Massage therapy has proven itself to be very effective in minimising the effects of prolonged inactivity. This form of therapy involves hands-on techniques to increase circulation, relieve tension, reduce stress, relieve anxiety, improve sleep, and promote relaxation throughout the entire body, as well as many other benefits.
UFIT Osteopath, Paul Stoenescu gives us a break down on the difference between a Physiotherapist, Osteopath and a Chiropractor to help you make an informed decision when you are unsure of the rehabilitation medicine that you should be going for.
The rise in mainstream popularity of combat sports in recent years has seen more people taking up the sport as a way to keep fit. Be it boxing, muay thai, jiu-jitsu, or mixed martial arts (MMA), combat sports are great for stress-relieving, as well as offer a cardio-intensive full-body workout.
While this development is exciting and highly promising, there is a growing concern over the increase in numbers of combat sport-related injuries we see in the clinic, particularly in the shoulders. This can greatly impact on your training and performance in the sport, and if not treated in time, develop into a more serious chronic condition.
Here are the top 3 most commonly seen combat sport-related shoulder injuries:
1. SHOULDER INSTABILITY
The gleno-humeral joint of the shoulder is a ball-and-socket joint, in which the spherical humeral head (ball) is ideally centered in the glenoid cavity of the scapula (socket).
Feeling “loose” in your shoulder, as though the shoulder is going to pop out of place with certain movements.
Shoulder instability may be due to one or more of the following contributing factors:
Structurally shallow glenoid cavity
Looseness of the ligaments from previous dislocations or misalignments
Generalized joint hypermobility
Decreased activity of surrounding stabilizing muscles
We’ve seen our fair share of shoulder dislocations while fighters are trading punches, or getting caught in a clinch. A dislocated shoulder can put you out of training and fighting for months. Left untreated, shoulder instability may result in recurrent misalignments and dislocations, causing fighters to lose precious training time and confidence in their punching, clinching, or grappling abilities.
2. ROTATOR CUFF DYSFUNCTION
The rotator cuff is a group of muscles in the shoulder that primarily moves the shoulder into internal and external rotation, and also functions to improve the stability of the shoulder joint.
Rotator cuff dysfunction may present as:
Rotator cuff weakness
Rotator cuff tendon inflammation
Rotator cuff tear
In the absence of acute trauma, rotator cuff dysfunction in combat sport athletes often begin as relative weakness of the external rotators in comparison to the internal rotators, which are often in a shortened resting position as a result of a typically-hunched fight stance. Over time, the external rotators become strained in an elongated position, as they counter the force of the internal rotators.
With repetitive straining over time, the tendons of the rotator cuff undergo degeneration with wear and overuse. Overtime, rotator cuff weakness and inflammation may eventually lead to a tear. Rotator cuff tears are often painful and debilitating, leaving fighters unable to train and compete for several months.
Rotator cuff tears have been known to heal poorly. The majority of rotator cuff tears often go on to become larger tears or full-thickness tears if untreated over time. Hence, it is important to seek treatment early to maximize healing and minimize further injury.
3. ABNORMAL MOVEMENT OF THE SHOULDER BLADE (SCAPULA)
The scapula is an important consideration in the shoulder joint. Since the glenoid cavity (as mentioned above, it’s where the ball-shaped end of the humerus) is part of the scapula, its position in motion is crucial in housing the humeral head to maintain smooth and efficient movement of the shoulder.
Scapular dyskinesia is a collective term referring to dysfunctional motions of the scapula during shoulder movement. It often presents with increased bony prominence of the scapula.
This often occurs due to a lack of control and variations in interaction between some of these muscles:
Trapezius – a major muscle covering most of the upper back and the posterior of the neck
Levator scapulae – at the back and side of the neck
Serratus anterior – fan-shaped muscle along the ribs underneath the armpit
While scapular dyskinesia itself is rarely the source of pain, it may be present in shoulder injuries or any muscular imbalance in the shoulders, making it worth an assessment for any contributions to structural and functional errors in the shoulder.
PHYSIO-RECOMMENDED WARM UP/”PRE-HAB” EXERCISES
To minimize the risk of shoulder injuries during training, here are some simple “pre-hab” exercises to warm-up and prepare our shoulders for a training session:
Foam rolling of the shoulders, concentrating the following muscles:
Shoulder internal and external rotation
Shoulder forward flexion with isometric external rotation
Scapular stability + rotator cuff activation
PHYSIOTHERAPY CAN IMPROVE YOUR SHOULDER FUNCTION IN COMBAT SPORTS
The above exercises serve as a general guideline to athletes looking for warm-up ideas for a healthy shoulder. Should you experience shoulder instability or pain during your martial arts training, or have been diagnosed with a rotator cuff injury, you might want to consider visiting a Physiotherapist.
During your physiotherapy session, your Physiotherapist can:
Assess for shoulder instability, possible rotator cuff injury, or any other shoulder injuries
Assess biomechanics, including the movement of your scapula, and identify biomechanical errors in your movement
Treat soft tissue limitations
Prescribe a rehabilitation program to improve shoulder stability, scapular motion, rotator cuff strength, and overall shoulder function
Your rehabilitation plan may often consist of a program that progressively loads the shoulder, with an emphasis on motor control and dynamic stability through movement. The aim is to get you back to training with greater confidence and reduced injury risk.
Do you participant in combat sports training regularly? We can help you in your training performance and recovery!
Do you spend long days in the office behind your desk? Do you find your body getting increasingly stiff, fidgety, or uncomfortable as the day progresses? The cause could be due to a weak core stability – the foundation of your body.
HIGH-RISE AND BODY-WISE
Think of your body like one of the skyscrapers in CBD. Your deep core muscles are like the foundations, beams and pillars which hold it upright. Should this internal scaffolding become weak or damaged, your body becomes an unstable structure, ready to break at any time. High-rise buildings of course have many supportive structures internally, externally and underground to allow for error (thank goodness) so that they can withstand the elements.
Our bodies are somewhat clever in that we too, have a back-up system. We have muscles that are ready to help out should our main structural system fail. However, these muscles simply aren't designed for this role of anti-gravity and postural support, so when they get tired and tight, this is where injury occurs.
Sitting at a desk all day causes our internal scaffolding to become ineffective, and our deep core in turn becomes weak and under-active. Aside from a weak core, we often find that our upper back and hips can become stiff. Our joints produce lubrication through movement. With long periods of immobility, the production of the fluid that oils our joints slows.
KEEP THINGS TICKING
Studies into lower back pain have proven that the muscles that support the trunk and pelvis become weak through a process called pain inhibition, i.e. a painful area becomes a weak area as the adjacent muscles just don't want to work. Seeing a Physio can help to put you on the right path through an assessment of your posture and functional movements, and subsequently a specific treatment plan to help target those weak or stiff bits.
General exercise and maintaining an active lifestyle will help to keep things ticking over. Or working with a personal trainer to have some specific guidance with your training can really help to build general or specific strength and endurance, depending on your individual goals.
BUILD THAT 'POWERHOUSE'
One form of exercise that is perhaps a little more targeted towards the core and our 'internal scaffolding' is Pilates. Pilates aids the activation and development of the deep core muscles, which are crucial for pain-free daily function, optimal performance during sports, and injury prevention. Through its extensive repertoire and targeting of very specific muscle groups, Pilates will make you 'feel' muscles you never knew you had, and also increase your body awareness significantly. So when you start to notice that your posture is off alignment and causing unnecessary stress on your body, you can correct and reposition yourself.
Pilates also helps to improve flexibility by encouraging you to counter-balance those positions that you find yourself stuck in for long periods of time – such as rounding forward over your keyboard, or slumping towards your computer screen.
Pilates can be done on a mat or with a specialist equipment, the most popular of the equipment being the reformer. Pilates is best taught by a qualified physiotherapist, or someone who has extensive experience within a rehabilitation setting. This allows them to scrutinise your every move to ensure you're doing the movements perfectly, thus eliminating the room for error to achieve the best results.
Regular activation and strengthening of these crucial deep core muscles with Pilates is important, whether you're experiencing physical pain or not. We all know that having an effective core or 'powerhouse' muscles is a recipe for success. The general rule is that after six weeks of twice-weekly Pilates sessions, your body will start to FEEL different, aside from looking more toned. And the best part about Pilates - ANYONE can do it!
The newest UFIT Clinic outlet at Orchard Central offers small group Physio-led Pilates Reformer classes. While there are other Pilates Reformer classes in Singapore, this will be the only class that offers an individually tailored program led by a physiotherapist who will pick from an extensive repertoire of exercises to best achieve your specific goals.
Align yourself mentally and physically from 24 February to 31 March, as UFIT Clinic Orchard will be offering 3 Pilates classes for $180!
This promotion includes 1 package per person and is open to new and existing clients. New clients will be required to attend a Pilates Assessment at $150 which includes a free class.
Sign up now with the form below:
About the author
Lucy Warren is a Physiotherapist and Pilates specialist from the UK. She has a first-class honours degree in Physiotherapy from Cardiff University, and is also an APPI-trained matwork instructor. Lucy has extensive sports experience with professional and semi-professional teams and athletes, having provided pitch-side physiotherapy for multiple elite sport teams in the UK. She has also worked for the British Army for two years, assessing and treating infantry soldiers and helping them to rehabilitate to peak fitness.
Lucy taught matwork Pilates for several years before making the transition across to Reformer Pilates. Lucy loves using the Reformer and other Pilates equipment with her clients in order to achieve their specific rehabilitation goals. She believes that it is an incredibly versatile tool which can lead to daily life improvements like better posture and more efficient movement, as well as relief from pain associated with physical imbalances.
In her own time Lucy is a keen netballer, skier, and loves to travel to new places.
It's so annoying to be injured. It stops you from doing what you want to do and brings a lot of discomfort with it. That niggling pain that bothers you every time you exercise, or the discomfort you have when sitting at your desk for hours on end. A lot of us will try to ignore the pain, hoping that it will go away with time or rest. Sometimes this works. You listened to your body telling you to take some time out to recover and HOORAY, you're back in the game. But sometimes this approach just won't kick it.
Understanding why you feel pain is the most important thing to do if you want to get rid of it effectively. One thing that's important to know is that PAINFUL doesn't necessarily mean HARMFUL. This doesn't mean to say that you should keep pushing yourself through the pain hoping it will just go away. What it means is that there may not be anything structurally damaged, but there is something happening biomechanically that your body just does not like. Injury can occur when there is altered stress on the body's tissues. The pain you feel in the body is your brain's way of telling you that something isn't right, like an early warning system.
How can we overcome pain? Rehabilitation is usually multi-faceted but to put it simply; we need to get the stiff bits moving and the bendy bits more stable.
The thoracic spine is just one part of the body that we frequently see as being 'stiff' - this is likely to be due to the modern day lifestyle of sitting too much and spending too much time in poor postures. Doing regular thoracic mobility exercises and foam rolling the upper back will help to increase range and free your upper back up so that the lower back doesn't have to do all the work.
Hips and ankles are two other common 'stiff bits', below are a few ideas of how to get them moving.
Increasing stability and control in the relatively 'bendy' bits is equally important. This may involve increasing core and gluteal activation, strength and endurance of the deep postural muscles in order to create a strong and stable foundation from which to move. Combining the two approaches is a recipe for success, as long as you do your homework.
This is just a little snapshot into what your rehabilitation may involve. So if you've got a niggling pain that just won't go away, or you think you could get a little more out of your training if only you could move a little better, book in a session with one of our physiotherapists for a full body check-up.
For now though, consider these three steps to help you stay injury-free:
1. Progress gradually
Don’t ramp up your training too quickly, it’s just not worth it. Our bodies take time to change and adapt so be consistent and avoid loading spikes. For example, if you've had a week of rest from exercise, don’t expect to do more than you previously did, as large fluctuations increase the load on our joints and soft tissues. Follow the 10 percent rule: add mileage OR intensity by 10 percent or less a week, and do not increase both at the same time. Monitor yourself with a training App to show what you have done each week. Also remember overload can be brought about by a combination of lifestyle and training. If you have been overloaded at work, this will affect your training too.
2. Recover well
Listen to your body. It needs time to recover, both mentally and physically. The micro trauma that occurs to the muscles and tendons stimulates further healing and growth, and this can only happen if they’re given a chance to rest and recover. If you start to feel a niggling pain, give yourself time to recover. Do not be afraid to adapt your training schedule to your needs. You won't lose fitness from taking one day off. Ensure your training programme includes recovery sessions - this can be swimming, pilates, yoga, or foam rolling sessions.
3. Strength and conditioning
We all have areas of weaknesses. An important component of any training plan is to make sure we have good flexibility, core stability, and strength. A dynamic strength and conditioning programme will target specific areas to help stabilise joints, promote postural balance, and improve muscle performance and efficiency. It helps the body tissues to become used to higher levels of loading, enabling them to deal with the increased demands of training and competing, therefore minimising the risk of injury. In essence - get the stiff bits moving and control the bendy bits!
When you have an injury that just won't seem to go away, see a physiotherapist who can assess different predisposing factors such as your biomechanics, alignment, muscle strength, muscle length, and motion control. Get this – often the source of your pain may not be where you feel it. At UFIT Clinic we don't just prod and poke the bit that hurts in the hope that the pain will go away. Our physiotherapists are highly skilled in assessing body biomechanics in order to fully understand how your body moves and why certain activities or postures are causing you pain. Book an assessment with us to find out more!
ABOUT THE AUTHOR
Lucy Warren is a Physiotherapist and Pilates specialist from the UK and is the Clinic Manager at UFIT Clinic Orchard. She has a first-class honours degree in Physiotherapy from Cardiff University, and is also an APPI-trained matwork instructor. Lucy has extensive sports experience with professional and semi-professional teams and athletes, having provided pitch-side physiotherapy for multiple elite sport teams in the UK. She has also worked for the British Army for two years, assessing and treating infantry soldiers and helping them to rehabilitate to peak fitness.
In her own time Lucy is a keen netballer, skier, and loves to travel to new places.
Meet Mok Ying Rong, our new physiotherapist at the UFIT one-north Clinic. A competitive runner and Nike Sponsored elite athlete, Ying is Singapore’s Half-Marathon record holder, and well placed to help clients recover from sporting-relating issues!
She’s joined up with #ROCKrunners in the lead-up to the Singapore Standard Chartered Marathon, where she’ll be giving talks on one of her passions – running pre-habilitation!
Tell us about your sporting and running background
I’ve always been too active! I started competitive swimming in primary school and represented my swimming club and school at national and club levels. I moved on to triathlons in high school before running seriously at 16 and representing my school, Raffles Girls Secondary, at national meets. I was getting on the podium at these and decided to try national level events.
At first, it was intimidating running with the giants but as I ramped up my training and became more systematic, found myself winning more and more races. I’ve always been self-coached, I feel very tuned-in with my body, and pretty soon, found myself knowing what works and what doesn’t. My first race representing Singapore was the Asian Cross Country in Bahrain when I was 16.
What have been your career highlights?
Signing a contract with Nike when I was in high school and representing Singapore in the 2016 World Cross Country Championships. The partnership with Nike really boosted my confidence in my training and racing, and I’ve been representing them for almost 7 years and am simply thankful for their unwavering support.
My most significant career highlight is definitely winning the 2016 Gyeongju Cherry Blossom Half Marathon, breaking the Singapore Half Marathon record by 2 seconds! My time was 1:23:14 and I vividly remember it to be one of the most painful and intense race I have ever done.
How do you train for your races?
I select the main races I’ll do at the start of the year and then periodise my training phases. Some overseas races pop up and I take them in my stride. I’ve always believed in the journey, rather than an end-goal as running is my passion, and always make sure I do my conditioning and prehab work so I can progress my running fitness safely.
What got you into physiotherapy?
I was getting my fair share of injuries, my most tragic moment being having 5 stress fractures at one time over my left foot. I also had multiple shoulder issues from swimming. I started to do my own research to understand why I was getting injured which sparked my interest in physio and I knew this was the career for me.
What is pre-habilitation?
As a physiotherapy student, I did workshops with companies and small interest groups, spreading my passion for pre-habilitation (prevention instead of rehabilitation) for runners. I initiated a project called ‘RunFree’ when I was in my 3rd year, which believed that running should be free for all, made possible if people can run free from injuries. I’ve run sessions for anyone wanting to progress their running safely, including a movement screen based on research and running biomechanics, followed by guidance with these runners on a safe running program.
What’s in your head before a race?
I’m still bad at this – always getting nervous before a race! But my favourite mantra for myself would be – just run! Just get out and run. No fear! ☺
Come and meet her at the UFIT one-north Clinic or within the UFIT running community very soon.
When we exercise frequently it's inevitable we'll get aches IN OUR ANKLES AND FEET FROM TIME TO TIME.
In the case of UFIT Clinic client Evy Theunis, a trip to senior physio Declan Halpin was definitely worthwhile after she experienced an extended period of foot pain.
FIND OUT about her steps to a solid recovery after an achilles tendonitis diagnosis ...
"At the end of my pregnancy, my left achilles started to hurt. I didn’t think much of it, and assumed it would just disappear after delivery.
Little Alexander came, but the pain in my left foot stayed! Short walks would still really hurt, so I decided to go see a doctor who referred me to a physio – and there came UFIT Clinic's Declan Halpin!
Apparently I had developed Achilles Tendinitis, and was in for a couple of months of recovery. No running, no tennis, no cycling outside, no lunges, no step ups, NO HEELS, no nothing, HELP!!!!
My plan to get back in shape before I would go back to work went out the window - or so I thought. Let alone do the Spartan race I had planned for in November.
But thanks to my weekly appointments where Declan stretched and massaged my Achilles (we did accupuncture as well), and thanks to the new exercises he gave me to strengthen my heel muscles, we quickly started seeing progress.
(An important point to note: when your physio gives you exercises, do them - sounds logical right - but most people apparently don’t. And it makes a huge difference).
As I was on a mission, Declan really worked with me to help me get as much variation in my training possible without jeopardizing or slowing down my recovery. I negotiated a lot :-)
All in all, it took us about 6 months to get me completely back to normal, AND, with the help of Declan’s magic hands, I made it to Bintan and finished my first Spartan!".
The award-winning UFIT Clinic is Singapore’s leading exercise rehab, injury recovery and women's health clinic. It's holistic approach and full range of physiotherapy and massage-related services by its experienced and friendly specialists can help you prevent injuries before they happen, or get you back on track as soon as possible once you're injured.
An ACL rupture is one of the most dreaded injuries in sport – not only is it painful, the rehab process is long and difficult, and tests the determination of even the most committed patient.
But like with many other types of injury - it is not all doom and gloom...
Thanks to advances in rehabilitation and improvements in surgical techniques, it's not the career-ending injury that sports people once feared. With proper guidance, patience, and a large dose of motivation, it is definitely possible to make a full and complete recovery.
Marie De Place is a perfect example of someone who overcame such a major setback, and is now stronger and fitter than ever. She had her first appointment at the UFIT Clinic in March 2016, after a skiing accident. A year later she has just done her first Olympic distance triathlon. Here she shares with us her road to recovery with senior physio Declan Halpin, and the ups and downs along the way.
Marie’s initial reaction wasn’t what you might expect:
“My first thought was ‘I'd better be skiing again soon as I just bought a nice brand new ski jacket yesterday’ (typical girl thinking I guess). My second thought was "Good news! I will not have to train for that stupid triathlon that my friends convinced me to join". My third thought was "Hey, I will finally experience going down a ski slope in a sleigh pushed by the rescue guys".
She really had no idea at that time that an ACL injury would lead to ten months of rehab before she would be able to ski again! Typical recovery from an ACL rupture can be anywhere between nine and twelve months, depending on the type of repair performed, the fitness of the patient, and how quickly their body responds to the treatment program. It is usually broken down into four phases:
1. Acute Phase - Where the focus is on reducing the pain and swelling and improving range of movement.
2. Activation Phase - Returning the knee to full range of movement, strengthening key muscles such as your hamstrings, developing knee stability with balance exercises, and introducing body weight exercises such as air squats, bear crawls and lunges.
3. Strengthening Phase - Building strength back into the leg to make sure both sides are equally strong. This usually means picking up some weights and doing lots of squats, deadlifts, step-ups, and other lower limb exercises.
4. Power Phase - Your leg can’t just be strong – it needs to be fast and powerful as well! In this phase we get you to hop, jump, skip, and run (in a straight line). This is often when the patient feels like they are really making good progress!
5. Return to Play - The final part of the rehab process is the most fun. Lots of side to side movements, agility runs, ladder work, and jumping around on wobbly surfaces!
So how did Marie find the process?
“Long, for sure. I did not expect it to last for 10 months but, as you get back to an (almost) normal life after a couple of months, the remaining eight months were more like cherries on the cake. Boring? Sometimes, especially when ending up in the same gym every night or so. Thank god, the exercises are not always the same. Fun? Yes, some good laughs, when I was wondering whether "crab walk", "bear crawling" and other weird animals jumps or moves were real physio movements or just Declan making fun of me.” [Declan: A little bit of both Marie!]
However, she reports that you get a real sense of achievement as you slowly return to full function:
"Beyond that, there is the satisfaction to feel that you are getting better and better and you can again do stuff you couldn't the week before.”
It is not just up to the surgeon and the physio to get you better – it takes a lot of commitment and hard work from the patient themselves. As Marie says,
“Motivation and commitment are key to recovery. Fortunately, you have your physio by your side, to support you and relieve the pain when necessary. However, when it it comes to leaving the office and going to the (so boring) gym to do difficult or quite painful exercise, only you can make it work.”
Finding the right physio and physio clinic is key – after all, you are going to spend the majority of a year working together, seeing each other weekly throughout the time period! Marie felt she made the right choice:
"At UFIT, Declan and the team have been supporting me along the recovery journey, giving me confidence I can do it, that I will recover and practice all the sports I like again. And this is not as easy as it sounds for sometimes I did not progress as fast as I expected, some other times I felt pain again and had to slow down or even go back to the previous month program. It would have been so discouraging without their support.”
Creating a supportive atmosphere is key, but Marie believes it is more than this, it also requires trust.
“I had a great experience at UFIT. Everyone, from the receptionist to the physio team is welcoming, positive and attentive to your needs. They are great professionals providing an efficient recovery plan, prescribing relevant exercises, executing targeted massage and treatment.
But they do much more: they build trust. The best technical skills are not worth much if you don't trust your physio and you don't trust yourself. When someone tells you "drop your crutches and walk to the end of the corridor", believe me, you need to trust that person to do it. Recovering from an injury is a challenge. As any challenge, it requires you to be confident that you can succeed.”
Marie’s recovery led her to committing and achieving an incredible goal:
“I have just run my first Olympic Distance triathlon. I was more motivated than ever. I trained intensively for the last 3 months, starting as soon as my recovery at UFIT ended. And believe me, I am nothing like an athlete! Yet, along my recovery journey, I learned how to strive for progress, endure long, sometimes boring exercise sessions and a reasonable amount of pain. A beneficial experience in many aspects.”
The process is definitely a two way street, and requires both the patient and the therapist to collaborate and work hard to get the best results. The UFIT Clinic Senior Physio, Declan Halpin enjoyed working with Marie,
“My job is easy when a patient like Marie comes in. From day one she was determined and motivated to succeed, and never backed down from a challenge, or said ‘No’ when I asked her for another rep or set. It is easy to see when patient’s aren’t sticking to their rehab program – their progress is slow, and they fall behind in their recovery. This was never the case with Marie, and you can see this from what she has achieved in less than a year after such a serious injury.”
Marie says there is nothing she would have changed in her rehab process, and has given the UFIT Clinic the best compliment that anyone can give – referring her friends and family to come and see the team.
“I would like to recommend the UFIT physio team and especially Declan to whom I owe a lot, but be patient when trying to get an appointment as they are some of the most recommended physiotherapists across the Island (actually I am sending all my friends, husband and sons to UFIT).”
Thank you Marie – congratulations on your recovery and your Triathlon, and hopefully see you soon (but not too soon)!!
If you have suffered from an ACL or other injury, or have questions about your own recovery, please do not hesitate to contact the UFIT Clinic at +65 6532 2025, or find us at www.ufitclinic.com