Optimal Loading for Tendon Rehabilitation

As a physiotherapist having many clients with tendon issues, the biggest question I have is why did injury occur in the first place? Was it due to trauma, is it linked to training loads or is it something else causing effects to the tendons. Our job is to help guide you to have the best rehab getting you back into your sport or activities. This blog will discuss the importance of optimal loading for tendon rehabilitation.

Optimal loading is what physios strive to achieve when talking about rehabilitation, although due to the nature of tissue healing and recovery it can be made difficult to follow a ‘recipe’ program. Therefore we need to adapt our exercises and progress you through the rehabilitation process to get you back to the top of your game.

When deciding what rehab pathway is appropriate we must first look at what stage of injury we are in. There are two key stages of tendon injury, reactive and degenerative. A Reactive tendinopathy can be described as an acute tendon injury where appropriate management strategies would be to de-load the tendon to let the inflammatory process settle down, then proceeding with progressing tendon loading. A degenerative tendon is where symptoms have been present for a while. A good progressive loading program to increase tissue capacity and tolerance to load is needed.

The table below describes the nature of these types of injuries:

Reactive Degenerative
Symptom Acute onset of symptoms, slow to settle down Chronic – long history of symptoms
Age 15-25 30-60
Time 2-6 weeks 3-6 months
Physio management Massage, orthotics, Dry needling etc. Progressive load
Treatment Unload and reload Load,- Heavy and slow

The image below can help us understand the architecture of a tendon. As a tendon injury starts to proceed into a degenerative tendon the striation of the collagen go from being very linear and to being disrupted and become more disorganised.  This demonstrates the change that occurs and therefore it is important to have an appropriate exercise program to prevent further injury.

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Here at Bureta Physio we can help guide you through your injury. We will focus on the injury itself but always ask the question to why this occurred in the first place.

Key points:

  • Depending on the type of injury, we need to work together to establish the best management strategies for rehab
  • Acute reactive tendons may need to be unloaded prior to reloading
  • Chronic degenerative tendons can take months to heal fully
  • As a degenerative tendon develops the architecture of the collagen fibres becomes disorganised. Through loading appropriately we can enable the tendon to be able to adapt to required loading and therefore allowing return to sport.

Please call us on 07 576 1860 to discuss your injury and our team will be more than happy to help.

Written by Braedon Catchpole – Physiotherapist

Concussion is a Mild Traumatic Brain Injury.

Concussions – Written by Kimberley Pilbrow (BHSc Physiotherapy)

With the start of another Winter Sports season now upon us, now is a good time for athletes, parents, coaches, officials & supporters to increase their knowledge about concussion.

Concussion is a Mild Traumatic Brain Injury which occurs when someone receives impact to the head or body causing a force to be transmitted to the brain, ie ‘shaking’ inside the skull. In a concussion injury there is no change to the macro-structure of the brain. Ie there is no permanent damage to the brain. However, there are changes at a micro level, meaning it may take some time to re-access the areas of the brain that were affected.

Historically people believed that to sustain a concussion you must be “knocked out” (loss of consciousness), this is not true- 90% of concussion occur without any loss of consciousness AND Loss of consciousness does not relate to their long-term outcomes. Ie someone who is knocked out may return safely to sport in 3-4 weeks, where as someone who is not may take 3months to recover- there is no relationship between “severity” of concussion and length of recovery.

As Concussion is a brain Injury- there is a wide range of symptoms such as:

Visible Signs:
-loss of consciousness
-slow to get up
-unsteady on feet/poor balance
-poor coordination or inappropriate playing behaviour (eg. standing out of position)
-clutching or grabbing at head
-dazed or confused
-vomiting (>once is of greater concern-take to Emergency Department)
-irritability/changes in emotions

Symptoms:
-dizziness
-headache
-nausea
-drowsiness
-“don’t feel right”
-blurred vision
-difficulty concentrating/remembering

If you (or your child) have an incident like this and have one or more of the following symptoms you should:
1) Be removed from sport immediately
2) Monitored by an adult
3) Seek Medical Attention from your GP or Concussion Trained Physiotherapist (Click here for our team)

A full list of symptoms can be found HERE– the Concussion Recognition Tool is a great resource for parents & coaches

Assessment and Treatment of Concussion:
A concussion must be diagnosed by a health professional. Examination from your Physiotherapist will include a group of tests as required including; SCAT5 or SCAT5 Child Assessment (Symptoms, Neurocognitive processing, Balance), Assessment of neck pain and movements, Neurological Exam, and Eye & Head Movements.
Treatment of each concussion is individual- REST IS NOT BEST!!
Your Physiotherapist will work with you on starting appropriate activities EARLY to aide a gradual return to daily activities (highly supported by research), followed by return to work/school and then return to sport. Your treatment plan may include; education about pacing activities, treatment of the neck joints and muscles, relearning eye tracking movements and gradual exercise progressing back to full function including work and sport specific tasks.

Key Points:
-90% of concussions occur without being knocked out
-If you suspect a concussion, remove the athlete from play IMMEDIATELY
-Seek Medical Assessment from someone trained in Concussion
-Rehabilitation is INDIVIDUALISED
-REST IS NOT BEST!
If you have had a concussion, Bureta Physiotherapy will work with you, your family and your doctor to take you through the required steps for full return to function-including sport, school or work.
Early Diagnosis is important for monitoring symptoms and guiding appropriate rehabilitation, contact us TODAY to book an appointment or discuss if our acute concussion service is right for you.

 

 

Abnormalities found on scans in asymptomatic people.

There have been many studies that have explored the abnormalities within our bodies through using different imaging techniques. The key take home message that research has brought to us is we are not all perfect, even if we are walking around pain free performing all our daily activities without issues.
However when injury does occur we may get x-rays, an ultrasound or refer you to a specialist who can get an MRI which can come back with findings such as a disc bulge. As demonstrated in the infographic above, it shows us that at least 37-96% of individuals can have this problem in their lower back, and up to 87% in their neck.
It is also reported that for men aged between 40 and 70 years old, up to 96% of individuals have shoulder abnormalities . Although these individuals can carry out their daily routine symptom free.
There are many findings on imaging from head to toe that are part of the normal ageing process and yet do not affect any part of our social or work life or our physical activity. What we don’t know is that we may have already been living with them for many years in our lives. This goes to show that even if we have an ‘abnormality’ within our body on imaging, it doesn’t necessarily mean that we are ‘injured’ or that our injuries are as bad as they present.

Image: Leedarrenh

Lateral ankle sprains – How should they be managed?

Diagnosis, Treatment and prevention of ankle sprains: Update of an evidence-based clinical guideline – vuurberg et al., 2018.
Lateral ankle sprains, how should they be managed

Lateral (outside) ankle sprains are the most common ankle injury. Approximately 40% of all traumatic ankle injuries occur during sport, and only 50% of individuals seek medical attention.
Due to the poor attention to injury, a large population develop chronic ankle instability. 1-4 years following initial injury, 5-46% of individuals with chronic ankle instability still experience pain, 3-34% has recurrent sprains, and 33-55% report instability.
Risk Factors
Predisposing factors that increase the risk of sustaining a lateral ankle sprain compose of Intrinsic factors (patient-related), and Extrinsic factors (sport, environment).
Intrinsic risk factors
Modifiable risk factors include:
• Reduced strength around the ankle and calf
• Limited ankle mobility and range
• Poor proprioception (“the sense of the relative position of one’s own parts of the body and strength of effort being employed in movement”)
• Low cardiorespiratory endurance
• Increased BMI (Body mass index)
• Preseason deficiencies in postural control/balance e.g single leg stand
Non-modifiable risk factors include:
• Anatomical abnormalities in the ankle, knee alignment, and multiple clinical defects
Extrinsic risk factors
• Sport dependent – Highest incidence of lateral ankle sprains were found in: Basketball, indoor volleyball (landing following jumping), field sports, climbing.
• Playing surface – Natural grass vs artificial turf vs court
• Position played in sport – e.g within soccer, defenders obtain 42.3% of lateral ankle sprains in the sport.
Treatment
Below is some of the latest evidence for the best treatment options, and how we can get you back running around with the kids, or back onto the sports field.

 R.I.C.E (Rest, Ice, Compression, Elevation)
Purpose: to reduce pain and swelling, improve patient function
RICE alone as a treatment is not enough, the best evidence is to apply the RICE principles alongside with exercise therapy.

 Non-steroidal anti-inflammatory drugs (NSAID’S) – E.g Ibuprofen, naproxen, diclofenac
Purpose: to reduce pain and swelling for acute injuries
If you have any concerns in regards to medication please discuss with your doctor.
Adverse effects may include: stomach discomfort, allergic reactions, heart burn, nausea, vomiting, diarrhea and/or constipation and more.

Immobilisation
A minimum of 4 weeks in a low leg cast following an acute lateral ankle sprain results in less optimal outcomes when compared with functional support (brace, tape, tubigrip/bandage) and exercise strategies with duration of 4-6 weeks.
However recent evidence showed a short period (less than 10 days) of immobilisation with plaster cast or rigid support (brace) can be of added value in the treatment of acute lateral ligament injuries as it helps reduce pain and oedema (swelling), and improves functional outcomes

Functional support i.e ankle brace/ tape/ tubigrip
Tubigrip/compression stocking following the acute phase of treatment begins to become unhelpful as it doesn’t provide sufficient support. Therefore using a lace up brace or semi-rigid brace will provide enough ankle support
Ankle braces results in better outcome compared to rigid or K-tape
K-tape is unlikely to provide sufficient mechanical support to unstable ankles

 Exercise
Consist of neuromuscular and proprioceptive exercises
Reduce the risk of recurrent injuries by reducing ankle instability, and associated with quicker time to recovery and enhanced outcomes

 Manual mobilisations
Manual mobilisations provide short term increase in ankle range of movement and can reduce pain in lateral ankle sprains
However manual therapy in combination with exercise therapy results in better outcomes than exercises alone

 Surgical therapy
60-70% of individuals who sustain lateral ankle sprains respond well to non-surgical treatment programmes
Surgery is mainly reserved for patients who have chronic ankle instability and who have not responded to comprehensive exercise-based physio programme.

Other therapies
Other treatment options are can also be used during treatment, although please discussed with your physio if these are beneficial for you.
These including: Acupuncture, Vibration therapy, laser therapy, electrotherapy, shockwave therapy, ultrasound.

Here at Bureta Physio we can properly assess your injury and give you the appropriate recommendations to get you back into what you love doing. Call 07 576 1860 to arrange an appointment time or click here to book online

 

Keeping you safe on the slopes

With the snow season commencing the excitement can be as intense as the chill; but there should be some things to take into consideration before strapping on our boots and hitting the slopes. Snow sports have a high risk for serious injuries. Although most injuries are caused from unexpected and uncontrollable factors such as weather conditions, falls and collisions; these can be minimised with good preparation and safety practices.

Falls and collisions on the mountain can be traumatic and could be caused by many factors;

  • Fatigue
  • Lack of instruction
  • Using slopes unsuitable for skill level
  • Faulty or ill-fitting equipment
  • Altitude sickness
  • Dehydration
  • Being off pieste
  • Back country without knowledge and/or experience
  • Failure to observe warning/ safety signs

Here are the National Ski Areas Association Responsibility Code for Reducing Risk

  • Always stay in control
  • People ahead of you have the right of way
  • Stop in a safe place for you and others
  • Whenever starting downhill or merging, look uphill and yield
  • Use devices to help prevent runaway equipment
  • Observe signs and warnings, and keep off closed trails
  • Know how to use the lifts safely

 

Equipment Essentials

  • Wear a helmet- it can save your life!
  • Good quality goggles; essential for seeing the contouring of the ground especially in low light conditions

Recommended for beginners and those who spend significant time on the mountain

  • Knee pads
  • Elbow pads
  • Wrist guards

Vital tip! Make sure your equipment is serviced and personally fitted to your experience level, weight and height. This ensures the safety features will work as they are designed to.

 

Stay within your skill level .
Familiarise yourself with which colour slopes match with which difficulty to avoid being in a slope that is too difficult.

Before considering going off pieste ask yourself; do I have the knowledge and experience? Are the conditions safe? Am I sure where the section will end up? Do I have the knowledge and gear in case of an avalanche?

If the weather changes suddenly make sure to; keep close to the slope markers and look out for warning signs and abide by them.

Most importantly make sure you feel confident to stop and/or change direction safely and quickly in case of an emergency.

Additional tips:
Parents supervise your children ensuring they are hydrated and fed, skiing appropriate slopes for their skill level and that they are abiding by the ski code.

AVOID DRINKING ALCOHOL- this can cause loss of judgement/ balance and control which could lead to injuries to yourself and/or others.

 

How physiotherapy can help?
To enjoy the ski season to its full potential prevention of injuries is more effective than treatment. The stronger, fitter and more flexible you are, the less likely you are to injure yourself in an accident and this is how physiotherapy can help! Physiotherapy can provide you with an individualised exercise program to increase your body’s capacity to cope with the physical demands of snow sports.  The program can be tailored to your personal weaknesses /tightness whilst also taking into account any previous and/or current injuries; chronic or acute. We can take you through the appropriate warm up and cool down techniques / exercises/stretches targeting your individual needs. Furthermore we can give pointers on your technique designed for injury management and prevention. By addressing these factors we can help improve your performance on the slopes and reduce your risk of injuries.

Enjoy your time on the slopes !

Running Injuries: Can I train through?

Authored by Donna Withers – Physiotherapist @ Bureta

This is a common question we get asked. As a runner it is always our goal to be running one hundred percent pain free. Unfortunately in reality this is often not the case as many runners are constantly dealing with a niggle whether it be a slight pain in the knee to a tight calf or a niggling hamstring. These small niggles and aches often don’t bother us enough to need to take time out from running but do stop training from being enjoyable.

There are a wide range of running injuries that are common complaints amongst the running population. These range from severe injuries which require a lot of time off to mild aches that can come and go. You can reduce the risk of needing to take too much time off with how you go about managing your injury. Taking the time to seek treatment and getting a treatment plan that focuses on the causative and underlying factors and developing a long term management plan for prevention which often includes strengthening, stretching and regular maintenance through the use of a roller and massage can significantly reduce time off.

An example of a very common running injury is Patellofemoral Syndrome also known as “runners knee” this is the irritation of the cartilage on the underside of your knee cap. This is commonly seen in runners who don’t have good biomechanics with loading/running. This can be caused by a number of factors i.e. weakness of the quads, gluts, hips or poor foot control/overpronation (rolling in). By focusing on the correct strength exercises which improve biomechanics and therefore reduce the loading of your knee training can be continued by reducing intensity and cross training.

Prevention is always the key whether you have an injury or you are just looking to avoid one your physiotherapist at Bureta can assess your biomechanics and work with you to develop a management plan to keep you out on the track. See our previous blog on some tips for running injury prevention. Remember the best injury cure is injury prevention – happy running!!

How To Recover From Injury Faster

In order to achieve wellness, optimal performance and/or full recovery from injury or illness a combination of movement and exercise, nutrition and hydration, rest and recovery, and thought and stress control are necessary.

Movement and Exercise:

The right type and amount of exercise stimulates the growth and strengthening of injured tissues and is vital to the healing process following an injury.

Nutrition and Hydration:

It is important to eat the right amount and right type of food to ensure that specific nutrients are available for tissue repair. Drinking an adequate amount of water is essential to allow hydration of your joints, allowing your cartilage, discs and nerves to function normally.

Rest and Recovery:

Your body heals when you rest. It is important to get a balance with the right amount of exercise versus the right amount of rest. At nighttime your body undergoes its physical repair between the hours of 11pm and 1am.

Thought and Stress Control:

Excessive stress, extreme emotional responses and negative thought patterns may all interfere with the healing process.

Your physiotherapist is able to discuss all of these components with you giving you advice and information on how you can manage these factors to achieve the best results for your injury.