Call 07 3102 3337

Call 07 3102 3337

reception@praxisphysio.com.au

Call 07 3102 3337
Book Online
Blood Flow Restriction – more than just a gimmick?

Blood Flow Restriction – more than just a gimmick?

by | Oct 11, 2022 | ACL, Gym and Strength, Knee, Reformer Pilates, Return to Sport

Summary:

  • Restriction of blood flow purportedly creates an internal environment of greater stress, thus greater adaptation
  • Importantly, the greater adaptation can occur with less absolute load to damaged or painful tissues
  • Started in healthy population to build muscles but the principles are transferable to rehabilitation
  • Best suited persons who are unable to tolerate normal load
  • Post surgery, tendinopathies and people needing to arrest atrophy or build muscle fast are best candidates

Blood flow restriction (BFR) training is becoming increasingly popular in rehabilitation and conditioning settings. As the name suggests, BFR training incorporates a restriction of blood to an area paired with low resistance training (20-50% of 1 rep maximum). The principle is to achieve greater muscle strength and hypertrophy gains for healthy and load-compromised populations with the same or less load than without a cuff. Essentially – more bang for your buck in the early phases of rehabilitation!

Benefits of BFR include; prevention of muscle mass in early post-operative periods, similar benefits of muscle mass and strength as heavier resistance training in achilles tendinopathies (>70% 1RM) (Centner et al, 2019), and improvement in maximum voluntary torque.

 

Whilst research is still being developed, multiple studies have been conducted recently showing the benefits of BFR training in post-operative populations ie. ACLR, patella / achilles tendinopathies, as well as knee osteoarthritis and patellofemoral pain syndrome.

Here at Praxis Physiotherapy, we have used a BFR cuff paired with low-resistance training on the reformer pilates and in the gym to optimise the distal quadriceps strength post ACL surgery. As you can see we are putting to the distal quadriceps to fatigue under a small amount of load, thus preventing muscle loss (Prue, et al. 2022) which can be common postoperatively.

General prescription guidelines according to the Australian Institute of Sport recommend that “the application of BFR should be limited to less than 20 minutes for lower limb, and 15 minutes for upper limb, before allowing adequate time for reperfusion of tissues (3 min).” (AIS, 2022).

In summary, this is an exciting new area of research that we are investigating clinically. Anecdotally, we hear from patients that they fatigue earlier in the desired muscle groups. We as a Praxis Team are embarking on some in clinic research in the area and hoping to provide feedback on our experiences so keep your eyes peeled. In the meantime, if you are pre or post your operation and are looking to maximise your recovery, come and have a chat with us about whether BFR is suitable for you!

Until next time,

Prevent | Prepare | Perform

Team Praxis

Jumper’s Knee (Patellar Tendinopathy)

Jumper’s Knee (Patellar Tendinopathy)

by | May 17, 2022 | Knee, Return to Sport, Sports Injury, Tendon

Do you play a jumping sport such as volleyball, basketball or AFL? Have pain in the front of your knee when jumping, landing or changing direction? Have you lost some jumping power recently? Well read on friends as you may have a grumbly knee tendon.

Summary:

  • Patellar tendinopathy is summarised clinically as pain and dysfunction in the patellar tendon
  • Most commonly affects jumping athletes from adolescence to early middle age.
  • Return to sport can be slow with physio useful as a front line management tool
  • Often requires prolonged rehabilitation centred around education, strength training and load management

Jumper’s knee (or patellar tendinopathy) as its name suggest predominantly affects athletes who engage in sports which require large volumes of jumping. Jumping dynamically loads the knee and places large loads on the patellar tendons due the large and repeated requirements of the thigh muscles (quadriceps). These include sports that require repeat jump / landing efforts and/or high volumes of load during training and competition. Elite adolescent male athletes tend to be at a higher risk, especially if you play volleyball.

Mid Potion Achilles Tendinopathy Location

Like most injuries, patellar tendinopathy reflects an overload of the tissue and a failed healing response. Tendons tend to most susceptible to long periods of dynamic loading given their role in storing and releasing energy like a spring. The stiffer the spring, the more effective the spring and the more punishment it can take before the function deteriorates.

This injury is one that can be mild or moderate in nature and as such allow playing to some degree. As such, player’s tend to not to miss a lot of games like more “traditional” injuries such as ankle sprains or hamstring tears. It can typically slowly present and have a “warm up phenomena” (as in it can get better during a game), however aches after activity and the next morning. The pain is often at the very bottom of the knee cap, and on the space between the kneecap and the top of the shin bone where the tendon lies.

Key management strategies include ensuring the correct diagnosis and an understanding of tendon pathology (for more on tendon pathology, check out this blog). From there, pain management strategies and workload management is a key tenant to rehabilitation. Above and beyond workload management and good patient education, we at Praxis Physio also test the strength and range of the hip, knee and ankle musculature as well as jumping / landing biomechanics to understand where the likely reasons are for your knee pain.

After a comprehensive assessment, targeted and graduated strengthening is provided. The premise of these early phases are to reduce pain, improve strength, improve function, increase power (specifically the energy storage potential of the tendon) then finally sports specific training and management on symptoms.

As someone who has had an 18 month history of patellar tendinopathy, I personally can attest to the frustration this injury provides. I made many mistakes along my rehabilitation journey – though this was before I was a physiotherapist and took a clinical interest in tendinopathies. Thankfully, the research has come a long way in the last decade, so if you are having ongoing knee pain that you suspect is jumper’s knee, book in with us so we can get you jumping back to your best.

Until next time, Praxis what you Preach.

Stephen Timms

FACT OR FICTION FRIDAY || Overuse injuries need rest and are because I’m doing too much

FACT OR FICTION FRIDAY || Overuse injuries need rest and are because I’m doing too much

by | Dec 20, 2019 | Gym and Strength, Pain, Return to Sport, Sports Injury

ANSWER: FICTION (Mostly – stay with us here) 🙊 Do you keep getting injured when you get back into your usual training after a period of rest 😤? The first graph shows a 65-day cycle of an Olympic athlete. The red lines indicate when the athlete was injured. Looking at the multi-coloured line, you can see that the injuries both occurred when the acute to chronic workload ratio was at its peak. Essentially that means that the loads that preceded the injury were too high relative to the longer term loading of the tissue 😫. This is typically called an overuse injury! Then along comes Mr/Ms physio and looks at the above cycle and says to the Olympian, “Come on mate, we can do better than this…” 😎 Ta da. The second graph shows the yellow section outlining the above 65-day period.
Mid Potion Achilles Tendinopathy Location

As you can see, training following this period is much more frequent and at higher intensities. So do we still assign the original injuries to overuse injuries given the athlete was able to handle much more relatively quickly after?! A better term would be a training load error and something that a sporting physio can help you with 👌. This is a particularly important thing to know given the holidays are just around the corner 🎅!

Get in touch with us if you want to train more with less injuries, or are looking to return to training! 📞(07) 3102 3337 or book online.

Team Praxis

PREVENT | PREPARE | PERFORM

Drew, M. K., & Purdam, C. (2016). Time to bin the term ‘overuse’ injury: is ‘training load error’ a more accurate term? Br J Sports Med, 50(22), 1423. doi:10.1136/bjsports-2015-095543

Sporting Injuries

Sporting Injuries

by | Dec 3, 2019 | Pain, Return to Sport, Sports Injury

Are you a weekend warrior who is plagued by injury or an aspiring athlete trying to find that extra 1% or somewhere in between? We know how frustrating it can sitting on the side lines and not being able to be involved in the things that make you happy. All the Praxis team have (or still do) play sport of some description and understand the anguish that goes hand in hand with injuries. That is why we do what we do!

 

Praxis has an expert team who have been fortunate to travel the country and even the world with various sporting teams. Whether it is Stephen with Cricket Australia teams, Cam with the ICONZ Rugby, Zac with Netball or Emma with AFL Praxis has you covered.
Mid Potion Achilles Tendinopathy Location

We separate ourselves from other therapist because we know that specific, personalised and evidence based physiotherapy is the most effective and efficient method to getting you back to what you love doing quicker and better. Combine that with our years of experience in treating all athletes from the elite to the weekend warrior, and there is no sport we can’t help with!

In summary, we believe that specific, personalised and evidence based physiotherapy is the most effective and efficient method in

If you are looking to Prevent future dysfunction, Prepare for your activity and Perform at your best, the Praxis Team has you covered and will get you achieving your goals sooner! See one of expert team members today by giving us a call on (07) 3102 3337  emailing admin@praxisphysio.com.au or booking online.

Team Praxis

PREVENT | PREPARE | PERFORM

Shin Splints | Physio Guide to Medial Tibial Stress Syndrome

Shin Splints | Physio Guide to Medial Tibial Stress Syndrome

by | Nov 27, 2019 | Ankle and Foot, Return to Sport, Running Injuries, Sports Injury

SUMMARY

  • Shin splints are essentially an overuse injury
  • Numerous factors contribute to symptoms but mainly involving the poor control of force through the lower limbs
  • Important to stop symptoms to avoid developing stress fractures, which require lengthier time away from activity
  • Corrective strengthening exercises, relative rest, and workload management all seem to be treatment mainstays
  • Physiotherapy has a significant role to play in getting back to running and sport
Mid Potion Achilles Tendinopathy Location

SHIN SPLINTS

Shin splints, or as it’s referred to as in the literature, medial tibial stress syndrome (MTSS), is a common injury seen in the recreationally active and army populations. Symptoms typically consist of an aching pain to the lower medial (inside) part of the shin, that can be sharp when running or when inflamed. There can also be some pain and stiffness when you first walk around in the morning, or when you first start your activity.

Risk Factors:

Over 100 potential intrinsic risk factors of MTSS were identified in a recent systematic review [1] involving 21 different studies. Of those risk factors, nine were identified as having a moderate to strong occurrence in clinical practice. Out of these nine, the risk factors that result in the greater loads on the body (such as body mass index) or poorer acceptance of load with running were the most important.

A number of range of motion parameters were also identified. For example, larger plantar flexion range of motion (the movement of pointing your foot down) was identified. It has been hypothesized that the increased plantar flexion results in a greater likelihood of the individual landing on their forefoot rather than their rearfoot while running, possibly increasing the strain on the rear inside leg (posteromedial tibia). Forces on the inside of the shin bone explain the why pain may be present in that area.

Treatment:

Most people tend to simply rest which may decrease symptoms in the short-term, but it doesn’t address the direct cause! The condition is very commonly seen in recreational runners and not as much in your higher-level athletes. Why is this? It’s quite simple! As mentioned in our previous running blogs, the adherence to well-planned running workloads is what separates recreational runners from the competitive or non-injured. Planned training leads to adequate adaptation of the body to the demands placed upon it.

One of areas patients with shin splints focus on is poor “foot posture”. It is very common to hear the same old story, “I have shin splints because my feet are flat, I need orthotics to correct that”. The biggest problem with that approach is that not a lot of people realise that the reason that they are flat footed is not necessarily because of a defect in their feet! It may be because they have strength and control of their hips which is in turn is causing over pronation or flattening of their feet.

The diagram below demonstrates that perfectly!

As the hips cannot stay level during running, this may cause the knees to fall inwards and in turn causes pronation or flattening of the foot. Then, voila! You have increased tractional stress on the medial aspect of the tibia/shin bone. Yes, there is some evidence that poor foot posture can cause the problem, but only in combination with extrinsic risk factors such as over-training and rapid increases in workload.

Poor hip control and strength is also a precursor for many other musculoskeletal conditions such as lower back, hip, knee and Achilles pain. So if we could reduce the risk of these outcomes occurring in the future, why wouldn’t we try!

It is possible that MTSS is a condition where the simple treatment of rest is enough to reduce symptoms. Until proven otherwise, relative rest remains the number one treatment option for reducing your symptoms. However, If addressed early, MTSS can be managed with the combination of targeted strength routines, running workloads, manual therapy and ensuring adequate recovery time between training sessions.

If you are experiencing shin splints or are looking to prevent such injuries from reoccurring, please feel free to book online or give us a call (07) 3102 3337. You’ll receive an in depth assessment and treatment plan to help you achieve your goals and run better for longer!

Till next time, Praxis what you preach.

The Praxis Team.

PREVENT | PREPARE | PERFORM

Images:

The above images are owned by the “Trainer Academy (https://traineracademy.org/) ” and used in this article with thanks.

References:

[1] Winkelmann, Z., Anderson, D., Games, K., & Eberman, L. (2016). Risk factors for medial tibial stress syndrome in active individuals: An evidence-based review. Journal of Athletic Training, 51(12), 1049-1052. 10.4085/1062-6050-51.12.13

Fact or Fiction – Preseason Training

Fact or Fiction – Preseason Training

by | Nov 22, 2019 | Gym and Strength, Return to Sport, Sports Injury

Answer – FACT

With preseason training just around the corner, this blog is a timely reminder that turning up to preseason training consistently will give athletes the best chance of being able to play most games next year.

Murray et al (2017) reported that AFL players who completed <50% of pre-season training were 2x more likely to sustain in-season injury than those who completed >85%! This is not just relevant to elite AFL, it is relevant to all sports of all levels (even more so)! So what’s the take home message? For the best chance to be able to play week in/week out during the competitive phase of the season, consistency during preseason is vital.

If you had injuries last season or are trying to make this your best season yet, see us to make sure you are ticking all the boxes!

#praxisphysio #preventprepareperform #factorfictionfriday #preseasontraining #praxispwhatyoupreach #afl #sportsphysio #preventprepareperform

References:

Murray NB, et al. Relationship Between Preseason Training Load and In-Season Availability in Elite Australian Football Players. Int J Sports Physiol Perform. 2017.