Readiness to train: When to push on and when to hold back…

Happy Friday all!

We’ve had another busy week here at Physiokinetic. Having had a few patient’s come and see me after developing some overuse injuries I thought it would be useful to give you some tips on monitoring your training load.

When you’ve decided to undertake a training plan and commit to those hours running, in the gym, on the bike or on the pitch; missing sessions or not training hard every session can be a really difficult task. However; training too hard continually, without appropriate rest periods or down time can lead to injury and illness. Whilst we can never truly predict injury or illness there are subtle signs that can indicate when our likelihood of getting injured or ill is higher. We can use these to steer our training.

The first tool we have is the ability to monitor training and competition load. In professional sporting environments Sport Science Staff have the ability to monitor load through GPS tracking and Heart rate data. This data gives an insight into the external load placed on the body (e.g. GPS data, gym load) and the internal response (heart rate data). So how can we track this information without the use of GPS units? There is actually a relatively simple alternative that will allow you to track your load over time. It is an estimate, but it does give you a useful insight into how your training load fluctuates and may guard you against increasing your training too quickly.

Rating a session using a RPE score (rate of perceived exertion) you can estimate the load of a session by scoring it on a scale of 0-10 (1-very light à 10-very very hard).  By multiplying this number by the duration of the session we get an arbitrary figure which represents that training session. For example, a bike session that lasts 60mins at an RPE of 6 would give a TRIMP (training impulse) of 360. Using this method to rate your training sessions will allow you to ensure ‘easy’ sessions are actually easy and hard sessions are hard!

The second tool we can use is recovery monitoring. This essentially assess your readiness to train. We can use simple questions to monitor how we are responding to training and whether we need to modify our plans. Rating your levels of fatigue, motivation and sleep quality can allow you to quantify whether your risk of injury or illness may be higher.

The following questions are a useful start to monitoring your readiness to train:

Rate them on a scale 1-5 (1 poor- 5 Excellent)

How many hours sleep have you had?

How would you rate the quality of your sleep?

How rested are you?

How motivated are you to train?

 

If you just starting out on monitoring your training and responses, then it will take a few weeks in order for you to assess what is normal for you.

Hopefully you’ve found this useful and given you some tools to start to monitor your own training and readiness to train!

 

Have a great weekend!

Becki

End stage rehab and self management

What a busy week!

Thank you to all of our patients for making this a challenging, and interesting period.

As physiotherapists we are always looking to give people the tools they need to solve problems themselves. We don’t just try and ‘fix’ you in the short term. A prime example from this week was a patient who initially came to see me a few months ago. During this first period of physiotherapy they had sustained a sudden onset of lower back pain. This was the first time it had happened to them and therefore involved a lot of fear of the unknown. We were able to help the patient resolve the issues and get them back to work and back to being active with their family. This same patient came back to see me this week and was able to proudly tell me how they had fully fixed themselves following a recurrence of back pain following an unfortunate event in the cold weather. They stated how the pain had come on, described their symptoms and was able to rationalise the situation based on the information they had received from us. This directed them on how to resolves the issue as quickly as possible. The first episode lasted 8 weeks. The new injury lasted only 1!

This stresses the point of education. We will always give you a full explanation of the problem and aim to give you the tools to get yourself better.

When considering your rehabilitation as physiotherapists it is our job to match your treatment to your goals. Its been great to see a few athletes this week reach the end stage of their ‘return to play’ targets.

This is an area often overlooked by athletes. Once you have achieved the advanced stages, you are not in pain, you have full movement and your strength scores are back within normal targets, what do you do to make sure you are ready to play? In the advanced athlete we would do this in conjunction with coaches and a multidisciplinary team of support staff, including nutritionists and psychologists. We develop a plan that is specific to each individual and specific to their sport.

To illustrate this point, think of a rugby player following an ankle injury. They are not in pain, they have full movement in their ankle and they can complete all strength requirements in the gym. Whats left to do? Well, we need to build a complete picture of their specific position, involving how far they run, how fast they run, if they lift or kick and even what kind of boots they use.

Once you have a complete picture, we then break down that activity into its component parts, test the athlete based on those components, and fill in the gaps. The rehabilitation should start to look like the sport. In this example, when lifting in the line out, how much force goes through the ankle in good technique? We would then reproduce that movement and force in the gym, this could be a ‘thruster’ exercise. But this wouldn’t be enough on its own, as in real life the ground is not flat and the weight is moving around to try and catch a ball. We have to recreate this, to a lesser extent, using unstable surfaces and loads, commonly adding resistance bands or external forces into the equation. By the time you have finished the athlete should feel confident they are ready to get back to their sport. It is worth noting that this process of accessing movement and training for it is often the way we try to improve an athletes performance.

Finally, good luck to all athletes and teams competing this weekend and a special get well soon to our proprietor, Mike, who has a sore throat.

 

Dan

 

 

 

Same injury….different athlete….

Hi all.

This week has been a busy week for us with the final stages of the British Junior Squash Open at the weekend and with many of the University’s Scholarship athletes returning from their Christmas break. There have also been lots of discussions within the department about several high profile athletes injury stories in the press over the holiday period.

I think one of the most contentious and high profile stories is Zlatan Ibrahimovic’s return from anterior cruciate injury (ACL). Whilst he has received huge praise for his dedication and determination to return at 7 months, many medical professionals have registered their concern about his early return.  Adding fuel to this debate is the player’s injury ‘recurrence’ which has seen him side-lined for at least another month at the end of December.  So why has he had a recurrence? Well this could be down to many factors. Being absent from training and playing for such a significant period will always make you more susceptible to another injury. Moreover he may have had additional injuries alongside the ACL which have been aggravated on his return.

So the big question did he return too soon? There are many factors that are used to determine an athlete’s readiness to return; these include strength, cardiovascular fitness, movement analysis and psychological readiness. Undoubtedly Zlatan Ibrahimovic would have met all of these targets before returning to training and match play. Many ACL rehab specialists will advocate a minimum of 6-9 months before returning to competitive sport. I think taking into account the research related to re-injury and the significance of the surgery I think it is reasonable to aim for a 9 month return to sport in the professional environment.

Does this differ for your amateur athlete? Ultimately yes. Professional athletes have the luxury of being able to focus on their rehabilitation full-time and the ability to work with physiotherapists and strength and conditioning coaches on a daily basis. So what does this actually mean? Well… there’s no juggling of work and rehab; when there’s those days that you just don’t feel like hitting the gym there’s people there to motivate and encourage you and essentially force you to the work that you need to do! This will have the ability to help professional athletes meet their goals sooner than amateur athletes.

So when thinking about amateur athletes sustaining significant injuries requiring complex surgery I would always look to allow 12 months before returning back to the previous level of sport. Juggling work, family and life commitments all take their toll and do have a negative impact on rehabilitation. Setting a target of 12 months is realistic and allows for not only the recovery from the injury but also gives the time to develop skill acquisition, confidence and reduce the fear of re-injury.

Here at Physiokinetic we deal with a wide range of athlete’s from amateur to fully professional. We are able to tailor rehabilitation to meet the lifestyle and goals of the patient. So if you need advice on management of an injury come and see us!

Have a great weekend from all at Physiokinetic!

Thanks Becki

 

New year, New sports, New injuries

Happy New year from Physiokinetic!

We hope you have enjoyed the festive period and no doubt are refreshed and ready to get back to work and into the next part of the winter season.

We have made a combined decision to keep you all informed of what’ s going on within Physiokinetic this year. This will not only keep you up to date with us, but also give you an opportunity to ask us questions and interact on all things physiotherapy. We would love to hear from you and hope to build discussions and helpful blogs to keep you in sport, at work or simply active!

2017 has seen us grow as a business. We have moved across to our very nice new home within the University of Birmingham at the sport and fitness centre. (https://www.sportandfitness.bham.ac.uk/) We are part of a state of the art build with the latest and best facilities. We love the wide range of people that use the facility. You can come to the gym and mix with people taking part in all sports. Whether that be Judo, squash or American football, its all here, a great opportunity to expose yourself to a new environment. Luckily for us we get to look after and treat people from all these areas, so whatever your sport, we have probably seen it!

If you are starting a new regime this January please check our previous blog on avoiding new injuries. My colleague Becki wrote an excellent post discussing the importance of managing your training and playing loads. This is particularly important as I have noticed a rise in the number of ‘load related bone stress injuries‘  over the last few months. This is where, due to a combination of factors, a load bearing bone is unable to deal with the forces a sportsperson puts through them. This results in a reaction within the structure of the bone which can lead to fractures if not identified and treated properly. Luckily at Physiokinetic we have a fast process to identify these injuries, including the use of MRI and help of a Sports Medicine Doctor. This means we can get you on the right course and back to your sport as soon as possible.

Now in 2018 we are hosting the British Squash Open, featuring the best young squash players from all over the world, follow our Instagram (https://www.instagram.com/physiokineticltd/) to see the pictures. We are the official physiotherapy supplier for the tournament and already have had an influx of players working to keep that physical edge. There is a real buzz around the building at the moment and the competition looks fierce.

Over the coming weeks we look forward to the return of our scholarship athletes and international hockey players ready for the coming season. We will be keeping you updated on their progress as they strive for premiership playoffs and the women’s and men’s team aim for University league gold medals.

We will also see the return of our groups of musicians, office workers and gardeners as they get back to normality after a typically low activity period. Remember our constant messages to you, keep moving and keep active!

I cannot finish this post without talking about my favourite activity…….skiing! The Alps is currently having some of the heaviest snowfall I have ever seen. It is truly setting up for a fantastic season. These snow conditions lead to particular problems. Deeper and softer snow sees a greater number of knee injuries in amateur skiers, due to the ‘phantom ski’ event. This is where the downhill ski does not release from a turn causing a twisting motion through the leg, normally resulting in knee injury. Being technically better helps this issue, but also being physically prepared for your skiing. During my time working in ski resorts, 90% of injuries occurred in people who had done no preparation for their ski holiday, so a little preparation goes a long way to ensuring you have a fun time this winter. If you are unsure of what to do, come and see us for advice and we can develop a personalised plan to help you.

 

Next week Becki will be keeping you updated on all things Physiokinetic. Until then have a great start to the new year!

 

Dan