During the Victorian winter season, many of us look forward to hitting the slopes for some alpine skiing or snowboarding at popular resorts such as Mt Buller, Mt Hotham and Falls Creek. These exhilarating sports not only offer a great way to stay active but also a chance to connect with nature and enjoy snowy landscapes. However, with the thrill of these activities comes the risk of injury, in particular ACL injuries. At Acland Street Physiotherapy, we're dedicated to helping you stay safe and injury-free while enjoying your time on the slopes.

The Risks Involved
Skiing and snowboarding are among the top contributors to sports-related injuries each year. The high velocities, varying terrains, and unpredictable conditions inherent to these sports increase the likelihood of injuries, particularly to the lower extremities. Common injuries include knee sprains, fractures, and muscle strains. However, with proper preparation, many of these injuries can be prevented.

The Importance of Physical Fitness
The role of physical fitness in preventing injuries cannot be overstated. A systematic review by Hébert-Losier and Holmberg (2013) found that while much of the focus on injury prevention has historically been on equipment and third-party involvement, there is a significant need for targeted physical fitness to meet the technical demands of skiing and snowboarding. Strength, endurance, agility, and balance are crucial components that help manage the intense physical demands these sports place on your body .

A more recent study by Wang et al. (2022) emphasises the importance of lower extremity fitness, specifically agility and balance, in reducing injury risk among recreational skiers. The study found that skiers with inferior agility or balance are at a higher risk of injury, highlighting the necessity of neuromuscular training that targets these areas .

Recommendations for Injury Prevention
Based on these findings, here are some evidence-based recommendations to help you prepare for a safe and enjoyable skiing or snowboarding season:

1. Focus on Lower Extremity Agility and Balance

• Agility: Incorporate exercises that improve your ability to quickly change direction, such as lateral jumps, agility ladder drills, and cone drills. These exercises mimic the quick, multidirectional movements required in skiing and snowboarding. According to Wang et al. (2022), better agility was associated with a lower risk of injury .
• Balance: Training on unstable surfaces, such as balance boards or Bosu balls, can enhance your ability to maintain control in challenging conditions. The same study by Wang et al. highlighted the importance of balance in preventing injuries, noting that lower composite YBT scores were associated with higher injury risk .

2. Build Endurance

• Alpine skiing and snowboarding can be physically demanding, requiring sustained effort over extended periods. To prepare, engage in endurance exercises such as cycling, running, or circuit training that target the lower body. Incorporating squats or box jumps into your routine can build the muscular endurance necessary for the repetitive movements of skiing and snowboarding. Although endurance was not found to be a significant factor in injury occurrence in the multivariate analysis, its role in overall fitness and injury prevention remains important .

3. Strengthen Key Muscle Groups

• Focus on strengthening the quadriceps, hamstrings, glutes, and core muscles. Strong muscles not only improve performance but also provide stability and support to your joints, reducing the risk of injury. Hébert-Losier and Holmberg (2013) emphasised the importance of physical fitness, including strength, in meeting the demands of alpine sports and preventing injuries .

4. Proper Warm-Up

• Before hitting the slopes, make sure to warm up properly. Dynamic stretching and mobility exercises can increase blood flow to your muscles and prepare your body for the intense activity ahead. A well-prepared body is less likely to suffer from strains and sprains during skiing or snowboarding.

5. Invest in Quality Equipment

• While physical fitness is crucial, don't forget the importance of well-fitted, quality equipment. Ensure that your bindings, boots, and skis or snowboard are properly adjusted to your specifications. According to Hébert-Losier and Holmberg (2013), equipment-related recommendations are among the most common in injury prevention, reflecting the importance of gear in reducing injury risk .

Conclusion
At Acland Street Physiotherapy, we believe that with the right preparation, you can significantly reduce your risk of injury and make the most of your skiing or snowboarding experience. By focusing on agility, balance, endurance, and strength, and using well-maintained equipment, you'll be well-equipped to enjoy the slopes safely. If you're preparing for the winter season and want personalised advice or training, don't hesitate to reach out to our team. We're here to help you stay fit, healthy, and ready for the challenges of the mountain.

Stay safe, stay active, and enjoy your winter adventures!
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References:

1. Hébert-Losier, K., & Holmberg, H. C. (2013). Exercise-based injury prevention recommendations for recreational alpine skiing and snowboarding: A systematic review. Sports Med, 43(5), 355-66. doi: 10.1007/s40279-013-0032-2.
2. Wang, Z., Cai, Y., Wu, J., Xie, S., & Jiao, W. (2022). Relationship between Lower Extremity Fitness Levels and Injury Risk among Recreational Alpine Skiers: A Prospective Cohort Study. Int J Environ Res Public Health, 19(16), 10430. doi: 10.3390/ijerph191610430.

Ankle sprains are a common but painful injury that can temporarily limit your mobility. Recent studies have shed light on the most effective treatments for managing this condition. A systematic umbrella review by Gaddi et al. (2022) in Frontiers in Medicine examined multiple studies to establish a clear guide for treating acute ankle sprains. Here’s what you need to know to navigate the recovery from an ankle sprain effectively.
Understanding Ankle SprainsAnkle sprains occur when the ligaments that stabilise the ankle are overstretched or torn, usually due to twisting or rolling the foot. Symptoms typically include pain, swelling, and limited mobility. While these injuries are prevalent, especially in physically active individuals, understanding the latest research can significantly aid recovery.
Effective Non-Surgical TreatmentAccording to Gaddi et al. (2022), non-surgical interventions are highly effective in managing acute ankle sprains. These treatments focus on minimising pain and swelling while optimising the healing process without the need for surgery. Here are the key findings:

• Functional Treatment Over Immobilisation: The review highlights a preference for functional treatment, such as physiotherapy and controlled exercises, over complete immobilisation. This approach encourages mild to moderate movement early in the recovery process, which has been shown to enhance the healing rate and improve long-term outcomes.
  
• Pain Management: Traditionally, NSAIDs (non-steroidal anti-inflammatory drugs) have been used to manage pain and reduce inflammation. However, the review suggests that paracetamol (acetaminophen) or opioids can be effective alternatives, particularly for those who experience side effects from NSAIDs. Please see your GP or pharmacist for specific advice to understand what medications may help. 
  
• Rehabilitation Therapies: Manipulative and supervised exercise therapies have been found effective in preventing re-injury and improving ankle dorsiflexion (the ability to move the foot upwards). These therapies help restore normal movement and strengthen the muscles around the ankle.
  

RICE Protocol: A Traditional ApproachThe RICE protocol—rest, ice, compression, and elevation—is a classic first-line treatment immediately following an ankle sprain. This method helps reduce swelling and pain in the critical initial hours and days post-injury:

• Rest: Avoid putting weight on the injured ankle to prevent further damage.
• Ice: Apply ice to reduce swelling and numb the pain. Ice should be applied over a cloth to protect the skin, for 20 minutes every two hours.
• Compression: Use an elastic bandage to wrap the ankle. This helps prevent excessive swelling and provides support.
• Elevation: Keep the ankle elevated above heart level to help reduce swelling.

When to Seek Professional AdviceWhile mild ankle sprains can often be treated at home, it’s crucial to consult a healthcare provider if you experience severe pain, cannot walk, or suspect a fracture. A medical professional can assess the injury and recommend appropriate treatment, which may include advanced therapies or imaging tests to rule out more severe damage.
ConclusionRecovering from an ankle sprain requires patience and adherence to proven treatment protocols. The insights from the umbrella review by Gaddi et al. (2022) emphasise the importance of functional recovery programs and appropriate pain management, tailored to individual needs and medical advice. By following these evidence-based recommendations, patients can expect a more efficient and effective recovery.
References

• Gaddi, D., Mosca, A., Piatti, M., Munegato, D., Catalano, M., Di Lorenzo, G., Turati, M., Zanchi, N., Piscitelli, D., Chui, K., Zatti, G., & Bigoni, M. (2022). Acute Ankle Sprain Management: An Umbrella Review of Systematic Reviews. Frontiers in Medicine, 9:868474. doi: 10.3389/fmed.2022.868474. PMC9301067.

In the quest for muscle strength, hypertrophy, and endurance, the principle of progressive overload stands as a cornerstone of resistance training. Traditionally, increasing the weight (load) you lift has been the go-to method for achieving this. However, recent research sheds light on an equally effective strategy that might just change the way we approach our workouts: increasing repetitions while maintaining the same load. Let's dive into what this means for your training regimen.

Understanding Progressive Overload
Progressive overload involves gradually increasing the demands on your musculoskeletal system, thereby stimulating muscle growth, strength, and endurance. Traditionally, this has meant adding more weight to the bar. However, is this the only way to achieve muscular adaptations?

The Study: Load Increase vs. Repetition Increase
A groundbreaking study published in PeerJ (2022) by Plotkin et al. compared two groups over an 8-week period to see which method of progressive overload was more effective: increasing load or increasing repetitions[1]. Participants, all of whom had at least one year of lower body resistance training experience, were divided into two groups:

• One group increased the load while keeping repetitions constant.
• The other group increased repetitions while keeping the load constant.

Key Findings
The study found that both methods led to muscular adaptations, with some interesting nuances:

• Rectus femoris (part of the quadriceps) growth modestly favoured the group that increased repetitions.
• Dynamic strength increases slightly favoured the group that increased load.
• No other notable differences were found across other outcomes, such as muscle thickness in different areas, muscular endurance, jump height, body fat, or leg segmental lean mass.

Implications for Training
These findings offer valuable insights for trainers and trainees alike, presenting another promising approach to programming resistance training. Here's what it means for your workouts:

Flexibility in Training
The study underscores the viability of both increasing loads and increasing repetitions for enhancing muscular adaptations. This flexibility allows for personalised training programs that can be adjusted based on individual goals, preferences, and the availability of equipment.

Tailored Goals

• For Muscle Growth: Focusing on increasing repetitions might be particularly beneficial, especially for targeting specific muscle groups like the quadriceps.
• For Increasing Strength: Adding more weight to your lifts remains a slightly more effective strategy, though the differences may not be significantly practical for most trainees.
  
  

Reducing Risk of Injury
For individuals recovering from injuries or those concerned about the risk of overloading with heavy weights, increasing repetitions offers a safer yet effective method of achieving progressive overload without the need to constantly increase the weight lifted.

Conclusion
The study by Plotkin et al. illuminates a path forward for those looking to optimise their resistance training strategy, offering evidence that both increasing loads and repetitions can lead to significant muscular adaptations. Whether your goal is muscle growth, strength, endurance, or rehabilitation, incorporating a mix of both strategies into your workout regimen can provide comprehensive benefits tailored to your unique fitness journey.
Embrace the flexibility in your training approach, and remember, the best workout is the one that is personalised, progressive, and most importantly, enjoyable!

Reference

1. Plotkin, D., Coleman, M., Van Every, D., Maldonado, J., Oberlin, D., Israetel, M., Feather, J., Alto, A., Vigotsky, A.D., & Schoenfeld, B.J. (2022). Progressive overload without progressing load? The effects of load or repetition progression on muscular adaptations. PeerJ, 10, e14142.

When embarking on a resistance training journey, one of the most common dilemmas faced by beginners and seasoned gym-goers alike is choosing between multi-joint (MJ) and single-joint (SJ) exercises. Both types of exercises offer unique benefits and can be pivotal in shaping your fitness regimen. Recent studies shed light on their effects, helping you make an informed decision tailored to your goals.

Understanding the Basics
Multi-Joint Exercises involve two or more sets of joints and muscle groups. Classic examples include squats, bench presses, and deadlifts. These exercises are lauded for their efficiency in working multiple muscles simultaneously, potentially offering greater functional benefits.

Single-Joint Exercises focus on isolating one joint and primarily targeting a single muscle group, like bicep curls or leg extensions. They are often recommended for targeted muscle development and rehabilitation purposes.
The Research SpeaksTwo significant studies provide insight into the ongoing debate between MJ and SJ exercises. Gentil et al. (2015) found that both MJ and SJ exercises produced similar increases in muscle size and strength in untrained men, suggesting that neither type is superior for beginners aiming to increase muscle mass and strength[1]. On the other hand, Paoli et al. (2017) demonstrated that when the total work volume was equated, MJ exercises led to greater improvements in VO2max and muscle strength than SJ exercises[2]. This suggests that MJ exercises might offer added benefits for improving cardiovascular fitness and functional strength.

Making the Choice: What's Best for You?
The selection between MJ and SJ exercises should align with your fitness goals, practical considerations, and personal preferences:

• For General Fitness and Functional Strength: MJ exercises may offer more bang for your buck by engaging multiple muscle groups, improving coordination, and enhancing cardiovascular health.
• For Muscle Isolation and Rehabilitation: SJ exercises are invaluable. They allow for targeted muscle strengthening, which is particularly beneficial for rehabilitation and addressing muscle imbalances.
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Practical Advice

• Beginners are advised to incorporate both MJ and SJ exercises to build a solid foundation of both muscle strength and isolation.
• Advanced Athletes might focus on MJ exercises for overall strength and functional fitness but still use SJ exercises to target specific muscle groups as needed.
• Rehabilitation Clients should consult with their physiotherapist to design a program that might include a higher proportion of SJ exercises initially, progressively incorporating MJ exercises as their condition improves.

Conclusion
Both MJ and SJ exercises have their place in a well-rounded fitness regimen. Understanding your personal goals, whether it's muscle gain, fat loss, strength, rehabilitation, or general fitness, is key to determining the right balance between the two. Consultation with fitness and health professionals can provide personalized advice and training programs, ensuring you get the most out of your workouts while minimizing the risk of injury.
Remember, the best exercise program is one that is sustainable, enjoyable, and tailored to your individual needs and goals. So, whether you're lifting heavy with the squats or focusing on that bicep peak with curls, you're on the right track to achieving your fitness aspirations.

References

1. Gentil, P., Soares, S., & Bottaro, M. (2015). Single vs. Multi-Joint Resistance Exercises: Effects on Muscle Strength and Hypertrophy. Asian Journal of Sports Medicine, 6(2), e24057.
2. Paoli, A., Gentil, P., Moro, T., Marcolin, G., & Bianco, A. (2017). Resistance Training with Single vs. Multi-joint Exercises at Equal Total Load Volume: Effects on Body Composition, Cardiorespiratory Fitness, and Muscle Strength. Frontiers in Physiology, 8, 1105.

In the competitive world of sports and the meticulous field of physiotherapy, discussions frequently orbit training methodologies, nutritional strategies, and the forefront of recovery technologies. However, a crucial element in athletes' well-being and recuperation that is often overlooked is the role of sleep. Emerging research unequivocally emphasises the profound impact of sleep on injury recovery and athletic performance, spotlighting its indispensable role in an athlete's regimen.

The Foundation of Recovery
Sleep stands as a fundamental pillar in the body's recovery mechanism, providing not only rest but also facilitating cellular repair and hormonal equilibrium. A systematic review in the British Journal of Sports Medicine delineates the significant role of sleep in the convalescence of sports injuries, pointing out that inadequate sleep quality and duration are common among athletes and considerably amplify injury risks . This body of work stresses the importance of incorporating sleep management into training and competition schedules to curtail injury rates and expedite rehabilitation.

Enhancing Muscle Recovery
The intricate nexus between sleep and muscle recuperation is especially noteworthy. According to a narrative review in the Journal of Science and Medicine in Sport, extending sleep duration not only bolsters performance but also enhances pain sensitivity and anabolic responses, such as elevated levels of GH/IGF-I, pivotal for muscle repair and recuperation from exercise-induced injuries. This evidence suggests that sleep interventions could serve as a critical tool in hastening recovery processes, presenting a topic of keen interest for medical professionals and coaches alike.

Sleep’s Role in Injury Risk Management
Further research detailed in the Journal of Sports Rehabilitation elucidates the association between sleep and injury risk, demonstrating that chronic insufficient sleep is correlated with an increased risk of musculoskeletal pain and sports injuries. Specifically, consistently sleeping less than seven hours is linked with a higher injury risk, underscoring the necessity of adequate sleep for injury prevention .

The Impact on University Athletes
The challenge of managing sleep extends beyond professional athletes to include university athletes as well. A study published in Frontiers in Sports and Active Living reveals how academic and social stresses can exacerbate sleep disruption, leading to adverse effects such as performance decline, mood alterations, and an increased vulnerability to injuries and illnesses. This highlights the widespread applicability of sleep management strategies across different levels of athletic engagement.

Practical Implications for Your Recovery Journey
For athletes embarking on the recovery path, or anyone aspiring to elevate their physical performance, the directive is clear: sleep must be prioritizsed. Here are actionable steps to integrate into your routine:

• Establish a Consistent Sleep Schedule: Strive for at least 8 hours of sleep each night, maintaining consistent bedtimes and wake-up times.
• Create a Restful Sleeping Environment: Diminish noise and light exposure and ensure your sleep area is comfortable and conducive to rest.
• Incorporate Relaxation Techniques: Engaging in activities like reading, meditation, or gentle yoga before bedtime can prime your body and mind for sleep.
• Limit Screen Time: Minimise evening exposure to screens and electronic devices to reduce the impact of blue light on your sleep cycle.

Conclusion
The expanding corpus of research on sleep's effects on injury recovery and athletic performance furnishes invaluable insights for athletes, coaches, and healthcare practitioners. As we delve deeper into the myriad benefits of sleep, it becomes increasingly clear that sleep is not merely a passive rest period but a dynamic process integral to athletes' health, well-being, and achievement. By prioritising sleep, we can optimise our recovery processes, mitigate injury risks, and unlock our utmost potential in sports and beyond

References Used 

1. Vermeir, P., De Leye, M., Grymonprez, R., Goethals, A., Vermeir, R., Vanden Bossche, L., & Mariman, A. (2021). The impact of sleep on the recovery of sport injuries. British Journal of Sports Medicine, 55(Suppl 1), A173.3. https://bjsm.bmj.com/content/55/Suppl_1/A173.3Chennaoui, M., Vanneau, T., Trignol, A., Arnal, P.,
2. Gomez-Merino, D., Baudot, C., Perez, J., Pochettino, S., & Eirale, C. (2021). How does sleep help recovery from exercise-induced muscle injuries? Journal of Science and Medicine in Sport. https://pubmed.ncbi.nlm.nih.gov/34074604/
3. Huang, K., & Ihm, J. (2021). Sleep and Injury Risk. Journal of Sports Rehabilitation. https://pubmed.ncbi.nlm.nih.gov/34099605/
4. Hamlin, M.J., Deuchrass, R.W., Olsen, P.D., Choukri, M.A., Marshall, H.C., Lizamore, C.A., Leong, C., & Elliot, C.A. (2021). The Effect of Sleep Quality and Quantity on Athlete's Health and Perceived Training Quality. Frontiers in Sports and Active Living. https://www.frontiersin.org/articles/10.3389/fspor.2021.705650/full​