Articles in Category: Sporting Injuries

Bike Fitting

Written by Don Williams BSc, MChiro, ICSSD. on Wednesday, 23 September 2015. Posted in Sporting Injuries, Training and Performance

Bike Fitting

By Don Williams

 

Cycling is becoming quite the popular sport in Brisbane. You only need to go to just about any local café in the city or around the bayside suburbs and esplanades to get a sense of how many people are getting involved in this sport, some more seriously than others.

 

Unfortunately we do get to see quite a lot of trauma cases at Institute of Sports and Spines due to car bike interface disorders, referred to more usually as collisions. Usually the cyclists fare worse than the drivers, but not always so. The disputes will rage long and hard over whether cyclists should or should not be on the road and who is generally at fault, so we will leave this debate alone.

 

Additionally though, we do see quite a lot of injuries which are overload or postural in origin who come into the clinic. Many of these injuries are preventable with correct bike position and set up, or by addressing imbalances and weakness in the system.

 

Many people would think that correct bike position is just a case of getting a bike that you can get your leg over and everything else should be just fine, however, there is a lot more to it than that.  Generally, on top of the basics of getting a frame that is the right size, alterations in seat height, forward and backwards position of the seat, handlebar width, stem height, relationship of the stem to seat height, pedal cleat position, crank length and angulation of the shoe can all have an impact on whether a ride along the bay on the weekend is an enjoyable or painful experience. At the higher end of the performance spectrum, this may have a significant impact on the power output, aerodynamics and general comfort allowing you to race to your full potential or falling short due to these deficiencies.

 

At Institute of Sports and Spines, we use cutting edge technology combined with years of clinical experience to help you overcome your injuries and enhance your performance needs.

 

We utilize a Wahoo Kickr stationary trainer so that we can accommodate road bikes, and all range of mountain bikes from 24’ to 29ers. We can also accommodate bolt through axles or quick release.  The trainer is extremely quiet and allows us to tie in power based assessments with your bike fit.

 

 Bike Fitting 1 Bike Fitting 2

 

Our video capture system is from Silicon Coach.

Bike Fitting 3 Bike Fitting 4

 

We utilize “Dialed in Motion” and “Silicon Coach Pro”, software to dynamically capture your position when riding under load from multiple camera sources in high definition giving us a very clear assessment of your true riding technique. We then assess the angles and position of all the relative joints to allow us to make changes to optimize your position.

 

We often have people discussing the Reutal System and its claimed accuracy.

Without being too critical, whilst the accuracy of the motion sensors in that system may be accurate to the millimeter, the placement of the markers on the body delivers the same inaccuracies of palpation that are inherent in the placement of markers or sensors in any system. Our view, having a clinician with years of experience in injury diagnosis and management melded with years of experience in cycling will yield great results in helping you achieve the fit you want. There are a number of places in Brisbane using the Reutal system, some are doing a fantastic job, others less so, and with some centers charging upwards of $400 more consistent results should be expected. Once again, the places who are doing a great job are usually combining technology with years of experience.

 

The whole point of a bike fit is to make you sit more comfortably (which will let you ride harder and longer) and to help you ride more efficiently. The transmission between the motor and the bike if you will.

 

Bike Fitting 5

 

Our process takes around 2 hours. It is very detailed and personal. You will have a pre-fit interview and assessment, to find any problems that may exist. 

Then we use HD Video motion analysis software your riding position. During the fitting we will assess the shoe, arch support, cleat position, saddle, stem length and height. We can then make changes and give you a detailed report of before and after fitting.

 

Your customized report has all the setting for your bike and your body measurements so that should you need to change back to the original settings or are looking to buy a new bike and want all your measurements to give to the bike shop, they are all at hand.

 

If you would like further information about bike fitting and assessment, call our friendly reception team for details.

Communication and Recovery

Written by Don Williams BSc, MChiro, ICSSD. on Thursday, 04 February 2016. Posted in Sporting Injuries, Training and Performance

Communication and recovery

By Don Williams

B.Sc., M.Chiro., ICSSD., PG Dip. NMS Rehabilitation Cert DNS. Memb: FICS, CEA

 

When I sat down to write this article it was initially intended as a discussion piece for a forum and website that I contribute to for elite athletes, however, after thinking about the issues involved, I really think it applies to the general population equally as much.

 

One of the challenges when managing patients/clients is ensuring that communication is adequate between all the parties involved in the management of the person with the complaint. For the general population this may include a GP, a surgeon, a Chiropractor, a personal trainer and a Remedial Massage Therapist, as well as the personal with the complaint. For athletes, there could be additional players including technique coach, strength and conditioning coach and team managers etc.

 

So let’s imagine a scenario where Michelle injures her knee. She has been training with a trainer at her local gym and gets regular massage with a great therapist.

After the injury she ends up seeing Jakob at Institute of Sports and Spines who diagnoses her with a significant tear of the meniscus and refers Michelle off for an MRI to confirm his suspicions. The scan confirms the major tear and Michelle will require a surgical approach to resolve the situation. Jakob then refers Michelle to a surgeon for management and also writes a letter to the GP. Currently in our healthcare “hierarchy” in Australia, a GP referral is required for the specialist visit and surgery to be covered under medicare.

Unfortunately this GP thinks that all Chiropractors are idiots and as a result, refers the patient to another surgeon. This surgeon is unaware of the other links in the chain in regards to where the complaint was first assessed and diagnosed and does not communicate with Jakob about the surgery and what was actually done in the operation.  Once the surgery is complete there is conflicting advice and Michelle doesn’t end up doing effective post-operative rehabilitation and ends up reinjuring the knee as a result of the breakdown in communication.

 

The above scenario is an unfortunate but common incident that we see in practice.

At the nuts and bolts level, the breakdown in communication is to blame and if all parties involved were to step back and really have a focus on what is the best way to manage the client/patient to get the best possible outcome then this sort of situation would arise much less frequently.

 

In an “optimal scenario”, the surgeon sends a post-operative letter and synopsis which guides an effective rehabilitation program so that Jakob can develop and implement a rehabilitation plan for Michelle to progress through the early clinical phase or rehabilitation and back into functional training and gym work. It is important to note that at times, a simple surgical intervention may be planned but once the surgeon commences the operation, the injury turns out to be far worse than anticipated or the approach may be different which can at times vastly change the required rehabilitation program. In Michelle’s case, a simple debridement of a meniscus would see a relatively simple recover and rehabilitation plan, however, if there was stitching and repair of the torn meniscus, the rehabilitation would be slower and more complex.

 

The healthcare landscape in Australia is rife with egos and opinions and often this ends up with the patient outcome of goal taking a backseat.

 

In the example given above, if solid communication was at the forefront, then the GP and surgeon would communicate back to Jakob what was done and any specific requests or advice given to ensure that early rehab was effective and targeted at getting the best outcome. This would then allow Jakob to give targeted feedback to the trainer and other therapists involved to ensure that everyone was on the same page to achieve a great outcome for Michelle.

 

It is important to note that the breakdown in communication is not always any particular party. I have chosen one aspect here, with a GP breaking the chain to highlight where co-referrals can compound issues. Our team at Institute of Sports and Spines have a great network of GPs, surgeons, radiologists, trainers and other therapists who we deal with regularly and have a tremendous amount of respect for. We certainly appreciate the communication and mutual respect which we have which we believe is one of the cornerstones for good patient outcomes.

 

The major plus of living in a big city is the ability to have a variety of practitioners with a range of specialisations and special interests available at hand to be able to better manage our clients/patients. When all the parties involved recognise their strengths and weaknesses and utilise the available pool of resources our management and outcomes of patients are greatly enhanced.

How Long will it take to Get Better?

Written by Don Williams BSc, MChiro, ICSSD. on Wednesday, 23 September 2015. Posted in Massage, General Health, Sporting Injuries, Acupuncture, Training and Performance, Chiropractic

How Long will it take to Get Better?

By Don Williams

B.Sc., M.Chiro., ICSSD., PG Dip. NMS Rehabilitation Cert DNS. Memb: FICS, CEA

 

One of the most common questions that we get asked every day in practice is, “How long will it take to get better?” Unfortunately there is no short answer to this question, however, in this article I will try to outline some of the contributing factors and delineate some guidelines and ideas which may help answer this question for you.

 

Everyone is an individual, and in that sense, how different people respond and heal from different injuries does vary somewhat, some injuries are particularly unpredictable, shoulders are particularly problematic in identifying how well or how quickly they will respond to treatment. However with most injuries, there are general time frames in which most healing will occur.

 

Most people who have ever had an injury and minor procedure which required stitches will remember that the stitches generally come out in around 7 days and this time frame is a good indication of how long a cut or trauma takes to “bond” back together, however, the general healing process generally takes around 21 days. This is the timeframe for the body to lay down a “callus” or matrix of fibres around the injury and develop new connections and bridges to stabilise the injury and repair. But this timeframe is dependent on good blood flow and environment for repair, additionally, just because the injury is stabilised, does not mean that it is fully healed and fully function. This healing process and time frame is specifically relevant for muscle and skin.

 

Areas of the body that receive poorer blood supply take longer to recover. Tendons and particularly joint cartilage and ligaments receive a lower direct blood supply and take longer to heal. We normally expect that tendon and ligament injuries will take 6 weeks to start to repair well and 3 months to be stable.

 

Bones fractures also take longer to heal. Interestingly, the ratio of cortical bone (the dense outer “shell”) to cancellous bone (the “spongey” inner core) also affects the healing rate. So when we look at bones like the tibia (the larger of the two lower leg bones) they take a particularly long time to heal (up to 4 months).

 

The other interesting thing to note is that an injury is not always something that is readily assessable via an x-ray or scan and often, the severity of the pathology on the scan can be very unrelated to the amount of pain. For example, someone with severe degenerative changes noted on an x-ray may not have any pain, and in contrast, someone with very severe pain may have really good looking x-rays.

 

It is also important to note that many people use pain as a guide to where they have a problem or not. This is a situation which has been reinforced with dodgy advertising commercials by big pharmaceutical companies suggesting that all of our aches and pains can be targeted and resolved with a little tablet.  At times pain killers can be helpful, but it is important to realise that, contrary to the advertising campaigns, and the statements of the celebrities fronting these commercials, these drugs do not “target” the source of pain. They work globally in the system to mask the pain. In fact anti-inflammatories drugs can actually slow the healing process and all of these drugs have potential for complications and side effects, some of these can be severe.

 

But pain is only the tip of the iceberg. Pain exists as an indicator that something is going wrong in our system. We have an area that is under duress or load which is unhappy or injured. Sometimes there are weaknesses or imbalances or inappropriate actions which have caused this problem to develop. Getting rid of the pain is a good start, but addressing the underlying dysfunction or causative factors is also important to reach a good long term outcome.

 

Part of our goal in assessment at Institute of Sports and Spines is to try to assess the contributing factors which caused your problem to develop in the first place and help you to eliminate or address these issues.

 

Another complicating factor as eluded to, early in the article is the individual nature of response.

Sometimes we will see muscle spasm problems which are very severe and painful, which is not related to severe pathology. At times these issues will respond very quickly to treatment and at other times they will be a little stubborn and take a little longer. Generally, the response to treatment gives a more accurate prediction of how quickly the issue will settle. Further to this, if you have had previous episodes of the same problem, the previous response rate is generally a reasonable indicator of the response rate for future episodes.

 

So as a general time line for healing rates:

  • Early tissue healing occurs in around 7 days

  • The majority of soft tissue healing takes around 21 days.

  • Early bone healing takes 6 weeks (up to 4 months so large, long bones)

  • Cartilage and Ligament issues take around 6 weeks to 3 months

  • Re-education and retraining takes a minimum of 3 months

  • Remodelling can take up to 1 year.

 

In a perfect world things can progress more quickly. The addition of complicating factors can drag these times frames out.  The better that problems are managed and treated increases the probability of a good resolution and good long term outcome.

 

Later in this newsletter and over the next few additions we will outline more specifically injuries of the neck, back, knee, hip, shoulder and tendonopathies.

 

If you have any further questions then talk to the team and we will help you out with more specific advice.

 

Fracture Healing -

 

Fracture Healing

 


Wound Healing -

 

Wound Healing