Author Archives: PhysioFitness Perth

Delayed onset muscle soreness (aka. DOMS) is the pain a person feels after exercise.¹ DOMS typically begins 6-12 hours post exercise and gradually increases until peak pain is reached at 48-72 hours.²

Following this period the pain experienced decreases until it is no longer perceptible 5-7 days post exercise.² In addition to local muscle soreness, DOMS is associated with reduced range of motion, altered function of adjacent joints, impaired muscle contraction and reduced force capacity.² As a result prevention and minimisation of DOMS has become a primary focus in post exercise recovery to enhance subsequent athletic performance.²

One of the main mechanisms behind the pain and fatigue associated with DOMS is the accumulation of metabolic waste (e.g. lactic acid) in muscles and the blood.¹ In order to combat this and enhance the rate of recovery low intensity activity is recommended.² Low intensity activity (e.g. jogging) after exercise accelerates blood lactate removal via an increased blood flow.² Furthermore, an active recovery also assists in the repair of damaged tissue caused during exercise as result of mechanical trauma when the muscles contract (aka. exercise induced muscle damage).¹

Exercise induced muscle damage (EIMD) is the other main cause inducing DOMS.² In addition to active recovery, research supports the use of compression therapy and cold water immersion therapy (CWI), not to be confused with ice baths or cryotherapy, to enhance recovery from EIMD.² See previous article on the role of stretching and foam rolling in recovery: http://www.physiofitnessperth.com.au/blog/43-stretching-static-vs-dynamic.html

Multiple studies have shown that wearing compression garments post exercise can enhance the function and strength of those targeted muscle groups thereby enhancing recovery and reducing the symptoms associated with EIMD.² CWI at a temperature between 11-15°C for 11-15 minutes has also been proven to be an effective method at alleviating functional and physiological deficits associated with EIMD.² CWI is particularly effective following prolonged endurance-based exercise.² See previous article on the role of cryotherapy in recovery: http://www.physiofitnessperth.com.au/blog/42-don-t-fall-into-the-trap-of-the-trend.html

SLEEP

Another important consideration in post exercise recovery is sleep.³ Getting adequate sleep is critical in optimising physiological and psychological recovery as well as subsequent performance.³

Studies show that the optimal conditions for cell growth and repair occur during deep sleep.³ Sleep deprivation impairs the body’s ability to sufficiently break down cells needed for future repair and growth, and stimulates processes leading to muscle degradation.³ As a result, a lack of sleep can have adverse effects on the physiological mechanisms involved in recovery following exercise.³ Sleep deprivation in athletes can manifest as impaired sport-specific skill execution, altered performance during submaximal sustained exercise bouts, reduced muscular and anaerobic power and cognitive deficits (e.g. reaction time, memory and decision making, mood variability etc.).³

The current evidence-based recommendations regarding hours of sleep that should be obtained daily are as follows:

• 7-9 hours of sleep for healthy adults.³
• 9-10 hours of total sleep for athletes.³

Sleep strategies can be implemented to help achieve this.³ Studies found the most effective strategy to be sleep extension which also demonstrated improvements in subsequent sports performance.³ Sleep extension aims to increase the total amount of sleep obtained either through increasing total sleep duration or via brief targeted naps.³ Naps should not exceed 30 minutes.²

The development of healthy sleeping habits (i.e. good sleep hygiene) has also proven to be beneficial in improving sleep and performance if sustained long term.³ Some examples include sleeping in a dark and quiet environment, no screen time before bed etc.³

NUTRITION

Appropriate dietary intake is vital when aiming to optimise post-exercise recovery and subsequent performance.⁴ Athletes, in particular those that partake in endurance-type exercises, need to prioritise the ingestion of adequate amounts of both carbohydrate and protein.⁴

Carbohydrates play an essential role in the replenishment of energy stores (i.e. muscle and liver glycogen) following exercise and are the primary fuel source relied upon during endurance-based activities.⁴ In order to optimally replenish these stores and prepare the athlete for future performance the following nutritional guidelines are recommended:

Recommended carbohydrate intake for short recovery window (<8h):

• Muscle glycogen (i.e. energy) resynthesis is greatest during the initial 1 hour after exercise.⁴
• Therefore, carbohydrates should be consumed immediately after exercise regardless of the available window of recovery to promptly begin the recovery process.⁴
• Quantified intake for <8h = 1.2g/kg/h for the first few hours, high glycaemic index foods (> 70) preferred, dosing at 15-30 min intervals.⁵
• May need to consume sports nutrition products such as recovery drinks, bars, gels etc. for convenience.⁴
• If unable to tolerate this volume can add caffeine (3mg/kg – 8mg/kg) or protein to boost glycogen repletion.⁵

Recommended carbohydrate intake for longer recovery window (8-24h):

• Consumption of adequate daily carbohydrate (independent of pattern or timing) is the best strategy to optimise muscle glycogen resynthesis.⁴
• Quantified intake:
  • First 24 hours post-competition = 8-10g per kg of bodyweight.⁵
  • Moderate intensity exercise (1h/day) = 5-7g per kg of bodyweight per day.⁵
  • Moderate-high intensity exercise (1-3h/day) = 6-10g per kg of bodyweight per day.⁵
  • Very high training load (4-5h of moderate-high intensity exercise everyday) = 8-12g per kg of bodyweight per day.⁵

Protein stimulates the repair and remodelling of skeletal muscle following exercise.4 Therefore, protein plays an essential role in the restoration and enhancement of muscle function and performance post-exercise.4 To maximise the above processes, the following nutritional guidelines are recommended:

Recommended protein intake for short recovery window (<8h):

• There is increased protein absorption 24h following exercise.⁵
• Protein should be consumed immediately after exercise to stimulate skeletal muscle repair and remodelling.⁴
• Quantified intake for <8h = 20g per meal or 0.25-0.3g/kg, high leucine content (e.g. whey protein), can be rapidly digested.⁴
• Masters athletes could benefit from increased post exercise protein intake due to impaired muscle remodelling and slower recovery rates.²

Recommended protein intake for longer recovery window (8-24h):

• Quantified intake = 20g per meal or 0.25-0.3g/kg, meals every 3-4/5h.⁴
• Pre-bedtime protein ingestion recommended to support skeletal muscle repair and remodelling during an 8h sleep period.4⁴/li>
• Leucine enriched foods ideal but vegetable-based proteins, protein blends and whole foods can be sufficient (will need approx. 25% greater intake due to lower leucine content).⁴
• Recommended that strength and power athletes consume in the higher range and endurance athletes in the lower range.⁵

Omega-3-fatty acids also play a role in reducing the symptoms associated with DOMS.² It is recommended that athletes ingest 1.8-3g of omega-3-fatty acids following exercise.²

HYDRATION

Along with nutritional replenishment, fluid replacement post exercise is vital to obtaining optimal recovery.⁶ Following exercise the goal is to completely restore any fluid and electrolyte deficit.⁶

If available recovery time is limited or the magnitude of fluid-electrolyte deficit (i.e. dehydration) is large then aggressive rehydration may be merited.⁶ The current evidence-based recommendation suggests that individuals should drink ~1.5L of fluid per Kg of body weight lost to completely recover from dehydration post exercise.⁶ More of this fluid is retained if there is additional consumption of sodium (> 60mmol/L).⁵ Ingestion of extra salt with meals or fluids is also useful when sweat loss is high.⁶

On a daily basis provided there is ample recovery time, consumption of normal meals and snacks containing adequate amounts of sodium in addition to sufficient volumes of plain water (~400-800 mL/h), will restore hydration levels.^5,6

References:

1. Zulaini, Harahap NS, Siregar NS, Zulfahri. Effect of Stretching and Recovery on Delayed Onset Muscle Soreness (DOMS) After Exercise. J Phys Conf Ser. 2021;1811(1):12113. doi: 10.1088/1742-6596/1811/1/012113
2. Hotfiel T, Mayer I, Huettel M, et al. Accelerating Recovery from Exercise-Induced Muscle Injuries in Triathletes: Considerations for Olympic Distance Races. Sports. 2019;7(6):143. doi: 10.3390/sports7060143
3. Bonnar D, Bartel K, Kakoschke N, Lang C. Sleep Interventions Designed to Improve Athletic Performance and Recovery: A Systematic Review of Current Approaches. Sports Med. 2018;48(3):683-703. doi:10.1007/s40279-017-0832-x
4. Moore, DR. Nutrition to Support Recovery from Endurance Exercise: Optimal Carbohydrate and Protein Replacement. Curr Sports Med Rep. 2015;14(4):294-300. doi: 10.1249/JSR.0000000000000180
5. Vitale K, Getzin A. Nutrition and Supplement Update for the Endurance Athlete: Review and Recommendations. Nutrients. 2019;11(6):1289. doi:10.3390/nu11061289
6. Sawka MN, Burke LM, Eichner ER, et al. Exercise and Fluid Replacement. Med Sci Sports Exerc. 2007;39(2):377-390. doi:10.1249/mss.0b013e31802ca597

What to do BEFORE exercise:

Dynamic stretching is commonly incorporated into the pre-exercise warm up routine.² But what is dynamic stretching and why is it preferred over static stretching before exercise?

Dynamic stretching involves controlled movement through the active joint range of motion required for a specific sport with repeated cyclical muscle loading and unloading.¹ Through the incorporation of an acute bout of dynamic stretching prior to activity the incidence of injuries among athletes is reduced and performance is enhanced.¹ This is due to a multitude of factors including:

• Net positive effect on joint kinematics (i.e. motion of the joint) and dynamic flexibility.^1,2 For example, a study conducted in 2023 outlined that dynamic stretching of the thigh, hip, hamstring and calf muscles for 30s on both legs increased range of motion during the forward and follow-through phase of the instep soccer kick.¹
• Lower levels of muscle stiffness allowing for greater energy absorption during activity and reductions in the severity of muscle soreness.1As detailed in a 2019 study, dynamic stretching of the hamstring muscle produces an immediate increase in knee range of motion and a decrease in hamstring stiffness, both independent risk factors for hamstring injury in sport.²
• Specificity to sport.¹ Dynamic stretching involves a number of joints replicating the movements required for a particular sport thereby preparing the body for activity.³ The muscle does not relax but rather is active through the movement.³ The degree of stretching required will depend on the type of sport.³
• Promotes the temperature-related benefits of warm up.³
• Psychological benefits.¹ Dynamic stretching may positively influence psychosocial stressors and alter the emotional state leading to decreased muscle tension and increased concentration or attention prior to games/competition.¹

In contrast, evidence shows consistently that static stretching prior to exercise impairs performance and compromises muscle function.³ A static stretch is slow and constant involving relaxation and concurrent elongation of the stretched muscle.³ It has been found that pre-exercise static stretching negatively affects maximal muscle strength, power and explosive muscular performance, running speed, reaction and movement time and strength endurance.^3,4 Furthermore, the ability to statically hold a stretch lacks sport specificity and can lead to reductions in muscle temperature.³ The above can be detrimental for competitive performance and therefore the use of static stretching during warm-up should be avoided.⁴

What to do AFTER exercise:

Evidence regarding cool down recommendations immediately post exercise is trivial and requires further investigation for a concrete conclusion to be drawn.⁵ However, there are some general protocols and recommendations in place which can be followed and used as a guide.

An active cool down is typically performed in preference to a passive cool down (i.e. no activity).⁵ However, the evidence supporting this belief is both limited and conflicting, suggesting that active cool downs are largely ineffective in facilitating post exercise recovery.⁵ Despite this, they may offer some benefits compared to passive cool downs.⁵ For example, active cool downs accelerate removal of lactic acid from the blood and enhance recovery of cardiovascular and respiratory systems.⁵ If an active cool down is to be performed post exercise it should be completed as follows:

• Dynamic activity performed at low to moderate intensity to increase blood flow but prevent additional fatigue.⁵
• Low to moderate impact to prevent development of further muscle damage and soreness.⁵
• Shorter then 30min performed within 1hr after training/competition.⁵
• Involve exercise preferred by the athlete.⁵

Static stretching and foam rolling is also typically performed in combination with an active cool down.⁵

Static stretching is performed with the aim of reducing post exercise muscle soreness and increasing range of motion.⁵ However, the above is only obtained if stretching is performed within 5-10 minutes after practice.³ This is due increases in elastic properties within muscles and tendons as a result of elevated muscle temperatures immediately post exercise.³

Foam rolling is also effective in increasing range of motion, reducing muscle soreness, enhancing next day performance and facilitating recovery from exercise.⁵

What to do LONG TERM:

To obtain longer lasting increases in flexibility and range of motion a stretching program is required.³ Stretching programs should include:

• 2-3x sessions/week for a minimum of 5 weeks.^3,7
• Static stretch duration of 30s repeated 2-4 times.^3,7
• Static stretch held at a position of mild discomfort (not pain).³
• All stretching sessions should be preceded by an active warm-up.^3,7

A systematic review published this year also found that the use of long-term static stretching not only increases range of motion but can also alter muscle architecture and function ultimately enhancing muscle performance.⁶

References:

1. Behm DG, Alizadeh S, Daneshjoo A, Konrad A. Potential Effects of Dynamic Stretching on Injury Incidence of Athletes: a narrative review of risk factors. Sports Med. 2023;53(7):1359-1373. doi:10.1007/s40279-023-01847-8
2. Iwata M, Yamamoto A, Matsuo S, et al. Dynamic Stretching Has Sustained Effects on Range of Motion and Passive Stiffness of the Hamstring Muscles. J Sports Sci Med. 2019;18(1):13-20. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6370952/
3. Baechle TR, Earle RW. Essentials of Strength Training and Conditioning. 3rd ed. Human Kinetics; 2008.
4. Simic L, Sarabon N, Markovic G. Does pre-exercise static stretching inhibit maximal muscular performance? A met-analytical review. Scand J Med Sci Sports. 2013;32(2):131-148. doi:10.1111/j.1600-0838.2012.01444.x
5. Van Hooren B, Peake JM. Do We Need a Cool Down After Exercise? A Narrative Review of the Psychophysiological Effects and the Effects on Performance, Injuries and the Long-Term Adaptive Response. Sports Med. 2018;48(7):1575-1595. doi:10.1007/s40279-018-0916-2
6. Panidi I, Donti O, Konrad A, et al. Muscle Architecture Adaptations to Static Stretching Training: A systematic review with meta-analysis. Sports Medicine – open. 2023:9(1):47. doi:10.1186/s40798-023-00591-7
7. Page P. Current Concepts in Muscle Stretching for Exercise and Rehabilitation. Int J Sports Phys Ther. 2012:7(1):109-119. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3273886/

Following on from the last article on back mobility the shoulder is the next joint to look at to ensure you get the most out of your golf. The shoulder is a highly mobile joint, for it to make movements like swinging a golf club, an overhead smash in tennis, swimming or paddling it needs stability to control. The glenohumeral joint (the ball and socket) of the shoulder can be liked to a golf ball on a tee, so for it to work well it needs to be controlled/stabilised in that position, when you move your arm there is an element of roll and slide within the joint to make movement possible and if this is not effective this may lead to pain.

The rotator cuff muscles along with the ligaments of the shoulder aid in stability and movement along with larger muscles which support the shoulder girdle (collar bone and shoulder blade). Stabilising the whole shoulder girdle sets a strong base for movement of the entire upper limb which enables us lift objects in front and overhead. Many of us experience pain in the upper shoulders and neck from sitting and working at a desk all day, and this too could be attributed to a lack of endurance in these muscles stabilising the shoulder. To avoid the pain of shoulders and to be able hit the golf ball well, swim pain free or just hang out the washing we need to work on maintaining and improving our overall shoulder stability and strength. As the rotator cuff suggests it is mainly responsible for rotary movements of the shoulder and we should therefore strengthen through full range, this can be done by working each of the muscles individually or more easily we can perform exercise that take the shoulder through much of its range as this then requires all muscles to work together to make the movement happen.

So to maintain shoulder position to get the best result from your golf swing or any other pursuit here are a couple of exercise to add into your routine. Wall slides

• Stand with your back against a wall and bend your knees a little.
• Your shoulders and head should be touching the wall
• Start with your upper arms at your side with your elbows bent.
• Your wrists and forearms should be touching the wall.
• Bring your arms up as high as you can get them, without any of your body parts coming away from the wall.

Mini Band Raises

• Take a small resistance band and hold between both hands, bend forward form the hips to about 45 degrees.
• Start with your elbows by your side and hands in front of your body with light resistance on the band.
• Palms facing together reach arms out in front of you keeping shoulder blades back.
• As you elbows straighten pull your arms further apart and continue to raise hands over head hold for 3 sec and return o the start position.

Reverse flys

• Bend forward from the hips to almost horizontal, the spine should be in a neutral.
• Keeping your elbows slightly bent, lift the arms up and out to the side, squeezing your shoulder blades together.
• Control the movement back to the start position.

Watch this space for article 3 coming soon.

Do you play golf or a sport that requires to rotate through the lumbar spine to generate your movement. Golf particularly involves a lot of rotation through the course of a round and often at high velocity. For the body to rotate effectively through the spine it needs to flex (bend forward) extend (Bend backwards) and side bend to enable the full rotation at the joint, and also requires good strength and stability to make this movement smooth.

If you are repeating this rotation between 70-100 times per round the stresses applied build up if you are not making use of the full mobility of the spine, which can in turn lead to injury or at least explain why towards the end of a game you cannot hit as far or have the same accuracy that you started with.

To enable the full range of the spine to help prevent injury and play better for longer we ne dot look at the movement available at the thoracic spine. A lot of golfers get most of their rotation from the lumbar spine, hips and knees. So to take some of the load out of these areas lets get some mobility in the upper back.

Here are three exercises to help with that thoracic rotation which will be beneficial for golfers and anyone needing more movement in their upper back.

Kneeling thoracic rotation:

• Start on hands and knees, moving your body back over your legs a little.
• Place one hand on the back of your neck, keeping the elbow pointed out.
• Rotate your body, leading with the elbow, so that your elbow comes down towards the middle of the floor, and then rotate back up.
• As the elbow comes up, you will get a twist in the middle of the back.

Side Lying thoracic rotation

• Lie on your side with your arms outstretched on the floor in front of you.
• Your lower leg should be straight and in line with the rest of your body.
• Your upper leg should be bent in front of you with both the hip and knee at 90 degrees.
• Take a deep breath in.
• As you breathe out, lift your top arm up from the floor towards the ceiling.
• Follow the movement with your head.
• Continue to move this arm up and over to the floor on the other side.
• Allow your upper body and head to follow the movement of this arm.
• Take a deep breath at this endpoint.
• As you breathe out, lift this arm back up from the floor, sweeping towards the ceiling and return it to lie on top of your other arm.
• Take a deep breath in, and then repeat.

Plank Rows

• Get into a press up position with a weight in one hand.
• Keeping a straight line from your head to your feet and lift the weight up and down, moving your elbow towards the ceiling.
• There will be a slight rotation in your torso.

I hope these are helpful in getting you moving, next we will look at the how and whys of shoulder stability.

Matt is an experienced Physiotherapist and Sport Scientist with 20 years in exercise rehabilitation in the UK and Perth, Matt’s approach to patient management is holistic, with a passion for whole body movement, understanding how the rest of your body may be impacting your current injury or area of pain.

He has a keen interest in gym, functional rehabilitation, and golf conditioning.

So for all the golfers out there… this may be your chance to get the scores down.

His goal is to help his patients achieve what they want from their bodies. In his spare time Matt likes to get out on the water paddle boarding, mountain biking and generally being active with his family.

I wanted to thank you all for the referrals and word of mouth to family and friends. I cant wait to take the next step in growing the business and making physiotherapy appointments more accessible to you.

To make an appointment, book today at https://physiofitnessperth.cliniko.com/bookings.

Did you know that your brain loves to save energy. The more you perform a task, the more it becomes automatic and requires very little effort. It becomes part of your subconscious brain or basal ganglia. When you try something new, it requires a lot of thinking and effort. For this you need to use your prefrontal cortex. When you repeat this new behavior over time it again becomes a habit and again this becomes automatic.

How does this even relate to an injury? If your back hurts when you move in a certain way, you will begin to change the way you move to stop the pain. Over time this becomes your new way of moving. It becomes your new normal. The brain does this by creating muscle imbalances, joint stiffness and weakness. This can lead to dis-function. Your physio can help you determine what these dysfunctions are. It is important to correct those patterns so we get back to moving as we should be. Simple enough right?…. Nope… Many people know this but why don’t they recover?

This still is not the secret, so how do you get better? Getting better takes a lot of hard work and a little help from others. There is no quick fix There is no magic pill There is no one Physio or professional that has all the answers, find someone you trust and follow exactly what they tell you to do. Communicate your outcomes so you can work together to get the best result. I often see patients who know what they need to do but then a friend will tell them about a magic cure or quick fix. Its too enticing and of course, there is no quick fix. There is no magic exercise plan that is better than another. Research shows that no matter what program you follow, it is the consistency of doing the exercises that makes all the difference.

So The secret is… Find a professional that can diagnose your injury and identify why you have injured yourself. Get started. You will never feel like doing something new as it takes energy and effort. Work on a plan to correct the imbalances and know that it is going to take a lot of effort before it becomes the norm. Be consistent and be prepared to work hard until the imbalances are corrected and become your normal again. Find a buddy that helps you be accountable. If you don’t have one, we do offer a strength class on a Monday morning at 6am. I also know a physio who is more than happy to keep you accountable.