We’ve all been there before…. Tracking along nicely on our fitness journey and then an injury pops up!

In part two of our chat with Chrissy Tadros from All Care Physio in Hobart, we dive in deeper as we discuss all things injury prevention and management.

Show notes

Hannah:
Welcome back, Burn Pod listeners. We’ve got our amazing Chrissy Tadros, who is a sports physiotherapist, on the podcast for our second episode. And it’s all about injury management. So, if you haven’t already, jump back to the previous episode and have a listen to that because it was all about injury prevention. And ideally, no one ever gets injured because we’re preventing it, but it’s life and we do get injured at times. And so that’s why we wanted to chat with Chrissy about managing the different types of injuries and what we can do to reduce the injury happening again and things like that. So, welcome back Chrissy.

Chrissy Tadros:
Thanks, Hannah.

Hannah:
Awesome. Well, let’s get straight into it. I guess, with injury management, we sort of touched on it before, but what are the different types of injury that you see? So, you mentioned acute and I think it was a non-acute, is that right?

Chrissy Tadros:
Yeah. Insidious or gradual onset or, yeah, same same.

Hannah:
Yeah. Well, tell us a little bit about those. What are they and what do they mean and how did they occur?

Chrissy Tadros:
So our acute injuries are an injury with a moment in time. So something’s happened, we’ve felt an immediate symptom or something’s kind of set that off and we really notice that quite specifically. Whereas out insidious onset or our gradual onset of symptoms might be, we’re not sure exactly what set it off. Maybe I was doing something, I can just notice pain or swelling or whatever else symptom may be just there and maybe it develops as we go along.

Chrissy Tadros:
So we have these two different streams and the way we manage those can be really different. And so that’s kind of a big one to say, “Okay, what happened? Was there a moment in time or has there been something? Say a gradual onset. Was there been something, any changes to your routine in the last three to four weeks that may have set this up in the first place.”

Hannah:
Yeah. So for example, you roll your ankle, that’s an acute.

Chrissy Tadros:
Yeah, so that would be an acute thing. So I might be playing soccer or in the bush and I felt, “Oh, I just rolled my ankle.” And I went, “Bang. There it is. I can feel it. That’s my symptom straightaway.” I might be doing an exercise class and I might be doing some squats and maybe I noticed my knee just felt a little bit niggly after it, or maybe it was during, and maybe a couple of days after that I started to notice it, but there wasn’t this moment in time that made my knee uncomfortable.

Hannah:
Yeah. So I guess, what are the main types of injury you see? For example, breaks or strains, in the body.

Chrissy Tadros:
So the breaks, we call it a fracture, which is the same as a broken bone. So sometimes that gets misinterpreted. And if we look at an acute fracture you might see the bone sticking out. There’s an immediate fracture. But you can have stress-related fractures. So, people that might be running and over time they notice they have pay in their foot and if we MRI it it looks like the bone’s a bit swollen, because bone is like a spectrum from healthy bone to a stress fracture. They can kind of get a fracture, but with repetitive load and not with this acute kind of mechanism. So fractures being one thing.

Chrissy Tadros:
Strains are looking mainly at muscles, maybe overstretching muscles or with a fast contraction. And often we’d see that with an acute mechanism. Like classic one might be, we see a lot of male footballers that might do their hamstring and they ping and they hold their hamstring and get off, and that’s there [inaudible 00:04:04] for them.

Chrissy Tadros:
And a sprain looks at more ligament. So that’s kind of like that ankle analogy where the joint, the ankle joint for instance, is taken to a position further than it can handle. So again, we often see that as an acute injury or the other example might be a ligament in the inside of the knee if we’re skiing or snowboarding and someone might feel that.

Chrissy Tadros:
And then we have tendon pain. So we can have things like the connective tissue that attaches muscle to bone. We can get things like tendinopathies, where the tendon is being loaded, again, more than it can handle, and that might be like an overuse thing. Or it could be an acute injury, like the Achilles rupture, which can happen. But it’s not as common as our tendinopathy.

Chrissy Tadros:
That’d be the main ones. You can get like bruises and corkys and stuff from muscle fibres.

Hannah:
Corky.

Chrissy Tadros:
and it bleeds. But that would probably be the main things we would see in a clinic setting in terms of types of injuries.

Hannah:
Are there different common injuries depending on age and sex?

Chrissy Tadros:
Yeah. So kids and adolescents have growth plates and I think in that age group, girls start to have a growth spurt around 10, 13 ish and boys, a couple of years later, so starting like 12, maybe up to 15, 16. So their growth plates are starting to… They’re getting their growth then and often we’d see different injuries in different growth plates different times for kids. So say there’s a growth plate. So at the ankle is common for kids and that tends to fuse first, so we’d see that the younger age group. And then it goes up into the knees, the next one to fuse, so we’d start to see kind of around 14 to 16, and then it’s the pelvis. That’s the last one to fuse so sometimes we see growth related injuries around the pelvis when they’re in their early to mid twenties.

Chrissy Tadros:
So the growth plates really affect the ability for that adolescent to cope with load as well. And I know some parents are really good at tracking their kid’s growth, but they just might notice in that time they start to get these funny little things that crop up a little bit. And girls going through puberty, that’s where they have a big change to hormones and change to coordination. Maybe some different types of knee symptoms can arise, but mainly from a coordination and biomechanical point of view. And that also affects their sport participation. Like it’s actually really common for girls to pull out of sport, which is such a shame, but it’s because they’re going through all these body changes and that then has a negative effect long-term for their bone health.

Hannah:
Yeah. That happened to me. I was pretty elite gymnast in Tasmania and I snapped my humerus when I was 14, I think it was. Sort of just at the height of my gymnastics career, not that I was ever going to go on and become a gymnast as a career. But I pulled out of a backsault, landed on my shoulder, snapped my shoulder in half, and we couldn’t do anything about it because it was in a growth plate. So all I could do was I couldn’t put anything on it, just strap it to my chest. And that was it.

Chrissy Tadros:
[inaudible 00:07:16].

Hannah:
Yeah, I had to stay home for two or three weeks because I couldn’t have anyone even bump it in the corridor at school. And that kind of ended everything for me because post that then puberty hit, you get boobs, you get hips, you get heavier. And then you can’t throw yourself around the floor or the beam when you’ve got a little bit of extra weight on you and a dodgy shoulder. So, yeah, [inaudible 00:07:41] gymnastics.

Chrissy Tadros:
Oh, that’s a shame. And that was so unlucky that you had a fracture, but also a growth plate injury at the same time where that fracture extended. So some kids are lucky because they get a greenstick injury or a fracture just bounces back so fast. Whereas when it hits the joint and the growth plate it can be like a whole nother ball game.

Hannah:
Yeah. And I’ve never had that full range of motion back in the shoulder for the way it healed, and I still get niggles, but a lot of other people probably have things that have happened when they’ve been growing up going through adolescence and you’re doing dumb things and you don’t have that coordination, that understanding of body awareness. So, if we come out of puberty and teenage years coming into your twenties or so, are there common injuries depending on that age and sex?

Chrissy Tadros:
So with twenties onwards, if I had to say the main thing for probably more, again, females, more than males, but we’re probably a lot more active, we’re kind of getting back into routine and probably stress fractures would be a common one, just maybe for what kind of sports I do see. So, that would be up there. We also start to get, again for females mainly, we can start to see like kneecap pain, we call it patellofemoral pain, and that can be just going hiking and going downstairs more or squatting, or sometimes even running and running different ways, downhill and things like that. So I would say they would be probably more common types of injuries.

Chrissy Tadros:
In males, again, I would see a little bit of low back stuff as well and I think low back pain tends to be one of the most common injuries we would see generally across the board. And also because for females our pelvis is wider, so we tend to get more knee pain and stuff like that. But for males, because their pelvis is narrow, they might have more hip and groin pain and symptoms. So, just biomechanically what we would see and maybe the type of sport that they might push towards, which might be a lot of this kicking sport, although females are coming up into that too, that their hip and groin might be something more common in the males in their twenties.

Hannah:
Yeah, yeah. And when we come to pregnancy in women, are there common injuries that occur pre post pregnancy that you see?

Chrissy Tadros:
Yeah, so pregnancy is a fun one. So, we would look a lot at probably more during pregnancy is pelvic related pain, or pelvic girdle pain, is a common thing, low back. And a lot of that’s to do with our centre of mass changing, like our body position changing with the way that the front and also the laxity and ligament changes that can occur obviously to prepare for baby. I think it’s good though to find activity that people can still do because even pelvic floor, there’s a lot of muscles around the pelvis that attaches to the pelvic floor. So like our adductors and our glutes and hamstrings and stuff. So it is just trying to obviously see someone that specialises in exercise for pregnancy and then try to get something there for you as a way to limit some of those symptoms.

Chrissy Tadros:
And then post, like after we’ve had some downtime, I would say there’s some really great pelvic floor physios around on women’s health physios just to touch base with and check because I think incontinence is something that is common for women, but it’s definitely treatable. And that’s not even with pregnancy that’s for a lot of mainly females again, is this leakage or urgency that can be really affecting their lives, but there is definitely stuff to improve that.

Hannah:
Yeah. Yep. And I guess coming into pre and post-menopause, what do you quite often see there?

Chrissy Tadros:
So, the main things we would see around menopause and to do with hormone changes is like tendon changes. So the oestrogen can really affect tendons. So, we start to see a lot of rotator cuff pain and tendinopathy. Just kind of shoulder tendons and muscle tendon units that might be overworked, but also that oestrogen affecting that. And the other common tendon pain is like gluteal tendons and the side of the hip muscles for menopause or going through that transition phase for those women as well. So that would be definitely tendons with menopause, but also again bone changes is a big one with, again, that change in oestrogen. So whether that be stress reaction or stress fractures, and just being aware of osteoporosis and stuff like that.

Chrissy Tadros:
And I guess we start to see a lot, not just in women at all, but around that age, maybe osteoarthritis type of symptoms start to become a bit more prevalent. But again, we would say that across the board, but around that age group it might just start to creep up in terms of symptoms. It’s not actually to do with age, it’s to do with previous injury or what kind of activities we’ve done in the past and family history.

Hannah:
And a history, yeah.

Chrissy Tadros:
But we would definitely start to see it a little bit more in around that age group.

Hannah:
Yeah. And when should people seek out physiotherapy?

Chrissy Tadros:
So I would say most people will have some level of discomfort creeping up in their lives, but if it lingers more than a few days, then we’re saying to say, “Okay, maybe that’s something that we need to address.” If symptoms are fairly high, so you might have a little bit of stiffness in the morning and it warms up, a few days later it’s actually fine again, that might be okay. But if we’re saying like, “I have six out of 10 pain and this is keeping me up at night,” then I think that’s a pretty clear indication that physio can be warranted. But it’s also good if you want advice and an understanding of what’s going on. So even if you’ve had a niggle, it might settle down quickly, but you’ve got something coming up and you want to make sure that that’s going to be okay, or you want preventative strategies. So whatever was going on, maybe that doesn’t happen again. So I would say that’s also another time. So a lot of education and information is given out from physio and also prevention of injuries too.

Hannah:
Prevention, yeah. So, you say you’re going to do the Kokoda Trail, for example, that might be a chance for you to go and have a chat to a physio and say, “Right, well, this is what I’ve been given as a training plan. What can I do around this to make sure that I’m not getting repetitive strain or maybe strengthening my ankles for the uneven ground,” and that sort of thing. So it’s not necessarily when you’re in pain that you should seek out physiotherapy, but it’s also preventative as well, which I think is really good to remember. Because I even forget that too. So, if you are someone that’s looking at going into, maybe you’re training for a marathon or that’s maybe a goal of yours or a half marathon this year, it wouldn’t actually be a bad idea to go and have a chat with a physio.

Chrissy Tadros:
Yeah, that’s a good idea. The [inaudible 00:15:08] is a big one actually because over the COVID period and a lot of groups went when they kind of reopened things, and that was cool. We just started to see a lot of people coming in and saying, “Okay, I need to be able to carry a pack or I need to be able to walk this distance and what can I do to kind of prepare myself?” So that was really nice.

Hannah:
Yeah, yeah. Awesome. Because it’s not often that people think that way. They sort of go, “Oh, hang on now something’s wrong. Now I’ll go see such and such.” It’s like, once again, dentistry, you want to stop your teeth from rotting out before they start rotting out.

Chrissy Tadros:
Preferably, yeah.

Hannah:
Preferably, yeah. Ideally.

Chrissy Tadros:
Yeah. I think COVID’s been good in a way because I think people are getting more aware of their health and wellbeing and just keeping active in what situation they’ve got and what they can access, I guess, in the moment. We’re getting busier, in fact, just from people actually coming in and saying like, “Okay, I want to be able to do, this is my new goal now, because I’ve got time and I’ve got new things that I want to be achieving.” So it’s really nice to see that.

Hannah:
Yeah, thanks so much for joining us Chrissy. It was awesome to talk about injury management in general. And guys, I hope that’s helped. We’ve looked at some really great stuff there. Thinking about that traffic light system, that between one and 10, just checking in on your load, getting an understanding that load looks different for us each week. It’s not always the same. I see it. I have these weeks where I’m like, “Yep, I’m smashing it.” And I’ve done a session and I’ve worked out every single day that week. And I feel great and I’ve got heaps of energy and I’m just like, “Yes! I could rule the world.” And then the following week, it’s a struggle. An absolute nightmare to try and get myself to even do three or four sessions.

Hannah:
And it’s not an indication of you’re not fit or you’ve lost your strength or that’s all it’s going to be. It’s [inaudible 00:17:03] load that you’ve had that week. You might be busier at work, you might be more stressed at work, you mightn’t have slept as well, you mightn’t have fueled yourself as well as you have previously, i.e. might’ve had a few extra wines to deal with the busy-ness at work and then that’s impacting on what you’re eating, so you don’t have the energy there. Or you might just be having a low week, i.e. it’s in your cycle. You might just be coming into about to have your period and my energy is always a lot lower and I’m pathetic mess at that point, wonder every single time why and then realise, “Oh yeah, that’s why.”

Hannah:
So, give yourself the break, check in with yourself. And this is where starting to recognise and learning and understanding, listening to your body and where you’re at and looking at all the things that are going on around you is really critical for us. It also stops that little voice, that really mean voice in our head that starts having a little goal at you because you mightn’t have as much energy and you mightn’t have done as many classes. And then we get the guilts and so on and so forth. It ends up being this lovely vicious cycle that we get ourselves into.

Hannah:
So, if we can take anything away from this podcast and something that I’d love you all to focus on for the rest of the year and the rest of your life is just checking in. Listening to your body and going, “Right. Well, I’m moving because, one, the consistency and getting to your classes regularly is really important.” But knowing that it’s showing up and then being there, it doesn’t matter if you’re not going as hard as you did the last week, knowing that you’ve had a busy week or listening to the body and going, “Right. Well, maybe I do need a down day. Maybe I do need to maybe switch my fourth class this week to two days time, because I just want to go for a light walk with the dog and that’s it.” That’s okay. So listening to that body is really important.

Hannah:
So I hope that helps. I’m loving it. We’re going to get into specific injury focus on the next podcast, guys. So get ready and have a listen to that one.

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