Are you sabotaging your recovery?

Coming back from an injury can be difficult, continuing to train through your injury though is even more difficult. At Active RX Physio we believe you should be able to train (in some capacity) whilst injured and we try to encourage active rehabilitation. With that said we certainly see some people that aren’t just pushing the envelope when it comes to training with an injury but are bursting through it.

We are hoping to provide a couple of pointers things you may be doing that are potentially sabotaging your rehab/recovery and keeping a little niggle around longer than it should be.

Training Through High Level Pain

When recovering, in most instances a little pain is something to be expected and not feared. However continuing to train when experiencing high levels of pain (not that good hard workout type of pain) is certainly not a good approach and its a sure way to keep an injury hanging around . We often will advise pain levels to stay around a 2-3/10 pain. Monitor how you  feel during, after and the next day, if you don’t feel any worse then you get the green light to keep training.. Most times too if you are truly honest with yourself you know when you’re pushing yourself too far.

Not Altering Your Workout

If you are finding that every time you back squat your hips hurts – don’t just keep doing them, there are literally over 10 + variations of the squat you could do to achieve a similar result. This can be extrapolated for nearly all training and it isn’t just limited in the gym – running, cycling etc. All have variations that could be used in the short term whilst you recover. Learn how to adapt, ask someone if you don’t know a alternative but altering a workout to keep you training should be something you can do. What’s that definition of insanity – doing the same thing every single day but expecting a different result?

Not Doing Rehabilitation Exercises

I know physio/rehab exercises sometimes aren’t the most exciting part of training, but if you’re injured they might be essential to your recovery. Remember you shouldn’t have to do these for the rest of your life they are a short term necessity for a quicker return to what you want to do. Not only do they help in recovery they also might be the missing link to make your future (uninjured) self run fast, lift heavier, move freer, jump higher, swim smoother, cycle further, breathe easier… I think you get the point. Physio’s don’t dream up boring exercises for no reason, most of the time they have a specific purpose related to your recovery goals.

Returning to What Injured You Too Soon

Yes we all want to get back to doing what we love to do as fast as possible BUT going back too soon to an activity that caused your injury in the first place may be a recipe for disaster.  You should be able to get back to whatever you like after most injuries (there are always exceptions to the rule) but slowly re-introducing yourself will be the key to making sure you don’t sabotage your recovery. Build the foundations for whatever you are training, whether that be running shorter distances before that marathon, lifting lighter weights before going for a PB – the key is to expose your body to the old movements hopefully with new found strength, mobility and resiliency.

The majority of injuries we see have the potential to recover 100% but I think 80% of injuries take a little longer than we may like thanks to one of the above mentioned factors. Yes it can be frustrating BUT short term self control and diligence will pay off in the long term.

Common mistakes in gym based exercises

Working as a Physio inside a gym has been an eye opening experience. Sure when you train at a gym you see the odd person doing an exercise a bit wrong but when you’re here all day you get to see all sorts of ‘modifications’ to common exercises. A lot of the time they are injuries waiting to happen, you might not get the pain straight away but it might be the reason for your nagging shoulder pain, tight back or stiff neck.

Today’s blog isn’t going to highlight the common culprits you would expect to read about like a deadlift or squat but rather mention a few exercises you might not realise you are compensating on.

Incline/Flat Dumbbell or Barbell Bench Press

I’ll start with the one all the guys love to do. The bench press, in its many forms,is a great way to build a big chest. I often see people lift the back of the head off the bench either throughout the movement or as they push up. This chin poke position will compromise your form and may end up being a contributor to  nagging neck pain.  If you find yourself suffering from a constant stiff neck, check in with your positioning next time you bench press.

Leg Press

Many people regard the leg press as a simple controlled leg exercise where form can’t really be sacrificed. Well unfortunately I disagree. The one error I want to focus on is range – are you going too deep for what your body can control? Of course I’m not encouraging people to do half reps (seriously one of my pet hates is when people only care about how many plates they can put on this machine!!!!) but you also don’t want to go too deep if you don’t have the mobility and strength too do so. Going too deep can irritate the front of your hip and/or your lower back. You should work in a range where your glutes and lower back stay in contact with the seat your hips don’t pull forward and up.

Shoulder Press or DB Seated Shoulder Press

In the pursuit of improving and lifting heavier weights often one will compromise form & it’s often seen in shoulder press movements. I regularly see people arching their lower and mid back to improve their chances of getting the weight above their head. In the short term you will probably get away with it, however the repercussions can be a stiff thoracic spine (upper and mid back), pain in the lower back and neck irritations.  Keep the back flat against the bench or think about keeping our rib cage over your pelvis and use appropriate weights that allow you to control this position.

Step Ups

When doing a step up the leg that should be working and taking the most load should be the leg on the step itself. How many of you feel like the leg on the ground pushes you up just as much? This may not  necessarily be a huge deal from an injury risk perspective but it’s a common mistake we see being made.  The second issue is probably more cause for injury and it’s usually the result of a step that is too high or a weight that is too heavy resulting in lack of control of the movement. We tend to see collapse of the knees especially which places undue stress on the hip and knee joints. Ideally we want too keep that knee over the foot or even have the knee drive out to the side as you step up.

Just so we are clear I am by no means suggesting that any of these exercises are inherently bad. Quite the opposite in fact. They are all very effective exercises that I have in my own gym program. At the end of the day it comes down to how the exercise is done. You will only get away with bad form for so long before something in the system becomes overloaded, tight or weak. I believe your goal should always be to  maintain form, in the long term this approach will make you stronger and more durable.

 

Sever’s Disease

Aches and pains are relatively common in growing children, especially these days where it seems to be the norm for kids to play multiple different sports during the one season. Often it can be tricky for parents of younger kids, some aren’t sure if they are being completely over protective while others feel they may not be empathetic enough to their child’s complaints of musculoskeletal pain.

We see kids regularly in our practice and 90% of them are suffering from a form of ‘growing pain’ with one of the most common areas being pain around the heels. This condition is known Severs Disease.

What is Severs Disease and what are the symptoms?

Severs disease is characterised by pain where the Achilles tendon attaches onto the heel bone (calcaneus). In children who are still growing this is a soft area of the bone where the growth plate has not yet closed. During periods of growth the skeleton grows slightly faster than the soft tissues, resulting in a ‘pulling’ of muscles at their attachment sites, in this case the Achilles into the heel bone. This results in pain right at this junction between tendon and bone or in some cases higher up in the tendon.

Quite often the symptoms can occur on both sides and can include;

  • Heel pain during exercise – traditionally this is increased with jumping and high velocity activities
  • Increased pain or ache after exercise
  • Limping or toe walking as they try to take pressure off the heal
  • Localised heel pain on palpation

Factors that contribute to Severs Disease

  • Growth Spurts – sometimes difficult to gauge as a parent that sees their child every day but kids tend to go through some noticeable spurts where they may jump a shoe size or shoot up a few cm in a short period.
  • Physical Activity Level – Sports that involve running & jumping. Kids that play multiple sports may be at a higher risk.
  • Shoes – Poor footwear choice can place extra strain on the Achilles Tendon.
  • Foot Posture – tight muscles, ankle joints, foot and calf strength can all contribute.

TREATMENT

Severs is an activity related and ‘self-limiting’ condition. For this reason parent & patient education play a very important role as the solution for Severs related pain is not to simply stop sport altogether. Relative rest, load management and activity modification will be important to reducing symptoms and improving recovery.

Potential contributing factors should be addressed by your physio such as;

  • Stiff joints: in this case the two ankle joints – subtalar and talocrural should be assessed
  • Tight muscles – especially the gastrocnemius & soleus muscles (aka the calf) may benefit from massage
  • Muscle weakness around the ankle joint.
  • Other biomechanical factors such as pelvic stability & proprioception.

Generally physiotherapy management will incorporate a strengthening and stretching program that will need to be performed on a regular basis.  Your physio may also offer heel raises / inserts which can be placed inside sports shoes – these work to unload the Achilles tendon and can be a useful aid during painful periods.

Analgesic strategies such as cold packs and medication can provide short term symptomatic relief.

Sever’s Disease can be painful and quite debilitating. We think its definitely worth getting on top of early it as early as a proper diagnosis combined with correct treatment strategies can greatly assist with pain levels and performance.

Self management for long term pain relief

At Active RX one of our main aims is to give our clients the basic knowledge and understanding of how the body is put together in the hope that one will have the ability to SELF-MANAGE their problems and a visit to the physio becomes a complementary appointment.

At the end of taking a new clients history I will ask – What are the goals of your treatment? Often the first reply will be “to have no pain”  and the second most common answer being self-management strategies.

To achieve long term pain relief self-management strategies are vital and this blog post focuses on a few simple ways that you can start to help manage your own pain and dysfunction.

Strengthening

It’s our belief that strengthening is the key to long term pain relief. Of course there are many other factors that contribute but overall weakness is one that simply cannot and should not be overlooked. When we talk about strength it’s all relative, you don’t have to be the strongest person in the gym but what is required is the strength for you to complete your activities of daily living. For example a labourer who loves to lift weights, surf + run will require different strength to a grandmother who like to go on walks and read BUT both need to be strong in their own right. The key is be aware of where you might be lacking and implement exercises that target such weaknesses. It’s also important to remember that the need for strengthening doesn’t mean you need a gym membership, for many simple resistance exercises can be very effectively done at home.

Mobility

Being flexible and pliable is also extremely important, but the term mobility fits the bill a bit better as to be mobile you need to have strength in your flexibility. It’s all well and good to be flexible but if you can’t control that range of motion of your joints and muscles then you may well find yourself on the physio table. Self management requires awareness of flexibility and the ability to be strong through your entire range of movement.  Too often we see someone who has taken up a vigorous stretching program only to find themselves more injured than before. Why? Because they have not learnt to control their complete range of movement. Mobility requires a balance between strength and flexibility. Too little or too much of one just can easily be a contributing factor to longer term pain.

Recovery

Looking after yourself seems like a no-brainer but it’s actually a part of training many people neglect. Recovering from your workouts, games and even everyday life is another step towards long term pain relief. If you’ve put yourself through a grueling training week, slow down for just a moment– have a dip in the ocean, go get a massage, do some stretching. You can check out our blog on ‘there’s no such thing as over training just under recovering’ for some good ideas. Recovery also applies to every day life situations, if you’re a breastfeeding mother a 10 minute trigger ball session can go a long way to release the upper back and shoulder tension. If you’ve just put in a 60+ hour work week to hit a deadline, go for a long walk & swim on the weekend. Then there is recovery in forms you wouldn’t expect; like nutrition, hydration, adequate sleep, sunshine + Vitamin D.  A body that is physically + mentally worn out will be more sensitive to pain, and this is a conversation we often have with clients because their pain may not necessarily be solely musculoskeletal so for a  long term recovery these other holistic factors need to be addressed.

Tips to help you avoid injury

Not all injuries can be avoided, there’s just those freak accidents that no amount of training or foresight can prepare you for. However many injuries occur when the your workload exceeds your capacity.

When we refer to workload we are talking about the demands you have been placing on your body which includes not only your training load but work, gardening, moving house, lack of sleep etc.

To put it simply:

WORKLOAD >> CAPACITY == POTENTIAL INJURY

To avoid these injuries you have one of three choices: increase you capacity, decrease the workload or improve your recovery.

Increase Your Capacity

This means increasing the demands your body can tolerate.

Think of it as a number. If your current capacity is 100, your aim is to improve it to 125 or 150 (or higher if your wish)

How? Through training in all of its forms – strength, flexibility, mobility, aerobic training, sports specific skill work etc. The aim of training  is to push your body as close to your ‘threshold’ as you can. With each session you may try do just a little more, whether its an extra set or few extra reps. This is called progressive overload and it forces your body to start to adapt and change.

Lets consider another example. You are training for your first marathon, and you’re not really a runner. Your first run shouldn’t be 42km, instead you will start small and slowly build up your running tolerance over a matter of weeks; as a result you are increasing your running capacity. This concept can be applied to simple day to day situations. If you don’t normally garden and all of a sudden you spend a weekend shovelling soil there’s a pretty good chance you’ll have a sore back by the end of it because your body is not accustomed to that amount of activity. On the flip side if you garden regularly you have better capacity to tolerate that type of load and your back may not get sore.

Having a greater ‘capacity’ can help to avoid certain types of injuries because the body is better conditioned to deal with greater loads.

Decrease Workload Accumulation

Decreasing workload might seem like the exact opposite of what we just discussed above BUT WAIT… the key word here is ACCUMULATION. Consider 100 as our capacity again. Each different type of workload represents demand on the body and that accumulates over time with the total being our functional capacity.

For example,

    • Workout = 40 + House work and gardening = 20 + Work  = 20

Which leaves us at 70/100. Then your friend rings and asks you if you can help her move house. You politely oblige and that’s another 40 points. Now your capacity is 110/100 and you wake up the next day with a sore, stiff back. It may not  necessarily be the lifting boxes and furniture that caused your back pain but rather an accumulation of that weeks worth of load. What’s the solution? Say no to your friend? Of course not!! It’s more of an awareness thing, firstly to be able to acknowledge that you probably did too much but then also to be able to apply this concept to your training by understanding when you may need back off to protect your body.

Recovery

A very very very important consideration when trying to avoid injury. RECOVERY.

I feel really strongly about this topic (so much so that I have actually written an entire blog on it which you can find HERE).

Let’s stick with our capacity of 100. Remember workload accumulates, and the sum of the total work is the capacity. Strategies that assist with recovery such as sleep, stretching, massages, dry needling, nutrition, hydration, de load weeks etc can all decrease the workload accumulation. They are essentially like a minus in the workload equation because you are paying back to your body. If you find yourself up near your functional capacity threshold, maybe its time to treat yourself to a massage (we have an amazing massage therapist if you need one!!)

These numbers we have used are arbitrary but I think it just helps break it down into simpler terms. Use some of these strategies and you might just notice some of those niggling aches and pains disappear for good!

Training through pregnancy

Falling pregnant is an exciting time for women but it can also be a little bit of an overwhelming and daunting time. Our bodies undergo this amazing transformation and I’ll be honest until I started to experience it myself I couldn’t begin to comprehend how some of my clients were feeling through different stages of their pregnancy.

I think one of the most confusing areas is exercise and training. There is so much information out there about what’s good, what’s bad, what needs to be avoided and unfortunately much of it is conflicting. This blog is aimed at trying to clarify some of the questions around training and exercise while pregnant using a combination of my own experience along with my pre and post natal training.

Can I continue my regular training while I’m pregnant?

The short answer. Yes.

Exercise is very beneficial during pregnancy as it can assist with a whole range of things including preventing excessive weight gain, reducing the risk of Gestational diabetes, reducing the risk and severity of low back pain,  helps maintain physical fitness and may improve symptoms of  depression.

The level of training through pregnancy will depend on a few things.

Firstly what were you doing for exercise before you fell pregnant? If you were regularly engaging in moderate to high intensity training going into pregnancy you can continue with this style of training as long as you are feeling ok.

Someone who was more sedentary prior to pregnancy would be encouraged to commence a lower impact exercise program and slowly progress until they reach the recommended  exercise levels for pregnant women which is 150 minutes of moderate intensity exercise per week (20-30 minutes on most days of the week).

One of the biggest realisations I have had in my own pregnancy is that every day is different. One day energy levels are sky high and I felt great training,  the next day a walk around the block can be a mental and physical struggle. My goal has been to just move in some capacity every single day. I often have to remind myself that I feel better afterwards, and this always runs true.

What exercises should I be avoiding?

This is a tricky one to answer as every women will be different based on their training background.I’m going to break it down into trimesters.

1st Trimester (up to week 13) – assuming you are feeling ok, minimal modifications need to be made. Many women are plagued with fatigue, nausea and morning sickness during the initial stages of pregnancy which can make gym workouts more difficult. I would encourage you to listen to your body, there may be days when. you just don’t feel up to lifting weights, instead go for a walk or a swim.

For cardio workout I encourage women to use their exertion levels as a guide. If 10/10 exertion is maximal activity where you can hardly breathe or speak and 0/10 is at rest then you should aim for about a 6/10 which is a moderate level of intensity. This is a better method than heart rate because naturally your heart rate will be higher during pregnancy.

What about abdominal exercises? Personally I felt uncomfortable performing exercises such as sit ups, crunches and leg lowers from quite early on so I discontinued them. It’s very important to distinguish between this type of abdominal exercise and ‘core’ exercises which are of course very important throughout pregnancy.

I would really encourage you to speak to a trainer or physio who has some experience working with pregnant clients to guide you with this.

As you head into the 2nd Trimester (week 13-27) you will start to notice more physical changes in your body. Yep this is when you will ‘POP’. This is seriously the strangest thing. Literally one day I had that awkward bloated pouch around my midline and then the next day I had this round little pregnant belly.

This is the golden period of pregnancy (for most). A time when you may have a surge in your energy levels and a welcome relief from nausea and morning sickness.

One of the main modifications during this time will be  monitoring (and maybe limiting) exercises that are performed lying flat on your back. (In the past physicians have advised women to  avoid lying on their back because the weight of the baby can put pressure on vena cava which is the main vein which carries blood back to the heart from the lower body). The current guidelines for this vary between different institutions so I think the best approach is to be mindful. If you experience any symptoms such as light headedness, tingling in the legs or general discomfort when on your back then its probably time to modify. You could try performing exercises on a slight incline or just eliminate altogether. At 28 weeks I still feel ok on my back, but every women is different. 

Abdominal exercises such as sit ups, crunches, med ball twists, leg lowers or raises should all be avoided from the second trimester. As previously mentioned ‘core’ based exercises are important and encouraged. If you are unsure I would strongly advice you to seek help from someone that can guide you with what core exercises are suitable at this time. The main concern as you progress into the 2nd trimester is looking for signs of Diastasis Rectus Abdominus which is bulging of the abdominal wall. (Read our blog on Diastasis Recti for more information on this topic)

For cardio based training again I again would encourage a moderate level of exertion (remember 6/10)

What about running? This  is a much debated topic and unfortunately there is no evidence based time when you should stop running.

I absolutely love running and prior to being pregnant I would run 2-3 x week. I chatted to my womens health physio about when I should stop and her advice to me was when it doesn’t feel right anymore and this is what the general recommendation is. This happened at about week 18-20 when I headed out for my usual loop of Centennial park and it just felt different can’t explain exactly what it was but usually running is zone out time and from that day I didn’t enjoy it as much. That was enough for me to consider alternatives.

The concern with higher impact activities such as running and jumping is the extra stress that is placed on our pelvic floor. This hammock of muscles is already working overtime to support the growing weight of the baby so in my opinion there is really nothing to gain my loading it even more. Instead I’ve traded my weekly runs for walking stairs. It get’s my heart rate up, I still get to be outdoors in the fresh air and because summer is coming I get my daily dose of vitamin D.

Trimester 3 (week 28-40): This is a time of rapid growth and also a time when women probably start to become a little more uncomfortable with general day to day movement. With that in mind the training focus from week 28 onwards is really about maintaining a COMFORTABLE level of movement.

Modifications with strength training may need to be made purely as a result if your growing abdomen and what feels comfortable.

I touched on it briefly above but It’s very important to start observing and palpating the abdominal wall for signs of Diastasis rectus abdominus during trimester 3. The abdominals have undergone a huge amount of stretch and the rectus abdominus (your 6 pack muscle) can start to pull apart from the midline of the body. How can you tell? Look and feel. Place your hand on your midline at the level of the belly button and above and you are feeling and looking for bulging. If you do have doming of the abdominals that particular exercise should be ceased or adjusted accordingly. Common exercises that may result in doming can include planks, crunches or front loaded positions.

(Read our blog on Diastasis Recti for more information on this topic)

As an example I regularly used to have cable tricep extension in my program – this is a front loaded exercise. From about 24 weeks I was unable to perform this without getting doming. I have since changed to a single arm version with less weight. This also allows me to use my free hand to monitor my abdominals.

Its also important to be mindful of common everyday positions and movements that can increase the strain on the abdominals such as sitting up out of bed of off the couch – that’s pretty much an identical movement to a sit up. Protect your precious abdominals and begin to roll onto your side to sit up. All these little small stresses can add up over the course of a day!!

Cardio in trimester 3 will really depend on how the woman is feeling. Many will be happy to let go of their higher intensity training towards the end of their pregnancy. Lower impact alternatives include swimming and walking and will probably be the more favourable options during this time.

This has only really scraped the surface when it comes discussing the journey of exercise through pregnancy but think the take home message from me is that if you are unsure of what you can and can’t do don’t turn to the internet for help. Ask someone who knows what they are doing. 

Em is a certified pre and post natal coach and she can help guide you through some of the confusing should and should not’s of exercise through pregnancy. Feel free to get in touch with me via email activerxphysio@gmail.com or comment below if you have any questions!!

Keep an eye out for more pregnancy related posts over the coming weeks!