Anthony Hawke Physiotherapy in Adelaide, South Australia | Medical and health

Anthony Hawke Physiotherapy

Locality: Adelaide, South Australia

Phone: +61 425 070 322

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25.01.2022 CRITERIA IS KEY, NOT TIME! Time is not the ONLY variable you should be using to dictate a return to sport. Not even close. In early stages post injury AND post-operatively, time allows us to understanding the healing mechanics of tissue and this helps us make informed decisions around management.... As we approach a return to activity (sporting or life), what becomes increasingly more important is OUR FUNCTION AND CAPCITY, not how much time has elapsed. Post-operative ACL rehabilitation may be one such case where time is a factor even as long as 12 months post. But this is certainly not the case for MUSCULAR INJURY. See more

24.01.2022 WHAT IS THIS MALADAPTATION YOU SPEAK OF?

24.01.2022 EXERCISE FOR LOW BACK PAIN (EARLY STAGES) Most studies recommend EXERCISE for the management of low back pain. There is however no clear evidence around which one is best. If theres no evidence-based best option, then we have to be able to order our thinking. Heres how you can do it.... NUMERO UNO: Understand the pathology. Have a hypothesised diagnosis in your head before you prescribe. If its less pathology-driven, understand that too. 1: If its really sore, things that are high capacity/mobility are probably not appropriate. No brainer. Focus on making movement less fear-evoking. 2: Knowing direction of pain is key. If pain is high, move into comfort initially. As things improve, open up the movements. Then add challenge (load, cognition). 3: Some people are stiff, some needs some stiffness. Give people what they dont have. 4: If they know an exercise type, theres less anxiety about doing it. If you know something well, you coach with more confidence. Dont be biased. Find the happy medium. BONUS ROUNDS: Use your assessment. And focus on patient GOALS and DESIRES. Important. There will be volume 2. And it will give more specifics. Lets give some structure to this whole EXERCISE thing. See more

24.01.2022 WHAT ITS REALLY ALL ABOUT We subscribe to the the idea that as physiotherapists, we rehabilitate people. I think thats flawed for 2 reasons: We are with out clients for a minuscule fraction of their time AND we do not have the capacity to take action FOR them. If I see a client for 1 hour every fortnight, Im with them 0.00297619% of the time. That statistic alone shows us how insignificantly our physical presence is. We still doing the rehabbing though, right?... And even if I was there more of the time, would that mean that people would do the right thing more of the time? Maybe, but what would happen when I wasnt there? Fortunately, our physical presence is a very small proportion of our contribution Our job as Physiotherapists it is to act as a friendly, knowledgeable guide that works WITH people through their journey of recovery by providing the tools needed to take SPECIFIC, CONSTRUCTIVE ACTION - enabling them to help themselves. We are there to usher people back on course and sometimes, to know when to change direction. We are there for support, encouragement and optimism, and sometimes to provide unwanted truths and persepctive. We are there for peoples biggest wins and sometimes, lowest lows. We dont do the rehabbing - you do. We just give you fractions of the body of knowledge (that has been generated by our incredible colleagues) that you need and provide direction along the way. It Is and always will be a pleasure to go through the process which each and every one of you.

23.01.2022 HAMSTRING TENDON PATHOLOGY! This post will pertain specifically to PROXIMAL HAMSTRING TENDON (the insertion of the hamstring to an area DEEP TO THE GLUTE). What you are going to find as you read through the slides are A LOT OF SIMILARITIES between the tendon pathologies regarding cause, progression and management. This is because they are similar structures and this respond similarly to load. What we MUST remember is that the framework in which this is applied to ...each INDIVIDUAL is HIGHLY VARIABLE. Hamstring tendon pathology is common in distance runners, jumping athletes, cutting athletes (football codes) and also occurs in the general population. The hamstring are made up of 3 muscles with the Semimembranosus being most commonly associated with tendon pathology (41%). The onset is gradual and clients will often report pain in the GLUTE CREASE, deep into the area of the sit bones. Its quite local and can be identified with the tips of 1-2 fingers. What is perhaps often overlooked in tendon pathology causes is INTRINSIC FACTORS that are related to our biology. Insulin resistance is particularly important as it has implications on tendon healing after exercise induced breakdown. Similarly high BMI may be associated with low-grade systemic inflammation. Recent corticosteroid use has also been shown to have effects on tendon health. Not to be overlooked! Progression of exercise is based on symptoms, not time. As symptoms decrease, load increases and the type of loading changes. The progression of this is based on the demands of the client! Before you may have heard (from teammates) or felt (yourself) these signs and symptoms without having awareness of the possibilites of pathology. Now you do! Congrats, youre now one @ Anthony Hawke Physiotherapy See more

23.01.2022 ADAPTATION OF ALL KINDS ADAPTATION is a massive part of the pain and rehabilitation process. In working with people, we are trying to facilitate adaptations that foster resilience, robustness and capacity.... What is also important to understand is that ADAPTATIONS can also come as a consequence of painful pathology - these are referred to as MALADAPTATIONS. Maladaptations (like changes to squat technique due to back pain) can persist LONG PAST a pain state has resolved, so it is important to identify and address them, When youre breaking down your own movement OR assessing your next client, ask yourself what adaptations have been made to cope with the pain state, and what adaptations do we need to make to move down the rehabilitation pathway?

22.01.2022 CAPACITY AT 9000! As a general consensus, us physios post about things not going so well and how to manage it (myself included). It is our bread and butter. Well Im breaking the cycle.... Heres a client and good friend of mine @kristos_papanotis Safety Bar squatting 225kg for 8 reps. At 75kg. No better way to celebrate capacity than a 3x body weight squat. For reps. On a safety bar.

22.01.2022 PAIN TO PERFORMANCE: Just the beginning. I have wanted the opportunity to share knowledge through education for very, very long time. On the weekend I had the privilege of doing just that. These awesome humans came to Pain to Performance for an opportunity to learn all things:... - Pain - Spinal biomechanics - Spinal assessment - Rehab framework - Strength programming to performance I loved every moment of it and I can’t wait to do it again (Part 2?). Its moments like these where you have to sit back and say thank you to everything that has got you to this point, and to the people that have helped you get here . 10/10 way to start off a new year

21.01.2022 CUING A SQUAT: MY FAVOURITE CUES! I have been treating long enough now and seen enough people to have found a pattern: A LOT OF US WOULD SQUAT A HELL OF A LOT BETTER IF WE GOT MORE TENSION AND BRACED BETTER. I have helped clients out with just these cues before and make a massive different to both their performance and their pain.... The spread the towel cue is phenomenal for promoting tension in the Glutes BEFORE you lift. I think it is profoundly important to generate as much tension as you can BEFORE you move. The squat itself should be a dynamic expression of the TENSION you have generated BEFORE the lift. The glutes are really important. Not only for overall power output, but also for their role in optimal lower limb alignment (promoting distributed loading!). Abdominal bracing is perhaps THE most important component of pre-lift tension. If you complain of something along the lines of, Im really weak out of the bottom of the lift, then bracing will very likely help. A LOT. The GO UNDERWATER CUE is perfect. Its a really great way to explain when to take air in and brace, when to hold the air in, and when to release. Of course theres more to bracing than just holding your breath, but I think @ethosstrength did a PHENOMENAL job of explaining that so Ill link that in my IG STORY. Apply these 2 cues to your squats and watch how much better it feels and how much better you perform. Get after it everyone! All the credit in the world to @whiteboard_daily and @dr.caleb.burgess such a great drawing. I have to get my whiteboard game up! See more

21.01.2022 BANG FOR YOUR BUCK: CADENCE Let’s be honest Physio friends, sometimes we try and get a little too fancy. We forget the basics. The real fundamentals that make a lot of change with fairly minimal effort. Increasing cadence is a great example for PAINED RUNNERS.... Cadence is a measure of how many times you step per minute. Increasing it by even a small amount (7.5%) can have profound influences on joint loading through all of the reasons listed. If want to do this, here’s how: Count how many times you step in 30 seconds when running, double it, that’s your cadence. Multiply that by 0.075. Add that number to your cadence and that’s your new target. Google a song with the same BPM as your new target, play it when you run and step to the beat. PS: it’s going to be faster than you think Very small effort, very strong change.

21.01.2022 ITS IN MY HEAD - THE KNEE EDITION. Now more than ever are we aware of the psychological contributors to pain states. What I have noticed however is that we are being very aware of the implications to LOW BACK PAIN.but way about the other limbs? Today, lets talk about the knee and use a recent study to outline some interesting points.... This study looked at correlation in psychological profiles and changes in tolerances to mechanical pain, thermal detection and repetitive exposure to the same stimulus. What they found was that people with knee pain (Patella-femoral pain) experienced more pain with a repetitive stimulus of the same intensity than those with no pain. They also had decreased threshold to painful stimulus. The group with knee pain also had significantly higher scores in fear of movement (kinesiophobia). Moreover, the fear of movement was always highly contextual to the patient. They also felt less capacity to make change in their conditions. So lets put this all together: Those suffering with knee pain have a DECREASED THRESHOLD TO PAIN, are MORE SENSITIVE TO REPETITIVE STIMULUS and are significantly MORE FEARFUL OF MOVEMENT (each with specific individual fears). So what does that mean for clinicians? Dont just get them less sore and more strong. Explain that their sensitivity is NORMAL (underpinned by understanding, not just dismissal), that they CAN get better, and really explore their pain-related fears to make their recovery personal. See more

21.01.2022 THE LITTLE THINGS! I made a series of instagram stories a while back around the small things you can do to make yourself a little better (go check it out of you havent). I have put 4 of them up that I still consistently do to this day.... You can probably tell a lot of my efforts go toward managing stress. Its huge. And I really feel that these things really help. Dont underestimate small repetitive efforts. They are huge.

21.01.2022 LOCKDOWN REMIX PART 2 Another post from previous lockdown. Still has all the relevance it did before.... I know it may be a little mentally tougher this time around, but keep moving and stay STRONG. You owe it to yourself. And if anyone needs a chat, my DMs are well and truly open to anyone Posted @withregram @ahphysiotherapy HOW DO I NOT LOSE MY STRENGTH?: TRAINING AT HOME PART 2 . So we’ve all lost access to our beloved gyms. And with this, our capacity to get under some heavy weight has been restricted (unless you have a mad garage gym, in which case lucky you!). Does this mean you’re going to whither away and become feeble and weak? . Your strength isn’t going to evaporate the moment that you realise you can’t train. As a matter of fact, its may take 3 weeks for you to lose a substantial amount (McMaster et al., 2013). And this is if you do nothing. . Moreover, gaining strength isn’t actually as hard as it seems (on paper). Studies show that you can certainly gain strength off 1 session per week (McLester et al., 2000). Increasing frequency up to 2-3x/week (with matched volume) will however be more optimal. And you may be able to get away with somewhere between 25-45 reps (as a minimum effective dose) (Barnalho et al., 2019; Feigenbaum et al., 1999) . Perhaps the most important thing is that you may not have to train THAT heavy to continue getting strong. Good news for a home gym set up. A recent 2017 study reported that there was no difference between 5-7 reps and 10-14 reps for improving squat 1 rep max (Cholewa et al., 2017) . See, you dont have to go overloading the hell out of yourself to STAY and GET strong. Use these guidelines to be more clear and precise with your exercise and keep your immune system humming at 100%. . PS: These tips aren’t just for home, use them everywhere.

19.01.2022 SO.IS BEING A PHYSIO GOOD? Yes. Absolutely yes. I love what I do. A lot. But like anything you do in life, there are some drawdowns. I had a question recently from a follower, What are the good and bad things about Physio, man?. It stopped and made me think, and here are some of the things I came up with.... What I found really interesting is that the things I LOVE and the things that ARE MORE CHALLENGING are really just opposing manifestations of one another. That made me think - Surely the good can be managed in a way we dont perceive them as not so great. So I came up with some strategies ill share later on in the week. As always, if you have any questions - hit me! See more

18.01.2022 EXERCISE FOR LOW BACK PAIN (EARLY STAGES) - VOL.2 Weve touched on some basic ideas to scaffold our thought. Lets go over some application principles with the same goals in sight that I always preach: CLARITY AND PURPOSE. These principles may seem simple, but thats the point. Simplicity is key ... Again, I want to stress that I think pathology is important and should underpin the decisions you make off these principles. Sort of like the Biscuit base of a cheesecake. The idea here is not to tell you what to prescribe, but rather what to be thinking about when you are exercising. Thats the most important thing. The specific modality you use becomes less important when you are clear with what your objective is. And dont think that just because strength is more important, that you cant sprinkle mobility (where needed) in there too. Patient needs exist on a CONTINUUM, not one specific spot. I cant stress that enough. Volume 3 will be a little more prescriptive. I hope you are all finding this helpful because Im enjoying doing it. See more

18.01.2022 THANK YOU ALL SO MUCH . . As our state starts to slowly roll back restrictions and things go back to (somewhat) normality, I just want to say thank you to all of my clients. . With all the uncertainty that plagues us every day, I feel so so very grateful to have such a loyal client base. I couldnt do the thing I love so much without each and every one of you. I... . So stay safe, dont get complacent and keep being awesome. See more

18.01.2022 CONTINUED CLIENT VICTORY - SAM HALL I posted a video of Sam winning a while back squatting a while ago after having gone through a lot of progression while managing a dic injury. Well, ya boy is back in the kitchen and this time he cooking up AMRAP of loads weights that previously made him fearful.... I know this video looks like a squat but let me tell you what it took to get here. A massive increase in KNOWLEDGE around his pathology A relentless ATTITUDE that kept going in tough times Increased CONFIDENCE around SELF-MANAGING his pain The capacity to SELF-REGULATE, learning the ebbs and flows of his movement Developing the capacity to educate others through the guise of his own journey. Leonidas-spec beard? Eh why not. Well done legend.

18.01.2022 TOUGHEST CLIENT I HAVE! I often hear from my lovely clients, Ahh I must be one of your most difficult clients to work with. Aside from the challenge of more stubborn pain being the challenge that give me a big WHY into loving what I do, youre not even close to the most tough client I have Because that is easily my mothership.... There is no educational purpose to this post, but it is pretty funny. And thats good enough for me. See more

17.01.2022 ANTHONY HAWKE PHYSIOTHERAPY STUDENT HELP GROUP . THE VIDEO SAYS IT ALL. . If youre a student and you need some help AND/OR you know someone who does - id love to help.... . The group I want to make will be an OPEN forum where we all discuss all things to do with assessment prep, assignment structure, textbook knowledge and even how to time manage (if you need me to!). . Really looking forward to trying to be the guy I WISH I HAD while I was at uni. . See you in the group. See more

17.01.2022 WORK IS NOT A WORK-OUT After ANOTHER conversation with family, I felt the need to share this post in all its glory. We should stop considering work as a modality of exercise because it is NOT.... The reasons are as clear as they can be. All credit to Adam Meakins for making it look all pretty and succinct. I need to up my infographic game, don’t I Posted @withregram @adammeakins WORK IS NOT A WORKOUT . Getting enough exercise a week to reap the physical and mental health benefits is tough Many of us live busy lives with family and work commitments taking up most of our time However, there is a common misconception that the activity and exercise we get during work or family activities counts towards our weekly physical quota Unfortunately it doesn’t and this is hard for many with busy physical jobs or lives to hear But the evidence and science is clear that you do NOT get the same physical or psychological benefits from occupational non intentional activity as you do from intentional recreational activity Your work is not a workout and you can be busy but still physically inactive! #Physio #physiotherapist #physiotherapy #physicaltherapy #sportsphysio #sportsphysiotherapy #trainer #personaltrainer #coach #strengthcoach #osteopath #osteopathy #chiropractic #chiropractor #sportstherapy #sportstherapist #rehab #therapy #myotherapy #kinesiotherapy #exercisephysiology #exercisephysiologist #dptstudent #shouldercomplex #cantgowronggettingstrong

16.01.2022 From an L5/S1 disc injury to hitting all-time PB’s and winning a gold medal. And overcoming psychological loads that aren’t shown on a barbell. If this is from pain to performance....I don’t know what is. Well done @ethosstrength, you have absolutely nailed it.

16.01.2022 FACE CAM: JEREMY ALLISON There is no educational content today. There is just this video, finished perfectly with the deep undertones of Jeremys voice.... Enjoy.

15.01.2022 ASK, AND YOU SHALL RECEIVE I had an IG follower ask me What do you look for in the right pair of runners? Typically id answer, Make sure they look good but that didnt seem like sound advice. So I went on a merry quest to answer said question. Here are my findings.... What I hope I have provided is principles to apply to your own decision making around the right running shoe for YOU. Im certainly not the foremost authority in shoe selection, but good principles to apply with sound reasoning are always helpful! If youd like any further advice - please let me know. Id love to help.

15.01.2022 FEAR-RELATED THOUGHT CYCLES Fear after an injury is exceptionally normal. As soon as you limp off a field after a sniper-shot to the hammy all you are thinking is, When will I be back - I wonder how bad it is? There is absolutely nothing wrong with fear around uncertainty. The issue presents itself when this uncertainty is unchecked, or worse yet - fuelled with unhelpful information that facilitates CATASTROPHISATION.... Unchecked catastrophisation is a very slippery slope toward poor outcomes. So can we break this cycle, and if so where? Of course we can, Ideally right at the onset. If we are able to inject high quality information around DIAGNOSTIC CLARITY, CLEAR EXPECTATIONS and STRUCTURED MANAGEMENT at the onset we lift the shroud of uncertainty and usher in CLARITY. With clarity comes CONFRONTATION and with confrontations come an empowered client that takes the necessary steps toward resolution. Break the negative cycles, get the positive outcomes

14.01.2022 PRE-IMAGING CHATS: IMAGING IS AS BAD AS THE COMMUNICATION Some evidence suggests early MRI predicts a worse outcome. How can an singular snapshot BE SO UNHELPFUL? One word: BELIEFS. An MRI in itself is not going immediately predict a poorer outcome, but your beliefs about what they mean for your long term health ABSOLUTELY CAN. Instead of BANISHING IMAGING, why dont we PROMOTE COMMUNICATION?! Helpful, realistic expectations are a sure fire way to minimise the risk ...of the generation of unhelpful beliefs. Heres how I do it: 1.) UNDERSTAND YOUR WHY: Is the referral to clear serious pathology, the presentation is behaving unpredictably, or because your client wants one? All are plenty good enough reasons 2.) IF YOU LOOK, EXPECT TO FIND: Chances are, there will be imaging findings. What is important is that you establish which ones you and the client will relate to their experience. 3.) FINDINGS DO NOT EQUAL PAIN: An image shows pathology, it does not show pain. Can imaging findings lead to pain? Yes. Do they always? No. 4.) HAVE A PLAN: Imaging is NOTHING unless you have a post-imaging management plan. Have a clear direction, and a contingency to that too. CLARITY AND DIRECTION IS KEY. See more

14.01.2022 WOULD YOU TAKE LESS MEDICATION THAN WHAT THE DOCTOR PRESCRIBED? The answer is almost always an unequivocal, NO. Normally followed by a Why would I want that?. It’s interesting that people often find that under-dosed pharmaceutical medication is out of the question, but are happy to UNDER-DOSE THEIR MOVEMENT.... Under-dosed movement comes through 2 avenues: Health professionals that do not provide sufficient progression and people that are satisfied to do less than what is needed. Perhaps both combine to provide partial rationale as to why conservative management in research has more favourable outcomes in the lower limb, but less favourable outcomes in the low back. Are our loading beliefs skewed? Movement to a physiotherapist is what pharmaceuticals are to a GP. And we both rely on people being motivated in their health behaviour enough to follow through to reach an outcome. Don’t sell yourself short of progress Take agency in your own health, don’t be scared to progress and let your health professional know that you FIND IT EASY. We absolutely love it.

14.01.2022 HISTORY IS HUGE! I dont know why im sore, I havent done ANYTHING recently True, but that doesnt mean you have done anything in the past. ... When we look for reason to feel some degree of musculosketetal pain, we look to what we have done in the previous 24 hours or even current moment. Unless were talking about an event with an incident, thats not a very helpful place to look. One of the most common causes of aches and pain is SPIKES IN LOAD. A spike can be UP or DOWN and often occurs quite rapidly. The speed and magnitude of the stimulus facilitates poor recovery and adaptation and something gets overloaded. This doesnt just apply to the athletic population, but to occupational environments too. Have you have a big assignment due and youve crammed 5 hours of desk work in an evening for a week. Thats a load spike. So youve had to unpack the house after moving. Load spike. So you decided im having a month off training because I feel like it. Load spike. Just downward. Its very important we understand the significance of our HISTORICAL ACTIVITY. So if you get an ache or pain dont tell yourself, I haven done anything. Ask yourself, Hmm what have I been doing less/more?. Once youve got the trigger, the management begins.

14.01.2022 WHAT SHOULD YOU EXPECT FROM YOURSELF? BLOG 3 UP NOW . I was initially going to name this something along the lines of, What is your Physio expecting from you?!. But really, who cares. Its not about us. Its about you. . Hopefully this video gives your some insight about some traits that I have identified as potentially helpful in the grand scheme of getting yourself down the path of recovery.... . As always remember that this is MY OPINION. Its not gospel. If youve got some points youd disagree with - Id love to hear them. . Link is in bio! See more

13.01.2022 BANG FOR YOUR BUCK: Elevate your heel This is something I use during a period of rehab for a knee, hip or even lumbar spine. A more upright torso is a more neutral position for the low back and distributes load better.... Less demand for mobility in the ankle and flexibility in the hamstring/glutes means stiff joints/tight muscles don’t shift undue stress to the knees. A stiff hips often one that lacks flexion (bringing knee to your chest). This is a great way to facilitate it. Use a 2.5kg plate, rolled up towel, 2x4. Were thinking a slight elevation here not a Smooth-Criminal type of thing, OK. If it’s helpful, you’ll know right away. If its not, ask me for an alternative - I’m sure I have some other tricks on the book.

13.01.2022 RETURNING TO THE GYM . It seems like were all about to go back to our beloved gyms! I am super excited for everyone to get back to getting stronger/fitter again, and getting back to physically expressing ourselves how (a lot of us) really enjoy. Id like to offer you some considerations to make the transition back as smooth as possible. . Volume is no doubt one of the most important variables in training (and perhaps the most important for hypertrophy) but its also the one... we tend to abuse. How good does it sound to go back and just smash it from the get go?! It shouldnt. Unless you have had access to a gym over the lockdown then its important you re-introduce yourself to volume. SPIKES IN LOADING is one of the things that I see cause a lot of injures. Slow and steady wins the race. . Assuming youve not had the opportunity to put a bar on your back, or pull some iron off the floor - take your time to get back into the groove of these bigger movements. Re-developing that mind muscle connection and re-establishing more efficient motor patterns is important early on. . The more GUARANTEED way to get where you want to be physically is CONSISTENCY. Heading back to the gym like a bull out the gate may seem great, but is that consistency sustainable? Probably not. And whats more fun GAINING MOMENTUM over time or LOSING MOMENTUM after a BIG BOOM. Ill leave that to you, but I know what I like. . This has also likely given a lot of us a significantly cleaner slate to get back to loading. Some of our niggles might now not be so much of an issue. Dont just go back to doing the same thing and getting the same issues. Think of ways to get add in helpful accessories, identify trouble exercises or even GET SOME EXPERT HELP. . A successful RTG isnt just about jumping back into what you were doing previously. Its about doing it in a careful, methodical way that is going to have your progress COILING UP like a SPRING for big leaps and bounds in the future. Have fun and stay safe! See more

12.01.2022 KNOWING THY ENEMY: SOCCER RELATED INJURIES Theres no point in me saying how important it is to know sport specific risks if I dont help you understand them! The differences in injury prevalence in male and female athletes are down to differences in: our anatomy, biomechanics, tissue biology and match-play variables. As such, mitigating risk must also change.... In season, hamstring and quad injuries dominate injury data (things are different pre-season). As such these are the things we should prepare for the most. Get strong, and run fast fairly often. Spread the running load over the week of 2-3 equal bouts. In female soccer, ligamentous injuries are most prevalent (weve seen this a lot in our WAFL, too). As such there should be more of an emphasis on quads strength, balance work and landing practice. This is not to say that both camps should not do both types of IP. Sprains still happen in the male game, and strains in the female. This is merely an effort to give people and understanding of THE MOST COMMON INJURY RISK and some basic principles on prevention As always, the FIFA11+ is a GREAT PLACE TO START. It is intended as a pre-season IP program but has great utility in season too. It always pays to know the risks of your engagement. Sport is no different. If youd like more specific information, you know where my DMs are! @ Anthony Hawke Physiotherapy See more

12.01.2022 THIS IS IMPORTANT: DONT BE VICTIM TO A FAILED PREP Tonight marks the first game back for my beloved Liverpool FC. SPORT IS BACK! For most this is exciting. For me, I have crippling anxiety about the implications of a short pre-season on Mo Salahs hamstring. SHOULD I BE SCARED?: Well no. But is there reason for concern? ABSOLUTELY THERE IS. Pre season facilitates good preparation. And fail to prepare well, prepare to fail. The German league has shown us that.... WHY IS IT SO IMPORTANT?: Time gives us the opportunity to load, strain, sweat, stress and most importantly - ADAPT. Adaptation is based on STIMULUS and TIME. Lacking one is not helpful. So what can you do UNDERSTAND THE RISKS: What injuries most commonly occur in your sport, and which ones cause the most time out. Find out. Then implement strategies to minimise. UNDERSTAND YOUR RISKS: Think of previous injuries. Thats the most important one. Have you rehabbed it before with success? Guess what, those exercises are probably great PRE-HAB TOO. DISCIPLINE: I cant express how underdone STRENGTH and RISK-MITIGATION is in amateur sport. Do your best to manage the effects of a short pre-season by STAYING CONSISTENT with injury prevention during the season. COMMUNICATE: Talk to the coaching and medical staff about any concerns you have about your capacity to adapt. Its a lot easier to manage a concern THAN IT IS AN INJURY. And additionally, use me as a sounding board. I cant express how much Im here to help. Ill post some management ideas during the week. @ Adelaide, South Australia See more

11.01.2022 WHY DID I DO MY OWN THING? I still get asked this A LOT. You’re pretty young, what made you want to go out and start up your own business? Or something similar. ... Apparently I unintentionally summarised it in 45 seconds during our Pain to Performance seminar. Do what you love, and do it how you want to do it too. Have a lovely Thursday friends.

10.01.2022 THE ELEPHANT IN THE ROOM: ESTABLISHING HELPFUL BELIEFS! Our beliefs shape our decision making. Our decision makings shapes our behaviour. And our behaviour shapes our outcomes. If we miss the foundation, were setting up for success poorly. Clients need to know that rehab is VERY RARELY LINEAR. As such, we need to make sure we broach this idea early on. ... Doing so sets up a realistic belief system that leaves people PREPARED physically and mentally. This creates a more resilient mentality and that sets up good long term application. All we want is the best for people, and it can be alluring to promise them that we can get it done without a hitch. Before we attempt to predict the future, we should consider which belief is going to be more helpful: Your physios pain-relieving spells are instantaneous OR that this is a process that we will approach with clarity, consistency, adaptability and realism. If we take pride out of it, no brainer really. @ Anthony Hawke Physiotherapy See more

10.01.2022 BREAKING CYCLES Poor health behaviours done long enough become habits. Habits become a self perpetuating cycle. Awesome if they are helpful, not awesome if they are not. Behaviour cycles play a big role in musculoskeletal pain. How? Lets have a think... Movement behaviour cycles: Our movement behaviour dictates just that - our movement. How we move dictates where we experience load and for how long. Load intensity and duration is vital in injury and pathology. If we move well, we distribute load well and share it throughout the system. If we dont, it concentrates at areas and maybe thats enough to cause discomfort. Simple Thought behaviour cycles: How we think about our movement dictates A LOT of things. Thought influences our capability and resilience beliefs which ties in immensely to how readily we participate in activity and life. The more unhelpful the thought cycle, the less resilient we perceive ourselves and the more readily we avoid things. Cycles can be consequences of occupation, compensatory mechanisms from previous injury or beliefs ingrained in us from youth or experience. ACKNOWLEDGING AND APPRAISING these cycles in our thinking and behaviour is essential in modifying our musculoskeletal pain. The slides will identify some common examples. Some are complex, some are simple but most are all MODIFIABLE! Maybe now you can identify some CYCLES that are not serving you very well and challenge them! Id love to help if I can.

10.01.2022 CONSISTENCY IS EVERYTHING! I know this is the most Im a Physio things to say but: I cannot stress enough how important prolonged consistency is. We often expect that because time has elapsed and we have implemented bouts of effort that we should be better. Unfortunately, time is not the main factor when we consider adaptation - stimulus is.... The 2 charts are marked by 2 different strategies. One BOOM-BUST and the other PLANNED CONSISTENCY. Although the same TIME elapses for both and PERCEIVED EFFORT is similar for both, only one hits the adaptation thresholds. Understanding this concept is the key between success and chronic rehabilitation. See more

09.01.2022 HAMSTRING STRENGTHENING POST ACL RECONSTRUCTION Strengthening the hamstrings is a vital component of post-op ACL rehab, particularly when the hamstring tendon is harvested for the graft. In this case, there can be chronic inhibition of the muscles and shortening of the tendon - leading to a decrease in function and increase in injury risk. When selecting strengthening exercise for the hamstrings consider the 4 four variables outlined.... Eccentric contractions have been shown to create positive changes to hamstring tendon architecture, potentially mitigating some of the post operative changes. Consider that they are also however more vigorous and often create more soreness. Contraction speed should be changed as functional demand change. Having the capacity for fast muscular contraction is important for running and power-based activities so consider implementing speed changes when those activities become immediate goals. Similarly to eccentric contractions, loading at longer muscle lengths has also been shown to cause positive changes to tendon architecture. Loading at shorter muscle lengths tends to be better tolerated in earlier stages. Finally, consider the position of the hip. Loading into hip flexion will create longer muscle lengths while positions of hip extension will create shorter muscle lengths. Be thoughtful, be comprehensive and don’t be scared to push people. At the right times, of course

09.01.2022 PRINCIPLES DO NOT APPLY IN LIFE AS THEY DO A VACUUM! I am a big fan of encouraging people to challenge their beliefs around their movement capabilities. If theyre safe and flexion is the barrier, you bet were challenging it. What we must understand however is that principles around challenging movement beliefs DO NOT APPLY THE SAME ALL THE TIME!... We must critically appraise the context of the application of something we know in the same way we do an article; with rigour and no bias. As an example, the flexion is safe argument is valid. Absolutely. That doesnt mean those principles can be applied to picking up a pen with the same utility as a heavy deadlift. They are different tasks entirely. Make sure you do the reading before you formulate an opinion. And always be prepared to take in and respect other opinions. Relativity, man And all the credit to @squat_university for an awesome post. They are great content creators!

08.01.2022 FOOT STRENGTH AND RUNNING INJURES A recent study has provided evidence that 4-8 months of foot strengthening may decrease risk of running related injury (RRI) when compared to a control. The rationale behind decrease in injury risk is by increasing foot strength, we increase the foots capacity to dissipate ground reaction forces and create a more resilient system.... This idea was supported by findings that not only did the exercise program decrease injury risk, there was also a direct correlation with foot strength. We all know how important strength work is, but perhaps this article is helpful in reminding us that the FOOT should be the first step in lower limb strengthening. Pun very intended. Have a lovely week!

08.01.2022 HYPERMOBILITY: WITH GREAT RANGE, COMES GREAT RESPONSIBILITY The hyper mobile kid in primary school was always the coolest. Turns out there certainly is more to it than range of movement. Hypermobility exists on a spectrum (much like all pathologies) and so do the symptoms experienced. Someone can experience ALL or NONE of these. Its massively interdependent.... It is also to be noted that there is a correlation between these, not necessarily a causation. It is however fascinating that there are correlations. I thought you would all like it too! If you want the articles that I have drawn from, please ask.

08.01.2022 THE THREE C’s Exercise selection can be tricky. We have a lot of choices at our disposal and we (as a profession) have a tendency to over complicate things. When I’m prescribing exercise I like to try and narrow down my selection into one (or more) of the categories provided by the 3 C’s - based on what my client needs. Let’s use an example:... A client is dealing with long term shoulder pain but can’t move their arm without their entire torso moving? We better focus on CLARITY to improve their dissociation and allow for better distributions of stress. Once they are able to better clarify their movement, then we can increase their CAPACITY. Now we have movement quality AND a more robust system. Winning. They’re doing really well. They are moving better and stronger than ever. Why stop there . Let’s add COMPLEXITY to encourage the expression of strength and CLARITY with more cognitive demand. Next time you’re stumped with exercise, step back and think about which category applies best to what my client needs RIGHT NOW. And where you can, keep it simple!

08.01.2022 THE REASONING BEHIND TOO MUCH, TOO SOON! Us physios always bang on about, Dont go too hard too quickly. Its always met with a roll of the eyes. But there is reason. This graph from Magnussen et al. (2010) article shows that after a bout of loading to a tendon, the first 36 hours result in NET BREAKDOWN of the proteins. ... Its not until 48 hours post that we see NET GAIN in tendon size. The process in muscular recovery is similar in principle (although different in biological process). You cant out-train pathobiology ladies and gents! Manage your load well and stay in the game - whatever that is for you. Stay Healthy! See more

08.01.2022 YOU HAVE TO EDUCATE YOUR PATIENT!. Yea, ok. But what does that mean? Education can take SO SO many forms. Let me give you a few points about how I like to structure it. 1: UNDERSTAND THE PURPOSE: YOU really need to understand WHY youre giving them the info. Is it to challenge beliefs, minimise fear, or provide a framework that is woven into treatment. Know what youd like to get out of it.... 2: LAYS DOWN A SOLID THEORETICAL FRAMEWORK: The information should provide a framework of understanding that ties into assessment, treatment and exercise prescription. Its not just a token 15 minutes. ITS A FOUNDATION 3: UNDERSTANDABLE LANGUAGE: If you can explain it simply, then perhaps YOU need more understanding. The goal of this education is so your clients can ADPOT it and INTEGRATE it into their understanding and language. Minimise scientific jargon. 4: MAKE IT CONTEXTUAL: Dont just rattle off a text book. Fill the information with patient-specific meaning. It will always be easier to understand and better accepted. 5: USE SEVERAL MODALITIES OF INFORMATION: Understand how each individual learns. Some like visual, some like verbal. A lot like both. If you dont know, ASK! 6: ASK ABOUT HOW THEY UNDERSTOOD IT: Just because you meant it a certain way, doesnt mean thats how it was interpreted. Always ask your clients what that information meant to them. See more

08.01.2022 AN ETERNITY OF REHABILITATION Well, not really. We have discussed previously how musculoskeletal pain states are not as correlated with time as we think. Some certainly are, but a lot are not.... They are however almost always correlated with CHANGE. Decreases, increases, removals, additions, incidents. All of these have the capacity to influence the way we are loaded (physically and/or non-physically). A program aimed at resolving a pain state seeks to give us the capability to tolerate what we currently cannot. It bridges the gap between the capacity we currently have and the capacity we need to overcome. Remember pain states are just that, states. By definition, it gives us a snapshot of us at a specific time. What we should instead perhaps ask is: How long am I going to do this to resolve the imbalance between WHAT I HAVE and WHAT I NEED? That will always give us a better answer (It depends again, doesn’t it).

07.01.2022 UPPER TRAPS - A MISUNDERSTOOD MUSCLE . I think one of the most common things I hear in clinic is - My traps are tight or My traps are so overactive. There is either 3-4 adjectives thrown in there too for good measure. So that begs the question, why do so many people complain about trap related issues? . Quick bit of anatomy: Your traps are really big and are certainly not just localised to the neck. There are middle and lower portions and these other areas have different... actions. We will focus on the upper fibres today. The upper fibres are commonly thought to SHRUG the shoulder, and this is true, but only to an extent. . If you look at the fibres, you can see they run obliquely - not just straight up and down. This orientation means that they are far more effective at SHRUGGING when the arms are about 30 degrees out from your body. Interesting. Moreover, they are also a very important upward rotator of the scapula which is ESSENTIAL for good OVERHEAD ACTIVITY. The also act on the collar bone and the compressive forces they produce here are VERY IMPORTANT for load transfer from the upper limb to the chain. . Is trap tightness a thing? Of course it can be. But perhaps not for the reason we all perceive. Perhaps lot of the time we experience the perception of tightness in the upper traps because they lack STRENGTH. A 2014 study reported that the muscle biopsy of subjects with upper traps pain compared to those who didnt have any, had changes in the way the tissue was vascularised and how it well metabolised carbohydrate (Andersen et al., 2014). These aerobic changes lead to chemical changes in the tissue that may cause pain. Do you know of a treatment that helps vascularity and carbohydrate metabolism in muscle? Resistance training! . And how about the overactivity argument? Well the only time we REALLY see overactivity of the upper traps is after a massive rotator cuff tear, nerve injury or a frozen shoulder pathology. Generally speaking, we tend to see that the upper traps are WEAK in those with neck pain and that strength training is effective in reducing neck pain (Andersen et al., 2014). . Maybe theyre arent such a bad guy at all! See more

07.01.2022 PAIN TO PERFORMANCE! I preach moving from pain to performance because I think it’s REALLY IMPORTANT. We shouldn’t stop when we are where we were. We should stop when we’re better than we were before.... Here’s Sam doing just that. Destroying the thing that injured him last time, only better. Wins. Posted @withregram @sammatherpt 5 months ago, I attempted 170kg for 8 reps. However, on the 8th rep, I injured my lower back pretty bad. I couldn't stand up straight, I couldn't tie my shoes and I was barely mobile for the next 2 weeks. Resultantly, my deadlift went to hell. Since that day, I've been terrified of pulling anything close to that load for similar reps at the risk of being sent back to square one. However, today I said f*ck that. My top working set was 165kg x1+ but I said "hey, what's another 5 kilos." So I did my first 2 working sets at 130kg x5 and 150kg x3 and then loaded up the bar. It's moments like this that make the pain, the nausea, the occasional dry heaving and indigestion from having to eat so much food worth it. And it also gives us something to think about. As @jockowillink says, GOOD. If I hadn't injured my back, I wouldn't have learnt all I have over the past 5 months, nor would I have been able to develop the trunk stability I now have to move this kind of weight safely. When life knocks you down, you get back up. You learn from your mistakes and from your hardships. Then you get after it. I also need to thank @ahphysiotherapy. This man is the reason I'm back to where I was 5 months ago. Although incredibly sadistic, he's one of the most knowledgeable physios around and doesn't give you some half-hearted rehab. Thank you man.

06.01.2022 ACCEPTABLE LEVELS OF PAIN They do exist and you should work into them... sometimes. When deciding if training into pain is OK you really need to be thinking about the context of pain I relation to THE PERSON and THEIR PATHOLOGY.... Some people are happier to work into pain than others. Think athletes returning to sport. Some pathologies encourage some pain during exercises. Think a tendon or a muscular injury toward the end of rehab. Always make judgements based on who and what is in front of you. Have a lovely week people!

05.01.2022 SO.HOW DO YOU MANAGE THE CHALLENGES? My previous post went through some of the challenges that clinicians face day-to-day, this post serves to identify some methods to address them. One pertinent themes you will see is that: MOST OF THEM ARE ACTIVE. In the same way we preach to our clients that self management is a major component of their journey - it is equally part of ours.... Keep yourself resilient and healthy so you help your clients get to the same place too. @ Anthony Hawke Physiotherapy See more

05.01.2022 EXERCISE FOR LOW BACK PAIN (EARLY STAGES) - VOL.3 We have discussed some categories of thinking on which to scaffold your thinking. Lets delve a bit deeper. Managing a painful presentation is very different to a well managed presentation. If more painful - slow it down, do it a lot and make it comfortable. Give your client control back. If well managed, look at getting them BETTER THAN THEY HAVE EVER BEEN.... The exercise ideas should coincide with our theoretical underpinnings above. Some of these should provide good example of how management can manifest. Perhaps the most important theme here is: Give people what they dont have! Its not going to provide concrete exercise prescription, but I will help you think a little more laterally And as always - dont let your biases influence your capacity to make MORE HELPFUL choices for your client. @ Anthony Hawke Physiotherapy See more

05.01.2022 BREAKING THROUGH BARRIERS AND PLATEAUS Coming to a barrier or a plateau is inevitable, so understanding how to negotiate it can be very helpful. I like to think of 3 LEVERS you can pull: Knowledge, Function, Symptoms.... Often a barrier is met because there is some insufficiency that needs to be addressed and I have found that thinking in the context of these 3 constructs is often very helpful. Lets look at an example. A client has had a 1 year history of knee pain with daily life and especially squatting. Rehab is going well. Pain with daily life is improving - but we can to get over the squat hurdle. We discuss why this is such an issue and we find that FEAR is a huge barrier. Great. We pull on the KNOWLEDGE LEVER and discuss beliefs around pain and damage and how they are not a direct correlation. The knowledge imparts new beliefs. These new beliefs encourage engagement in squats. WIN! This is just one example, thered be a million more. So when you hit a barrier ask yourself, What lever can I pull here?

04.01.2022 SO WHAT DID THE PHYSIO SAY? Leaving a good physiotherapy consult should feel like youve got a LOT of value. And part of that value should almost certainly be EDUCATION. Taking ownership of your pathology through understanding, consistent effort is ABSOLUTELY EVERYTHING.... Einstein was quoted saying, If you cant explain it to a child, you dont understand it yourself. I prefer to use family and friends (no insult intended!). When you get home they will inevitably ask you, So what did the Physio say?. Be prepared You dont need to know as much as your Physio does (initially, anyway), but you should DEFINITELY know more than before you walked into the consult room. And if you cant lay it out in basic terms for the fam..how much did you REALLY take in? Always ask questions. Always seek clarity. Thats what we are here for.

04.01.2022 RESISTANCE TRAINING AND TIGHTNESS: THE GYM HAS ME SO TIGHT . So is the gym really the Titanic Temple of Tightness that Ive heard so many of us propose it is? I dont think its that simple. . When we weight train we are squeezing our muscles against the resistance of the external load to produce enough force to move it. That squeeze is called a muscular contraction. And theres not just one type. That would be too easy.... . Lets use a curl as an example can consider the biceps. When youre curling the weight upward against the load, youre SHORTENING the muscle to produce force. This is called a CONCENTRIC contraction. . When youre slowly lowering the weight against the resistance, youre actually still producing force. The difference is here that the force is produced by a LENGTHENING muscle. This is called an ECCENTRIC contraction. . The act of holding the curl in the mid point against gravity (feel the burn!!) involves the production of force with NO CHANGE IN LENGTH. This is called an ISOMETRIC contraction. .What we know about contraction types is that they all influence muscle muscle architecture differently. CONCENTRIC contractions SHORTEN the length of the fascicle. ECCENTRIC contractions LENGTHEN the fascicle. ISOMETRICS are a bit of IT DEPENDS. . Endurance training in the article was done through stationary bike. This is just a frequent CONCENTRIC contraction. No surprise on the SHORTENING effect on the FASCICLE LENGTH then. Interesting how resistance training which involves ALL 3 types of contraction was able to buffer the effects. . The results of this super recent study do a good job of highlighting that perhaps its not so much about JUST WHAT youre doing as much as it is about HOW youre doing it. @ Anthony Hawke Physiotherapy See more

04.01.2022 TEACHING - MY FAVOURITE! I am really super passionate about passing on knowledge to others. It is so, so fulfilling. This seminar that @ethosstrength and I are putting together is going to be a product of all the info that I have been fortunate enough to accumulate through my years as a student (twice), physiotherapist and business owner. ... All packed into a way I wish it was delivered to me. Through the lens of a physiotherapist AND a strength athlete. I am very, very exited. I hope you are too. And why does Odinson make an appearance? How else with this Seminar be Marvel-ous. See you there!

04.01.2022 TIME and PAIN Has anyone thought about how much emphasis we put on the relationship between TIME and PAIN? Does the relationship REALLY make sense though?... Pain is in its nature protective. It is the product of the brains appraisal of the current internal and external environment as one that is dangerous, and that you need to know about it. A biological best guess. Did you see anything about time in there? Its true, sometimes the cant-check-your-blind-spot-neck pain you woke up with vanished but was that TIME? Or was that the movement you do day-to-day bringing down the threat value? And yes your hamstring tear healed in 4 weeks, but was that the pathological processes or the ticking of the clock? Im posting about this misconception because I see TIME hold way too many clients hostage. Persistent pain states drag on but having pain for a long time doesnt necessarily mean that youre destined to have it forever. Or not that to that degree at the very least. Perhaps what hasnt happened is the identification of the contributors to the danger. And even if theres a lot, thats ok! There a lot of way to modify pain too. Dont let duration be the thing that holds you back from seeking UNDERSTANDING and making and EFFORT to improve. Even if its the 10th time.

03.01.2022 LOCKDOWN - The remix So gyms are closed for a little...again. I made this post a while back to remind everyone that withering to a twig is not as easy as it sounds. These tips are as helpful now as they were in March.... Stay healthy and stay positive! Posted @withregram @ahphysiotherapy HOW DO I NOT LOSE MY MUSCLE?: TRAINING AT HOME PART 3 . Losing strength is one consideration, but how about heard earned muscle tissue?! I know we discussed maintaining strength, but can we do it with muscle? At home?! . You most definitely can. Access to weights that are far away from your maximum intensity doesn’t mean you’re going to wither and fade. Well, if you COMPLETELY STOP MOVING, yes you will (Wall et al., 2013). If you can keep moving though, you won’t. Similarly to strength, it takes about 3 weeks before you start to lose some of your hard earned tissue (Kubo et al., 2013). Any immediate loss is more than likely water volume from your muscle! . Maintaining muscle can be done by sticking to the same principles that you used to get it in the first place. As a matter of fact, it may be even easier - particularly the more trained you are! It seems like training at volumes as low as 1/3 of your previous volume is sufficient to maintain your tissue (Bickel et al., 2011). Brad Schoenfeld even offered that 10 sets per muscle group per week at a rep range of 8-12 at 80-85% of 1 rep max was enough to stimulate MAXIMUM muscle growth (Schoenfeld and Grigic 2017). . Remember, intensity is relative. You can do a banded wall squat and make it hard enough to fit within the 80-85% of 1 rep max FOR THAT EXERCISE, no worries. It doesn’t even look like you not being able to do your beloved exercises is that much of an issue. Exercises variation (even workout-to-workout) was acceptable to build muscle. . As long as you’re working at a sufficient relative intensity, for enough volume, and you can handle some glycogen related deflation - everything is gonna be aaaalllright. . Take care of yourselves, and each other.

03.01.2022 MANAGING HIP PAIN Hip pain is something a lot of us are going to see as clinicians or experience as people! The good news, there are some well studied clinical landmarks we should be watching out for. Strengthening a pathological hip will always have its merit. Hip flexion and hip adduction have however been linked to quality of life in long term hip impingement sufferers. This info comes from self-reported outcome measures so its meaningful data! ... When going through rehab or working with someone through the process be aware that there are gender specific strength impairments that are well researched. Plan accordingly. Clinical milestones are vital and often show us how under-rehabbed most people are. A minimum cut-off score of 16 single leg squats (from a chair) and a 34 second side plank is well researched and recommended as a LOW END FUNCTIONAL TARGET. Read that a couple of times. Tl;dr: Hip flexion and adduction strength is REALLY IMPORTANT. Strength deficits are gender specific. Minimum cut off scores are more than most peoples top end targets so rehab thoroughly and for AT LEAST 12 WEEKS!

03.01.2022 PSYCHOLOGICALLY INFORMED PRACTICE! Like a lot of other phrases in the physiotherapy world, this ones gets thrown around a lot. I like to understand PIP as the art of Working WITH clients as opposed to working FOR them.... The four themes of this post are initially identified by Denneny et al. (2020) and summarised by @physionetworks @robinkerr888 during the monthly research report! Phenomenal stuff. Building a Therapeutic alliance is vital. The recovery process is very much a two person job so laying the foundation of teamwork is vital. If BOTH participants arent seen as important, trouble is afoot. Pain is an unpleasant sensory experience and is by nature threatening. Decreasing threat value through planning and reinterpretation is vital to overcome future barriers. The unpleasant nature of pain often takes a toll on our beliefs, which influence our behaviour. Appraisal of pain beliefs is imperative to long term success. Self-efficacy is how confident someone is in managing their own presentation. Fostering this IS what will facilitate long term outcomes. I really hope this post has helped in understanding what psychologically informed clinical behaviours looks like! @ Anthony Hawke Physiotherapy

03.01.2022 MAJOR KEYS : Anterior knee pain People with anterior knee pain often report that COMPRESSION is an aggravator of their knee pain. Knowing which positions cause the most compression of the patello-femoral joint gives clues as to which exercises choices might be most appropriate initially.... When strengthening, get the hip AND the knee going together. Evidence suggests that it works better than either in isolation. When working with people with knee pain understand that fear avoidance is often high and is often perpetuated by misconceptions around damage. Education is a potent weapon for managing misinformation. In short; Know how to fine tune exposure to aggravators through biomechanics, improve strength of the hip and knee, and provide eduction to address any misconceptions around pain.

02.01.2022 LEARN FROM THOSE YOU RESPECT! If you view my content or are a client of mine you may have identified something: Im a big fan of improving capacity through training. I am very much looking forward to up-skilling how I understand and coach the big 3 lifts through the guidance of someone I have A LOT of respect for.... If youre not following @ethosstrength, you should be. If youre going, I shall see you there. See more

02.01.2022 BETTER IS THE ONLY OPTION! Too often do I hear that the aim of rehab is to get people back to where they were, to their previous level of function As clinicians is that all we really want to do for people? Get them back to the level of function that still resulted in injury? Is that enough? Im not so sure. ... Think of a muscular strain. Is returning to the previous level that still resulted in muscular failure enough? It should’nt be. And how about someone who has been dealing with back pain for 6 months. Is getting them pain free with no strategies to promote longer term resilience ok? I don’t think so. Our goal should be to make people MORE resistant to stress/load (physical and non-physical) than they ever have been. We should encourage people to seek more out of their physical capacity as their knowledge and understanding (and concurrently, perception of safety) improves.

02.01.2022 WHY DO MUSCLES BECOME PAINFUL? ISSUES IN THE TISSUES! . So I will be talking to this point from a purely pathological standpoint. There are of course other contributors to any pain state but this is all about the tissue. This info is based on a study in 2014 looking at the Upper Traps. If youd like it, message me. . We all understand that muscles can be a source of pain. How often do we all say things like Oh my *insert muscle* is so sore because its so tight. OK, but ...why does tissue actually become PAINFUL? . Changes in vascularity can be seen in tissue that is causing myalgia (muscle related pain). We see decreases in how many blood vessels are in the muscle and in particular the Type I muscle fibres. This type of muscle relies heavily on oxygen-mediated energy processes to function and decreased blood supply results in decreased oxygen. As a result we see increases in Type I megafibres. MEGA doesnt mean youre getting more jacked. As a matter of fact the MEGAfibres are significantly less efficient users of oxygen due to decreases blood vessels infiltrating them. Not what we want. . Increased concentrations of Serotonin have been found during work, stress/load and rest in painful muscle tissue. This tissue may be linked to happiness in the brain but in peripheral tissues can cause more sensitivity and LESS RESILIENCE. . The changes in energy utilisation are very important. A painful muscle has been shown to less readily use carbohydrates for energy. This sets the muscle up to work more anaerobically (oxygen deficient) and produce more LACTIC ACID. The lactate build up causes chemical changes in the muscle that sets it up for more sensitivity. . Short and long of it: Changes to the structure, extracellular environment and utilisation of energy causes changes to the chemical environment (production of lactic ACID) that causes chemical changes that lead to pain. Man, that was a mouthful. I hope this helps! See more

01.01.2022 ARTICLE OF THE WEEK: HAMSTRING STRAINS This article by MacDonald et al (2019) is a phenomenal piece of literature that really delves into the DETAIL ABOUT HAMSTRING STRAINS. It really emphasises the idea that the LOCATION is as important as the GRADE OF INJURY and weighs heavily on the rehabilitative process.... If you are yet to delve into the idea of how the location of an injury can impact on recovery time and rehab, this is where you should start.