Endurance training, also known as cardiovascular training, refers to activities aimed at improving endurance and the cardiovascular system. It includes movements such as running, cycling, swimming and other forms where the heart rate increases. According to the health organization WHO, 150 minutes (2.5 hours) per week is recommended.

Do you have questions about your individual endurance training? Or even received a doctor’s recommendation to do one? There are various reasons why a doctor may give you this prescription: for cardiovascular complaints or after heart surgery, for lung diseases, for weight control (both overweight and underweight), for mental impairments (e.g. depression, burn-out) and many more. At Physio Restart, we are happy to support you during your rehabilitation or prevention phase.

Here are some important points you should know about endurance training

1 Cardiovascular function: Endurance training increases your heart rate over a longer period of time and strengthens your cardiovascular system. This naturally improves your heart health.

2 Endurance: Regular endurance training improves your body’s ability to work for longer periods of time without feeling fatigue. This can be noticeable in various areas of life, from sporting activities to everyday tasks.

3 Fat burning: Endurance training is an effective way to burn calories and lose or maintain weight. It boosts your fat burning and can help reduce body fat by stimulating your metabolism.

4 Stress reduction: Regular endurance training can reduce stress and improve your general well-being by promoting the release of endorphins, which are responsible for your sense of relaxation and well-being.

5 Mental health: There is strong evidence that regular endurance training can improve mood and even help to alleviate symptoms of depression and anxiety. Hormones such as dopamine, endorphin and serotonin are released, which lead to your feelings of happiness.

6 Prevention of physical complaints: Problems and pain associated with your posture, for example, can be reduced. Appropriate endurance training helps to regulate your back pain, especially if your working day is predominantly sedentary. Even small interruptions of just a few minutes a day can help to provide your muscles with sufficient blood flow.

7 Social interaction: Endurance training is also ideal when done in company or in a group. Cycling tours, Nordic walking but also joint hikes with inclines promote a social get-together and can also increase your self-esteem, especially if you find it difficult to perform sports.

Types of endurance training with different metabolic activation

Depending on the intensity, you make use of a different metabolism that depends on your individual heart rate. Your metabolism involves a series of complex biochemical processes that take place in your cells and are responsible for converting nutrients into energy and maintaining vital functions.

1 Aerobic area (fat): Nutrients such as carbohydrates, fats and proteins are converted into energy (ATP) using oxygen. You can talk normally during activity, breathing is almost normal, only slightly more difficult. Fats serve as your main source of energy in aerobic metabolism, especially at lower intensities and longer durations of activity.

2 Anaerobic area (carbohydrates): For shorter, more intensive loads, the sole supply of oxygen is not sufficient to provide you with energy. Glucose is therefore obtained from carbohydrates, which produces lactate (lactic acid). You will probably no longer be able to talk fluently, only a few words and more intensive, shorter and shallower breathing will occur.

Structure training

To maximize the benefits of endurance training, it is important to develop a balanced exercise routine that combines regular endurance exercises with strength training and mobility exercises. It is also advisable to work with a therapist to develop your individual training plan that meets your own needs and goals. Endurance training can be divided into different intensity levels, from light to high intensity. Choosing the right training plan depends on your individual goals, fitness level and health. As with all training, recovery is also crucial for endurance training. Sufficient rest between training sessions is important to avoid overload and injury.

Important: Endurance training alone is not enough for your health. Strength exercises should also be done to stabilize joints, maintain bone health and prepare the muscles for the stresses and strains of everyday life.

Author:

Oliver Penny

New at Physio Restart: Performance analysis. We would like to expand our physiotherapy services by assessing your mobility, strength and posture using various methods so that we can treat you more precisely and also optimize your health and training design.

An intervention includes screening using Kinvent: deltas, pull and push. With the help of these three devices, we can now measure your performance, your training progress and your rehabilitation and prevention success. We will introduce you to all three in this article. In the last section, you can find out how to register and what the measurement process looks like.

Kinvent is based in France and offers various products that can make our collaboration with you as a physiotherapist even more precise, varied and successful.

1st K-Deltas Elite Force Plates

These are two measuring plates that measure your jumping ability and load distribution on your feet or hands during different positions. For example, during an upright two-legged stance, we can assess how you distribute your body weight on your feet and where on the foot you place your center of gravity (more in the front, middle or back, inside or outside?). We can do the same for the one-legged stand or with eyes closed. It is also possible to perform jumps. Jumps from the squat position, jumps from an elevation, one-legged jumps and landings and more.

By using it, we can evaluate your rehab progress: where are you currently at? What deficits can we still take into account? How close are you to returning to sport and competition? We can also screen you preventively to identify any asymmetries that you should take into account in your training.

2. k-pull

This device is attached to a belt and a fixed object (on the training area at fitness luxor). The latter makes it possible to test your maximum strength potential without us therapists having to offer resistance. Using various movements, we can assess your isometric strength, your strength ratios in a lateral comparison (for example, left and right front thigh muscle) and endurance. The K-Pull is particularly suitable for the lower extremities. As an evaluation, you receive the measured strength, but also data on the second in which you reach your peak, when you tire and how you stand in comparison to people of the same age, height and weight.

3. k-push

The lightweight and versatile K-Push is designed to meet the need for quick assessment. With its accessories, the maximum and isometric strength of almost 40 muscle groups can be measured without the need for an object. We tend to use it for the upper extremity (trunk, shoulder, arms and head).

Measurement procedure

You can make an appointment for the measurement by booking online(here). Click on: Performance analysis. We ask you to let us know in advance which test you would like to take. You can specify this in your booking or let us know separately by email or on site. We ask that you warm up thoroughly before the start of the appointment, as the measurement will include questions about your maximum strength potential. Use the endurance area on the first floor and choose a machine suitable for the muscle group being tested. Your warm-up should increase your heart rate (HR average of approx. 50-60% of your maximum heart rate). We will send you a document with further information by email in advance.

Do you have any questions? Feel free to contact us.

More information about the devices: Homepage – Kinvent Physio.

Author:

Anneke and Oliver Penny

“A regular cycle with only moderate symptoms is an important indicator of good general health.” (Welsh Athletics)

“The complexity of the menstrual cycle is seen as a major obstacle to the inclusion of women in clinical trials.” (translated by Bruinvels G et al.)

“Female athletes train and compete under the potential influence of hormonal fluctuations during the menstrual cycle”. (translated by Ekenros L et al.)

The female cycle may be associated with discomfort for many women. Even though regularity with only minor discomfort is synonymous with good health, not every woman is pleased when she is in the bleeding phase. But with the right diet and exercise, we can help ourselves to alleviate, even improve and prevent certain conditions.

For a long time, women took a back seat when it came to conducting scientific studies. And there is still too little emphasis on thinking gender-specifically and taking a closer look at the female body. One of the reasons for this is that women seem to be too complex to be included in studies.

Today, however, we want to look at a topic that is attracting more and more attention in the media, in the field of sport and nutrition and also in science. Because the female cycle can influence our performance, our body and our mind.

Adapting your diet and training to your female cycle may seem challenging at first, but it can bring great benefits for body and mind. More specifically, cycle-oriented means that we adapt our diet and training to the hormonal conditions that change over the course of the cycle.

Physical and mental complaints such as periodic water retention, skin blemishes, exhaustion, mood and weight fluctuations as well as stomach and intestinal complaints can change over the course of the cycle. With the help of apps, we can record these symptoms as well as our menstruation in order to get to know and understand our body better. Anneke uses the Garmin app for this, which also connects to her watch during sporting activities. In her opinion, Clue or Flo are also good apps for recording your cycle and all the associated factors.

What is the most important thing we should know in advance?

Every woman is unique. Our cycle, hormone levels and the associated physical and mental conditions can vary greatly from woman to woman. It is therefore essential that you first observe your cycle and write down in detail (as mentioned above) when your menstruation and ovulation occur, how long the individual phases last and how you feel during them. The more precisely you write it down, the more targeted you can make your diet and training plan afterwards. If you are using hormonal contraception, you have no natural hormone levels, no natural menstrual bleeding (or even no bleeding at all) and usually no ovulation, so there is no point in adjusting under these circumstances.

What does nutrition and training look like in the first phase of the cycle?

The first phase begins on day 1 of bleeding. It is important that we do not count the brown discharge (so-called spotting), which can occur a few days before, as day 1. During the bleeding period, many women are often less able to perform physically due to their symptoms. A lack of iron due to blood loss reduces the supply of oxygen to the muscle, as iron is an important component of haemoglobin in red blood cells and should help with this. Light endurance training, walking, yoga and mobility are recommended. The diet should be rich in iron, vitamin A, magnesium and omega-3. Other women, on the other hand, feel more powerful and may of course adjust their training accordingly.

Follicular phase- Phase 2

As soon as you feel better and your bleeding decreases, your energy level increases. You can set new training stimuli and perform maximum strength training at high intensities. Use the increased oestrogen levels to improve your performance. Make sure you eat enough protein, good fats, fermented and sprouted products. If you want to keep your weight stable, you can reduce your carbohydrate intake.

Ovulation

Some women have similar symptoms to those at the time of menstruation. Slight or even strong pulling in the abdomen, cramps, skin blemishes, etc. You can reduce the intensity of your training and focus more on coordination and stability . This is because we seem to be more susceptible to injury during this phase. Your meals should be rich in calcium, antioxidants, vitamin D and fiber.

Luteal phase- Phase 3

During the luteal phase, progesterone increases while the other hormones decrease. Many women suffer from pre-menstrual syndrome, i.e. water retention, mood swings, fatigue and other symptoms already mentioned above at the end of this phase. A reduced training intensity with a focus on regeneration, gentle strength and endurance units can help. The diet may contain carbohydrates, dehydrating foods, vitamin B6 as well as alpha-linolenic acid (triple unsaturated fatty acids) and ligans (plant substances with an estrogen-like effect).

To summarize, it is worth trying out, but not every woman will benefit from it in the end. Start by keeping a cycle diary and create your training and nutrition plan based on the conditions you have. If you need help with this, you are very welcome to book an appointment with Anneke and/or browse the resources below. Anneke can highly recommend the information from Swiss Olympic! Also consider talking to your coach, colleagues and others about this – they can support you in optimizing your well-being and performance.

If you want to know what your hormone levels are, you can have them determined by taking a blood test. However, you should bear in mind that the values differ depending on your cycle phase.

Finally, we would like to point out that it is always best to check your training and diet with a doctor and, if necessary, with a nutritional therapist who is familiar with the subject. We can share our contacts!

Author:

Anneke Penny

References:

1 Tanja Oosthuyse; Andrew N. Bosch (2010): The Effect of the Menstrual Cycle on Exercise Metabolism. In: Sports Med 40 (3), pp. 207-227. DOI: 10.2165/11317090-000000000-00000.

2 Giuseppe Fischetto; Anik Sax (2013): The Menstrual Cycle and Sport Performance. In: New Studies in Athletics 28 (3/4), pp. 57-69. Hakimi, Osnat; Cameron, Luiz-Claudio (2017): Effect of Exercise on Ovulation: A Systematic Review. In: Sports medicine (Auckland, N.Z.) 47 (8), pp. 1555-1567. DOI: 10.1007/s40279-016-0669-8. J. Martin: Adaptative processes. Endocrinum.

3 Oleka CT. Use of the Menstrual Cycle to Enhance Female Sports Performance and Decrease Sports-Related Injury. J Pediatr Adolesc Gynecol. 2020 Apr;33(2):110-111. doi: 10.1016/j.jpag.2019.10.002. Epub 2019 Oct 31. PMID: 31678355.

4 Bruinvels G, Burden RJ, McGregor AJ, Ackerman KE, Dooley M, Richards T, Pedlar C. Sport, exercise and the menstrual cycle: where is the research? Br J Sports Med. 2017 Mar;51(6):487-488. doi: 10.1136/bjsports-2016-096279. Epub 2016 Jun 6. PMID: 27267895.

5 Ekenros L, von Rosen P, Solli GS, Sandbakk Ø, Holmberg HC, Hirschberg AL, Fridén C. Perceived impact of the menstrual cycle and hormonal contraceptives on physical exercise and performance in 1,086 athletes from 57 sports. Front Physiol. 2022 Aug 30;13:954760. doi: 10.3389/fphys.2022.954760. PMID: 36111164; PMCID: PMC9468598.

6 Sung E, Han A, Hinrichs T, Vorgerd M, Manchado C, Platen P. Effects of follicular versus luteal phase-based strength training in young women. Springerplus. 2014 Nov 11;3:668. doi: 10.1186/2193-1801-3-668. PMID: 25485203; PMCID: PMC4236309.

7 Carmichael MA, Thomson RL, Moran LJ, Wycherley TP. The Impact of Menstrual Cycle Phase on Athletes’ Performance: A Narrative Review. Int J Environ Res Public Health. 2021 Feb 9;18(4):1667. doi: 10.3390/ijerph18041667. PMID: 33572406; PMCID: PMC7916245.

8. Statham G. Understanding the effects of the menstrual cycle on training and performance in elite athletes: A preliminary study. Prog Brain Res. 2020;253:25-58. doi: 10.1016/bs.pbr.2020.05.028. Epub 2020 Jul 22. PMID: 32771127.

9. menstrual cycle: diet, exercise & psyche by phase (css.ch)

10. in harmony with your own body: what female triathletes should know about cycle-controlled training – tri-mag.de

11th PowerPoint presentation (swiss-athletics.ch)

12th cycle and competitive sports – SEMS-journal

13 The Impact of Menstrual Cycle Phase on Athletes’ Performance: A Narrative Review (nih.gov)

14. cycle-oriented training makes a difference – ÖKK (oekk.ch)

15. cycle nutrition: food for every phase – foodspring

16. training and the female cycle: what you should bear in mind (foodspring.de)

17. nutrition during your cycle – how to support your body – rundumpflanzlich

Training principles are fundamental concepts that should be used when planning and implementing training programs . These principles help to make training more effective and efficient and to achieve optimal performance. There are different training principles that target different aspects of the training program, including intensity, volume, frequency and progression.

We also use these principles in physiotherapy and in the care of athletes, regardless of whether you have just recovered from an injury, are in the midst of a seasonal break, are pregnant or have just given birth, are celebrating your 80th birthday or are running your first marathon in two weeks’ time.

We will now explain the most important ones in this text.

The first and most important training principle is progression.

Progression refers to the gradual increase in training load over time. This means gradually increasing the training volume and intensity to challenge the body and adapt to the demands of the training. Progression that is too fast can lead to injury, while progression that is too slow is not challenging enough for the body.

Example: You no longer feel any great fatigue after 8 repetitions of a deadlift of 65 kg, it is time to increase the weight.

Results indicate that progressive overload is necessary for maximal muscle fiber recruitment and consequently increases muscle fiber hypertrophy and strength.

The second training principle is overloading.

Overload refers to the demands placed on the body in order to achieve an increase in performance. In order to achieve overload, the strain must be greater than what the body is already used to. Overload forces the body to adapt and improve its capabilities.

Example: You run at a faster average speed of 5.5km/h per minute during your next running session, instead of 5 as before.

The third training principle is specificity.

Specificity refers to the requirements of the training program, which should be specifically tailored to your goals and needs. Each sport and goal requires different types of training and movements. Therefore, it is important to tailor the training specifically to the requirements of you, your sport or your activity.

Example: As a footballer, it makes sense to train sprint units, among other things, so that you have the ability to sprint short distances better and possibly without injury during the game. Think about precise goals (SMART) when planning.

The most effective resistance training programs are those that focus on specific training goals.

The fourth training principle is variation.

Variation refers to the variety in the training program. By incorporating different training methods and exercises, you can prevent injuries, avoid boredom and promote continuous performance improvement. However, too much variation can lead to a lack of focus and hinder performance improvement.

Example: In team sports, we often work with periodization. Macro and micro cycles. The contents of these are continuously changed.

The use of periodization is not limited to elite or advanced athletes, but has been successfully used as a basis for training people from different backgrounds and fitness levels.

The fifth training principle is regeneration.

Regeneration refers to the recovery phases between training sessions. It is important to give the body enough time to recover and prepare for the next training session. A lack of regeneration can lead to overtraining, injuries and fatigue.

Example: Remember to give your body a rest. Go for walks and saunas, do light stretching and mobility units and change the type and parts of your training to give certain areas a break.

Robinson et al. found that it leads to a 7% increase in squat performance after 5 weeks of training came when 3-minute rest intervals were used, compared to only 2% with 30-second rest intervals. It is important to note that the length of rest intervals will vary depending on the goals of that particular exercise, meaning not every exercise will use the same rest interval.

The sixth training principle is continuity.

Continuity refers to the regularity of the training program. Regular and consistent implementation of the training program is crucial for continuous improvement in performance. Interruptions or longer breaks in training can lead to a drop in performance.

Example: Your muscle mass is suddenly at 35%, you were at 41% a few weeks ago, but had too few training sessions in between due to vacation and illness.

Overall, training principles are an essential part of an effective training program. Using these principles will allow you to achieve your goals more effectively while avoiding injury and overuse.

What does this mean for our physiotherapy training?

We try to successfully incorporate these principles when giving and implementing exercise programs. It is important that you give us constant feedback so that we can adapt and change the principles. If you no longer need physiotherapy sessions with us, discuss your programs with your trainers, e.g. from luxor fitness.

What is the minimum amount of exercise an adult should do?

Adults should do at least 150 minutes of moderate-intensity exercise per week

Exercise recommendations can be achieved through 30-60 minutes of moderate-intensity training (five days a week) or 20-60 minutes of intensive training (three days a week)

Both one continuous session and several shorter sessions (of at least 10 minutes) are acceptable in order to achieve the desired daily amount of exercise

It is recommended to gradually increase the duration, frequency and intensity of training in order to achieve a high level of adherence to therapy and reduce the risk of injury

What are the recommendations regarding strength training?

Adults should train each major muscle group two or three days a week, using a variety of exercises and equipment

A very light or light intensity is best suited to older people or adults who were previously sedentary and are starting to exercise

Adults can improve their strength and performance with two to four sets per exercise

For each exercise, 8-12 repetitions will improve strength and power, 10-15 repetitions will improve strength in middle-aged and older people starting out, and 15-20 repetitions will improve muscular endurance

Adults should wait at least 48 hours between strength training sessions

People who cannot meet these minimum requirements can still benefit from a certain amount of activity.

You can use the tables below to familiarize yourself with various parameters relating to endurance and strength training. Please bear in mindthat the figures may vary slightly depending on the literature. There is also more and more evidence and therefore recommendations to go to fatigue in strength training, especially when training only with your own body weight. This assumes that quality is maintained during execution. Below is a short detour on the subject.

*calculated for a 30 year old, healthy male.

You can find out your maximum heart rate (HRmax) in a test. Polar will show you how, but make sure that a medical expert is present during the test: Calculating your maximum heart rate | Polar Blog | Train Better. You can also use the calculation “220 minus your age” to determine your maximum heart rate, but this calculation is somewhat inaccurate.

Strength training forms

You can also calculate and/or test your one rep max: 1RM calculator: Maximum strength calculator for your One Rep Max (akademie-sport-gesundheit.de).

Side trip: Train to complete exhaustion?

“Training to failure” refers to a weightlifting technique in which a person lifts weights until they are no longer able to perform another repetition with proper form. This method is often used to push muscles to their limits with the aim of increasing muscle hypertrophy and strength.

While training to failure can be an effective way to challenge muscles and stimulate growth, it can also be risky if not done correctly. Lifting weights to failure can lead to excessive fatigue, increased risk of injury and longer recovery times .

In addition, training to failure is not suitable for everyone. Beginners, people with previous injuries or health problems and people who are not used to high-intensity exercise should approach training to failure gradually or avoid it altogether.

It is important to note that training to failure should not be the sole focus of your training. Including a variety of exercises and repetition ranges can help prevent plateaus and overuse injuries. In addition, adequate rest and recovery time is critical to maximizing training success and avoiding injury.

Do you have any questions for us?

90 – 100

Authors:

Oliver Penny and Anneke Klostermann

Book your appointment for physiotherapy, massage or group courses: here.

References:

1 Kasper, Korey MD. Sports Training Principles. Current Sports Medicine Reports 18(4):p 95-96, April 2019. | DOI: 10.1249/JSR.0000000000000576

2. https://www.akademie-sport-gesundheit.de/magazin/one-repetition-maximum.html

3. https://www.polar.com/blog/de/berechnung-der-maximalen-herzfrequenz/

4 Kasper, Korey MD. Sports Training Principles. Current Sports Medicine Reports 18(4):p 95-96, April 2019. | DOI: 10.1249/JSR.0000000000000576

5 KRAEMER, WILLIAM J.1; RATAMESS, NICHOLAS A.2 Fundamentals of Resistance Training: Progression and Exercise Prescription. Medicine & Science in Sports & Exercise 36(4):p 674-688, April 2004. | DOI: 10.1249/01.MSS.0000121945.36635.61

6. https://www.acsm.org/education-resources/trending-topics-resources/physical-activity-guidelines

7 Izquierdo M, Ibañez J, González-Badillo JJ, Häkkinen K, Ratamess NA, Kraemer WJ, French DN, Eslava J, Altadill A, Asiain X, Gorostiaga EM. Differential effects of strength training leading to failure versus not to failure on hormonal responses, strength, and muscle power gains. J Appl Physiol (1985). 2006 May;100(5):1647-56. doi: 10.1152/japplphysiol.01400.2005. Epub 2006 Jan 12. PMID: 16410373.

It was the second online symposium of the VBG (statutory accident insurance Germany) which took place on October 22nd. Physio Restart took part and summarizes the most important information we took away from the excellent speakers. VBG – Homepage

We regularly participate in online and live courses and congresses to utilize this information and ensure that we can provide our patients with evidence-based, and if not already available in the literature, good quality treatment.

Anneke is a sports physiotherapist for a local soccer team in Zurich and started as a substitute sports physiotherapist for the SFV national teams. Oliver currently coaches a floorball team and has experience in ice hockey.

What is the most common injury in football?

The ischiocrural muscle group(hamstrings), which is located on the back of our thigh, is often injured in this sport. The biceps femoris in particular is predominantly affected at 79% (BJSM). However, the mechanism of injury, prevalence and treatment are“a major, as yet unknown problem“.

The most common injury to this muscle group occurs during the lunge movement (59%), along with kicking (30%) and landing (7%).

If a player is in a stretching position with the back of the leg (extended knee) and is about to slow down or stop the movement, he or she has a 52% risk of injuring this muscle group. In a sprint during the moment of acceleration, the risk is 48%.

What kind of training should be included in soccer training?

For sure: sprints! Most of a soccer player’s training sessions should include sprints with variations: Changing direction, slowing down and stopping.

Eccentric exercises should also be included. These exercises implement “force production during active muscle lengthening” (Harris-Love et al. 2021). One example is the Nordic hamstring curl for the back of the thigh(see image below). If we want to do this exercise on the sidelines, two players should fix the legs (not just one).

Nordic Hamstring Curl (NHE)

Important: only move forward far enough to avoid a hollow back. Otherwise, feel free to drop forward onto your hands. Feet must be well fixed.

© PHYSIO RESTART

Train SMART!

Another factor is plyometrics, this type of training focuses on “repetitive rapid stretching and contracting of muscles (as by jumping and rebounding)” (Merriam-Webster).

An important factor to consider is how and when we incorporate these specific training components. Each performance of exercises should consider the individual player, especially if he or she has had an injury to the affected muscle group. Fatigue and pain should be taken into account. In addition, we must always incorporate variations with changes in: the type of exercise, repetition, duration, speed, resistance and range of motion. We must remember to perform increases if the player is performing well and is without compensation or discomfort. The same goes for regressions if the exercise is causing problems. And if the player has a game every Sunday, it makes sense to include the specific, more intensive and eccentric training in the middle of the week. To warm up before the game, it is recommended to perform isometric exercises that do not shorten or lengthen the muscle, for example:(see pictures below)

Supine bridge

Lift the pelvis only about 1 fist’s width from the floor and keep it straight, trying to prevent the left side from tilting.

© PHYSIO RESTART

Prone Leg curl

For the isometrics of this exercise, we want to hold the leg at a certain angle (we like to test different angles). There is no movement.

© PHYSIO RESTART

What other exercises are recommended for the back of the thigh?

Single leg romanian deadlift

Use little to no weight at first to learn the correct technique. The supporting leg is almost fully extended, look towards the floor, hips on one level, abdomen tensed to avoid a hollow back.

© PHYSIO RESTART

Hip extension

When doing this exercise, many people make the mistake of moving their leg too far back and falling back into a hollow back.

© PHYSIO RESTART

Romanian deadlift

To activate the back of the thighs more, we also stretch the legs in this exercise. Move the weight up and down along the legs close to the body.

© PHYSIO RESTART

Note: The Nordic Hamstrings Exercise (NHE) is a widely discussed but proven injury prevention exercise for the back of the thigh in football. We must consider the potential to even cause an injury with this exercise if performed incorrectly. As it requires a lot of muscle strength and correct execution, experts recommend replacing the NHE with a guided push-up for the time being if necessary. The knees are placed on a towel and each hand on a football, while another person stabilizes the lower legs.

What are common mistakes in rehabilitation on the part of healthcare providers?

Neglect or absence of:

• correct diagnosis
• Adequate time management (late diagnosis and start of treatment)
• Tissue healing phases (too early or too late tissue loading)
• mental readiness (no teamwork with the patient)
• Individualization (non-specific treatment)
• Tests to check progress (incorrect progress or no progress at all)

Physio Restart ensures that we avoid precisely these mistakes. We do this with good cooperation from other specialists.

When is the time to return to sport after a muscle injury?

Everyone is different, it always depends on the type of person, the sporting and professional strain, age, previous injuries, treatment interventions (etc.), but we can assume the following: (VGB)

• Hardened muscle 1 – 3 days
• Sore muscles 2 – 5 days
• Muscle strain 3 – 5 days
• Torn muscle fiber 10 – 14 days
• Torn muscle bundle 6 weeks
• Muscle tear 12 – 16 weeks
• Muscle contusion 2 – 3 weeks

Last but not least:

We work with you, respect your thoughts and goals. We think outside the box and are ready for unexpected changes, modifications and customizations.

Author:

Anneke Klostermann and Oliver Penny

Book your appointment for physiotherapy, massage or group courses: here.

… and what’s the deal with the 🥒 cucumber?

Today we want to talk about muscle cramps in sport in an interview with Physio Restart . Anneke has been coaching teams with great passion for years. The topic of cramps on the pitch comes up from time to time.

Physio Restart: An anecdote that is actually used: drink the leftover juice from gherkins when muscle cramps occur as a result of sport. This reduces the duration of the cramps by a few seconds. (Miller et al. 2010) But is this the solution to the problem? No. Basically not, because firstly: the juice really doesn’t taste good, … does it? And secondly: the cause has not been solved.

Interviewer: Interesting, introductory anecdote. Anneke, what exactly are muscle cramps?

Physio Restart: Maybe you know the situation: 81st minute of the game, the score is 1:0 in your favor, but the opponent is hungry, you are exhausted and no more player changes are possible. In other words: pull through and carry on. Suddenly your left calf cramps, followed shortly afterwards by your right calf. Running on is virtually impossible.

This cramp is an involuntary or unintentional muscle spasm . (Of course you didn’t want to get this very painful cramp in the middle of the field during this game, right?)

In principle, our brain communicates with our muscles via the nerves. This requires certain electrolytes (ions), including magnesium. This is why people are quick to say that a muscle cramp occurs because there is a lack of magnesium. But in fact this is not the answer to the problem and often not the cause.

Muscle cramps can be caused by:

1. disturbances in the electrolyte balance (e.g. loss of sweat at high temperatures)

2. dehydration (not drinking enough)

3. insufficient warm-up or lack of routine stretching

4. altered neuromuscular activation/fatigue (e.g. last minutes of the game)

If we take a closer look at the literature behind it, we can quite quickly (and many years ago!) critically question the claims made in points 1 and 2.

1) Even at cool temperatures (10-12°C), almost 20% suffered from exercise-induced muscle cramps. (Maughan 1986) Marathon runners were tested.

2. despite sufficient water intake (in relation to sweat loss), almost 70% of the test subjects had cramps. (Jung et al. 2005) However, this study population was very small.

Supplement to point 1+2: Many of these claims are based on case studies, which are not good sources.

Interviewer: Too bad. So not: take magnesium, done. Okay. And point 4… Neuromusku… what? And now the whole thing again in German…

Physio Restart: Laughs.

Sorry. “Neuro” means “concerning the nerve”, “muscular” of course the “muscle”. In other words: neuromuscular = the control or communication between nerves and muscles, which, as mentioned above, trigger muscle contraction and relaxation. Experts are increasingly in agreement that this is often the problem with cramps. It is simply fatigue during intensive exercise, but not a lack of any particular ion.

Interviewer: Ok, that was actually not difficult to understand. Good, and now that I know all this… What do I do the next time I have a cramp?

Physio Restart: There’s a lot you can do for yourself and your teammates. But not just on the pitch!

Try to drink enough before the game. Before the game means at least 1 hour, as the water needs time to be absorbed and processed by the body. Apparently it takes up to 13 minutes….

Drink the right amount before and during activity. 1 liter of nutrient-rich water or an isotonic drink. Remember: not all water is nutrient-rich. It should contain sufficient potassium, calcium and magnesium, as well as many other elements . According to the FSVO, tap water here in Switzerland is of good quality. Mineral water should contain <100mg potassium, >70mg magnesium and >300mg calcium . In comparison, as a woman I need about 4000mg potassium, 500mg magnesium and 1000mg calcium . (BLV) So I also have to get it from my food.

Avoid ingesting magnesium directly before the game. Your gastrointestinal tract can cause you problems during this time.

Warm up. Warm up sufficiently and properly before the game. Maybe you have a joint warm-up routine from the physio?

Avoid tight clothing. Excessive compression, for example due to shoes that are laced too tightly, can disrupt optimal blood circulation.

If you do suffer a cramp, avoid stretching abruptly at all costs. What many people do: quickly lie on their back, raise their legs in the air, put their toes up and stretch. However, this can actually lead to strains. Instead, stand in a stepping position and stretch yourself. Otherwise, do it carefully and slowly. Ask your physio to help you massage the cramped muscle lengthwise.

Stay warm. If you are sitting on the bench as a substitute, try to keep warm. Not just by wearing clothes, but by using the Blackroll, skipping rope, jogging on the sidelines. It’s not advisable to dance around a bit just before taking the field. Laughs.

Have yourself replaced if it happens several times in quick succession. This indicates fatigue, which can subsequently lead to an injury. Neuromuscular fatigue!

Birthday party the night before? Alcohol promotes muscle cramps.

Hot and cold showers after the game and as a general preventative measure.

Interviewer: Take Home Message as always with Physio Restart? Except that I shouldn’t celebrate my 30th right before an important match or only with iso drinks……

Physio Restart: Laughs. All I can say is:

“Don’t believe everything you read and hear. Look at information with a critical eye. You can also judge this text. Nevertheless, I hope I have been able to give you a few tips: work on the cause of the problem, because prevention is the best cure, even for muscle cramps.”

Book your appointment for physiotherapy, massage or group courses: here.

References:

1.Jung A, Bishop P, Al-Nawwas A, Dale R. Influence of hydration and electrolyte supplementation on incidence and time to onset of exercise-associated muscle cramps. J Athl . 2005;40:71-75

2.Maughan R. The effect of osmolality and carbohydrate content on the rate of gastric emptying of liquids in man. J Physiol. 1995;486:523-531

3,Bye A, Kan A. Cramps following exercise. Aust Paediatr J. 1988;24:258-259

4.Schwellnus MP. Skeletal muscle cramps during exercise. Phys Sportsmed. 1999 Nov;27(12):109-15.

5.Miller, K. C., Stone, M. S., Huxel, K. C., & Edwards, J. E. (2010). Exercise-associated muscle cramps: causes, treatment, and prevention. Sports health, 2(4), 279-283.

6.Schwellnus M, Derman E, Noakes T. Aetiology of skeletal muscle “cramps” during exercise: a novel hypothesis. J Sports Sci. 1997;15:277-285