Blog Posts

Cycling your Tour-De-Beach-Road? Have that engine of yours go the distance!

15/9/2020

Are longer rides reducing your fun with discomfort or aching? Or the aftermath-pain outweighs the glory?

Over 80% of recreational cyclists sustain repetitive overuse injuries and more than one third of that group will need treatment to keep on the road (1)

Cycling for fitness or leisure is a great activity and very useful low impact aerobic fitness exercise if you have joint problems. It does involve prolonged posturing without much option for variation of body position as in other sports. The pedalling action is also repetitive.

So…. if the niggles associated with riding are left unchecked, un-monitored or you simply don’t care for your body in the right way…… overuse injuries become the busted spokes in your ‘wheel’. You can’t out ride and out compete overuse soreness. The predominant parading reruns in our clinic are neck, knees, wirst/hands, butt and back.

Everyone’s main concern is navigating the road safely, obeying the rules, using good bike etiquette and not being distracted. However pain and fatigue are needless distractions and we believe keeping safe also means being fit and healthy to ride according to the conditions you choose to ride in as well as your fitness and skill level to ride.

Physiotherapy examination of the cyclist includes

Biomechanical breach-points in your flexibility, strength, endurance.
Examining range of motion for specific joint actions.
Muscle length and measuring force generation.
Load testing, can you sustain the load required in a simulated clinical exam to test-load you?

In the lower limb it is important to evaluate hip muscle function which influences your control of knee and ankle position (2), hamstring length and back curve.

Looking at your ‘engine’ also includes

The ergonomic fit of you to the bike. This may include looking at your cycling technique and gear.
Discussion on cycling volumes, distance, indoor vs outdoor training, hills or flats.

Getting expert physiotherapy advice will identify areas to build healthy muscle, ligaments with the right exercises, the right exercising strategies beyond just pedalling to make your ride comfortable, minimising the risk of injury and enhancing safety.

The benefits are…

better management of injury and having the tools to look after yourself.
understanding what your physical limitations are and goal setting overcoming these with a clinically informed treatment plan.
Alternatives to just cycling to train for cycling involving other forms of exercise to target the same goals. Think of strength exercises, endurance and flexibility work.

We truly believe road cycling can be safer, more satisfying and healthier when the right ground work is in place for our cyclists.

Can you relate to any of these issues in your ride?
Then know that physiotherapists can assess, manage and get you on top of your cycling injuries to get you back to the saddle. At this clinic our process involves clinical examination in a “three stroke strategy”.

Injury assessment.
Musculoskeletal screening for contributing factors.
Bike set up and discussion on goals, training loads and progressions.

Your treatment is bespoke to these findings, your goals and health needs.

You are your Tête de la course!

References:

Int J Sports Med 1995; 16(3): 201-206
Curr Sports Med Rep. May-Jun 2016;15(3):199-206.

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Q & A: Know Osteoarthritis to get control of it.

27/8/2020

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Osteoarthritis is the type of arthritis that happens over time as the cartilage layers change over time making them less resilient. Cartilage is the spongy tissue that coats the ends of bones in joints and acts as a shock absorber. Normally, damaged cartilage is constantly being repaired as old cartilage is degraded. When the balance between degradation and repair is thrown off, cartilage thinning occurs. As a result of cartilage thinning, the joint has more friction causing a joint to become inflamed.

What’s the Difference Between Osteoarthritis and Rheumatoid Arthritis?

Osteoarthritis is the most common type of arthritis, resulting from thinning cartilage levels. Rheumatoid arthritis is less common and occurs when the immune system mistakenly attacks the joint lining, causing painful swelling that can eventually result in deformity of the joint.

What are the Risk Factors For Osteoarthritis?

While there is still much to learn on the subject, some known risks factors include:

Overweight: increases load through the knee
Age and gender the older you are
Gender: women over 50 are more likely to have OA than men over 50
Genetics
Trauma: previous injury to the knee, including sports injuries, can lead to OA Knee.
Repetitive stress injuries: which are usually associated with certain occupations, particularly those that involve kneeling or squatting.

What Are the Most Common Symptoms of Osteoarthritis?

Pain is the most common symptom of osteoarthritis, occurring primarily when the joint is moved, rarely at rest. Other symptoms include:

Limited range of motion
Crackling sounds
Stiffness
Buckling or locking of the joint
Swelling / inflamed joints

How is Knee OA Diagnosed?

Our clinicians can diagnose osteoarthritis of the knee based upon the symptoms you are experiencing and through a physical examination. In terms of imaging, x-rays can be done to verify osteoarthritis and show the level of progression in the joint.

What Are My Treatment Options?

It depends on the severity. Initial treatment is generally directed at non-invasive pain management. Pain related to joint osteoarthritis may have different causes, depending on the individual and the stage of the disease.

We ensure individualised treatment prescription based on your examination findings. This is best current practice (1).

In general, treatment is

Specific targeted exercise to address, strength, agility, coordination to cushion joints, stimulate healthy cartilage and minimise friction.

Also included is:

Health and behaviour modifications, such as patient education, physiotherapy, exercise, weight loss, and bracing.
Physiotherapy is aimed towards strengthening muscles around the joint and participating in a low impact graded cardiovascular exercise program.

Treatment options also include medication for pain relief such as anti-inflammatories or Panadol.
Corticosteroid injections are also an option.
Platelet Rich Plasma injections are becoming more common place with good outcomes in the short term. The longer-term benefits are still being investigated by researchers.

What If Non-Surgical Treatment Doesn’t Work for Me?

Unfortunately for some people, especially those whose osteoarthritis is at a more advanced stage, conservative treatment is not enough for a lasting solution.

When quality of life and makes daily activities difficult to perform then a joint replacement maybe recommended whereby the knee joint is replaced with an artificial prosthesis. This surgical procedure has been shown to reduce pain, enhance quality of life, and improve your ability to perform everyday activities with fewer or no restrictions.

References

Curr Opin Rheumatol. 2018 Mar;30(2):151-159

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Shin Splints

14/8/2020

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Shin Splints or Medial Tibial Stress Syndrome are common leg overuse injuries in athletes and people new to running. These injuries are caused by repetitive loading on your tibia (shin bone) over time without recovery and are often seen in running and jumping sports, especially when there has been an increase in volume or intensity of training workload. If left unchecked this can lead to stress fracture.

Healthy bone is constantly adapting, recuperating, and strengthening depending on how much load is being put through it during day to day activities and how much recuperation time is available. In almost all cases the body is able to adapt to the load being put through the bones and repair any micro-trauma that has occurred in the bones. If the load, recuperation and strengthening timeframes are unbalanced the bone trauma may lead to a fracture. Fractures are caused by the continued loading allowing for the merging of multiple cracks to the point of the shin becoming painful. If the load being put through the bone is not reduced, in some scenarios, the stress fracture can continue until complete fracture occurs⁽¹⁾.

Symptoms of Tibial stress are often described as pain with activity such as running which subsides with rest. The pain will gradually worsen over time if no treatment or activity modification is pursued. Tenderness around the site of pain is also common and, in some cases, swelling may also be present.

Your first step in a case of “bony” shin pain is to reduce the frequency of the work outs or the distance of the workout to reduce the load and have some rest and recovery for the bone. This initial healing process will involve a period of rest to reduce the forces going through the healing bone and in some cases, crutches or a “moon boot” may be required.

Step two is to undertake a thorough physical examination with physiotherapy to look at the subtle things that may easily overload stressed bone. This can include:

Biomechanics, how you control your leg, hip, knee with jumping, landing or running
Discussion on training frequency, distance, load, locations
Strength, joint and muscle flexibility and agility

Recovery is tailored to the examination results, and your goals. Recovery will also include a specific exercise program based on what we find from your examination. Your program will likely include substituting aggravating activities with more appropriate exercises such as cycling, elliptical training or swimming to maintain your current level of fitness. This programme sticks to timeframes of bony and soft tissue healing using that time to build healthier strength, endurance and control.

Once pain is under control we will make a recommendation of when to gradually return to sport and if a strength and conditioning program might be appropriate. Rehabilitation and strengthening are extremely important to reduce the likelihood of re-injury, let alone risk this developing into a stress fracture.

Your physiotherapist may also discuss with you some risk minimisation strategies while training or competing. This may include such things as:

Proper footwear selection
Warm up prior to exercise
Stretch and strengthen muscles
Cool down properly after exercise

In summary, respect rest as you respect the value of exercise and the value of specific rehabilitation with physiotherapy to outsmart those running “smarts”.

References:

Miller, T., & Best, T. (2016). Taking a holistic approach to managing difficult stress fractures. Journal Of Orthopaedic Surgery And Research, 11(1). doi: 10.1186/s13018-016-0431-9

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