Physiohealth Articles

Goal Setting- Steps to Success  

by Scott Rolph

Why set goals?

No matter who you are or what you are trying to achieve goal setting is an integral part of successful planning.  Goal setting can be applied to sports performance, work career, family matters as well as recovery from an injury.  Goals give us something to aim for and when implemented correctly are effective at helping us to get what we want and where we want to get to.

What do goals have to do with Physiotherapy?

When working in a physiotherapy clinic we know that people come to us with particular goals or things they wish to achieve in mind.  This may include decreasing their pain, improving movement and function.  For others it might be to maintain results of past treatment or to improve their performance for sports.

What type of goals are there?

Goals differ greatly and whilst it is good to have big long-term goals they must be supported by small achievable goals.  These smaller goals act as milestones to help you measure your progress giving you feedback as to whether you’re heading in the right direction or not.  For example when recovering from the a serious knee injury a footballers long term goal may be to return to football however short term goals will involve managing swelling and pain then achieving levels movement and strength.  Now you change goals to improving mobility, balance then progressing to high level sports specific work. Even shorter goals than these may include performing exercises as prescribed each day/week.

Without short term goals, long term aims and aspirations seem to remain at a distance.  With the implementation of short term goals long term outcomes seem more achievable as you know the steps you have to work through to get there.

SMART goals

When making goals whether big or small they should be SMART goals.  This means that they should be constructed in a way that is:

• Specific – be precise about you wish to achieve
• Measurable – how will you know if you achieve it, what are your measures (pain levels, degrees of movement, level of strength, speed/times etc)
• Achievable – Set goals that keep your abilities in mind but don’t be afraid to push yourself
• Realistic – keep in mind the resources and time you have available to devote to pursuing your goals
• Time oriented – give your self a time limit to achieve this.

Goals differ greatly between people and it is important to discuss with your physiotherapist what your goals are.  This will improve the formulation of a step by step plan to help you to  achieve the results you are after.

Patello-femoral Pain (PFP) Syndrome

What is Patello-femoral Pain (PFP) Syndrome?

Patello-femoral pain syndrome is commonly associated with pain felt behind the knee cap. Activities like walking up and down stairs or getting up from sitting after prolonged periods of time can exacerbate the pain. The most common cause of Patello-femoral pain syndrome is abnormal movement of the kneecap as the knee is bent and straightened. This may lead to wear and tear of the cartilage on the back of the kneecap. Tight muscles, structural abnormalities and weakness of the lower limb may contribute to the pain.

Typical Symptoms

• Gradual onset of pain around the knee cap which is often vague and nonspecific.
• Often aggravated by stairs, hill climbing, walking, running, squatting, kneeling or prolonged sitting.

How common is PFP?

• PFP most frequent knee pain in adults under 50 and often occurs before osteoarthritis.
• Individuals with osteo- arthritis (wear and tear of the cartilage behind the knee cap) are more likely to have had PFP as younger individuals. Hence, prevention and early management is very important.
• 17% of Runners get PFP.
• Females, post puberty are more likely to get PFP than males.

What causes PFP?

• Multifactorial. Research shows that PFP has many causes and the cause of the symptoms varies from patient to patient. These factors are split up into extrinsic and intrinsic factors.

Intrinsic Factors

• Knee cap (Patella) mal-alignment and mechanics
• Weak and poor timing of VMO (inner thigh Quadriceps muscle)
• Tightness in soft tissues surrounding the knee cap.
• Bony or structural abnormalities around the knee cap eg Patella Alta where the knee cap sits high out of the knee joint, lengthening the patella tendon.
• Poor tracking of the knee cap with sport/walking etc…

Extrinsic Factors

• Poor foot mechanics, particularly pronators, people that roll their feet inwards.
• Poor gluteal (buttock) muscles strength
• Loading up running and sport too quickly. Eg going from no running to running 20 kilometres in 2 weeks.
• High BMI (Body Mass Index)

How can a Physiotherapist Help?

On visiting a physiotherapist:

• the therapist will perform a detailed assessment working out which intrinsic and extrinsic factors have caused your particular case of patello-femoral pain.
• Rule out any other pathologies which may be causing your knee pain with a detailed assessment.
• Imaging such as an X-Ray o MRI may be ordered if the therapist suspects other pathologies. But these are only ordered if the therapist thinks they will be helpful for the management of your knee pain.

Treatment

As the causes of patella- femoral pain are varied the treatments are also highly variable depending on which factors have led you to have your knee pain. The goal of the treatment is to help with your pain but also prevent it from coming back repetitively. The treating physiotherapist may use the following treatments:

• Massage of the Soft Tissues around your knee cap
• Taping of the knee cap to prevent mal-tracking
• Orthotics to help correct foot mechanics
• Exercises to strengthen and work on timing of the VMO muscle
• Exercises to strengthen the Gluteal (buttock) muscles
• Electrotherapy and Ultrasound if there is excessive inflammation
• Exercises to stretch tight muscles
• Advise to lose weight
• Correct footwear advice

The most common treatment approach for PFP is conservative treatment with your physiotherapist but there are some rare cases which may require surgical intervention. If this is the case your physiotherapist will advise you and refer you to an Orthopaedic Surgeon specialising in knee surgery.

Prevention Strategies

• Wear the right footwear
• Stretch and warm up before exercise
• Cool down after exercise by performing light stretches
• Build up an exercise program slowly over time
• Avoid sudden jarring motions and turn through the balls of your feet when changing direction, rather than twisting through your knees

Things to Remember

• Seek early advice from your Physiotherapist if you think you are suffering from PFP.
• It is a complex injury which is multifactorial and needs professional assessment and treatment.
• It is very treatable with the right advice!

Overuse Injuries In Sport

Overuse injuries in sport result from doing repetitive activities or maintaining poor postures over a period of time.  These activities and postures initially result in minor trauma to body tissue which may include tendons, ligaments and/or bones. This minor trauma usually heals with rest. However, when the minor trauma occurs in a repetitive or sustained manner the consequences are far more serious. In sports overuse also results from doing a lot of repeated high intensity training/games without the appropriate recovery from the fatigued muscles.

Single Incident

When the minor trauma occurs from a single incident we don’t normally feel pain.  The body is fully able to heal the injured tissue and we are back to playing sport as if nothing happened.

Multiple incidents

When this minor trauma to the tissue occurs repeatedly and without a recovery period the body is unable to keep up with the healing process.  The minor trauma accumulates and the result is pain, inflammation and wear and tear on the tissue. The individual is then unable to perform at their usual level. 

Common overuse injuries

Common overuse injuries include: Achilles tendonitis, stress fractures of the foot, shin splints, osteitis pubis and “growth injuries” such as Osgood Schlatter’s disease and Sever’s disease.

Signs and symptoms of overuse injuries

The common signs and symptoms of overuse injuries are: pain, muscle weakness/soreness, swelling and restricted mobility in the joints.

Physiotherapy helps!

Physiotherapy should be your first point of call when suffering from overuse injuries. Your physio will look at the complete picture by managing the injury, managing your return to sport and, managing your workload/intensity in order to reduce the risk of re-injury. They will provide you with:

1. Pain relief
2. Tissue healing
3. Exercise prescription (this includes increasing your flexibility)
4. Self/Load management strategies for the injury
5. Identify and correct by mechanical deficiencies
6. Advice on appropriate recovery post exercise
7. Prevention advice

Prevention Advice

• Do not overdo the same activities, try and alternate activities/training deals.
• Modify the intensity levels of training/games.
• Give your body enough time to recover by having appropriate rest periods.
• Alternate activities, so you not constantly stressing the same body part.
• Remember pain is your body telling you that you are damaging body tissues, respect this message and seek advice from your physio early as this will allow you to maintain your activity.

Stretching - What, Why, Who, How?

Many Physio’s receive questions related to stretching.  The most common ones are what type? how long to stretch for and should I stretch before sporting contests/games?

How long to stretch for?

The general rule of thumb is to stretch for a combined total of 1 minute, whether that’s 3 x 20 seconds, 2 x 30 seconds or 1 x 60s.  If there is severe tightness specific long positional holds such as 2-3 mins may be useful. 

Stretching before an event…

Before sporting contests static stretching is ok, however when we stretch our muscles there will be a power lag for around 90 mins, meaning there will be a force production deficit of around 2-5%.  So if your tight it would be wise to stretch and loosen up well away from your competition and stick to more sport specific and dynamic movements closer to the game/event. 

Stretching post match and event…

The most important time to stretch is immediately post your activity before your completely cooled down.  With exercise your muscle length will shorten so to prevent  any accumulative joint range of motion loss always adhere to 15 – 20 mins of static stretching after your event. 

Low Back Stretch Examples…

Core Stability - What, Why, Who, How?

What is core stability?

Core stability is the ability of the supporting structures of the trunk to maintain correct position of the low back and pelvic girdle. This is due active structures (core muscles), passive structures (bones, ligaments, fascia) and neural control (messages from the brain/spinal cord via the nerves).

Why is core stability important?

Poor core stability leads to excessive movement to occur in the joints of the low back, pelvis and hip. Excessive movement directly increases the loading on these structures. Furthermore it can also lead to increased loading on the joints of the leg including the knee, ankle and foot. The increase in loading can result in injury and pain in any of these regions.

Who is at risk of instability? :

• Acute/chronic low back pain sufferers
• Athletes
• Pre- and post-natal women

Can I improve my core stability?

YES!!!
You may require one or more of the following interventions to enhance your core stability:

• Hands on physiotherapy – Pain in the low back can be reduced and eliminated by hands on physiotherapy techniques and electrotherapy modalities. This allows for the muscles of the core to be reactivated.
• Clinical pilates -Clinical pilates is specially designed to increase the activation and strength of core muscles. Best results are achieved by gaining a specific, individualised program with a physiotherapist trained in clinical pilates.

How can I organise an assessment?

Contact your local Physiohealth practice and our friendly staff will organise an appointment with a physiotherapist for you.

Management of Ankle Injuries

Ankle injuries are the most common injury seen on the football field. Correct management is crucial for healing.

Ankle injuries may be classified into three categories.

Grade I (mild) – Involves a stretching of the ligament with little or no stability. The athlete is able to walk on the ankle with some discomfort and mild swelling.

Grade II (moderate) – Rupture of a portion of the ligament, the athlete often has a lot of difficulty putting weight through the ankle and will experience some instability, pain and swelling.

Grade III (severe) - Involves a complete rupture of the ligament and pain fibres. There will be gross swelling, bruising and instability of the joint. Due to the rupture of pain fibres the patient may not feel pain. Injuries such as these require surgical intervention.

Simple first aid principles should be applied in the first 48hours…

Protection - Immobilise the ankle with tape or a brace
Relative Rest - Crutches may be required due to pain however it is best to weight bear as soon as possible for optimal healing. Check with your physiotherapist before you weight bear if you are unsure.
Ice - To reduce pain and swelling
Compression - Tape and tubigrip will help control swelling
Elevation - Elevate the leg whenever possible to control swelling and promote healing

It is important that you see your Physiotherapist immediately following an ankle sprain for appropriate treatment and rehabilitation (sport specific) as the ankle will be weak and prone to further injury.

“Should I use Ice or heat”?

Acute Injuries:
The best rule which applies with all injuries, but particularly an acute injury is, when in doubt use ice.
On a sprain, strain or contusion (bruise), icing should be performed for 15-20min every hour.

The time varies according to the depth and the severity of the injury, but generally you should continue icing until all the swelling has resolved and you are feeling much better. Not for only the first 72 hours.

NEVER use heat in the acute phase of injury (which is approx the first 72 hours from the time of the injury) as it will exacerbate inflammation and possibly increase bleeding into the area.

Sub-acute Injuries:
In the sub-acute situation (4 days – 7 weeks after injury) it is best to follow the advice of your physiotherapist, again when in doubt use ice, ice will be helpful at this stage of the injury to help reduce inflammation and particularly reduce muscle spasm. In the sub-acute phase ice can also be combined with exercise for example: lying on your back with the ice under the lower back while performing some gentle abdominal or lumber mobility exercises. Ice can also be combined with a stretch. For example; calf or hamstring so that the ice and stretch are done con-currently (together).

Heat may be used in this situation particularly in the clinical setting by a physiotherapist prior to mobilizing a stiff joint or before massaging tight muscles; this is when heat is being used for relaxation.

In the sub-acute phase, ice is not needed as frequently as in the acute phase but may still be done 2-3 times per day, especially at the end of the day or after exercise or activity.

Chronic Pain/Injury:
It is in this stage of the injury (when the injury has prolonged over the amount of time it should of healed) where client preference and therapist preference creates more of an option to use heat or ice, although heat and ice are opposite modalities they have some functions in common such as pain relief, relaxation and increase blood flow. Some people find much better pain relief and relaxation with heat than ice and in the chronic situation it is normally fine to use heat, such as a microwave heat bag, hot shower etc. In some chronic conditions it is helpful to heat prior to exercise or stretching and to use ice post exercise. This is utilizing the benefits of both heat and ice.

General Precautions:
• Both ice and heat can burn, always cover ice or heat pack adequately.
• If in doubt consult your therapist

REMEMBER IF IN DOUBT USE ICE!