Back Pain and Disc Bugles

No your disc hasn't slipped! But it might be injured.

If only I had a dollar for every time a patient told me they “had slipped a disc in their back”. This is a phrase that we hear all the time as physiotherapists and it is one that tends to make us cringe a little because it does not paint an accurate picture as to what is actually going on in the spine.

Your discs do not slip out of place and unfortunately this also means that you cannot simply click them back into place. The spine has ligaments that hold the vertebrae and the discs in place so whilst the discs are held in place pretty snugly, they can suffer injury. 

What is a disc?
Discs are part of the spine and they sit between each vertebrae so for example the disc sitting between lumbar vertebrae number 4 and 5 would be called the L4/5 disc.

To understand how a disc can be injured, let's first have a quick look at the make up a disc. A spinal disc is made up of two parts, the annulus fibrosis (Annulus) and the nucleus pulpous (nucleus).

The annulus fibrosis is the outer wall of the disc and the nucleus is the soft gel like substance in the middle of the disc. To picture this, think of water balloon filled with jelly. The annulus would be the actual balloon and the nucleus would be the jelly on the inside.

Types of injuries that occur to discs
Below is a picture that explains the types of disc injuries that occur in the spine. The term herniation is used to describe the what is occurring to the nucleus of the disc.

  1. Nuclear Herniation
    This refers to a small amount of the nucleus herniating (sticking out) into the annulus. The annulus itself is not damaged and remains intact.
  2. Disc Protrusion
    This is where a bigger amount of the nucleus herniates in one direction (usually either to the side or the back of the spine, or a combination of the two). This injury results in the disc changing its shape slightly. The annulus again remains intact, however due to the herniation of the nucleus the wall of the annulus is stretched and weakened.
  3. Nuclear Extrusion
    The nucleus herniates to such an extent that the breaks through the wall of the annulus and is now sticking out into the spine itself. This is where it can put pressure on nerve roots causing things like sharp shooting pain and pins and needles.
  4. Sequestered Nucleus
    As in the nuclear extrusion, the nucleus has broken through the annular wall and in this injury (which is very serious) the nuclear substance starts breaking away into the spine and surrounding tissues.

Disc protrusion injuries are quite common, and are often able to be managed with physiotherapy and pain relief and some activity modifications. Thankfully, nuclear extrusions and sequestered discs are not very common as this degree of disc injury is difficult to manage and often requires surgical intervention to repair the disc.

What causes disc injuries?
Generally discs are injured in one of two ways, a single episode of very high force, or low force trauma done repeatedly.

There are a lot of variables that can lead to disc injuries in the spine. Some studies have shown that males are more likely than females to suffer an injury to their disc. We also know that typically disc injuries occur in the 30 – 50 year old age group.

Repetitive lifting with poor technique can be a factor in developing a disc injury. Lifestyle factors such as body weight and a sedentary lifestyle can also be considered contributors.

In some cases, a disc injury is the result of an acute event or trauma to the spine.

Some typical signs of a disc injury

Treatment of disc injuries
With the exception of disc extrusion and sequestration type injuries, a majority of spinal disc injuries can be treated conservatively with physiotherapy. The first step is to attempt to determine the severity of the injury which will involve asking a series of questions along with some physical testing. In some cases, your physiotherapist may advise that a scan such as an MRI is advised to help determine the severity of any injury.

The next step in the management of disc injuries is to restore function and movement. Pain relief is also important in the early stages. In the early phase of treatment, your physio will use a combination of soft tissue therapy, manual therapy and taping to assist with pain management and restoration of movement.

Once function is restored, strengthening exercises are performed along with any education and re-training on correct lifting techniques. Educating patients on good spinal mechanics is a great way to make sure that further injury and harm to the disc is avoided. The last phase of treatment of a disc injury is to ensure that we get specific on the functional demands of the person and design a specific higher level rehab program to meet these demands. Not only does this improve strength, but it also provides the patient with confidence that they are able to function again safely.

Unfortunately, far too often we see people stop the rehab of a disc injury far too early. This is often at the point where pain has gone and movement has returned. Without good movement re-training and increased strength there is a likelihood of the disc injury returning (and even worsening).

In closing, it is important to remember that not all lower back pain is the result of injury to the disc. In many cases, it is referred to non-specific lower back pain meaning that the pain in the back is not due to damage to any one particular structure. However, discogenic lower back pain is quite common and the key take home message is to see a physiotherapist for assessment, diagnosis and treatment. In a lot of cases, it can be managed conservatively without the need for invasive procedures.

Physio Tips for a Long Haul Flight

International borders are now open again which means our patients are back to travelling all over the world for business or pleasure. With this in mind, we thought we would share some tips to help your body feel a little less stiff and sore at the other end of a long flight.

  1. Compression Socks
    Investing in a good pair of compression socks will be money well spent. Not only are they a defence against deep vein thrombosis (DVT), but they also help to reduce swelling in the ankles that occurs at altitude due to the different cabin pressure.
  2. Keep Moving
    Having an aisle seat is ideal but even if you are not in an aisle get up and walk around the plane at least every 2-3 hours. Usually you can find a galley or section of aisle that opens up a little and this is a great place to stand up and do some calf raises, calf stretches and if possible some quad stretches. Even just a good old stretch out of the arms can help reduce stiffness. Again, the movement and the calf raises are a good thing to do to prevent DVT.
  3. Neck Pillows
    There are a lot of option on the market but a wrap-around neck pillow will allow you to get some sleep while maintaining a neutral neck position. This should help reduce neck pain and stiffness both during and after the flight.
  4. Drink Water
    Make sure you are steady with your fluids as the pressurised cabins can result in dehydration. On planes it is easy not to drink, as you typically aren’t doing much and the temperature is often quite cool. Water is always the best form of hydration.
  5. Pack your trigger ball
    Sitting for such an extended period is going to cause stiffness pain. Once you get to your destination you can use your trigger ball to release tight muscles in the neck, shoulders, back and glutes. For less than the size of a tennis ball in your suitcase, you can have a portable massage tool wherever you are in the world.

Enjoy travelling the world again, it's been too long. With a bit of thoughtful planning you can make sure you are at your best at the other end so you can hit the ground running. Safe travels.

How to find intensity in your training while nursing an injury

I wish I could say that injuries don’t happen, but they do.  Even well trained and seasoned athletes get injuries.  One of the biggest challenges I see in my athletic population is how to satisfy their desire to still train at moderate to high intensity while looking after their injury.   Physios also get injured from time to time, even if we lead you to believe otherwise.   

So this leads me to a little case study involving myself.

For the last 3 months or so I have been battling with an injured calf (more specifically I had a 9cm tear in the medial head of my right gastroc).  This happened during a low intensity run in my efforts to try and do some distance running again.  I have always struggled with calf injuries since my first significant calf tear during a Crossfit workout.  Workouts with a lot of jumping, burpees, sled pushes and skipping always make me nervous.  The problem I (and a lot of my patients) face is that training with intensity is not only more fun, but it is also more efficient, can be more effective (depending on your goal) and is slightly addictive.  

So the challenge really becomes, how do we maintain intensity while recovering from an injury? Sure you can train around an injury and still get your exercise fix which in my case could have been an upper body strength based session with perhaps some squats and deadlifts thrown in; making sure my heels stayed planted on the ground so that I did not load my calf too much.  This type of training is fine, and to be honest is good for me, but it was some intensity that I was craving.  

So what exactly is intensity? Probably the simplest way to describe intensity would be to look out how much energy is expended during a workout in a set time.  Let’s use calories (unit of energy) per hour (unit of time).  So the higher the calories per hour, the more intense the exercise.  Now, before all the exercise physiology gurus troll my post, there is more precise ways to measure exercise intensity (such as %VO2 max or ml/O2/min) etc but when we start talking like this we lose a majority of people so for the purposes of this post let's keep it simple.  

So back to how to train with some intensity while still looking after your injury.  Here was my solution which worked in my case.  I did what is known as an EMOM (every minute on the minute) style of workout. 

The Workout:

Alternating EMOM for 20mins

What this means is that I set up two barbells, one loaded for the hang power cleans and the second loaded on a rack for my back squats.  These two movements were picked to maximise joints moved in the session without too much pressure on my calf.  With a clock running, at the start of the first minute I did movement 1 with the rest of the minute off.  Then at the start of the second minute I did movement 2 as per the first minute.  Repeated until I had done each movement 10 times for a total of 20 mins.  

The result:

In 20 minutes, 230 calories burned.  Average heart rate was 132bpm with a max heart rate of 157 (which is 85% of HR MAX).  If we extrapolate this out, my calories per hour was approximately 700, which compares to classes such as F45 and our HIIT style workouts.  Not a bad effort in my books, particularly since it only involved a barbell and some plates and there was not a box jump, burpees or double under in sight and most importantly, no harm done to the calf.

So the moral of the story, with some out of the box thinking, a good knowledge of exercise prescription and knowledge of the effects that certain movements and certain prescriptions will have on the body, a solution for intensity can be found, even when injured.  This is where your health professional should come in and be your trusted advisor.  The intensity came from adding a time domain to the workout, and picking a load that allowed for quick movements so that power was maintained.     

Physiotherapists with a good understanding of exercise prescription are well placed to help you come up with great workout options while you are injured.  In my opinion, physiotherapists are the best placed health professionals to prescribe exercise to injured patients because of our high level understanding of functional anatomy and musculo-skeletal pathology.

If you are stuck doing boring workouts because you are injured, or worse still have been told to rest, then give us a call.  We will be more than happy to help you find some intensity again.  

Yours in health

Chris from Out of the Box Physio        

Don't Weaken

So you have heard of Osteopenia, but have you heard of Sarcopenia?

Believe it or not, I still have people that tell me that they do not want to do any form of resistance or strength training and that they would rather do pilates, yoga or just go for a walk.  All of these are fine, but what if I told you that strength training is vital if you want to age well.  What if I told you that after middle age, people lose an average of 3% of their muscle strength every year?  This phenomenon is known as Sarcopenia.  So where osteopenia is the term used to describe a decrease in bone mineral density (or bone mass), Sarcopenia is the term used for a loss in skeletal muscle mass due to ageing.

So let’s look at it a different way.  As we age, strength training is not about bulking up or body building, it is really about trying to stop us getting weaker.   Losing muscle mass (and hence getting weaker) will affect your ability to do daily tasks such as getting up out of bed, getting out of a low chair and doing tasks like grocery shopping.   Studies have also shown that people suffering from sarcopenia are 2.3 times more likely to suffer from fractures from falls (think hip fractures, arm fractures etc) due to an increased falls risk and frailty.  

The good news is that we can fight back against sarcopenia.   Using a progressive resistance training program, lean muscle mass can be increased.  A progressive resistance training program is one where loads and reps are manipulated over time to try to limit plateaus in strength gains.

In 2018, Out of the Box Physiotherapy did away with pure pilates programs and we introduced progressive resistance training programs to our clients using a range of equipment and training techniques.   Whilst we don’t hate pilates, we were more comfortable offering people exercise programs that we knew would have the biggest impact on their health.  

We currently deliver these programs in a variety of formats, from one on one personal sessions in our gym to group circuit classes with other options that sit in between this such as semi-private sessions and the like.  

Our physios love seeing our clients improve their strength and we love helping people to fit back against ageing.  We firmly believe that everyone, regardless of age, gender or injury history can do a progressive resistance training program that will help to fight off not only osteopenia (and osteoporosis) but also sarcopenia as well.  

So after reading this, if you would like to start incorporating some resistance training into your life then please reach out to us and book a consultation.  This will allow us to get to know you and your situation and provide personalised options to help you move forward.  This can even be a program that we develop for you to do at home or your current gym.   The biggest thing is that you get started sooner rather than later and fight back against that ageing process.  The moral of the story, “Don’t Weaken”. 

Yours in health

Chris from Out of the Box Physiotherapy.

Injury Risk in Young Netball Players

Netball is a great way to learn team based skills, get fit and enjoy socialising but unfortunately some players are at increased risk of injury than others. If you have a young netball player in your family, then this article explains why injury could occur, what to look out for and what to do.

What are the major risk factors for injury?
One of the biggest risk factors for injury is having sustained an injury in the past. We don’t know exactly why this is, but the most likely cause is underlying musculoskeletal factors that weren’t completely rehabilitated before returning to sport. Another risk, though one we can’t do much about, is age. At the age of 13/14 our risk of injury in netball increases and this is likely due to growth spurts that are typical around that time (Franettovich et al., 2020).

What areas are injured most?
Across community netball, the ankle and the knee are the most commonly injured with around 40% of those injuries represented by ankle sprains (Finch et al., 2002). When looking specifically at younger age groups, the forearm, wrist and hand are just as common due to ball strikes and falls.

What can I do about this?
The first step is recognising if your child is at risk of injury. The following questions are all good things to think about when looking at injury risk.

Take home message

If your child is reporting pain and it does not seem to be getting better on its own, call our clinic or book online to see one of our friendly physiotherapists. Our physiotherapists are trained to assess and treat a number of musculoskeletal conditions that can occur during the netball season as well as create exercise programs to reduce the risk of injury. 

See our other blog post: Common Injuries in the younger population for information on specific injuries and areas of the body to look out for with your child. 

Yours in health
Hannah and the team from Out of the Box Physiotherapy

Should I have a cortisone injection for my shoulder pain?

Cortisone injections for shoulder pain are common, really common. A pathway we see in the management is, GP appointment --> Ultrasound Scan --> Injection.

The problem is, in a lot of these cases, patients then present to physiotherapy still in pain, and understandably frustrated. Often the medical advice they have been given in these circumstances is that they should try another round of cortisone. So what should you do? One of the most common questions we get in clinic from our patients is whether or not they should get a cortisone injection for their shoulder pain (or knee pain, or back pain, for that matter). Most often, the answer from us here at Out of the Box Physiotherapy is “Perhaps’. But we need to look at what has been done so far and whether or not an injection is indicated will depend on a number of factors, some of the major ones are?

1. Do we have a diagnosis or at least an idea as to what structure (or structures) might be causing the shoulder pain? If not, then we need to know this before proceeding.
There are several structures all really close together around the shoulder and this means that identifying a specific structure or source is difficult. We have tests that can identify movements that cause pain and these can give us an idea on the type of shoulder dysfunction that is present but often we need to treat the shoulder holistically as a whole complex rather than just trying to fix a specific tendon or bursa.

2. Is the pain coming from an inflammatory source? If not, then cortisone is unlikely to have an effect.
If the only pathology found on imaging is an inflamed bursa in the shoulder, then injection of corticosteroid may have an effect on pain and function

3. Have oral anti-inflammatories been trialled? What effect did they have?
If oral NSAIDS did not have an effect we should possibly question the effect that cortisone (which is also an anti-inflammatory) might have?

4. What treatment and exercises have been used so far in the management of shoulder pain?
Have we loaded the shoulder properly in trying to rehabilitate it, have we taken away painful impingement movements and worked on strengthening the scapular and rotator cuff complex?

5. How long has physiotherapy or other treatments been trialled for?
Research has shown similar outcomes for patients at 12 weeks with either injection, physiotherapy, or injection and physiotherapy


The challenge with treating shoulder pain is that in a lot of cases, there are multiple structures that might be causing the shoulder to be sore. Structures such as the sub-acromial or sub-deltoid bursa might be inflamed, but there could also be some changes in the rotator cuff tendons as well, and some arthritis in the AC joint. Rarely in shoulder pain cases do we see only one of these structures involved so the best course of treatment is physiotherapy, with some initial hands on treatment if required to restore balance and then treatment needs to focus on exercise-based management to improve shoulder strength and function. This needs to be done progressively and over the course of 3-6 months. So the answer to the question, Should I have a cortisone injection for my shoulder pain? Ultimately it is up to you, the patient to decide. There is not a lot to lose from having one, but our experience also tells us that in a lot of cases there is also not a lot to gain. Hopefully the answers to some of the points above help you to make a decision and we are more than happy to discuss your shoulder pain with you further and we will always provide you with the most honest advice we can. Those patients that get the best outcomes, in our opinion, are those that work on improving the mechanics of their shoulder and whole upper body and take their time to do this well.

3 Things you MUST do if you are working from home

More and more people are working from home and there are some great benefits to his more flexible way of working. Unfortunately though, as physios we have seen an increase in neck and back related pains. This can be due to ergonomic set up however in a lot of cases it is simply due to the longer hours that many who work from home put in. Without the commute into the office, it is easy to find yourself logging in while you eat your breakfast and in some cases logging back on after dinner. The good news is that being at home also makes it more comfortable to do some exercises to help.

In this video, Chris shares 3 quick tips that you should be making part of your daily working from home routine.

Read this before you buy expensive custom orthotics

Plantar fascia pain is the most common foot complaint we see as physiotherapists. The pain associated with plantar fasciitis is typically around the heel but can be in other parts of the sole of the foot. The pain is often worse in the morning and for the first few steps after being seated for some time.

Plantar foot pain can vary from mild to very debilitating and often our patients report that the symptoms have been present for quite some time. The most common question we get asked by patients with plantar fasciitis is “do I need to see a podiatrist for orthotics”?

Our answer, probably not because research has shown no difference in effectiveness between the prescription of prefabricated orthoses (like the ones we use here at Out of the Box Physio) vs custom made orthotics.

The first study to look at this was Pfeffer et.al (1999) in their journal article. Further to this, in 2008 a review was published in the Cochrane database with the following conclusions for plantar fasciitis “Custom foot orthoses may not reduce foot pain after 2-3 months or 1 year compared to non-custom foot orthoses.

So the current evidence suggests expensive custom-made orthotics are generally no more effective than cheaper non-customised ones.

To make sure we make the right prescription here at Out of the Box Physiotherapy we will tape your foot to simulate what an orthotic might do before prescribing them. This allows us to measure the response that the arch support and correction might provide and allows us to make a clinical decision based on your response (i.e. did it reduce pain and help you symptoms). We call this a treatment direction test and we use this to then develop a treatment plan, based on footwear advice, exercises to load and strengthen the foot and possibly some arch support in the form of orthotics if we think this would be necessary.

Be aware of the big claims made on the TV about arch support and how they are “good” for your feet and make physio your first point of call for heel pain or plantar fasciitis. We have heard of patients spending upwards of $1500 on arch supports at a retail shop that really are no more effective than a $60 pair we would fit here at Out of the Box Physio. You might not only save a reasonable amount of money, but you will actually get a solution that works towards long term relief rather than a temporary fix.

If you have any questions about your foot pain please get in touch. We are more than happy to give you some advice.

References

1. Pfeffer G, Bacchetti P, Deland J, et al. Comparison of Custom and Prefabricated Orthoses in the Initial Treatment of Proximal Plantar Fasciitis. Foot & Ankle International. 1999;20(4):214-221. doi:10.1177/107110079902000402

2.Hawke F, Burns J, et al. Custom-made foot orthoses for the treatment of foot pain. Cochrane Database Syst Rev. 2008;16:CD006801.

Common Injuries in Junior Netball

No one likes to think about injuries in junior sport and thankfully they are often less severe than in adults. That being said, with netball season commencing this week and a lot of young players potentially playing for the first time, we thought we would outline some of the injuries that can be seen in netball and how they occur. In younger netball players, injuries are most often from direct collisions (28%) or landing awkwardly (27%) or a combination of both (Franettovich et al., 2020). As players begin to reach adolescence, injuries can develop from increased loading of joints, bones and tendons.

Direct collisions

Direct collisions can lead to injuries such as contusions, fractures and concussion. Of particular focus for netball is the knee. If you are hit on the outside of the knee, it is more likely you will cause a sprain of the medial collateral ligament due to how the force is applied and the way the ligament supports the joint. The opposite is true for a blow to the inside of the knee, where the lateral collateral ligament is more likely to be injured. If the shin bone (tibia) is struck when the player has a bent knee, the posterior cruciate ligament is at risk. If the player's knee cap (patella) is struck, a dislocation can occur. Knee trauma is always best assessed in the physio clinic where we cans use a range of functional and orthopaedic tests to determine what has happened.

Landing awkwardly

The poor old knee can also cop a bit of hiding when landing awkwardly. If the knee joint is extended back past its available range, the anterior cruciate ligament is at risk of a sprain. When twisting the leg after a sudden stop, the cushy pad that protects the bones from each other (meniscus) and the anterior cruciate ligament is at risk. When pivoting after a jump or twist, a meniscus tear or patella dislocation is the most common injury. Ankle sprains are also extremely common injuries and unfortunately painful injuries. When landing on the outside of your ankle by movement of your ankle inwards (inversion injury), the ligaments on the outer side can be damaged. When landing on the inner side of your ankle (eversion injury) you can damage the deltoid ligament. The syndesmosis or “high” ankle sprain occurs when the ankle is moved quickly upwards (dorsiflexion), inwards (eversion) and the leg rotates out (external rotation). Physio assessment will help to determine if x-ray is indicated and also aim to determine which ligament/s have been injured.

Overuse injuries in netball during growth periods

Adolescent growth periods can be difficult at the best of times, when your child also begins to report pain it can be even worse! A number of different conditions are common in the growing child as their bones, ligaments and tendons try to keep up.

Knee:
Os Good-Schlatter is a knee condition where pain is felt at the tibial tuberosity due to repetitive quadriceps contraction and is common in running and jumping sports.

Sinding-Larsen-Johansson is a knee condition similar to Os Good-Schlatter disease but is located at the inferior pole of the patella (lowest edge of kneecap).

Ankle:
Sever’s is a condition where pain is felt at the heel, where the Achilles’ tendon inserts. There can be tightness in the calf muscles.

The above overuse injuries are self limiting conditions and will often resolve over time in the vast majority of children. Our team have helped hundreds of adolescent and pre-adolescent athletes to manage their overuse injuries so if you notice your child starting to limp or complain of soreness in the knee or ankle please reach out to us for help. In a lot of cases, with good early management and advice, minimal rest time is needed and small alterations to load with some home exercises can go a long way. Yours in HealthHannah from Out of the Box Physiotherapy

References
Browne, & Barnett, P. L. (2016). Common sports-related musculoskeletal injuries presenting to the emergency department. Journal of Paediatrics and Child Health, 52(2), 231–236. https://doi.org/10.1111/jpc.13101

Franettovich Smith, M.,M., Mendis, M. D., Parker, A., Grantham, B., Stewart, S., & Hides, J. (2020). Injury surveillance of an australian community netball club. Physical Therapy in Sport, 44, 41-46. doi:http://dx.doi.org/10.1016/j.ptsp.2020.04.004

Hopper, A. J., Haff, E. E., Joyce, C., Lloyd, R. S., & Haff, G. G. (2017). Neuromusculartraining improves lower extremity biomechanics associated with knee injury during landing in 11-13 Year old female netball athletes: A randomized control study. Frontiers in Physiology, 8, 883-8

Joseph, C., Naughton, G., & Antcliff, A. (2019). Australian netball injuries in 2016: An overview of insurance data. Journal of Science and Medicine in Sport, 22
Micheli LJ, Fehlandt AF. Overuse injuries to tendons and apophyses in children and adolescents. Clin Sports Med 1992;11(4):713–26.

Tibialis Posterior Tendon Dysfunction

The tibialis posterior muscle is located on the medial (inside) aspect of the lower limb and ankle. The function of this muscle is to act as a stabiliser of the medial aspect of the arch of the foot and it also produces movements of plantar flexion and inversion.

Dysfunction in this tendon refers to a progressive problem that can worsen over time and can result in tearing or rupture of the tendon.

Because of its attachment to the medial arch of the foot, tibialis tendon dysfunction is sometimes incorrectly diagnosed as plantar fasciitis.

Some signs of tibialis tendon dysfunction are;

Treatment

The first step in managing this condition is to settle down the pain and dysfunction it is causing. In a lot of cases, this can be achieved using specialist taping techniques to help support the arch and de-load the tendon. In severe cases a period in a moon boot may be required. Occasionally there can be a need to use anti-inflammatory agents in addition to the above (even cortisone injections).

Once settled, a progressive loading program to restore tendon function is required. This will be supervised by your physiotherapist.

Caution should be taken on returning to high energy movements such as skipping, box jumps and even running. Your physiotherapist will guide your progress.

In many cases, good progress can be made over a 3-month period, however in severe cases it can be much longer.

It is important to manage this condition as early as possible, preferably before we see a collapsing of the arch. This will make recovery quicker and prevent the need for the use of an orthotic. If you have pain on the inside of the ankle, then it is time to get it assessed. Yours in health Chris from Out of the Box Physiotherapy

The 3 mistakes we continually see that almost always end up in injury

Whether it be shoulder pain, knee pain, ankle pain or foot pain there is often commonality as to how our patient has ended up injured. Whilst the diagnosis and prognosis is different, how our patients have ended up needing treatment is often due to some similar factors.

Tendinopathies, bursitis, stress fractures, muscle strains can often feel like they come out of nowhere. Frustrating injuries with no acute cause. Having been a physio for the last 16 years, here are three key mistakes that I see my patients making that more often than not can be considered the cause of there injury.

1. Loading Errors

This is the classic going “too hard, too soon”. It is so easy to do both mentally and physically. Mentally we can feel motivated and keen to get going and establish new routines and try to make up for lost time. This can lead to poor planning from a load perspective with inadequate recovery.

Physically what happens on commencing a new training program, whether this be strength or cardio (or both) is that things change quickly. Running gets easier and you feel like you can run further or faster (or both). Strength can increase quickly, and it sometimes even feels like every time you train, you are putting more weight on the bar.

The problem here that certain structures in our body do not handle rapid and dramatic changes in loading as well as other. Bones and tendons tend to become irritated (injured) if they are subjected to repeated periods of excessive loading. So how much is excessive I hear you asking? Well this is the million dollar question and is not easy to answer. There are many factors that need to be considered when determining load but the main ones are, type of exercise, how much, how hard, how long and how much recovery time between sessions. The good thing about load is that it can be controlled, so often a reduction in load is all that is required rather than complete rest.

2. Doing the same thing all the time

Do you think that because you do F45 and a “different” workout everyday that you can train everyday? Well I am sorry to tell you, but this is probably not the case. Doing a weights session one day and high intensity cardio session the next which might happen to have push ups and burpees in it is not actually giving your shoulder joint a break. Not only that, but if your sessions are always 45 mins long and you are basically going max effort for this time, then it is not really that varied from an intensity perspective. The movements might be slightly different, but the metabolic effect on the body is the same. Most overuse injuries are the result of repetition, so the real art of programming is planning over the longer term, not just what was done within the session but also what is done in the next session, and the session after that. Variation of movement and intensity is the key. Changing intensity is vital. Even runners should look at changing intensity with the inclusion of long slow runs, mid-range fast runs and even speed / sprint work.

If you are strength training, changing your set and rep scheme is a great way to help prevent injury. It does not always have to be 5 sets of 5 reps, or 3 sets of 10 reps etc. Do you always bench press? Try Dumbbells, or Cable chest press, vary the movement and if you do want to train everyday, then look at getting a well thought out split program written for you.

3. Sleep and recovery

Professional athletes sleep a lot. Why, because it is good for them and they need it. Trying to burn the candle at both ends might be possible for a short period of time, but will likely end in injury, burnout or both. Sleep is important, so if you are training early in the morning as part of your new routine, plan for 1-2 days in the week where you sleep in and train later or even have a rest day.

Try not to be sold on the hype of pre-workouts and recovery formulas. Get enough sleep, eat well and drink plenty of water and you will have all of the fuel you need. And remember, some days it is normal and acceptable to feel sluggish, so don’t panic. Get rest and you will feel amazing in your workout tomorrow. As always, we are here to help. We can not only help with managing your injury, but with our strong backgrounds in exercise science, we are also able to help with you with your programming and provide advice and support around this. We are more than just your typically physio clinic and we love helping people be more active and achieve their physical goals. So often we see the best of intentions end in injury which in many cases could have been avoided with the right approach and a bit of pre planning and education. If any of this blog resonated with you, feel free to get in touch. Yours in health

Chris from Out of the Box Physiotherapy

Don't be ridiculous

What if I told you that your shoulder blade and / or arm pain was coming from your neck?

If a nerve is mechanically compressed at what is known as the nerve root (which is where the nerve exits the spine in the neck) then it can cause pain and other symptoms. When it is only causing pain, this is often referred to as radicular pain. When it is causing, pain, pins and needles, numbness and or weakness then it is known as Cervical Radiculopathy.

The nerve root compression can be caused by a range of factors including cervical disc protrusion, osteophytes (think bony spurs) or stenosis (spondylosis). In many cases it is a combination of all three of these factors.

Thorough assessment from a physiotherapist can usually determine the area in the neck where the nerve is believed to be compressed and can often also provide good advice on how severe any compression appears to be. In some cases, medical

The good news is that in a majority of cases (approximately 80%), symptoms from cervical radiculopathy can be managed conservatively without any surgical intervention. Physiotherapy is effective, with the first aim of treatment to improve or restore range of motion in the cervical spine. Physio will also aim to settle down the irritated nerve using special exercises that address what is known as “mechanosensitivity” (think mobility and irritability of the nerve). Then once settled, physiotherapy will provide you with a program of strength work targeting the cervico-thoracic muscles (upper back and neck).

Typically our patients who present with cervical radicular symptoms are in a lot of pain at their first session. This often settles with treatment and rest across the first 3-4 sessions (1-2 weeks) with the whole treatment plan taking somewhere between 6-12 weeks to complete.

In many cases, before a severe episode of cervical radiculopathy, patients may experience one or two episodes of less severe neck and or arm pain of only a few days duration. Other things that might occur before a severe episode of pain is a generalised reduction in your neck range of motion. Stiffness usually presents before pain, so this is a great time to get in a see a physiotherapist for assessment and treatment. It is much quicker to settle down neck symptoms before the nerve becomes irritated.

Please reach out to us if you have any questions about your neck or arm / shoulder symptoms.

Yours in health

Chris from Out of the Box Physiotherapy