Exercise and performance for the developing body

Baby image



The evidence is coming thick & fast. Growing bodies require exercise like they require food and water.
However... Many considerations remain confusing to parents, coaches and young athletes alike:
Are some sports better than others for young people? How much is enough? How much is too much?
What pre-disposes a young body to injury? Can / Should young people weight train?
·    The importance of exercise and the impact on learning
·    Physical dysfunction in a growing body
·    Kids and injury

for a discussion with:
91 Wattletree Road, Armadale
TUE 28 NOV, 7pm




Ankle sprains are one of the most common sporting injuries. If you experience an ankle sprain for the first time it can be surprising how much they hurt.

How you manage the injury in the initial inflammatory phase can make all the difference to how quickly and how well you recover and return to sport. Hopefully you have heard of the R.I.C.E. approach to managing an acute sports injury. This is the best approach to follow. Compress the ankle as soon as possible with a compression bandage. Ice the ankle for 15-20 minutes at a time repeatedly. Maybe ice every couple of hours. The best way to ice it is in a bucket of ice and water. Stick the foot in… it will hurt initially but will soon go numb. When you finish the 15-20 minutes in the ice bucket you can leave it there until next time and just chuck in some more ice when it is time. Elevate the ankle by lying down and getting the foot up.


The other thing to do is come and see a Sports Physiotherapist. If you can’t take your body weight on your ankle come and have it assessed straight away. You may need an Xray. If you can still walk on the ankle it may be fine to see your physio after 48 hours. But use the 48 hours well with the R.I.C.E approach.

The next step in managing your ankle injury will totally depend on what you have injured and how severe it is. The goal of treating ankle sprains is to return to sport safely, quickly and with the lowest possible risk of re-injury.

Written by Sam Bugeja, Sports Physiotherapist

Heel Pain - Plantar fascia injury and treatment

Plantar fasciosis or plantar fasciopathy is a common injury in runners and walkers. It is often referred to as plantar fasciitis. This condition causes heel pain on the under side (plantar surface) of the foot. Most patients will describe an ache or bruised feeling under the heel with weight bearing activites. It is common for the pain to quite bad first thing in the morning as the sufferer gets out of bed and takes their first few steps. 

Plantar fasciopathy is caused by a mechanical overload of the plantar fascia. The plantar fascia is an inelastic connective tissue which runs from under the heel all the way to the toes. The overload of this connective tissue usually occurs as a result of a combination of an increase in the amount of walking or running plus a problem with the biomechanics. 

Treatment of plantar fasciopathy involves: initially off-loading the painful tissue with the use of tape or an orthotic device to allow the pain to settle; correcting the biomechanical issues which have lead to the injury in the first place; strengthening the tissue through specific exercises; a gradual return to the activities which overloaded the plantar fascia such as running or walking. This method of treating plantar heel pain is usually quite effective. Usually this injury can be managed without having to stop running or walking entirely.

There are other conditions which can cause pain under the heel which are less common and can occur in isolation or in combination with plantar fasciopathy. These include: nerve entrapment of the medial or lateral plantar nerves; fat pad contusion; referred pain from the lumbar spine. 

If you are suffering from heel pain you should seek an accurate diagnosis and treatment plan from one of our Sports Physiotherapists or Podiatrists. 

Sam Bugeja - Sports Physiotherapist

Plantar fascia

Saddle stools for better sitting posture

In an evolutionary sense humans are designed to be standing, walking, lying down and occasionally sitting. Unfortunately, modern life increasingly involves sitting down for prolonged periods. Often we sit hunched over in front of a computer unaware of the postural strain we are placing on our spine until it is too late. 

Earlier this year I suffered a recurrence of a disc injury in my lower back. Too much sitting and then too much bending in the garden triggered the injury. This time the injury was worse and I had a prolapsed L5/S1 disc which was compressing my S1 nerve root. A nasty injury which was really painful and started causing weakness in my calf. Sitting and bending made the pain worse. 

I found myself spending most of my day standing because sitting was just too painful. However, constant standing was not practical for work given that I have to sit down to interview patients. A standing desk wasn't a great option or I would be towering over my patients as they sat and told me about their injury. The solution to my problem was to buy a saddle stool. This allows me to sit but still keep my pelvis and spine in an upright position as if I was standing. The stool is fantastic and has helped my back a lot. Once I overcame the initial saddle soreness I found the position really comfortable. 

There are a lot of saddle stools on the market. I opted for a Salli Sway saddle stool which has a split down the centre to take pressure off the perineum (a very good feature, particularly for men).


Top 10 tips for sitting posture

Maintaining good posture throughout life is important to reduce the risk of injury and to make sure you function at your best. When your body moves well you feel good. There are many different postural problems and different ways to correct them. The most common problems are as a result of time spent sitting and as a result of lack of movement. If you have pain as a result of your posture or you are concerned with your posture then you should seek help from an expert in this area such as a Physiotherapist.

The top 10 tips for sitting posture are:

1.       Stand up and move around

2.       Use a lumbar support

3.       Sit tall

4.       Lift your shoulders up and back slightly

5.       Have your feet on the ground spaced at hip width

6.       Knees and hips at about a 90 degree angle

7.       Have your screen at eye height

8.       Have your mouse and keyboard close to you so you aren’t having to reach

9.       Stretch at regular intervals (ask your physio which stretches are beswt for you)

10.   Don’t sit if you don’t have to (try standing up every time you answer the telephone).

Sever's Disease. A common cause of heel pain in children and adolescents

A common cause of foot pain in children and adolescents is a condition referred to as Sever’s disease. It is also known as Calcaneal Apophysitis. This problem results in pain in one or both heels, particularly with activity.

Sever’s disease is common amongst physically active children who participate in high impact sports involving jumping or sprinting (eg- football, basketball, soccer, athletics, netball). Excessive forces placed on the heel bone at the site where the Achilles tendon inserts leads to inflammation of the growth plate of the bone.

The condition is more prevalent in the early stages of puberty and generally effects females between the ages of 8 – 13 and males from 10 – 15. Sever's disease is similar to Osgood-Schlatter disease, a condition affecting the bones in the knees.



-          Overactivity or increased training load

-          Flat feet or high-arched feet

-          Tightness of calves and Achilles tendon

-          Playing on hard surfaces

-          Poor or unsuitable footwear

-          Obesity


Signs and Symptoms:

-          Pain on the back or sides of the heel bone or around the Achilles tendon

-          Pain in the heel with activities involving explosive movements i.e- jumping, running/sprinting

-          Pain can be worse initially after activity but generally settles after rest

-          Limping when walking or running

-          Tender or painful to touch



-          Rest

-          Reduction or modification of activity levels for a short period

-          Ice or heat to the area

-          Biomechanic assessment by a Podiatrist

-          Orthotic insoles may be required for flat or high-arched feet

-          Stretching of calves and Achilles





Foot injuries in dance

Foot injuries

Incidence rates of 34% - 62% of dance injuries are foot related

Common causes

  • Anatomical alignment
  • Poor technique and training
  • Strength/ROM
  • Females increased risk of injury
  • Environmental factors
  • Shoes –fit
  • Surface
  • Temperature
  • Training Regime

Common foot injury sites

  • 1st MTPJ
  • Sesamoid
  • Lesser digits
  • Metatarsal
  • Forefoot
  • Midfoot
  • Ankle
  • Heel

How can we help?

  • Pointe assessment
  • Gait assessment
  • Footwear
  • Offloading - padding, splinting, taping
  • Orthotics
  • Strength & conditioning

For further information book in to see one of our expert Podiatrists.

Strength Training for Runners

Most runners love to run. As a result it is easy to fall into the trap of only running and not doing any other form of training. However, it has been shown that resistance training can enhance performance for runners. Strength training can improve the muscles ability to store and release elastic energy and reduce the amount of energy wasted. What's more it can reduce your risk of injury and keep you running uninterrupted and pain free. Weight training has been shown to improve strength and running economy (GREGOIRE P. MILLET, 2002) (KYVIND STKREN1, 2008). Plyometric training has been shown to improve distance running performance in athletes (PHILO U. SAUNDERS, 2006).

So what sort of strength training is important for distance runners. First of all calf strengthening is vital. The calf/achilles complex contributes a huge amount to shock absorption, horizontal and vertical propulsion. Any deficit in calf strength, endurance or power can lead to poor shock absorption and predispose you to injury. Improving the calves ability to store and release elastic energy can also increase stride length and therefore increase running speed.

Hip strengthening is also of great importance to runners. The hips are the fulcrum around which our legs move to drive us forwards. Our trunk and upper body must also remain balanced on the hips as we run. Weakness in the hips can lead to a loss of lower limb rotational control, a loss of lateral pelvic control, poor trunk posture, overstriding, increased ground contact time and many different injuries. Many runners make the mistake of only strengthening the hip extensors. It is equally important to strengthen the hip rotators, flexors and lateral hip muscles.

Finally strength training is only useful if it translates into improved movement. Attention needs to be paid to running technique to allow the gains achieved by muscle strength, endurance and plyometric training to carry over into your running. This should help make you more efficient, faster and injury free. 

For more information consult your Physiotherapist at Lifecare Malvern Sports Medicine.

Overuse injuries and training load - by Sam Bugeja, Sports Physiotherapist at lifecare malvern physiotherapy

Most overuse injuries occur as a result of training error. A training error occurs when training load is increased more rapidly than the athlete can tolerate. The human body needs time to adapt to a given training load and rapid changes in training intensity or volume can lead to pathological overload of tissues through not allowing adequate adaptation time.

Load management is about controlling training loads to optimise performance and reduce the risk of injury. Too little or too much training can result in failure or injury. 

Training load is a measure of type, volume, intensity and frequency of training. The first step in managing training loads is to measure and record it. There are many methods that can be used to measure loads. One commonly used method is to record the time and intensity of each training session. The intensity can be measured using a Rating of Perceived Exertion or RPE scale of 1-10 (1 being the easiest and 10 being the hardest). If training time is multiplied by RPE then you have a measure of the load for that session. You can then calculate training load for each week, month, etc.

Recording this is the first step towards reducing training errors and reducing your risk of overuse injury. Sports Physiotherapists are well versed in training load, training error, overuse injuries and injury risk reduction. 


Plantar Fasciitis - by Tim Lane, Podiatrist in Malvern

One of the most common musculoskeletal problems Podiatrist’s see is painful heels. Plantar Fasciitis(sometimes referred to as a heel spur) is the most common cause, affecting approximately 10% of the adult population at some point in their lifetime.

What is it:
The plantar fascia is a thickened, fibrous band of connective tissue that originates from the base of the heel, extending along the sole of the foot and fanning out to connect to the base of the toes. The role of the plantar fascia is to provide arch support and shock absorption for the foot and leg.
Repetitive activity or trauma such as walking or running can cause degeneration of the plantar fascia at the heel bone, leading to inflammation in the area. A calcium deposit, known as a calcaneal (or heel) spur, can develop on the base of the heel bone due to the increased stress to the area. 
Who it affects:
Plantar Fasciitis (PF)is generally seen in people with a pronated foot type (i.e.- foot “rolls in”) where the arch collapses, placing increased pressure on the fascia. Very high arches and supinated (“rolling out”) foot types are also at risk as the foot is unable to evenly distribute forces during weightbearing.
Tight calf muscles increase the risk of developing PF due to a decrease in ankle joint movement. 

One of the most common symptoms of PF is pain in the heel when getting out of bed in the morning or after periods of prolonged rest. The pain usually settles once the foot has limbered up.  Periods of prolonged standing can cause the pain to return. Patients will generally complain of stabbing pains or a constant ache.

PF can subside by itself, however this can take  6-18 months or longer. Early diagnosis will result in a greater success rate to conservative treatments:
-    Rest from aggravating activities or surfaces (i.e.- asphalt, concrete) and wearing supportive, non-fatigued, and adequate-fitting footwear will assist in recovery.

-    Strapping or accommodative orthotics may be warranted to address poor foot or lower-limb posture.

-    Stretching and strengthening programs can assist in addressing flexibility and weakness issues. Heat, ice and Non-steroidal Anti-Inflammatory Drugs (NSAID’s) such as ibuprofen can provide relief for pain and inflammation.

-    In some instances, a corticosteroid injection may assist with inflammation in the heel area. Should all other forms of conservative treatment fail, surgery may be warranted.

Lateral Ankle Sprains - by Sally Naylor

Lateral Ankle Sprains

Lateral ligament sprains are a common injury in sports, especially those that involve changing direction or jumping and landing. 

Mechanism of Injury
These ligaments are placed under stress and subsequently injured when the foot is inverted.  Often this will occur when someone stands on another player’s foot or lands on an uneven part of ground.  They will then feel pain on the outside of the ankle. Depending on the severity (grade 1-grade 3) there will be swelling, bruising, and difficulty weight bearing through the injured ankle.

Initial Management
“RICE” the ankle- Rest, Ice, Compression and Elevation. This protocol is followed for the first 72 hours post injury. 
-Rest from aggravating activities e.g. running, walking (if severe). 
-Ice: 20 minutes every couple of hours. 
-Compression- evidence suggests semi-rigid ankle braces provide the best compression, with less long-term ankle instability and quicker return to sport rates. 
- Elevate: above the level of the heart
Crutches may be required if unable to weight bear. However, evidence favours functional mobilization rather than immobilization for earlier return to sport.

Do I need an X-ray?
There are specific guidelines that physiotherapists use to determine whether an x-ray is required, including specific points of tenderness and ability to weight bear. It is recommended that you see your highly skilled physiotherapist at Lifecare Malvern Sports Medicine who can assess and refer for an x-ray if necessary.

When can I return to sport?
Your physiotherapist will prescribe a rehabilitation program focusing on improving range of motion, ankle strength, balance and other biomechanical/strength deficits. This will reduce your risk of re-injury when returning to sport. Depending on the severity, return to sport can be between 3-6 weeks, however severe sprains can take even longer. It is recommended that the athlete return to sport wearing an ankle brace to provide further stability to the ankle. 

Peterson, W., Rembitzki, IV.,Koppenburg, AG., Ellerann, A., Liebau, C., Bruggemann, GP., Best, R. (2013).  Treatment of acute ankle ligament injuries: a systematic review.  Archive of Orthopaedic and Trauma Surgery, 133, 1129-1141.doi:10.1007/s00402-013-1742-5