Call 07 3102 3337

Call 07 3102 3337

reception@praxisphysio.com.au

Call 07 3102 3337
Book Online
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

Unilateral vs Bilateral Training: Part 1 – Your Comparative Guide

Unilateral vs Bilateral Training: Part 1 – Your Comparative Guide

by | May 19, 2023 | Gym and Strength, Hip, Knee, Lower Back, Return to Sport

We often get asked what are the benefits of one form of exercise versus another. Sometimes this is as simple as discussing the difference between cardio and weights. Today’s article focuses on the difference between a two types of gym based loading programs Bilateral vs Unilateral training. In Part 2, we delve more into some of what the evidence says regarding these modalities.

In general, strength training plays a pivotal role in athletic development, enhancing performance, preventing injuries, and promoting overall fitness. This is especially true for the injured population. As such, our Praxis physiotherapists will discuss with you how your rehabilitation plan will incorporate strength training.

When it comes to strength training though, two primary approaches are often employed: unilateral and bilateral training. Unilateral training focuses on exercises that isolate a single limb or side of the body, whereas bilateral training involves movements that engage both limbs simultaneously. This blog aims to contrast the benefits and drawbacks of unilateral and bilateral strength training methods, examining their impact on athletic performance and overall physical development.

Unilateral Strength Training

Unilateral strength training involves exercises that emphasize working one limb or side of the body independently. One of the significant advantages of unilateral training is its ability to identify and correct muscle imbalances. By targeting each limb separately, athletes can pinpoint weaknesses, imbalances, or asymmetries, and address them with specific exercises. Unilateral training also enhances proprioception and balance by requiring greater neuromuscular control. It activates stabilizer muscles and enhances coordination, which can lead to improved athletic performance and injury prevention.

Moreover, unilateral training allows for greater range of motion and flexibility development, as each limb can move freely without the restrictions imposed by bilateral movements. This can be particularly beneficial for athletes who need to improve mobility and functional strength in specific joints or muscle groups. Additionally, unilateral exercises offer sport-specific advantages by simulating movements that athletes encounter during competition, such as single-leg jumps in basketball, change of direction football or one-arm strokes in swimming.

However, unilateral training does have limitations. It generally requires more time and effort to complete a full-body workout due to the need to perform exercises separately for each limb. Additionally, unilateral exercises tend to involve lower weight loads, which may limit their potential for developing maximum strength.

Bilateral Strength Training

Bilateral strength training, on the other hand, focuses on exercises that engage both limbs simultaneously. One of the primary benefits of bilateral training is the ability to lift heavier weights. This can lead to significant gains in maximal strength and power, making it particularly advantageous for athletes involved in sports that require explosive movements, such as weightlifting or sprinting.

Mid Potion Achilles Tendinopathy Location

Bilateral exercises also promote increased overall muscle mass and hypertrophy due to the higher loading potential. By engaging multiple muscle groups simultaneously, bilateral training can provide a time-efficient method for achieving muscle growth and development. Additionally, the bilateral movements help improve intermuscular coordination, allowing athletes to transfer strength gains more effectively across various activities.

However, bilateral training may not address asymmetries or imbalances as effectively as unilateral training. In some cases, stronger limbs may compensate for weaker ones, perpetuating muscle imbalances and potentially increasing the risk of injury. Moreover, bilateral exercises may not fully translate to specific sport-related movements that often require unilateral actions.

In summary, both unilateral and bilateral strength training methods offer unique benefits and drawbacks for athletes. Unilateral training aids in identifying and correcting muscle imbalances, enhancing proprioception, and improving sport-specific movements. It is a valuable tool for injury prevention and rehabilitation. On the other hand, bilateral training allows athletes to lift heavier weights, develop overall muscle mass, and enhance intermuscular coordination. It is particularly effective for activities that demand explosive power. Ultimately, the choice between unilateral and bilateral training should be determined by an athlete’s specific needs, goals, and the demands of their respective sport. Further, an accurate assessment of any asymmetries that may be present helps to decide where to start. A well-rounded strength training program can incorporate elements of both methods to optimize performance and minimise the risk of injuries.

To read more about the specifics of athletic performance, read our Part 2 Blog.

To help with the genesis of a training program or to chat about your training your goals, book in with one of our knowledgeable Praxis physiotherapists. We are here to help!

Until next time,

Praxis What You Preach

Treatment Strategies

Physiotherapy plays a pivotal role in the management of Achilles tendinopathy. Treatment strategies focus on reducing pain, promoting healing, and improving function. These will include calf strengthening exercises, stretching routines and activity modification as frontline options. Moreover, physiotherapists can guide patients in proper footwear selection, gait retraining, and implementing preventive measures to minimize the risk of reinjury.

Rehabilitation and Prevention

Rehabilitation programs are essential for individuals recovering from Achilles tendinopathy. Gradual progression of exercise intensity, functional training, and sport-specific drills enable patients to regain strength, flexibility, and proprioception while minimizing the risk of relapse. Educating patients on proper warm-up and cool-down routines, appropriate footwear selection, and regular monitoring of training loads can significantly contribute to preventing Achilles tendinopathy in the future. One of the common errors patients make is making rehabilitation too easy, or returning to sport too quickly. Again, physiotherapy play a pivotal role in ensuring you undertake a graduated return to loading as the application of mechanical stress to the Achilles tendon promotes tendon healing and remodeling.

Conclusion

Achilles tendinopathy requires a comprehensive approach for effective management. As physiotherapists, our knowledge and expertise are invaluable in helping you overcome this condition and return to their active lifestyles. To discuss your Achilles issues with us to get you back to what you love doing, book online with Praxis today.

Until next time, Praxis What Your Preach.

Team Praxis

Plantar Fasciopathy: Understanding how to heal your heel pain

Plantar Fasciopathy: Understanding how to heal your heel pain

by | May 16, 2023 | Ankle and Foot, Running Injuries

Feel like your walking on glass in the mornings?  Those first few steps after a long period of sitting hurt the underside of your heel? Struggling to stand at the end of a long day due to your feet? If so, then you may have plantar fasciopathy, also known as plantar fasciitis. Plantar fasciopathy is a common condition that affects the plantar fascia – a thick band of connective tissue on the bottom of the foot. Plantar fasciopathy commonly affects individuals between the ages of 40 and 60, but can affect almost anyone. In this article, we will delve into the causes, symptoms, treatment options, and preventive measures to help you understand, and more importantly manage, this condition.

Causes and Symptoms

Plantar fasciopathy is often caused by repetitive strain or excessive loading of the plantar fascia, leading to microtears and inflammation. Factors such as overuse, improper footwear, high-impact activities, flat or high-arched feet, and tight calf muscles can contribute to its development. The condition is characterised by sharp pain or a dull ache on the underside of the heel or along the arch of the foot. Pain is typically worse in the morning or after periods of inactivity, and may improve with movement. Standing for long periods or walking on hard floor can also be aggravating.

Treatment Options

The treatment of plantar fasciopathy focuses on reducing pain, promoting load tolerance, and addressing the underlying causes. Physiotherapy interventions play a crucial role in managing this condition. Therapeutic techniques such as manual therapy, stretching exercises, and strengthening exercises can help relieve pain, improve flexibility, and restore foot function. Specifically, improving the windlass mechanism (a phenomena that refers to the tightening of the plantar fascia during the push-off phase of walking or running when you big toe extends). This mechanism helps distribute forces evenly throughout the foot and reduces strain on the plantar fascia. More generally, improvement of the footy intrinsics and plantar flexors more generally have been shown to reduce the severity and duration of symptoms as well.

Additionally, the use of orthotics, taping, or night splints may provide support and alleviate symptoms. Extracorporeal shockwave therapy (ESWT) and ultrasound therapy are also viable treatment options in some cases. In severe or persistent cases, corticosteroid injections or surgery may be considered, though this is usually reserved for when conservative measures have failed.

Preventive Measures

Prevention is key to reducing the risk of plantar fasciopathy starting in the first instance. If you are keen to ‘pound the pavement’ for example, then gradually increase activity levels. Avoid sudden changes in intensity or duration to prevent overloading the foot. This may mean dancing long bouts for the first time in a while, or returning to running post injury. Wear footwear that provides adequate arch support and cushioning. Understand the importance of regular stretching exercises for the calf muscles and plantar fascia.

As physiotherapy professionals, we understand that addressing the symptoms of plantar fasciopathy early is essential for providing effective care. At Praxis, effective care means arming you with adequate advice and education so you can help manage the symptoms yourself. Further, implementing appropriate treatment options and emphasizing preventive measures, we support individuals in overcoming foot pain and restoring quality of life. After all, we aim to Prevent, Prepare, Perform! So if you have heel pain that is stopping you from doing what you would like to do, discuss it with our knowledgeable team today!

Until next time – Praxis What You Preach!

📍 Clinics in Teneriffe, Buranda, and Carseldine

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

Stress Fractures in Young Cricket Fast bowlers: A persistent challenge

Stress Fractures in Young Cricket Fast bowlers: A persistent challenge

by | May 16, 2023 | Lower Back, Return to Sport

Lumbar stress fractures are one of the most serious and persistent injuries affecting cricket fast bowlers, especially in adolescents. The repetitive, high-load forces of the bowling action place significant strain on the lower back—particularly the L4 and L5 vertebrae—leading to stress fractures in up to 15–30% of elite junior bowlers. While not the most common cricket injury, they are among the most severe, often sidelining players for 3–6 months—much longer than soft tissue injuries like side strains or hamstring tears. Drawing on my years of experience in cricket physiotherapy, I’ll break down the causes, symptoms, treatment, and prevention of this typically season-ending injury.

Causes and Symptoms:

Lumbar stress fractures in fast bowlers are primarily caused by the high volume of repeated lumbar extension, side flexion, and rotation involved in the bowling action—especially during the delivery stride and follow-through. This repetitive mechanical load places excessive stress on the pars interarticularis, a small but critical bony structure in the lower spine. Over time, microtrauma accumulates and can progress to a stress reaction or fracture, particularly in adolescent bowlers whose bones are still maturing and whose core and hip musculature may lack the strength and control to absorb the forces effectively.

Symptoms typically develop gradually and may include deep, localised lower back pain that worsens during or after bowling, along with stiffness, tenderness to palpation over the lumbar spine, and occasionally pain with hyperextension or single-leg loading tasks. Pain is typically on the opposite side of the bowling arm. Early recognition is key, as continuing to bowl through pain may worsen the injury and extend time away from sport.

Diagnosis:

Lumbar stress fractures are best diagnosed through a combination of clinical assessment and imaging. Clinically, a history of progressive lower back pain in a young fast bowler—particularly pain aggravated by lumbar extension or single-leg loading—is highly suggestive. While plain X-rays are often inconclusive, MRI is the gold standard for early detection. Specifically, THRIVE or VIBE sequences are highly sensitive for identifying bone stress reactions and early pars defects, often before a fracture line is visible. These sequences provide high-resolution, fluid-sensitive imaging that helps detect bone marrow oedema and subtle cortical changes, enabling early intervention before the injury progresses.

Treatment and Rehabilitation:

The management of lumbar stress fractures requires a comprehensive approach. Initially, rest and avoiding activities that exacerbate the pain are essential to allow the bone to heal. A period of complete rest from bowling, coupled with appropriate pain management is usually recommended. A structured rehabilitation program focusing on core stability, flexibility, and strengthening exercises on the lumbar spine, pelvis and lower limbs is crucial for a safe return to bowling. Once a players has reestablished the requisite physical attributes, a graduated bowling plan is established.

Typically, the timeframes vary but follow this timeline

  • Phase 1: Protection & Pain Control – Weeks 0–4 (up to 6 if acute)

  • Phase 2: Early Rehabilitation – Weeks 4–8

  • Phase 3: Progressive Loading – Weeks 8–12

  • Phase 4: Return to Running/Sport Prep – Weeks 12–16

  • Phase 5: Full Return to Sport – ~Weeks 16–20 (or longer for high-load sports)

Prevention Strategies:

Prevention is key in mitigating the risk of lumbar stress fractures. Fast bowlers should maintain a balanced training regime that includes multi-joint strength training, flexibility exercises, and proper warm-up and cool-down routines. Regular monitoring of workload and ensuring adequate recovery time between bowling spells can also minimize the likelihood of injury. Of particular note, is avoiding back to back days of fast bowling in adolescent cricketers.

In summary, lumbar stress fractures pose a significant challenge to cricket fast bowlers, especially those in their teen years or as they transition to junior cricket to senior cricket. A diagnosis typically requires extensive time away from bowling and requires a targeted rehabilitation plan and a cautious return to the sport. By understanding the causes, recognising the symptoms, and implementing effective prevention and strengthening strategies, bowlers can continue to bowl fast and trouble the batsmen down the other end!

If you wanting to minimise your risk of a stress fracture, or think you may have one, feel free to consult with one of our expert physiotherapists, well versed in the cricket literature.

Until next time, Praxis What You Preach

📍 Clinics in Teneriffe, Buranda, and Carseldine

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

About the author. Stephen is an experienced Cricket Physiotherapist having spent 15 years working in elite and semi-elite cricket. He was fortunate enough to have Dr Marc Portus as his mentor early on in his career. Dr Portus is an authority on stress fractures in fast bowlers having completed his PhD in the area and helped shape modern day workload parameters. Stephen’s particular area of interest is in the high performance pathways (U16-U20’s) cricket where stress fractures are often first experienced before professional senior cricket.

To read more about Stephen or book, click here

Understanding Sever’s Disease: A Common Foot Condition in Active Growing Children

Understanding Sever’s Disease: A Common Foot Condition in Active Growing Children

by | May 16, 2023 | Ankle and Foot, Return to Sport, Running Injuries

Understanding Sever’s Disease in Growing Children

Sever’s disease — medically known as calcaneal apophysitis — is a common heel condition affecting active children, especially during growth spurts. Despite its name, it’s not a “disease” in the traditional sense, but an overuse injury of the growth plate at the back of the heel.

What Causes Sever’s Disease?

Sever’s disease develops when repetitive stress irritates the growth plate in the heel bone (the calcaneal apophysis). During adolescence, especially between ages 8–15, the heel bone may grow faster than the surrounding muscles and tendons, causing excessive tension at the Achilles insertion site. When coupled with repetitive impact — such as running, jumping, or playing on hard surfaces — this mechanical overload leads to inflammation and pain.

It’s especially common in sports like soccer, basketball, AFL, netball, and gymnastics. Kids going through growth spurts, or who are highly active without sufficient recovery, are most at risk. Tight calf muscles, poor footwear, and biomechanical factors like flat feet or poor shock absorption may also contribute.

Common Symptoms

The main symptom is heel pain that worsens during physical activity and settles with rest. Children may complain of:

  • Pain or tenderness at the back or underside of the heel

  • Limping or toe-walking, particularly after sport

  • Discomfort when pressing on the heel or squeezing it from both sides

  • Stiffness first thing in the morning or after periods of inactivity

Symptoms are usually one-sided but can be bilateral. If left unaddressed, the pain can start to interfere with participation in sport and physical education at school.

Diagnosis

A diagnosis is usually made through clinical history and physical examination by a physiotherapist. Key indicators include heel pain during activity, recent growth, and tenderness at the posterior heel. The “squeeze test” — applying gentle pressure to both sides of the heel — is often positive.

Imaging (X-ray or MRI) is rarely needed unless symptoms persist longer than expected, or there is suspicion of another diagnosis. Importantly, a visible growth plate on X-ray in this age group is normal and not a reason for concern in itself.

Treatment and Management

Treatment is focused on reducing inflammation, offloading the heel, and supporting the child’s return to normal function. It is important to reassure both child and parent that this is a temporary, self-limiting condition.

Key management strategies include:

  • Load modification: Avoiding or reducing high-impact activity is key, especially sports with frequent jumping or sprinting. Your physio can help create a weekly plan to reduce flare-ups while keeping your child engaged and active.

  • Ice: Icing the heel after sport can reduce inflammation and pain, especially in the early stages.

  • Heel lifts or orthotics: Studies, including the 2016 randomised trial by James et al., show that both orthotic devices and cushioned heel lifts can effectively reduce heel stress. These inserts help absorb shock and reduce Achilles tendon tension.

  • Calf stretching and strengthening: Tight calf muscles increase load on the heel. Scharfbillig et al. (2008) emphasised the role of flexibility programs, particularly eccentric calf training, in improving outcomes.

  • Footwear advice: Supportive, well-fitted athletic shoes are essential. Avoid barefoot running or flat-soled footwear during recovery.

  • Manual therapy and taping: In some cases, hands-on techniques and taping methods may be used to reduce load on the Achilles insertion.

According to the trial by Weert et al. (2016), physical therapy combining load management and exercise-based rehab was just as effective as orthotic devices. This supports a flexible treatment approach tailored to the child’s specific needs and activity level.

Medication: Short courses of anti-inflammatory medication such as ibuprofen can help in more severe cases, especially when pain interferes with sleep or daily function. However, these should always be used under medical advice.

Prevention and Long-Term Outlook

The prognosis for Sever’s disease is excellent. Most children recover fully once the growth plate fuses — typically by age 15 for boys and 13 for girls. The condition does not cause permanent damage, though symptom duration can vary from a few weeks to several months depending on activity levels and adherence to management.

To reduce the risk of recurrence:

  • Encourage a proper warm-up and cool-down routine

  • Ensure sport participation is balanced with adequate rest

  • Maintain calf flexibility and foot strength

  • Use shock-absorbing shoes or orthotics during growth spurts

  • Avoid large increases in training volume or intensity

It’s also helpful to educate kids and parents that some discomfort during growth phases is normal, but persistent pain warrants a review. At Praxis Physiotherapy, our clinicians are experienced in managing growing athletes — and ensuring they don’t miss more game time than necessary.

Summary

Sever’s disease is a common and manageable cause of heel pain in growing children. Early recognition, temporary load reduction, and a guided rehab program can ensure a smooth recovery and quick return to sport. If your child is experiencing heel pain that isn’t improving with rest, book in with the friendly and knowlegable team at Praxis Physiotherapy for a tailored management plan.

Until next time, Praxis What You Preach

📍 Clinics in Teneriffe, Buranda, and Carseldine

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

References

James, A. M., Williams, C. M., & Haines, T. P. (2016). Effectiveness of footwear and foot orthoses for calcaneal apophysitis: a 12-month factorial randomised trial. British Journal of Sports Medicine, 50(20), 1268–1275. https://doi.org/10.1136/bjsports-2015-094986

Scharfbillig, R. W., Jones, S., & Scutter, S. D. (2008). Sever’s Disease: What Does the Literature Really Tell Us? Journal of the American Podiatric Medical Association, 98(3), 212–223. https://doi.org/10.7547/0980212

Weert, H. C., van Dijk, C. N., & Struijs, P. A. (2016). Treatment of Calcaneal Apophysitis: Wait and See Versus Orthotic Device Versus Physical Therapy. Journal of Pediatric Orthopaedics, 36(2), 152–157. https://doi.org/10.1097/BPO.0000000000000417