Prioritize your recovery: The power of sleep

Sleep and sleep hygiene play a crucial role in the management of injuries and the overall process of recovery. In this blog post we will investigate key reasons as to why sleep is important in injury management and recovery, as well as how good sleep hygiene practices can enhance these processes: 

1. Tissue Repair and Growth: During deep sleep, the body releases growth hormone, which is essential for repairing and rebuilding tissues, including muscles, tendons, and ligaments. This is critical for the healing process after an injury. 

2. Inflammation Reduction: Adequate sleep helps regulate the body's inflammatory response. Chronic inflammation can delay healing and exacerbate pain, so reducing inflammation through sleep is beneficial for recovery. 

3. Immune Function: Sleep is closely linked to immune function. A well-rested immune system is better equipped to fight off infections and assist in the healing process, especially if an injury increases the risk of infection. 

4. Pain Management: Sleep is a natural painkiller. It can reduce pain perception and improve the body's ability to tolerate discomfort. This can be particularly helpful for individuals recovering from surgeries or dealing with chronic pain due to injuries. 

5. Mental Health and Coping:

   Coping with an injury can be mentally taxing. Sleep plays a vital role in emotional regulation and can help individuals manage stress, anxiety, and depression, which are common emotional responses to injuries.

6. Memory Consolidation:

   Sleep is essential for consolidating memories and learning. This can be valuable for patients who are undergoing rehabilitation and need to retain and apply new information about their injury, treatment plan, and exercises. 

7. Energy and Physical Performance: Adequate sleep is necessary to restore energy levels and support physical performance. Individuals recovering from injuries may require extra energy to facilitate rehabilitation exercises and mobility. 

 To optimise the benefits of sleep for injury management and recovery, it's important to practice good sleep hygiene: 

Consistent Schedule: Go to bed and wake up at the same time every day, even on weekends. 

Create a Comfortable Sleep Environment: Ensure your bedroom is dark, quiet, and at a comfortable temperature. Invest in a good mattress and pillows. 

Limit Stimulants: Avoid caffeine in the hours leading up to bedtime. 

Technology Use: Reduce screen time before bed, as the blue light emitted by phones and computers can interfere with sleep. 

Physical Activity: Regular exercise can promote better sleep but avoid vigorous exercise close to bedtime.

Limit Food and Alcohol: Avoid large meals and alcohol before bedtime, as they can disrupt sleep.

Relaxation Techniques: Practice relaxation techniques such as deep breathing, meditation, or yoga to reduce stress and promote better sleep. 

Limit Naps: If you need to nap, keep them short (20-30 minutes) and earlier in the day to avoid interfering with nigh time sleep. 

In summary, sleep is a critical component of injury management and recovery. It aids in tissue repair, inflammation reduction, immune function, pain management, mental health, and overall well-being. By practicing good sleep hygiene, individuals can maximize the benefits of sleep during their recovery process. 

Smart Off-Season Training: A Game-Changer for Injury Prevention during the Season Elevate Your Performance, Safeguard Your Season!

Greetings, Athletes and Sports Enthusiasts!

Welcome to another edition of our newsletter, where we're about to delve into a topic that could be the key to taking your game to the next level: the importance of strength training in the off-season to reduce injuries during the season. Whether you're a professional athlete or a dedicated sports enthusiast, understanding the role of off-season strength training in keeping you injury-free during the grind of the season is absolutely crucial. So, let's lace up our knowledge sneakers and explore why hitting the gym during the off-season is a strategy you can't afford to ignore!

1. Laying the Foundation for Resilience:

Picture your body as the ultimate athletic machine. Just as you'd tune up your car before a long journey, your body requires preparation before the demands of the sports season hit full throttle. Off-season strength training is your toolkit for building a robust foundation. By focusing on exercises that target muscle imbalances, flexibility, and core stability, you're setting the stage for optimal performance and injury prevention.

2. Addressing the Weak Links:

We're only as strong as our weakest link, and the same holds true for our bodies. Often, injuries occur when one area of the body is disproportionately weaker than the rest. Off-season training allows you to address these vulnerabilities head-on. By targeting muscles and movements specific to your sport, you're improving overall biomechanics and reducing the risk of overuse injuries that can plague your season.

• 3. Balancing the Load:

  In-season practices and games are intense. They place high demands on certain muscle groups, leading to imbalances and overuse injuries. Off-season strength training gives you the opportunity to restore balance by working on opposing muscle groups and performing functional exercises that mimic the demands of your sport. This balance is your armour against injuries caused by muscular imbalances.

4. Enhancing Proprioception and Kinaesthetic Awareness:

Off-season training isn't just about lifting heavy weights. It's about enhancing your body's awareness and responsiveness. Incorporating exercises that challenge balance, coordination, and proprioception—such as stability ball exercises and single-leg movements—improves your body's ability to react effectively during the unpredictable moments of your sport, reducing the risk of awkward falls and sudden injuries.

5. Active Recovery and Injury Rehabilitation:

Injuries are often the result of accumulated stress on the body. The off-season provides a golden opportunity for active recovery and targeted injury rehabilitation. Engaging in strength training with lighter loads and focusing on controlled movements helps in rehabilitating minor injuries and ensuring that your body enters the season in top form.

6. Mental Resilience:

Physical training isn't just about the body; it's also about the mind. The discipline and commitment you demonstrate during the off-season translate into mental toughness during the season. Knowing that you've put in the effort to prevent injuries through intelligent training boosts your confidence and allows you to focus on the game itself. Off-season strength training isn't a detour; it's a direct path to peak performance and injury resilience. Think of it as an investment in your body's longevity and your sports journey's success. Remember, consult with a qualified physiotherapist to design a program tailored to your sport and individual needs. Here's to a season marked by strength, resilience, and triumph!

Wishing you a successful and injury-free journey, from the team at Reload Physio.

Gabbett, T. J. (2016). "The training—injury prevention paradox: Should athletes be training smarter and harder?" British Journal of Sports Medicine, 50(5), 273-280.

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2. Myer, G. D., Faigenbaum, A. D., Chu, D. A., Falkel, J., & Ford, K. R. (2011). "Rationale and clinical techniques for anterior cruciate ligament injury prevention among female athletes." Journal of Athletic Training, 46(4), 471-475.

3. Hewett, T. E., Myer, G. D., Ford, K. R., Heidt Jr, R. S., Colosimo, A. J., McLean, S. G., ... & Succop, P. (2005). "Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study." The American Journal of Sports Medicine, 33(4), 492-501.

4. Sugimoto, D., Myer, G. D., Bush, H. M., & Hewett, T. E. (2015). "Effects of compliance on trunk and hip integrative neuromuscular training on hip abductor strength in female athletes." Journal of Strength and Conditioning Research, 29(9), 2397-2406.

5. Silvers-Granelli, H. J., Bizzini, M., Arundale, A., Mandelbaum, B. R., & Snyder-Mackler, L. (2017). "Does the FIFA 11+ injury prevention program reduce the incidence of ACL injury in male soccer players?" Clinical Orthopaedics and Related Research, 475(10), 2447-2455.

6. Anderson, L., Triplett-McBride, T., Foster, C., & Doberstein, S. (2003). "Impact of training patterns on incidence of illness and injury during a women's collegiate basketball season." The Journal of Strength & Conditioning Research, 17(4), 734-738.

7. Faigenbaum, A. D., Farrell, A., Fabiano, M., Radler, T., Naclerio, F., Ratamess, N. A., ... & Kang, J. (2011). "Effects of integrative neuromuscular training on fitness performance in children." Pediatric Exercise Science, 23(4), 573-584

Dynamic vs. Static Warm-Ups: Which is Best Before You Exercise?

Before diving into any physical activity, warming up your body is essential to prepare your muscles, joints, and cardiovascular system for the upcoming challenge. Warm-ups can help reduce the risk of injury, enhance your performance and improve your workout effectiveness.

When it comes to warming up, there are two primary approaches: dynamic and static warm-ups. In this blog post, we will explore the differences between these two methods and help you determine which one is best suited for you!

Let’s start with Dynamic Warm Ups Dynamic warm-ups involve performing movements that mimic the exercises you'll be doing during activity. These movements are done in a controlled manner and gradually increase in intensity to raise your body temperature and stimulate your muscles. Dynamic warm-ups typically involve active stretching, mobility exercises, and light aerobic activities. Here are a few of the key benefits they provide:

• Firstly, they improve your joint range of motion! Dynamic movements take your joints and muscles through a full range of motion, promoting flexibility and mobility. This can be particularly beneficial for activities that require a wide range of motion, such as gymnastic sports, weightlifting, or high-intensity interval training (HIIT).

• Secondly, Dynamic Warm Ups enhance Blood Flow: The active nature of dynamic warm-ups increases blood circulation, delivering oxygen and nutrients to your muscles. This helps to optimize muscle performance and reduce the risk of injury.

• Thirdly, they help with your pre-exercise Mental Preparation. Dynamic warm-ups engage your mind and they can help you focus, improve coordination, and enhance neuromuscular activation. They provide a good way to listen to some music and get in the zone!

In contrast to dynamic warm-ups, static warm-ups involve holding a stretch or stationary position for a prolonged period, typically around 20-30 seconds. Static stretches target specific muscle groups and aim to improve flexibility and soothe “tight” areas. While static warm-ups might not be as effective for every type of workout, they can still offer some of the following benefits:

• They increase your flexibility. Static stretches allow your joints to tolerate greater ranges of motion and therefore improve their overall flexibility. This can be advantageous for activities that require a greater range of motion, such as yoga, Pilates, or martial arts. They can be used after exercise as a good way to prevent delayed onset muscle soreness.

• Choosing the Right Warm-Up The decision to opt for a dynamic or static warm-up depends on various factors, including the type of exercise, your fitness goals, and personal preferences. If we had to choose one, we mostly advocate for more of a dynamic warm up approach, since the benefits are suited to various activities, whereas static stretching is more for sports and exercise where you require greater ranges of motion.

So with that out of the way, here are a few guidelines to consider when selecting your warm-up:

1. Dynamic Warm-Ups: Best for activities involving explosive movements, sports, or high-intensity exercises. - Ideal for improving range of motion, agility, and overall performance. - Recommended before cardio-based workouts, strength training, or plyometric exercises.

2. Static Warm-Ups: Suitable for activities that require increased flexibility and muscle relaxation. - Ideal for low-intensity workouts, yoga, or activities focused on balance and control. - Can be used as a cool-down method post-workout.

Concluding thoughts: In the dynamic vs. static warm-up debate, there isn't a one-size-fits-all answer. The best approach depends on your specific workout routine, personal goals, and preferences.

Ultimately, the most effective warm-up is one that you enjoy and that adequately prepares your body for the demands of the activity you’re about to do. Listen to your body and try experimenting with different warm-up techniques over the next few weeks and see which type you like!

Concussions 🧠- A Physio Perspective

Concussion. It is in the news, we know it is bad but what is it? We know that it causes people to have a mandatory 2 weeks off sport but why?   

According to the Berlin Consensus statement on concussion in 2017, they describe it as: “A traumatic brain injury induced by biomechanical forces”.   

The truth about concussion is that even though it can't be seen it is a real injury. It is actually a metabolic and physiological change in the brain's chemistry. Initially after a concussion injury, the synapses in your brain fire off in this electrical storm and then have a sudden decrease in energy. The problem is when we don't give our brain the time to heal itself and return to metabolic homeostasis. This can be the cause of symptoms such as fatigue, headache and some of the others listed in the list above.  

The Berlin statement reported that if any of the following are experienced after a knock to the head or enough force applied to any other area of the body a concussion can be suspected:  

• Symptoms: somatic (e.g. headache), cognitive (e.g., feeling like in a fog) and/or emotional symptoms (e.g. lability)  

• Physical signs (e.g., loss of consciousness, amnesia, neurological deficit)  

• Balance impairment (e.g. gait unsteadiness)  

• Behavioural changes (e.g. irritability)  

• Cognitive impairment (e.g. slowed reaction times)  

• Sleep/wake disturbance (e.g. somnolence, drowsiness)

 Seeing your medical or healthcare professional is an important step if you suspect you or a family member might have a concussion. Often waiting until you have been symptom free for 24 hours means you are ready to progress and gradually participate in more activities. Giving your brain time to heal and a gradual return to work or sport is often recommended to get you back to your full potential.  

 Sometimes symptoms can linger for longer. If symptoms persist for more than 3 weeks, it can often be called PCS or Persistent Concussion Syndrome. Treatment for PCS often involves input from a multidisciplinary group. However, a Physiotherapist's role in concussion often includes:  

• An individualised symptom-limited aerobic exercise programme in patients with persistent post-concussive symptoms associated with autonomic instability or physical deconditioning. 

• A targeted physical therapy programme in patients with cervical spine or vestibular dysfunction, and  

• A collaborative approach including cognitive behavioural therapy to deal with any persistent mood or behavioural issues. 

So, if you or someone you know isn't sure if you have a concussion and you are experiencing one of the above symptoms, chances are you have a concussion and should see a health professional with specialised training in management of concussions, so you can get back to what you love quicker!  

At Reload Physio, Olivia N is experienced in the Physiotherapy Management of Concussions. Olivia can help you get back to what you love as soon as possible.

McCrory P, Meeuwisse; W, Dvorak J, et al. Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016 British Journal of Sports Medicine 2017; 51:838-847. 

RELOADing your Running- Load Management for Runners

RELOADing YOUR RUNNING  

Following on from our previous two blog topics that covered energy deficiency in sport (RED-S) and bone stress injuries where both touched on managing your load as you train. Today we would like to delve deeper into load management, with a focus on running (since we love it so much!). It should give you an idea how to progress yourself safely and effectively, whilst not foregoing your performance targets in your weekly Park Run!

Load management in sport is both a science and an art. It can be thought of as the delicate balance between training and competition, and rest and recovery. It is the difference between a well beaten dollop of cream and clumpy cream but-not-quite-cheese result.

Correct load management will allow you to meet your fitness and performance goals while ensuring that you do not sustain an injury or burn-out. It will empower you to return to running safely after some time off, or to increase your speed and endurance for an event.

Alternatively, incorrect load management is one of the greatest contributors to overuse running injuries that we see in the clinic, and it contributes to injuries such as achilles tendon problems, recurrent calf sprains, lateral hip and knee pain, shin splints, stress fractures and so many more.

As a keen runner and physiotherapist, I have had an interesting relationship with load management over the years. I have tipped the scales a little too far in either direction on numerous occasions and suffered the consequences. As a result I have learnt some great lessons: how to monitor load, listen to my body and to get the results that I strive for. You are definitely not alone, and I hope that you can learn from my mistakes!

Okay, so you’ve also suffered from an overuse injury, or are currently suffering from one… where did you possibly go wrong?

Lets think back on your running history. When your symptoms started, what was your running program like? How have things progressed or regressed since then? There are many more questions that we will need answers to, as the key to where your load management went gone slightly askew lies somewhere in the midst of all the fog.

Common scenarios that make our ears pick up include:

• Returning to running after time off from an injury

• Returning back to training after a month or two of holiday (how good)

• Increasing intensity following a couple of weeks of illness where loads were reduced (shorter, less intense runs)

• Sudden changes in training goals or race distances

• A change in training surface, terrain (hills), intensity (e.g. intervals) or footwear

• The weekend warrior – someone who typically doesn’t do a lot during the week but goes all out in the weekend!

Do any of the above sound vaguely familiar?

If so, lets take a leaf out of my book and do things differently from here on out...

What is the best way to monitor and manage load? You might be wondering “how do I best structure your training program to get the best results?”

There are numerous ways in which athletes and health professionals choose to manage training loads. Here are a few ideas:

The 10% rule

The 10% rule is simply not increasing your weekly training loads by more than 10% from one week to the next. It is a very simple and often effective way to ensure that your loads are not increased too quickly. You need to consider what your baseline loads are, what surfaces you are normally training on (hills, grass, road etc), and the intensity of your training, as they will affect your overall training load and therefore injury and burn-out risk. Please note that the 10% rule has significant limitations at the different ends of the spectrum of runners, such as those who run less that 15-20km per week, or over 100+km per week, but is great for its simplicity for the majority of runners.

The Acute/Chronic Workload Ratio (ACWR)

The ACWR is becoming more popular and you might see it in your current program. It takes into consideration your baseline loads, training surfaces and training intensity to ensure that you are not over or under training. It’s a bit more tedious to analyse all the data that you need to collect, however it is a great tool to predict your future injury risk based off your current levels of loading. It looks into your rate of perceived exertion (RPE) alongside the distance or duration of your run; and compares your current training week to the previous three weeks. The acute/chronic workload ratio ensures that your loads remain between safe parameters. Speak to us if you would like to know more details about the ACWR.

Lastly,

Periodisation

Periodisation is used to structure training programs which involves planning a few weeks or months in advance. I know right, its time to get organised! Periodisation is often based around an end goal for example a certain distance or time that you would like to achieve. You also need to keep an eye on your overall well-being as your mood, energy and sleep quality are vital to your success. Your physiotherapist or coach will likely throw ‘easy’ or ‘recovery’ weeks in between challenging ones.

The most successful runners have followed one of the above principles, including all of Arthur Lydiard’s athletes. Whether or not you are a weekend warrior or a seasoned ultra marathon runner you need to make sure your running loads are safe to avoid getting injured. Structuring your program with periodisation in mind will help not only with injury prevention, but other health concerns such as relative energy deficiency in sport (RED-S).

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So here are my top tips for load management

• Remember that load can be affected by distance or duration, intensity, recovery and training surfaces!

• Do not increase your running load by more than 10% each week.

• Consistency is key. Put on those shoes year round and stay active!

• We are all different and hence, different training programs work best for different athletes because our capacity to adapt to mechanical stress is unique.

• It is best to follow a program from someone who is aware of load management principles – have a chat to your physiotherapist or your running coach, or come and see one of our running specialists at Reload.

At Reload Physio we offer one on one running programs, strength and conditioning and recovery work. If you would like more information, or just need some reassurance with your current program please reach out.

Book a Comprehensive Running Assessment and report session (60mins), or an Initial Injury Consultation below.  

RED-S

Relative Energy Deficiency in Sport

Do you have to ‘make weight’ for your sport? Are you in a very physically demanding job? Have you increased your training load? If so, you need to be aware of the risks associated with “Relative Energy Deficiency in Sport” (‘RED-“S” or “REDS”).

What is RED-S?

You might be familiar with the term ‘the female athlete triad’, which is a classification system used to identify female athletes who suffer from athletic amenorrhoea (loss of their monthly period), osteoporosis (weaker bones) and eating disorders.

In 2014 the female athlete triad was ‘upgraded’ to RED-S to recognise the fact that both males and females, young and old are affected by it. Furthermore, it identified widespread and long-term health effects and a reduction in performance in those affected by RED-S.

The basic principle of RED-S is low energy availability. In other words, an athlete is not consuming enough energy through their diet to sustain their training load as well as day-to-day living.

 Just to ‘be’ requires energy and fuel. The athlete’s normal physiological processes such as bone health, hormone production, reproductive health and the immune system get placed on the ‘less important’ list as the athlete’s body is essentially in starvation mode.

Why would their body use energy to maintain their ability to reproduce if there is not enough food going around?

RED-S is defined as: “impaired physiological functioning caused by relative energy deficiency and includes, but is not limited to, impairments of metabolic rate, menstrual function, bone health, immunity, protein synthesis and cardiovascular health”

Sporting codes that have a high prevalence of RED-S include running, triathlon, cycling and dancing. In the past, it was favourable to lose weight in order to ‘go faster’, ‘jump higher’, be easier in ‘point’ if you were lighter. Unfortunately, the long term health effects of a sustained energy deficit are becoming more and more apparent in recent years.

RED-S is a continuum from mild, moderate to severe. Therefore, the earlier it is addressed, the better.

Common signs that you might be suffering from low energy:

Have you noticed a declined in performance? Are you unable to sustain high-intensity efforts like you used to? Taking longer to recover after training? Waking up tired in the morning? Suffering from body soreness?

Females – have you had any changes with your monthly cycle, especially if you have not had your period for six months or more? Males – have you noticed a decline in your sex-drive?

Have you had reoccurring colds, coughs or upper respiratory tract infections? Have you suffered from stress fractures in the past? Have you been diagnosed with low iron?

Are you relatively strict with what you should or should not eat? How do you feel if you miss a training session (anxious/angry or frustrated, or do you accept your circumstances)?

It is essential to identify low energy availability as soon as possible to minimise the impact on your health and performance.

 As an athlete, you might not be too concerned about your immune status or your ability to reproduce. What if I told you that RED-S has a significant impact on your ability to perform at your best, that it could be the one thing that is holding you back?

Performance consequences of RED-S

• Decreased muscle strength

• Decreased endurance performance

• Increased injury risk

• Decreased training response

• Impaired judgement

• Reduced coordination

• Reduced concentration

• Irritability

• Depression

• Depleted glycogen stores

If the above does not motivate you to seek treatment to improve your athletic ability, then I am not sure what will!

How do we treat an athlete who’s suffering from RED-S?

The treatment of RED-S requires an interdisciplinary team approach. Often a sports medicine doctor, dietitian, physiotherapist and psychologist are involved in getting the best outcome for the individual.

It is crucial to regain the balance between the athlete’s ‘energy in and energy out’; to restore their morning energy levels, regain regular menstrual cycles (females), return homeostasis to oestrogen and testosterone levels, alongside a graduated return to exercise.

Sounds simple right?

Please note – the oral contraceptive pill is NOT the answer to restore the athlete’s period.

If you would like further information, please do not hesitate to talk to one of the physiotherapists here at Reload Physio or do further reading. The following links offer great insight to both athletes, parents and coaches: