizzari, T. (2013). Risk factors for hamstring muscle strain injury in sport: A systematic review and meta-analysis. The British Journal of Sports Medicine, 47. 351-358
Al Attir, W., et.al. (2017). The effect of injury prevention programs that include the Nordic hamstring exercise on hamstring injury rates in soccer players: A systematic review and meta-analysis. Sports medicine, 47(5), 907-916
Australian Institute of Sport. (2015). Prescription of training load in relation to loading and unloading phases of training.
Anybody can run, right? But if you are overcoming an injury or are looking to improve your running performance, should you look at your technique? Running, particularly distance running, is all about efficiency and economy. Being fit certainly helps, but if you’re the fittest person on earth yet still run like a duck you won’t win many races!
So what makes an efficient technique?
Efficient runners are effectively able to do two things:
- Minimise braking forces
- Optimise the use of elastic energy in their tendons
Minimising braking forces
Simply put, Braking forces are forces that stop you moving forward. The classic example is over-striding, where your foot contacts the ground in front of your knee (Figure 1).
As you can see in the picture above, the runner on the left contacts the ground with his foot in front of his knee, this will result in a large reaction force that will slow him down; he is effectively running with the brakes on. The runner on the right contacts the ground with his foot under a flexed knee, this allows his foot contact to be more of a glancing blow which won’t cut his momentum.
The other type of braking force comes from having a high vertical oscillation, which is the amount that you bob up and down when you run. Running is about moving forwards, not up and down! So as a general rule, the lower your vertical oscillation, the more efficient you’ll become (figure 2).
From a physio perspective, a lot of running-related injuries can be avoided or overcome by minimising these braking forces. Over-striding creates huge problems when running and can contribute to several different injuries including shin pain, patellofemoral pain, tendinopathy and even back pain. High vertical oscillation tends to cause stress related injuries, particularly shin pain (the further you jump up, the harder and faster you come down).
Optimise the elastic energy in your tendons
The other thing efficient runners do very well is utilise the elastic energy stored in their tendons to propel them forwards. When tendons are loaded, they stretch and recoil like a spring (figure 3). The stiffer the spring, the better the recoil. Imagine jumping on a pogo stick with an old, soft spring at the base – you won’t jump far with that. But, if you put a brand new, shiny, stiff spring on it, all of a sudden you will get a lot more propulsion.
When running at a constant pace, the muscles job is to contract and stiffen the tendon, making it more effective at utilising the stored energy.
So essentially you want to create stiffer ‘springs’ to run faster. There are several ways to do this:
- Running often and on different surfaces – Running requires high levels of motor control and coordination. Running on grass/sand/concrete/uphill/downhill all require subtle changes in muscle timing. So by practising on different surfaces your body will automatically begin to refine the timing and coordination, so the muscles contract to stiffen the tendons at the right time.
- Running Drills – their purpose is to refine the muscle timing and coordination of your running technique.
- Strength training – heavy resistance training not only strengthens muscles, over time it will increase tendon stiffness…very helpful, and very underrated.
- Plyometrics – these are high intensity activities such as jumping and hopping which are designed to train you body to use the elastic energy in your tendons. They can be useful but they are quite intense so you need to have an adequate strength otherwise you can cause an injury.
So is running technique important? Bloody Oath! Remember, anybody can run, but we can always improve!
Peak Sports Physiotherapy offers comprehensive running assessments and individualised programs to help you improve your running performance and reduce your risk of injury. For more information, please call 03 5721 4162 or book an appointment online.
Peak Sports Physiotherapy