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STRENGTH TRAINING IN REHABILITATION

Designing Strength based rehabilitation

Picture4When starting to design your strength program from a rehabilitation point of view -post injury, surgery and/or deconditioning for any reason – you have to observe – above all – the safety and the good technique.  What happens when you fatigue, and form goes out the window? Or, on the flip side, what if an exercise has become too easy?  We understand that no one wants to put themselves in harm’s way by doing an exercise incorrectly or waste their time on an exercise program that won’t achieve their goals.  You may be faced with altering the strength training initially!

These adaptations are exactly what our highly trained and experienced instructors/ physios at Pilates Power and Physiotherapy Cronulla are trained to do - straight from their exercise toolbox!!

Regression = an approach to decrease the demand of an exercise or movement.

Progression = an approach to increase the demand of an exercise or movement.

Modifications in:

1.   Intensity / Load

2.   Range

3.   Height

4.   Speed

5.   Body Position

BUT: while you adjust the variable you MUST always maintain the exercise stimulus (overload) that suits your strength level: specific training leads to specific outcomes!! Read the Principles of Strength Training!

Clinical adaptations:

Picture1

  • Pain
  • Joint swelling
  • Range limitations
  • Surgical restrictions
  • Limb immobilisation

 

You may also require changing the mode of muscle activation:

  1.   Isometric work

Isometric training has shown to improve strength in other joint ranges as well as concentric strength (increased 12-15%) but only at long muscle lengths, f e quadriceps isometric near knee flexion 90 degrees is more beneficial that at 60 or 30 degrees of flexion.

Power and speed of contraction understandably did not increase with isometric work.

Noorkõiv M et al. J Sports Sci. 2015;33(18):1952-61. 7

  1.   Eccentric work

Meta-analyses: eccentric training performed at higher intensities vs concentric:

Total strength and eccentric strength increased significantly more! Eccentric work develops higher forces due to a specialised neural pattern and there is increased stimulus to build additional sarcomeres (muscle tissue)

Roig,et al. (2009). Br J Sp Med. 43, 556-558

Compound vs Isolation exercises:

Compound exercises recruit >1 muscle groups, are more functional as they ask for more coordination and can also share the load – result in a higher challenge

Isolation exercises are very focussed and less technical, thereby safer. Here it is generally easier to manipulate the range of motion – are less functional

Common isolation exercises: calf raises, biceps curls, quadriceps knee extension exercise

Common compound exercises: leg press, dead lift, squat and lunge.

PLANNING AND PROGRAMMIMG

Hierarchies of importance & determining rehabilitation focus:

Picture2

 

 

 

 

 

APPLICATION

Example Knee OA - Week 1-3

Picture3

 

 

 

 

 

 

SUMMARY:

WHAT DO YOU WANT TO ACHIEVE? Strength, Power, Control, Endurance?

PLAN & DESIGN: Principles of Training: Specificity, Overload, Progression.

DELIVER: Clinical consideration/limitation, Patient characteristics, time & equipment.

 

CONSULT YOUR PROFESSIONAL TEAM AT PILATES POWER AND PHYSIOTHERAPY

If you have any further questions, please do not hesitate to ask!

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A Pain in the Butt…well Hip!

Hip for Blog

Following on from my blog from last week, here is some more information on a common tendon issue …remember the tendon is the part that attaches the muscle to the bone and is very sensitive to sudden overuse or repetitive lifestyle habits. This one can be a real pain in the butt, literally!

Your buttock or gluteal muscles are actually made up of multiple layers of muscle all with different roles. Some are designed for big powerful movements like stepping up, jumping or squats. However, there are many which play an important stabilising force around this hip and pelvis like the gluteus minimus and medius.

It is these two muscles, and their respective tendons, that can give you a real pain in the butt or, more specifically, the side of the hip. Pain when lying on the side of your hip at night, climbing stairs, or after sitting in a low chair. Depending on the stage of tendon aggravation your symptoms will vary, for some you may just feel sore on the outside of the hip initially on starting exercise or the next day after doing exercise. These are just some of the symptoms.

Habitual patterns of standing, like hanging off one hip, crossing your legs when sitting can also contribute to the problem. Remember, I mentioned how tendons don’t like compression…that’s what happens when you hold the body in the above static positions, the tendons can get stretched across the bone where they attach. This can also then compress the bursa (or cushion) that sits between the tendons and the bone.

This tendon issue can creep in with a sudden fitness regime of long walks if we are not strong enough in some of the deep stabilising muscles around the hip and pelvis and don’t build up slowly. A common mistake is that people try to stretch the gluteal muscles with exercises that pull the leg across the body or stretch the ITB over the outside of the hip, which further aggravates the problem.

Remember the rule of thumb – increase by no more than 10% each week and to start with, consider a day off in between long walks, especially, if they involve a lot of stairs or hill climbing. Also, a strengthening program that focuses on the core and deeper gluteal muscles will prepare you well and hopefully prevent a pain in the butt later when increasing or starting a walking or running.

Nikki Scott, Physiotherapist

*****************

Tendon Injuries, Running and Starting a new Exercise Program during Lockdown

While lockdown has meant more of us can work from home, some of us have also found we have more time or more motivation to exercise. 

Remember, it is important to build up slowly. Some parts of our body need longer to adjust to a new exercise regime or changes in routine.

Tendons are the pTendon Injuryart of our body that connect our muscles to our bones and can be sensitive to sudden changes in load or demand.

For example, the Achilles tendon is located at the back of the heel. If someone suddenly decides they are going to run every day during lockdown with no build up, this may lead to what we call Achilles tendinopathy.

This is where the tendon becomes aggravated due to overload. There are other causes as well of course, such as poor running shoes or running style but, in many cases, it develops due to a sudden change in training load without enough recovery time. Tendons are also very sensitive to compression load but I will go more into that in the next blog!

To ensure you build in enough recovery time, try to add variety into your routine and try to give yourself a day off in between the same exercise. That rest day could be an opportunity to do some pilates or yoga or a different activity such as swimming or cycling.

In general, progress slowly, increasing you weight session or running sessions by no more than 10% each week.

If you’ve never run before, there are some good apps that will build you up slowly and split your running into walking and running intervals until you are running continuously. For example, ‘5K’ Couch to 5K – Run Training.

Running is great, as you require no equipment (other than a good pair of running shoes) and you can literally open the door and go. However, if you have suddenly decided to give running a go, make sure you build up slowly and have a day off in between running sessions.

If this is you already, there are some specific exercises you can learn to assist. The first step is to get it properly diagnosed. Next, learn what exercises and lifestyle changes you can make to decrease your pain and to build healthy tendons.

I’ll be writing some more blogs about common tendon injuries over the next few weeks, such as those affecting the shoulder hip and foot…stay tuned….

Nikki Scott, Physiotherapist

 

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Posted by on May 30, 2022 in News | 0 comments

Have you been putting off getting any new or recurring injuries assessed? Have you lost your fitness during Covid?     We know the last 2 years have been tough on everyone and routines have been turned upside down. NOW is the time to reclaim your health and fitness goals.  To welcome you to PPP Cronulla we would like to offer you our Autumn Special for the price of $249.00 – normally $300, comprising: Physiotherapy Initial Consultation 2 x 30 min Clinical Rehabilitation Private Sessions So, what are you waiting for? Get in touch...

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Posted by on March 17, 2022 in News | 0 comments

STRENGTH TRAINING IN REHABILITATION Designing Strength based rehabilitation When starting to design your strength program from a rehabilitation point of view -post injury, surgery and/or deconditioning for any reason – you have to observe – above all – the safety and the good technique.  What happens when you fatigue, and form goes out the window? Or, on the flip side, what if an exercise has become too easy?  We understand that no one wants to put themselves in harm’s way by doing an exercise incorrectly or waste...

read more

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Posted by on October 11, 2021 in News | 0 comments

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Posted by on July 19, 2021 in Uncategorized | 0 comments

A Pain in the Butt…well Hip! Following on from my blog from last week, here is some more information on a common tendon issue …remember the tendon is the part that attaches the muscle to the bone and is very sensitive to sudden overuse or repetitive lifestyle habits. This one can be a real pain in the butt, literally! Your buttock or gluteal muscles are actually made up of multiple layers of muscle all with different roles. Some are designed for big powerful movements like stepping up, jumping or squats. However, there are many which play an...

read more

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Posted by on June 25, 2021 in Uncategorized | 0 comments

Masks now mandatory in all indoor settings! Due to the growing COVID-19 cluster in Greater Sydney, masks will be made compulsory from 4pm Wednesday the 23rd of June, in all indoor settings which includes exercise studios. Please bring mask/towel/water to your session. All staff will be wearing masks to ensure your safety and we encourage you to continue your sessions unless advised otherwise.  Fitness is health!...

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Posted by on May 31, 2021 in Uncategorized | 0 comments

Please join us in welcoming Carlo Morato as one of our massage therapists. Carla is a physiotherapist trained in Argentina. She moved to Australia 2 years ago chasing her dream of helping people have a healthy way of life and is passionate about movement and sports. Back in Argentina Carla was trained in sports rehabilitation, lymphatic drainage and neurological rehabilitation. Since moving to Australia Carla has been developing her hands-on skills working as a remedial massage therapist of high performance athletes. In 2019 she was the...

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Posted by on May 27, 2020 in Uncategorized | 0 comments

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Posted by on March 26, 2020 in News | 0 comments

The APA has received the following advice from the Federal Minister for Health, The Hon Greg Hunt: The Australian Minister for Health confirmed on Tuesday March 24th, 2020 that ALL allied health practices can continue operating and are encouraged to do so.  Barbara, Karina, & Nikki will continue to be offering Physiotherapy treatment and Physiotherapy Rehabilitation sessions as normal – Private & Group (maximum 2 with social distancing measures in place) sessions of either 30 minutes or 1 hour as prescribed by your...

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