Using Your Time in Rehab To Improve Athletic Performance

Speaking to some of the sporting population I deal with on a regular basis, there biggest fear after an injury is the idea that they may not be able to ever reach the same level of performance once they return to their chosen sport.

The number one priority for physiotherapists are to return their clients to sport safely (see my previous blog“When Is It Safe To Return To Play”), however there are many injured athletes out there who cannot be bothered with the massive amount of effort a rehabilitation program takes, if they can’t return to their desired level of performance.

Speaking from personal experience and a long list of previous injuries related to playing Australian Rules football, I now feel as though I can’t run as fast, jump as high, or kick as long as I previously could.

Previous to becoming a physio and knowing what I do now, I was more worried about getting back on the park ASAP, rather than ensuring I was able to perform at the same level I could pre-injury.

Now, I understand the importance of not just rehabilitating the injury, but rehabilitating the athlete as a whole to help achieve their ultimate goal, to be the best player they can be.

For longer term injuries in particular, maintenance of strength, flexibility and power in regions away from the injured area are extremely important to ensure future injury risk is decreased and athletic performance is maintained.

For example, consider a young 18 year old footballer who has suffered a stress fracture in his foot. Quite possibly, the player could return to the football field after a period of complete rest from running allowing the fracture to heal.

However, if the player does not maintain their global lower limb strength, flexibility and power, as well as aerobic conditioning, they are much more likely to sustain another injury (not necessarily in the same region), and return to play with a lower level of performance.

This is where physio can play a massive role in ensuring all baseline objective values (strength etc.) are met at the very least, before returning to play. Unfortunately, unless you are working with an elite sporting team, you are unlikely to have these baseline values at your disposal, but you can always compare to the uninjured side!

And I believe a shift of thinking to returning the athlete to baseline athletic performance, rather than just treating the injury itself, can make the journey to return to sport a much more enjoyable one for all involved.

There is scientific evidence to support this idea also. An injury prevention program set up by soccer’s world governing body FIFA, called the “FIFA 11+ Injury Prevention program” not only helped to reduce future injury, but was also found to significantly improve balance, jumping and sprinting measures.

This is an example of how more athletic movement based exercises (not just exercises specific to a previous injury) can lead to better athletic performance, whilst also keeping the player out on the park for longer.

So rather than dreading your inevitable rehab once an injury occurs, try looking at it as an opportunity to work on your athletic weaknesses, and return the field stronger, fitter and faster than you ever have before.

Research Link:

https://www.ncbi.nlm.nih.gov/pubmed/28192831

When Is It Safe To Return To Play?

After all the countless hours you’ve spent in the gym and on the track, the thirst to get back out there with your teammates or back into individual competition would be high. I’m sure you’ve wondered why your physio has held you back from getting that important tick of approval to return to play (RTP).

Well let me give you an insight into our decision making process when it gets to this stage of your rehab plan.

Firstly and possibly most importantly, we ensure that the injured area has healed appropriately based on standard healing times. For example, we know a broken bone usually takes around 6 weeks to heal, so RTP would definitely not be safe before this timeframe.

Next, we look at the body symmetry of important objective measures. Strength, flexibility and joint control are all important factors that should be as close to pre-injury baseline as possible. When a physio doesn’t have the information to your baseline measurements, they will often compare to your uninjured side to get a rough idea.

Thirdly, the physical requirements of your sport must match up to your current physical capacity. For example, AFL football requires components such as high speed and endurance running, agility, jumping and landing and power when being tackled or knocked off the ball. It is important that all components have been ticked off in training without any increase in symptoms and at pre-injury level prior to RTP.

Training load is also a very important part in returning to play with as little risk of future injury as possible. There has been a lot of scientific research published recently in relation to making sure training load is built up safely to reduce risk of future injury.  This is an important part in making the decision in RTP, in relation to whether the current training load compared to playing load is too high.

Finally, the psychological nature of RTP is also a very important consideration. If a player is not confident in returning to their chosen sport, they are likely to compete differently which can also put them at increased risk of injury.

Hopefully this overview can give you an idea of the aspects of your rehab plan you must tick off before helping you to achieve returning to your chosen sport at your best.

Don't Be Scared of Needles

Have you ever wondered how people managed their aches and pains thousands of years ago, without the use of modern day medications and fancy physio modalities we so often take for granted?  Surely those Chinese Warriors must have done something right to get themselves up for battle back in the day?

It turns out that traditional acupuncture, used widely to treat these warriors for their sore bits, is coming back into fashion in the physiotherapy world some 2000 years later, and for good reason too.

Now slightly reformed, and termed “dry needling”, the use of solid, filament needles are used predominately to be inserted into muscle and the thin wrapping around it to try and release its “myofascial trigger point”. In simple terms, a myofascial trigger point can be thought of as a small contraction knot in a muscle. So whenever you are feeling a bit sore at the back of your neck, and feel as though your muscles are all knotted up when you reach back there, there is a high chance you may have developed a myofascial trigger point.

But before we get to how these little (often 30-50mm in length depending on the area involved)  needles can help, I am sure you are all wondering how these annoying trigger points can develop in the first place (if not, I’m going to tell you anyway!)

Even though there is still much controversy around how exactly these trigger points form and their true prescence, we understand that they can occur in a muscle for a multitude of reasons, including an acute muscular strain, a fall, a sprain or fracture, or excessive or unusual exercise. However, trigger points can also develop over a less acute period, and are often the result of chronic overload of a muscle due to poor sitting/standing posture, sleeping habits and repetitive work tasks. Stress can also be closely linked to the prescence of trigger points due to the person holding increased tension through their muscles throughout their whole body.

A myofascial trigger point can present as a localised hyperirritable spot of a muscle. It can also cause referred pain to another area of the body, and there seem to be common referral areas for trigger points found in certain muscles around the body. Compression of a myofascial trigger point can also elicit a localised twitch of a muscle. 

Now lets get down to business and talk about how we can get rid of these annoying things.

Dry needling is thought to work in a number of different ways. The first mechanism, can be thought of as fighting pain with pain. By inserting a sharp object such as a needle in to the body, this causes the brain to focus on this pain (transmitted to the brain by slightly different pain fibres) and blocks onward pain transmission of another type of pain fibres responsible for the dull ache often associated with myofascial trigger points. Evidence has also shown that by stimulating a trigger point, a chemical called cortisol increases in the body, which is a chemical which eventually leads to an anti-inflammatory and pain numbing effect in the body (acknowledgment to Acupuncture, Muscles and Pain course- Glenn Ruscoe).  

Physiotherapists are well placed to practice dry needling, as we are competent in assessing for the presence of myofascial trigger points and assessing why these trigger points may be present.

Even though I’m sure you all cant wait to get some needles put into you to alleviate all your aches and pains after reading this, it is important you take some responsibility for your pain to get the most optimal effect from dry needling. As effective as dry needling is, supported by medical studies done in the past (Effectiveness of dry needling on the lower trapezius in patients with mechanical neck pain: a randomized controlled trial., Pecos-Martin et. al is just one example), it is important the correction of posture, alleviation of stress and muscle stretching is all completed to ensure your pain does not come back!

So even though our understanding of pain and the way we treat it has come a long way since the days of ancient Chinese Medicine, it seems that some things don’t need to change.