ACL rupture: an insiders point of view

Knee injuries are all too common in skiers, with the anterior cruciate ligament (ACL) being one of the most common and most feared injuries we see. In Val d'Isere this season, we have seen high numbers of ACL injuries occurring, greatly influenced by the snow and conditions.  This has led to this weeks blog on the recovery journey. At the end of the winter season, people are often deciding whether or not to have surgery or starting the recovery process after the operation.
This blog aims to highlight that whilst an ACL injury can be a huge shock, there is light at the end of the tunnel.  As much as a serious injury can have a negative impact, long term people often come back fitter and stronger with a better understanding of their body.

As physio's we can usually tell if an ACL is ruptured through taking a detailed history of the injury and through the tests that we perform, however ultimately an MRI scan will confirm this. The diagnosis of an ACL injury is often a huge blow but it does not mean the end to your skiing career. In fact, it is very unusual not to be able to return to the slopes once you have recovered from an ACL rupture.  Lindsey Vonn, Ted Ligety, Bode Miller, Jenny Jones and Mikaela Shiffrin are a few examples of alpine professionals that have all made successful comebacks post ACL injury.  

Recovery after an ACL reconstruction can be a long road and it is important to pay attention to your emotional and psychological needs as well as your physical ones.  People have different coping strategies to get through such difficult times and if the emotional impact of an ACL injury is overlooked it can have a detrimental effect on a persons rehabilitation and performance.  Post ACL injury, it is not uncommon for people to report feelings of frustration, isolation and disengagement. Rehabbing from ACL injury takes huge commitment and motivation which can be affected by negative thoughts. If you are struggling with the emotional impact of an ACL injury, seeing a sports psychologist can help.

To gain a better insight into the journey after an ACL tear in skiers, we have asked some fantastic instructors about what they went through when they ruptured their ACL.  As a physio, it is bad enough telling someone that their ski holiday is over if an ACL rupture is suspected, let alone having to tell a ski instructor that is likely that their season is over! Rehabbing from an ACL injury is a very personal process with many highs and lows. As you will see from the answers below, every journey is different. Sincere thanks to the instructors that have given us a personal insight to what they went through.

1 - When you injured your knee, did you suspect that it was your ACL at the time, even before it had been examined?

Clare Angus (CA) http://www.tdcski.com/val_disere/about_tdc_valdisere/

No - didn't hear a pop and it didn't swell massively but it was a bit unstable and sore. As I have rather lax joints anyway and have had a minor knee injury before I assumed it was a tear rather than rupture

James Allen (JA) http://jamesallenskicoaching.com/val_disere_ski_instructor.html

Yes because I was skiing with a few guys who'd previously torn their ACL and they thought it was torn for sure. That said i had my doubts as i was able to ski down to the bottom of the run so thought maybe it wasn't fully torn

Joe Harkness (JH) http://www.tdcski.com/val_disere/about_tdc_valdisere/

After an evening in denial, with the swelling in back of the knee, I knew it was the ACL.

Nicko Braxton (NB) http://www.tdcski.com/val_disere/about_tdc_valdisere/

Knew both times (or was pretty sure). Couldn't stand on them.


2- When an ACL rupture was confirmed, how did you feel?

CA - I was anxious prior to first being examined as I knew it wasn't going to be great news. It was early season training so the whole season lay ahead. First diagnosis was as a tear which was pretty devastating as I was meant to do another 4 weeks race training and also had a number of ISTD exams booked and I wasn't sure how things were going to go. I spent 6 weeks off skis then got back on with ISTD teaching and technical exams and also did my EMS training exam and carried on training for exams and eurotest, so all in all things were looking ok. It wasn't until my knee still felt a bit wobbly 6 months later that I got an MRI and rupture was confirmed. However by this point I knew what it was still capable of and so was not too disheartened by the diagnosis.

JA - I knew what was ahead of me as I was lucky to have people there who'd been through it previously. I was determined to make a full recovery, what ever it took!! I looked upon it as a challenge to myself to prove i could rehab correctly and take it seriously from start to finish and come back stronger than ever.

JH - As I already suspected it, I was ready and accepted the injury and was just keen to get on with the rehab process and treatment to get back on my feet

NB - Miserable. Sat in a wheel chair in the restaurant at the bottom of the motte and burst into tears


3 - What was the worst part of the journey?

CA - I had 6 weeks off skis early season when meant to be training. Having to make decisions about how to proceed. But all in all I have, so far and touch wood, been very lucky.

JA - Having to watch everyone go up skiing in great conditions whilst i stayed indoors resting wasn't easy, but i knew i'd had some great times in the past and also knew i'd have them again, so didn't let it get to me too much. Also having to hold back on the rehab and do as i was told by the physio was tough as I felt I could take things to the next level sooner but had to do it all by the book, otherwise risk the long term recovery!

JH - The steps backwards you take after surgery and the slow process around 3-4 weeks after surgery. The rehab initially was so slow I found it frustrating after being so active.

NB - Perhaps 2-3 months post op. Still on boring repetitive exercises.


4 - What surprised you most about the process after ACL rupture?

CA - The fact that I had a ruptured ACL that I skied to a high level on for such a long time before finding out it was ruptured!

JA - How soon i was able to push weights in the gym and generally how well the whole rehab process went.

JH - The huge loss of strength in the hamstring from losing the tendon for the graft. 2 years on and still need to do so much work to minimize imbalance between left and right legs.

NB - The amount of time you must dedicate - like a full time job but no one is paying you.


5 - What positives have your taken from your journey?

CA - What doesn't kill you makes you stronger!

JA - Plenty!! I now know what's required to recover well and more so that I'm able to recover from something as serious as this without it being a major hinderance to my life in general. I've learnt a lot about good nutrition, health and fitness which is all good, especially given the lifestyle and job i do as a sports coach. I'm almost certainly fitter than i was before the injury and probably stronger in general. Knowing that a major injury like this doesn't mean you're off games for a long time as i was able to get out and do sports again pretty soon afterwards. Even more so, the fact i was back on skis the following season and skied hard all season without any major issues.

NB - That you can make a full recovery and you are in control. The operation does not predict the out come.The work that you put in does. You get out what you put in.


6- Any tips for people going through ACL injury.

CA - My advice is to not rush into surgery. I realise some people will need to have surgery but it is not the only option, although I believe most people believe there is no alternative.

JA - One of the best bits of advise I received was from my surgeon which was to hire a 'Game Ready' pro ice machine. I'd highly recommend this for a speedy reduction in the swelling post-op. Minimum 4wks and the results will help you progress in the rehab programme much quicker. Look up online the ideal diet and nutrition for knee ligament rehab and follow this as closely as possible. Be sure to do ALL the exercises your Physio advises, especially in the early stages. Stay positive throughout, it's not as bad as you might think!!

JH - It's hard to stay motivated at times and can feel very slow, but the moment you get the clear to get in a bike was huge for me.... That gave me freedom again, and from that point on I could see the light at the end of the tunnel.

NB - Don't push at the start. It doesn't shorten the healing time. If anything you just endanger the graft. It takes longer as you get older  Be picky about your surgeon - talk to people


If you are unlucky enough to rupture your ACL, you are likely to find that everyone has an opinion on your recovery process. Whilst this can be helpful, sometimes too much information can lead to confusion and uncertainty. We hope that the insights we've been given help to show that each and every person will have a different journey. No two people will go through the same process, even with identical injuries and a full recovery is very achievable. Thank you to Clare, James, Joe and Nicko for sharing parts of your journey with us.

Prior to next season, I will publish a blog on ACL injury prevention.  Follow us on facebook to stay up to date with our blogs.

Disclaimer:

The purpose of this blog, is to provide general information and educational material relating to physiotherapy and injury management. Bonne Santé physiotherapy has made every effort to provide you with correct, up-to-date information. In using this blog, you agree that information is provided 'as is, as available', without warranty and that you use the information at your own risk. We recommend that you seek advise from a fitness or healthcare professional if you require further advice relating to exercise or medical issues.

LSA

       Bonne Santé          info@bonnesantephysio.com         0033 (0) 4 79 06 07 27

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Skiing in Slush - Top tips from Val d'Isere Instructors

Love it or hate it, warmer spring weather will result in slushy pistes, especially lower down. Personally, I love skiing in slush, although it took a little while to start to enjoy it. Initially I did not have the right technique and found it hard work, but I now find powering through the slush great fun.

However, if you don't have the most efficient technique or good levels of ski fitness, skiing slush can feel heavy and tiresome. In slushy spring conditions, we see more over use injuries, particularly to the patella-femoral (knee) joint, more calf strains from a 'plant and ride' (where the ski's get stuck in a bank of snow, the bindings don't release and the skier continues over the top) and more knee ligament injuries, especially to the anterior cruciate ligament (ACL).

To help prevent injuries in the slush, listen to your body.  If you are tired, take a rest. At the end of the season, skiers are often tired but keen to push on to make the most of the snow while the lifts are still open. Use rest time to rehydrate, refuel and stretch.  Fatigue is probably the largest cause of why injuries occur in slushy conditions and the ACL is often the unwilling victim.

Good strength and neuromuscular control of the legs and core is also essential to help reduce the risk of injury.  A strong core will help limit excessive movement of the upper body when being thrown around in variable conditions. Good balance and proprioception is necessary to help recovery and prevent falls.

Practicing your balance is probably the best way to help prevent injuries in slush, but you want to make this training dynamic and variable.  You can start by practicing static balance on an uneven surface such as a bosu ball (as shown in the picture).  A pillow or cushion will do if you don't have access to similar equipment.

To further challenge this, try and juggle a tennis ball or take hold of a medicine ball and pass it around your body.  Trying to regain your balance when you move outside of your base of support is great training and will help to sharpen your righting reactions which is important in preventing falls when you are thrown around in variable slushy snow.

It is also important to perform balance practice dynamically, as skiing is never about just standing on one leg!  Star excursions are are great starting point.  If possible, draw a large eight prong star on your patio or in your garage.  Stand on one leg in the middle of this and reach your other leg as far down the first prong as your can.  Repeat this all the way round each of the eight prongs.  Reach as far as you can to challenge the supporting leg.  You can then swap sides.  Introduce a wobble cushion under the supporting leg to make it a lot harder.

Other ideas for improving dynamic balance include:

• hop to deep land.  Hold the landing for 5 seconds. 
• Travelling hop and hold.  As above but vary the direction that you hop in to include forwards and backwards, side to side and diagonally. 
• slack lining

When skiing in slush, our leg muscles work a lot harder and there is a high chance that you may aggravate any pre-existing injury, especially if you have knee or back problems. If your legs are felling particularly tired, stick to easier pistes, take regular breaks and book a massage with us to help accelerate recovery. If you combine good ski fitness and balance with good technique, you will significantly help to reduce your risk of injury.  

We've asked some of Val d'Isere's fantastic ski instructors for their top tips on skiing slush?

Lena Hauritus-Neilson
http://www.tdcski.com/val_disere/about_tdc_valdisere/
Point your ski's and go.  Power through and keep momentum.  Ideally do medium rounded turns.

Rupert Tildesley
http://www.mountain-masters.fr/rupert-tildesley-moniteur-ski.asp
Make sure the ski goes forwards along its length through the slush.  Try not to pivot it assuming it will slides sideways (it probably won't).

Xavier Raguin
http://www.skinewgen.com/instructors/xavier-raguin/
Use your weight to push through the snow and use your speed.

Pamela Nardin
https://oxygene-ski.com/fr/
Don't be too rough otherwise you will get stuck and fall.  Keep your legs active to turn the ski's.

Clare Burns
http://www.clareburns.com/
Stay centered and distribute your weight over the whole of your foot. Use speed and momentum to power through it.

Thank you to everyone that has let me pick their brains.  There are some very useful tips which will hopefully help to prevent injuries occurring.

Disclaimer:

We do not recommend that you introduce these exercises without consulting a physiotherapist if you have any current injuries or back issues. We do recommend seeking advise from a healthcare or fitness professional when starting new exercises.

The purpose of this blog, is to provide general information and educational material relating to physiotherapy and injury management. Bonne Santé physiotherapy has made every effort to provide you with correct, up-to-date information. In using this blog, you agree that information is provided 'as is, as available', without warranty and that you use the information at your own risk. We recommend that you seek advise from a fitness or healthcare professional if you require further advice relating to exercise or medical issues.

LSA

       Bonne Santé          info@bonnesantephysio.com         0033 (0) 4 79 06 07 27

Please like us on Facebook to stay up to date with news and developments: Bonne Santé Physiotherapy 
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Performance Series: 'A'-Frame skiers - part 2

Before I start, I want to emphasise that there is no 'one size fits all' in terms of ways to help correct or improve an 'A'- Frame position. Every single person will have individual needs. However, the suggestions below have been collated from over a decade of working with skiers and identifying common movement patterns and compensations. This includes work analysing hundreds of instructors working their way through various stages of the BASI system and work alongside BASI trainers to ensure accuracy and carry over between off hill and on hill training.

These exercises can benefit anyone that struggles with an 'A'-Frame posture. They are not limited to ski instructors, but I hope that instructors will find the information useful from not just a personal perspective, but also a coaching perspective.  I also hope this information will be useful to anyone looking to improve their ski performance and hopefully technique.

This blog is designed to follow on from last week on 'why an 'A'-Frame position may occur', so we recommend that you read this prior to continuing below.

In terms of exercise prescription, as a general rule if it challenges you it is probably something that you need to work on.  It is not easy to recommend repetitions, weights and frequency of the exercises but as a general guide aim to practice the exercises that are relevant to you 3 times a week for a minimum of 6-8 weeks to make a difference.   The training over this time should also be progressive, so that the muscles are constantly being challenged as they develop.  The exercises should be made harder and challenge you further every 1-2 weeks.  A static program will not allow for continual progression and will soon become tiresome and uninspiring.

The exercises below are aimed at improving neural connections, movement patterns and endurance for skiing, rather than specifically for strength training.  With that in mind, you ideally want to perform the exercises into fatigue, taking care not to loose form and to ensure good quality of movement.  It is not as simple as saying how many times to perform each movement.  Every single person will be able to work at different levels and perform different numbers of repetitions, therefore assessment and progression by a physiotherapist or personal trainer is highly recommended.  The exercises below are a framework to start from and ideas to share with clients.  They should not be performed if they cause any pain and we recommend seeking medical advise if you have a pre-existing injury.

To re-emphasise, there is no overnight fix to correct an 'A'-Frame through exercises. It is likely to take a minimum of six weeks to start to notice changes when a progressive programme is carried out regularly, however we recommend at least 3 months of training to really make an impact.

Postural and position awareness

Did you know that only a very small proportion of people actually train to get fit to ski before a skiing holiday. Some of our data collection suggests that this figure may be as low as 4%! This figure applies to recreational skiers rather than instructors and professionals, however when I have been presenting to gap ski courses often less than 10% have done any ski specific fitness prior to starting their course!  Its no wonder we see so many ski related injuries on the slopes.

For those that do get fit to ski before coming away, how you train will greatly influence your movement patterns on the slopes.

Right knee falling into a
valgus 'knock-kneed' position

Lets start with simply seeing if you are able to correct a knocked knee position. Stand in front of a mirror with your feet facing forward and ski width apart. Keep your back straight and squat down so your thighs are almost parallel with the floor. Repeat this a number of times whilst watching yourself in the mirror. Do your knees track nicely over your middle toes or do they come together?

Good alignment demonstrated.
Knees tracking nicely over
middle toes.  

If they come together, are you able to correct it?  Can you maintain this corrected position as you repeat the movement?












This is often clearer to see on one leg. Repeat as above but this time perform a single leg squat (you won't necessarily be able to go so deep). Again, watch the position of your knee over your toes. Can you correct this simply through awareness and the feedback of watching yourself in the mirror? Repeat this for at least 60 seconds to see if you can maintain the position, even as you fatigue. We don't usually learn a lot through just one repetition. Movement faults are easier to identify as muscles start to tire.

    

If you are able to correct this, practice and regular repetition will help the body make neural adaptations which will improve coordination and proprioception. Proprioception is a term which describes the unconscious knowledge of the position of our body and limbs. Research has shown that proprioceptive control in a single leg stance may be a key factor in reducing injuries.

To challenge your position sense further, stand on an unstable surface such as a bosu ball and repeat the single leg squats. Maintain optimal knee position through out.




Weak hip abductors and external rotators 

As well as abducting the leg (pulling it in a sideways motion), one of the main roles of the gluteus medius is to stabilise the pelvis. As mentioned last week, a weak gluteus medius can cause the pelvis to drop on the opposite side. At times, people may also attempt to compensate for this on their supporting limb by rotating it inwards and allowing the thigh to draw across the body. Both these actions can result in a 'A'-frame ski position.

The exercises below will start to give you some ideas of how to improve the function of the gluteus medius muscle:

1 - Hip hitch

This is a good starting point for activating the gluteus medius and improving neural connections between the body and the brain.  Stand sideways on a step with one leg free over the edge. Keep your shoulders level and slowly drop and raise your free leg. To increase the difficulty you can add ankle weights.

               

2 - Side planks

Side planks are a great core stability exercise and also a great way to engage the gluteals. Gradually build up how long you can hold a plank position, aiming for 30 - 60 seconds and repeat this 3 - 5 times.

Short lever

Long lever

3 - Monster walk

Place a piece of theraband around your lower legs and stand in a long corridor. Squat down with a neutral back and look forward. Keep your stance wide and maintain good tension on the band. Side step keeping your knees bent and feet wide apart. The deeper the squat, the harder the challenge.

Make sure that your knees are always well aligned over your toes and feet are pointing forward. If your glutes are very weak, the knees tend to buckle in to compensate. Don’t let them!

4 - Hip rotations with theraband resistance

Hook a piece of theraband around one ankle and stand on the other end.  Draw your foot up your shin then turn your knee out. Your pelvis should stay facing forwards, whilst your knee lifts and you twist from the hip. This works your gluteals as well as challenging your balance, engaging your core helps with hip and pelvis dissociation. 

                                     


Tight ITB (iliotibial band)

If you have a tight ITB, it may well contribute to internally rotating your thigh (turning it inwards). As I mentioned in last weeks blog, if you have a weak gluteus medius muscle, this will often be coupled with a tight ITB, therefore one of the first steps I would take in an assessment of the ITB would be to also assess the gluteus medius muscle. If strength or endurance issues were highlighted, I would initiate a hip and gluteal muscle program as above.

I would also recommend foam rolling to help improve the fascial matrix of the ITB.  There are all sorts of foam rollers on the market, but the ITB can be a highly sensitive area, therefore we recommend a standard foam roller to start with. Place the roller under your thigh, as in the picture below. I usually divide my thigh into upper, mid and lower portions and then lever myself back and forth for as long as I can tolerate.

How long should you roll for? Initially I recommend 10 - 20 seconds if it feels very sore but build up to 2 mins of rolling the length of the ITB over a period of 4 - 6 weeks. A good time to roll is after skiing.


                                      

Foot over-pronation

The foot needs a certain amount of pronation to function effectively, however over pronation can often be (not always) more problematic. The feet are highly complex structures and I do recommend seeking professional opinion if you feel that over pronation may be contributing to an 'A'-Frame position.

As I mentioned last week, working out why the over pronation is occurring is key to applying the correct treatment. As a physiotherapist, I aim to work out if there is structural or functional cause of over pronation (or a combination of both). If the problem is structural, it is not likely to change with exercises, however more often that not there is a functional cause or contribution e.g. the muscles, fascia and other soft tissue structures are not doing their job properly! How do you know if your problem is structural or functional? Well, you probably won't without the professional opinion of a physiotherapist, podiatrist or highly trained boot fitter.

A recent study (Hashimoto and Sakuraba, 2014) looked at strength training for the intrinsic flexor muscles of the foot and found a positive effect on muscle strength, the foot arch and dynamic parameters. They concluded that intrinsic foot flexor strength training is useful for improving standing and walking performance, in addition to improving the performance of sports athletes engaged in activities involving greater exercise loads.

This research is just one study in a large body of evidence which adds support my anecdotal findings. If the problem is down to muscle imbalances, the exercises below can be introduced as part of a training program. I would also include gluteus medius work, as shown in the section above. As I mentioned before, these exercises must be performed regularly and be progressive in nature. If its not challenging you, you will not continue to make progress.


1 - Supination Exercises

Wear sock on a shiny surface. Transfer your weight more towards the outer edge of your foot and work the muscles under the arch of your foot.

When you can maintain this position for periods of time, you can also try to maintain it during more functional training such as squats, heel raises and lunges.

The movement is not well demonstrated in these pictures, but if you look closely you will see that in the first picture, the foot is rolling in. The inside ankle bone is more prominent.  This has then been corrected into a 'neutral' stance in the second picture.

2 - Towel folding

This exercise aims to strengthen the plantar fascia and deep intrinsic muscles of the foot.  Stand with a towel laid out on the floor in front of you. Grasp one corner with your toes (not inbetween your toes - thats cheating, aim to scrunch up your toes so the towel is held in between your toes and the pad of your forefoot).  Fold the corner of the towel into the middle, and repeat with the other three corners. Then using the same action, unfold each corner again. Compare one foot to the other. If you find it easy, your probably don't need to practice it.  

3 - Calf raises

Stand on a step. Rise up onto the ball of your toes, pause and then slowly sink your heels down.  You can aim to perform 3 sets of 15 repetitions.  If this is easy, try the same exercise on one leg.

To progress even further, wear a rucksack on your back and add hand weights or bottles of water to increase the resistance and the load on the muscles.   It is important that you perform this slowly and allow yourself to go up and down to the limit of your range.

4 -Big Toe Pushdowns

Stand with your foot and ankle in neutral position. Push down through your big toe without allowing the ankle to roll in or the arch to collapse. Start by holding that for 5 seconds, 10 times on each side (or do both sides at once). As you get stronger, hold the toe down for longer stretches and fewer repetitions. You’ll start to feel that muscle (flexor hallicus) contract under the arch of the foot. As it gets stronger, you’ll be able to consciously engage that muscle whenever you’re performing weight bearing exercise.

5 - Eversion on a Step

This exercise helps to target the tibialis posterior muscle, which amongst other roles helps to support the medial arch of the foot.  Stand sideways on a step so that the inside of the foot is just over the edge.  Very slowly roll the arch of the foot inwards, as if trying to get the big toe down to the floor
Reverse the movement to bring you back up to the starting position. As with the calf raises above, aim for 3 sets of 15 repetitions and if easy, use a weighted rucksack to increase the resistance.

6 - Run around a lawn barefoot

This exercise is as it says on the box.  Let the small muscles of the foot work hard to stabilise the foot and ankle complex over uneven ground.  Lose the support of shoes for a while and allow the muscles to do their job.

Orthotics

Often, a progressive program to correct muscle imbalances in the lower limbs is sufficient, other times orthotics or foot beds are necessary.

Colin Martin, a certified podorthotist based at Solutions 4 Feet in Bicester www.solutions4feet.com was kind enough to contribute the following:

'From a boot fitters perspective we try first to stabilise the foot, then to look at what else is going on, often the client can do exercises to strengthen muscles and get a more neutral stance, other times the natural body shape simply does not allow this to happen, it is then were we can intervene using the cuff adjustment ( often called canting) of the boot. Or but working under the sole of the boot using many methods of TRUE canting to get the best result. SOME PEOPLE ARE NOT CANTABLE sometimes you have to settle for skis flat on the snow and a bow legged or knock kneed stance, other people are lucky and can have perfectly parallel shins AND skis running flat.

Trouble is people want an instant fix and many will not do the exercises so try to insist on fixing the problem using canting, my job is to find the right balance for each individual to give them the best skiing experience'

Hip Joint

As I mentioned last week, occasionally, an 'A'-frame skier may not be able to correct their position because the cause is inherent within the ball and socket joint of the hip. I was recently asked what the best thing to do in this case was. This is a tricky question to answer because everyone is individual with different needs. If it's truly an issue with the hip joint, exercises are less likely to help, although often the body does have ways of developing compensation strategies over time, even if an 'A'-frame position can't be completely corrected. For example, people with congenital hip problems (from birth) that haven't needed orthopaedic input are likely to have compensations further down the chain, such as increased external rotation through their tibias. Seeing a good boot fitter or alignment specialist may also be of benefit.

Osteoarthritis and Rheumatoid arthritis of the Knee Joint

If the inner aspect of your knee has been affect by arthritis, it will probably be a structural problem that is causing an 'A'-Frame.  However, I would still implement some of the training above, starting with seeing if you can correct the position in front of a mirror and improve proprioception of the knee joint.  The majority of the time, people with arthritic knees can also benefit from training the hip and gluteal muscles as above.  I would also recommend discussing orthotics, wedges and canting options with an experienced boot fitter, preferably one that has an understanding of arthritic pathology.  

Disclaimer:

We do not recommend that you introduce these exercises without consulting a physiotherapist if you have any current injuries or back issues. We do recommend seeking advise from a healthcare or fitness professional when starting new exercises.

The purpose of this blog, is to provide general information and educational material relating to physiotherapy and injury management. Bonne Santé physiotherapy has made every effort to provide you with correct, up-to-date information. In using this blog, you agree that information is provided 'as is, as available', without warranty and that you use the information at your own risk. We recommend that you seek advise from a fitness or healthcare professional if you require further advice relating to exercise or medical issues.


References;

Proprioceptive Training and Injury Prevention in a Professional Men's Basketball Team: A Six-Year Prospective Study. Journal of Strength & Conditioning Research: February 2016 - Volume 30 - Issue 2 - p 461–475 Riva, Dario; Bianchi, Roberto; Rocca, Flavio; Mamo, Carlo

Strength Training for the Intrinsic Flexor Muscles of the Foot: Effects on Muscle Strength, the Foot Arch, and Dynamic Parameters Before and After the Training. J Phys Ther Sci. 2014 Mar; 26(3): 373–376. Takayuki Hashimoto and Keishoku Sakuraba

LSA

       Bonne Santé          info@bonnesantephysio.com         0033 (0) 4 79 06 07 27

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