Archive | Sports Physiotherapy RSS feed for this section


12 Mar


Competitive cyclists are potentially at risk of suboptimal bone health. Although cycling is excellent for cardiovascular fitness, this type of non skeletal loading exercise does not mechanically stimulate osteogenesis (bone formation). This situation of low mechanical osteogenic stimulus to build bone can be compounded by restrictive eating patterns and associated hormone dysfunction of relative energy deficiency in sports (RED-S)

The pic shows how different sports exert site specific effects on the bone mineral density of the skeleton. In general terms, hip femoral neck BMD is more dependent on mechanical loading osteogenic stimuli, whereas lumbar spine BMD is more dependent on nutritional and Endocrine status.
What are the most effective mechanical osteogenic stimuli? Evidence from animal models demonstrates that bone responds to exercise that is dynamic, non-repetitive and unpredictable.

Load and repetitions are not such important factors. This is shown in a study of track and field athletes, where sprinters were found to have higher BMD at load bearing sites of the skeleton than long distance runners due to a local loading effect rather than a systemic effect associated with repetitive loading nature of longer distance running.

The other important consideration is that sprinters and rugby players tend to weigh more with higher lean mass than distance runners, providing higher skeletal loading forces.

These differences in anthropometric and body composition metrics are also associated with different nutritional and Endocrine status.

Swimming and cycling are similar in that both these types of exercise do not provide mechanical skeletal loading osteogenic stimulus.

Skeletal loading exercises for cyclists would have to be effective and practical, not requiring access to gym and possible to fit into training schedule throughout the season.

Fascia, the new fitness focus.

2 Jan

Fascia is a systemic net of connective tissue an extra-cellular matrix (ECM), which includes everything in your body that isn’t cellular. It’s a web that wraps your muscle and attaches to the bone. Its also found in internal structures, the viscera etc.

Remodeling and Tensegrity

Just as your muscles remodel themselves in response to training, the fascia remodels itself in response to direct signaling from the cells ; injury; long-held mechanical forces; use patterns; gravity; and certain chemistry within your body

The idea of tensegrity (tension and integrity) and the phenomenon of remodeling are the basis for structural therapy, including yoga and the forms of soft tissue manual therapy, including foam rolling. Change the demand and the fascial system responds to that new demand.

How to Train the Fascia

1.      Specific training can enhance the fascial elasticity

What’s in: Plyometrics: Make use of elasticity of the muscle

Jump drills:  When you land on the ball of your foot, you decelerate and accelerate in such a way that you not only make use of but actually build elasticity into the tendons and entire fascial system.

Stretch – Shorten Fascia:  : Preparing for a movement by making a countermovement—for example, winding up before a pitch makes maximum use of the power of fascial elasticity to help make and smooth out the movement.

2: The fascial system responds better to variation than to a repetitive program.

The evidence suggests that the fascial system is better trained by a wide variety of vectors—in angle, tempo and load

What’s in

Whole-Body Movements. Engaging whole-body movements is the better way to train the fascial system. Every exercise is stimulating multiple nerves, involving multiple muscles and employing fascial tissues all around the site of effort, as well as “upstream” and “downstream” from it.

Proximal Initiation. It’s best to start movements with a dynamic pre-stretch (distal extension) but accompany this with a proximal initiation in the desired direction, letting the more distal parts of the body follow in sequence, like an elastic pendulum. Imagine Throwing.

Adaptive Movement. Complex movement requiring adaptation.

Variable loads build different aspects of the fascia. Sticking with near-limit loads will strengthen some ligaments but weaken others. Varying the load is the better way.

Varying the tempo of your training allows different fascial structures to build strength and elasticity.

3: Proprioception and kinesthesia are primarily fascial, not muscular.

What’s in:

Skin and Soft Tissue Stimulation Enhance Proprioception. Rubbing / foam rolling and moving the skin and surface tissues is important to enhance fascial proprioception.we have seen our ancient wrestlers and kabaddi players rubbing some sand and tapping the muscle before performance.

Feel the Fascial Tissues. Focusing on multiple joint/fascia stretch in a yoga pose can help prevent injury and make the perception of kinesthesia more accurate and fully informed, rather than focusing on an isolated muscle stretch.

Shift from ligaments to Joint-Receptor for stability. Given that the ligaments are often tensed by the muscles, the emphasis on joint receptors for joint position sense, co-ordination and balance with a more general attention to the whole area, from the skin on down to the joint.

A deeper understanding of the role of fascia in training changes your perspective, your work, your words and your effect. Fascia is not just a sling or a wrap. It has a life of its own!!

4. Stretch as a Whole

What’s in

Fascia is a wholistic structure, not starts from one joint and finishes in the next like the muscle. Stretching the biceps or quadriceps alone are not the way ahead.

Stretch your body as a whole, your posterior chain of muscles, anterior, lateral, spiral chain etc.,

Isolated muscle stretches are out and wholistic stretches like yoga, taichi, gymnastic (ballistic) stretches are in!!


Walk Jog Run Sprint!!!

16 Oct

Increasing interest with running marathons, whether full, half 5k or 3k has opened a serious of discussions on technique, training, shoes, injuries etc. There are so many doubts in an avid runner on how to go about it. Most runners are recreational runners / joggers whose objective is to keep fit, healthy and stress free.

Health Fitness & Medical Screening:

This should be the first step any novice runner should embark on before starting the physical activity. If you are a male and above 40 and not used to vigorous form of exercise or activity, it’s

a wise option to undergo the medical screen & clearance with a physician’s consultation.The next step is to meet a Health & Fitness Specialist or a Sports Physiotherapist and get

evaluated on your Cardio vascular fitness, muscle strength and endurance, flexibility and body composition. A good posture evaluation to find out if you have any bio mechanical faults (like,

flat foot, knock knees, etc) soft tissue tightness, preexisting injuries, if any  and based on the findings she/he may advice you on a corrective exercise program, which can help you to enhance

performance and prevent injuries. Get your running mechanics evaluated.

Shoes & Terrain:

Investing on a good pair of shoes is of paramount importance. Shoes with good cushioning, toe room and arch support are things to look for in a shoe. It’s also important to pick up the shoe in

the evening when the toes are little expanded. Remember to change your shoes roughly after every 500kms of use.

Hard surfaces give you a push or bounce to run, with more impact, softer surfaces like the lawns, beach sand might offer less impact, but increases the muscle force or activity. So choose

a firm running surface like the running tracks, level grounds or good treadmills to train. Running up hill and downhill , cross country will enhance your fitness, but also will cause

injuries. If you are running out doors, be aware of the environment.

The FIT principle of training:

How often, how long and how intense should you train? It is the frequency, Intensity and the duration principle. If you are doing a less duration (less than 60mins) and low intensity (walk-

jog speed) you need lesser recover time and hence can train 5-6 days a week. If you are training at a high intensity (say running or sprinting) or longer duration (70 minutes

or more) you need longer recovery time and hence 2-3 times a week, not on subsequent days is advisable. You can however cross train those days with swimming, cycling or yoga.

Always start slowly and build gradually, giving time for the tissues to adapt. When you can walk or jog without going out of breath, you can progress to running!

Always warm up before the training, if you are planning to jog, a brisk walk for 5-10minutes would be a good option, followed by stretches of the muscle groups that are going to be in

action, obviously your calf, thighs back and shoulders. Do the same for a cool down.

Types of Training:

There are different types of training, the common ones are continuous training (steady speed through out), interval training ( 3 minutes run and 2 minute walk ), cross country (different

terrains) and fartlek training, which blends the continuous and interval training. If you are someone beginning to jog use the interval training and progress to continuous mode after

gradually increasing your percentage of jog.

Strength & Flexibility:

A 2 to 3 days a week of strength training on non-subsequent days to strengthen the core amd legs with moderate intensity with 8 to 12 repetitions, 2 sets for each major muscle groups

will be ideal.

Flexibility exercises like yoga or sports stretches can be done for 20-30minutes for the major muscle groups with 15 seconds hold for each, without breath holding, 2 sets each will be good.

Add to that the foam roller for glutes, hamstrings, IT band and calf muscles and foot.

Running Injuries & How to handle them!

Injuries happen, if you try and progress too quickly, if your frequency, intensity and duration are high, if you have poor strength and flexibility, improper foot wear, poor running mechanics

and bio mechanics, and other external factors, like fall etc.

Remember RICE; Rest from activities that cause pain, Ice for 15-20mins 3-4 times a day (if not more often), Compression in case of swelling with elastic bandage and elevation above heart

level, in case of swelling.

The common running injuries are mostly because of overuse. Stress fractures of the metatarsals, plantar fasciitis, runners knee, muscle strain,, Achilles tendinitis, groin pulls, low

back ache etc.,

Hydration & Nutrition:

Remember to hydrate well, with water or isotonic solution. There are various ORS drinks available in the market, to prevent cramps and to fuel. Carbs are the fuel for any endurance

activity, so make sure your carbs are not depleted, by vigorous training the previous days. On the day of the run have enough carbs and depending on the distance have a moderate or

low glycemic index fruit or snack 30 minute before the run.

Happy running!!

Prevent Sore Neck / Neck Strain During Ab Workout.

29 May

It’s fairly common to hear exercisers complain about neck soreness or strain from abdominal workouts. This discomfort is most often caused by improper form and it’s very easy to correct.When the head is pulled forward during abdominal exercises, immense strain is placed on the posterior neck muscles. Many exercisers lace their fingers behind their head and pull forward during crunches, for example, thereby making the crunches easier – but also placing unnecessary pressure on the neck muscles.

To prevent neck soreness, change the placement of your hands. Instead of placing your hands behind your head, fold them across your upper abdomen. Alternatively, keep them by your sides. If you want to keep your hands by your head, just touch your ears lightly with your fingertips to prevent any forward pull. In addition, it may be helpful to concentrate on the ceiling. Doing so prevents your head from lifting forward. It may also be helpful to imagine an apple tucked under your chin allowing for space between your chin, neck and chest.

Alternatively, you can try exercises such as the reverse crunch that work the abdominal muscles without involving much upper body movement. Beyond preventing neck soreness or strain, you’ll also be increasing the effectiveness of your abdominal workout. Because lifting your head forward makes the exercise easier, some intensity and effectiveness is lost in the process.

If muscle soreness persists, it’s always a good idea to consult with your physician.

Choosing the Right Foot Wear!!!

7 Mar

Walking and running are a popular form of exercise for many. Trekking is becoming a favorite past time and Running is gaining popularity, with increasing number of mini, half and full marathons happening in our city and so are running injuries. What matters is, are we wearing the right kind of foot wear? Improper foot wear can lead to a lot of Lower body injuries and increased stress on the spine. We see a lot of Increase in the Heel pain, foot, ankle and shin in recent times. Most times caused by improper foot wear. The common foot problems caused by improper foot wear include Calluses, Corns, Plantar fasciitis, heel spur(heel Pain), metatarsalgia (fore foot pain), Tendinitis of the foot muscles, ankle pain, pain in the top of the foot, pain in the lower leg, calf pain, stress fractures of the leg and foot, knee pain etc., There is a lot of misconception, when it comes to picking up the shoe. Some say they pickedup the most expensive shoe, some say it’s a light weight shoe, five finger Vibram, glute toners, rocker bottom and other fancy names to sell the shoes. But what is important is to pick up the right shoe for your foot!!!

Foot Types:

Normal foot : Absorbs Shock well, Well supported with Muscles and has a good alignment of bones. In the pronated(flat foot) and Supinated (High Arch) foot, there is a muscle imbalance and there is improper alignment of the bones and joints leading to improper bio mechanics there by adding stress to the lower limb.

How to choose the right foot wear:

The first step in finding an appropriate shoe is to determine your foot type. The key is to recognize how the foot functions when it’s in motion; however, thinking of the footsteps you leave walking on a sandy beach can be helpful. The over-pronator will leave a full impression of the foot while the under-pronator will leave

only a crescent shape impression with much of the arch missing. Running shoe companies make shoes for the three foot types discussed above.

1.Make sure the shoes have good cushioning, Remember, Only sprinters wear light weight shoes, so do not look for light weight shoes, which most times doesn’t have enough cushioning to absorb the shock.

2. Make sure the mid portion/waist is nice and broad at the bottom if you have a flat foot and the insole/sock liner has an arch support in the inside of the shoe.

3. The shoe should not be too flexible nor too rigid, ideally you don’t want the fore foot of the a shoe to touch the heel pad when you fold. Half way to three fourth would just be fine.

4. Make sure the heel counter is rigid and holds your ankle. Also check if the shoe has adequate Achilles tendon padding.

5. Make sure the toe box is wide and the tongue of the shoe has enough padding.

6. The sole of the foot also is important. If you are going to do a lot of trekking/slippery surface then shoes with rubber studs/cleats will help.

7. Remember to pick up your shoes in the evening change your shoes every 500kms.,those who are diabetics, should consult their physician before picking up the shoes and should inspect their foot quite often and follow good foot care practices as poor circulation and impaired sensation might have caused blisters and infections.

Keep your foot smiling!!!

Passive Stretches

24 Mar

Recently a client asked me, i see a few trainers giving personal stretch on the floor.,what do you think of that??

Well that made think..

We know that passive stretching is a form of static stretching in which an external force exerts upon the limb to move it into the new position. This is in contrast to active stretching. Passive stretching resistance is normally achieved through the force of gravity on the limb or on the body weighing down on it. It can also be achieved with the help of a partner, stretch bands, or mechanical devices.

‘I do give passive stretches, when i feel the soft tissues are tight, say for example a one knee to the chest with the other on the floor, a tight hip flexor on the limb that is extended and down will let the hip flex/lift, so while the client pulls the bent leg, keep the extended leg down with passive force of yours. This is indicated when the muscle imbalance is the cause (or may cause) of the musculoskeletal problem, like a back or knee pain

I also use a passive stretch for frozen shoulder, however with caution in the osteoporosis population., Post traumatic stiffness is also another case to use passive stretch, make sure the # or the ligaments have heeled sufficiently before you attempt one.

Neurological conditions like stroke, CP and parkinsons, also warrant a controlled passive elongation of soft tissues.,care should be taken to check their medications (anticoagulants) and that the valsalva maneoure by the client should not be encouraged.

I have come across, clients who had developed # , avulsions, muscle tears & ligament tears, neural tissue irritations during passive stretches..a vertebral slip can happen too..if there is a listhesis and a passive extension is given!! So lot of caution and controlled sustained force is the key, with a good knowledge of end feels, the biomechanical levers, the clinical condition you are dealing with, integrity of the musculoskeletal structures and of course the physiological & anatomical range, a comparison with the other limb wouldn’t hurt.

Whenever possible i advocate a self sustained passive stretch with low load for 10-15 minutes, letting the gravity and external load do the job..a foam roller release will not be a bad option in myo fascia tightness and active stretch for 15 sec hold within physiological range as per the clinical condition warrants, should be encouraged more often during the day., controlled passive stretch in a sustained manner, without jerks when indicated i give for 15sec to 2 mins as per the requirement of the condition.. i have recently found thai massage, which involves a lot of stretches very fascinating, yet to explore it though..

Happy Reading

Earnest Vijay, Sports Physiotherapist

Preventing Shoulder Injuries

26 Feb

The shoulder is a Synovial joint with a ball & socket orientation allowing multiple degrees of freedom and hence more mobile and less stable, as the bony congruence does not give bony stability, and hence it depends on the soft tissues like capsule, ligaments and muscles around the joint making it vulnerable for injuries. The common shoulder injury in sports being the rotator cuff muscles.,These muscles primarily provide stability for the joint, which means, keeps the ball in the socket, while we do dynamic movements.,like a tennis serve or pulling the shirt etc. the pain in the shoulder can be excruciating and annoying, it painfully takes a long time to settle down.,

They are vulnerable because of the increased movement that’s available and they are precariously placed under the shoulder blade (acromion). Shoulder injuries can be prevented by 1. Reducing the repetitive use & overhead activity (being ambidextrous, bowl on dominant hand and throw on non dominant hand) 2. Strengthening the cuff muscles with a low load high rep program, 3.Good scapular control and posture of the spine and shoulder, 4. avoiding risk taking activities like extreme arm abduction and rotations or pressing more weight than actually you can, 5. ensuring proper flexibility of the shoulder capsule & larger muscles around the shoulder like the pecs, latts and deltoid. 6. Proprioceptive work, an awareness of where the shoulder is in space.,  7. Proper equipment and techniques for the sport or activity

Advice for chronic low back pain

21 Jun

Chronic low back pain often results from a weakness in the muscles supporting your back which may lead to instability or incorrect functioning  of the lower part of the spine (lumbar spine). Strengthening the muscles responsible for providing support to the spine is therefore very important. You need to remember to strengthen your stomach muscles as well as your back muscles so that your spine is equally supported at both the front and the back. Loss of stability in your spine can lead to microscopic damage to the surrounding soft tissues so it is particularly important to address this problem quickly to minimize damage. (more…)

The Do’s & Don’ts of Treating a Sports Injury

13 Nov

The Do’s; If you suffer an injury such as a sprain, strain, muscle pull, or tear, immediate first aid treatment can prevent complications and help you heal faster. How we manage an injury, be it a sprain or a fracture in the acute or the first 72 hours plays a major role in the recovery time. The commonly used practices are rubbing, pulling, and applying heat to the injured area. This unfortunately, doesn’t hasten the recovery. The following are the scientifically proven methods on how to treat an acute injury and are widely accepted across the globe. (more…)