Author: Michael Ranger

Adolescent sports injuries

Young athlete

Adolescent sports injuries

There are two types of sports injuries: traumatic and overuse—or acute and chronic. An injury that occurs suddenly, such as a sprained ankle caused by an awkward landing, is known as an acute injury. Up to 60 per cent of all sporting injuries in adolescents affect the ankle.

Chronic injuries are caused by repeated overuse of muscle groups or joints and include cramps, tears and strains. With increased exposure to sport in the adolescence period, there is higher risk of overusing the muscles, tendons and bones.

In adolescent children with a joint injury (sprain), the growth plate of the joint may be injured. The growth plate is the area where the bone grows throughout childhood until the skeleton is mature.

Commonly, the anterior cruciate ligament (ACL) inside the knee can be injured in cutting, landing and twisting sport activity. In contact and dodging sports, there is a reported increase in the amount of these injuries, particularly in girls (up to eight times that in boys).

Return to sport/exercise is varied guided by the area and type of injury sustained. Through consultation with your chosen practitioner, you should plan your return to sport considering all variables to reduce the risk of recurrent or secondary injuries.

 

What are important measures to take to prevent injury or re-injury?

Before starting a sport, adequate warm up with emphasis on cardiovascular fitness, muscular strength and coordinated skills is important, as well as nutrition and hydration. It is important to avoid heavy fatigue as tired muscles stiffen and lose the ability to freely work, which increases risk of strain during quick activity.

Adequate recovery is also very important. Some adolescent children play for several teams and several sports, increasing their exposure risk to injury. During growing years, it is recommended a child receives a minimum of eight hours sleep and good nutrition to prevent chronic and overuse injuries.

Good equipment such as correct shoe type and fit, breathable sports clothing, mouth guards and helmets are vital in injury prevention. Suitable supervision and umpiring to maintain fair play is also essential for safe play in organised sport and recreational activities.

 

Young Athlete additional information

For a more detailed look into the intricacies of care of the young athlete, check out the following fantastic link to a resource provided by the AIS: https://www.ais.gov.au/position_statements/content/sport-specialisation-in-young-athletes .

 

 

Staff profile – Eliza Osborn

Eliza Osborn

The Physio Plus Footscray team is proud to announce the addition of Eliza Osborn to the Physiotherapy team.

Originally from Gippsland, Eliza graduated from La Trobe University with a Bachelor of Applied Science and Master of Physiotherapy Practice.

Eliza’s passion for physiotherapy stems from her sporting background and keen interest in health and fitness. Personally, Eliza has played and continues to play competitive netball and professionally she has worked with the Melbourne University Blacks in the Victorian Amateur Football Association and has recently gained a position as a Physiotherapist with Williamstown FC in the VFL, assisting with injury prevention and management.

Eliza has experience with a range of musculoskeletal and sport-related injuries. Rehabilitation to optimise function and recovery in all cases is a focus of Eliza’s to help her patients achieve their desired goals in the fastest possible time. Eliza prefers a hands-on approach utilising the best available evidence and manual therapy techniques with a strong focus on exercise rehabilitation and injury prevention.

Outside of the clinic, Eliza enjoys the outdoors – all things boating and water sports, playing basketball & netball and spending time with family and friends.

 

ACL Injuries

Anterior Cruciate Ligament (ACL) injuries:
what is the usual history?

A good history alone will often diagnose to near certainty an ACL rupture.  This is what you might expect to hear from a patient with acute ACL rupture:

  • Non-contact event usually when decelerating, stopping suddenly, twisting, cutting, or jumping.
  • “Knee falls in” with a fixed foot, creating the sheering which exceeds the capacity of the ACL.
  • Oftentimes the patient will recall hearing or feeling a “pop”.
  • Sometimes they may report brief a hyperextension of the knee joint.
  • There is usually immediate severe pain, which eases over a period of minutes.
  • Patients may then feel they can continue activity, but notice “giving way”.
  • Usually considerable swelling occurs within few hours.
  • In a subacute presentation patients involved in sports may describe feeling like they need to “round” their cuts rather than being able to pivot easily on the injured leg.
  • In a contact injury (typically football) the ACL is usually ruptured after a direct blow to the lateral side of the knee.  Other structures are frequently injured in addition to the ACL. This is often seen as the ‘unhappy triad’ that includes the ACL, medial collateral ligament (MCL), and the medial meniscus.

 

Anterior Cruciate Ligament (ACL) injuries:
To reconstruct or not?

If there is one injury that strikes fear into the hearts of most active people it is the dreaded Anterior Cruciate Ligament (ACL) rupture of the knee.  It’s likely you’ll be asked, “Should I get my knee done?”

After an ACL injury, it is common for a patient to feel angry, depressed, frustrated and uncertain about their future. Making a plan with your patient is important and provides them with hope. Your plan should include (and in this order):

1. Gathering the rehab team
2. Starting rehabilitation straight away
3. Deciding whether to have surgery (or not)

The rehab team is likely to include exercise professionals (e.g. physiotherapist), a surgeon, a GP/sports doctor, a coach, team-mates, family, and friends.

Patients should begin high-quality rehabilitation immediately after an ACL injury irrespective of surgery plans.

Deciding whether to have surgery is complex.  Encourage patients to gather information, consider their goals, consider their values, and consider risks.  The best course of action is to try to return normal knee function as soon as possible while deciding whether to have surgery.

There is no clear evidence that surgery is superior to undertaking high quality rehabilitation alone. There is only one published randomised trial comparing the two options. This reported no difference in pain, function or return to pre-injury activity levels at 1-, 2- and 5-years after an ACL injury.

It is clear that some patients need surgery and that some will cope well without.  Of course in either case they need physiotherapy and indeed we typically see the surgical group for a longer period.

 

ACL Rehabilitation: What to expect.

We rehabilitate ACL injuries in phases.  There are many protocols, but three main phases.:

  • Early:
    • Exercises to regain full range of movement and muscle activation.
    • Riding an exercise bike.
    • Practising weight bearing and walking evenly on both sides.
  • Middle:
    • Exercises to single leg balance and control.
    • Exercises to improve general leg strength (eg. squats, lunges, and deadlifts).
    • Exercises to improve single leg strength with (eg. single leg squats).
    • Practising running.
  • Late:
    • Exercises to improve landing ability (eg. hopping and landing practice).
    • Exercises to improve your ability to change direction.
    • Practising unexpected change of direction and agility.
    • Gradually returning to sport-related activities.

There exists a significant risk of re-injury.  We manage this risk by only clearing people to return to sport after they pass a battery of performance, confidence and functional tests and return to sport criteria.  Even after return to sport, we teach exercise based injury reduction programs as part of ongoing risk mitigation.

Of course we are happy to see your patients with knee injuries and to be part of their rehab team.  Referrals can be made by phone, walk-in, online or email found here.

Bowen Summer 10s Carnival

The Bowen Summer 10s Carnival of Rugby took place on the weekend with the Tropic Thunder taking out the Women’s 10s and the Miners taking out the Men’s competition.

Although wet and wild, our very own Senior Exercise Physiologist Yvette Porter competed for the Ladies Carltons playing some technical footy, scoring a few flashy tries and completing a drop kick conversion along the way.

Great work Yvette and everyone that enjoyed the weekend at the Bowen Summer 10s.

Back Pain

Lower back pain – According to the WHO, 60-70% of individuals will experience debilitating lower back pain at least once in their lifetime. This makes it one of the most common presentations we see at Physio Plus.

Given the large prevalence in the community a lot of research has gone into lower back pain. The STOPS trial (specific treatment of problems of the spine) looks at diagnosis and management of lower back pain. The most common sub groups of back pain are outlined briefly below and in more detail via the specific area links.

  • Disc herniation with associated radiculopathy (this is explained in greater detail on our radicular leg pain page).
  • Reducible discogenic/ Non-reducible discogenic lower back pain
    • Common findings we see here are:
      • limited sitting time before pain
      • pain worse the day after the incident
      • difficulty with forward bending, lifting and sneezing
      • history of working in a manual labour job
    • Facet joint dysfunction
      • Common findings of this pathology are:
        • One sided symptoms that tend to be quite localized.
        • Pain with leaning back or side bending to the affected side
      • Multifactorial/non-specific lower back pain (this is explained in depth below in the acute and persistent sections).

If you would like more information about different back injuries or you are struggling with back pain currently, feel free to make a booking today.

 

Ehlers-Danlos Syndrome (EDS)

What is Ehlers-Danlos Syndrome?

Ehlers-Danlos Syndromes are a group of disorders that share a number of common features such as; easy bruising, joint hypermobility, skin that stretches easily and weakness of tissues.

Ehlers- Danlos syndromes are inherited in the genes that are passed from parent to child. They are categorised according to both the forms of genetic transmission and the varied features.

What are the types of Ehlers-Danlos Syndromes?

The Classical type of Ehlers-Danlos usually presents as joint hypermobility and skin laxity and fragility. The fragile nature of the skin is prone to bruising and tearing easily. Joint instability can lead to commonly occurring strains, sprains and dislocations. This classical type is directly passed on from parent to child.

Hypermobility type is as the name suggests, the type where the major factor is joint hypermobility. Any joint in the person’s body can be affected and results in frequent dislocations.

The vascular type of Ehlers-Danlos syndrome is arguably the most severe as it can cause spontaneous rupture of arteries and bowel which can lead to death. Veins can be visible through the skin and the degree of skin laxity can be varied. Clubfoot can be present at birth. It is most commonly directly passed on from one parent to child, but it can also be recessive meaning that it might only be found in one generation of members of the same family, meaning that the individual must inherit 2 copies of the mutation, one from each parent.

Fragile eyes, significant skin and joint laxity and severe curving of the spine are all traits of the Kyphoscoliosis type. Like the vascular type of Ehlers-Danlos, the kyphoscoliosis type can be passed from parent to child and can be recessive.

Patients with the arthrochalisa type are short in height and suffer from severe joint laxity and dislocations. The level at which the skin is affected by the syndrome is quite varied, and a skin biopsy can be used for diagnosis. Dominant and recessive inheritance occurs with this type.

A rare form of Ehlers-Danlos Syndrome is the dermatosparaxis type. This type can also be diagnosed with a skin biopsy. Patients with this type of syndrome have severely fragile skin which is very soft, resulting in sagging and folding.

Tenascin-X type of syndrome is inherited as a recessive direct passing from parent to child. Patients with this type present with hyper elastic skin, fragile tissue and joint hypermobility.

What are the Signs and Symptoms of Ehlers-Danlos syndrome?

The symptoms include loose skin that stretches easily and skin that is saggy and soft in appearance that may be fragile or tear easily. Bruising easily without a significant trauma to the bruised area and joints that move easily past the usual range of motion are signs indicative of Ehlers-Danlos.

What is the treatment for Ehlers-Danlos?

The treatment for Ehlers-Danlos varies patient to patient depending on the symptoms the individual presents with. Skin protection is critical as the fragile skin can be hard to stitch should injury occur. It is recommended to protect the fragile skin from sun and trauma where possible. As joint injury is common, bracing can be used to aid in joint stability and exercises strengthening the muscles around the joint can help to minimize joint injury.

 

The importance of sleep

Everyone knows to perform at your best you need to be fuelling your body with the best foods and keeping yourself hydrated. What many people don’t realise is that sleep plays an equally important role in optimising performance and body function.

A lot happens while we’re sleeping. At night we cycle through different sleep stages, usually from light sleep to deep sleep, back to light and then into REM although everyone’s sleep cycles naturally vary.

REM sleep (Rapid Eye Movement) typically occurs later at night as is important for your memory and mood. Light sleep is essential, it promotes mental and physical restoration. It is no surprise we spend a big chunk of our night in this stage. Deep sleep is responsible for physical recovery and aspects of memory and learning. People usually awaken feeling extra refreshed after a solid night of deep sleep.

The quality and duration of sleep is crucial for optimal performance. A short or restless sleep means that our body is unable to correctly cycle through the sleep stages. This can mean it doesn’t have time to repair, consolidate memory and release hormones. Continued poor sleep or sleep deprivation has been found to impact the way we store energy for exercise. Sleep deprivation has a detrimental effect on our in the moment decision making, our mood and concentration.

Getting the right amount of sleep is the secret ingredient in continually putting your best foot forward in all aspects of your life.

Make 2021 a good one!

The beginning of a new year is the perfect time to turn over a new leaf. January brings with it that extra boost of motivation everyone needs to start a new chapter, full of fresh resolve and better habits. After everything 2020 threw at us, it is not surprising that we now more than ever are looking for a clean slate and making resolutions.

It is much easier to make a New Year’s resolution than it is to keep one. Once you move out of holiday mode and settle back into routine, it’s easy to also slip back into old habits.

If you’re looking for help sticking to your resolutions, whatever they be, there are a few simply steps that you can take to help achieve your goals.

Be specific! Many people resolve to “get fit” or “be productive”. The struggle with these kinds of goals comes when motivation dwindles and it’s hard to see any measurable change with such a vague target. A more concrete goal such as “run 5km” is much easier to complete and gives you the opportunity to plan and tick off achievements along the way.

One at a time! Don’t overwhelm yourself. Choose one thing to focus on so you can put all your energy into it. It can also be helpful to break your goal down into a process. Plan how to tackle your resolution and take it one step at a time.

Remember it’s a process. Breaking old habits is hard. It won’t happen overnight. Be patient with yourself, you should expect a few setbacks. It may take longer than you envisioned, try to remember your reason for starting. When you hit a bump in the road, it is a good time to look over your plan for achieving your goal, you might have to adjust your method but it is no time to give up. You’ll get there.

Team up! Having people to lean on helps keep you motivated and accountable. A resolution buddy can also make the hard work more fun, see if you can talk a friend, family member or colleague into joining you. Simply telling friends and family what you’re striving for can increase your likelihood of success.

Celebrate along the way! Victories throughout the process, no matter how small deserve to be celebrated. Ticking off a milestone on your way to your goal is the perfect time for a pat on the back and a look at how far you’ve come.

Resolution setting doesn’t have to be a yearly disappointment. The difference between success and failure can be as simple as choosing the right goal to strive for and the way you go about achieving it. Be patient with yourself and be flexible, the road to success is not a straight line. The journey towards the end goal is just as important as the end goal itself. Good luck for the year ahead from the entire Physio Plus team!