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Warm up! Key to success

Warm up! Key to success

Okay. So you’ve decided to embark on a fitness regime in order to shed some kilo’s, get fit or just for fun. New gym membership. Check. New sparkling runners. Check. Gym gear (a bit tight at the moment). Check. Alright, let me at that treadmill/rower/crosstrainer/zumba class!
“Hold on a second – what about your warm-up!”
“Warm-up” you scoff, “you’ve got to be kidding. No time to waste on that”.
Sorry folks, but the warm-up is an important part of your exercise routine and plays a crucial role in preparing your body for exercise. Skimp on the warm-up and you run the risk of injury during exercise or sport, as well as reduced performance levels.
“But what’s so important about doing a few stretches?” I hear you ask.
A proper warm-up involves more than just standing around stretching and talking. It prepares your body for the exercise/sport it is about to undertake and should simulate the actions involved.
The benefits of a warm-up are:
1) Increase in core body temperature
2) Preparation of muscles, tendons and joints for the stresses/strains of activity
3) Increase in nerve impulse conduction to muscles
4) Increase in blood flow to muscles
5) Increase in respiratory (breathing) rate
Let’s have a closer look at each of these benefits.
1. Increased core body temperature – this is important as it prepares the body for the change in activity level from being sedentary to exercising and gets the body into a ‘ready’ state. This also results in an increase in muscle temperature which makes them more pliable, supple and loose.
2. Prepares muscles, tendons and joints for activity – each sporting activity stresses the body in different ways so it is vital to prepare in a way that simulates these activities. For example, if you are a basketballer you need to include in your warm-up the jumping, running and change of direction that occurs during the game. If you pump weights at the gym, it is vital to perform a warm-up set of each exercise at a lower weight to allow your body to adjust to each specific movement.
3. Increased nerve conduction – muscles that are in a ready or aroused state react quicker and more efficiently than muscles that aren’t prepared for activity.
4. Increased blood flow to muscles – through increased blood flow there is an increase in oxygen flow to muscles as well as nutrient flow. This increased flow allows for improved performance
5. Increased respiratory rate – prepares the lungs for an increase in activity level and improves oxygenation of the blood flowing to the muscles.
Okay, so now that we know why we are performing a warm-up, what should it involve?
One common misconception out there these days is the importance of stretching as part of a warm-up. Note I said part of a warm-up.
Stretching on its own does not constitute a warm-up – rather it forms a critical part of one.
An effective warm-up has a number of very important key elements, which work together to minimize the likelihood of sports injury and prepare the individual for physical activity.
These key elements are:
1) The general warm-up
2) Static stretching
3) Sport specific warm-up
4) Dynamic stretching
1. The general warm-up
This consists of light physical activity such as walking, jogging, easy swimming, stationary bike, skipping or easy aerobics. The intensity and duration of the general warm-up is dictated by the fitness level of the participating athlete. For the average person, this part of the warm-up should last between 5 and 10 minutes and result in a light sweat.
2. Static stretching
Yes! Static stretching. This is a very safe and effective form of basic stretching. There is a limited threat of injury and is beneficial for overall flexibility. All the major muscle groups should be included for a period of 5 to 10 minutes.
Debate has raged about whether static stretching should be part of a warm-up and some studies have shown that static stretching can have an adverse effect on muscle contraction speed and therefore performance. It is for this reason that static stretching is performed early in the warm-up and always followed by sports specific drills and dynamic stretching. It is important these first two elements are completed properly as it allows the more vigorous and specific activities of elements three and four to then be performed.
3. Sport specific warm-up
In this part, you are specifically preparing the body for the demands of your particular sport or activity. During this part of the warm-up, more vigorous activities should be employed. Activities should reflect the type of movements and actions which will be required during the activity.
4. Dynamic stretching
Finally the warm-up should finish with a series of dynamic stretches. Caution should be taken with this form of stretching as it involves controlled, soft bouncing or swinging motions to take a particular body part past it’s normal range of motion. The force or the bounce of the swing is gradually increased but should never become radical or uncontrolled. These exercises should also be specific to the sport or activity.
Another important factor to keep in mind when undertaking any new exercise regime, is the time it takes for the body to adapt to training. If you have had a period of time away from sport or activity, then your body won’t be used to the stresses and strains put on it from exercise. It can take up to 4 to 6 weeks for your muscles, tendons and joints to become adjusted to the movements involved in your sport or activity.
During this period it is advisable to start with low to moderate intensity exercise which gradually builds over time. Heading straight up the red or blue arrow as your first exercise session in 3 or 4 months isn’t a great idea. Starting out with flat walks or jogging and gradually increasing time and intensity is a better way to start. After 4 to 6 weeks you will be at the stage where you can tackle more intense sessions.
The same goes for weight training. Starting with lighter weights and more repetitions will allow your tendons and joints in particular, to adapt to lifting load. Going too heavy too soon can lead to tendon injuries or severe muscle and joint soreness.

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Tennis elbow…perhaps not from Tennis!

Tennis elbow…perhaps not from Tennis!

Lateral epicondylalgia or tennis elbow is the most common cause of musculoskeletal
pain located near the elbow. It is commonly known as tennis elbow as it can be a significant problem amongst tennis players. However, you do not need to play tennis to have experienced this injury. It is reported that approximately 40% of people will experience this type of pain at some point in their life and it usually presents in males or females aged between 35 and 54. Lateral epicondylalgia is an injury to the forearm muscles that act to extend the wrist and fingers. The point of injury occurs at the site where the muscle attaches to the bone near the elbow.

What causes tennis elbow?
Lateral epicondylalgia is usually caused by an overload of the forearm extensor muscles where the load is more than what normal muscle tissue can handle. Associated neck or shoulder pain may also contribute to the presentation. Common causes or activities can include:

Poor technique during sports or other activities i.e. racquet sports
Manual workers with jobs involving repetitive gripping and hand tasks
Office workers with jobs involving repetitive use of the keyboard and mouse
Diagnosis

Symptoms of lateral epicondylalgia include tenderness over the side of the elbow and pain with activities involving gripping or wrist extension. There may also be areas of tightness through the forearms and pain when the involved muscles are stretched. Your physiotherapist will be able to diagnose this condition based on physical examination and gathering a complete history of your injury. Your physiotherapist may also send you for medical imaging scans to assist in ruling out other causes of elbow pain including muscle tears, ligament injury and elbow instability or pain that is originating from the neck.

Physiotherapy
The goals of treatment are to reduce pain, promote healing and decrease the amount of stress applied to the elbow. Also, to restore full strength and movement of the elbow and wrist. Early treatment may include:
Rest from aggravating activities
Exercise programs involving gradual strengthening and stretching
Massage and other soft tissue techniques
Taping to reduce load on the muscle and tendon
Acupuncture or dry needling
Once pain levels have decreased, physiotherapy will involve prescription of more difficult or specific strengthening exercises and correction of any predisposing biomechanical or technique problems. These are essential to prevent future aggravation and shorten recovery time.
Braces

Braces are available which are designed to assist in alleviating pain by reducing the amount of stress on the tendon. However, not all people will benefit from using a brace. Your physiotherapist will be able to guide you through all stages of rehabilitation.

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Shoulder Pain for Freestyle Swimmers. Yikes

Shoulder Pain for Freestyle Swimmers. Yikes

 

Elite and competitive swimmers log between 60,000 and 80,000 meters weekly — swimming the length of an Olympic-sized pool 1,200 times — which places significant stress on their shoulder joints. “The upper body provides 90 percent of the propulsive force to move through the water. Due to the amount of force generated and the range of motion required to swim efficiently, the shoulder needs to have perfect mechanics to avoid injury,” says Dr. Elizabeth Matzkin, lead study author of a literature review in the August issue of Journal of the American Academy of Orthopaedic Surgeons and assistant professor of orthopaedic surgery at Harvard Medical School.

Swimming is an endurance sport but “swimmer’s shoulder” — a broad non-medical term often used to describe a variety of shoulder injuries — can affect swimmers at all levels. According to the literature review authors, many shoulder injuries are preventable with proper technique, training, stretching, and strengthening.

Shoulder pain affects 40 to 91 percent of competitive swimmers. Overuse and poor shoulder mechanics can cause muscle imbalances, decreased range of motion of the shoulder, and less efficient swim strokes, all placing athletes at greater risk for further injury. The most common swimming-related injuries include:

Impingement — As swimmers becomes fatigued, the pectoralis muscles (commonly known as “pecs”) compensate for tired muscles, which can cause the peak of the shoulder blade to rub (impinge) against the rotator cuff (tendon and bursa), stress the anterior (front of the body) ligaments, and create tears in the tissue that holds the top of the arm bone in place.

Scapular dyskinesis — Intense, repetitive rotation of the shoulder blade over the chest wall can overstretch and loosen the upper back muscles that keep the shoulder bones in a healthy position. Abnormal shoulder mechanics (scapula dyskinesis) can cause pain near the collarbone when the upper chest muscles tighten to compensate for the loosened upper back muscles.

Glenohumeral internal rotation deficit (GIRD) — Intense, repetitive rotation of the shoulder blade can cause the front shoulder ligaments to overstretch and loosen. This can cause the soft tissues and muscles in the back to tighten to compensate for the loosened front shoulder muscles while limiting the internal rotation of the shoulders, which puts swimmers at greater risk for rotator cuff tears. Swimmers must maintain some shoulder looseness to remain competitive. However, about 20 percent of competitive swimmers have hyperlaxity — the ability of joints to move beyond the normal range of motion — which increases the likelihood of greater shoulder instability and susceptibility to pain.

Possible and often subtle signs of shoulder injuries among swimmers may include:

A dropped elbow during the recovery phase of the freestyle stroke.
Excessive body roll, which may signify shoulder pain.
Drooping of the affected shoulder.

“Injury prevention is best accomplished by proper training. Most importantly, swimmers need to stretch, especially the posterior shoulder capsule, and avoid muscle imbalance by strengthening both the rotator cuff and the scapular stabilizer muscle groups,” says Dr. Matzkin. When a swimmer experiences shoulder pain, a thorough physical examination is important to diagnose the source of the pain, whether there is atrophy in the shoulder or reduced strength in the shoulder joint.
Treatment may include nonsurgical (e.g., a combination of ice, stretching, and anti-inflammatory medication, focused rehabilitation to reduce pain) or surgical (e.g., for structural injuries to manage pain rather than to enhance athletic performance) options to potentially prevent future injuries.

Journal Reference:
Elizabeth Matzkin, Kaytelin Suslavich, David Wes. Swimmer’s Shoulder. Journal of the American Academy of Orthopaedic Surgeons, 2016; 24 (8): 527 DOI: 10.5435/JAAOS-D-15-00313

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