Optimal Loading of Soft Tissue Injuries by Philip Young


22375224_10154705410555518_842168349_o.jpgToday’s article comes from soon to graduate La Trobe University podiatry student Philip Young.

Acute soft tissue injuries have traditionally been treated using the RICE method. Using this method, we are told that immediately following a soft tissue injury we must Rest, Ice, apply Compression and Elevate the affected structure. Whilst rest of affected structures is important following an acute injury, is this mindset tending towards patients and practitioners being too conservative and wary of exercise following an acute injury?

Since 2011 there has been a movement to supplant RICE with POLICE (Bleakley, Glasgow and MacAuley, 2011). POLICE stands for Protection, Optimal Loading, Ice, Compression and Elevation. This short article discusses optimal loading, and how is can be used during rehabilitation of your clients.

What is optimal Loading?
Optimal loading describes the amount of load that results in the largest physiological adaptation to affected structures (Glasgow, Phillips and Bleakley, 2015). It is based on the principle of mechanotherapy, whereby mechanical loading prompts cellular responses that promote structural changes in tissue. Indeed, optimal loading is a term that encompasses all exercises that drive tissue repair through the process of mechanotransduction, these exercises range from isometric and isotonic contractions, to manual therapies such as massage and passive range of motions. Optimal loading is achieved through applying a mechanical stimulus which induces a variety of neural and cellular changes that result in physiological adaptations to the affected structures (Glasgow, Phillips and Bleakley, 2015). The key component of optimal loading is the manipulation of mechanical loading variables such as magnitude, direction, duration, intensity and frequency to maximise the desired physiological adaptations.

When should loading occur?
Optimal loading is early loading! In saying this, it is important to be aware that protection of an injured structure immediately following an injury is important. However, the period of rest following an injury should be as short as possible. An interesting concept to consider when rehabilitating an athlete, is that you cannot take stimulus away. What we must realise is that absence of load is a physiological stimulus in itself. The principle is that we still want to protect the tissue, but in the early stages adding a mechanical stimulus to impart changes at a biological level is important as it influences tissue molecularly, cellularity and changes the tensile properties of the tissue (Glasgow, Phillips and Bleakley, 2015). If we add this load in a gentle, controlled environment, then we are effectively imparting physiological changes through optimal load.

How should we apply load?
Load should be applied in a specific and individual manner. We must firstly determine the sport the athlete partakes in, and then perform a thorough assessment to ascertain he structures that are repetitively loaded, the intensity of loading and the direction of the load.

So the questions we must ask are:

  • What is the activity your client needs to return to?
  • How are the injured tissues loaded during the activity?
  • How do we restore normal form and function of tissue to expedite return to activity?

Early stages of rehabilitation
In the early stages of rehabilitation we are looking for consistency and quality of movement. Exercises should be performed with strict form and under close guidance. Progression should be maintained however exercises should be added gently and with caution. Passive movements are fantastic in this stage, as are aquatic and isometric activities.

The goals in the early stages of rehabilitation are:

  • Reduction in pain
  • Maximisation of re-capillirisation
  • Reduction in scar tissue
  • Facilitate recruitment of muscle tissue

Later stages of rehabilitation
Optimal loading needs to have appropriate progression, and should be performed in a systematic and progressive manner that is specific to the individual’s sport/activity.
At this stage in the rehabilitation our aim is to integrate newly formed robust tissue into specific loading and movement patterns. Exercises still need to be controlled, however, our aim is to now facilitate exercises that require the person to look for better movement solutions. At this stage, we are looking to restore specific loading patterns based on the individuals sport, and we achieve this through exercise selection, but also working across all ranges of the force velocity curve.

Return to sport
Activities and exercises should be performed at game speed, under pressure and include unpredictable variability. The rate of loading should be in line with the individuals function and pain, and muscles should be recruited at varies lengths. Exercises should include changes of direction, bounding, high speed work, directional and rate of speed changes. Unpredictability is an important aspect at this stage, as reactive agility is the foundation for successful performance of most sports. Training for this is incredibly important as is requires activation of the entire neuromuscular system.

Until Next Time

Philip Young
Podiatry Student

Jackson McCosker
Director/ Chief Editor

References:

Bleakley, C., Glasgow, P. and MacAuley, D. (2011). PRICE needs updating, should we call the POLICE?. British Journal of Sports Medicine, 46(4), pp.220-221.

Glasgow, P., Phillips, N. and Bleakley, C. (2015). Optimal loading: key variables and mechanisms. British Journal of Sports Medicine, 49(5), pp.278-279.

Glasgow, P. (2017). Optimising load to optimise outcomes. British Journal of Sports Medicine, 51(13), pp.985-985.

 

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Going From Strength to Strength: Australian Athlete Development with Christian Woodford


Today I catch up with Christian Woodford, Performance Coach and Director of Woodford Sports Science Consulting. Christian has become a leader in athlete rehabilitation and development over the last five years working with individuals to reach their personal best.

Christian Welcome!

The way you address athlete development appears very different to other strength and conditioning coaches I have come across. Why do you think this may be and where have you gained most of your insight into your techniques?CWoodford_profile

I don’t think I do things “differently”, I just do things that are PROVEN and I know work. Athletic development in Australia is not very well understood, especially compared to the USA, and as such, many athletes and coaches do not understand properly periodised strength and conditioning programs. In this day and age, every one with a social media account is an “expert”, so my drive is to educate and empower all athletes and coaches to what athletic development is about, but also what it’s NOT! 

You have spent a lot of time in the United States who are arguably the world’s front-runners in athlete development. How do their systems and processors compare to that commonly seen in Australia?
The USA model for athletic development is superior because mainly of the understanding of what coaching strength and conditioning is. Think of their “mainstream” sports: baseball, gridiron, basketball etc. These sports require development of neuromuscular qualities such as; strength, power, speed etc. You only need to look at their high school system where they hire strength and conditioning staff to oversee the physical preparation of their student-athletes to understand why they have athletes run a 4.4s 40 yard sprint! They strength train compound movements (lift heavy and light for power), sprint, jump, throw and push heavy things. They understand from a YOUNG age how vital preparation for sport is outside “skills” training. Australia is far behind mainly because of the lack of understanding on the importance of physical preparation outside of sport – it’s just not ingrained in our culture like it is in other countries. It’s 2017 and we still have teams that only static stretch before training. Moreover, there are still many athletes and parents who believe that strength training will make you “bulky” and “slow”. The only way we can develop higher performing more efficient athletes is by educating the importance of physical preparation. This education has to start at the junior level by the parents who have such a huge potential to positively impact the culture of their clubs.

Many endurance athletes would benefit from regular strength sessions. For those competing in Ultra-marathons, marathons and multi-sport endurance events how often do you believe this should be and where is their time best spent?
Endurance athletes NEED to strength train while completing their endurance based training. If you look at strength and endurance training they are on opposite ends of the metabolic continuum. Strength training is anaerobic (without oxygen), and endurance is aerobic based (depending on work: rest ratio) meaning they do not go well together (concurrent training). It’s very important then to understand the appropriate loading parameters (sets, reps, rest periods, exercise selection) to maximise endurance performance. Properly implemented and programmed strength training leads to improved endurance performance. Heavy load – low rep (strength) and light load (power) training develops CNS efficiency and prolongs time to fatigue which equates to improved running economy. These are driven by “neural” adaptations and have little to do with the muscle itself. If you are an endurance athlete strength training WILL improve your performance.

Resistance training image

With the AFLW competition beginning this year, there was a disproportionate number of knee injuries that took place in the short season when compared to the longer season of the male counter parts. Could this have been foreseen and what do you believe is the answer to preparing for this next season?
Females have a higher chance of ACL injuries due to a number of reasons; q angle of the pelvis and menstrual cycle for example. But I believe the reason the AFLW has such high proportion of ACL injuries is due to minimal contact time to prepare the players combined with increased intensity of the game. Many are not prepared for the stress of going from playing at the amateur level to playing at the highest level in Australia. This should change next year as clubs get a better understanding of what is needed for these female athletes.

 With evidenced based medicine and practice being the gold standard within the allied health industry and therefore the risk of practitioners and professionals to be funnelled into one way of addressing injuries or the over-lapping of “scope of practice” – where do you believe hand over should occur regarding an injured athlete?
It’s a hard one because so many “practitioners” think they are a jack of all trades. Here is my rule; if your area is physio stick to diagnosis and EARLY stage treatment (low level activation and mobility) then pass the athlete onto the performance coach for mid to end stage return to PERFROM programming. There needs to be OPEN communication with both professionals so the athlete has smooth transition from all phases of their rehab program. Remember it’s about the athlete NOT us.

Until Next Time,

Jackson McCosker                                                     Christian Woodford
Director/ Chief Editor                                               B.App.Sci (HONS)