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Returning to Sport after Injury

Here at Barefoot, a lot of our clients present to us with an injury they sustained during sport. From dance to yoga and football to power-lifting, there is nothing more frustrating than having an injury prevent you from doing the activity you love. The most common question in returning to sport after injury, is how long should I wait? or get treatment for?

Other questions 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 myself again?

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

Over the next few paragraphs we’ll discuss sporting injuries, and the approach we take to them at Barefoot Physiotherapy, and how we determine if an athlete is ready to return to their 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 returning to sport after injury (After acute management has been given):

  1. First and foremost – we need the athlete to have no nerve irritation. An athlete with nerve [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 tense up and may spasm to protect the nerve. This reduces movement and places higher forces on joints/structures in the body, consequently taking the body longer to recover. If not cleared fully it also 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 returning to sport. This is done by starting with the most basic principles of their chosen activity, and working our way up to the most complex/challenging aspects of it. To truly be able to determine if someone is ready for returning to sport at 100% intensity, we recreate their sport specific environment, and assess their performance.
    • If the client has any pain, discomfort, imbalance or poor motor patterns during the assessment of their abilities…then they are surely not ready to SAFELY return to sport at this time. See below example for returning to sport for a soccer player 

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

  1. Running in a straight line – slow pace, no change in speed no change in direction
  2. Then in a straight line – medium pace, no change in speed no change in direction
  3. Followed by running in a straight line – fast pace, no change in speed no change in direction
  4. Then Zig-zag between pylons – slow pace, no change in speed
    • Repeat at moderate to fast speeds
  5. Finally running 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 (1m) – inside of the foot
    • Repeat at moderate and long distances
    • All of step 6 above with a top of the foot pass
    • Again all of step 6 with right and left foot
  7. 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 Physio, at the last second Physio will point either 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: get the athlete jogging, not knowing when the Physio will pass her the ball, and when it’s passed, having her pass it back  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 Assessment

The assessment above is done in such an order (most basic drills to the most challenging) because we 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 we would not be happy to tell somebody that they are ready to be returning to sport.

The above example is a fairly basic one. At Barefoot Physiotherapy, returning to sport assessments are tailored to the individual and their specific position and or role in their chosen activity.

Our Job at Barefoot

Athlete 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 return to your chosen activity. 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!

Physiotherapy for Pain Management

Here’s a great article from our Industry Body explaining the current situation with Codeine becoming prescription only, and how Physiotherapy for Pain Management can be an effective treatment option.

With codeine becoming a prescription only drug from February, a large number of Australians will be seeking alternative ways to manage their pain.

National President of the Australian Physiotherapy Association, Phil Calvert said, ‘The good news is that physiotherapy is proven to provide effective pain relief, which treats rather than simply masks the underlying cause of pain.’

‘We appreciate that restricting access to codeine may cause anxiety for people who suffer an injury. So we want them to know that physiotherapists help people to manage their pain and recover movement with great success, without the use of addictive drugs.’

Research has shown that the relative level of pain that is experienced by someone can be influenced by a range of factors including their emotions and social environment. This means that pain can be a very complex issue to successfully treat.

‘There is no one size fits all approach in assessing and treating someone’s pain. So physiotherapists are practiced in considering a range of factors that may be contributing to the pain. We’ll talk with patients about their lifestyle goals and introduce an appropriate treatment including exercise programs, joint manipulation and mobilisation,’ said Mr Calvert.

What to expect from a physiotherapy consultation:

  • Your physiotherapist will perform a physical examination and find out more about your history and any other factors that may be contributing to the pain.
  • In most cases of acute pain (the period in which an injury is expected to heal), the pain will settle as the tissue heals. Your physiotherapist will explain the nature of the injury and normal healing times. They may provide early treatment, but in many cases advice regarding self-management strategies, including gentle exercise, will be enough to help resolve the pain and return you to full function.
  • In situations where the pain has become chronic (generally more than three months – longer than normal healing times), assessment and management may be more complex. Things other than tissue damage may be contributing to your pain, which your physiotherapist will investigate. In complex situations other specialists may also form part of a wider treatment team.
  • At all stages of pain management, physiotherapists will work with you to encourage self-management, remaining active as appropriate and avoiding a reliance on medication.

If you’re experience pain or difficulty with movement that may cause pain, please don’t hesitate to get in touch with us.  Here’s a BLOG of ours to read, If you’d like some simple exercises to assist with pain management: http://www.barefootphysiotherapy.com.au/easy-exercises-keep-healthy-active-age/

 

Top tips for keeping your body happy at work!

Top tips for those who are sitting at their desk all day.

If you are an office worker chances are you have come across or experienced first hand the pains of sitting for too long. While a typical desk job may seem to expose the body to little physical strain, prolonged sitting can wreak havoc on the body. The reason for this is that we are meant to move. Our anatomy and biology is set up for us to walk, stand, squat, twist, pull, push and a whole lot more. As the saying goes, “if you don’t use it, you lose it”. In this case sitting all day causes us to lose our mobility. Muscles become tight and weak, our posture changes, and we become stiff and sore. To remove the risks of prolonged sitting check out our list of top tips you can do to maintain your mobility and move well regardless of the demands of your job.

  1. Perform an audit of your workstation setup

Often making a few changes to your workstation can cause you to form good posture without having to even think about it. Here’s some common faults and top tips for your workstation setup.

Common faults with workstation setup:

  • Chair too low → looking up at monitor
  • Monitor too low → looking down at monitor
  • Desk too low or seat too high → hunched over keyboard

Fix these with:

  • Chair at proper height → eyes are level with top of monitor
  • Hands comfortably at keyboard → shoulders are not rounded
  • Monitor at correct height → neck in neutral position

Want to learn more about how to setup your workstation? Click here.

 

Optimise your sitting posture:

often when we think about posture, it can seem overwhelming, often you are left with one question . . . What is the right way to position my body?

To ensure that the curves of the spine are maintained: roll your pelvis forward until you achieve a very slight curve in the lower back, sit up a little straighter through your mid/upper back, and check that the position of your head isn’t too far forward of back. It should feel nice and balanced over the rest of your body.

The next step is to get used to what being in this position feels like so you can adjust your position without thinking about it too much. After this you must form a habit of getting into and maintaining this position. To form a habit it is helpful to have habit triggers. Every time one of the following occurs hold your good posture for 5-6 deep breaths or until you forget about it:

  • You get an email
  • You answer or hang up the phone
  • You take a sip of water
  • You set your desktop background to a picture of someone with good posture and do what they do when you see it.
  • You set a reminder on your phone to notify you that its time to practice your posture habit.

Remember the most important point is that the body is made to MOVE. Even though we have outlined a perfect posture position above, remember that it’s always good to change positions often.

Regularly change your position throughout the day.

Been sitting for an hour? Why not stand for the next half hour? Or even kneel? The point is to do something different and to put your joints in a different position.

Don’t have this option? Get up go for a short walk to refill your water bottle, make a tea, go to the bathroom. You could even try marching on the spot, rolling your shoulders in circles, or doing a couple yoga moves. The takeaway from this is that there a million +1 ways to move your body and you must move it away from the position you have been spending a lot of time in.

Ideally change your position every 20-30 minutes but another useful technique is to listen to your body, i.e. is it starting to feel stiff? Are you starting to twist and move around in your seat to find a better position? If so, it’s time for a break. Get up and move or change your work position.

  1. Move often

 This can take the form of formal exercise, gardening, going for walks, anything really. If your body can handle regular movement/exercise it will develop better resilience to the strain that lengthy desk work can have on the body. Plus you’ll reap the numerous other health benefits of exercise.

  1. Get a thorough assessment from your physiotherapist

At Barefoot Physiotherapy, we assess your nerves, joints, muscles and movements to measure the amount of strain you have built up in your body. You do not need to have any symptoms or conditions to have this assessment; think about it like going to the dentist for a check-up to prevent something happening! If there is any strain building up in your body, we can help teach you how to reduce the strain and prevent it coming back again. Want to learn more or book an appointment? Click here. We hope you find these top tips useful.

Accumulative Strain explained

You’re bending down, or doing a movement you have done hundreds of times and then all of a sudden you’re in a world of pain. Accumulative strain can present in multiple ways, and significantly affect how we function and move on a day to day basis.

Have you turned slightly the wrong way and had your back go?

Have you had an injury seemingly come out of nowhere?

These are just a few examples of how accumulative strain presents in our body.

 

So what is Accumulative Strain?

It is a build-up of load from various sources, such as:

  • Postural load
  • Sports technique
  • Previous Injury
  • Poor footwear
  • Lack of sleep
  • Stressful/Emotional load on our brain (anxiety, worry, depression)
  • General Health issues (immune system, endocrine/hormonal systems, infections, illness)

And leads to:

  • Tight muscles
  • Stiff joints
  • Irritated nerves

One thing on its own may not be enough to cause injury or symptoms, but in combination, strain can add up so that a small change in one aspect of your life can lead to a seemingly disproportionate amount of pain/ injury/ dysfunction. If previous injuries/stressors were never completely resolved we bring our tipping point closer to the pain threshold.

In the graph below you can see this depicted. Ideally everyone should be functioning in the optimal zone. This is when muscles and joints feel relaxed and mobile, movement ranges are 75% + and other factors such as nutrition, sleep and stress are being addressed.

What can I do to limit strain?

To limit strain in your body you want to improve all aspects that contribute to it. For example:

  • Improve your posture at work, on the couch at home, driving in your car, or standing at a bar having a drink.
  • Set your workstation up best for YOU!
  • Ensure you are as fit and strong as you can be for the activities you do.
  • Be smart about your footwear.
  • Getting enough sleep. Sleep is essential for brain development and cell recovery.
  • Lead a Balanced Lifestyle. Try to take time out to do the things you enjoy often. Working too much or feeling stressed can have negative effects on your body & your health.
  • See a Barefoot Physiotherapist. To work out if strain is building up in your body that would eventually become an issue, we can do a thorough assessment of your nerves, muscles, joints and postures. You do not need to have symptoms to have an assessment. It is a positive step towards injury prevention.

At Barefoot our goal is to get you back to doing what you love. Whether you are an elite athlete, an office worker, a parent or even a student, it’s so important to listen to your body. At Barefoot Physiotherapy we want to help you continue to live the life you choose, pain free. Want to find out more? Click here.