The Need for SPEED

Structuring a Speed Session:

Looking to improve your speed? Wondering where to start in structuring a speed field session?

Lets break it down into a few components.

Warm Up- Speed Mechanic Drills- Accelerations- Repeated Sprint Efforts.

Warm up:

This warm up needs to prepare you to Run- To Run fast.

Include:

-       Dynamic Stretches

-       Isometric Holds- Single leg Bridge holds/ Single leg calf holds

-       Running forward/ backwards at slow speeds.

-       Gradually increasing running speed

-       Accelerations over short distances

Speed Mechanic Drills:

Sprint posture drills can assist to improve your sprinting efficiency.

Examples Include:

-       A March

-       A skip

-       Wall Drills 

A Skip:

Wall Drill:

Accelerations:

Accelerating over small distances. Ensure you have enough space to decelerate.

-       Build speed 0-20m- accelerate 20-40m- Decelerate slowly

-       Gradually building to 100% Speed

-       90 second rest between efforts

Repeated Sprint efforts

This needs to be sport specific. Over smaller distances (10-20m for court sports and 40-60m for field sports) .

-       Introduction to speed sessions should start at smaller volume. 1x5 Efforts and building to 2 Sets.

-       2mins Rest in between efforts, when aiming for maximum efforts and 30seconds rest when aiming for increasing aerobic capacity.

Speed programs should be tailored to the individual athlete, be sport specific and should focus on the goal aiming to be achieved through the speed session. If you are looking for a tailored speed program contact HPRS.

Article Written by Antonietta Del Pinto

Return to Sport testing. Why is it Important?

Returning to sport without sport specific testing is like driving a car without checking if it has any petrol tank, it’s a risky game to play!

Returning to sport following injury is the most important decision you and your physiotherapist need to make. This decision needs to respect injury pathology healing time frames, strength levels, a return to training and most importantly a sport specific battery of tests.

Each injury is different and will require different tests, as well as tailoring the testing battery to what activity you aim to return to. Here are a few common tests we use at HPRS to assist the decision making process when returning an athlete back to sport.

Returning to sport testing needs to include three elements. Strength, power, and reactive strength/power. Mechanics and movement biomechanics need to analyzed and tests can assist to use metrics to compare to baseline measures and assess limb symmetry (difference between left and right).

Countermovement Jump (CMJ)

• Can be performed and tested using force plates or jump mat. The movement starts with hands on hips then jumping as high as you can.

• Metrics measured here are jump height, contact time and Reactive Strength Index (RSI).

• This can be a good sport specific movement to test as force production through jumping can also correlate with athletic ability and strength.

Single Leg Vertical Hop

• Can be done and tested on our jump mat. The movement starts with the athlete standing on one leg hands on hip then jumping as high as they can and landing on the same leg.

• The same metrics as the CMJ are measured here as well as side to side differences.

  Different to CMJ as it can be used as a single leg strength/power measure as well it can assess your landing ability on one leg.

• Lee et el, 2018 showed that this test is a functional measure of strength, power and ability to absorb force through a single limb.

Single Leg Vertical Drop Hop (Jump)

• This occurs where an athlete steps off a box, lands on the jump mat with one foot and hops vertically in the air. We use this test to measure reactive power.

• Hop height, Contact Time and RSI are measured here. Each metric can assist the therapist to target their rehabilitation according to what needs to improve. Eg increasing strength and power can assist jump height, while contact time can be improved through plyometric and jump mechanics training. Particularly working on fast reactive plyometrics focusing on fast ground contact time.

• Kotsifaki et el, 2022 showed that single leg vertical tests and performance metrics showed larger limb discrepancy and asymmetry than horizontal jump testing.

• The ability to jump and land on a single leg is crucial in sport and especially important in sports that require you to take off on one leg.

Broad Jump

• The movement starts with hands on hips then jumping as far forward as possible.

• The distance from the jump is the measure.

• This tests your ability to produce horizontal force through your jumping ability.

• A very simple test to administer.

• Your ability to take off and produce force through a double leg jump is sport specific as all sports require you to produce force through your legs in some form eg jumping for as header, jumping for a mark or even diving off a platform.

What other tests do we do?

Tailored testing will be prescribed specific to the injury. Strength testing is also important but again tailored to what the injury was. For example Quadriceps and hamstring strength testing is crucial for ACL injuries where Calf muscle strength testing may be more important for ankle and foot injuries. In the clinic these type of tests are done using 1RM testing or using our hand held dynamometer.

Restoration of pre injury test measures are ideal, if this information is unknown then limb symmetry can be used and researched benchmarks can also assist to make the return to play decision.

Example Testing Scores:

Here is an example of two sets of testing for an athlete completing their ACL Rehab. The top Table was tested at 6 months and the bottom table is tested at 10months.

What does this testing show us?

The orange boxes show the difference between Right and Left leg scores.

Things to note:

• Difference in contact time- At 6months this athlete was spending a longer time in contact with the floor before hopping up - meaning they are less reactive and slow.

• The difference in jump height- At 6 months this athlete could only achieve a hop of 12cm high off the ground, improving this height at 10months.

• RSI- The difference shows at 10months this athlete is spending less time on the ground and a higher hop - meaning they are faster with their hop.

This is just a snapshot of the type of testing done at HPRS. Again, this will be tailored to the specific athlete and specific injury. Testing as seen here helps aids decision making when returning to sport, assists goal setting and can show outcome progress.

Article Written by Antonietta Del Pinto

Acromioclavicular (AC) Joint Instability

AC joint instability can be defined as a disruption to the ligamentous integrity of the joint, creating instability between the acromion and clavicle. This is most often associated with trauma or direct contact and can usually be successfully treated with a graded conservative rehabilitation program.

Anatomy

The AC joint is comprised of two bones: the acromion of the scapula (shoulder blade) and the clavicle (collar bone).

The primary ligaments of the AC joint are:

1.      Acromioclavicular ligament

2.      Coracoclavicular ligament

3.      Coracoacromial ligament

Grades of AC Joint Injuries

 The Rockwood Classification is most commonly used to diagnose grading of AC joint injuries. This classification accounts for the mechanism of injury, clinical presentation and plain radiographic (X-Ray) presentation.

 The table below outlines the anatomy of AC joint injury grades and their clinical presentation:

 When Should I get an X-Ray?

 Imaging for your injury should always been guided following assessment from a medical professional. It is not always necessary to image a suspected AC joint injury, especially if there is no obvious step or other bony deformity.

Some indications for imaging would include:

·       Suspected high grade (≥ Grade III) AC joint injury

·       Tenderness on the clavicle, separate to AC joint tenderness

·       Persisting night time pain (aching/throbbing without provocation)

Surgery for AC Joint Injuries

 Conservative management (non-operative) is often successful, and patients are able to return to their previous sports and daily function without issue. Because of the strong outcomes of conservative management for Grade I-III AC joint injuries, surgery is often considered an unnecessary expense. However, not all AC joint injuries are able to be successfully managed without surgery. A confirmed Grade IV, V or VI injury must be treated with surgery and a consult with a specialist surgeon should be immediately arranged if this is the case.

In the physiotherapy world, Grade III injuries often carry a debate of surgery versus conservative management. Some indications for considering Grade III surgery would include:

·       Excessive and unsettling pain, causing day-to-day dysfunction

·       Cosmetics and patient expectations

·       Work demands (e.g. overhead/press movement requirements)

·       Contact/overhead athletes

·       Unstable/dislocating joint

AC Joint Rehabilitation

 An individualised and graded rehabilitation program is fundamental to the successful outcome of your injury, regardless of surgery or not. Due to the anatomy of the injury, targeting upper trapezius and deltoid strength throughout the rehab program is key to reducing deconditioning and long-term joint dysfunction.

 Like any injury, a rehab plan should be discussed in the early stages of your recovery, systemised into specific phases, with goals set for each phase, in order to achieve an overall goal of returning to your chosen sport or activity.

 A few key muscle groups that are not to be missed in the rehab of any AC joint injury include the upper trapezius, deltoids and serratus anterior.

·       Upper trapezius – this muscle has a partial insertion on the acromion and will play a part in improving joint stability of the AC

·       Deltoids – a group of three muscles which are primary movers of the glenohumeral joint (shoulder) in flexion, abduction and extension

·       Serratus anterior – often a deficit in this muscle is a contributing factor to not restoring full upward rotation of the scapula, leading to limitations in end range shoulder flexion (overhead)

 Like any other injury, it is important you liaise with your treating health care provider when rehabilitating your AC joint injury.

 If you have sustained an injury to your AC joint, please feel free to contact one of our Sports Physiotherapists for assessment and management of your injury.

Written by Edward Gellert – HPRSP Physiotherapist

Contributors to Hamstring Injuries and Reinjuries

1 in 3 Hamstring strains will reoccur, usually in the first 1-2 weeks after returning to sport. It has been speculated that there are potentially a few reasons for this. Are athletes returning too early to sport, are we missing a piece of the puzzle in rehab, or are there some risk factors that are stacked against us anyway?

To date, we don’t have an exact answer to this question, as most injuries are multi-factorial, it can go back to the correlation vs causation argument e.g. If you smoke, it doesn’t mean you definitely WILL get lung cancer, but you are more likely to get lung cancer. The figure below shows the consideration required to prevent injuries in a professional sports team – with a little bit of luck coming into the equation!

So how should we go about reducing these injuries if there are all these potential causes?

1.      Starting well – is it actually a hamstring injury?

Pain at the back of the thigh can vary in cause and that is an important factor to note. We can’t manage an injury to its potential if we don’t know where the origin of the pain is coming from.

Some of the causes of pain at the back of the thigh include:

-          Hamstring Strains – muscle tears and ruptures

-          Neural Hamstring pain

-          Referred Pain from the lower back or glutes (deep gluteal syndrome)

-          Quadratus Femoris pain

-          Tendon pain (tendinopathy)

-          Delayed onset muscle soreness (DOMS)

-          Adductor Magnus Muscle strain

 A correct diagnosis is a great place to start. In most cases, this can be done in the clinic by a physiotherapist or sports doctor without imaging, however, there are some circumstances where medical imaging may be warranted. Imaging is justified if treatment will differ depending on the diagnosis or if required to rule out another diagnosis.

 A sharp pain on a specific point at the back of the thigh whilst performing an activity such as running (usually sprinting), kicking or a rapid change of direction movement should create some suspicion of a hamstring strain/tear.

 2.      Age

Over the age of 23, hamstring injuries are more common. We call this a non-modifiable risk factor as it is something we can’t change, because we can’t turn back time! This means we just have to be more diligent with preventing and managing hamstring injuries after this age, particularly if there is a past history of hamstring injuries.

 3.      Previous history of hamstring injury

Unfortunately, once you have had a hamstring injury, you are more likely to suffer another one. This is likely to do with scar tissue (what replaces the injured muscle tissue) being weaker than the original muscle tissue. Like age, this is another non-modifiable risk factor.

 4.      Tendon involvement  

The tendons in the hamstrings are very long, and in some places they overlap the muscle (see image below of the back of the thigh). The significance of tendon involvement is that it receives less blood flow than muscle, leading to a slower healing process. Tendon involvement can significantly slow the athletes return to play or cause a re-tear of the hamstring if certain activities are commenced too soon. Hence it is important to return to sport confident that all the boxes have been ticked by your physio.

 5.     Exposure to High Speed Running

As with strengthening your muscles in the gym via resistance exercise, if you perform high speed running, this will improve the ability of the muscle to withstand the forces required for running. As sprinting is one of the most common ways to injure your hamstring, it should be approached in a calculated manner (not too many) but not avoided completely.

The exposure to high speed running on a regular basis (>90% efforts) was successful for Tom Trbojevic’s return in the 2021 NRL season after a series of hamstring injuries.

 6.     Eccentric Exercises

Eccentric exercises are where the muscle is working as it lengthens, compared to a concentric contraction, where the muscle is working as it shortens e.g. lifting the weight up to your shoulder during a bicep curl). When you are lowering the weight back down to your waist/side (starting position), that is the eccentric phase.

 The “leap” phase of running in the photo above, where the foot is advancing forward before impact is where the hamstring works most with sprinting. It works to decelerate the foot so that it doesn’t shoot out too far in front of you. This is where the hamstring is at its weakest and where we need to work on getting it stronger, it is an eccentric contraction as the hamstring is working but stretching at the same time.

 Much like exposing your hamstrings to high-speed running to make the muscles more adaptable and resilient, we need to strengthen it in a certain way to get the best results.

Exercises like the Nordic are popular in hamstring injury prevention, reducing injury rate by around 50%. https://www.youtube.com/watch?v=NfBGKhjedD8 It is quite a challenging exercise, and can lead to DOMs (delayed onset muscle soreness for a few days afterwards. It is advised that you perform this exercise with good supervision at least initially and a proper warm-up or build up beforehand. Modifications are often required due to its difficulty.

 It works the hamstrings eccentrically in the range of motion required to reduce the chance of muscle failure i.e. a muscle tear.

7.      Returning to sport when the hamstring stops being painful (too early!)

The absence of pain when walking or jogging is not enough when it comes to returning to sport. In fact, pain free jogging and walking is generally something achieved quite early in the rehab process for a hamstring injury, it is high-speed running and kicking which needs to be built back in.

It is heavily encouraged to have a tickbox approach to return to play with set criteria, this should involve at minimum the following steps:

-          Successful completion of high-speed running sessions

-          Successful completion of a training week at full intensity

 A physiotherapist will also use some of the following criteria to gauge readiness to return to training and sport:

-          Full pain free strength, comparable to the other side

-          No pain with stretching the muscle

-          Completion of agility, hopping and running tests

-          Other hamstring specific tests

-          No pain when pushing (palpation) over the area of the tear

 In Summary

Whilst hamstring muscle injuries are common and there are some risk factors that may be out of our hands (such as age and previous injury), it is important to have appropriate guidance with these injuries to rehabilitate them thoroughly and leave no stone unturned. Returning too early without completing adequate rehabilitation is something that is in our control.

 If you need assistance or guidance with a hamstring injury, or any other muscle tear, feel free to contact one of our Sports Physiotherapists.

Written by Matthew Anthis – Titled Sports and Exercise Physiotherapist and Hamstring Researcher

Imaging for Sports Injuries

Imaging is a commonly used tool in professional sport for Sports Injuries. It is also accessible to the general public for Sports and Musculoskeletal injuries.       

Imaging is used to get more information on an injury after an initial clinical assessment has been done by your Sports Physio or Doctor.

Common imaging options include X-Ray, MRI (Magnetic Resonance Imaging) and CT (Computed Tomography) scans.

MRI Machine

What Is Imaging?

Medical imaging is most commonly done in private radiology clinics or within hospitals.

There are many different types of imaging that allow us to see our musculoskeletal anatomy that assist in an injury diagnosis.

This can be useful in many types of injuries, especially if injury diagnosis is unclear after standard clinical assessment.

Why Is Imaging Used?

Imaging can be used to give further information about an injury, or to confirm or exclude a diagnosis.

Imaging for sports injuries can give important information that directs the type of management and treatment of an injury. In all cases imaging results need to be interpreted by an experienced Sports Doctor or Sports Physiotherapist and used in conjunction with your clinical presentation and symptoms.

Types of Imaging

The most common types of imaging used for sports are;

X-Ray – This is the easiest, most affordable and most commonly used. X-rays give good information on bone injuries such as fractures, and also some information about joints and swelling eg. Knee Osteoarthritis.

Ankle fracture on X-Ray

MRI – Gives great information about soft tissue injuries such as muscle strains and ligament sprains. These scans can be very useful in assisting diagnosis and prognosis of injuries.

They also provide further insight into hard tissue such as cartilage and bone.

Knee MRI - Green arrows pointing to Meniscus cartilage tear

CT – Used for more detailed information on bone. Commonly used when an X-Ray provides a negative result but a fracture or bony injury is still suspected.

What Injuries Are Scans Useful For?

Scans can provide crucial information for both acute and longer-term chronic injuries. Some examples of these include hamstring and calf muscle strains, knee and ankle ligament sprains, eg. ACL/MCL, and for acute fractures.

Scans give information about grading of these injuries, which is important to decide how each injury is managed, including whether a rehab period is appropriate or referral to a specialist or surgery is needed.

MRI - Green line and surrounding white fluid indicating Hamstring Strain

Once you have had a scan it is important to consult with your Sports Physio or Sports Doctor to get an accurate assessment and diagnosis of your injury.

Written By Sports and Exercise Physio Chris Bailey

Gluteal Tendinopathy and Bursitis

A common cause of pain on the lateral (outer side) part of the hip is from tendinopathy of either the gluteus minimus and/or gluteus medius tendon.

What is the Cause?

Gluteal tendinopathy is often caused by a change in load of these tendons with a spike or change in activity levels, or from a new form of exercise. A baseline weakness of the attached glute muscles also contributes. This creates a higher demand than the tendon can tolerate, which can elicit a painful response and tendinopathy. This pain typically begins the day following exercise, and gradually worsens as you continue to move and exercise.

The large bursa (a fluid-filled sac – in the picture below) in the lateral hip is the greater trochanteric bursa. When the gluteal tendon becomes overloaded and painful, this often causes the bursa to also become inflamed and painful – called bursitis.

ANATOMY

The hip is a ball and socket joint. The ball arises at the top of the thigh bone, called the femur. The socket, called the acetabulum, is made of the three bones of the pelvis – the ilium, ischium and pubis.

The gluteus medius and gluteus minimus originate from the ilium of the pelvis and insert onto the greater tuberosity of the femur. As such, they are important abductors of the femur relative to the pelvis – meaning they take the leg away from the body. They also help to control the rotation of the hip joint and stabilise the hip when walking or running.

The greater trochanteric bursa is located between the femur and the gluteal tendons and functions to de-load the tendon friction over the bone. If this occurs excessively it can cause high levels of pain

How Does This Injury Present?

A patient will typically report their symptoms are felt at the start of exercise (e.g. the first 1km of a walk, or the first few steps after getting up from a chair), which then eases as you “warm-up”. Painful symptoms may then return toward the end of an exercise session as the body is fatiguing.

Patients may also report walking up and downstairs is painful, lying down directly on the affected side or crossing their legs also replicates pain.

This injury is far more common in women due to the differences in hip anatomy between men and women.

What is the treatment?

Like other tendinopathies, diagnosis and determining the type of tendon injury is crucial as early as you have symptoms. Offloading the tendon somewhat while maintaining physical activity is important if this can be done in a fashion that does not aggravate your lateral hip symptoms; either during, after or the following morning. 

Based on your examination, you will be provided with a small series of exercises to begin improving the strength tolerance of your affected tendons. Once symptoms are beginning to settle, your prescribed exercises will likely become progressively more difficult to facilitate the healing and strength of your tendon and musculotendon unit.

Tendon-based injuries may take an extended period to fully recover, this is in part due to the lower blood supply compared to other soft-tissues, but it is possible to return to your full levels of activity prior to full resolution of symptoms. Rehab timeframes are often months rather than weeks for full resolution of symptoms.

Imaging may be used to assist in the diagnosis and management of this injury if symptoms remain persistent.

If you are having any lateral hip pain, please feel free to contact one of our Sports Physiotherapists for assessment and establishing a management plan for your injury.

Written by Ed Gellert

The Sporting Shoulder - Atraumatic Injuries

Injuries to the shoulder can occur with or without an incident or trauma. For shoulder injuries that occur without a mechanism, pain is often felt locally around the shoulder or can refer pain down the outer aspect of the upper arm. Commonly the pain starts as a minor annoyance but gradually worsens. A physiotherapy appointment at the initial onset of the pain can help with an accurate diagnosis, leading to a quicker return to performance.

Shoulder Pain

The most common cause of shoulder pain without incident or trauma is an “overload” in your chosen sport (e.g. swimming). Often after a break from your sport, even for just a short period, a return to your previous training loads can be enough to cause an injury. Some common signs and symptoms to look out for regarding your shoulder pain include:

·       Pain reaching away from the body at shoulder height

·       Pain at the start and/or toward the end of your exercise session

·       Pain reaching across your body (e.g. when showering or pulling on your seatbelt)

·       Pain at night, often worse when lying on your affected shoulder

·       Feeling “tight” in the muscles above your shoulder

ANATOMY OF THE SHOULDER

The shoulder is a ball and socket joint, with a large ball called the humeral head (on the long arm bone) and a shallow socket called the glenoid (on the shoulder blade), which allows for the large freedom of movement of the shoulder.

The rotator cuff is a group of four muscles which originate from the shoulder blade and insert on the humeral head. These muscles are:

·       Supraspinatus - helps to take the arm out to the side of the body

·       Infraspinatus - helps to turn the arm outwards

·       Teres minor - aids infraspinatus

·       Subscapularis - helps to turn the arm inwards

Rotator Cuff Muscles

Each cuff muscle has an individual action, though as a group of muscles their primary role is to help stabilise the humeral head within the glenoid as we move to use our arm and shoulder.

Sitting in the subacromial space between the “roof” of the shoulder (the acromion of the shoulder blade) and top of the humeral head lives two fluid-filled sacs, called bursae. A bursa helps to cushion these bones, lubricate the joint and partially protect some of the rotator cuff tendons. The term “bursitis”, meaning inflammation of the bursa, is often associated with shoulder injuries and can be a source of significant shoulder pain.

COMMON DIAGNOSES

·       Rotator cuff tendinopathy and bursitis – refers to an overload of one or more of the rotator cuff tendons. This often leads to pain and the bursa becoming inflamed as a result of the altered function of the shoulder. 

·       Rotator cuff tear – more commonly associated with a trauma in younger athletes, however, an older athlete may have normal age-related changes of the rotator cuff tendons, including a small tear, which can be made symptomatic by an acute overload of the shoulder.

·       Sub-Acromial Impingement – this occurs when your shoulder muscles are not strong enough to support your ball (humeral head) in your socket (glenoid) which causes increased movement in the shoulder space and compression and pain of those soft tissue structures that live there. This is particularly common in sports such as swimming and tennis with repetitive overhead use, or jobs with repetitive activities.

·       Frozen shoulder – presents in its early stages similar to a rotator cuff tendinopathy and bursitis, though is unresponsive to therapy. Please speak to your GP or physiotherapist if you feel you may have a frozen shoulder.

TREATMENT OF THE SPORTING SHOULDER

Treatment is determined by your presentation at initial physiotherapy examination. Often when a shoulder is overloaded, the load needs to be managed appropriately to allow symptoms and structures to settle. This then allows for a faster and more successful return to performance.

The four common stages for shoulder specific treatment are:

1. Control (Acute) phase – regaining neuromuscular control of the scapular and rotator cuff muscles with pain and inflammation symptom management as required.

2. Load introduction phase – strength-based exercises targeting muscles and actions specific to your sport.

3. Reconditioning phase – progressing your individualised gym strength program and building to reintroduction into your sport at reduced loads.

4. Return to performance phase – getting back to your chosen sport or activity to a pre injury level, while maintaining your strength rehab work to prevent an injury recurrence.

Shoulder Rehab

If you are experiencing any shoulder pain, please feel free to contact one of our Sports Physiotherapists for assessment and management of your injury.

Written by Edward Gellert – HPRS Physiotherapist

Calf Muscle Injuries and What To Do?

Pain felt in the calf is often the result of a strained or “pulled” calf muscle. With a specific incident, these can be occasionally confused with an Achilles Tendon rupture as you may feel a “pop” or as if you’ve been hit in the back of the leg. Typically, the incident causes sharp pain in the calf which progressively increases over time.

Typical symptoms are:

·      Unable to walk

·      Bruising in the back of the calf

·      Inability to rise onto tiptoe

What Causes a Calf Muscle Tear?

Generally, these injuries happen at steady state running or when accelerating. The most commonly torn calf muscles are your medial gastrocnemius as it crosses over both the knee and ankle joint, and your deeper soleus muscle as it plays a large role in running.

Calf Anatomy

The calf is composed of 3 muscles:

·      Gastrocnemius – comprised of medial head which has more faster twitch muscle fibres and the lateral head.

·      Soleus – lies deep to the gastrocnemius and the largest of the 3 muscles. This muscle takes up to 8 x body weight load when running (compared to x 2 times in other muscels) which significantly increases it’s risk of injury in running activities .

·      Plantaris – located in posterosuperficial compartment of the calf and isn’t a prime mover but acts with gastrocnemius as a knee flexor and ankle plantarflexor

All 3 of these muscles form together to attach into the Achilles Tendon and attach on the calcaneal bone (heel).

Calf Injury Classification

Grade 1

·      This is a mild strain involving partial tearing of a small amount of muscle fibres. Symptoms can vary from being able to continue playing to acute sharp pain at the moment of injury and pain on walking. They do however recover quickly and often returning to sport within 3 weeks.

Grade 2

·      Occurs with a greater degree of partial tearing of calf muscle fibres or a partial calf tendon tear. Players are usually unable to continue playing, although some describe a strong cramping sensation in a particular location of their calf. Return to running loads and sport specific training should be guided by your Sports Physio to prevent a further tear which unfortunately can be common in moderate calf tears.

Grade 3

·      This is the most severe calf strain causing a complete tear or rupture of your muscle fibres or tendon. These injuries require an extended rehab period prior to return to sport and this time frame will be affected by which muscle or tendon unit is involved. In a grade 3 tear it’s important to clear if there has been an Achilles Tendon rupture. If this is the case recovering can be upwards of 6 months.

Management of Calf Injuries

Whilst management depends upon the severity of injury the first step is to get an accurate diagnosis of degree of injury from your Sports Physio or Sports Doctor and work on a management plan. Appropriate rehabilitation is required for these to ensure they recover and are safe to return to sport, and avoid a risk of re-injury.

Early Protection Phase – Like most muscle injuries the initial management is to follow RICER principles to reduce the load and protect the local area. Along with this it is important to regain range of motion of the ankle and reintroduce correct walking patterns.

Introductory Loading Phase – Begin to strengthen the calf complex and lower body strength. If necessary these may begin non-weightbearing and then progressively increase to resistance exercises. Low level running can be introduced here.

Transition Phase – Progress to power and plyometric exercises such as sled push (or prowler - see picture below) along with sport specific skills and training as appropriate.

Return to Perform – As mentioned above it’s important to ensure that the calf is able to withstand high loads relevant to the sport and thus the final step is to work on the higher level plyometrics such as repeated jumping and sprinting.

If you have a calf injury or are having recurrent issues then please get in contact with one of our Sports Physiotherapists to assess and design a program suited to your needs.

Written by Simon Wybenga - HPRSP Physiotherapist

Sports Injuries and Load

There are many factors that interact to contribute to most sporting injuries.

Overall training load and training error are one of the most common causes we see.

Other factors can be important, and need to be addressed, but not at the expense of a through look in to the athlete’s training history and current training load.

These other factors include;

-       biomechanics (the way you move),

-       age or stage of development (if the athlete is still growing),

-       strength,

-       mobility, and

-       past history

And of course, sometimes there is just plain bad luck. Being in the wrong place at the wrong time. Many collision or contact injuries fall into this category. It is however worth addressing technical aspects of the movement or injury mechanism here if these injuries continue to recur eg, sprained ankle or concussions.

what is load

Load is the stress we place on the body during training or playing or sport (or sports). Crucial factors to consider with regards to load are training intensity, frequency, and chronic long term load.

Training consistency over the long term is what allows us not only to build up the skills for our chosen sport(s), but also builds the physical resilience that prevents many sports injuries from occurring. Where this commonly goes wrong is when we have a poor chronic training load, or we progress the intensity or frequency of our training too quickly.

Progressive overload is a basic training principle that can be applied to any form of training to improve skill and/or physical capabilities. There is a sweet spot where training can be increased in a safe manner to achieve these improvements. There are however many factors that contribute and each individual will have a different tolerance to the amount of increase in stress that can take.

Source: https://www.alaia.ca/physio/

common overload injuries

The most common injuries we see when a training error has occurred are tendon injuries such as tendinopathies, bone stress injuries and muscle strains.

The most common presentation we see are runners that run most days, and often field based athletes that train hard frequently which lead to the injuries above. Contributing factors may be that these athlete’s don’t have the strength base required to tolerate their training – gym based strength work can help here.

children and adolescents

In younger age groups the injuries that manifest from training overload occur in their developing skeletal system.

As children grow parts of their bones are softer than adults and overuse injuries occur in 2 common areas;

-       Where there is excessive pulling of strong and tight tendons on bones around growth plates, eg. Severs disease in their heel bone, or Osgood Schlatters at their patella tendon attachment. These often occur in sports such as soccer, AFL and basketball.

-       Areas where there is repetitive stress through their bones, eg. Lumbar spine stress fractures in cricket fast bowlers or in gymnasts’.

how to avoid load related injuries

There are several strategies that you can put in place to avoid these types of injuries which include;

-       consistency of training over a long period of time, and

-       adequate time for recovery, with the use of recovery modalities such as ice baths, compression tights, sports massage and compression boots, if training loads are particularly high.

-       Gradual increases to your training load over time. You may need to consult a coach regarding this or an experienced Titled Sports and Exercise Physiotherapist.

-       Targeted strength training.

-       Variability of exercise type, volume and intensity. There is a link between monotony of exercise and these types of injuries.

Written By Chris Bailey - Titled Sports and Exercise Physiotherapist

Growing Pains in the Heel– Severs Disease

Severs disease is a common cause of heel pain in young girls and boys. It is also known as calcaneal apophysitis – where a skeletally immature bone has a growth plate which becomes irritated from excessive sports and activity.

Causes

The Achilles tendon inserts into the heel/calcaneus and puts repetitive strain on the growth plate in the heel. The relatively soft growth plate becomes irritated from excessive forces from sport and activity.

This condition often coincides with the growth spurt and/or sudden increase in sports related activity. During the early adolescent growth spurt, bone growth exceeds the ability of the muscle-tendon unit stretch. This results in a tight calf-Achilles muscle-tendon unit, causing increased tension on the growth plate with activity and sport.

Other contributing factors include:

·      Tight calf-Achilles muscle-tendon complex

·      Weak calf muscles

·      Poorly cushioned shoes / worn out shoes

·      Running on hard surfaces

·      Excessive foot biomechanics – over-pronation or over-supination

What Age Severs Occur?

Severs occurs during a period of rapid growth in active adolescence:

·      Girls – median age of 11 (8-13 years old for girls).

·      Boys – median age of 12 (10-15 years old for boys).

Severs Disease Symptoms

Typical presentation includes an active adolescent with either unilateral or bilateral heel pain that gets worse with activity or sore after activity. Symptoms often coincides with a recent growth spurt and also an increase in training loads. There is no mechanism of injury and symptoms gradually come on.

Symptoms can progress if they are not rested, which may limit activity such as running, jumping and at its worst walking.

Diagnosis

Correct diagnosis of symptoms can be completed by one of our trained physiotherapists. This can also be done by a Sports Doctor or GP.

On examination the patients can have pain on walking, running, jumping, hopping, calf raise and walking on toes. They often get pain on stretching their calf muscle and will often have reduced ankle ROM (knee to wall test). They will have tenderness on their posterior calcaneus (heel) where the Achilles tendon inserts and squeezing the heel posteriorly (squeeze test), will reproduce the patient’s symptoms.

Further Investigations

Severs disease is a clinical diagnosis and imaging is usually not required. If presentation is atypical with severe or persistent pain referral to a doctor would be wise to rule out other less causes of heel pain.

Treatment / Management

Severs is a self-limiting condition that resolves with skeletal maturation and growth plate closure. Treatment and management should be directed and progressed by one of our trained physiotherapists, as they can safely introduce and progress rehab accordingly. The main treatment / management options are:

·      Pain Management –

o   Rest from aggravating activities

o   Ice application

o   Anti-inflammatories as prescribed by doctor / pharmacist

o   Anti-inflammatory gel (Voltaren gel) – as prescribed doctor / pharmacist

o   Use of heel cups / pads to off-load symptoms

o   If unable to weight-bear and walk – a period of immobilisation (in a boot) or non-weight-bearing (on crutches) to allow pain to reduce before walking pain free again.

·      Rehabilitation – Must be progressive and planned appropriately:

o   Ankle ROM exercises (calf stretches) to increase the ROM of the ankle joint

o   Strengthening of calf muscle

o   Plyometric training

o   Rehab running

·      Load Management – managing how much sports / activities are completed letting pain be the guide. One of our trained physiotherapists have experience in planning and periodising running loads here.

·      Footwear – must be well maintained and up-to-date.

Prognosis

Symptoms can last for 6-12 months and recurrence is common. Symptoms are expected to resolve when there is closure of the growth plate and skeletal maturation. Treatment and management options above are usually reasonably successful with no long-term complications with prognosis being excellent.