Tag Archives: injury management

The Upside of Injury

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Status Update: “Broken”.

Most athletes and a fair share of non-athletes have been there. The nature of our profession is that for the most part, we see people when they are down and out; our job is to diagnose the damage and to build them back not just to par, but to stronger than they were before the injury. My usual position as a Physiotherapist is to guide my patients from the tough day of diagnosis, through the often lengthy rehab process and safely back into their return to sport. We often get quite close to our patients and as athletes ourselves, ride the journey with them. In 2013 I was unlucky enough to flip the coin and be the one sitting in the sports physician’s office trying to swallow the gravity of my own injury situation: a stress fracture gone wrong following my latest Ironman triathlon. I think in this situation it’s arguably easier knowing less rather than more – I knew before the lovely Dr Chris Ball told me that I was looking down the barrel of major foot surgery, and a very long time away from my beloved sport.

 

 

 

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What it looks like to finish an Ironman on a broken foot…it ain’t pretty!

 

Injury of any kind sucks, and I always advocate well-managed injury prevention program as “Plan A” but in reality, injuries happen – most athletes don’t have the most solid grasp on their self-preservation dial (and hey, I was beating my husband by 2 hours in that Ironman – there was no way I was pulling the pin so close to the end!). Jokes aside, there can be a silver lining. The team you have around you and your attitude are key to getting through the rough patch and flying out the other side as a more resilient and stronger athlete.  As tough as injuries can be, I have learnt over the years from the process with countless patients as well as from my own experience post- foot surgery that there can indeed be a few upsides to injury:

 

  • Learning opportunities:
    • First and foremost, immediate questions need to be asked: What is the best course of treatment for short and long term outcomes? What are my options? (often there are a few good ones, especially where surgery vs conservative treatments are involved). How long will I have off my sport? Will this affect work/school etc?
    • Once a course of treatment has been set that you as well as your health care team are happy with, the less urgent but just as important questions need to be asked: What went wrong? What will I do differently next time? Where is the weak link in the chain? How do we (as in, you and your Physio +/- surgeon and sports physician) build the body back to a point where it’s stronger than before? How can I prevent this from happening again? Do we need to change things upon return to sport (training load, technique, footwear etc)? Knowledge is power, and I cannot reiterate enough that you need to ask and ask until you get the answers that you need; your sanity during your rehab and your ability to avoid injury in the future depends on it. If you aren’t happy with your physio/doctor/surgeon, then find another one – you need to find the best quality care at all costs to get the best results.

 

  • Respect for your body’s boundaries:
    • So you found that mystical line in the sand, the actual safe limit of what your body can achieve; many never find it so you can take one thing away from the situation and that is that as an athlete, you are tough! But going forwards, if your injury was “overuse” in nature (ie stress fractures, tendinopathies etc) then you need to respect that boundary. Learn from it and take note of your body’s cues in future training and racing scenarios.
    • If your injury was more traumatic in nature (eg broken tibia from a soccer clash or dislocated shoulder from a cycling accident), then there’s not a lot more you can do other than accept that playing sports involves risks. Given a choice, you’d still take those risks to sitting on the couch getting fat and unhealthy, right?!

 

 

  • An Attitude of Gratitude:
    • There’s nothing better than that moment your surgeon (or doctor or physio) gives you the go-ahead to do some exercise. Even if it’s technically “rehab” – “I’ll take it!” you yell as you hug them (Ok exaggeration. Only slightly though.) Prior to a major injury you may be guilty of complaining when the alarm clock goes off at stupid o’clock, if it’s cold/hot/raining; if the session is too hard…or not hard enough….If your race didn’t go perfectly, and so on. Afterwards I can honestly say that every single step I take is done with an “attitude of gratitude” – my coach and husband will vouch for the fact that every run is a bonus, every race is a bonus, and I am thankful to be able to have a fit, strong and healthy body again. Hell, I’m even grateful to be able to do the housework these days – taking an independent person and attaching them to crutches for 3 months is enough to send anyone crazy! I have been guilty of treating my body somewhat like a rental car in the past, but I now appreciate it and treat it much more lovingly (Karma, my friends, Karma…).

 

 

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  • Mental Toughness:
    • And by this I don’t mean your ability to push through and “eat the pain” as my husband would say – if you got injured in the first place by pushing too far you definitely don’t need to learn this. But in my experience it’s often the athletes who are able to blindly push through that are also in need of some mental “balance”. I am by no means exempt from this generalisation. I took the time after my surgery to finally learn how to slow down and meditate (I highly recommend it, you’ll never look back), as well as to focus on other things in my life other than training 20 hours a week and working full time. It was not the most fun I’ve ever had – by choice I would much rather be working and training! – but it has taught me a sense of balance which I had never had in my life before, and I think that this has benefitted both aspects of my life well after the initial injury period. For most athletes I would therefore consider the slowing down process as “building mental toughness”, even if it’s not the traditional sense of the phrase.

 

 

  • Absorption of training:
    • A wise triathlete (Emma Snowsill) once said that if you don’t allow your body to rest, it will force you to via sickness or injury. I would put pregnancy in the same category here simply because the reduced training load while you’re growing a human has the same affect – time to let the body take stock. To absorb all the months/years of training it has done, and to build back a little stronger. As physios we educate patients on how a bone will actually be stronger where it broke after the healing has occurred, because extra bone is laid down in the healing process; this is a nice metaphor for the entire healing process of the body. Reassure yourself that you WILL come back from the injury, and that all the training you’ve done in the past will not be gone.

 

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Sesamoid bone graft and 1st Metatarsal dorsiflexion osteotomy on my Right foot, done in 2013 by Dr Ben Forster

 

 

So there you have it, my version of what I’ve learnt through injury in a nutshell. I’ve kept many details of the injury and whole rehab process pretty close to my chest up to this point; as a physio it is not the easiest boat to be in. Physiotherapy may be my “day job” and I certainly love it, but I am first and foremost an “athlete” and in the past have certainly had trouble switching that part of my personality off, even if the Physio part of my brain is telling me something is a bad idea. As I get older and more experienced with both Physiotherapy and Ironman racing, I am learning how to strike the balance but it is always a work in progress. I am very fortunate to have two very patient and understanding men in my life in my husband Patrick Shannon and my coach Scott DeFilippis. Without them I would not be on track to be lining up again for Ironman NZ in 4 months’ time – 1 year post-baby and just over 2 years post foot surgery.

 

Hopefully this post will hit home with a few “broken” athletes out there and help to get you through and back to your passion. If you would like to follow my journey back to the Ironman start line you can find me on Instagram (@KRISTY_SHANNON), I’d love to have you along for the ride!

 

Kristy Shannon

B.Appl.Sc(HMS); B.PHTY(Hons)

Director and Principal Physiotherapist First In Physio  

 

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Kids and Sport: When to see a Physiotherapist

 

 

Often parents are unsure when to seek the opinion of a Physiotherapist in dealing with their active kids. Now more than ever, kids and adolescents are getting involved in organised sports, with a multitude of social and health benefits to be gained from their participation. It is not unusual to see kids that are actively competing in several different sports every week, often with once- or twice-daily training sessions and multiple weekend games or competitions. Combine this activity with the demands of growing on a young body and you find the balance is a delicate one: get it right, and the child thrives; push too hard, and it doesn’t take long before niggles and burnout can arise.

Research tells us that sport is the main cause of injury in adolescents (Brukner, 2008). The number of under-15’s seeking medical attention for sporting injuries increased by 60% between 2004 and 2010. This can be attributed to an increase in kids’ participation in organised sports, improved diligence by parents in seeking medical care for their children’s sporting injuries, and higher levels of competitiveness (or skill) in children of younger ages.

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INJURY MANAGEMENT:

We often get asked when is an appropriate time to see a Physiotherapist with respect to a child’s injury or pain. Growing children who are active will often get transient aches and pains that are normal – when these last only a few days and are mild in nature, ie do not stop the child from participating in any activities, then these can be managed without significant interventions. Often rest or a few days off sport will help in these cases. If, however, a child has any of the following, you should seek out a Physiotherapist for diagnosis and treatment:

  • Pain that lasts longer than a few days;
  • Pain that is increasing or sharp in nature;
  • Pain that gets worse with activity – ie it does not “warm up”;
  • Pain that is stopping them from participating;
  • If they are limping/modifying their activity;
  • Pain that is affecting their sleep;
  • Pain that is mild but recurrent in nature;
  • Redness or swelling around the painful area.

A Physiotherapist will be able to diagnose the injury, develop a treatment plan, and work on prevention strategies so that the injury is less likely to reoccur. If scans are required to assist diagnosis, these can be ordered through the Physiotherapist. The earlier treatment is sought, the easier the injury will be to treat and as a general rule, the less treatment sessions that will be required. Don’t feel like your child needs to be in severe pain or unable to participate before you book an appointment – a good Physio will be able to find their diagnosis no matter how “mild” you may think their symptoms are. Keeping a child active and involved in their sports is always a priority and this is much more likely to happen if the injury is seen to at an earlier stage of its progression.

The wonderful thing about children and adolescents is that their bodies have a marvellous capacity to repair and respond to increased training loads (otherwise known as: “kids bounce”). Generally, we can use the same principle in treating injuries that arise: in the majority of cases, kids can continue participating in their chosen sport(s), albeit with a few modifications to unload the injured area and allow it to heal. They are a beautiful example of what we also see in adult athletes: that when we are able to keep the body active through injury, in a safe and supervised way, the body heals faster and is able to bounce back stronger than it was before the injury. Our bodies like to move, and they respond favourably to the increased circulation, muscle mass, and the hormonal response that comes with exercise.

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INJURY PREVENTION:

Physios also play an important role in injury screening and prevention. This has been the case for a long time in sports such as ballet and swimming, where the unique demands of the sport (eg extra flexibility through the shoulders in swimmers, or characteristics of the feet in dancers) mean that the injury risk is higher if the child is not well-prepared and well-suited to the sport (Gamboa, 2008). Typically with these sports we do a Musculoskeletal Screening on young athletes at the start of every year, to flag any strength, growth or flexibility issues and to develop an exercise program to reduce the risk of injury. This process usually requires a one-off musculoskeletal assessment, followed by 1-2 sessions to supervise the implemented intervention and reassess any high-risk measures.   Such programs have been shown to be effective in reducing injury risk (Eils, 2010), and as an added bonus these kids tend to see an improvement in technique and efficiency due to their improved preparedness. Of course, not all injuries can be avoided; traumatic injuries such as those typically seen in contact sports are difficult to prevent, while overuse or growth-related injuries tend to be decreased with the use of screening programs (Emery, 2003). Good candidates for musculoskeletal screening include:

  • Dancers, especially those about to go en pointe;
  • Children and adolescents swimming more than 3 x week;
  • Children who are going through an aggressive growth spurt, or who are likely to be particularly tall;
  • Children with a family history of growth- or overuse-injuries eg older siblings or parents had ongoing knee and ankle pain during growth spurts;
  • Children and Adolescents involved in more than 6 hours of organised sport/training per week;
  • Children and adolescents with a history of recurrent injuries or niggles.

 

 

WHEN NOT TO SEE A PHYSIO:

The following conditions require urgent medical attention and should be assessed by a doctor (usually at a hospital or via ambulance) immediately:

  • Concussion or head trauma;
  • Suspected acute fractures – eg the child has sustained a trauma and is unable to bear weight or move the affected limb;
  • Pains that also involve rashes, fevers, headaches and other systemic symptoms;
  • Traumatic joint injuries eg shoulder and knee dislocations (these will require Physio, however need to be assessed in the acute phase to clear fractures and to get an assessment from an orthopaedic specialist);
  • Pain that is causing vomiting or nausea.

The key point to remember is that early treatment results in less time away from sport, and generally less treatment. Physiotherapists work very closely with other allied health professionals as well as doctors and specialists, ensuring that any patient that requires referral on will be obtaining the best possible care and follow-up.

For more information and advice, contact your local Physiotherapist.

 

Happy Training!

 

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REFERENCES

  • Brukner, P., Kahn, K. Clinical Sports Medicine. Revised Second Edition. (2008). McGraw-Hill Australia Pty Ltd.
  • Eils, E., Schroder, R., Schroder, M., Gerss, J., Rosenbaum, D. Multistation proprioceptive exercise program prevents ankle injuries in basketball. Med Sci Sports Exerc 2010; 42:2098-2105
  • Emery, C.A. Risk Factors for injury in child and adolescent sport: A systematic review of the literature. Clin J Sports Med 2003; 13:256-268
  • FIFA 11+ Webpage: http://f-marc.com/11plus/home/
  • Gamboa, J., Roberts, L., Maring, J., Fergus, A. Injury patterns in elite preprofessional ballet dancers and the utility of screening programs to identify risk characteristics. J of Ortho & Sports Phys Therapy 2008; 38(3) 126-136

Fun Run Season is Here – How to Stay Injury-Free!

While other states are shivering into their hot chocolates, we are lucky enough in the far North of Queensland to be experiencing perfect running weather – beautiful crisp and sunny days with minimal humidity in the air. There is no better time of the year to be upping your running training and looking ahead to one of the many fun runs on offer around the area in the coming months.

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Not coincidentally, it is about this time of year that we start to see an influx of running injuries come through our clinic doors. As runners ourselves, we can understand the frustration and stress involved with having to sit out of training or worse, missing your planned race. There are many simple things that runners can do to minimise their injury risk and keep their bodies healthy and minds happy. We’re pretty sure you know all of these , but like most runners, need a simple reminder that you are not “special” – your body is not superman and it does, in fact, need just as much time to adapt to training stimulus as everyone else’s does!

 

  • Training Load

A large proportion of running overuse injuries are caused by simply doing too much, too soon. The classic situation is the runner who has had a few months off, maybe gained a few kilos and not been diligent enough with their strength work, and then decides to do an 8-week training program for an upcoming half marathon or 10km fun run. The first few weeks go by OK with sore muscles and slow shuffling, and then week 3-4 hits and you have shin or foot pain that won’t go away in a hurry…..Sound familiar? While the enthusiasm is great, it is important to “train for the training”. Consider your base level of fitness before jumping feet-first into any training program; if the first week of the training program looks “scary” to you, then you are not ready yet. Running is a wonderful sport for the body but it comes with a high injury risk if you are doing it sporadically. Once you are gradually building up the weekly mileage, give yourself a recovery week once a month, typically reducing the training load to about 60% of your previous week, further giving your body a chance to absorb the training. The healthiest and usually the fastest runners are those who are consistent with their training, year-round, allowing for natural and gradual increases and decreases in their load around race season and off-season.

 

  • Specific Strength Work

Every time you take a step when running, you are literally doing a single-leg squat with up to 4-6 times your body weight going through the chain from your foot up through your knee, hip, pelvis and spine. Think about that. The amount of recreational runners we see come into our clinic who cannot do one quality single-leg squat with one x their body weight – let alone quadruple that amount – is truly scary! Your muscles are very well equipped to take up the excess loads of running so that your joints and bones don’t have to get overloaded; in fact, well-trained muscles will act like springs and propel you forwards with ease and speed. We recommend that all runners do a minimum of 2-3 strength sessions a week, but it must be run-specific ie lots of core, glutes, single leg squat work and lower limb strengthening as well as the all-important balance and flexibility work. A quality session might take you 20-30 minutes, but it will be the best injury prevention investment you can make. An Exercise Physiologist or Physio with an interest in running can help you to design a program that addresses your weaknesses, and most can be done in your own lounge room without fancy equipment.

 

  • Running Technique

If your core and general strength is good, your balance and flexibility and adequate, and you are not excessively overweight, you will have a much easier time achieving optimal running technique. What is “ideal” technique is an often-debated topic amongst the literature, and when it comes down to it, everyone is different and will have a slightly unique “perfect form” that suits their body. Having said that, there are certain key factors that need to be considered to ensure that you are running safely, for both injury management and to increase your speed and efficiency. These include things like high knee lift to utilise the powerful glutes; mid or forefoot strike to optimise the calf muscles as a spring; a leg turnover of about 180 strides per minute (count how many times per minute your right foot hits the ground, then double it); a nice upright torso with a very slight forward torso lean etc etc. If you feel like you aren’t running at your best or you continually get overuse injuries such as shin pain and plantar fasciitis, having a qualified professional assess your running technique could prove to be a worthwhile investment. Coaches, Physios, Podiatrists, and Exercise Physiologists with an interest in running are all qualified to do such an assessment.

 

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Nutrition

Running is a wonderful sport for promoting weight loss and maintaining a healthy body weight. The best runners tend to be the lightest, but that doesn’t mean that you have to look like Paula Radcliffe to enjoy healthy running. If you are more than 5kg above your ideal body weight, be respectful of the extra load on your body as you increase your training load. Also ensure, no matter what your weight, that you fuel well before, during and after your hard run sessions. Optimal nutrition results in faster recovery, better performance and less injuries. Accredited Sports Dieticians are the best people to talk to about fuelling for both running performance and for weight management.

 

  • Shoes

This can be another controversial area that professionals love to debate over. Most qualified health professionals have their opinion on what shoe type is best for you; my advice would be to listen to your body. If you feel like it is hard to run fast, that your shoes are working against you, or that you get a lot of niggles in your current shoes, consider trying something different. I am a fan of the 4mm heel drop shoes and have had great success in them with all of my runners, but as with anything – change needs to be a very gradual thing. If you are used to running in super cushioned, 12mm heel drops and you suddenly swap to a “barefoot” style of running shoes (which I don’t recommend either, unless you weigh 40kg and look like the Kenyan Olympic marathoners), your body will be shocked by the change. You need to allow adequate time to adapt and ensure that you lower your training load and increase your strength work while you change over. I also advise people to have two pairs of runners on the go and to rotate them throughout the week. Most recreational runners doing 40-80km/week will need to change their shoes over every 3-4 months, depending on their weight and the surfaces they train on. This may seem expensive, but when you consider what equipment in some other sports (like cycling) costs, not to mention the cost of a potential injury, it is a relatively cheap investment for foot health!

 

  • Training Surfaces

Try to vary your terrain as much as possible – this is good for load but also a great way of incorporating some strength work and balance (eg. soft surfaces like trail running) into your running. Cement is the highest load for your body to cope with so try to do less than half of your training on it as a general rule.

 

  • Factors outside of Training

This is the one area that runners often neglect. Our training isn’t separate to the rest of our lives, it is included within it. That means if you are tired from lack of sleep, stressed from work or family, or under-fuelled from working through lunch – these things will all impact on your running form and also increase your injury risk. You need to consider how your body feels going into any run – and adjust accordingly. If you are wrecked from work or stress, don’t do that hard track session today; swap it for an easy 5km run and come back stronger for the track session in a few days’ time. I will also add here for the ladies that wearing high heels on fatigued legs is a great way to give yourself a stress fracture – you would be amazed how many times we have seen this in our female athletes! If you must have that big day at the races, at least wear lower heels and stretch calf muscles etc before and after the event.

 

 

The number one take-home point is that the body hates rapid change. The human body is an incredible specimen capable of adapting to remarkable training loads: think about what Ultramarathoners and Ultraman (back-to-back Ironman triathlon events) athletes are capable of achieving. They are no different to you or I – they don’t have magical superpowers that allow them to run 100km. They simply dedicated themselves to the process early in their lives and have consistently added training load to allow adaptation in a slow and planned manner. The bottom line is that our body will adapt beautifully to change, if we allow it time to do so. It’s not exciting, but if you ask any long-time marathon runner, it simply works. So if you’re like me and you idolise those crusty 70+ year-old distance runners that line up beside you at races, hoping that one day you too will be still running happily at their age, then take a leaf out of their book: consistency is the key to a long, happy running life.

 

Happy Training!

 

Kristy Shannon    B.Appl.Sc(HMS); M.PHTY

Physiotherapist and Exercise Physiologist

 

 

REFERENCES

American College of Sports Medicine., American Dietetic Association., Dieticians of Canada. (2009) Nutrition and Athletic Performance: Joint Position Statement. Medicine & Science in Sports & Exercise. 0195-9131/09/4103-0709/0

Barr, K.P., & Harrast, M.A. (2005) Evidence-Based Treatment of Foot and Ankle Injuries in Runners. Phys Med Rehabil Clin N Am 16:779-799

Beck, B.R., Rudolph, K., Matheson, G.O., Bergman, G., Norling, T.L. (2014) Risk Factors for Tibial Stress Injuries: A Case-Control Study Clin J Sports Med 0:1-7.

Buist, I., Bredeweg, S.W., van Mechelen, W., et al (2008) Prevention of Running-Related Injuries Among Novices. Am J Sports Med. 36:33-39.

Van Gent, R.N., Siem, D., van Middelkoop, M. (2007) Incidence and Determinants of Lower Extremity Running Injuries in Long Distance Runners: a Systematic Review. Br J Sports Med 41:469-480.

 

Pointers for Preventing Injuries ‘en Pointe’

pointe-shoesEvery budding ballerina dreams of the day she can one day transition into pointe shoes and dance up on her toes; indeed, many years of foundation training and development go into preparing a young dancer for this exciting stage in her dancing life.  However, along with the excitement comes much more demand on the body and a higher risk of injury.  Even with optimal technique, dancers who wear pointe shoes are bound to experience wear and tear on their feet.  In adolescents, overuse can also be a very common problem – we see a sharp increase in dance injuries as students build up their hours leading into exams and eisteddfods (typically in the middle of the year), and then towards concert time at the end of the year.  Dr Justin Howse, former orthopaedic surgeon to the Royal Ballet School, states that “no dance-related injury is an act of God”.  Variables such as the time spent dancing per day/week/month; experience level; anatomical limitations; technical knowledge; quality of teaching and quality of shoe fitting; history of previous injury; surfaces on which dancing is performed; and strength and conditioning level are among the factors that determine the likelihood of sustaining a pointe-related injury.

 

The following is a list of pointers to help prevent unnecessary pointe-related injuries:

 

 

– Get your pointe shoes fitted by someone with a lot of experience, and especially with fitting beginners if you are just starting en pointe.  Even if you have to travel to do this, it is worth the investment compared to having to see a physio and have a lot of time off later when injured.

 

Take your time getting onto pointe.  There is no “right” age to start – every body and dancer is different.  A dancer is ready when they have done most of their growing, have very good technique, flexibility and strength, and when their teacher feels it is time.  For most dancers this is between 12-14 years of age.  Going on pointe too early can cause a host of injuries and developmental issues in the feet – some irreversible.  Not to mention the cost of replacing pointe shoes every few months during a big growth spurt!

 

– Get a pre-pointe musculoskeletal assessment from someone qualified in assessing dancers.  This is usually a physio with a special interest in dance.  These assessments pick up any potential areas of weakness before they have a chance to cause you problems en pointe.

 

– These days there are a host of padding and toe spacing options to fit inside your shoes, but you do not need to have every single one of them.  I often see young dancers coming in with shoes full of bits and pieces and as a result, they lose the ability to control the end of the shoe well.  Experiment with padding and spacers, and do what feels best for you.

 

– Do not wear ribbons that are too tight – this cuts off circulation and can hide shoe-fitting problems.

 

– Ensure that you tie ribbon knots on the inside of the ankle, not over the back of the ankle, which can apply undue pressure to the achilles tendon.

 

– Be aware of how feet are used when they are not dancing.  Many a foot injury has been blamed on pointe shoes when the dancer is not wearing supportive shoes such as joggers at school or when walking on concrete etc.

 

– If you are having trouble with centre and balance work en pointe, look for weaknesses in muscles higher up the chain – it could be a lack in hip or core strength.

 

 

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– If you have very good muscle strength and still have troubles with single-leg pointe work, consider changing to a pointe shoe with a square box instead of a round one.

 

– Look at the whole body en pointe when trying on shoes.  Observe how the shoe affects the alignment of the rest of the body.  Beware of shoes that thrust the hips forwards.

 

– Never skimp on warming up and stretching.  When the body is not warm enough, or does not have sufficient flexibility to perform a particular technique, something else will pull or strain in order to achieve the desired result.

 

– Whenever possible, take a regular class before a full pointe class.  This will assist in warming up the body and help to decrease the risk of tendinopathy from pointe work.

 

– Don’t be “lazy” en pointe.  If you are wearing pointe shoes, you must have warmed up, be switched on, and aware of your body.  Never mark out dances or go ‘half up’ on pointe because you can’t be bothered in rehearsal – this is where some of the worst injuries occur.  If you are marking out or fatigued, swap into your demi-pointes.

 

– Check the wear pattern on the heel of your pointe shoes.  If there is evidence of foot contact a half inch or longer on the satin at the heel of the shoe, the size may be too short.

 

– A shorter shoe may create a better line and make the instep look higher, but it can also cause a tendinopathy or a bone spur at the back of the foot.  Short shoes also prevent the arch from expanding.  Once the elasticity of the arch is lost, the ability to jump is lost, as is the ability to perform deep pliés.

 

– Conversely, shoes that are too big lessen control over movements.  A shoe that fits correctly allows full flexion and full ability to spread the arch, as well as control the foot and ankle.  A large shoe can cause sprained ankles, overstretched tendons, and overdevelopment of muscles that are straining to hang on to the shoe.

 

– Pointe work is not just about the feet.  Remember to strengthen all muscles around the joints, from the foot to the knee to the hip to the spine; only then will you be able to accomplish your maximum range of motion with beautiful control.

 

– Many dancers stretch but forget to strengthen the deep stability muscles, especially around the hip and the foot.  Working particularly on the instep and the forefoot will decrease the risk of ankle injuries.

 

– When increasing your dance load or when going through a growth spurt, ice the feet at the end of the day.  Muscles swell as you dance, and ice assists in constricting the blood vessels and decreasing swelling and aches.  Also pay careful attention to calf length, and stretch more frequently (2-3 times a day).

 

– Ensure that you don’t allow the skin on the feet to become dry and cracked.  If this is a problem for you, get into the routine of massaging your feet and toes with Vaseline or a good quality moisturizer at night.

 

– Finally, be especially aware of your form when fatigue sets in.  Studies have shown that the majority of ballet injuries occur between 4-6pm, rather than during morning classes.  Physical and mental fatigue can lead to increased injury risk.

 

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It is important for dancers to learn about the anatomy of their bodies, and what they are designed to do, as they get older and more experienced with dance.  When dancers go onto pointe is a great time to start learning about their feet and how to look after their bodies ongoingly.  Often a dancer can carry minor weaknesses for a long time without realising that anything is wrong, until a growth spurt or extra rehearsal load comes along and tips their body over the edge.  Unfortunately this usually happens right before exams or concert time!

 

Thankfully, many of these injuries can be prevented or at least better managed if the dancer has been looking after their body and knows their body well – it’s strengths as well as its weaknesses.  If you are unsure about when is the right time to go onto pointe, whether your body is ready, and how to best transition without the fear of injuries, a dance Physio can assess your body and then work with you and your dance teacher to ensure that you are as ready as you can possibly be.  The end goal should always be facilitating the young dancer to achieve their full potential in the safest and most enjoyable way possible.

 

– Kristy Shannon

Physiotherapist and Exercise Physiologist

 

 

 

 

Why it’s Important to Stay Active When Injured

One of the most common misconceptions among the general public is that one must “rest” while injured.  I’ve lost count of how many times I’ve had one of my Pilates clients call to cancel “because they have back pain”.  They should be coming to Pilates because they have back pain!  Often the assumption is that the injured or painful structure needs to “rest”.  Rest from aggravating activities?  Most definitely.  Rest from all activities?  Definitely not.  The body requires blood flow, nutrients from the inflammation process, and gentle movement to stimulate healing.  If this can be done with minimal pain, you have a win-win situation: the body can get stronger while it heals itself.

Conversely, one of the most common misconceptions and fears amongst athletes is that their physio or doctor will tell them to stop their activity when an injury is looming, so they avoid making an appointment.  This often results in delayed diagnosis and treatment, worsening of their condition and significantly prolonged time off their sport in the long run.  The earlier the injury is treated, the more likely it is that the athlete will be able to continue with a modified version of their usual sport – which can mean faster healing, improved biomechanics through careful analysis and correction, and less time on the sidelines.

 

 

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Whichever end of the spectrum you sit at – from previously sedentary to elite athlete – there are a few key points to remember when facing an injury: 

1)      Activity Modification is the key.  Be creative!  Your Physio and Exercise Physiologist will be able to develop a program for you to follow, no matter what the injury, how long you’ve had it, or how you got it.  Even athletes with broken legs can be training hard in the gym and possibly the pool if done correctly.

 

 

2)      Golden Rule: Pain must stay below 2/10.  Some pain is good, and normal, in order for healing to occur.  80% of an injury’s healing occurs in 20% of the time (ie if a lumbar disc injury takes 10 months to get back to 100%, 80% of the gains will be achieved in 2 months, then next 8 months will be spent getting the final 20%).  Why wait the whole 10 months to get back to fitness?  The amount of muscle loss and degeneration achieved in that time may well set you up for a lifetime of back injuries in the future.  Staying fit through swimming, walking, Pilates, etc and keeping the pain <2/10 may well prepare you for a lifetime of less back pain.

 

3)      Athletes will often “train” harder when injured than when not.  Look at it like a time to rebuild the body and to work on any weaknesses that caused your injury in the first place.  Ask an elite athlete how much time they had to lay around and feel sorry for themselves after their last major injury.  Chances are, they will tell you how it was the hardest training they’ve done – hours spent in Physio and Exercise Physiology sessions, the gym and the pool.  Not to mention nailing their nutrition and recovery in between those sessions with extra sleep, massage, ice baths and so on.  We are all designed to be athletes, even if our modern “sitting” lifestyle has made that hard to believe.  So a middle aged man with a lumbar disc injury is no different – he should be doing more activity when injured in order to assist the healing and make him stronger than before the injury.  Look at it like this: the injury is a cry from your body that something is not right.  The rehabilitation process is your chance to fix that, so that you never have to experience it again.

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4)      The same principle applies for joint replacements.  Another very common misconception is that you should “rest” and ease off activity after a knee or hip replacement.  This couldn’t be further from the truth.  In the months leading up to a joint replacement, patients need to be working hard on their muscle strength in order to get the most out of the surgery and to assist in their recovery.  Your Physio or EP will be able to give you the least painful and most safe exercises for this.  After the surgery, the work continues – ever wondered why the Physio is there on day 1 to kick you out of bed and get you walking?  Because the joint will do best if you stay active.  Those “bed exercises”?  Same deal.  We need to wake up the supporting muscles as efficiently as possible for the body to heal well.  The pestering about your pain levels?  Because if your pain isn’t well-controlled, we won’t be able to exercise effectively.  There is always method to our madness……

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5)      Its never too early to see your Physio; prevention is the best cure.  My patients often come in with full-blown injuries, such as low back pain or chronic plantar fasciitis.  When I’m taking their history, they say that they first experienced the pain months ago and that it’s been progressively getting worse, and yet it’s taken them this long to see me.  They sometimes feel as though the problem has to be “serious” to warrant a visit – this couldn’t be further from the truth!  Had they come in when the pain first surfaced, the treatment would have been so much more efficient and the consequences much less significant.  Your physio can also help with prevention of injuries.  If you know you have a job where you sit a lot, then it might be worth chatting to your Physio about some strategies to prevent the onset of neck and back pain – being proactive is the key.  Physios and EP’s are well-trained to work with you to find an exercise program that is safe for your body, that fits in to your lifestyle, and that you enjoy doing.

 

The human body is an amazing specimen, capable of adapting to most things that we throw at it.  Your body puts up with a lot – why not give it something back by prioritising healthy ageing?  You only have one body, after all.

 

Kristy Shannon

B.Appl.Sc(HMS); M.PHTY(Hons);

Director and Principal Physiotherapist – First In Physio

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 REFERENCES                                                                                

Adams, T; Band-Entrup, D; Kuhn, S.; Legere, L; Mace, K. (2013) Physical Therapy Management of Knee Osteoarthritis in the Middle-Aged Athlete.  Sports Med Arthrosc Rev 21:2-10.

Chilibeck, P.; Vatanparast, H.; Cornish, S.; Abeysekara, S.; Charlesworth, S. (2011) Evidence-based risk assessment and recommendations for physical activity: arthritis, osteoporosis, and low back pain.  Appl Physiol Nutr Metab 36: S49-S79

Williams, P. (2013). Effects of Running and Walking on Osteoarthritis and Hip Replacement Risk.  Med Sci Sports Ex

Melov, S.; Tarnopolsky, M.; Beckman, K.; Felkey, K.; Hubbard, A. (2007) Resistance Exercise Reverses Ageing in Human Skeletal Muscle.  PLoS ONE 2(5): e465