Avoid HARM for acute injuries (TOP TIPS)

Avoid HARM for acute injuries

After injuring yourself it can be difficult to know what to do. Do you use, ice or heat? Rest or movement? Elevation or massage? The asnwers to these questions are found in the type of injury that you have sustained.


Acute Injuries

An acute injury is an injury with a sudden onset, usually as a result of some sort of impact or trauma, such as a fall, sprain or collision. Acute injuries are sudden and sharp, occur immediately (or within hours) and cause pain (possibly severe pain). With this form of injury, two acronyms are extremely valuable to remember: RICE and HARM.


The RICE acronym is one that should be followed as the four factors help to reduce swelling and inflammation that is likely to occur within the first stages of healing for an acute injury. RICE stands for:

  • Rest
  • Ice
  • Compression
  • Elevation


In contrast, the HARM acronym provides four factors that should be avoided with acute injuries, and stands for:

  • Heat
  • Alcohol
  • Running
  • Massage

HARM is extremely important to remember within the initial 48 hours following an acute injury because both heat and alcohol cause the blood vessels to dilate (open up) – this increases the bleeding in the injured area. Exercising the body part or massaging the area also has the same impact and can be detrimental to the healing process.

Chronic Injuries

Differing to acute injuries, chronic injuries can be subtle and may emerge slowly, with no known factor that triggered it. Chronic injuries may come and go, and may cause dull pain or soreness. Long standing low back pain is a classic example of a chronic injury, and often results from overuse and repetitive movements. However, if an acute injury is not effectively treated, it may lead to a chronic problem.

Heat therapy

Heat therapy is frequently used for chronic injuries or injuries that have no inflammation or swelling – such as nagging muscle or joint pain. Using a heat pad, or getting into a warm bath can help to increase the elasticity of joint connective tissues and stimulate blood flow, which can consequently aid pain relief. Whilst this is often a temporary solution, it can provide relief nonetheless.

Prodced by JB Physio and re-produced with permissions via twitter

Outdoor Training Time

The Warm-up Trail

In this series of blogs we are going to take a look into the world of training outdoors with Chris Watson, an expert in outdoor personal training and conditioning. Enjoy this weeks blog:

Run! Here come the boys…

Now that summer is finally upon us and the weather seems to be picking up (hopefully) it’s time to leave the treadmill behind and get outdoors and into your local park! Don’t get me wrong I love the gym but what’s the one thing many gyms don’t have? Space! Especially during those peak hours at lunchtime and after work. No more waiting for machines or banging into people at the squat rack. So what’s so good about training outside I hear you ask? Well, it’s free, you don’t need any kit and when the sun is shinning on a summers evening there’s no better place to train. So let’s get our gear on and get outside!

First you need to identify a suitable park, preferably within running distance from work or home. Use the run there as part of your warm-up. Find a good spot, something that has a handy bench and maybe a few trees nearby. Give the area the once over, gotta check for the usual suspects, glass, stones, dog muck, etc. Now you’re ready to get stuck in. The fun bit about outdoor training is using your surroundings, get creative! Sure have a plan in your head of what you want to do during your session, but you may find a tree perfect for pull-ups or an old tree stump for box jumps or a handy bench for dips. Every park offers hidden training gold.

I have various parks where I like to train as each one offers something a little different and that’s how I structure my training session or that of my clients. For example, a typical session will consist of a light jog to said park, a dynamic warm-up then usually 5/6 exercises over 3/4 sets with varying rep rates. I’d always allow a good hour. Start with a 10min run followed by a 5min warm-up to get nicely stretched. Around 25/30 mins for your session, finishing off with a light warm down run (back). Spend at least 10mins stretching at the end. Job done!

Man of Steel…

Over the next few weeks we’ll look at the different types of sessions you could plan. Whether you have an hour or just 20 mins. The exercises you could include and the effectiveness of weight-free training for burning fat. Things you can use, goals you can set and how you can bring a bit of fun to your training.

Thanks for reading and see you next week

[level 3 PT- outdoor training specialist]

Chris Watson

Enquires for PT to cdwatson1972@gmail.com

Neuromuscular Control – What does it mean???

Neuromuscular Control – What Does it mean?

Neuromuscular control is certainly a complex procedure undertaken by the body but this has been made easier to understand by Vern Gambetta, a top performance coach from the U.S. Great reading and this will certainly improve that understanding of movement.

Movement is quite simple and from that wonderful simplicity comes the complexity of sports skill and performance. Twenty-five years ago in an attempt to better explain movement and how we should effectively train movement I came up with this simple diagram I call the Performance Paradigm.
It was somewhat like what Albert Szent-Gyorgi, once said, “Discovery consists in seeing what everyone else has seen and thinking what no one else has thought.” Essentially it is the stretch shortening cycle of muscle with a more global interpretation and proprioception brought into consideration. It is the basis for what some people call the Gambetta Method; to me it is common sense. I use this to evaluate movement efficiency or deficiency and then to guide training and if necessary rehab.

Essentially all movement is interplay between force reduction and force production. The quality of the movement is dictated by our proprioceptive system. We begin movement by loading the muscles – this is the force reduction phase. Basically this is the eccentric loading phase as a well as instantaneous isometric action that lends stiffness to the muscle. This is the most important component of the performance paradigm, but probably the most overlooked as well as the most misunderstood. There are several reasons for this; the most notable being that it is less measurable. Because it is more difficult to quantify we have tended to emphasize the more measurable component, force production. It is during the force reduction phase that most injuries occur. Think landing on one leg and tearing an ACL or planting to cut and spraining an ankle. It is during this phase that gravity has its greatest impact; it is literally trying to slam the body into the ground.

Once force has been reduced the subsequent result is force production. Force production is easy to see and easy to measure. Consequently it gets an inordinate amount of attention in the training process. We see it because it is the outcome. It is how high or far we jump. It is how much we lift. But just because it is easy to see and measure does not mean it should receive the inordinate emphasis, in training that it does. It must be stressed that it is the component of the performance paradigm that is highly dependent on the other phases.


The third component of the Performance Paradigm is proprioception. Ultimately it is the glue that binds a whole functional program together is proprioception. Proprioception is the awareness of joint position and force derived from the sense receptors in the joints, ligaments, muscles, and tendons. It is that component that gives quality to the movement. “The quality of movement, in part, is dependent upon neurologic information fed back from proprioceptors within muscles and joints to the higher brain centers. The information returning to the central nervous system from the periphery includes “data” concerning tension of muscle fibers, joint angles, and position of the body being moved.” Logan and McKinney (Page 62) It is the feedback mechanism that positions the limbs to be able to achieve optimum efficiency. It is a component of movement that has been all but ignored in most traditional training programs until recently. It is highly trainable, especially if it is incorporated as part of a whole program.

It is almost too simple. Perhaps to appreciate proprioception we should look at the extreme case of a stroke victim that is able to return to normal movement patterns. Why can’t an athlete who has all their capacities enhance the quality of their movement by focusing on the same things that the stroke victim has to focus on to get back to function? The key to that is proprioception. We must strive to constantly change proprioceptive demand throughout the training program in order to enhance the quality of movement.

The performance paradigm will serve as a guide to determine how we train all components. It can also serve as a very useful guide to help us to evaluate movement from a slightly different context. It should serve as a guide to be more functional in our approach by emphasizing the timing and sequence of all three components of the paradigm. The synergistic interplay between them will produce the highest quality of movement.

It is very easy to get caught in the trap of measurable strength. How much you can lift or how many foot-pounds of force you can express on a dynamometer are meaningless numbers. Functional training does not depend on measurable strength. Quality of movement, coordination and rhythm are more important. The goal is always to apply the strength that is developed in the actual sport performance. How is the force expressed? Can you produce and reduce the force? Force production is all about acceleration, but often the key to movement efficiency and staying injury free is the ability to decelerate and stabilize in order to position the body to perform efficiently. A good functional training program will work on the interplay between force production, force reduction and stabilization. The end result is functional strength

Thanks for reading, see my next post on ACL and neuromuscular control!!!

TA Physio

prehab not rehab for sport injury prevention
prehab not rehab for sport injury prevention

Top Tips for Eccentric Training & Tendinopathy

Eccentric Training for Tendinopathy Injuries:

Image courtesy of http://www.injuryexplained.com/

Eccentric training is a form of training in which the muscle is worked as it lengthens. In contrast, concentric training involves a muscle working as it shortens. A good example of these can be observed within a bicep curl – as the elbow bends the biceps work concentrically and the muscles shorten as they work. However, as the elbow then straightens the bicep muscles are lengthening, but they continue to contract and work as they control the movement.


It has been found that the faster a muscle contracts concentrically (shortening), the lower the tension it is able to generate (1). Tension in muscle fibres when lengthening (eccentric) is considerably greater than when muscle fibres are shortening (2).

Previous studies have shown that when a muscle is eccentrically lengthened, the energy requirement falls substantially in comparison to concentric contractions because ATP breakdown and heat production are both slowed (2). Furthermore, with increased heat generation during concentric work, there is a concurrent increase in cellular metabolism. Thus, more waste products will be generated with concentric work, potentially leading to chemical irritation of nerves and eventually pain (6).


Tendons are the extremities of a muscle that attaches to bone and injury to tendons can occur from sudden trauma, overuse or repetitive strain. Tendon injuries account for 30-50% of injuries in sports (4). Specifically, chronic problems caused by overuse of tendons result in 30% of all running-related injuries, and elbow tendon injuries can be as high as 40% in tennis players (8). Incidence of patellar tendonopathy is reported to be as high as 32% and 45% in basketball and volleyball players, respectively (5). It is therefore important to quickly diagnose and treat such injuries with physiotherapy.

Eccentric training for tendinopathies

The Alfredson et al (1) protocol has frequently been used since its production in 1998 and appears to be a safe, effective method of implementing the eccentric training program for tendinopathies. However, this protocol was produced for and used in the treatment of achilles tendinopathies and their exact recommendations may not be appropriate for all tendons or regions.

The Alfredson protocol used three sets of 15 repetitions of bent knee and straight knee calf raises, twice a day, seven days per week over 12 weeks. Athletes were told to work through pain, only ceasing exercise if pain became disabling. Training load was increased in 5 kg increments with use of a backpack that allowed for the addition of the weight once training with bodyweight was pain free. The eccentric phase of the exercise should be performed relatively slowly, counting to 3-4 seconds as you complete the movement. The concentric phase should be avoided and the other limb can return you to the starting position of the exercise.

All of the subjects within the initial study (1) who used this protocol, returned to pre-injury activity levels and found a significant decrease in pain with a significant increase in strength.

According to Lorenz & Reiman (6), the physiotherapist may use the Alfredson protocol for an example of volume and frequency of training, but addition of weights and resistance should be dictated by the amount of pain experienced by the individual, and the exercises should be dictated by a physiotherapist to ensure correct technique and suitability of exercises.

Curwin (3) has also proposed a method to determine training load in eccentric training for tendon injuries. One significant difference between Curwin’s and Alfredson’s programs is that the athlete performs both the concentric and eccentric portion of the exercise in Curwin’s program, with the eccentric portion being performed faster. In Curwin’s protocol, they suggest that the athlete should experience pain and fatigue between 20 and 30 repetitions at a given load, when performing three sets of 10 repetitions.

Their rationale for experiencing pain is based on the premise that exercise load should be determined by the tendon tolerance, which is indicated by pain experienced during the exercise. If there is no pain after 30 repetitions, the stimulus is inadequate. Either load or the speed of exercise performance should be increased, but not both simultaneously.

Based on the clinical experience of the authors and others (7), it is recommended that 6-12 repetitions over four sets be completed to emphasize strength in the muscle-tendon complex. The athletes use the load from the six repetition resistance and build up to twelve repetitions prior to increasing load again. This process helps to maintain safe and progressive eccentric training. Additionally, the authors advocate three to four sessions per week instead of every day.

Lorenz & Reiman (6) suggest that the physiotherapist or athlete do not perform the concentric portion of the exercise or perform it with the assistance of the uninvolved limb, followed by having the athlete perform the eccentric portion of the exercise independently. Based on clinical experience, the concentric portion of the exercise can be attempted without assistance once non-sport/day-to-day activities, like walking, stair climbing and washing, are pain free.

As with eccentric exercise, progression of the concentric portion of exercise should involve a gradual increase. Once the concentric portion of exercise is pain free, the athletes can begin jogging or more sport specific activities.


1. Alfredson H, Pietila T, Jonsson P, & Lorentzon R. (1998) Heavy-load eccentric calf muscle training for treatment of chronic Achilles tendinosis. Am J Sports Med. 26: 360-366.

2. Curtin N A & Davies R E. (1970) Chemical and mechanical changes during stretching of activated frog muscle. Cold Spring Harb Symp Quant Biol. 37: 619-626.

3. Curwin S L. (1996) Tendon injuries: Pathophysiology and treatment. In: Athletic Injuries and Rehabilitation. J Zachazewski, DJ Magee, WS Quillen, ed. Philadelphia, PA: WB Saunders Co. 27-54.

4. Khan K M & Scott A. (2009) Mechanotherapy: how physical therapists’ prescription of exercise promotes tissue repair. Br J Sports Med. 43: 247-251.

5. Lian O B, Engebretsen L & Bahr R. (2005) Prevalence of jumper’s knee among elite athletes from different sports: a cross-sectional study. Am J Sports Med. 33: 561-567.

6.Lorenz D & Reiman M. (2011) The role and implementation of eccentric training in athletic rehabilitation: Tendinopathy, hamstring strains, and acl reconstruction. International Journal of Sports Physical Therapy 6(1): 27-44.

7. Ratamess N A, Alvar B A, Evetoch T K, et al. (2009) Progression models in resistance training for healthy adults: ACSM Position Stand. Med Sci Sports Exerc.  41(3): 687-708.

8 Sharma P & Maffulli N. (2006) Biology of tendon injury: healing, modeling, and remodeling. J Musculoskelet Neuronal Interact. 6: 181-190.

Blog produced by www.jbphysio.co.uk and re-produced with permission via twitter

10,000 Steps

10,000 STEPS A DAY:
“10,000 steps a day keeps the doctor away”

How many steps do you walk each day?

Maybe you have heard the guidelines about walking 10,000 steps per day. How far is 10,000 steps anyway? The average person’s stride length is approximately 2.5 feet long. That means it takes just over 2,000 steps to walk one mile, and 10,000 steps is close to 5 miles.

A sedentary person may only average 1,000 to 3,000 steps a day. For these people adding steps has many health benefits. I have outlined the basic 10,000 steps program, but also added a commentary below.

A reasonable goal for most people is to increase average daily steps each week by 500 per day until you can easily average 10,000 per day. Example: If you currently average 3000 steps each day, your goal for week one is 3500 each day. Your week 2 goal is 4000 each day. Continue to increase each week and you should be averaging 10,000 steps by the end of 14 weeks.

Wearing a pedometer is an easy way to track your steps each day. Start by wearing the pedometer every day for one week. Put it on when you get up in the morning and wear it until bed time. Record your daily steps in a log or notebook. By the end of the week you will know your average daily steps. You might be surprised how many (or how few) steps you get in each day.

There are many ways to increase your daily steps. Use your imagination and come up with your own list:
-Take a walk with your spouse, child, or friend
-Walk the dog
-Use the stairs instead of the elevator
-Park farther from the shop
-Better yet, walk to the shops
-Get off the tube one stop early
-Get up to change the channel
-Window shop
-Plan a walking meeting
-Walk over to visit a neighbor
-Get outside to walk around the garden or do a little weeding

Continue to track your daily steps and/or mileage; and keep notes on how you feel, how your body is improving, or other changes you are making to improve your health.

If you are in very poor physical condition or at any point you feel that you are progressing too rapidly slow down a bit and try smaller increases. If you have any health concerns seek your physician’s advice prior to starting or changing your exercise routine.

Notice: We have outlined the standard 10,000 step program because so many people ask about it. This is a good program to help get people motivated, or to get sedentary people moving. It is however our recommendation that most individuals fit 30 to 60 minutes of dedicated walking (or other exercise) into their routine at least 3 to 4 days a week. You can start with as little as ten minutes per day and gradually increase your walking routine.
Courtesy of the walking site