In the clinic I have noticed that many of my patients (and my boss!) are going to participate in open water swimming events this year, whether it is the swim series, triathlons or aquathons. Most people train for these events in the pool which is excellent for building up technique, strength, breathing patterns and fitness. The real test comes when you transfer those skills to the open water events. Below are some of my best tips which may help you with this.

• Firstly it is really important to be prepared. I would recommend a wetsuit for all competitors. The wetsuit has a few benefits. Firstly heat and warmth. The body temperature can drop during events such as Taupo ironman or longer distances. A quality wetsuit can prevent this from happening. Secondly the most important function of a wetsuit is to increase the buoyancy of your body which will improve your efficiency in the water. It is particularly important to keep the legs up and floating to reduce the drag of the legs. To prevent injury and tension build up in the shoulders, it is essential you wear the wetsuit correctly. I would advise wearing baby oil or wetsuit friendly lubrication to help get the wetsuit on. This is important to be able to get it off in a hurry (eg a triathlon), but also to ensure that it has been put on correctly in the first place. To create less tension at the shoulders, the top seam should be pulled right up to the top of the shoulder. This will allow a greater amount of movement at the shoulder, and prevent pain. (Even more important if you have had a recent shoulder injury). The baby oil will help you to be able to pull this right up without friction at the wrist or elbow. Test the shoulder range of motion before getting in the water by lifting the arms out in front and out to the side of the body. Wetsuits are made with flexible panels at the arm pit and it should feel easy to lift the arms up. If you do not want to use baby oil on your wetsuit, place plastic bags over your hands and wrists and the wetsuit will also slide up more easily. The same applies to the ankles and legs, and if the wetsuits is pulled high enough up the legs, then this will also improve the stretch at the armpit/shoulder area.
• Cut your nails- it’s not a great look to have little rips in the wetsuit from finger nails digging in whilst pulling it on.
• I wash the baby oil off my hands in the sand prior to touching my goggles. Oily goggles are no help to anyone trying to keep on course!
• Some people like to place their goggles under their caps when racing to help them stay on. The only issue with this comes when there is a tussle and the goggles might get ripped off and take the swimming cap with them! I feel it is better to potentially lose the goggles only and take the risk, then lose the cap and goggles! This will be a personal preference however.
• Practice in the pool swimming with your head up. It is much better to look to where you are going then to follow someone right off course! Many open water swimming events have been won by the smarter swimmer who is actually looking where they are going. Even the bright orange buoys can be hard to sight when you are swimming in open water, particularly if it is big swell. Find out your sight markers prior to the race by using a land mark eg a big tree which lines up with the buoy. This can be done in the warm up and can make a huge difference mid-race. You will have to take shorter, quicker strokes when you have your head up. Try and minimise this time, as it is much more efficient to be swimming with the head down.
• You can swim smarter when swimming in open water by being in the slip stream of the swimmer in front. There are a few techniques for this. The first and easiest is just tapping the toes of the swimmer in front- its very annoying for the swimmer in front, and watch out for a kick in the face- but it is worth it if you can get away with it! The second which creates the greatest efficiency is by placing your hand in the section of water just below the person in fronts’ armpit. This will reduce the amount of pull through the water that they can achieve, as you have already pulled that body of water before they have. You will save energy and they will be expending more to stay that bit in front. The third way to be efficient is by swimming just below the middle of two swimmers in front. Just tuck in at the level of their hips and they will create a slipstream for you. If you are the swimmer in front, and want to lose them, then put in a solid effort for 200m to really lose them, or else if you can’t beat them, then join them! Don’t do all the work for them, just so they can pass you on the run up to the beach!
• Swimming in large swell can be challenging. You have to read the surf and use the currents to your advantage. If the current is pulling into the left of the beach and you have to swim out and around to the left of the first buoy, then start to the right of the field. This way if you swim relatively straight, the current will bring you to the buoy without any extra effort. If you start left then you will have to swim against the current and it will also make it harder to round the buoy.
• Swim to the conditions. You may need to change your breathing pattern to suit. On a glassy day, your natural pattern will be fastest and most efficient. When there is large swell however, you will need to change to a 2 or 4 pattern and breathe away from the waves! Drinking salty electrolytes does not mean taking in gulps of sea water! Practice in training breathing to different sides – then it will not be such a shock when you have to do it in the open water.
• Research has been done with top level triathletes which show that the place the competitor is at the first buoy (which is usually 250-500m from the start line), will determine the place they exit the water. This is especially important  when it comes to draft legal triathlons as you always want to maximise the position going out onto the bike so that you can make the front bike pack. Key point here is: go hard to the first buoy! And then try and maintain your place for the rest of the swim (using some of the tips above!). The energy that you will expend keeping a high place in the water will be paid back to you when you are sitting in the front bunch and not busting your gut chasing the front cycling pack. This will inevitably leave you with fresher legs for the run- woo hoo!

Open water swimming events are such fun and a great way to enjoy our beautiful New Zealand summer (!) Stay safe and always use the life guards if you need help. Then make sure you book in and see us the following Monday for a shoulder, neck and back massage!

A new year a new goal. It is a common misconception that all Australians are Ian Thorpe like creatures and swimming comes as naturally as walking. In reality I grew up on a farm some 200km from the nearest ocean and the nearest swimming pool was a 30minute drive away so needless to say that my swimming style is more like “not drowning” than actually swimming. So this year, I have set myself the lofty goal of learning to swim with the ultimate goal being to take part in an ocean swim at the end of the year. Having completed a marathon last year I have this newfound belief that if you put your mind to it , anything is possible. Well, we’ll see.

So off I went to the tog shop to kit myself out in all the gears. After trying on 25 different pairs of speedos with my 5 year old in the dressing room with me I gave up. Buying togs at the best of times is traumatic but being a slightly pudgy 36 year old woman, it was not pretty squeezing myself into high cut racing togs and it was only later I realized that they are only for a)teenagers or b) those trying out for the national swim squad and on another rack there were some perfectly decent low leg, black, non-descript speedos.

So togs, goggles and swim cap in hand I went off to my first lesson today. Thankfully there was only one other person in my class so the embarrassment was contained. After 45 minutes of thrashing around my diplomatic swim coach tells me that I have improved a lot over the first lesson, so that should give you some idea how bad I was at the start. At the moment everything is aching and I am so tired I can barely keep my eyes open to finish this. At this stage a 2.9km ocean swim feels the equivalent of climbing Mt Everest but I have 10 months to go and I promise to give it my very best shot. If anyone out there reading this has any advice for me I will gladly accept it, otherwise stay tuned for the next chapter in what plans to be a very challenging 2012.

Sports injuries to the groin are all too common these days – despite their highly preventable nature. Too few participants take adequate precautions prior to engaging in sport, which results in weakness of the tendons and muscles – particularly around the groin. The adductor muscles of the inner thigh – adductor magnus, adductor longus, adductor brevis, pectineus and gracilis – are a fanlike system of muscles that aid stability of the hip joint, and attach the pelvis to the thigh bones. They are also extremely vulnerable to sports injury; most notable groin strain.

The most common complaint with regard to groin injury is localised pain resulting from a pulled or strained muscle. In more serious cases, a severe tear can result in a sudden, intense pain, which may be accompanied by swelling or bruising of the affected area. The area is often tender and sore to the touch, a sensation that increases with resistance movement, and stretching or straining of the inner thighs or hamstrings. These more serious groin injuries can often be caused by a rapid change in direction while running, or by stopping and starting movement abruptly. As such, those who play field or court sports are more prone to suffering these types of injury.

How do I recognise a Groin Strain?

A groin strain injury is often mistaken for a sports hernia, as it can be difficult to distinguish between the symptoms of the two. If you experience a dull, painful ache that increases in intensity with physical exertion, you most likely are suffering from a sports hernia. An inguinal hernia, on the other hand, is characterised by an extremely painful bulge in the lower abdomen or upper groinal region, where the intestine or bowel protrudes through a weak section of the abdominal wall.

Groin injuries, however, are characterised by feelings of cramping or tightness, or pain when muscles are contracted or stretched. Groin strains are divided into several grades – Grade One is considered less serious, while Grade Two causes more serious pain, including pain while walking. The groin of the afflicted is also painful to the touch.

Grade Three injuries, though rare, are severe enough to keep the athlete from walking without experiencing intense pain. Grade Two and Three injuries will often induce a large bruise around the groin, caused by damaged tissue bleeding beneath the skin.

Adduction exercises can help to identify a groin strain injury, if you’re unsure of your symptoms. Placing a weighted object between your legs – a medicine ball is a common choice – and compressing it between your thighs will highlight damage to the adductor muscle group. If you experience pain as a result of the exertion, there’s a good chance you’ve pulled or torn a muscle in your groin.

How can I treat a Groin Strain?

An over-the-counter (steroid-free) anti-inflammatory may help to reduce pain or swelling. In time, as swelling subsides, a strengthening program of gentle groin stretches may be pursued, as well as low-intensity exercises. At this stage, a sufferer of a pulled groin may also begin to run once more, although only gradually, and sprint work or uphill runs should not yet be pursued. Remember to reduce the frequency or intensity of your exercise if you begin to experience an increase in pain or swelling.

Light massage (be careful not to aggravate the affected area, or you’ll cause additional pain rather than alleviating it) can be highly effective in encouraging the tissue relax and loosen. All flexibility exercises and stretches should be stopped immediately if pan should occur.

The R.I.C.E method – which stands for Rest, Ice, Compression and Elevation – can be very effective in the treatment of groin injuries. After such an injury has been sustained, it is important not to irritate the area further. A gradual return to sport may be possible, provided it is achieved slowly, so as not to over-exert the existing weak point. Taping of the area can help to reduce pain, and prevent further injury.

How I do prevent Groin Strain?

While gradually returning to sport, it’s important to take appropriate precautions to avoid incurring more damage. After gentle exercise, ice should be applied to the strained or pulled area, after which the thigh should be wrapped or bandaged, in order to compress it. The injured region should then be kept elevated and rested.

In the interests of preventing future groin strain injuries, there are simple measures that can be taken. Warming up thoroughly and stretching before physical exercise ensures flexibility of the muscle tissue, thereby ensuring that a strain or pull is less likely. Remember – if in doubt, take it easy. It’s easy to get caught up in the excitement of the game, if you play a lot of sports, but it will pay dividends if you focus on not over-exerting the muscles in your groin.

Dan Hart is an experienced writer of physiotherapy-based articles, and has had a keen interest in the field since undergoing physiotherapy for a ganglion cyst in his wrist. For more information on groin strain, please visit http://www.physiocentre.co.uk/groin_strain.htm

The main shoulder joint is essentially a shallow ball and socket joint which is held together by a capsule (connective tissue which encases the bones together), ligaments and muscles. Subluxation occurs when the arm bone (the ball of the joint) partially stretches out of the socket (the shoulder blade). In this situation the joint usually relocates easily but results in capsule, ligament and muscle strains. Dislocation occurs when the arm bone completely shifts out of the socket, and severe strain of the tissues that surround the joint will be inevitable.  A dislocated shoulder should be relocated at an Accident and Medical Centre under scanning to avoid pinching of important structures within the two bones. Fracture of the shoulder is also common with this injury, and this will also need to be eliminated at this time.  Those players who regularly sublux or dislocate their shoulder may be able to relocate it by themselves, but this is an indicator that they need rehabilitation! ACC Shoulder Clinical Guidelines also suggest for these people that a referral to a specialist is indicated. We can arrange and recommend this for you.

Physiotherapy for these conditions is imperative to: reduce swelling and scar tissue, improve strengthening of the stabilising muscles of the shoulder, release any muscles which are in spasm, and tape the shoulder for immediate stability. Physiotherapists will also give you sound advice on time frames to expect with this injury, activity modification, specialist referral and when you can return to the pool. We would be more than happy to see anyone who has recently subluxed or dislocated their shoulder, or anyone who has done this a while ago but feels they need treatment to return to full function and strength.

-Jenny Payne, Physiotherapist.

Boocock, M. et al (2005) OOS Prevention Literature Review: Report to the Accident Compensation Corporation. downloaded from www.acc.co.nz, October 19th, 2011

So the big question is, can my child still do sport and exercise, and are their other things that can be done to help? The answer, as is often the case in conditions such as this is…it depends. It depends on the severity of symptoms, the sport that the child is doing, the level of participation etc. As a general rule, the child will need to in the very least modify the amount of activity they are doing, or have a short period of time off the aggravating sport or activity. Often this can be as little as 2-6 weeks, to allow the acute aggravation and inflammation to settle. After this time period, symptoms have often settled but not fully eased, and this is when gradual introduction back to sport can be initiated. It may be that some hard decisions need to be made if the child is playing a number of different sports that aggravate, or are training to an intense and high level. It needs to be made clear that this isn’t for life, it’s only for a restricted amount of time while the acute aggravation settles.

In terms of treatment, again there are modalities that can help settle things down. Local icing and as stated above relative rest of the affected area are worthwhile. Maintaining as good a level of flexibility as possible is important to try and take the load of the tendon insertions, and this is where your Physiotherapist can be of assistance in teaching and demonstrating the best stretches. In the case of Osgood-Schlatters, particular attention should be paid to the quadriceps and hip flexor muscles, and in the case of Severs the calf and hamstring muscles need particular attention. For Osgood-Schlatters, I personally find the use of patella tendon straps to be of benefit to relieve symptoms particularly when returning to sport. For Severs, the use of heel cups or heel raises are helpful. In cases where the child has marked foot biomechanical problems, referral to a podiatrist who can assess for the potential benefits of using insoles is indicated. Sports massage to decrease tension through tight muscle groups is also helpful, as is the use of a foam roller at home to assist this process. Biomechanics assessment of core stability and movement patterns is also worth doing. This will help identify imbalances that can be worked on, that will decrease the likelihood of the symptoms returning once the acute pain has eased.

Overall, it can take 12-24 months to fully settle. Only in rare cases is there any ongoing problems, so rest assured that these problems are commonplace and normal, and will settle with time. Of course there are always symptoms that need further investigation…have a read of my previous post on growing pains to see what these are.

The name basically says it all…it’s a sprain in the high part of the ankle. The majority of ankle sprains occur when you roll your ankle over, and often end up spraining the ligaments that join the end part of the fibula and the talus bone in the ankle. The high ankle sprain occurs with more of a twisting or rotational force, where the foot normally is twisted outwards. Rather than spraining the ligaments described above, you end up spraining the ligaments and tissue that joins the two bones of the shin (the tibia and fibula) together, which is also known as the syndesmosis of the ankle.

The pain is often at the outside and front of the ankle, rather than under to the side of the ankle as with common sprains. It’s not uncommon to be quite swollen, and for the person injured to have trouble with weight bearing. A common test by a Physio or doctor is to squeeze the lower part of the leg whilst turning the foot outwards, which causes the talus bone in the ankle to wedge or force apart the two shin bones, which would normally be held together by the syndesmosis ligaments. Needless to say, this can be very painful test! X-rays are often taken, both to check for any bony injury,and also sometimes to check for how much the shin bones are separated.

This is not a nice injury to have. It often requires the patient to be in a moon boot and on crutches often for a number of weeks. The patient can often get back to walking in a straight line, but any activities that involve twisting and rotation, as occurs in most sports, can generally take a long time (ie. 2-3 months +) to get back to. Treatment consists of physiotherapy to lessen swelling and bruising, regain ankle mobility and re-education walking. After this, it’s a period of strengthening, balance, proprioception and sports or function specific training.

In worst case scenarios, where there is ongoing or excessive instability in the syndesmosis, surgery may be required to insert a screw between the tibia and fibula. This is to hold the bones together while the syndesmosis heals. Excessive walking early on can cause the screw to break,so generally in is situation the patient is non-weight bearing for 6 weeks.

So how severe is Kieran Reads injury, and will he be back playing in the Rugby World Cup? I have absolutely no inside knowledge as to the severity of his sprain. But the reality is, he is only 10 days post-injury, and from what I can see in the sports news is still in a moon boot. He is likely to be out of this in a few weeks. However the demands of rugby and particularly scrummaging means that a great deal of stability and rotational control is needed in the ankle to ensure good performance. And for this to occur within a 6 week time frame, in my opinion, is tight at best. That is without taking into account the decrease in match and cardiovascular fitness.

Time will tell, and so we can only keep praying to the health gods for know (and wish his physio and sports doctor luck)! Meanwhile, on with the Rugby World Cup!

The results showed a vastly decreased incidence in hamstring injuries in the eccentric strengthening group when compared with those that did not undergo the program, to the tune of 71%!! Definitely worth introducing in your pre-season training I would suggest! Obviously this was for top level footballers, so it would be interesting to see the results on lower level footballers and through other sports.

You can find more details here.

Speak to your coach, physio or trainer about whether this strengthening program is right for you, particularly if you are prone to hamstring problems.

-Andy Schmidt

• Be aware of your scapula (shoulder blade) positioning: too many people try to lift too heavy and end of engaging in poor movement patterns, such as rounding the shoulder blades forward or elevating them up towards the ears. This decreases the space in your shoulder joints between which the rotator cuff tendons run, increasing the likelihood of pinching the tendon and inflaming it
• Don’t overload your shoulder muscles, particularly the rotator cuff muscles: the rotator cuff muscles aren’t particularly big or powerful, as there role is often that of endurance and stability. So don’t try and do routines that work the shoulders for more than 2 days in a row, let the muscles recover. This can include resting from chest and back strengthening too, as they can also fatigue the shoulder muscles. Fatigued muscles mean you are likely to subtly change the way you are morving and lifting, and this can lead to impingement of the cuff tendons
• Be careful when doing strengthening in overhead positions: the reality is that the shoulder is less stable when overhead, so the cuff muscles have to work strongly to support the shoulder. Therefore be aware that they can fatigue easily in this position. This also applies to positions when the arm is in the ‘stop sign’ position, ie. out to the side and externally rotated. The shoulder is vulnerable to instability in this position, and heavy weights in such a position can exacerbate this
• Don’t ignore pinching pains in your shoulder: these are warning signs that something is being irritated, and can progress rapidly if ignored. Recognise the difference in your body between fatigue and distress pains.

So by all means get going on those shoulder weights, but be smart about how you are doing them, and get any niggles looked at early. Often a simple change in position can be enough to settle the problem, and carry on in no time. A physiotherapy assessment of your shoulder biomechanics can help with this.