Category Archives for "injury"

What is PNF Stretching?

Proprioceptive Neuromuscular Facilitation, also known as PNF stretching, is a technique employed to improve muscle elasticity and range of motion. PNF is frequently used by therapists to restore functional range of motion and increase strength capabilities in patients who have sustained soft tissue damage or in post-surgery rehabilitation. It is found that consistent performance of PNF stretching and PNF stretching post-exercise may increase athletic performance by increasing range of motion. It is evident in literature that there are two types of techniques that can be utilized under PNF stretching.

The contract-relax method (CR) includes lengthening the targeted muscle and holding it in that position while the targeted muscle is contracted to its maximum isometrically for a period of time. A short period of relaxation and a passive stretch of the targeted muscle follows this initial contraction phase. The contract-relax-antagonist-contract method (CRAC) begins with the same procedure as the CR method. However, it takes a further step by contracting the antagonist muscle to the targeted muscle instead of passively stretching the targeted muscle.

How to Properly Perform a PNF Stretch:

Contract-Relax (CR) Method:

1) Stretch targeted muscle to the limit of normal range of motion. Contract the targeted muscle group for 5 – 10 seconds while a partner or immovable object such as a band applies sufficient resistance to inhibit movement of the muscle group.

2) Relax the targeted muscle group for 3 – 5 seconds.

3) Have your partner passively stretch the targeted muscle group by applying a controlled, deeper stretch for about 20 – 30 seconds into a greater range of motion.

4) Relax the muscle for approximately 30 seconds before repeating the above process 2 or 3 more times.

Contract-Relax-Antagonist-Contract (CRAC) Method:

1) Stretch targeted muscle to the limit of normal range of motion. Contract the targeted muscle group for 5 – 10 seconds while a partner or immovable object such as a band applies sufficient resistance to inhibit movement of the muscle group.

2) Relax the targeted muscle group for 3 – 5 seconds.

3) Contract the antagonist muscle (opposite to targeted muscle group) for 5 – 10 seconds.

4) After brief period of relaxation, have your partner passively stretch the targeted muscle group by applying a controlled, deeper stretch for about 20 – 30 seconds into a greater range of motion.

5) Relax the muscle for approximately 30 seconds before repeating the above process 2 or 3 more times.

Example of PNF Stretching for the Lower Body: 

Begin by lying on your back with one leg on the floor and the other leg extended and stretched into the limit of your normal range of motion. 

Contract the hamstring of the stretched leg and have your partner resist leg movement. 

Relax the hamstrings then have your partner passively stretch the leg past its normal range of movement.
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Knee Injury Prevention Guideline

Knee and ACL injuries commonly occur in sports such as soccer, ultimate, and rugby. Athletes may require months to even more than a year to recover and to be able to return to play. There is a vast amount of literature describing a number of ways on how to prevent knee and ACL injuries. However, the most effective prevention strategies are the ones that are based on scientific evidence, a thorough assessment made by the coach and medical team, and the individual’s input.

Strongly suggested by research, programs most beneficial in preventing injuries consist of flexibility drills, running drills, strength training, core strength, and plyometrics. Each session should last approximately 20 minutes with a goal of exercising a minimum of 30 minutes per week. Programs should be implemented through out the year from preseason to regular season. Although most research studies focused on athletes between the ages of 12 and 25 years, these programs may benefit older individuals.

Recommended Exercises

Dynamic Stretches:

1) Toe Taps: Standing tall, kick one leg up and touch your toes to the palm of your hand. Alternate legs. Repeat 10 times on each side.

2) Reverse Lunge & Hop: Step back with one leg until you get into a lunge position. Swing the back leg forward until your knee is bent at a right angle by your chest. Maintain an upright body and repeat on the other side. Perform 10 repetitions on each side.

3) Calf Stretch: Standing tall on one leg, extend the other leg forward with only the heel in contact with the floor. Gently bend forward at the hips and feel a stretch along the front leg. Hold for 30 seconds and repeat on other leg. Perform 3 times on each side.

Running Drills: 

Perform running drills such as forward and backward running or bounding. Watch Physiotherapist Claire lead two athletes through a series of running and other dynamic drills below.

Strength Training: 

Two-legged Squat:

Starting with tall posture, engage your core below the belly button by drawing the inner core muscles towards the spine without arching the low back. With arms in a ready position do a two legged squat with your body weight distributed equally over both feet. Don’t go any lower than a ninety degree bend in the knees, keeping your knees in alignment with your second toe and over your heels as much as possible. Hold for a good long second and then straighten back up with your butt muscles to the start. Do three sets of fifteen repetitions daily.

Advanced Superman Deadlifts:

Start by holding on to a 5 pound dumbbell on the same side as the leg that you are going to extend back on. With nice tall posture, engage your core below the belly button. Keeping your spine flat, bend forward at the hips while you extend the leg back and reaching forward with the opposite arm and holding onto the 5 pound dumbbell with the other hand. Remember to keep that hip down on the side you’re extending the leg back on. Do 3 sets, 10 repetitions, holding for 3 seconds.

Split Squat Jumps:

Start with a nice tall posture and your inner core pulled in to keep your low back flat. Engage your back leg into extension by pushing the back forefoot into a solid bench or a chair supported against a wall. With your arms in the ready position bend the knee to 90 degrees by bringing the butt down and then jump back up. Keep your thigh strong by preventing the knee from buckling inwards. Keep your knee over the heel and don’t let it go over your toes. Do 3 sets of 10 on each side.

Core Strength Exercises:

1) Planks: Begin on the floor resting on your forearms and knees. Extend both legs until your whole body forms a straight line from the top of your head to your feet. Engage the core and glute muscles. Begin by holding this position for 30 seconds. Progress to 60 seconds or more to increase difficulty.

2) Glute Bridge: Begin on the floor with your back flat, legs bent at approximately 90 degrees and both feet on the ground. Place both arms to the side then engage your core as you lift your hips up. Hold for a second or two at the top as you squeeze your glute muscles.

Plyometrics

1) Box Jumps: Use a box that is around your knee height or higher. Stand in front of the box with your feet shoulder-width apart. Bend slightly downwards, swing your arms back, then swing them forward and explode up off the ground onto the box. Repeat 10 times.

2) Lateral Skater Jumps: Begin by standing on one leg and bend the other leg. Jump sidewards and land on the leg that was bent. Then switch sides. Repeat 10 on each side.

References:
https://www.ufvcascades.ca/2018/01/cascades-mens-soccer-program-to-host-id-camp/
https://www.jospt.org/doi/full/10.2519/jospt.2018.0509
InSync Physiotherapy is a multi-award winning health clinic helping you in Sports Injuries, Physiotherapy, Exercise Rehabilitation, Massage Therapy, Acupuncture & IMS.

Quick Recovery for Finger Sprains

Finger sprains commonly occur in sports and every day activities that involve heavy lifting or repetitive hand motions. Falls or contact sports such as football may even force a finger out of its normal joint position resulting in a dislocation. The force to the finger may cause joints in the finger to hyperextend or move sideways. Sprains of the finger are classified according to the extent of injury or damage.

Classification:

1) Grade I – Mild: A first degree sprained finger is present when the ligaments are only stretched but not ruptured. There may be localized swelling, slight pain, and slight reduction in range of motion, but strength remains unaffected. An individual may continue to engage in an activity. Taping of the injured finger may be more effective. Recovery is immediate.

2) Grade II – Moderate: A second degree sprained finger occurs when there is partial ligament tears, a greater reduction in range of motion and some loss of strength with more swelling and pain. The joint capsule may also be damaged. Recovery will take longer.

3) Grade III – Severe: A third degree sprained finger involves complete rupture of the ligament, complete loss of range of motion and typically dislocation of the finger. Significant pain and swelling is present. X-ray is required for diagnosis and surgery may be indicated.

Treatment:

In the first 48 to 72 hours after the sprain, the individual should protect the finger by taping it to the adjacent finger or by using a finger brace. Apply ice for about 15 min every two hours with a small ice pack wrapped in a dry towel or use a large cup filled with cold water and some ice for immersion.

Once swelling has gone down, the individual may begin light range of motion exercises by placing a soft object such as a tennis ball or rolled sock in the palm of the hand and gently squeezing the object.  Repeat 10 times and stop if any pain arises. Surgery may be indicated for third degree sprains. Consult a physician for the appropriate diagnosis.

Strengthening:

1) Ball Grip: Hold a ball in the palm of the hand with all fingers enclosing the ball and gently squeeze. Hold, then relax.

2) Pinch: Place a ball between the thumb and index finger. Gently squeeze, then relax.

3) Opposition: Hold a ball with the thumb and pinky finger. Gently squeeze the ball using the two fingers, then relax.

4) Side-Squeeze: Place a ball between any two fingers and gently squeeze, then relax.

InSync Physiotherapy is a multi-award winning health clinic helping you in Sports Injuries, Physiotherapy, Exercise Rehabilitation, Massage Therapy, Acupuncture & IMS.

5 Strengthening Exercises for Dancers

Overuse injuries are commonly found in dancers due to their intense training regimes. Nearly 60 to 90% of dancers experience an injury or multiple injuries during their careers (Steinberg, Siev-Ner, Peleg, et al., 2013). These injuries include chrondromalacia patella (“runner’s knee”), Achilles tendinopathy, and metatarsal (foot) fractures. Some major causes of injury may be due to anatomic structure, genetics, training regime, improper technique, floor surfaces, age, body mass index, muscle imbalance, nutrition, and menstrual function (Steinberg et al., 2013).

Dance typically includes being on the toes and forefoot in a extreme plantar flexion position, known as “en pointe.” Individuals with poor balance and landing techniques will experience higher ground reaction forces which may subsequently strain the back, knees, and ankles. Incorrect form in many non-professional dancers entail a valgus knee position (knees caved inwards) and hip adduction. Conversely, mature, experienced dancers are able to rely on stronger hip and knee joint muscles to stabilize themselves during landing from jumps. Young dancers also experience lower back pain. Causative factors include high preseason training intensity, history of low back pain, low body weight, scoliosis, and stress fracture in the pars articularis of the spine (Steinberg et al., 2013).

Studies have recommended minimal exposure for young dancers to overload exercises, especially those involving the spine and caution with extensive stretching exercises (Steinberg et al., 2013).

Prevention

Here are a few essential tips to reduce the risk of injury:

  • Wear proper footwear and clothing
  • Drink fluids regularly
  • Do not dance through pain as it will exacerbate the damage
  • Practice correct dance technique 
  • Take adequate breaks during and between dance sessions
  • Ensure proper warm-up and cool-down (approximately 5-10 minutes)
  • Use preventative taping and/or braces if necessary

Strengthening

1) Woodchops – hold a light dumbbell or single cable in the highest pulley position with both hands and bring the weight downwards diagonally to the side of the leg opposite to the starting position. Remember to keep a flat back and tight core through out the motion. Repeat 8 to 12 reps on each side.
2) Lateral Step Downs – stand beside a step or a box, then place one foot on the step. Lift the other leg upwards by bending the knee to 90 degrees. Then bring the foot back down to the ground. Repeat 8 to 12 reps before switching sides. 
3) Core Stability – place your stomach onto a ball and keep the spine in a neutral position. Keep the inner core muscles engaged and reach one arm up in front with the opposite leg extended back. Hold for 3 to 5 seconds before switching sides. Repeat 10 times on each side.
4) Superman Deadlifts – hold a light dumbbell to the same side as the leg that will be extended back on. With a nice tall posture, engage the core and bend forward at the hips while you extend the leg back and reach forward with the opposite arm. Repeat 10 times on each side.
5) Squat Jumps – start with a tall posture, engage the core muscles by drawing the lower ab muscles inward toward the spine. Avoid arching the low back, with arms in a ready position, do a one-legged squat with the body weight equally distributed over the foot. Lower the body downwards by bending at the knees, then jump straight back upwards by engaging your glute and thigh muscles. Repeat 10 to 15 times for 3 sets.

Steinberg, N., Siev-Ner, I., Peleg, S., Dar, G., Masharawi, Y., Zeev, A., & Hershkovitz, I. (2013). Injuries in Female Dancers Aged 8 to 16 Years. Journal of Athletic Training48(1), 118–123. http://doi.org/10.4085/1062-6050-48.1.06
InSync Physiotherapy is a multi-award winning health clinic helping you in Sports Injuries, Physiotherapy, Exercise Rehabilitation, Massage Therapy, Acupuncture & IMS.

Which is Better for an Injury: Ice or Heat?

Ever wondered whether to use ice or heat for your sore muscles, your healing fracture, or any injury? Both ice and heat have been commonly used to treat an array of injuries, but when to use either one is critical in preventing further damage and promoting faster recovery.

Acute irritation or inflammation of a muscle, ligament, or tendon is typically treated with ice. The cold application reduces inflammation and numbs the pain, especially when the superficial tissues are red, hot, and swollen. The inflammatory response associated with damage to tissues is a defence mechanism in the human body that lasts for the first several days to protect against infection. The response involves immediate changes to blood flow, increased permeability of blood vessels, and flow of white blood cells to the affected site.

ICE APPLICATION

Ice can be used for gout flare-ups, headaches, sprains, and strains. It is crucial to apply ice to the site of injury during the first 48 hours post-injury to minimize swelling. For soft tissue injuries such as muscle strains or ligament sprains, an ice massage involving elevation of the injured body part above the heart and circular movement of an ice pack around the affected area may promote faster recovery of these acute injuries. Apply for 10 minutes at a time, then take a break from icing for another 10 minutes. Repeat this process 3 to 5 times a day. Remember to wrap the ice pack in a dry cloth or towel.

HEAT APPLICATION

Heat can also be used for headaches, sprains, and strains as well as arthritis or tendinosis. Heat causes blood vessels to dilate which increases blood flow and relaxes tight or stiff muscles and joints. Do not use heat during the initial inflammatory response as this will further aggravate the site of injury. For minor injuries, applying heat for 15 to 20 minutes at a time may be sufficient to relieve tension. However, longer periods of heat application such as 30 minutes to an hour may be required for major chronic injuries. Hot baths, steamed towels, or moist heating packs can be used as different heat options.

InSync Physiotherapy is a multi-award winning health clinic helping you in Sports Injuries, Physiotherapy, Exercise Rehabilitation, Massage Therapy, Acupuncture & IMS.

How to Prevent Elbow Injuries in Young Throwers

Recent research has shown that nearly 40% of 7 to 18 year old baseball players endure elbow and shoulder pain during their baseball season. Nearly half of these injured players report their ongoing participation despite having pain. A recent epidemiological study of ulnar collateral ligament (UCL) injuries in athletes 17 to 20 years old reported the number of UCL reconstructions has increased dramatically for this age group. Early education and detection of elbow injuries in throwing sports may help reduce the number of overuse injuries from developing.

Symptoms

“Little league elbow,” or known as medial epicondyle apophysitis, is most commonly found in young throwers. Sports such as baseball, softball, tennis, or golf, can result in this overuse injury to the growth plate on the inside of the elbow. Repeated stress to the growth plates may cause inflammation and lead to pain or swelling. Serious injury may even result in separation of the growth plate from the rest of the bone. Players may also experience a reduced range of motion and a decreased ability to throw hard or far. A child experiencing any symptoms involving their arm should cease activity and see a pediatric specialist or their family physician. X-rays may be required to determine the extent of damage.

Prevention

Prevention begins with identifying causative factors early in the season and adhering to strict guidelines such as the pitch count for young players and the duration of participation in a given year. Total body conditioning that involves strengthening the hip, back, and legs may help reduce the strain on the athlete’s arms. See below for exercises on how to stretch and strengthen the forearm.

Playing in a variety of sports rather than engaging in one particular sport, known as early sports specialization, may promote athletic dexterity and minimize risk of overuse injury.

Treatment

Partial UCL ruptures can be successfully treated with nonsurgical treatment. However, with or without surgery, players must cease any throwing activity prior to undergoing an organized throwing rehabilitation protocol to reduce the risk of further progressing the injury. Promoting mental health is also important in the young athlete’s recovery period. Preventing the athlete from participating in their sport may result in significant psychosocial trauma. Therefore, special attention to the athlete and feelings of sadness or depression should be addressed with coping strategies.
Watch the video below on how to perform “nerve flossing” for chronic neck, shoulder, elbow pain or stiffness:

Watch the video below on how to warm up properly before games or training to prevent injuries and perform better:


References:
https://www.breakthroughpt.com/wp-content/uploads/2018/05/Reducing-Elbow-Injuries_jospt.2018.0607.pdf

InSync Physiotherapy is a multi-award winning health clinic helping you in Sports Injuries, Physiotherapy, Exercise Rehabilitation, Massage Therapy, Acupuncture & IMS.

Strain vs Sprain? How To Recover Optimally

Acute sprains and strains may impede performance and delay return to a sport. Proper management, treatment, and prevention is essential to recovering effectively. An athlete must first understand the definition and recognize the differences between a “sprain” and a “strain.” A sprain is defined as a violent overstretching of one or more ligaments in a joint. A sprain can result in pain, tenderness, swelling or bruising at the joint. A strain is defined as a stress or direct injury to the muscle or tendon. A strain may also cause pain when moving or stretching the injured muscle, but can also cause muscle spasms.

Grades of Strain:

1) Grade I – Mild Strain: slightly pulled muscle with no muscle or tendon tears and no loss of strength and low levels of pain
2) Grade II – Moderate Strain: partial tearing of the muscle or tendon at the bone attachment with reduced strength, moderate pain levels
3) Grade III – Severe Strain: complete rupture of muscle-tendon-bone attachment with separation, substantial loss in strength and high levels of pain

Grades of Sprain:

1) Grade I – Mild Sprain: minor tearing of some ligament, no loss of function
2) Grade II – Moderate Sprain: partial rupture of portion of ligament, moderate loss of function
3) Grade III – Severe Sprain: complete rupture of ligament or separation of ligament from bone, substantial loss of function

Proper RICE Treatment:

1) REST: Do not continue to use the affected muscle or ligament immediately after injury. Use crutches for the lower extremities (i.e. leg or ankle) and splints for the upper extremities (i.e. arm or hand)

2) ICE: Sudden cold may help constrict capillaries and blood vessels to slow or restrict internal bleeding. Place an ice pack between a towel or dry cloth. Apply ice every hour for 10 to 20 minutes at a time.

3) COMPRESS: Compression can help reduce swelling post-injury. Wrap the injured part firmly with an elasticized bandage, compression sleeve, or a cloth. Do NOT wrap the cloth too tightly as it may cut off blood circulation and lead to more swelling.

4) ELEVATE: Elevate the injured part about level of the heart to reduce swelling and pain. Place a soft object such as a pillow or piece of clothing to use as a prop below the body part.

Continued Recovery:

Continue to follow the above RICE method for two to three days post-injury. Daily stretching may help loosen the muscle. Key to prevention is to stretch the tight muscles and strengthen the weak muscles.

Watch the videos below on how to recover from a common ankle sprain or shoulder strain:

InSync Physiotherapy is a multi-award winning health clinic helping you in Sports Injuries, Physiotherapy, Exercise Rehabilitation, Massage Therapy, Acupuncture & IMS.

Responding to a Cervical Spinal Cord Injury


A catastrophic cervical spinal cord injury occurs with structural distortion of the cervical spinal column due to actual or potential damage to the spinal cord. Damage above the C5 vertebrae in the spinal column results in the greatest risk of immediate sudden death for an athlete. Above this level, damage may impair the spinal cord’s ability to transmit respiratory or circulatory control from the brain. Effective acute care is critical in preventing permanent dysfunction or death in an athlete as a biochemical cascade of events can occur during the initial 24 to 72 hours post-injury.

Any of the following symptoms warrants the initiation of a spinal cord injury management protocol:

– unconsciousness or altered level of consciousness

– bilateral neurologic complaints

– significant midline spine pain

– obvious spinal column deformity

Treatment:

When treating a cervical spinal injury, stabilize the spine in a neutral position immediately. Avoid applying traction to the cervical spine to create as little motion as possible. After manual stabilization of the spine, immobilizers such as foam blocks or straps may be used. If rescue breathing becomes necessary, the person with the most training and experience should establish an airway using the safest technique. 

If the athlete is in a position that prevents treatment of the airway, slowly realign the cervical spine. However, stop movement if the athlete experiences increased pain, neurologic symptoms, or muscle spasms. Prepare for transport to the nearest hospital.  The team physician or athletic trainer should accompany the athlete to help guide equipment removal.
If possible, remove equipment to clear access to the airway. Remove helmet and shoulder pads if necessary.

Prevention:

1) Use appropriate technique when tackling or engaging in contact (keep your head up)
2) Medical personnel should be able to recognize and respond promptly to cervical spinal injuries
3) Ensure equipment hardware is not rusted and is repeatedly inspected for maintenance
Athlete may return to play only after full tissue healing, neurologic recovery, and medical clearance from a physician.

Watch Iyad, physiotherapist at InSync, demonstrate how to mobilize a stiff neck with a quick and easy exercise:

Casa, Douglas J., et al. “National Athletic Trainers’ Association Position Statement: Preventing Sudden Death in Sports.” Journal of Athletic Training, vol. 47, no. 1, 2012, pp. 96–118., doi:10.4085/1062-6050-47.1.96.
InSync Physiotherapy is a multi-award winning health clinic helping you in Sports Injuries, Physiotherapy, Exercise Rehabilitation, Massage Therapy, Acupuncture & IMS.

3 Key Exercises to Improve Balance

Why is it important to include balance training in your regular exercise program?


Balance is needed for just about everything you do on a daily basis from carrying groceries to putting on your shoes. Balance training involves strengthening exercises that target your entire body, especially the core. This not only reduces the risk of injury, but may improve motor coordination (Oliveira et al., 2017). At least 3 days of balance training per week is recommended for inactive and active older adults (> 65 yr). Activities such as pilates, yoga, tai chi, dance, or brisk walking are suitable for improving one’s balance. Implements such as bosu balls, balance boards, or foam pads can be used to add variety to your exercises. 

Try the Following Exercises Below:

1) Step-ups

a.     Stand in front of a box with a tall posture
b.     Step up with one leg, then bring the other leg up so that both feet are on the box
c.      Step down one leg at a time and repeat 10 times for each leg
d.     Increase the difficulty by using a taller box or increase your step up pace

2)  One Legged Squat

a.     Stand with a tall posture
b.     Bend your right knee and lift your right foot off the floor
c.      Keep your chest upright and arms extended to the front, slowly lower your body to the floor by pushing your hips back and down
d.     Slowly push up to the starting position and switch feet
e.     Remember to keep your knee in line with your second toe as you squat
f.      Repeat 10 times on each leg
3)  Single Leg Dead Lift

a.     Stand on your right foot, enagage the core, and slowly bend forward at the hips
b.     Reach towards the floor with the left hand and lift the left leg straight behind you
c.       Hold for 1-2 seconds and squeeze your butt muscles as your return to the starting position
d.     Switch sides and repeat 10 times on each leg
e.     Optionally: hold a light dumbbell in one hand as you reach toward the floor

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InSync Physiotherapy is a multi-award winning health clinic helping you in Sports Injuries, Physiotherapy, Exercise Rehabilitation, Massage Therapy, Acupuncture & IMS.