All posts by First in Physio

Thirty minutes a day keeps the doctor away: What does this mean for the average Aussie bloke and his sexual life?

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When it comes to servicing, us men are usually quite good at getting our vehicles or machines done on a regular basis. Although we are good at this (most of the time), we are notoriously bad for servicing our own machine (our body). Too many men come into our clinic and to GP’s with an issue that they have “just put up with” or “thought it would get better on its own”. This is how the majority of men deal with their own health issues and usually it doesn’t make it “better”.

There’s no secret that physical exercise is good for everybody, and it is recommended that the average Australian should be exercising for 30 minutes minimum daily. But what does this mean for us, the average Aussie male? Physical exercise helps with improving general well-being, by promoting a healthy weight and improving mental health, but it also helps with reducing the risk of chronic diseases. Something that I found interesting during researching conditions that are common in the average male was erectile dysfunction. 

Discussions surrounding sexual health of every patient is important, especially for getting a good past medical history for physicians, but it is something that is often missed. In Australia, there are currently around one million males that are affected by erectile dysfunction, which is an extraordinarily high number! With this in mind, shouldn’t there be a bigger focus on this condition? I believe its because of the sensitive nature of talking about bedroom performance or lack thereof.

To get a better understanding of how erectile dysfunction works, I will give a basic overview. Erectile function is controlled by the functioning of our arteries, our central and peripheral nervous systems, and our endocrine system. For most Aussie male’s erectile dysfunction occurs due to these main factors; overweight/obesity, sedentary lifestyle, alcohol and tobacco use, which inhibit or disrupt the systems which control erectile function.

In our clinic we deal with almost exclusively musculoskeletal injuries – whether due to a sporting incident or playing with the kids and doing something we shouldn’t have. Our general questions involve how it happened, how long ago, and how is this impacting on function. At the end we usually ask if there is any medical information we need to know about, which encompasses anything from previous surgeries to cardiovascular health. Usually in the older population, the usual responses are; “I take blood pressure tablets for high blood pressure”. In my experience this is usually the only action that is taken to treat this problem. We know that we all need on average 150 minutes of moderate intensity exercise for general health and well- being, but even with cardiovascular issues, most of us aren’t hitting this target. 

So let’s get back to it, such a high number of Aussie blokes being affected by something that isn’t talked about enough and isn’t treated as well as it could be. For the high percentage of cases which are affected by weight issues, sedentary lifestyle, alcohol and tobacco use can be managed with the use of…… you got it! EXERCISE! From a literature review I conducted from my undergraduate degree, I found that the most effective form of exercise was one that targeted our aerobic system or cardio exercise (which we all love). It was agreed that high volume (200-300 minutes/week) had the greatest impact at a moderate intensity. By doing this it reduces cardiovascular and metabolic risk factors, which leads to weight loss! And the less excess weight we have, the better our arteries can work to pump blood around our body!

But to get a proper understanding about why your erectile function may be impaired it is best to get a proper assessment by a physician, as it may be needed to be treated with medical interventions and not solely by exercise.  Opening up this conversation with your Physio or GP could be the start to a healthier, happier you!

Physiotherapist Joe Denison

B.PHTY

Steel Rebar Products to Suit Your Every Need

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Whether it is pipe, roof sheeting or fencing, South African buyers can easily find whatever steel products – in any size or shape – they require.

Steel Rebar products can be broadly categorized into long or flat products. Long products are typically used in construction, for example re-enforcing bar (rebar) or pipes, while flat products are most often used in the manufacture of cars, ships and white electric goods such as fridges and washing machines. Stainless steel is used in the manufacture of cutlery and surgical equipment.

As these products are used in such a wide variety of applications, different types of steel are used to comply with different requirements. Depending on the production process, steel can be made stronger, non-corrosive or more flexible.

Hot-rolled steel – steel that is processed while hot – is rougher in appearance than cold-rolled steel and less expensive, but also stronger. High-quality products, such as cars and fridges, are usually made using more expensive cold-rolled products.

Stainless steel is manufactured by adding chromium and nickel, leaving the end product resistant to rust, stains and corrosion.

Galvanised steel products – steel that are covered in a layer of zinc – are also widely used in applications where rust resistance is needed, for example roof sheeting. Aluminized steel – steel covered with aluminium and silicon – is commonly used for heat exchangers in residential ovens, water heaters, fireplaces and baking pans.
With steel products being used in anything from irrigation to security, steel suppliers offer a wide variety of products and value-adding services, allowing buyers to have products rolled, cut, bent or welded to specification.

Some of the available products include seamless piping, valves, gaskets, nuts and bolts, window sections, construction bars, beams, palisade and wire fencing, and walkway grating.

Why Yoga?

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In a society where “busy” and “stressed” are the new buzz words and it’s considered abnormal to be “relaxed and well, thanks”, one may say why NOT yoga?  We are so busy and stressed now in our lives that it would seem we need a formal class time to allocate towards self-care, mindfulness and relaxation. Yoga is good for that. But so is running, swimming, walking – actually, any form of exercise will get the endorphins flowing and act like a moving kind of meditation if you can find a way to enjoy it. Pilates certainly falls into that category too. Many of my Pilates clients come for relaxation benefits as well as the core work that is on offer. So why are we here at First In Physio embarking on the yoga journey and offering classes at our studio?

 

The simple answer would be because there is a demand for it. We get asked on a weekly basis if we run Yoga classes, and there are many people in the area who have benefited from Yoga in the past when there have been classes held locally. They can all tell me stories of how it impacted their lives and bodies for the better; I even have one patient who told me she conceived her fourth child because of Yoga! (I’m going to say that’s because of the mental health benefits, not her newfound flexibility…).
The complex answer is because it has changed my life. And knowing the impact it has had on my life, I almost feel a responsibility to bring classes to the area so that others can also reap the benefits.

 

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Those who know me or have followed my journey to attempt to race an Ironman triathlon a year after having my baby boy Jude, would know that the shit hit the fan in a spectacular manor a couple of weeks out from race day when I got glandular fever. That was in February of this year, and for 6 months afterwards I was allowed to do very minimal training of the type I like most – high intensity and/or long swim, bike and running sessions. In order to recoup my body (and mind), I was allowed to do only gentle exercise with a low heart rate and low stress on the body. Those who know me would also vouch for the fact that I am extremely “Type A” and would probably hit the top 3 on their “least likely to meditate….or relax at all for that matter” list. So I wasn’t a likely yogi. But desperate times and all that….

 

Enter Yoga.

 

I signed up to online yoga classes and spent most early mornings when I would normally be out pounding the pavement, instead “rolling around on the floor” as my husband would say watching the sun come up out on our deck. Twisting my repairing body into positions of flexibility it hasn’t been into since my dancing days, getting stronger through my core in ways that are unique to Yoga, and calming my breathing and mind into a state of pure relaxation and acceptance in the mediation component (aaahhhh Savasana).

 

 

I have always maintained that “running is my therapy”, and indeed I would still argue that. I have never in my life come across anything that offers even close to those benefits for me – that makes me feel as calm, happy and relaxed as running does. But Yoga, well, it comes pretty damn close.
So that’s my “Why Yoga”. But what can you get out of yoga?

 

 

Well there’s pregnancy, according to my patient, so there’s that. Then there’s the improved flexibility, especially for males. We treat so many males who have a physical job like building or plumbing and struggle as they lose flexibility and fitness over time. Often we end up treating them for back injuries in their 30’s because the demands of their work life are outweighing their core strength and stability. Engaging in a regular yoga practice can help to prevent or treat their issues, essentially allowing them to extend their healthy work life which is a priceless benefit if that job is the only one they plan on doing in this lifetime. Yoga is also popular with male and female athletes alike, for good reason – often the “10 percenters” like stretching, massage, and core work get pushed to last on the priority list and as a result often niggles start to creep into the picture. Weekly yoga gives you an hour of benefits for your body and “brownie points” with your coach (and Physio…). I actually can’t think of anyone who wouldn’t benefit from the physical benefits of yoga, and the practice is such that any age, gender and ability is able to do it – it’s designed to be your practice, and there are so many variations that you will always be able to find a level that suits you. The whole essence of yoga lies in non-competition – it is not about being “the best” or “the most flexible”, it’s about staying on your mat and focusing inwards on yourself, treating yourself with compassion.

 

The real magic though lies in the mental health benefits. Yoga has been around for centuries and practiced worldwide, so it’s no surprise that there is a plethora of research available to prove what Yogi’s have known since its inception: yoga actually makes you smarter (1), makes you sleep better (2), improves depression symptoms, lowers cortisol (our stress hormone), and makes you happier (3). A consistent yoga practice can lead to a highly improved outlook on life through better sleep, improved mood and the ability to be more compassionate towards yourself, your family and people in general. Not to mention that you get to live in a body that moves well, because of the physical asanas of yoga: Win-Win.

 

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So it sounds too good to be true, right? I’ve been blessed through this journey to meet and be taught by some seriously enlightened Yogis, and I must say they are some of the most amazing humans I have ever come across. I am only at the start of my personal Yoga journey, and I’m so excited to be able to teach the practice of Yoga to those who choose to come along for the ride. If you’ve always been curious about Yoga, or even if you have no idea about it but you struggle with body aches and pains, or poor sleep, or stress…..the list goes on….. then why not give it a try? You’ve got absolutely nothing to lose. Our classes will be aimed at the beginner to intermediate level, and every single body is welcome – old or young, Ironman or couch potato, man or child.

 

 

If you are interested in joining our yoga classes, please give our friendly receptionists a call on 4783 7284. We have early morning, lunchtime and evening classes on offer.

 

Namaste.

 

 

Kristy

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

Principal Physiotherapist, First In Physio.

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Kristy is the co-owner of First In Physio along with her husband Patrick, who is also a Physiotherapist.  When not at work or spending time with her baby boy, Kristy can be found in the pool or out on the roads training for long course triathlons, traveling around the countryside to races with her family or doing Yoga.

 

 

 

1. In a recent study aptly titled, Neuroprotective Effects of Yoga Practice, the brains of experienced yoga practitioners were compared to those of non-practitioners with similar health profiles. Using magnetic resonance imaging (MRI), researchers at The National Center for Complementary and Integrative Health were able to identify regions of activity and growth. As a result, this study found that a regular practice combining breath awareness, physical postures and meditation can increase the volume of gray matter (brain tissue) in different parts of the brain, effectively reducing the naturally occurring, age-related decline of brain cells. With most of the observed gray matter volume changes having occurred in the left-side of the brain, the implication is that yoga shifts the automatic response of the practitioner from fight-or-flight (right-brain, sympathetic nervous system activation resulting in acute physical stress) to rest-and-digest (left-brain, parasympathetic nervous system activation promoting calm and relaxation)

2. K. M. Mustian, O. Palesh, L. Sprod, L. J. Effect of YOCAS yoga on sleep, fatigue, and quality of life: A URCC CCOP randomized, controlled clinical trial among 410 cancer survivors. Journal of Clinical Oncology, 2010 ASCO Annual Meeting Abstracts. Vol 28, No 15_suppl (May 20 Supplement), 2010: 9013

3. Woodyard C. Exploring the therapeutic effects of yoga and its ability to increase quality of life. Int J Yoga 2011;4:49-54

An Idiot’s Guide to Finishing an Ironman (and Staying Married)

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As I write this I am now 4 weeks out from Ironman New Zealand. Which means that most of the big sessions are now in the bank, the mental preparation has been done, and the main part of what’s left is just getting excited to actually race soon! It will be almost 3 years since I last lined up for an Ironman, with a lot of water under the bridge in that time. This time around my goals are completely different: to finish an Ironman one year after my son was born. The training has reflected that with less focus on performance, more focus on efficiency and creativity – trying to get the quality sessions done around being a new mum and running a business (not easy but do-able). I’m aiming to get to the finish happy, healthy and with the ultimate prize at the finish line – seeing my baby boy Jude with my husband Patrick waiting for me.

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I must say it’s been a super fun lead up and I’ve been really lucky to have an awesome crew to train with. I’ve accidentally convinced one of the guys I ride with to sign up for his first Ironman (go Pete!), which has gotten me thinking about back when Pat and I did our first Ironmans. I also get asked a lot of questions from my patients about how I manage the training around family and work, how I stay motivated, and what Ironman training involves. I love to talk, so I’m more than happy to share some pearls of wisdom that I have learnt along my Ironman journey so far – which has included both tremendous highs and momentous f#ck-ups. I’ll never “know it all” and that’s what I love about the sport – it’s ever changing and always challenging!

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Ironman is Not Normal, and You are Not Superhuman…

…But in order to finish one, you need to get yourself to a point mentally and physically where the Iron distance seems “normal”, and your body is “scary fit” – that is, on any given day, you could bust out a 4km swim, 180km bike, and a marathon if you had to. So while on a more objective level Ironman isn’t “normal”, you should surround yourself with people who encourage you, have faith in you, and even better – have done it themselves. Avoid people who tell you how “crazy” or “impossible” it is, especially in the month before the race….and in the same spirit, maybe don’t tell every person you run into on the street that you are in Ironman training (unless you do want that negative reinforcement time and time over…plus let’s be honest, not everyone wants to hear about it).

I’ll never forget last time we did NZ Ironman, we were on the flight over and I found a documentary on this marathon runner on the in-flight entertainment list. I start watching it, and the theme of the whole thing was along the lines of being super dramatic about “how epic the marathon distance is, and how the training is the hardest thing you could ever face” and so on. Needless to say I had a chuckle and then turned it off – we were flying towards a race in which we were going to do a marathon AFTER swimming 4 km and riding for 180 km, on hills no less. We had spent the last several months mentally getting to a point where that was not only OK but appealing, so I didn’t need to hear about how hard the marathon is in great detail…

Final note on the Scary Fit phenomenon: it does not mean you are Superhuman. If you do stupid things, you will still break (see my previous post on Busso Ironman 2012 – “The Upside of Injury”). Super Fit is good; Super Stupid is not. Respect your body, be nice to it, and build into things gradually and with consistency.

Make a Priority List….And Stick to It

Mine goes like this:
1) My husband and baby boy
2) Running our Physio Clinic
3) & 4) Ironman training and Social Life.

The last two are tied because I sway between the two. The priority list becomes super important when you get to those tough decisions during the training block: you have a long run scheduled but you also have an invite for breakfast with girlfriends; or it’s your husband’s birthday on a Sunday when you have a 5 hour ride planned and a 3km swim with several hours of exhausted-getting-your-sh#t-together time in between the two. The priority list is important to help you decide when you should change the plan, so that you can get to race day and not only be fit but also still have a marriage, a child who knows your name, a business that’s still functioning and friends to tell you how awesome you are for finishing an Ironman. You may think I’m joking here but you would not believe how many Ironman athletes I know who can pull out amazing race times but are unhappy in every other aspect of their lives. A bit of perspective and some smart decisions go a very long way. Most Ironman athletes by their very nature (myself included) are very “Type A” control freaks; learning to be a bit more flexible with fitting training around your life and relationships (not the other way around) is key to getting it done and still being happily married at the finish line.

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Involve Your Family and Friends – it’s supposed to be FUN

Following on from the above point – I try to combine points 1, 3 and 4 by training with my husband and friends where possible, and if we get really creative, our baby boy Jude as well (usually for part of a long run in the Mountain Buggy). I have a Cycling Wife (thanks Carly) plus a bunch of guys who are always keen to come for part or all of my long rides (I’m talking 4-5 hours on the road). I do think that for newbie Ironman athletes, it’s important to do some of the big sessions on your own to ‘get into your own head’ – more as a confidence thing to prepare to do it on race day – but I don’t think it’s healthy to be doing all of your sessions on your own.

There’s a tradition in Ironman to go back to the finish line after you’ve done your race to cheer on the rest of the athletes and bring them home. You have up to 16 or 17 hours (depending on the race) to get the distance done. I always say that everyone should experience an Ironman finish line at least once in their life – even if it’s just watching the athletes finish. Watching the emotions of the age group athletes as they come down that finish chute after what’s likely been the hardest physical and mental thing they’ve ever done, hugging their husband or wife and crying with tears of happiness, pride, relief, joy…. In a world where we are bombarded with negative news stories and surrounded by obesity and chronic diseases, it’s heartwarming to be reminded of what the human body and mind is capable of doing when it is treated well. It’s a sight you will never forget, and it’s one of the many reasons why we will continue to travel away to triathlons as Jude grows up – so that he too can be surrounded by such an uplifting and inspiring group of people doing extraordinary things as a reminder of how positive life can be. Personally, I found watching my husband finish his first Ironman far more emotional than finishing my own first Ironman (and it still makes me teary thinking about it). There’s something special about being on that journey together. Race day is the celebration, but there’s a lot of hours of training that happen in the lead up, and involving your loved ones makes it so much more special.

Reality Check: Lower Your Standards

You can pick up any fitness magazine these days and they’ll have you believe that not only is Ironman achievable, it’s even easy – it must be, since every Tom, Dick and Harry is doing one now (Men’s Health Magazine and Triathlete I am talking to you). Not only that, but the Holy Grail of landing a Kona spot (ie qualifying for the world championships) should be on your “goals” list now too, apparently.

What these magazines fail to address is the reality of the Age Group Ironman World: lots of unhappy marriages; lots of athletes running away from something in their lives or having a mid life crises and training 30 hours a week, or worse – the newbies that sign up and never make it to the start line because the training alone leaves them broken and disillusioned.

Be clear on your goals, and see the situation for what it is: if you are considering doing your first Ironman, just aim to get to the finish line HAPPY and HEALTHY. Full stop. The athletes that qualify for Kona are insanely talented and spend upwards of 20 hours a week year in, year out training for that right. They will be at the finish line not long after the Professional Ironman Athletes are. Forget about everyone else racing; just set your own goals, focus on enjoying the journey, and allow yourself to be proud of your efforts. Less than 1% of the world’s population will ever finish an Ironman; you should be proud of that, no matter what the finish time is.

The Serious Stuff: Get a Good Coach (+ Dietician + Physio)

OK I’m a Physio so I can’t help myself: I am always mystified by people who are willing to drop 6k on a bike, 1k on race entry, god knows how much on travel, accommodation etc….and won’t invest any money at all in a coach, let alone a good one (yes, just like anything you get what you pay for with coaching). Trust me on this one: you will get way more confidence, speed, fitness and less injuries if you have a decent coach as compared to a decent bike. A new time trial bike might make you look super fast but the joke’s on you when the old ladies on their road bikes start passing you in the second half of the bike leg (I’m not joking…). I’ve had the same coach for the last 5 years: he knows my body; knows how to handle me; when to push and when to back off. Doing an Ironman without him guiding the process would feel like trying to swim without my right arm. Triathlon is an expensive sport but you can spend money wisely to get the most out of your journey.

On a similar note, it’s worth spending the money on seeing a good sports dietician and a physio before you start your big training block. This is particularly important if you have any injury history, or if you are looking to alter your body composition and get advice on race day nutrition and how to train that aspect of the race. If you go out there and start downing Gu’s for the first time on race day you will spend more time in the port-a-loos than on the bitumen; there’s a reason they call nutrition the “fourth discipline” of triathlon. Your body can store about 90 minutes worth of glycogen for exercise, so the nutrition plan becomes super important if you want to race for upwards of 12 hours and finish in one piece. A Physio can help with bike set up, core work and screening for injury risk so that you can strengthen up before an injury derails you.

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If you have goals of doing a triathlon or even an Ironman one day but don’t know where to start, don’t hesitate to reach out to one of us and have a chat – or even better, come along for one of our group runs or rides. We can help guide you with your training (see our Bio on Ironman coach (and my coach) Scott DeFilippis on our home page) as well as your injury prevention plan, bike set up, dietician referral, sports nutrition products and much more (we stock Gu nutrition products at First In Physio).

Thanks for reading and as always, Happy Training! You can follow the final weeks of my journey to NZ Ironman on Instagram @KRISTY_SHANNON – I’d love to heave you along for the ride. Thanks to everyone who has reached out already, it really means a lot to have your support along the way. Race day is the 5th March, 2016.

Kristy Shannon
Director and Principal Physiotherapist
First In Physio

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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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Returning to Sport after Pregnancy

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Exercising after pregnancy has many physical and psychological benefits which will help you return to your pre pregnancy fitness and sport. Many of the physiological changes of pregnancy can persist for several months post partum, but exercise can speed up and assist your recovery.

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Benefits of postnatal exercise include:

 

  • Increased muscle strength
  • Increased cardiovascular fitness
  • Decreased back pain and incontinence
  • Reduced postnatal depression
  • Assistance with weight loss
  • Improved mood and energy
  • Reduced stress
  • Improved sleep

Exercise postpartum must be gradually increased and individualised as each woman’s pregnancy experience is different. Due to hormonal changes, your ligaments and joints are more lax which increases the risk of an injury, however keeping your muscles as strong as possible will decrease this risk. Soon after pregnancy, gentle abdominal and pelvic floor exercises can be introduced.  These muscles will be lengthened and weakened which decreases your spinal and pelvic stability, increasing your risk of back pain and injury. Strengthening these deep core muscles will also assist with any incontinence or bladder problems after childbirth. If you have had abdominal separation (Rectus Diastasis), which occurs in up to 70% of women during pregnancy, specific exercises can be introduced under the supervision of a Physiotherapist or Exercise Physiologist to facilitate closure of the stomach muscles. This is important for preventing back pain, but also for preparation of any future pregnancies. Back strengthening exercises will also be beneficial for restoring your posture, reducing neck and shoulder pain, and for ease of lifting and carrying your baby.

 

Many women post partum, look forward to returning to running or team sports. Our Exercise Physiologists can guide you through a safe home or gym based strength and cardiovascular program suitable for your chosen sport, which meets your individual goals. They can also show you several exercises where you can incorporate your baby, allowing special bonding time for mum and bub.  Working with an Exercise Physiologist will help you to return to sport as soon as possible, whilst minimising your risk of injury.

 

No referral is needed to book an Exercise Physiology appointment, and most private health funds will rebate a large proportion the fee.

 

For more information or to book an appointment please call our friendly reception staff on 4783 7284.

 

 

References:

  1. Artal, R., & O’Toole, M. (2003). Guidelines of the American College of Obstetricians and Gynecologists for exercise during pregnancy and the postpartum period. British journal of sports medicine, 37(1), 6-12.
  2. Pool-Goudzwaard, A. L., ten Hove, M. C. S., Vierhout, M. E., Mulder, P. H., Pool, J. J., Snijders, C. J., & Stoeckart, R. (2005). Relations between pregnancy-related low back pain, pelvic floor activity and pelvic floor dysfunction. International Urogynecology Journal, 16(6), 468-474.

Kids and Sport: When to see a Physiotherapist

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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

Pregnancy and Exercise

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IMG_0432_2The American College of Obstetricians and Gynaecologists recommends the accumulation of 30 minutes or more of moderate intensity physical activity on most, and preferably all, days of the week during a normal, healthy pregnancy. We now know that exercise – whether in the form of running, swimming, Pilates or anything in between – is hugely beneficial from pre-conception right through to the post-partum stages.

 

Benefits of Exercise to Mum and Bub include:

  • Significantly Reduced risk of Preeclampsia (hypertensive disorders during pregnancy)
  • Significantly Reduced risk of gestational diabetes;
  • Reduced incidence of Low Back Pain during pregnancy and post-partum
  • Improved tolerance of labour with increased fitness and strength levels, and faster recovery post-partum;
  • Improved bone density with weight-bearing and strength exercises;
  • Reduced incidence of pregnancy-related carpal tunnel syndrome with water-based exercise programs;
  • Psychological benefits including reduced rates of pre- and post-natal depression;
  • Improved placenta development
  • Reduced morning sickness symptoms in some women;
  • Better circulation throughout the body and to the placenta
  • Less constipation and bloating;
  • More energy and better sleep;
  • Lower rates of incontinence;
  • Improved muscle support for the pelvis

 

 

 An Exercise Physiologist can help with:

  • Prescription of a home exercise program for low-risk pregnancies, and supervised exercise sessions for higher-risk pregnancies;
  • Managing safe exercise around the many physiological changes occurring, such as increased joint laxity, weight gain and a changing body;
  • Prescribing appropriate exercises to minimise your risk of Rectus Diastasis (split abdominal muscles), a common condition affecting up to 67% of pregnant women;
  • Prescribing a balanced weekly exercise programme based on your individual fitness and health, and adjusting throughout the pregnancy;
  • Pelvic floor exercises to assist with prevention of incontinence and other bladder problems;
  • Answering any of your questions about exercise during pregnancy – from elite athletes through to previously sedentary mums-to-be. Common questions include: “how hard can I go?”, “Is it safe to run/ride/strength train while pregnant?”, “what precautions do I need to take while exercising?”, “what are the warning signs to stop exercising?”.

 

 

A Physiotherapist can help with:

  • Management of common pregnancy complaints such as pelvic and low back pain;
  • Advice regarding physiological changes occurring during pregnancy and how to help manage them;
  • Preventing neck and back pain during breastfeeding
  • Managing early return-to-exercise programs post-partum.
  • Retraining pelvic floor muscles after childbirth
  • Caesarean section recovery

 

Pregnancy is a wonderful time full of many changes both physiologically and emotionally. Always check with a health professional (your Doctor, Obstetrician, Exercise Physiologist or Physiotherapist) before starting any new exercise program.

 

 

 Do I need a Referral?

  • No referral is needed to book in with an Exercise Physiologist or Physiotherapist. Our professional staff maintain constant communication with your doctor and Obstetrician, to ensure that everyone is up to date with your exercise and health plan throughout the pregnancy and beyond.

 

 

What is the Cost?

  • If you have private health cover you will be able to claim on these services. For more information on prices and to make a booking, please call our friendly reception staff on (07) 4783 7284

 

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References:

 

O’Toole, M., Artal, R. (2003). Guidelines of the American College of Obstetricians and Gynaecologists for exercise during pregnancy and the postpartum period. British Journal of Sports Medicine 37:6-12

 

 

Pinto, Kristina.; Kramer, Rachel. Fit and Healthy Pregnancy: How to stay strong and in shape for you and your baby. VeloPress books, 2013, Boulder, Colorado.

 

Pivarnik, J., Chambliss, H., Clapp, J., Dugan, S., Hatch, M et al (2006). Impact of Physical Activity during Pregnancy and Postpartum on Chronic Disease Risk. Medicine and Science in Sports and Exercise – Roundtable Consensus Statement 0195-9131

 

 

 

 

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

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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’

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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