A few clips from the past few days with @jgomeznoya 🇪🇸 & Coach @theplews on location in Auckland @autmillennium 🇳🇿 Working on the upcoming season 🎯 🏊🏻🚴🏼🏃

[TACKLING LOW ENERGY AVAILABILITY] 👀 Due to the start of my 2 year Sports Physio Specialist training @physicalperformanceshow output has markedly slowed. We will still output Episodes as we can such as this week’s release Episode 359 feat New Zealand Performance Sports Dietitian & Researcher Dane Baker 🗣️ 🇳🇿 Low Energy Availabilty & it’s close ‘counterpart’ Relative Energy Deficiency in Sports (RED-S) have been extensively covered in the past by some of the world’s leading minds (Dr Mountjoy, Trent Stellingwerf, Meg Kuikman, @r_mcgregor). Adding to this back catalogue this week Dane Baker does a great job of sharing key concepts relating to the treatment & recovery from RED-S 📈 ✅ How you can maintain body weight but still be experiencing the detrimental effects of RED-S ( health and performance see @bjsm_bmj schematics ➡️ ) ✅ Energy Distribution and why it matters ✅ Fuelling for sessions (pre, during, & post) I hope the learnings are useful for your endurance sporting pursuits 🎧 📌 Avaialble now @spotify @applepodcasts @youtube

[TENDINOPATHY DIAGNOSIS] 🦵🏻 We spend 1hr with our initial appointments @pogophysio We do this for good reason. Arriving at an accurate diagnosis at the start of the rehabilitation process is the ‘rate limiting’ step in most instances. I often tell patients ‘you can throw things at the wall & hope something sticks but it’s not a good strategy’. When assessing for lower limb tendinopathies (Achilles, proximal hamstring, gluteal, peroneal) these are a few of the foundational assessment items that must be present/observed ✅ I tell patients that ‘dogs bark 🐶, cats meow 🐈, & cows moo 🐮’ and tendons ‘behave like tendons’. There’s a clinical discipline to not ‘trying to fit a square peg in a round hole’. If the patients presentation is not consistent w tendon ‘behaviour’ keep assessing for your differential diagnoses. 💻 from my ‘Treating the Injured Runner course ‘ recently presented for @sports_medicine_australia

Some nice take homes from @runeasy.physiotas attending @sports_medicine_australia ‘Treating The Injured Runner’ workshop I recently presented in Hobart. Posted @withregram • @runeasy.physiotas Last weekend, @sports_medicine_australia hosted a great workshop with @brad_beer , covering all things related to treatment and management of the injured runner. This was a fantastic day with a range of different topics including; injury assessment, management of bone stress injuries, understanding bone loading, gait assessment, strength & conditioning, and understanding Relative Energy Deficiency in Sports (RED-S). There were a number of important learnings from the workshop but here are a few of our key take aways: - Running alone may not be enough for bone health - Previous bone stress injury is the biggest predictor of future bone stress injury - Runners should consider planning an off or down week in their training to manage bone loading - Current evidence suggests that running biomechanics don’t predict injury or performance - Running gait retraining may be useful to help manage tissue load Get in touch if you have any questions or would like to learn more, we would love to hear from you! #runeasy #running #injury #physiotas #movebetterfeelbetter

[DON’T STOP] 🕠 When an athlete stops their progressive tendon loading program because they are not experiencing pain or any other associated symptoms, the door is opened for a potential flare, or return of symptoms. This can be seen in runners with Achilles tendon pain, proximal hamstring, gluteal or peroneus tendons 🦵🏻 Stopping S&C efforts can ‘open the door’ for down regulation of calf properties (for example less peak force that be generated, less endurance to repeatedly develop force, and less reactive /plyo capabilities). Assoc Professor Jill Cook often cites that there can still large descending inhibitory drive for up to 12months post cessation of symptoms, to the muscles ‘pulling on the tendons’ - Achilles, peroneal, proximal hamstring tendinopathy. While a maintenance approach is key there are still many ways you can keen progressing /preparing your tissues 🏋️‍♀️🏃🏃‍♀️ If you’ve overcome a running related tendinopathy be sure to keep targeted S&C work going -while@ever you intend to run ⛰️

A big weekend gone with @sports_medicine_australia in Hobart presenting my one day course ‘Treating the Injured Runner: an Evidence Based & Practical Approach’ 🏃‍♀️🏃 We covered a lot of ground: ✅ Epidemiology of running related injuries (RRI) ✅ Assessing the Injured Runner ✅ Common RRI assessment & treatment (bone stress injuries, tendon pathologies, patellofemoral pain, IT band pain, calf muscle strain injuries) ✅ The role of gait retraining (theory & practical) ✅ Strength & Conditioning for runners ✅ Special Populations (junior & masters athletes) Great to meet my foot physio ‘hero’ @yourfeethealthlife (Stuart Imer) and my @physioaustralia Sports Specialisation Registrar colleague Brice also 🤝 I’ll be delivering a few more teaching sessions across the year -stay tuned for some practicals with @learn.physio (Achilles tendinopathy, patellofemoral pain, and bone stress injuries) to be progressively released 🏃📒

[👀🏃🏃‍♀️] The hard reality 🙋🏼‍♂️🙋‍♀️ Running related injury (RRI) causation is multifactorial taking into consideration a runner’s biomechanics, psychology, and physiology (eg energy availability, hormonal profile). However essentially all RRI are ‘training load’ errors, as you cannot get a RRI without running. For most bone stress injury & runnning related tendinopathies a training workload error will have been made in the preceding month or weeks respectively ahead of symptom onset. The error will typically be along the lines of ‘too much, too soon, too fast, too frequent etc’. Irrespective in the prescence of other known RRI risk factors (as outlined above) the training error can catalyse the onset of the RRI. 📌 It isn’t easy (& I have made my fair share of RRI over the years produced by workload errors) BUT if in doubt ‘leave it out’, or stick w the planned program vs for example ‘adding more’ or going just a ‘little harder’. Stay ‘smart’, consistent, & as @montanarunninglab states here avoid doing ‘dumb things’ 👀

Just two weeks left to register for @brad_beer ‘Treating the Injured Runner: an evidence based & practical approach’ @sports_medicine_australia one day course (in beautiful Hobart) 🏃🏃‍♀️ Ideal for practitioners of all levels of experience 📝 The course will cover: ✅Epidemiology of running related injuries ✅Assessment of the injured runner ✅Common running related injuries assessment & management ✅Gait retraining ✅Strength & conditioning for runners ✅Special populations 📌Jump over @sports_medicine_australia website for registration details

[THE INJURY CYCLE] 🔄 It can be a vicious cycle: sustain a running related injury ➡️ deload to settle symptoms/heal tissue (ie post bone stress)➡️ as are result lose tissue condition (down regulation of bone density, tendon stiffness, muscular strength/endurance/reactive strength/size) ➡️ return to running too much/too soon/too fast (training errors) often due to index injury ‘feeling ok’ ➡️ due to running workload exceeding tissue tolerance incur a further & subsequent running related injury 😔 I’ve personally been through it , I’ve seen many patients over the years going through the cycle as well. It’s a cliche but taking the time required to safely reload the running body post injury is so key. Respecting the tissue pathology (bone, tendon, muscle) and the mechanics required to safely return to participation & sport ASAP is also key. I spent a great two days last weekend @montanarunninglab ‘Restoring Load Capacity in the Injured Runner’ @complete.physio furthering my understanding regarding RRI rehab. Rich Willy is in my opinion the best running related injury clinical researcher on the 🌍 Thanks for the input Rich. Snuck in a long run Sunday with @rundmc_neill & @joepatrickryan to round out a great two days ✅

👁️Every picture tells a story 📸 Physical examination of the runner starts with observation. The appearance of the calf muscles can tell you a lot about their current condition, previous injury history & guide further testing. 📸Here are a few examples of some things to look for, so test yourself & see how many you can pick 👉 1️⃣ Right calf atrophy due to chronic knee pain 2️⃣ Left medial gastrocs deficit due to previous high-grade tear 3️⃣ Atrophy of left medial gastrocs with chronic Achilles tendinopathy 4️⃣ Left calf atrophy due to chronic left ankle injury 5️⃣ Right calf atrophy, 1 year post ACL rupture, 3 months post surgery 6️⃣ Right calf atrophy due to right sided L5/S1 disc extrusion 7️⃣ Left calf atrophy with chronic medial tibial stress syndrome 8️⃣ Left calf atrophy 13 weeks post Haglund removal 🔑It's important to remember that observation forms a PART of the physical examination. As we like to say: assess not guess! 👋Runners & health professionals, how'd you do picking the correct leg? Let us know your score out of 8👇 . . . . #calf #calfmuscles #collaboration #physio #chiro #sportsphysio #sportschiro #physiotherapy #chiropractic #running #runninginjury #physicaltherapy #rehab #legmuscles

[TENDON REHAB] 🦵🏻 Every time I listen to clinical researchers Ebonie Rio or Jill Cook share around tendon rehab I learn. I’ve heard both of them speak scores of times but there’s always some solid gems that they deliver 💎 This statement from Ebonie on the necessary clinical approach to successful tendon rehab jumped out on a recent podcast I enjoyed 👀 Assuming that the patient is presenting with a bona fide tendon condition heed Ebonie’s advice 🗣️ Being a ‘thoughtful clinician’ is an ongoing quest-really lean in and listen, observe, and assess systematically & comprehensively. Keep your antennae up 🤖 Enjoy the clinical thrill of helping your tendon patients 🦵🏻

[CALF MUSCLE STRAIN INJURIES]🦵🏻 To rehabilitate calf muscle strain injuries well the clinician must have an appreciation of running kinetics. A short while ago I sat down and penned a comprehensive rehab blog for @pogophysio on the rehabilitation of calf muscle strain injuries (link in BIO to read 💻) 👇🏻 Posted @withregram • @rethinkingphysiotherapy 💥 Given the high peak muscle forces that a runner's body generates, it is understandable that the calf can be a potential site of muscular injury.⁠ ⁠ 😍 This incredibly thorough blog by @brad_beer has to be the BIBLE for rehabbing calf strains. ⁠ ⁠ 👉🏻 It covers anatomy, diagnosis, prognosis, rehabilitation and return to running - complete with a tonne of pictures and videos of exercises. [𝗟𝗶𝗻𝗸 𝗶𝗻 𝗕𝗶𝗼]