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Episode 10: Injury Management and Prevention  

Show notes

Hannah:
Welcome back everyone, we are here on the Burn Pod and we are still speaking with Chrissy Tadros from AllCare Physio. We've had her on the last couple of episodes, so if you haven't had a listen, jump back two episodes to our injury prevention, that's a brilliant, brilliant podcast. Last podcast we did injury management hour and that was a little bit more just in general injury management, that was brilliant, so jump back to that because a lot of the stuff we talked about in that podcast we'll be referring to in this one that we're about to jump into. Now this one is all about a little bit of a specific injury focus, so we talked more generally about injury prevention, injury management, but we wanted to kind of touch on some of those sort of regular, I guess, injuries that we see.

Hannah:
So things like back discomfort, shoulder issues, and then you've got your joint issues like your knees and your ankles, and what they are, how can we reduce the likelihood, so preventative steps, how can we strengthen around, and also how do you actually exercise safely when you have discomfort or some type of injury? And whether you even can. So thank you so much for joining us and let's get straight into it. The biggest one that we get with our women at the studio is, "I've got a dodgy back," or, "I've got back problems," or, "Lower back pain," but I mean I'm sure there's a range of different things that cause that, but what are kind of the main ones that cause lower back pain or discomfort?

Chrissy Tadros:
Yeah so there is ... I guess this is where age group ... like the age of a patient really changes what we're thinking. So say if it is like a middle-aged female maybe we would say, "Okay well gardening's been a very common one over this summer period," so a lot of people do get into the garden and again, like we spoke in the last podcast about injury prevention is that kind of loading if maybe they haven't been in the garden for a long time and they've decided to go at it for three hours and a lot of weeding and pulling and bending over and just more repetition than their body can handle is probably a common one. Sometimes we would see technique, like you know, maybe how they're doing their deadlifts of their squats or how they're sitting, like we spoke last time too.

Chrissy Tadros:
Like maybe their back's overworking and it's getting tired and that's what their ... previous injury does have a bit to play with lower back, so if we've had an injury before it might be a little bit easier to feel symptoms arise again, and things like even smoking can be a risk factor for back pain too, so you know, in terms of they're the main ones we would see, seating [crosstalk 00:03:06]-

Hannah:
And would that be more of like a strain or a sprain type of injury?

Chrissy Tadros:
So this is where injury management comes from, you know, when we're looking at injury management we're saying number one, let's rule out really nasty things, so what we call red flags. For most people ... there's not a lot of people that fall into that category, so now we're working with lower back pain, in terms of then diagnosing that it's saying, well, there are so many things that contribute to pain, so if I had an empty cup and I filled it up with how strong I was, maybe my previous injury, maybe I was sitting ... I drove around Tasmania for a few days and I had ... my sitting load went really up and actually the week before I did do some gardening so maybe my load was different and I have been stressed lately, then structure might be in there, but it might not be the main tipping point.

Chrissy Tadros:
And so it's when the cup is full that we get pain. So there's often a lot of contributions to why someone might get lower back pain and maybe in the class they might get a little bit of a niggle in their back but it's not the main ... it might not be a structural pathology is the thing that's crying out the most. So it does get tricky and I think that's why we really want to sit down with someone and say like, "What's going on? What's our history?" Even mental health plays a part and so a lot of our treatment for lower back stuff comes on education because you know, if we scan everyone with a lower back pain, they're probably going to find stuff in there but it's not significant, it's like what they're finding on the MRI is not reflecting what's actually going on in symptom-wise, so there's a lot of education with lower back stuff.

Chrissy Tadros:
And the main things I would say is if you have lower back stuff, it's very focal, it might just need a few days to calm down, pain relief is great because pain inhibits our movement patterns from working well, but it is trying to find then what the back loves to do. Does it love to go for a swim? Or does it love walking? Or maybe it does love to stretch with yoga or doing some barre but modifying a few things, so I think having that education on that type of injury and what pain means is really important, but then trying to get back moving. I see the back often as the victim, because something maybe around might not be working as well and so-

Hannah:
And the back just takes over.

Chrissy Tadros:
And the back just takes over, and sometimes I feel sorry for it, so yeah.

Hannah:
Yeah. So I guess [inaudible 00:05:35] some of the preventative steps that we can take to look after our back but also to work around soreness and stiffness just starting to find the movement patterns that feel okay for you and then moving on from there?

Chrissy Tadros:
Yeah.

Hannah:
I guess with backs, is there any particular ... while we're on this specific one I may as well get into it, is there anything that you can do to strengthen around lower back discomfort to reduce recurring discomfort and injury?

Chrissy Tadros:
Yeah, so we would look a lot ... like if I was saying so the back's a victim, I'd probably look a little bit at hip strength, pelvis strength, what their motor control's looking like, so a lot of glute strengthening people find helps as time goes on. You know, maybe some abdominal strengthening can be helpful as well, I would also look at sort of flexibility around the hips and pelvis, particularly people sitting long periods and their hip flexors feel like they might just tighten up with that sitting position, and also I do think the way ... again like that technique, like we can get a lot more out of exercise if it's either ... like supervised is great because there's someone probably looking over you and just making sure that we're not doing anything crazy, crazy and we're actually getting the most out of that exercise as possible.

Hannah:
Yeah, and we often like to say there's no point doing the higher option or trying to go as fast as you can if you're doing an [inaudible 00:07:04] if you're not actually doing the right technique, because you're not using the muscles in the right way-

Chrissy Tadros:
Yeah exactly.

Hannah:
And ultimately there's other muscles around that will compensate and that's when injury can actually occur.

Chrissy Tadros:
Yeah absolutely.

Hannah:
So you're doing yourself a disservice if you're not taking the time to do the moves properly. Quality moves over quantity or-

Chrissy Tadros:
That's it.

Hannah:
Yeah.

Chrissy Tadros:
Quality over quantity.

Hannah:
So if we look at, you know, some of the specific injuries I guess we see in our classes but maybe also you see in ... maybe not specifically sports-related but you know, your day-to-day ladies, let's look at ... we've already talked about back pain, but maybe we see a lot of shoulder issues that come up, and when I say issues, it's a painful shoulder we get told, what are the types of injury that you see that occur or make those shoulders sore?

Chrissy Tadros:
Yeah, so definitely the main one we would see is sort of rotator cuff pain, so that's the ... there's four of the tendons that surround the shoulder and it can help with maintaining a nice position of the shoulder as it goes through range, but also performs and helps with some of the strength around the shoulder, so you'd see it a little bit in sort of maybe like a lot of yoga or a lot of swimming, maybe some overhead activities, and sometimes that is in conjunction with some bursitis which a lot of people might have on an investigation as well. So they would be the main kind of shoulder pathology that we would see for people, and you know, the rotator cuff ... so if we think about, kind of like even say yoga's got a lot of pushing to it, so can we balance that out a little bit with a lot of pulling strength for instance might be a nice way to balance it out, or we might look at specific rotator cuff and shoulder blade strengthening.

Chrissy Tadros:
The shoulder is fairly interesting because it has quite a big play with neck pain as well and this referral, so we kind of look at the whole unit and say like okay, what's the thing that's driving the most? But mainly looking at shoulder blade strengthening, rotator cuff strengthening, balancing out those movement patterns between pushing and pulling, and going from there really.

Hannah:
And is there ways that people can exercise safely around a sore shoulder?

Chrissy Tadros:
Yeah like it depends on the extent of symptoms, so I like the traffic light rule where if it's sort of this kind of less than four out of 10 and it's just a bit there and it's just not too bad afterwards, we kind of say it's like a green light, like keep going with what you're doing, but you might just pop in and get some advice on how to change that. If it's kind of like this four to six out of 10 we're kind of in this orange light, maybe we need to modify something, and then if it's six or more out of 10 maybe we need to pull back from that particular activity, but there's so much activity out there which is excellent, but it might be more like a period of more lower limb or leg exercises like cycling or hiking or you know, doing maybe your floor-based stuff but just watching how much weightbearing you're doing in the shoulder if that's the thing that aggravates you.

Chrissy Tadros:
It is just trying to find ... because everyone will be really different what symptoms they have and what things they can and can't do, and it is just saying well like, "If it is a bit uncomfortable can I keep going? And if it is pushing too far, can I pull back from some of the shoulder stuff and stick to more leg-based work or more core stuff but less weightbearing?" For instance.

Hannah:
Yeah I love that, so ... that between a one and a 10, so like you said, one and a four, if it's a bit niggly but not giving you too much discomfort post, well maybe ... I mean a couple of minor modifications if it's uncomfortable doing the exercise, maybe stop, but yeah, anything sort of above a four and if you're looking at above a six you'd probably need to get off that shoulder and definitely see someone, but between a four and a six then maybe just go and check it out, but you know, as you said, modify around, and a lot of ... if you're not at a studio with us, I mean any other sports or class instructor should be able to give you variations or modifications around a shoulder, shoulder discomfort.

Chrissy Tadros:
Yeah, that's great. Yeah and I think that's where like that traffic light rule is nice, because you know, we always try to rule out the nasty nasty things, but for most of us we can fit in this pattern and it works really well and I think the main thing is we know that pain doesn't necessarily mean damage, and that's what we see a lot of people coming in and saying, "I'm worried I'm damaging my shoulder because I feel pain," there's a lot of awesome, awesome research now looking at our brain and what pain means, and it's saying well maybe pain's a warning sign, it's trying to tell you something, but it doesn't mean necessarily there is actual structural damage happening to that area.

Hannah:
Yeah, I mean if it's acute pain then probably need to-

Chrissy Tadros:
Yeah if it's acute pain, you've fallen and fractured your shoulder [crosstalk 00:12:04] different, but for our gradual onset of things that have [inaudible 00:12:09] for a while we might just approach it somewhat differently.

Hannah:
A bit differently, yeah, and I really love that because I know that for the women that are ... and you even said so yourself, when you're in something and you're working out and you're feeling great and then some sort of lower level injury occurs, it can be so disheartening because you think that's it, you're going to have to stop, you're going to have to get right off that shoulder or that ankle, but it doesn't necessarily mean that you have to stop, sit down, and lose everything you've done, it just means you need to probably, once again, check in between one and 10, where are you sitting, go and have a chat with a physio and maybe just modify around and do something slightly differently.

Chrissy Tadros:
Absolutely, because I mean exercise is so important for like even like mental health and well and people probably have a social, particularly at Burn Theory you know there's probably such a social lovely atmosphere there that you don't want to be missing out on things, so it is nice to say like ... just really trying to work out what we can and can't do, and just sticking to some form of movement would be ideal, yeah, depending on what it is.

Hannah:
So I've got one for you that might be a bit of a curly one. When it comes to knee and ankle discomfort, because it's hard to kind of modify off your legs because they kind of do most of the ... you know, you've got to stand on them and that sort of thing, I mean we can modify around squats and lunges and stuff like that, don't go as low, don't hold as much load, don't even do a lunge, but I guess are there specific types of ankle and knee issues and injuries that you see and common ways that this actually occurs?

Chrissy Tadros:
Yeah so if we ... maybe if we start at the knee itself, so I guess knee osteoarthritis or kneecap pain can be quite common, and in terms of modification, if ... like some people find kneeling quite uncomfortable, so say in yoga, they might find that deep kneeling ... so sometimes I might just say, "Okay try not to sit on your ankles but maybe just stay in a four-point kneeling position or a high kneeling position if that feels like that makes the knee feel better." With boxing you might be able to do your boxing but you might not be able to do, like say squats in between or something like that, so it does ... like it really depends on what people are feeling, but you can, even outside of classes, find pools or the ocean's really beautiful and doing some activity in water can be really nice, and particularly for some people like with knee OA where they might just get to the point where even walking feels uncomfortable, where we might say, "Well if you can't walk for 30 minutes because your knee's sore, you can maybe walk for 20 but maybe do it twice a day if you love your walking. Or maybe get in a pool and try some activity in the pool and walk in water," because our body weight's not kind of there.

Chrissy Tadros:
And I guess similar to the ankle in that, and stationary bikes can be really helpful, like for the knee you might need to change the seat height but often it can be pretty good, and also you get your quad strength or some quad conditioning with some cycling and same with ankle pain or achilles pain or whatever it may be, you know, maybe doing some bike stuff and pool stuff, and usually your yoga and your barre, and to an extent boxing without impact is quite good for like, say, achilles pain or back of the heel pain can be still doable. Sometimes the yoga, like excessive stretching like in down dog for the achilles can be uncomfortable but there's definitely ways of, again, modifying your activity so those things are comfortable, but like I said, there's so much variety out there now.

Chrissy Tadros:
Like I think I opened a yoga app Down Dog, and it was ... you could do chair yoga, or you can do like lying down yoga, you can do this ... so there is ways of doing things and making you mentally happy and keeping your body moving but without irritating too much and letting that injury kind of settle down a little bit.

Hannah:
Yeah, and once again it comes back to listening to your body and understanding where you are on that scale of one to 10 with discomfort, working around that and chatting to your instructor or someone to ask, you know, "What is it that I can do to modify around," and as you said it might mean that if you're doing a class that's leg heavy and you've got discomfort in your knee and your ankle, you might just need to drop back instead of doing your five sessions a week or however many you do, maybe bring that back to only three sessions and do some swimming or something else or some stationary bike at home in between if you want to keep that consistency up, but just take the load off that particular ankle or knee.

Chrissy Tadros:
Yeah, perfect.

Hannah:
Yeah.

Chrissy Tadros:
And it is about communicating, because like I mean it's really nice in Burn Theory where you guys have instructors that can help modify and supervise things and I think that sort of stuff's really important because sometimes people might just kind of hold things to themselves and not really have an idea of where to go and what to do and can kind of either make symptoms worse or linger it so long that now they ... it can be tricky when someone comes in and they're like, "Oh I've had it for three months. I thought it was going to get better after a month but it still kind of ... I was just kind of waiting for it to get better." I think communication [crosstalk 00:17:16]-

Hannah:
Waiting for it to get better doing the same thing.

Chrissy Tadros:
Yeah.

Hannah:
Yeah, and it's also ... you know, when you're in class guys and you do, you're doing a move and then you might feel a little bit of a twinge or a discomfort, or if you're not really sure if you're doing it right, always stop and grab us and ask, you know, "Can you check that I'm doing this movement correctly?" Or, "Am I holding the plank position correctly?" Or, "I'm feeling it in my lower back when I'm doing this, what am I doing wrong?" And you know, it's always good to ask those questions so we can pick it up then and there before it's something that you do consistently incorrectly and then the injury or this discomfort becomes worse.

Chrissy Tadros:
Yeah lovely.

Hannah:
Yeah. So Chrissy we'll wrap that one up and I'm literally just loving this so much. It is so great [crosstalk 00:18:06] it's an area that I always think maybe I should go back and study, but thank you so much for being onboard.

Chrissy Tadros:
Oh thank you.

Hannah:
How do our listeners get in touch with you?

Chrissy Tadros:
So probably the easiest way is at the AllCare Clinic, so either calling the clinic or emailing as well, so my email is chrissy.tadros T-A-D-R-O-S @allcarephysio.com.au, so all lowercase, so yeah, either one's probably the best way to get in touch and I'd be really happy to answer any questions and chat to anyone that may want to learn a little bit more about any of this sort of stuff too.

Hannah:
Yeah amazing, and we'll pop your email address and the link to the AllCare Physio in the show notes guys, so if you just head to burntheory.com.au and head to the podcast you'll find this episode there. So once again Chrissy, thank you so much for your time, it's been an absolute awesome hour, I've loved ... I could just sit here, like I said, and listen to you for the whole day, soak everything up.

Chrissy Tadros:
I don't know, just hang out, get a coffee.

Hannah:
Yeah exactly. Why don't we talk about injury for an entire day.

Chrissy Tadros:
Yeah actually that sounds great.

Hannah:
Thank you so much and good luck with the new bub-

Chrissy Tadros:
Thank you.

Hannah:
And have a wonderful year ahead.

Chrissy Tadros:
Thanks so much.

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