AC Joint Injury in BJJ

We know the feeling. You’ve been training solidly, competing well and things feel like they’re coming together (finally!).

Until that moment amongst a heated roll, that you lose your base and land smack-bang on the point of your shoulder.

You have an immediate reflexive wince of pain. You feel like someone stuck a knife into the point of your shoulder and your arm ain’t moving very far away from your body.

It definitely doesn’t like you moving the arm across the body and it may even look like a little speed hump at the end of your shoulder.

Welcome to the acromioclavicular joint, the notorious AC joint in contact sports like BJJ. This is the joint that lies between the end of your collarbone and shoulder blade and acts as a strut to stabilise the shoulder/arm complex.

These AC joint injuries are classified into 6 different types according to the commonly used Rockwood Classification:

DO I NEED SURGERY?

Management of AC joint injuries follows the general principles of all ligament injuries and will be dependant on the grade (type) and the end goals of the individual.

As a general rule, surgical intervention may be indicated for type 4, 5 and 6 AC joint injuries and type 3 injuries that do not respond to non-surgical management.

Low grade AC Joint injury - what now?

Like all injuries, the rehabilitation and exercise or loading exposure will vary from person-to-person. As a general guide, initial management begins immediately and aims to minimise bleeding and swelling and treatment aims to:

• promote tissue healing

• prevent stiffness

• protect from further damage

• strengthen shoulder musculature to provide dynamic stability.

Isometric strengthening exercises can be started as soon as pain allows and usually begin close to the body with a progression plan to move away from the body as the body undergoes it’s natural healing response to injury.

When can i return to sport? When can I roll again?

We usually look for no AC joint tenderness and full pain-free movement as a starting point for starting the conversation about returning to sport.

We like to see the completion of a full rehabilitation program that focuses on restoring full function and strength of the entire shoulder complex, as well as a graded return to rolling that may involve light drilling and flow rolls initially, with an increase in exposure as the shoulder adapts to the additional stress loads of training.

Full return to training will be individual-specific and criteria driven.

Keep Rolling!

Knee pain while exercising?

With the temperature heating up and daylight savings in full swing most people are shedding the extra layers of clothing and some are hoping to also shed a few extra kilograms.

Gym and bootcamp numbers are increasing and it looks as though everyone is now coming out of hibernation. Unfortunately, as a consequence of this we see more people present to the clinic with common complaints related to their new exercise regimes.

What is patellofemoral pain?

One of the most common presentations we see is patellofemoral pain, that is pain arising from the kneecap and its articulation with the femur or thigh bone.

It often presents with the gradual onset of pain and will commonly be aggravated by squatting and lunging motions along with stair-climbing and running, it often settles with rest however, can often cause a dull ache when sitting for extended periods which is known as movie goer’s sign.

What causes it?

We often see people present with an increased load, they have often commenced or increased squatting, lunging and running which can cause aggravation of the patellofemoral joint.

There are a multitude of factors that play varying roles including behavioural, biomechanical/anatomical, technique, muscle imbalances, weakness or restriction.

Here we will cover a general but thorough approach to what is worth looking at in the treatment of patellofemoral pain.

Alignment and control

This is about looking upstream and downstream, the patellofemoral joint does not like a rotary component which can be caused by poor lumbopelvic control (what the core/hip is doing) upstream or poor foot biomechanics (what the foot is up to) downstream.

Technique

How do the movements look unweighted, weighted and when fatigued?

Load management

There is usually a load related component so it is always worth looking at how much you are doing currently vs what you were doing previously and furthermore how to plan the load to ensure it improves. Gradual loading is the best loading (3).

Strength

How strong are the glutes and quad muscles as these 2 groups of muscles are shown to be very important when it comes to patellofemoral pain (1-3). Additionally, how strong are the calves, groin, core and hamstrings? If everything is stronger than even better! There is a significant reduction in injury risk with increased strength (4-5).

Range of motion

Are there restrictions elsewhere in the biomechanical chain causing the knees to compensate?

Is there a previous ROM limitation at the ankle due to a previous injury causing the knee to compensate? Is there limitations/tightness in the hamstring or calf? Is there significantly limited thoracic extension causing you to fall forward placing excess strain on the knees during squatting or overhead movements? Is the foot rolling outwards to make up for restricted ankle ROM (1-3)?

How best to approach it?

Unfortunately, patellofemoral pain is often a very niggly condition and a large number of people experience ongoing issues even with some form of treatment (6). As patellofemoral pain is such a multi-faceted condition it requires a very thorough approach to specifically address all the potential contributing components. It will take time but it is important to be consistent, thorough and methodical in the approach to get best results.

General areas to address:

• Alignment and control

• Lumbopelvic control

• Foot mechanics

• Technique

• Load management

• Strength

• Range of motion

References

1. Barton CJ, Lack S, Hemmings S, et al. The ‘Best Practice Guide to Conservative Management of Patellofemoral Pain’: incorporating level 1 evidence with expert clinical reasoning. Br J Sports Med 2015;49:923-934.

2. Crossley KM, Callaghan MJ, Linschoten RV. Patellofemoral pain. Br J Sports Med 2016;50:247-250.

3. https://www.mickhughes.physio/single-post/2016/06/21/Patellofemoral-Joint-Pain

4. Lauersen JB, Bertelsen DM, Andersen LB. The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. British journal of sports medicine. 2014 Jun;48(11):871-7. PubMed PMID: 24100287. Epub 2013/10/09. Eng.

5. https://www.mickhughes.physio/single-post/2016/12/26/8-Simple-Ways-to-Avoid-New-Years-Resolution-Induced-Injury

6. Thomas MJ, Wood L, Selfe J, Peat G. Anterior knee pain in younger adults as a precursor to subsequent patellofemoral osteoarthritis: a systematic review. BMC musculoskeletal disorders. 2010;11:201. PubMed PMID: 20828401. Pubmed Central PMCID: PMC2944218. Epub 2010/09/11. Eng.

Pelvic Floor Pain | Common but not NORMAL

Women’s Health Wednesday

Here is a great video below that talks about how pelvic floor health issues are common, but how they are not spoken about and are not normal. 

Let’s start talking about it, so we can lead happier and lives.

SOURCE

How to manage hip and knee osteoarthritis - What's the latest?

Did you know that Australians living with Osteoarthritis is expected to rise from 2.2 million in 2015 to almost 3.1 million by 2030?

So what can you do about it?

The Royal Australian College of General Practitioners recently updated their guidelines for management of hip and knee osteoarthritis.

Little to our surprise, the interventions that come with strong recommendations based on available evidence for managing these conditions include EXERCISE and WEIGHT MANAGEMENT.

What is Osteoarthritis?

Osteoarthritis the most common form of chronic arthritis that is characterised by joint pain, stiffness and swelling, and mainly affects the hands, knees and hips.

Osteoarthritis frequently occurs in people aged over 55 years, however younger people can also be affected.

What are the risk factors?

Risk factors for OA include:

• Joint injury

• Being overweight or obese, and

• Older age

 

How can you manage Osteoarthritis best? What does the evidence say?

Lifestyle, lifestyle, lifestyle. We are seeing a recurring pattern here. In short, regular exercise and weight management are the interventions that are strongly recommended for people living with osteoarthritis.

Regular exercise is strongly recommended as a key factor for relieving pain and improving function in people with knee and/or hip osteoarthritis. This includes muscle strengthening exercises as well as walking and Tai Chi.

Weight management is strongly recommended for people with knee and/or hip OA who are overweight or obese.

How can you get help to develop an exercise program for osteoarthritis?

An exercise program that is tailored specifically to you and your level of function is a key aspect of helping to manage osteoarthritis. It is not a once size fits all approach, particularly when it comes to proper programming for strength and cardiovascular endurance. This is where the help of a physiotherapist or exercise physiologist will help. 

The RACGP suggests the following;

Clinicians should prescribe an individualised exercise program, taking into account the person’s preference, capability, and the availability of resources and local facilities.

Realistic goals should be set. Dosage should be progressed with full consideration given to the frequency, duration and intensity of exercise sessions, number of sessions, and the period over which sessions should occur.

Attention should be paid to strategies to optimise adherence.

Referral to an exercise professional to assist with exercise prescription and provide supervision either in person or remotely may be appropriate for some people.

Exercise has many other health benefits that can assist in managing lifestyle diseases and optimising health. See post here.

What does it all mean?

In conclusion, what this means is that there is plenty that you can do in order to optimise your function and quality of life. Exercise, particularly strength training and weight management are strongly recommended in the management of osteoarthritis.

Getting advice from a physiotherapist or exercise physiologist will help in getting started on the path back to better health.

What is an over-active pelvic floor? Women's Health Wednesday

This week charlotte, our women's health physio in sutherland, explains AN OVER-ACTIVE PELVIC FLOOR?

Like any muscle in the body it is important that the pelvic floor can both contract and relax.

If you think of your bicep muscle this needs to be able to contract to pick something up and relax to put something down. Imagine if the bicep was contracted all day long, it would be really hard to use your arm functionally and your bicep muscle would not work efficiently. Especially when strength is needed, the pelvic floor is the same.

Some women have pelvic floor muscles which have difficulty relaxing and remain constantly contracted. This however does NOT mean they are strong, imagine how tired they would be when you need them! 

OVER-ACTIVE ≠ STRONG

What are the symptoms of an over-active pelvic floor?

Symptoms will vary from person to person, but often include:

• Pain with sex

• Pain with using tampons

• Pain with pap-smears

• Pelvic or back pain

• Difficulty emptying bladder or bowel (constipation)

• Incontinence

• Increased sensation of needing to urinate

Who is at risk of an over-active pelvic floor? 

People who tend to have a higher risk for an over-active pelvic floor include:

• People with an overactive bladder, this is due to always needing to squeeze their pelvic floor to minimise leaking

• Strong athletic women with strong outer core muscles

• People with anxiety

• Sedentary work/life style (poor posture can shorten the pelvic floor muscles)

• Mouth/chest breathers

What is the treatment for an over-active pelvic floor?

Our initial treatment will always look at the way you breathe!

If you imagine your core and trunk muscles as a box, your pelvic floor is the base of your core with your transverse abdominus being the walls and your diaphragm muscle (breathing muscle) being the ceiling.

It is really important that all aspects of your core are working efficiently. If you are always breathing through your mouth, with a chest pattern of breathing the pelvic floor does not have a chance to relax.

Diaphragmatic breathing or “belly” breathing is essential as this allows the pelvic floor to descend and relax. 

Can I still do pilates with an over-active pelvic floor?

Yes! However more focus should be on the strength of your muscles (not including your pelvic floor initially) therefore you should not actively contract your pelvic floor during initial pilates sessions. 

As symptoms decrease, we start to add in a graded strengthening program for you pelvic floor