Youth Strength & Conditioning training

Youth Strength training

There is clear evidence that strength or resistance training can be a worthwhile and beneficial activity for children and adolescents, with some of the many documented positive outcomes including improved strength, power and speed; stronger bones; reduction in injury rates & increased sports performance.

And whilst a growing number of youths are participating in resistance training programmes in schools, gyms and sports training facilities, most parents still wonder at what age should children start resistance training, and what precautions should be taken so that training is safe for their growing bodies?
A common misconception about strength training in children is that exposure to loads greater than their own bodyweight can cause damage to their bones and muscles, however there is no evidence to support this.

The risk of injury resulting from resistance training, weightlifting and plyometrics is not any greater than other sports and activities in which children and adolescents are regularly involved in.

The risk of harm to a child undertaking resistance training is actually more related to the level and quality of supervision, or the lack of, rather than the resistance training per se. Inadequate professional supervision leads to poor exercise technique and inappropriate management of training loads.

Resistance training can start at as little as 6 years of age, provided the child can follow clear instructions and appreciate the dangers present with training. This is something as physiotherapists we often do without the child or parent even knowing – adding in bodyweight and resistance band exercises at home to rehabilitate injuries for instance.

Before beginning resistance exercises, specific criteria to measure strength with bodyweight tasks should be met. These vary depending on age and sex, and these criteria should be strictly adhered to by an adequately qualified supervising professional. The professional should meet youth training guidelines imposed by strength and conditioning governing bodies in Australia such as ASCA (Australian Strength & Conditioning Association) and have a strong knowledge of developmental anatomy & physiology and injury rehabilitation.

The dosage and resistance level of exercises should depend on the age and skill level of each child, and should be highly individualised to the inherent biomechanical attributes and goals of each child. This means that programs should be tailored to reduce risk of injury depending on each child’s musculoskeletal attributes, & also to their sport-specific, activity-related or general goals in wanting to begin resistance training.
Strength & conditioning programmes designed and supervised by qualified professionals who have an understanding of youth resistance training guidelines as well as the physical and psychosocial uniqueness of children and adolescents appear to be an effective strategy for reducing sports-related injuries in young athletes, & can contribute to developing healthy lifestyle choices in young people.

To kickstart your child’s resistance or sports performance program, enquire about D.R.Physio’s new Youth Strength & Conditioning Classes in Olinda with ASCA trained physiotherapists starting September 16 2019.

See our timetable and book online here

References:

https://www.ncbi.nlm.nih.gov/pubmed/17241104 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3483033/

https://www.strengthandconditioning.org/images/resources/coach-resources/resistance-training-for-children-and-youth-asca-position-stand.pdf 

https://journals.lww.com/nsca-scj/FullText/2017/12000/NSCA_Strength_and_Conditioning_Professional.1.aspx

Are you & your children getting enough exercise? You may be surprised what the WHO guidelines are

The World Health Organisation (WHO) recommends for all adults over 18 who are able to, should perform:

  •  150 minutes of moderate intensity exercise or 75 minutes of vigorous exercise per week, or a combination of. 
  • Muscle-strengthening (resistance training) involving major muscle groups on 2 or more days a week. 

For additional benefit, the WHO recommends that people should consider increasing the level of moderate exercise to 300 minutes and/or vigorous exercise to 150 minutes per week.

Bouts of aerobic exercise should be in at least 10 minute blocks.

The benefits of resistance training cannot be underestimated either, with a recent study stating that performing 3 sessions of aerobic exercise and 2 sessions of resistance training per week provides more cardiovascular benefit that performing 5 sessions of aerobic exercise per week*.

The above holds for both adults 18-64 and for those aged 65 and over, with the benefits to those aged over 65 including:

  • lower rates of all-cause mortality, coronary heart disease, high blood pressure, stroke, type 2 diabetes, metabolic syndrome, colon and breast cancer,and depression;
  • are likely to have less risk of a hip or vertebral fracture;
  • exhibit a higher level of cardiorespiratory and muscular fitness; and
  • are more likely to achieve weight maintenance, have a healthier body mass and composition.

Adults who currently do not meet the recommendations for physical activity should aim to increase duration, frequency and finally intensity as a target to achieving them. The assistance of a qualified health professional such as a physiotherapist can be vital for this group of people in achieving good outcomes.

The American College of Sports Medicine go further to recommend neuromotor exercises two or three days a week, & suggests participating in activities like yoga and Pilates. Functional resistance movements involving a significant degree of balance and multiple muscle groups might also help fulfill the recommendations for neuromotor exercise. Our very own GLA:D exercise classes fit the bill for combining strength, balance and neuromotor exercises for people with knee and hip Osteoarthritis.

Children 5-17 years should participate in 60 minutes of moderate to vigorous intensity daily physical activity. 

Amounts of physical activity greater than 60 minutes provide additional health benefits. Most of the daily physical activity should be aerobic. Vigorous-intensity activities should be incorporated, including those that strengthen muscle and bone such as running, jumping or weightbearing sports, at least 3 times per week.

Appropriate practice of physical activity assists young people to: 

  • develop healthy musculoskeletal tissues (i.e. bones, muscles and joints);
  • develop a healthy cardiovascular system (i.e. heart and lungs);
  • develop neuromuscular awareness (i.e. coordination and movement control);
  • maintain a healthy body weight.

Read more:

Children Physical Activity: https://www.who.int/ncds/prevention/physical-activity/factsheet_young_people/en/

Adults 18-64 Guidelines for Exercise: https://www.who.int/dietphysicalactivity/factsheet_adults/en/

Adults >64 Guidelines for Exercise: https://www.who.int/dietphysicalactivity/physical-activity-recommendations-18-64years.pdf

*https://journals.lww.com/acsm-healthfitness/Fulltext/2009/07000/ACSM_STRENGTH_TRAINING_GUIDELINES__Role_in_Body.7.aspx

I Woke Up and I’m So Dizzy – is it BPPV?

You just got up, the room is spinning, you feel like throwing up, you are more dizzy than you have ever been and the day hasn’t even started. 

Benign Paroxysmal Peripheral Vertigo, or BPPV, is a common reason for intense and debilitating dizziness. It is characterised by a feeling of the room spinning or “vertigo”, symptoms worsening on head movement but lasting for less than 1-2 minutes each time and a sudden onset. BPPV can be commonly confused for other inner ear pathologies like vestibular neuritis (an infection of the fluid in the ear) or much more serious conditions like a stroke. However, when diagnosed correctly, BPPV can be managed effectively by a physiotherapist. 

Our inner ear system has an important role in regulating our balance and sense of position in space. Each ear has a set of 3 semicircular canals which contain floating crystal-like calcium carbonate material, known as otoconia. These otoconia, or crystals, move within the ear with respect to gravity inside the semicircular canalsThis movement of the floating crystals happens each time we move our heads to give us a sense of movement, the right ear working in tandem with the left ear.  

 However, when the crystals float out of the correct canal into a different one it does not belong in, the wrong messages regarding our sense of movement are sent to the brain. This results in BPPV and the feeling of severe vertigo.  

Physiotherapists use the Hallpike assessment as the gold standard test to determine if the patient truly has BPPV.  If this is confirmed, the Epley manoeuvre is performed on the patient where it uses gravity to tip the crystals back into the correct canal.  The Epley manoeuvre often results in an almost immediate improvement but usually the procedure will need to be performed regularly but the person themselves at home, or with a physio, over a 3-4 day period until symptoms fully settle, depending on the patient.  

BPPV is highly treatable but it is very important to have an assessment with a Physiotherapist or Doctor to ensure that the dizziness you are experiencing is not another more serious condition requiring different medical intervention.  

How to safely return to running postnatally

Jen Vardy, Pelvic Health Physiotherapist @ Drphysio Olinda & Mt Evelyn

Having a baby is a time of incredible joy and exhilaration and a time to adjust to motherhood, sleep deprivation and the amazing changes a woman’s body has undertaken in growing, carrying and birthing a little one.  New mums are usually keen to return to exercise and all the activities they loved doing before baby but are often unsure how to safely begin.

Runners are often a different story. They are usually itching to get back on the trails for both the exhilaration of the run and the mental break from newborn life. However, they may not be aware of the impact of running on their recovering bodies both in the now and also in the future. Fortunately, to help support postnatal women to return to running safely there are new guidelines based on the best available current evidence (1). The guidelines have been produced by three passionate UK based Physiotherapists who have sought extensive collaboration from leading international Health Professionals. They recommend that there is no one size fits all approach and that most women should wait until at least 12 weeks postnatally before a graduated return to the pavement.

Some women will cringe at waiting this long but consideration must be given to the high impact loads of running and the physical, psychological and hormonal factors of postnatal recovery.

Running produces a sudden rise in intra-abdominal pressure and acknowledged increased ground reaction forces of around 1.5-2.5 times bodyweight. Postnatal women have weakened lower limb muscles following pregnancy and childbirth and poor ability to absorb such dramatic elevations in pressure. Abdominal and pelvic floor muscles are also recovering post both birth and if such forces are transferred to these vulnerable muscles they will struggle to maintain continence and organ support.  No new mum wants to encounter bladder or bowel leakage or an onset of prolapse symptoms.

The stakes are high for a mum wanting to return to running. Throw in sleep deprivation as the new norm which causes a reduction in muscle protein synthesis. And breastfeeding and its increased energy requirements, and no wonder the guidelines recommend every mother should access a pelvic health and physical assessment with a specialist Physiotherapist.

Until Medicare funds such a postnatal screening assessment for every new mum this may not always be achievable. Best practice should at the very least include starting an appropriate exercise program early which includes specific pelvic floor and abdominal muscle training and education to ready the running mum for herappropriate time to return to running.

  • Goom, T., Donnelly, G., & Brockwell, E. (2019). Returning to running postnatal – guideline for medical, health and fitness professionals managing this population.

https://www.researchgate.net/publication/331608702_Returning_to_running_postnatal_-_guideline_for_medical_health_and_fitness_professionals_managing_this_population

Is Running Bad for My Knees?

Running is a highly popular, easily accessible physical activity that provides a number of physical and mental health benefits including reduced risk of mortality and chronic health conditions.

Despite this, for many years there has been a stigma attached to running from many health professionals and those in the community that running is bad for your knee joint and causes osteoarthritis (OA). For quite a few people this has meant that they been advised to reduce or stop running in order to protect their joint, yet there is little evidence to support this approach.

 

However, there is a growing amount of research that demonstrates recreational running in distances up to a marathon has a protective effect against the development of knee OA compared to non-runners. Runners should understand that there are other risk factors more likely to increase the risk of OA including higher body mass, previous knee injury, previous knee surgery and heavy occupational workloads rather than running alone.

Management and progression of training loads, strength training, adequate recovery (including sleep) and running technique improvement are important to consider to minimise the risk of knee injury.

Cross-training with appropriately guided strengthening, Pilates, non-weightbearing activities and other associated remedial therapies such as joint mobilization, massage, dry needling and myotherapy can assist to improve recovery and reduce injury risk.

Pain and injury are likely to develop when the body is pushed passed it’s capacity, such as when training loads are too heavy or not increased gradually, and also when biomechanics of gait are sub-optimal. This is where seeking guidance from a physiotherapist can be invaluable – to assess what can be improved and how. This may be as simple as planning training loads, looking at key muscle groups to strengthen or assessing foot and lower limb biomechanics.

To summarise, the total running an individual can tolerate will vary from person to person and will depend on factors previously mentioned. Be sure though that running at an appropriate level for yourself will not cause you any damage to your knees, and instead likely help them.

Prevention of the ACL epidemic in female sports

Another ACL injury! Fremantle AFLW player Alex Williams clutches her knee this week, courtesy of The Advocate.

ACL (anterior cruciate ligament) knee injuries in female sports has increased dramatically in Australia in recent years, correlating positively with the huge uptake of AFL by girls and women. In fact, there have been up to 43% (74% under 25 years) more ACL injuries over the past five years!

The peak rate of these injuries occur during the age of 15-19 years old & are likely due to increased participation levels and changes during puberty, plus a range of other physiological factors.

The ACL attaches to the area in front of the intercondylar eminence of the tibia (lower leg), it extends backwards and laterally, to attach to the posterior part of the inside of the lateral condyle of the femur (thigh bone).

Its primary role is to resist excessive anterior translation and medial rotation of the tibia, in relation to the femur.

The ligament is stretched or torn in 70% of all serious knee injuries (Tortora & Grabowski (2000).

It is more commonly torn in women than men for a number of reasons:

– ligament is smaller and less strong in female
– less thigh muscle strength means there isn’t as much muscular protection to the ligament
– the increased elasticity in females means that there is more of a delay in hamstring firing, which will protect the ACL less (particularly with hormonal changes during the menstrual cycle)

– Greater Q angle due to wider pelvic compared with males (see diagram below) which places increased stress on the ACL

– Narrower intercondylar notch (which has an increased shearing effect when knee is under stress)

The good news however is that there are effective measures to help reduce the incidence of injury. Injury prevention programs have been shown to decrease severe injuries (including ACL) by up to 74% and all other lower limb injuries by 55% (including ankle, other knee injuries and muscular strains).

These programs focus on improving strength and control of movement (including balance and agility) that can easily be incorporated into routine warm-ups for training and games. Not only do these programs reduce the risk of injury, but they also performance of players completing the program (increased strength, improved movement patterns and balance/agility).

These programs have been implemented in both female and male community and elite sport throughout the world for different sporting codes. In Australia such programs include; the FIFA 11+ for soccer, FootyFirst for AFL and the netball KNEE program for netball.

The physiotherapy team at Dandenong Ranges Physio have developed our own abridged version of these

preventative training regimes assist local coaches, parents and trainers in the implementation of these programs. One downside of the above programs is that they often take 20-25 minutes to complete, and when coaches only have their players for 1-2 hours of training they are reticent to spend this time on preventative training. Perversely it is the younger and mid-teen girls teams which have shorter trainings yet are the demographic that would benefit most from preventative training.

So far we’ve presented this to local youth and adult football, soccer and netball clubs coaches, trainers and player with great uptake.

If you or your local club is interested you can get in contact by emailing info@drphysio.com.au or calling us on 97510400.

Overuse Knee Injuries

There are a number of common knee pain complaints that we see every day that are labelled as ‘overuse’ injuries. Overuse doesn’t necessarily mean that you as a person have overused that joint or body part (though it could well do!), rather than a soft tissue or connecting structure has been overloaded. In fact the cause may be from a change or increase in training, poor foot biomechanics, and often gluteal or hip weakness. The symptoms can be sharp, acute pain or a dull ache that lingers after activity – it varies depending on the condition.

Remember that pain is not equivocal to damage, rather it is a signal, and the more chronic the pain the more the signal may be interpreted abnormally by our brains!

This month’s blog article looks at the causes, symptoms and treatment for three overuse conditions that often cause knee pain:
– Patellofemoral Joint Pain Syndrome (PFPS or PFJ syndrome)
– Iliotibial Band Friction Syndrome (ITB syndrome)
– Patella Tendinopathy (Jumper’s knee)

Plus Knee osteoarthritis, which often underlies soft tissue changes in people over 40 years of age (yes, only 40!).

Patellofemoral pain syndrome (PFPS or PFJ syndrome):

PFPS is pain arising from the tissues within or surrounding the knee cap (patella) and the femur (thigh bone).

Pain is typically a vague, overall tenderness at the front aspect of the knee and can be hard to localize. It is usually aggravated by activities that involves a high amount of knee bend (eg. up/down stairs, running (especially downhill), squats, lunges, sitting in a car, plane or cinema for prolonged time).

There are a number of risk factors that may increase the stress placed on the patellofemoral joint including lower limb muscle weakness, abnormal patellofemoral joint alignment, increased foot pronation, increased Q angle at the hip, weak external rotator of the hip (gluteals), change in training load.

Patella tendinopathy (jumpers knee):

Patella tendinopathy is a diagnosis of pain and dysfunction in the patella tendon. This condition presents with well localized pain in the patella tendon, usually at the attachment to the patella. Typically people with this condition have aggravation with activities that increase loading on the patella tendon such as running and jumping.

Risk factors for this condition are similar to that of PFPS, however the most common trigger is an increase in training volume and frequency and reduced quadriceps muscle strength and length.

Iliotibial band syndrome (ITB Syndrome):

The ITB is a thick structure called fascia that runs from the outside of the hip to the outside of the knee. ITBS is an overuse condition where pain is felt on the outside aspect of the knee. It was previously thought that this was caused by increased friction of the ITB on the bone outside the knee, with excessive knee bending movements causing inflammation and pain. Recent literature suggests that there is a highly innervated layer of fat between the ITB and bone that is responsible for the pain felt.

Common causes of ITBS are once again rapid increases in training volume and intensity, thigh muscle weakness particularly gluteal and quadriceps, increased foot pronation, poor movement control and poor tissue flexibility of the ITB and glutes.

Treatment:

The treatment of these issues involves addressing lower limb biomechanics that may be contributing to increased pressure on the injured structure including lower limb muscle weakness, increased foot pronation and poor movement control.

Soft tissue techniques including dry needling and massage can be effective in order to reduce sensitivity of tight muscles contributing to the injury.

Taping can also be effective in the initial phase of rehabilitation in order to offload injured areas and enable easier return to activity.

Load management is also a key component that needs to be addressed, as rapid increases or decreases in activity often lead to these injuries developing.

Your physiotherapist will be able to guide you through a specific rehabilitation program and which of these methods of treatment will be suitable to you.

Knee osteoarthritis (OA):

Knee OA is another condition not to forget when considering overuse injuries around the knee. This condition typically arises when people have changes in activity level (either too much or too little). Common symptoms are pain with weight bearing, reduced range of joint motion, sensation of the knee giving way and joint line tenderness.  Our recent article discussing the latest evidence for knee OA and the GLA:D program will detail the appropriate treatment strategy in greater detail.