By Gemma Percy Chronic, Elbow, Injury, Overuse, Running, Sporting, Tendon pain

Overuse injury – The what, why’s and how’s answered.

What is an overuse injury?

An overuse injury, sometimes referred to as a chronic injury, refers to an injury that is associated with repeated stress or micro-trauma over time. Unlike an acute injury, such as an ankle sprain, over use injuries typically have no specific incident that caused the pain, rather it will typically gradually worsen with activity with a steady increase in pain. Common overuse injuries include tendinopathies, bursitis, stress fractures/bone stress and shin splints.

It is common to see overuse injuries in the athletic population however they can be seen in all population groups – whether your 10 years old starting netball for the first time, 37 and trying to return to a loved past time or 71 and wanting to start walking more, you must know your limits. Overuse injuries are often related to activities that require repetitive stimulus such as long distance running, swimming, occupation demands such as typing and computer mouse use.

What causes an overuse injury?

An overuse injury will occur for a number of reasons and is related to a break down of tissue structure when the load input exceeds the tolerable level for that specific tissue. Common causes of overuse injuries can include:
• A sudden and/or significant increased load; including but not limited to increased intensity of training, increased hours of training, increased frequency of training
• A change to training conditions; including but not limited to addition of hills, change of footwear, change of training surface
• Return to activity after period of inactivity – e.g. start of sporting season return to walking after surgery etc.
• Inadequate rest periods – leads to increased muscle fatigue and therefore increase load/reliance on tendons, bones and other structures.

How to prevent an overuse injury?

Given that the biggest and arguably only cause of an overuse injury is overload it goes without saying that the best chance at preventing an overuse injury is to follow a progressive loading program and avoid going in too hard too soon.

When starting a new exercise routine or looking at increasing your current training regime it is crucial to have a graded and steady increase. This may look like short periods of work in combination with periods of rest when starting running/walking/swimming or other exercise routines. Ensuring you take regular rest days in the early stages of beginning an exercise routine to allow for adequate muscle recovery is another vital key in reducing your risk of overuse and injury.

If you are an avid exercise goer and looking to increase or alter your current regime following the guidelines of progressive overload will limit placing too much demand on your body systems too soon. Progressive overload can be applied by changes to duration/intensity, frequency, exercise technique/execution or external load – in any of these cases an incremental increase of no more than 10% is advised to reduce the risk of overload and injury.

In the case of overuse injuries in day to day life or with work place demands consideration may given to desk ergonomics and/or technique of repeated movements to attempt to reduce strain on specific body parts that may be at risk over overuse.

How to treat an overuse injury?

Unfortunately due to the slow progression and repeated micro trauma of overuse injuries it is often too late for preventative measures by time your pain develops. If you develop pain that you believe may be an overuse injury it is important to seek medical advice to ensure you receive advise specific to your injury and needs.

When visiting your healthcare provider (Osteopath or Myotherpaist etc.) you can expect your practitioner to assess your tolerance to specific loads and determine a management plan to get you back on your way to achieving your goals. Things that may be considered in your long-term management may include:

• Resting without or without the use of a brace or aid if severely intolerant to load.
• Reducing provocative loads and activity – this may look like a 50% decrease in kms walked/run, or reducing frequency of sessions in the gym
• Limiting spring like loads such as jumping that place a large load through injured areas
• Implementing a exercise/rehab regime specific to your goals.

It is important to note that in all cases of overuse injury LOADING with exercise is essential for long-term recovery and prevention of re-injury. An exercise regime tailored to you is likely to include the following:

• Isometric exercises – those that involve holding a sustained position for an allocated time frame e/g. wall sits/planks etc.
• Isotonic exercise – those that involve moving a body part through its range of motions with or without external forces/load
• Plyometric/return to play – If your goals require you to return to sports/high levels of exercise your program will progress to a sports specific return to play plan
that will involve explosive efforts

In all cases you can expect a program to progress through different stages in line with what you are hoping to achieve and usually takes between 6-12 months for adaptations to occur – Rest assured this does not mean your pain will persist for this period of time!

In conjunction with a loading program your practitioner will work with you to reduce and manage your pain. This may be done through the use of braces/taping, manual therapy (such as soft tissue massage), Ice, Dry needling and/or anti-inflammatory medications.

When indicated your practitioner will also work to find underlying bio-mechanical imbalances or deficiencies in surrounding areas and guide you with the steps required to address these also – This may include looking at your hip when dealing with an Achilles (lower leg) tendinopathies.

Please note that this advice is generalised and we encourage you to seek further advice if you think you may have an overuse injury – For more specific advise or to get started on your journey to recovery from an overuse injury book an appointment with one of our qualified practitioners today!
Book an appointment online here today!
Tennis Elbow – in the non-tennis playing individual!
Tame Your Achilles Tendon Pain!

December 23, 2021

By Gemma Percy Exercises, Running, Sporting, Tendon pain

Tame Your Achilles Tendon Pain!

With the warmer weather and a new year in sight it is likely many of you are experiencing a surge in motivation to get your body moving more – however it is important to bear in mind that doing too much too soon or too quickly can wreak havoc on the body if unprepared! In this article we will touch specifically on Achilles tendinopathies unravelling the who, what’s, how’s and why’s behind why your Achilles might be angry.

What is a tendon?

A tendon is a well-organised collagenous tissue designed to bear large loads and act as an imperfect spring as we move our body. Tendons are all over the body connecting our muscles to our bones and work to store and release energy to produce high and fast loads that allow us to walk, run and jump at max efforts!

Who gets Achilles tendinopathy?

Achilles tendinopathies hold no prisoners affecting nearly all population groups – young & old, walkers & runners and those playing multi directional sports. So what causes tendinopathies to develop? The largest risk factor for developing a tendinopathy is a sudden and unprepared change in load – for the Achilles this could include:

• Increased distance of walking/running
• Increased speed
• Introducing hills
• Change of footwear
• Change of surface
• Training for an event

This change in load causes the tendon to become overloaded resulting in a cascade of changes within the cell make up of the tendon resulting in inflammation and often pain.

Symptoms of Achilles tendinopathy:

Those with Achilles tendinopathy will often complain of localised pain over the Achilles insertion, pain that is worse with walking or hills, morning pain/stiffness. Typically pain associated with a tendinopathy will be worse before and after a session and tend to improve throughout the session itself.

How to manage Achilles tendinopathy?

So what to do if this is all sounding a little too familiar? It is a common misconception that when experiencing pain we should immediately stop all aggravating activities and rest – however when dealing with tendons this is not the case. Due to the nature of tendinopathies it is important that part of the treatment involves loading the tendon to improve its capacity to store and release energy through explosive movements.

Initially to reduce pain you may be required to partially de-load your tendon and stop explosive efforts that require large amounts of stretch & shorten through your muscles. This could include reducing the km’s you walk/run by 50% and resting from all jumping activities while working on slowly loading the Achilles tendon.

In the initial stages of your Achilles tendinopathy your health professional may use therapies such as:
• Manual therapy – soft tissue massage, joint mobility and stretching
• Myofascial dry needling
• Taping to offload the affected area
• Heel wedges or orthotics

Those with Achilles tendinopathy may also find it useful to:

• Limit prolonged standing
• Limit calf stretching
• Limit flat shoes/barefoot

Finally your health professional will work with you to develop a rehab program that will target strength of the Achilles tendon – this will likely include isometric exercises, which require you to hold a certain position for periods, isotonic exercises such as calf raises and in the later stage the introduction of specific hopping, jumping and explosive exercises to ensure a safe and pain free return to walking, running or sport!

For more specific and tailored advice be sure to chat to your Osteopath to work out a plan that works best for you and to address any barriers or fears you may have associated with your Achilles pain. Always consult your healthcare provider before commencing a new exercise program.

December 17, 2021

By Josh Roberts Exercises, Running, Sporting, Strength

How to Overcome Your Hatred of Exercise

Being physically active is an extremely daunting prospect for many people. A lot of us have had very negative experiences with exercise over our lifetime. Social pressures, perceived failures, injuries, pain, and being forced into sports and activities that we genuinely don’t enjoy, has tainted exercise for many of us. Now, into our adult life, there are other responsibilities that soak up so much of our time and energy. It can feel almost impossible to carve out enough time to get a workout in.

Unfortunately, our aversion to exercise is really hurting us. The benefits of physical activity are so broad and encompassing, and so extremely meaningful and powerful. If scientists were able to design a pill that provided the same physical, mental and social benefits as exercise, every person on the planet would be taking it.
Although it’s not as easy as taking a pill, physical activity doesn’t need to be hard and complicated either. Physical activity should be as easy and as painless as possible. It can, and should, fit into your life in a way that becomes second nature.

Exercise can become something that anyone can enjoy, it just needs to be reframed and rethought. These tips are here to help you form a positive habit and build exercise into your lifestyle.

1. Start small

Image: https://www.mentalfloss.com/article/67661/16-little-words-and-phrases-describing-small-amounts

Doing any physical activity is better than doing none. If you’re fairly inactive at the moment, just take the first step. It doesn’t need to be grand. In fact, habits are more likely to stick if they have a low barrier-to-entry and a good chance of immediate success. That means, don’t worry about fancy equipment or expensive gym memberships. What’s the most simple activity that you can think of that involves moving your body? Walk, dance, crawl, roll, sweep, dig, run, jump, swim, ride, play, pilates. Anything. Just move a little bit more than you did yesterday and you’re becoming physically active! Achieving a meaningful goal, no matter how small, will unlock the brain’s neurotransmitters to 1) make you feel good about yourself, and 2) rewire the neural circuitry of the brain to make that habit more permanent.

2. Have fun

Image: https://host-students.com/dance-workouts-you-can-do-at-home/

In what way could you move your body that will provide you with a feeling of happiness and fun? It’s different for everyone, and it can often take a long time to find the activity that lights you up. So be ready to experiment. And think outside of the box, it doesn’t need to be an organised form of exercise – like running, golf, kayaking, rock climbing, frisbee, etc – it can be any random activity that involves movement; kicking a ball around with your dog, dancing in the kitchen, walking to the supermarket, rearranging furniture in your house… Absolutely anything. Don’t restrict yourself to the schoolyard parameters of beep tests and team sports.

3. Team up

Image: https://www.austinfitmagazine.com/March-2015/stay-in-shape-by-walking-with-friends/

More often than not, you’re not the only person in your social circle who is looking to get more active. Be vulnerable and ask a mate if they’ll start going on a morning walk with you once or twice a week. Having an accountability partner makes it easier to get out of bed when the alarm starts ringing. It’s harder to bail on a buddy than it is to bail on yourself. Plus, the benefits of chatting, laughing and spending time with other people compounds the mental and emotional benefits of exercise!

4. Be forgiving

Image: https://centerforliving.org/blog/5-best-self-care-tips-this-fall/

It’s OK to miss a day, a weekend, a week, a fortnight… Don’t sweat it. We’re all human, fallible and imperfect. Sometimes life gets in the way – you get tired, become distracted, unmotivated or lazy. That doesn’t mean you’re a bad person. Your self-worth doesn’t depend on you being perfect, or exercising every day, or being kind and calm and caring to every person you interact with! You are allowed to stuff up. You’re allowed to be selfish. You’re allowed to sit on the couch eating ice cream and watching telly. You’re enough, regardless of these behaviours. So when you miss a day, wrap a metaphorical arm around your own metaphorical shoulder and forgive yourself – there’s always tomorrow, and every day thereafter, to go out and exercise. Habits aren’t built in a day, so having one off won’t derail the train. In his book Tiny Habits, leading behavioural expert B.J. Fogg says it best; “people change best by feeling good, not feeling bad”.

The Nuts and Bolts

Adult Australians are recommended to do 2.5-5 hours of moderate intensity exercise per week, or you can halve that time and do your exercise at an intense level for 1.25-2.5 hours.

Image: https://www.amhf.org.au/essa_helps_men_move_with_new_male_specific_exercise_resource

So what does that look like in practice? Here’s a couple of suggestions to get you up to the baseline requirement for physical activity without breaking a sweat.

You can briskly walk 15-minutes from your car to your workplace (and vice-versa) 5 days a week, and you’re hitting the low-level guideline. If you haven’t walked much for many months or years, start with a 5-minute walk and build up over a few weeks.
In the morning before work, put some music on while making breakfast, and dance around like a fool for 15 minutes til you get a little breathless. Do the same when you get home that evening, and bingo, there’s your 30-mins of daily moderate intensity activity.
Go for a 5 minute walk in the morning sun. Put on your favourite song and dance for 5 minutes. Do 2 push ups. Quickly vacuum the hallway. Throw a ball to your dog 5 times. Park 500m away from work. Do 5 squats on your lunch break. Get home and go for a 5 minute walk in the afternoon sun. Water the garden. Surely that’s 30 minutes all up?

Take Home Message

Don’t make it complex. Don’t make it hard. Make it fun, make it silly and make it likely to succeed. Once you get a few wins on the board you’ll be even more likely to start adding in more, higher intensity, activities.

September 4, 2021

By Josh Roberts Exercises, Running, Sporting, Strength

5 Must-do Exercises for Beginner Runners

Some people might say I’m crazy but I seriously love running. It sets up my day, drags me out of bed, and gives me a boost of endorphins that allow me to drive all the way to work with very few road rage incidents. I use it as a way to catch up weekly with friends, meet new people, and keep myself relatively healthy. It’s easy, basically free, and accessible to almost anybody.

There are a myriad of benefits to running! It’s a safe and effective way to improve cardiovascular health, bone density, muscular endurance, boost mood, and improve energy. With these few exercises, some smart programming, and a few expert tips you too can enjoy all of these benefits – physical, mental and social.

But beware, all of the exercises in the world won’t make up for doing too much too soon. An estimated 60% of running related injuries are linked to increasing mileage too quickly. Get a running plan in place that is tailored to your needs and slowly increase your weekly load in 10% increments. If you’re new to running altogether, start by increasing your daily walking before beginning to add small bouts of running.

Every individual has their own unique injury history, strengths, weaknesses, and running goals. Therefore it may be helpful to speak to the team at Peninsula Osteopathy + Allied Health, to get screened and assessed on your current capacity, and provided with an individually tailored plan to ensure you hit the ground running! (Pun intended).

Single leg sit-to-stand

Single leg strength, stability, and endurance is a huge component of running efficiency and capacity. The average runner should be aiming to take around 160-180 steps per minute, so for a 25-minute jog, each leg must support the weight of the body approximately 4000+ times! The single leg sit-to-stand is the perfect way to begin loading the muscles of your hip, buttock and leg – in a similar fashion to the way they are required to work during running. Your health practitioner can help ascertain when and how to progress the exercise, by adding weights, increasing the range of motion, and more!

Glute bridge

This exercise focuses on hip extension and increasing the control of your lumbopelvic region (from your low back into your hips and buttock). Our hip extensors, such as the gluteus maximus, are the powerhouse of the running stride. The glute bridge can be altered to become single leg, weighted or with different tempos, all of which may be smart progressions for your practitioner to explore with you.

Hamstring bridge

Weakness in the single leg hamstring bridge test has been shown to predict hamstring related injuries in AFL players and military personnel. While we may not be reaching the pace of an AFL player, hamstring strains, tendinopathies, and niggles are still very common amongst casual runners. Start double leg and work towards a single leg variation.

Copenhagen adduction

Hip and groin pain is another common running niggle. This exercise increases the strength and control of your adductors (groin) while also providing a side plank core control exercise – bang for buck! Begin with a short lever (knee on the chair) and progress to long lever when ready (ankle on the chair).

Calf raises

The calf complex is made up of the gastrocnemius (the big two headed muscle you can see) and the soleus (underneath and severely under-appreciated). The soleus actually produces the majority of force in the ankle during running. To strengthen the soleus do calf raises with a bent knee and to strengthen the gastrocnemius do them with your knee straight. Did anyone notice that I snuck in 6 exercises?

Bent Knee Variation | Straight Leg Variation

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Category: Running