Category Archives for "prevention"

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
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How to Avoid High-Altitude Illnesses

Altitude training involves spending several weeks at a higher altitude (preferably over 2000 m or 8000 ft above sea level) to adapt the body physiologically. At elevations greater than 1200 m or 3950 ft, there is a decrease in atmospheric pressure which reduces the partial pressure of oxygen in inspired air. This causes decreased arterial oxygen levels and leads to increased ventilation and cardiac output, along with an elevation in heart rate. Performance will decrease for individuals that have not acclimatized to the change in pressure and are consequently exposed to a risk of high-altitude illnesses.

Acclimatization

Acclimatization is the process of adapting to the decrease in oxygen concentration at a specific altitude. With acclimatization, there will be an increase in heart rate, blood pressure, bicarbonate excretion, respiratory frequency and volume along with a reduction in plasma volume. To compensate for the decreased arterial oxygen levels, erythropoietin (EPO), a hormone in the body, will trigger more red blood cell production to aid in oxygen delivery to the muscles. Training at high altitudes allow athletes to produce additional red blood cells that will provide a greater cardiovascular effect on performance at competitions held at lower elevations.

Acclimatization requires an altitude exposure of more than 1 week. Staged ascents promote gradual and partial acclimatization when an individual resides at a moderate elevation before ascending to a higher elevation to reduce the adverse consequences of rapid ascent. The first stage of ascending should be greater than 3 days at a moderate altitude. Remaining at a moderate altitude for 3 to 7 days will reduce the symptoms and risk of altitude sickness. However, a time period of 6 to 12 days will improve athletic performance.

High-Altitude Illnesses

High-altitude illnesses can occur at elevations above 2500 m. Mild altitude illness can occur between 2000 and 2500 m.

Acute mountain sickness ( is commonly experienced by individuals 6 to 12 hours after ascending to elevations above 2500 m with the prevalence and severity increasing with higher altitudes. Symptoms include: headaches, nausea, dizziness, and sleep disturbance. Some risk factors may be a lack of previous acclimatization, history of migraines, age of 46 and above, or being a female. Symptoms typically resolve within 1 to 2 days with rest or with non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin. If symptoms become severe, descend immediately or use supplemental oxygen.

High-altitude cerebral edema (HACE) is a more severe form of altitude illness. Symptoms include: truncal ataxia (loss of body control), decreased consciousness, mild fever, and coma. If a headache is poorly responding to NSAIDs, then this is an indication of acute mountain sickness progressing to (HACE).

High-altitude pulmonary edema (HAPE) presents with a loss of stamina, dyspnea, dry cough, cyanosis (bluish skin), or pink, frothy sputum (phlegm). The risk of HAPE increases with increased altitude and faster ascents. HAPE occurs when fluid accumulates in the lungs due to rapid altitude ascent or ascent accompanied by strenuous exercise. Untreated HAPE may result in death approximately 50% of the time.

PREVENTION & TREATMENT

Prevention of high-altitude illnesses involve acclimatization before exposure, slow ascent, and appropriate pharmaceuticals for the corresponding illness. For mild AMS, take a rest day or descend 500 to 1000 m if there is no improvement in symptoms. For severe AMS, descend immediately and use supplemental oxygen at 2 to 4 L per minute. A hyperbaric may also be used for severe AMS. AMS may be treated with NSAIDs or acetazolamine. For severe AMS, use an appropriate dosage of dexamethasone.

Descend immediately if symptoms of HACE or HAPE are experienced. Use supplemental oxygen at 2 to 4 L per minute or a hyperbaric bag. Consider dexamethasone for HACE and nifedipine for HAPE. Consult a physician for more information on which drugs to use.

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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.

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.

Building a Stronger Core to Prevent Low Back Pain

Up to 80% of individuals will experience some lower back pain at least once in their lifetime. Lower back pain (LBP) results in high costs and places a burden on society. These costs include diagnostic, treatment, and indirect costs associated with work disability. A number of conditions can lead to low back pain such as infections, tumours, fractures or dislocations of the spine. However, lifting heavy loads is generally thought to be a key predictor of LBP. An important element in prevention of LBP is to correctly stabilize the trunk during lifting by pre-activating the abdominal wall muscles. By doing so, the spine will increase in stiffness to reduce the effect of undesired spinal perturbations. Exercises aimed at bracing the abdominal muscles may reduce the risk of LBP.

There are two ways of stabilizing the abdominal muscles: an abdominal hollow or abdominal brace. An abdominal hollow begins by drawing in the lower abdomen (transversus abdominus) while maintaining relaxation of the other surrounding abdominal muscles such as the obliques. At the same time, small muscles of the lower back (close to the spine) such as the multifidus are contracted while the larger back muscles are relaxed. With contraction of the lower abdomen and small back muscles, intra-abdominal pressure is increased and the fascia surrounding the spine increases in tension. Combined, these contribute to provide intersegmental stability.

An abdominal brace is performed by activating all of the abdominal and lower back muscles, rather than specific muscle recruitment. By tensing the entire trunk without drawing the muscles in or pushing them out, global activation of the ab and back muscles may provide increased stability in all directions in various movement patterns.

Both the abdominal hollow and brace can help increase the stiffness of the spine to minimize lower back pain. The use of either one will depend on the desired movement pattern and the goals of the individuals in stabilizing their core. Strengthening the core muscles is also essential in reducing the amount of loading on the lower back muscles. Watch these videos below:

Back Pain, Lower Back Treatment “Building Core Strength”:

Back, Sacro-Iliac-Joint Pain & Dysfunction: Core Stability Foam Roller:

Strengthening Hips, Pelvis and Low Back For Ultimate Frisbee: “Psoas March”:

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.

Exercising in the Heat

As the temperature beings to rise, athletes must be aware of the effects of exercising in the heat on the body and on performance. Heat loss during exercise can occur through four different processes: evaporation, radiation, conduction, and convection. As the body’s core temperature rises, blood is transported to the periphery for cooling. This leads to a deficit in the body’s central fluid, which results in a smaller stroke volume (volume of blood pumped from the heart) and an increased heart rate for a given exercise intensity. Splanchnic vasoconstriction, a reduction in blood flow to the internal organs, especially to the abdomen, attempts to compensate for the peripheral outflow. However, this may lead to gastrointestinal and kidney issues.

Heat Stroke:

There are various heat illnesses that an athlete may be susceptible to. Exertional heat stroke (EHS) occurs at a body temperature of greater than 104°F (40°C) immediately post collapse and central nervous dysfunction. Symptoms include: headache, confusion, dehydration/muscle cramps, gastrointestinal upset, profuse sweating, rapid pulse, low blood pressure, and quick breathing. To treat EHS, immediately remove equipment and excess clothing. Cool the athlete as quickly as possible within 30 minutes via whole body ice water immersion. However, if this method is unavailable, move to a cool area and rotate cold wet towels. Check for airway, breathing, circulation and continue to monitor vital signs until paramedics arrive. Cease cooling when body temperature reaches approximately 101-102°F (38.2-38.9°C).

DID YOU KNOW?

That heat-related fatalities occurring during sports have more than DOUBLED since 1975. (Source: Korey Stringer Institute)

Heat Exhaustion:

Heat exhaustion is another heat illness commonly experienced by athletes and occurs due to cardiovascular insufficiency and energy depletion that may or may not be associated with physical collapse. Individuals with a body mass index of greater than 27 or exercising at temperatures greater than 33°C are at a higher risk of experiencing heat exhaustion. Symptoms include: fatigue, nausea, weakness, hyperventilation, core body temperature between 96.8-104°F (36-40°C), and heavy sweating. Treatmentbegins with moving the athlete to a cool area and removing equipment or excess clothing. It is important to elevate the legs to promote venous return. Attempt to cool the individual with ice water or fans and rehydrate.

Heat Cramps:

Heat cramps are painful involuntary cramping that often occurs in the legs, arms, or abdomen. Athletes may experience these abnormal muscle contractions if they are prone to excessive sweating, not acclimated to the heat, have heavy clothing or equipment, exercising for prolonged periods without proper hydration, or experiencing muscular fatigue. Similar to the previously mentioned heat illnesses, treatment is to move the athlete to a shaded area, rehydrate with cold water, and stretch or massage the cramped muscle in its fully stretched position. Provide foods that are high in salt content to replenish lost electrolytes from sweating.

General Prevention: 

The best predictor of recovery is early recognition and rapid treatment. Enforce a gradual progression of exercise and acclimation to the heat. Educate athletes on how to recognize heat illnesses and be aware of when to cease activity. Hydrate and rest appropriately throughout training.
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.