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Health News 17/11/21

17/11/2021

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  • Physical activity benefits outweigh risks for people with long-term health conditions -
  • Helmets may be doing more harm than good for cricket concussions​ -  
  • The Connections Between Overtraining and Underfueling - 
  • 4 Ways to Use the Training Data from Wearable Tech - 
  • Recommendations and Nutritional Considerations for Female Athletes: Health and Performance - 
  • Youth Athlete Development and Nutrition - 
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Health News 4/11/21

4/11/2021

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  • Modern-day rugby league players at equal risk of brain injuries, says lawyer - 
  • Here’s How Weather Conditions Affect Your Running Speed - 
  • ‘You can expect the actual concussions to be 10 times this data’: Medicos call for rugby codes to do more - 
  • Here’s How Much Extra Energy a Gnarly Trail Burns - 
  • Hiding behind the concussion industry: The NRL’s ticking time bomb - 
  • 5 big reasons people don't exercise (and how you can overcome them) - 
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Health News 29/10/21

29/10/2021

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  • What is a ruptured ACL and how do you fix it? - 
  • NFL points the way for dealing with concussion - 
  • Caffeine Increases Exercise Performance, Maximal Oxygen Uptake, and Oxygen Deficit in Elite Male Endurance Athletes - 
  • Concussion history in rugby union players is associated with depressed cerebrovascular reactivity and cognition - 
  • World-first study of league players finds no link between concussions and depression risk - 
  • Former rugby league internationals launch concussion class action in Great Britain - 
  • 6 WAYS THE BODY TELLS ATHLETES IF THEY’RE EATING ENOUGH - 
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Health News 18/11/21

18/10/2021

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  • Nobel prize: how chilli peppers helped researchers uncover how humans feel pain - 
  • The Not-So-Terrifying Death Stats for 5K Races - 
  • Former England captain calls for heading ban to address dementia crisis - 
  • Concussion in Para athletes: One size doesn’t fit all - 
  • Does prevention pay off? Economic aspects of sports injury prevention: a systematic review - 
  • Why Women Might Need Different Hydration Advice - 
  • WHEN TRAINING IS ABOUT TO CHANGE, YOUR DIET SHOULD TOO - 
  • Law change allows rugby men to wear tights - 
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Recovery Protocol

13/10/2021

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Summary of: 
FOOTBALL RECOVERY STRATEGIES 
(Grégory Dupont, Mathieu Nédélec, Alan McCall, Serge Berthoin and Nicola A. Maffiuletti, 2015)
Cold water immersion for recovery

Does Fatigue Cause injury?

  • High intensity exercise leads to fatigue.  
  • Fatigue causes a decline in performance.  
  • A high percentage of injuries occur late in each half of a game, suggesting that fatigue is a risk factor for injury.

Fatigue Mechanisms

  • Combination of central and peripheral factors.
  • Central fatigue = decreased maximal voluntary muscle contraction and sprinting ability.
  • Peripheral fatigue = muscle soreness, damage, and inflammation.
  • Depletion of glycogen stores.
  • Dehydration.
  • Muscle damage / stiffness / swelling.
  • Mental fatigue / motivation.
  • Jet lag / disrupted body clock / stress / poor sleep.

How long does it take to recover from exercise?

  • Immediately after a match, 20M sprint time, quadriceps strength, and vertical jump height are decreased by about 10%.  
  • Full recovery can take between two and four days.  
  • Injury rates are increased when there are less than 6 days between matches.

"When playing two matches per week, the 3-day recovery time between two successive matches may consequently be insufficient to fully recover."



What can we do to reduce fatigue after exercise and recover faster?

Recovery Protocol

Nutrition & Hydration

Immediately after a match, players should drink a large volume of fluid (about 150% of the sweat loss) with a high concentration of sodium (about 500 to 700 mg/L of water), flavoured milk, and tart cherry or berry juice. Then, they should eat a meal containing high-glycaemic index carbohydrate and protein within the hour following play.

Rehydration and consumption of carbohydrates and protein are effective techniques for optimising repair of muscle damage.  The addition of sodium at 500-700mg/L promotes fluid retention, stimulates thirst, delays urine production, and increases glucose absorption.  It is recommended to drink a large volume of fluid after the match instead of small quantities gradually.

It is recommended to take 1.2g of carbohydrate per kilogram of bodyweight per hour for up to 5 hours after a match to enable maximum re-synthesis of muscle glycogen stores.

20g of milk protein during the first 2 hours of post-exercise recovery stimulates muscle protein synthesis.  Flavoured milk is an effective beverage for post-exercise recovery. It contains carbohydrate and proteins in similar amounts to those used in studies demonstrating improved post-exercise recovery.

Juices such as tart cherry juice, tomato juice, or berry juice are also recommended to enhancing the recovery process. These juices are loaded with a high antioxidant capacity, which reduce oxidative stress and inflammation.

Alcohol delays recovery as it is a diuretic, increases urine output, impairs sleep, delays the muscular recovery process, and decreases maximal strength.


Sleep

  • Sleep is an essential part of recovery management.
  • Lost sleep reduces endurance performance, maximal strength, cognitive performance, and the immune system.  
  • Less than 7 hours sleep per night triples the risk of infections and double the risk of musculoskeletal injuries.

Cold water immersion

  • Several meta-analyses confirm the benefits of cold-water immersion for recovery.
  • The recommended regime of cold-water immersion is: whole-body immersion lasting 10 to 20 minutes at a temperature of 12 to 15°C immediately after the match.

Active recovery

  • Active recovery performed after a match does not present any benefit for physical performance.

Massage

  • Most studies fail to find a significant beneficial effect of massage for recovery.
  • Psychological benefits: decreased subjective symptoms of soreness / improved perceptions of recovery.

Stretching

  • There is no substantial scientific evidence to support the use of stretching to enhance post-exercise recovery.
  • Stretching is not clinically worthwhile in reducing muscle soreness in the days following exercise. 
  • Recovery of physical performance is not improved after stretching.

Compression garments

  • Meta-analysis on the effects of compression garments on recovery following damaging exercise indicated that the use of compression garments had a moderate effect on recovery of muscle strength, muscle power, creatine kinase and in reducing the severity of delayed onset muscle soreness.  
  • A placebo effect due to wearing the garments could not be excluded.


CONCLUSION

  1. The first step is hydration; the mass of the players should be measured and compared to the pre-match body mass in order to propose the appropriate quantity of fluid to drink (150% of body mass lost). The fluid should contain a combination of water and a large amount of sodium (500 to 700 mg/L of water).
  2. The second step consists in drinking a tart cherry juice and chocolate milk in order to restore glycogen, to reduce oxidative stress and inflammation, to stimulate muscle repair and to promote quality and quantity of sleep.
  3. The third step is the cold bath. The players should immerse themselves up to the neck at a temperature between 12 and 15°C for 10 to 20 minutes to accelerate the recovery process.
  4. The fourth step is to wear a compression garment until bedtime.
  5. The fifth step is to eat a meal high in carbohydrate with a high-glycaemic index and protein within 1 hour after the match (for example soup, well-cooked white pasta or mashed potatoes, chicken or fish, yogurts or cake).
  6. The final step is to have a good night’s sleep.


WATCH DR DUPONT'S PRESENTATION AT ASPETAR'S POST-EXERCISE RECOVERY CONFERENCE:
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How Important is Stretching?

7/10/2021

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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:
  • to warm up
  • to cool down
  • to prevent injury
  • to help muscle soreness
  • to improve flexibility
  • to improve performance

​I’d guess that most people feel guilty about not stretching enough.

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?

No.  There is a lot of evidence that stretching does not reduce the risk of injury.  This systematic review and meta-analysis of randomised controlled trials found stretching does not prevent injuries, whether done before or after training.  This randomised controlled trial, and this systematic review concluded stretching before exercising only reduces the risk of injury by less than 1%.  

​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?

No.  A systematic review concluded that stretching before or after exercising does not confer protection from muscle soreness (ref).  Stretching was found to reduce muscle soreness by a trivially small amount - less than 2%.

“Most athletes will consider effects of this magnitude too small to make stretching to prevent later muscle soreness worthwhile.”

​DOES STRETCHING INCREASE RANGE OF MOVEMENT?

​No.  Stretching for the amount of time that most people would hold their stretches, does not make any actual difference to flexibility.  The mechanisms of stretching have been extensively studied.  There is moderate evidence from a systematic review that stretching can increase flexibility (ref). However, to achieve an actual improvement in muscle compliance we know the total duration of stretching needs to be at least five minutes per muscle group (ref).  Therefore to stretch hamstrings, quads, and calves, both left and right, as part of a warm up before sport, it should take at least 30 minutes - which is practically impossible as part of a warm up.  We know the one or two, thirty second stretches the majority of athletes would perform during their warm up are just not enough to actually improve their flexibility (ref).
​

​DOES STRETCHING HELP PERFORMANCE?

What people find most surprising about static stretching is it impairs subsequent performance (ref).

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:

“Based on the majority of the literature, it would seem logical to recommend that prolonged static stretching not be performed prior to a high level or competitive athletic or training performance.”

​WHAT ABOUT DYNAMIC STRETCHING?

​Obviously, I’ve been talking about sustained, static stretching.  It has been shown that there is no stretch-induced strength loss with dynamic stretching (ref).  However, the efficacy of dynamic stretching for increasing flexibility is yet to be determined (ref).
​

​SO WHY STRETCH?

I do get people to stretch if there’s a specific pathology that needs treating.  And you do need to stretch if you need flexibility to achieve certain positions in your sporting performance (hurdlers / gymnasts / divers, etc).
​

​SO SHOULD WE STOP STRETCHING?

If you’re happy with your stretching routine, keep doing it.  If you think it feels good to stretch after exercise then there’s no harm.  But I definitely wouldn’t recommend stretching at the expense of other techniques that are proven to aid recovery.



Do you love a good stretch?  
​Or feel guilty you're not stretching enough?...

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HEALTH NEWS 30/9/21

30/9/2021

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  • Full-contact training should not exceed 15 minutes per week, World Rugby guidelines say - 
  • How to prevent and manage muscle injuries - 
  • How does sleep help recovery from exercise-induced muscle injuries? - 
  • Do very active people have a higher risk of heart attack? - 
  • HEALTHY SWAPS TO INCREASE FIBRE INTAKE - 
  • What parents need to know about sensitive periods in physical development - 
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Health News 22/9/21

22/9/2021

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  • Resistance band workouts are everywhere – but do they work? - 
  • Recommendations and Nutritional Considerations for Female Athletes: Health and Performance - 
  • Padded Headgear does not Reduce the Incidence of Match Concussions in Professional Men’s Rugby Union - 
  • Concussion is rising in community footy, with kids bearing the brunt - 
  • Management of plantar heel pain: a best practice guide informed by a systematic review, expert clinical reasoning and patient values - 
  • Major Sports Injuries Can Possibly Be Predicted and Avoided Through DNA Testing - 
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Health News 16/9/21

16/9/2021

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  • New solutions to deal with breast pain women experience after exercise - 
  • Hot pack or cold pack: which one to reach for when you’re injured or in pain - 
  • The Concussion Conversation: addressing medical inequality - 
  • Risk factors for pelvic floor problems and what can help - 
  • Aiming for 10,000 steps? It turns out 7,000 could be enough to cut your risk of early death - 
  • Kids’ fitness is at risk while they miss sport and hobbies — but mums are getting more physical - 
  • Exercise and fitness in the time of COVID — it's hard for some and easy for others - 
  • ‘Compelling’ new concussion figures spark call for AFL revamp - 
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"A BIT OF A TIDY UP"

10/9/2021

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I’ve been treating a chap with a sore knee who really wants to have an arthroscope (keyhole surgery). The knee’s been sore for a while. There’s some “degenerative changes” on a scan, including a torn meniscus. There’s a local knee surgeon who’s really good and is a friend of his. He thinks it’s a no-brainer. He needs an arthroscope. It a quick and easy solution to his problem that has worked well for him and his friends previously. It’s time to have “a bit of a tidy up”.
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This is a very common presentation, and having an arthroscopic debridement is a very popular decision. 75,000 knee arthroscopies are performed in Australia each year. Therefore, you would imagine there is good evidence to support having one. Unfortunately it depends on who you speak to…

A change has been in the air since a 2002 randomised controlled study allocated 180 patients with osteoarthritis to either an arthroscopic “tidy up”, or sham surgery (where the patient was given an anaesthetic, incisions were made, but no actual “tidying up” was done) and the study concluded there was no meaningful difference in pain or function between the groups at follow up.

Since then, a number of studies have compared arthroscopic debridements and partial meniscectomy for degenerative knee injuries with exercise or doing nothing (Herrlin 2007, Kirkley 2008, Katz 2013, Sihvonen 2013, Yim 2013, Kise 2016) and the results have been unanimous.

A recent systematic review summarises: “these findings do not support the practise of arthroscopic surgery for middle aged or older patients with knee pain, with or without signs of osteoarthritis.”  

And another: “A trial of nonoperative management should be the first-line treatment for such patients.” 



Editorials summarise that:
“This high quality evidence dictates that meniscectomy is an ineffective treatment for symptomatic degenerative meniscal tears.”

And that…

“Arthroscopy for degenerative meniscal tears is no longer supported.” (ref)

And

“There is now overwhelming evidence that arthroscopic knee surgery offers little benefit for most patients with knee pain.” (ref)
​​

​SO WHY DID THE ARTHROSCOPE WORK FOR ME?

We do a lot of arthroscopes and people get better. What’s happening?

When you come and see me with degenerative knee pain and I tell you, “you need to do six to twelve weeks of strengthening exercises”, it sounds like hard work. Pffft. Understandably we want an easier option.

“Have surgery” sounds like an easier option. Someone else is doing the work for you. After the surgery, you proceed to do six to twelve weeks of strengthening exercises, but this time you’re happier to do the work because we take surgical post-op instructions seriously.

Twelve weeks later both these two groups are a lot better. Bingo-bango, “surgery” fixed me.

Two million knee arthroscopies a year globally, costing billions of dollars.
​

​WHY DO PEOPLE HAVE SURGERY?

A pretty typical pathway goes something like:
  • Sore knee
  • GP says “you’re silly to have played football”, try some pain killers
  • Not much better
  • GP says “we better get a scan”
  • MRI shows “degenerative changes / meniscal tear” which seems like a structural injury
  • Who fixes structural injuries?… Surgeons
  • Refer to surgeon
  • Surgeon wants to help. What can he do? An arthroscope and a “bit of a tidy up”.

​I think we need to be careful at the MRI stage. MRIs are a lot cheaper and easier to get these days so it’s less of a big deal to get one. I was chatting to a mate with a sore knee and his MRI showed some degenerative changes. Rather than being told that it’s normal to see those sorts of things in knees as old as ours, and that it’s not necessarily the thing that’s giving him pain, he was told the knee is “bone on bone”. How can anyone ever expect to recover without surgery with that sort of imagery? Bone on bone seems definitive. Surely the only way to fix “bone on bone” is surgery?

But we know degenerative changes on MRI are poorly associated with symptoms, and degenerative changes are the norm in middle-aged knees (ref). 

Let’s try some strengthening. You will be surprised.
​

​SO WHO SHOULD HAVE SURGERY ON THEIR CARTILAGE?

The people I do refer to a surgeon for cartilage surgery have suffered an acute twisting injury with mechanical “locking” symptoms (i.e., an inability to fully extend the painful knee because of a meniscus tear lodged between the articular surfaces).
​



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Health News 6/9/21

6/9/2021

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  • How often should we exercise to get in shape? - 
  • Tokyo 2020: does the Paralympics empower disabled people? - 
  • Tokyo Paralympics: how Paralympians are affected by the heat - 
  • How online mindfulness training can help students thrive during the pandemic - 
  • Rugby players’ brains affected in single season, study suggests - 
  • How ‘Dr Cool’ will help Socceroos stay chilled in 40-degree Qatar furnace - 
  • Why has rugby taken so long to wake up to what boxing has long known? - 
  • Normal Concussion Recovery Could Take Up to a Month - 
  • COVID can worsen quickly at home. Here’s when to call an ambulance - 
  • 3 reasons why Paralympic powerlifters shift seemingly impossible weights - 
  • Why Fitter People Drink More Alcohol - 
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Health News 26/8/21

16/8/2021

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  • Seeking a Grand Theory of Injury Prevention - 
  • PARALYMPIC CLASSIFICATION EXPLAINED - 
  • Why is Eliud Kipchoge So Much Better Than Everyone Else? - 
  • What is Bell’s palsy? - 
  • UNDERSTANDING YOUR PORTIONS – HOW TO MANAGE YOUR INTAKE - 
  • Innovation and inner-strength: the stories behind Australia’s Paralympians - 
  • Can 'lifestyle medicine' such as diet, exercise and mindfulness help treat chronic pain? - 
  • Return-to-running following childbirth - 
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Health News 16/8/21

16/8/2021

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  • Muscles are important, but stiff tendons are the secret ingredient for high-speed performance - 
  • Soccer balls should have health warning: dementia expert - 
  • Shoe wars: World records spike on track as battle of brands intensifies - 
  • There’s New Evidence on Heart Health in Endurance Athletes - 
  • Heat, the track or super spikes: what is causing fast times at the Olympics? - 
  • Bed rest in hospital can be bad for you. Here’s what nurses say would help get patients moving - 
  • Why Older Athletes Lose Explosive Power - 
  • Use it or rapidly lose it: how to keep up strength training in lockdown - 
  • Exercise Vigorously for 4 Seconds. Repeat. Your Muscles May Thank You. - 
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Health News 3/8/21

3/8/2021

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  • Kids’ grip strength is improving, but other measures of muscle fitness are getting worse - 
  • What Olympic gymnasts can teach us about improving our balance - 
  • How to feed an Olympian: the delicate mix of timing, carbs and protein - 
  • Strength training is as important as cardio - and you can do it from home during COVID-19 - 
  • For older people and those with chronic health conditions, staying active at home is extra important - 
  • How to stay fit and active at home during the coronavirus self-isolation - 
  • What Olympic athletes can teach us about regulating our emotions and staying dedicated - 
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Health News 29/7/21

29/7/2021

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  • The Science of Track and Field’s New Super Spikes - 
  • Elite Athletes Don’t Sleep As Much As You Think - 
  • WHY ARE WARM-UPS SO IMPORTANT? - 
  • Damning DCMS report on head injuries in sport seen as ‘turning point’ - 
  • One in four elite rugby players could have brain damage, bombshell new study finds - 
  • ADVICE FOR ATHLETES EATING HEALTHY BUT NOT SEEING RESULTS - 
  • Thinking of choosing a health or PE subject in years 11 and 12? Here’s what you need to know - 
  • THIS MIGHT BE WHY YOU GET SO HUNGRY AT NIGHT - 
  • Keto diet may ramp up fat burning but comes at direct expense of elite performance - 
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Health News 20/7/21

20/7/2021

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  • How Weight Training May Help With Weight Control - 
  • How Mental Training Can Make You Physically Stronger - 
  • Why strength training is important and how to get started - 
  • 30 minutes of daily exercise 'not enough' for those who spend days sitting down - 
  • How Walking Can Build Up the Brain - 
  • In search of walking equality: 70% of Indigenous people in Sydney live in neighbourhoods with low walkability - 
  • Sport science body to track female athletes’ hormonal changes linked to menstruation - 
  • Little changes can drive big gains at Olympic Games - 
  • How to Heat-Proof Your Training - 
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Health News 8/7/21

8/7/2021

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  • Cardiac arrests in young people - 
  • ‘Modern day mouthguard’: female footy players embrace breast protection - 
  • Carbohydrates: why carbs are so important for exercise, recovery and brain function - 
  • Evaluating the effects of oral contraceptive use on biomarkers and body composition during a competitive season in collegiate female soccer players - 
  • Poor sleep is really bad for your health. But we found exercise can offset some of these harms - 
  • To Avoid Running Injuries, Don’t Shake Up Your Routine Too Much - 
  • Technological advances in elite marathon performance - 
  • 'Survival of the fittest': Tokyo set to be hottest ever Olympic Games - 
  • DIETARY TIPS TO HELP SUPPORT YOUR MENTAL HEALTH - 
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COVID Lockdown Update

30/6/2021

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Sydney is in lockdown again from Friday June 25th to Friday July 9th.

During this current lockdown, Fit As A Physio is staying open to continue offering quality care to my clients.

The Department of Health has specifically confirmed that physiotherapy is deemed an essential service. The Health Minister has encouraged private practices to remain open, as it will reduce demand on general practice and the hospitals if patients can still see their physiotherapist for their musculoskeletal and acute care management.

I have completed the Department of Health's "COVID-19 Infection Control Training".  I have reviewed all clinic hygiene practices, to ensure optimal safety and care for every person who attends the clinic.

There are many things I am doing as a registered health professional to minimise risk of exposure, through rigorous hygiene practices, and patient screening, to keep you safe.  

You are welcome to attend your appointment, subject to the following conditions:
  • Please do not come to your appointment if you are unwell with any potential COVID symptoms.
  • Please do not come to your appointment if you have been advised to quarantine or self-isolate.
  • Please sign-in at the front door with the Service NSW QR code.
  • Please wear a mask.
  • Please use the hand sanitiser at the front desk on entering and leaving.

Thank you for your cooperation with these measures.

For our safety:
  • I am leaving space in-between appointments to allow time for cleaning, and to minimise patient interaction in the waiting room.
  • I will not be greeting you with hand shakes or other contact hand gestures.
  • I am wiping down contact surfaces between appointments with Viraclean Hospital Grade disinfectant.
  • I am continuing with my normal hand hygiene measures of thorough hand washing before and after all patient contact.
  • ​I have the COVIDSafe app downloaded and open, and encourage you to do the same.


​If you are in self-isolation or would prefer to minimise contact in any way, you may like to consult with me via video. "Telehealth" uses technology that’s readily available on your computer or phone to receive assessment, diagnosis, and rehab prescription. FaceTime, Skype, or PhysiApp are easy options. The standard consultation via telehealth is $39/15mins.

If you would like to talk to me about commencing or continuing your physio through Telehealth, please phone 9969 6925, email fergus@fitasaphysio.com, or book online here.

Stay safe and well.

Kind regards,

Fergus Tilt
Sports & Exercise Physiotherapist
Fit As A Physio | MOSMAN
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Health News 24/6/21

24/6/2021

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  • How to improve health and quality of life for long-term care residents: Sit less, move more - 
  • Leafy greens key to maintaining muscles - 
  • Ultramarathon running: how safe is the sport? - 
  • The Best Type of Exercise? - 
  • What It Takes to Run a Fast Mile - 
  • Lifelong Exercise Adds Up to Big Health Care Savings - 
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Reframing MRI abnormalities as a normal part of ageing

18/6/2021

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http://dx.doi.org/10.1136/bjsports-2020-103563
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​Sports and exercise medicine clinicians often refer for diagnostic imaging to help direct clinical management. The use of musculoskeletal MRI has risen rapidly in recent decades, yet the clinical benefit of MRI is uncertain. Imaging is useful for the differential diagnosis of many health conditions, including possible red flags, however, there are growing concerns of potential harm from MRIs caused by clinicians misinterpreting results triggering unnecessary interventions escalating patient fear/distress. Evidence-based reporting and clinically relevant interpretation of MRIs is critical.

Recognising the clinical significance of MRI findings is often a challenge given the substantial discordance that exists between structural pathology and symptoms. Emerging evidence indicates a high prevalence of so-called abnormal findings on MRI in individuals without symptoms. A collation of systematic reviews (and cohort studies when no review available) highlights that typical features of deterioration, such as cartilage lesions, hip and shoulder labral tears and spinal changes (eg, disc degeneration/bulge) exist in many healthy asymptomatic adults (figure 1). Approximately 8 of 10 adults aged ≥40 years have asymptomatic disc degeneration, while almost half of all adults aged ≥40 years have knee cartilage lesions but no pain. Although the prognosis of these asymptomatic findings is not well established, even in cases of further structural deterioration (eg, longitudinal cartilage loss) the association with pain appears minimal.5 These findings are critical for clinicians and patients to understand the relevance of structural pathology and can be used to address recent calls for radiology reports to include age-matched asymptomatic prevalence rates. Such an approach, together with discussion with patients putting MRI findings into context, may help minimise patient anxiety, and beliefs they are damaged and vulnerable, as a result of a diagnostic label. Including such epidemiological information on spinal MRI reports reduced subsequent opioid prescription although had little effect on healthcare utilisation.

The high prevalence of asymptomatic changes on MRI emphasises that such features may not always be the source of pain in symptomatic patients and should not routinely be considered as pathological processes requiring intervention. Instead, in many people they likely represent part of the normal ageing process—like wrinkles on the skin.

Current evidence suggests that it is more common than not to have a cartilage lesion or disc bulge as we age. Perhaps it is time we redefine what a ‘normal’ MRI is and start being ‘CLEAR’ with patients when discussing imaging results—consistent language, including epidemiological information and assessment of relevance.
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Health News 8/6/21

8/6/2021

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  • PRACTICAL WAYS TO SUPPORT YOUR IMMUNE SYSTEM DURING SEASONAL CHANGE - 
  • Eating disorders and energy deficiency: athletes straddle fine line in pursuit of goals - 
  • How to Choose the Right Dose of Exercise for Your Brain - 
  • Science playing catch up in women's concussion research - 
  • New research reveals running boom during Covid-19 pandemic - 
  • How to Harness the Pain-Blocking Effects of Exercise - 
  • Rugby, concussions and duty of care: why the game is facing scrutiny - 
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Health News 26/5/21

26/5/2021

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  • How Exercise Affects Pregnant Women - 
  • Revolutionary VR technology to detect concussions set to be trialled in Super Rugby Trans-Tasman - 
  • How long does it take to become unfit? - 
  • NRL can cut concussions within a season, says top rugby doctor-
  • The advice every junior is given that could slash NRL head injuries - 
  • Christina was a rising star in soccer. Too many headers gave her a brain injury - 
  • What really happens inside Australia’s sports concussion labs - 
  • Are AFL players being as honest as they should be about head knocks? - 
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Health News 17/5/21

17/5/2021

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  • Explainer: what we know about concussion in Australian sport - 
  • What's behind the runner's high? It's more likely endocannabinoids than endorphins
     - 
  • Sports concussions affect men and women differently. Female athletes need more attention in brain research - 
  • Why Exercise Can Be So Draining for People With Rheumatoid Arthritis - 
  • The Science of Getting Stronger – Mid to Long Term Planning - 
  • The Elusive Art of Predicting Running Injuries - 
  • How Exercise May Help Us Flourish - 
  • Do Statins Really Cause Muscle Aches? - 
  • TRAINING THE GUT FOR MARATHON SUCCESS - 
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Health News 3/5/21

3/5/2021

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  • 14 SALAD COMBINATION IDEAS FOR ATHLETES - 
  • The Complicated Link Between Sleep and Injury - 
  • Walking workouts are great for heart, bone, and muscle health – and almost everyone can do it - 
  • Ice for Sore Muscles? Think Again. - 
  • Brief, intense exercise helps students cope with HSC and life stress - 
  • How to train like a woman - 
  • The New Science of “Fatigue Resistance” - 
  • Guidelines for concussion management in community football - 
  • A third of kids develop a mental health problem after concussion - 
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Hamstring Rehabilitation Exercises

30/4/2021

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The two most important factors for successfully rehabbing a hamstring strain, are:
  • Loading exercises
  • A graded increase in running pace

(Other factors include: stretching, massage, rolling, ice, compression, tape, sleep, stress, maintaining cardio, skills, general strength.)

Three exercises to start from day 1, are:
  • Active Knee Extension
  • Single Leg Romanians / Arabesque
  • Hamstring Bridges

ACTIVE KNEE EXTENSION

Hold and stabilise the thigh of the injured leg with the hip flexed approximately 90° and then perform slow knee extensions to a point just before pain is felt. Three times a day, three sets of 12 repetitions.

SINGLE LEG ROMANIANS / ARABESQUE

Hip flexion (from an upright trunk position) of the injured, standing leg and simultaneous stretching of the arms forward and attempting maximal hip extension of the lifted leg while keeping the pelvis horizontal; angles at the knee should be maintained at 10–20° in the standing leg and at 90° in the lifted leg. Owing to its complexity, this exercise should be performed very slowly in the beginning. Three times a day, three sets of 10 repetitions.

HAMSTRING BRIDGES

​This exercise is started in a supine position with the body weight on both heels and then the pelvis is lifted up and down slowly. Start with the knee in 90° of flexion. The load is increased by putting more of the body weight on the injured leg and by having a greater extension in the knee. Ultimately, only the slightly bent injured leg is carrying the load. Three times per day, 3 sets of 10 repetitions.
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