Do you Suffer Calf Pain when you Run?

By Physio & current National Champion, Ultra-running 20-25yrs 50km & 100km, Kyle Weise 

Most runners know the feeling of running along and then out of nowhere, ‘pop’, a sharp pain in your calf muscle area. Or some mornings when you wake up with a tight calf muscle and start running and it doesn’t warm up like usual, and stiffness or pain just gets worse and worse.

Over the last few months in the clinic we have seen a rise in the number of runner’s presenting with first time and recurrent calf strains. This is a very common injury in runners.

Many runners become very frustrated with recurrent calf pain & this type of injury, as they will feel like they are on top of it and then they end up right back at square one with a re-strain.

So let’s take a look at what happening’s in a Calf Muscle Strain Injury:

The calf muscle is made up of two different muscles: the Gastrocnemius which is made up of the medial (inside of leg) and lateral (outside) heads, and is the muscle that most people think of when they hear the term “calf strain.” Then there’s the Soleus, which runs deeper/under the two heads of the gastrocnemius.

Muscles are made up of lots of muscle fibres, with these bands of fibres running in parallel. A muscle strain occurs when the force applied to these fibres exceeds the resistance strength of them. Aliken this to what happens when you cut your skin- the force to the skin fibres was more than they could resistance so you end up with a visible separation in the skin where the skin fibres do not join each other.

Now there are many grades and locations of calf strains in runners, and the time to return to running will vary depending on the grade and location of injury. However, the initial rehabilitation process will follow a similar pathway as each injury will follow a similar process of acute response to the tissue damage and then regeneration, repair & remodelling.  Again, think about what happens with you skin cut- platelets should form a layer that connects the ends of the skin cells, then the cells with the platelets start to change into a cell form that resembles skin cells, then these immature skin cells become stronger skin cells.

It is important to understand that when running, the calf muscles are placed under a high level of load. Research has shown that the force on the calf muscles during running is up to 7x your body weight! Therefore, the goal is to build strength and robustness in your calf muscle to withstand these high forces during running to prevent reinjury.

However, when running, the speed of contraction is much faster than when doing a slow, heavy resistance exercise in the gym. Therefore, the exercises during the strengthening and muscle fibre remodeling phase need to reflect this. This phase is often missed by a large proportion of runners when returning from a calf injury.

Most runner’s will go through a block of heavy slow resistance exercises and be able to complete this symptom free. This is when most runners will return to running as they feel their calf muscle is strong and pain free and therefore ready to return to running- Only to end up back at square one within the next few weeks to months.

This is a classic example of the story I hear from numerous runners who present to the clinic with ongoing calf pain.

It is crucial that a thorough strength and conditioning plan is developed to increase robustness in your calf muscle to allow it withstand the high workload placed on it during running. This exercise plan needs to targets all aspects of how the calf functions during running and should also be planned around a graded return to run program that will be carefully directed by your Physio.

What if your calf pain is not from a muscle strain?

In addition to the muscular causes of calf pain, pain can also arise from vascular (blood vessles), neurologic (nerves) and other skeletal conditions (ie bone) and non-skeletal causes (ie. tumors). This is another reason why it is of great importance to have your calf pain assessed by a physiotherapist to accurately help you diagnose the cause of your Calf pain, and then help direct with the best management plan to achieve your goals of running.

If you have been suffering with ongoing calf pain or recurrent calf strains, you can call our clinic on o7 5500 6570 and book in an appointment with our experienced Physio’s that have an interest in Running to ensure you receive a proper diagnosis and management plan so you can return to running pain free.

OUR TEAM WANTED TO LET YOU KNOW THAT WE ARE STILL HERE TO HELP YOU

(Updated 13th Dec 2021)

Your health & hygiene, as well as the health & hygiene of all our staff, & their families remains our highest priority in continuing to help you.

We Thank you for being patient with us while we work our way through our safety and precaution processes once Qld Borders open on December 13^th, 2021.

Here is some information we would like to share with you:

Information Specific to When Qld Borders Open

-All our Team will be Vaccinated, as mandated by the Qld Government for the Healthcare Sector

-We remain available for Consult to both vaccinated and unvaccinated clients, both face-to-face and via Telehealth.

• • We encourage you to let us know if you are concerned about your vulnerability status as we can offer some additional precautions to your safety for face-to-face treatments.

The  single most important thing we can all do at this time is:

DO NOT attend the clinics if you have any cold or flu symptoms.

-We know this seems like overkill, but with very little information provided by the Qld Govt on how they will be handling Businesses that are Contact Sites, we need to be a little overly cautious to avoid a temporary closure for deep clean & isolation requirements for our Team.

Vaccination Status

-Please do not be offended that we are currently requesting that you volunteer to share with us your Vaccination status (& date of last vaccination) by allowing us to view your Vaccination certificate when politely requested by our Team.

Your vaccination status does not affect the treatment you will receive, & your status will not be shared.

-We will be storing your vaccination status in our practice management software which meets all privacy and security guidelines.

-Your vaccination status information will only be used for the purpose of completing an internal risk assessment should a positive case present in clinic, and to determine the level of PPE (protective personal equipment) both you and your Therapist may be required to wear during your consult. At this time, Qld Health are still suggesting that Close Contacts will be self-isolated therefore, part of our Risk Assessment is knowing vaccination status & use of PPE while in clinic to avoid our Clinics be closed and Therapists having to isolate and being unable to work.

Other Precautions Our Team Will Be Taking

-All our Therapists are hands-on providers (other than Psychology and Dietitian) & will be wearing N95 Respirator Masks & Glasses during your face-to-face Consults until we deem what precautions Qld Health recommends. We will be requesting that you wear a surgical mask while in clinic (except when exercising)

-As an employer of a big Team, we have an obligation to protect our Team, Our Families & all of you who attend in clinic, so unvaccinated clients (or those who do not wish to declare their vaccination status) will also be asked to wear an N95 mask as added protection until we hear otherwise from Qld Health.

• • We will supply you with a fresh mask on arrival & ensure correct fitting. There will be an additional cost to you for this mask that is our purchase price (between $2-$4), or you are welcome to supply your own in intact packaging.

When Attending Your Appointment

-Please continue to Check-in using our QR codes at the doors

-Hand sanitise when you arrive or immediately wash your hands: cleaning should take 20-30 seconds

-We ask that you only walk into the Clinic at the exact time of your appointment and suggest you may like to wait in your car if you arrive early. We aim aiming to reduce the number of people crossing-over in the waiting room

-We have social distancing recommendations in place & we ask you remain 1.5m from Others (except for your Therapist)

-Our Frontdesk Team will be sanitising the Banking Terminal between every use should you need to input a pin. Where possible, WE REQUEST PAYING BY TAP-&-GO to avoid touching the Tyro terminal.

-During Classes, maintain distancing of 1.5m at all times & cleaning as you go will help us A LOT.

Cleaning

-Our Team will be cleaning all surfaces regularly through-out the day & are using an antimicrobial agent on all touchpoints as added protection.

-More santisers and wipes are available in all areas so please clean after yourself if exercising, and sanitise after touching your face, coughing/sneezing or using a tissue.

DON’T FORGET WE CAN STILL HELP YOU VIA TELEHEALTH

A FINAL WORD

Our Team appreciate there are going to be some changes in our clinics, however, WE REMAIN COMMITTED TO PROVIDING YOU WITH THE MOST EXPERIENED PHYSIO, MASSAGE & OTHER HEALTHCARE ON THE GOLD COAST.

This plan is expected to be flexible and modified as further information is provided to small business on the management of Covid19 within Qld Communities.

Every one of us has the capacity to handle change and not let it become a burden, so we Thank You again for your ongoing support to our local GC Family Business.

Britt Caling, Albie Firley & Our Team

Lancet Series: Low Back Pain

The Lancet has published a series of three papers on the global impact of low back pain that present the challenges and causes of low back pain; the evidence for the effectiveness of treatments and a call for action.

What low back pain is and why we need to pay attention

This paper discusses the many contributing factors to low back pain and disability; potential nociceptive contributors to low back pain that have undergone investigation and the burden and impact of low back pain on society and economically.

Summary (link below in separate page)

• Low back pain is an extremely common symptom in populations worldwide and occurs in all age groups, from children to the elderly population
• Low back pain was responsible for 60·1 million disability-adjusted life-years in 2015, an increase of 54% since 1990, with the biggest increase seen in low-income and middle-income countries
• Disability from low back pain is highest in working age groups worldwide, which is especially concerning in low-income and middle-income countries where informal employment is common and possibilities for job modification are limited
• Most episodes of low back pain are short-lasting with little or no consequence, but recurrent episodes are common and low back pain is increasingly understood as a long-lasting condition with a variable course rather than episodes of unrelated occurrences
• Low back pain is a complex condition with multiple contributors to both the pain and associated disability, including psychological factors, social factors, biophysical factors, comorbidities, and pain-processing mechanisms
• For the vast majority of people with low back pain, it is currently not possible to accurately identify the specific nociceptive source (i.e disc vs facet joint)
• Lifestyle factors, such as smoking, obesity, and low levels of physical activity, that relate to poorer general health, are also associated with occurrence of low back pain episodes
• Costs associated with health care and work disability attributed to low back pain vary considerably between countries, and are influenced by social norms, health-care approaches, and legislation
• The global burden of low back pain is projected to increase even further in coming decades, particularly in low-income and middle-income countries

Full text article

[embeddoc url=”https://www.gcphysio.robicoweb.com.au/wp-content/uploads/2020/02/What-low-back-pain-is-and-why-we-need-to-pay-attention-1.pdf” download=”all” viewer=”google”]

Prevention and treatment of low back pain: evidence, challenges, and promising directions

This paper summarises the evidence for and against various options at treating and preventing low back pain; the gap between current practice and guideline recommendations; and promising directions for the improved management of low back pain globally into the future.

Summary (link below in separate page)

• Guidelines recommend self-management, physical and psychological therapies, and some forms of complementary medicine, and place less emphasis on pharmacological and surgical treatments; routine use of imaging and investigations is not recommended
• Little prevention research exists, with the only known effective interventions for secondary prevention being exercise combined with education, and exercise alone
• The evidence for prevention and treatment comes mainly from adults in high-income countries and whether the resulting recommendations are appropriate for children or those in low-income and middle-income countries is not known
• Non-evidence-based practice is apparent across all income settings; common problems are presentations to emergency departments and liberal use of imaging, opioids, spinal injections, and surgery
• Promising solutions include focused implementation of best practice, the redesign of clinical pathways, integrated health and occupational care, changes to payment systems and legislation, and public health and prevention strategies
• The evidence underpinning these solutions is inadequate and whether they are appropriate for widespread implementation is not known
• Further testing of these promising solutions, and development of new solutions, is needed, particularly in low-income and middle-income countries

Full Text (PDF)

Low back pain: a call for action

This viewpoint panel explores the most pressing political, public health, and health-care challenges and identifies actions to meet them.

Summary (link below in separate page)

Key Messages:

• Use the notion of positive health—the ability to adapt and to self-manage in the face of social, physical and emotional challenges—for the treatment of non-specific low back pain
• Avoid harmful and useless treatments by adopting a framework similar to that used in drug regulation—ie, only include treatments in public reimbursement packages if evidence shows that they are safe, effective, and cost-effective
• Address widespread misconceptions in the population and among health professionals about the causes, prognosis, and effectiveness of different treatments for low back pain, and deal fragmented and outdated models of care
• Policy, public health, health-care practice, social services, and workplaces must jointly tackle the low back pain paradox in low-income and middle-income countries, where improving social and economic conditions could prevent or reduce low back pain incidence, but at the same time create expectations and demands for medical investigations and low-value health care that increase the risk of long-term back-related disability

Full Text (PDF)

Written by Remedial Massage Therapist, Pilates & Natal Pilates Instructor & passionate Mum, Katie Harders

Remedial massage during your pregnancy can help change your experience, for the better, during the most amazing time in your life.

Once perceived as a form of alternative therapy, remedial massage is increasingly becoming a popular way for women to reduce pregnancy discomfort.

Research has shown remedial massage has multiple health benefits during pregnancy, including helping you feel revitalized and allowing you to remain active and feeling great during this time.

What are the Health benefits of Massage during Pregnancy?

• Reduce prenatal anxiety-  cortisol (commonly known as the stress hormone) can be reduced significantly by pre-natal massage. This allows you to experience ‘good’ or ‘happy’ hormones which improve mood, vitality and immunity.
• Help improve sleep – remedial massage can help increase the production of melatonin and serotonin hormone in the body which will regulate sleep rhythms. This can improve the quality of sleep which we know is important for all body systems to function.
• Reduce joint swelling– this is a common occurrence during pregnancy and is caused by low circulation and extra pressure on the blood vessels. Remedial massage can stimulate the soft tissues and decrease the build-up of fluids in swollen joints.
• Lessen muscle pain and cramps- these are a very common occurrence in pregnant women due increased muscle tension and heightened motor neuron activity. Prenatal massage can help lessen and manage these common symptoms during pregnancy.
• Reduce nerve pain –– during pregnancy, many women experience sciatic nerve pain. This can arise if the growing uterus and baby put pressure on the sciatic nerve causing inflammation and pain. This is more common during the later stages of pregnancy as the baby gets bigger. Our therapists can help with management of sciatic nerve pain.

What to expect when you’re expecting from a remedial massage?

During your first trimester you may not feel comfortable lying down due to nausea. If this is the case, you might decide to wait until these symptoms pass (usually around the 12 week mark). If you have any other medical issues, other than nausea, a doctor’s clearance is advised before commencing treatment. If you were attending for remedial massage prior to falling pregnant, it is usually safe to continue as normal.

In your second trimester, as your tummy starts to grow, laying on your front will become uncomfortable. A pregnancy massage pillow will be used during your treatment. As these changes take place and your tummy and breasts grows and your posture starts to adapt, it is quite common to notice some stiffness and tightness in your lower back, hips and shoulders. Booking a regular massage will help you manage these symptoms during the second trimester.

In the third trimester your body will undergo significant changes. Often the aches and pains may be more noticeable, particularly in your lower back, upper back and pelvic area. At this stage of pregnancy, the therapist will lie you on your side and use pillows to make you comfortable, this allows the therapist to continue to treat all areas.

What to expect with a post-natal Remedial Massage

With the arrival of your baby, your body will begin healing from the birthing process, but will also have to adapt to new postures such as holding and feeding your baby.

Post-natal remedial massage can help with these aches and pains, as well as improve mental wellbeing during this period. During the first few months after delivery we understand it can be uncomfortable to lie on your front. We are able to use pillows under your chest or hips to help make you comfortable during your session with us.

At Gold Coast Physio & Sports Health we offer pre and post-natal remedial massage at both linics with Katie Harders and Paige Single. Please call the clinic to book an appointment 07 5500 6470 or use our online booking system through our website, www.mygcphysio.com.au

Some Interesting Info about Para-Sports: Classification in Para-Sport Explained

We will be lucky enough to witness some amazing human performances at the Tokyo 2021 Paralympic Games.

The Paralympic Games will take place between August and September 2021 and will feature 4,400 athletes who will contest 540 medal events across 22 sports. This is more than ten times the number of athletes who competed in the first Para-games in 1960 in Rome, where only eight sports were included.

Para-sport exists so that athletes with an impairment have equal opportunities to compete and be successful in sport.

When you watch Para-sport it’s helpful to understand the classification process, and as the games get closer there will be an increase in media exposure on this process.

So here is some Interesting Information about ParaSport Classification

To ensure athletes are competing fairly, a classification system is used to group athletes with similar impairments into categories for competition.

The classification system determines which athletes are eligible to compete in a sport, based on their impairment. This, to a certain extent, is similar to grouping athletes by age, gender or weight. The classification system is varied across different Para-sports, with different eligible impairments.

At an international level the classification process is overseen by the International Paralympic Committee (IPC) and the individual sport’s international federation (IF). Domestically, the classification process is overseen by Paralympics Australia (PA).

Classification is a stringent process which, for most sports, involves the identification of a key impairment/s, a physical assessment and a sports-specific assessment. Athletes are grouped by the degree of activity limitation resulting from their impairment. Sports require athletes to perform sports-specific movements and skills to demonstrate limitations.

Further to this, for most sports, the classification panel observes athletes within competition to ensure they are competing in the most appropriate class and will only grant a confirmed status if there is high certainty of the correct classification.

Some Sports require specific Medical tests on the Athletes sensory ability ie. Visual or Hearing Impairment tests.

The classification process is an evolving process as the evidence base increases with more knowledge on the impact of impairments on performance. However, the ultimate goal of governing bodies will always be to ensure a fair competition. Classification changes can result in class changes for athletes or, in some cases, an athlete may become ineligible for a certain sport.

As a Sports & Exercise Physio, I am lucky enough to be involved in this process as a Para-Canoe/Kayak National Classifier and as Physio to the Australian Para-Canoe/Kayak team. My personal experience with classification has highlighted how this is an athlete-centred process, with the welfare of the athlete and fairness of competition for all athletes being the priority.

This process enables many athletes with an impairment to access fair international competition and celebrate amazing achievements with integrity.

I’d encourage all Australians to get behind the Australian Paralympic team and start to follow their journey as they set out on an inspirational journey to Tokyo 2020.

Meet some of the Qualified Athletes & their most amazing & inspirational stories from the Australian Paralympic Website: APC

BPPV Benign Paroxysmal Positional Vertigo: A Summary for GP’s

Definition

Recurrent attacks of positional vertigo, typically lasting less than one a minute

Provoked by positional change of the head, for example: turning over in bed, lying down, neck extension, bending forward.

May have associated nausea, vomiting, sweating,.

Hearing loss, tinnitus, aural fullness/pressure are not associated with BPPV

Diagnosis

Diagnosis is by positional testing which reproduces provokes vertigo and canal specific nystagmus.
Diagnosis includes the specification of the affected semicircular canal(s) and the pathophysiology (canalithiasis or cupulolithiasis).
Clinical features essential for the diagnosis are the latency, direction, time course, and duration of positional nystagmus.
Usually, further vestibular and auditory testing is indicated only when a pre-existing disorder of the inner ear (e.g. vestibular neuritis, Menière’s disease) is suspected.
Brain or ear imaging is not required in typical cases of BPPV.

Treatment

Canalith Repositioning Manoeuvres typically done by a Physiotherapist with an interest in Vestibular Rehabilitation (Helen Sibbald has experience & a special interest in this)

BPPV Information

The posterior canal is the most frequently affected canal (80– 90%); next is the horizontal canal (5–30%). Involvement of the anterior canal is rare.

1. Canalithiasis of the posterior canal.

Diagnostic criteria:
A) Recurrent attacks of positional vertigo or positional dizziness provoked by lying down or turning over in the supine position.
B) Duration of attacks < 1 min.
C) Positional nystagmus elicited after a latency of one or few seconds by the Dix-Hallpike manoeuvre or side-lying manoeuvre (Semont diagnostic manoeuvre). The nystagmus is a combination of torsional nystagmus with the upper pole of the eyes beating toward the lower ear combined with vertical nystagmus beating upward (toward the forehead) typically lasting < 1 minute.
D) Not attributable to another disorder.
Note:
Usually, the duration of positional nystagmus is no longer than 40 seconds before it dampens spontaneously.
Positional nystagmus rapidly increases in intensity and then declines more slowly (crescendo-decrescendo type)
After the patient returns to the upright position, positional nystagmus with reversed direction of lesser intensity and shorter duration often occurs.
Fatigability of nystagmus and vertigo with repetitive positional testing is common.
The direction of nystagmus is essential to specify the affected canal. In contrast to central positional nystagmus, positional nystagmus in BPPV always beats in the plane of the affected canal and in the expected direction for canal excitation or inhibition.

History and physical and neurological examinations do not suggest another vestibular disorder – or such a disorder is considered, but ruled out by appropriate investigations – or such disorder is present as a comorbid condition that can be clearly differentiated
Assessment: It is essential to perform positional manoeuvres for both the vertical and the horizontal semicircular canals in every patient with positional vertigo as multiple canals may be affected .
Dix Hallpike manoeuvre or Semont diagnostic manoeuvre tests the vertical canals and the supine roll test for the horizontal canals.
For observation of positional nystagmus, Frenzel goggles or video-oculography can be helpful, particularly when the nystagmus is weak or momentary. In most cases, however, nystagmus can be seen clinically without special equipment.
The differential diagnosis of BPPV includes central positional vertigo due to vestibular migraine and structural brainstem and cerebellar lesions. CNS disease can usually be excluded by a thorough neurological examination.
Greater care should be taken in patients with dominantly horizontal or downbeat positional nystagmus forms, since these are most frequently reported in central mimics.
Cerebral imaging with MRI is usually only indicated when symptoms or signs of concurrent brainstem or cerebellar dysfunction are present, or when positional vertigo and nystagmus present with atypical features or fail to resolve with repeated therapeutic positional manoeuvres.

Treatment: Epley manoeuvre

2. Cupulolithiasis of Posterior canal:

Diagnostic criteria:
A. Recurrent attacks of positional vertigo or positional dizziness provoked by lying down or turning over in the supine position.
B. Positional nystagmus elicited after a brief or no latency by a Dix-Hallpike manoeuvre beating torsionally with the upper pole of the eye to the lower ear and vertically upward (to the forehead) and lasting > 1 min.
C. Not attributable to another disorder.

Treatment: Semont Liberatory Manouevre

3.Canalithiasis of the horizontal canal
Diagnostic criteria
A. Recurrent attacks of positional vertigo or positional dizziness provoked by lying down or turning over in the supine position and head rotation, extension, flexion in erect position.
B. Duration of attacks < 1 min.
C. Positional nystagmus elicited after a brief latency or no latency by the supine roll test , beating horizontally toward the undermost ear with the head turned to either side (geotropic direction changing nystagmus) and lasting < 1 min.
D. Not attributable to another disorder.

Note:  During the supine roll test, the faster the head turn, the shorter the latency and the higher the intensity of nystagmus. The intensity of nystagmus tends to be higher with larger head rotations.

To confirm the affected ear: the intensity of nystagmus is usually stronger with the head turned to the affected ear in the supine roll test. The Bow and Lean test: nystagmus beating toward the affected ear in the bow position and nystagmus beating toward the healthy ear in the lean position.

Transition from geotropic to apogeotropic nystagmus may occur during diagnostic and therapeutic manoeuvres. Transition of canalithiasis from the posterior canal to the horizontal canal may occur as a result of therapeutic positional manoeuvres.

Treatment: BBQ roll or Gufoni for Geotrophic variant

4.Cupulolithiasis of the horizontal canal:

Diagnostic criteria:
A. Recurrent attacks of positional vertigo or positional dizziness provoked by lying down or turning over in the supine position.
B. Positional nystagmus elicited after a brief latency or no latency by the supine roll test, beating horizontally toward the uppermost ear with the head turned to either side (apogeotropic direction changing nystagmus), and lasting > 1 minute.
2. Not attributable to another disorder.

Note: As direction-changing apogeotropic positional nystagmus also occurs as a sign of central-vestibular dysfunction, it is mandatory to exclude CNS disease.
The side of the affected ear: The intensity of positional nystagmus is usually stronger with the head turned away from the affected ear in the supine roll test.
Apogeotrophic direction changing positional nystagmus may also occur with canalithiasis of the horizontal canal where otoconia are located in the anterior part of the horizontal canal (transient nystagmus, not persistant like cupulolithiasis)
Treatment: Gufoni for Ageotrophic variant or Casani Manouevre

Link for the Consensus document of the Committee for the Classification of Vestibular Disorders of the Bárány Society -BPPV:

Here

Vesticam Googles for accurate nystagmus diagnosis

Gold Coast Physio & Sports Health has infrared video googles to enable our Physio’s to visualise abnormal eye movements during testing of patients complaining of vertigo. Having best practice technology allows us to more accurately diagnose and therefore choose best treatment pathways & better outcomes.

BBPV has a very classic presentation of vertigo with Nystagmus that beats in a certain predicatable direction for the particular affects semi-circular canal, and it latent plus fatigues. So the affected semi-circular canal can be accurately identified with the Googles and therefore the correct treatment manoeuvre used.

Not every patients experiencing positional Verigo has BBPV. If, for example, the patient experiences vertigo on BPPV testing but has a persistent nystagmus is observed, this is NOT BPPV, but rather central positional vertigo, and the underling central cause would need to be identified with further investigation/ MRI. Googles make it accurate to observe the direction of nystagmus, and the movement is recorded to watch and check repeatedly, or to pass on to other Specialists for accuracy in diagnosis.