refined-physiotherapy

Are you stretching enough?

Tue, 18 Feb 2025 00:12:08 GMT

Read about the best ways to stretch to get the benefits

Firstly, Why do we need to stretch?
There is strong evidence to show that stretching our muscles helps to improve our joint mobility and muscle flexibility.

There are different types of stretching with the most common being:
1. Static stretching
This involves holding a position of a muscle for a certain period of time. An example is reaching forwards to touch your toes to stretch your hamstrings.

2. Dynamic stretching
Involves moving a muscle through a controlled range of movement, often mimicking a specific activity or sport. An example is a runner doing long strides or walking lunges before a run.

When should I stretch?
It depends. Research has found that before exercise or sport, it is best to perform dynamic stretches, as they will better prepare you for your activity. It is no longer recommended to do static stretches beforehand, as it can sometimes reduce your performance, particularly for sports requiring explosive power and speed such as basketball and sprinting.

Stretching alone, especially before exercise, will not help to prevent or reduce the chance of injury as once thought either.

How long should I stretch for?
A static stretch should be held for a minimum of 30 seconds (No, 10 seconds is not enough!) and repeated 1-2 times in a session. To achieve maximal flexibility, it is recommended that you stretch at minimum 2-3 x week however daily is more effective.

Does stretching help muscle soreness?
Contrary to popular belief, no. There is no solid evidence to show that stretching will reduce the delayed onset muscles soreness (DOMS) associated with exercise. While most people will agree that stretching feels good and it is completely safe to do so after exercising, focus more on your recovery of sleep and nutrition to help with that DOMS.

Should I stretch if I have an injury?
Most injuries don’t tolerate stretching in the early stages; so it is best to steer clear of them. Talk to your physiotherapist to discuss the best strategies to help recover from your injury the fastest.

Take home messages:

Stretching alone does not prevent the most common injuries
Stretching is great for improving flexibility and mobility
Dynamic stretches are best performed before exercise and sport
A minimum of 30 seconds is best for static stretching and consistency is key

McHugh, M. P. and C. H. Cosgrave (2010). “To stretch or not to stretch: the role of stretching in injury prevention and performance.” Scandinavian Journal of Medicine & Science in Sports 20 (2): 169-181

https://www.acsm.org/blog-detail/acsm-certified-blog/2021/03/18/stretching-and-flexibility-guidelines-update

Magnesium Contrast Therapy – The 6 key benefits for health and injury

Fri, 10 Jan 2025 03:48:43 GMT

You'll be surprised at the benefits a magnesium pool can have!

What’s involved with a contrast magnesium pool session?

At Refined, we have two pools – one at approximately 38 degrees and one at approximately 8 degrees. A session involves submerging as much of your body as you like, in one pool, for up to 5 minutes at a time, then switching to the other pool to get the “contrast” effect.

These temperature shifts on the body cause rapid expansion and contraction of your blood vessels, which increases the flow of blood and fresh oxygen through the body. This has been found to have numerous beneficial effects, as well as the absorption of magnesium – for mental and physical health.

What are the benefits?

1. Reduction of pain and swelling
Studies have found that contrast therapy can reduce swelling associated with injury, as well as pain levels. It also reduces post-exercise soreness associated with training (DOMS).

2. Reduced inflammation
The contrast therapy also assists with a reduction of inflammatory markers in the body that can be associated with injury. This leads to an improved recovery time and overall improved general health.

3. Increased joint range of movement
The increased blood flow, reduced joint load on the body as well as a reduction in swelling and inflammation can all help to improve joint flexibility and range of movement.

4. Faster muscle recovery
The rapid contraction of the blood vessels led to increased removal of toxins and lactic acid from the blood and can assist with reducing perceived fatigue levels post-exercise. The magnesium in the water is also beneficial for muscle recovery.

5. Reduced stress and anxiety
A reduction in muscle tension, improved relaxation and better sleep are other benefits that the magnesium contrast pools have been proven to have.

6. Improved sleep and energy levels
The alternating hot and cold stimulates the release of endorphins, leaving you with an improved mood but also more energy. When done regularly, it also helps to improve your immunity.

BOK A SESSION

Is contrast therapy good for injuries?

Absolutely, the magnesium is beneficial for muscle injuries and the cold water can help to reduce swelling, pain and improve tissue recovery.

There are some injuries and conditions where it is advised against the contrast therapy, that so please consult with your physiotherapist before trying this modality.
To book an appointment click here

Shadgan B, Pakravan AH, Hoens A, Reid WD. Contrast Baths, Intramuscular Hemodynamics, and Oxygenation as Monitored by Near-Infrared Spectroscopy. J Athl Train. 2018 Aug;53(8):782-787. doi: 10.4085/1062-6050-127-17. Epub 2018 Sep 13. PMID: 30212235; PMCID: PMC6188085.

Vaile JM, Gill ND, Blazevich AJ. The effect of contrast water therapy on symptoms of delayed onset muscle soreness. J Strength Cond Res. 2007 Aug;21(3):697-702. doi: 10.1519/R-19355.1. PMID: 17685683.

Weerasekara RMIM, Tennakoon SUB, Suraweera HJ. Contrast Therapy and Heat Therapy in Subacute Stage of Grade I and II Lateral Ankle Sprains. Foot & Ankle Specialist. 2016;9(4):307-323. doi: 10 .1177/1938640016640885

Understanding Ankle Sprains Part 2: Why do I keep rolling my ankle?

Wed, 04 Dec 2024 03:26:24 GMT

Chronic Ankle Instability: Why do I keep rolling my ankle?

Unfortunately, it is very common for people to still experience pain months after they have injured their ankle, or to keep re-injuring it. Even when your pain has gone, the ankle still might not be completely healed, or you could have ongoing instability, poor strength, balance or proprioception that you are not aware of.
If you continue to roll your ankle, this is called chronic ankle instability and almost 1 out of every 2 ankle sprains will develop this.

What are the causes?
1. Ligaments - When the ligaments have been compromised (either stretched or torn) then you are most likely to re-injure your ankle as it is structurally not as stable.
2. Muscle Weakness – after an ankle injury you can get changes to your calf and peroneal muscles which stabilise the ankle joint. If these are not rehabilitated correctly then you will be more likely to roll your ankle again.
3. Poor Balance/Proprioception – Can you stand on one leg without falling over? Or walk over uneven ground without feeling unsteady? Regaining these elements of balance are often neglected after an ankle sprain.

4. Power & Agility – Being able to run, jump and hop, even if these are things you don’t do very often are important for the ankle to be able to function normally. If you can’t do these with your injured ankle then you are more likely to roll your ankle again.

Will I need surgery?
In 89-90% of cases, physiotherapy will fix ankle sprains but in some cases, surgery is necessary to tighten the ligaments to restore full stability to the ankle joint.

Preventing Ankle Sprains
There are a number of things you can do to reduce the chance of injuring your ankle again.

1. Good Footwear : Supportive shoes are important both in sports and for daily wear to reduce the chance of an ankle sprain.

2. Ankle braces and taping ; Your physiotherapist can show you the best way to strap your ankle or a suitable brace for your level of activity.

3. Targeted Exercises – Full range of movement, strength, balance and power are needed for ankle stability.

4. Good Warm-up and Cool-down : Completing these routines around your sport or exercise will reduce the chance of you re-injuring your ankle.

If you keep rolling your ankle, or are still experiencing pain or swelling, then it is important that you book in for physiotherapy so we can identify what the issue is. Refined Physiotherapy can help you now: Book here.

A rdakani, M. K., Wikstrom, E. A., Minoonejad, H., Rajabi, R., & Sharifnezhad, A. (2019). Hop-stabilization training and landing biomechanics in athletes with chronic ankle instability: a randomized controlled trial. J ournal of athletic training , 54(12), 1296-1303.

Biz, C., Nicoletti, P., Tomasin, M., Bragazzi, N. L., Di Rubbo, G., & Ruggieri, P. (2022). Is kinesio taping effective for sport performance and ankle function of athletes with chronic ankle instability (CAI)? A systematic review and meta-analysis. Medicina, 58(5), 620.

Cain, M. S., Ban, R. J., Chen, Y. P., Geil, M. D., Goerger, B. M., & Linens, S. W. (2020). Four-week ankle-rehabilitation programs in adolescent athletes with chronic ankle instability. Journal of athletic training, 55(8), 801-810.

Chang, S. H., Morris, B. L., Saengsin, J., Tourné, Y., Guillo, S., Guss, D., & DiGiovanni, C. W. (2021). Diagnosis and treatment of chronic lateral ankle instability: review of our biomechanical evidence. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 29(1), 3-16.

Dhillon, M. S., Patel, S., & Baburaj, V. (2023). Ankle sprain and chronic lateral ankle instability: Optimizing conservative treatment. Foot and Ankle Clinics, 28(2), 297-307.

Rowe, P. L., Bryant, A. L., Egerton, T., & Paterson, K. L. (2023). External Ankle Support and Ankle Biomechanics in Chronic Ankle Instability: Systematic Review and Meta-Analysis. Journal of Athletic Training , 58(7-8), 635-647.

Understanding ankle sprains: Part 1

Mon, 18 Nov 2024 03:38:05 GMT

What is an ankle sprain and how to fix it? Read on below

What is a sprained ankle?

Commonly known as a ‘rolled ankle’, an ankle sprain is an acute injury that occurs when your foot twists beyond its normal range of movement. This is often very painful and causes pain, bruising and swelling around the ankle joint.

Most ankle sprains cause damage to the ligaments in your ankle, which are the structures that connect the bones together and provide stability. The ligaments can either get stretched, like a rubber band or torn.

Types of ankle sprains
Depending on what position your foot was in when you injured yourself, or what way the ankle twisted, will determine which ligaments have been damaged. There a 3 main types of ankle injuries:

1. Lateral Ankle Sprains
These are the most common, when your foot twist inwards (inversion) damaging the ligaments on the outside of your ankle. There are 3 ligaments on the outside of the ankle: Anterior Talofibular Ligament (ATFL), Calcaneofibular Ligament (CFL) and the Posterior Talofibular Ligament (PTFL).

2. Medial Ankle Sprains
These are less common than lateral ankle sprains and occur when your foot twists excessively outwards (eversion), causing pain to the inside of your ankle. The deltoid ligament is the primary ligament on the inside of your ankle that can get damaged.

3. High Ankle Sprain (Syndesmosis)
These are also infrequent but usually more severe. This injury affects the ligaments that sit at the top of your ankle, connecting the tibia and fibula bones together.
Symptoms of a syndesmosis injury are pain and swelling across the front of the ankle joint and the outer part of the ankle.

It is important to see a physiotherapist for a full assessment to determine what type of ankle injury you have and the severity of it.

Signs and Symptoms of Ankle Sprains

The most common signs and symptoms are:
1. Pain – Pain around the ankle bones that is often intense and occurs immediately after the injury
2. Swelling and bruising – These can happen immediately after the injury or over the next 24 hours.
3. Pain with walking, or being unable to walk or put weight through your foot. If this is the case, then you may need an x-ray of your foot and ankle to rule out a fracture.
4. Feelings of instability or giving way – it is common if the ligaments have been damaged to feel like your foot and ankle may roll again. If this is the case then you need to get physiotherapy to address this.

Physiotherapy Treatment for Ankle Sprains

The physiotherapy journey for ankle sprains begins immediately after your injury:
1. Protection: In the early stages we want to protect the injury, by following the ‘PEACE & LOVE’ guidelines – for more information, see our blog on this here .
2. Immobilisation : Depending on the severity of your injury, you may need a CAM boot, ankle brace or strapping, or all of these to help in your recovery.
3. Dry needling : This can help to reduce pain, swelling, inflammation and muscle spasm after your injury
4. Exercises: This is a crucial part of ankle sprain management. Your physiotherapist will give you exercises to help your walking return to normal, as well as exercises to restore your range of movement, strength, balance and stability to get you back to your pre-injury function.

All ankle injuries need physiotherapy to help restore the full function of the foot and ankle. Have you hurt your ankle? Book in here to get an assessment from our experienced sports physiotherapist.

Bachmann, L. M., Kolb, E., Koller, M. T., Steurer, J., & ter Riet, G. (2003). Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review. British Medical Journal, 326(7386), 417.
Bleakley, C. M., O'Connor, S. R., Tully, M. A., Rocke, L. G., Macauley, D. C., & McDonough, S. M. (2012). Effect of accelerated rehabilitation on function after ankle sprain: randomised controlled trial. BMJ, 344, e3042.
Delahunt, E., Bleakley, C. M., Bossard, D. S., Caulfield, B. M., Docherty, C. L., Fourchet, F., ... & Gribble, P. A. (2018). Clinical assessment of acute lateral ankle sprain injuries (ROAST): 2019 consensus statement and recommendations of the International Ankle Consortium. British journal of sports medicine, 52(20), 1304-1310.
Doherty, C., Bleakley, C., Delahunt, E., & Holden, S. (2020). Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis. British Journal of Sports Medicine, 54(11), 621-626.
Fong, D. T., Hong, Y., Chan, L. K., Yung, P. S., & Chan, K. M. (2007). A systematic review on ankle injury and ankle sprain in sports. Sports Medicine, 37(1), 73-94.
Kerkhoffs, G. M., Kennedy, J. G., Calder, J. D. F., & Karlsson, J. (2021). Ankle syndesmosis injuries: diagnosis and treatment. Journal of Orthopaedic & Sports Physical Therapy, 51(3), 103-116.

How to Best Manage Your Acute Injury

Wed, 30 Oct 2024 10:30:56 GMT

For decades we have been told to ‘RICE’ after we get an injury, but it’s time to let go and make room for some ‘PEACE & LOVE’.

This new acronym has replaced the old ‘RICE’ acronym and it has some significant changes, including avoiding ice and anti-inflammatories after an injury as these have been found to disrupt the natural healing process that we want to occur.

It also gives us more guidance on what to do after the initial injury phase, a crucial step that was missing from the old ‘RICE’ acronym.

For the first few days after an injury, give them some ‘PEACE’

P: Protect
We want to protect the injury by de-loading and reducing movement for the first 2-3 days to prevent further damage and allow the healing process to occur. Prolonged rest can in fact lead to longer recovery times.

E: Elevate
Try to keep the injured limb elevated higher than the level of your heart; this will help to reduce swelling out of the area.

A: Avoid anti-inflammatory modalities
It is now recommended to avoid taking anti-inflammatories, such as ibuprofen and aspirin in the first few days after your injury as these can interfere with the inflammatory process and slow down tissue healing. Applying ice to an injury may also disrupt this process; it can be still be used to assist with pain relief. After the first few days heat can also be used for pain management.

C: Compress
Compression of the injured area using bandages or tape is recommended to help reduce swelling and bleeding.

E: Educate
Education plays a huge part in any injury management. Your physiotherapist will provide education specific to your injury and situation to help you understand your recovery times and what you need to do to get better fast.

After the first few days have passed, injuries need ‘LOVE’

L: Load
Try to resume normal activities if your pain and symptoms allow; this will promote repair, remodelling and improve tissue tolerance. Your body will tell you when it is okay to increase the load, or if it is not ready.

O: Optimism
Be optimistic about your recovery! People who are optimistic have better outcomes as the brain plays an important role. Fear and avoidance surrounding your injury can be barriers to recovery. Working with your physiotherapist can help to improve your confidence with getting moving again after your injury.

V: Vascularisation
Starting some cardiovascular exercise, such as a walking, swimming or a stationary bike will help to increase blood flow to the injured area. This, combined with rehabilitation exercises can help with pain relief and getting your back to your usual activities faster.

E: Exercise
Your physiotherapist will give you the specific exercises required to rehabilitate your injury and restore factors like mobility, strength and proprioception, as well as helping you to prevent the same injury from occurring again!

To find out the best way to manage your injury, book in for an appointment where you will get your own comprehensive and individualised rehabilitation plan.

Dubois B, Esculier JF. Soft-tissue injuries simply need PEACE and LOVE. Br J Sports Med . 2020;54:72–73.

Heat or Ice – Which is best for my injury?

Wed, 30 Oct 2024 10:30:51 GMT

One of the most common questions I get asked is should I use heat or ice for my injury?
There’s no correct answer, it ultimately depends on the type of your injury and which stage of the healing process it is at.

When should I ice an injury?

Ice has traditionally been used straight after an acute injury or surgery. For up to 72 hours after an injury, there is an inflammatory response occurring in the body. Signs of inflammation include localised skin redness, swelling, and heat, as well as pain.

Cold therapy helps to reduce the blood flow to the area, thus helping to reduce the inflammation as well as giving pain relief.

However, new research is showing that ice has little effect on skin temperature and reducing swelling. While it may numb the area and provide temporary pain relief, it’s ability to accelerate healing beyond the initial stage of an injury appears to be not as effective as we thought it was.

What about ice baths? – see our other blog on them here

Should I use a heat for my injury?

Heat has the opposite effect of ice, promoting increased blood flow within the body. It is best used in the days after your injury, or if you are experiencing a chronic issue or tightness.

Heat can assist with promoting tissue healing, decreasing muscle pain and spasm and improving muscle and joint motion. It can be particularly helpful for conditions such as chronic pain and arthritis.
Heat packs, hot baths and saunas are all effective ways to deliver heat into our bodies.

So, how do you decide between ice and heat for your injury?

In general, cold therapy may be more beneficial for acute injuries, where there is redness, heat, swelling and intense pain. If you do not have these signs, but are experiencing tightness, stiffness or reduced movement, such as muscle spasm, then heat therapy may be better.

Both heat and ice applied correctly should not cause further harm. Follow the guidelines as described in the pictures.

Heat and ice alone will not fix your injury. For the most effective treatment consult a physiotherapist for a full assessment and advice on how best to fix your injury.

Petrofsky et al. Cold Vs. Heat After Exercise-Is There a Clear Winner for Muscle Soreness. J Strength Cond Res. 2015 Nov;29(11):3245-52.

https://www.fisiologiadelejercicio.com/wp-content/uploads/2024/09/Cryotherapy-for-treating-soft-tissue-injuries-in-sport.pdf

https://www.proquest.com/openview/b68a6dfa85462eb8052d59c548210165/1?pq-origsite=gscholar&cbl=18750&diss=y

What is an APA Sports Physiotherapist?

Wed, 30 Oct 2024 10:09:54 GMT

What is a Sports Physiotherapist?

They are a highly qualified physiotherapist with expert knowledge and skills in the prevention, diagnosis and treatment of sports injuries. The Title awarded by the Australian Physiotherapy Association, serves as a professional mark of distinction in the field of Sports Physiotherapy, which not all physiotherapists have.

They have undergone intensive training and a rigorous selection process by demonstrating expertise and achieving an outstanding level of contribution to the field of sports physiotherapy.

Clare completed this process, obtaining her titling as a Sports Physiotherapist in 2018, after completing a Masters of Sports Physiotherapy degree. Clare has also earnt membership into the Australian College of Physiotherapists; a distinguished group of leaders in physiotherapy clinical practice.

Sports Physiotherapists are skilled in fixing all sports injuries and work with people across the physical activity continuum; those returning to exercise, weekend athletes, fitness fanatics and elite athletes.

At Refined, you can be reassured that you are receiving the best care with Clare, as she has demonstrated the highest standard of clinical experience and knowledge to accurately identify, prevent and treat injuries.