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7/23/2019 0 Comments

Rotator Cuff

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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?
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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
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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).
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SYMPTOMS

  • Pain and tenderness in the shoulder and on certain types of movements
  • Weakness of the shoulder
  • Discomfort when sleeping on the affected side
  • Decreased range of motion especially in abduction
  • ​Pain and difficulty performing daily activities
  • Swelling
  • ​In some cases, there can be no symptoms with a rotator cuff tear. A study by Hiroshi Minagawa found that 65.3% of rotator cuff tears were asymptomatic and 34.7% symptomatic

CAUSES

  • Most common cause is a degenerative process due to the tendons wearing down as the body ages
  • Repetitive trauma to the area from movements in sport, work or daily activities that involve overhead movements or lifting
  • Single trauma such as falling on outstretched arm or lifting something heavy
  • Poor posture
  • Bone spurs that decrease the space for tendons and impinge cause inflammation

RISK FACTORS
  • >40 years of age
  • Participating in sport that requires forceful overhead actions or heavy lifting (e.g tennis or baseball pitchers)
  • ​Working in an occupation such or painter, carpenter or other trades-person that is required to perform repetitive overhead activities for long periods

TREATMENT
  • Period of rest
  • Ice
  • ​Discontinue activities that aggravate the shoulder during the healing process
  • Over the counter anti-inflammatory medicines (e.g Ibuprofen)
  • ​Pain free range of motion
  • Rehab exercises to place the tendons underload and strengthen the rotator cuff and surrounding shoulder muscles
  • ​Corticosteroids (if other forms of treatment have not helped)
  • Surgery (large full thickness tear or significant weakness and poor function)

​​Treatment through chiropractic:
  • Massage
  • Trigger point therapy
  • Dry needling
  • Manipulation
  • Mobilisation

PREVENTION
  • Shoulder warm up and stretches before performing activity
  • Strengthening exercises
  • Balance between the muscles at the front and back of the shoulder complex

If you have had a rotator cuff injury or shoulder discomfort, we recommend visiting your local health practitioner for an accurate diagnosis of your complaint with proper treatment and rehab plan. As mentioned above there are four muscles in the rotator cuff and making sure treatment is directed to the right area is vital. If you are local to the Loftus area, we are happy to help or answer any questions you may have.
​

Written by Joshua Hallinan,
Chiropractor
Health Associates
Working Tuesday (AM & PM), Wednesday & Friday (PM)



References 

Minagawa, Hiroshi, et al. "Prevalence of symptomatic and asymptomatic rotator cuff tears in the general population: from mass-screening in one village." Journal of orthopaedics 10.1 (2013): 8-12.

Yamamoto, Atsushi, et al. "Prevalence and risk factors of a rotator cuff tear in the general population." Journal of Shoulder and Elbow Surgery 19.1 (2010): 116-120.

Jerosch, J., T. Muller, and W. H. Castro. "The incidence of rotator cuff rupture. An anatomic study." Acta Orthop Belg 57.2 (1991): 124-129.

Ellenbecker, Todd S., and Ann Cools. "Rehabilitation of shoulder impingement syndrome and rotator cuff injuries: an evidence-based review." British journal of sports medicine44.5 (2010): 319-327.

Lin, James C., Nancy Weintraub, and Dixie R. Aragaki. "Nonsurgical treatment for rotator cuff injury in the elderly." Journal of the American Medical Directors Association 9.9 (2008): 626-632.



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7/16/2019 1 Comment

Hip Pain

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Have you got pain on the outside of the hip? Perhaps you have been diagnosed with bursitis?

Pain on the outside of the hips is an extremely common complaint coming into the clinic. The vast majority of people with lateral hip pain are women in their 40’s 50’s and 60’s. In the past this has often been called hip bursitis and treated with cortisone injections. Unfortunately this has mixed success due to the fact that tendons are often involved and cortisone injection has limited use for tendon injury. In fact 4% - 46% of people have bursitis visible on imaging and tendinopathy 18% to 50% of people.
The technical terms that are often used include:
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  • Hip Bursitis (trochanteric bursitis)
  • Greater trochanteric pain syndrome (GTPS)
  • Gluteal tendinitis (Gluteal tendinopathy)
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We prefer the term GTPS as it more realistically encomasses the common causes of outer hip pain. 
Classic symptoms of GTPS include pain on the outside of the hip, especially at night when side sleeping and with the sore side down ALTHOUGH  it quite often gets painful with the sore side up as well - due to the fact that the leg is hanging across the midline of the body essentially tractioning the outer hip muscles.

Three things you can do right now to help relieve this problem.
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✅✅✅Sleep with the sore side UP & place a pillow between your legs ✅✅✅
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​❌❌❌Do NOT cross your legs when seated❌❌❌
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​❌❌❌ Do NOT stand with all your weight posted onto one leg. ❌❌❌
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Excessive loading of the gluteal tendon attachments to the top of the thigh bone along with direct compression (from side laying in bed) may be partly responsible for the development of lateral hip pain. As such, decreasing the repetitive loading on the muscles and tendons can help alleviate the symptoms in the SHORT term.

Now GTPS can be particularly tricky to get better. In our experience one of the major challenges is doing too much too soon in the recovery process. Slow progressive exercises are the best way to a long term solution. 

If you would like further advice on the best progressive exercises for GTPS or other tendon issues we recommend consulting your local healthcare provider that has a special interest in tendon rehabilitation. If you are local to Health Associates we would be more than happy to help.

Further Resources

For a fantastic visual resource relating to any tendon problem click on the link below to view Jill Cooks - 10 Things NOT to do if you have lower limb tendon pain . 

Written by Christopher Bowles
Chiropractor 
Working at Health Associates Monday, Thursday, Friday and Saturday​

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​Credentials
Master of Chiropractic
Diploma Sports Chiropractic
Registered Sports Trainer
Active Release Technique
Personal Trainer
Functional Movement Screen

​
Chris created Health Associates on the belief that movement is essential to living well. It is his personal mission to keep people active and moving for as long as possible. Recreational to elite, Chris will make sure that you are provided the best treatment possible and will help keep you in your sport. Chris is very empathetic to the pain and suffering of his patients. That is why he gives everything he can to ensure that they receive an accurate diagnosis and the most recent evidence based treatment plan.

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7/2/2019 0 Comments

Pelvic Mechanics and Glute Activation

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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. 
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  • 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.​  
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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.
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  • 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.
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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/

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Chiropractor
Bachelor of Chiropractic Science
Masters in Chiropractic

Joshua is a very focused, dedicated and committed practitioner. Joshua is committed to health and has achieved significant personal success in sport and through adopting a healthy lifestyle. 

Joshua is very ambitious and he is always setting himself personal targets to improve and be the best practitioner he can be. You know when you see Joshua that you are in the hands of someone who continually strives to be ahead in his profession and will bring that knowledge and skill to all of his patients. 
​
Joshua has a special interest in sports injuries, musculoskeletal complaints and headaches. He enjoys helping relieve pain and alignments and supporting his patients to live optimally. Josh has a great friendly and enthusiastic personality. His relaxing and down to earth approach leaves you feeling comfortable and confident in his treatment and recommendations. 

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6/25/2019 0 Comments

Involuted Nails

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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. 
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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.
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​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
Who experiences these pesty nails?

Any one can have involuted or ingrown nails. Usually seen from the age of wearing footwear and consistent weightbearing, onwards e.g. walking and running around.
Anyone that is exposed to one, many or any of the above-mentioned causes is vulnerable to involuted or ingrown toenails!

How do we tame these naughty nails?

Let’s talk involuted…
  1. Figure out why the shape is changing and address the cause e.g. correct the position of the toe as result of a bunion with the help of a prefabricated or custom-made orthotic device; or look at purchasing shoes with a more appropriately fitting toe box.
  2. ​Correct the cutting technique. This may mean you will need to frequent a podiatrist so they can gradually correct your nail shape and direct the growth away from the site of pain.
  3. Depending on the severity of the curvature of the nail, conservative cutting techniques that are pain free may be completely fine. However, if the nail is particularly curly and has been left for too long a portion of the nail may need to be removed under local anesthetic. 

 And of course, the nasty ingrown…
​
  1. If the toe is infected, you will need visit your GP for possible prescription of antibiotics. In the meantime, keep the toe incredibly clean, cleansing it with warm salty water twice a day. You will need to keep this dressed in clean and new materials.​
  2. Do not try and cut any of the nail away, immediately visit your Podiatrist to have this addressed properly, cleanly and safely in order to save yourself any further complications! No pliers or scissors PLEASE...​
  3. Nail surgery to remove a part or the entire nail under local anesthetic is the most likely, effective treatment for this depending on the severity. This is something your podiatrist will discuss with you in detail. It’s a very quick procedure and depending on how tough your tummy is you can even watch! However, if you’re uncomfortable with the idea of blood or anything slightly invasive your Podiatrist will make sure you feel completely at ease and we can have you laying down talking about how much fun you’re going to have when you have your normal toe back!
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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/ 
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Written by Anneliese Ball
Podiatrist at Health Associates
Working Monday and fortnightly Saturday
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Anneliese Ball
Podiatrist
Anneliese is at Health Associates as a podiatrist working Monday and fortnightly Saturday.
She holds both a Bachelor of psychology and podiatry and has dedicated herself to studying full time for 7 years.
As a podiatrist she combines her proficient knowledge of human mechanics and ability to connect and engage with her patients to deliver outstanding clinical outcomes and an exceptional customer experience.
Anneliese loves health and fitness and enjoys encouraging her patients to maximise their health.

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6/14/2019 0 Comments

Hamstring Strain

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Hamstring strain is a common sporting injury due to the muscle being prone to tears and strains. They are common in sports that need a large amount of speed, power and agility such as rugby (54% of injuries), AFL, athletics (14%), basketball and football (10%). It hasn’t been un-noticed that 2019 appears to be the year of hamstring injuries with some big-name players in the NRL suffering tears to their hamstrings early in the season such as Tom trbojevic and Matt Moylan. To understand why this is happening to these professional athletes so early in the season we need to know what hamstring injuries are, the anatomy of the muscle, signs and symptoms of an injury, possible factors that make an athlete more at risk and ways to prevent hamstring strains from occurring. When an injury does occur, we must know what to do and how to manage it to return to play as soon as possible.

WHAT ARE HAMSTRING STRAINS/TEARS?
Acute hamstring injuries occur when there is a forceful contraction of the posterior thigh muscle/s or a sudden movement, this occurs when hamstrings decelerate hip flexion and knee extension. The person immediately feels discomfort and is aware of what has happened, there can be an audible pop. A Hamstring strain can occur in one or more of the three muscles in the group.
​

ANATOMY OF THE HAMSTRING
  • The hamstrings are composed of 3 muscles on the posterior thigh, bicep femoris (long and short head), Semimembranosus, Semitendinosus.
  • The top of these muscles attaches to the pelvis and run down along the posterior aspect of the femur and attach just below the knee joint on the tibia and fibula (shin bones).
  • The hamstrings are innervated by the sciatic nerve.
  • The hamstring performs two movements flexion of the knee joint and extension of the hip joint.
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SIGNS AND SYMPTOMS

Hamstring strains are classified from grade 1-3 depending on severity.

Grade 1 (Mild)
  • Overstretching muscle fibres or tendon without tearing the muscle.
  • Minimal to no loss of muscular strength or flexibility.
  • Increased tightness of the muscle during stretching or through full range of motion.
  • Mild discomfort felt along the muscle on palpation.
  • There may be discomfort when sitting or walking uphill/stairs.
  • Depending on the severity there may be mild swelling and difficulty doing daily activities including walking.

Grade 2 (Moderate)
  • Partial tear in muscle fibres.
  • Strength and flexibility of the muscle decreased.
  • Pain is more immediate and greater than grade 1.
  • Pain on range of motion and contraction of the muscle.
  • Pain when pressing on the muscle.
  • Change in normal walking and sometimes sudden twinge of pain.
  • There may be bruising and swelling.

Grade 3 (Severe)
  • Major tear or complete rupture of the muscle. The muscle can be bunched together making a depression where the tear has occurred.
  • Total lack of muscle function.
  • Immediate intense pain in the back of the thigh usually sharp.
  • Difficulty walking or weight bearing.
  • Large bruise and swelling within a few days after injury.
  • Usually occurs at the origin of the muscle.
  • May need surgical repair to re-attach the muscle.
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​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.

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6/4/2019 0 Comments

Blisters - How to Get Your Feet Across the Finish Line

It’s not just winter putting our feet back into enclosed shoes, we have some fierce events coming up!
With the Maximum Adventure Race Series June 1st, PAYCE Sutherland 2 Surf on the 21st of July followed closely by the Sutherland Half Marathon on the 27th of July we have many things to consider in regards to our feet carrying us the distance.


A big concern is those relentless BLISTERS.
Blisters are so painful and self limiting, yet so many people excuse them, some even expect them!
Blisters are absolutely unnecessary and you really, REALLY do not have to put up with these common pests!
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Blisters are just another way of our body saying “Hey, I really hate what you’re doing to me here, so I am going to let you know somethings wrong and start fixing the problem behind the scene”. The “scene” being that fluid filled, puffy sack. This is a protective mechanism the skin provides so the injured skin underneath can begin to get some TLC (tender loving care); someone’s go to do it!

No other body part sustains the high coefficient of pressure and friction as much as feet do. Which is why it is so important to address internal and external factors creating blisters.

Causes can include:-
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- Trauma; such as that from ill fitting footwear or the wrong socks (fit or material)
- Poor skin integrity; too much or not enough moisture in the skin
- Foot deformities or bony prominences; bunions, lumpy heel bones, clawed toes ect.
- Bacterial or fungal infections; highly irritable and weak skin is prone to blistering.
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Prevention is going to be your most powerful tool against these merciless blisters.

1.  Not only should your shoes fit well but your SOCKS should fit just as grand. From the toes all the way to the cuff of the sock should be neither tight or loose. We want to reduce the friction of any materials on our skin, so just as you’d get your shoes fitted correctly, fit your socks just as well! You can ask us about the fitting of both if you’re ever unsure of what to look for and if not more importantly, what to AVOID.

2.  On the topic of SOCKS. Merino wool is going to be your best friend, especially on those long walks, runs or even big work days. Merino wool actually works to wick the moisture away from your feet keeping them in a more optimal environment for longer. Cotton actually holds moisture next to the skin increasing the risk of more nasty rubbing.

Now, how can The Podiatrist help!?


1.  After locating those high pressure areas on your feet or toes that are vulnerable to blistering, they can be easily protected with various different materials and devices. Not only do they provide a cushioning effect, they work to offload the area and give those sensitive areas a rest. Custom made for you, Otoform devices can provide instant relief!

2. CALLUS is that hard, dry skin that builds up adding more unnecessary pressure onto the healthy skin underneath or next to. Callus is a common culprit for causing blisters. Removal of this callus is crucial and can be safely and effectively removed.

3. It’s all about keeping the integrity of our skin and its many layers as pristine as possible! Applying a moisturiser that contains UREA (a naturally occurring compound that exfoliates and moisturises skin) is great at providing a barrier for the skin, keeping it strong and resilient against shear forces. Frequency of application, required concentration of Urea and reliable brands are just a few hot tips we can provide you with.

4. Before those big events you may want to consider TAPING your feet and or toes into a more functionally desirable position. Clawed, hammer or mallet toes are common deformities that tend to rub on shoes causing nasty sores and blisters. It is actually possible to put these toes where they should sit and behave! Taping can be highly beneficial in avoiding irritable spots anywhere on foot.

5. Never ever, ever should you have to break in your SHOES! Getting that perfect fit should never be underestimated. Understanding where and how your feet should be sitting in your shoes is a common misunderstanding. And just when you think there is no better shoe for you, we can throw in a game changing lace-lock as well.

So you haven’t read this blog in time and your crippled with blisters....

1. COMPEED Blister packs can be found at pharmacies such as Priceline. These nifty skin savers provide a medical grade technology called “hydrocolloid”. Acting as a second skin they support the natural moisture balance, reducing pain and increasing the healing rate.

2. Blisters can get big and angry, fast! If they become unmanageable or show signs of infection it’s best to bring them in for clean and safe removal, followed by a suitable dressing and ongoing management if need be.

Now, that will get your feet across the finish line!


References
Picture 1 - https://www.runnersworldonline.com.au/blisters/
Picture 2 - https://www.youtube.com/watch?v=dgL4bWtNiWM


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Anneliese Ball
Podiatrist
Anneliese joins Health Associates as a podiatrist working Monday and Saturdays.
She holds both a Bachelor of psychology and podiatry and has dedicated herself to studying full time for 7 years.
As a podiatrist she combines her proficient knowledge of human mechanics and ability to connect and engage with her patients to deliver outstanding clinical outcomes and an exceptional customer experience.
Anneliese loves health and fitness and enjoys encouraging her patients to maximise their health.



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5/27/2019 0 Comments

Ankle Sprain and Rehabilitation

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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
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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).

 
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5/16/2019 0 Comments

Get the latest research on football shoes!

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 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

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Anneliese Ball
Podiatrist
Anneliese joins Health Associates as a podiatrist working Monday and Saturdays.
She holds both a Bachelor of psychology and podiatry and has dedicated herself to studying full time for 7 years.
As a podiatrist she combines her proficient knowledge of human mechanics and ability to connect and engage with her patients to deliver outstanding clinical outcomes and an exceptional customer experience.
Anneliese loves health and fitness and enjoys encouraging her patients to maximise their health.

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5/9/2019 0 Comments

Tips and tricks - Ankle sprains and what to do about them.

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Soccer is the most popular sport on the globe with over 270 million participants and it’s easy to see why. It is fast, dynamic, exciting and crazy, almost every emotion within 90 mins can be experienced. The performance of a soccer player is made up of many different variables such as tactile, mental, technical and physiological. During a game, elite level players run about 10km at an average intensity close to the anaerobic threshold (80-90% of maximal heart rate). Within this time there are a number of explosive movements including jumping, kicking, tackling, sprinting, turning and deceleration. Strength and power are equally as important as endurance in soccer. Now with this large number people playing and the high demands of the game there will be injuries. Let’s analyse to trends of injuries in soccer and how they can be managed and prevented, paying close attention to ankle sprains
Most soccer injuries occur to the lower extremity at approximately 87% and the common injury types include strain, sprain and contusion. The UEFA injury study showed thigh strains makes up 17%, hamstring 12% and ankle sprain 7%. The incidence is higher during the game at 57% making injuries quite high during training at 43%. 16% accounted for more than 28 days away from training and game. 12% with season ending injuries. Another study among amateur soccer players in Spain showed there was an average of 0.11 injuries per player per year. A large number of injuries led to 1 competitive match being missed (87%). Midfielders had the highest injury rate at 34.3%. The knee and ankle making up 42.3% making them the most common injury location. Ligament sprains accounted for 32.1%.
Risk factors:

  • Previous injury
  • Age (older players tend have a greater number of injuries)
  • Play intensity
  • Poor rehabilitation to injured area
  • Lack of strength and stability
  • Increased risk towards end of the game – fatigue
  • Inadequate preseason preparation (see more overuse injuries)
 A change in score also has a strong correlation with an increase in injury incidence, this is because it changes:
  • Team strategy
  • Player precautions
  • Players attitudes
  • Intensity of the match
  • Competitiveness


As mentioned, ligament sprains are common within especially in the ankle. 80-90% of ankle injuries are on the outer aspect of the ankle (lateral) with 69% being on the dominant leg. Most of the time the sprains are uncomplicated, however, 60% suffer from a repeated sprain after the initial event. 63.3% occurs with player contact and most occur to defenders. The mechanism of injuring is due to landing, twisting, turning or running which leads to rolling the ankle.
 How to recognise an ankle sprain:
  • Pain or discomfort around ankle post rolling it
  • Swelling
  • Discoloration
  • Limited ROM
  • Non-load bearing pain
  • Instability
  • Weakness
  •  
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
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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

Once swelling and pain have decreased begin a rehabilitation program to be able to return to play and decrease the risk of re-occurrence.
Prevention strategies for ankle sprains:
  • Bracing
  • Tape
  • Strength, flexibility and balance training
  • Good warm ups
  • Hydration
  • Conditioning
  • Good pre-season preparation


References:Lehnhart RA, Lehnhart HR, Young R, et al. Monitoring injuries on a college soccer team: the effect of strength training. J Strength Cond Res 1996; 10 (2): 115–9
Stølen, T., Chamari, K., Castagna, C. et al. Sports Med (2005) 35: 501. https://doi-org.simsrad.net.ocs.mq.edu.au/10.2165/00007256-200535060-00004

Am J Sports Med. 2014 Jan;42(1):78-85. doi: 10.1177/0363546513507767. Epub 2013 Oct 17. Injuries among Spanish male amateur soccer players: a retrospective population study.
Ryynänen J, Dvorak J, Peterson L, et al Increased risk of injury following red and yellow cards, injuries and goals in FIFA World Cups Br J Sports Med 2013;47:970-973.
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
Med Sci Sports Exerc. 1999 Jul;31(7 Suppl):S470-86. Foot and ankle problems in the young athlete.
Kofotolis, N. D., Kellis, E., & Vlachopoulos, S. P. (2007). Ankle Sprain Injuries and Risk Factors in Amateur Soccer Players during a 2-Year Period. The American Journal of Sports Medicine, 35(3), 458–466. https://doi.org/10.1177/0363546506294857
Safran MR , Benedetti RS , Bartolozzi AR 3rd , Mandelbaum BR  Medicine and Science in Sports and Exercise [01 Jul 1999, 31(7 Suppl):S429-37] Lateral ankle sprains: a comprehensive review: part 1: etiology, pathoanatomy, histopathogenesis, and diagnosis. 
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4/10/2019 0 Comments

Strength training for young athletes and athletes of all ages.

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Training is an integral part of any athletes daily routine. It allows the body to cope with the demands of the sport and helps gradually build strength, endurance and improve skill levels. Training helps to gain motivation, ambition and confidence as well as learning about the importance of having a healthy mind and body. Many people believe that to be successful you need to spend hours on hours playing that sport. While part of this is true, time must be devoted to learning the finer principles of movement to excel at the chosen sport. This must be specific to the athlete and their sport and include a range of training types including aerobic exercise, strength training and functional training. This will help to improve endurance, power, speed, co-ordination, flexibility, agility, balance, muscle recovery and decrease the risk of injury. Now how does this relate to young athletes looking to improve in their sport and gain an extra edge over opponents?
 
As mentioned, strength training is just one component of training and not the most important factor but can be very useful for young athletes. Firstly, there is a negative stigma around young athletes and strength training and how it may affect the athletes growth and health. This is because most people immediately think of a young athlete throwing around heavy weights, but this is not the case. Heavy bodybuilding exercises serve little to no purpose for athletes in general. They have little neural requirements and do not improve movements or skill in fact they’ll most likely make the athlete slower and inefficient. Instead it should be focussed on specific movements to activate certain muscles. Strength is a component of what the body requires to perform athletic actions against resistance. Current research highlights that resistance training can be safe, effective and worthwhile for young athletes. This must be under the supervision of a qualified professional with age-appropriate exercises and proper lifting techniques. For best results the athlete should focus on their weaknesses which will show up in a series of tests and skill assessments, it will also help monitor progress. Working on weaknesses will continually challenge the athlete’s ability in those movements and skills.
 
The importance of strength training for young athletes and how to be safe and effective.
 
Strength training has been shown to improve performance which can give an extra edge over opponents. Young athletes may not have the strength, endurance or stability to properly perform the techniques within the sport as their bodies are still developing. Strength training will guide the young athlete for optimal mobility, co-ordination, strength, stability, and movement efficiency. The training should begin with simple light exercises, even body weight and then progress slowly once technique is perfected. This should be done under guidance of a strength coach/professional. If the strength training is completed properly not only will the athlete build strength but also knowledge and understanding of muscle mechanics, body position and proper technique. This will reduce the risk of injury during training and sport. The weight will never injure someone if done properly and safely, improper technique (even with light weight) can lead to injury during the exercise or in the future.
 
Strength training can also help the athlete to create a platform to build on as they go into adulthood with the development and growth of those motor skills and muscle mechanics. Research suggests it can also have a positive effect on self-esteem and self-confidence. A training program allows the athlete to gain focus, attention and dedication. Although, need to take into consideration that young athletes are still kids and must design the program to be fun and enjoyable and also need to avoid burning out or pushing them too hard.
 
So, I know what you’re thinking, is it safe for my child to “lift weights?” or what is the “best age to start?” or “when is it safe?” or “It will stunt my child’s growth?”. Age-specific strength training can begin as early as 8 years old, but most recommendations are during pre-adolescent phase when the athlete has developed some health and skill related fitness. Strength training if done properly it will not stunt growth of the athlete and in fact promote health and growth.
 
Further research on strength training:
 
A research conducted in  AFL showed there was a decrease in the amount of hamstring injuries after adding a training program including anaerobic interval training, stretching and sport specific training drills. This also highlights that balance is important not to just focus on strength, but the training program should encompass endurance, power, speed, co-ordination, flexibility, agility, balance and muscle recovery.  Sprinting for example research has shown that plyometric training, including unilateral exercises and horizontal movement of the whole body elicits significant increases in sprint acceleration performance. Research has also shown that there is a large amount of force travelling through the spine during a golf swing, in fact eight times their body weight. With such force through the spine it is important that the golfer has a training program that improves strength and stability of the core and spine whilst maintain range of motion.
 
 
https://www-sciencedirect-com.simsrad.net.ocs.mq.edu.au/science/article/pii/S1440244012000357
https://journals-humankinetics-com.simsrad.net.ocs.mq.edu.au/doi/abs/10.1123/ijspp.1.2.74
https://bjsm-bmj-com.simsrad.net.ocs.mq.edu.au/content/39/6/363.abstract
https://www.noregretspt.com.au/index.php/resources/blog/43-2014/213-6-must-haves-before-embarking-on-strength-training-for-sports
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3827762/
https://bjsm-bmj-com.simsrad.net.ocs.mq.edu.au/content/44/1/56.short
https://www-ncbi-nlm-nih-gov.simsrad.net.ocs.mq.edu.au/pmc/articles/PMC3105332/
https://www-ncbi-nlm-nih-gov.simsrad.net.ocs.mq.edu.au/pmc/articles/PMC3105332/
https://www-tandfonline-com.simsrad.net.ocs.mq.edu.au/doi/pdf/10.1080/07303084.2001.10605847


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