At some stage we’ve all had an injury of some sort, and we all know how debilitating and frustrating these can be. Over the next couple of episodes, we’re chatting with Chrissy Tadros from All Care Physio in Hobart, about injury prevention and injury management
Show notes
Hannah:
Welcome back to The Burn Pod. Now at some stage, we’ve all had an injury of some sort. It might be sore lower back or dodgy knee or a dodgy shoulder. And we all know how debilitating and frustrating these can be. Well, over the next couple of episodes, we’re chatting with a very special guest. Her name is Chrissy Tadros from AllCare Physio here in Hobart. We’re talking to her about injury prevention and injury management. So welcome Chrissy.
Chrissy Tadros:
Thanks Hannah. Thanks for having me.
Hannah:
No worries. Now, before we get into it, do you want to just give us a bit of a background on yourself and what you love and any health and fitness journey you’ve been on and what you do?
Chrissy Tadros:
Sure. Yeah, so I’m a sports physio that works at a local private practise in Sandy Bay. And I’ve been a physio for over 10 years now. So I grew up in Hobart. I guess the physio journey started at school. I always loved playing sport, variety of sport, loved it so much. I want to be Sporty Spice at all the different parties, although I had all the Scary Spice hair, so I had to change that one. And I think during school years I started to get a couple of injuries and that stopped me playing sport. And at that age it felt like the end of the world. So I was exposed to physio then, and that helped me to get back. And that’s probably where the inspiration came from.
Chrissy Tadros:
So I moved to Sydney and I studied my undergrad there and I was exposed to a local football team and water polo there, which really set me up for later, which was great. And then I moved to Melbourne to do my Masters. And like most Hobart people, we always can’t hack it on the mainland as they say in Rose Haven, and made my way back to Hobart. But really my interests are with sports injuries and musculoskeletal injuries. I’ve been really fortunate to be working across different sports, like water polo at a national state club level VFL club, and was lucky to work with the North Melbourne AFOW team when they had their little hub in Hobart last year.
Hannah:
Wow.
Chrissy Tadros:
So it was really great, really, really great group of people. So hockey state club and soccer at a community level, but it’s been across different ages. So junior team, senior teams, and across the men and the women. So it’s been lovely because I have a really big passion in women in sport, because I do think there’s such complexities to it and quite a data gap there in how different [crosstalk 00:02:58].
Hannah:
Yeah.
Chrissy Tadros:
So I really enjoy working with women in sport and I do love running, which is one of my passions. But just keeping moving, keeping active, hiking, playing football. My partner would hope I would put surfing there, but been on [inaudible 00:03:10] for like five years now, so that hasn’t progressed much.
Hannah:
Oh, that’s brilliant. I also wanted to be Sporty Spice when I was younger, but I had the blonde hair. So I had to be Baby Spice, which yes, I wasn’t happy with that.
Chrissy Tadros:
Create a new one.
Hannah:
Exactly. Well, what amazing experiences you’ve had over the last 10 years. That’s incredible. Well, let’s get into our first key focus, which is injury prevention. And I guess when we thought about starting this conversation, it would make sense to dive into this to start with. And this might be a really, really basic question, but I guess in general, what is injury prevention when we talk about it? What do we actually mean? What does it entail?
Chrissy Tadros:
Yeah, so it’s really trying to be proactive, I guess, with your health and wellbeing. So if we break it up into injury, it sort of occurs when, for most of the part, when our load or activity exceeds our body’s capacity. So our body just can’t handle that stress, if we’re looking at more of an overused type of injury. If we’re looking at an acute injury, maybe there was this moment in time, which still can have that increased load or stress in the background. And the prevention really comes from finding ways to limit our risk factors. So a lot of the time when we’re looking at injury prevention, we are looking at the research, what are the risk factors for injury in the first place? And then they’re the things that we might target, like modifiable risk factors, and there’s non-modifiable risk factors.
Chrissy Tadros:
So the non-modifiable ones might include genetics, age, previous injury’s a really big one, but they’re things that we can’t really change. So a lot of the research is really on our modifiable risk factors. They’re pretty good in sports. We see it as screenings, when someone goes and has a screening in a sports setting, it might be partly with the physio, partly with strength and conditioning, partly with a sports doctor. And we’re trying to get an idea of all their subjective history, their strength, maybe their motor control, and say, “Is this person at risk of any type of thing? Or can we intervene now before they get down into that injury pathway?”
Hannah:
Yeah. Right. So are you able to give us an… Because I find this stuff fascinating. Are you able to give us a bit of an example of someone, say a female, mid 30s, comes to you?
Chrissy Tadros:
Yeah. So with the screening stuff, like in our subjective history, we might… And it really depends on maybe what their goals are or what sport they want to be playing or what are their passions, I guess. If there’s a female in their 30s, I sort of think the female again, can be really different. So we’re talking about hormone changes and menstrual cycles. So some of the subjective questions that we would look into is do they track their menstruation, mainly for the energy levels across the cycle; and also for are they having a regular period, which is really important; it’s sort of a flag for us if they are missing their period for more than three months, or it’s been really inconsistent. Mainly again, it’s to do with bone health.
Hannah:
Yeah. Okay. Does that include when you’re skipping your pill, for example?
Chrissy Tadros:
Yeah. So it’s really hard when someone’s on the pill, because it’s hard to monitor that sort of stuff. So it’s really tricky if someone’s continued to skip, because that rules out that information for us. So for people that aren’t on the pill, we just want to really… Menstruation is such a helpful thing for a physio to understand where they are. Are they actually in what we call relative energy deficient deficiency in sport, where maybe they’re over-training and so their periods are being missed? Our cycles give us a lot of information on that. So we do want to ask for females maybe in their 30s, are they getting their regular period? We might have a look at, do they have any dietary restrictions? Vegan and vegetarian is great, but it’s just wondering are we doing it in a way that we are getting enough vitamin D and our calcium, again mainly for our bone stuff.
Chrissy Tadros:
Just looking if there’s any allergies, particularly if we’re travelling with sport teams, we want to know what sort of allergies maybe someone’s having. And any past injuries is a really big one because that can predispose us again to either similar injuries or things that might be linked there. So we would sit down with someone and say, “Okay, what are your previous injuries? What treatment did you have? Have you had any surgery and anything that might be niggling at the moment?” So it’s kind of like a snapshot in the screening. And often in sport they’re kind of in and out with health stuff, but our clinic we have a lot more time. And sometimes the sports physician would often, or sports doctor that might be travelling with you, would look a lot at that type of stuff with you.
Chrissy Tadros:
From physio point of view then, in our screenings we would have a look at range of motion, having a look at some of the strength testing. And again, it’s really dependent on what we’re looking at. So in water polo, we’d look a lot at shoulder strength and shoulder range of motion and thoracic, or your trunk rotation, and hip mobility. But if we were looking at footy, we might be looking a lot at calf capacity or calf strength and having a look at your range of motion through your spine.
Chrissy Tadros:
And if you’ve got access to strength and conditioning, they might even do further tests and further strength tests, particularly around the lower limb and a little bit in the shoulder as well. So we’re just trying to look at, I guess, the whole picture. But yeah, it’s pretty fascinating stuff and it’s really good. I think screenings are great. I think just, we need to address something, there’s one thing to do with screening, but then it’s like, “Okay, this is what we’re going to do about it, and can we stick to a routine and can we work together and get somewhere with it?”
Hannah:
Yeah. Now, if you were just your everyday person that doesn’t have access to this screening and maybe doesn’t play the high-end sports, which most of our ladies don’t, can you do your own kind of screening? Is there things that you can look out for that might then give you an indication of a predisposition to a potential injury?
Chrissy Tadros:
Yeah. So if we scale it back from being specific in sport and saying, “Okay, well what are the risk factors for injury generally?” We look at a load being a really big one. So this is something that people self monitor. And so load is that kind of amount of stress on our body. So it looks at intensity and duration of exercise. So someone might do a boxing class for 60 minutes and rate it, it was like eight out of 10 intensity. Or someone might do a yoga class for an hour, so 60 minutes, but it was a one out of… They found it really easy or something.
Chrissy Tadros:
So when we’re looking at load, we’re looking at, “Okay, can we sort of just track an idea of different exercise, what the intensity and duration is?” Because everyone has a sweet spot, a range I guess, of what they can and can’t tolerate. And we want to sort of be exercising within this sweet spot. So there’s a ceiling effect and a floor effect. And sometimes if we’re doing more than our body can handle, we’re maybe spiking a little bit far. And sometimes if we’re doing too little exercise we’re passing down and maybe that’s an injury risk. So everyone will have their own, like my example I always give is I’m really sensitive to load. I have to make sure I’m in my sweet spot. My friend who doesn’t run for three months can just get off the couch and go for a 15k run and is fine, where I’m probably maybe not so fine.
Chrissy Tadros:
So everyone can just work out a routine. The body loves, it’s like a buffet, it loves variety. It loves having a mix of routine from one day to the next. So that’s really important for the body to have this on one day, this on another day. Mix it up, but staying in your sweet spot, if we’re not trying to progress something. And consistency is key. Like I guess like for people that are having injury over Christmas or coming out of Christmas, were they on a break for three weeks and then try to get back to the same level of activity they were doing before that break? Any kind of period off, we probably would say, “Well, let’s see if we can spend a little bit more time just getting back into your activity routine, but it might take you a few weeks to get back there.” So it is sort of going a little bit slow. So people can self monitor their own load, I guess is one.
Hannah:
And you should know that when you’re doing something regularly, like you have a regular fitness class. I guess it’s when people go and do something that they’re not used to, like i.e. I haven’t gardened for a whole year, and then I’m going to spend an entire time lifting rocks or something for a rock wall.
Chrissy Tadros:
Exactly. Exactly.
Hannah:
That’s when the injury can occur because you don’t have that understanding of load. But it’s just tuning in with your body and feeling your way through and then going, “Oh, hang on. That might be a bit too much. Let’s not overdo it.”
Chrissy Tadros:
Yeah. I have a bag of orange analogy. So if we’re trying to maintain what we’ve got, you’ve got a bag of oranges to use up in a week. So if you did your garden session, which you haven’t done in such a long time, that is part of your load. It’s not just exercise, it can be things like gardening, and you went for a walk with a friend, or you were on your feet at work more. So you’ve used up some of your oranges on that day, so you’ve actually got less oranges in the week. So if you spike something, you might change your week a little bit just to balance out the rest of that week and that load.
Hannah:
I love that analogy. And that’s something that we always like to say to our ladies, that you not every week’s going to be the same. You’re not going to have the same amount of energy or motivation each week.
Chrissy Tadros:
Yeah, no. Totally.
Hannah:
If you’ve had a massive week at work, it’s going to drain you, and then to try and force yourself to do that higher level of intensity that maybe you’re used to doing, because you’ve had easier weeks, it can be a detriment to your training and to you.
Chrissy Tadros:
Exactly. School holidays is a big time that we’ll see people taking time off or going travelling. It’s really hard to keep up with the same routine. And so there are things, and being ill, everyone gets a bit run down and stressed and whatever sometimes. So it is just listening, looking ahead and saying, “Okay, it’s fine if I have a down week because I need to recover. So maybe I’ll just spend the next couple of weeks of just building myself back into what I was doing before.” So I would say definitely load would be something to self monitor, and just having recovery days is important. It is a time for the body to repair itself. So I do think that having one or two relative rest days or down days, as we like to say it, is really important.
Chrissy Tadros:
And sleep quality is becoming huge. And it’s crazy, for adults if we’re sleeping less than seven hours, the risk is about one and a half times more likely for injury. So it does make a difference and it can be really hard for people that are busy and have children. Sometimes it’s just not feasible, but sleep hygiene, temperature of room and regular sleep wake cycles. And just trying to prioritise it, maybe have naps, can really be a positive for that side of things too. And it’s crazy like adolescents, so kind of 14 to 17, they need eight to 10 hours. So it’s just trying to prioritise a little bit of that sleep can be really helpful. And the link between being fatigued and rundown and illness, and illness then affects our ability to maintain our consistency with exercise.
Hannah:
Yeah. Yeah. And when it comes to sleep, even things like drinking alcohol before you go to bed doesn’t help.
Chrissy Tadros:
It doesn’t help.
Hannah:
No.
Chrissy Tadros:
Drinking water in my case before going to bed, been waking up many times in the night.
Hannah:
Yeah. So are there specific things in our everyday lives that we can just keep an eye on? I.e. if you’ve got a desk job, sitting posture, things like that, that we can just keep an eye on to help prevent the injury?
Chrissy Tadros:
Yeah. So there is a lot of evidence on sedentary behaviour, and it can be hard for people with more of an office job. People that are working in the hospital and they’re in the K block now, the new K block, they’re on their feet like crazy now, whereas some people might be fairly seated and sedentary. But we keep talking about organised exercise and exercise classes and activity, but incidental exercise is so important. And it’s okay just to bring that into your routine, particularly if you do have a sedentary job, because there’s so much evidence on prolonged sitting and stationary positions and its effect on your metabolic rate, obesity, type two diabetes, like even your mental health. So trying to find ways of just being incidentally moving, whether park further away from the office or walk around the office to deliver messages rather than calling and little things like that can be really effective.
Chrissy Tadros:
In terms of posture, the head weighs about seven kilos. So if I’m sitting and I am [inaudible 00:16:24] am I going to get a sore neck? Maybe. We can’t guarantee, but for me personally, I probably would. Or our lower back, if we’re sitting. For me, stationary sitting does aggravate. Maybe I get a little bit of lower back stiffness and whatever. Maybe our hip flexes get a little a bit tight and that affects our posture. So we kind of went from sitting and being worried about sitting to then standing all day. And that wasn’t ideal either. So it is just saying, well, movement is probably more important. And just trying to find any way of getting moving just within your days is really helpful.
Hannah:
Yeah, than trying to sit up straight for three hours nonstop.
Chrissy Tadros:
Yeah.
Hannah:
We still end up getting a sore back anyway doing that.
Chrissy Tadros:
Yeah, exactly. That’s almost exactly what we see, I’ll see a lot of people and it’s almost like they’ve had an acute back injury in the past, like they’ve bent over, picked something up and someone said, “Okay, you need to avoid slouching now.” And so they go the other way. So they sit up super tall, and the injury’s past, and three years later they’re sitting so tall that their muscles in their back are overworking and then their back gets sore.
Hannah:
Yeah. And their core’s gone.
Chrissy Tadros:
Yeah. [crosstalk 00:17:30] But yeah, I guess posture can help, but movement’s probably our priority.
Hannah:
Yeah. Yeah. I love that. And I guess the last thing before we wrap up the injury prevention side of it, is there anything in terms of our diet that we can do that could make a difference?
Chrissy Tadros:
So I love sending patients to the dieticians, because I think they have so much to offer. Within our scope, like I mentioned before, your vitamin D is important for bones. Because I would see a lot of stress reactions, stress fractures. But I think protein needs to really be a priority, particularly post exercise for muscle gain. And I think the window, particularly for women, is a little bit shorter as to when we should be refuelling after exercise.
Chrissy Tadros:
And it’s even more important for menopausal women, is this amount of protein that we are actually getting in to help with the muscle mass that we will be losing. Because 30 years of age and our muscle mass is at this peak, and then it will start to go from 30. So it is important to say that protein can really affect our muscle gain in a positive way.
Chrissy Tadros:
And also carbohydrates, like it is the fuel source for the brain, but after about 45 minutes of exercise our body’s needing that carbohydrate intake. And also probably for some of the athletes we see as well, it is required for some of the intense performances and high-intensity exercise too. So I would say that would be my main things I would encourage people for.
Hannah:
And I guess also having a think about what you’re eating or drinking that could affect your sleep as well.
Chrissy Tadros:
Yeah, exactly. Yep. If that’s our priority. And everyone will be really different. I know if my partner has a second coffee after 12, he will not sleep that night. So everyone will have their own, where some people might need a coffee to go to bed. But it is just trying to find what works for you and maybe getting advice on that if that’s something that needs to be brought up.
Hannah:
Yeah. That was awesome. I learned so much from that. I think the key for me is the orange analogy and the load, understanding what your load is. And I think we do know that when we’re doing, as I mentioned before, doing exercise or doing classes and we’re doing them regularly, but I think we forget to take into consideration the incidental loading that we do during our day and during the week and when we have different energy weeks and different pressure weeks.
Hannah:
And then secondly, moving the body in different ways, it’s like the repetitive strain, you’re doing something and you’re doing exactly the same way again and again and again and again and again, potentially you might get that strain on those muscles. So getting the body moving. And that’s, like we talk about with our ladies, we don’t advocate doing a boxing class every single day because that’s the same thing every single day, [inaudible 00:20:17] impact. But if you mix it up with some walking or some yoga or some barre or something like that, it just makes the muscles move in a different way and could potentially strengthen them in ways that they weren’t getting in the previous exercise class, but also hoping to reduce any injury down the track.
Chrissy Tadros:
Absolutely. Yeah.
Hannah:
Yeah. Well, thank you so much, Chrissy. That was amazing. I literally could talk to you about this and pick your brain for hours.
Chrissy Tadros:
Yes. I do enjoy it. Great. Thank you.
Hannah:
I really appreciate that. Thank you so much.
Chrissy Tadros:
Thank you so much.
