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Why The “Wait And See” Approach May Leave You With A Poorer Outcome.

Why The “Wait And See” Approach May Leave You With A Poorer Outcome.

by | May 29, 2023 | Pain, Recovery

We are all guilty of it. Putting off seeing someone about that niggle. “it will be right” we tell ourselves as we trudge on through life, sport and recreation. The “wait and see” approach, when applied to acute musculoskeletal injuries, refers to a common tendency for individuals to delay seeking appropriate medical intervention and instead hope that the injury will resolve on its own over time. While some minor injuries may indeed improve with rest and self-care, this approach can potentially lead to poorer outcomes in several ways. Let’s take a look at how putting off seeking treatment have a negative affect on your rehabilitation.

Delayed Diagnosis:

“Dr Google” is great but often it doesn’t always provide the end user (you) a balanced view. By waiting to seek medical attention, you risk delaying the accurate diagnosis of your injury. Prompt diagnosis is crucial as it allows for appropriate treatment planning and prevents potential complications. Certain injuries, such as fractures or ligament tears, may require specific interventions like imaging, immobilization, casting, or surgery. Without timely assessment, the injury might worsen or heal improperly. Even something less “serious” like a muscle tear has been shown to do better with early interventions, when compared to delayed rehabilitation.

Increased Pain and Discomfort:

Many acute musculoskeletal injuries, such as sprains, strains, or muscle tears, can be quite painful. Delaying treatment means prolonging your pain and discomfort. Seeking appropriate care early on can provide pain relief measures, such as solid advice and education regarding what positions or activities may ease or aggravate your pain. Further, physiotherapists can offer manual therapy techniques to manage your symptoms effectively. When appropriate, they can refer to other healthcare professionals regarding medications for pain relief.

Impaired Healing:

Many a moon ago (and unfortunately in some corners of the rehabilitation world) the number one method for recovery was rest. In fact, one study that explored the effects of prolonged bed rest on back pain is the “Oslo Back Pain Study” published in 1998. This study followed 278 patients with acute low back pain and randomly assigned them to two groups: one that received two days of bed rest and one that received seven days of bed rest. The study found that there was no significant difference in pain intensity, functional disability, or sick leave between the two groups. This has been further backed up with a cochrane review in 2005 outlining the same results.

Proper management and intervention in the early stages of an acute injury can facilitate optimal healing. Physiotherapy, for example, can play a crucial role in promoting healing by utilising specific exercises, manual therapy, and modalities to reduce pain, restore joint mobility, improve muscle strength, and prevent complications like muscle stiffness or spasm. Delaying physiotherapy may lead to prolonged healing time, reduced range of motion, muscle weakness, and diminished functional outcomes even reducing the chance of developing chronic pain.

Delaying Care Implications:

A landmark study by Linton et al (1993) from the Orebro Medical Center in Sweden found that early active physical therapy significantly reduces the risk of chronic pain in patients experiencing their first episode of acute musculoskeletal pain. In the study, patients were either seen by a physical therapist within three days of injury or had to wait weeks to months for treatment. All patients were medically assessed to rule out serious conditions, and the early intervention group received tailored advice on maintaining daily activities and exercises, with optional ongoing treatment for up to 12 weeks.

At 12-month follow-up, early intervention led to markedly better outcomes: only 2% of this group developed chronic pain versus 15% in the delayed group. Those receiving early therapy also had fewer days off work—32% missed no days at all, and only 17% were off for more than 30 days, compared to 31% in the delayed treatment group. These results highlight the clear benefits of early, active physiotherapy in preventing chronic disability.

Functional Limitations and Disability:

Without timely intervention, an acute musculoskeletal injury can lead to functional limitations, decreased mobility, and potential disability. The longer you wait to address the injury, the more time it may take to regain full function and return to your regular activities. Physiotherapy can help expedite the recovery process by providing targeted exercises and interventions aimed at restoring strength, flexibility, and functional abilities.

Psychological Impact:

Acute injuries can have a significant psychological impact in some people, causing frustration, anxiety, and a sense of helplessness. Delaying treatment may exacerbate these emotional challenges, as prolonged pain and functional limitations can lead to increased stress and reduced quality of life. Seeking prompt medical attention and engaging in a comprehensive rehabilitation program, including physiotherapy, can help address both the physical and psychological aspects of the injury. As they say, fail to plan is a plan to fail.

In summary, taking a “wait and see” approach to acute musculoskeletal injuries often leads to poorer outcomes. Early medical advice—especially when combined with physiotherapy—can accelerate healing, reduce pain and disability, and support a faster return to full activity. At the very least, it ensures you’re on the right path from the start. So, if you do find yourself injured (hopefully not anytime soon!), don’t hesitate to reach out to one of our expert and friendly Praxis Physios. We’re here to help you recover with confidence.

Until next time… Praxis What You Preach

📍 Clinics in Teneriffe, Buranda, and Carseldine

💪 Trusted by athletes. Backed by evidence. Here for everyone.

References:

  1. Chou R, Qaseem A, Snow V, et al. Diagnosis and treatment of low back pain: A joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147:478–491. [PubMed]
  2. Linton SJ, Helsing A, Anderson DA. Controlled study of effects of an early intervention on acute musculoskeletal pain problems. Pain. 1993;54:353–359. [PubMed]
  3. Pinnington MA, Miller J, Stanley I. An evaluation of prompt access to physiotherapy in the management of low back pain in primary care. Fam Pract. 2004;21:372–380. [PubMed]
  4. Bigos S, Boyer O, et al. Acute low back pain in adults. AHCPR Publication 95-0642. 1994.
  5. Fritz JM, Delitto A, Erhard RE. Spine. Vol. 28. 2003. Comparison of classification-based physical therapy with therapy based on clinical practiced guidelines for patients with acute low back pain: A randomized clinical trial; pp. 1363–1371. [PubMed]
  6. Delitto A, Erhard RE, Bowling RW. A treatment based classification approach to low back syndrome: Identifying and staging patients for conservative treatment. Phys Ther. 1995;75:470–485. [PubMed]
  7. Spengler D, Bigos SJ, Martin NZ, Zeh J, Fisher L, Nachenson A. Back injuries in industry: A retrospective study. Overview and cost analysis. Spine. 1986;2:241–245. [PubMed]
  8. Leavitt SS, Johnson TL, Beyer JD. The process of recovery, Part 1. Med. Surg. 1971;40:7–14.[PubMed]
  9. Hagen, K. B., Jamtvedt, G., Hilde, G., & Winnem, M. F. (2005). The updated cochrane review of bed rest for low back pain and sciatica. Spine, 30(5), 542–546. https://doi.org/10.1097/01.brs.0000154625.02586.95
Hamstring Strain Injuries: Lessons from Personal Experience and the Latest Research

Hamstring Strain Injuries: Lessons from Personal Experience and the Latest Research

by | May 29, 2023 | Gym and Strength, Return to Sport, Running Injuries

Recently, in an effort to keep the ballooning effects of the all-you-can-eat buffet at bay during my Cricket Australia Indian tour, I ramped up my high-intensity running load. Things were going splendidly — four days of high-intensity running under my belt — until day five, when 90% of the way through a very intense interval session, I tore my hamstring.

I felt the tell-tale sensation so many of my patients describe: a sharp tearing and retraction sensation in my outer thigh while sprinting. I had to pull up immediately and iced the injury straight away. You’ll be happy to hear that I’ve since fully recovered. No longer ‘gun shy’ at my top speeds (which, admittedly, are not that fast!), my strength has vastly improved, and I’m back running at full capacity.

Having treated countless hamstring injuries through my long involvement in recreational, semi-elite, and elite sport — especially with Cricket Australia teams and the Aspley Hornets NEAFL squad — this experience gave me even deeper appreciation for how tricky these injuries can be. Hamstring strains are one of the most common injuries in running athletes, responsible for significant downtime and lost performance. Hamstring injuries have remained the most prevalent injury in professional AFL for the past 21 consecutive seasons (Orchard et al., 2013), with the average 2012 injury costing clubs over $40,000 per player!

Understanding Hamstring Injury Mechanisms

Most hamstring tears occur during the late-swing phase of running, where the hamstring undergoes rapid lengthening while producing high forces (Danielsson et al., 2020). Key risk factors include:

  • High eccentric loading demands.

  • Poor neuromuscular control.

  • Muscle imbalances (particularly hamstrings vs quadriceps).

  • Fatigue — as evidenced by my own injury, occurring late in a demanding session!

Importantly, the long head of biceps femoris is the most commonly injured muscle, partly due to its higher proportion of fast-twitch fibers and its anatomical position under stretch during running (Martin et al., 2022).

Fatigue, poor trunk/pelvic control, and sudden spikes in high-speed running are emerging as significant contributors to hamstring strain risk, particularly in field and court sports (Martin et al., 2022).

Preventing Hamstring Injuries

The good news is, hamstring injuries can often be prevented with smart training. Strengthening the hamstrings through eccentric exercises like Nordic hamstring curls and single-leg Romanian deadlifts has been shown to reduce injury rates significantly (Al Attar et al., 2017; Martin et al., 2022).

Effective prevention programs should also include:

  • Agility and trunk stabilization exercises — not just strength work (Martin et al., 2022).

  • Warm-up routines with dynamic stretching and sport-specific drills.

  • Monitoring high-speed running loads to avoid sudden spikes in intensity.

Addressing muscle imbalances is key too. Maintaining a healthy strength ratio between the quadriceps and hamstrings — and ensuring good trunk and gluteal control — promotes optimal biomechanics and reduces injury risk (Martin et al., 2022).

Recovering Well After a Hamstring Injury

A proper recovery should include:

  • Early management: Controlling swelling and pain with ice and appropriate activity modification.

  • Progressive eccentric strengthening: Integrated carefully to build resilience.

  • Functional rehabilitation: Sprinting drills, agility work, and sport-specific movements are crucial before returning to full play (Martin et al., 2022).

Interestingly, studies show athletes who follow programs that include eccentric training and trunk stability work have lower reinjury rates than those who just focus on basic strength and stretching (de Visser et al., 2012; Martin et al., 2022).

Return-to-play decisions should be made carefully. Factors like strength symmetry, absence of pain, and readiness for high-speed running should all be considered to reduce the risk of reinjury, which can be as high as 30% otherwise (Martin et al., 2022).

Final Thoughts

Even as a physio, my personal hamstring tear was a stark reminder that fatigue, progressive loading, and structured rehab are vital ingredients for both prevention and recovery. Whether you’re a weekend warrior, a professional cricketer, or just trying to beat the buffet, hamstring health is crucial.

If you’d like help strengthening your hamstrings, managing an existing injury, or optimising your running and performance, feel free to reach out. I (and my hamstrings) would be happy to help!

Till next time, Praxis what you Preach!

Backed by evidence. Trusted by athletes. Here for every body.

References

  • Al Attar, W.S.A., et al. (2017). The effectiveness of injury prevention programs in reducing the incidence of hamstring injuries in soccer players: a systematic review and meta-analysis. Journal of Physiotherapy, 63(1), 11–17.

  • Danielsson, B., et al. (2020). Mechanisms of hamstring strain injury: current concepts. Sports Medicine, 50(4), 669–682.

  • Martin, R.L., et al. (2022). Hamstring strain injury in athletes: Clinical Practice Guidelines. Journal of Orthopaedic & Sports Physical Therapy, 52(3), CPG1–CPG44.

  • Orchard, J.W., et al. (2013). AFL Injury Report 2012.

Understanding the “side strain” in cricket fast bowlers: Your guide to rehabilitation

Understanding the “side strain” in cricket fast bowlers: Your guide to rehabilitation

by | May 26, 2023 | Gym and Strength, Return to Sport

Cricket Side Strains in Fast Bowlers: Causes, Prevention, and Rehabilitation

Cricket, a sport demanding significant physical prowess—especially from fast bowlers—often sees athletes pushing their bodies to the limit. This intensity, while integral to performance, can lead to injuries, with side strains being notably common. This Praxis What You Preach blog explores their causes, prevention, and rehabilitation strategies, emphasising the pivotal role of physiotherapy in recovery and return to play.

What is a Side Strain?

A side strain, or intercostal muscle strain, involves damage to the muscles between the ribs—most commonly the internal obliques. These muscles stabilise the rib cage and generate trunk rotation during bowling. Side strains typically cause acute lateral trunk pain, often on the opposite side to the bowling arm, and usually occur during a forceful delivery, particularly when the front arm pulls down (Orchard et al., 2016). As someone who has torn his side twice bowling, it felt like someone had stabbed me! 

Risk Factors

Common risk factors for side strains in fast bowlers include:

  • Early Season Exposure: Injuries often spike at the beginning of the season due to sudden increases in load (Orchard et al., 2016). This is especially true in athletes transitioning to senior cricket. 

  • Incomplete Rehabilitation from Previous Injuries: Athletes with prior injuries, especially involving the trunk or spine, are more vulnerable (Kountouris & Connell, 2013).

  • Fast Bowling Biomechanics: Fast bowlers are at significantly greater risk than spinners due to higher trunk rotation velocity and forces (Hardcastle et al., 2015).

  • Recurrent Injury Rates: There is a high recurrence rate of side strains within the same season if not managed properly (Kountouris & Connell, 2013).

Diagnosis

Diagnosis is primarily clinical, based on sudden pain over the lower ribs, tenderness, and pain during oblique muscle activation (e.g., resisted side bending). Our deep exposure to professional cricket—working closely with elite fast bowlers—gives us a unique edge in accurately diagnosing side strains, often identifying subtle movement patterns and tissue responses that general assessments may overlook. MRI is often used to confirm the diagnosis and assess tear severity (Orchard et al., 2016).

Management and Rehabilitation

Effective rehab balances protection and progressive loading. Key strategies include:

  • Initial Rest and Pain Management: Reduces inflammation and prevents worsening.

  • Graduated Physiotherapy: Builds strength and flexibility in core and trunk muscles (Solomen et al., 2015).

  • Sport-Specific Drills: Return to bowling should include load monitoring and video-based feedback.

  • Cross-Training: Maintains cardiovascular fitness and lower-body strength without aggravating the injury.

Mild cases resolve in 4–5 weeks; severe injuries may need 6–8 weeks or longer (Orchard et al., 2016).

Prevention Through Strength & Conditioning

A 2015 study by Solomen et al. showed that preseason core strengthening exercises significantly reduced side strain incidence among medium-pace bowlers, highlighting the importance of structured prevention programs (Solomen et al., 2015). 

Final Word

In summary, fast bowling is tough work so your body has to be strong and resilient. Good structured strength training helps! If you do suffer a side strain, patience, adherence to rehabilitation protocols, and close monitoring are essential for a successful recovery from a side strain.

If you’re a cricketer struggling with side strains or looking to prevent them, don’t wait for the season to take its toll. At Praxis, we specialise in cricket-specific physiotherapy, grounded in professional-level expertise. With years of hands-on experience in elite cricket environments, we offer advanced assessment, rehab, and return-to-play strategies tailored to the demands of fast bowling. Book a consultation today and let’s get you back to doing what you love—stronger, safer, and better prepared.

For more on fast bowler injuries – check out our blog on lumbar stress fractures 

Until next time, Praxis What You Preach

📍 Clinics in Teneriffe, Buranda, and Carseldine

💪 Trusted by athletes. Backed by evidence. Here for everyone.

Split Squat vs Squat vs Deadlift: How to tailor your lower body training

Split Squat vs Squat vs Deadlift: How to tailor your lower body training

by | May 26, 2023 | Gym and Strength, Return to Sport, Running Injuries

The age old question: What’s the best gym activity for my sport? Well – the answer should always be “it depends”. Even the same athlete playing the same sport will have different requirements at different parts of a season. Generally speaking, there are some common exercises in utilised by strength coaches when programming for athletes. The split squat, squat, and deadlift are all compound exercises that target various muscle groups and are commonly included in strength training programs. In today’s Praxis What You Preach article, we are going to breakdown the kinematic (joint angles) and inverse dynamic (joint forces from assumed joint angles) differences between these exercises. We’ll also briefly discuss what sports may benefit, but as just mentioned, the answer is “it depends”.

The Split Squat

The split squat is a unilateral lower body exercise that primarily targets the quadriceps, hamstrings, glutes, and hip stabilisers. It is a personal favourite of mine as I believe it replicates many athletic positions and helps identify any asymmetries there may be. In this exercise, you start in a staggered stance with one foot forward and the other foot positioned behind. The front leg performs most of the work, while the back leg provides support.

The Movement

  • The front knee flexes and extends, moving vertically.
  • The rear leg remains relatively stationary, providing balance and stability.
  • The hip joint of the front leg moves through flexion and extension.

What’s working?

  • The front leg experiences greater joint forces and moments due to supporting most of the load.
  • The knee extensors (quadriceps) and hip extensors (glutes) generate the majority of the force to extend the knee and hip joints.
  • The rear leg primarily acts as a stabilizer rather than generating significant force.

Sports?

The split squat is a versatile exercise that can benefit individuals participating in a wide range of sports. Running, jumping and change of direction field sports such as AFL and soccer seem to benefit well due to the asymmetrical load on the pelvis. The increased loading of the hip stabilising muscles make this a useful exercise for tennis players, volleyballers and track and field (eg triple jumpers) athletes as well.

The Squat

An absolute staple of the gym! The squat is a bilateral lower body exercise that primarily targets the quadriceps, hamstrings, glutes, and lower back muscles. For the sake of this argument, talking about a Barbell back squat. It involves descending into a squatting position while maintaining a relatively upright trunk and then returning to a standing position.

The Movement

  • The hips and knees flex simultaneously, moving in a coordinated manner.
  • The knees move forward, tracking over the toes
  • The torso tilts forward slightly, maintaining a neutral spine but a bit of flex here is fine (and biomechanical studies show you can’t not flex the spine)

What’s Working?

  • The quadriceps, hamstrings, and glutes generate force to extend the hips and knees during the ascent phase.
  • The erector spinae and other lower back muscles provide stabilization and contribute to maintaining an upright posture.
  • The knee extensors (quadriceps) experience higher forces and moments during the descent and ascent phases.

Sports?

Squats help with vertical force generation so jumping sports like basketball and volleyball are sports that would benefit. The Barbell back squat is also central in powerlifting, olympic lifting and Crossfit. Given you can load significant weights to the bar, back squats are also useful for football codes whe are required to absorb impacts during tackles.

The Deadlift

The deadlift is a bilateral exercise that primarily targets the posterior chain, including the glutes, hamstrings, erector spinae, and upper back muscles. It involves lifting a loaded barbell or other weight from the floor while maintaining proper form.

The Movement

  • The hips hinge backward, allowing the torso to lean forward while maintaining a neutral spine.
  • The knees flex to a lesser extent compared to the squat.
  • The barbell moves vertically in a straight line close to the body.

What’s Working?

  • The glutes, hamstrings, and erector spinae generate force to extend the hips and maintain a neutral spine.
  • The quadriceps contribute to knee extension.
  • The upper back muscles help stabilize the spine and prevent excessive forward flexion.
  • The lower back muscles experience significant forces and moments due to their role in maintaining spinal alignment.

Sports?

Powerlifting, Olympic lifting and Crossfit are the obvious ones that spring to mind. But tackling sports such as rugby can benefit. Given the predominance of back musculature, rowers will benefit here. Wrestlers and MMA athletes will also benefit due to the whole body nature of a deadlift.

Overall, while all three exercises involve lower body movements, they differ in terms of joint angles, muscle activation patterns, and force distribution. Understanding these differences can help tailor training programs to specific goals and individual needs. We also modify these exercises further to tailor our rehabilitation needs, In that vein, it’s important to be conscious of technique when performing these exercises to maximise their effectiveness and reduce the risk of injury.

So if you are growing stale in your lower body workouts, try and mix it up with some of the above. There are also plenty of variations of the above to alter the movement and forces even more! If you are after some help to modify your gym program, chat to us today – we are here to help!

Until next time, Praxis What You Preach…

📍 Clinics in Teneriffe, Buranda, and Carseldine

💪 Trusted by athletes. Backed by evidence. Here for everyone.

Unilateral vs Bilateral Training – Part 2: Performance outcomes

Unilateral vs Bilateral Training – Part 2: Performance outcomes

by | May 22, 2023 | Uncategorized

In part 1 of this blog, we discussed the generalities associated with bilateral vs unilateral training. In part two, we discuss the findings of a scientific systematic review and metaanalysis (essentially getting all the papers published in the area and collating the data. The paper by Liao et al (2022) discusses how the type of training effects strength, jump performance, speed and change of direction.
Mid Potion Achilles Tendinopathy Location

Strength Gains:

Unsurprisingly, one of the key findings of the review was that both unilateral and bilateral resistance training interventions led to significant improvements in strength measures. However, the analysis revealed that bilateral training demonstrated a slightly greater effect on maximal strength gains compared to unilateral training. This is primarily attributed to the increased activation of synergistic muscles and neural adaptations that occur when both limbs are engaged simultaneously.

Jump Performance:

Jumping ability is a crucial determinant of athletic performance. The review highlighted that both unilateral and bilateral resistance training had positive effects on jump performance, particularly in terms of vertical jump height and power. However, when comparing the two training modalities, bilateral training showed a slight advantage in eliciting greater improvements in vertical jump performance. The increased activation of the lower limb muscles during bilateral exercises likely contributes to enhanced explosive power.

Linear Speed:

Again, the findings of the review indicated that both unilateral and bilateral resistance training interventions can improve linear speed to a similar extent. Unilateral training, focusing on the individual limb, has been shown to improve stride length and stride frequency, which are essential determinants of sprinting speed. On the other hand, bilateral training enhances muscular power and coordination, leading to improvements in overall running speed.

Change of Direction Speed:

Change of direction speed, commonly assessed through agility tests, is crucial for sports that involve rapid changes in movement direction. The meta-analysis revealed that both unilateral and bilateral resistance training interventions significantly improved change of direction speed. However, unilateral training appeared to have a slightly greater effect on agility performance. Unilateral exercises require greater stabilization and control from individual muscles, which can enhance an athlete’s ability to decelerate, change direction, and accelerate again quickly.

In summary, based on the systematic review and meta-analysis, both unilateral and bilateral resistance training interventions have positive effects on measures of strength, jump performance, linear speed, and change of direction speed. While bilateral training may lead to slightly greater improvements in maximal strength and vertical jump height, unilateral training may offer a slight advantage in terms of change of direction speed. It is important to note that the choice between unilateral and bilateral training should be based on individual goals, sport-specific requirements, and the patient’s needs. Therefore, sports physiotherapists and strength and conditioning coaches should carefully consider these factors when designing exercise programs to optimise outcomes for their patients.

Remember, it is always recommended to consult your qualified Praxis physiotherapist before starting any exercise program, especially if you have pre-existing medical conditions or injuries. We can provide personalised guidance and ensure that your training program aligns with your specific needs and goals.

Until next time,

Praxis What You Preach