SYMPTOMS

Symptoms will vary with each individual and may include:

• Uneven height of shoulders.
• Waist crease are uneven.
• Scapular winging on one side (shoulder blade more prominent than the other).
• One hip higher than the other.
• Uneven musculature.
• Head not centred directly above pelvis.
• Rib prominence when bent over.
• Obvious exaggerated curvature of the spine.
• Back pain or discomfort.

ADOLESCENT VS ADULT

• Adolescent:
  • Highly progressive.
  • Often flexible.
  • Pain not main issue.
  • Correction primary goal.
• Adult:
  • Slowly progressing.
  • Pain is the main issue.
  • Usually rigid.
  • Limited amount of correction.

​
TREATMENT/MANAGEMENT

• Observation:
  • The greater the cobb angle, the greater risk of progression during pubertal growth:
    • 5° curve = 10% risk of progression.
    • 10° = 20% risk of progression.
    • 20° = 30% risk of progression.
    • 30° = 100% risk of progression.

​

• The main goals of treatment:
  • Prevent curve progression at puberty.
  • Prevent/treat respiratory dysfunction.
  • Prevent/treat spinal pain.
  • Improve aesthetics.

​

• Physio-therapeutic scoliosis specific exercise (PSSE)

​

• Bracing:
  • Soft-bracing
  • Night-time rigid bracing
  • Part-time rigid bracing (12-20 hours per day)
  • Full-time rigid bracing (20-24 hours per day)

​

• Casting?

​

• Conservative care such as physical therapy and chiropractic.

​

• Surgery
  
  
  

If you would like further information about scoliosis or any other back issue, we recommend consulting your local health practitioner. If you’re local to health associates we would be more than happy to help you. 


REFERENCES

Negrini, S., et al. "SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis Spinal Disord 13: 3." (2016).

Schwab, Frank, et al. "Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population." Spine 30.9 (2005): 1082-1085.

Weinstein, Stuart L., et al. "Adolescent idiopathic scoliosis." The Lancet 371.9623 (2008): 1527-1537.

Konieczny, Markus Rafael, Hüsseyin Senyurt, and Rüdiger Krauspe. "Epidemiology of adolescent idiopathic scoliosis." Journal of children's orthopaedics 7.1 (2012): 3-9.

Noshchenko, Andriy, et al. "Predictors of spine deformity progression in adolescent idiopathic scoliosis: A systematic review with meta-analysis." World journal of orthopedics 6.7 (2015): 537.

Soucacos, Panayotis N., et al. "Risk factors for idiopathic scoliosis: review of a 6-year prospective study." Orthopedics23.8 (2000): 833-838.

If you’ve experienced heel pain, you will know how inconvenient it was and how important your feet suddenly became!

Feet functioning properly is surprisingly important when they begin to let us down! It's so easy to neglect your feet and take them for granted. Heel pain not only occurs in adults, but children commonly experience sore heels too. You’re going to hear about it from your kids, considering they’re using them all the time so it's so important to try and react to these signs and symptoms early if you can as it could possibly be more than just a blister or a splinter, these heel pains unfortunately, are the cries of some underlying issue demanding attention.

Heel pain can be due to one or multiple different issues. It can involve any structure in the feet including:

• Bone
• Nerve
• Bursa
• Adipose tissue
• Tendon
• Ligament
• Joints
• Muscles
• Skin

 
Heel pain can occur in any area of the heel and can also radiate or refer pain to other areas.

Signs can include things such as

• Erythema (red appearance)
• Swelling
• Heat
• Discoloration or spots
• Lumps or pitting
• Flaking skin
• The child not putting the heel down or lifting it early
• Limping
• Toe walking
• Pain on palpation

Symptoms can include things such as

• Pain worse after rest
• Pain worse after activity
• Pain whilst stretching
• Pain while doing activity
• Deep set pain
• Numbness
• Stinging
• Pain changing locations
• Occurring in conjunction with a low immune e.g. general cold
• Itching
• Burning
• Malodor

Once we react and take action to signs and symptoms, it also allows us to become proactive in the face of possible re-occurrence or in any other issue/s that have have been bought to our attention.
​
The most common pathologies causing heel pain include (not in order)

• Calcaneal apophysitis (otherwise known as Sever’s or growing pains)
• Bursitis (the posterior foot has many different bursae that can become irritated)
• Tendonitis (different tendons may be under strain. Depending on the location this could be the Achilles, Posterior Tibialis or Peroneal’s)
• Fat pad contusion (bruising of the adipose tissue under the foot.
• Plantar fasciitis
• Warts (Human Papilloma Virus)
• Tinea Pedis
• Haglund’s Deformity

Less common pathologies can include

• Pitted keratolysis (bacterial skin infection)
• Calcaneal stress fracture
• Tarsal coalition (fusion of bones)
• Tumors
• Cysts
• Juvenile Idiopathic Arthritis

It is important to visit a podiatrist for proper assessment, diagnosis and management or referral. Even if it seems straight forward and self-explanatory about what may be going on with your child’s heel pain it is important to seek professional advice as your home treatment plan is likely to not be as effective. Also, understanding why this issue has popped up is just as important as treatment!
 
Addressing signs and symptoms of heel pain, then consequently the underlying issue may also shine light on other issue/s that have gone unnoticed e.g. tight muscles; limited range of motion in joints, limb length difference etc. Addressing these can lead to a healthier, more comfortable and active life. It may help with sport performance and or just feeling more confident to get out and play!

Written by Anneliese Ball, Podiatrist
Health Associates
Working Monday and every 2nd Saturday
 
 
References

1. DAVISON, M. J. et al. Careful assessment the key to diagnosing adolescent heel pain. Practitioner, [s. l.], v. 260, n. 1793, p. 30, 2016. Disponível em: <http://search.ebscohost.com.ezproxy.newcastle.edu.au/login.aspx?direct=true&db=ccm&AN=115842957&site=eds-live>. Acesso em: 21 jul. 2019.
2. http://www.asgfootcare.co.uk/wp-content/uploads/2012/04/childrens-feet700.jpg  

A rotator cuff injury is when there is a strain, tear or damage to the one or more of the rotator cuff muscles. It is one of the most common injured areas of the shoulder. The injury usually involves damage to the rotator cuff tendons (The part of the muscle that connect the muscles to bones). By the age of 50 approximately 10% of people will have a rotator cuff tear. A study by Yamamoto showed 20.7% of 1366 shoulders had full-thickness rotator cuff tears in the general population of a mountain village in japan.

WHAT IS THE ROTATOR CUFF?
​
The rotator cuff is a group of muscles that stabilise the shoulder joint, it does this by attaching the scapular (shoulder blade) to the humerus (upper arm bone). The rotator cuff also provides and helps guide movements of the shoulder.

​The rotator cuff is made up of 4 muscles (look at diagram for where they are):

• Supraspinatus. The supraspinatus tendon is the most common site of injury.
• ​Infraspinatus
• Subscapularis
• ​Teres minor

​
Movements that the rotator cuff perform:

• Internal rotation (rotate upper arm towards the body).
• External rotation (rotate the upper arm away from the body).
• Abduction (move the arm away from the body).

​❌❌❌ Do NOT stand with all your weight posted onto one leg. ❌❌❌

Before performing any movement whether that would be a golf swing, throwing a punch in boxing, a 150kg back squat or even something as simple as going for a run/walk, we must make sure you know how align yourself in the best way possible to be able to get the most out of the movement, starting with the pelvis and importance of glute activation. When the pelvis is in neutral for you, you are able to properly activate the glutes.

UNDERSTANDING THE PELVIS:
​

• Learning about how to properly position the pelvis can have a dramatic effect on your postural health. It also helps with muscle imbalances and decreasing the risk of injury.

​

• ​​A neutral pelvis has a slightly anterior tilt, there should be a slight activation of glutes and lower abs. Only small percentage of the population have a neutral pelvis, 9% of males and 18% of females. 

​

• Anterior pelvic tilt and when the pelvis rolls forward and down excessively. A study showed 85% of males and 75% of females have an anterior pelvic tilt. The reason why these percentages are so high is because when we sit the pelvis is place in this position, a large number of people sit for long periods at work and live sedentary lifestyles. Complications of anterior pelvic tilt include weak muscles such as hamstrings, glutes, lower abdominals and hip flexors. This pelvis position makes it difficult to activate and strengthen the glutes. 

​

• Posterior pelvic tilt is when the pelvis rolls back and up. Roughly 6-7% of males and females present with this pelvic position. This position creates higher chance for more painful low back pain compared to anterior pelvic tilt. Complications of posterior pelvic tilt include tight abdominals and hamstrings and weak lower back muscles and hip flexors.

​​

• Before beginning a rehab or resistance training program, you must be able to understand pelvis positioning. You should be able to perform basic functional movements while holding a neutral pelvis such as squat, hip hinge, lunge, glute bridge and plank.

HOW TO FIND YOUR PELVIC NEUTRAL POSITION FOR MAXIMUM GLUTE ACTIVATION:
​

• Everyone’s pelvic neutral is going to be slightly different.

​

• ​​​Squeeze your glutes as hard as you can see if there was a shift, if so, you were not in a neutral position. 

​​

• Begin standing nice and tall with hands on hips. Relax the glutes and core and allow the pelvis to rock forward into an anterior pelvic tilt without bending the knees. Now engage the glutes and lower abdominals to roll the pelvis back and up without bending forward. Perform this another 4-6 times and find what feels like midway between those two movements, that is your pelvic neutral.

WHAT ARE THE ‘GLUTES’?

• Gluteal muscles refer to the muscles in your buttock.

​

• The glutes are made up of three major muscles;
  • gluteus maximus (The main muscle of the buttock)
  • gluteus medius (Upper part of the glutes)
  • gluteus minimus (Smaller and deeper muscle)

​

• Function of the glutes is to extend, abduct, externally rotate, internally rotate the hip joint.​  

CAUSES OF WEAK GLUTES?

• For many individuals, their glutes are underactive or not functioning to their optimum. 

​

• There are many reasons why this may be the case, one of the main causes is many of us are living increasingly sedentary lifestyles. 

​

• Many jobs involve long periods of sitting or after a long day of work we go home and sit on the couch, this means the glutes are not being activated.

​

• Most people compensate with other muscles around the hip and lower back which can cause discomfort in these areas.

​

• In many cases regardless of regular exercise you may have weak glutes which means they need to be activated by performing isolated glute exercises.

WHY IS GLUTE ACTIVATION AND STRENGTH SO IMPORTANT?

• Learning to activate your glutes helps you to strengthen and build them.

• Glutes can have an impact on overall body strength.
• Support your core and improve stability of pelvis and spine.
• They help perform a range of exercises and compound movements.
• Under active glutes can contribute to a variety of health issues including:
  • Poor posture.
  • Low back pain.
  • Balance problems.
  • Decreased flexibility.
  • Muscle pain.
  • Increase the chance of injury.
    

​
​GLUTE ACTIVATION EXERCISES:

• Bird-dog/Quadruped
• Clamshells
• Glute bridge
• Donkey kick
• Crab walks

GLUTE STRENGTH EXERCISES:

• Hip thrust
• Squats
• Lunges
• Leg press machine
• Step-ups
• Single leg squats

There is not one exercise that will build your glutes. You will need to perform a variety of glute exercises that target different parts of the glutes. You must include this new awareness of glute activation and pelvic position. Activation of glutes and core will ensure an increase in strength and decrease risk of injury when performing strengthening exercises.

Written by Joshua Hallinan,
Chiropractor
Health Associates
Working Tuesday and Thursday

​References

Mitchell B, Colson E, Chandramohan T Lumbopelvic mechanics British Journal of Sports Medicine 2003;37:279-280.

Which Exercises Target the Gluteal Muscles While Minimizing Activation of the Tensor Fascia Lata? Electromyographic Assessment Using Fine-Wire Electrodes
David M. Selkowitz, George J. Beneck, and Christopher M. Powers
Journal of Orthopaedic & Sports Physical Therapy 2013 43:2, 54-64 

Reiman, Michael P., Lori A. Bolgla, and Janice K. Loudon. "A literature review of studies evaluating gluteus maximus and gluteus medius activation during rehabilitation exercises." Physiotherapy theory and practice 28.4 (2012): 257-268.

Cambridge, Edward DJ, et al. "Progressive hip rehabilitation: the effects of resistance band placement on gluteal activation during two common exercises." Clinical Biomechanics 27.7 (2012): 719-724.

Boren, Kristen, et al. "Electromyographic analysis of gluteus medius and gluteus maximus during rehabilitation exercises." International journal of sports physical therapy 6.3 (2011): 206.

Herrington, Lee. "Assessment of the degree of pelvic tilt within a normal asymptomatic population." Manual therapy 16.6 (2011): 646-648.

Image 2 - http://www.ultimaterob.com/2013/05/30/glute-strength-and-activation/
Image 3 - https://moveu.com/blog/build-glute-strength/

Lately in clinic, I have been hearing a lot of concerns regarding painful nails, sometimes accompanied by red, hot and swollen surrounding skin, OUCH! The type of nails that just don’t seem to know where to grow and patients are completely bewildered as to what they have done to deserve this?!

These types of nails are often referred to as involuted or if you’re experiencing the worst type, INGROWN.
Ingrown vs involuted is quite simple. Involuted refers to a nail shape that as it grows, changes shape encroaching on the surrounding skin causing pain. Involuted nails can have varying degrees of pain and curvature in the plates shape. 
​
An ingrown nail is one that has surpassed this and is now cutting into the skin, commonly causing infection or the skin to hypertrophy (increase in size) and envelop the nail plate. These are incredibly painful and can stop you from doing what enjoy such as playing sport or performing the worm on the dance floor, pain free.
​

​What causes this stubborn issue?!
​
Usually there are multiple factors contributing to your nails misbehaving in this way. Until you discuss what you and your feet have been up to with your Podiatrist, it may be hard to put your finger (or toe) on it.

It is all good and well addressing symptoms of pain much like any other problem in the body, however, until you 'nail' the cause, this can stick with you for many new shoes, netball games, trail runs or whatever it's stopping  you from doing.

The main causes include (some more common than others)

• Genetic predisposition
• Trauma to the nail
• Posture of the foot
• Biomechanics of the foot in movement
• Foot deformity e.g. bunions and clawed toes
• Poor cutting technique or picking nails
• Poor fitting shoes and or hosiery
• Sweating
• Brittle/weak nails (this can be due to things like diet or arterial insufficiency)
• Fungal infection
• Medications e.g. beta blockers; Isotretinoin

Depending on whether this is your first one or you’ve had this recurring problem for years, the main message I want you to take away from this blog, is there is hope and your toe/s will be looking and feeling great again before you know it!

Image 1 - http://dubaipodiatry.com/ingrown-toenail-dubai-podiatry-centre/
Image 2 - https://www.palmettostatepodiatry.com/ways-to-prevent-smelly-feet/
Image 3 - http://www.yourpodiatrist.com.au/condition/ingrown-toenails/ 
​​
Written by Anneliese Ball
Podiatrist at Health Associates
Working Monday and fortnightly Saturday

​RISK
Hamstring injuries usually occur due to an imbalance between itself and the quadriceps muscle. The quadriceps are large and powerful group of muscle that extend (straighten) the leg at the knee joint. When there is a powerful contraction of the quadriceps muscle it may over stretch the hamstring and place a large load on the muscle.

• Previous hamstring injury.
• Increasing age of player.
• Sudden change in movement (acceleration or deceleration).
• Poor flexibility.
• Weakness in the muscle.
• Muscle fatigue.
• Muscle imbalances, hamstring to quad ratio.
• Poor or no warm up.
• Body mechanics.
• Psychological factor.
• Poor technique during activity.

PREVENTION

• Proper warm up before exercise including sport specific function movements as well as sport specific skill drills.
• Include speed work within training program to allow the hamstring to sustain high acceleration forces.
• Have a high level of endurance to prevent muscular fatigue.
• Include stretching, functional and strength training within the program.
• Having adequate pre-season preparation prior to competition to ensure readiness to play.
• Gradual increase in training duration and intensity.
• Wearing the right and comfortable protective gear and footwear.
• Adequate recovery times between session to allow the body recover and prevent burning out/over-training.
• Avoid activities that cause pain.

ACUTE MANAGEMENT

• RICER protocol for the first 48-72 hours; rest, ice, compression, elevation and referral. The leg should be elevated when applying ice. The ice should be used for 20 minutes every 2 hours. This protocol will reduce the swelling and bruising of the muscle.
• Another protocol for acute hamstring injuries is the No HARM protocol. This is no heat, no alcohol, no running or activity and no massage. This will also help to decrease bleeding and swelling in the tissue.

REHABILITATION

• Rehab will vary based on the severity of the injury.
• restore flexibility of the muscle.
• Re-activation of muscle fibres.
• Progressive eccentric loading on the muscle.
• Restore endurance.
• Strengthen the hamstring back to usual strength.
• Strengthen other muscles of lower limb and trunk.

RETURN TO PLAY (depending on how well managed the injury is)

• Grade 1 = 1-3 weeks.
• Grade 2 = 4-8 weeks.
• Grade 3 (may require surgery) = approximately 3 months.

Early return to play and/or poor rehabilitation of the injured muscles will increase the chance of re-injury. Full range of motion and strength is required along with the muscles ability to endure full speed training. The player must be able to perform sports related activities such as jumping, sudden change of direction and twisting.

Joshua Hallinan
Chiropractor
Working Tuesday and Thursday at Health Associates

​
References
Prior, M., Guerin, M., & Grimmer, K. (2009). An Evidence-Based Approach to Hamstring Strain Injury: A Systematic Review of the Literature. Sports Health, 1(2), 154–164. 

Hamstring Strain Injuries: Recommendations for Diagnosis, Rehabilitation, and Injury Prevention Bryan C. Heiderscheit, Marc A. Sherry, Amy Silder, Elizabeth S. Chumanov, and Darryl G. Thelen Journal of Orthopaedic & Sports Physical Therapy 2010 40:2, 67-81 

Hamstring strain injuries Opar, D.A., Williams, M.D. & Shield, A.J. Sports Med (2012) 42: 209.

Verrall GM, Slavotinek JP, Barnes PG, et al Clinical risk factors for hamstring muscle strain injury: a prospective study with correlation of injury by magnetic resonance imaging British Journal of Sports Medicine 2001;35:435-439.

Sherry, Marc A., Tyler S. Johnston, and Bryan C. Heiderscheit. "Rehabilitation of acute hamstring strain injuries." Clinics in sports medicine 34.2 (2015): 263-284.

An ankle sprain occurs when the ligaments of the ankle are undergone a force that stretches them beyond their capabilities and tear. Ligaments of the ankle are tough bands of tissue that provide support to hold the ankle bones together and prevent excessive movement. The lateral (outer) part of the ankle is made up of three ligaments the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL) and posterior talofibular ligament (PTFL). The deltoid ligament supports the entire medial (inner) aspect of the ankle. There is an interosseous ligament, which is tissues that runs between the entire length of the tibia and fibula. Most ankle sprains occur on the lateral aspect of the ankle, affecting the ATFL ligament. Anyone can experience an ankle sprain at any age.
 
There are three different types of ankle sprains:

1. Inversion ankle sprain
   - Usually involves inversion + plantar flexion + rotation
   - Damages the lateral ligaments of the ankle
   - Peroneal muscle and tendon strains (lateral muscles of the leg)
   - Peroneal nerve injury may also occur in serious cases
2. Eversion ankle sprain
   - Rare
   - Most events are severe
   - Damages medial ligaments of the ankle
3. Diastasis/syndesmosis
   - Damage to the distal talofibular ligaments
   - There can be ankle instability
   - Often associated with a fracture

 
There are 3 grades to a sprain:

1. Grade one
   - No bruising, mild swelling and tenderness
   - Mild to no limp, can raise up on toes
   - No joint laxity, pain at end range of motion
   - 1-2 weeks recovery
2. Grade 2
   - Bruising on one side of foot, more extensive swelling
   - Less localised tenderness, i.e. both sides of ankle
   - Visible limp and unable to raise up on toes
   - Slight laxity and pain with most movements
   - 4-8 weeks recovery
3. Grade 3
   - Bruising and swelling both sides of foot.
   - Tenderness on both sides
   - Unable to weight bear
   - Large amount of laxity
   - 2-6-month recovery

Phase 1 - Acute management of ankle sprain (within 24-72 hours of injury):

• RICE protocol – rest, ice (20 min on, 1 hour off), compression, elevation
• Move ankle through pain free active range of motion as soon as possible
• Watch for significant swelling or changes to ankle which means major damage has occurred
• Weight bear when tolerable, use crutches if it is too painful to load the ankle

 
Phase 2 - Post-acute phase management (Recovery time will vary depending on severity):

• Provide support around the ankle when needed.
• Continue to move the ankle through pain free range of motion
• Strengthen muscles that invert (turn foot inwards) and everters (turn the foot outwards), this depends on the type of sprain. This can be achieved with a resistance band.
• Single leg stance with eye close to improve proprioception (perception/awareness of the position and movement of the body). This can be made more difficult with an unstable surface such as a foam matt or folded pillow.
• Ankle manipulations (done by an allied health practitioner) to promote movement and healing within the joint of the ankle.
• Use massage ball to release tight muscles that have compensated because of the injury.
• Increase weight bearing; use pain and swelling as a to guide the intensity
• Heel/calf raises to increase strength and stability of the ankle

  
Phase 3 – Return to play when all of the above is achieve:

• Begin running with focus on agility and side stepping.
• Jump rope/hopping with increase the intensity of bearing weight onto the ankle.
• Return to sports specific drills.
• Return to play if there is no discomfort during the sports specific training.

​
Josh Hallinan
Chiropractor
Available for Appointment Tuesday & Thursday at Health Associates

Vuurberg G, Hoorntje A, Wink LM, et al Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline British Journal of Sports Medicine 2018;52:956.
 
Kerkhoffs GM, van den Bekerom M, Elders LAM, et al Diagnosis, treatment and prevention of ankle sprains: an evidence-based clinical guideline British Journal of Sports Medicine 2012;46:854-860.
 
Walls RJ, Ross KA, Fraser EJ, et al. Football injuries of the ankle: A review of injury mechanisms, diagnosis and management. World J Orthop. 2016;7(1):8–19. Published 2016 Jan 18. doi:10.5312/wjo.v7.i1.8
 
Wolfe, Michael W. "Management of ankle sprains." American family physician 63.1 (2001).
 

 A great study titled "Six different football shoes, one playing surface and the weather; Assessing variation in shoe-surface traction over one season of elite football" has recently been released discussing what type of football (soccer) shoes are best for reducing the risk of lower limb injuries such as the commonly experienced ACL damage.

Football involves a high amount of acceleration, deceleration and changing direction. Both require an adequate amount of traction between shoes and surface in order for the movement to be executed quickly, safely and effectively.

Previous studies have shown that compared to other team sports football requires the greatest amount of cutting movements. A player can perform up to 800 cuts per game! 

A players ability to accelerate, decelerate and change direction is influenced majorly by the tractional properties of boots and playing surface.

The components of traction studied in this paper were translational and rotational. Translational relating to the player moving in a straight or side to side pattern.

Previous studies have proven that increased translational movement is linked to improved performance whereas increase rotational movements are associated with an increased risk of lower limb injuries such as ACL damage. 

The study looked at the relationship between:-
Shoe outsole purpose

• Artificial grass
• Firm ground
• Soft ground
• ​Stud cleat configuration

With 

• Playing surface

​
This study was completed to shed some more light on which external factors are contributing to lower limb injury in football players. The external factor here being footwear and the way they interact with the playing surface.

The study was done in Doha, Qatar at the Qatar national team outdoor training pitch. The study was carried out over a single season on the one natural grass football pitch.

6 Nike Shoes were included:-
Artificial grass

• Tiempo (AG)

Firm ground

• Hypervenom
• Tiempo
• Magista
• Mercurial

Soft ground

• Tiempo (SG)

​
​All 6 shoes, one at a time, were attached to a portable traction testing device which is designed to mimic foot movements employed by football players.

This allowed the researchers to pool data about all 6 shoes and their translational and rotational traction qualities.

What were the results?!
Soft ground outsoles showed to have the highest translational traction, however they also showed to have had the highest rotational traction!

Shoe outsoles designed for artificial grass, so the Nike Tiempo (AG) had the lowest rotational traction and came out on top.

So what does all this mean?
Decreased rotational traction in a shoe is proven to decrease lower limb injuries WITHOUT causing any detriment to player performance. 

So YOU want increased translational traction, helping the player move forward and side to side more effectively and safely, and decreased rotational traction, meaning they can rotate and pivot without that increased chance of hurting themselves!

This doesn't mean that if you put the Nike Tiempo on that you're invincible and you'll never hurt yourself. Many things come in to play when aiming to reduce the risk of injury. Adequately strengthening and stretching the correct muscle groups, building the appropriate skills and recruiting safe and effective movement patterns and strategies all compound together to make you a stronger, better player that will be able to stay in the game for longer.

Moving forward towards purchasing footwear, artificial grass shoe outsoles are small round moulded studs vs the screw in metal studs used with soft ground outsole shoes. Also, making sure the fit of the shoe is correct is just as important as getting the appropriate outsole. Having a shoe that is wide enough, deep enough and long enough is crucial!

Moving forward in the world of research they forecast studies looking further into the relationship between shoes and several different playing surfaces, soil types, and grass species to get a more complete understanding of shoe-surface traction.

Stay tuned players!

Access the whole research paper here, hot off the press!
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0216364

References
Taylor JB, Wright AA, Dischiavi SL, Townsend MA, Marmon AR. Activity demands during multi-directional team sports: a systematic review. Sports Medicine. 2017 Dec 1;47(12):2533–51. pmid:28801751