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Sometimes – less means more

Sometimes – less means more

23 July 2024

Unfortunately, sometimes we come face to face with patients who have a rather long road ahead of them when it comes to returning to their pre-injury status. An ACL or Achilles reconstruction for example. This means a longer period for them to be vigilant, compliant and motivated with their session attendance, exercise and management techniques in and away from face-to-face sessions. I for one know that if I was placed in this scenario, I would find it tough to keep the same level of determination to adhere to my programme from beginning to end. So, can we use a little something to aid this lengthy process for our patients which will not negatively impact their progress? In my opinion, yes. Deloading.

Bell et. al (2023) (1) define ‘Deloading’ as a period of reduced training stress designed to mitigate physiological and psychological fatigue, promote recovery, and enhance preparedness for subsequent training.

In the realm of sports rehabilitation, the concept of deload periods has gained significant traction as an approach to managing and enhancing recovery from injuries. Deload periods, often implemented within a structured rehabilitation program, involve a planned reduction in exercise intensity and or volume. This technique is particularly beneficial in long-term recovery processes, offering numerous physiological and psychological benefits that can expedite healing and improve overall outcomes

The primary physiological benefit of deload periods is the mitigation of overtraining and excessive fatigue (Rogerson et.al 2024) (5). During a prolonged rehabilitation process, continuous high-intensity training can lead to increased stress on the injured tissues, potentially exacerbating the injury or slowing down the healing process. By incorporating deload periods, the body is afforded the necessary time to recover and adapt to the rehabilitation exercises without being overwhelmed by continuous strain.

Deload periods can also play a crucial role in preventing the risk of re-injury. As targeted structures are gradually strengthened during rehabilitation, they require adequate rest to fully recover and adapt to the increased loads. Without sufficient recovery, these structures remain vulnerable to further damage. As per Mosewich, Kent and Kowalski (2013) (4) deloading helps ensure that the healing tissues are not subjected to undue stress, thus reducing the likelihood of setbacks.

Additionally, deload periods facilitate metabolic recovery. Intense exercise sessions can deplete glycogen stores, disrupt hormonal balances, and lead to an accumulation of metabolic byproducts. A period of reduced training intensity allows for the replenishment of glycogen stores, normalization of hormone levels, and clearance of metabolic waste, thereby optimizing the body’s readiness for subsequent training phases (Ivy 2004) (3).

Beyond the physiological advantages, deload periods offer substantial psychological benefits that are vital for a successful rehabilitation journey. Long-term injury recovery can be mentally taxing, often leading to feelings of frustration, anxiety, or even burnout. Scheduled deload periods provide individuals with a break, helping to alleviate mental fatigue and maintain motivation throughout the rehabilitation process. It is a well-known fact that within elite sport it is common for a player to be advised to go away to somewhere warm to put their feet up for 7-10 days at a certain stage of their recovery. This gets the player away from the current rehabilitation setting, enabling them to switch off mentally and relax.

The psychological relief afforded by deload periods also promotes adherence to the rehabilitation program (Bell et. al 2022) (2). Consistently high levels of training intensity can lead to a sense of dread or reluctance towards rehabilitation sessions. By incorporating periodic reductions in training demands, individuals are more likely to remain engaged and committed to their recovery plan, ultimately leading to better long-term outcomes

The implementation of deload periods within a rehabilitation program should be tailored to the individual’s specific injury, recovery progress, and overall training load. Generally, deload periods are scheduled every 6-8 weeks, but this can vary based on the intensity and frequency of the rehabilitation exercises. Monitoring the patient’s feedback, progress, and any signs of overtraining or fatigue can help in deciding the optimum time for this process also.  During a deload week, exercise intensity and volume are typically reduced by 50-70%, allowing the body ample time to recover without completely halting progress.

So, I think based on the above, it is safe to say that as therapists we should very much consider the implementation of the deload principle into the rehabilitation plans of those patients who have a longer and slightly more mentally and physically testing battle ahead. It is a big part of our role to support our patient’s and to keep them on the right track. Sometimes that may mean periodically seeing them and doing less to achieve more down the line.

Reference List

 

  • Bell, L., Ben William Strafford, Coleman, M., Patroklos Androulakis-Korakakis and Nolan, D. (2023). Integrating Deloading into Strength and Physique Sports Training Programmes: An International Delphi Consensus Approach. Sports Medicine – Open, 9(1). doi:https://doi.org/10.1186/s40798-023-00633-0.
  • Bell, L., Nolan, D., Immonen, V., Helms, E., Dallamore, J., Wolf, M. and Androulakis Korakakis, P. (2022). ‘You can’t shoot another bullet until you’ve reloaded the gun’: Coaches’ perceptions, practices and experiences of deloading in strength and physique sports. Frontiers in Sports and Active Living, [online] 4. doi:https://doi.org/10.3389/fspor.2022.1073223.
  • Ivy JL. Regulation of muscle glycogen repletion, muscle protein synthesis and repair following exercise. J Sports Sci Med. 2004 Sep 1;3(3):131-8. PMID: 24482590; PMCID: PMC3905295.
  • Amber D. Mosewich , Peter R.E. Crocker & Kent C. Kowalski (2013): Managinginjury and other setbacks in sport: experiences of (and resources for) high-performance women athletes, Qualitative Research in Sport, Exercise and Health, DOI:10.1080/2159676X.2013.766810
  • Rogerson, D., Nolan, D., Korakakis, P.A. et al. Deloading Practices in Strength and Physique Sports: A Cross-sectional Survey. Sports Med – Open 10, 26 (2024). https://doi.org/10.1186/s40798-024-00691-y
Person resting in bed, shot in black and white
Osteoporosis prevention and management

Osteoporosis prevention and management

8 February 2024

Osteoporosis is a common condition characterised by a reduction in bone density and quality, leading to an increased  risk of fractures. As per the Royal Orthopaedic Society, risk factors for developing Osteoporosis include; smoking, too much alcohol and low body weight. We also know the females, particularly post menopausal females, are at higher risk of being diagnosed.

Recent research has suggested that resistance training can be highly beneficial for individuals with osteoporosis (Zhang et. al 2022). (3)

Resistance training involves placing stress on bones, which stimulates bone remodelling and increases bone density. This can help counteract the bone loss associated with osteoporosis, making bones stronger and more resistant to fractures. Resistance training targets not only bones but also muscles. Strengthening muscles can improve balance, stability, and coordination, which are important for reducing the risk of falls and fractures, particularly in older adults with osteoporosis. Regular resistance training has numerous other health benefits, including improved cardiovascular health, better insulin sensitivity, and enhanced mood and well-being. These benefits contribute to overall better health and may indirectly help in managing osteoporosis.

The LIFTMOR trial 2017 (2) shows that targeting large multi joint strength exercises is an effective way of enhancing – or at least limiting a reduction in bone density. Through the use of 4 fundamental exercises; deadlifts, overhead presses, back squats and a chin up landing drill, positive results were shown.

The frequency of resistance training for individuals with osteoporosis can vary depending on factors such as your current fitness level, overall health, and goals. However, general recommendations suggest aiming for resistance training exercises at least 2-3 times per week with a day of rest between sessions to allow for muscle recovery. This frequency was also tested and shown to be efficacious and superior to previous programs for enhancing bone at clinically relevant sites, as well as stature and functional performance of relevance to falls in postmenopausal women with low to very low bone mass. (Watson et al 2017) (2)

Another important component in the management and prevention of Osteoporosis is nutrition (Garach et. al 2020). (1). The correct nutritional changes to your diet can support bone health, especially when combined with resistance training. Some key components to consider include:

  • Calcium: Adequate calcium intake is essential for maintaining bone health. Good dietary sources of calcium include dairy products (such as milk, yogurt, and cheese), leafy green vegetables (such as kale and broccoli), tofu, almonds, and fortified foods (such as fortified plant-based milk alternatives and breakfast cereals). Aim for the recommended daily intake of calcium, which varies depending on age and sex.
  • Vitamin D: Vitamin D helps the body absorb calcium and plays a crucial role in bone health. Sources of vitamin D include sunlight exposure, fatty fish (such as salmon and mackerel), fortified foods (such as fortified dairy products and cereals), and supplements. Consider getting your vitamin D levels tested and talk to your healthcare provider about supplementation if necessary.
  • Protein: Protein is important for maintaining muscle mass and supporting bone health. Include sources of lean protein in your diet, such as poultry, fish, beans, lentils, tofu, eggs, and dairy products. 
  • Magnesium: Magnesium is involved in bone formation and metabolism. Good dietary sources of magnesium include nuts, seeds, whole grains, leafy green vegetables, and dairy products. 
  • Vitamin K: Vitamin K plays a role in bone metabolism and may help reduce the risk of fractures. Include foods rich in vitamin K, such as leafy green vegetables (such as kale, spinach, and Swiss chard), broccoli, Brussels sprouts, and fermented foods in your diet. Limit Sodium and Caffeine: High sodium intake can increase calcium excretion in the urine, potentially weakening bones. Limit your intake of high-sodium processed foods and try to minimize added salt in your diet. Excessive caffeine intake may also negatively impact calcium absorption, so moderate your consumption of caffeinated beverages. 
  • Maintain a Healthy Weight: Being underweight can increase the risk of osteoporosis and fractures. Aim for a balanced diet that supports a healthy weight and includes a variety of nutrient-rich foods.

We are proud to be able to assist all of our patients at Opus who require assistance in the prevention or management of osteoporosis through a full MDT approach including our Sports Medicine physician – Dr Porter, physiotherapy team and nutritionist. Through our expertise we are able to implement the important points made above into the patient’s package of care.

Reference List

 

  • Muñoz-Garach, A., García-Fontana, B. and Muñoz-Torres, M. (2020). Nutrients and Dietary Patterns Related to Osteoporosis. Nutrients, [online] 12(7), p.1986. doi:https://doi.org/10.3390/nu12071986.
  • Sl, W., Bk, W., Lj, W., At, H., Sa, H. and Br, B. (2018). High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial. [online] Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research. Available at: https://pubmed.ncbi.nlm.nih.gov/28975661/.
  • Zhang, L., Zheng, Y.-L., Wang, R., Wang, X.-Q. and Zhang, H. (2022). Exercise for osteoporosis: A literature review of pathology and mechanism. Frontiers in Immunology, 13. doi:https://doi.org/10.3389/fimmu.2022.1005665.
Athlete performing a sprint drill against a wall outdoors

The Role of Sports Medicine in Training and Recovery

The Role of Sports Medicine in Training and Recovery

24 March 2023

Physical training can take a toll on an athlete’s body, often resulting in injuries and fatigue. However, with the right sports medicine strategies in place, athletes can maximise their training and recovery, ensuring that they perform at their best. In this article I discuss the importance of sports medicine in training and recovery and provide some tips for athletes to help them stay injury-free and achieve their goals.

Sports medicine encompasses a wide range of healthcare disciplines, including physiotherapy, nutrition, and biomechanics. The goal of sports medicine is to help athletes improve their performance, prevent injuries, and recover from injuries quickly.

One of the key aspects of sports medicine is injury prevention. Sports medicine professionals work with athletes to identify potential risk factors and develop strategies to mitigate them. This may involve improving biomechanics, ensuring proper nutrition, and developing personalised training plans.

Another important aspect of sports medicine is recovery. Athletes can experience a range of injuries, from minor strains to more severe sprains and fractures. Sports medicine professionals use a range of techniques, including physiotherapy, massage, and orthobiologics, to help athletes recover quickly and safely.

Maximising Training and Recovery with Sports Medicine:

Here are some tips for athletes to help them maximise their training and recovery with sports medicine:

  • Develop a personalised training plan: Work with a sports medicine professional to develop a training plan that is tailored to your needs and goals. This can help you train more efficiently and effectively, reducing your risk of injury.
  • Focus on proper nutrition: Nutrition plays a critical role in athletic performance and recovery. Ensure that you are getting the right balance of macronutrients (protein, carbohydrates, and fat) and micronutrients (vitamins and minerals) to support your training and recovery.
  • Use recovery techniques: Incorporate recovery techniques such as stretching, massage, and cold therapy into your routine to help your muscles recover more quickly and reduce the risk of injury.
  • Listen to your body: Pay attention to any warning signs that your body may be overtrained or at risk of injury. If you experience pain or discomfort, take a break and seek the advice of a sports medicine professional.

Sports medicine is a critical component of any athlete’s training and recovery strategy. By working with sports medicine professionals and incorporating the tips outlined above, athletes can reduce their risk of injury and perform at their best.

Reference List

 

Sprinter set in the starting blocks on a red athletics track