Squat to it!

I’d like to paint you two pictures. In the first, you are a novice gym goer who is looking to get fit and healthy this winter but really struggles with planning your gym routine or deciding which machine to use. The second scenario sees you as an avid gym attendee who has developed an occasional knee ache over the course of a few months and is now concerned about which exercises to do and which to avoid for fear of “setting it off”. In either scenario you’re now headed to the gym, what exercise is at the top of your list for tonight?

The answer should be squats. It should always be squats. Even if you did them yesterday. Even if you plan on doing then tomorrow. Do more squats.

Why should I be squatting you ask? For a beginner this may seem like a bridge too far. A compound lift that requires too much technical skill, the squat, you’ve heard, can be dangerous. As for the gym regular, who may have the form down pat, the squat is a knee intensive exercise. Surely a movement like that will only aggravate their knee. While these are valid concerns in the minds of either of our avatars, they are wholly unfounded. Let me explain why.

First let’s discuss the technical/dangerous aspect of a squat. Can you stand up from a chair? Yep, you’ve mastered the squat. That’s all squatting is and if that’s challenging enough for you then do that. A bunch. At some point this might become easy for you in which case it’s time to start adding weight or variations but by then you’ve got the basics down.

If knee pain stops you from squatting, you may be missing out on one of the best exercises to help clear that up. A new study shows therapeutic exercises do not exacerbate knee pain or cause inflammation1. The squat is most definitely a therapeutic exercise. With most joint injuries the goal is to increase the resiliency of that joint and its ability to cope with the rigours of everyday life. Squatting will do that. Building muscle mass in the quads, glutes and hamstrings offloads the knee joint and makes you more able to get up from a chair, get up a flight of stairs or just get up to face the day.

As an aside, high weight/low rep or, conversely, low weight/high rep multi-joint exercises increase testosterone production in the body. Testosterone builds muscle, which burns fat, which makes you a better you.

Go do some squats.

If you’ve got knee pain and need a program tailored for you or you want to start squatting but are unsure of the finer points, come in and we’ll get you started on the right path.

Elliot Rechtin

MPhysio

Accelerate Physiotherapy

 1.       Bricca, A., Roos, E.M., Juhl, C.B., Skou, S.T., Silva, D.O. and Barton, C.J., 2019. Infographic. Therapeutic exercise relieves pain and does not harm knee cartilage nor trigger inflammation. British journal of sports medicine, pp.bjsports-2019.

OWN IT!

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One of my favourite things when seeing a patient is when it becomes increasingly obvious that they’ve done a bit of research into their condition. I enjoy when a patient asks if trans ab or multifidis exercises would be beneficial for treating their lower back pain or whether I think their pec length and poor posture are contributing to their shoulder discomfort. It tells me a lot about the person sitting in front of me. It says that they want to understand their condition and get better while acknowledging that this isn’t their area of expertise and need guidance when it comes to rehabilitation. It also means that, in general, this individual is going to adhere to the advice that I give and ultimately get better, faster.

Research has shown that active participation in rehabilitation leads to better outcomes.(1-3) Normally this applies to adherence, which will be discussed later, but I have found that people who do their research and increase their understanding of what’s going on with their body fare better on the path to rehabilitation. This, of course, comes with a bit of a disclaimer: Take Google search results for what they are, an algorithm-based response to key words. They cannot replace the tests we perform and the bigger picture information we process on our way to your diagnosis.

Adherence is key. We don’t ask you to do exercises for our own amusement or stop you doing what you love as a form of punishment. We want to see you get better. We want to get you back to what you love. The advice we give out is based on evidence and experience and when followed it should go a long way towards addressing your pain. Try to stick to what we advise. The feedback we get for your body’s response is invaluable for planning the rest of your rehab journey.

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That’s not to say your input isn’t important. As discussed earlier, if in the course of your research there are things that you’d like to try, let us know. It may not be appropriate but it also may be a perfectly acceptable course of treatment and the feeling of being involved in that process has been shown to improve outcomes.(4)

The moral of the story is ownership. Own your injury, own the rehabilitation process, and own the feeling of achievement of being able to do what you love pain free.

Elliot Rechtin

MPhysio

Accelerate Physiotherapy

1. Bassett, S.F., 2003. The assessment of patient adherence to physiotherapy rehabilitation. New Zealand journal of physiotherapy, 31(2), pp.60-66.

2. Marshall, A., Donovan-Hall, M. and Ryall, S., 2012. An exploration of athletes’ views on their adherence to physiotherapy rehabilitation after sport injury. Journal of sport rehabilitation, 21(1), pp.18-25.

3. Kolt, G.S. and McEvoy, J.F., 2003. Adherence to rehabilitation in patients with low back pain. Manual therapy, 8(2), pp.110-116.

4. Jordan JL, Holden MA, Mason EEJ, Foster NE. Interventions to improve adherence to exercise for chronic musculoskeletal pain in adults. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD005956. DOI: 10.1002/14651858.CD005956.pub2.

Injured? Here's something to read about!

Play On 

I hate the Canberra winter.  

I very much doubt many of you are excited about it but the truth is there is a silver lining here. With winter comes footy season. Being a new Australian I’m an equal opportunity code enthusiast. I’ll watch whatever’s on, and in general root for whoever’s closest to Canberra.  

It’s no secret we at Accelerate have our favourite local teams (Come on Easts and the Blues) but we treat athletes from all sports, clubs, and levels. Every athlete we see is treated with the same priority in mind; getting you playing at your best as soon as possible.  

Our main focus in accelerating your potential is to get you back on the court/field/floor better than when you came off, whatever the circumstances. In this post I’d like to help you through our thought process in getting you back to what you love. We are a team, and if we are on the same page, we will reach our goals faster. 

Some things just take time 

I’ll start with the not so pleasant bit. Some injuries, especially ones where a structure is damaged, take time to heal. Our bodies have biological healing time frames that unfortunately cannot be rushed. They are not definitive, but you can’t expect a broken bone to heal in a week and neither do we. In instances like these the aim is to brace or support the damaged structure, giving it time to heal, whilst also giving it an appropriate amount of load to promote tissue regeneration.

With injuries like these we’ll refer you to a sports doctor when necessary, but will always give you a time-frame, based on the best available research, for your return to sport, and work with you to make sure you’re ready when the time comes. While waiting for something to recover/heal it’s a great time to work on other areas of deficiency in the body that we can identify with an assessment, which serves a good way to stay motivated while returning form injury.

Playing with an injury but not through it 

The next level of injury may be one in which nothing is significantly damaged but still presents with significant pain or weakness. These are tough. The scale of these injuries can vary greatly player to player and body part to body part. Also, with these types of injuries, we understand that you may really want to play and often feel you can, but your safety is our first concern. We don’t want things to get worse which would ultimately delay you getting back to doing what you love. Here’s where we as physios come into our own. We’ll work together to come up with a plan with input from you and your coaches regarding load management, appropriate exercise, and game/training adjustments. We’ll track your progress and modify things along the way so that you can reach your goals and get back out there because we’re not happy with you playing at 80%. We want the best possible you lacing up your boots! 

An ounce of prevention 

Sometimes injuries are unavoidable. Being unlucky is a factor in sport and try as you might these things do happen. Other times injuries are issues that could have been addressed long before they become problematic, ideally before the start of the season. If you’re unsure, get it checked out. A screening can easily identify areas of concern that can be readily treated. I’d rather teach you how to squat than spend 6-9 months rehabbing a knee injury! 

 Good luck this season!

Author Elliot Rechtin, Physiotherapist

Image 1. Estimate Healing Times for Various Injuries Courtesy of Dr Caleb Burgess, DPT.

Image 1. Estimate Healing Times for Various Injuries Courtesy of Dr Caleb Burgess, DPT.

Pain: A Primer

As physiotherapists we encounter all sorts of pain and the people affected by it. Pain is a very complex thing and would require thousands of pages to properly explore, so instead I’d like to focus a bit more on how we as physios interpret your pain and the information it provides us. The hope is that after reading this article you have a better understanding of why we ask the questions we do and what that tells us about the pain you feel.

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Describe your pain.

What we’re looking for here is to be as descriptive as possible. We want to know if your pain is dull, sharp, tingly, burning, and/or all of the above. These adjectives give us clues as to what might be causing your pain. We also want to know the intensity of your pain. This is usually described on a scale from 0-10. 0 being no pain at all to 10 being the most excruciating pain you could possibly imagine. Although this is varies from person to person, it gives us a good idea as to what treatments are appropriate for you.

When does your pain occur?

I don’t mean at 9:45 on Tuesdays, I mean is your pain associated with a period of the day or activity. Is it worse in the mornings? Does it come on 2km into a jog? Is it the first few steps after getting up from your desk? Again, your pain pattern tells us a lot about the structures involved. Part of this line of questions involves giving us an idea as to how long you’ve been in pain and if it’s getting better, worse or staying the same. While the exact amount of time may not be important, a close approximation is. A 3-day old knee injury is very different from a 3 month or 3 year old one.

Where is your pain and is this your pain?

This tends to be a notoriously tricky question to answer and knowing that, as physios, we’ll try to help you answer with some tests. These tests may be uncomfortable but are very important in nailing down the specific structure involved in producing your pain. If a test elicits pain we need to know about it and we need to know if that’s the pain that’s brought you in to see us.

How does your pain change?

What we’re looking for here is how specific movements and positions change how your pain feels. When I press here does your pain get better or worse? If you’ve been popping an ice pack on your shoulder, does it help? If you bend forward, does your pain go away? While this can reaffirm the structure involved, it also gives us ideas as to how to help you feel better.

Basically, we’ve covered the how, what, when, where and it’s our job to tell you why. When we arrive at the why we can come up with a plan to sort out the pain you’re feeling. The take-away here is to be mindful of your pain and pass on as much information as possible to your physio. It might just save you some unnecessary pain.

 

Elliot Rechtin, MPhysio

Accelerate Physiotherapy

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Not just tennis elbow

Ah, finally, spring is in the air. While the warmth and beauty of spring brings about good feelings for most, there may be a small sense of dread for others. The weeds need to be picked, the roses pruned, and the backhand needs a bit of work if you’re ever going to beat the neighbour in the weekly tennis match.

So, what do you do? You get motivated and set aside a weekend to kick goals. While this may seem like a good idea, you may be setting yourself up for injury…Cue the dreaded Tennis Elbow (AKA Lateral Epicondylalgia)

Tennis Elbow is a painful condition and, as anyone who has been afflicted with it will tell you, is fairly debilitating. It affects the outer part of the forearm just below the elbow and can be characterized by a sharp pinch with certain movements and a dull ache when aggravated. Usually brought on by either a long history of intensive upper body workload or, as above, a sharp increase strenuous elbow usage, Tennis Elbow affects 40% of people at some point in their life. A full 50% of tennis players encounter this pathology at some point in their career and as many as 17% of upper body intensive manual labourers are affected with Tennis Elbow.  The scary thing about this condition is the disability and longevity of symptoms.

Diagnosis is straight forward. A physiotherapist taking a good patient history with a good knowledge of human anatomy can narrow down the diagnosis quickly. The trick is knowing what to do about it.

The best available evidence we have points to exercise and load management as the best treatment. Isolated, focused exercise can go a long way towards fixing the problem while investigation and treatment of the neck and back will help keep the issue from coming back.

Prevention, however, remains the best treatment. Enjoy the spring but increase activity gradually and incorporate lots of rest to smell the roses and banter with the neighbour about how good your backhand has gotten.

 What can we do for you:

-      Diagnosis

-      Education on pain management

-      Tailored exercise prescription

-      Global biomechanical investigation

-      Advice regarding injury prevention

 Author: Elliot Rechtin, MPhysio - Accelerate Physiotherapy

New Guidelines for the Treatment of Knee and Hip Osteoarthritis (OA)

The Royal Australian College of General Practitioners (RACGP) have recently released new guidelines for the management of knee osteoarthritis (OA). They outline the best, evidence-based treatment options for knee and hip OA and physiotherapy is at the top of the list! Keep reading to find out more!

Accelerate Recovery By Moving Early!

Accelerate Recovery By Moving Early!

Accelerate your recovery with early mobilisation!

As winter sport rolls into the point edge of the season, how are all you weekend warriors going? Have you ever been 'snipered' whilst running at full tilt? Ever joked that calf tears are an old person's injury?

Did you know that acute soft tissue injuries (muscle strains) can result in substantial loss of time from work and exercise? Delayed rehabilitation can lead to prolonged pain and increased chance of re-occurrence.