Articles in Category: Training and Performance

Preventing Injuries

Written by Don Williams BSc, MChiro, ICSSD. on Monday, 04 April 2016. Posted in Training and Performance

Preventing Injuries

By Don Williams

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


Injuries among the general population are relatively common. In consideration of back pain alone, around 80% of society will suffer back pain at some point in their lives. If we look at the entire body, I would wager that no-one goes through their life without an injury of some sort.


Certainly athletes, from an injury perspective, are no different. It would be difficult to find an elite athlete that hasn’t had an injury at some point in their career. At any given athletic meet, it would be reasonable to assume that a large proportion of the competing athletes would be carrying an injury of some sort.


So, why does this happen?


Really, injuries are multifactorial.

In a perfect world, all athletes (and the greater population at large) would:

  • have a perfect diet;
  • have a great sleeping routine;
  • manage their stress exceedingly well;
  • limit (or hopefully completely eliminate) smoking, drinking and recreational drugs;
  • have great genetics;
  • ensure training load is optimised to ensure they are preparing for their target meets/events;
  • ensure motor patterns are perfect, and their technique is unquestionably perfect;
  • get regular massage/soft tissue work;
  • visit their chiropractor or physiotherapist regularly;
  • be completely on top of any other health issues/concerns with their GP to ensure they are performing perfectly all year round


Hands up everyone who can tick all those boxes!


At first glance there is an overwhelming list of things to consider; however, it need not be that intimidating or daunting.


Athletes need support and direction to have a successful career. Great athletes ensure they seek out, and take on board the best advice and resources to give them the support they need. Certainly, as a start point for young athletes, having great mentors who have been there and done that is a great place to start. Build your support network of professionals who can help you manage the elements which come together to give you a platform on which to base your performance and achievements.


Simple starting points are to develop routines which ensure you:

  • have adequate sleep and rest
  • utilise your support network to ensure that you have good advice in regards to your diet and training load (preferably from qualified dieticians/nutritionists and from technique and strength and conditioning coaches)
  • have regular massage/soft tissue work, from a “gun” masseur who has experience/expertise in working with athletes
  • keep your equipment/shoes/clothing in top condition


So now you have covered the basics but what about overuse injuries and trauma?


Analysis of great athletes who have had great sporting careers generally reveals natural ability and skill and low, or well managed injury levels.

I like to use the example of Roger Federer. He is such a fantastic athlete to watch. His technique is awesome; however, what is most fascinating to watch is his optimised movement mechanics. Whenever Roger hits a ball, he looks effortless and in control. If you start to analyse this from a technical perspective, we would call this optimised movement mechanics or optimal joint centration. His limbs and joints are in the optimal position when he strikes the ball and moves around the court.

Juxtapose this with early footage of Rafael Nadal. Certainly not taking anything away from Rafael, he is an incredible player; however, earlier in his career he was plagued with injuries and when you watch his body positioning and joint mechanics, they could be considered sub optimal.

If you contrast footage from early in his career and later in his career you will see differences. In the later footage, he looks more fluid while simultaneously his injury levels dropped. His movement mechanics has been addressed and improved.


This is one area that we see as a gold mine for athletes to address. Most athletes look for the big accident/crash/fall that caused their injury, and while this is often the case, most injuries occur as a result of more repetitive micro-trauma.  Suboptimal patterns, which when repeated over and over, slowly traumatise the tissues (muscles, ligaments, tendons or bone) until something finally gives.

The big traumas are often hard to predict and usually more difficult to manage from an injury prevention perspective.


At Institute of Sports and Spines, we love communication from coaches in regards to issues, injuries and problems that are arising with their athletes. We can then assess the movement patterns the athlete is using, identify less than optimal biomechanics and then work with the athlete and coach to address these issues and develop a plan to get the athlete functioning optimally, which gives them the best possible chance of performing at their best.


It is critical to understand that while technique varies considerably from sport to sport. Optimal movement mechanics do not. Any sport or movement pattern can be broken down to the component parts, hence identifying the requirements of the body to produce that movement pattern in an optimised pattern.


Injuries still can and do happen, and when they do, reassessing and re-optimising the patterns in the rehabilitation program are equally important.


From my perspective, optimising movement mechanics and technique early in an athlete’s career should be paramount. This increases the potential for a long and successful career while minimising the likelihood of injuries.

Red Flags

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

Red Flags

Red Flags

By Don Williams

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


Health care practice is an interesting and ever changing profession. One of the challenges that keep us on our toes is the assessment and management of different injuries and ailments.


The first goal in assessment is (or certainly should be) to identify what the complaint is, whether it is a serious or potentially serious condition that requires urgent intervention.


Recently, we have had a number of quite serious cases which have left us a little baffled as to the management they had unfortunately NOT received.


So this month I thought I would write an article on important symptoms to watch out for so you are not feeling sore and sorry.


Red Flags; this is believe it or not, a technical term for signs and symptoms which may indicate serious underlying pathology. These flags are many and varied and their presence is merely a potential indicator of pathology. This means that just because you have a “Red Flag” doesn’t mean you have a problem.


In compiling this list, it is by no means exhaustive and is a reflection of some of the things that we see showing up in our clinic.


So regionally, what are the things you should watch out for and what can they mean?


Back Pain

If you have back pain with referral down the leg, total numbness or loss of muscle strength it may be important. Loss of bowel and bladder control is certainly something we would want to know about.


Chest Pain

Most people know that chest pain can be an indicator of a heart attack. Most people realise that this is more commonly on the left side, however, pain in the lower front of the neck, the left arm, the left upper back and the right side of the chest can also be indicators. This would be reinforced by an increase in pain with exercise and or shortness of breath.


Night pain

Pain that wakes you from sleep is a concern, additionally; if this pain is accompanied by night sweats we would be a little more concerned. Sudden loss or gain in weight for no apparent reason is also a concern.



“The worst headache I have ever had” is not a great thing to hear. If this is in conjunction with vomiting and dizziness it is more of a concern. The feeling that the head is going to explode is more of a concern. Disturbances in any of your higher senses (vision, taste, hearing or smell) can also be a concern



Unremitting pain of 6 months or more of duration may be serious. If this is high intensity pain, then it is more of a concern. If the problem is not responding to conservative treatment then it is more concerning again.


If you have had a problem which won’t go away or you have some interesting symptoms that you are just not sure about, then get them checked out. Sometimes they may mean nothing, sometimes they may be important. My thought, always, if in doubt check it out.

The Knee

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

The Knee

By Don Williams

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

Cert. DNS.   Memb: CAA, FICS, CEA.


This month I thought I would write a brief article about the knee.


The Knee is such a fascinating joint and unfortunately, is a regularly injured joint, necessitating visits to our clinic for many people.  We regularly receive referrals to assess knee injuries to identify what is actually wrong and how to manage the problem. This often necessitates us referring out for MRI scans and in some cases on referral to some of the excellent orthopaedic surgeons that we deal with.


The Knee 1  


Types of Knee Injuries:

Knee injuries and pain associated with those injuries generally fall into 3 categories.


Firstly, degenerative problems:

This can be osteoarthritic change or general wear and tear due to age or overuse of the knee.

Often age correlated or a result of lots of aggressive sport in the younger years.


Secondarily, biomechanical overload injuries:

These are often the result of;  genetic mechanical issues such as pronation of the feet and ankles, “Knock knee”, “bow legged” posture of the knees,  inappropriate footwear, poor technique in running, walking and other fitness activities, poor setup on bike position or sporting equipment or weaknesses and imbalances of the supporting musculature.


Thirdly, the pathological or traumatic injuries:

These are things like anterior cruciate ruptures (ACL), Meniscal tears (often referred to as the cartilage), fractures, and collateral ligament tears and issues. Bursitis and tendonitis issues are sometimes grouped into this category but are often more accurately grouped into the second category.


But what makes the knee so susceptible to injury:

Several factors really. The knee can be thought of as a force transducer. When we are walking, running, turning and jumping, our knee is subjected to high forces or loads in a multitude of directions.


The mechanics of the knee are complex and this article will be far from exhaustive in the description of the knee. But in basic terms the knee is a rolling/gliding hinge joint. Thinking simply, the knee is not a simple hinge (like a door), as the knee straightens, the femur glides across the tibia as it rolls towards the straightened position. This is why the end of the femur has a lengthened cam-like shape, in contrast to the relatively flat shape of the top of tibia. This means that the contact point and force vectors through the joint constantly change as the knee bends and straightens, combine this with the fact that the knee also pivots slightly right at the end of the straightening process make the knee a regularly injured joint.


Many health practitioners are taught at university that for the knee to have a pathological or major injury, there must be a large impact or nasty injury mechanism occurs to cause the damage. However, this is very clearly not the case with many of the patients we see at Institute of Sports and Spines.


In fact, the 2 worst knee injuries I have seen this year came from very low force activities; one from standing up after sitting on the ground and one from walking along the ground at work and turning to speak to someone. In fact, my own knee injury was not the result of a twist, fall or accident, but purely jogging along a flat footpath, the articular cartilage got caught and tore and it has been a problem ever since.


Scans and Imaging for the knee:

Depending on the injury or suspected injury, a range of scanning options are used.

Xrays and pretty good for looking at fractures of and around the knee, gross degenerative change and biomechanical position, they are not good at assessing soft tissue and ligament issues.

Ultrasounds are used to look at tendonitis and bursitis issues and muscle tears around the knee.

MRI scans are generally the image of choice for the knee and are the only means to effectively view meniscal tears, cruciate ligament injuries, collateral ligament injuries and articular cartilage defects.

I have included a couple of images below for interest.


Image 1                                                                                             Image 2

The Knee  2  The Knee 3 

The Knee 4


Image 1 above, the green oval shows reasonable articular cartilage with some thinning. The red circle shows a tear or defect in the cartilage (the white area), the end of the bone has a light area which is bone swelling.


Image 2 The blue circle shows good articular cartilage and a healthy meniscus in the correct position (black triangle on the right side).

The red circle shows the lateral meniscus in the wrong place (this is bad ;)) and the green arrow shows us where it should be.


 Image 3 to the left shows a vertical tear in the meniscus and a little bit of swelling to the left of the arrow.


Management of Knee Pain:

When you have knee pain, correct assessment and diagnosis of the problem is critical. We have unfortunately seen many patients who have had a lot of treatment for the wrong diagnosis, resulting in poor outcomes.  A comprehensive physical and orthopaedic examination should give a working diagnosis which may then indicate treatment direction or relevant investigations to confirm the suspected diagnosis.


At IOSAS, we generally start our assessment with gait analysis, looking at joggers, work shoes etc, analysis of movement patterns and muscle strength to look for weakness and imbalances, followed by an orthopaedic joint assessment. This then directs how we will manage the presentation to move you towards the outcome you desire.


Most biomechanical issues of the knee and overload syndromes can be managed conservatively and don’t progress to surgery.  Advanced degenerative change of the knee will often require joint replacements and ruptures of ligaments and meniscal tears which catch or lock will usually require surgery with a degree of urgency.


Treatment options:

For many overload / degenerative and biomechanical issues, addressing mechanical issues and contributing factors can be a big part of the solution. Acupuncture, Massage and Chiropractic and other physical therapy interventions can be useful to address the current pain presentation. Progression towards rehabilitation and retraining may be indicated to prevent recurrence.


Due to the nature of the cases that we see, some patients require surgical intervention to help resolve their issues. It is vital in the post-operative phase to focus on rehabilitation and strengthening to make sure there is relatively good balance or symmetry in the strength and control of the knees to hopefully prevent future recurrences.


Generally, effective assessment and management of knees gives a greater probability of a good outcome.


If you have a new or ongoing issue with your knee, come in and see us, we might be able to help you get a better outcome.