Swimmer’s Shoulder

– with Sports Physiotherapist Ivan Hooper

Spring has hit and with it warmer weather is on its way. As the temperatures rise our exercise thoughts often turn to swimming as a way of keeping fit and keeping cool.

Shoulder pain is a common complaint for swimmers, and is especially prevalent as people are ramping up their kilometres in the pool after a long winters hibernation. Here are a few tips from our Sports Physiotherapist Ivan Hooper, who has spent the last 2 years working with the Australian Swim Team as their Clinical Services Manager – Physiotherapy. His role is to coordinate and manage the physiotherapy services being provided to elite swimmers around Australia. With Ivan’s extensive experience, he has shared with us some tips on what to be considering, that might help prevent shoulder pain from happening to you as you hit the water this spring.

Make your shoulder strong – Making sure that the muscles of your shoulder are strong will decrease your risk of injury when you get back in the water. Whilst everyone is a bit different, the common muscles that need strengthening to avoid injury are the muscles that control the position of your shoulder blades, and the rotator cuff muscles. Try these exercises to get a head start. Remember that everyone is a bit different, and you may need a strengthening program that is more specific for you. In that case it would be a good idea to drop in a see your physiotherapist at QSMC for an individualised program.

Prone T Raises

Starting with arms on ground straight out from the body just below shoulder height. Engage between shoulder blades and lift arms off the ground keeping thumb pointing to ceiling. Hold squeeze at top for 1-3 secs and slowly release back to the ground. Repeat for 10-20 reps. Ensure not to engage neck or upper trap muscles.

Prone Y Raises

 Starting with arms in Y position above shoulder height with thumbs point up. Engage shoulder blades to lift arms off ground, hold squeeze for 1-3 seconds and slowly release back to the ground. Repeat for 10-20 reps. Ensure not too engage neck or arch up through lower back

Build up slowly  – One of the big mistakes lots of people make is to get back into things too quickly and do more than their body is ready for. There is lots of evidence now that how much you do, and how quickly you increase that amount has a big impact on the risk of developing an injury. If you have been out of the pool for a while make sure you take it easy at first and slowly build up the amount that you are doing. Early on it is advisable to only swim every second to third day to allow time for your muscles and joint tissues to recover and adapt.

Keep an eye on the frequency of your sessions (how many sessions you are doing a week) the volume of the sessions (how much you do each session) and the intensity within the sessions (how hard you are going). Try to build all of these areas up slowly and you are a good chance of avoiding an injury.

Recover between sessions  – When you haven’t been swimming for a while it can be a bit of a shock to the system. Often you feel pretty good in the first session, but your muscles pull up sore and tight, and the next session can seem a lot harder. Making sure you give your muscles some care and attention between your swimming sessions will help you hit each session feeling good. Doing some self massage and stretching to the muscles that work hard might do the trick.

Self massage 

Back of Shoulder – Position a tennis ball against a wall and lean the back of your shoulder blade onto the ball. Roll across the back of the shoulder blade to find tight / sore areas within the muscles. Hold the pressure on the tight areas for 20-30 secs before moving onto the next tight spot. Do this for a total of 3-4 mins.

Front of shoulder – put your shoulder in a pec stretch position, pictured. Using the fingers of the other hand massage across the pec muscles from the point of the shoulder towards your sternum. The pec muscle is a fan shape – so make sure you cover all areas for a total of 3-4 mins.

Stretching

Lat Stretch – put the arm that you are stretching on the floor in front of you with your palm facing up. Lean your body away to extend your shoulder to feel a stretch in your lat. Hold the position for 20-30 secs and repeat 3 times each side.

 

By sticking to these tips, chances are you can build up your swimming and enjoy all the benefits of this great sport. If you do sustain an injury or feel you need a more detailed assessment before hitting the water, make sure you get in touch with your physiotherapist at QSMC. Don’t let an injury get in the way of your exercise goals this spring.

Calf Strains

Calf Strains in runners

We are now well into the running season, with some having just completed the Gold Coast marathon or Half Marathon, and the Brisbane marathon festival happening this Sunday. Others are preparing for the Bridge to Brisbane, the Noosa Triathlon and a host of other running events in the coming months.

As a preparation for an event picks up, runners will increase the length of their runs and the weekly mileage starts to  creep up. One very common running complaint suffered by nearly all runners at some time is calf soreness or calf strains.

Usually runners complain of a dull aching pain, but in severe cases a sharp intense pain is felt and the person will find it difficult to walk. A runner’s worst nightmare is to pull a calf muscle during a race or during the last few weeks of preparation. The calf muscle is a group of 3 muscles at the back of the lower leg. The gastrocnemius muscle (which has 2 parts, an inside and outside portion) is at the top of the lower leg and is stretched with the knee straight. The lower, deeper soleus muscle is stretched when the knee is bent. Both these muscles attach onto the heel via the Achilles tendon.

Common causes of calf strain:

  • Overload and fatigue
  • Speed or hill training
  • Ineffective warm up and warm down routines
  • A sudden increase in mileage
  • Dehydration and cramping
  • Calf tightness from back and sciatic pain
  • Inappropriate footwear

Assessment

There are 2 quick measures Physiotherapists use as part of an overall assessment of a clients calf. You can use these as a guide to see how your calf stacks up.

  1. Knee to wall measure – To assess the flexibility of the calf and ankle we get the patient to place a ruler perpendicular to the wall. The patient stands with their big toe on the ruler and keeping their heel down, bends the knee to touch it to the wall. You continue to move the foot back until you are no longer are able to touch the wall with your knee while maintaining your heel on the ground. The last point you can manage this is the measurement. For most people we would like have a measurement over 10cm.
  2. Single leg calf raises – The patient stands on one leg and rises up and down onto their toes as many times as they can. The magic number we are looking for to indicate adequate strength in the muscle is the ability to do 30 calf raises on each leg.

Treatment

If you have injured your calf, the early treatment aims at reducing inflammation and strain on the muscle. This may include:

  • Ice massage over the muscle several times during the day.
  • Compression to limit bleeding and swelling in the muscle.
  • Elevating the leg whenever possible.
  • Stopping running and limit all activities that aggravate the condition.
  • Using a heel raise/shoe insert that helps take the pressure off the muscle as it heals
  • Potentially using anti-inflammatory medication (if advised by your doctor or treating therapist).
  • Early mobilisation and pain free strength work as advised by your physiotherapist.

As the rehabilitation progresses your Physiotherapist will guide you through the necessary steps to get you back to running. These may include,

  • A graduated calf strength program
  • Calf flexibility and mobility
  • Plyometric exercises such as jumping, skipping and hopping.
  • Addressing other predisposing factors such as lower limb and foot biomechanics, decreased ankle range, and weakness in other muscle groups
  • Advice on safe activities to keep your fitness going whilst you work through your rehabilitation
  • Technical advice on running technique, and running drills
  • A detailed return to running program
  • An ongoing home exercise program to minimise the chances of recurrence

When treating runners one of the most difficult things is to convince them of, is the need to take time out from their running schedule to let their injuries heal. We as a runners know how mentally hard it can be, feeling like you are going to loose all your fitness and undo all your hard training. The good news is that research points to the fact that endurance training doesn’t disappear overnight. In fact, the benefits of those long runs last upwards of 6 months! Also cross training, and particularly water running have been shown to maintain your fitness while you are out of action. The key is to get better so you don’t re-injure yourself or change your running style and suffer continued injuries and problems.

As always prevention is the key! Ask your Physiotherapist for the specifics that relate to you, but some strategies that may help include,

  •       A good warmup and cool down routine.
  •       Avoid dramatic increases or changes to training.
  •       Address small injuries quickly – don’t make them big injuries!
  •       Modify your training when fatigued.
  •       Wear good quality, supportive shoes appropriate for your feet.
  •       Keep well hydrated

Hopefully this keeps you on track for your running goals this year and aids your preparation for this running season. If you have any questions about your personal running technique, niggling injuries or are in need of a strength and conditioning program, contact our friendly reception team on (07) 3891 2000 or email reception@qsmc.net.au for booking your next appointment with a Physiotherapist or Accredited Exercise Physiologist.

Hydration Matters

 

Our body is made up of 60% water (can be up to 78% depending on age) water.

It is crucial for survival so it is important to be aware of our body’s need for hydration. Our body needs water for the following functions:

  •    It transports materials throughout the body
  •    It eliminates toxins and waste products
  •    It acts as solvents for nutrients
  •    It regulates body temperature
  •    It is used for energy product in
  •    It aids in digestion and absorption

Every system in the entire body depends on water and requires hydration!

It is recommended that the average individual take in at least 3L of water a day…that figure is raised to 4L during hot days or in hot climates.

Sports and Hydration

Caffeinated beverages, such as soft drinks, coffee and tea act as diuretics and can increase urination that can lead to dehydration. It’s important therefore to consult your Sports Dietician if using caffeine pre-event to ensure to ensure you are getting the stimulant vs hydration balance right.

What happens during exercise?

Heat is generated as a by-product of your working muscles. As body heat rises, body temperature and heart rate also rise. As the exercise continues, the body is limited in transferring heat from the muscles to the skin surface. The body will require hydration.

Exercising in hot, dry climates presents additional risks to dehydration. Body fluids will evaporate rapidly so that you may not notice any symptoms. In humid climates, when moisture increases, sweat decreases. When your sweating rate decreases, your body temperature rises and you will fatigue more easily and your risk of heat injury is greater.

What is heat injury?

Heat injuries include heat cramps, heat exhaustion, and heat stroke.

  •    Heat cramps are severe muscle spasms resulting from heavy sweating.
  •    Heat exhaustion is severe fatigue resulting from excessive exposure to heat that can lead to collapse.
  •    Heat stroke is a life threatening condition that develops rapidly and may not have any warning signs. It is the third leading cause of death among athletes.

There are three factors that contribute to heat injuries. They are –

  •    Increased body temperature
  •    Loss of body fluids
  •    Loss of electrolytes

Symptoms to look for include –

  •    Weakness
  •    Chills
  •    Goose pimples on your chest and upper arms
  •    Nausea
  •    Headache faintness
  •    Disorientation
  •    Muscle cramping
  •    Cessation of sweating

To reduce the risk of heat injuries, adequate fluid replacement is essential before, during and after exercise.

What fluid is best for rehydration?

Water is the appropriate drink before, during and after exercise. However, for exercise lasting longer than one hour and after exercise, it is important to replace electrolytes lost. Sodium replacement not only maintains blood concentration but also increases palatability, and therefore the desire to drink.

The addition of carbohydrates will delay the onset of fatigue and help to maintain blood glucose concentration. A sport drink with 4%-8% carbohydrate is recommended for replacement during exercise, especially with exercise bouts lasting longer than one hour.

So the next time you exercise, remember the importance of hydration. It is a simple step that can save your life!

 

 

Ankle Injuries – 14 Day Balance Challenge

What to do about that ‘dodgy’ ankle?

Try this quick test without shoes on – stand on one foot and close your eyes.
Have a friend time how long you can keep your balance.
If you can’t stay balanced for at least 30 seconds you need to read on.

Ankle Sprains – The Facts!

Ankle sprains are the most common team sport injury and account for up to 60-90% of all injuries. Unfortunately after the first time sprained, and without any rehabilitation, you have around a 70% chance of rolling the same ankle again.
Balance is very important to ankle stability. Balance is made up by a combination of three different senses:

  1. Vision
  2. Vestibular (Ears)
  3. Joints

Unfortunately, once we sprain our ankle the message of ‘Position’ to our brain gets a little confused and in effect makes our balance worse. The good news is balance can be improved with practice. This can then decrease your chances of re-injuring the ankle again.

Give this 14-day balance challenge a go to improve balance and prevent re-injuring the ankle.

14-Day Balance Challenge

Exercises should be completed twice daily and should take approximately 10mins with no footwear or tape.

Day 1 – 3
1) Single leg balance, eyes open, standing on the floor – 30secs x 10reps
2) Single leg balance, eyes closed, standing on the floor – 30secs x 10reps

Day 4 – 6
**Note – unstable surface = either a pillow, foam mat/mattress, mini-tramp or a wobbleboard/durodisc at your gym
1) Single leg balance on unstable surface eyes open – 30secs x 10reps
2) Line walking – heel toe walking over 10 metres – 10m x 5reps
3) Standing on injured leg, kicks whilst maintaining balance – 4 x 10 kicks forward, backward & sideways whilst maintaining balance

Day 7 – 9
1) Single leg balance on unstable surface eyes closed – 30secs x 10reps
2) Forward hop-soft landing, hold landing 3secs – 2 x 10reps

Day 10 – 12
1) Single leg 1/4 squat on unstable surface, eyes open – 4 x 10reps
2) Sideways hop on ground, hold landing 3secs – 2 x 10 each way
3) Forward hop off step, land softly, hold landing 3secs – 2 x 10reps

Day 13 – 14
1) Single leg 1/4 squat on foam, eyes closed – 4 x 10reps
2) single leg hop with 1/4 turn on ground – 2 x 10 clockwise & anticlockwise
3) Sideway hop off step, land softly, hold landing 3secs – 2 x 10reps to each side

Final tip to a quicker recovery – Sport specific retraining is the key!

To make an appointment with one of our Physiotherapy team to discuss your ankle injury, sports specific retraining and when to return to sport book online, email reception@qsmc.net.au or call 07 3891 2000.

The ‘Need-to-Know’ on Knee Injuries

The ‘Need-to-Know’ on Knee Injuries.  What injuries cause the most prolonged absence from sport and how to know when to return?

The knee joint is formed by the thigh bone (femur) and shin bone (tibia). Your kneecap, or patella, sits in a groove on your femur and this joint is know as you patellofemoral joint. The main movements that your knee performs is bending (knee flexion) or straightening (extension). There are four main ligaments that help restrict unwanted movements at your knee: the anterior and posterior cruciate ligaments, the medial ligament which is on the inside, and lateral ligament which is on the outside.

The major structure that when injured causes the most prolonged absence from sport is the ACL, which stops the tibia moving forward on the femur as well as rotation. Commonly it is injured when pivoting or landing and it is accompanied by a loud ‘pop.’ Typically you are unable to continue the activity due to the knee giving way and pain. This is usually followed by swelling. If the ACL has ruptured, you will more than likely require a knee reconstruction. Diagnosis of such an injury is able to be made by your physiotherapist but may also require an orthopaedic surgeon to assess the knee and possibly investigations such as a magnetic resonance imaging (MRI) scan to confirm the diagnosis and to assess for other coexisting pathologies..

The most common type of reconstruction performed uses your hamstring tendon as the graft for the new ligament. The surgeon may elect to use another method such as your patella tendon, or even a synthetic graft.  In the reconstruction, the surgeon will take a portion of your hamstring tendon and insert it to take the place of your ACL. This is all done by arthroscope and physiotherapy will generally start within the first week. Over the course of the next nine to twelve months, a rehabilitation program will be followed which is set out by the orthopaedic surgeon in consultation with your physiotherapist. After such surgery and a comprehensive rehab program, you can reduce the risk of injury to almost the same risk of injury as you had before your initial injury.

ASP_041_Cropped

But at the end of your rehabilitation, how do you know when you right to return to sport? Below are a series of hop tests which can help you and your physiotherapist decide when you are right to return.

Studies have shown that 3 simple tests: vertical jump, hop for distance and a side hop can accurately show when your knee is right for action. Your injured side must be at least 90% of your un-injured leg in all tests to pass. The tests look at the strength of the muscles surrounding your knee, the ability to control your knee under high load as well as its resistance to fatigue. It is important that these tests are done under appropriate supervision of your physiotherapist.

Vertical Jump
Start by standing upright on your un-injured leg with your arm up as high as possible with chalk bend your knee and jump as high as possible while striking the wall with your hand at the highest point. Repeat with your injured side.

Hop for Distance
Stand on your uninjured leg with hands behind your back, bend your knee and hop as far as possible. You must be able to hold the landing for 3 seconds. Measure from your toe at push off and the heel where you landed. Repeat with your injured leg and compare the two scores.

Side Hop
Get two strips of tape 40cm apart on the floor. Stand on your un-injured leg and hop from side to side without touching the tape as many times as you can in 30 seconds. Repeat the test with your injured side and compare the two results.

The results of these tests will let you know what elements you need to work on: strength, stability or fatigue. These tests should be completed under appropriate supervision and it is also important that if you have had a reconstruction, before you return to sport, you are cleared by your orthopaedic surgeon.

To make an appointment with one of our Physiotherapy team to discuss your keen pain or when to return to sport book online, email reception@qsmc.net.au or call 07 3891 2000.

What causes tendon pain?

Research suggests that many tendon troubles are associated with tendons that are given a load that is more than they can cope with. This leads to tissue breakdown without the traditional inflammatory response that other injuries get. This ‘degenerative’ process happens in athletes of all ages who go through a period of stressing their tendons more than they can cope with.

A common (and surprising) example of this is the sedentary office worker who plays the ‘one-off’ game of touch football at a family barbecue. Another example may be an athlete who experiences a sudden increase in their training load such as the start of preseason. The prolonged ‘inactivity’, or reduced activities of the individual has the tendon feeling good but susceptible to damage with the sudden change in workload which may tip the tendon into a degenerative state.

Get and Stay Active – Follow these guidelines to maximise the chance of a successful recovery:

Activity
Be Active. Low load endurance activity that is relatively symptom free has enormous benefits to your physical, psychological and recuperative health. Avoid exhaustive and high heart rate exercise as it promotes free radical production that fosters further troubles with your tendons. Further, avoid a sudden increase or decrease in your activity loads. A well-balanced general activity program is of paramount importance to a good recovery strategy for tendinopathies.

Unload
Tape, brace, or the use of an orthotic may be required to unload the injured tendon. Your Physiotherapist will advise you if these interventions are appropriate for your condition.

Lose weight around your belly
Tendon injuries have been shown to be much more common in men with a waist girth of greater than 108cm and women with a waist of more than 88cm.  Get on that ‘pushie’ to shed some kilos.  You don’t even have to be exercising the injured part to help its recovery.

Tendon Loading Program
Your physiotherapist or Exercise Physiologist can design a specific exercise program that research shows is the ‘key’ to a successful rehabilitation program. Your clinician can also show you how to perform these activities at home with appropriate technique.

Action Plan
With activity being the key to successful rehabilitation, being armed with an injury management plan from your physiotherapist, sports physician or accredited exercise physiologist will have you on the road to recovery faster.

To make an appointment with one of our Physiotherapy team to discuss your tendon pain book online, email reception@qsmc.net.au or call 07 3891 2000.

Out of the Lions den and into the Centre

Over the last 12 years one of QSMC’s Directors and Sports Physiotherapist Shane Lemcke has been at the Centre in a reduced capacity to enable him to work full-time with the Brisbane Lions. Particularly in the last 7 years as Medical Coordinator, Shane has had the opportunity to work with players and other practitioners on a multi-disciplinary approach to treatment of players at an elite level. At the end of the season Shane decided it was time to move on from the Lions to allow him more time to devote to his young family and share his experience with the staff here at QSMC. We are very excited to be getting his experience back on the treatment floor full-time as of November.

Shane is looking forward to getting back to the Centre to work with our exciting range of practitioners and reconnect with his clients. Shane will also have capacity to take on new clients and with his experience in working with athletes in a pressured environment to minimise the impact of injury.

We asked Shane to give some insight into working with the football team and how it differs from the QSMC treatment floor.

Firstly, welcome back! What made you decide to move on from the Brisbane Lions?
After 12 years working with the club I decided that it was time to step away from football and head back to the Centre. I have a young family now and it’s important that I devote some time to them, which is difficult to do when travelling with a football team. It was time for a change and I’m really looking forward to getting back to the Centre environment.

What is the best thing about working with a football team such as the Brisbane Lions?
For me it’s about the relationships that have been built over a long period of time. Even though we didn’t always achieve the win, it doesn’t take away from being part of a team and working together for a common goal. Watching players develop and improve is really exciting to be able to contribute to their growth and development as an individual and an athlete is extremely fulfilling.

What are the main differences when treating athletes?
You get to have access to them, essentially full-time. The treatment that you are providing to them can be as often as required and the approach is a collaborative multi-disciplinary treatment plan to get the best outcome for the player. You find yourself working with a strong team of experts daily, coordinating treatment in the gym and taking them right through to running onto the field for a game.

What do you feel you have gained as a Sports Physiotherapist?
Definitely the experience of managing injury. For an athlete you want to minimise the impact that injury has on their ability to play and maximise the outcome to get them back to playing as quickly and safely as possible. It’s a pressured environment and makes you a better practitioner for it. I’m looking forward to working with clients and developing strong injury management plans from my experience with the Lions to get them back to their sport or activity of choice.

Lastly, what are you most looking forward to coming back to at QSMC?
I think at QSMC we have such an exciting range of practitioners which such vast experience. I have been at the Centre in a somewhat part-time capacity for the last few years, focusing more on the management side of things and have seen the Centre go from strength to strength within our team. I’m looking forward to getting back to the floor full-time and working with all of that great experience as well as getting to contribute. Mostly I’m looking forward to reconnecting with previous clients and building relationships with new clients to work on the most effective treatment plan for them.

Everyone at QSMC is really looking forward to having Shane back full-time and treating as of November. If you are looking for a high quality injury management plan, book an appointment with Shane by contacting the Centre reception on 07 3891 2000.

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Return from Rio Olympics

Want to be treated like an Olympic medalist? Fresh from his stint at Medical Headquarters for newsletter-pic_ivanthe Australian team at the Olympics, Ivan Hooper is back treating clients at QSMC.

Those who know Ivan will recognise that he is no stranger to Olympic teams having made Rio his fifth berth.  Previously with Kayaking and Rowing, Ivan has been a fixture in every Australian Olympic team since Sydney 2000.  This makes Ivan among the most experienced Olympic physiotherapists in the country.

Ivan has just reopened his schedule on return to QSMC and while he is still juggling commitments to Australia’s Olympic sport program, he is available for consultations Monday, Tuesday, Wednesday and Friday.  Call our reception on 3891 2000 and book an appointment.

Running Assessments with Dolph Francis

With summer well on the way many of us will dust off the running shoes and start hitting the pavement to try and get fit after the winter hibernation. At QSMC we know that in the eagerness to get stuck into it, you can often run into injury trouble by going too hard too early. Injuries such as shin splints, Achilles tendinopathy, anterior knee pain and plantar fascia are all common running injuries that we see as people get back into the swing of things.

In addition to how quickly the volume of running is increased, your running technique can also play a role in the development of injuries. How your foot interacts with the ground, how good your muscle control is around your hip as well as other factors can be critical in making your running technique more efficient, and decreasing your risk of injury. QSMC is fortunate to have a number of physiotherapists with experience in treating runners over a long period. Dolph Francis, an ex-elite runner in his own right, has a specific interest in running mechanics and has helped many runners around Brisbane with his running analysis and technique correction work.

Do you feel that your running technique might be a playing a role in your injury? Is your technique limiting the amount of running you can achieve? If yes, then a running assessment with Dolph may be the answer for you. Don’t let injury get in the way of your running goals this summer, book your running assessment with Dolph. Contact reception on 07 3891 2000.