Why we need to be careful when it comes to imaging!

One very common question we get in the clinic is; will I need a scan? When we get asked this, a patient is asking if they are required to be referred for some sort of imaging to assess their injury or concern. It may be what they are used to with previous injuries, maybe a friend has told them they need one, or they think it’s always good just to ‘double check’ the diagnosis.

“The truth is, however, that there a lot more scans or imaging being done than their probably needs to be.”

There are a couple of reasons why we should be cautious when it comes to jumping to get a scan- the main one being that a lot of findings are quite normal!

But how can it be normal to have a ‘bulging disc’ in my back (for example)?

“Many studies have shown that imaging ‘findings’ can be quite common in the non-symptomatic population.”

For example, a recent study looked at how ‘abnormal’ findings can commonly be present in magnetic resonance imaging (MRI) of the cervical spine (neck). They completed MRI on over 1,200 healthy individuals, of which 87.6% of them had disc bulging. What was interesting was that even a high proportion of 20-year old’s (around 75%) had some level of disc bulging (Nakashima et al., 2015). The knee is also another interesting area when it comes to MRI. A review of 63 different studies in 2018, showed that as people get older, osteoarthritis (OA) features become more common, even without pain. For people over 40, the prevalence of OA features can range between 19-43% in the non-symptomatic population (Culvenor et al., 2018).

So I shouldn’t bother about getting a scan?

Different forms of imaging can definitely be helpful when it comes to making a diagnosis- but the important thing to think about is that a scan doesn’t show the whole picture. It can also be very common for someone with pain to come back with a scan that doesn’t seem to show anything wrong! 

You might be someone that has recently had a scan and been told by a health professional that you’ve got a really bad ‘bulging disc’ or a knee that is ‘bone on bone.’ What you need to remember is that imaging alone does not predict what your outcome is going to be. This is where your physio comes into play, to assess the whole picture and ideally give you confidence on improving the things that maybe you can’t see on your scan!

WANT OPINION AND ASSESSMENT OF YOUR INJURY?
SIMPLY CONTACT THE CLINIC ON 5174 7250 or BOOK ONLINE
with myself or one of our expert Physio's below. We can't wait to help get you back to your best!

AUTHOR: JARRYD CROXFORD - Physiotherapist

Culvenor, A., Øiestad, B., Hart, H., Stefanik, J., Guermazi, A., & Crossley, K. (2018). Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and meta-analysis. British Journal of Sports Medicine, 0, 1-12.

Nakashima, H., Yukawa, Y., Suda, K., Yamagata, M., Ueta, T., & Kato, F. (2015). Abnormal findings on magnetic resonance images of the cervical spines in 1211 asymptomatic subjects. Spine, 40(6), 392-398.

Training Load Management

The festive season can be a time of year where we ask a bit more from the body than what it is used to; namely our drinking and eating levels. Most of us have some time off over the Christmas/New Years’ period, so there is always an excuse to have a few beers on a Wednesday night, or indulge in multiple left-over ham sandwiches. If you’re a seasoned veteran, your body will be trained to handle these excessive loads, for others however- the intake on Christmas day may have been such a surprise you’re still feeling the effects! These patterns can be quite similar when it comes to getting back into your exercise/sport training, however poor training management can lead to keeping you out of playing, rather than Boxing Day kick-ons.

Sports science and medicine is continually progressing and playing an integral role in team sports, particularly in the prevention of injuries.

“A common misconception is that training at high levels will increase your injury risk, however there is evidence to suggest that higher training loads can help prevent against injury.”

In turn, under-training can increase injury risk. To get your head around this, it is first important to understand what ‘training load’ actually means. Training load can be categorised as either external load (the physical work done), and internal load (how it feels for the athlete). For example, an external load would be how many km’s a footy player ran in a game, and the internal load could be a 1-10 rating on how hard they feel they worked (commonly known as ‘RPE’). If you were measuring your training load for one week, this is known as ‘acute’ load, whereas your ‘chronic’ load is the average  over a longer period (usually 3-6 weeks).

But what does this mean for the local-level athlete? Simply put, if you want to decrease your injury risk going into the season/leading up to an event, you’ll have to track these numbers yourself. Unless your club has a sports scientist, or a very dedicated sports trainer! An easy approach is to multiply your time of training/play (minutes) by your 1-10 rating, and you’ll get the acute load for that session, add them together and you’ve got your number for the week. After a few weeks- you can get your average for those weeks. But how do I use this information?

The reason to monitor these numbers is to reduce your injury risk- by making sure your training in the ‘sweet spot.’ A study on elite fast bowlers showed that if a bowler bowled 1.5 times more bowls in a week than their average, there risk of injury is 2-4 times higher over the next week, compared to if the kept their bowling levels ‘normal.’  In general, your acute load should stay around 10% above or below your chronic load. This would mean during footy pre-season (for example), you shouldn’t decide to throw in extra sessions and bump training up by 30% to be ‘ready’ for the practice match. On the other hand, try and not get lazy and not rock up for 3 weeks in the middle of July (and decrease training by 80%). In summary, there is some responsibility on you, but using some easy tools to monitor your training levels can help keep you on the track!

IF YOU WANT TO KNOW MORE ABOUT HOW TO BEST MANAGE YOUR TRAINING LOADS
SIMPLY CONTACT THE CLINIC ON 5174 7250 or BOOK ONLINE
with myself or one of our expert Physio's below. We can't wait to help get you back to your best!

AUTHOR: JARRYD CROXFORD - Physiotherapist

Gabbett, T. J. (2016). The training—injury prevention paradox: should athletes be training smarter and harder?. British Journal of Sports Medicine, 50(5), 273-280.

Hulin, B., Gabbett, T., Blanch, P., Chapman, P., Bailey, D., & Orchard, J. (2014). Spikes in acute workload are associated with increased injury risk in elite cricket fast bowlers. British Journal of Sports Medicine, 48(8), 708-712.

Overstriding

In our recent video we discussed the most common and arguably the most destructive running flaw: Overstriding.

For most adult runner’s (especially those with a desk job) the heel strike is the most common foot strike during running.

“This happens primarily because of tight hips and lazy glutes”

Because of this we lose the ability to use our glutes and hamstrings effectively resulting in our leg reaching out much further than it should. This is what we refer to as ‘‘overstriding’’.

“The first step to fixing it is identifying the problem.”

You will need to have someone film your running technique from side on and then identify where your foot hits the ground and how far it may be in striking in front of your hip. Contact us for a running assessment where we do exactly this using slow motion video analysis.

The next step is to try and correct it! Here are 4 simple steps to help you improve your run:

1. Monitor and Increase your cadence: There are plenty of iPhone or android apps that can help you with this. You could even use a simple metronome app. The cadence that you should be aiming for is 170-190 steps per minute or between 85-90 strides per minute. I will doing a step by step blog on this soon for people that have not got experience calculating cadence.  

2. Work on flexibility and range of motion of hip extension. If we are stiff in the hips we will not be able stride powerfully. Tight hip flexors and lazy glutes and hamstrings are the most common culprits. If you do not have a mobility or strength program specific to you than you need one ASAP!

3. Increase forward lean: The runner’s that I have seen who over stride the most tend to run very very upright. Remember the goal is to land with the hip directly over the striking foot. There is no chance of doing that if we hold our selves incredibly rigidly in the trunk.

4. Include some hill training: It is almost impossible to over stride whilst running up a hill. Use a treadmill or pick a hill with a moderate incline and keep the repetitions short so you can focus on your form without wearing yourself down.

If you want to know how to improve you own running form and develop the most efficient stride and training program for YOU SIMPLY CONTACT THE CLINIC ON 5174 7250 or BOOK ONLINE with myself or one of our expert Physio's below. We can't wait to help get you back to your best!

AUTHOR: NITIN MADAN - Physiotherapist

Minimalist Running Craze!

If you are not a keen runner yourself then you may not have heard of the term ‘barefoot running’. It might be something you do during a game of backyard cricket, but why would someone run a few k’s without any shoes on?

In terms of this article, we will refer to barefoot running as minimalist running, which refers to using a ‘minimalist’ shoe to run in. Due to the concepts’ increasing popularity, an international panel of experts got together a few years ago to define what a minimalist shoe is. They came up with an index, with more minimalist shoes being very light, having less sole thickness, being very flexible, and having less of the normal things running shoes have in order to provide support.

“But why would someone want less support for their feet?”

It has been shown that running in minimalist shoes can cause changes in someone’s running gait (technique), and various research has shown that these changes may reduce the risk of various injuries (Lenhart et al., 2014). Note; the injury risk is related to the technique, not the shoe.

“In my opinion- I’m against using/ transitioning to minimalist shoes”

A recent study (completed in 2017) has shown that the use of minimalist shoes increased the likelihood of calf related pain, as well as shin and ankle pain. They also found that people who were heavier had a higher overall running-related injury risk when using minimalist shoes (Fuller et al., 2017). This study was supported by another in 2014, which found that over a 12-week period, runners wearing minimalist shoes had 3 times more injuries than those wearing ‘neutral’ shoes (Ryan et al., 2014).

There are always limitations in research, and you may have no injuries if using a minimalist shoe. However, a lot of the research recommends being cautious when using these types of shoes. A major goal for runners and Physio’s is to prevent injury and providing the foot with the support it needs is one aspect of this.

If you are thinking about using a more minimalist shoe, or you are not sure whether your current or potential new shoe is providing the support your foot needs, the best option is to get an expert opinion from a Physiotherapist.

IF YOU’RE ARE SEEKING RUNNING ADVICE SIMPLY CONTACT THE CLINIC ON 5174 7250 or BOOK ONLINE with myself or one of our expert Physio's below. We can't wait to help get you back to your best!

AUTHOR: JARRYD CROXFORD - Physiotherapist

Fuller, J., Thewlis, D., Buckley, J., Brown, N., Hamill, J., & Tsiros, M. (2017). Body mass and weekly training distance influence the pain and injuries experienced by runners using minimalist shoes: A randomized controlled trial. The American Journal of Sports Medicine, 45(5), 1162-1170.

Lenhart, R., Thelen, D., Wille, C., Chumanov, E., & Heiderscheit, B. (2014). Increasing running step rate reduces patellofemoral joint forces. Medicine and Science in Sports and Exercise, 46(3), 557.

Ryan, M., Elashi, M., Newsham-West, R., & Taunton, J. (2014). Examining injury risk and pain perception in runners using minimalist footwear. British Journal of Sports Medicine, 48(16), 1257-1262.

Cadence - The Why | The What | The How

Your body loves rhythms. Heart rate, breathing rate and blood pressure for example are all consistent and measurable rhythms of the body. We all know what happens if any of these get too high or low. So think of cadence like the rhythm to your running. You don’t have to be a marathon runner or even a serious runner to need to know what it means.

“Anyone that even does a little bit of running should have some idea of what their cadence is”

Cadence is essentially the number of steps per 1 minute of running.

Why is it important?

A shorter stride length and a quicker stride rate will help you to run faster and better! If you have a low cadence you are likely to have a long stride. Runners who over-stride tend to slam their heel into the ground which effectively puts the brakes on creating a choppy, bouncy looking run which puts extra pressure on bones and muscles leading to conditions such as:

• Shin splints and stress reactions

• Runners knee

• Hip pain during and after running

• Jarring pain in Lower back

• Plantar Fascia and heel pain

What is the magic number?

Well, think of cadence like sleep. With sleep there is no magical number of hours and minutes that each of us should sleep. However we do have general guidelines that it should be between 7-9 hours per night. Essentially it is the same with cadence - there is no magic number. There are however guidelines that you can follow to help you know if you need to work on improving your cadence.

“Most good fitness tracking watches can track your cadence for you but if you don’t have one, here is a method by which you can track it yourself!”

Step 1

Cadence is best measured at an easy pace of running. We first need to calculate what an easy pace is for you. So step 1 is to go for a light 1.6km run. Do not try to set a world record here! It is just an easy run. All you are looking to do is see whether it takes you longer or shorter than 10 minutes.

If you ran it in

• Faster than 10 minutes: Your target cadence should be between 170-180 steps per minute

• Slower than 10 minutes: Your target cadence needs to be 160 steps per minute or higher.

Step 2

Run at the same speed for another 60 seconds and calculate how many times your right foot hits the ground. Multiply this by 2 (To account for both feet). This will give your cadence.

For example if your ran the 1.6 km run slower than 10 minutes and then you measured your cadence in the next 60 seconds to be 140 steps per minute, you will need to increase it!

Step 3

Adjust your cadence accordingly, if you were well below the target range try and download a cadence trainer or a metronome app and use it to help your trial out faster cadences. It is best to try this on a treadmill first so you can see how it feels on your body and you can keep the run at a consistent pace.

Step 4

Some other ways that can help to improve your cadence are

• Add hill training

• Get your running shoes fitted correctly

• Condition your legs with some specific strength training and technique drills

• Focus on using ‘small steps’ instead of ‘running fast’ as your main cue

IF YOU’RE STRUGGLING WITH YOUR CADENCE OR ARE SEEKING RUNNING TECHNIQUE ADVICE SIMPLY CONTACT THE CLINIC ON 5174 7250 or BOOK ONLINE with myself or one of our expert Physio's below. We can't wait to help get you back to your best!

AUTHOR: NITIN MADAN - Physiotherapist

Femoroacetabular Impingement (FAI) Diagnosis - What to do next?

What to do once I’ve been diagnosed with hip impingement?

In part 1 of this blog, we discussed what FAI (or hip impingement) is, and how a diagnosis is made. The article may have rung some alarm bells for you, or perhaps you have been diagnosed as having hip impingement. The burning question now is, how can I fix it?

There are 2 different pathways involved when it comes to the management of true hip impingement- surgical or non-surgical. At times- they may coexist. As physiotherapists, we clearly are involved in the non-surgical approach, but it is important to shed light on both options.

What does physio involve?

The first thing that your physio will usually address is looking at the factors and movements that are aggravating the pain- and providing education and direction on how to correct these. We never want to take you away from your sport or hobby (unfortunately it may have to happen for some time), so we will discuss management strategies instead. A big focus is placed on building up your strength and control through your glute (butt) muscles and carrying this over to movements you typically complete during your sporting activity. If required, we will also combine this with manual techniques, with an aim of reducing any soft tissue restrictions and improving the hip joint’s mobility. 1

What does the surgery involve?

With the bony changes that are found with hip impingement- surgical management aims to improve the congruency of the ball and socket aspect of the hip joint. This will typically be done with arthroscopic (‘key-hole’) surgery, unless the imaging findings are quite unusual compared to ‘typical’ FAI. Depending on type of lesion found (part 1), the surgeon will remove the area of concern, in order to stop that area causing the bone impingement. If there is damage to the lining of the socket, this will also be repaired. Hip arthroscopy is typically a day procedure, and most surgeons with have specific physiotherapy protocols to follow during the rehab timeframe. 2

Is one better than the other?

In a recent consensus statement from international experts, it was agreed that rehab and surgical management can both be suitable management options. 3 An interesting point is that from late 2016, arthroscopic surgery for hip impingement symptoms was removed from the Medicare Benefits Scheme, potentially indicating that the government could not justify the cost for the number of surgeries that were being undertaken at the time. As FAI is quite a ‘new’ condition, there still lacks a massive amount of evidence that shows one option is better than other. With this in mind, we would typically commence a period of conservative rehab management, before exploring invasive surgical options.

IF YOU’RE STRUGGLING WITH HIP PAIN SIMPLY CONTACT THE CLINIC ON 5174 7250 or BOOK ONLINE with myself or one of our expert Physio's below. We can't wait to help get you back to your best!

AUTHOR: JARRYD CROXFORD - Physiotherapist

1 Mansell, N. S., Rhon, D. I., Meyer, J., Slevin, J. M., & Marchant, B. G. (2018). Arthroscopic surgery or physical therapy for patients with femoroacetabular impingement syndrome: a randomized controlled trial with 2-year follow-up. The American Journal of Sports Medicine, 46(6), 1306-1314.

2 Ganz, R., Parvizi, J., Beck, M., Leunig, M., Nötzli, H., & Siebenrock, K. (2003). Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clinical Orthopaedics and Related Research, 417, 112-120.

3 Griffin, D. R., Dickenson, E. J., O'donnell, J., Awan, T., Beck, M., Clohisy, J. C., ... & Hölmich, P. (2016). The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. British Journal of Sports Medicine, 50(19), 1169-1176.

Are you suffering Neck Pain?

Have you ever woken up after ‘sleeping funny’ and noticed some stiffness and pain in the neck?

Maybe you’ve done a quick head check in the car and ‘tweaked’ your neck?

Or perhaps you’ve had long term issues with having a ‘crook’ neck because of work, and you’re starting to think it’s not just work causing your headaches?

Let us assure you, you are not alone!

“Worldwide, neck pain is estimated to be the fourth leading cause of disability, with almost 50% of the population experiencing neck pain in their lifetime!”

Rest assured, the usual outcome of an acute episode of neck pain is usually positive, but wouldn’t it be good to prevent it from happening again?

Earlier this year, a systematic review (a big study of multiple studies) looked at what strategies are effective in reducing the likelihood of a new episode of neck pain occurring. The review included studies that looked at both exercise programs and ergonomic programs (workplace set up and posture). It was found that exercise interventions could as much as half the risk of a new episode of neck pain. Interestingly, there was little evidence to find that ergonomic changes had any effect on the chance of neck pain occurring.

As is common with most reviews, we need to take caution when it comes to interpreting the results. Firstly, there was only 5 studies all up included in the review, with most of them only including office workers in the results. Secondly, it seems most of the trials only included people who didn’t have neck pain before starting the particular exercise or ergonomic program. And lastly, the studies that looked at exercise used different exercise programs/methods, and these programs also went for a long time.

So does that mean we shouldn’t exercise or think about our work set-up to reduce the chance of neck pain? In our opinion and from experience- both can be beneficial and therefore we commonly incorporate them when it comes to treating neck pain.

“When it comes to neck-specific exercise, this is based around building up the endurance and control of the smaller, ‘fine-tuning’ muscles around the head and upper body, as well as incorporating range of motion and mobility exercises.”

When it comes to determining what is causing your neck pain, it’s essential to seek professional help, from someone such as a physiotherapist. Once the diagnosis is made, that’s when the path to recovery can start!

SIMPLY CONTACT THE CLINIC ON 5174 7250 or BOOK ONLINE with myself or one of our expert Physio's below. We can't wait to help get you back to your best!

AUTHOR: JARRYD CROXFORD - Physiotherapist

Ganz, R., Parvizi, J., Beck, M., Leunig, M., Nötzli, H., & Siebenrock, K. (2003). Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clinical Orthopaedics and Related Research, 417, 112-120.

I have been told I can never run again.......

Have you been told you shouldn't be running because of your bad knees?

What if we told you that running was actually good for your knees?

What if we told you that runners have the lowest amount of knee osteoarthritis when compared to most other athletes?

“Sadly many surgeons and doctors have told patients with a bad looking knee Xrays to give up running”

People sometimes make the decision themselves. They associate the running with wear and tear of the knees and so they give it up. Most of the time this decision is completely unfounded and often does more harm than good. If you have stopped running because of 'bad knees' let me show you the science.

A 2008 study followed approximately 100 runners and non-runners across 20 years with repeat knee Xrays. Whilst they found initial increases in arthritis in the running group; by the end of the study there was minimal difference between the two groups. In fact the running group had slightly less arthritis in their knees!

A 2017 review compared all of the available scientific literature available on the topic of running and knee degeneration and found that there was no association with running and knee osteoarthritis. It further concluded that running actually had a protective effect against a knee replacement!

“So the science says running isn’t bad for knees and also suggests it could even be protective against needing knee surgery”

Why then are so many people being told the myth that running is bad for their knees?

Obviously there are cases where inappropriate footwear, poor foot mechanics, poor running technique and inappropriate load management could lead to injuries if they are not addressed. However a carefully mapped out running program complimented with appropriate stretching and strengthening exercises as directed by a Physiotherapist is the safest way to get the running shoes back on!

IF YOU WANT ADVICE ON GETTING BACK TO RUNNING SIMPLY CONTACT THE CLINIC ON 5174 7250 or BOOK ONLINE with myself or one of our expert Physio's below. We can't wait to help get you back to your best!

AUTHOR: NITIN MADAN - Physiotherapist

Ganz, R., Parvizi, J., Beck, M., Leunig, M., Nötzli, H., & Siebenrock, K. (2003). Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clinical Orthopaedics and Related Research, 417, 112-120.

I’ve been told I have hip impingement - what does that mean?

Femoracetabular impingement (FAI) is a relatively new diagnosis (from 2003) which is used to explain pain in the hip and groin region. To simplify things we will use the term ‘hip impingement’ to explain the condition, and what that means for you as a sports person. 

To be 100% confident that you do have hip impingement, there are 3 things that need to be ticked (or crossed) off:

1. Suffering from specific symptoms

2. Positive physical findings (in-clinic assessment)

3. Imaging findings (usually with an x-ray)

Let’s go into a bit more detail on each of the above:

SYMPTOMS

Hip impingement symptoms will tend to begin to show in the athletic/active younger adult population, and usually presents as a slow onset groin/hip pain with or without a traumatic incident. Pain can often feel like it starts in the hip, but refer to other areas, commonly the groin and buttock regions. Early on, the pain is usually on and off, and presents as an ache. Aggravating or exacerbating factors are commonly an increased exercise or general activity load. It is not uncommon for long periods of sitting-particularly in low chairs/seats, to increase pain levels. As well as pain, it is not uncommon to feel sensations such as locking, catching, or giving way. 

Physical Findings

You might be starting to ‘self-diagnose’ after reading through the above symptoms. However, your Physio plays a key role in the diagnosis side of things. The major things we look for is limited range of movement in the hip, particularly with the hips ability to rotate internally. At times, the flexion in the hip can also be limited/sore, with a combination of the two mentioned movements being quite painful. There a number of other tests used to determine how irritable the hip is, and also whether there may be bony abnormalities causing limitations.  

IMAGING FINDINGS

Usually an x-ray is all we need to confirm the diagnosis of hip impingement. Hip impingement itself comes about due to bony abnormalities of either the socket (acetabulum) or ball (head of femur) aspects of the hip joint. X-ray imaging will pick up whether someone has a bump on the ball (called a CAM lesion) or a hip socket which is too deep (which causes ‘Pincer’ impingement). In some cases- there can be a combination of both. In the images below; A: represents a ‘normal’ hip joint, B: shows a ‘CAM’ lesion, C: shows a ‘Pincer’ lesion, and D: the appearances of combination of both lesions. 

In part 2 of the blog, we will discuss the treatment and management of hip impingement once the diagnosis has been made. 

IF YOU’RE STRUGGLING WITH HIP PAIN SIMPLY CONTACT THE CLINIC ON 5174 7250 or BOOK ONLINE with myself or one of our expert Physio's below. We can't wait to help get you back to your best!

AUTHOR: JARRYD CROXFORD - Physiotherapist

Ganz, R., Parvizi, J., Beck, M., Leunig, M., Nötzli, H., & Siebenrock, K. (2003). Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clinical Orthopaedics and Related Research, 417, 112-120.

How do the world's best manage their Hamstring Strains?

16 minutes gone of the third quarter of the second last game of the home and away season. Your team is up by 14 points against the top team. You know that you have got them by the scruff of the neck. A win here would do wonders for the confidence of your team. After an up and down season for your things have finally started to click into place. You are feeling great!

You run past a team-mate who has just taken a strong mark 60 meters out from goal. You know that he is a weak kick. You sprint past him like a man possessed willing the handball. He dishes it off to you. This is your chance to seal the game! You sprint 10 meters with the ball eyes set on the goals. You wind back the right foot ready to thump the ball over the goal umpires head.

"As your foot makes contact with the ball you feel an almighty POP at the back of your thigh. It feels like someone has shot you."

You instantly grab for the back of your leg as it collapses underneath you. As you lie there pounding the floor you know that your chance of winning a premiership is all but done.

That night you lie there in bed with ice strapped to the back of your leg and consult Dr. Google. You read multiple different management strategies. Some say stretch some say don’t! Should I move it, should I not? Should you book in for a massage? When can I run? 

"Sadly, the above scenario is all too common for the seasoned player. Unfortunately, most players still do not know how to best manage their muscle injuries"

The advice below is based on a consensus from international experts in sports medicine and using these principles you will be able manage your injury safely and effectively. 

TIP 1: Although the research is still scarce at this point of time, EARLY ICE AND COMPRESSION remain essential. By icing immediately, you can restrict blood flow to the injured area and prevent excessive inflammation. My recommended icing protocol is 15 minutes on and 45 minutes off 4-5 times per day. 

TIP 2: EARLY MOVEMENT and motion is important. This should not be to the point of pain so stay away from overloading the muscle or aggressive stretching. However gentle movements should be commenced even in the first 24 hours! 

TIP 3: Early SOFT TISSUE RELEASE and JOINT MOBILISATIONS of the lower back can make a large difference to recovery rates and this can be commenced 3 days after the initial injury.

TIP 4: MRI scans can be helpful and in some cases imperative however the DETAILED ASSESSMENT from an expert clinician will be your best guide to recovery times and rates. This is because we know that imaging doesn’t make a great predictor of return to sport timing. 

TIP 5: Return to sport timing should be based on the exact muscle affected, the position of the player and the quality and consistency of the player’s commitment to rehabilitation. We always try to keep our rehabilitation GOAL BASED rather than time based. Our Physiotherapists always give you a plan of action after assessing your personal situation. 

TIP 6: Your rehab plan must be specifically tailored to your individual injury and must include ECCENTRIC STRENGTHENING. This is the type of strengthening in which we are loading up a muscle whilst putting it on stretch. In the case of hamstring strains a single leg deadlift would be an example of an eccentric exercise. Your ability to progress to this phase of rehab needs to be determined by a Physiotherapist or you risk causing further damage! 

All soft tissue injuries are different require individual exercises, management strategies and rehabilitation plan’s. The best advice that we can give you is to consult with an expert Physiotherapist to help you map out a clear plan with achievable goals of rehabilitation. 
 

SIMPLY CONTACT THE CLINIC ON 5174 7250 or BOOK ONLINE with myself or one of our expert Physio's below. We can't wait to help get you back to your best!

AUTHOR: NITIN MADAN - Physiotherapist

1 Thorlund, J. B., Juhl, C. B., Ingelsrud, L. H., & Skou, S. T. (2018). Risk factors, diagnosis and non-surgical treatment for meniscal tears: evidence and recommendations: a statement paper commissioned by the Danish Society of Sports Physical Therapy (DSSF). British Journal of Sports Medicine, 52(9), 557-565.

2  Siemieniuk, R. A., Harris, I. A., Agoritsas, T., Poolman, R. W., Brignardello-Petersen, R., Van de Velde, S., ... & Helsingen, L. (2018). Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline. British Journal of Sports Medicine, 52(5), 313-313.

3 Kise, N. J., Risberg, M. A., Stensrud, S., Ranstam, J., Engebretsen, L., & Roos, E. M. (2016). Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up. British Medical Journal, 354, i3740.