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Hamstring Strain Recovery

 

Outline

Our Hamstring muscle makes up most of our thigh muscle. At the back of our leg it crosses both our knee and hip joint. Because it crosses two joints, it’s primary action is to flex (bend) the knee and extend (bring leg back) at the hip. 

The hamstring is not composed of one muscle but of 3 large muscles: 

  1. Bicep femoris
  2. Semimembranosus
  3. Semitendinosus

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(https://www.jospt.org/doi/full/10.2519/jospt.2010.3047)

For those of you that run, when you are running at 100% speed, at the terminal swing phase your hamstring muscles are percentage activity is:

-Bicep femoris 67% 

-Semi membranisis and semitendinosis at 37%

This is why when we see a running hamstring injury it is usually your bicep femoris.

With hamstring injuries, the most common are hamstring strains (tears) and tendinopathy (tendon overuse injury). 

Recovery

Phase 1 – Protection, Ice, and  NSAIDs (if prescribed by Dr first few days). Therapeutic exercises consist of neuromuscular and isometrics in a protective range. The physio will give you progression criteria to pass you to phase 2. An example of a progression would be normal walking without pain.

Phase 2 – Protection in this phase – the muscle should be pain free in full range, however, we still avoid passive stretching into full range if weakness is still present. Therapeutic exercises consist of neuromuscular and isometrics in a protective range. Therapeutic exercises include neuromuscular, core stabilization, and strength focusing on eccentric control. All exercises need to be pain free. One example of the progression criteria in this phase would be pain free manual muscle test for the hamstring

Phase 3 – In protection for this phase there is no restriction in passive stretching however, sprinting/accelerating should be avoided until the athlete meets return to sport criteria. Therapeutic exercises should consist of sports specific drills, continuing progression of eccentric strength exercises leading towards end of hamstring range and trunk stability.  

Return to sport criteria – In order to return to sport your physio will do some final testing and once you have achieved all the criteria you will be asked to try 2 full training sessions. If there are no impairments such in pain, strength or performance you will be able to return to sport. The hamstring will still be vulnerable 2 months during return to sport. Also, with the recurrence rate of hamstring injury being 2x as likely, it is advised to have a physio monitor your progress throughout your season of sport.

By Physiotherapist, Paulina Backiel

 

 

 

References
1.Erickson LN, Sherry MA. Rehabilitation and return to sport after hamstring strain injury. Journal of sport and health science. 2017 Sep 1;6(3):262-70.
2.Heiderscheit BC, Sherry MA, Silder A, Chumanov ES, Thelen DG. Hamstring strain injuries: recommendations for diagnosis, rehabilitation, and injury prevention. journal of orthopaedic & sports physical therapy. 2010 Feb;40(2):67-81.
Photo retrieved from: http://sportsinjury.wpengine.com/wp-content/uploads/2018/04/Hamstring-Muscles-983×1024.jpg
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3 Steps to Netflix and Chill with Ease

BOSIC Specials

The What

According to recent studies on average we spend 71 minutes if not more on Netflix per day. However, when we find an addictive show we all spend 2 hours, maybe 3 hours sitting down. Long and behold there’s a greater chance of low back pain. 

The How

How did we end up with this pain?

Let’s take a step back and think about it. We have been sitting at our desk for 8-10hours. We have dinner sitting down with your friends and family. Finally to unwind from the day we sit down and cuddle with our partners watching Netflix. Therefore, the grand total of sitting down went from 8 hours to 12+ hours. 

 

Top Recommendations

To help your back and avoid this ache/niggle here are my top 3 recommendations:

1.Move more. 

This is no better time to multitask.  Use this time wisely to fit in your rehab exercises, stretch or increase your mobility. Here is my favourite stretch to Netflix and chill with:

 

    • Hip flexor to hamstring stretch
    • Fig 4 stretch

2. Slouching doesn’t look cool or feel cool.

Slouching generally adds to much strain on your neck and lower back. 

In a slouching position we will be with rounded shoulders forcing us to bend our necks to look up. This will eventually cause neck pain.

 Likewise for the lower back we posterior pelvic tilting and compressing the back making it hard for us to get out the couch. 

TIP: Slide your butt back against the back edge of the couch so you can rest your entire torso against the backrest to sit upright. 

 

3.Ad breaks

Yes ad breaks, but not as you know. Yes, you’re probably thinking, “but I subscribe to Netflix to NOT get ad breaks!” But break time is essential when spending time sitting or lounging.  

Think about scheduling your own breaks during the show or movie (ie every 20minutes) to stretch, go to the bathroom, replenish your snacks, or hell even grab yourself a well deserved drink. Breaking up the TV binge watching cycle will help alleviate the stress on your neck and back so you can watch at the safety and comfort of your own home. 

 

Those are my top 3 Netflix and Chill recommendations. Give those a try and let me know your thoughts. If you are still struggling with pain, don’t forget to book in here or call us at 8599 9811. 

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Types Of Runs For Distance Runners

By Physiotherapist, Paulina Backiel

Introduction

Are you interested in changing up your running routine? Perhaps you are training and are looking to add more challenging types of runs into your routine. Here, Paulina is going over all of the different types of runs that you can do as a distance to runner to improve your speed, cadence, and stamina. 

 

Tempo run
A sustained effort run, running at a higher pace than casula running pace over a given distance or time period.
Ex. 10km at sustained 4’30min/km pace

 

Fartlek
Defined in Swedish for “speed play”
This type of run can vary in distance, playing with quick and slow speeds throughout the run. These runs are usually based on set time intervals rather than distance and utilizing intensity zones.
Ex. 2x3mins at 60% effort, 4x1min at 70-80% effort, 6x30sec at 85-90% effort, rest between each effort

 

Intervals/speed sessions
Also called repetitions, usually a certain distance repeated a number of times.
-Passive recovery = sedentary recovery is considered rest
-Active recovery = walking between each interval is considered rest
Ex. 5x400m, active recovery between intervals (30s walk)
Ex. 6x800m, passive

 

Hills
Usually repetitions done on a specific hill or choice, however you can also change it up and do a hilly distance course.
Ex. Hill repetitions: 60m hill x5 with 20s rest between
Ex. Hilly run: 6km with 300m elevation

 

AT (Anerobic Threshold) run
Running at a hard pace (83-87% MHR) continuously until you start to decline in power/speed due to lactic acid buildup in your muscles preventing you from maintaining that power/speed.
-Anerobic threshold = 83-87% max heart rate (MHR)
-Max heart rate = 220 – Age
Ex running 25mins at 10km pace

 

Long run
An easy run that is the longest run of the week to improve endurance levels, and bodies ability to adapt to sustained energy effort. A long run is dependent on the athlete and their training. Ex half marathon runner’s long run may be 18-20km.

 

Mid-week long run
-50-60% distance of long run
Additional long run

 

Absorption/Recovery Run
An easy short run in the week for the body to absorb the training loads and recover from any hard sessions during the week. These are essential for all runners because recovery is important to decrease injury risk and aid in physiological changes running causes on the body.
Ex. 7km slow run (usually a pace of ~1km/min slower than your average pace)

 

Progressive Run
Just like in the name, in a Progressive run you start at a slower pace then progress to a higher speed slowly in a short or long run.
Ex.5km progressive: (progress 10 sec less every km) 1km – 7’10, 2km – 7’00, 3km – 6’50, 4km – 6’40, 5km – 6’30

 

If you are interested in getting started with running program but don’t know where to start, then start with my personalized running program – Run Faster and Smarter. This bespoke running and strength program will get you running faster and feeling stronger in just four weeks. Click here to book now!

 

Your physio, 
Paulina

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Plantar Fasciitis Treatment

podiatry BOSIC

Do you wake up in the morning with a sharp pain in the heels of your feet? Does this pain subside after you’ve taken a few steps? You’re probably suffering from Plantar Fasciitis. 

So, where exactly is your plantar fascia? Take hold of your foot and pull your toes back. Now run your fingers along the arch of your foot. The rope-like connective tissue that pops out is your plantar fascia. It’s the strongest and longest ligament in your body, stabilising your foot’s arch when you walk.

When the plantar fascia degenerates, it leads to chronic heel pain that we call plantar fasciitis. Doing more activity than normal, exercising when injured, wearing new shoes and even standing for long periods can all cause micro-tearing of the plantar fascia, leading to inflammation and scar tissue formation. More often than not, this will heal if you are off your feet to rest for a while. But if your feet do not get a chance to rest, the tissue will be damaged again as soon as you stand on the feet. That’s why most people feel the strain the first thing in the morning when they wake up. 

 

heel pain

Here are some of the ways our podiatrists treat patients with heel pain:   

  • Do an x-ray and/or ultrasound scan of the foot to find out what’s wrong
  • Help you find the right shoes to wear and advise on activity/ exercise changes to alleviate symptoms
  • Show you how to do specific plantar fasciitis exercises and foot mobilisation for your feet
  • Make custom-made orthotics at our in-house laboratory for your shoes to offload the painful area 
  • Assist with taping and plantar fasciitis strapping techniques – to support the injured area
  • Use the Fasciitis Fighter to do strength training exercises on the fascia
  • Do shock wave therapy for chronic heel pain 

 

Our podiatrists will take measures to speed up the healing process and ensure your heel pain doesn’t return. They will also recommend strength training exercises once your plantar fasciitis issues are resolved. If you’re suffering from plantar fasciitis, give our clinics a call on the numbers below.

Barangaroo: 8599 9811
Bondi Junction: 9386 5400
St Ives: 9440 4600
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Rotator Cuff Muscle and Rotator Cuff Injury

Rotator cuff muscle

The rotator cuff muscle is actually not one muscle but four muscles that all act together to help stabilize our shoulder. The shoulder(glenohumeral joint) is a multi axial joint meaning it can move in multiple directions with stabilization provided by our ligaments, shoulder capsule, and the rotator cuff muscles. Here are the four muscles and the actions they provide:

1. Supraspinatus – shoulder abduction (eg. raising your arm at your side)

2. & 3. Infraspinatus and teres minor – shoulder external rotation (eg. rotating shoulder back when you throw a ball)

4. Subscapularis – shoulder internal rotation (eg. placing hand on belly)

Diagram of the four shoulder muscles that make up the rotator cuff

Shoulder Injury

You can have an overuse (tendinopathy) injury to one of your shoulder muscle(s) or most commonly a muscle tear (strain). The risk of injury increases with age from 9.7% those <20 years to 62% in 80+ year olds. Both tendinopathies and strains can be diagnosed by your physiotherapist. Usually if there is a suspected strain (tear) the physio may send you in for a scan to see how big the tear is. Tears are classified by the National Health Service in England as:

-Small (less than 1cm)

-Medium (1-3cm)

-Large (3-5cm)

-Massive (over 5cm)

Once the physio gets the report they may send you for a consultation with a surgeon if the tear is 3cm or greater to get further guidance for better prognosis. If you have had already had a surgery or are waiting on one, a physio can help you regain functionality during post-op recovery under the guidance of your surgeon.

If you have any concerns about your shoulders, have a shoulder injury, or just want a bit more help finding out how to strengthen your shoulders our physios would be happy to help. Book an appointment HERE. 

 

By Physiotherapist, Paulina Backiel

 

 
 
References
1.May T, Garmel GM. Rotator Cuff Injury. In: StatPearls. StatPearls Publishing, Treasure Island (FL); 2020. https://europepmc.org/article/nbk/nbk547664#free-full-text
2.Scott-Dempster, Claire. “Outpatient Post-Operative Physiotherapy guidelines.” NHS Foundation Trust, August 2019. https://www.ouh.nhs.uk/shoulderandelbow/information/documents/rotator-cuff-repair.pdf
3. Photo retrieved from https://bodyharmonics.com/wp-content/uploads/2015/05/Rotator-Cuff-Muscles.jpg

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Carpal Tunnel Symptoms

Where is my carpal tunnel?

Your carpal tunnel is a shallow and narrow passage in the palmar side of your wrist. It is surrounded by the bones of your wrist, many tendons that run through it and your median nerve. Your median nerve controls the sensation in your thumb, index, middle and half of your ring finger. Carpal tunnel symptoms can occur for a few different reasons.  

Because so many structures pass through this narrow structure, if there is any swelling, the median nerve gets compressed which results in carpal tunnel syndrome. 

What are the symptoms? 

  • Pins and needles into the fingers 
  • Numbness in the first 3 fingers
  • Sharp pain in the wrist 
  • Weakness of the hand 
  • Increased pain in gripping and putting pressure on your palm

 

 

Common causes of carpal tunnel syndrome

There are no real causes of carpal tunnel syndrome but here are a few factors that can increase the your risk: 

  • Pregnancy: due to fluid retention and the compression of the median nerve. 

  • Overuse injuries: where the tendons that pass through the carpal tunnel can get inflamed. 

  • Arthritis: such as rheumatoid arthritis, which can cause swelling and inflammation.

If you have any tingly fingers or wrist pain that you think may be carpal tunnel symptoms, come on in and get it checked out! Give us a call at 8599 9811 or book in here to see one of our physiotherapists today. 

 

 

By Physiotherapist, Vanessa Boon

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What Is The Difference Between Sciatica And Sciatic Nerve Pain?

Many people get diagnosed with sciatic pain but do they know what sciatic pain really is? The words “sciatic pain” and “sciatica” get passed on to many of our patients by health professionals but what do these words mean? 

 

Let’s break it down

The sciatic nerve is the largest spinal nerve in the body. It runs from your lower spine to your toes. This nerve is important, as it helps our lower limb muscles receive signals from the spine, resulting in motor (movement) and sensory (sensation) control of our lower limbs.

Sciatica and sciatic pain/irritation are completely different, however they get mixed up all the time.

 

What is sciatica?

Sciatica is defined in the medical world as a “radiculopathy”(1,2). This means there is a compression of the nerve root at the spinal cord (1,2). Sciatica effects around 40% of lower back patients, with with up to 40% of adults annually (2). The most common types of nerve root compression we see are herniated discs and disc bulges on scans (2). Common signs/symptoms include: radiating pain down the affected limb or limbs, pins and needles, burning sensation, electric sensation or numbness (1,2).

 

What is sciatic nerve pain?

Sciatic nerve pain is an umbrella term used for pain that is associated with lower back and/or lower limb pain (3). The two most common being piriformis muscle syndrome and sacroiliac joint pain. These are often mistaken for sciatica because the symptoms can feel similar however, they do not last as long and are usually not associated with a burning sensation. Piriformis pain is the most common with around 6% of people diagnosed with lower back pain having piriformis syndrome (3). The reason that piriformis pain is often mistaken as sciatica is because in 15-30% of people the sciatic nerve actually passes through the piriformis muscle (3). The nerve can then become compressed as it exits the greater sciatic notch in the glutes causing pain down the leg that can even reach the knee (2,3).

 

 

“The reason that piriformis pain is often mistaken as sciatica is because in 15-30% of people the sciatic nerve actually passes through the piriformis muscle.”

 

 

If you experience any of the above, the treatment that is highly suggested is a combination of physiotherapy and medical (doctor) treatment. The physiotherapist will work with your doctor to help in your recovery. If you have been experiencing ongoing pain in your back that travels down your leg(s), it may be time to visit a physiotherapist. Book in for an appointment HERE. 

 

By Physiotherapist, Paulina Backiel

 

 

 

 

 

References
1.Saleem M, Iftikhar S, Javaid R, Rana T, Rana M, Arfat Y. Sciatica: Medical treatment or Physiotherapy?. African Journal of Pharmacy and Pharmacology. 2019 Aug 31;13(14):203-12.
2.Anikwe EE, Tella BA, Aiyegbusi AI, Chukwu SC. Influence of Nerve Flossing Technique on acute sciatica and hip range of motion. International Journal of Medicine and Biomedical Research. 2015;4(2):91-9.
3.Gondal MJ, Iqbal MA, Nasir RH, Tabasssum R, Rasul A. Study of treatment outcome of piriformis syndrome with and without physiotherapy treatment. Annals of King Edward Medical University. 2015;21(2):78.
4.PHOTO 

https://t3.ftcdn.net/jpg/03/90/14/38/360_F_390143883_DXJPW1m0KAZs9YKezV8nOoVc2KnqaPbd.jpg

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How To Bulletproof Your Shoulders

Have you ever wondered how many of us have experienced shoulder pain? The answer is up to 70%! The pain is usually caused by previous injuries, trauma, or overuse. Any cause could be sports, as certain sports can increase your risk of getting shoulder pain/injuries. Examples of these sports would be swimming, baseball, gymnastics, tennis – any sport that has lots of repetitive movements or overhead movements. In this blog, I am going to outline some of the best exercises to help you bulletproof your shoulders so that you stay injury and pain-free. 

Strengthen your shoulders

The best way to prevent yourself from getting shoulder pain would be to properly strengthen your shoulder stability muscles and work it into your exercise routine. Here are top 3 exercises you can use to bulletproof your shoulders! 

 

Man with doing handstand on bars with strong shoulders1. Resisted external rotation 

How to: 

  • This can be done in side lying with a dumbbell or standing with a resistance band/cable.
  • If done in right side lying, lay on your side keeping your shoulder pointed towards the ceiling.
  • Use a weight between 1-3kg (i do not recommend anything heavier).
  • Place a towel under your right elbow and lightly press down.
  • Start with your hand in front of your belly and lift the weight towards the ceiling.
  • It should be a slow and controlled movement.
  • Perform 15-20 repetitions to increase muscular endurance. 

 

2. Scapula push-ups 

How to: 

  • Start in a high plank with hands directly under shoulders. 
  • Keep core and glutes tight and keep spinal neutral, keeping elbow straight throughout. 
  • Picture a coin between your shoulder blades and pinch while lowering your chest towards the ground. 
  • Push your hands apart and push shoulder blades apart and chest away from ground. 
  • It should be a small controlled movement. 
  • Perform 15-20 repetitions to increase muscular endurance. 

 

3. Low rows 

  • Start standing in front of a resistance band or cable machine
  • Arms outstretched but not locked, keep spinal neutral and core tight with knees unlocked. 
  • Start by picturing a coin between the base of your shoulder blades, squeeze your shoulder blades and pull the band towards your naval 
  • This should be a slow and controlled movements 
  • Perform 15-20 repetitions to increase muscular endurance. 

If you are having ongoing shoulder pain, it may be time to see a physiotherapist. Book in HERE. 

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What Exactly is Tennis Elbow?

Introduction

Tennis elbow is an injury that involves the common extensor tendon situated at the lateral (outside) part of your elbow. This common tendon extends into the muscles that extend the wrist (extensor carpi radialis brevis (ECRB) and longus, extensor digitorum, extensor digiti minimi, and extensor carpi ulnaris). Throughout our day we use and abuse this tendon and associated muscles when we type, use a mouse, lift objects with our hands, garden and more. We commonly use our wrists in sports such as golf, tennis, weight lifting and other racquet sports. 

This injury is an overuse injury, wherein the tendon is not strong enough to handle the load and gets overloaded, irritating the tendon and ultimately causing pain (1). The tendon that is involved mostly 90% of the time is the extensor carpi radialis (1).

diagram of the elbow and forearm showing the area where tennis elbow pain occurs
 
Tennis elbow injury medical vector illustration on white background eps 10
 

 

We used to believe it was tendonitis, however, studies now show it is not an inflammatory disease but an overloading injury (1). This is why if we rest the tendon and then go back to doing daily activities the pain comes back. 

Statistics show about 40% of people will experience tennis elbow in their lifetime, and prevalence of 15% in people who have jobs that require highly repetitive tasks using their hands (2). In half of tennis players with an elbow injury, 75-80% is tennis elbow (2).

 

Are you experiencing tennis elbow? Try this exercise

Isometric wrist extension

-Support forearm of injured elbow on a table with wrist sitting off the edge.

-Place other hand on knuckles

-Extend wrist of injured arm into palm of good hand and hold. You should see your wrist extensors working. This exercise should not be painful.

-Do 3 sets of 10 repetitions of 10s holds

Woman demonstrates an isometric wrist extension to treat tennis elbow
 
 

 

If you are suffering from elbow pain or tennis elbow that has been around for a while feel free to reach out to one of our physiotherapists. They will be more than happy to get you on your way towards recovery.

By Physiotherapist, Paulina Backiel

 

 

References

1.Bhabra G, Wang A, Ebert JR, Edwards P, Zheng M, Zheng MH. Lateral elbow tendinopathy: development of a pathophysiology-based treatment algorithm. Orthopaedic journal of sports medicine. 2016 Nov 1;4(11):2325967116670635.

2.Bisset LM, Vicenzino B. Physiotherapy management of lateral epicondylalgia. Journal of physiotherapy. 2015 Oct 1;61(4):174-81.

3.(photo) https://www.therapy-centre.co.uk/images/Tennis_elbow.jpg

 
 
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The Link Between Your Pillow And Neck Pain

Did you know that your pillow could be the main cause of your neck pain? Besides getting better sleep and feeling rested, the right pillow for you can prevent you from waking up with a “stiff/wry neck”. The question then is which is the best pillow out there to prevent this. The answer is, it depends. The best pillow for you depends on which type of sleeper you are (back/side/front).  

 

Is there a better position to sleep in? 

The answer again is, it depends. Sleeping on your back with a pillow that is too firm or high pushing your into a tucked chin position over stretches the back of your neck. Sleeping on your side with a soft or thin/low pillow does not provide enough support for your neck where it becomes overly bent on one side and over stretched on the other. Sleeping on your front with a firm/medium pillow with your head tilted and twisted towards one side just puts your neck in all sorts of bad angles. The trick is to choose the right pillow for your sleeping posture! 

Woman sleeping in a manner that may cause neck painHow do I pick the best pillow for me? 

There are many ways to select the best pillow but the most important one is, pillow height. I personally prefer and would recommend one with a contour (to support you neck) and made out of memory foam or latex. But again, you have to pick what is best for you and what makes you comfortable.                                   

 

What is the ideal pillow for back sleepers?

A pillow with a low profile, neck support and contour for your head would be ideal. If you do not have that sort of pillow but want to trial if it might be the right fit for you, get a thin towel, roll it up and place it under your neck while your head rests on the pillow. But overall, a low profile pillow is the best for back sleepers. 

 

For side sleepers?

A medium – high profile pillow with a contour is ideal, depending on your shoulder width. Rule of thumb is getting your head and base of neck in alignment with your upper back (how it would be if you were sitting up with your head straight). For those who are wondering if their pillow is too low for them, try adding folded towels under your pillow to trial heights before purchasing a new one.

For tummy sleepers? 

This is definitely not a recommended sleeping position for anyone with neck or upper back pain. But if this is your preferred sleeping position,and you prefer using a pillow, a flat low profile pillow would be the most ideal. 

If you are constantly waking up with neck pain, a stiff neck, want to find a suitable pillow for you or if you cannot figure out what is affecting your sleep quality, give us a call at 8599 9811 or book in here and let us help you sort it out!