Ignore Off-Season Rehab at Your Peril!

OK.......So here we are at the end of the winter sports season and it is time to reflect after a long and arduous season.

HOW DID YOUR BODY HOLD UP? 

HOW MANY WEEKS WERE YOU FORCED TO MISS?

Many of the seeds for an injury that will occur next season are planted right NOW! Most players do not understand this and come the middle of the next season or just before finals they will be the ones expecting miracles from their Physio.

The better approach is to address your issues now, work on them hard over the summer, and hit the season well and truly rehabilitated.

Let us use a little story of a simple hamstring strain to demonstrate what happens when your choose the RIGHT path instead of the LAZY one:

THE TYPICAL LAZY APPROACH

A football player suffers a hamstring strain in the middle of this year, but its a club function night so forget the ICE, its party time. He drops in to see our physio a couple of times but ignores our recommendations and comes back a week earlier than he should have, but he's feeling OK. He lacks the speed he had prior to injury and struggles for form in the next month.

By now the rehab exercises prescribed by the physio have been well and truly forgotten and the foam roller use has dropped off completely. Finals are around the corner though and now the ice bath is getting pulled back out as a desperate measure to make the legs feel better. Nope, its not working. Our physio gets another call and the player throws his hands in the air are preaches he has done everything right. We try our best but the injury is killing any performance, and his team lose the grand final. Season over!

Swaps the boots for the thongs, hang at the beach all summer, drink bucket loads of alcohol, and rocks up at training after Christmas, expecting everything to be healed up and ready to go. Hamstring is feeling good. No pain so it must be all good, right??

All goes well during pre-season despite some episodes of hammy tightness and round 1 is approaching. First quarter of the first game, BANG! Hammy goes again. Our physio gets another visit and the player can't believe his luck, throws his hands in the air again and says 'Why me!!?'.

THE PRO-ACTIVE PROFESSIONAL APPROACH

A football players suffers a hamstring strain in the middle of this year, sets the alarm every 2 hours through the night to ICE and keeps the swelling down. He visits our physio first thing on Monday for assessment, sticks to the rehab plan religiously, and sees us on a regular basis for treatment and guidance. He takes the extra week to return, making sure the leg is strong enough. He makes a successful comeback and finds the ball just like he did prior to injury.

He continues the rehab plan as a preventative measure right through the year and continues to receive regular massage treatments despite the injury not giving him any trouble. Finals arrive and he is in peak condition. Racks it up in the final series, best on in the 'Granny', and celebrates a flag with the boys.

A couple of weeks to rest up and then a review with the Physio to assess the body and rejig the plan. Training hasn't officially started but rehab continues anyway. He stars during the preseason and hits round one, strong, fit, and READY!

Have a serious think about which one of these stories sounds like you.

If its the first one, CALL US NOW! (03) 5174 7250

Devon Soutar - Physio | Managing Director @ ABSOLUTE

6 Tips for PT's to Stay Out of Court

6 Tips for PT's to Stay Out of Court

With increasing participation in the fitness industry, Personal Trainers are opening themselves up to litigation with slack protocols and procedures. The old saying 'It will never happen to me' could come back to bite you. Here are 6 tips to keep you out of court.

1. EVALUATE CLIENTS FOR INJURY

Simple screening sessions and/or questionnaires are a fantastic way of getting information about a clients history. The most important information to gather is past injuries and general health issues. This info can be extremely handy if a client attempts to blame you for an injury that may have been their in the first place. Also do not neglect screening for Group Exercise Classes. You must ensure participants are told to come forward prior to a class starting if they have any injury concerns.

2. INFORM CLIENT OF POTENTIAL RISK

Notice that whenever you undertake some sort of risky activity: bungy jump, skydive, go kart, rock climb, you are forced to sign a form prior to participating. This form basically is you acknowledging that you have been informed of the risk involved and confirming that despite these risk you are happy to proceed. This is no different for guided physical activity. Don't get caught out, produce a simple waiver form, explain the risks, and get a signature.

3. ENSURE SAFE AND PROPER EQUIPMENT AND ENVIRONMENT

If you are not currently inspecting your equipment and your workout environment then you must start NOW! But only inspecting the area and not documenting that it has been done could be your downfall. Without maintenance or inspection documentation their is no record of when or how often it was completed. Only the list in your head exists. Unfortunately the list in your head won't hold up in court. Get a folder and document. The most common environment missed are outside areas such as parks or fields. Don't rely on the council to keep these areas spotless, common items such as potholes and syringes could land you in hot water if you failed to inspect the area adequately

4. KEEP GOOD RECORDS

Keeping good records is no brainer. An accurate rundown of exactly what was completed in each session should be documented as it will certainly be called upon in a legal setting. You wouldn't want to go to your doctor and have him say 'what was that medication I put you on again?'. You would sue the pants off him! So don't leave yourself open and write things down. It makes me smile every time I see a PT walking around a gym floor with a client and an iPad,

5. IMPROVE YOU LEVEL OF KNOWLEDGE

If you know more, you become more competent, and competence means less mistakes. Simple. Who do you think looks more vulnerable in a court case, an inexperienced PT operating from their shed using a cable machine they brought at a garage sale, or a  knowledgeable PT who completes regular professional development, has dual qualifications, a large list of happy clients, and a couple of industry awards. I know which one I'd rather be on the stand.

6. FIND YOUR HIGHER AUTHORITY

Picture this: you have a client who comes into your PT session only 9 weeks post an ACL reconstruction and you are not sure what they should or shouldn't be doing. Do you just wing it or do you recommend they see a Physiotherapist first? The Physiotherapist is your higher authority. By getting input from your higher authority you are simple shifting or handing over the risk. The Physio can then give you guidelines to work within. If an injury happens under those guidelines you are pretty much in the clear as you are only following the recommendations of your higher authority. See how it works. We as Physio's have our higher authority, we can refer to a Sports Physician or GP and follow their recommendations. It a way of handling risk and something you need to consider. If you just winged it and the client ruptures their ACL graft, guess who could be in serious legal trouble.....YOU!

Devon Soutar - Physiotherapist | Managing Director @ ABSOLUTE

ASK A PHYSIO - Back Pain in PT Sessions.

ASK A PHYSIO - Back pain in PT Sessions

"Hi Absolute,

I have recently been running a book camp with my clients and a few of them are reporting back pain. What can I do to identify those who are at risk and what can I add to the program to manage these episodes? "

Stacey (Personal trainer)

Hi Stacey,

Thank you for your question.

Back pain is a common problem in the exercising population. Most cases of back pain are multifactorial - ie they are brought on by a combination of a lack of range of motion, decreased core muscle strength for support, and tightened or overworked global muscles attempting to correct movements.

Here are some keys tests to predict and prevent back pain:

1. Perform a one leg squat: if the knee travels medially or the hip drops - your client may be lacking strength in the gluteals. This causes a shift through the pelvis when running creating a shearing effect in the lumbar spine. Strengthen this area with glute targeted exercises like bridges, step-ups, one leg squats, and exercise tubing crab walks.

2. Check lumbar extension: have your client lay prone and place their hands under their shoulders. Perform a push up action but leave their hips on the ground. If your client has good range of motion they should be able to be comfortable with fully extended elbows. This becomes a prescribed stretch if needed.

3. Check thoracic spine extension - Test your clients range by asking them to sit up in a chair - outstretch their arms - place their palms together - and see how far they can take their outstretched arms over their heads. A good result is 170 degrees and above - if your client does not have adequate thoracic spine extension then add plenty of foam roller extensions to their program.

4. Do an Active Straight Leg Raise test : have the patient lying supine, instruct them to lift their straight leg 10-20cm off the ground. Watch for pelvis movement. Clients with a well functioning core will maintain a stable pelvis automatically without the need for you to cue them to activate their core. If the pelvis on the opposite side lifts when the leg is lifted then there is a inner core control deficiency. These clients should be commenced on low grade core exercises such as knee roll-outs, supine bent knee lifts and pointers before being progressed to standing core and cables.

These tests are a good start however often these clients may still need hands on intervention and a comprehensive assessment from your local health professionals.  Remember that if any of your clients have referred pain, weakness, numbness or pins and needles its essential they seek assessment by a health professional as soon as possible - this protects you from legal nightmares and ensures your client is back on their feet and training at their peak with you sooner.

Hope this helps Stacey.

Tamika Fasoli - Physiotherapist

Manage Your Back Pain

MANAGE YOUR BACK PAIN

The following advice is provided to help better manage and control your back pain. Please consult your physiotherapist if you do not understand any of the advice or it gives you an increase in your pain.

Maintain Good Posture:

Your Back prefers positions where your spine is in neutral and maintaining its normal curves.

• When Standing- try to stand tall, as if a string was gently drawing you up from the crown of your head. Try keep weight evenly between both legs.

• When Sitting- use a lumbar support or small cushion or rolled up towel to fill in the small curve between your lower back and chair. Sit your bottom well back in the chair with your feet resting flat on the floor. Soft, low chairs tend to be worse. Try not to cross your legs.

• When Sleeping- try a pillow between your knees if lying on your side or pillow under your knees if lying on your back, to help support your back in a neutral position.

Try to Avoid:

• Prolonged sitting. If you have to sit try and get up and change positions or stretch briefly every 15-20mins.

• Bending from your back. Bend from hip and knees instead

• Lifting heavy objects

• Bending and twisting eg mopping or vacuuming. Again bend from knees and use your feet to twist rather than your back

Lifting:

When lifting (even light objects) bend at your knees and hips so you can keep your back straight. Use your leg muscles to help you lift the load, and brace with your deep tummy muscles to support your back.

Exercise:

• Gentle regular exercise like walking or swimming is often beneficial. Start gentle and pace yourself, especially if you have not exercised for a long time.

• High impact sport exercise like running and jumping sometimes needs to be avoided while your back pain is very acute.

• Good core muscles have recently shown the importance of reducing lower back pain and reoccurrence of back pain.

• Heat pack can be useful to reduce muscle spasm

• Physiotherapist may suggest some exercises to do at home to help your pain

Tamika Fasoli - Physiotherapist @ ABSOLUTE

Juddy's ACL Injury

JUDDY'S ACL INJURY

ACL injuries are relatively common in the sporting world. They occurs most commonly is sports that involve high speed changes of direction when running and landing such as football, soccer, basketball and netball.

In 2013 there were 23 ACL reconstructions in the AFL alone!

Chris Judd has been all over the news in the past week following his ACL injury. For those who saw the incident Judd landed on a single leg and a rotation occurred at his knee under his entire body weight. The knee is not designed to take this kind of rotation load and his ACL is stressed to the point where it ruptures.

The video below shows where the ACL lies and how it becomes stressed on a rapid change of direction.

These injuries do not often happen in isolation. They are generally combined with damage to other knee structures such as the medial ligament or joint cartilage.

Judd will undergo an ACL reconstruction where a new ligament will be created most likely using a piece of hamstring tendon. Following surgery he will undergo extensive rehabilitation over the next 9-12 months to make sure his knee return to optimal function.

This is where us PHYSIOTHERAPISTS come into play. We are the experts in guiding the treatment and rehabilitation process to ensure optimal levels of movement and strength are achieved and it is important this process if completed entirely to prevent secondary issues and even recurrent injury.

Devon Soutar - Physiotherapist @ ABSOLUTE

GaitScan™ System - Foot Scanning Technology

Look at what has just arrived @ ABSOLUTE!!!!

The State-of-the-Art GaitScan™ Foot Scanning System

WHAT IS IT?

The GaitScan™ System is a computerised foot scanning technology that uses an extremely sensitive pressure plate to measure both pressure distribution and timing sequences during gait. The software then collates and analyses all the data received from the plate and converts this information into a format that allows health professionals to identify faulty foot function.

WHAT IS IT USED FOR?

Your feet have a significant impact on the rest of your body and can often be an underlying factor to many lower limb injuries. Poor shock absorption and sub-optimal pressure distribution can not only create issues at the level of the foot, but also overload other joints and muscles including the knee, hip and even lower back regions. GaitScan™ helps to determine the cause of your complaint, whether you feet my be a contributing factor and to confirm whether a custom orthotic device would be of benefit. If indicated, custom foot orthotics are easily ordered directly via the GaitScan™ software, and are manufactured specifically to your feet and to fit any type of footwear.

CLICK HERE FOR A

FREE GAITSCAN™ ASSESSMENT and REPORT!

WANT TO KNOW HOW YOUR FEET ARE FUNCTIONING?

WANT TO FIND OUT MORE ABOUT YOUR FOOT PAIN?

WANT TO KNOW IF YOUR FEET ARE CONTRIBUTING TO YOUR OTHER INJURIES?

WANT TO KNOW IF YOU NEED FOOT ORTHOTICS?

CLINIC TOUR - Traralgon

CLINIC TOUR - TRARALGON

Get a peak at our Traralgon clinic and learn more about our Physiotherapy and Podiatry services.

ASK A PHYSIO - Leg Extensions

ASK A PHYSIO - WHATS THE DEAL WITH LEG EXTENSIONS??

Ask a Physio is a section of our monthly PT newsletter that allows you to have your burning questions answered by our Physiotherapists. If you have a question that you would like to ask a member of our team email info@absoluteim.com.au for the chance to have it included in the next edition.

Hi Physio,

I have been reading a lot about the issues with the Leg Extension exercise and I am a little confused as to whether I should be using it with my PT clients or not – can you give me your opinion please?

Nick - PT (Traralgon)

Hi Nick,

This is a very hot topic and one that will surely raise some discussion – however here is a simple summary of the issues with this exercise.

1. Shearing Forces :

In the majority of ground based leg exercises – such as squats and lunges – the resistance to movement runs through the knee joint – basically compressing and stabilizing the knee itself. However – in an exercise such as the Leg Extension the resistance is at 90 degrees to the shin – as this is where you are pushing against to raise the shin pad.

The resistance is at 90 degrees to the long axis of the bone (the tibia) – which has the effect of producing shearing forces across the knee – compared to a squat where the resistance runs along the long axis of the bone. This comes in to play especially with those recovering from ACL repair as the shear forces can significantly load the ACL graft.

2. No Co-Contraction:

In conventional squats and lunge type movements there is contraction of the quadriceps ( to extend the knee) at the same time as there is contraction of the hamstring group ( to extend the hip ) – this is termed co-contraction.

In the Leg Extension exercise there is contraction of the quads with limited hamstring involvement – again promoting shearing forces across the knee and reducing muscle involvement.

3. Functional Transfer:

The actual motion of the Leg Extension exercise produces limited functional carry over to real life sports and daily tasks - compared to squatting and lunging movements that are common patterns in everyday life.

4. Reduced Muscle Involvement:

The majority of PT clients are time poor and are better off doing an exercise involving a large number of muscle groups compared to smaller isolated groups – simply from a time management and results perspective.

My opinion - stick with the closed chain weightbearing exercises - the benefits of definitely outweigh those of the leg extension machine.

Devon Soutar - Physiotherapist

Choosing the Right Exercises!

Are You Choosing the Right Exercises?

In talking to Personal Trainers I am often asked about the most effective and productive exercises – and to tell you the truth when I look around most gyms – there are plenty of PTs wasting their clients times with low value exercises.

Here are a few questions that I often advise PT's to ask themselves when selecting exercises for a new workout program:

a)    Are we effectively balancing muscle groups?

e.g.: make sure you perform wide Bent Over Rows to balance the wide Bench Press that you are doing in your programs – neglecting this can lead to shoulder injury.

b)   Is tension being maintained in the muscle for the majority of the joint action?

e.g. : The simple Tricep Kickback involves a hell of a lot of wasted movement – with the first 45 degrees of the extension phase being effectively across gravity – you are better off doing a Two Arm Dumbbell Extension where the tension is maintained for the full range of motion.

c)    What part does momentum play in the performance of the exercise?

I am sure you have all seen the last 20cm of a fast Seated Cable Row – where momentum completes the last phase of the exercise – tip – slow down and feel the tension to maximize hypertrophy.

d)   Does the exercise involve a full range of motion and pre-stretch?

Close Grip Pull downs will beat Wide Grip Pulldown every day of the week based on this principle – make sure your exercises give a full Pre-stretch and as large a range of motion as safely available.

e)    What hormonal effects occur with response to different exercises?

Squats and Deadlifts are proven to increase levels of circulating testosterone and growth hormone – exercises such as leg press and bench press – do not – so look for hard core exercises that deliver the best hormonal outcomes.

Are You Balancing Your Shoulder Workouts??

Are You Balancing Your Shoulder Workouts?

At Absolute we see a large number of shoulder injuries often related directly to the two main injury causes – overtraining and poor program design – one common program design fault made by personal trainers and their clients relates to unbalanced exercise choices.

The concept of balance in the shoulder area is nothing new – it may relate to balancing the shoulder internal rotators with the external rotators, or balancing the humeral head depressors with the humeral head elevators – however the most common recent issue relates to simply not balancing the planes of motion in shoulder related exercises – let me explain…….

The majority of weight training programs include some version of the old favourite – the Bench Press – either machine based or free weight – in the performance of this exercise the Gleno Humeral Joint (shoulder joint) goes through a basic motion of Horizontal Adduction – ie the humerus starts at 90 degrees of abduction and then moves in the horizontal plane across in front of the body – simple enough so far?

Now the use of the Bench Press exercise is a fair enough choice – although highly over-rated (the topic for another discussion no doubt) - but to truly balance this exercise its counterbart back exercise also needs to be in a horizontal plane of movement, for example the 'Bent Over Row'. Can you see that the wide grip action of the Bent Over Row is the exact opposite exercise to the Bench – ie Gleno Humeral Horizontal Abduction.

It is a shame that the Bent Over Row has been replaced by the easier to teach – supported row and cable row – as these more popular exercises often use a more flexion / extension motion at the shoulder joint – and not the required Horizontal movements that provide better balance for the shoulder joint.

So do your clients a favour and include the old favourite “Bent Over Rows” – shoulder width grip – with elbows out to the side – not only a great exercise for the middle back but can also assist with shoulder injury prevention – Happy Rowing.