Hip Archives - Praxis Physiotherapy

Unilateral vs Bilateral Training: Part 1 – Your Comparative Guide

by Stephen Timms | 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

Chronic Groin Pain (Athletic Pubalgia)

by Stephen Timms | Oct 26, 2019 | Gym and Strength, Hip, Pain, Return to Sport, Sports Injury

GROIN PAIN

Groin pain, referred to also as athletic pubalgia, is a common problem for a number of athletes, particularly those who engage in sports that require specific use (or overuse) of lower abdominal muscles and the proximal muscles of the thigh. Predominantly, these activities centre around kicking sports such as AFL and soccer, as well as long distance running. Ice hockey is also a well renowned sport in which chronic groin pain occurs. All these sports involve repetitive energetic kicking, twisting, turning or cutting movements, which are all risk factors for causing pubalgia.

SUMMARY:

Four structures are commonly implicated in the causes of groin pain
Adductor muscles
Pubic bone
Abdominal wall
Iliopsoas
Understanding which of these four structures is causing your pain is key in effective management
Exercise therapy and activity modifications should be the mainstay of treatment
Absolute rest has been shown to be ineffective
Steady gradual progressions through strength and function, tailored to your goals, is key to successful management

ROLE OF HIP ADDUCTORS (groin muscles)

Similar to other joints in the body, the hip relies on muscular control for stability and movement. At the hip, there are five key planes of movement; flexion, extension, abduction, adduction and rotation.

The adductor muscles are a large group of muscles located on the inner side of the thigh, attaching from below the knee, along the shaft of the femur and into the pubic bone of the pelvis.

While acute tears of the adductor muscle is common, more long standing pain is usually the result of an overload of the adductor tendon that attach to the pelvis. This is called an adductor tendinopathy. Adductor enthesopathy is common disorder which effects the bony attachment point of the tendon, with a slight structural difference from tendinopathy, however, management is similar in both cases

MANAGEMENT OPTIONS

Exercise:

Strength and functional based exercise are the core management strategies for adductor tendinopathy, and have been shown to increase function, decrease pain and reduce likelihood of injury [4].

Activity Modification:

Activity modification, especially in the acute phase or when symptoms are significantly affecting function, is key in reducing load on the affected structures and allowing tissues to adapt. [1]

Rest:

While activity modification is important, absolute rest has been shown to be ineffective in the management of adductor tendinopathy, and does not promote adequate tissue repair. [1,2]

Other:

Other conservative measures such as manual therapy, electrotherapy and stretching have been [1] explored, with reduced effect compared exercise prescription. Surgical management is also a potential option, with some positive results emerging for groin pain, though specific evidence [10] around adductor tendinopathy is limited. [10]

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WHY IS EXERCISE IMPORTANT?

Exercise has been shown to increase tendon turnover, meaning in the first 24-36 hours there is a reduction in tendon integrity, but after that there is an overall increase in integrity and strength. Other benefits include: increased blood flow, increase in growth factors, and a reduction in altered pain processes in the brain [14].

WHAT’S THE BEST EXERCISE?

Isometric exercise has been shown to be effective in short term pain relief. Current evidence is unclear as to the best long term exercise strategies, with evidence supporting both eccentric and heavy-slow isotonic exercise. [12]

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EXERCISE PLAN

The Copenhagen Adductor Program [9], with the below dosage, has been shown to significantly improve adductor strength, as well as being effective in groin injury prevention. It is important to note that though the program is eight weeks long, most effective tendon[12] adaptations take ≥ 12 weeks, and a tailored dosage should be discussed with your physiotherapist towards the end stage of rehabilitation.

Depending on how the symptoms affect your function, a reduction in training, running and kicking may also be required. Example progressions are noted below in the running program, in order of loading on adductors.

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ADDITIONAL STRENGTH AND PROGRAMS

While targeted strengthening to the adductors is key, global strengthening around the hip may also aid in a reduction of loading to the tendon. Thorough assessment of your strength through all five movements noted previously is needed, as well as a tailored training program to resolve any discrepancies.

As symptoms reduce and function improves, part practice of painful activities, can be beneficial to reload structures, for example, banded kicking movements in preparation for return to soccer.

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SUMMARY

In chronic adductor tendinopathy, tendon adaptations take time. It is important to understand this as you begin your rehab journey and not progress more than your body can tolerate. Steady gradual progressions through strength and function, tailored to your goals, is key to successful management.

As always, if you have a history of groin pain or are concerned about performance in your chosen sport, contact us today and chat to one of our friendly and knowledgeable physiotherapist to ensure you can Prevent. Prepare. Perform. Alternatively you can book online here

Till next time, Praxis what you Preach