Eccentric exercise for Achillies Tendinopathy

Eccentric exercise for Achillies Tendinopathy

Musculoskeletal rehabilitation

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Eccentric Exercise for Achillies Tendinopathy

In a clinical setting it’s extremely common for patients who have recently returned to running or increased their training load to complain of pain in the lower extremity.  One such condition that occurs as a result of overuse is Achilles tendinopathy. There are many methods of treating tendinopathies, however current research has consistently shown that eccentric exercise training provides superior pain relief and functional gains than traditional resistance training or electrotherapeutic modalities. Consequently clinicians readily prescribe eccentric exercise as their preferred treatment method. The most popular of these protocols is the Alfredson protocol, consisting of  3 sets of 15 reps twice per day at a slow speed for both bent knee and straight knee plantar flexion. It is expected that training is uncomfortable but not unbearable. This is a challenging exercise to complete for the patient due to the level of discomfort, and therefore may not be suitable for all. A recent publication in the Journal of Orthopaedic & Sports Physical Therapy provided some key reminders to clinicians about the choice of loading strategy. In short, although there are some studies that show eccentric loading of the tendon it more effective than concentric training, the loads used in these studies can not always be comparable. Additionally, the time under tension and the speed of contraction isn’t well researched. It makes sense that we can load the tendon to a greater extent with eccentric training, and control slower contractions for longer and therefore provide greater load to the tendon. But despite 30 years of research there continues to be as many questions as answers. The use of long hold isometric contractions, slow concentric contraction, and eccentric only protocols all have some merit. If you have been battling with Achilles tendinopathy, speak to your Accredited Exercise Physiologist or Physiotherapist before starting a new exercise treatment, as they have the skills and knowledge to determine the most suitable exercise treatment for you.  (CF, Accredited Exercise Physiologist)

http://www.ncbi.nlm.nih.gov/pubmed/26471850

http://www.ncbi.nlm.nih.gov/pubmed/26471850

Taking on CrossFit this year?

Taking on CrossFit this year?

Health, Research

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Taking on CrossFit this year?

Crossfit and other extreme high intensity training programs are becoming far more common and the craze has facilitated the explosion of boxes popping up in many neighbourhoods. I support the use of high intensity interval training and see the value for both healthy populations and emerging evidence in some chronic diseases. However I’ve always been concerned with the attitude and training methodology used in Crossfit that result in poor technique, potentially exposing the participant to injury. Two studies have been published to date to evaluate the injury rates within the Crossfit community. The first, a 2013 study published in the Journal of Strength and Conditioning Research reports that injury rate occur in 74% of Crossfitt participants. The second study published in the Orthopaedic Journal of Sports Medicine in 2014 suggest that the incidence is closer to 20%, although this study failed to use exposure as a key variable in their analysis. If we are to consider the first study that includes exposure in the analysis, there will be 3 injuries per 1,000 hours of training. This constitutes a much higher injury risk than other heavy contact sports and traditional strength and conditioning approaches.

Should you do Crossfit? I would say that you could certainly contemplate taking part in Crossfit training providing you consider a few suggestions. I would advise that you develop a sound strength training base, progress to power training and work closely with an exercise Physiologist, Exercise Scientist, Strength and conditioning coach, or experienced personal trainer to develop the SKILL of lifting. When deciding to start Crossfit training, choose a trainer that continually provides feedback on technique and not just training volume targets. If you are not receiving feedback on technique (it is unlikely that it is perfect for every single exercise), then you should consider a new trainer. If you are required to perform an exercise that feels unsafe or unnatural, ignore the peer pressure, ask for some feedback on technique, and if you are still not happy, omit the exercise.

Enjoy your sessions this year. If you are unfortunate to suffer an injury or simply would like some training advice, speak to your Accredited Exercise Physiologist or Physiotherapist.

Higher BMI associated with postural deformity

Higher BMI associated with postural deformity

Clinical Exercise Physiology

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Higher BMI associated with postural deformity

Scoliosis is a condition of the spine in which results in either a “C” or “S” shape curvature when reviewing the spine from the back. A condition of this type can develop over time as a result of poor posture or progress from birth. Such a condition may be managed conservatively through he use of corrective exercises. Advanced cases in patients that experience pain may require orthopaedic corrective surgery. Many people with the condition are asymptomatic, however many experience pain, early muscular fatigue and are functionally disadvantaged due to muscular imbalance. A recent publication assessed the spine of 180 patients with scoliosis and showed that obesity increases the risk of having more severe curvature of the spine than non-obese children. This is the first study to evaluate the association between obesity and severity of scoliosis, however it isn’t the first to demonstrate that obesity increases the risk of developing musculoskeletal complications. Children with obesity are far more likely to suffer from conditions such as tibia vara, slipped capital femoral epiphysis, fractures, musculoskeletal pain, and impaired mobility. Why is this a problem? We have a nation where one quarter of our children are overweight or obese. It isn’t simply an issue of aesthetics, it is setting our children up for a life of disability and disadvantage. An overweight child with musculoskeletal pain may engage less with physical activity and therefore spend a greater number of hours in sedentary behaviours. This can lead to greater deconditioning and further decline in physical capacity and consequently less physical activity. Discuss with your Accredited Exercise Physiologist how you can best manage scoliosis through the use of corrective exercises, or how your family can work together to provide a fun and physically active lifestyle to prevent musculoskeletal complications associated with overweight or inactivity. http://www.ncbi.nlm.nih.gov/pubmed/25963009

Effective rehab doesn’t have to be a pain in the neck

Effective rehab doesn’t have to be a pain in the neck

Musculoskeletal rehabilitation, Research

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Effective rehab doesn’t have to be a pain in the neck

Neck and shoulder pain is a highly prevalent phenomenon in western society, especially amongst individuals who perform repetitive work tasks. Such pain is associated with cognitive stress, poor coordination of upper body musculature, overactivity of the upper trapezius (often the site of the neck and shoulder pain), and pain at other body sites.

In a study recently published in the Journal of Occupational Rehabilitation, the experimental group undertook 10 weeks of Intensive Scapular Function Training (SFT). This involved three 20 minute sessions per week, utilising two exercises that were selected based on ability to activate muscles commonly underactive in individuals with neck and shoulder pain, whilst minimising activation of the upper trapezius.

Compared to the control group who performed no exercise, the experimental group reported significantly diminished neck and shoulder pain following the 10 week period. The exercise group also displayed increased maximal shoulder elevation strength, and reduced sensitivity to pressure at the area of the lower trapezius.

Of specific interest is that desirable training effects elicited by SFT were achieved while avoiding activation and aggravation of the upper trapezius. This is highly relevant when prescribing exercise because compliance to a training program will likely suffer if the individual experiences increased discomfort from the regime, even be it temporary. As well as reducing compliance, such discomfort may escalate to an acute flare-up and result in absenteeism in cases where the affected area is aggravated beyond a given threshold.

This research supports the concept that restoring healthy biomechanics is a cornerstone of effective rehabilitation. If you or someone you know is experiencing pain or discomfort, an Accredited Exercise Physiologist can likely help by identifying the biomechanical basis, then working with you to address the problem.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4000422/

Not losing weight with High Intensity Interval Training?

Not losing weight with High Intensity Interval Training?

Research

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Not losing weight with High Intensity Interval Training?

High Intensity Interval Training (HIIT) is not new, but has gained much attention and popularity in the last five years due to its ability to develop aerobic fitness in less tie than traditional long duration moderate intensity exercise. There is growing evidence that HIIT may also be of benefit to those with metabolic disorders like type 2 diabetes. Obesity, and excess fat around the waist is a strong risk factor for the development of both cardiovascular and metabolic disease. A research group from the University of Sydney (Keating et al., 2014) set out to determine whether HIIT is as effective for reducing abdominal fat as traditional continuous aerobic exercise. As expected, the HIIT group of participants improved their fitness to the same extent as the continuous exercise group, but in half the time. But does this result in comparable weight loss? Unfortunately not. The continuous exercise group lost more body fat from around their waist than the HIIT group.

Although this study did not show clinically significant weight loss in either group after 12 weeks, it does remind us of the importance for choosing the right exercise for our desired goals. Weight loss is challenging, and is unfortunately hard work. Unlike fitness improvement, we can’t take short cuts. For weight loss, exercising harder isn’t the key. Exercising smarter will be the trick to longer lasting, more substantial weight loss. Overall, the fundamental principle of energy in versus energy out still resides. If attempting to reduce your weight, speak to an Accredited Practicing Dietitian for nutrition advice, and your Accredited Exercise Physiologist for sound exercise and physical activity advice. (J. Woods, AEP).

http://www.ncbi.nlm.nih.gov/pubmed/24669314