Articles in Category: Training and Performance

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

 

 

 

 

 

How to Lift Correctly

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

How to Lift Correctly

By Don Williams

B.Sc., M.Chiro., ICSSD., PG Dip. NMS Rehabilitation,

Cert. DNS.   Memb: CAA, FICS, CEA.

 

Effective lifting mechanics are an important aspect for our everyday lives. Patients often complain of low back pain and have not considered lifting or squatting technique as a factor in their complaint.

It really doesn’t matter whether you are lifting 100kg of weights on a bar or a tissue off the floor, correct form and technique is important.

 

One of the major problems which does catch people out is the magnification of force with loads in front of the body.

 

Low back mechanics are very complex, as demonstrated by the picture to the right (technical biomechanics are available in this link).   http://cnx.org/content/m42175/latest/?collection=col11406/latest

 

Figure 1

 

For lifting mechanics, we have a range of different lever classes and a stack of joints involved (ankles, knee, hips, spinal segments, shoulders elbows and wrists). But to put it in relatively simple terms, if you think of the low back as a pivot point, the lumbar extensor muscles are only 2-5 cm from the pivot point, when we lift, it is quite easy to have the load out in front 50cm. This can easily give us a magnification of force by 10 to 20 times the load. Essentially, this means that even though it is only 5kg you are lifting, the required compressive load in the lumbar extensors may be 100kgs. Wow!

 

Figure 2

 

 

Lifting with a straight back is not correct

There is a common misconception in the general population that we should lift with a straight back. (See diagram on right)

 

Many people interpret this as that the back is perpendicular to the ground. Lifting in this manner pushes the knees in front of the toes and necessitates lifting the heels off the ground to lift items at floor level. This increases load on the hips and knees, causes a lack of balance and a decreased lift capacity.

 

Figure 3

 

Don’t use you back

We certainly shouldn’t lift bending forward from the hips either.

As in the earlier explanation of lifting mechanics and lever arms, bending forward from the hips and lifting using the low back (like a crane) dramatically increases the likelihood of needing to see the team at Institute of Sports and Spines more often. We often hear complaints from people suggesting that using the hips and knees causes the knees to ache, commonly, when we assess the lifting mechanics with these people they are pushing too far forward with the knees causing increased load and pain, when we improve the mechanics, the knees feel much better in the squat position.

 

Figure 4 

 

Neutral Spine Position

When standing up straight and tall in good posture we have a lumbar lordosis and thoracic kyphosis. This “neutral” position of the spine is what we should strive to maintain when lifting and squatting. Effective use of this position should see the knees stay in line with or behind the toes, good balance capacity and effective use of the gluteal muscles as the main drive for the movement.

 

Figure 5

 

Additionally, good squatting technique should see alignment of the knees in the midline of the foot. In Prague school terms, this would be referred to as good “centration” of the joints. Poor alignment of the feet, knees and hips often contributes to pain on the inside of the knee or the outside of the hip (Trochanteric  bursitis)

 

Figure 6          Figure 7

    Poor Centration                                           Good Centration

 

Correct Squat (lifting) technique

At the bottom of the squat the lumbar lordosis should be maintained. Putting this into simple terms, this means that as you squat down, there will be a point at which the low back starts to “flatten out” and reverse the curve, this is the bottom of the safe lifting range and will be different from person to person. The knees should be in the midline of the foot and the knees should always be behind the toes. The feet should be straight or at maximum 15 degrees externally rotated (pointing out)

 

Figure 8

 

Squatting Drills

A great drill to assess your squat mechanics and to improve your function is to stand with your toes touching a box (or bedside table at home will work). It may be a good idea to put a chair behind you as some people will overbalance and fall backwards when they start this exercise. Slowly squat down, as if you were planning on sitting on the chair, and try to feel the point at which your back starts to move or flatten out. Try to ensure that your knees do not touch the box and that the knees stay in the midline of the feet. If you tend to collapse into the chair when you start this exercise, don’t lose heart, keep at it, reach out in front with the arm, the glut strength will build and this should become easier over a number of weeks. Try this 2-3 times per day, 10 reps each time for 6 -12 weeks until this pattern is easy and natural feeling.

 

Figure 9

 

Other Factors to consider

 

The last thing to mention in wrapping up is that when lifting load at work and around the home, weight is not the only factor which causes issues. The NIOSH guidelines are essentially internationally guidelines and equations which help to identify safe lifting practice and application in the workplace, the following links are very useful for those interested in learning more.

http://www.ergonomics.com.au/niosh.htm

http://www.cdc.gov/niosh/docs/2007-131/pdfs/2007-131.pdf

 

The following is a summary of the modifying factors for your consideration.

Increased weight. This is a no brainer, the heavier the load the harder it is to lift and to a degree, the more the risk. A good start point for safe working loads for 1 person are generally 15kg for females and 25kg for males.

Safe Lifting Zone. We tolerate and accommodate lifting loads between the knees and the shoulders fairly well, when the loads are above or below these points, the weight must be reduced.

Distance lifting (vertical or horizontal). Lifting an object from the knees to the shoulders repetitively is more difficult than just lifting from a bench at hip height to a bench 10cm higher.

Distance from the body. The further away from the body (out in front) the load is, the higher the relative load is on the back.

Repetitions or number of lifts. The more often you have to lift the load, the more the force summates on the back (and the body in general) and once again the greater the risk.

Object Size or Shape. Lifting a really big box (hopefully an exciting present) feels much heavier than a dumbbell of equal weight.

Constant vs Dynamic Load. If the load keep changing weight (a squirming child) it is a more difficult lift than a static load (a sleeping child).

 

If you have any further question or would like to work through lifting mechanics, please contact the team at Institute of Sports and Spines for more information.

How to Run Faster

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

How to Run Faster

By Don Williams

B.Sc., M.Chiro., ICSSD., PG Dip. NMS Rehabilitation,

Cert. DNS.   Memb: CAA, FICS, CEA.

 

At this time of year, many people are trying to get in shape to look good on their holidays or just generally coming out of their winter slumber.

 

I always get a good laughing watching the hibernating bears starting to hit the esplanade in the morning for a jog, walk or in some cases some other movement activity which needs to be seen to be appreciated, but does not necessarily fall into the above categories.

 

Many people are trying to improve their running speed, and the evolution and growth of the parkrun groups around Brisbane is testament to an improvement in the public sentiment about improving health and fitness.

 

We do speak to a lot of people about their running and for many a desire or goal to be able to run faster and at the basic level, this is just human nature.

 

There are a number of factors which can play a roll in increasing your speed, or in fact hindering your ability to increase your speed. The aim of this article is to help you identify and address some of these issues.

 

Footwear Choice

At the most basic level, correct footwear is important. This is even more important if you get, foot, ankle, knee, hip or back pain when you run. There are a range of different runners to suit different foot types and also different events, choosing a shoe that suits you and your intended sport is always very important. Correct footwear choice will usually save you money and prevent frustration long term from injuries.

 If you are not sure if your shoes suit, maybe book in and have your gait assessed on the treadmill and we can point you in the right direction.

 

Gait Mechanics

Secondly, gait mechanics. The mechanics of the gait cycle (walking and running mechanics) are really quite complex, so I will keep this section brief and untechnical. Essentially, when we walk, as our leg swings out in front, the heel of the foot strikes the ground (creating a deceleration or slowing moment), then we pull through with the foot into weight-bearing and then the heel lifts, the other heel strikes the ground and we push off with the toes. As people progress into jogging, the mechanics change a little, with one of the big differences being that only one foot is on the ground at any point in time. For slow jogging, this works fine, however, if you want to run fast (probably around 4 minutes 30 seconds per kilometre or faster) we need to improve our gait mechanics to minimise the deceleration phase, so that the foot is travelling backwards when the heel strikes the ground. This is a fascinating area and one which is rich in opportunities to improve. If you have never had your technique assessed, do it. This may have a dramatic impact on your speed and overall enjoyment.

 

Cardiovascular issues and Muscular Endurance

People often think of fitness as a cardiovascular issue. Certainly this is a major component, however, muscular endurance also plays a roll.

To break this down, the cardiovascular system is the heart, lunges and blood vessels and essentially, this system extracts oxygen from the air and transports it to the muscles, and returns the waste products back to the lunges etc. Improving fitness in this area improves the ability or efficiency of our bodies to do this effectively.

Muscular endurance describes the ability of the muscles to contract repeated during an exercise.

Both of these systems will adapt and improve with training. The muscular endurance ability tends to be a little more sport specific and will adapt most effectively to the training you are doing, as in , riding a bike won’t improve your running performance as much as running training will.

Cardiovascular fitness is a little less sport specific and generally, a range of cross training activities can all have a positive impact on your aerobic conditioning.

 

The efficiency and effectiveness of these systems will evidently have a significant impact on your running speed and training can be made much more effective or targeted by understanding what your thresholds are for aerobic capacity, allowing you to train more effectively to increase these thresholds. If you would like to know more about your cardiovascular and muscular endurance, we have a range of testing options to directly test and assess these systems and can then provide you with targets for your training.

 

Injuries

Obviously, injuries can slow us down. Common injuries in runners are calf and Achilles injuries, hamstring strains and tears and low back strains. Knee and hip issues also play a roll.

Many of these injuries can be controlled or prevented by correct footwear choice, effective training strategies and evolving or increasing your training and distance over a period of time.

If you have injuries, address them early and resolve them before returning to training and racing. Mismanagement of injuries can be a major contributor to long term disability and whether you enjoy your running over the long term or retire early, hurt.

 

Training techniques

Lastly, training techniques and the type of training you do can greatly increase your speed.

Often runners will plod along at the same pace every time they run. Their body adapts to the speed and load that they place on it so it essentially “gets used to” that pace.

For these people, altering training to help the body adapt to faster speed when running can be effective. Think of this as training to increase leg speed.

Certainly, it can be much easier to quantify this type of training if you use a running computer or watch. There are a variety of products available on the market, Suunto, Polar and Garmin certainly make some great products which allow you to assess your speed, distance, time, heart rate and more advanced models even look at stride counter, stride distance…and the list goes on.

At Institute of Sports and Spines, we carry the Garmin Forerunner watches, which are and excellent product and the different models will fairly much meet the needs of even the most discerning runner.

I am a BIG fan of using technology to improve training specificity and effectiveness. I cannot stress this enough.

By using a computer, you can accurately measure your speed and time for 1km, 5km, 10 km etc, you can look at your running pace per kilometre, which then gives you the ability to target improvements in speed and time over a given distance so you can gauge your progress.

 

Simple Drills to try

Obviously it is great to do some time trials of the distance and time you want to improve so you know where you are at, then, set some realistic goals of what you want to achieve and in what time frame. For these drills, lets assume you can run 5km at a 6 minute per kilometre pace. Giving a total time of 30 minutes (perfect for those parkrunners in our midst).

 

Speed intervals.

Try running for 1 minute at 5minutes per kilometre pace, then run for 2 minutes at a recovery pace of 6 minutes per kilometre, continue for the duration of 5 kilometers.

 

Distance intervals.

Trial your next run at 5 minutes 45 seconds for 1 kilometer, then do a recovery kilometre at your usual pace. Repeat this to have completed 5 km with 3 at the fast pace and 2 at recovery. You will have knocked 45 seconds off your 5km time.

 

Strength intervals.

Hills are great for this. Find a hill near home, try and run your normal 5km pace when running up a medium incline. This is not great for leg speed but will increase your strength.

 

Speed pyramids.

Trial this on a 400m track or keep a close eye on your computer. This is punishing, but at the same time, can be very good for getting used to running faster. It will help with cardiovascular conditioning, muscular endurance, leg speed and mental conditioning.

 

Run 400m comfortably.

Sprint 100m then coast for 300m. Stop and Rest 1 minute.

Sprint 200m then coast for 200m, Stop and  Rest 1 minute.

Sprint 300m then coast for  100m, Stop and Rest 1 minute.

Sprint 400m, Stop and Rest 1 minute.

 

Then do the drill in reverse back to the start.

 

Hopefully these ideas and concepts will give you a start point if you are trying to get faster this summer. As always, if you have any concerns or issues, get them checked out before you embark on intense training sessions and if you need any assistance with gait patterns, performance testing or injuries, let us know and the team will be more than happy to help.

 

Happy running!