The STOP X training program was developed on the basis of scientific findings.
At the Sports Medicine Congress in Berlin in May 2022, which Physio Restart attended, there was a presentation by the Committee for Rehabilitation and Ligament Injuries of the German Knee Society. The content was the presentation of the two training programs Stop X: 1. rehabilitation and 2. prevention of knee injuries.
The Stop X rehabilitation program is divided into the: Early phase (weeks 0-6 after injury or surgery), late phase (up to week 16) and return to sport.
The rehabilitation program is intended to supplement your individual treatment plan , which is drawn up and carried out by an experienced physiotherapist. The program is always based on the doctor’s instructions (if consulted), set goals, your subjective complaints and the objective conditions of the knee and body that can be seen in physiotherapy. The brochure guides you through the various phases and offers you simple but important exercises to carry out independently. Tailored examinations and tests in the physiotherapy sessions evaluate your progress in the individual rehabilitation phases and adapt the exercises and management according to the criteria.
Champions are not made in training halls. Champions are made by something they carry within them: a desire, a dream, a vision. They need exceptional stamina, they need to be a little faster, they need the skills and the will. But the will to win must be stronger than the ability. Muhammad Ali – Boxer
The Sport X prevention program is designed to help you identify possible deficits and prevent knee injuries through special training.
The exercises accompany your usual, sport-specific training plan and physiotherapeutic treatment interventions. They integrate the areas of functional diagnostics, running exercises, mobilization, activation and neuromuscular training. This allows you to work on maintaining or even improving your strength, coordination, speed, balance and general performance.
Physio Restart will be happy to provide you with a brochure if you are interested in topping your performance. PR will be happy to show you how the exercises look, how they work and how they should be adapted to your individual needs.
The 37th annual GOTS congress took place in Berlin from May 19 – 20, 2022 and PHYSIO RESTART was there. I already arrived on 18.5 for the Pre-Day, which we organized as the board of the Young Academy. I have been a member of GOTS since 2015 and a representative of the Young Academy since 2020.
The main topics of the congress were professional and high-performance sport, injuries to the knee, ankle and shoulder joints: Knee, ankle and shoulder joints, stem cells and “orthobiologics” (treatment with the body’s own serum), prevention and biomechanics. On Wednesday, I was able to give a presentation on concussions in rugby and on Thursday I led a workshop on the three most common taping techniques in the sport.
Due to the many exciting lectures and workshops, it was unfortunately not possible for me to attend everything, but I still gained an intensive insight into the latest scientific findings and was able to share the experiences of experts.
You can now find out what the latest news is and which of it I am putting into practice – a small excerpt:
PEACE and LOVE acute sports injuries instead of using PRICE.
Dubois B, Esculier J-F. Soft-tissue injuries simply need PEACE and LOVE. Br J Sports Med 2020;54:72-73.
What has changed in terms of acute management on the sidelines? The omission of ice, ice spray. Why? There is no evidence that the pain-relieving, cooling effect helps with healing. On the contrary. Studies have shown that applying ice to acute injuries disrupts the healing process. More specifically, it interrupts the formation of new blood vessels (angiogenesis) and the release of anti-inflammatory enzymes (neutrophils and macrophages). It can only alleviate pain. But in the long term, the healing of the injured tissue is much more important! In addition, often used but actually criticized: Anti-inflammatory drugs. These drugs also interfere with the long-term healing of the tissue. Let the body reduce the inflammation on its own.
Tendon injuries need active treatment
We have long known that passive treatment interventions for tendon injuries are not effective. Tendonitis is not an inflammation per se. There are no signs of inflammation in the tissue itself. It should rather be called a tendon disease. Healing it does not require relief, but the opposite. Strengthening with stretching in particular helps the tendon to become accustomed to the strain that could have originally caused the injury. Tendons need tensile loads to stimulate tenocytes (important cellular components of the tendon).
Valgus moment in the knee is not the decisive point of injury
The fact that the moment when the knee makes an inward movement (see image below) should lead to an isolated anterior cruciate ligament injury is the subject of controversial debate. It is questionable whether this moment of stress alone really injures the cruciate ligament. What else contributes to this injury? Higher oestrogen levels in women, muscle imbalances in the quadriceps and hamstrings, hyperlaxity, changes of direction, athlete fatigue, inadequate training or competition preparation, poor equipment, and much more. By the way: cruciate ligaments have healing potential. Not every rupture necessarily requires surgery. The latest findings prove that anterior cruciate ligaments grow together without surgical intervention.
thisisfirstaid4sport.co.uk
FIFA 11+ is also available for the shoulder
The FIFA 11+ prevention program has been available for the lower extremities for some time now and has proven to be very effective. Now there is also a program for the shoulder. A study found that 50% of upper limb injuries in football could be reduced with the help of this program. Try it out!
ResearchGate
There is so much more I learned at this congress. Next year it will take place in Luxembourg – I’m already looking forward to it.
Saved the date.
Author:
Anneke Klostermann
Book your appointment for physiotherapy, massage or group courses: here.
References:
1.Dubois B, Esculier J-F. Soft-tissue injuries simply need PEACE and LOVE. Br J Sports Med 2020;54:72-73.
2.Murtaugh B, Ihm JM. Eccentric training for the treatment of tendinopathies. Curr Sports Med Rep. 2013 May-Jun;12(3):175-82. doi: 10.1249/JSR.0b013e3182933761. PMID: 23669088.
3.O’Neill, S., Watson, P. J., & Barry, S. (2015). Why are eccentric exercises effective for Achilles tendinopathy. International journal of sports physical therapy, 10(4), 552-562.
4.Boden, B. P., Sheehan, F. T., Torg, J. S., & Hewett, T. E. (2010). Noncontact anterior cruciate ligament injuries: mechanisms and risk factors. The Journal of the American Academy of Orthopaedic Surgeons, 18(9), 520-527.
5.Ristić V, Ninković S, Harhaji V, Milankov M. Causes of anterior cruciate ligament injuries. Med Pregl. 2010 Jul-Aug;63(7-8):541-5. doi: 10.2298/mpns1008541r. PMID: 21443155.
6.Quatman, C. E., & Hewett, T. E. (2009). The anterior cruciate ligament injury controversy: is “valgus collapse” a sex-specific mechanism? British journal of sports medicine, 43(5), 328-335.
7.Razi M, Soufali AP, Ziabari EZ, Dadgostar H, Askari A, Arasteh P. Treatment of Concomitant ACL and MCL Injuries: Spontaneous Healing of Complete ACL and MCL Tears. J Knee Surg. 2021 Oct;34(12):1329-1336.
8.Al Attar WSA, Faude O, Bizzini M, Alarifi S, Alzahrani H, Almalki RS, Banjar RG, Sanders RH. The FIFA 11+ Shoulder Injury Prevention Program Was Effective in Reducing Upper Extremity Injuries Among Soccer Goalkeepers: A Randomized Controlled Trial. Am J Sports Med. 2021 Jul;49(9):2293-2300.
Last week, the company Orthelligent® PHYSIO visited RESTART. They were invited because we were looking for something that would support and optimize our work in clinical practice. It has to be evidence-based, high quality, time-saving, easy to set up and use and motivating for the patient.
The exercises are standardized tests that we use in a clinical setting to evaluate your performance after an injury, but also as prevention to detect asymmetry and deficits. We are able to compare the function of your injured limb with your healthy one.
Why is the benefit advantageous?
Because the tests…
ensure a faster recovery and a safer return to activity and competition
Evaluate range of motion, coordination and strength/speed and provide immediate feedback
make reliable statements about the healing process, which is ideal for function-oriented aftercare following an injury
Track the progress of recovery and the effectiveness of the therapy
Are there goals to achieve?
Yes, Orthelligent has a large reference group consisting of scores from healthy and injured people of different ages and weights. This data gives us the opportunity to compare your results and evaluate your progress in different rehab phases.
For example: In phase 1 after cruciate ligament surgery, you should achieve full range of motion in the knee, as complete knee extension is important for a normal gait, 110° flexion when cycling. In the final phase of rehabilitation, studies recommend that you should have at least 85-90% of the power of the healthy leg.
Who is it suitable for?
for individuals undergoing a conservative rehabilitation program to manage their development and return to sport/competition following a lower limb injury
for people after surgery to manage their progression and return to sport/competition after a lower limb injury
for healthy people who want to know more about the performance of their extremities in terms of range of motion, stability and coordination
*Injuries include muscles, ligaments, tendon strains / ruptures or contusions, joint instabilities, degenerative joint diseases, muscle imbalances and much more!
We think this device will simplify our decision-making in the clinical process for our patients in the future (PHYSIO RESTART)
Are you interested in a check-up with Orthelligent?
Author:
Anneke and Oliver Penny
Book your appointment for physiotherapy, massage or group courses: here.
References:
1.Barber-Westin SD, Noyes FR. Factors used to determine return to unrestricted sports activities after anterior cruciate ligament reconstruction. Arthroscopy. 2011; 27(12):1697-1705. [PubMed: 22137326]
2.Wellsandt E, Failla MJ, Snyder-Mackler L. Limb Symmetry Indexes Can Overestimate Knee Function After Anterior Cruciate Ligament Injury. J Orthop Sports Phys Ther. 2017 May;47(5):334-338. doi: 10.2519/jospt.2017.7285. Epub 2017 Mar 29. PMID: 28355978; PMCID: PMC5483854.
I am delighted to have completed my Master’s degree at the prestigious University of London. (Anneke)
After I graduated in July 2021, the results were confirmed by the examination board in December 2021. Now the certificate finally flew over from London.
I can look back on three great years and am grateful for the experience I was able to gain in the operating theater and during medical consultations in expert clinics. It was great that therapists, doctors, sports scientists, strength and conditioning coaches and osteopaths studied together and learned from each other in this Master’s program. I was able to learn a lot about their work and responsibilities in everyday professional life.
These included, for example, the diagnosis of sports injuries, indications/contraindications of imaging procedures, rehabilitation measures for athletes and surgical interventions.
I was fascinated by the British healthcare system, which I can now compare with my Bachelor’s degree in the Netherlands and my self-employment in Switzerland to optimize the responsibility for my patients.
A special thank you goes to my family, especially my mother, who was my best friend until the end. (Rest in peace, mom)
Author:
Anneke Penny
Book your appointment for physiotherapy, massage or group courses: here.
The one-legged jump upwards on the spot (vertical jump) and the one-legged jump forwards (horizontal jump) do not measure the same!
The correlation between these two functional tests is only 0.63 – 0.71.
That’s why we at Physio Restart attach so much importance to knowing exactly when we use which jump test and which exercise in practice.
If you are interested in our check-ups, read more under: Physio Check-up or book an appointment now: here.
Single-leg jumps are a good indicator for assessing biomechanics during multi-directional, sport-specific activities, among other things. However, they alone do not determine return to sport!
We can use jumps to assess your explosiveness and leg axis stability during rehabilitation in everyday clinical practice. It also makes sense for our team support on the sidelines to use these two core competencies after certain lower limb injuries in order to avoid returning to competition too early. Nevertheless, we also assess psychological readiness and muscle strength, because only then is our decision reliable.
The one-legged forward jump in particular is often used by physiotherapists in the later rehabilitation phase to make a statement about the function of the knee. Although this jump is easier to measure, document and compare , the knee joint is actually much less involved in the take-off and acceleration phase and therefore only contributes 1/3 to the result (jump distance achieved).
If we compare these two one-legged jumps with each other, we can see relevant differences in terms of the force involved in the joints. To what extent are the hip, knee and ankle joints involved in these jumps? Male, healthy subjects were examined in a cross-sectional cohort study at the Aspetar Orthopaedic Sports Clinic in Qatar . In percentage terms, the following data was obtained with regard to force involvement:
Long jump:
Jump off:
Hip 44% Knee 13% Foot 43%
Landing:
Hip 24% Knee 65% Foot 11.4%
High jump:
Jump off:
Hip 31% Knee 34% Foot 34%
Landing:
Hip 29% Knee 34% Foot 37%
Kotsifaki et al. 2021
So is our statement “you are ready to return to sport because your difference in distance has improved in the one-legged long jump” unspecific?
We can only answer this question with YES. There are other publications that support this. For example, Zarro et al. had athletes perform both tests 7.33 ± 2.05 months after an ACL injury and concluded that the vertical jump still showed deficits in knee function that the horizontal jump could not determine. In addition, symmetry in the distance jumped does not mean symmetry in muscle strength.
Conclusion: The one-legged long jump is mainly used to assess the functional hip and ankle joint ability, the one-legged high jump has significance for all three joints. Due to insufficient involvement of the knee in the one-legged long jump, further tests should be added to determine your knee joint performance and thus your return to sport.
Thanks to @aspetar for these study results, generated in March 2019.
The very low number of participants in this study population, which is also only male, is worth mentioning!
Author:
Anneke Penny
Book your appointment for physiotherapy, massage or group courses: here.
References:
1.Hamilton, RT, Shultz, SJ, Schmitz, RJ, Perrin, DH. Triple-hop distance as a valid predictor of lower limb strength and power. J Athl Train. 2008;43:144-151.
2.Taylor, JB, Ford, KR, Nguyen, AD, Shultz, SJ. Biomechanical comparison of single- and double-leg jump landings in the sagittal and frontal plane. Orthop J Sports Med. 2016;4:2325967116655158.
3.Kotsifaki A, Korakakis V, Graham-Smith P, Sideris V, Whiteley R. Vertical and Horizontal Hop Performance: Contributions of the Hip, Knee, and Ankle. Sports Health. 2021 Mar;13(2):128-135.
4.Zarro MJ, Stitzlein MG, Lee JS, et al. Single-Leg Vertical Hop Test Detects Greater Limb Asymmetries Than Horizontal Hop Tests After Anterior Cruciate Ligament Reconstruction in NCAA Division 1 Collegiate Athletes. IJSPT. 2021;16(6):1405-1414.
Physio Restart attaches great importance to the quality andindividuality of your treatment.
That’s why we take enough time at the beginning to take a medical history and carry out an examination to find out more about your physical problem, but also about you as a person and your everyday and sporting environment.
During the examination, we use test batteries that can provide us with information about the possible causes of your complaints. Test batteries are a series of physical tests and questionnaires that can make the assessment more subjective and at the same time more objective, thereby standardizing it. The results of the tests help you to better understand the findings and to help determine the course of treatment.
Our choice of tests is based on scientific findings, which we update through our study programs and regular further training.
The tests should be repeated over the course of the treatments in order to assess your condition and to determine and guide your return to everyday life, sport and competition.
Direct access has been common practice in the Netherlands since 2006, with almost half of patients choosing it.
During our Bachelor’s degree in the Netherlands, Master’s degree in England and various further training courses in Germany, Austria and Switzerland, we gained extensive experience with direct access in physiotherapy and sports medicine diagnostics. With direct access, patients can go to physiotherapy without a doctor’s prescription. First of all, relative and absolute contraindications to physiotherapy treatment must be eliminated. If there are no contraindications, an examination, assessment and finally treatment follow. Nevertheless, we value the expertise of doctors and work together with appropriate practices.
[Man erwartete,] that direct access would improve access to primary care and slightly reduce the workload of GPs. Direct access should bring greater recognition for physiotherapy, but also greater responsibility.
We are happy to take on this responsibility and ensure that we maintain our expertise in this area.
Author:
Anneke Penny
Book your appointment for physiotherapy, massage or group courses: here.
References:
1 Swinkels, I.C.S., Leemrijse, C.J., Barten, J.A., Veenhof, C. Direct access to physiotherapy in the Netherlands=Accès direct à la physiothérapie aux Pays-Bas. Physioactive:2014(6),13-19.
Sleep, the miracle cure. It makes you smart, efficient, creative, strong and satisfied. It is the cheapest medicine you can take every day. Be careful with it.
Perhaps it is the cheapest type of therapy. But certainly one of the most difficult tasks.
You should sleep well, not too little, not too much. You should avoid late, hearty meals in the evening and intensive exercise. The consumption of blue light and noise from the TV and cell phone reduce the quality of your sleep. The time you go to bed and get up should be as consistent as possible. And it’s best to wake up shortly before the alarm clock rings.
You have probably read and heard one or even all of the recommendations somewhere before. But it’s understandable if it’s almost impossible to follow them all. What do I do if my team sport is from 20.00-21.30 in the evening due to the hall times? How do I explain to my boss if I only order a glass of water for a business lunch? And should I leave my one-year-old child crying in bed when he calls in at 1.00 a.m.?
This means that we cannot follow many rules about sleep at certain stages of our lives. That is a fact.
Influences of sleep
Nevertheless, all of you probably know how nerve-wracking and exhausting the next day at the office or the competition on the pitch can be if we have slept too little and poorly the night before. What else can affect our sleep and impair its quality? Lots of things.
The hormone testosterone can extend the duration of sleep.
The female hormone oestrogen can reduce our core body temperature and cause tiredness.
A lack of physical activity during the day and an unhealthy lifestyle can be reasons for sleep problems and increase the risk of suffering from chronic diseases.
Taking certain contraceptives can increase the release of melatonin* and lead to earlier bedtimes in the evening.
*Melatonin is a hormone that determines the human day-night rhythm.
So we can and should become aware of certain negative influences of sleep and try not to let it become a habit.
Did you know that:
… only 5% of the world’s population dream in black and white? Most dreams are actually colorful. However, this is difficult to objectify and the results are based on questionnaires.
… women tend to have a poorer quality of sleep than men? And that this can be explained by the role of gender and hormones?
If you are more interested in the topic of sleep, I can recommend the book Why we Sleep by Matthew Walker . A little tip: it’s not an easy read.
Why We Sleep is an important and fascinating book…Walker taught me a lot about this basic activity that every person on Earth needs. I suspect his book will do the same for you. Bill Gates
And now: Sleep well!
If you would like to know more about the importance of regeneration, book a private appointment with us:here.
Author:
Anneke Penny
Book your appointment for physiotherapy, massage or group courses: here.
References:
1 Zielinski MR, McKenna JT, McCarley RW. Functions and mechanisms of sleep. AIMS Neurosci. 2016;3(1):67-104.
2 Santhi N, Lazar AS, Mccabe PJ, Lo JC, Groeger JA, Dijk D. Sex differences in the
circadian regulation of sleep and waking cognition in humans. 2016
3 Mallampalli MP, Carter CL. Exploring sex and gender differences in sleep health: A society for women’s health research report. J Women’s Heal. 2014;23(7):553-62.
4 ASA American Sleep Association. What is Sleep and Why is It Important?
5 Sleep Foundation | Trusted Sleep Health Information and Product Reviews. Sleepfoundation.org. (2022). Retrieved April 3, 2022, from https://www.sleepfoundation.org/.
Unfortunately, there are few trustworthy guidelines in the medical databases that can give us information on how to return to exercise after pregnancy and childbirth. This is why the recommendations of doctors, therapists and midwives are not always satisfactory, as we have little evidence (scientifically based proof).
… it is crucial that specialist pelvic health physiotherapists, midwives and obstetric and gynaecological consultants are included in the multidisciplinary team supporting their return-to-sport. – Donnelly et al.
A new study* published in the British Journal of Sports Medicine in 2021 provides an overview of the conditions for returning to sport. The authors recommend the collaboration of a multidisciplinary team consisting of physicians, pelvic floor physiotherapists (more information on our services during pregnancy here) and midwives to provide pregnant women with the best possible support in their everyday sporting and professional lives.
It was identified that the 6-week postnatal check is too long to wait for postnatal women to resume or begin a low intensity physical activity program. Evenson et al.
Recommendations and requirements
The first physiotherapy session should be promptly after the birth.
Basically, it is important that we therapists preserve the individuality of each patient. To do this, we need to record information about the pregnancy, the birth and the professional and everyday situation in advance. Together with the physical examination, we can set short and long-term goals and gradually increase the return to sport.
The examination is based on subjective and objective tests that give us information about the anatomical and physiological position inside the pelvic area. The surrounding trunk muscles should also be included in the examination. A holistic approach with further information on nutrition, recovery, sleep, the type of sport and equipment for it should be taken into account.
PHYSIO RESTART includes a biofeedback measurement that examines the perception, tension and relaxation ability of the pelvic floor.
Book your appointment for physiotherapy, massage or group courses: here.
References:
1 Donnelly GM, Moore IS, Brockwell E, et al Reframing return-to-sport postpartum: the 6 Rs framework British Journal of Sports Medicine 2022;56:244-245.
2 Donnelly, G., Brockwell, E., & Goom, T. (2020). Return to running postnatal – guideline for medical, health and fitness professionals managing this population. Physiotherapy 2020;107,188-189.
3 Evenson, K. R., Mottola, M. F., Owe, K. M., Rousham, E. K. and Brown, W. Summary of International Guidelines for Physical Activity Following Pregnancy Obstet Gynecol Surv 2014;69(7):407-414.
