Steven Saba @leadingedgephysiotherapy

• 
  May 2019

  Long-term effects of chronic static stretching are consistent with the short-term effects of acute static stretching. Both = significant reductions in max contractile force and power production. . 15.4% decrease in eccentric peak torque following a 24-day static stretching intervention. . On the contrary, Long Term dynamic stretching did not negatively affect strength or performance.

• 
  May 2019

  Shoulder pain and imaging. Important considerations 🤔 —————————————————————— As with the lumbar spine, abnormal findings on imaging does not guarantee that these abnormalities are the cause of pain. . MRI study of subjects performed showed that 34% of people with no shoulder pain had stage 3/4 tears (stage 4 being full thickness ). . There is a relationship between rotator cuff tears and age, however no link between rotator cuff tears and pain.

• 
  May 2019

  Yoghurt is rich in probiotics which has proven to reduce muscle damage and improve muscular recovery in clinical trials (Jager et al., 2015 ). . Along with its high protein content, yoghurt also offers electrolytes – calcium, potassium and magnesium. These electrolytes are lost during exercise when we sweat. . Furthermore, new research is developing for the link between probiotics, gut health and exercise performance, so its well worth adding yoghurt into your diet!

• 
  May 2019

  Do I put ice or heat on my injury? —————————————————————— As a general rule of thumb, but not for all cases: ❄️ is used for more acute injuries (first 72 hrs ) 🔥 is used for more chronic/longstanding injuries. . WHY? 🤔 ❄️ limits the normal inflammatory process by reducing blood flow to the area through vasoconstriction (narrowing of blood vessels ), therefore slowing the metabolic process. . 🔥 produces a minor inflammatory effect through increased blood flow. Put simply, this 'flushes' out the pre-existing excess inflammatory metabolites. . If you are unsure, please consult a health professional for an assessment and guidance!

• 
  Apr 2019

  Rearfoot vs. Midfoot vs. Forefoot: What type of runner are you? ---------------------------------------------------- 1️⃣Rearfoot Strike 👉🏼Less muscle exertion. Bone absorbs the ground reaction force, rather than muscle = less energy expenditure. 👉🏼As a result, increased load on hip and knee 👉🏼Longer stride length, efficient for endurance . 2️⃣Midfoot strike 👉🏼Places more stress on Achilles/gastrocs than rearfoot 👉🏼Shortens time foot is on the ground, which helps quicken pace. . 3️⃣Forefoot strike 👉🏼Great for running fast 👉🏼Increase load on foot and gastrocs. 👉🏼Loads Achilles tendon 15% more than rearfoot runners. Over 1km, this is an increased load of 30 times their body weight 👉🏼Higher potential for Achilles tendinitis ---------------------------------------------------- OPINION: Rather than categorising running into 3 styles, this phenomenon should be seen as a continuum. Evidence shows that as forefoot and midfoot runners fatigue, they begin to adopt a rearfoot style to offload the muscles. Large changes in footstrike should be avoided, as they increase load on different tissues suddenly and can lead to injury. Changes should only be made gradually to alter load distribution, (especially for those who experience knee or hip pain ) as it can be useful in managing pain and injury. . Happy running!

• 
  Apr 2019

  Only 10.6% of people with ACL reconstructions reach symmetrical knee function within 6 months! —————————————————————— Some factors decreasing the chance of symmetrical function include: 1️⃣Age > 30 2️⃣patella tendon graft as opposed to hamstring 3️⃣medial meniscus repair required with ACL reconstruction

• 
  Apr 2019

  What happens to your knees when you squat? If your knees cave inwards (knee valgus ) then there might be more to it than simply just 'poor form'; often there are underlying causes. . The most common are: 1️⃣Inadequate gluteal/hip external rotator strength 👉🏼This causes the the femur to internally rotate and adduct as seen on the right. Often this weakness is also coupled with overactive hip adductors. This makes it even harder for the glutes/external rotators to work eccentrically as stabiliser muscles during a squat. . 2️⃣Inadequate vastus medialis (quad muscle ) strength 👉🏼Often there is a biomechanical reasoning for a weak VMO. This needs to be assessed by a physio prior to strengthening! . 3️⃣Decreased range of motion of the ankle 👉🏼Prevents adequate movement of the knee over the toes (dorsiflexion ). As a result, the foot pronates = tibia internally rotates = knee valgus. . ⚠️Do not ignore the signs! This movement is a precursor to serious knee pain, the dreaded ACL tear and in some unlucky people, hip impingement 😥

• 
  Apr 2019

  Studies have shown that blueberries can reduce the effects of delayed onset muscle soreness (DOMS ) and help regain strength faster (McLeay et al., 2012 ) . This is because dark coloured fruits have powerful antioxidants that accelerate the elimination of waste products produced during training.

• 
  Apr 2019

  A muscle strain occurs when the muscle fibres are overloaded, causing rupture. They are classified under 3 grades: ———————————————————————— Grade 1️⃣ Mild strain with little to no swelling and bruising. There is associated pain, however strength and mobility are generally unaffected. Usually heals within 2-3 weeks . Grade 2️⃣: Moderate strain with symptoms of pain, swelling and bruising/discolouration. Strength, function and mobility are impacted. Usually heals within 2-3 months . Grade 3️⃣: Complete muscle tear with complete loss of function. Significant swelling, bruising and pain with visual deformities. Surgery is often performed, with a much longer rehabilitation process lasting up to 6 months.

• 
  Apr 2019

  Dry needling significantly increased vertical jump height performance in healthy, young adults performed 10 minutes after their initial jump. . Further research is needed to determine the long term effects of dry needling on Vertical jump height performance. . Source: Bandy (2017 )

• 
  Apr 2019

  Trigger point dry needling (TrP-DN ) for shoulder dysfunction? 🤔 --------------------------------- Exercise will always remain the gold standard treatment for those with subacromial shoulder pain. . Research suggests that the addition of TrP-DN alongside exercise is more effective in improving shoulder pain-related disability than exercise alone! . Trigger Points can lead to alterations in normal motor patterns and muscle activity. By releasing these trigger points (in the above population ) it can account for the improvements in shoulder dysfunction. . Arias-Buria et al., J Pain 18 (2017 ) 11-18

• 
  Apr 2019

  Calf stretching is a common technique used as part of the treatment of several ankle/foot conditions. But what type of stretching is effective to increase range of motion? ----------------------------------------- ✅Static stretching - Reaching a certain ROM and holding. Believed to increased fascicle length or increased tolerance to the stretch sensation. ✅PNF stretching - combines isometric contractions of the target muscle group and static stretching in a cyclical pattern. It is believed that the relax phase allows for lengthening to occur via a neural response. ❌Ballistic stretching - bouncing movements in and out of a muscle’s end of range position. Did not improve range of motion, but can have a positive effect on performance.

• 
  Apr 2019

  What is the role of applying ice (cryotherapy ) in soft tissue injuries? ---------------------------------------------------- Many of you may be thinking its role is to reduce swelling, however this is a common misconception 🤔 . So why do we apply ice? ❄️Ice has an analgesic effect, which may be effective in reducing pain. It does this by lowering the speed that nerve cells send electrical signals to the brain. ❄️Decreased pain allows for effective rehabilitation (mobilisation and exercise of the injured area ). Rehabilitation allows for muscles to pump and squeeze swelling out of the injury site. Therefore, ice has a SECONDARY effect in reducing swelling! ---------------------------------------------------- What to avoid when applying ice? ⛔️Do not leave ice on for long periods of time. There is no gold standard of application, however 20 minutes on, 20 minutes off is widely used. WHY? Applying ice decreases tissue temperature, which slows the production of inflammatory markers. This essentially means that you’ve slowed down your immune system, preventing the body from repairing itself, which may increase recovery time. ---------------------------------------------------- How to apply ice? ✅Ensure that you have a barrier between the ice and skin to prevent adverse reactions. Examples are a WET towel or plastic bag.

• 
  Aug 2018

  Nothing beats a home made calisthenics gym 😍😍

• 
  Aug 2018

  Did you know excessive inversion/supination on heel strike has been linked to increased risk of lower limb injuries like Achilles tendinopathy, ACL ruptures and lateral ankle sprains? 😨 stay woke fam

• 
  May 2018

  Know anyone who sits with their wallet in their back pocket? ———————————————————————— Sitting on your wallet causes one side of your hip to be elevated. As a result your lumbar spine compensates by bending to the side that your wallets on. What’s the issue with this? . 1️⃣Excess pressure is placed on one side of your lumbar discs which overtime can compress on to the sciatic nerve, causing back and even leg pain. . 2️⃣ It compresses the piriformis muscle, which is infamous for compressing on the sciatic nerve, causing leg pain . 3️⃣ keeping the spine in a prolonged curved position can create muscle and tissue imbalances that can be a precursor to further injury.

• 
  Mar 2018

  5 ergonomic tips to prevent office related aches and pains—————————————————— 1️⃣ Keyboard stands 🚫 they add unnecessary strain on your wrist extensors 2️⃣ Ensure your feet are firmly placed on the floor, this will reduce a lot of strain placed on your lower back 3️⃣ To reduce neck strain, adjust monitor height so that your eyes are level with the top of the screen 4️⃣utilise arm rests to reduce strain placed on your upper traps 5️⃣ take regular breaks to stretch and refocus your eyes on something far away. Sustained postures are a precursor to injury

• 
  Dec 2017

  Don’t ignore your aches and pain, you too could be turning into a candy cane 😂

• 
  Dec 2017

  Following on from our last post, optimal management of a ‘corked thigh’ includes: . 1️⃣ RICER principle to reduce inflammation, control haematoma formation, limit intramuscular bleeding and allow early muscle regeneration. . 2️⃣ 24-hr Immobilisation in a brace/figure 8 bandaging in 120 degrees of knee flexion has proven to decrease time taken to return to play compared to usual care. . 3️⃣ NSAIDS for moderate to severe contusions, in order to reduce the risk of MOT (we discussed in last post ). Consider waiting 48-72 hrs before commencing due to increased bleeding risk . 4️⃣ begin active quad stretching and strengthening after first 24 hrs. Progress from isometric to isotonic to isokinetic training. . When are you ready to return to sport? 👉🏼 range of motion is equal and pain free on both sides . If you’re unsure or if pain is persisting longer than it should, get assessed by your physiotherapist to optimise your recovery😊

• 
  Dec 2017

  It is common in contact sports to get a ‘corked thigh’ or ‘dead leg.’ It is also common practice to ‘run out’ the cork. But is that really the best treatment?🤔 ———————————————————————— A cork is a contusion to the muscle fibers, causing capillary rupture and subsequent bleeding into the quadriceps tissue. . What can happen if not managed properly? 1️⃣Acute Compartment Syndrome 👉🏼although only in severe cases, not managing efficiently causes increased pressure (from inflammation and bleeding ). 👉🏼leads to nerve damage and tissue necrosis. 2️⃣Myositis Ossificans 👉🏼Calcium (bony ) formations within the muscle tissue form. 👉🏼Causes restrictions in Range of motion and localized pain during exercises. 👉🏼caused by returning to training too early and neglect of proper treatment. . Our next post will go through recommended treatments and things to avoid after your quadriceps contusion.

• 
  Oct 2017

  Do you suffer from debilitating buttock pain that is sometimes felt in the back of your thigh? Often the sciatic nerve being compressed is the issue, with the majority of cases arising from spinal involvement. However, piriformis syndrome can present itself similarly, yet requires different treatment. . What is piriformis syndrome? 👉🏼The compression of the sciatic nerve by the piriformis muscle as shown above. 👉🏼In 20% of people, the sciatic nerve runs through the piriformis and can become irritated if there is injury to the piriformis muscle due to inflammatory agents. 👉🏼Piriformis muscle spasms due to repetitive motions or running downhill can also cause sciatic nerve compression. . How do you know if your sciatic pain is due to piriformis syndrome? 👉🏼If pain radiates below the knee, it is unlikely to be piriformis syndrome 👉🏼Stretching the piriformis by combination of of hip flexion, adduction and internal rotation will provoke buttock pain with/without radiation to hamstrings 👉🏼Tenderness to palpation over the piriformis muscle . It is essential to involve a physiotherapist to conduct a full physical examination and explore clinical history to help determine suitability for imaging and to help correctly diagnose and treat your condition correctly.

• 
  Oct 2017

  Following on from our last post, how are lower back stress fractures (spondylolysis ) treated? -------------------------------------------- Treatment varies for each individual case, however there are some general recommendations. . 1️⃣Implementing PRICES: Protect (and pain management ), Rest, Ice, Compression, Elevation and Support 2️⃣Restricting the athletic activity that is responsible for the pain 3️⃣Stretching hamstrings and gluteal muscles to reduce shearing forces on the lumbar spine 4️⃣Strengthening (pain-free ) abdominals and back extensor muscles 5️⃣Correcting technique to limit amount of hyperextension, and if necessary a brace can be worn during sporting activities. . Once aggravating movements become pain free and there’s no tenderness on palpation, a gradual resumption of the aggravating activity can commence, with pain being an indicator to regress. . It is essential to involve a physiotherapist when implementing a graded exercise program for spondylolysis in order to limit adverse effects of overtraining.

• 
  Sep 2017

  Stress fractures in the pars interarticularis of lumbar veterbrae (lower spine ) as shown above is referred to as spondylolysis. It is the most common cause of significant back pain among athletes😣 -------------------------------------------------- Who is most at risk? 👉🏼Athletes in sports emphasizing extension of the spine (e.g. ballet, volleyball, football, gymnastics, weightlifting, high jump ) 👉🏼Age 10-15 👉🏼Males (ratio 2:1 ) . What causes Spondylolysis? 👉🏼Physical shearing forces are accentuated by combined extension and rotation. 👉🏼Overuse injury or traumatic fracture. 👉🏼Insidious onset usually with an increase in training load. . Signs/symptoms 👉🏼Pain increases with activity (especially extension ) that can also radiate into the buttock or thigh. 👉🏼Tender on palpation of paraspinal muscles or hyperactive paraspinal muscles (guarding ) 👉🏼Shortened hamstrings with increased anterior pelvic tilt/lumbar lordosis. . How is Spondylolysis Diagnosed? 👉🏼Physical examination performed by a physiotherapist is crucial in deciding the need for imaging via X-ray. 👉🏼Bone scan is the most sensitive and gold standard diagnostic tool. . Our next post will focus on how to manage spondylolysis and treatment options available!

• 
  Sep 2017

  Essential interventions to lessen the effects that high heels place on your body! ------------------------------------------------- 1️⃣Stretching: Add calf stretching and foam rolling as part of your daily exercise regime. Stretch for 1 minute in total (30sec x 2 ). . 2️⃣Consider shorter heels Studies have shown that lower heels cause significantly less forefoot and knee joint pressures. . 3️⃣Listen to your body! If you’re experiencing pain when wearing heels, only aim to wear them for special occasions. If not, keep a pair of flat shoes with you to change.