How Physio helps recovery from Anterior Cruciate Ligament skiing injury

With the Easter holidays underway, it’s that time of year again for skiing fun!

Hopefully you will have done your pre-skiing preparation but unfortunately, even with the best laid plans, injuries can still occur.

Katherine Ashmore is one of our team of Physiotherapists and a keen skier herself. In this blog she runs through the common mechanisms of ACL injury, how the diagnosis is made, the options for treatment and how Physio is vital to recovery whether you choose surgery or not.

Common mechanisms of injury

Common down-hill skiing injuries to the knees occur when landing from a jump or going over moguls, colliding with another skier as you exit the ski lift, or simply falling and twisting your knee.

We also see upper limb injuries when falling onto the outstretched hand or landing heavily onto the shoulder.  The injuries are often brought on by one too many at lunchtime, bad snow, tiredness at the end of a day or when bindings do not release!

The most prevalent types of injury are bone fractures, joint dislocations or soft tissue injuries such as ligament strains, tears and ruptures. The knee is the most common area to injure and more specifically –  injuries to the ACL (anterior cruciate ligament), MCL (medial collateral ligament) and medial meniscus (inner cartilage) tears being top of the list!  A combination of all three is called ‘The Unhappy Triad’.

Focusing on the Anterior Cruciate Ligament

sourced from www.sportsmedicineeuk.co.uk

The anterior cruciate ligament (ACL) is located deep inside the knee joint and attaches the thigh bone (femur) to the main shin bone (tibia). It keeps the knee stable by preventing the forward motion of the shin from going too far and the knee from rotating too much.

The vast majority of ACL injuries happen during slow-speed turns, often in sticky, slushy snow, towards the end of the day when the skier is distracted and tired. The ski goes one way and the skier’s body weight goes the other causing rotation of the knee. Because of the slow speed the bindings don’t release.

This tends to happen to beginners, but can also happen to experts who have their bindings very tight and get momentarily distracted in the conditions described above. At higher speeds, the bindings release and the injury is less likely; hence, the advice is to ski positively and ensure that the ski bindings set properly.

How do I know it’s an ACL injury?

With severe injury, one hears a loud pop or feels a snapping sensation, followed by intense pain and immediate swelling and difficulty walking.   Diagnosis is confirmed by a specialist (Physiotherapist or Orthopaedic Consultant) and MRI.  An arthroscopy can detect a partial tear. Much less usually very experienced skiers can carry on skiing after injury.

How can Physiotherapy help?

sourced from milfordphysio.co.nz

Once you have your diagnosis there are two routes – surgery versus non-surgery.

A surgeon will weigh up the factors with you: your age, lifestyle and sports interests and whether you wish to go through the surgical route.  The knee can be very strong and able without requiring a functioning ACL and these options will be discussed with you, including any associated risk of further injury or limitations in exercise or mobility.

Whether or not you opt for surgery, Physiotherapy is vital to strengthen the knee and get you back to full fitness. Without Physio the knee can remain weak and more susceptible to recurrent injury.

What is prehab?

Often if surgery is required, the surgeon will wait for the swelling to go down first.  This is a great opportunity to receive ‘prehab’. Our Physios will help you to strengthen your knee muscles prior to surgery and get you physically and mentally prepared for your operation. Having knowledge of the exercises you will need to do post surgery is a great help and we find our clients do better with this preparation.

Post op rehab

Where the prognosis indicates surgery, the surgeon will discuss with you whether you use one of your own tendons (commonly a bit of the hamstring) to repair the ACL or use a synthetic option. It is a very common procedure and depending on your level of exercise will take 8-12 months of graded physiotherapy rehabilitation to get back to full sport.  You may even be back to skiing within the year!

What does rehab involve?

Treatment will involve:

  • a carefully graded exercise programme
  • advice on swelling reduction measures
  • graded return to exercise (we can tell you what exercise, how much and at what stage) and
  • latterly sports specific exercise drills if required

Some surgeons have very specific protocols they like us to follow and others are not so prescriptive. but either way we have the expertise and experience to guide you through the process.

We work closely with Orthopaedic Consultants locally and in central London clinics and can fast track you to be seen quickly with one of them if necessary.

Should you receive a skiing injury we are here to help you with both diagnosis and treatment. 

Please don’t hesitate to book an appointment with our Physiotherapist,  Katherine Ashmore, or another member of our Physio team. 

To book an appointment:

Call 0203 916 0286

Book an appointment online

Email us here

Or just drop in for a chat with one of our Physios!

If you have enjoyed this blog and would like to read our other skiing blogs click here.

 

Read how Physio helps experienced runners improve performance and manage injury risk

If you are an experienced runner, it’s highly likely you’ve trained and competed whilst injured.

Indeed, research shows that runners often carry old “niggles” that have never been properly sorted out.

If you are a seasonal runner, or tend to aim for certain events, you may find that you are susceptible to injuries at certain times of the year, or points in your annual training cycle.

We asked Dave Burnett, who heads up our Running Clinic, to explain the common causes of injury and how we can help you reduce your risk and manage ongoing issues whilst at the same time improve your performance!

What caused my injury?

This is a commonly asked question at the clinic!

In the absence of an acute trauma or a specific isolated event, “overuse” is a common cause of injury.

To be more specific overuse usually means “training load errors”.  Simply put, if your training load (i.e. the frequency, intensity, time & type of training) is higher than what your tissues (e.g Achilles Tendon or Knee-cap Joint) can tolerate, you’ll get injured.

And why hasn’t my injury resolved yet?

Tissue tolerance is related to to several different factors and all of these can affect your ability to get over an injury:

  • your age – we all recognise that we become less elastic and quick to recover as we get older
  • our genetics – some people just have good genes
  • our general health and level of fitness
  • previous injuries we have suffered
  • our strength & flexibility
  • our biomechanics – the way we are built or the way we move
  • and finally our recovery, sleep, nutrition & lifestyle!

Runners that are at a higher risk of injury

Certain sub-groups of runners are at higher-risk of injury including

  • Beginners with less than 1 year’s experience
  • Runners with previous injuries (particularly in the first 3 months following the injury)
  • Marathon runners who run more than 40 miles/ 65km per week
  • Runners who rapidly increase their  speed or distance
  • Women with a low BMI or reduced bone density (Osteopenia or Osteoporosis)

(JAMA, 2014)

How can training load affect injury?

Various factors influence training load including:

  • The nature of your weekly running programme  – i.e. the frequency, intensity, time and duration)
  • Any other exercise or strength and conditioning you may do on top of your running
  • The nature of your running training is also a factor and some injuries are more commonly “volume-related” versus “pace-related”.

 

How can I improve my tissue tolerance?

Improving your tissue tolerance will reduce injury risk and can be achieved in several ways:

  • Cross-Training – using a variety of types of exercise in your training e.g. using swimming/cycling/cross-trainer
  • Optimising or adapting your running style– your running style will change the forces placed on your joints and muscles- small adaptations are often effective to help solve ongoing niggles and can help improve your economy and performance.
  • Optimising your footwear for your specific running biomechanics– this will help reduce load on the system
  • Taping can help offload your tissues so they have more tolerance to exercise
  • Running Specific Strength and Conditioning – it is now widely accepted that running performance can be improved by combining endurance training with explosive strength training. Adapting common gym-style strength work to make your programme specific to your running demands will help you improve your tissue tolerance more quickly
  • Maximise nutrition, hydration and sleep– these will undoubtedly help performance, recovery and tissue repair.

How Physio can help

At Physio on the River, we can help you both:

  • recover from injuries which are stopping you from running
  • help those ongoing niggles you are carrying whist continuing to run and
  • help reduce the risk of re-injury

Our physios are specialists at assessing the way you move and identifying the causes of injury. Combining our clinical skills and video gait analysis we can give you a really thorough screening and a baseline of information to create a tailor-made plan of action.

Our Standard 60 minute Running Assessment includes:

  • Establishing the specific details of your running history by exploring your training programme, coaching advice and goals for up and coming competitions
  • A physical screening to identify important biomechanical factors related to running (e.g joint and muscle flexibility tests and lower limb strength and muscle control measurements)
  • Treadmill analysis of your running with Hi-Speed video
  • A report of your video analysis findings
  • An exercise programme to help facilitate your rehabilitation

NB- if your Screening Assessment and/or running analysis identifies a specific injury requiring treatment then a course of physiotherapy can be provided.

How to book a Running Assessment with Dave or one of our team of Physios:

Call 0203 916 0286

Book online here

Email the clinic here

Or just pop in and speak to one of our Receptionists

If you found this useful and would like to read our other running related blogs just click here.

Read how Physio Dave helped an Open Water Swimmer recover from shoulder surgery

 

Earlier this autumn, Physio Dave Burnett interviewed one of his clients about his recovery from shoulder surgery. Read on to learn of his challenges and triumphs!

 

 

Dave: Hi Matt, tell us a bit about yourself and what sport & exercise you do?

Matt: Hi Dave. I’m a 36 year old Australian Structural Engineer. I have been living in the Barnes and Mortlake area for nearly 10 years and I have a pretty hectic lifestyle, trying to balance work travel commitments with a young, active family.

Between work and family, I manage to squeeze in some time to play a good variety of sports including rugby, surfing, tennis, squash and swimming. Over the past few years I have tended to focus on Open Water Swimming. This means training at least 2-3 time per week for distances of between 1 -3 km.

Sourced from Adventure - how stuff works

Sourced from Adventure – how stuff works

Dave: Can you tell us how and when your shoulder problem started?

Matt: I have historically had a weak shoulder from playing rugby. I’ve found swimming a great help to keeping fit but last year I began to notice some pain in my arm below the shoulder joint after training. This progressively became more painful to a stage where I was struggling to lift my arm above my head.

Dave: Please tell us about the operation you underwent?

Matt: I was fortunate enough to have a Physio-focused surgeon who encouraged me to investigate all avenues before surgery was undertaken. But in the end I had a Subacromial Decompression procedure.

As you explained to me, this is an operation to make more space under the bony arch above the shoulder joint where important tendons pass. Before the operation there was not enough space under this arch and the bones and tendons were rubbing against each other. The tendon was overloaded and in time became thickened and weakened.

I believe it’s a condition that can typically come one with a lot of repetitive overhead movements like in swimming.

Dave: In what ways did you find the  Physiotherapy  helped you recover after the operation?

Matt: Dave was a great help in aiding my speedy recovery by helping me to set realistic strengthening goals and not overload me too early with too many exercises.

Ultimately, I also appreciated the time he took to focus on what Physiotherapy exercises would specifically help improve strength for my long distance swimming in the longer term.

Dave: How are you getting on now and have you achieved your goals?

Matt: I had my operation in late January 2016 and I was back swimming competitively in summer 2016 – about 8 months of hard work, carefully guided by Dave!

 

Sourced from Amphibian open water challenge

Sourced from Amphibian open water challenge

Dave: Do you feel confident you can keep your shoulder fit for the future?

Matt: I am significantly more confident with my shoulder strength now – to a stage where I don’t think twice to do an activity which I previously might have thought would strain it.

I will continue to see Dave and the physio team on a quarterly basis to ensure that my recovery is maintained.

 

If you are suffering with a shoulder injury or facing shoulder surgery and would like to book a Physiotherapy appointment click here or call us on 0203 916 0286.

Running a marathon? Read our Physio, Nic Pugh’s marathon story

 

Earlier this week I interviewed Nic Pugh, one of our Physios who has decided to run the London Marathon for the first time.

Read on to find out how her first three months of training have gone and the highs and lows – even for the professionals!

Hello Nic. Tell us a bit about yourself?

I’m a  Physio here at Physio on the River. I also work at King’s College Hospital as an Extended Scope Practitioner  – which means my advanced skills see me work closely with the Orthopaedic and Rheumatology Consultants to manage musculoskeletal complaints.

I have also been a keen runner for the last 10 years. I live in Barnes and regularly run along the tow path nearby.
Nic Pugh

What inspired you to run the London Marathon this year?

Well I’ve done a number of 10k runs – about one every other year, but running the London Marathon has been a bucket list achievement I’ve wanted to do for as long as I can remember! I just decided that if I didn’t do it this year I never would.

My boyfriend is also running the marathon and we thought we could spur each other on. He runs a bit faster than I do so when we run ‘the two bridges’ we set off in opposite directions and high five half way round!

Which charity are you fund raising for?

Sourced from en.wikipaedia.org

Sourced from en.wikipaedia.org

I decided to choose a charity that would be relevant to many of my clients. So I chose Arthritis Research UK.

Arthritis is such a common condition which can be very painful and have a huge detrimental effect on people’s lives. There is much we don’t yet know about tackling the disease but also so much we can do to help these clients..

Arthritis Research promotes research into the cause and treatment of all forms of arthritis and helps us to get better at treating it.

Can you tell us when you started your training?

Picture of training plan from www.mymarathoncoach.blogspot.com

Image sourced from www.mymarathoncoach.blogspot.com

 

I received lots of information from the London Marathon including advice on training. Because I had done some running before, I pitched my training at the intermediate plan and started with great enthusiasm as suggested, in November.

They recommend that you run two short runs a week, spend one session on conditioning (strength, core, flexibility and balance) and do one longer run at weekends. The longer run increases by 2k each week.

Because I had run before and regularly done 10k I started running home from work (Clapham to Barnes 7K or Vauxhall to Barnes about 10K). The run was quite hilly from Clapham and the runs were mainly on the pavements – a hard surface.

Despite my professional knowledge, in hindsight I think I overestimated my capacity and started out too hard too fast.

I should have started on the beginner’s schedule and worked my way up through the training a bit more quickly instead.

By the end of November I was already injured!

Please explain a bit more about your injury?

I started getting Medial Tibial Stress Syndrome – what used to be called Shin Splints. Basically you get pain down the inside of your shin and it’s usually related to your biomechanics (the way you run and the alignment of your leg).

How did you get over your injury?

image sourced from www.ridersecrets.co.uk

image sourced from www.ridersecrets.co.uk

Firstly I asked our Podiatrist to take a look at my running pattern. He quickly identified that I was really overpronating (rolling my ankle inwards) on the left leg. My calves were very short and tight and I didn’t have good control of my core – my gluteal muscles (buttock muscles) in particular were weak and failing to control the rotation in my leg properly.

My trainers were quite old and had become a bit too worn to be doing a good job so I got a new pair of the same type.

A colleague at work gave me acupuncture and this greatly helped the pain. I also had a few sports massages – both for the increasing tension in my left shoulder muscles and to loosen up my tight calves.

On my part, I started Physio Rehab with glutes and core strengthening exercises. I used a foam roller to self-massage my calves and other main muscle groups in my legs and I spent more time stretching my calves.

I rested from running for 6 weeks.

Did you lose your form during this period?

No, because although I had to stop running I continued training by doing other things like gym classes and continuing with cycling, cross trainer and the rowing machine.

How did you restart your running?

I returned to running in January. I was very strict with myself and made sure I dropped my distance right back to 2-3k twice a week and a much shorter long run at weekends.

Although I felt I could have run further I resisted the temptation and stuck to the plan! I gradually worked my way back up to 10k twice weekly and increased my longer run by 2k each week to 22k this Sunday.

Last weekend I did the Bath Half Marathon so I’m back on schedule!

What have you learnt from your experience so far on the other side of the treatment couch so to speak?

Oh, I’ve learnt lots! The experience will definitely help me to help other marathon runners in the future.

  • Firstly I think if I had got one of my physio colleagues to assess me before I started training I could have identified my tight calves, faulty running pattern, weakness of my glutes and tension in my shoulders. I could then have started tackling those issues before starting and in conjunction with my early training.
  • I should have assessed my level as beginner and worked my way up to intermediate more swiftly than a true beginner. In other words erred on the side of caution.
  • It would have been wise to start with a fresh pair of running shoes and to get a Podiatrist to assess my gait.
  • As my training goes on I’ve booked myself in to see our sports massage therapist at regular intervals to keep my soft tissues in good condition as the stresses increase with higher training levels. At Physio on the River we have a great offer on at the moment – a course of 6 massages for the price of 5!
  • I’ve now started a core stability class regularly which I should have done months ago!

If you would like any physiotherapy advice on how to stay running fit, then call 0203 916 0286 or click here to contact us.

If you would like to support Nic and Arthritis Research UK please click here to go to her Just Giving page and donate to a fantastic cause!

Are you training to run a Marathon? Please share your training stories with us, just leave your comments below.

If you have enjoyed reading this blog, take a look at our other running blogs such as:

10 top tips for injury free running

Running the marathon? Is massage a luxury or a necessity?

How Pilates is helping new mums to get back to running safely – post pregnancy

Running the London Marathon? Why it’s a good idea to get checked out by a Physio first.

London Marathon race day preparations

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