The 6 tick boxes to return to sport from ACL rehabilitation

Anterior Cruciate Ligament (ACL) injuries can be distressing for patients and its rehabilitation is one that needs to be taken seriously. We understand that it is a timely rehabilitation, but also understand that time is not the only factor that needs to be accounted for when dealing with an ACL injury. It has been reported that 81% of individuals with an ACL injury will return to any kind of sport. Only 65% will return to their pre-injury level and merely 55% return to competitive sport.

Re-injury rates for ACL vary between 6% to 25% thus making the decision for when it is appropriate to return to sport a decision that ultimately must be made with clearance from the orthopaedic surgeons, physiotherapists and osteopaths such as those at the Injury Rehab Centre in Cheltenham.

What are the criteria to return from ACL injury safely?

One study set out to explore an objective return to sport/discharge criteria and evaluate whether strength or functional tests were risk factors for ACL graft rupture. They examined 158 professional male athletes in Qatar and followed up with the individuals 6 months after their return to sport.

The discharge criteria examined were:

• Isokinetic Testing – Quadriceps Strength Deficit <10% at 60 Degrees/Second between legs

• Single Hop – Limb Symmetry Index (a measure to standardise test results with lower limb length) >90%

• Triple Hop – Limb Symmetry Index >90%

• Triple Crossover Hop – Limb Symmetry Index >90%

• On-Field Sports Specific Rehab

• Running Agility T – Test (ability to run and change direction over a set of cones in a T shape set 10 metres apart) – <11 seconds

Of the 158 athletes that participated:

• 116 (73%) fully discharged

• 42 (27%) did not achieve

Injury Occurrence

• 26 (16.5%) sustained graft rupture

  • 17 occurred within the first 6 months of return to sport

• 11 (7%) sustained opposite side rupture

Was there a difference in those that were fully discharged versus not?

YES!

• 12 out of 116 (10.3%) that were fully discharge sustained an ACL graft rupture

• 14 out of 42 (33.3%) that did not meet the 6 criteria sustained an ACL graft rupture

Take home messages:

• ACL re-rupture rates range from 6-25% and a high amount of individuals return to sport (81%)

• Not meeting all 6 variables examined by the study places you at a 4x greater risk of rupture

• For strength examined, every 10% decrease in hamstring to quad strength ratio there was a 10.6x greater risk of ACL rupture

  • DON’T NEGLECT THE HAMSTRINGS!!

At the Injury Rehab Centre we utilize a functional and objective measures to help mitigate your risk of injury before you return to sport. We utilize a variety of tools and combine some of the tests above with force plate technology to increase our understanding of your capability. If you’ve had an ACL injury recently or had a previous ACL injury, ensure that you are ready for your next upcoming season with the Injury Rehab Centre and book with a physiotherapist or osteopath now!

What we do at the Injury Rehab Centre

At the Injury Rehab Centre in Cheltenham we go above and beyond traditional Physiotherapy and Osteopathy clinics by using the latest assessment technology to perform tests as previously described to collect data on how you move to assess your risk of ACL injury or how your rehabilitation is progressing.

We utilise:

• M.A.T Assessment created by the therapists of the Injury Rehab Centre to laser focus on areas of flexibility, balance and movement that identify whether your are at risk to sustain an injury.

• Slow Motion Jumping and Running Video Analysis to IDENTIFY YOUR BAD LANDING AND CHANGING DIRECTION HABITS that maintain a risk of injury.

• Strength Testing to identify any strength discrepancies that have a huge role in increasing your injury risk.

• Force Plate Technology to put a number on differences in the power you can generate through each leg that can lead to compensations and can cause repetitive stress injuries and prevent return to full performance.

•  Traditional Physiotherapy and Osteopathy examinations to identify dysfunction.

Individual management plans can then be created using baseline data to track progression of a program to address movement deficiencies and discrepancies (muscle and tendon strength, stamina, specific flexibility) as well as increasing your movement skill to make you more efficient out on the road, track or trail to bullet proof your body from injury and increase performance.

The Injury Rehab Centre is currently seeking participants for research we will be conducting into the effectiveness of treatment and rehabilitation for ACL reconstruction patients.

As part of this research participants at the Injury Rehab Centre will receive a FREE M.A.T assessment in which detailed lower limb testing will be performed to identify deficiencies and discrepancies in lower limb function to calculate risk of injury.

If this sounds like you or someone you know go click here to register your interest in being part of this study and getting a FREE assessment today.

Reference:

Kyritsis P, Bahr R, Landreau P, et al Likelihood of ACL graft rupture: not meeting six clinical discharge criteria before return to sport is associated with a four times greater risk of rupture Br J Sports Med 2016;50:946-951.

How strength training will reduce pain and injury by 50%

At the Injury Rehab Centre our Physiotherapists and Osteopaths who service the Cheltenham, Moorabbin, Mentone, Highett, Hampton, Black Rock, Beaumaris and Heatherton suburbs have the philosophy that stronger people are harder to kill injure. That’s why a big part of our management for dealings with patient pain and injury often involves an active approach teaching our patients to become stronger and move more efficiently.

Exercise is good for us!

jogging

Most patients that our Physiotherapists and Osteopaths see understand that physical activity is beneficial for many common diseases and pathologies. It’s now commonly known through research that exercise helps with:

• Cardiovascular disease

• Diabetes

• Cancer

• Hypertension

• Obesity

• Depression

• Osteoporosis

How does injury occur?

So exercise is good for our body but what about pain and injury? Many of us engage in a variety of different activities and sports that all inherently put our body through stress and strain. We accept the risk of injury because we simply enjoy activity and the benefits outweigh the cons. But what happens when our body doesn’t have the capacity to tolerate the stress and strain that we put it through? Well, injury of course. Whether it be an acute over stretching of a muscle or ligament or repetitive strain over time often the story is simply that we don’t have the strength to care for this amount of stress.

What does the research say?

One study conducted a systematic review (high level evidence) to examine what the effects of strength training, balance/proprioception, stretching, and a combination of these techniques on injury rates.

Main Findings:

• Combination, strength, and balance/proprioception all displayed a tendency to decrease risk of injury!!!

• Stretching alone had no effect

• Strength training had highest preventative effect among all techniques

• Both acute and overuse injuries could be significantly reduced

• Overuse injuries could be reduced by nearly 50%

The take home message:

• Stretching along before and after your workouts is NOT enough to help you reduce your risk of injury

• A strength-training program integrated as a part of your sport/activities should almost be essential to help you reduce your risk!

What do the Physiotherapists and Osteopaths at the Injury Rehab Centre in Cheltenham do?

At the Injury Rehab Centre We specialise in assessment and collecting actionable data using the latest technology previously only found in elite sporting institutions particularly in understanding our patients strength and capacity. This includes:

• M.A.T Assessment created by the therapists of the Injury Rehab Centre to laser focus on areas of flexibility, balance and movement that identify the risk factors of low back pain.

• Slow Motion Video Analysis of fundamental lifting techniques such as squats, deadlifts and presses TO FIND BAD HABITS that can cause injury to areas such as the lower back.

• Strength Testing to identify any strength discrepancies that have a huge role in injury risk.

• Force Plate Technology to put a number on differences in the power you can generate through each leg that can lead to compensations and can cause repetitive stress injuries such as those activities that contribute to back pain.

• Traditional Physiotherapy and Osteopathy examinations to identify dysfunction.

Next our treatment process achieves pain relief in the shortest amount of time by using hands on Physiotherapy and Osteopathy techniques such as soft tissue massage, joint manipulation, articulation and stretching techniques. This may include the use of the True Stretch system as well as Dry Needling and Taping techniques.

Finally your management plan will involve an individualised training plan to build your strength and capacity (muscle and tendon strength, stamina, specific flexibility) often to improve discrepancies from side to side that could be the true cause of your low back pain and build confidence in your body.

If you suffer from low back pain and want to get off the treatment merry-go-round and back to feeling better, moving better and performing better contact the Injury Rehab Centre today on 95537024 or book online using the link at the top of the page.

Reference:

Lauersen, J.B., Bertelsen, D.M., Andersen, L.B. The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomized controlled trials. Br J Sports Med, 2014, 48: 871-877.

Why does your heel hurt? 2 factors that cause Plantar Fasciitis.

Plantar Fasciitis is one of the most common causes of symptoms for heel pain in runners and is usually categorised by a sharp pain particularly in the morning that warms up or reduces with walking or running. At the Injury Rehab Centre our Physiotherapists and Osteopaths in Cheltenham see many presentations of Plantar Fasciitis every week. About 10% of Plantar Fasciitis cases are linked with running and incidence peaks for individuals between 40-60 years of age.

Why is it happening to me?

Plantar Fasciitis like many other repetitive stress injuries occurs when there is too much load for what the body can tolerate. This repetitive stress causes micro trauma in the Plantar Fascia that is constantly irritated from time spent walking or running in activities of daily living. The foot faces repetitive strain from deformation of the arch during running with landing forces up to three times body weight with every step and this may lead to the development of Plantar Fasciitis.

Am I at risk?

The following factors have been identified in the research as being major risk factors for Plantar Fasciitis.

• Reduced ankle dorsiflexion range of motion

• Obesity (BMI > 30 kg/m2)

• On feet majority of workday

Amongst Runners:

• Use of racing spikes

• High Foot Arch/Varus Hindfoot

• High frequency of running days per week

• Increased running volume km’s/week

• Years of running activity

• Inefficiencies in running form

 What are the common symptoms that I might get with plantar fasciitis?

• Pain with first steps in morning or after inactivity

• Throbbing, searing, or piercing pain located on arch / inferior heel

• Walking on toes, barefoot, or upstairs may make you worse

• Pain will often ease up after period, but may get worse with continued activity

Is there anything that I can do?

Therapeutic intervention should consist of consulting a Physiotherapist or Osteopath to assess, treat and train any underlying dysfunctions or discrepancies causing the Plantar Fasciitis.

Studies examining the foot’s musculature in individuals with Plantar Fasciitis tend to display a decrease in:

• Toe Flexor Strength

• Foot Intrinsic muscle strength

  • These muscles are important as they provide DYNAMIC arch support of the foot during propulsion of gait in running.

Exercises to help Plantar Fasciitis should focus on evening up the ledger between how much stress and strain is being put through the body whilst increasing the tolerance of the Plantar Fascia and the body as a whole to these stresses.

A simple exercise that you may want to try to increase the local capacity of the muscles of the foot is the Foot Shortening Exercise or “Arch Doming” exercise: (See figure)

Keep toes in neutral position and attempt to not bend or extend the toes of your foot while contracting the arch.  This exercise will take PRACTICE in order to get good at and you may experience some cramping in your arch, which is a good sign that you are activating these intrinsic muscles.

Perform this exercise multiple times a day with sets of 10 repetitions.

What’s my prognosis if I already have it?

The odds are in your favor! 80% of individuals who have Plantar Fasciitis had resolution of their symptoms in 12 months. However to get the best possible outcomes with your recovery a strategic approach to addressing causative and maintaining factors needs to be implemented. Patients should expect a recovery time of 6-12 months to make full resolution with Physiotherapy and Osteopathy management.

What should I do if I start noticing heel pain sticking around after a week or two?

Don’t delay. The earlier you can begin management to address Plantar Fasciitis with a Physiotherapist or Osteopath the better your outcomes in treatment with be.

The reasoning for this is likely the repetitive nature of the sport where little issues can then cause more stress and strain becoming painful over time.

Particularly if you are a runner our Return To Running Program has a comprehensive history taking and assessment process going above and beyond what other clinics do, so we can identify the root cause of your running related injury. This process is equally applicable to non runners with Plantar Fasciitis and utilises the latest technology including:

• M.A.T Assessment created by the therapists of the Injury Rehab Centre to laser focus on areas of flexibility, balance and movement that identify whether your are at risk to sustain an injury.

• Slow Motion Running Gait Video Analysis to IDENTIFY YOUR BAD RUNNING HABITS that stop you from progressing that next step in your running.

• Strength Testing to identify any strength discrepancies that have a huge role in increasing your injury risk.

• Force Plate Technology to put a number on differences in the power you can generate through each leg that can lead to compensations and can cause repetitive stress injuries.

•  Traditional Physiotherapy and Osteopathy examinations to identify dysfunction.

Next our treatment process achieves pain relief in the shortest amount of time by using hands on Physiotherapy and Osteopathy techniques such as soft tissue massage, joint manipulation, articulation and stretching techniques including the use of the True Stretch system.

Finally your management plan will involve an individualised training plan to build your running/walking movement capacity (muscle and tendon strength, stamina, specific flexibility) as well as increasing your movement skill to make you more efficient out on the road, track or trail to bullet proof your body from injury and increase performance.

Don’t delay. Contact the Injury Rehab Centre to get back on track to resolving your heel pain today. Call our friendly reception on 95537024 or book your appointment online by clicking the link below!

References:

Buchbinder, R. Plantar Fasciitis. New England j med; 2004, 350;21: 2159-2166.

Cole, CC, Seto, CS, Gazewood, J. Plantar Fasciitis: Evidence-Based Review of Diagnosis and Therapy. American Family Physician; 2005, 72 (11): 2237-2242.

Di Caprio, F, Buda, R, Mosca, M, Calabro, A., Giannini, S. Foot and lower limb diseases in runners: assessment of risk factors. Journal of Sports Science and Medicine (2010) 9, 587-596.

McKeon PO, Hertel J, Bramble D, et al. The foot core system: a new paradigm for understanding intrinsic foot muscle function. Br J Sports Med 2015;49:290.

Riddle, DL, Pulisic, M, Pidcoe, P, Johnson, RE. Factors for plantar fasciitis: matched case-control study. The Journal of Bone and Joint Surgery; 2003, 85(5):872-877.