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CERVICOGENIC HEADACHES!

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The art of efficiency in sport isn’t as easy as it looks

25 Oct 2016 4:40 PM -

Did you watch any Olympic events this year and think that the athletes were making it look too easy? Commenting on the rowing like “They would’ve placed better if they were sharper with their blade-work!”, the gymnastics with “She should have done a triple flip, rather than just the double!” or the table tennis “He should’ve added some more top spin to that last one”… Yeah, we might’ve been guilty of that too!

In most, if not all, sports there is a degree of skill acquisition that requires the athlete to be powerful, strong, accurate and/or fast whilst expending minimal energy. The outcome is that it looks easy, almost effortless. But it isn’t.

This is the art of sporting efficiency; using only the muscles absolutely required, the exact amount they are needed, no more. Using more than what is specifically required is not only a waste of energy but can also lead to decreased performance and even overuse injuries. It’s a trained skill to be efficient and accurate; it’s how Olympians make super-human feats look like a piece of cake!

We can think of it almost like a monetary budget: athletes should be aiming to cash in all their energy-budget for what is going to give them the biggest return for their investment, rather than wasting it on tense shoulders, excessive gripping or toe-curling, especially when the lactic acid or fatigue kicks in, for example. Most people require immense training to enforce this near-perfect muscle and nervous system relationship in a pressured system like elite sport competition. It takes time, feedback and a complete network of healthy muscle and nervous tissue working well to achieve that one perfect sporting moment!

At Prevent though, we often find that people forget that learning a new physical skill in adulthood in sports (or otherwise) is actually incredibly challenging. It is the same process you might have gone through in childhood trying to learn a musical instrument: playing the whole song may be out of your reach on the first try, but you can hit some of the notes right. In fact, it might take you several weeks of trying before you can play the entirety without making a mistake. Whilst piano playing is a coordination of your upper limbs and fingers, sporting activities are just big, whole-body movements and coordination feats of the same nature. Consider the theory of three stages of motor learning:

table sourced from: http://www.alphaknightscrossfit.com/category/blog/

In this theory, let’s compare it to when you learnt to drive, and in particular turn the corner:

Cognitive stage: you needed prompts to indicate, place your foot over the brake, brake slowly, turn the wheel and then accelerate through.

Associative: you were able to consider the turn ahead, then simultaneously perform the above steps fluidly like a chain-reaction.

Autonomous: you left your house and arrived at your destination without consciously considering the cornering at all.

Every time we learn a new physical skill, we step through this same process. However, if we need to refine a certain skill or change it slightly we need to step back to the Cognitive Stage again. Repeating the cycle as necessary until we meet a new Autonomous Stage. This is why bad habits are hard to break: we need to un-write a whole series of neural patterning and muscular activation.

Our top tips for making a technical change, and moving through the cognitive and associative stages of learning are:

1. Get feedback: have someone watch you, video yourself, get a mirror or use props (a wall, Theraband, tape or a seat) to feel when you have performed the task differently. Counterintuitively, If it feels or looks wrong, different, even unusual, then you’re probably doing it right! If it feels the same, it probably is the same…

2. Part-practice: break big movements into little, bite-sized pieces. They are much easier to digest this way. It can also help you to hone in on what exactly is causing your technique to falter. This can be a good way to identify small muscle imbalances or tissue length issues too.

3. Repetition is key: especially if you’re looking to break a bad habit! Do it once perfectly and then do it again and again. This is not so much challenging the muscles themselves, but more the muscle-brain relationship. Get that brain working hard to instil and maintain the change!

4. Progression is vital: Once you feel confident, you are able to maintain form and you do not have any injury concerns- up it. Do more repetitions, make it heavier, slower or faster, further and higher. The body is fundamentally designed to be pushed; all our tissues respond to physical stress by getting stronger. Start with little progressions, keep a rest day between training days and make sure you can maintain form in the progression.

It’s Golf Month this month in Adelaide. So if you are having issues with performance or injury, consider where the fault may lie in your technique. Because Golf requires so much from the whole body, it really can be anything along any part of the system. And at first, it may not necessarily be an obvious technical or physiological change. Golf is all about efficiency and coordination.

By Suzannah Michell

Physiotherapist

PILATES AND PHYSIO

17 Oct 2016 11:46 AM - Why do they work together?

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World University Rowing Championships

8 Sep 2016 4:44 PM -

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Women’s Health

12 Jul 2016 10:20 AM - Stress Urinary Incontinence (SUI)

Urinary Incontinence affects up to 37% of Australian women. That’s more than 1 in 3! (Australian Institute of Health & Welfare, 2006)

Stress Urinary Incontinence (SUI) is the leaking of small amounts of urine during activities that put stress on the bladder. “Stress” refers to an increase in pressure on the bladder; a physical stress. Increased pressure can be caused by coughing, sneezing, laughing and heavily lifting, and it can also be caused by jumping, running or any large downwards force on the body. All of these things are an increase in abdominal pressure, which translates to an increase in pressure downwards on the bladder and pelvic organs.

Risk Factors:

Pregnancy, childbirth and menopause are very common predisposing factors to experiencing SUI. As previously discussed, pregnancy and childbirth can cause stretching, weakness or incoordination in the pelvic floor muscles. In the case of menopause though, it is a lack of oestrogen that can lead to physiological changes in the urethral lining that causes some leaking. Elite sportswomen also suffer from SUI commonly due to jumping, running, heavy lifting, straining and/or decreased amounts of oestrogen. Trampolining, parachuting and base jumping have been identified as a sports with high incidences of SUI within their female populations.

SUI can be mild, moderate or severe;

For some women it can make them feel uneasy about their chosen sport, and others it can make a sneeze in public their worst nightmare.

So why does it happen?

Well firstly, we have to understand the fundamentals. Yes, it is linked to your deep pelvic floor muscles! But no, it is not because the deep pelvic floor constricts around your urethra! Following on from the last post- your pelvic floor helps to hold your abdominal organs up and in the most advantageous position. In the case of the bladder and urethra, this a position where the urethra and bladder neck (where the bladder turns into the urethra) are upright and supported.

As seen below, when the bladder neck is well supported and we have an increase in abdominal pressure the pressure is equally applied to the whole system. This causes a forced closure of the urethra equal to the pressure applied to the bladder, and hence there is no loss of urine. However, on the right hand side, when these structures are less supported, the force is not applied evenly and urine escapes. The pressure downwards may just move the urethra instead of stinting it closed up against a firm, contracted pelvic floor muscle (or fascia).

So what can we do about this?

Let’s not forget that the deep pelvic floor muscles are in fact muscles! And just like all other skeletal muscles in our body, they can adapt to loading. That’s right- if you want a strong bicep, you’d have to do bicep curls regularly to increase its strength, and it’s no different for the pelvic floor.

There are a few ways we can go about this strength training though depending on symptoms. So let’s think about these two different examples:

1. you suffer from mild SUI only when you cough or sneeze 

2. you suffer from mild SUI only when you go for a 5km run

In the first example, we would focus more on maximal strength and coordination of the pelvic floor (equivalent to a persons’ 1 rep maximum). And in the second example, we would focus more on the resting tone and endurance of the pelvic floor (more like, how many reps you can do at the same lower weight).

Why is this? Consider the time frame of each event: Even in running, we turn on and off our muscles in a rhythm, but we would never expect a single muscle to contract the entire time. Muscles don’t like to be turned on and kept on. So we would never try and train the pelvic floor to turn on and hold for 5km!! However, if it is a single, shorter event that you can predict that causes SUI, it makes sense that you need a very strong, effective contraction to make a change in leakage.

Some treatment ideas could be (corresponding to the different symptoms above):

1. Frist of all we would teach the patient how to coordinate a strong contraction during a cough or sneeze. Interestingly, this reflex is usually lost after giving birth and it is more a coordination issue rather than a strength one. Depending on this efficacy then, we would prescribe pelvic floor exercises focusing on fast activation, maximal holds and/or pulsing holds towards maximum. Importantly these exercises are based at fatiguing your pelvic floor and should only be done at the end of the day in bed, before sleep.   

2. In order to change the endurance and resting tone of your pelvic floor, we need to build muscle bulk in the pelvic floor. For this we would be aiming for 8-12 repetitions pushing the muscle to fatigue, and doing 1-2 sets per day. It is recommended that strength training occurs for three to four months. Additionally, for women with good strength, but lifestyles that exceed normal pelvic floor requirements (such as elite sportswomen, powerlifters or cross-fitters), vaginal weights can be excellent to increase resistance and hence build the needed muscle bulk.

But…

SUI symptoms may be caused by other pelvic floor or bladder issues, and it is always worth seeing a medical professional about your issues before attempting anything by yourself. A lot of women don’t contract their pelvic floor muscles properly, and are often pushing down instead of pulling up, hence worsening their problems, not making it better! Furthermore, severe SUI can be a sign of other issues in the pelvis and a multifactorial approach may need to be taken, not just pelvic floor retraining.

If you have any issues or you want to discuss anything further about any symptoms you may be experiencing you can call us on 8361 8182 to book an appointment today with Suzannah. Women’s Health is an area that only Women’s Health specifically trained professionals will be able to fully assess and treat, so give us a call to help you on your way.

Suzannah Michell

APA Physiotherapist- Women’s Health

Women's Health

24 Jun 2016 4:13 PM - The Pelvic Floor

When we are talking about Women’s Health we are generally talking about urinary, faecal and sexual health in women. And it sounds like a scary, taboo topic, doesn’t it? Well, of course, we are here to tell you that it really isn’t. And thinking about Women’s Health as such may be holding us back from big changes in wellbeing and health in Australia. This piece will be one of several to help debunk some myths around Women’s Health and hopefully educate and empower women facing these issues. And if you are someone who has problems, you are not alone!

Urinary incontinence affects up to 37% of Australian women (Australian Institute of Health and Welfare, 2006), however of those who reported they were suffering, only half reported seeking help from a health professional (Byles & Chiarelli, 2003).

Did you know that your uterus can expand to one thousand times its normal size when pregnant? And a placenta can create up to one thousand times the normal amounts of oestrogen and progesterone than the ovaries usually do when you’re not pregnant? Crazy, right? So why aren’t we taking about the other things that can happen to the female body with such respect?

A fantastic physiotherapist, Taryn Hallam, once described the pelvis to me like a soup can. The filling of all the soup in this analogy is your organs: uterus, bladder, intestine, stomach etc. However this tin of soup has no top and no bottom to the can. So what’s then stopping all the contents just falling out? The pelvic floor muscles and fascia; a genius, yet potentially flawed design of the female human body. In one regard, it’s great- muscles are stretchy and can be strengthened, so a baby can pass through a woman’s pelvis to give birth and recover afterward. But on the other, they can be forgotten about, weakened and altogether misunderstood.

Did you know at the end of pregnancy, the weight of the baby on the pelvic floor has been found to be equivalent to a 100kg man standing on a trampoline?

If that man stood on that trampoline for weeks or months, think about what that trampoline would look like when he got off. Or better yet, someone tried to push him through the fibres of the trampoline!

What really is the pelvic floor then?

The pelvic floor muscles span from your pubic bone to your sacrum, as drawn in in bright pink on this image:

(Adapted from www.fda.gov image, viewed 21/06/2016)

Note that this picture is from the side. Note the positions of the bladder, the uterus and the rectum next to each other. Your pubic bone is the hard bone you can feel at the front of your pelvis, and the sacrum is a continuation of your spine which ends in your coccyx bone.

What does it do?

The pelvic deep pelvic floor muscles sit a bit like a sling. So what do you think would happen when they contract? They get tighter and straighter, making the shortest line between the pubic bone and the sacrum. Whilst there are muscles around the anus and urethra that work by constricting around these exits to stop defecation and urination respectively, these are not your deep pelvic floor muscles. The pelvic floor muscles do not hold your urine and faeces by constricting around your passages. So why do physios go on and on about them?

Well, firstly, when they are weak you can see that they sag down. When the pelvic floor muscles are tight and taut, the weight of your organs is more evenly distributed. When it sags, you have an increase in pressure in the very centre, towards the vagina. Therefore, having weakened pelvic floor muscles puts you more at risk of a prolapse (which is where your bladder, uterus or rectum slips downwards, usually towards your vagina), as you can see below. Prolapses will be more closely discussed in further posts.

Just briefly and very simply, this sagging of the pelvic floor is one of the reasons that women experience loss of urinary and faecal continence as well. Because the organs are not well supported, their function can be altered. This is especially the case with Stress Urinary Incontinence (SUI), which is the loss of urinary continence when there is an increase in pressure (i.e. stress) on the bladder. This increase pressure is most commonly caused by coughing, sneezing, laughing, heavy lifting or jumping/running. We will continue to expand on this in coming posts.

So what can you do?

Well, unfortunately research has found recently that

Up to 50% of women perform a pelvic floor contraction incorrectly if only given verbal cues.

However, an appropriately trained physiotherapist with a special interest and training in Women’s Health can assess and treat pelvic floor weakness and dysfunction. At Prevent, we have private and confidential treatment rooms and specialised equipment to help you.

Want the good news though? According to the Incontinence Foundation of Australia:

80% of sufferers can be improved or cured with conservative treatment

Further, Pelvic Floor Muscle Training (PFMT) for people with SUI has been systemically reviewed to increase quality of life and have very few reported adverse effects (of which, none were serious) (Dumoulin & Hay-Smith, 2010).

So let us help you to improve your confidence, health and wellbeing. If you have any issues that you would like to discuss with our trained Physiotherapists regarding the pelvic floor or anything in this article, do not hesitate to call us on 8361 8182 or email physio@prevent.net.au

By Suzannah Michell

Physiotherapist

Acknowledgements:

Information, analogies and concepts from Taryn Hallam’s Introductory Course of Women’s Health Training Associates (WHTA) are used throughout this article.

Dry Needling

9 Jun 2016 2:35 PM - What exactly is it?

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