Category: Blog

Winter is a period that brings with it a different set of obstacles relating to musculoskeletal injuries.  Engaging in winter sports or activities in colder temperatures can increase the risk of injury. However proactive pain management strategies can help you navigate the winter season safely and effectively to minimise discomfort. In this blog, we will explore common winter musculoskeletal injuries and provide practical advice for managing pain.

Sprains and Strains:

Sprains and strains are one of the most common musculoskeletal injuries during winter. Sprained ligaments, muscles or tendons, particularly in areas such as ankles, wrists, and knees, can result in pain, swelling, and limited mobility.

 

Pain Management Advice:

Acronyms such as RICE, PRICE and POLICE are used to help manage the acute stage of pain. Dubious et al 2019 presented a slightly different acronym that helps with the immediate care but also the subsequent care of injuries. These acronyms are PEACE and LOVE: 

 

Protection – avoid activities and movements that increase pain during the first few days after injury

Elevation – elevate the injured limb higher than the heart as often as possible

Avoid Anti-inflammatories – avoid taking anti inflammatory medication (example) as they reduce tissue healing. Avoid ice

Compression – use elastic bandage or taping to reduce swelling

Education – your body knows best. Avoid unnecessary passive treatments and medical investigations and let nature play its role

 

Load – let pain guide your gradual return to normal activity. Your body will tell you when it’s safe to increase load.

Optimism – condition your brain for optimal recovery by being confident and positive.

Vascularisation: choose pain-free cardiovascular activities to increase blood flow to repairing tissues

Exercise – restore mobility, strength and proprioception by adopting an active approach to recovery

Back Injuries:

Winter activities such as skiing can put further strain on the back which may lead to injuries such as muscular spasms/strains, as well as injuries to the spinal structures such as the disc, or more commonly non specific structures of the lower back. All these injuries can arise both from contact or non contact scenarios.

 

Pain Management Advice:

• Heat Therapy – Apply a heating pad or taking a warm bath relaxes muscles and may alleviate back pain. To note sometimes applying heat in an area that is highly irritable may not be possible at times and this may need further opinion by a health professional
• Gentle movement – Perform gentle movements targeting the back muscles to improve flexibility and reduce tension
• Activation exercises – engage in bodyweight/banded exercises that can help the musculature surrounding the trunk such as the glutes, hamstrings and quadriceps e.g banded sit to stands, crab walks with loop band around the ankles
• Temporary altered lifting techniques – When lifting heavy objects, use your leg muscles instead of your back to minimise strain on the spine. As time progresses, you will be more confident to start bending your back without feeling overly protective of perfect ‘mechanics’

 

Fractures:

Frosty or icy surfaces can sometimes result in fractures as the incidence of slips and falls increase. Wrists and ankles are common sites of fractures that we tend to see in the clinic. These injuries require immediate medical attention.

 

Pain Management Advice:

• Immobilisation –  Keeping the fractured site/limb immobilised using splints or casts as instructed by your physiotherapist or healthcare professional
• Pain Medication – prescribed pain medication as directed by your doctor to manage discomfort during the healing process
• Physiotherapy – Consult with your physiotherapist as to when to start your rehabilitation journey as this can vary depending on the types of fracture, your physiotherapist may be able to prescribe exercises that can improve range of motion and strength surrounding the injured site while minimising pain within the appropriate time needed

 

Overuse Injuries:

Engaging in winter sports or activities like cycling, skiing, ice skating, or snowboarding can heighten overloaded tissues and may need certain models of care depending on the activity at hand. Pain management advice may differ depending on when symptoms are reported – acute treatment is very different to long-term symptoms

 

Pain Management Advice:

• In the clinic, we try to follow similar principles to PEACE & LOVE in addition to exercise as measures for pain relief
• If we believe an overloaded tissue is causing your pain,we try to calm things down by offloading the affected tissue. This may include altering activities or equipment. For example, cyclists may have to adjust their bike set up, skiers could adjust their skis, and runners could adjust their footwear or weekly running volume. At times, we may prescribe rest to allow sufficient time for recovery to avoid overexertion. 
• If both PEACE and LOVE principles as well as activity modifications do not help, an assessment by your physiotherapist would be the next step to follow

 

Conclusion:

When it comes to musculoskeletal injuries during winter, prevention and proactive pain management is key. By taking precautions such as wearing appropriate footwear, being mindful of your movements, and staying cautious on slippery surfaces, you can reduce the risk of injuries. In the event of an injury, we suggest following the pain management advice provided and seeking help from a physiotherapist or other healthcare professional if needed.

If you need further assistance with managing or coming back from a winter sporting injury, our team of physiotherapists are here to help. Click here to book an appointment today!

By Ehsam Popal | Senior Physiotherapist

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References 

1. Dubious B, Esculier J-F.Br J Sports Med Month 2019 V0 No.0
2. Singh DP, Barani Lonbani Z, Woodruff MA, et al. Effects of topical icing on inflammation, angiogenesis, revascularization, and myofiber regeneration in skeletal muscle following contusion injury. Front Physiol 2017;8:93

 

One of the overlooked benefits of exercise is its impact on mental health and wellbeing. Alongside the physical benefits, exercise has been proven to improve mood,  stress, sleep and energy levels; as well as reduce the incidence and severity of mental health conditions like anxiety and depression. For a long time, the impact of exercise on mental health was seen as a “chicken or the egg” situation, but evidence is clear that this is a causal relationship.

Why exercise?

Exercise causes a number of chemical reactions in the brain, including the release of “happy hormones” like endorphins, dopamine and serotonin. This has a huge impact on how we feel, as these chemicals contribute to regulating mood, sleep and motivation (Basso & Suzuki, 2017). These changes occur extremely quickly and a single bout of exercise (e.g., a short 15-minute run) can lead to an immediate feeling of euphoria. This is known as the “runner’s high,” which can also be applied to general exercise. 

On top of its acute benefits, exercise is also extremely effective in the prevention and treatment of mental health conditions, particularly affective disorders like anxiety and depression. In fact, exercise has been shown to be more effective than antidepressants in treating depression without the side effects (Singh et al, 2023).

In an increasingly busy and connected world, exercise also benefits your mental health by giving you time away from checking your phone, emails or other sources of lifestyle stress, which can be quite meditative.  

How can we make sure we’re exercising enough?

Some people love the gym and can do a structured workout 5+ days a week; but if you’re not that person, you can still find a way to get at least 3+ exercise sessions in every week. Some strategies that can help you stay committed to training are to pick a type of exercise you like, have a training buddy to keep you accountable and to use exercise to explore (e.g., walking or cycling around a different area).

Still need some guidance?

Our friendly Exercise Physiologists at Exercise Lab can help by providing you with a suitable exercise program for your individual needs. Click here to start your journey today. 

 

By Simon Latham | Exercise Physiologist

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References

1. Basso JC, Suzuki WA. The Effects of Acute Exercise on Mood, Cognition, Neurophysiology, and Neurochemical Pathways: A Review. Brain Plast. 2017 Mar 28;2(2):127-152. doi: 10.3233/BPL-160040. PMID: 29765853; PMCID: PMC5928534.

2. Singh B, Olds T, Curtis R, et al. Effectiveness of physical activity interventions for improving depression, anxiety and distress: an overview of systematic reviews. British Journal of Sports Medicine Published Online First: 16 February 2023. doi: 10.1136/bjsports-2022-106195

 

What can we do?

By Rachael Kent | Exercise Physiologist 

As the Winter sporting seasons begin to kick off, it’s imperative to continue checking in with your body  to minimise injuries during the season. The start of the season is when we tend to see an uptick in injuries as individuals ramp up their loads up without observing how their body is handling the stress.

 

Our connective tissue continuously adapts to the loads we place on it. However, like all parts of our body, our connective tissue has a certain limit. Tendons are a type of connective tissues that are significantly affected by sudden changes in load. A common tendon injury we see when presented with excessive or sudden changes in loads are termed tendinopathies (aka “unhappy tendons”). Our most up to date understanding of tendinopathies can be summarised in the model below:

We effectively want to keep our tendons happy and pain-free by incorporating interventions that address overall tendon function and capacity (Cook et al., 2016). Tissue capacity is a measure of how much load your tissue can currently handle. When we slightly exceed our tissues current capacity, we inherently challenge our bodies to adapt in order to make the activity easier the next time we perform it. However, stressing our tissues well beyond their capacity levels exponentially increases the risk of injury. 

 

Previous injuries that have not been rehabilitated completely can develop into recurrent injuries; as well as become key contributors for the cascade of compensatory factors that place abnormal forces through otherwise healthy body tissues (Hylin et al., 2017). A good proxy for avoiding this spiraling effect is to be aware of niggles throughout your training or sporting season. It is always better and easier to manage niggles or aches immediately, rather than down the track after they have blossomed into chronic injuries. In fact, niggles and previous injuries are the primary predictors for the development of future injuries (Whalan, Lovell & Samson, 2020).

 

The tricky part is determining when you should continue to push your training versus deloading and recovering. Although there are recommended guidelines around this, it should be individiualised based on current tissue capacity, previous injury history and possibly associated compensatory factors (i.e., biomechanics/movement patterns).

 

If you are unsure where your current tissue capacities lie, want to screen previous injuries or assess your biomechanics, seeing a physiotherapist or exercise physiologist can be quite useful in determining the best plan around injury prevention, as prevention really is the best cure. Click here to book an appointment today!

 

By Veeral Patel | Senior Physiotherapist

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References

1. M. Whalan , R. Lovell & J. A. Sampson, (2020). Do Niggles Matter? – Increased injury risk following physical complaints in football (soccer), Science and Medicine in Football, 4(3), 216-224, DOI: 10.1080/24733938.2019.1705996
2. Cook JL, Rio E, Purdam CR, et al. (2016). Revisiting the continuum model of tendon pathology: what is its merit in clinical practice and research? British Journal of Sports Medicine, 50, 1187-1191.

3. Hylin, M. J., Kerr, A. L., & Holden, R. (2017). Understanding the Mechanisms of Recovery and/or Compensation following Injury. Neural plasticity, 7125057. https://doi.org/10.1155/2017/7125057

If you’re serious about getting into running (or any exercise for that matter) and it’s been a while since you’ve thrown on the runners, there’s a few things to consider and tick off the checklist before heading out the door. 

The list below contains some important factors for injury prevention that people often forget when starting a running program.

Correct Loading Mechanics:

The load placed on your body when running is huge – depending on your speed and gait patterns, you place anywhere between 3-8x your body weight with every step! A 5km run will average a little over 6000 steps, so loading your joints correctly (particularly your hips and knees) is important for the longevity of your joints. 

Hip strength and stability should be at an adequate level to support movement and loading patterns pertaining to running. These include (but are not limited to) hip extension and thoracic rotation.

Difference in Limb Strength:

Strength discrepancies between your left and right leg are normal and common. However, exceeding a 10% difference in strength for a given muscle group (in comparison to its counterpart) can lead to joints experiencing loads they were not biomechanically designed to withstand. The negative impact on the joint is only exacerbated by the increased impact from walking to running.

Before we clear someone to start running or continue after an injury or time-off, it is important for us to run some tests. We use AxIT technology to record and measure the strength between the muscles of their right and left legs. 

For example:

• A normal Hamstring to Quadricep ratio less than 0.66 has been shown to negatively affect lower limb performance (2)

• Hip abduction/adduction ratios of less than 80% have been shown to influence physical performance. (1)

Correct Loading & Preparation for Tendons and Ligaments 

Creating programs which strengthen and prepare muscles is straight forward. However, progressive loading of the tendons and ligaments is often less considered when returning to running – leading to overuse injuries. Tendons and ligaments are incredibly smart.  Like muscles, they adapt in their size and/or material properties according to mechanical load. Developing stiffer tendons by increasing collagen synthesis will assist with the way that both the muscle and tendon together – are able to withstand load. 

Initially, a walking program should be followed to introduce a gradual increase in load to the tendons and progression of volume (e.g., kilometers). When both strength levels are adequate and a progressive walking program has been completed, a running program can be initiated.

As a general guideline, increases should be around 10% per week. However, this is not a concrete rule and should only be used as a guideline for tendon adaptation whilst taking other injuries into consideration. 

Like muscles, tendon and ligament fibers break down slightly during training and during the recovery period – build up stronger in adaptation. The difference is that muscles yield a higher blood supply, therefore their recovery is much faster (up to 24 hours)!

Green line: – acute increase in collagen & protein synthesis. Peaking around 24 hours post exercise and staying elevated up to 80 hours post exercise.  Maroon line: degradation of collagen which occurs simultaneously. Degradation occurs earlier and to a greater extent. This is a normal tendon response.  Purple line: The net balance of collagen synthesis and collagen degradation. A negative net balance occurs 18-36 hours after exercise, following with a positive balance up to 72 hours later (3)

 

Click here to learn more about our team at Exercise Lab.

By Pip Tockuss | Exercise Physiologist

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References

1. Hip Strength testing. (2020). Strength by Numbers. Retrieved March 23, 12 C.E., from https://www.strengthbynumbers.com/resources
2. Knee Strength Testing. (2020). Knee Strength Testing. Retrieved March 23, 12 C.E., from https://www.strengthbynumbers.com/resources
3. Managing patella tendinopathy in powerlifting Pt.1 – Understanding Tendinopathy. (2023). Modern Physiotherapy Aus. Retrieved March 23, 13 C.E., from https://modernphysio.com.au/managing-patella-tendinopathy-in-powerlifting-pt-1-understanding-tendinopathy/