A recently published article by Haroy et al, in the British Journal of Sports Medicine, described a simple exercise routine that decreased the number of groin injuries in male footballers by 41%. Groin injuries are very common in football. Research shows that weaker groin muscles are associated with an increased risk of groin muscle injury. So strengthening groin muscles can potentially prevent injury. The paper studied the Copenhagen Adduction exercise, which has previously been shown to strongly recruit adductor longus. Haroy et al, offered the Copenhagen at three levels of resistance, based on the players’ pain. Players started with Level 3. If the exercise gave them more than 3/10 pain, they were instructed to do the exercise level below instead: 3 > 2 > 1.
The training protocol is shown in the following table: Being only one, quick exercise, compliance was high. They found performing the Copenhagens decreased the risk of groin injury by 41%.
The full article is HERE. Copenhagens are definitely worth adding to your training. The concept is similar to strengthening hamstrings with the Nordic Hamstring Curl which has been shown to prevent 70%-85% of hamstring strain injuries.
HEEL PAIN IN CHILDREN
Sever’s is most common in 9 - 12 year olds. It’s sore to squeeze the bone at the base of the Achilles where it attaches onto the heel. It’s not something that can be seen - it never seems to look red or swollen. It’s worse after sprinting, jumping, and hopping. It settles with rest. It is an overuse injury so it’s common in pre-season, or anytime training loads increase too quickly. My kids get it when they do extra sessions in running spikes or footy boots, without the normal heel support of their running shoes. It’s an overuse injury from excessive loads.
OVERUSE INJURY
When we talk about excessive loads it can be “external” load such as:
I think the running pace is the more powerful multiplier in this list. Extra sprint sessions will do it. My kids got sore once when we did a boot-camp session with a novel plyometric exercise - split jumps. There are also “internal” variables that determine our ability to cope with the training load:
My kids definitely are more prone to Sever’s if they’ve had a couple of late nights that week. And, if they’re having a growth spurt, their bodies are busy spending resources on growing rather than recovering from the stress of a training session. NATURAL RECOVERY
Text books say that Sever’s disease is self-limiting because the growth plate eventually fuses by the age of 15 or 16. But I don’t think there’s anyone who would be happy to just let it run its course until then. It is usually sore enough to stop you participating in sport, so it needs treatment.
WHAT DO WE DO?
I used to put kids with heel pain in orthotics, until I read this research which confirms that a simple heel wedge is more effective than orthotics for Sever’s disease.
I get them to do an isometric Achilles strengthening program which also helps with pain control. But ultimately recovery comes down to load management. Load management means reducing the excessive loads. So this could be:
And aid recovery with:
With these type of overuse injuries, I interpret "soreness" as essentially the same thing as "tiredness". If they've been training more, sleeping less, or growing more, we would expect some "tiredness". If they were tired what would be the treatment?... Sleep more and train a bit less.
Summary of:
FOOTBALL RECOVERY STRATEGIES (Grégory Dupont, Mathieu Nédélec, Alan McCall, Serge Berthoin and Nicola A. Maffiuletti, 2015) Does Fatigue Cause injury?
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Often when I’m talking to my patient about their injury and why it has happened, they guiltily report that they don’t stretch enough. We’ve all grown up being told how important is it to stretch:
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Interestingly, health professionals have changed our tune about the importance of stretching. Research over the last 15 years has suggested static stretching is not as beneficial as was once thought. I’ve been having conversations about the reasons to stretch (or not) for at least the last 15 years, but the current science on stretching just isn’t catching on.
So, what do we know?…
DOES STRETCHING PREVENT INJURIES?
Therefore, in practical terms the average athlete would need to stretch for 23 years to prevent one injury. Definitely not worth it.
DOES STRETCHING HELP MUSCLE SORENESS?
DOES STRETCHING INCREASE RANGE OF MOVEMENT?
DOES STRETCHING HELP PERFORMANCE?
A substantial body of research has shown that sustained static stretching acutely decreases muscle strength and power (ref). Stretching before an endurance event lowers endurance performance and increases the energy cost of running (ref). Cycling efficiency and time to exhaustion are reduced after static stretching (ref).
Pretty much any measure of performance is made worse by stretching. Static stretching impairs:
- strength
- maximal voluntary contraction
- isometric force
- isokinetic torque
- one repetition maximum lifts
- power
- vertical jump
- sprint times
- running economy
- agility
- balance
A comprehensive review (ref) from 2011 concludes:
WHAT ABOUT DYNAMIC STRETCHING?
SO WHY STRETCH?
SO SHOULD WE STOP STRETCHING?
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Some pain or discomfort during exercise is OK and safe. It is a good sign if your pain warms up as you exercise and doesn’t feel worse the next day.
KEEP MOVING
Resting too much can be more aggravating than staying active. Reduce your training volume enough to settle symptoms and ensure you don’t feel worse the next day.
PLAN AHEAD
Avoid consecutive days of impact exercise (like running and jumping) if you are sore.
/ Sunday / - / Tuesday / - / Thursday / - / Saturday /
MONITOR MORNING STIFFNESS & SYMPTOMS
Low and stable symptoms are OK. A spike in stiffness, tightness, or pain, means you’ve probably overdone it the day before. You don’t need complete rest. Continue resistance training, do less impact training.
BE PATIENT
There’s no quick fix.
GENERAL HEALTH
We also need to consider general health variables that contribute to recovery:
- Nutrition
- Hydration
- Stress
- Sleep
J Orthop Sports Phys Ther 2024;54(1):95. doi:10.2519/jospt.2023.9001
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BPPV is caused by a problem with the inner ear, where a small calcium deposit forms and moves with gravity around the different angled canals of the inner ear. BPPV is “positional” as it is triggered by specific head movements, for example, turning your head to the left with rolling over in bed. Symptoms of vertigo are room spinning, disturbed balance, and nausea.
BPPV typically resolves within a few weeks, but can be recurring.
Your GP can give you anti-nausea medication, and Physiotherapists treat BPPV with a sequence of movements and positions, called the Epley Manoeuvre, that uses gravity to re-position the calcium crystals.
A video of the Dix Hallpike test for BPPV is HERE.
Information on the Epley Manoeuvre is HERE.
A video of the Epley Manoeuvre is HERE.
Do you have vertigo? Book a physiotherapy appointment in Mosman to perform the Epley Manoeuvre HERE.
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