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Importance of calf capacity

Importance of calf capacity

29 October 2024

The Importance of Good Calf Muscle Capacity in Preventing and Rehabilitating Lower Limb Injuries

Calf muscles, primarily consisting of the gastrocnemius and soleus muscles, play a vital role in lower limb function and overall biomechanics. These muscles are essential for movements such as walking, running, and jumping, contributing to ankle stability, propulsion, and shock absorption. Strong and flexible calf muscles not only enhance athletic performance but also prevent lower limb injuries and support rehabilitation after injury. This article outlines the importance of calf muscle capacity, provides data on its impact on joint loading, and explains how to assess calf capacity in clinical settings.

The Role of Calf Muscles in Lower Limb Function

The calf muscles work as a dynamic powerhouse during movement. The gastrocnemius and soleus muscles, in conjunction with the Achilles tendon, drive plantarflexion, which is the action of pushing the foot off the ground. This movement is crucial for walking, running, and jumping, as it propels the body forward. Additionally, the calf muscles play a role in absorbing the impact forces generated when the foot strikes the ground, thus reducing stress on other structures like the knee, hip, and lower back.

By acting as shock absorbers and stabilizers, the calf muscles influence the load distribution across the entire lower limb. Proper calf function ensures that forces are dispersed evenly, preventing overloading of other structures and contributing to balanced biomechanics. When calf muscles are weak or fatigued, they fail to perform this role efficiently, leading to improper movement patterns and potentially contributing to injuries of the lower limb, such as ankle sprains, Achilles tendinopathy, anterior knee pain, and plantar fasciitis. Weak calf musculature may also exacerbate symptoms such as osteoarthritis in the foot, ankle and knee.  A study by Alshami and Alhassany (2020) 1, found that calf muscle strength was significantly reduced in the patients with knee OA compared with that in the healthy control participants. Therefore it could be a good idea to ensure that within an OA knee patient’s exercise programme, there is targeted calf strengthening.

Impact of Strong Calf Muscles on Knee Joint Loading

Strong calf muscles not only support the ankle but also significantly reduce the load on the knee joint during various activities. Research has shown that adequate calf strength can reduce knee joint loading by absorbing the ground reaction forces that occur during walking or running. The soleus muscle, in particular, is known to play a key role in reducing the stress on the knee by generating posterior shear forces at the tibia, which counteract the forward forces that tend to overwork the knee.

A 2019 study by A. Bohm, 2,  found that the soleus muscle can contribute up to 50% of the force needed to decelerate the body during walking and running, thereby offloading the knee joint considerably. Research indicates that strong calf muscles can reduce the load on the knee by up to 20-25% during activities like walking and stair climbing . This effect is critical in both preventing injuries such as patellofemoral pain syndrome and in managing conditions like osteoarthritis, where reduced joint loading can slow the progression of cartilage wear.

In individuals with weakened calf muscles, this offloading effect is diminished, forcing the knee and other structures to take on additional load, which increases the risk of injury. Athletes, in particular, benefit from strong calf muscles, as these muscles allow them to handle high-impact activities like running and jumping without overstressing the knee joint.

Testing Calf Capacity in Clinical Settings

Given the importance of calf muscle capacity in preventing and rehabilitating lower limb injuries, clinicians need reliable methods to assess both the strength and endurance of the calf muscles. Below are some of the most effective ways to test calf capacity in a clinical setting:

  • Calf-Raise Test (Repetitive Heel-Raise Test): The single-leg calf-raise test is a simple and widely used method to assess calf muscle endurance. In this test, the patient stands on one leg and performs heel raises, lifting the heel off the ground as high as possible with the number of repetitions completed before fatigue, recorded. This test evaluates both the gastrocnemius and soleus muscles, providing a measure of endurance, which is critical for injury prevention. Hebert et. Al (2017) 2, carried out a great study which generated a guide to target rep ranges for different patient groups based on age and sex.
  • Maximal Voluntary Isometric Contraction (MVIC): This test measures the maximum force a person can generate during an isometric contraction of the calf muscles. Using a dynamometer, clinicians can measure the force output when the patient pushes against resistance in a fixed position. The MVIC is a reliable method to assess the maximal strength of the calf muscles, especially useful in identifying deficits that may contribute to injury risk or delay rehabilitation.
  • Single-Leg Hop Test: This test is used to evaluate functional strength and power in the calf muscles. The patient is asked to perform a series of single-leg hops for distance or height. A significant discrepancy between the two legs indicates potential calf muscle weakness or imbalance. This test is particularly useful for athletes who need to perform explosive movements during sport, as it mimics the high-force demands placed on the calf muscles.
  • Functional Movement Assessments: Assessing how the calf muscles function during movements like squats, walking, or running is also valuable in clinical settings. Analysing gait or performing functional movement screens allows clinicians to observe whether the calf muscles are functioning optimally during dynamic activities. This type of assessment is particularly relevant for athletes and individuals recovering from injury, as it highlights any biomechanical deficiencies related to calf muscle performance.

Rehabilitation of Lower Limb Injuries: Calf Strengthening

Injury rehabilitation programs often include exercises aimed at restoring calf muscle strength, endurance, and flexibility. Isometric calf exercises can be used early in rehabilitation to improve muscle activation without placing too much strain on the injured tissue. Over time, patients progress to more dynamic exercises such as calf raises, hopping, and plyometric drills, depending on the severity of their injury and their physical goals. Green et. Al (2022) 3, break up the involvement of calf specific exercises into 4 nice stages which a patient or player should go through in order to go from day 1 to return to play. These stages are: Early loading and foundation calf and lower limb function, Loaded strengthening, loaded power, plyometrics and ballistics and finally, Locomotion.

Conclusion

Good calf muscle capacity is vital for preventing lower limb injuries and supporting effective rehabilitation. Strong and flexible calf muscles reduce the load on the knee joint by as much as 20-25%, play an essential role in stabilizing the ankle, and help prevent common injuries such as Achilles tendinopathy, plantar fasciitis, and knee injuries. Clinicians can use a variety of tests, such as the calf-raise test and MVIC, to assess calf muscle strength and endurance. By incorporating calf training and flexibility exercises into rehabilitation and prevention programs, individuals can improve their lower limb function, reduce the risk of injury, and ensure a quicker recovery following injury.

Reference List

 

  • Alshami, A.M. and Alhassany, H.A. (2020). Girth, strength, and flexibility of the calf muscle in patients with knee osteoarthritis: A case–control study. Journal of Taibah University Medical Sciences, 15(3), pp.197–202. doi:https://doi.org/10.1016/j.jtumed.2020.04.002.
  • Bohm S, Mersmann F, Santuz A, Arampatzis A.. 2019. The force–length–velocity potential of the human soleus muscle is related to the energetic cost of running. Proc. R. Soc. B Biol. Sci. 286, 20192560 ( 10.1098/rspb.2019.2560)
  • Hébert-Losier, K., Wessman, C., Alricsson, M. and Svantesson, U. (2017). Updated reliability and normative values for the standing heel-rise test in healthy adults. Physiotherapy, 103(4), pp.446–452. doi:https://doi.org/10.1016/j.physio.2017.03.002.
  • Green, B., McClelland, J.A., Semciw, A.I. et al. The Assessment, Management and Prevention of Calf Muscle Strain Injuries: A Qualitative Study of the Practices and Perspectives of 20 Expert Sports Clinicians. Sports Med – Open 8, 10 (2022). https://doi.org/10.1186/s40798-021-00364-0
Runner in shorts and trainers on an outdoor athletics track
Stay Active, Stay Healthy: The Importance of Physiotherapy for Active Individuals

Stay Active, Stay Healthy: The Importance of Physiotherapy for Active Individuals

3 October 2024

Clinician working with a patient fitted with prosthetic limbs
Photo by Annie Spratt on Unsplash

Maintaining an active lifestyle is crucial for overall health and well-being in today’s fast-paced world. Whether you’re a seasoned athlete or simply someone who enjoys staying active through sports and exercise, taking care of your body is paramount. However, as you age, changing your approach to fitness is essential to stay active. Proactive preventive approaches such as physiotherapy can prevent injuries, enhance performance, and enable you to continue enjoying the activities you love for years to come.

Who is a physiotherapist? How can a physiotherapist help me?

Physiotherapists, also known as physical therapists, are highly trained healthcare professionals who specialize in assessing, diagnosing, and treating a wide range of musculoskeletal and movement-related conditions. Their primary focus is on optimizing movement, promoting physical well-being, preventing injuries, and rehabilitating individuals who have experienced physical impairments. Here’s an overview of what physiotherapists do and how they can help you stay active:
  • Assessment: Physiotherapists begin by comprehensively assessing the patient’s condition. This involves evaluating their physical function, range of motion, strength, posture, and pain or discomfort. The goal is to identify the underlying issues that may be causing the patient’s problems.
  • Diagnosis: Based on the assessment, physiotherapists diagnose the underlying causes of the patient’s symptoms. They determine the root of the issue, whether it’s a specific injury, a musculoskeletal problem, a neurological condition, or a combination of factors.
  • Treatment Planning: Physiotherapists create personalized treatment plans tailored to the patient’s needs, goals, and condition. These plans often include a combination of various therapeutic techniques and exercises designed to address the identified issues.
  • Exercise Prescription: Physiotherapists prescribe specific exercises and therapeutic activities that target the patient’s condition. These exercises strengthen weak muscles, improve flexibility, enhance balance, and address movement abnormalities.
  • Patient Education: Educating the patient about their condition, proper body mechanics, injury prevention, and self-management techniques is a significant part of a physiotherapist’s role. Patients are empowered to participate in their recovery and long-term health actively.
  • Rehabilitation: Physiotherapists play a crucial role in the rehabilitation process after surgeries, accidents, or injuries. They help patients regain strength, flexibility, and function, guiding them through a structured recovery program.
  • Monitoring Progress: Throughout the treatment process, physiotherapists continually assess the patient’s progress and adjust the treatment plan as needed to ensure optimal results.

Top 5 reasons why physiotherapy is essential for active individuals

Active lifestyles put increased stress on our bodies, making them more susceptible to overuse injuries, muscle imbalances, and joint problems. Physiotherapists at Opus Biological specialize in identifying and addressing these issues before they escalate, thus reducing the risk of injuries. They design personalized exercise plans to strengthen weak areas, improve flexibility, and optimize biomechanics, improving performance and efficiency in sports and activities. Moreover, as individuals age, physiotherapy ensures that they can adapt their exercise routines to maintain mobility, balance, and function, allowing them to enjoy an active lifestyle for life. Here are the top 5 reasons to choose physiotherapy to maintain an active lifestyle:

  • Injury Prevention: Active individuals often engage in high-impact activities that put a strain on muscles, joints, and ligaments. Physiotherapy helps identify areas of weakness, imbalance, or poor biomechanics. Through targeted exercises and corrective techniques, physiotherapists can prevent injuries by strengthening these vulnerable areas, reducing the risk of overuse injuries, strains, and sprains.
  • Improved Performance: Physiotherapy isn’t just about preventing injuries; it’s also about optimizing performance. Physiotherapists can analyse an individual’s movement patterns, identify inefficiencies, and provide tailored exercises to improve form, strength, and flexibility. This optimization leads to better athletic performance and increased endurance.
  • Faster Recovery: If an active individual does experience an injury, physiotherapy is essential for a swift and effective recovery. Physiotherapists employ manual therapy, targeted exercises, and modalities like ultrasound or electrical stimulation to speed up the healing process, restoring function and reducing the risk of complications.
  • Personalized Guidance: Physiotherapy at Opus Biological offers individualized care that aligns with your needs, goals, and physical condition. This personalized approach ensures that active individuals receive tailored advice, exercises, and strategies that address their unique challenges, helping them achieve their fitness objectives while minimizing the risk of setbacks.
  • Staying Active for Life: Physiotherapy helps adapt exercise routines to address age-related changes, such as reduced joint flexibility or muscle strength. This ensures active individuals can continue enjoying their preferred activities as they age, promoting overall health and well-being.

Managing Injuries Better with Physiotherapy

Physiotherapist guiding a patient through a resistance band exercise

Photo by Sincerely Media on Unsplash

Preventing injuries is always better than treating them, and that’s where physiotherapy shines. A physiotherapist is a healthcare professional trained to assess and address musculoskeletal issues, identify potential problems, and design personalized prevention plans. By identifying weak areas, poor movement patterns, or imbalances, a physiotherapist can create exercises and strategies to address these issues, reducing the risk of injury.

For active individuals, this proactive approach is a game-changer. It allows you to identify and correct small issues before they become significant problems. It’s like giving your body a regular check-up, ensuring every joint, muscle, and ligament functions optimally. By investing time in physiotherapy, you’re investing in your body’s longevity.

Individualized Care Matters

Physiotherapist supporting a patient lifting small dumbbells

Photo by Sincerely Media on Unsplash

One of the significant advantages of physiotherapy at Opus Biological is its personalized approach. Every person is unique, and their needs, goals, and physical conditions are distinct. Our physiotherapists work closely with you to understand your specific conditions and design a customized plan that addresses your concerns.
Whether recovering from a sports injury, looking to improve your athletic performance, or seeking guidance on maintaining an active lifestyle as you age, our physiotherapists can provide the tailored care you require. The individualized attention you receive ensures that you’re on the right path, with exercises and strategies that align with your goals, ultimately helping you achieve desired results.

Final Thoughts

Staying active is a beautiful way to maintain your health and enjoy life to the fullest. However, taking a proactive approach is essential to ensure that you can continue being active without unnecessary setbacks. Physiotherapy offers a comprehensive solution, focusing on prevention, performance enhancement, and longevity in your active lifestyle.
By investing in regular physiotherapy sessions at Opus Biological, you’re investing in your body’s well-being. You’re taking steps to prevent injuries, optimize your performance, and adapt your approach to physical activity as you age. With the guidance of a skilled physiotherapist, you can ensure that you’re staying active and healthy for years to come, enabling you to enjoy the activities you love and lead a fulfilling, active life. So, make physiotherapy an integral part of your active lifestyle – your body will thank you for it.
The Effectiveness of Physiotherapy on Subacromial Impingement Syndrome

The Effectiveness of Physiotherapy on Subacromial Impingement Syndrome

7 August 2024

Subacromial impingement syndrome (SAIS) is an umbrella term for a variety of inflammatory pathologies within the subacromial space. These include rotator cuff syndrome, bursitis, tendinopathy and calcific tendinitis. Conservative treatment is used to decrease inflammation, restore range of motion in the shoulder and strengthen the rotator cuff (Gebremariam et. al, 2013). Physiotherapy has shown to be an effective method for treating SAIS and should be considered as the first line of care (Dicken et. al, 2005). However, it is important to understand which therapeutic modalities should be prioritised and considered when treating SAIS.

There is a wealth of research suggesting to focus on scapular stabilization and rotator cuff strengthening when rehabilitating patients with SAIS. For example, Baskurt et. all investigated the effectiveness of scapular stabilization on pain, shoulder range of motion, joint position sense (JPS), scapular dyskinesis and quality of life in patients with SAIS. They discovered the combination of scapular stabilization, shoulder strengthening and stretching is the most effective method in improving JPS and decreasing scapular dyskinesis (Baskurt et. al, 2011).  Michener et. al compared various treatments for SAIS (exercise, joint mobilisations, laser, ultrasound and acupuncture) in a systematic review. The evidence suggested laser therapy is only beneficial when used in isolation and there is no benefit in using ultrasound or acupuncture. However, the most effective treatment for SAIS is the combination of rotator cuff strengthening and scapular stabilisation alongside joint mobilisations (Michener et. al, 2004). Additionally, Celik concluded that patients with SAIS exhibited a lower visual analog scale score when exercises were performed within pain free range of motion (90 degrees and below). Overall research illustrates rotator cuff strengthening, scapular stabilization and joint mobilization are essential when treating SAIS. Furthermore, during the early stages of rehabilitation, prescribing exercises below 90-degree shoulder flexion can aid in pain management (Celik, 2009).

When creating a rehabilitation programme, practitioners should consider a patient-centered approach. It is important to recognize patients’ pain tolerance and threshold when prescribing exercises for SAIS. Vallés- Carrascosa et. al compared painful eccentric exercises (PEE) to pain free eccentric exercises when treating SAIS. Remarkably, PPE was found to provide no additional benefits. Therefore, practitioners should consider prescribing pain free exercises to promote compliance with rehabilitation programmes, especially for patients with a lower pain tolerance (Vallés- Carrascosa et. al,2018).

 

Reference List

 

  • Başkurt, Z., Başkurt, F., Gelecek, N. and Özkan, M.H. (2011). The effectiveness of scapular stabilization exercise in the patients with subacromial impingement syndrome. Journal of Back and Musculoskeletal Rehabilitation, 24(3), pp.173–179. doi:https://doi.org/10.3233/bmr-2011-0291.
  • Celik, D. (2009). Comparison of the effects of two different exercise programs on pain in subacromial impingement syndrome. Acta Orthopaedica et Traumatologica Turcica, 43(6), pp.504–509. doi:https://doi.org/10.3944/aott.2009.504.
  • Dickens, V.A., Williams, J.L. and Bhamra, M.S. (2005). Role of physiotherapy in the treatment of subacromial impingement syndrome: a prospective study. Physiotherapy, 91(3), pp.159–164. doi:https://doi.org/10.1016/j.physio.2004.10.008.
  • Gebremariam, L., Hay, E.M., van der Sande, R., Rinkel, W.D., Koes, B.W. and Huisstede, B.M.A. (2013). Subacromial impingement syndrome—effectiveness of physiotherapy and manual therapy. British Journal of Sports Medicine, 48(16), pp.1202–1208. doi:https://doi.org/10.1136/bjsports-2012-091802.
  • Michener, L.A., Walsworth, M.K. and Burnet, E.N. (2004). Effectiveness of rehabilitation for patients with Subacromial impingement syndrome: a systematic review. Journal of Hand Therapy, 17(2), pp.152–164. doi:https://doi.org/10.1197/j.jht.2004.02.004.
  • Vallés-Carrascosa, E., Gallego-Izquierdo, T., Jiménez-Rejano, J.J., Plaza-Manzano, G., Pecos-Martín, D., Hita-Contreras, F. and Achalandabaso Ochoa, A. (2018). Pain, motion and function comparison of two exercise protocols for the rotator cuff and scapular stabilizers in patients with subacromial syndrome. Journal of Hand Therapy, 31(2), pp.227–237. doi:https://doi.org/10.1016/j.jht.2017.11.041.
Close-up of a man's raised arm and shoulder
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
Recovering from Delayed Onset Muscle Soreness

Recovering from Delayed Onset Muscle Soreness

26 June 2024

Delayed onset muscle soreness (DOMS) is defined as ‘ultrastructural damage of muscle cells due to unfamiliar sporting activities or eccentric exercise, which leads to further protein degradation, apoptosis and local inflammatory response’ (Hotfiel et. al 2018) The micro tears caused by eccentric movements can impact performance by reducing joint range of motion and alter muscle recruitment patterns. This can increase risk of a soft tissue injury but treatment strategies for DOMS remain uncertain. Common treatment strategies include anti-inflammatories, massage and cryotherapy. Seidel et. al investigated the optimum treatment for DOMS and found non-steroidal anti-inflammatory drugs did reduce the pain but delayed the recovery.  Other interventions were examined (nutritional and physical) and found that there was a reduction in inflammation but no treatment aided muscle regeneration. (Seidel et. al, 2012)

Massage can be an effective tool to aid recovery from DOMS, however most research states the type and timing of the massage is important.  Hilbert et. al found that there was a reduction in muscle soreness 48 hours post exercise when massage is administered 2 hours after exercise, (Hilbert et. al, 2003). However, Visconti et. al found massage to be an effective tool to reduce DOMS during the onset of symptoms (Visconti et. al, 2015).

Cryotherapy has conflicting research on the effectiveness to alleviate DOMS. For example, Eston and Peters studied the use of cold-water immersion for recovery. They found 2-3 days post exercise, participants who used cold water immersion had increased joint range and reduced creatine kinase activity compared to the control group. However, both groups presented with muscle tenderness, swelling and reduced isometric strength 3 days following exercise. Howaston and Van Someren investigated the impact of ice massage therapy on DOMs, however discovered it is not an effective treatment due to only noticing creatine kinase reduction at 72 hours (Bishop et. al, 2008).

Evidence suggests adapting your exercise programme is the most efficient method to alleviate DOMS however the analgesic effect has been shown to be temporary (Zainuddin et. al, 2011). Cheung et. al suggests when exercising on a daily basis, one should reduce intensity and duration of exercise 1-2 days following DOMS. Training body parts that are less affected by DOMS and progressively overloading eccentric exercises over a 1 to 2 week period are efficient methods to manage DOMS (Cheung et. al 2003).

Reference List

Bishop, P.A., Jones, E. and Woods, A.K. (2008). Recovery From Training: A Brief Review. Journal of Strength and Conditioning Research, [online] 22(3), pp.1015–1024. doi:https://doi.org/10.1519/jsc.0b013e31816eb518.

Cheung, K., Hume, P.A. and Maxwell, L. (2012). Delayed Onset Muscle Soreness. Sports Medicine, [online] 33(2), pp.145–164. doi:https://doi.org/10.2165/00007256-200333020-00005.

Hilbert, J.E., Sforzo, G.A. and Swensen, T. (2003). The effects of massage on delayed onset muscle soreness. British Journal of Sports Medicine, [online] 37(1), pp.72–75. doi:https://doi.org/10.1136/bjsm.37.1.72.

Hotfiel, T., Freiwald, J., Hoppe, M., Lutter, C., Forst, R., Grim, C., Bloch, W., Hüttel, M. and Heiss, R. (2018). Advances in Delayed-Onset Muscle Soreness (DOMS): Part I: Pathogenesis and Diagnostics. Sportverletzung · Sportschaden, 32(04), pp.243–250. doi:https://doi.org/10.1055/a-0753-1884.

Seidel, E., Rother, M., Hartmann, J., Rother, I., Schaaf, T., Winzer, M., Fischer, A. and Regenspurger, K. (2012). Eccentric Exercise and Delayed Onset of Muscle Soreness (DOMS) – an Overview. Physikalische Medizin, Rehabilitation Medizin, Kurortmedizin, 22(02), pp.57–63. doi:https://doi.org/10.1055/s-0032-1304576.

Visconti, L., Capra, G., Carta, G., Forni, C. and Janin, D. (2015). Effect of massage on DOMS in ultramarathon runners: A pilot study. Journal of Bodywork and Movement Therapies, [online] 19(3), pp.458–463. doi:https://doi.org/10.1016/j.jbmt.2014.11.008.

Zainuddin, Z., Sacco, P., Newton, M. and Nosaka, K. (2006). Light concentric exercise has a temporarily analgesic effect on delayed-onset muscle soreness, but no effect on recovery from eccentric exercise. Applied Physiology, Nutrition, and Metabolism, 31(2), pp.126–134. doi:https://doi.org/10.1139/h05-010.

Man raising his arm behind his head while his shoulder is assessed
Take a dip!

Take a dip!

18 June 2024

Hydrotherapy, or aquatic based therapy, is a treatment method I have personally used with patients ever since first becoming an MSK physiotherapist. From my first ever exposure to the method in my early NHS, Junior Physiotherapist role, to using a pool with elite athletes competing in a number of different sports in my more recent career, I very rarely find that the patient doesn’t leave the session with some form of positive gain. Hydrotherapy is defined as the external or internal use of water in any of its forms (water, ice, steam) for health promotion or treatment of various diseases with various temperatures, pressure, duration, and site (Mooventhan and Nivethitha, 2014) (4). Like many good things, it has been used for 1000s of years to assist in the management of health conditions whether that be to aid movement or relieve pain. Today, we very much utilise the benefits of water to treat a variety of health conditions ranging from cardiovascular, to rheumatological, neurological and musculoskeletal injuries. So what are the benefits of hydrotherapy? Well, to break it into pointers, these are the reasons as to why we can find benefit from hydrotherapy:
  1. Pain Relief 
  • Immersion in warm water can help reduce pain and inflammation in muscles and joints. The heat increases blood flow, which can ease discomfort and accelerate the healing process. The pressure exerted by water also helps to reduce swelling and improve circulation
  1. Muscle Relaxation and Recovery
  • Warm water helps to relax tense muscles, reducing spasms and stiffness. It can also enhance muscle recovery after intense physical activity by promoting blood flow and reducing lactic acid buildup.
  1. Improved Circulation
  • Warm water immersion helps dilate blood vessels, improving circulation throughout the body. This can aid in delivering oxygen and nutrients to tissues and removing waste products.
  1. Stress Reduction and Mental Health
  • The soothing properties of water can help reduce stress and anxiety. The buoyancy and warmth create a relaxing environment that can promote mental calmness. This can have a direct positive correlation to improving a person’s ability to sleep due to the relaxed state they enter.
  1. Mobility
  • The buoyancy of water reduces the load on joints, making it easier to move and perform exercises. Water provides a low-impact environment for exercise, reducing the risk of injury. This makes hydrotherapy an excellent option for rehabilitation after surgery or injury.
It is easy to see how we can utilise hydrotherapy to benefit a variety of patients based on the benefits mentioned. Carere and Ore (2016) carried out a review which concluded that hydrotherapy has a positive effect on pain, quality of life, condition-related disability and functional exercise capacity. In fact, the perceived benefit of well-being was actually superior to land-based exercise protocols in cases where water temperature was within a thermoneutral range (33.5–35.5 °C). (2) Cikes et al. (2021) (3) looked specifically at the use of hydrotherapy as an alternative to dry land therapy for rotator cuff repair patients. Through their study they found that the use of pool-based rehabilitation was as effective as dry land rehabilitation at the 1 and 2 year follow up points but that Pool based rehab was in fact MORE effective than dry land exercise at the 3 month follow up point. This therefore suggests that the use of water in the early to mid stages of this particular recovery is beneficial. Then, away from rehabilitation, the pool can also be a useful tool in the role of optimizing recovery for athletes between heavier training sessions or competition. As such, the pool can be used as a recovery tool to support low load conditioning and accelerated recovery between training sessions or match play. This is particularly relevant following intense training days on the field and/ or in the gym, which are designed to load the athlete to develop their tolerance to increased training demands. (Buckthorpe et al 2019) (1) So, whether it be for: rehabilitation from surgery or an acute injury, pain management for a longer-term condition or as a tool in optimizing active recovery, hydrotherapy is another great string to our bow as physiotherapists and can be of great benefit to a large chunk of our patient population.

Reference List

 
  • Buckthorpe, M., Pirotti, E. and Villa, F.D. (2019). BENEFITS AND USE OF AQUATIC THERAPY DURING REHABILITATION AFTER ACL RECONSTRUCTION -A CLINICAL COMMENTARY. International Journal of Sports Physical Therapy, [online] 14(6), pp.978–993. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6878863/.
  • Carere, A. and Orr, R. (2016). The impact of hydrotherapy on a patient’s perceived well-being: a critical review of the literature. Physical Therapy Reviews, 21(2), pp.91–101. doi:https://doi.org/10.1080/10833196.2016.1228510.
  • Cikes, A., Kadri, F. and Lädermann, A., 2021. Evaluation of Three Different Rehabilitation Protocols After Rotator Cuff Repair, and the Effectiveness of Water/Pool Therapy. A Randomized Control Study. Journal of Shoulder and Elbow Surgery, 30(7), p.e421.
  • Mooventhan, A. and Nivethitha, L. (2014). Scientific evidence-based Effects of Hydrotherapy on Various Systems of the Body. North American Journal of Medical Sciences, [online] 6(5), p.199. doi:https://doi.org/10.4103/1947-2714.132935.
Swimmer gliding underwater in a lane of a swimming pool