A question I often get asked as an AFL Physiotherapist is “What do you do on game day?”

I have had the pleasure of working for 3 different AFL clubs over the last 10 years (St Kilda, Gold Coast and Richmond FC) and the game day role remains challenging and enormously rewarding.

Players arrive at the ground usually two hours prior to the game starting. Players like to familiarize themselves with the ground, check the weather/wind direction, check the grass surface and decide which boots to wear etc.

We have two Physiotherapists work on game day and we are ready to treat the players from the time they arrive.

Treatment pre game consists of specific strapping of ankles and shoulders and a variety of other body parts when needed. Taping provides the players with a sense of support, can be used to restrict joint movement, and some evidence suggests it may reduce injury severity. We use mobilization and soft tissue techniques to loosen up stiff ankles and lower backs. We also provide massage when required. We help players complete specific warm up exercises utilizing resistance bands and weighted vests. Almost all of the players would check in with us or get treated pre game.

Once the game begins, we have two Doctors and two Physiotherapists that sit on the interchange bench. We all continually monitor the players injuries and provide treatment. Most small injuries can be dealt with on the side of the field, but more serious cases require change room access where we can utilize equipment to assess and treat injuries. Most commonly we see sprained ankles, dislocated fingers, muscular contusions and strained muscles. Rarely, we may see a fracture or concussion that requires stretcher retrieval from the field of play. In these cases, both Doctors and Physiotherapists follow a strict protocol to ensure player safety.

If a player is able to safely return to play then they are closely monitored. If required we can reduce game time exposure by increasing interchange rotations for individual players. As the game progresses into the fourth quarter we can get very busy on the interchange bench.   Monitoring 3-4 players with game day injuries and managing muscular cramp in fatigued players.

Post game, injury management begins straight away. All players will check in with the Doctor and Physiotherapist regarding injuries sustained. Treatment begins immediately (compression/ICE etc.) and players are given an initial 24hour plan.

Post Game recovery for the players is either at our training facility when playing in Melbourne or at our hotel when travelling interstate. This consists of Ice Baths, Pool Recovery, Massage, Stretching, Rehydration/Food Replenishment and can take players up to 2 hours to complete.

Stuart McKenzie is a director at Restore Physiotherapy & Pliates. He has worked as a physiotherapist at the Richmond Football Club for the past 3 seasons. Stuart’s role involves match day coverage as well providing physiotherapy services to the players during the week. Prior to Richmond, Stuart had stints at both the St Kilda and Gold Coast Suns Football Clubs.

Below is an account of the international trip Restore physiotherapist Joel Ames undertook with Melbourne Football Club player Christian Petracca. Christian was the number 2 pick in the 2014 AFL Draft. Unfortunately, Christian suffered a season ending knee injury in February 2015.

Joel and Christian attended the high performance training facility Hp Sports in Philadelphia, Pennsylvania in the United States. Hp Sports is run by world-renowned Athletic Trainer and Strength & Conditioning coach Bill Knowles. Bill has trained many NFL, NBA and professional soccer stars as well as AFL players Tex Walker, Daniel Menzel, John Patton and West Coast pair Eric McKenzie and Mitch Brown. Bill presents and lectures at many conferences around the world sharing his progressive reconditioning and athletic development strategies.

DAY 1: Saturday, September 12 2015

A day of travel flights, flights, flights.

Melbourne to Sydney. Sydney to Dallas. Dallas to Philadelphia.

After leaving Melbourne at 10.30am we arrive at our hotel at 11.00pm Saturday night Philly time. After 26.5 hours, 3 flights and 4 airports we are absolutely exhausted and need sleep!!!

DAY 2: Sunday, September 13 2015

Breakfast is followed by a quick run and kick in Valley Creek Park to blow out some cobwebs and stretch some pretty tight muscles after yesterday’s travel. On return to the hotel we complete a recovery session in the pool.

The rest of the day is spent shopping for food and learning the road rules, driving on the opposite side of the road has its challenges. Sunday is NFL (American Football) Day in the US, we have arrived Week 1 of the 2015/16 season and everybody over here is going nuts for the start of the season. TV is wall-to-wall NFL.

DAY 3: Monday, September 14 2015

Day one with Bill Knowles at his training facility Hp Sports. The facility is amazing indoor soccer field, gymnastics floor, trampolines, ice baths, pools etc. First session starts at 8am, with an introduction to Bill, his team and his philosophies. Bill is an energetic and enthusiastic American who clearly loves his job of training athletes.

Christian undertakes a series of drills and exercises for an hour working on stability and tension through his body. We then have 2.5hours till our next session, which allows us to have lunch. Another 2-hour session follows in the afternoon building on the exercises and techniques from this morning. Christian is exhausted by the end, his glutes and calves burning as they get hammered in the session.

The rest of the afternoon is about recovery ice baths, pool recovery and stretching. Dinner is followed by physiotherapy treatment for Christian, this is going to be a huge part of the week to ensure Christian can get up for 10 sessions in five days.

DAY 4: Tuesday, September 15 2015

Another day, another early rise. Although for me this was earlier than expected. Still suffering the effects of jet lag and woke up at 4am, unable to get back to sleep.

First session today, built on the drill work we did yesterday, Christian is picking things up really quickly and progressing well. Been some solid leg work over the past two days and his glutes, quads and calves are getting fatigued.

Also training at Hp Sports with Bill this week are two professional Rugby Union players from the UK who have also suffered ACL injuries. Talking to their physiotherapist gives me a great opportunity to learn about treating athletes in a different environment and country. Again one of the benefits of this great experience.

The afternoon session focuses solely on upper body and core, giving the legs a much needed rest. Ice bath and recovery follow. Both of us a pretty cooked in the 28-degree heat – not used to this coming off a cold Melbourne winter. Physiotherapy again follows that evening in preparation for the day ahead.

DAY 5: Wednesday, September 16 2015

The third day in a row and Christian is starting to feel the effects of the back-to-back sessions. Today focused on reinforcing the drills learnt from the past two days. We also introduce balancing exercises using water bags, which add a variable load to his knee.

The afternoon session was conducted in the pool, and was a chance to unload Christian’s legs and work his core.

Later in the day we had some down time to explore Philly. We had a Philly Cheesesteak – basically a heart attack in a bun!!! We also checked out a baseball game; Philadelphia Phillies vs. Washington Nationals. The Phillies have been struggling for the entire season and this continued last night with the Phillies going down 12 to 2. Despite this it was another great American experience.

DAY 6: Thursday, September 17 2015

Solid two sessions today. The morning session was all about quick feet work on the gymnastics floor. This floor enables the athlete to get more elevation and spring, which is great for plyometric/explosive work. The afternoon session was about gymnastics which Christian found fun, fun, fun. Forward and backward rolls, over pommels, cartwheels and the odd tackle bag thrown in. Although enjoyable all these exercises had a purpose – putting Christian in positions where he needs to develop speed and power quickly.

Another physio arrived today to observe Bill at work, Remi, who works with the UK National Rugby Union team. Remi worked in the past with Geelong Football Club in the AFL. Again it was great to share thoughts and experiences from other physio working in the elite sporting environment.

One day to go.

DAY 7: Friday, September 18 2015

Last day of the training camp. Christian is starting to get physically and mentally fatigued. It has been a very intense week, requiring not only large physical efforts, but also a lot of concentration and mental application.

The morning was spent applying the movement patterns and principles, we had learnt over the past 4 days, to the field. This included a lot of acceleration/deceleration drills, agility and change of direction. It was great to see the progression from what Christian learnt on Monday and how it was applied to increasingly difficult tasks.

The afternoon was spent doing numerous squatting, hopping and jumping activities against resistance bands. By the end Christian almost collapsed in a heap from fatigue.

The evening was spent out for dinner and a couple of drinks with the team at Hp Sports and the professional rugby players and their physios. Another great opportunity to swap stories, compare codes and share information. Not too mention the pulled pork and ribs!

This was a fantastic experience. Providing a great insight into how the Americans train their athletes. Also some great learning about exercises and drills for athletes recovering from major knee injuries. The camp also highlighted the importance of coaching and skill acquisition in a rehabilitation setting. The experience also provided me with the opportunity to learn from one of the world leading experts in ACL rehabilitation and reconditioning, Bill Knowles.

This whole experience has certainly enhanced my own skills set as a physiotherapist. Skills, that I will be able to implement and apply to my Restore Physiotherapy and Pilates patients on my return to Australia.

Joel Ames is a director at Restore Physiotherapy & Pilates. He has worked as a physiotherapist at the Melbourne Football Club for the past three seasons. His current role is fulltime with game day responsibilities as well as responsibility for providing physiotherapist management of injured players in the rehabilitation program.

A number of diets or lifestyle eating plans have gained popularity over the last few years. Amongst these is the Low Carb High Fat Diet.

THE HISTORY:

Low Carb High Fat Diets are not new. In the 1800s, William Banting, an obese London undertaker was prescribed a low carbohydrate diet to lose weight, by his doctor. So pleased with the results, he published a Letter on Corpulence addressed to the public to spread the word of the benefits of avoiding carbohydrates. Robert Atkins in 1972 published the Dr Atkins Diet Revolution advocating low carbohydrate consumption. However, due to its recommendation of high fat and protein content it was met be scepticism amongst the medical community. Recently, the Paleo Diet, which restricts carbohydrate intake, has gained popularity.

THE SCIENCE:

When carbohydrates are consumed they are broken down into glucose in the gut and absorbed into the bloodstream. Insulin, a hormone secreted from the pancreas, helps to keep blood glucose down. Insulin causes glucose to be taken up by the liver and muscles to produce energy. The downside is that insulin causes excess carbohydrates to be stored as fat. Exposure to large amounts of carbohydrates over a period of time can result in increased blood glucose levels (Type 2 diabetes) and/or obesity.

If the energy the body gains from carbohydrates is reduced, it needs to be replaced with an alternative fuel source. Proponents of the Low Carb High Fat Diet recommend replacing carbohydrates with saturated fats to provide energy.

THE BENEFITS:

Evidence exists that benefits from a Low Carb High Fat Diet may include weight loss, reducing the risk of Type 2 diabetes and fatty liver, and a reduction in abdominal discomfort and bloating. It is also possible that a Low Carb High Fat Diet may reduce the risk of dementia, Alzheimer’s disease and some forms of cancer.

This article is of a general nature. Individuals should consult an accredited healthcare professional before commencing any form of diet or eating plan.

Drinks and canapés will be served during the evening.

RSVP: Friday 13^th February. Contact reception:
reception@restorephysio.com.au
Ph 9855 1122

RSVP ONLINE

To reward our loyal customers and celebrate Restore Physiotherapy and Pilates providing excellent service to the Kew community for the past 10 years, we are offering a discount on our group Pilates.

For the month of February, customers who purchase a 10 pack of Pilates sessions, will only pay $400. This is a saving of $15 per session over the usual sessional rate.

Ask reception for more details.

Restore Physiotherapy & Pilates opened its doors at the High Street Kew address in January 2005.

It was established by Stuart McKenzie and Mary Di Iorio, musculoskeletal physiotherapists who were independently working in North Balwyn. They recognised a need for high quality, evidence based physiotherapy services in Kew. Restore was the first practice to introduce the health benefits of Pilates to Kew. The Restore team grew and Joel Ames, a long serving employee, became a partner in the business.

We have had the privilege of meeting and providing health solutions to over 6,000 clients, many of whom have been part of the Restore family for 10 years. Our clients have become valued members of the Restore community and we are honoured to have experienced the good and hard times with them over that 10 year period. There has been many weddings, births, countless overseas trips, surgeries and sadly, a few deaths which we have shared in.

Our incredible staff has been instrumental to the formation and growth of Restore. Their high quality skills as well as their care and compassion has enabled Restore Physiotherapy and Pilates to be considered leaders in the delivery of Physiotherapy and Pilates services. Physiotherapy staff are strongly encouraged to commit to further study and many have completed Masters degrees in Sports Physiotherapy, Musculoskeletal Physiotherapy, Women’s and Men’s Health Physiotherapy and Public Health. The benefits of further study and knowledge then get passed on to other staff and of course our clients. Our staff has been involved in teaching at Post Graduate and Undergraduate level, providing physiotherapy services to underprivileged communities overseas and providers of physiotherapy to St. Kilda, Richmond and Melbourne AFL football clubs.

Our competent and caring reception staff are the backbone of the practice and their hard work and dedication ensures the smooth running of day to day operations. They have also been known to go above and beyond the call of duty by driving clients home, cooking some meals for them and even providing technical support for their computer issues! This year we farewell Suellen Roberts, our first employee. Suellen was instrumental in the development of the caring culture at Restore. We thank her for her amazing contribution and wish her well for her future endeavours.

Joel, Stuart and Mary would like to thank all our clients and staff at Restore Physiotherapy and Pilates for their support over the last 10 years and for making it such a wonderful family! We look forward to many more years of service.

Zee is a GP working at South Yarra Medical and Olympic Park Sports Medicine Clinic. Zee has also worked as the club doctor at Melbourne Football Club in the AFL for the past three seasons.

Zee received his medical degree from Monash University in 2003 and has also completed a Masters degree in Public Health and Tropical Medicine. He is also in the process of completing the Sports Physician training program.

Zee’s two passions are sports medicine and nutrition. He is a strong believer in using exercise and sport to promote health and well being, and prevent disease and morbidity.

However, it is nutrition where Zee has gained most notoriety. He believes appropriate nutrition, exercise, stress management and sleep is paramount in the prevention and treatment of most chronic diseases including cardiovascular disease, diabetes, hypertension, hypertriglyceridemia, fatty liver, polycystic ovarian syndrome, gastro oesophageal reflux and irritable bowel syndrome.

He has successfully assisted numerous patients lose weight and maintain their weight loss with a well formulated personalised nutrition plan. Zee has also given numerous public lectures exploring these themes and has appeared in various forms of media discussing this subject. He is also very experienced in using low carbohydrate high fat and ketogenic diets for exercise performance particularly endurance athletes. A strategy he has introduced to the Melbourne Football Club over the 2015 pre season.

In this quarterly newsletter we will keep you updated with the latest happenings at Restore Physiotherapy and Pilates. You can read about the latest cutting edge information regarding your health and well-being.

What are the pelvic floor muscles? This month Tamara Wraith, Restore’s highly qualified and experienced Women’s and Men’s Health Physiotherapist, provides information about these important muscles and their role in everyday life.

Do you or your children play competitive sport? Are they adequately protecting themselves from injury by completing a proper warm up? Joel Ames, co-director at Restore and physiotherapist at Melbourne Football Club in the AFL, provides information regarding the key features of a warm up and what the latest research tells us your child should be doing pre-game, training or during competition.

Each issue we will also give you some background on members of our friendly, passionate and professional Restore Physiotherapy team.

You may have noticed a change at Restore over the past few months as our rebranding nears completion. Our amazing new blue window signage spanning the entire street frontage of 260 High Street Kew has been prominent since early in the year. We also have a stronger online presence through the creation of our new website (link), allowing you to access all the information you need about our team and the services provided at Restore.

Hope you enjoy this newsletter and remember at Restore Physiotherapy and Clinical Pilates “YOUR WELL-BEING is OUR PRIORITY”.

Q: What is a firm foundation for upper limbs, lower limbs and trunk control?

A: Core stability!

Yes we have all heard the term and it is exchanged over cups of coffee, before a gym session or whilst walking around the golf course: “I am working on my core…”

To work on your core really means co-activating or engaging the transversus abdominus muscle (deepest abdominal muscle which acts like a corset) and the levator ani muscles. What and where are the levator ani muscles? They are your pelvic floor muscles – they form a floor to your bony pelvis and are vital for supporting abdominal organs in men and women, young and old.

So your pelvis is the powerhouse for core strength. Your pelvis is the foundation stone for weight bearing lifestyles.

• Is your pelvic floor muscle engaged?
• Have you experienced any signs of weakness?
• Bladder control or bowel control issues?
• Prolapse symptoms, prostate symptoms or pelvic pain of any sort?

If so, speak to your physiotherapist, GP or specialist and make sure you optimise your pelvic floor control and build a firmer foundation. Improve your body mass index to not overload the pelvic floor.

Try completing the following male/female questionnaires to ascertain if you are putting your Pelvic Floor First. Visit www.pelvicfloorfirst.com.au or ask at the Restore reception for a copy of this questionnaire.

Tamara Wraith

Tamara Wraith is our experienced Women’s and Men’s Health Physiotherapist who joined the Restore team two years ago. Tamara has focused on clinical excellence and compassion as a pelvic floor physiotherapist for 15 years and has tutored at Melbourne University on the Post Graduate course since 2010. Tamara as well as working in many private clinics, has been a Senior Physiotherapist at many of Melbourne’s leading hospital specialising in obstetrics and gynaecology, including Mercy Hospital for Women and Francis Perry House. Tamara recently travelled with an Aus Aid Urology Team coordinated by the College of Surgeons to Solomon Islands to help establish a Continence Clinic there – a project she is thrilled to have an ongoing involvement with.

A warm up is defined as a period of preparatory exercise in order to enhance subsequent competition or training performance.

But what is the most appropriate form of warm up and is the traditional version of a warm up the most appropriate in enhancing performance and preventing injury?

We all know that a warm up prior to sporting activity is important, but why? What are the benefits? The purpose of a warm up is increase blood flow to the periphery, increase muscle temperature, increase muscle and tendon suppleness and enhance co-ordinated movement.

Warm ups have traditionally consisted of aerobic exercise, followed by stretching and then by sport specific activity. Warm ups incorporating these three components are supported by numerous authors in the literature. However, much conjecture exists about the specifics within these three categories.

The most controversy exists as to whether static or dynamic stretching should be included. Static stretching involves passively elongating a muscle to the end of its range then holding (usually at the point of discomfort) for a period of time.Dynamic stretching involves whole body movements and actively and rhythmically contracting a muscle group through part of its range of movement. Examples of dynamic stretches include; hopping, jumping, leg and arm swings, sidestepping, high knees, leg kickbacks and walk lunge. Recent evidence has shown that dynamic stretching is superior to static stretching in improving performance. In fact some evidence points to static stretching having a negative impact on performance. Static stretching has shown to decrease strength, jump height, reaction time and balance. Pre exercise static stretching has also been shown to have no benefit in reducing injury risk. In contrast dynamic stretching often incorporated into a sport specific warm up has shown to improve concentric strength, agility, speed, agility and jump height.

The length of a warm up is also another area in which opinions vary widely. Specific time frames are difficult to provide because they are influenced by the sport undertaken, level of competition and age of the participants. Evidence has shown that warm ups focusing on an increase in body temperature have been shown to be more effective in reducing injury. However, fatigue is also a positive predictor for injury. So as general rule, the length of the warm up should be enough to achieve optimal levels of body temperature but not too long to cause fatigue.

The sport specific activity included within a warm up should involve similar body parts to those used within the sport. Therefore, coaches and trainers should analyse key skills and tasks performed during the sport and incorporate similar movements into the warm up.

Using the above principles a general warm up for sporting activity should include:

1. A period of aerobic exercise to increase body temperature. E.g.: gentle shuttle runs, laps of Netball court etc
2. A period of sport-specific dynamic stretching to stretch the muscles used in the subsequent performance. E.g. high knees, sidestepping, leg kickbacks, leg and arm swings, walk lunges, jumping and skipping.
3. Sport specific movements similar to those used in the sport. E.g.: passing drills, shooting drills, kicking drills etc.

A full list of references for this article is available on request.

Joel Ames is a musculoskeletal physiotherapist and director at Restore Physiotherapy and Clinical Pilates in Kew. He is also a full time physiotherapist at Melbourne Football Club in the AFL.