The Art of Returning to Sport after Injury

Here at Barefoot, a lot of our clients present to us with an injury they sustained during sport. From football to cricket to gridiron, there is nothing more frustrating than having an injury prevent you from playing the sport you love.

Many questions are commonly asked such as:

How long until I can get back to running?

How long until I can compete again/re-join my team?

If I play will I re-injure this again?

There are some injuries with healing timeframes which dictate roughly the minimum amount of time an athlete will spend on the sidelines. For example a bone fracture or a complete rupture of a muscle or ligament will have very specific timeframes (and possibly surgical involvement) which will prevent someone from returning to sport within those first couple weeks…

Over the next few paragraphs I want to discuss sporting injuries, and the approach we take to them at Barefoot. I will walk you through how we determine if an athlete is ready to return to sport.

The most frequent types of injuries we see in clinic are ligament, muscular and tendon soft tissue injuries – of varying degrees.

The steps we take at Barefoot when aiming to get someone back on the field (After acute management has been given):

  1. First and foremost – we need the athlete to have no neural irritation. An athlete with neural irritation stemming from the spine will not recover as fast as one who is neural clear. When nerves are irritated (as shown objectively on our Neural Dynamic Tests) the muscles around them guard/spasm to protect the nerve. This reduces movement and places higher forces on joints/structures in the body, takes the body longer to recover and if not cleared fully predisposes them to further injury. This is a crucial step.Barefoot nerve testing
  2. Appropriate Ranges of Motion (Ideally throughout the entire body – and definitely equal on both sides of the body). By going through the Barefoot Plan, we will determine areas of the body contributing to reduced ranges of motion, and treat those accordingly until an athlete has full range.
  3. Full Strength and Proprioception about the affected joints – To regain strength and balance, steps 1 and 2 need to have been addressed. The actual strength gains itself will be developed through a therapeutic, sport specific graded exercise program prescribed by one of Barefoot’s Physios or one of the trainers who we commonly refer to.
    • By this point in an athletes rehabilitation, pain should be substantially diminishing, if not completely gone
  4. Once steps 1-3 have been accomplished, it is now time to think about actually getting this athlete back to their sport. This is done by starting with the most basic principles of their sport, and working our way up to the most complex/challenging aspects of the sport. To truly be able to determine if someone is ready to return to 100% intensity of their sport, I want to recreate their sport specific environment, and assess their performance
    • If the client has any pain, discomfort, imbalance or poor motor patterns during my assessment of their abilities…then they are surely not ready to SAFELY return to sport at this time. See below example for return to sport for a soccer player 

For example, assessing a soccer player’s ability to return to sport would involve: 

  1. Running (straight line – slow pace, no change in speed no change in direction
  2. Running (straight line – medium pace, no change in speed no change in direction)
  3. Running (straight line – fast pace, no change in speed no change in direction)
  4. Running (Zig-zag between pylons – slow pace, no change in speed)
    • Repeat at moderate to fast speeds
  5. Running (jogging backwards, then turning and running in the same direction forwards – slow pace)
    • Repeat at moderate and full speeds
  6. Soccer ball skills
    • Passing a soccer ball short distance (5 feet) – inside of the foot
      • X10
    • Repeat at moderate and long distances
    • Repeat all of step 6 with a top of the foot pass
    • Repeat all of step 6 with right and left foot
  • Dribbling the soccer ball
    • Slow pace
    • Moderate pace
    • Fast pace
      • All of the above performed in a straight line, and in varying pylon set ups (zig zags)
  1. Incorporate an unstable environment:
    • Steps 1-5 re-performed without the athlete knowing which way they are going to run
      • Example:
        • Athlete running at a moderate pace towards me, at the last second I point to either my right or left and the player has to sprint for 3 seconds in that direction
  1. Combination of steps 1-5 with steps 6 and 7
    • Incorporating running with ball control
    • Example:
      • Athlete jogging, not knowing when I am going to pass him/her the ball, and when I do, having him/her pass it back to me immediately with one touch
    • This can be incredibly variable, and will start slow and steady and progress to full speed drills in an unstable environment, where the athlete has to change their speed, change their direction and perform sport specific (soccer ball) skills, all on one drill.

Physio soccer

The above is done in such an order (most basic drills to the most challenging) because I want to know immediately if there are any concerns with the athletes’ injury recovery. Unless all of the above can be performed with no concerns, then I would not be happy to tell somebody that they are ready to return to sport.

The above example is a fairly basic one. In real life, all return to sport assessments are tailored to the individuals sport and their specific position/role in the sport.

Here are Barefoot, the athletes safety and recovery is of the utmost importance, and we are here to support you. As part of your support system, it is our job to take you through the above steps, and make sure you are FULLY RECOVERED before we give you our OKAY to head back out on the field – there is nothing worse than being told you are recovered, and going out and re-injuring yourself.

If you have any sport specific questions about rehabilitation, please do not hesitate to ask 🙂

Happy sporting!

Ben Murphy soccer

Stay hydrated this Summer!

Summer in Brisbane is definitely kicking into gear, so we want to make sure you are all staying well hydrated (especially through the silly season!)

How much water to drink

SO….HOW MUCH WATER SHOULD WE BE DRINKING?

To work out how much water you should drink per day you can do this simple calculation:

Your Body Weight x 30mL = ‘x’ mL water to drink per day

For eg: 65kg x 30mL = 1950mL/day (1.95L)

If you are exercising in your day your water intake will be more as you need to consider your sweat rate (every Sweaty Betty is different!). To calculate your sweat rate you will need to weigh yourself before and after your activity. For every .45kg lost 473mL of fluid is also lost (which needs to be replenished).

Therefore, if a 65kg person lost .45kg of weight during their daily exercise they would need to drink

1950mL + 473mL = 2423mL/day (2.4L)

And remember – Do what suits you to keep your fluids up. Something that works for me is having my water bottle handy at the clinic.

water bottle at workwater bottle outside

Cheers!

To Stretch or not to Stretch 2.0

We have had some great feedback from our recent blog on stretching (dynamic and static), so we thought we would follow it up with some examples of different dynamic and static stretches with pictures!

Dynamic: As detailed in the last blog (To stretch or not to stretch part 1), dynamic stretching requires constant movement. See below exercises and picture examples:

Leg swing

Description: A good way to loosen up most muscles in your legs before any running event or sport!

Leg swing

Arm swing

Description: Essential before any exercise or sport requiring your arms (Cricket, footy, baseball, basketball and any sport with lots of running)

Arm swing

High knees

Description: A great way to loosen up your lower limbs, most specifically targeting your glutes and hamstrings!

High knees

Kick back

Description: Kick backs loosen up your quads and hip flexors around your pelvis!

Kick backs

Static: Static stretches are you most traditional type of stretching, consisting of putting the body in a stretched position, and holding it in that same position for an extended period of time. See pictures and descriptions below:

Adductor stretch

Description: Great stretch to perform after leg day, or any sport that is heavily leg dependent (rugby, footy, or any running event/sport).

Adductor stretch

Posterior shoulder stretch

Description: This stretch should be performed after any sport requiring predominantly the arms, but can also be used to simply relieve tension if you carry a lot of stress around your neck/shoulders.

Shoulder stretch

Shoulder stretch

Hip flexor stretch

Description: Essential after any running sport/event, biking or even just after a long day of sitting at a desk. Tight hip flexors can alter muscle balance around the pelvis, and is thought by some to contribute to lower back pain. It will only be beneficial to do this stretch on a regular basis!

Hip flexor stretch

Hope that’s helpful! It’s my modelling debut for Barefoot… I think I’ve got Cherelle beat. We’ll get Blue Steel looks for you to compare soon 🙂

Ankle Oedema in the aircraft

Two weeks ago my girlfriend and I had the pleasure of flying home to Canada for a week to attend a good friend’s wedding. The flights took us a route home which was “backwards” more or less, however it did save us a little money.

Our flight path from Brisbane to Toronto:

  • From Brisbane to Perth
  • From Perth to Abu Dhabi
  • From Abu Dhabi to Toronto

This totalled a little over 30 hours of in air flying time. By the time I finally arrived in Toronto, I noticed that my ankles felt really tight while I was waiting at the luggage carousel. When I rolled up my pant legs, I noticed that both my ankles were significantly swollen.

During the flights I moved around as much as I usually would, up for a walk every couple hours, and tried to keep my legs/feet quite active even while I was sitting in the seat. I had hope this would be enough to prevent ankle swelling, however I was quite wrong.

So, why do our ankles swell when we fly, especially on those long trips? Is this dangerous? How do we prevent it?

Let’s start with why this happens. Whenever we are sitting for a long period of time in a plane, the muscles in our legs that are usually responsible for pumping blood and fluid back up are legs are not being used at all. Over time, this will lead to an increase in fluid and blood pooling in our lower limbs (ankles).

Additionally, on long flights in a low air pressure aircraft cabin, it is easy avoid drinking lots of water. Firstly, the stress of flights sometimes makes an alcoholic beverage a more appealing choice, and secondly a lot of people avoid too much water because they do not want to be getting up and going to the toilets on a regular basis while flying. This makes it very easy to become mildly dehydrated on airplanes. Being dehydrated can reduce your blood circulation, making it that much easier for fluid to pool in your ankles on those long flights.

Is this dangerous? The ankle swelling itself is not dangerous, however the reasons which cause it can also cause things like blood clots or deep vein thromboses (blood clot in your calf), which can be seriously dangerous and has the potential to cause death. So although the ankle swelling itself is not a reason for concern, the reasons which caused the ankle swelling is definitely reason enough to take it seriously and take any necessary precautions to prevent it.

How do we prevent it?

  • The biggest thing you can do to prevent poor circulation and subsequent ankle swelling is movement. Aim to get up on a half hourly basis (Assuming you are not asleep) for a walk around the cabin. Aim to be up walking for at least 3-5 minutes each time.
  • It is crucial to stay hydrated. This means drinking water before and during the flights. Even if you are having a glass of wine or a beer, try and also have a bottle of water on the go as well.
  • It is important to keep your feet and legs moving as much as possible even while you are seated. Pump your ankles from side to side and up and down on a regular basis.
  • Some people wear compression stockings while flying to prevent blood clots in their legs. There is evidence suggesting that wearing these stockings can significantly reduce your chance of a blood clot which is great, however it is important to remember that stockings are NOT a substitute for any other of the above precautionary measures, most importantly exercise and frequent movement on a plane.

IMG_8952