Have you heard of the FIFA 11+?

If you are a soccer (or “real” football) player or coach, then we’re hoping that you have!

Whilst the soccer season might be starting the wrap-up, the following is super important and worth a read.

The FIFA 11+ is a warm-up program which has been specifically designed by the medical division of FIFA. It has been demonstrated to reduced injury rates and is applicable for all abilities.

If we get more specific, the FIFA 11+ is a neuromuscular training program. This means that it trains, develops and conditions the muscles and neural pathways in the body to ensure that your body knows how to appropriately deal with the situations which it is likely to encounter when playing soccer. The components therefore are very specific to soccer and regular completion of it is key.

Much of the research into the effectiveness of the FIFA 11+ in the past has been conducted with adolescent females. This is due to the fact that females have a higher rate of injury for certain key injuries, including serious knee injuries like Anterior Cruciate Ligament (ACL) ruptures. Whilst it may seem reasonable to be able to extrapolate the results of these studies to males, this does have its limitations, as one cannot simply presume that because something seems to happen in adolescent females that it would happen in mature males in the same way.

Good news for all you males out there! An article published in December of 2015 by Silvers-Granelli et al. looked at the efficacy of injury prevention using the FIFA 11+ on MALE collegiate soccer players.

What did they do?

65 teams of national level college soccer players were invited to participate in the study. These teams were randomised into either a control group or a the FIFA 11+ group. The FIFA 11+ group completed the FIFA 11+ program as a warm up 3 times a week. The control group performed no additional training on top of normal levels. This was performed over the course of one soccer season.

What were they looking for?

The study looked at:

• How often the teams/players played & trained,
• How many injuries occurred,
• Compliance of the FIFA 11+ group using the FIFA 11+ program.

What did they find?

A study found a number of things including:

• The FIFA 11+ group had significantly fewer injuries per teams compared to the control group,
• The FIFA 11+ group had a lower number of injuries during both training & games compared to the control group,
• There was a significant relationship identified with respect to utilisation and compliance of the FIFA 11+ program within the FIFA 11+ group. That being, the greater the compliance to the FIFA 11+ program, the lower the injury rate.
• Injury rates in the FIFA 11+ group were significantly lower as well when accounted for injury type:
  • Control group reported 115 ankle injuries, whereas the FIFA 11+ group reported 59 ankle injuries;
  • Control group reported 102 knee injuries, whereas the FIFA 11+ group reported 34 knee injuries;
  • There were 16 ACL injuries in the control group compared to 3 ACL injuries in the FIFA 11+ group – representing a greater than 4x reduction in ACL injuries;
  • 55 hamstring injuries were reported in the control group compared to 16 in the FIFA 11+ group – representing an almost 3 fold reduction in likelihood of hamstring injury.

What does this mean?

In order to reduce the likelihood of lower extremity injury within sport an appropriate neuromuscular program can be extremely effective. It is vital that you and your team is completing a program such as the FIFA 11+ throughout the season to reduce likelihood of injury and to keep you on the field!

Are there any limitations?

The study was only completed over the course of one season, so the long term impact is unknown. The participants ranged between 18-25 years of age and were American male soccer players – so extrapolating to all populations has its limits. Furthermore, there was no controlling for previous injuries which could have influenced the data.

What does this mean for me?

If you’re a coach – you need to be implementing an appropriate neuromuscular program with your team to reduce their risk of injury. The FIFA 11+ program is designed as a warm-up. There is no need to be developing your own warm-up or completing anything in addition to this program. There are also a wealth of resources of the FIFA 11+ website (simply google FIFA 11+). If you want to know what would be appropriate, speak to a sports physiotherapist with knowledge in this area.

If you’re a player – even if your team isn’t completing an effective neuromuscular program, you can complete one yourself to reduce your risk of injury and maximise your injury free playing time. If you want a good program speak to a sports physiotherapist or you can seek out the FIFA 11+ resources online.

While the proverbial pain in the neck gets plenty of publicity, our experience here at Arrow Physiotherapy is that pain in the shoulder is just as nasty (if not more so!). When you’ve hurt your shoulder, so many of life’s daily activities become painful – getting dressed, picking up bags or children, gardening, driving, even lying in bed.

The shoulder joint comprises the collarbone (clavicle), shoulder blade (scapula) and the upper arm bone (humerus), which are held together by muscles, ligaments and tendons.The shoulder must be both mobile enough to undertake a large range of movements while also being stable enough to enable you to pull, push and lift. This is where issues largely lie – achieving a balance between movement and stability is a delicate business and when this balance isn’t right the shoulder is particularly vulnerable to a variety of problems.

The majority of shoulder injuries arise from dysfunction of the soft tissues surrounding the joint. Many individuals experience problems with damage of the rotator cuff (a group of tendons which surround the ball part of the shoulder), caused by ageing, trauma, sporting injury or repeated use. Pain surrounding the shoulder blade is often linked to long periods of sitting at a computer, where poor posture puts additional strain on the shoulder and scapular muscles. It can also be due to overuse with many forms of physical activity. Tendinopathy (damaged tendons) and inflammation of the bursa (bursistis) are also responsible for the debilitating pain and loss of movement associated with shoulder injury and often attained due overuse or ‘wear & tear’. Other shoulder issues include dislocation, ‘frozen shoulder’ and complications arising from arthritis.

If you are one of the many individuals who suffer from shoulder problems, here are four vital steps to help restore your shoulder to health:

1. Avoid aggravating the problem. If there are activities that make your shoulder hurt, like lifting weights at the gym or raising your arms, then minimising these actions as much as possible is pertinent.
2. Take action against inflammation. In addition to resting the region, it may help to regularly ice the affected shoulder for 15-20 minutes at a time (no more frequently than every 2 hours). Anti-inflammatory medication may also assist as a short-term option for reducing any inflammation present – speak with you doctor or pharmacist.
3. Work on flexibility and strength. If you have reduced flexibility in your shoulder area, your shoulder joint and surrounding structures are placed under extra pressure. Consult your physiotherapist about ways in which you can increase flexibility and strength in your shoulder. It is important that you balance any resistance training with a thorough stretching/flexibility routine, focusing in particular on your chest, neck and upper back regions.
4. Care for your shoulders. There are lots of ways you can reduce the load your shoulders endure on a daily basis. Try to carry only the essentials in your backpack or hand-bag, and practise good posture when you sit at the computer, making sure you get up and move around regularly. Consider whether the pillow you use offers enough support to your neck and shoulder region, and avoid long drives where possible, as extensive periods with arms outstretched on the steering wheel can be a source of strain. If you have recently started a gym routine, make sure that your program is well-suited to your ability and that you don’t try to be superman with what weights you are lifting!Shoulder pain can be hugely debilitating and if not addressed swiftly can take a long time to heal but the good news is you are not alone. Here at Arrow Physiotherapy we are serious about sharing the load, and our team of physiotherapists are qualified to diagnose and develop a personalised recovery plan for your specific shoulder injury. Call us on 02 8850 7770 today.

HAD AN ‪ACL‬ RECONSTRUCTION? THIS MIGHT INTEREST YOU!

Failure to meet a variety of clinical outcome measures has been shown to increase risk of Anterior Cruciate Ligament (ACL) graft rupture following reconstruction surgery.

Up until now, there has been limited research on factors that impact risk of graft rupture following ACL reconstruction. Much of the research had focused on identifying outcome measures associated with successful return to pre-injury level of sport.

One of the questions that I’m regularly posed by my clients here at Arrow Physiotherapy is “when do I use ice or heat to treat an injury?”

As ice and heat work differently they each serve a different purpose when it comes to injury management.

Say you’ve twisted your ankle playing Netball or landed awkwardly on your shoulder playing Rugby; in each of these cases using ice is your best option.  Ice will provide almost immediate pain relief but more than that it will reduce swelling and inflammation by constricting blood vessels, thereby preventing blood from accumulating around the injured area.

Ice is ideally used directly after the injury has been sustained in order to have its best results.  Using ice sooner rather than later will also give you a head start in rehabilitating any injury.

Tip: Don’t apply ice directly to the skin, use a thin towel or ice pack.

As you may imagine, heat works directly opposite to ice in that it opens up blood vessels to increase blood flow.  In this manner heat works in the same way as a massage.  For this reason heat would be more suitable for those suffering from stiffness of the lower back or neck, conditions normally suffered by those who spend long hours at a desk.

Many people use heat rubs or heat packs before sport or activity to help ease any feeling of stiffness and prepare their muscles for action.

Tip: Don’t use heat if there is swelling or bruising in the affected area.

If you are unsure whether ice or heat may be appropriate for your particular situation, ask your health professional.

Laurence Pratt

Remedial Massage Therapist

It’s Chris Musgrave and I’ve recently joined Brendan and the team at Arrow Physiotherapy.  I have a special interest in tendon injuries and rehabilitating them back to full function.

Don’t miss the tips below to manage Achilles tendon pain!

Achilles tendon problems can be very painful and frustrating conditions. If you’ve had the pain for quite some time it can start to impact how much you exercise and especially limit how much running you can do. They usually present as pain and stiffness at the back of the heel running up towards the calf muscle. Often they are painful in the morning and upon commencing exercise, but tend to improve once warmed up but may again deteriorate over the course of an exercise session or day. Additionally, they can be very painful the day after a lot of exercise.

The Achilles tendon is an important component for generating power and propulsion during fast paced activities such as running and jumping. Often sub optimal loading of the area can result in pain and irritation. Tendons are generally very robust structures, however they do not respond well to large changes in loading – for example someone increasing their running distance in one week from 10km to 50km (total km’s over the week).

“Have you recently increased how much activity you are doing?”

Fortunately, if your pain is recent it can be managed fairly quickly with some active rest and proper loading of the area. On the other hand, if your pain has persisted for a long time you will need a highly structured, detailed and personalised rehabilitation plan. This may include:

• A structured individualised exercise loading program
• Assessing your biomechanics
• Strength training
• Use of orthoses
• Strapping to assist in deloading the tendon
• Avoidance of  particular aggravating activities

In summary, load management is the most important aspect in both keeping your tendon healthy and rehabilitating your tendon from injury.

Avoid large spikes in running, walking and your exercise activities and ensure the appropriate amount of rest between sessions.

Some common mistakes we see include:

• Excessive stretching of the tendon
• Aggressive massage over the tendon
• Pushing through the pain

If any of the above applies to you or you are experiencing any of the symptoms outlined, whether recently or for a long period of time, come in to the clinic for a personalised rehabilitation plan to get you back doing the things you love.

How’s your goose’s foot?

If you get pain just below your knee, it may well be your goose’s foot!

We’ve been seeing quite a few people with issues with their goose’s feet lately and thought you should know about yours.

Just below the knee on the inside of the leg there is a structure called pes anserinus, which literally means goose’s foot! As 3 tendons come together at this point, it resembles the appearance of a goose’s foot.

There are usually underlying biomechanical issues, which means that excessive strain is being placed on the tendons and attachment area of the goose’s foot.

Pes anserinus injury is highly painful and usually results in having to cease running or walking and even causes a limp.

The good news is that alleviating the pain can be achieved by:

• using anti-inflammatory measures
• taking the strain off the injured tendons (e.g. taping)
• limiting activity levels
• soft tissue techniques

Whilst getting rid of the pain is all well and good, the most important thing for those with pes anserinus issues is to address the biomechanical issues underlying the condition and allow return to physical activity.

This requires a thorough assessment with an experienced physiotherapist with a sound understanding of lower limb biomechanics. Altered biomechanics can be addressed in a number of ways including:

• specific strengthening exercises
• targeted stretching
• changes in footwear or orthotics

If you think you may may be having issues with your goose’s foot, we can help you get out of pain, get back exercising and improve your biomechanics. To make an appointment with one of our experienced physios phone 8850 7770 or click here.

• Do you find yourself waking at night with hand pain or numbness?
• Are you frequently shaking your hands due to lack of sensation?
• Do you get shooting pain up your forearm?

If so, you may have Carpal Tunnel Syndrome.

Carpal Tunnel Syndrome is more common than you may think and we’ve been seeing it (to varying extents) in a large proportion of our patients. It can also be a highly debilitating condition impacting many aspects of daily life.

What is Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome is damage or irritation to the median nerve as it passes through the carpal tunnel (a ring of bones in the wrist). The result of damage to the nerve is commonly pain, pins & needles or numbness in the hand (typically the palm side of the hand, including the thumb, index and middle fingers). These symptoms can occur at any time, although they are often worse at night with people frequently waking with a dead hand sensation as well as having severely disrupted sleep.

If Carpal Tunnel Syndrome is left untreated, it can result in:

• Persistent pain, tingling and/or numbness in the hand,
• Weakness in the hand, which may lead to functional impairments (including reduced grip strength and hand dexterity),
• Additional nerve damage further up the arm and even in the neck,
• Permanent damage to the median nerve.

Those with Carpal Tunnel Syndrome will tell you that they will do anything to get rid out it. Why wouldn’t you want a pain-free, fully functioning hand with normal sensation? Or perhaps an uninterrupted night of sleep, the ability to open jars again or not having to shake your hand to “wake it up”?

Tailored physiotherapy programs can treat the symptoms of Carpal Tunnel Syndrome that you may have. Physiotherapy treatments for Carpal Tunnel Syndrome include:

• Splinting, which involves wearing an appropriate brace to ease the strain and reduce the irritation on the median nerve.
• Nerve gliding exercises, which are specific exercises to get your median nerve moving well through the carpal tunnel as it often gets “stuck” when it is irritated.
• Wrist and forearm stretching and strengthening exercises.
• Addressing postural concerns and neck issues which can be associated with Carpal Tunnel Syndrome.

Our physiotherapists are well-versed in identifying and assessing for Carpal Tunnel Syndrome, as well as differentiating this from other similar conditions.

If you are waking in the night with hand pain or think you may be experiencing Carpal Tunnel Syndrome, a consultation with one of our physios will help put a plan together to put an end to it. Phone 8850 7770 or click here and we’ll help you get on top of it ASAP.

Foot pain can be extremely debilitating, not to mention extremely inconvenient given the amount of time we all spend on our feet during the day.

Lately, with the warm weather and people spending plenty of time out and about being active, we’ve seen an increase in foot complaints and in particular, a high number of stress fracture injuries.

A stress fracture is a nasty injury; however, it is important to note that it differs from a regular fracture in many ways.

So here’s the big question:  How do you know when you have a stress fracture or are at risk of developing one?

As professional physiotherapists, we see a lot of nasty foot injuries and have extensive experience in picking the difference between stress fractures and standard fractures (as well as numerous other foot complaints).

A stress fracture is the result of repetitive stress imparted on a particular segment of bone, and is therefore classified as an overuse injury. It is not the result of acute trauma. Typical activities that can result in foot stress fractures include dancing, running and jumpingactivities. We have even seen foot stress fractures recently from excessive walking!

The single greatest contributing factor to a stress fracture is load – that is the volume of activity that you are doing and therefore the cumulative stress that you are putting on the bones in your feet.

Other factors that contribute to developing foot stress fractures include decreased strength and flexibility (especially in your calf and toe flexor muscles), reduced balance, poor biomechanics (including feet rolling in), foot anatomical variances including having a 2^nd toe longer than the 1^st (known as a Morton’s foot!) and inappropriate footwear. Believe it or not the surface on which you are exercising (too hard) can play a role as can low bone density, poor nutrition and even menstrual irregularities in females.

Combine any number of these risk factors together with a high load of running, walking, dancing or jumping activities and you place yourself at high risk of developing a stress fracture and spending a lengthy period of time away from these activities.

The reality is that stress fractures can occur in any of your bones in your body with repeated stress applied to them and they do! Due to the complicated biomechanics of the foot, and the fact that we spend large portions of the day on our feet transmitting our body weight through these tiny bones, it should come as no surprise to know that stress fractures are particularly common in the feet.

The most important role that we can play as physios is in the prevention of a foot stress fracture. This is achieved through noting the early signs of bone stress which include foot pain after activity (which may not be severe initially) which progressively worsens with activity and focal pain on palpation.

In most cases identifying what needs to be done to avoid a stress fracture of the foot is as simple as having a thorough discussion with the patient to ascertain activity load (and recent changes to this) and conducting an assessment of the lower limb biomechanics. This allows us to identify activity overload or biomechanical issues in the area, as these are the main contributors to injury and their identification is key to prevention.

Once it has been determined that you are at risk, our physios will take a number of steps in order to help you recover and prevent further injury. This will typically include:

• Altering activity load as appropriate,
• Gait/running/jumping analysis and intervening to make appropriate changes as required,
• Assessment and recommendation of appropriate footwear ,
• Personalised stretches, strengthening & stability exercises,
• Potential prescription of supportive orthotics,
• Soft tissue release techniques (e.g. massage, foam roller),
• Taping techniques to de-load the area at risk or to facilitate changes to biomechanics.

If a stress fracture is actually diagnosed in the foot, the aim of treatment is to facilitate optimal healing, reduce pain levels in the early stages and ultimately facilitate return to pre-injury activity, whilst minimising the risk or recurrence. Treatment may include the following (in addition to the things listed above):

• Immobilisation of the foot for a period of time (e.g. moon boot or cast),
• Rest from foot loading activities (e.g. running, jumping, dancing),
• Mobilising with crutches to eliminate/limit stress applied to the foot,
• Use of anti-inflammatory measures (e.g. medications & ice)
• Personalised plan to return to the loading activities that you desire!

Got a foot complaint?

No problem, we’ve got you covered.

Here’s what you need to do:

Simply call us at the practice on 8850 7770 and we will prioritise you as a matter of urgency.

Keep those feet happy!

Our team of expert physiotherapists have found over the years that whilst summer sports are in full swing, patients experiencing calf strains are at a peak.

Calf strains are very common among athletes, especially runners and those participating in sports that involve lots of explosive movements like tennis. This injury is caused by a combination of overuse and lack of strength, flexibility and general conditioning.

Suffering from a calf strain can cause you a lot of grief. You will feel a lot of sudden pain up the back of your leg (predominantly in the calf area), have difficulty standing on your toes and experience swelling and/or bruising of the calf muscles.

If you want to ensure that you don’t re-strain your calf, risking further (or repeat) damage, and want to be pain free again, it is highly recommended that you opt to get physiotherapy treatment to restore full function to the area.

What can you do for relief?

The best form of relief for the typical initial symptoms of a calf strain (sudden pain, pain rising on tiptoes, swelling and bruising) can be gained by utilising the RICE method – rest, applying ice and compression and keeping the affected area elevated.

In addition to this, physiotherapy treatment is required in order to restore full function to the area and to aide prevention of injury recurrence.

So, what are typical treatments for a calf strain?

Great question! Typical treatments can include manual therapy, strengthening and stretching exercises, footwear analysis, running technique analysis and a range of other options. After initial treatment and once the muscles have returned to full strength, a plan of progressive running and sport-specific exercises will be recommended to build condition and pave the way for return to active sports.

Can you tell who is at risk of developing a calf strain?

Whilst there is no crystal ball to tell who will sustain a calf strain, there are some factors that can indicate who is at risk. These include those having had previous calf and hamstring strains, especially if they were not completely rehabilitated. Many people sustaining calf strains report a feeling of tightness or lack of strength before sustaining the injury!

So if you or someone you know is experiencing tight calves or has a calf strain, contact the clinic today to take the first step on the road to recovery so you can get back to pain free activity.

Knee pain is one of the most common injuries we see in our clinic. This is partly due to there being many different types of knee pain. Today we want to talk to you about the most common knee injury we treat here, it’s known as Patellofemoral Pain Syndrome.

Keep reading…

So, what is Patellofemoral Pain Syndrome and who is at risk?

Great question!

Patellofemoral Pain Syndrome is a term to describe the pain in and around your knee cap.

For some patients the source of pain can be hard to locate and even harder to describe. As clinicians we describe the pain as vague and diffuse in nature.

Almost everyone who is active is at risk of knee pain, including Patellofemoral Pain Syndrome, but there are certain groups that are more susceptible.

People who exercise or play sports, particularly those that involve sudden changes in movement or speed could be vulnerable to knee injuries. This is because when you run, jump, twist and turn, the extra force and impact is taken by the knee joint.

What leads to Patellofemoral Pain Syndrome?

Just like any injury, the exact causation can vary tremendously from one person to the next.

Some of the most common contributing factors include:
– Feet which roll inwards (pronate),
– Having a knee cap which sits towards the outside of the knee,
– Lower limb muscle tightness,
– Poor muscle function or weakness/imbalance (very common),
– External factors such as poor training routines or inadequate footwear (also very common and often missed in differential diagnosis to the untrained eye).

In many of the Patellofemoral Pain Syndrome cases that we treat, there is often a combination of several of the above contributing factors present.

What can you do to help combat this injury?

First of all, you will need to be assessed by an expert who sees Patellofemoral Pain Syndrome and successfully treats it often.

When you do present to your practitioner, it will really help in our differential diagnosis and subsequent management if you can keep a record of how your pain has been behaving up to that point.

Important aspects for you to note are:
– The specific location of your pain (although this is often difficult),
– What activities make your pain worse,
– A thorough history of when your pain started,
– Whether you are experiencing any clicking, or giving way of your knee,
– The presence of any swelling around the knee.

You should also always inform your therapist of any previous injuries you have suffered that may be affecting your present condition and future management.

The more accurate the information you are able to provide your physiotherapist, the easier it is to determine the best management plan for you so that you can make a successful recovery.

So if knee pain is preventing you for performing the activities you enjoy, or if you believe the way your body moves may be placing you at risk of developing knee pain in the future, please call our clinic for an initial consultation and we can get you on the road to recovery.

That’s all from us today.