Evolutio Australia Blog

Physical Therapy, CrossFit Injury, Olympic Weightlifting and Gymnastics Mobility, Stability, Injury Prevention and Management https://www.evolutio.com.au                                                               

[evolutiosportsphysioblog]

How to Train the Splits

Is achieving the splits a goal that you have? Whether it’s front or side splits, I’ve heard people say often that they’d ‘love to be able to do the splits’ or that they’re ‘working towards being able to do the splits.’ I’m not surprised, it is a cool skill to have, and it can feel like the BIGGEST achievement EVER because it takes so damn long! As rewarding as it is in its entirety, I think it’s important to set people up with a little background knowledge which can help avoid disappointment (like the kind that you get from social media or YouTube), prevent one from giving up, and hopefully set you on a path towards quicker and safer progress.

Some common questions or comments that have popped up in recent discussions are

I’ve been training for over 3 months, I thought I’d have them by now

What sort of things will affect my split?      

Can splits training be dangerous?       

Should I feel pain when I’m stretching?

What sort of things will affect my splits?

Age

Flexibility does generally decline with age, that does not mean that you cannot make flexibility gains as an adult, or even achieve a split. It just might take longer than say, if you were to start as a child and/or have maintained your flexibility consistently throughout your adolescent and adult life. The reason why many adults give up is the misconception that they will achieve it within months. It can take years to achieve a full split. Whereas the biggest factor in not achieving this is hip alignment.

Hip Angle

The ‘normal’ angle of the hip (so between the long thigh bone – the femur, and where it bends - we call this the neck of femur which then forms a socket with your pelvis) is between 33 and 38 degrees, roughly. This allows for 125 degrees of hip rotation (or range), roughly.

There are variances which will make it either easier or more challenging to make progress towards a split. And here’s a curve ball, some individuals may even have a different alignment between their left and right sides.

If you achieve the splits super easy, you may have a wider hip angle (aka Coxa Valga). If you’ve ever heard of the term Hip Dysplasia, this condition can sometimes be in conjunction with a larger hip angle and this allows for a lot of rotational movement, but not a lot of stability to control the hip joint in these ranges.

If you feel blocked in the hips or feel sharp pain in your hip joint, especially when in a side split stretch (ie. with one or both legs out to the side), you may have a smaller hip angle (aka Coxa Vara) which means that there will be a limited range that the hip will structurally be able to achieve.

The only way to know for sure is by having a scan but it’s not necessary for most people. What is important though, is understanding what you should feel in a stretch, and how to train accordingly for your body’s needs.

Progressive Programming

First, figuring out which structures are actually tight, versus needing to be strengthened... yes, flexibility training should predominantly be a strength workout! Working with a coach (or a physiotherapist) who can help you understand your body, and what each soft tissue needs, will help set you up for success AND help you avoid the monotonous stretching of hamstrings and hip flexors with no gains (sound familiar?) Hint: There is a reason why that alone doesn’t help.

What should you feel while stretching?

If done safely stretching is highly beneficial. Whereas, if done incorrectly it can lead to injuries associated with overstretching. This can include muscle and ligament strains (especially the hamstrings or groin), nerve pain, or damage to the joint capsule itself in the longer term.

Stretching is for the most part uncomfortable, and it’s often described as ‘painful’ which it is. It’s important to know the difference between types of pain though, and when you should be feeling a particular sensation over another.

As a rule of thumb, muscles like being held in a stretch, nerves don’t. So if you are holding a stretch and you feel sharp pain (especially in your calf), tingling, or numbness, this isn’t ideal. Further, if this is something you feel, stretching may not be the safest course of action for you in the beginning. Rather you’d benefit from getting some advice from sports physio on how to manage neural tension first.

Feeling stiff or sore (that dull, achy feeling) in your joints for days after (ie. your hips, somewhere in the knee) it might mean that you are either not preparing your body enough beforehand, or if you are on the naturally bendier side of life, then you may be straining your ligaments instead of stretching your muscles. It’s important to know whether you lie somewhere along the Hypermobility spectrum, as your training will need to look very different compared to someone who is less mobile. Hypermobility is becoming more recognised and acknowledged in healthcare, and there are a variety of Physiotherapy assessments that can help you understand your hypermobility and how to get the most out of your training.

Coming soon will be the ongoing debate in the world of splits training – Is an Open Split ‘bad’? We’ll dive into splits anatomy and what the differences are in an open versus closed split.

https://www.evolutio.com.au/blog/how-to-train-the-splits

[evolutiosportsphysioblog]

Peace & Love

Anyone involved in any form of sport and exercise knows the age-old acronym RICE. Rest, ice, compress, elevate. Damaged your hamstring? Your trainer will hog-tie it to your leg until it turns purple and screams with repulsion.

However, later that night, you’re at home watching reruns of Buffy the Vampire slayer, with the ice hanging there like a warm mojito, you suddenly can't remember what the trainer told you. Was it 20 minutes every 15 minutes, 20 minutes every hour, or an hour every 20 minutes? Furthermore, your partner no longer thinks it's cute that you're injured, and looking after you is getting damn tiresome.

Fear not, student of the world, I have your back (or leg), or whatever you’ve injured. Here are the answers to replenish your relationship and prevent your bed from turning into a waterbed disaster from our parent's generation (can you believe people slept on those!?)

Although our humble friend RICE has been a staple of our first-aid principles from before Christ was born, our information on body healing has changed significantly since this phrase appeared in our realms of understanding.  Yes, we know that ice has an anti-inflammatory effect and reduces blow flow, and with that swelling. And Yes, we know in some situations, this can be very helpful.

However, what if the body, and specifically the tissue, needs that blood flow? Don't look at me like I told you to keep your tomato sauce in the cupboard, peanut butter in the fridge, or tim tams in the freezer (legit a great idea, they last an eternity), but maybe blood is exactly what that tissue needs.  

Stay with me here, scholar of the world, you're doing a fantastic job.

Let me introduce you to the modern-day warrior. The next generation of healing disciples. Peace and Love. No, they're not my children's names, but perhaps when I move to Seminyak they will be. No Peace and Love is the new version of RICE. Here's an infographic to show you what I mean

Now we haven't mentioned "LOVE" here and that's because this is something that needs to be guided by your physiotherapist. LOVE starts to load up the damaged tissue and needs to be treated on a case-by-case basis depending on severity, injury location, age, recurrence of injury, sport…….

So, have you Injured yourself recently? Follow our modern-day warrior PEACE for the first 48-72 hours.

Are you ready to learn about LOVE? Sign up here for the next season of Love Island Evolutio, where 4 injured people are partnered up with a physiotherapist each on an island and have to rehabilitate.

Just kidding, if you actually want to know more, or you've injured yourself recently, book in here with me and use the code 'matesrates' for $20 off your Initial Physio Session. I'll save you days, hours and minutes off your injury, so you can spend it buying Tim tams, and playing the activities you genuinely Love that give you Peace.

[evolutiosportsphysioblog]

Concussion & Rehabilitation

noun

Pathology. injury to the brain or spinal cord due to jarring from a blow, fall, or the like.

-         shock caused by the impact of a collision, blow, etc.

-         the act of violently shaking or jarring.

Concussions are a form of mild traumatic brain injury that affects the way your brain functions, and have recently been thrusted into the limelight with contact sports. Many retired professional athletes are now being diagnosed with chronic traumatic encephalopathy, which is caused by repeated blows to the head and concussions (think Danny Frawley / Shane Tuck etc). Although concussions have received extensive media attention in professional sport they can often be neglected in amateur sport, especially when it comes to the recovery process.

So, how do you know if you have a concussion? What should you do if so? How can you get back to work, school, sport and all other activities? Here we go……

1.      What to look out for? Signs & Symptoms.

Concussive symptoms can start immediately after a knock, but can also sometimes take 24-48 hours to develop. Symptoms can be as mild as feeling a bit off to loss of consciousness and seizures. Most of the obvious symptoms of concussion usually resolve in 10-14 days but can hang around for much longer if not properly addressed. See the table below for a list of potential symptoms:

2.      Immediate & Follow-up Management

If you have any of the critical symptoms listed, seek urgent medical attention at your nearest hospital emergency department to rule out significant injuries. Otherwise, the athlete should remain in the presence of another individual, avoid driving and any alcohol and consult a professional re: medication use.

For the 24-48 hours post-concussion cognitive and physical rest is required. This includes time off work / school and avoiding activities that provoke your symptoms. Low stimulation is your friend during this time, which means no television, screen time, excessive light or noise.

It’s also recommended to jump in with a Physiotherapist. In these early stages they can screen for any neck injuries or whiplash that occurred simultaneously and assess if headaches or other symptoms are originating from sources other than your concussion and begin treating them. Physios are also able to start a plan for returning to day-to-day activities and sport.

3.      Getting back to Life and Return to Sport

After the initial period has passed, if your concussion symptoms are settling and have planned your return to activity with your physio you can resume some day-to-day activities around the house and begin some very light exercise. This can sometimes commonly provoke symptoms; if it does cause significant and sustained deterioration in your symptoms then you aren’t ready yet to complete that task and need to give your body more time to recover.

This is where working in conjunction with your physio is really important as each person’s road to recovery is different and will require tailoring to the individual. Rehabilitation can include exercises, massage and soft tissue work, neck specific rehab, visual and vestibular rehab and a structuring a plan to return to contact and games.

An example of our treatment plan looks like this………

Please note this return to play plan, is only an example and is not a one size fits all. Every individual will need to have a plan built based on their injury, symptoms, previous incidents etc. So please don’t follow this without consulting a professional.

If you’ve had multiple issues with Concussion injuries or it’s your first time dealing with one, it can be quite worrying at various times. Come and talk to an Evolutio Physiotherapist today, we can work in tandem with the Melbourne Concussion centre to help you return to sport and monitor your progress safely.

We’re lucky enough to have Mitch write this blog for us. Mitch has worked extensively with football clubs and heads up the main Physio role at Melbourne High Unicorns (Go the Corns) after time at StKilda Football club as a trainer. He’s an exceptional physio, and all round good guy. If you need help with Concussion, just want a chat or you need help moving house, give him a call. You can book in with him here

[evolutiosportsphysioblog]

Mixed Grip Deadlifts are Still Fucking Stupid. Misogyny Aside, Version 2

About three years ago now I wrote what I thought was a pretty banal blog about deadlift grips. Every few months or so it gets someone all huffy in the comments, and we laugh. The pinnacle was reached last year when a Mr. “Tony Mak'' left this absolute diamond:

“You don’t know what the fuck you are talking about. Come lift with real men repping 700-1200 lbs* with mixed grip. Get your girly shit outta here”

I’ve been chasing that high ever since. Tony, if you’re out there: I miss you every day.

*For reference the world record, held by Hafthor Bjornsson (AKA The Mountain), is 1,104.5 pounds for one rep. So there are probably quite a few people who would love to meet our Tony and his 100% real and not made-up deadlift that definitely exists.

Honourable mention also goes to Blake, who calls me names and mentions being “outlifted in front of your girl”. I love you too, boo.

Sarcasm aside, how about the misogyny?

I disagree with most of the comment-leavers, but that’s great - the world needs different points of view. I’m open to changing my mind with new information and I’m always here to talk it out. Not that that would be a particularly interesting chat in this case because anyone who read past the headline knows the gist of my blog boils down to : double-overhand is better for you than mixed grip, except for when it’s not.

Which, you’ll note, has NOTHING to do with gender.

I don’t have a habit of pulling my punches, and I don’t expect anyone else to, either. Unnecessarily aggressive debate is why I get out of bed in the morning. (Pls refer to previous blogs or ask Phill the physio for confirmation). But there is a difference between talking smack and being sexist and I’m not here for anyone who can’t tell - or won’t learn - the difference. 

Instead of refuting the point, people like T.Mak will attack the person making it. In this case with an attempt to denigrate femininity in order to dismiss opinions coming from women and non-men as somehow less valid.

This is known as an ad hominem argument and is the intellectual equivalent of going for the player rather than the ball. It’s a dirty move, it’s beside the point, and it lacks finesse. This one isn’t even original, so I’d give it a 1/10 at a stretch.

The term “real men” is also revealing, suggesting that not only men, but specifically only real men, have a right to express themselves on this topic. 

But what is a Real Man? How could we ever define that? Is it someone who can deadlift 1200 pounds? Cos that’s precisely zero persons worldwide, my dude. 

But apparently Tony knows what makes a rEaL mAn - which would make him the realest of the men, right? Uh huh sure.

As for the heinous crime of “being outlifted in front of your girl”. As if a woman’s place in the gym is to clap our tiny hands and squeal in feminine delight when our male partner lifts more metal off the ground than some undefined Lesser Man… sweet Jesus please let it be tax time because I cannot think of anything more boring. 

Insinuating that women are there to admire men’s achievements rather than work on their own is peak misogyny, not to mention full-on narcissism.

Blake’s word choice is also telling. Possessive pronouns aside, surely by his own logic being outlifted BY your girl would be an even sicker burn? But that implies that women have every right to be in the weights room, lifting heavy… and if you let that idea have any air then the whole house of cards starts to shake.  

The implication of comments like these are that women and non-men are not welcome in (what they see as) male spaces (eg: gyms) unless they toe the line. And that when they don’t, it justifies the use of dismissive and bullying tactics to put those intruders back in their place.

But possibly the most problematic aspect is the blind assumption that the writer of my article must be a straight man (and as such would be absolutely ruined by allegations of girliness). 

I understand that my name can be confusing - but there is a picture of me looking girly AF, as well as a bio including the word ‘she’ and ‘female’, literally one centimetre below the last line. (Not that I needed any confirmation that they hadn’t read past the first paragraphs.)

To me, this reveals that it simply does not occur to them that a person with an opinion about lifting weights would be anything other than male. Like, not even worth the five seconds it takes to check. 

Not that I’m shocked - it happens all the time.  

Yeah it is changing but sadly it hasn’t trickled down to the bottom of the swamp, yet.

I kind of can’t believe it even has to be said at this point, but the idea that any kind of physical pursuit affects a person’s Femininity or Masculinity is a colossal rip-off to all genders. 

It stifles women by putting up stupid barriers to waste our time. Having to answer back to this shit, and talk about how my hobbies somehow don’t match my genitals, has been a part of my life for as long as I can remember and I’m bloody tired of it.

It stifles men by making it seem like the only true goal is becoming a Real Man - and you’d better believe those goalposts don’t stay still. 

And it perpetuates the myth that we all have to fit into these two little gender boxes, and that anyone who falls outside or in between doesn’t get to be heard.

Peta, works here and there for us as a Remedial Therapist, but is transitioning into a Full Time roll with the Melbourne Fire Brigade. However she still writes cool shit for us, and looks after our plants. She’s been part of our team for the past 5 years.

[evolutiosportsphysioblog]

The Four Ways Dry Needling Can Help Your Body during Physiotherapy Treatment

Dry Needling is a useful treatment technique that can be used for many acute and chronic presentations. It is a minimally invasive procedure where fine needles (the same needles used in acupuncture) are inserted into muscle. The needles target what we call myofascial trigger points, which is a fancy way to say tight spots in muscle. These myofascial trigger points are often hypersensitive and associated with pain, they are commonly felt as palpable knots or taut bands. 

As physio’s we commonly see things present in patterns within the body so a lot of the time we can target a specific muscle with dry needling or we can target a group of muscles that may be over working or dysfunctional. 

Although the process in which dry needling works is not fully understood there is a lot of research suggesting some of its benefits and potential mechanisms of action. In a clinical setting we know it works well for the right conditions. The main mechanisms of dry needling are stimulation of blood flow and the local twitch response. There are also some newer mechanisms, which relate to dry needling, but also the positive effects that physiotherapy and rehabilitation can have on neuroplasticity and pain.

1. Increase Blood Flow 

Pain caused by trigger points is due to hypoxia (low oxygen) and decreased blood flow within the trigger point. When muscles contract they occlude blood flow, think about this clench your fist for 5 minutes - after 30 seconds you might notice your knuckles start to become whiter, your hand starts to ache and your grip seems to fatigue. After a few minutes you feel like you need to shake your hand out and open and close your fingers, which stimulates blood flow and your hand feels normal again. 

Lack of blood flow leads to a decreased pH which activates the muscle pain receptors (nociceptors) to restore homeostasis. Placement of Dry Needles into muscular trigger points increases blood flow and helps the muscle relax. 

2. Local Twitch Response 

Dry needling can induce a ‘local twitch response’, which  is described as stimulation of an involuntary spinal cord reflex. A spinal cord reflex is similar to a patella tendon jerk reflex. Think back to when you saw a doctor/physio test your reflexes using a reflex hammer. The most common one people know is the patella tendon reflex. Hitting the patella tendon at the right spot, causes your leg to kick outwards. What also happens after the kick is that the leg falls back down again. So you get a contraction and then a subsequent relaxation of the muscle.  

The ‘Local Twitch Response’ is suggested to reduce concentrations of chemicals found in active myofascial trigger points such as calcitonin gene related peptide, substance P, serotonin & interleukins (Shah et al. 2008). The reduction in these pain producing chemicals is thought to be due to increased blood flow and changes to pain fibre firing (nociceptor fibres). Typically, clients can feel a reduction in pain instantaneously or might notice a dull ache that resolves within 12 to 24 hours post treatment. 

3. Stimulation of the body’s endogenous opiate-like chemicals (endorphin & serotonin)

It is well established that acupuncture stimulates release of the body’s own endogenous opiate-like chemicals such as endorphin and serotonin. These chemicals have a positive effect on the brain and spinal cord, reducing nociceptive input (pain signals to the brain). These findings about acupuncture may be able to be extrapolated to dry needling, however more research is needed. 

4. Stimulates Neuroplasticity in the brain affecting areas such as the Somatosensory Cortex 

Current literature on pain sciences, now links local changes at a muscular level and spinal cord level with changes in the brain and how your body perceives pain. Dry needling as described above can have positive impacts on pain and therefore can have an effect on the brain’s chemistry. From a rehabilitation point of view if we can decrease someone's pain and then provide movement back into their system, their brain learns from these experiences and as a follow on effect rewires and creates new pathways. 

Interestingly, a part of the brain called the somatosensory cortex, which is the part of the brain where you perceive your body,  changes as a result of chronic pain. Australian Professors of Pain Science Lorimer Moseley & David Butler describe a phenomenon called ‘smudging’, where due to pain your perception of your body changes. This then decreases the accuracy of pain signals and may result in pain almost being learnt as a habit rather than from a structural issue or injury. Dry needling may offer a way to break the chronic pain cycle and allow movement, strength work and rehab to happen that can create a positive experience and therefore change the brain's circuitry and reverse smudging. 

The effects of dry needling can be varied from individual to individual as always. It is one treatment modality that we can offer, but in isolation rarely can solve someone's pain. Incorporated as part of a rehab program it can offer a very effective means to relieve someone's pain and allow them to move more freely and get stronger in the right areas. 

References 

Butler, D. S., & Moseley, G. L. (2013). Explain Pain 2nd Edn. Noigroup publications.

Cagnie, B., Barbe, T., De Ridder, E., Van Oosterwijck, J., Cools, A., & Danneels, L. (2012). The influence of dry needling of the trapezius muscle on muscle blood flow and oxygenation. Journal of manipulative and physiological therapeutics, 35(9), 685-691.

Chou, L. W., Kao, M. J., & Lin, J. G. (2012). Probable mechanisms of needling therapies for myofascial pain control. Evidence-Based Complementary and Alternative Medicine, 2012.

Fernández-de-Las-Peñas, C., & Nijs, J. (2019). Trigger point dry needling for the treatment of myofascial pain syndrome: current perspectives within a pain neuroscience paradigm. Journal of pain research, 12, 1899.

Hong, C. Z. (1994). Lidocaine injection versus dry needling to myofascial trigger point. The importance of the local twitch response. American journal of physical medicine & rehabilitation, 73(4), 256-263.

Shah, J. P., Danoff, J. V., Desai, M. J., Parikh, S., Nakamura, L. Y., Phillips, T. M., & Gerber, L. H. (2008). Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points. Archives of physical medicine and rehabilitation, 89(1), 16-23.

Unverzagt, C., Berglund, K., & Thomas, J. J. (2015). Dry needling for myofascial trigger point pain: a clinical commentary. International journal of sports physical therapy, 10(3), 402.

All our Physio’s & Myotherapists use Dry Needling as part of their treatments. This blog was written by Bayden. He is our friend. He could be your friend too. He’s been voted the number one Physio in Melbourne 15 years running. With a special interest in foot biomechanics, Flexor hallucis longus, powerlifting and running injuries. You should see him. You can book in here.

[evolutiosportsphysioblog]

How to Ace your Return to Run Post ACL Reco

It is the question that every sports person wants to know after they have had an ACL reconstruction - when can I run again? And the answer is: it depends! ACL rehab is not linear or time-framed. Rather it is imperative to tick off certain criteria to ascertain whether your body is ready for the rigours of running. And everyone will progress at a different rate. So how do you know when you're ready to return to running post ACL injury? Read on to find out…

Keys for returning to run post ACL reconstruction or even with out a reco:

1. No swelling within the knee.

Swelling or effusion within the knee is you're knees way of screaming “Oi pal, back off - I’m a bit pissed off”. And we need to really listen to this. Swelling within the knee capsule tells us that the demands you're placing on the knee are outweighing its current capacity. Adding a high impact exercise on top of this is just going to make your knee, and likely you pretty grumpy.

2. Full range of motion of the knee

Trying to run on a knee that won’t straighten or bend is like trying to walk through a door that only half opens. I just doesn’t work very well. Extension is particularly important, and ideally we want this equal to the opposite side. We start working on this the moment you are out of surgery. Flexion is important as well and you should be able to bend your knee to about 90% of the uninjured limb before you start to run.

3. Quad strength 70%+ compared to the other side

Not only do big rippling quads look fantastic, they’re pretty bloody important to our function as well. Insufficient strength through our quads to absorb the impact of running will lead to some pretty crook gait patterns and the possibility of the knee buckling. This is best tested with hand held dynamometry like …. which we have in clinic.

4. 90% limb symmetry in functional strength tests

Its all good and well to see that you have strength with numbers on a screen but we want to see that you can use that strength and show us some good endurance. Performing some functional muscular endurance tasks well and being similar to the other side is imperative prior to running. These could include single leg squats, side planks, hamstring bridges and single leg calf raises. This will give us a good idea if there is a weak link that might pop up during your gait

5. Good gait mechanics 

You know the Victoria Secret fashion show where the models are strutting their way down the catwalk looking all majestic with their hips swaying side to side? Yeah, physio’s really hate seeing that. Good gait mechanics include being able to control your hip from dropping excessively during the stance phase of gait. Performing some running related drills or movements with sufficient control tells us that you’re ready to run. 

6. Hopping competently 

When running you spend no time with two feet on the ground, hence why it is so important to be able to control yourself on one leg. Hopping is a perfect example of this. Someone who hops well will show good force production and absorption at the ankle and hip. Our knee is a direct product of what happens at the joints above and below. 

But how will I know if I am ticking all these boxes?

Not to toot our own horns but having a physio to guide you through the rehabilitation process is pretty important. Knowing what to be doing and when you should be doing it will make the transition from surgery back to running all the easier, and most importantly, safer.

This is Scott, one of our amazing Physio’s. He Loves working with clients whom have injured their knee, including ACL ruptures. Book in with him here!

[evolutiosportsphysioblog]

How to Use Blood Flow Restriction Bands at the Gym

1.      Start by using either a pressure cuff or floss band to allow for blood flow restriction. In our clinic we use the latest Sports Rehab Tourniquet device. For those wanting a ‘prison-fit’ vibe, floss bands are great, (especially for all the crossfitters who have them stashed away in their gym bags).

2.      Aim for 60% of Max Blood Flow Occlusion Depending on what device you’re using, science says all the good things seem to happen around 60% of max blood flow occlusion. This allows for just enough venous restriction with continued arterial blood flow.

With a Sports Rehab Tourniquet - pump the pressure until you can no longer feel an arterial pulse (my advice it to use medial malleolus/ inner ankle pulse). Then measure approximately 60% of that OR aim for between 130-150mmHg – for first timers start lower (thank me later). For floss bands it becomes more of a guessing game. Wrap around the limb as if you’re compressing a bleeding wound. You’ll know quickly if it’s too tight; main complaints are the limb is now purple or you have one hell of a pins and needles party going on and can’t move it. Not to worry, just loosen it off a little.

3.      Begin the exercise(s) of choice with the following rep schemes; 30-15,15,15 or 40-30-10-5. There is no concrete evidence for repetition amount currently, however science likes to follow the reps of 30-15-15-15. I believe it’s important to consider why you’re choosing blood flow restriction training in the first place – hypertrophy (lets chat endurance and BFR next blog). So high reps / volumes are required, especially the first set as it allows for a pooling effect from the start. For all of the science stuff and a more detailed outline of what occurs physiologically check out Peta G’s blog – ‘Blood Flow Restriction training during this glittering tropical storm of cosmic proportions’ Blood-Flow-Restriction-Training For training purposes, aim for one long set followed by 3 shorter fatigue sets, giving yourself 30-60 seconds rest between sets. The goal is to leave the cuff on for the whole time. Depending on how many exercises you’re doing, the cuff will remain on for 5-10 minutes.

4.     Then let the Blood Flow Restriction magic happen. This is the time to put your game face on, grit your teeth and grind out some reps. Is it easy? Nope. Will it hurt? I’d say it’s more of a tickle – like the type your cat gives you when he’s starving and really wants his biscuits, that kind of tickle. Like most training elements there is some hurt associated with it. To quote my great mate Peta “It burns. A lot. In a way that it would be pointless for me to try and describe; you reeeeeally have to experience it yourself. but you can’t say I didn’t warn you” There are a lot of nice things happening to your joints, ligaments and tendons that are now getting a short holiday from any extra stress load.

5.     When to use Blood Flow Restriction? Blood Flow Restriction training can be used during; gym training, hypertrophy training, rehabilitation, body sculpting, tendonopathies, or post surgery. If you can understand what your aim is, then you’ll know when to use it.

Or just ask me!

Phill is one of the leaders of the free world. Currently working as a dual clinic manager here at Evolutio, he has strong interest in Olympic lifting, strength, conditioning and blood flow restriction for biceps. He is currently the Rehab Physio for the AFL Bulldogs women’s team here in Melbourne.

You can book in with him here!

[evolutiosportsphysioblog]

Anatomy in Motion

Five years ago I was lucky enough to come across a treatment modality that just resonated with me. This particular treatment style isn’t necessarily a treatment style, rather, a framework to view, assess and understand the human body in a different way. 

Gary Ward was the founder of AiM - Anatomy in Motion and author of ‘What The Foot’. His book and course has basically reverse engineered how the human body moves gracefully through the gait cycle (aka walking). Through using Gary’s flow motion model we can assess a client's look at their movement and based on the flow motion model look at what they are doing well, what they lack or what they have trouble accessing. It gives you a great way to essentially interview the body assess and limitations, lack of movement or areas that move too much. 

Flow motion model breaks gait into phases: Strike, Suspension, Transition, Shift, Propulsion and Swing each of these phases takes you through a full cycle from left foot contact through to swing and back to left foot contact again. Gary broke down each phase into its mechanics and looked at what happened at each joint of the body in 3dimensions, if that sounds like a lot, it is. But through this he was able to make something very complex and mind boggling into something clean, concise and at times seemingly simple. 

As a part of his Flow Motion Model, he was able to establish 5 laws of motion that are relevant for human locomotion. 

1. Joints act Muscles React

Muscles can only shorten (concentric contraction) or control the rate of lengthening (eccentric contraction). During the gait cycle muscles will always load due to joints either opening or closing. 

2. Muscles Lengthen before they Contact

To effectively use a muscle or group of muscles in human movement you need to first lengthen it and then it will contract. Take hamstrings for example they will lengthen at heel strike and then shorten with the glute to pull the body forward and then drive off into the next stride. 

3. Everything Orbits Around Centre 

Walking and human locomotion is essential just mass management and utilising the effects of gravity. Looking from the centre there are small subtle movements and the further out from centre the more pronounced the movement. 

4. Perceived Centre Dictates Pain, Performance and Potential 

Humans are amazing at compensating. The central nervous system has control over what we experience or don’t experience. Perception of what that is is individual and what we think we are doing may be complete or may be partially complete. It’s like the quote 

“There are known knowns, things we know that we know; and there are known unknowns, things that we know we don't know. But there are also unknown unknowns, things we do not know we don't know.” Donald Rumsfeld.

5. Perfection is Hardwired and Pre-Installed 

The human body has an amazing capacity to compensate, but also has an amazing potential to heal, adapt, get stronger and thrive. Put in the right conditions, environment and stressors it can do things that most people wouldn’t even dream of. Tapping into this intuitive process can have an effect of years of pain disappearing within a few sessions, unlocking new ranges of motions, freeing up ‘tight’ tissues or making movement effortless.  

These 5 Rules once experienced in your own body make so much sense. During an AiM session in the clinic I’m constantly amazed at peoples faces when you get their foot to pronate and then their glute springs to life. They always walk lighter and can’t believe what you have done to them. 

Book in for an Initial or and Extended Consult with Bayden Senior Physiotherapist and our Anatomy in Motion Practitioner 

This is Bayden. He is our friend. He could be your friend too. He’s been voted the number one Physio in Melbourne 15 years running. With a special interest in foot biomechanics, Flexor hallucis longus, powerlifting and running injuries. You should see him. You can book in here.

[evolutiosportsphysioblog]

The Best Shoulder Strength Exercise – Bar None

COVID has brought about many travesties and hardships to us all. Times are indeed tough – we cannot visit loved ones or get outside for hours on end to enjoy the delicious Melbourne winter weather (which seems to be one of the more mild ones in memory just to rub it in our faces). Gyms are closed, and so are our favourite restaurants and bars – this has forced me into finding a different type of bar to pass the time and get me through COVID lockdown 2.0 – the kettlebell arm bar.

Before you start worrying that I may have hung up my drinking hat for a life of sainthood I can assure you that as soon as the bars are back open, I will be one of the first to be banging on the door asking the publican to let me in. But for now, having some more time to dedicate to getting a pesky, recurrent shoulder niggle back under control is somewhat of a silver lining.

The kettlebell arm bar is a great exercise to improve your strength, mobility and stability all while giving your thoracic spine a nice opener as well. Not since Maccas were slinging cheeseburgers for a gold coin donation have we seen such great bang for your buck.

I once heard someone describe the shoulder joint as a golf ball sitting on a tee. And this is a pretty apt description as the humeral head (top of your arm bone) is far larger than the glenoid fossa (part of the scapula) that it articulates with. The capsule and passive structures around the shoulder provide little stability to the joint, this means the active structures, operatively the muscles, play a massive roll in controlling the shoulder.

The other difficulty with the shoulder is that the scapula is also a very mobile articulation as it moves around the rib cage throughout different planes. The scapula has a highly variable motion between individuals. This is where the arm bar can really help you to learn how to control your shoulder blade, prepping you really well to attack any sort of press or pull exercise.

I have been incorporating a lot of these lately not only into my programming but also for clients who need some assistance with shoulder mobility, lat activation and learning to use their lats and serratus anterior throughout pressing exercises.

So here goes:

 1.     Lay on your back with your kettlebell in one hand. Press it to the roof and lock out the elbow

2.     Bend the knee up on the same side as you are holding the bell. Take the opposing hand up above your head

3.     Push through the foot, rolling yourself onto your side. Keep your arm pointing vertically to the roof. At this point it is really important to try and activate the lat by depressing the shoulder blade – this should pack your shoulder into a nice and stable position

4.     Take your top leg over to the floor – from here you can continue to rotate through your thoracic spine, maintaining the scaps squeezed back and down and your gaze on the bell

5.     Maintain this position for a few nice controlled breaths and then reverse the motion to come back to the start

Voila, now you can knock out the kettlebell arm bar. Feel free to thank me when you have shoulders like boulders and are turning heads in your muscle tee when Melbourne finally opens back up in time for Summer!

This is Scott, one of our amazing Physio’s. He wrote this blog on the kettlebell arm bar, so you can be a jet like him. Book in with him here!

[evolutiosportsphysioblog]

Your Ego is Ruining your Running

The passer-by

It’s my first long run after a couple weeks off and I'm struggling through the last kilometre. I spot someone up on the path ahead. It’s a man walking his dog and heading in my direction. I discreetly adjust my posture - stand tall, shoulders back, strong strides. I’m getting closer, about 10metres away. I have to time this just right. I wait until the last moment. Í take one last breath of air and then, holding my breath with the most relaxed face I can muster up, I seamlessly glide past the pair, abdominals braced, silent and effortless as if I could do this all day! 

A couple more strides to get out of earshot and I open my mouth in a panic, gulping in as much air as I can. Red faced and my form deteriorating into loud foot-slaps onto the pavement, my whole upper body catches the wind like a giant windsock, slowing me down as I struggle to regain my breath. 

I’d love to say that every time I run it’s fast, effortless and graceful, but it’s just not. No one expects people to look perfect or perform phenomenally every time, so why is it that we feel the need to impress others every time, or give off the impression that we’re better than we are?  

Pro’s don’t post the boring stuff. 

Long slow walks, boring repetitive training sessions where you hardly work up a sweat, or a slow monotonous jog. This isn’t the type of stuff getting posted to social media or uploaded on Strava. Does it mean it’s not being done? No. Every pro athlete is doing it, but they’re just not posting about it. And why would they? It’s boring! But it’s also super important. 

When we exercise for a period of time, we increase our heart rate. Heart rate increases more with longer efforts, and harder work rate. So it makes sense that a slow 5k run will increase heart rate less than a fast 5k where we are really pushing our speed up. Our heart rate is controlled by our heart. The heart is a muscle. 

When exercising at the gym, it’s common to alternate upper body days with lower body days. We do this because we know that working the same muscles hard, twice in a row, doesn’t allow enough rest time and can lead to injury. But how much have we thought about our heart as a muscle? If we are pushing to our max effort every workout and every run, when are we letting our heart muscle recover? 

Sure we aren’t likely to “strain” our heart muscle like you strain a calf. But what does result is increased general fatigue, poorer ability to perform in subsequent sessions, and reduced return in fitness improvements.

So this is where the easier, boring days (that no one posts about) are key. When athletes say they train 12 times per week, they aren’t hitting 12 PBs a week. 

So, next time you’re planning your weekly training sessions, remember that it’s the mixture and variety of both lighter and heavier workouts, that combine to make a more resilient and robust athlete. Enjoy your weekly speed sesh or ego boost as you charge around the Tan Track, but also don’t be ashamed to log a slow recovery run on Strava, or you could do something really outrageous - don’t post it!

This is Kristina. She’s cool like us and one of our senior physio’s with more experience in the snow than many of us have on land. You can book in with her here for a session face to face. Or here for a virtual appointment.

[evolutiosportsphysioblog]

Mixed grip deadlifts are fucking stupid

 Warning: strong language.

Also warning: rant.

A mixed grip deadlift is when you hold onto the barbell with one hand in a supinated/underhand position (palm facing out) and the other in an overhand position (back of hand facing out).

It can make deadlifting feel lighter or easier on the hands by sandwiching the bar between the opposing fists.

I reckon everyone should stop doing it so fucking often, and here's a comprehensive list of reasons why: 

It looks dumb

It is dumb.

An overhand grip with straight arms and good scapular retraction (shoulders back and down) will recruit the big, broad muscles of your lats to connect your arms, core and back to the lower-body powerhouse of the pull. 

The underhand grip, on the other hand (lol), will force that shoulder into a more protracted position, resulting in more tension through glenohumeral joint of the shoulder, specifically the long head of the biceps.

The glenohumeral joint is sometimes referred to as the 'true shoulder' and is involved in all of your favourite arm-based activities. If you like doing stuff, this is a joint you'd probably like to keep intact.

Biceps tears can and do happen during heavy deadlifts, and are more prevalent in the supinated arm. Chronically speaking, biceps tendinopathies are not much more fun.

Basically your lats are a lot bigger and stronger than one half of your biceps* and so will do a better job of taking that load and keeping your shoulder safe.

*if this is not the case please do a shitload of lat pull-downs every week for the rest of your life, thank you.

Let's have a closer look at your lats. From the Latin words “latissumus” (broadest) and “dorsum” (of the back), they cover a lot of body, originating at the centre of the body from :

the spinous processes of T7-L5 vertebrae (ie: quite a few mid-low backbones)

the wide, super-strong sheet of fascia around the lower back 

the top crest of the pelvis 

the lowest 3-4 ribs 

the bottom corner of the shoulder blade, 

… and ending in a single tendon inserting into the top of the humerus at the other end. 

 We all know and love the lats for their 'pull up' actions (adduction of the arm, as well as shoulder extension and medial rotation), but aside from that they also contribute synergistically to rotation, lateral flexion and extension of the trunk. So when lats on both sides are contracting simultaneously they have a powerful stabilising effect on the spine, they keep the barbell close to your centre of gravity, and can help you keep your back from rounding. Conversely, having one shoulder more protracted and externally rotated than the other will mean one lat is in a stronger position than the other – which may lead to slight bending or rotating to that side. You don't need me to tell you that this is not ideal posture under load for the spine.

Injuries aside, constantly training one side differently to the other will OBVIOUSLY result in different muscle development on each side. The underhand side will get a gimpy lat. You don't want a gimpy lat. 

The benefit of the mixed grip deadlift is that at heavy loads it will allow you to lift more. This is because squeezing the weight between the opposite-facing hands gives your grip strength a boost. Grip is often the weakest link when deadlifting and the mixed grip is a neat way around that – at heavy loads. 

So if you are a competitive powerlifter : ignore me, get off the internet and listen to your coach.

Everyone else : the mixed grip is for competing, testing rep maxes, and for your heavy-ass working sets. It's a great tool to be able to whip out of your pocket when you really need it, but if it's constantly used in training it will actually limit strength gains. Leave it in the pocket when you're warming up or training light.

 “But I can't hold on to the bar any other way, it keeps slipping out of my hands.”

If your grip strength is your limiting factor in the deadlift, here's an idea: train your grip.

Or try chalk, straps if you must, or hook grip (thumb around the barbell, fingers over thumbs.)

 “But I don't like hook grip it's uncomfortable.”

Consider the possibility that you are a giant sooky lala. Call yourself a waaambulance.

 “But I alternate which hand is which so it will even out.”

No, you don't. Unless you keep a training diary featuring sentences like “Working sets 1, 3 and 5 were in a left-hand supinated mixed grip setup, working sets 2 and 4 and back-off set were right-hand supinated,” I don't want to hear it. I also would rather peel my eyelids off than read that diary.

You may think you're alternating your grip but I call bullshit. You're probably overhanding your dominant side more often or at heavier loads than the other side. Just keep it simple, stupid : double overhand until you're working really hard. 

“But we should be training the back to be strong and resilient pulling in a variety of positions and planes.”

Bravo, I couldn't agree more – that must be why I see you doing so many Jefferson deadlifts, hey? Or single leg deadies, single leg good mornings, single arm ring rows, landmine/torsonator stuff, Pallof stuff, renegade rows, KB windmills, TGUs ... IDGAF but if you want to train odd positions or rotation just train it properly – mixing grips at light weights is half arsing everything.

The most reliable way to ensure your training is balanced is to perform bilateral movements symmetrically (as often as sports-specificity allows), and use unilateral movements to detect and correct imbalances. 

Mixing grip on a deadlift is a handy trick, but one that should be used sparingly - once you've perfected everything else about your deadie and it's time to get heavy.

Rant over.

Peta works as our Head Remedial Therapist and S & C Coach. She’s in the VIC state team for Surfboat Rowing and owns the world record for the 1km Ergo at 30-39yrs Female category. She can also hipthrust 220kgs. You can book in with her at Evolutio here

[evolutiosportsphysioblog]

Jacked Calves and Running through COVID

So here’s what’s up with me. I reckon I’ve touched more calves in the last three months than in the preceding five years.

I’m not mad about it - it’s a really cool area to treat. It isn’t, however, usually among my clients’ favourite areas to get treated. If you’ve ever had a firm massage to the lower leg you’ll know what I’m talking about.

As usual, I’m kind of talking myself out of a job here, but I’d like to intervene a few weeks/months before you get to the point where we have to demolish your baby moomoos on the treatment table. Even if you’re already at a point where massage feels “necessary”, here’s a secret : it won’t make the hurties go away for good. 99.99% of the time, if you don’t also address the root cause of a problem, massage is only ever going to be a temporary solution.

So what is the root of the problem? To grossly generalise, lately it’s got a lot to do with running.

With gyms closed and team training’s off, a lot more people have taken up jogging as their primary form of exercise - which is awesome. However, some of us are pulling up with particularly sore and tight lower legs, and I think a lot of that comes down to a few main trends I’ve noticed lately in my calf-based clientele.

Increasing volume (or intensity or load) too fast.

The age-old rule with volume is that you shouldn’t increase by more than 10% each week, and your program should include regular deloads. I would add another principle to that : just because you can doesn’t mean you should*.

For example: if your longest run of the week is currently 5km, it should take at least eight weeks to work that up to 10km. You’re probably already more than capable of 10km, but if you up the volume up in one step, you risk overloading the system without giving it enough time to adapt. And that can equal cooked calves.

I get the impatience to get to a goal ASAP, but honestly, you will get there faster this way - rather than making the jump too soon and spending six weeks injured, only to have to start again from square one.

It can be harder to quantify, but the same principle usually applies to intensity (speed) and load (running with weight/ introducing slopes).

A common trap here is people who come in hot from other types of training, and so are fit enough for, say, a one hour run, but aren’t conditioned to that kind of volume on the trot. Similarly, those who used to do a lot of running, but haven’t for a long time, can have a tendency to forget the process of working up to big runs.

Not using the posterior chain for power

I’m yet to meet a struggling runner who hasn’t benefited from activating their glutes and hammies. Often the main mechanism that overloads the calves during running is a failure to produce the necessary force further up the chain. Ideally, the hamstrings and glutes should be generating a significant amount of running power, with that proportion going up as speed increases.

This is particularly relevant for those of us who find that we spend even more time sitting down than usual during isolation, which can cause the glutes to become ‘lazy’. Activating the posterior chain before runs, and training the hips, glutes and hamstrings for strength at the very least once a week are the keys rebalancing your running engine.

Mindset is also fundamental : do you see distance as your only running goal? If 100% of your training is grinding away at crazy long runs no wonder your calves have given up the ghost.

The faster you run, the more you’re going to recruit your glutes and hammies, so try some shorter, faster sessions and interval running with even more speed. You can even switch up the goal of your whole program - are you just training for a marathon because that’s what everyone does? IMHO, a super fast 5km is a lot sexier - and the program is generally more fun.

One of the best things about running is its “functionality” - all humans should be able to move fast on their feet. I would argue that shorter runs are a lot more functional. I mean, if the zombies do come and you haven’t outpaced them over the first few kilometres, I don’t see you doing it over the next 40.

Calf strength

Sorry, but your gastrocnemius and soleus muscles are probably not strong enough for long distances. Welcome to the club, there’s a few billion of us.

I’ve said it before, but if a muscle isn’t coping with a certain load and we can’t reduce that load, then we have to increase its capacity. To try and exemplify this with completely made-up numbers: if the calf is exerting 1 unit with each stride, but your maximum calf raise is only 10 units, that’s a 10% effort on every step. That muscle is going to fatigue fast. If you can increase the maximum to 20 or 30 units, then each step is only requiring 5 or 3% effort from the muscle, which is going to be a helluva lot more sustainable.

Calves, particularly the soleus muscle, have incredible endurance. Just ask any bodybuilder - they will cop an absolute belting without budging in size. You can train them several times a week - ideally in a program that includes concentric, eccentric and isometric exercises at moderate and high loads. Controlled loading, particularly isometric, is also crucial for tendon/ connective tissue troubles such as Achilles tendinopathy and plantar fascial pain.

Technique, technique, technique

This is a mega huge root of the problem. If you’re getting hurt because you’re not running well, then all the massages and foam rolling and new shoes and compression socks and magnesium supps and recovery machines in the world will not make a jot of difference.

Running often gets approached with an “I already know how to do that” attitude. When you set your mind to almost any other sport, you know in advance that you’re going to have to watch and learn from more advanced athletes, repeat drills, progress slowly and get feedback and follow instruction from a coach. Running, however, involves tying up your laces and heading out the door, right? Yeahnah can do, but not always. Even if you’ve been doing it for years or decades, professional input can be a gamechanger.

Obviously you can do it without one, but if you a) are trying to get into running with an existing injury, b) have a history of running injuries or c) are looking to improve performance in any way, there is nothing I would recommend more than an experienced coach.

Our mate Nathan Fenton, of Run Power Coach (@runpowercoach), Enfer Running (@enferrunning) and the Runner Chats podcast puts it much better than I can:

“A lot of people are averse to getting a coach because they feel their flexibility will be taken away; they will be locked in to do what the coach says when the coach says it.  But it doesn't have to be like that.  A good coach will be flexible with your plan and understand that you're doing this because you enjoy it, not because it's your job.  Get a coach to shorten your learning curve and avoid the mistakes that will cost you time and performance.”

So there you have it - my very incomplete list of things that may be making your calvies give you grief. We love comments, so feel free to add yours below!

*If anyone wants to call me out on calling the kettle black at this point, I hear you.

Peta works as our Head Remedial Therapist and S & C Coach. She’s in the VIC state team for Surfboat Rowing and owns the world record for the 1km Ergo at 30-39yrs Female category. She can also hipthrust 200kgs. You can book in with her at Evolutio here

[evolutiosportsphysioblog]

Why Sitting Could Actually be Your New Best Friend!

Sitting generally gets a pretty back wrap.. Sitting at your desk all day can be a pretty big contributing factor to that pesky neck or back pain that you have been experiencing. Not to mention that increasing waistline that sitting at a desk all day won't be helping.. Most health professionals might agree that sitting could be classed as the new smoking.

This may be true but as with most things in life it depends on the context. We actually use sitting in a few rehab programs to help clients work on their strength, mobility and muscle activation. Sitting can add more stability, proprioceptive feedback or gives us the ability to exercise harder or easier.

One of the best sitting exercises I have been using with clients recently is the Seated Good Morning. This exercise hands down is one of the best ways to build strength in the posterior chain, mobilize the hips, hamstrings and lower back as well as hitting the medial hamstring and adductors. I have found it really effective with clients who suffer from chronic lower back pain, hamstring troubles, groin or hip impingement and adductor issues. If you have tight hips, trouble hitting depth on squats or find everyone keeps telling you to strengthen your glute, but all the activation and strength work under the sun hasn’t helped, you need to try this:

The aim of the exercise is to eccentrically (load while stretching/lengthening the muscles) load the hamstrings, glutes and lumbar erectors. So this means when performing the Seated Good Morning you should feel as stretch in your adductors, hamstrings, glutes or lower back - it may be different depending on your body

As always technique is king:

Un-rack bar or you can use a broomstick

-       Position bar on shoulder blades, shoulders back and in, wrists strong

-       Abs braced - keep rib cage down and stacked over hips

-       Lean chest forward aiming for down in between knees

-       Feel like hips are rolling over - “stick your bottom out”

-       Knees push out wide

-       From the bottom to the top drive heels into the floor and squeeze your bottom

-       Repeat for desired rep range

For rehab depending on the individual we tend to start using a broomstick and then program to an Olympic barbell. Depending on the desired result adding weight as required. A nice goal for most clients would be body weight load on the bar 3x8 reps chest to bench. All reps are strong and controlled.  Or pushing the envelope to do this !?!

As always feel free to have a play. If you have any trouble let us know or get in for a session because if there is a problem, it potentially is the cure you have been looking for just in disguise. 

This is Bayden. He is our friend. He could be your friend too. He’s been voted the number one Physio in Melbourne 15 years running. With a special interest in foot biomechanics, Flexor hallucis longus, powerlifting and running injuries. You should see him. You can book in here.

[evolutiosportsphysioblog]

Blood Flow Restriction training during this Glittering tropical fuckstorm of Cosmic Proportions

At time of writing the only people who have access to all the gym equipment they need to train with any kind of normalcy are either very lucky, very resourceful or very rich.

Personally, I’m not the kind of person to have a gratitude journal but if I did I’m sure there would be many pages on how grateful I am that my amazing gym loaned me some of their weights, I was able to borrow some from the clinic, and my twin sister has been stockpiling second-hand gym equipment from Gumtree for years (I’m sorry about all the jokes Kel - it wasn’t weird, you are a fkn genius.) 

Everyone else has to be a bit creative with what they can do at home, and it’s great to see the number of home workouts and creative new things being shared around.

A lot of the people putting that content out there are a lot more qualified, original, innovative and fun than I am so far be it from me to to try to add to that pile.

What I would like to bring to the table is the renewed relevance and utility of Blood Flow Restriction training during this glittering tropical fuckstorm of cosmic proportions in which we find ourselves.

BFR training involves applying a device to the arms or legs that partially occludes the blood flow, before performing body-building type exercises. I’ll get into the science-y crap in a bit, but basically what makes it especially useful at the moment is that it allows you to train, very hard, with weights that are only about 20-30% of what you would usually be using. In addition to that, it allows you to place an enormous stressor on the muscles, while taxing the joints and tendons relatively less. Which, certainly for me, neatly ticks both the “I’m using isolation to get totally massif” and the “maybe I should be using this time to let my body recover a bit” boxes.

So how do you do it? Ideally you have a blood pressure cuff for each side but you can also use elastic wraps. These are applied at the top of the arm or leg, or below the knee for calves. Tightly. Well, not to start with but they do get real cozy real fast.

Don’t worry, they mostly occlude venous return rather than arterial supply to the muscle. That means blood is still coming in, but it’s not getting back out of the area. You have to get it pretty wrong to do any damage. We recommend occluding for the time it takes you to do a superset, so probably around five minutes. But I’ve been occluded for up to half an hour and I still have both arms, promise.

It’s really only useful for hypertrophy training, so should be used with high reps. One of the more common BFR rep schemes is 30-15-15-15, but 4 or 5 by 20 is also good and we do 40-30-10-2 because LOLsies. It’s not really that important what rep scheme you choose because they all work fine and you probably won't be able to do the last reps of the sets anyway.

How does it work? Ok here we go. There are a lot of theories and I’ll try to outline the main ones I’ve seen - if you don’t care about the science then you can snooze here for a bit.

As I mentioned just then, BFR allows blood to enter the working muscles, it just blocks the ‘used’ blood from getting back out. This results in a pooling effect where there is physically a higher volume of blood in there than there ‘should be’. AKA the pump is very, very real. One theory suggests that this can lead to cellular-level swelling and muscle growth is an adaptation to try and accommodate the extra blood.

In addition to the sheer volume of blood, the muscles become deprived of oxygen and waste products accumulate, creating a LOT of localised metabolic stress, which is one of the three mechanisms of muscle growth. (The others being mechanical tension and muscle damage.)

On top of that, due to the diminished availability of oxygen, slow-twitch fibres will fatigue much more quickly. Slow twitch fibres are oxygen-dependant and they are the ones we are training with body-building type exercise. BFR allows us to not only create that hypertrophy stimulus for slow-twitch fibres using much smaller weights, but once they spent the fast-twitch fibres will also get called in. Those guys usually only get out of bed for sprints, explosive work and very high weights (aka higher-risk training), but if you can get them working they really come to the party for muscle growth.

If you want to dive down another level, there is also evidence that BFR training elevates hypertrophic signaling, specifically growth hormone and insulin-like growth factor, as much as or possibly more than equivalent but non-occluded resistance training. Hypertrophic signaling is a term for the hormones and substances that are released in response to exercise. They signal to the body that some (good) damage has occured to muscle fibres and that they need to be rebuilt - but a bit bigger and stronger to resist damage in case that activity happens again. This is the adaptation that training is trying to elicit.

In a rehab setting, BFR allows us to perform hypertrophy or strength-endurance training on a muscle group when an associated joint, ligament or tendon is perhaps not ready for loads that those muscles would otherwise need. This allows for low-risk re-introduction of resistance training, and is great for reversing muscle-loss or atrophy after injuries.

OK downsides chat:  as you can see, it’s kind of a way to trick your muscles into growing bigger. However, ya central nervous system isn’t as easily duped. Gains in actual strength come from neurological adaptation to load as well as growth in muscle size. At the end of the day we’re still lifting pretty light weights during BFR training so it doesn’t increase strength as much as it works on muscle size. That said, most strength programs start with a lower-weight hypertrophy phase - so we can transition smoothly into strength gains once quarantraining is over.

Oh also it burns. A lot. In a way that it would be pointless for me to try and describe; you reeeeeally have to experience it yourself. But you can’t say I didn’t warn you. The flipside of this downside is it’s pretty hard to think about COVID-19 when your arms are full of molten lava.

So if you're interested in giving this a go, we would love to hear from you! We have floss bands in stock and all it takes is a virtual appointment to get you started. We will ask for pain face photos afterwards though because that's almost the best part.

Peta is our Remedial massage therapist at Evolutio. She's an elite Surf Boat Rower, holds the 1km Ergo world record (30-39yrs F) has coached CrossFit for several years and is a qualified S&C coach. Peta works Tuesdays and Thursday afternoons at our clinic in Richmond. You can book in with her here

[evolutiosportsphysioblog]

take a Walk on the Wild Side

Thinking back to my teens, I distinctly remember hearing my mum talking about going for a walk and thinking to myself “what a lazy form of exercise”. I thought, “my parents just got slack, that’ll never happen to me”, and “why walk when you can run??”. 

How immature and completely wrong I was! 

As a teenager without a car, walking ten minutes each way to the train, then a further twenty minutes each way from my stop to school at the other end. Walking across the school campus between classes, attending regularly PE and a variety of daily sports. How was I to know that in fact I WAS walking as part of my routine. That the reason I could run so easily was because I had such a solid base of strength from my high, yet totally unnoticed, incidental daily walking. 

At university and driving my first car, the walking decreases slightly, then to my first job sitting at a desk, I still walk to take the train into the city but am hardly on my feet through the day.  Another few years on and I move into the city. I don’t need to take the train so I ride my bike door to door, living the dream!

Still sitting most of the day, but I’m at the gym doing classes 5-6 times per week so able to keep up my fitness… 

But wait! Where did my walking go? 

It just so happens that around six months after the change to bike and loss of walk to/from the train station I sustained my first running injury. Coincidence? Maybe not… 

So what are the benefits of keeping up walking in your routine, and why might it become an issue when we stop? 

1. Hip Stability

Our hips are the most stable joints in our body. The most stable hip position is a flexed hip positions, for example sitting or squatting positions. In this position the top of our leg bone sits deep into our hip joint and is stabilised by the bony joint surfaces, requiring less muscle control to maintain the position. 

When we are standing there is less of this natural structural stability, and our muscles need to work to provide stability. 

For this reason walking actually requires far more muscle stability and strength than sitting at a desk, or even bike riding. 

How much activity or exercise do you do in a standing position?

2. Avoid foot and ankle pain and injury 

Now I want you to imagine an apple, and a tennis ball. First take the apple and bang it repetitively onto the ground with moderate force. It shouldn’t take long for the apple to begin to break down and be crushed by the force into the ground. Now take the tennis ball and repeat the same thing. The tennis ball would take hours, if not weeks to show signs of breakdown. 

The apple and tennis ball can be likened to the well trained foot and ankle (tennis ball), or the untrained and weak foot and ankle. Someone that is a regular walker and has developed adequate strength and maintained regular loading will have a better resistance to load, whereas the untrained foot and ankle, like the apple will be far more susceptible to overload and failing. 

Don’t be the peach! 

3. Posture

Slumping and poor posture is more common than ever before. But we weren’t designed to slouch, just like we weren’t designed to sit all day. 

Walking has the ability to “wake up” all of our key postural muscles. Our natural arm swing promotes activation of the shoulder stabilising muscles, just like looking ahead or at the scenery improves neck position and postural activation. 

I will say here that it is also possible to walk in poor postures, and this is more likely if we have been sitting in poor postures and are less active. Be mindful about standing tall when walking. 

Standing up regularly from your desk throughout the day and even just walking to the coffee machine can be enough to help improve your posture when you sit back down. Getting up and walking for longer will have a more lasting effect. 

4. Improve your running! 

I see multiple clients that come to me with running injuries, determined to increase their running to 10, 20km, yet never walk for more than 10minutes throughout the day. Sure they still go to the gym or do other forms of exercise like swimming or riding, but they just aren’t accustomed to prolonged time on their feet. Our bodies aren’t capable of jumping ahead to the heavier demands of running, without first tolerating the slightly less loaded, but similar, activity of standing and walking. 

In Physiotherapy we often talk about “functional training” being the best style of training to progress in any given sport or task. This essentially means that whichever exercise most closely mimics the actual task or sport needing improvement, will be the best exercise to achieve the required improvement. So it makes sense that you should first be competent in strong and prolonged walking, before progressing to running. 

Conclusion:

Think back to my story and slow decrease in daily walking. My endurance for standing, let alone walking started to severely suffer. I didn’t notice this at first as I wasn’t trying any prolonged walking or running and my gym work was fine. However when I attempted to get back into running, it didn’t take long for my body to start breaking down (like the peach) and injury to result. 

If this story sounds familiar to you, or maybe you’ve already noticed pain symptoms developing with standing, walking or running. Perhaps you should consider whether your body has been primed to handle whatever load is causing the aggravation.

If you’re having any issues with building your running. Feel free to swing down and see me at Evolutio Sports Physiotherapy in Richmond, Melbourne. You can book in here.

This is Kristina. She’s cool, like us. She’s one of our senior physio’s with more experience in the snow than many of us have on land. You can book in with her here for a session face to face. Or here for a virtual appointment.

[evolutiosportsphysioblog]

Top 4 Tips for Preventing Hamstring Strains

 What’s your favourite muscle group within the body? It might be the one that you think looks the best or the one that you like to train the most.  Boys, I can hear you all screaming from the top of your lungs the biceps – but unless you look like Arnie they aren’t that impressive.

What about the hamstrings? Probably didn’t get too many people throwing up their hands for that one but the hamstrings are a very interesting muscle group. They consist of three individual muscles that spans across both the hip and knee joints. That means the exercise options for these muscles are plentiful – hip-based, knee-based, eccentric, concentric, heavy & slow, plyometric – you name it and there are parameters that you can manipulate to train this muscle differently, and specific to the chosen sport.

The hamstrings are also the most commonly injured muscle group in sports that involve high speed running. Every local footy club has an old stalwart with tissue paper hamstrings but the issue is not limited to the amateurs. Hamstring strains account for up to 26% of the total injuries in the AFL each year and there are 4.9 new incidences of hamstring injuries per club each season. This is a pretty considerable statistic and it highlights the need for high speed athletes to train smarter, not harder.

Now I have never strained a hamstring in my life, mostly because my top speed rivals that of your geriatric grandmother (anyone who has watched me on a footy field will attest to this), but I also like to think that I do the right things to prevent injury from occurring as well.

Two rules for avoiding injury – be strong, be long. Maybe you have been told before that size and length doesn’t matter, but it does when it comes to the hamstrings.

 So here are some tips for preventing hamstring strain injuries:

 1       Throw your stretching exercises in the bin

I don’t really mean this, but I am sure there are many of you out there who have been stretching your hamstrings for years and years but they still feel tight, am I right? Stretching does not increase the length of your muscles. You will gain more range of motion but this is due to becoming more tolerant of the uncomfortable stretch sensation, not actual muscle lengthening. Your muscle will still reach its yield point (the point it goes twang) all the same if enough load is placed on it under tension. So stretch if you like it and it feels good, but there is better bang for your buck elsewhere.

 2       Add some eccentric hamstring loading into your program

it is quite obvious to preach that strength is important to prevent injury but just sitting on a hamstring curl machine smashing concentric contractions is not necessarily helping. Performing only concentric muscle contractions of the hamstrings has been shown to shorten muscle fibre length – the inverse is true for eccentric contractions. Focusing on eccentric contractions of the hamstrings in the gym will both lengthen your muscle and improve your strength. Tick, tick for strength and length.

 3       Maintain eccentric load in season

when you stop loading your hamstrings eccentrically the muscle will eventually revert back to its previous length. Don’t neglect the gym in season, you just have to be smarter about how you do it!

 4       Not every session needs to be at 100%

if you’re training a lot, not every session needs to be bull at a gate. Having a regular sprinting load is important for injury prevention but it does not need to be everyday or every session. Olympic level 100m sprinters might be lucky to hit top speed 1x per week in training.

 So have a crack at implementing some of these things to bulletproof your hamstrings for the upcoming winter sports season. Or if you want more specifics about an individualised program for yourself or just to come in and hear about my detailed football career (peaked in under 14s) then give us a call to book an appointment.

Scott is one of our newest members in the team. Coming from a wealth of experience in ACL Rehabilitation, and AFL playing in the VAFA. He’s a jet and is a back to back winner of the anatomy quiz winner here at Evolutio in Richmond. You can book in with him for a Physio session here

[evolutiosportsphysioblog]

Technique is King - or is it ??

If you’ve ever done any of the exercise, it’s likely that you’ve heard the phrase “technique is King” (or similar). 

I’d like to play the devil’s advocate here, just to question whether our fetish with form has missed the point. Maybe it hasn’t - I’m happy to be wrong on this one.

I feel like culture around technique has drifted so far out of context that it’s more like the Emperor’s new clothes. It seems to have devolved into a lot of mansplaining dweebs stipulating narrower and narrower terms and conditions on any movement and trolling any differing perspective until everyone’s too tired of the criticism to step out and say “Oi! Maybe there’s a bit more to it than that.”

Just like with everything in training (and literally any other subject), trying to make real world problems fit black-and-white principles does not work. In practice, not only is defining optimal technique a moving target, it’s also a matter of context, opinion and what is actually practicable. There are a helluva lot of shades of grey.

So why exactly is it so difficult to fit into the neat, satisfying box we want it to?

Well, everyone has variations in their anatomical structure, obviously. But I just need to take a second to stress that these variations can be a) imperceptible from the outside, and b) mind-boggling. Some people have hip sockets that point in a different direction. Some people have bone structures that block off ‘normal’ range of motion. Some people have whole muscles or attachments that other people don’t have. Some people have disabilities. Trying to make any one technique fit every body is not only pointless but can do actual damage.

Then there are variations in activities. Different sports need different things. For example, a bodybuilder, a cyclist and a rugby player may all squat differently. Even among the strength sports, where squatting is one of the biggest components of their training, not only will squat technique vary between the disciplines and from athlete to athlete, but form fads come and go and athletes will tinker with their technique over the course of their career. 

And then there are neurological differences in movement literacy, learning and co-ordination. Technical things are hard and people that do things perfectly are very, very rare. So I’m going to shout this for the people at the back : EVERYONE HAS THE RIGHT TO BE A BIT SHIT AT SOMETHING, ESPECIALLY BEGINNERS.

So purely to prove my point I’m going to defend the indefensible, the cardinal sin, the one thing everyone knows is BAD: knee valgus. But that’s just an example - the same line of questioning can apply to anything: round backs, arched backs, extended wrists, pronated feet, using momentum, etc. Even if in a majority of cases these things should be avoided, there will always be exceptions. Trying to gate-keep ‘good form’ without understanding what’s really going on is just as destructive as ‘bad form’ can be.

Valgus is simply a term for movement or positioning of the knee towards the midline from a starting point. That’s all it is, and its opposite is varus.

From the language we use, it’s quite clear which is The Good Guy. For varus we say things like ‘drive out’ or ‘push out’ the knee, while any and all valgus motion gets called ‘caving’ or ‘collapsing’.

Now, valgus collapse is the term for specifical cases when the movement becomes problematic, and can be defined as unintentional, uncontrolled and excessive inward movement of the knee. Valgus collapse classically occurs due to a weak gluteus medius and is more often observed in untrained or beginner athletes. It has a well documented causal link with MCL and ACL injuries, particularly during dynamic movements.

That said, not all observable valgus movement is valgus collapse. If the knees are ‘out’ at the bottom of a squat, they sometimes move inwards and then out again during the ascent. Particularly if we are looking at lifting near-max weights - if you think about it anatomically, seeing a slight shift in the knee is pretty understandable.

Adductors do a massive amount of work getting out of the bottom of a squat, two of the three hamstrings are internal rotators and contracting the quads can also rotate the leg (try it). When all of those muscles are maxing out, there are a lot of forces pulling the knee inwards, so we can forgive it for wavering - if that movement isn’t excessive. 

In addition to that, there are theories that the valgus moment can increase the squat by putting the glutes on stretch so that they are at a mechanical advantage when you need them most.  

Valgus also happens in sports like basketball, where some players deliberately set up for a shot with their knees and toes pointed in, again using that to put tension on the glutes and spring-load the hips for a tight jump. However, keep a close eye on the same athletes landing those jumps and you probably won’t see any. 

Both of those examples are athletes using the movement to improve their performance. It is happening in a controlled, moderate dose during the concentric phase of the movement (the eccentric would be during the descent of the squat or the jump landing). There’s no need to diagnose from your armchair or hit the ‘comment’ button. There are ‘rules’ that we all learn when we start lifting, but I think we all need to learn that there are also coaches and athletes out there making the informed decision to bend or break those rules. 

I’m not a knee-cave apologist, or denying the link between valgus collapse and injuries. I’m just saying that not all valgus movement is collapse, it’s not always pathological, and it’s not always bEcaUsE yOuR GLuTeS aRe WEak AnD yOU sHoUlD bE dOiNg CLaMsHelLs nOt sQuAtS.   

You just cannot simplify it that much. Because on the other hand, you may not be solving any problems by forbidding valgus and exaggerating varus in a squat. Not only could that rob you of performance potential, but it could end up in injury too. Overdoing knees-out squats can mash the femur into the hip socket, rub the labrum, irritate nerves, hamper activation of the glutes, hamstrings or lower leg musculature due to lost big to connection with the big toe*, etc. etc. etc. 

All that said, my number one issue with technique dogma is that it plays into the notion that the human body is fragile - which is not only false but noxious. It makes us feel that there’s only one correct way to move, and everything else is wrong and unsafe. It whips up this feeling that training is fraught with danger and at any moment you could make a false step that will lead to lifelong pain and injury. When in reality, avoiding training with a variety of challenging weights and movements is a lot more likely to lead to pain and injury. 

It’s just easier to swallow “bad technique will get you injured and good technique will protect you” than the reality of having to add ‘sometimes’ and ‘not always’ to that sentence. The truth is, although we see a lot of injuries that are easily attributed to bad form, there are also plenty of people out there that train with shoddy technique their entire lives and don’t have any side effects other than getting motherfucking strong. That’s not me promoting shonky form, I’m just saying this shit is complex and subtle and messy and none of us actually know for sure what’s going to happen, but that’s OK.

Muscles and joints get stronger and more resilient from progressive overload, which happens by increasing intensity, load and volume - not technique. Technique is just an instrument that allows you to apply that stimulus. 

In a perfect world, technique would always be perfect… but what about IRL?

Never allowing someone to load up a movement because of their technique is a noble idea, but consider the opposite: are you doing them a disservice by denying them access to what they need to get stronger?

Is there not a grey area where sometimes the right thing to do is to apply weight to a suboptimal technique? 

Maybe sometimes the right thing to do is allow a minor fault to continue temporarily while you address a larger one? 

Is it sometimes more risky to correct a fault when you won’t have time to cement it before the athlete has to go back to training at intensity or playing their sport? 

I don’t know the answers to these questions, I just want to be able to ask them.

‘Technique is king’ sounds great in theory but if you’re working where the rubber actually hits the road, I think there’s more to it than that and we need to embrace a more nuanced view.

Peta works as our Head Remedial Therapist and S & C Coach. She’s in the VIC state team for Surfboat Rowing and owns the world record for the 1km Ergo at 30-39yrs Female category. She can also hipthrust 200kgs. You can book in with her at Evolutio here