How to classify muscle injuries on MRI using the British Athletic Muscle Injury Classification (BAMIC) system

How to classify muscle injuries on MRI using the British Athletic Muscle Injury Classification (BAMIC) system

Soft tissue injuries are very common in sport/physical activity and recovery timelines can take anywhere from 10 days – 16 weeks. These timelines are decided using physical assessment and understanding of muscle-tendon complex injury healing but, in the case of lower limb injuries, can be aided with an MRI of the area. The radiologists who interpret the scan results will often use the BAMIC system to identify the area and grade of the injury which can help in determining return to play timelines.

Understanding Rotator Cuff-Related Pain

Understanding Rotator Cuff-Related Pain

Rotator cuff related pain is a common musculoskeletal condition that affects millions of people worldwide. The rotator cuff consists of a group of four muscles and tendons that stabilize the shoulder joint and allow for a wide range of motion. When these structures become injured or damaged, they can lead to pain, discomfort, and limited mobility. In this blog post, we will delve into the causes, symptoms, acute phase management, and long-term outcomes of rotator cuff related pain.

Patterns of Knee Instability

There are four type of knee instability each characterised by different directional instability based on structures involved.

Anteromedial Instability (AMRI)

Anteromedial instability relates to an unstable to medial knee compartment caused by chronic medical collateral ligament damage/laxity.

The pattern of instability noted is anterior displacement of the medial tibial plateau on the medial femoral condyle. The lateral compartment remains stable unless any ACL ligament involvement.

Anterolateral Instability

Anterolateral instability is associated with ACL ligament injuries. Instability is characterised by a posterior and lateral displacement of the lateral femoral condyle on the tibial plateau.

Posteromedial Instability

Posteromedial instability can be caused by damage to the posterior horn of medial meniscus, superficial and deep fibres of the MCL and the posterior oblique ligament. This type of injury is usually associated with multi-ligamentous injuries.

Posterolateral instability (PLRI)

This pattern of instability is characterised by posterior displacement of the lateral tibial plateau in relation to the lateral femoral condyle. Injury to the posterolateral corner associated with this type of instability. The posterolateral corner consists of the lateral collateral ligament, popliteal ligament and the popliteus tendon complex.



Flexor Hallucis Longus tendon injuries

Flexor Hallucis Longus tendon injuries

Flexor Hallucis Longus muscle (and subsequent tendon) runs down the medial border of the tibia past the malleolus and inserts into the plantar surface of the foot and into the base of distal phalanx of hallux. Its role is to move the big toe downwards. FHL pain is usually characterised by medial ankle and foot pain. Sometimes, the discomfort can run up into the medial calf.

Plyometrics: Why Should They be in Your Gym Program?

Plyometric training is when we use exercises to make muscles exert a large amount of force in a short amount of time to improve our power output.

 

Plyometric exercises like jumping, hopping and landing causes the nervous system to develop reflexes to sudden high-stretch loads, improving the rate and scale of motor unit activation.

 

Key components of plyometric training are:

Focus on rapid movement between phases of muscle contraction (fast movement)

Typically body weight or light weights only (light weight)

 

These types of movements produce greater power than concentric only movements as more force is released in the plyometric action. This is because it allows the muscle-tendon complex to store more elastic energy which must be released. If we do these movements slowly, we lose this elastic energy (as heat) and therefore it is not efficient.

 

Research suggests that stretch-shorten cycle exercises should be implemented at the beginning of a training session (or on a separate day by themselves). This reduces the chance of poor technique due to fatigue and allows the athlete to maximize the velocity of movement. 

Examples of plyometric exercises

-       Drop jump

-       Box jump

-       Hopping

-       Lateral hop/skater

-       Split squat jump

Overall evidence based practice suggests the use of plyometrics with traditional strength training for best performance of an athlete.

Proximal Hamstring Tendinopathy Middle to late Rehabilitation

Proximal Hamstring Tendinopathy Middle to late Rehabilitation

In the early stages of rehabilitation, the focus was acute management and early loading to assist with pain relief and base tendon activation avoiding compressive/provocative positions.

In the middle to early phase the focus is on progressive loading of the tendon, isotonically in initially non-compressive loads but gradually progressing to them.

Syndesmosis sprains : The high ankle injury

Syndesmosis sprains : The high ankle injury

You may have heard various athletes suffering a high ankle sprain or injuring their syndesmosis. But what exactly is a syndesmosis injury? And how does it differ to a normal lateral ankle sprain?

The ankle syndesmosis is the joint between the distal (lowest aspect) of your tibia and fibula. It is comprised by three main supporting ligamentous structures – The Anterior inferior tibiofibular ligament, Posterior inferior Tibiofibular ligament, and interosseous membrane (see Figure 1). The role of the syndesmosis is to provide stability to the tibia and fibula and resist separation of these two bones during weightbearing tasks. It also plays a role in assisting with mobility of the ankle.

COMMON ADOLESCENT CONDITIONS – PART TWO: KNEE

Part two of load related adolescent conditions focuses on the knee.

Osgood-Schlatters Disease

 What?

An irritation of the insertion of the patella tendon into the tibia. This differs from adult patella tendinopathy due to the immaturity of the adolescent skeleton which means it affects the actively remodelling trabecular metaphyseal bone.

How?

It is usually due to the area’s inability to deal with an increase in activity (particularly activity that uses that area eg running or jumping sports). It can also be related to growth spurts which puts increased tension through the muscles and therefore tendons.

 When?

More common in boys and usually between the ages of 10-15 compared with girls which is usually between the ages of 8-13.

How does it resolve?

Usually self resolves with time (6-24 months) however the reason it’s best to seek treatment/advice is due to the pain that accompanies the condition which can affect sports performance and most importantly day to day activities. 

What is the treatment?

The main focus of treatment is to reduce pain levels. This can be done in a few different ways including:

-       Manual therapy (eg muscle massage)

-       Taping to offload the tendon

-       Exercises to strengthen key areas 

-       Implementation of load management strategies (eg RPE scale)

-       Advice regarding recovery (eg icing)

 

The main takeaways about the condition are:

-       The adolescent will grow out of it

-       It can still be quite painful so there should be a focus on pain relief

-       Load management with guidance from a physiotherapist can allow the continued participation in sport without compromising day to day function 

If you would like your injury reviewed by one of our physiotherapists, then don’t hesitate to book an appointment. All of our physiotherapists specialise in sport and have had extensive experience with adolescent athletes.

Bowel and bladder health and Pelvic Floor Muscle Dysfunction

The pelvic floor consists of bone, ligament and muscular structures which all work to support internals organ, control bladder and bowel functions as well as assist in reproductive function.

30% of women experience pelvic floor dysfunction including pelvic pain, prolapse, stress incontinence (leaking), urgency incontinence, and frequency incontinence.

Risk factors for developing Pelvic Floor Muscle Dysfunction

-       Age

-       Pregnancy + childbirth

-       Pelvic floor injury

-       Increased abdominal pressure

-       Intense physical effort

-       Constipation

-       Obesity

-       History of lower back pain

Some of these factors are more controllable than others so it’s best to ensure we are putting our best foot forward with those that we can change. Good bowel and bladder habits are the easiest to change.

-       Bowel habits:

-       Use of a squatty potty (posture involving chest forward with knees higher than hips)

-       No breath holding

-       Avoid straining/constipation

-       Ensure adequate fibre

 

-       Bladder habits

-       Fluid intake 2-3L/day

-       Voiding every 2-3 hours,

-       Avoiding fluids 2 hours before bed

-       Reducing alcohol/diuretics

Hagen S, Elders A, Stratton S, Sergenson N, Bugge C, Dean S et al. Effectiveness of pelvic floor muscle training with and without electromyographic biofeedback for urinary incontinence in women: multicentre randomised controlled trial BMJ 2020; 371 :m3719 doi:10.1136/bmj.m3719

Relative Energy Deficiency in Sport (RED-S)

Relative Energy Deficiency in Sport (RED-S)

Are you unable to recover between training sessions? Experiencing severe wide-spread muscle ache/DOMS? As a female athlete, has your menstruation ever been affected by your training? These can all be signs of energy deficiency and overtraining. Our blog explores what energy deficiency is, how to identify it and how to treat it.

Proximal Hamstring Tendinopathy and Early Stage Rehabilitation Exercises

Proximal hamstring tendinopathy occurs due to an overload of the hamstring tendon inserting into the buttock bone, the ischial tuberosity.  It is quite common in runners also in sports/activities which require repetitive tension on the hamstrings plus increased forward trunk lean.

It’s caused by a sudden change in volume, frequency or intensity of exercises, or exposed to high compressive loads such as hill walking/running or forward lean position.  Both these activities increased the strain on the proximal tendon.  Running technique plays a major role, including an increased stride length or trunk lean puts increased tension on the tendon combined with any major changes in running load.

Much like other tendinopathies of the patella and achilles, pain can initially come on with running then have a ‘warm up’ effect, then return post activity with stiffness the following morning.  In more severe cases pain comes on during the run and remains throughout.

Assessment is performed through progressive loading of the hamstring tendon to reproduce pain, in addition to palpation over the tendon.  Ruling out other diagnosis such as involvement of the lumbar spine and sciatic nerve involvement are important.

Treatment is aimed at load modification, but just as importantly performing progressive targeted, non-compressive loading of the tendon to enhance its tolerance to load.   This starts off with isometrics, dependent on the patient’s irritability but then progressing towards gym-based strengthening and sports specific exercises.

With respect to running, working on reduce stride length, increasing cadence and avoiding hills will assist with reducing stress on the tendon.

Early stage isometric exercises include: 5 reps, 30-45 seconds hold and can be performed daily prior and post runs. These also act as ‘panadol’ to assist with pain relief.

Single Leg Bridge Hold                                                                                     

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Prone Hamstring Curl Isometric

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Early Stage Ankle Sprain Rehabilitation

Ankle sprains are one of the most common lower limb injuries reported by active individuals, with a high reoccurrence rate. The lateral ligaments (outside of the ankle) are the most commonly injured, as discussed in one of our previous blogs as seen here https://www.eastvicparkphysiotherapy.com.au/news/2021/1/14/chronic-ankle-instability
Injury prevention and rehabilitation is an effective way to reduce the risk of post injury recurrence.

Key areas of a rehab plan include the following

Restoring full range of movement
Restoring range of motion is important in the initial stages of rehab, this can be achieved by correct heel toe walking (if needed with the assistance of crutches dependant on severity of injury). These exercises are used in the beginning phase of rehabilitation
Ankle Active range of motion
- Ankle Alphabets
- Ankle Pumps
- Calf Stretching

Pain free stationary cycling is also a great way to progress active range of motion exercises as well as re introducing a cardiovascular component to the program.

 

Muscle Strength
Strength needs to be addressed in all directions available in the ankle. These include dorsiflexion, plantar flexion, inversion, eversion. To increase the difficulty of these movements, your physiotherapist may use external resistance, such as therabands, or using your own body weight, through calf raise exercise. Body weight exercises are encouraged as soon as the injury is pain free.

 

Proprioception  
Proprioception is the awareness of joint position and movement, and this becomes impaired after a ligament injury. It is an important part of ankle injury rehabilitation and can start early in your program. Examples of proprioception exercises include:
- Standing on one leg
- Balance Boards

The above exercises are only a guide and will need to be progressed to ensure a full recovery. If you have experienced an ankle sprain please book in with one of our physiotherapists to have your rehabilitation individualised to suit your needs.

Low Back Pain Myths

 Low Back Pain Myths

There is a lot of information out there on low back pain and injuries. Some of which is very useful but on the other hand there is a lot of misinformation which can sometimes lead us in the wrong direction. In this blog we will look to debunk some of the most common low back pain myths!

Costochondritis - A real pain in the chest

Costochondritis - A real pain in the chest

There can be many medical reasons for chest, rib and upper back pain including heart and lung conditions, infections and trauma incidences like fractures.

However, once that has been ruled out a diagnosis to be considered is costochondritis.

The condition is classified as inflammation of the costochondral junction of the ribs (where the bone and cartilage meet) or of the costosternal joints (where the ribs connect to the chest bone). The issue is normally unilateral (one sided) but can sometimes be bilateral.