Injury management - Sports Injury

Advanced rehab for leg injuries

by Pete Colagiuri - Sports Physiotherapist

This post on Advanced rehab follows on from Phases 1 and 2 of leg injury rehab, found here.

Phase 3

Load the injured tissue during complex movements

Select movement patterns that mimic sporting demands.

Control the loading via speed, range and complexity of the movement.

There should be no discomfort or soreness at the injury site, however mild tightness may be experienced.

Eg. Walking lunge for calf tears

Add a combination of heavy loading, complex and high speed movements

Select sport-specific movement patterns

Deliberately involve the injured area but only with correct technique (no compensations).

Add load or speed based on the requirements of the sport.

Eg. Box jumps for return to basketball

Sport-specific cardio

Focus on correct technique separately, ie. not during high intensity sessions.

Be wary of fatigue as it will adversely affect technique.

Short sessions of high intensity with variable workload are best for regaining fitness.

Eg. Running intervals of 100m with longer rest breaks

KT tape for lower back pain

by Pete Colagiuri - Sports Physiotherapist

KT Tape for lower back pain is becoming more common.

It seems that the use of KT Tape for lower back pain is being driven by a move away from medication as a way of managing lower back pain.

Is it actually effective or is it just a big band-aid solution – pun intended?

What is the effect of KT Tape generally?

KT Tape, also known as dynamic tape, is a very elastic adhesive tape applied to the skin.

It doesn’t provide any restriction to movement in the way that classic rigid tape does (that is, as a physical barrier to movement.)

Its job is to provide additional feedback to the brain to assist in controlling movement.

As the trunk/limb moves through range of motion, the tape pulls on the skin and provides increased awareness of that movement.

This can be particularly useful in situations where the normal feedback mechanisms have been disrupted, such as ligament damage, or when improved control of the limb can reduce the risk of reinjury.

When using KT Tape for lower back pain, the intended purpose is to improve the awareness of posture and position.

What are the causes of lower back pain?

In modern medicine, this is literally the trillion-dollar question.

Lower back pain is the most common musculoskeletal injury in the world and accounts for huge amounts of time off work and lost productivity.

You can imagine the research dollars that have been poured in to discovering the cause of lower back pain.

So far, after around 50 years of research, we’ve got (almost) nothing.

We know what doesn’t cause lower back pain and we know who’s most at risk of lower back pain but we haven’t cracked the formula on exactly who will get it.

Posture as a cause of lower back pain has been found to be unreliable as a predictive cause.

So if you fix your posture, it doesn’t save you from lower back pain.

Once you’ve got lower back pain, it’s a slightly different story.

The change in posture that we see in those suffering lower back pain is the body’s way of trying to move away from the pain.

But it can also lead to early muscle fatigue and increased soreness later in the day.

How effective is KT Tape for lower back pain?

As mentioned above, KT Tape is not effective in preventing lower back pain episodes.

KT Tape may have a small role in reducing soreness after the onset of lower back pain.

But it’ll only be effective in those who have poor adaptive strategies – in people who subconsciously adjust their posture for the lower back pain but inadvertently cause more pain.

As a Physiotherapist, our advice would be that it’s not the first thing to try after the start of a lower back pain episode.

But if you’re running out of options or if you feel like improved posture might assist your lower back pain in resolving faster, then it’s worth a try.

How to fit KT Tape for lower back pain

The trick to KT Tape for lower back pain to improve posture is to ensure that the tension is just right.

If you’re using it for standing posture, it should be fitted while you’re standing.

Vice versa if you’re using it for your sitting posture, you should apply it while sitting.

Step 1: Move yourself to the position you’d like to be in – that is the posture that gives you the most relief from your symptoms.

Step 2: Apply the KT Tape with only a tiny amount of tension as it comes off its sticky backing.

Once in place, you should only be aware of the tape sticking to your skin without a great deal of tension.

If it already feels like it’s pulling firmly, you need to reduce the amount of tension by removing half the tape and reapplying it over a slightly shorter area.

Step 3: If you then slump down or move into the undesirable posture, you should feel the tape increase noticeably in tension.

If you don’t feel the tape increase in tension, you need to adjusted to be firmer.

Just lift half of the tape off and reapply it over a slightly longer area to increase its base level of tension.

All done: So the end result is a tape that is barely noticeable when you’re in the correct position and distinctly pulling on the skin when you move into the undesirable position.

Warming up when it’s cooling down

by Pete Colagiuri - Sports Physiotherapist

This is an article written for Australian Ultra Running Association (AURA) on warming up in cold weather.

Warming up at the start of a training session serves a number of purposes.

It helps to get joints moving through their normal range to allow efficient biomechanics.

It gets blood flowing through muscles to ensure they’ve got adequate blood supplies for the job ahead.

And it improves the elastic bounce of your connective tissues to ensure they can effectively store energy and aren’t damaged in the stretch/rebound cycle.

Most runners idea of warming up is to just start their run a little slower.

Starting out slower for the first 5 minutes allows time for everything to warm up.

It lets you ease into your optimal, efficient running technique.

However in cooler conditions, warming up like this can present a few challenges, heightening your injury risk.

A typical winter morning in Melbourne, or any winter day in Hobart, involves temperatures in single digits and a wind chill that makes sure you know it’s winter.

Although it feels like you may never get warm, your internal body regulation is still remarkably effective – deeper and bigger muscles will warm up quickly with exercise.

The problem actually relates to feeling cold and having reduced control over your periphery.

When your surface temperature is way down, the ability for your brain to perceive movement is reduced.

With reduced body awareness comes inefficient movements and an increased risk of injury.

We often see a number of mid-winter injuries relating to cold starts – calf injuries from having to jump up over a gutter or hammy injuries in muscles that weren’t ready to stretch out.

SO WHAT’S THE BEST WAY OF OVERCOMING A COLD START?

Dressing for the conditions is good but it still relies on your body providing the warmth that your clothing will retain.

And as any cold weather runner will know, the clothing that makes you comfortable when you step out of the door usually makes you way too hot a few minutes later…

Starting with a good indoor warm-up routine is your magic solution!

That’s not running laps around your living room or garage (as we all did it the height of COVID).

To cover each aspect of the warm-up that we mentioned at the start, you need to get the blood pumping, your joints moving and your connective tissue bouncing.

Once you’ve done your warming up indoors, you can head out the door with the right combo of warm muscles and movement awareness (as well as clothing that’s already begun to store body heat.)

You can get straight into your optimal running technique without the risk of inefficiency or injury.

There’s no right or wrong way of warming up indoors, as long as it provides increased heart rate, full range of motion in leg joints and some bounce.

HERE’S A SIMPLE EXAMPLE FOR WARMING UP (AROUND 30 SECONDS ON EACH EXERCISE)

Alternating forward lunge with increasing depth
Push ups
Box squats over a chair or couch
Walking lunge focusing on stretching out and maintaining stability
Jump squats

Another injury risk factor in cold weather relates to stopping mid run.

This might be a food stop, pausing for a gear change or stopping to chat to a friendly passing runner.

Once any rest stop hits 3 minutes, your heart rate has significantly slowed and there’s less blood pumping to your working muscles.

After around 5 minutes, muscles have started to stiffen up which will affect your technique and efficiency when you start running again.

In cold weather, the negative effects of a rest stop are heightened as your skin surface temperature drops a lot quicker.

Your ability to feel and adjust your running technique is diminished and the risk of injury increases until you warm up again.

If you need to stop for a break of 3 minutes or more, try to keep moving – even walking will maintain connective tissue and muscle properties.

If you cool down too much, start out slow or walk for a few minutes before returning to your training pace.

3 reasons to consider an online injury diagnosis

by Pete Colagiuri - Sports Physiotherapist

In a rapidly advancing digital world, looking for an online injury diagnosis is becoming more common. But this usually leads to reading countless webpages of conflicting info.

Getting an online injury diagnosis with a virtual Physiotherapist is something many wouldn’t have considered.

We’re happy to go to trusted sources online for our finances, food, transport… the list is almost endless.

When it comes to our medical needs, it seems there are two options:

1. the traditional approach (ie. dealing with real people face to face), or

2. the internet’s version of Russian roulette – typing a description of your symptoms into Google and hoping it finds that one page that matches your needs.

The traditional approach to injury diagnosis

There’s nothing wrong with the traditional approach. It’s not broken and it’ll never be replaced with AI-bots delivering online injury diagnosis and rehab.

There’s a certain trust with seeing who you’re dealing with. We make judgements, right or wrong, about their skills based on their appearance (“White lab coat? Must be smart!”)

The obvious downsides are the waiting time for an appointment and the cost of the appointment.

Emergence of the Virtual Medical Professional

Some companies, like Virtuwell, offer online medical services for illness. Other services, like HeyDoctor, offer prescriptions for common ailments.

Both companies are growing at an exponential rate. That’s in part due to COVID but it’s also highlighting a growing integration of medical services and the online world.

These companies are treading a careful line between modern online convenience and traditional medical regulation, which was written long before we contemplated online injury diagnosis and delivery of medical services.

Given the benefits that virtual medical services can offer, it’s hard to ignore the compelling argument for their role in health management.

Available 24/7, 365 days a year

A virtual Physiotherapist is available 24/7 for online injury diagnosis.

That’s important because many conditions benefit from early diagnosis. It can significantly shortened recovery times by ensuring that the correct treatment starts as soon as possible.

For example, you twist your ankle on a Sunday morning run and have to limp home.

Your regular doctor and physiotherapist aren’t back to work until Monday and even then, you’ll need to take time off work to get there.

If you wait until Monday, the injury will be more swollen and painful.

So you decide to do something today.

You ice the area and take some Advil or Nurofen (anti-inflammatory meds).

But if you’ve torn a ligament, the anti-inflammatory meds will increase the bleeding and swelling, delaying your recovery.

Getting advice as soon as you got home from your run would have helped reduce the initial fall out from the injury.

Provides reassurance

Some injuries can be a little concerning but not super debilitating.

It’s not enough to visit your local health professional. But the possibility of a stress fracture or tendon problem can play on your mind.

A virtual Physiotherapist can provide an online injury diagnosis and quick reassurance without the need for an expensive visit to the doctor.

It can confirm (or refute) your suspicions and get you started on the right path to recovery.

Cost effective rehab

Injury rehab is always a careful balance between a comprehensive program and a cost-effective approach.

Cost limitations can often leads to incomplete programs that take shortcuts or miss the final weeks of training.

That’s where a virtual Physiotherapist really shines!

It can deliver customised programs, exercise & instructional videos and a comprehensive “return to sport” approach.

The cost of the program is only a fraction of a program from face to face therapist, making it more likely you’ll be able to see out the full program.

Time to embrace high tech healthcare?

The days of vague or generalised website advice and overly simplistic diagnostics are gone.

The latest crop of virtual medical services are combining expert medical input and cutting edge programming.

This provides an accurate online injury diagnosis, clearly explained.

If offers programs with exercise videos and the same injury advice you’d receive in person from your doctor or physio.