Author: Michael Ranger

Spring has sprung which means cricket season is officially upon us.

Cricket is a popular non contact sport that requires a combination of physical fitness, skill, and strategy. Overuse and impact injuries are common since players engage in  running, throwing, batting, bowling, catching, and diving. A physiotherapist can identify risk factors for prevention of  sport injuries, provide effective strengthening/conditioning exercise programs  to improve muscle imbalance  and promote safe return to sport

So let’s take a look at some of the most common injuries 

1. Lower back pain

Lumbar spine injuries are very common in fast bowlers since the technique  involves placing a large amount of force repetitively  through the back  at great speed. The result of repeated or forceful trunk  lateral flexion   with rotation during the delivery stride and follow-through puts the lumbar spine at risk of developing disc degeneration or spondylolysis, a stress fracture occurring at the pars interarticularis. Bowling injuries tend to be overuse injuries and often present gradually over time. It occurs more often in young fast bowlers and  are usually seen on the side opposite to the bowling arm. 

1. Shoulder injuries

The rotator cuff muscles are stabilizing muscles around the shoulder joint. A rotator cuff injury is an overuse injury due to repeated overhead throwing during fielding, bowling and wicket-keeping. 

1. Hamstring injuries

Cricketers are prone to hamstring strains because they may be required to perform an explosive movement after a long period of standing relatively still. Hamstring strains  occur during sprinting with  fast bowling, while fielding or sprinting between wickets as a batsman. The severity of the strain may vary between a dull ache or  extreme pain making it difficult to stand or walk.  

Contacts to email:

1. Le page Park – Senior Womens Cricket Co-ordinator – Tim O’Meara  E: [email protected]
2. Le page Park – Senior Mens Coach – Steve McConchie – E: [email protected]
3. Chelt cricket [email protected]
4. Kingston Heath  [email protected]
5. [email protected]
6. [email protected]
7. [email protected] 
8. [email protected] 

A research piece recently published in the British Journal of Sports Medicine described “extraordinary levels” of ice used at the summer Olympics as not always being evidence-based and bad for the planet.

They report that over the last decade, there has been a sharp increase in CWI requests. Data provided  courtesy from games organizers indicate that the request for CWI at Athens 2004 and London 2012 were 10%  in comparison with Rio 2016 at 44%, where the majority of these were used for recovery. Tokyo 2020 Olympic games required 22 tons of ice and had an additional 42 tons delivered to the Olympic village residence for ice dispensing machines. Paris 2024 first estimated 1624 tons of ice, at a cost of €2.5million, however, the estimate was reduced to 650 tons (450 tons for the Olympics and 200 tons for the Paralympics). The researchers point out the environmental concerns as ice provision requires a considerable amount of energy for production and storage as well as logistical challenges related to transportation. In addition, ice is often used to obtain benefits which are not evidence-based. More importantly, ice could have the opposite effect to that expected, such as delayed tissue regeneration or impaired recovery.”

Cryotherapy (also known as cold therapy) is utilized as a physical intervention in the treatment of injury and exercise recovery. This may vary from ice packs, compression pumps, ice baths, ice towels, ice massage and cold water immersion. Traditionally, ice is used in the treatment of musculoskeletal injury to reduce pain while cold water immersion (CWI)is used to reduce muscle soreness for recovery from exercise.

( Kwiecien SY, et al. Eur J Appl Physiol. 2021 Aug;121(8):2125-2142.)

Postexercise CWI is one of the most widely used recovery strategies among athletes and pooled data analysis show that it is better for muscle power and perception of recovery than active recovery, massage or contrast baths. However, recent studies have reported that cooling decreases long-term strength adaptations (Roberts et al. J Physiol 2015;593:4285–301)  and may impair acute performance following exercise (Solsona et al. J Sports Sci 2023;41:1126–35). The researchers suggest therefore  given the financial, logistical and environmental implications involved in  setting up  a CWI area at a competition venue , the approach of organizers should rather be tailored towards recovery goals in order to reduce ice requirements. They advise that CWI may be recommended and appropriate for recovery following exercise in the heat for fast relief of heat exhaustion, prolonged exercise in normal temperatures  for relief of muscle soreness and during multi day training conditions where muscle soreness is anticipated over several days. They also suggest that CWI may be ineffective or unsuitable for recovery when used for high intensity consecutive exercise, acute recovery following resistance training and long term recovery following resistance training.

They conclude that ice should remain available for the relief of acute pain, specific recovery needs and management of heat stroke and organizers should plan better for the provision of ice to minimize the use of non-evidence-based practices and promote better sustainability. The sport and exercise medicine community needs better data on the actual amount of ice consumed at major sporting events, for what purposes and at what financial and environmental costs.

Interesting read!

Melissa Martin

CLICK THROUGH TO WINTER TIPS

Rugby – Ankle sprains and balance – Melissa Martin

A study by Martin et al.(2021) was conducted to examine differences in objective dynamic
balance outcomes of female rugby players with and without a history of lateral ankle sprains.
The Noraxon myoPressureTM (Zebris) pressure plate was used for this study to measure
objective dynamic balance during 3 sport specific tasks, namely single-leg catch-and-throw,
single-leg jump landing and side stepping with statistically significant differences noted.

Women’s rugby is growing in popularity worldwide (King et al.,2019) The most common type of
ankle injury in female rugby players was identified as lateral ankle sprains, mostly involving the
rupture or tear of the anterior talofibular and calcaneofibular ligaments (Gribble et al.,2016).

Ankle sprains mostly occur in rugby due to impact or collision of players when the ankle twists
inward (Richie & Izadi,2015). The tackle is considered the most dangerous phase of play as it
contributes to 61% of all injuries in rugby, with joint sprains more common to the ball carrier (
Matthewson & Grobbelaar,2015). However, ankle sprains may also occur spontaneously in
rugby during running and cutting manoeuvres particularly on uneven field surfaces. During
cutting manoeuvres, players are required to run, change direction and leap away for other
players at a high velocity. The ankle moves through extreme ranges of movement from
dorsiflexion and inversion to plantarflexion and inversion which stresses the plastic restraint of
the lateral ankle ligaments, resulting in a high risk of inversion sprains (Vijam et al.,2015).

An ankle sprain often results in loss of postural control, leading in turn to loss of proprioception,
nerve conduction and reduced strength as well as range of movement (Richie & Izadi,2015).
Optimal dynamic balance is important for rugby players as they need to be able to avoid falls
whilst performing and executing highly skilled sport specific tasks such as tackling, kicking,
passing and catching (Chiwaridzo et al.,2016). Technological advancements in balance
assessment over time have led to the utilization of pressure or force platform systems to
quantify dynamic balance ( Duarte & Freitas,2010; Mancini &Horak,2010; Schubert &
Kirchner,2014). These systems can objectively assess balance and provide quantitative
feedback to guide clinicians in assessing and monitoring proprioceptive retraining during
rehabilitation before return to play and during the implementation of preventative programmes.

At Physio Plus Cheltenham, we are able to provide a comprehensive assessment of your sport injury utilising
the Strength by Numbers AxIT testing system. The AxIT system can measure the force that you
produce and absorb when completing different exercises, such as Single leg balance, Squat,
Jumps and calf raises to name a few. This system helps to set goals and subsequently
motivates you to keep up with your rehabilitation and exercise plans, even once the pain from
your injury has subsided.

If you need help with your injury rehabilitation, get in contact with us today!

Rehab framework for the calf

Estimating prognosis
Positive:
– First time calf injury
– Not high energy mechanism eg not
running/accelerating
– If there is a disconnection between capacity
and pathology on MRI
– Good calf baseline
– Good calf strength

Negative:
– Recurrent injury
– Running or high energy mechanism
– PHx of calf, ankle or knee injury
– Older age
– Poor calf baseline profile
– Poor calf synergists both local and
upstream

Acute rehab examples (completed ~3 x day)
– Theraband plantarflexion
– aROM + isometric
– Isometric standing straight knee heel raise
– Isometric seated bent knee heel raise
– Focus on proximal synergists early – hip and knee strength

Early rehab examples:
– Body weight heel raise → Neutral position – aim for around 60bpm on metronome
– Isotonic seated calf raises in neutral position
– Body weight isometric switches → Monitor heel drop
– Smith machine isotonic standing heel raises
– Early locomotive
– Lunges
– Heel to toe walking
– Stair walking

Locomotive exercise progressions:
– Stair ascents
– Walking – start at ~90bpm on metronome
– Weight vest/waterbag
– Jogging – ~170bpm
– Lunges
– Walking lunges
– Lunge arabesque
– Lunge doubles
– Progressing to using barbell/medicine ball

Intermediate to end stage rehab examples:
– Bodyweight single leg heel raise → Progressing into dorsiflexion
– Isotonic seated calf raises → Progressing into dorsiflexion
– Smith machine isometric switches → Increase load
– Smith machine isotonic standing heel raises → Increase ROM
– Plyometrics
– Start with vertical and progress to horizontal
– Once comfortable with above progress to lateral/rotation
– Running drills → A + B walk/skip variations
– End stage locomotive
– Triple extension onto box from hinged position → Add weight with dumbbells/barbell
– Prowler progressions

Plyometric progressions
– Double leg
– 1 on 1 off
– 2 on 2 off
– Single leg

Combat sports – where the athlete puts it all on the line to break down his/her opponent, either physically or mentally. Due to the nature of the sports, it is inevitable that injuries will occur. Therefore, it is imperative that medical practitioners have a comprehensive understanding of the training and competition combat athletes participate in, as well as the injury characteristics to be prepared for the most pertinent injuries and its rehabilitation course.

There are many components to the combat athletes training regime. The martial arts gym is where the athlete develops skills and tactics to ensure they are well equipped in their ability to defend and attack in their sport. The weights room is where the athlete develops and enhances their general physical qualities (e.g strength, power and speed).  And lastly, the cage/ring/mats, are where the athlete puts it all together in competition, to display their unique style of martial art against their opponent.

When an athlete becomes injured, whether in training or in competition, it is imperative that their rehabilitation is guided by a qualified health professional (such as a physiotherapist/physical therapist), as the biggest risk factor for injury is previous injury to the site. It is also crucial that the practitioner understands the biomechanics and demands of the sport, as it will allow for a specific and effective rehabilitation program. Musculoskeletal injuries usually occur when an internal/external stress is applied to the bones, tendons, ligaments, joints and cartilage which is beyond the normal tissue capacity. This can be either acute or chronic.

In 2020, the UFC (Ultimate Fighting Championship) developed a cross-sectional performance analysis and projection of the UFC Athlete. They found that the most common injuries sustained from grappling were diagnoses’ involving the neck, low back and shoulder. The most common striking-related injuries involved knee pain, wrist/hand pain, concussions and foot pain. Finally, the most common injuries involved in submission techniques included knee and elbow injuries that involved ligament sprains.

Physiotherapists are experts in musculoskeletal rehabilitation, as well as prehabilitation. They are proficient in assessment and treatment, exercise prescription, manual therapy, and concussion/vestibular rehabilitation. And whilst there are many other physiotherapy clinics you can receive treatment from, Physioplus has practicing martial artists, who train and compete in mixed martial arts, wrestling, jiu-jitsu and muay thai. They understand the demands of the sport and what is required to make a full return to the mats, which makes them the most qualified to help you return to/optimise your martial arts journey.

Balance is a complex process that relies on the integration of sensory information from proprioception, vision, and the vestibular system. These three systems work together synergistically to maintain postural stability and enable smooth, coordinated movement. Understanding their combined effect sheds light on how optimal balance is achieved.

1. Proprioception:

• Definition: Proprioception refers to the body’s ability to sense its position, movement, and forces acting upon it.
• Role in Balance: Proprioceptors in muscles, tendons, and joints provide continuous feedback to the brain about the body’s position in space. This information is crucial for maintaining balance, especially during static and dynamic activities.

2. Vision:

• Definition: Vision provides information about the environment and the body’s position relative to external reference points.
• Role in Balance: Vision helps in orienting the body and adjusting posture based on visual cues. It provides additional information to supplement proprioception, especially in situations where proprioceptive input is limited or conflicting.

3. Vestibular Function:

• Definition: The vestibular system, located in the inner ear, detects head movements and provides information about spatial orientation and movement.
• Role in Balance: The vestibular system helps in maintaining gaze stability and detecting changes in head position, which are critical for balance and spatial awareness, especially during rapid movements.

4. Combination Effect on Optimal Balance:

• Synergistic Interaction: Proprioception, vision, and vestibular function work together to provide a comprehensive picture of the body’s position and movement in space. This integration allows for precise adjustments in posture and movement to maintain balance.
• Compensatory Mechanisms: When one sensory system is compromised, the other systems can compensate to maintain balance. For example, if visual input is reduced, proprioception and vestibular input become more critical for balance control.

Optimal balance is achieved through the synergistic interaction of proprioception, vision, and vestibular function. These sensory systems work together to provide the brain with accurate information about the body’s position and movement, allowing for precise adjustments to maintain stability. Understanding the combination effect of these systems is crucial for improving balance and mobility, especially in clinical settings where balance impairments are common.