Recovering From Concussion – How Physiotherapy Can Help
The importance of timely and appropriate Sports-Related Concussion (SRC) management is an area of healthcare that has been receiving significant media and community exposure over the past few years. With recent high-profile cases such as Australian cricketer Steve Smith and St Kilda footballer Paddy McCartin, the potential impact of SRC has never been so front and centre in the public eye. With escalating health sector and community concern surrounding SRC and potential health ramifications in later life, we are now equipped with a rapidly expanding body of high quality research assisting medical professionals in accurately identifying symptoms of SRC and ensuring best practise care in recovery and return to sport.
Due to the potentially serious nature of SRC, consultation with a Sport and Exercise Medicine Physician should be arranged at the earliest opportunity in order to establish a clear diagnosis and streamline a structured and appropriate treatment plan. In the majority of cases, a short period of rest (24-48 hours) can be followed by light activity and exercise, transitioning into more intense exercise and ultimately a return to sport, all the while paying close attention to the possible resurfacing of symptoms that would in turn mandate a decelerated rehabilitation.
Many people aren’t aware that Physiotherapists can have a very important role in assisting rehabilitation. Your physiotherapist will complete a full assessment of the neurological function of your upper and lower limbs, assess your neck, your balance and the function of your visual and vestibular systems (part of your inner ear that assists in balance control). From this assessment they will be able to provide targeted treatment which, according to needs, may include manual therapy and stretches for your neck, postural correction and strengthening, or specialised techniques to aid those with troublesome visual or vestibular symptoms. Working alongside your doctor they will guide and help you to return safely to the activities and sports that you love!
For detailed information on the topic of Sports-Related Concussion click here:
Eric Coleman is an APA Physiotherapist and member of the Musculoskeletal Physiotherapy Association. He works at Lifecare Prahran Sports Medicine on Tuesday and Saturday. The clinic is close to suburbs including Malvern, South Yarra, Richmond, Caulfield and Hawthorn, and has early and late appointments for all your Sports Medicine and Sports Physiotherapy needs.
Is it too late to start?
A common question that we get in the clinic is:
“Is it too late for me to start lifting weights at the gym?”
The short answer is: “No”.
Resistance training has been shown to be extremely beneficial, and is recommended by health professionals to help maintain your bone and muscle quality. The World Health Organisation recommends adults take part in muscle strengthening activities at least twice per week. What’s more, this recommendation doesn’t change for adults over 65 years.
The human body continuously goes through a remodelling process of replacing old muscle cells with new ones. Weight training encourages the body to replace old cells with stronger ones to help cope with the load that is introduced via the exercises. As such, it is highly recommended for older individuals to pick up weight training as part of their exercise routine.
Resistance training can also help manage various musculoskeletal conditions such as osteoarthritis, osteoporosis, osteopenia, sarcopenia, and it can help with weight management as well as various other health benefits!
Going to a gym may feel like a very daunting and intimidating experience, but understand that there are other alternatives to get you started even in your very own home! Being supervised by a physiotherapist is a great way to start if you are unfamiliar with strength training.
Unless you have been advised by a medical professional that you have a medical condition that stops you from doing weight or resistance exercise, there should be no reason for you to feel like it is too late! Physios are well placed to advise you on which type of exercise.
If you feel like you require assistant in getting started with your training or exercise, feel free to contact our clinic at Lifecare Applecross and speak to one of physiotherapists.
What is Low Back Pain? An Introduction
It’s often surprising to learn that back pain is the leading cause of disability worldwide. People’s experiences with back pain can vary greatly and often include other symptoms such as numbness, pins and needles or pain in the buttock or leg. Whilst many episodes of back pain are mild and resolve by themselves, the chance the pain will recur remains high. The causes for back pain are wide and often overlap. Tasks such as repetitive lifting or maintaining one posture for a long period of time can contribute to its onset. Other factors which may influence pain include lifestyle factors, such as diet, as well as social factors like stress or not enough sleep.
A common misconception when it comes to managing back pain has been that the best thing to do is take painkillers and rest. However with the benefit of modern research we know that movement and exercise are the keys to a faster and more successful recovery. Understanding the reasons a person is experiencing their pain and how they can monitor and manage their recovery is also essential.
When working with back pain, your physiotherapist will take a detailed history of your condition and any factors which may have influenced its onset and ongoing presence. They will also perform a thorough physical exam to isolate any body structures, positions or movement patterns which may be contributing to your pain. Together, this detailed history and assessment will allow your physiotherapist to provide a treatment that is tailored directly to you and your condition.
A physiotherapist’s treatment may utilise multiple approaches depending on what will be most effective for you. This may include taping, soft-tissue therapies like massage, joint mobilisations or dry needling, as well as helping you establish an appropriate active exercise program aimed to resolve your pain and prevent it from happening again. These may aim to strengthen certain muscle groups, or to improve the action of those that support posture and balance, such as through Clinical Pilates-style exercises. Finally, they will assist you in understanding the causes of your condition and help guide you towards a pain-free future!
Eric Coleman is an APA Physiotherapist and member of the Musculoskeletal Physiotherapy Association. He works at Lifecare Prahran Sports Medicine on Tuesday and Saturday. The clinic is close to suburbs including Malvern, South Yarra, Richmond, Caulfield and Hawthorn, and has early and late appointments for all your Sports Medicine and Sports Physiotherapy needs.
Foster, N. E., Anema, J. R., Cherkin, D., Chou, R., Cohen, S. P., Gross, D. P., … Maher, C. G., (2018). Prevention and treatment of low back pain: evidence, challenges and promising directions. Lancet 391, 2368-2383.
Hartvigsen, J., Hancock, M. J., Kongstead, A., Louw, Q., Ferreira, M. L., Genevay, S., … Underwood, M. (2018). What low back pain is and why we need to pay attention. Lancet 391, 2356-2367.
Summer fitness; 5 tips to help prevent injury
When the sun comes out and the weather improves the temptation is to jump straight into an intensive exercise program to kick start a fitness regime. Boot camps, gym classes and running programs are all fantastic ways to help improve your general health, wellbeing and fitness but can result in injury if you are not properly prepared. Following these simple tips can help prevent some of the unwanted injuries putting a halt on your new fitness program.
Tip 1: Load management
- Have an understanding of what your baseline level of loading involves. Jumping straight into an intensive 8 week boot camp or training 5 times per week without some preparation is almost guaranteed to result in injury. Using Fitbits or health apps on our phones can help you to gain an understanding of your current level of loading. A good rule of thumb is working out your weekly average number of steps per week over the preceding 4 weeks. To help prevent injuries only increase this weekly average by 10-20%, as you are building your training up. A gradual build in activity levels can help prevent overload injuries such as muscle strains, shin splints, knee cap pain and bone stress injuries.
Tip 2: Address underlying injuries
- It is important to address your underlying injuries prior to beginning a fitness program. These issues may be just in the background during your normal daily activities but they may become more apparent when you start to run, jump, squat or ride a bike at a higher level than normal. It is easier to address these issues now rather than needing a frustrating rest period during the middle of a training program. Your Sports and Exercise Physiotherapist can help you overcome these injuries.
Tip 3: Strengthening exercise is protective of injury
- An individually designed strengthening program that is gradually built up can help protect your body from injury. For example, quadriceps strength and calf endurance can be important factors with running based activities as they can help prevent knee overload injuries. Your Sports and Exercise Physiotherapist can help assist you with designing a program specific to your needs.
Tip 4: Cross training
- Cross training allows us to continue to build our training activities and helps prevent overload injuries. Consecutive days of squatting, jumping and running can excessively load our lower limb joints. A swimming session or yoga/pilates session can be restorative on your mind and can continue to develop other focal fitness areas but allows your joints a well-deserved rest from weight bearing activities.
Tip 5: Diet is king
- A simple rule to follow is, “you can’t out exercise a bad diet”. What we fuel our bodies with is a crucial part of any exercise program. Weight loss is often a key part of why we are exercising and it can help prevent some injuries. Our Sports Dietician can you give some guidance on the best eating plan to assist you to your goals.
Our Team at Prahran Sports Medicine can assist you to reach your fitness goals and help prevent injury along the way. Happy training!!
Ben Ludbrook is an APA Titled Sports and Exercise Physiotherapist. He works at Lifecare Prahran Sports Medicine on Tuesday, Thursday and Saturday. The clinic is close to suburbs including Malvern, South Yarra, Richmond, Caulfield and Hawthorn, and has early and late appointments for all your Sports Medicine and Sports Physiotherapy needs.
Safety Down Under – Dive Medicine in Australia
Australia is blessed with some of the world’s best underwater-diving locations, with the Great Barrier Reef being the jewel in the crown. Despite the awaiting underwater paradise amongst the myriad reefs and wrecks around the country, diving is not without potential risk to health. Certain medical conditions can significantly increase this risk even to the point of posing a risk to human life.
It is not just ‘another world’ awaiting divers in the depths of the deep blue; it is a whole new world of medicine also – even to the point that there are doctors specifically trained and experienced in the assessment of patients with respect to dive safety. These doctors have completed specific courses and qualifications in order to carry out what are routinely known as ‘dive medicals.’
Underwater diving involves significant increases in barometric pressure (a hyperbaric environment) with increasing depth of a dive. This is not a proportional change however, with maximal rate of change occurring in the earlier stages of submersion – meaning that shallow water dives (even to 10 metres) are just as dangerous as the deeper dives. As divers return to the surface, the reverse is true, and barometric pressure reduces again, returning to atmospheric pressure at the interface between water and the outside air.
With a complex interplay between changing barometric pressure and it’s subsequent effect on partial pressures of inhaled gases and a diver’s lung volumes, the use of Self Contained Underwater Breathing Apparatus (SCUBA) is on one hand genius, whilst also potentially fraught with danger. SCUBA allows us to pressurise inhaled gas to a level that counteracts the pressure of the surrounding water at increasing depths of a dive. Inhaled gases are a mixture of oxygen and nitrogen, with some special mixtures at greater depths also including helium.
Indeed, divers are subject to a very unique collection of medical conditions not seen in any other environment. These conditions emanate from:
- Expansion of gas surrounding or within soft tissues / potential spaces / or respiratory system (“Barotrauma”)
- Excess absorption of nitrogen gas into the bloodstream at deeper dives (“Nitrogen Narcosis”)
- Failure to adequately remove nitrogen from the system resulting in gas bubble formation in bodily systems (“Decompression Sickness”)
- Impaired removal of carbon dioxide (“Oxygen Toxicity”)
Other conditions / issues potentially faced by divers include:
- Panic / Anxiety (arguably the greatest cause of death in divers)
- Fatigue / lack of fitness
- Salt water aspiration
- Temperature regulation issues / hypothermia
- Extra strain on pre-existing medical conditions (eg heart disease / hypertension)
- Envenomation from marine life
Home to some of the most treacherous waters, rips and tidal swells in the world, combined with our nation’s consistently high general safety and medical standards, Australia is amongst the strictest country in the world for ensuring all SCUBA divers, whether recreational or occupational, remain safe in our waters.
Anyone wishing to SCUBA dive is required to fill out a specific Dive Questionnaire, enquiring about a whole range of symptoms or known medical conditions, that may pose health risks to diving safely. Certain conditions may even contraindicate diving completely – the commonest and most mundane being asthma. If any section of the questionnaire is answered “yes” (eg. to symptoms or known conditions), prospective divers will be required to undergo a formal Dive Medical. Certain dive companies may require formal Dive Certificates for anyone over age 55, whilst depending on the type of diving (eg some courses / occupations requiring diving) some divers may require annual Dive Medical review / assessment. Most Australian tour operators will not accept a Dive Medical Certificate obtained overseas if it does not explicitly state it meets Australian Standards.
The Australian Dive Medical is required by law to be carried out by Medical Practitioners who have trained to a satisfactory level of expertise under the Australian Standard (AS 4005.1 / AS 2299.1) and these standards closely follow those set out by SPUMS (South Pacific Underwater Medical Society).
Dr Gary Zimmerman is a certified Dive Medical Practitioner and has many years of experience in this field. To book an appointment to see Dr Zimmerman to obtain or renew your Dive Medical certificate, phone Lifecare Prahran Sports Medicine on (03) 9529 8899.
Useful Links for Further Information:
Getting to Know Your Physio – Greg Diamond
Greg qualified in July 1982 graduating from the W.A.I.T (now Curtin University) and began his career at Royal Perth Hospital working in various areas of expertise as he gradually rotated through the different disciplines. This was a fantastic experience for a new graduate as he was exposed to so many different experiences.
He left in 1985 to continue Post Graduate studies and completed a Post Graduate Diploma in Manipulate Therapy (now called Musculoskeletal Therapy). He returned to Royal Perth Hospital as the Senior Physiotherapist in the Out Patient department for two years before a foray into private practice working for another practitioner in the city then joining his father’s practice in 1989.
Concussion in Cricket
“A knock to remember – a case of concussion in cricket”
It is both ironic and a testament to Cricket Australia’s research and Head Injury Policies, that Steve Smith became the first ever player to be substituted in an international match under the newly devised ICC Concussion Substitute Rule. In the last 5 years Cricket Australia has rolled out their own Concussion & Head Trauma Policy and introduced concussion substitutes in the Sheffield Shield season 2017-18. Incidentally, the author of this blog was medical officer on duty at the MCG on the day Tasmanian batter Jordan Silk became the first ever First Class cricketer to be substituted out of a match due to concussion in November 2017. It is worth noting that he too, was substituted the day after being struck to the helmet by a bouncer, and with the delayed evolution of symptoms, was ruled out under precisely the same guidelines as those followed recently by Steve Smith. These guidelines combined with clinical assessment tools allow practitioners to assess, manage and expedite a safe return to training and sporting participation.
Symptoms vary enormously in type, severity and timing of onset, and can also vary in duration, meaning practitioners and athletes alike must be wary of a broad spectrum of possible presentations. Treating practitioners especially must be familiar with the need for ongoing assessment and surveillance for late presentations, whereby an earlier clinical assessment might escalate to a revised diagnosis of delayed onset SRC. This was the case with Steve Smith in the recent second Ashes Test, where his final diagnosis was a combination of sound clinical judgement, risk stratification and adherence to well-structured clinical pathways and policy.
Smith’s return to play later on the day of the incident was scorned by some as unsafe, crazy and for the betterment of the team whilst compromising personal health. His return however, was only following rigorous assessment including clinical examination, a Standardised Concussion Assessment Tool (SCAT-5) – formulated by an expert panel known as the World Concussion Group, and a CogSport test – a computerised assessment tool focusing on memory recall, reaction speed and accuracy. Both the SCAT-5 and Cogsport tools are performed pre-season by all Australian first class cricketers as a baseline, from which further post-injury assessments can be compared to aid in decision making when assessing SRC. It is imperative to understand however, that these tools do not make a diagnosis of SRC in their own right – this remains a clinical judgement and requires medical expertise. Smith’s return to the crease was no different to AFL or NRL players returning to the field after being cleared with the same battery of tests and clinical assessment. History tells us Smith went on to develop delayed-onset SRC, was substituted out, and even missed the following match, but in no way was his return to the field medically incorrect according to current best-practise guidelines.
With heightened community awareness of SRC in recent years, there is growing and justified concern for athlete welfare in both the immediate and longer terms. The ground-breaking work of Cricket Australia with regards to the introduction of concussion substitutes and their continuing (and ultimately successful) push at ICC level has paved the way for safer management of concussion in cricket. With no resultant impairment to a team now being ‘a player down’ from a concussed player being ruled out of the match, batters are now more willing to readily report symptoms and medical staff have significant pressures removed in their decision making around a diagnosis of concussion. This has been a massive win-win for cricket and player welfare in general.
SRC is a brain injury and is defined as a complex physiological process affecting brain function, induced by biomechanical forces. It may be caused by either a direct or indirect blow to the head, face, neck or body causing an impulsive force transmitted to the head. In the vast majority of cases, impairment of brain skills such as memory and thinking are only temporarily impaired and show full recovery with no ongoing sequelae. SRC does not involve structural damage or permanent injury to the brain.
SRC can be observed in all manner of sporting activities – typically those involving contact and/or speed. Whilst the football codes account for the far greater outright numbers of cases of SRC, it is in fact motor sport and equestrian that rank highest ‘risk’ when incidence is adjusted for rates of participation. Whilst most events typically emanate from a direct head impact, a significant linear or rotational head force sustained as part of contact to a distant part of the body can also result in concussive symptoms. Of some concern, concussion is also significantly more common in children than any other age group.
Signs of concussion can include:
- Unconsciousness (seen in only 10-20% of cases)
- Slowness to get up
- Prolonged holding of head
- Glazed or glassy look (like ‘no one home’)
- Muscle rigidity / posturing or even seizure activity
- Slowness in response to questions / instructions
- Slurred speech
- Balance issues / unsteadiness on feet
Symptoms of concussion can include:
- Nausea / vomiting
- Feeling “in a fog” /“not quite right” (very common patient reports)
- Blurred or double vision
- Memory impairment
- Drowsiness / fatigue
- Emotional lability
- Difficulty concentrating on tasks or focusing
- Hypersensitivity to light or sound
The presence of one or more of these symptoms and signs should result in a high index of suspicion for SRC, and athletes regardless of their level of expertise should be removed from play for assessment. Accepting that most non-elite level sporting teams do not have immediate access to medical expertise, players (and especially children) should be consulted by a qualified medical doctor at earliest convenience. This could be a Sports Medicine or GP clinic, or nearby Emergency Department.
Collaboration between the Australasian College of Sport & Exercise Physicians (ACSEP), Sports Medicine Australia (SMA), the Australian Medical Association (AMA) and the Australian Institute of Sport (AIS) earlier in the year delivered the “If in doubt, sit them out” initiative including a comprehensive website (link below) with information on sport-related concussion for coaches, parents, athletes and medical practitioners alike.
In cases involving unconsciousness, seizure activity, worsening mentation (increasing confusion / irritability), worsening after injury (eg vomiting / worsening headache) or with any neurological concern (eg pins and needles, numbness or weakness in limbs) or neck pain – urgent ambulance transfer to the nearest emergency department with spinal precautions / immobilisation is required.
In confirmed cases of SRC, the vast majority (80-90%) of cases settle within 10 to 14 days, provided the condition is recognised quickly and appropriate rehabilitation is initiated. Complications are rare but can be increased by failure to recognise the condition and / or allowing return to play in a concussed state or with inadequate recovery. Occasionally symptoms can persist for longer and can even persist for months in severe cases.
It is of paramount importance that each case is treated on its own merits and recovery and rehabilitation is tailored to the individual needs of the patient. No two concussions are necessarily the same, even in the same patient over time. There have been links demonstrated between depression and other mental health issues and repeated or prolonged concussion episodes. Considerable attention has been paid to media coverage of Chronic Traumatic Encephalopathy (CTE), though at the present time there has been no definite link between concussion and chronic brain damage and ongoing research is required.
Unsurprisingly, the cornerstone to effective management of concussion is rest; both physical rest and cognitive ‘brain’ rest. This mandates a period of no work / school, no ‘screen time’ (TV / computers / phones) and no physical exertion. In most cases 24-48 hours will be sufficient, though rest should continue until all symptoms have resolved.
Return to school or work should be medically cleared, graduated and subject to ongoing review. In turn this should be followed by a stepwise return to physical activity, provided successful completion of each step and ongoing medical review. This is outlined below:
- Rest until symptoms resolved
- Light aerobic exercise (eg exercise bike / walking)
- Light, non contact training (eg running / ball skills)
- Progression to more complex non-contact training drills and light resistance work
- Full contact training
- Return to play
Each step should require 24 hours as a minimum before progression to the next level, and only if symptoms remain absent. Occasionally symptoms can re-appear and this then mandates return to the previous level at which there were no reported symptoms.
With developing brains and the requirement for learning, children and adolescents typically require longer to recover from concussion and should be slowed down in their rehabilitation. Perhaps one of the fundamental differences in SRC management between children and adults is the emphasis for children to return to school for ongoing learning rather than to sport. An initial rest period of 48 hours is often recommended and return to sport should in most cases be a minimum of 14 days.
Liaison between the patient’s doctor, parents, school and sporting coaches are imperative and require flexibility in dealing with transition through rehabilitation stages and dealing with difficulties as they arise. Consideration may be required for class attendance, examinations, driving lessons etc.
Persistent symptoms beyond 10 days, highly troublesome symptoms, or worsening over time should result in assessment by highly specialised experts in the field of concussion. Occasionally recommendation may be made for consultation with specialised neuropsychologists, psychiatrists and there are specialist centres available for specific post-concussive physiotherapy rehabilitation.
Useful Links For Further Information on This Topic:
It should be noted that none of the content in this article replaces proper medical assessment and Specialist consultation. The information is provided as an educational guide only. Return to work / school and / or physical activity should only commence on the recommendations of a qualified medical practitioner.
ACL Reconstruction: A Patient’s Journey (so far)
My name is Jacqui Needham. I hope by sharing my personal physiotherapy journey that other patients undergoing an ACL Reconstruction feel confident, knowing that the Lifecare Point Walter Team will provide exceptional, holistic patient care during their recovery.
- Tell us about your initial injury and your thoughts when you were told you’d ruptured your ACL.
I was playing netball, running towards the baseline when I jumped up high on the run to catch an overhead pass.
I felt an instant ‘jarring’ sensation, no sharp pain but I felt/heard a ‘crunching’ sound. I walked off the court and applied ice, at this point I didn’t feel I’d done anything major. I went back on to play, but immediately felt my knee give way when landing from another jump. Scans confirmed I’d ruptured my ACL and had a small tear in the lateral meniscus.
My surgeon offered me both surgical and non-surgical options. He was very supportive of both options and was very thorough in his explanation of both options. I opted for surgery as my surgeon advised that this would likely be the best outcome for my situation and the activities/sports I wanted to return to. My physiotherapist Jon set a detailed pre-habilitation program for me, with clear instructions and directions to have me in the best possible shape for my upcoming surgery.
- What surgery did you have? How were your first few weeks post-operatively?
I had a complete ACL Reconstruction with a hamstring-graft. My experience in hospital was relatively comfortable, going home the next day without any complications. There was certainly a lot of bruising from the graft-site down to the ankle, however the swelling improved gradually.
Jon advised me with exercises to improve my range of motion, most importantly knee extension. Jon was able to carefully work around the surgical sites to maintain mobility of my knee-cap and assist in reducing the swelling. At all times he monitored my pain levels and clearly communicated why he was performing certain movements. He clearly explained what pain was acceptable to push through but also when to stop. By day 11 I had regained a fairly normal walking pattern and was meeting all my range of motion goals.
- Did you have any complications following surgery?
I went back to work on crutches after approximately 2 weeks. Unfortunately, I experienced a setback at work. I had to take evasive action to avoid being kicked in my injured leg by a student. It all happened very fast. The student kicked my crutch out from under me, forcing me to plant my foot abruptly to avoid falling over. I didn’t have any pain, but my knee felt a bit stiff and tingly.
A couple of days later, I woke up in the early hours in excruciating pain. My leg was swollen from the thigh down to the main incision site below my knee. The pressure continued to build throughout the morning. It was very painful to walk and I couldn’t bend or straighten my knee completely anymore. I saw my surgeon later that day, who diagnosed me with a ruptured arterial vessel. I had surgery that day to drain the haematoma. Surgery was successful, but I had significant pain.
I was very anxious resuming physiotherapy, as I was worried of further damaging my knee. Jon knew I was struggling and was constantly reassuring me that we could move forward from this setback. As physio sessions commenced I just had to trust and believe in the plan put in front of me. Unfortunately, with all our hard work as a team, I was still unable to achieve sufficient range of motion, so we agreed on another surgical procedure which was a great success.
- How have you found your rehabilitation so far? Have you been pleased with your care?
Throughout my challenging ordeal this past year, I have continually been provided with exceptional care from my surgeon and physiotherapists. I have endured an ACL injury, ACL reconstruction procedure, a traumatic workplace incident causing a haematoma, 2 further arthroscopic surgeries in close succession due to complications and a MUA (manipulation under anaesthesia).
Jon continuously checked to see how I was feeling and encouraged me to stay positive. He never gave up and worked hard with me to get my muscles firing again. I particularly appreciated the detailed explanations given to me. I’ve also completed a hydrotherapy program with Jordan Lake to assist in my rehabilitation. Jon and Jordan work closely together and were able to discuss my progress. This was very motivating for me as I felt that both physios were working as a team in helping me to achieve realistic physiotherapy goals.
I took part in an ACL group session with patients who had the same injury and similar rehab timelines. This allowed us to support each other, set goals and see progress while performing our exercises under physio supervision. I believe this helped greatly with my emotional recovery as I was struggling with the setback and was anxious that my leg would never get back to normal.
At all times I have felt cared for with clear and realistic physiotherapy goals being set. I strongly believe this commitment to my extended rehabilitation and my team’s enthusiasm to motivate me to put in the effort at home is directly responsible for the positive outcomes I have achieved so far.
I’m currently completing a supervised gym-based program and by all reports, making excellent progress.
- Do you have any advice for patients who are going to be undergoing an ACL reconstruction?
A few pieces of advice for anyone preparing to undergo an ACL Reconstruction
- Take a decent amount of time to recover from the operation before returning to work. Even though I pushed hard to meet my goals and milestones, I should have given my body more time to heal before returning to work and being on my feet all day. If I had my time again, I would have taken at least 4 weeks.
- Listen to your body and apply R.I.C.E (Rest, Ice, Compression, Elevation) longer than recommended. It really does help long after surgery.
- Listen to your physiotherapist and get to work on achieving full knee extension as early as possible. It is the most important part of getting back to normal
- Trust and believe in your physio. The exercises they set are part of a big plan. Replicate the exercises at home and stick to the program – put in the work and see the reward!
I am in a new territory now. Totally out of my comfort zone but trusting in my physio’s expert knowledge and enjoying the challenge of pushing myself under the strict supervision of my care team!
3 mobility exercises that will help Improve your golf swing
When developing your golf swing, good mobility is essential, it can prevent injury and improve your golfing performance. A key area that many golfers should focus their attention on is their torso rotation, which is the movement of the upper body on the backswing that winds the body up and prepares it for a smooth release down towards the ball.
A great way to visualise your torso rotation is to imagine yourself pulling back on a bow before releasing and transferring all that stored energy to the arrow.
Here is an example of poor torso rotation.
You can see that the lower body moves to physically get the upper body into position. This can cause issues such as lower back pain.
Good torso rotation means the player is able to turn their upper body fully whilst remaining solid in their lower body. It’s a practised skill that requires you to have good upper back mobility and good separation of movement in the lower body.
Here is an example of good torso rotation and upper to lower body separation
Notice how his belt buckle stays still as the upper body moves through its full range of movement.
Because of this range of movement, the golf swing places a huge demand on your body. It is very rare that our bodies move through 250° per second of rotational force in day to day life. Most of what we do, whether it is office work or a labour-intensive job, only really explores a very small amount of rotational movement, which requires very little speed and control.
If you are finding difficulty in swinging the club back or struggling to get into the correct positions on your backswing it may be because your upper back is stiff or there is poor control between your torso and lower body.
Here are 3 exercises to improve your torso rotation and golfing performance.
Part 3: Managing an ACL recovery, 4 Tips To Prepare Yourself For ACL Surgery
If you’ve decided to have an ACL operation, here are a few tips from my own experience. The current evidence strongly supports having a short period of time between ACL injury and ACL reconstruction. 4-6 weeks of ‘prehab’ has shown to result in improved outcomes following ACL reconstruction. I’ve personally found this to be very effective and would advise that you discuss this with your surgeon and physiotherapist.
Focus on achieving full knee extension
- Your surgeon will strongly encourage you to focus on achieving a straight knee. Most patients come in concerned that they are not getting enough knee flexion (bend), however, this will typically improve gradually over time. Failing to achieve full extension in the early stages of your rehab will potentially pose greater long-term issues.
- Prone knee hangs – This exercise, although it can be quite unpleasant at the time is certainly one of the most effective at regaining full knee extension. Start with ~ 5 minutes and increase to 10-15 minutes as tolerated, adding weight if possible
- If you’ve had a hamstring-graft, hamstring tendon pain may limit your ability to perform a prone knee hang. This can be balanced out with isometric hamstring exercises.
Focus on improving your ability to contract and activate your VMO
- This is one of the muscles in your quadriceps. Improving activation of your VMO is incredibly important to allow you to progress to the next stages of your rehabilitation.
- Starting this in your prehab prior to surgery will help
- Work closely with your physio in the early stages if you’re
having difficulty. Electrical stimulation using a TENS machine is something your physio can provide to help you along
Forget about time-frames
- The most common questions surgeons and physios get following ACL reconstructions include
- Should I be further along at this stage?
- When can I go back to running?
- When can I return to sport?
- All valid questions, however, the reality of it is – everyone progresses slightly differently.
- The answer to this is – when you’re ready, you’re ready. If this means you don’t run till 15 weeks instead of 12, so be it. If you’re not able to perform a certain exercise at a given stage, we’ll find you something different for the time being. There is no perfect recipe for your rehabilitation. Your physio will work for you to determine what is going to work for YOU.
- At the 6-week mark following surgery, the graft is at its weakest. Immediately following surgery the knee will feel quite stable. Care should be taken through the 6-10 week period with daily activities.
- In regards to returning to the sport, going back before 12 months can be done, but there is certainly a higher risk of re-injury. My advice – believe me, you don’t want to do this twice. Delaying your return to sport beyond 12 months significantly reduces the risk of re-injury.
Join a gym!
- If you don’t already have a gym membership or access to weights, a stationary bike and a leg press – get one!
- Much of your rehab can be done at home with minimal equipment in the early stages, however, it becomes much easier to deliver the best rehab with access to gym equipment.
- If you’re new to the gym setting, it can be a bit daunting. Doing
a supervised session with your physiotherapist or under the guidance of a good personal trainer will be hugely beneficial not only for your rehab but for maintaining good health in the future.
The main message I’d like to get across is that the decision making for ACL management must be individualised and made on a case-by-case basis. I’ve gone down both pathways, both with positive and negative experiences.
Finally, although it’s a pretty rough injury to deal with, it’s not the end of the world. The rehabilitation process you’ll undertake to get back to the sport will help to reduce the risk of many other injuries associated with poor hip and knee stability. If you’ve never done resistance training in your lifetime, you’re about to begin a form of exercise that will reduce your risk of osteoporosis, arthritis, heart disease, depression and lower back pain just to name a few.
If you have any questions about your ACL injury or rehabilitation, please feel free to ask me at email@example.com. Trust your physiotherapist and work closely with them. They are experts in injury rehabilitation and will get you to where you want to be.