Physio

Returning to sport after ACL surgery - Sutherland Shire Physio

What is guiding your return to sport after your Anterior Cruciate Ligament (ACL) surgery?

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What makes you confident in your decision to return to sport?

It could be the all clear from the surgeon. The discharge from physio. The time since your surgery.

We too often see clients who have no clear pathway to return to sport. Here is a brief snapshot of what we assess to make sure we are helping our clients decrease their risk of re-injury when returning to sport:

  1. >90% on lower limb strength testing comparative to uninjured side

  2. >90% on hop testing comparative to uninjured side (single leg hop, single leg triple hop, single leg crossover hop, timed 6m hop, lateral hop)

  3. >9 months post surgery

  4. Implementation of an ongoing prevention program

  5. Confidence to return to sport as assessed through questionnaires

We know that returning to cutting sports like AFL, soccer, rugby, netball after an ACL surgery means around a 4 times greater risk of re-injury. Making sure you meet these criteria before return to sport has been shown to reduce injury rates by up to 84%.

What guiding your decision to return to sport after ACL reconstruction? We’d love to know!


Exercise for Low Back and Neck Pain

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Exercise is Medicine - Low Back and Neck Pain

Exercise is not only the key to a healthy life but also leads to a comfortable life. The old saying “move it or lose it” was correct! We have previously discussed the importance of movement for general health and well being purposes HERE.

Move it, or lose it

Today we will talk about the benefits of movement for reducing the incidence of neck and back pain, which, unfortunately is becoming far too common in society today.

In 2014-15, 1 in 6 Australians reported back and neck problems which equates to approximately 3.7 million people.

1 in 6 Australians Reported back and neck problems in 2014-15.

The AIHW reports that neck and back troubles were the 3rd leading cause of disease burden in Australia in 2011 (1).

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What does the research say?

As these levels are very high, there is a growing field of research to identify what we can do to prevent these issues. The recurrent stand out is exercise! Exercise has time and time again shown to be medicine for a variety of conditions (2-3).

Exercise programs have been shown to substantially reduce the risk of a new episode of neck pain (4) and the same just happens to be true for low back pain. Evidence suggests that exercise as a stand alone intervention or in combination with education is effective in the prevention of low back pain (5).



The Cherry on top

To really add the cherry on top, if this is combined with some strengthening exercise, then the risk of not only neck and back issues but all sports injuries is reduced to less than one third and the rate of overuse injuries is halved (6).

What does this mean?

Exercise is one of the best things that can be done to not only live a healthy life but also to feel good whilst doing so. All of the research suggests that it doesn’t necessarily matter what you are doing as long as you are moving. So don’t over analyse things just do what you enjoy!

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In case you’re wondering how much?

  • It is advised that for adults aged 18-64 years, 150-300 minutes of moderate intensity physical activity or 75-150 minutes of vigorous physical activity, or an equivalent combination of both, per week is recommended.

  • Strengthening activities should be performed at least twice per week.

  • For adults 65+ at least 30 mins of moderate intensity exercise is advised daily(3).



Take Home Message

  • Exercise is meant to be a long term drug, consistently taking it over time leads to the greatest benefits.

  • Do what you enjoy and do it often.

  • Add some variety and gradually progress.

  • If you fall off the bandwagon don’t stress, life happens, just get back on.





References:

  1. https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/back-problems/contents/what-are-back-problems

  2. https://www.primalplay.com/research/

  3. http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4364.0.55.001~2014-15~Main%20Features~Exercise~29

  4. de Campos, T. F., Maher, C., Steffens, D., Fuller, J., & Hancock, M. (2018). Exercise programs may be effective in preventing a new episode of neck pain: a systematic review. Journal of Physiotherapy, 64(3), 159-165. DOI: 10.1016/j.jphys.2018.05.003- https://research-management.mq.edu.au/ws/portalfiles/portal/89732879/Publisher_version_open_access_.pdf

  5. Steffens D, Maher CG, Pereira LSM, et al. Prevention of Low Back PainA Systematic Review and Meta-analysis. JAMA Intern Med. 2016;176(2):199–208. doi:10.1001/jamainternmed.2015.7431- https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2481158

  6. Lauersen JB, Bertelsen DM, Andersen LB. The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials Br J Sports Med Published Online First: 07 October 2013. doi: 10.1136/bjsports-2013-092538- https://bjsm.bmj.com/content/early/2013/10/07/bjsports-2013-092538




AC Joint Injury in BJJ

We know the feeling. You’ve been training solidly, competing well and things feel like they’re coming together (finally!).

Until that moment amongst a heated roll, that you lose your base and land smack-bang on the point of your shoulder.

You have an immediate reflexive wince of pain. You feel like someone stuck a knife into the point of your shoulder and your arm ain’t moving very far away from your body.

It definitely doesn’t like you moving the arm across the body and it may even look like a little speed hump at the end of your shoulder.

Welcome to the acromioclavicular joint, the notorious AC joint in contact sports like BJJ. This is the joint that lies between the end of your collarbone and shoulder blade and acts as a strut to stabilise the shoulder/arm complex.

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These AC joint injuries are classified into 6 different types according to the commonly used Rockwood Classification:

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DO I NEED SURGERY?

Management of AC joint injuries follows the general principles of all ligament injuries and will be dependant on the grade (type) and the end goals of the individual.

As a general rule, surgical intervention may be indicated for type 4, 5 and 6 AC joint injuries and type 3 injuries that do not respond to non-surgical management.

Low grade AC Joint injury - what now?

Like all injuries, the rehabilitation and exercise or loading exposure will vary from person-to-person. As a general guide, initial management begins immediately and aims to minimise bleeding and swelling and treatment aims to:

  • promote tissue healing

  • prevent stiffness

  • protect from further damage

  • strengthen shoulder musculature to provide dynamic stability.

Isometric strengthening exercises can be started as soon as pain allows and usually begin close to the body with a progression plan to move away from the body as the body undergoes it’s natural healing response to injury.

When can i return to sport? When can I roll again?

We usually look for no AC joint tenderness and full pain-free movement as a starting point for starting the conversation about returning to sport.

We like to see the completion of a full rehabilitation program that focuses on restoring full function and strength of the entire shoulder complex, as well as a graded return to rolling that may involve light drilling and flow rolls initially, with an increase in exposure as the shoulder adapts to the additional stress loads of training.

Full return to training will be individual-specific and criteria driven.

Keep Rolling!

Knee pain while exercising?

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With the temperature heating up and daylight savings in full swing most people are shedding the extra layers of clothing and some are hoping to also shed a few extra kilograms.

Gym and bootcamp numbers are increasing and it looks as though everyone is now coming out of hibernation. Unfortunately, as a consequence of this we see more people present to the clinic with common complaints related to their new exercise regimes.

What is patellofemoral pain?

One of the most common presentations we see is patellofemoral pain, that is pain arising from the kneecap and its articulation with the femur or thigh bone.

It often presents with the gradual onset of pain and will commonly be aggravated by squatting and lunging motions along with stair-climbing and running, it often settles with rest however, can often cause a dull ache when sitting for extended periods which is known as movie goer’s sign.

What causes it?

We often see people present with an increased load, they have often commenced or increased squatting, lunging and running which can cause aggravation of the patellofemoral joint.

There are a multitude of factors that play varying roles including behavioural, biomechanical/anatomical, technique, muscle imbalances, weakness or restriction.

Here we will cover a general but thorough approach to what is worth looking at in the treatment of patellofemoral pain.

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Alignment and control

This is about looking upstream and downstream, the patellofemoral joint does not like a rotary component which can be caused by poor lumbopelvic control (what the core/hip is doing) upstream or poor foot biomechanics (what the foot is up to) downstream.

Technique

How do the movements look unweighted, weighted and when fatigued?

Load management

There is usually a load related component so it is always worth looking at how much you are doing currently vs what you were doing previously and furthermore how to plan the load to ensure it improves. Gradual loading is the best loading (3).

Strength

How strong are the glutes and quad muscles as these 2 groups of muscles are shown to be very important when it comes to patellofemoral pain (1-3). Additionally, how strong are the calves, groin, core and hamstrings? If everything is stronger than even better! There is a significant reduction in injury risk with increased strength (4-5).


Range of motion

Are there restrictions elsewhere in the biomechanical chain causing the knees to compensate?

Is there a previous ROM limitation at the ankle due to a previous injury causing the knee to compensate? Is there limitations/tightness in the hamstring or calf? Is there significantly limited thoracic extension causing you to fall forward placing excess strain on the knees during squatting or overhead movements? Is the foot rolling outwards to make up for restricted ankle ROM (1-3)?

How best to approach it?

Unfortunately, patellofemoral pain is often a very niggly condition and a large number of people experience ongoing issues even with some form of treatment (6). As patellofemoral pain is such a multi-faceted condition it requires a very thorough approach to specifically address all the potential contributing components. It will take time but it is important to be consistent, thorough and methodical in the approach to get best results.


General areas to address:

  • Alignment and control

  • Lumbopelvic control

  • Foot mechanics

  • Technique

  • Load management

  • Strength

  • Range of motion


References

  1. Barton CJ, Lack S, Hemmings S, et al. The ‘Best Practice Guide to Conservative Management of Patellofemoral Pain’: incorporating level 1 evidence with expert clinical reasoning. Br J Sports Med 2015;49:923-934.

  2. Crossley KM, Callaghan MJ, Linschoten RV. Patellofemoral pain. Br J Sports Med 2016;50:247-250.

  3. https://www.mickhughes.physio/single-post/2016/06/21/Patellofemoral-Joint-Pain

  4. Lauersen JB, Bertelsen DM, Andersen LB. The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. British journal of sports medicine. 2014 Jun;48(11):871-7. PubMed PMID: 24100287. Epub 2013/10/09. Eng.

  5. https://www.mickhughes.physio/single-post/2016/12/26/8-Simple-Ways-to-Avoid-New-Years-Resolution-Induced-Injury

  6. Thomas MJ, Wood L, Selfe J, Peat G. Anterior knee pain in younger adults as a precursor to subsequent patellofemoral osteoarthritis: a systematic review. BMC musculoskeletal disorders. 2010;11:201. PubMed PMID: 20828401. Pubmed Central PMCID: PMC2944218. Epub 2010/09/11. Eng.