Check yourself before you wreck yourself - Injury prevention for knees and hips

By Jonny Kilpatrick of Physio Effect

Injury prevention is obviously preferable to injury cure. It is common for people to adapt their work desks and equipment to improve their posture as a form of injury prevention. It is also common for gym-goers and athletes to practice good form when using weights as a means of injury prevention. What is uncommon is paying attention to and correcting our most frequently used movements that arguably have some of the more devastating effects on joints if performed badly over a lifetime. 

With almost all leg injuries, as physiotherapists, we will assess basic movement patterns. Two of these are frequently found to be faulty and likely to either have contributed to an injury or are likely to hinder a speedy recovery. These movements are:

• Standing to Sitting / Sitting to Standing 

• Step Up / Step Down

We perform each of these movements numerous times each day, hundreds of times each week and thousands of times each year. Little attention is paid to our “form” on these movements and commonly we will see people putting their knee joint under uneven stretching and compressional forces that over time will strain on ligaments and degenerate joint surfaces. Almost always the fault seen in both movements involves the person’s knees or knee drifting inwards once the hips are lowered. This puts the knee into a position known as genu valgum, which is associated with the following conditions:

• Patello-femoral (knee cap) joint osteoarthritis 

• Inner knee pain from overstretching the medial collateral ligament

• Outer knee pain from increased tension on the Iliotibial Band and compressional wear and tear to the lateral meniscus and joint surfaces

• Osteoarthritis of the knee joint

• Increased risk of knee trauma in sports such as ACL rupture

Poor movement pattern with Sit to Stand and Step-Ups fig.1

Poor movement pattern with Sit to Stand and Step-Ups fig.2

The reason this knee position and movement pattern has such a destructive effect on the knee is to do with the way our knee has been designed to move. There are various interlocking grooves and troughs within our knee that require a certain movement pattern to align correctly and provide stability. This movement is called the screw home movement and it involves the femur (thigh bone) rotating approximately 10 degrees inwards on the tibia (shin bone) to achieve a fully straightened position. Conversely when the knee is bending the femur should rotate outwards on the tibia to keep everything aligned correctly and avoid excessive forces to one area. This in practice means that your knees should stay out over your feet when bending and the hips flexing. This can be achieved by rotating your femur outwards by using your Gluteal Muscles (Butt). 

We have seen this movement problem much more prevalently in women who also tend to suffer higher rates of frontal knee pain and knee trauma in sport than men. This is thought to be in part because of women having a wider pelvis than men which results in an increased angle (Q Angle) from the outside of their hips to the knee cap in normal standing. We also believe the cultural expectation of sitting in a “lady-like” way with their thighs closed rather than open may have contributed to women sitting and stepping in a manner that switches off their glutes and allows their knees to track inwards. With this consistently poor movement pattern during a “functional squat” such as sit to stand over a lifetime it is unrealistic to expect ourselves to move well when the task requires greater control and strength such as during single leg step-ups when going up or downstairs or running which is actually just a series of single leg hops.

Correct movement pattern on Sit to Stand and Step-Ups fig.1

Correct movement pattern on Sit to Stand and Step-Ups fig.2

A common phrase within a gym or weights room when discussing form and technique is “check yourself, before you wreck yourself”. This, we would argue, is equally, if not much more, important with everyday movements as over a lifetime the wear and tear you inflict on your joints may not be reversible or easily rehabilitated in the same way as a minor muscle strain or postural stiffness. In the instance of these movements we would really recommend making time to practice some squats to and from a chair and step ups where you keep your knee from moving inwards of your foot. This should in turn help with how you move in everyday life if you are mindful of it. 

At Physio Effect you can expect physiotherapy, massage and holistic services that address your unique needs. We will always strive to exceed your expectations through our honest and results-driven approach, delivered by our team of specialised practitioners.
You’ll be empowered to address your injuries and any associated lifestyle issues with a diagnosis and treatment plan that has been logically explained and is achievable for you.

Find out more and book online at PhysioEffect.co.uk

How Physio Effect helped me on my Journey to the London Marathon - a Customer's Testimonial

I started a 16-week marathon training program in January, only to get a recurring calf injury in the second week, but thanks to treatment and advice from Jonny, I was able to get back to training in a couple of weeks and back to running properly is a couple more, but it was a less than ideal start.   

Then life got in the way a bit as it does, as did two snowboarding holidays a few weeks apart, the last one being the week before the marathon!   I know; planning, eh?

So I found myself at the start line: nervous, carrying a few extra kilos I'd rather not have and feeling a bit under-trained - but nevertheless committed to do my level best.

At no point in the race did I experience any asymmetric pain whatsoever. Neither calf so much as murmured nor did my right ITB, all which are known to do so. I'm not saying everything didn't hurt like buggery from the halfway point onward but that was just muscle fatigue from the pace and duration. I saw so many people pulling up all over the place to limp or stretch and passed (apparently) a good few thousand forced to walk or slow right down. 

The point of this is despite all of the above, the only regular thing I did for the entire lead up to the race was to get proactive sports massage from Nicki at Physio Effect with some dry needling for the stubborn knots and also massages from Melanie too.  

I totally attribute my successful and injury free day to this and would heartily recommend anyone to do the same in undertaking any sporting endeavour.

And my time?  3:59:21 since you asked :-) 

Scott Cherry - Physio Effect client and all-round good guy!

Real Life Stories: Recovering from a disc injury

Fiona Callan is a CrossFitter and Ultra-marathoner who injured her back in 2017. She had an MRI which confirmed an L5/S1 disc bulge with nerve root irritation. In this interview we discussed how she avoided surgery and returned to the things she loved doing best.

Hi Fiona, thank you for taking the time to share your experience with us. We know you've come a long way from a pretty bad back injury. Before we begin, tell us a bit about yourself! What type of work do you do and what's your sport/exercise/fitness background?

I work in the NHS, primarily an office based job. Preceding my injury I was also studying for an MSc so basically spent all day and night sitting at a desk.

I started running in 2008, mainly 5k and 10k distance on roads but I wasn’t very good and didn’t enjoy it so moved to trail and hill running instead when I started gradually to increase my distance. I met some really cool people to run with as well. In 2012, I was talked into a trip to Nepal by a friend but it wasn’t until around 4 weeks to go that I found out he had signed me up to an ultra marathon. I didn’t even know what that was! It was sheer determination that got me through that and I really caught the ultra marathon bug.

In 2014 I started CrossFit as I thought some strength and conditioning type training would help with my running and I had no idea what I was doing in a conventional gym. The coaching and set workout approach has really worked for me and made me use muscles I didn’t know I had.

So the big question, when and how did you injure your back? Was it after one incident or was it something that gradually built up and got worse? What were your symptoms (i.e. back pain? leg pain? numbness etc...)

To be honest I’ve always had a bit of a lower back niggle, probably postural, but thought it would just go away. It was definitely something I started to feel more when I started CrossFit as I really had to use my back and core more than I had been doing running. Slowly I noticed it had started to affect my running, I had pain in my right buttock that shot down my leg now and again and my leg generally felt heavy. If I left it a few days it would go away but it meant I couldn’t really run or CrossFit as much as I wanted to.  

It started affecting my job as I couldn’t sit comfortably for any period of time. I was travelling by train to Edinburgh at least twice a week which became difficult. On one journey I had to get off the train and go back to Glasgow as I couldn’t face sitting for an hour.

Then during a workout involving a barbell I cried so much I had to admit that something wasn’t right.

My initial symptoms were primarily in my lower back, there was a build up of pressure around my stomach and back even when I bent over the sink to wash my face. I tried to keep active but really scaled back on what I was doing. I kept up my hill walking as this is an activity I love doing with my nephew – I used poles and made Ewan carry my bag as he’s the young one! I tried running but could only manage 1k before I felt my back stiffen.

One Saturday I went walking with Dad and Ewan in the Lake District. It was an amazing day. The hill wasn’t too hard; we took our time and enjoyed it. It was the shooting pain in my right leg that woke me up early on the Sunday morning. I tried to stand up but my leg just wouldn’t work. I limped to the bathroom hanging onto the wall and at that point I knew there was something seriously wrong. It sounds dramatic but I genuinely felt paralysed down that whole side of my lower body, first thoughts were ‘I’ll never run again!’ and panicked. My boyfriend called NHS24 and a nurse managed to calm me down and suggested I took paracetamol with ibuprofen and try find a comfortable position until a doctor could get to me. A few hours and one injection later the pain had dulled. He said it was my sciatic nerve; I should try to relax and spend less time sitting down!   

What was the initial management i.e. what treatment did you seek?

I got an appointment with Jonny who did some needling on my lower back/ glutes and gave me some exercises to do. I am the most impatient person and after a week of exercises I didn’t feel any different so I saw another physio (sorry!) who basically told me the same thing and gave me the same exercises. I really was in denial about how serious it was. I spoke to coaches in the gym, chatted to other runners and did a lot of Googling but all the answers were the same.

It was the mental part I actually found the toughest to deal with. I have made so many friends through running and CrossFit and my social media is full of it too so I was always seeing and hearing about all these amazing runs and PBs. I just felt stuck and disconnected. I saw my GP as I really felt like I was struggling to cope. People were always asking how I am and telling me I should ‘do this and do that’ and eventually I just got fed up talking about it. My GP didn’t really help me; she referred me to her physio friend but I didn’t go.

At the same time, Jonny had passed me onto Mariam for Clinical Pilates and it was during my consultation that she suggested some short term medication for my nerve problem in my right leg. I went to another GP for this and as well as giving me the medication, he was really keen to get me back running and to the gym so he referred me for an MRI.

Am I right in saying you ended up seeing a consultant neurosurgeon? What did the MRI show?

Yeah I was really lucky in that I got an MRI pretty quickly. I think the 2nd GP had something to do with that. A few weeks after the scan. I received a letter with a hospital appointment but with no other information. Frustrating and worrying. I thought well there must be something not quite right and because of my problem with patience, I called the GP and asked him to give me a brief overview of the scan. He said he could see a disc bulge and I should continue doing my physio exercises until my appointment. I had just started with the Clinical Pilates class so I let Mariam know the issue and she tailored exercises for me until I found out more about the problem.

So there was the prospect of having surgery? How did that make you feel? Was this something on the cards or wanting to avoid?

I remember getting a phone call from a surgeon in the spinal unit and it made me feel sick. I actually don’t remember what he said to me as the idea of back surgery just terrified me. I wasn’t exactly in crippling pain so the idea of surgery just felt a bit extreme to me. This was something I definitely wanted to avoid. I just really trusted my physios and they really believed I could get better without it. I didn’t feel that my pain was bad enough for surgery – for me this was the last resort, I’ve never heard positive stories about it.

At the appointment, the doctor went through my scan which I found fascinating. I actually felt a bit of weight come off my shoulders when I could physically see the issue. It had been hard to accept when I didn’t know for sure what the problem was but there it was clear in front of me. She then told me that they would do surgical intervention if I was getting sharp pains down the top of my leg. I told her I had that a few weeks before but it had been getting much better. We left it at that and I was told to get in touch if anything changed.

I had so many conversations with my boyfriend, my parents (and myself) and decided that it wasn’t the end of the world if I couldn’t run 50 miles or couldn’t deadlift 100kg as long as I could stay active. I would just scale back what I was doing.

You've spent the best part of a year doing some serious rehab with Clinical Pilates. In your own words can you explain what that is and how it helped you? 

I had done a bit of Pilates before as I’d read and heard it was good for runners. It was one of those things I struggled to stick to because I never left the class feeling like I’d worked hard and my issue with patience didn’t help. When I told my boyfriend about it he signed me up for 6 weeks because he knew I’d have to go if he paid for it! I noticed a huge difference after these 6 weeks.

It is basically pilates but physio led so your exercises are all tailored to whatever issue you may have so we’re all doing something different generally. It’s a small class but everyone is in the same boat and really friendly. Mariam checks in with you regularly during the class and pushes you when you’re ready but also changing exercises if something isn’t quite feeling good.

I expected my exercises to all be lower back focused as that’s where my injury was but actually they’ve been full body movements. As well as having a stronger back, I have a stronger core and much improved posture. Mariam also spent some time working on my legs, particularly my right leg as the nerve had been affected and I had limited movement and very little strength.

Eventually you returned to CrossFit and trail-running. How long did that take from when you first injured yourself?

I was always doing a scaled back version of CrossFit and a bit of trail running while I was injured but I was mindful of undoing my hard work. It was important to me mentally that I kept in touch with coaches/ friends in the gym and my runner friends.

I accepted my injury in May 2017 and started Clinical Pilates in the October. In May 2018 I was a more confident runner so decided to train for a race following a plan, building up in distance and I finished the Mad Hatters Half Marathon and the Glentress Half Marathon with a PB and no back or leg pain. Not quite back at ultra marathon distance but I’m actually enjoying the shorter runs at the moment. In June 2018 I started back at CrossFit and noticed that I’m better at a lot of the movements as I actually use my back and core as I should. I’m always conscious of loading too much weight on bars and I know certain movements still aggravate my back but I know when to stop and I just need to gradually build my strength back up. I was asked if I’d like to be part of a team from the gym for a CrossFit competition, I said yes why not I can try and we finished in 3rd place with no back injury!

Most people in this day and age are seeking the "quick-fix" or miracle cure. In fact, most people in your shoes would opt for surgery given the opportunity. What advice would you give them?

Your back is such a major part of your body so decisions on surgery should never be made lightly. Unless a professional is telling you there is no other option I would encourage people to commit to the exercises, spend less time sitting down and stay active by doing anything you find fun (that’s obviously not going to hurt you)

Working through this injury has taught me so much about my body and my lifestyle as well as making me a better runner and CrossFitter. This is all coming from the most impatient person!

Case Study: Frontal Knee Pain (Part 3)

Single leg exercises should be incorporated in strength and conditioning sessions as it is the best way to mimic the single leg work required in running with landing and push-off. It is also a good way to identify any imbalances from one side to the other. In the final part of this series, Jonny’s pain had largely settled and his rehab focused on single leg control. He also practiced a more efficient running technique to minimise loads placed on the knee.

Case Study: Frontal Knee Pain (Part 2)

During the initial stages of rehab, the primary focus was to maintain muscle function which can be inhibited by pain. During assessment, it was also established that Jonny was weaker on one side of his outer hip muscles (glutes) when looking at the way he balanced on one leg. The video below looks at a couple of simple exercises he worked on to improve this.

Case Study: Frontal Knee Pain (Part 1)

Knee pain is a common issue in runners. It can start off as a niggle and can easily be ignored until the point where running is no longer tolerable. This is frustrating particularly when training for a race or event. In part 1 of this month’s case study, we will look at some common physiotherapy techniques we use for pain relief in the treatment of anterior (pain in the front of) knee pain.

Jonny hurt his knee during a 42-mile Ultra Marathon which was on trail and had plenty of up and down hill sections. This caused an acute overload of the structures around his knee cap, causing pain and swelling.

Case Study: Ankle Sprain Rehab - Part 3

This concludes our 3-part series following Mariam’s ankle rehab programme after a bad sprain two weeks before her first trail marathon and then her first trail ultra-marathon five weeks after that.

Phase 1 (first 2-3 days after injury):

• Ice, Elevation, Compression

• Crutches

• Avoidance of non-steroidal anti-inflammatories (i.e. ibuprofen)

Phase 2:

• Non-weight-bearing exercises

• Training modification

• Progression to weight-bearing and single leg exercises

Phase 3:

• Training modification

• Running technique modification

• Progression to plyometrics and impact loading

Case Study: Ankle Sprain Rehab - Part 2

Part 2 of our ankle rehab case-study following Mariam's injury two weeks before a trail marathon. This is a sports physiotherapy approach to the treatment and management of an injury leading up to a specific event. In this episode, we looked at progressing her exercises and training modification leading up to the run.

Case Study: Ankle Sprain Rehab: Part 1

We all know injuries happen and, in most unfortunate instances, they can happen before a sporting event you have been training for months. It can be disheartening when you’ve spent countless hours training for such an event with the prospect of having to pull out. In this month’s case study, we will be looking at managing an ankle injury coming from a personal experience from one of our own physios, Mariam. We will be demonstrating a sports physiotherapist’s approach to dealing with an injury leading up to an event over a 3-part series. Part 1 is below:

The Tool of our Trade

IASTM - What is it?

A revolutionary treatment technique used in physiotherapy is the use of an instrument or a tool, which enables the physiotherapist to locate and treat an area of soft tissue dysfunction.

The official term is called Instrument Assisted Soft Tissue Mobilisation or IASTM. The technique itself is said to have evolved from the traditional Chinese Medicine technique called Gua Sha. However, Gua Sha uses the principle of Meridians to move the bad “Qi” out of the body. You could perhaps say that IASTM is a modernised version of Gua Sha using anatomical reasoning. IASTM is growing rapidly in popularity due to its effectiveness and efficiency in treating musculoskeletal conditions while remaining non-invasive compared to other treatment techniques such as Trigger Point Dry-Needling or Acupuncture. 

IASTM is performed using an ergonomically designed tool most commonly made of stainless steel. The tool is used to detect and treat fascial restrictions, effectively treat scar tissue, chronic inflammation and/or degeneration.  As with any physiotherapy treatment, the use of IASTM is also supplemented with exercise prescription and additional methods such as joint mobilisation designed to correct any biomechanical issues by addressing musculoskeletal strength and muscle imbalances or weaknesses. 

IASTM Tooling around the knee at Physio Effect

How Does IASTM Work?

Soft tissue injury involves damage to muscles, ligaments, tendons and fascia (connective tissue) somewhere in the body. Common soft tissue injuries usually happen after a sprain, strain or a blow to the body resulting in ruptured blood vessels or overuse of a particular body part. Soft tissue injuries can result in pain, swelling, bruising and loss of function. Adhesions within the tissue may develop as a result of repetitive strain/overuse, surgery, or immobilisation. 

Often, people with soft-tissue injuries do not seek out treatment until the injuries have become chronic (weeks/months after injury). By this point, the body has completed most of its self-healing process. Scar tissue and adhesions are formed during this healing process, which limits motion and often causes pain. Scar tissue and adhesions essentially act like super glue in your body. When scar tissue is created after injury, new cells are laid down excessively and in a disorganised manner. Scar tissue/adhesions prevent the muscle or other tissues from lengthening appropriately. It is often necessary to restart the healing process in order to remodel the soft tissues in the affected area. By introducing controlled micro-trauma to affected soft tissue using IASTM, a local inflammatory response is stimulated. This micro-trauma initiates reabsorption of inappropriate or excessive scar tissue and facilitates a remodelling of the affected soft-tissue structures. After IASTM treatment, scar tissue can be remodelled so that the cells become organised in a direction that better promotes movement.

The ergonomic design of the tool used for IASTM provides the physiotherapist with the ability to locate these soft tissue restrictions and allows them to treat the affected area with the appropriate amount of pressure.  

What should I expect after an IASTM treatment? 

It is important to note that IASTM’s ability to reinitiate healing comes from the fact that it is essentially re-injuring the body (although to a lesser degree and in a controlled manner). This may cause mild discomfort during the procedure. There may be soreness in the treatment area for a day or two following treatment and occasionally bruising may occur.

What are common conditions treated with IASTM?

• Tennis or Golfer’s Elbow

• Neck or Back Pain

• Plantar Fascitis

• Rotator Cuff , Achilles or Patella Tendinopathy

• DeQuervain’s Tensosynovitis

• Post-Surgical Scars

• Ligament Sprains

• Muscle Strains

• IT Band Syndrome

• Shin Splints

• Chronic Ankle Sprains/Stiff Ankle

• Arthritic Pain

What are the benefits following IASTM?

• Improved range of motion

• Improved muscle strength and function

• Altered pain perception and reduction of pain

IASTM is a common treatment technique utilised by the therapists at Physio Effect. The dedicated team at Physio Effect provides a full package of services that will ensure you’re supported through injury prevention, assessment, recovery and helping you achieve your ultimate performance goals. 
 

Dry Needling: The most effective pain treatment you may never have heard of!

Dry needling is a type of acupuncture that has become very popular with physiotherapists in recent years in our treatment of injury and pain. Also known as Western Medical Acupuncture, Dry Needling differentiates itself from traditional acupuncture by being administered to soft tissue structures such as muscles and fascia (connective tissue) in order to stimulate the central and peripheral nervous systems. This results in the release of pain relieving substances within the body, which can desensitise painful structures as well as the loosening of excessively tight muscles, therefore restoring movement and function and facilitating a healing response. Dry needling is often used in conjunction with other treatment techniques as part of a treatment plan. This is different from traditional Chinese Medicine type Acupuncture which places needles along meridian lines and is based on a model of treating and restoring energy flow within the body.

Why is it called Dry Needling and how does it work?

This was to differentiate it from the more traditional western medicine approach to treating painful muscles and joints that involved the use of a hypodermic needle to inject a medication such as a steroid solution.

Dry needling uses only a thin acupuncture-type needle to stimulate and deactivate myofascial trigger points, muscles and connective tissues. This can also have both diagnostic and treatment benefits whenever a practitioner is attempting to address problems in deeper muscles and structures that massage techniques cannot be effective at reaching.

Myofascial Trigger Points can be found to be causing pain in nearly every musculoskeletal pain problem. (Myo=Muscle; Fascia=Connective tissue - the term ‘myofascia’ describes that area). These trigger points present as hypersensitive localised muscle tenderness that can also cause prolonged ache in a more widespread area. They can arise from overloading and overuse of muscles and structures such as in sport or after trauma, or even while sitting with a poor posture with the example being pain to the neck or back. As well as pain, myofascial trigger points can cause weakness of the affected muscles and restrict range of movement, both which can contribute to other problems and compensations developing.

Generally as the needles used are so thin, a patient can often not even feel the needle being inserted. When dry needling is administered effectively to a myofascial trigger point the patient may experience a local twitch response from the muscle. This instantaneous involuntary contraction confirms the presence of a myofascial trigger point and the practitioner may stimulate this twitch response a number more times manually using the needle or via an electrical current from a TENS machine to successfully deactivate.

Results can often be instantaneous when assessing restricted ranges of movement in muscles and joints and your practitioner will often demonstrate this with before and after treatment testing.

After a dry needling treatment a patient may instantly experience improvement in their pain and dysfunction being treated however it is quite common to experience muscle soreness around the needle site for between 24-48 hours. This post treatment soreness, however, is comparable to what can be expected from most hands-on therapies such as deep tissue massage.

As dry needling is administered in a clinical environment by highly trained and regulated physiotherapists, it should be considered to be a very safe treatment option and your clinician will have taken every precaution to minimise risk of injury or infection from the needle. It would however not be advisable to try for anyone who suffers from a significant phobia of needles.

Injuries and conditions to consider dry needling with:

• Postural and work-related pain

• Sports injuries affecting all muscles and joints

• Muscle and Joint Tightness

• Disc injuries

• Migraines and Tension-Type Headaches

• Tendon Injuries

• Fibromyalgia and Complex Regional Pain Syndrome

Are you taking a HIIT in Training?

In the last number of years we’ve seen a huge shift in the exercise industry towards high intensity interval training (HIIT) as a means of providing time efficient and intense workouts.

There is no doubt that HIIT training can rapidly increase fitness and provide the numerous health benefits associated with exercise but there are also a number of pitfalls to training exclusively like this that should be considered in order to ensure this works for you.

As Sports Physiotherapists we have seen numerous patients fall into repetitive cycles of injury while training in the gym. It becomes all too easy to just suggest this is because that person does Crossfit or trains at a boot camp and attribute the blame to this.

We work closely with a number of Crossfit and Functional Fitness style gyms and, in our experience, they are providing great instruction of movement form/techniques and offer a good variety of training ranging from strength and gymnastic to HIIT training.

We feel that the problem with injury usually arises because of the individual participating in this training not fully appreciating what is involved in it and where they fit into it at any point in time. Often, intense, sweaty workouts are favoured over the more strength or technique based sessions as there is a greater association with feeling fit or losing weight.

The problem with this is that in these HIIT type session exercises are being performed quickly in order to set a time or score. This requires pushing into fatigue using weights or load that can often be disproportionately high for your current strength levels and abilities. This can cause soft tissues and joints to become overloaded and injured. To train like this at a maximal or “competition” intensity 5-6 days per week is unsustainable and unproductive on so many levels and will nearly always lead to burn-out, disappointing performances and injury.

No professional athletes would ever train at full intensity on every session; instead they will do this in limited amounts and work on the various components of their sport in order to peak for short periods only a few times per year. This ensures continual improvement and decreases their likelihood of injury.

We appreciate most people have no aspirations with their exercise to compete in anything, however in order to train consistently, safely and effectively over a number of years, the principles need to be much the same whether recreational or competitive. Class-based exercise instructors will teach technique and oversee safe performance to the best of their abilities in a large group but they cannot be expected to know each individual or monitor everyone to the same degree as a personal trainer or coach. This is why it is essential to take more of an individualised approach and responsibility within these environments in order to lessen injuries, frustration and lack of improvement.

Things to consider with your HIIT sessions:

Have you been training regularly to have built up a sufficient base of fitness and strength to attack a workout at maximum intensity?
If not, you can always modify the workout slightly by going lighter, slower or changing the exercises to something that is more appropriate for you. There’s no shame in it, the shame would be to continually miss sessions due to injury

Do you warm up appropriately for intense exercise sessions?
Most people will exercise early in the morning or after work and at both these times the body is stiff from being sedentary for long periods. It’s unrealistic to expect to move well or safely during intense bouts of exercise without preparing the joints and muscles for this.

The Coach (and mini-coach!) at our Partner Gym EveryDay Athlete leads a structured warm up appropriate to the programmed HIIT workout

What are your individual needs when warming up? Eg. do you require extra stretching for your shoulders because that day you’ve been hunched over a desk all day? 
This may not be covered in a class-based environment and you should make sure to cover this yourself before the class starts.

What are your expectations?
If you plan on moving quickly and repetitively with a weight or movement, do you have the strength and skill to perform this same movement in a much more controlled manner?
If you want to get a sweat on in every session that’s okay too but this can also be achieved by training at 80% instead of 100% on some sessions.

Long Term Goals

Year in and year out exercise and training requires consistency and dedication. Similar to more extreme diets, we shouldn’t be looking for a quick fix as it is often unsustainable and doesn’t provide long term results, as this approach can be tortuously difficult and we will lose motivation quickly or get injured.

Have you discussed with your coach, instructor or physio what your individual needs and expectations are with training?
This will reduce that feeling that you’re expected to perform at full intensity on every session. They can help identify things that you may do in your own time or out with class times in the gym that should help you progress to where you want to.

Image from one of the HIIT Classes at one of our partner gyms EveryDay Athlete at our Northside Clinic and Studio in Port Dundas

Running injury prevention; do you need a musculoskeletal screening?

Sports-specific screening available!

Musculoskelatal screenings are available from our team of experienced and expert Sports Physiotherapists – but what is it? Imagine, someone could look you over and help flag issues before they become injuries!

Here's what Jonny says:

“A 60-minute assessment which will include a full body assessment of flexibility, strength, balance and body control to highlight potential for injury or problem shoot issues experienced by a runner. This may also include treatment if needed as well as education on issues flagged up with suggestions of how to fix these.”

We have a broad spectrum of sports expertise here at Physio Effect – everything from running, martial arts and football to rugby, mountain biking and roller derby! Whatever your sport or activity, whatever your level, we’ll be able to assess and treat you!

What is the difference between ‘Regular’ and ‘Clinical’ Pilates?

Regular Pilates is conducted by a Pilates instructor, whereas Clinical Pilates is prescribed and supervised by a Physiotherapist. The difference is very important because a physiotherapist has an in-depth knowledge of injury, pathology, body function and movement patterns. The physiotherapist will assess each person and determine which exercises will be the most effective for each individual. This becomes especially important if you have a history of injury such as low back pain, whiplash, hypermobility or an athlete coming back from an injury. There will be certain exercises which need to be adapted specifically for you.

For more information on our Clinical Pilates classes here at Physio Effect, have a look on our Clinical Pilates page

#KnowledgeShare – Shoulders Month – Rotator Cuff

23rd February 2017

We see a lot of clients coming to us with shoulder injuries – sometimes it’s not what they think! In this new video, Danny gives us a the basics (and a bit more!) on the rotator cuff!

#KnowledgeShare – Shoulders Month – Mobility Exercises

Here's Jonny from a few years ago demonstrating some exercises to improve overhead range of movement using small equipment you'll find in your gym

#KnowledgeShare – Back Mobility

17th March 2017

It’s Back Month here at Physio Effect! Here’s Jonny (and Ash) showing us how to use the foam roller for a bit of mobilisation!

Foam Rolling: What is it? What’s the Evidence? How to apply it!

Foam Rolling

What is it?

Self-myofascial release is a name given to the use of equipment or tools to perform self-massage and stretching with the aim of increasing joint range of motion and improving muscle recovery and performance. One of the most commonly used tools is a foam roller. You will often see people in gyms attempting to manoeuvre their bodies in various positions over one of these rollers.

Most commonly rollers will be used in a way that the body is positioned with the roller in contact with a specific muscle or muscle group. The user then uses gentle motion to stretch and massage the area while controlling the pressure exerted by adjusting their position and the weight going through the area.

The theory is that using foam rollers used to massage and stretch our muscles, joints and soft tissues can make them more pliable thereby increasing range of motion. It is also theorised that pressure applied to soft tissues can stimulate change through the central nervous system by sending signals which alter the tissue activity and reduce tension levels.

What’s the evidence?

In general terms, self-myofascial release using a foam roller appears to have short-term effects of increasing joint range of motion without exhibiting any negative effects on muscle or joint performance. There is also some evidence to suggest that post exercise muscle soreness can be reduced while muscle recovery is enhanced when foam rolling is used after strenuous or intense exercise.

The overall summary of the evidence to date suggests that foam rolling is a safe tool to use prior to or after exercise to assist with warm up and/or recovery. However, the research is limited and fails to come to a consensus on what the optimal methods, techniques or frequency of foam rolling should be. There is not yet enough research or evidence to define the best way to roll specific muscles or how many sets or repetitions is appropriate.

How can I apply it?

The general consensus is that foam rolling is safe and can be a welcome addition to assist in warm up and recovery. While we do not have enough evidence to create exact protocols there is room here for individual preference and some experimentation to see what works best for you. From personal experience and from reviewing the literature we would suggest trying:

• 3-5 sets of 30+ second repetitions on each targeted muscle or muscle group

• Apply gradual pressure in various planes and directions.

• For larger or longer muscle groups consider dividing the application into 2-3 areas

• Consistent application aiming for a minimum of 3 times per week

• Slight discomfort during application is acceptable but strong or intense pain is not

• Position yourself carefully to avoid unnecessary strain on other muscles or joints

Below are a few examples of positions used to foam roll various muscles

Foam rolling outer thigh    

Foam rolling upper back

Foam rolling calf muscle

A word of caution

Foam rolling can be a useful adjunct to any exercise or training routine and may also be used by more sedentary individuals to reduce muscle and joint stiffness. Foam rolling, however, is not an appropriate tool for treating damaged or injured tissues and we would warn that it should not be used as such. Always seek advice from a qualified professional if you are in any doubt.

Foam rolling does not replace or negate the need for adequate warm up and the use of correct techniques when exercising. We would suggest using foam rolling to compliment your existing training or exercising routine but not to replace any aspect.

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Article written by Daniel Wray – Senior Physiotherapist and Director at Physio Effect

The dedicated team at Physio Effect provide a full package of services that will ensure you’re supported through your pain management, injury prevention, assessment, recovery and helping you achieve your ultimate performance goals. We offer a range of services including Physiotherapy, Sports Massage, Craniosacral Therapy, Clinical Pilates and Yoga.

Kinesio-Taping

Article written by Daniel Wray – Senior Physiotherapist and Director at Physio Effect

6th November 2017

What is Kinesio-taping?

Kinesio-taping is a commonly used form of support taping applied to the muscles and joints of the body. There’s a good chance you will have seen this brightly coloured tape on a friend or colleague or through its wide use across many sports including football, tennis and swimming. Tape is normally applied by a trained health and fitness professional and can stay in place anything from 24 hours up to one week. The tape can stay in place after bathing or swimming and its breathable elastic properties mean it is generally well tolerated by the skin.

The theory behind kinesio-taping suggests that it works via its unique elastic properties lifting the skin to improve fluid movement and alleviate pain. A suggested mechanism of how this works is the alleviation of pressure on pain receptors interrupting the normal transmission of pain signals to the spinal cord. Other popular notions suggest that application of kinesio-tape can help stimulate and strengthen a weakened muscle or relax and release a stiff or tightened muscle depending on the level of tension applied to the tape. It may also offer support and restriction of movement when this is required as part of treating injured tissues or joints.

Kinesio taping application for shoulder support

Kinesio-taping application for shoulder support

What’s the evidence?

As Physiotherapists and health professionals it is central to good practice that we seek out solid evidence to support the use of any therapy or treatment. Kinesio taping falls almost entirely into a category of little to no hard scientific evidence supporting its use. There have been numerous studies and systematic reviews of the evidence that conclude that kinesio-taping offers little to no clinically significant benefit. It appears most of the evidence and positive reviews from patients and health professionals to support kinesio-taping are anecdotal or based on single case reports or small samples.

Should I use kinesio-taping?

Despite the clear lack of evidence for its use the spread of kinesio-taping throughout health and sport practices does not appear to be waning. As a Physiotherapist with more than 10 years in clinical practice I have been officially trained and certified as a kinesio-tape practitioner and while I recognise the lack of hard clinical evidence I do still have a place for using kinesio-taping in my practice.

There is no clear evidence that proves any clinical risk in using kinesio-taping and anecdotally within practice I have had many patients report a sense of support or relief associated with the tape application. There may well be an element of placebo effect here but as long as that effect is positive and the potential benefits or lack thereof have been openly and realistically explained to patients then I see no issue with kinesio-tape use as part of a bigger clinical picture.

The use of kinesio-taping should not be considered as a complete treatment for any injury or condition and patients should understand it has limited evidence. Kinesio-taping should be considered as one aspect of treatment and any practitioner using it should be able to provide a rationale for doing so even if this comes down to personal clinical experience over specific evidence. Kinesio-taping should not be considered the mean to the end and should be an adjunct to support a full treatment and rehabilitation plan based on careful evidence based clinical assessment.

Article written by Daniel Wray – Senior Physiotherapist and Director at Physio Effect

The dedicated team at Physio Effect provide a full package of services that will ensure you’re supported through your pain management, injury prevention, assessment, recovery and helping you achieve your ultimate performance goals.