Tag Archives: exercise

The Upside of Injury

October 20, 2015Blogcoach, doctor, exercise, exercise rehabilitation, Injuries, injury management, injury prevention, Ironman, low back pain, meditation, Overuse Injury, pain, Physiotherapist, Physiotherapy, plantar fasciitis, pregnancy, safe, Shin Splints, sport, sports physician, strength and conditioning, stress fracture, surgery, Training, TriathlonFirst in Physio

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.

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…).

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.

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

Pregnancy and Exercise

September 3, 2014Blogathlete, Benefits, childbirth, exercise, exercise as medicine, Exercise Physiology, exercise program, exercise rehabilitation, injury prevention, low back pain, Physical Activity Guidelines, Physiotherapist, Physiotherapy, Pilates, postpartum, pregnancy, safe, TrainingFirst in Physio

The 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

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

Are you an “Active Couch Potato”?

March 28, 2014Blog, UncategorizedBenefits, ESSA, exercise, exercise as medicine, Exercise Physiologist, Exercise Physiology, exercise program, exercise rehabilitation, healthy ageing, injury prevention, obesity, Physical Activity Guidelines, sedentary behaviour guidelines, weightFirst in Physio

Fun runs are a great way to stay active and motivated

Recently we have seen the establishment of new “Physical Activity and Sedentary Behaviour Guidelines”, doubling the recommended amount of daily exercise to 60 minutes every day and for the first time, addressing our nation of couch potatoes. “Sedentary behaviour” includes sitting or lying down, not including sleeping time during the night.

The New Guidelines: How Do You Stack Up?

– Doing any physical activity is better than doing none. If you currently do no physical activity, start by doing some, and gradually build up to the recommended amount.

– Accumulate 150 to 300 minutes of moderate intensity physical activity or 75 to 150 minutes of vigorous intensity physical activity, or an equivalent combination of both moderate and vigorous activities each week.

– Be active on most, preferably all, days every week.

– Do muscle strengthening activities on at least two days each week (gym/Pilates/weights etc)

– Minimise the amount of time spent in prolonged sitting. Break up long periods of sitting as often as possible.

“Active Couch Potatoes”

Frightening statistics show that Australians are sedentary on average for 7 to 10 hours a day, and this does not include sleeping. The highest health risks exist for those people who are sedentary at work, at home, and who do not do any other formal exercise. However, there does exist another group who accumulate their 60 minutes of exercise a day, but sit for the rest of the day at work. It has become apparent that the health benefits of their exercise bout do not completely override their globally sedentary behaviour, and these “active couch potatoes” would benefit from being more active during their work day as well.

I have a sitting job, help!

We can actually take away a lot of positives from the new guidelines, most notably that simply being more active throughout your day can start to give you some of the health benefits that those weekend warriors are getting with their 3-hour, one-off bike rides. If you hate exercise, this is good news for you. By being creative and adding activity into your day, you can be doing your body a lot of good. Walking or cycling to work; parking at the far end of the car park or a few blocks from work; going for a short walk to get your lunch; scheduling a “walking meeting” with a colleague; installing a standing desk in your workplace; and drinking more water so that you have to get up to go to the toilet more often are all easy ideas. If you want to get even more creative, you can get in the habit of walking every time you answer the phone; doing 20 air squats every morning tea and lunch break; or setting yourself a task of 20 push ups and a 1 minute plank every time you watch the news at night. Keeping the body moving and the engine revving is the key point. And the best part is, we are creatures of habit: before long, it will be second nature to be moving more (and your body will be thanking you for it). If you haven’t been very active in the past, it’s a good idea to start with small daily habits and then build in more structured exercise as you feel more comfortable to do so. The key is to find things that you can make fit into your work and home life, and ideally that you enjoy as well.

Where’s the Incentive?

Increasing amounts of studies are finding links between sedentary behaviour and weight gain, type 2 diabetes, poor muscle tone, heart disease and early death. From a Physiotherapy perspective, we are seeing more and more overweight patients coming in with pain and disability from osteoarthritis through the hips, spine and knees. The gold standard of treatment for these patients is to increase the supporting muscle strength around the joints, and to advise the patient to lose weight: even losing 10% of their body mass results in significant reductions in pain scores. It is argued that many of these conditions could be largely prevented by keeping a healthy body weight and staying active in the first place. After all, these are weight-bearing joints, and if you are overweight you are asking a lot of your joints every time you move. Similarly, from an Exercise Physiology perspective, we see many patients giving us highly creative “barriers” to exercise – reasons why they can’t or won’t prioritise physical activity in their lives, even when they are in pain and significantly overweight. It is not uncommon to have patients say they would rather have surgery to “fix” their problem, than to increase their activity and allow their body to become stronger and lighter. I am certain that a large part of this mindset comes from how “normal” it has become to be sedentary and overweight. But does that make it OK? Do you want to be “average”, if that’s what “average” has become? Do you want to live to a ripe old age, only to be overweight and in pain for the majority of that time? I certainly don’t!

What About my Kids?

It is more important than ever to keep our kids active, healthy and happy. Structured exercise is not only crucial for developing little minds and bodies, it is also important for social and health reasons too. Getting into the habit of being active early on can set you up for a lifetime of good habits, which is a gift that you can give your children for life. For kids 5-17 years of age, aim for at least 60 minutes of moderate to vigorous activity daily; and up to several hours daily to achieve even greater health benefits. Ideally this activity will be a mixture of strength and aerobic activity, which is where structured sports like soccer and netball, and active family time like cycling and walking the dog all come into the mix. Of most importance is the new recommendations to limit use of electronic media (TV,computers, ipads etc) to less than 2 hours a day. With childhood obesity on the rise, it is more challenging and hence more important than ever to aim for these goals.

Everyone is unique with their daily lifestyle, job requirements, and previous injury and health history. If you need help fitting these guidelines into your lifestyle, or have concerns about previous health issues or injuries, a few sessions with an Exercise Physiologist will help you to work out a program that you can do on a daily basis, without pain, and ideally with ease. Research has shown us time and time again that the most successful activity programs are achieved when the whole family gets involved and supports one another. Our children model themselves off our behaviours – from food to exercise to language, and they are facing the most sedentary generation in history: let’s teach them from a young age how to be anything but “average”!

More information about healthy living, including references to other Australian Government guidelines concerning healthy weight and healthy eating, can be found at www.health.gov.au

REFERENCE LIST

http://www.health.gov.au/paguidelines

Healy, G.N., Dunstan, D.W., Salmon, J., Shaw, J.E., Zimmet, P.Z., Owen, N. (2008) Television time and continuous metabolic risk in physically active adults. Med. Sci. Sports Exerc. 40(4) 639-645.

Sugiyama, T., Healy, G.N., Dunstan, D.W., Salmon, J., Owen, N. (2008) Joint associations of multiple leisure-time sedentary behaviours and physical activity with obesity in Australian adults. Int J Behav Nutr and Phys Act 5(35) 5868-5-35

Nelson, M.C., Gordon-Larson, P., Adair, L.S., Popkin, B.M. (2005) Adolescent physical activity and sedentary behaviour: patterning and long-term maintenance. American J of Prevent Med. 28(3) 259-266

Patrick, K., Norman, G.J., Calfas, K.J., Sallis, J.F., Zabinski, M.F., Rupp, J., Cella, J. (2004) Diet, Physical activity, and sedentary behaviours as risk factors for overweight in adolescence. Arch Pediatr Adolesc Med 158: 385-390

More than half of all Australian adultsare not active enough. Source: Australian Bureau of Statistics (ABS) 2013. Australian Health Survey: Physical Activity, 2011-12. ABS Cat. No. 4364.0.55.004. Cnaberra: ABS

Why it’s Important to Stay Active When Injured

February 13, 2014Blogback surgery, cast, exercise, exercise as medicine, Exercise Physiology, fitness, healthy ageing, injured, injury management, injury prevention, low back pain, pain, Physiotherapy, Pilates, plantar fasciitis, safe, Shin Splints, stress fracture, surgery, TrainingFirst in Physio

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.

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.

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……

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

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

Tag Archives: exercise

The Upside of Injury

Pregnancy and Exercise

Are you an “Active Couch Potato”?

Why it’s Important to Stay Active When Injured

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