The reason for these cramps, risk factors and causes are not completely understood.  Currently, many athletes, coaches and medical team members believe that cramps are caused by dehydration or electrolyte imbalance.  Medical research shows that these theories are not scientifically supported, but based on observational studies.  EAMC may occur in the presence of electrolyte or fluid losses during exercise, the underlying cause can be due to other factors such as muscle fatigue.
 
During sports competitions, training or other intense physical activity, repeated loading on certain muscles can result in localised muscle fatigue.  Fatigue seems to be an important contributing factor as EAMC mostly occurs at the end or after exercise.  The cause of muscle cramps is still unknown but more research is pointing towards a neurological origin, in other words, the communication between your muscles and your nerves.  There are 2 sensors that send input to your brain about muscle contraction.  The muscles spindles are the first sensors in your muscle and they detect muscle lengths.  When you stretch your muscle the muscle spindles send a message to your brain (via sensory neurons) to immediately contract the muscle so that the muscle doesn’t tear.  This contraction signal is sent from the brain back to the muscle (via motor neurons).  The second sensors are Golgi tendon organs which are found in the tendons.  Golgi tendon organs pick up muscle tension, so when your muscle is contracted, these sensors are activated and your brain sends a message to the muscle to relax (via motor neurons).  In summary, the muscle spindles tell your brain to contract muscles and Golgi tendon organs tell your brain to relax muscles.

The altered neuromuscular control theory indicates that muscle cramping may alter the excitability of the central nervous system.  This theory describes cramping to increase excitatory inputs (“contract” signal) and decrease inhibitory inputs (“relax” signal) to motor neurons during fatigue.

EAMC occurs more often when the muscle is contracting (in a shortened position).  This may explain why cramping in the calf muscles of swimmers is common.  In swimming races a swimmer must swim with pointed toes that require the calf muscle to contract in a shortened position.  In a shortened position there is increased tension on the muscle for the Golgi tendon organs to detect, therefore, there are no “relaxing” signals being sent to your brain.  Studies have found that fatigue causes the muscle spindles to be more excitable and the Golgi tendon organs to be inhibited.  Your brain receives more “contract” signals and not enough “relax” signals, resulting in your muscle cramping uncontrollably.
 
EAMC are more likely in less well-trained athletes and events of long durations.  A positive family history of cramping, older age, poor conditioning and stretching habits are also risk factors.  Cramps are more common in men than in women, and those more susceptible to heat illness.
 
Different athletes may have different mechanisms leading to EAMC, so a treatment that works for one athlete my not work for another athlete.  Passive stretching seems to be the most popular and effective treatment technique.  Passive stretching increases the “relax” signal to the motor neuron, which supports the altered neuromuscular control theory.  Management aimed at changing fatigability and neuromuscular control may help prevent cramps.  Generalised conditioning and endurance, maintaining carbohydrate reserves, plyometric and eccentric exercises improve neuromuscular control.  Massage and myofascial trigger point therapy may also improve the effectiveness of the muscle and decrease fatigability.
 
Many factors cause muscle cramps, each factor being unique to each athlete and caused by changes in the nervous system.  We will be more successful preventing EAMC if we identify each athlete’s risk factors and target those risks with interventions.
 
References

1. Brukner, P & Khan, K. (2017) Clinical Sports Medicine. 5th ed. McGraw-Hill Education, Australia.
2. Gerbino, PG. (2016) Exercise Associated Muscle Cramps. Sports Medicine and Rehabilitation Journal.  1 (2):1009.
3. Miller, KC. (2015) Rethinking the Cause of Exercise-Associated Muscle Cramping: Moving beyond Dehydration and Electrolyte Losses. American College of Sports Medicine. 353-354.
4. Qui, J & Kang, J. (2017) Exercise Associated Muscle Cramps- A Current Perspective. The Scientific Pages of Sports Medicine 1(1):3-14.
5. Google images. Viewed 4/6/18, http://www.bowenworkmaui.com/how-does-it-work.html

2018 has jumped started and is on a steady sprint into sport / meetings / school projects / exams and deadlines. Before this year runs away with us lets focus on something that can decrease stress and improve performance.

Breathing

Breathing is an automatic body function controlled from the brain. Breathing supplies much needed oxygen to our organs and muscles. When we are in a stressful situation our breathing changes. It becomes short, shallow and fast as part of the ‘fight or flight’ response. This decreases the amount of oxygen available due to the most gaseous exchange happening in the lower lobes of our lungs. If we then need to sprint to the finish line / kick for goal or meet a deadline our body needs more oxygen. The body’s response is to try and increase air in by using neck and shoulder muscles to help with breathing. This could lead to pain and stiffness which will influence performance and technique.

Proper breathing can lower your heart rate and reduce the level of stress-hormones in your blood. This can lead to a clearer mind improving concentration and performance.

So how should we breathe?

Start by relaxing your shoulders. Focus on using your diaphragm when you breathe. Imagine you have swallowed an umbrella. When you inhale the umbrella opens up causing the diaphragm to move down and the ribs to move sideways. On the exhale the diaphragm rises up as the umbrella closes.

Before your next race / meeting / game or when you are feeling stressed.

Remember to just BREATHE

References:
​Bell-Jenje, T. 2012. Are you a heavy breather? Published in the ride mag . https://docs.wixstatic.com/ugd/385e2d_da81fe9661b651c03f64d94b70d23f0f.pdf

Kelly Marksberry. 2012. Take a Deep Breath. The American Institute of Stress. 

"​Tennis Elbow (or Lateral Elbow pain) is one of the most common overload injuries that we see in the over 35’s. It is characterized by pain on the outside of the elbow, usually near the prominent bone where the tendon attaches, aggravated by gripping or wringing activities. This report summarises some of the common causes, presentations, treatment myths as well as best current treatment Tips and Tricks as at 2017! " Read more
​

A-Z OF POSTURE AT SCHOOL     

Children are not only injuring themselves in the playground or on the sports field; the time in the classroom also presents its own postural challenges. 

Most postural problems start from childhood or adolescence, when the body is developing.  Poor posture can result in pain or disability.  Good posture in childhood ensures good habits in adult life.

What is good posture?
Posture is the positioning of the parts of the body when standing, sitting or lying down.
Good posture is the state of balance between muscles and joints which protects the body against injury.  This puts the least amount of strain your back. 

​​Regular exercise such as running, swimming or playing different sports will help keep the muscles strong.

​There are many causes of incorrect posture in children.  Nowadays factors such as prolonged sitting in front of the TV or playing games on the tablet or cell phone play a major role in poor posture.  Heavy schoolbags are another weighty problem.  Other causes include poor seating, beds or desks; diseases and disabilities; obesity and self esteem. 
Children spend increasingly more time in a seated position, in the classroom and at home in front of the TV or computer.  Maintaining a sitting position for a long time causes asymmetries of the body.  The normal lumbar curve decreases and the thoracic spine slouches into a kyphosis.  

​The weight of children’s schoolbags and consequences of such heavy loads on the developing spine is an ongoing concern.  A general guideline for acceptable weight of scholars’ backpacks is 10% of body weight.  In a recent study conducted in Ireland, results show that most scholars’ backpacks weigh more than 10% body weight.  This may lead to pain and discomfort of the neck, shoulders or back in the short term and imbalances in postural alignment and damage to the neural structures in the long term. 
Heavy backpacks carried on one shoulder cause the spine to compress on one side and puts stress on the muscles, ligaments and discs of the spine.  Children mostly bend forward when schoolbags are too heavy - Hinging forward at the hips and causing a forward head posture.  This changes the natural ‘S’ curve of the spine.

The wheelie bag may be a good choice but it has its own set of problems.  It causes rotation of the upper body when pulling the bag.  It is therefore recommended to roll the bag next to the body or push it in front of the body.
 
Prevention is better than cure.  It has been found that preventative postural exercises have the best long term prognosis.  In a recent study conducted in Brazil, results show that postural education in schools and by parents at home should be encouraged to improve health and prevent injuries related to the spine.  If your child does complain of back ache or neck pain due to poor posture, assessment and treatment by a physiotherapist will help to identify the problem, and restore and preserve good body mechanics.  Exercises to strengthen weak muscles and stretch tight muscles help to achieve this muscle balance.
 
 
References

1.  Fonseca C, Dos Santos A, Candotti C, Noll M, Luz A, Corso C. (2015). Postural education and behaviour among students in a city in southern Brazil: student postural education and behaviour. Journal of Physical Therapy Science, 27, 2907-2911.
2. Kendall F, McCreary E, Provance P, Rodgers M, Romani W. (2005). Muscles testing and function with posture and pain. 5th Edition, 51-115.
3. Dockrell S, Kane C, O’Keeffe E. (2006). Schoolbag weight and the effects of schoolbag carriage on secondary school students.  (Online). Available at www.iea.cc/ECEE/pdfs/art0212.pdf (Accessed on 20/06/16).

Participation in school water polo has become very popular, making it one of the fastest growing sports.  Water polo is one of the best workouts around and is a great way for children to incorporate swimming and a ball sport into a team environment.
We are becoming more aware of overuse and acute injuries in water polo.  Acute injuries, such as contusions, lacerations, sprains, dislocations or fractures usually occur when defending a player or wrestling for the ball.  Overuse injuries are often the result of repeated movements, such as swimming, throwing and treading water.
The most common injuries are listed below.

1. Shoulder injuries

Shoulder injuries commonly occur from repetitive throwing and swimming.  This can be as a result of weak shoulder, scapula and core muscles.  Some shoulder injuries result from a direct blow to the shoulder.
Usually rehabilitation focusing on good posture, strengthening of the shoulder and core muscles, medication, rest, and icing are indicated as treatment.
 

1. Thrower’s elbow

Players often complain of pain on the inside of the elbow.  Repetitive throwing puts stress on the MCL (medial collateral ligaments) of the elbow.  Treatment consists of activity modification, physiotherapy, strapping and learning the correct technique for throwing.
 

1. Knee injuries

Pain on the inside or front of the knee commonly occurs from the repetitive egg-beater kick or treading.  Different structures of the knee, such as ligaments, bursa or joints can be affected.  Relative rest, ice, physiotherapy and medication are indicated as treatment.
 

1. Finger injuries

The ‘jammed finger’ often happens due to the finger being struck by the ball or another player’s body.  Any injury that is associated with significant pain, dislocation, deformity or inability to move the finger should be examined by a doctor or physiotherapist.  Ice, medication, range of motion and strengthening exercises is important treatment for a finger joint sprain.
 

1. Facial injuries

Swimmer’s ear, eye injuries, nose bleeds and ear drum trauma are common injuries that need medical attention.  Concussion is another common yet serious injury that requires immediate medical care.
 
 
Risk Factors

• Poor stamina and flexibility 
• Beginners may not have the skills to meet the demands of the sport
• Poor technique puts unnecessary strain on joints and muscles
• Neglecting to wear protective equipment- a cap with ear guards, or a mouth guard

Prevention tips

• Always warm-up before training and competition.
• Allow an adequate cool-down
• Strength and agility training, e.g. a combination of dry and wet training
• Improving the flexibility of the body by stretching  
• Staying well hydrated

If your child complains of any of the above mentioned injuries or other pain, do not hesitate to make an appointment with your physiotherapist. 

Heel pain is a common complaint in kids between the ages of 8-15. A painful bone disorder that results from inflammation (swelling) of the growth plate in the heel known as Severs disease can be the reason for their heel pain. Although the name might sound pretty frightening, Sever's disease is really a common heel injury that can be painful, but is only temporary and has no long-term effects. 

It usually occurs during the growth spurt of adolescence. During a growth spurt the heel bone grows faster than the muscles, tendons, and ligaments in the leg. In fact, the heel is one of your child’s first body parts to reach full adult size. When the muscles and tendons can’t grow fast enough to keep up, they are stretched too tight.

If your child is very active, especially if he/she plays a sport that involves a lot of running and jumping on hard surfaces (such as soccer, basketball, or gymnastics), it can put extra strain on their already overstretched tendons. This leads to swelling and pain at the point where the tendons attach to the growing part of her heel.

Symptoms can include:

• Pain, swelling, or redness in one or both heels
• Tenderness and tightness in the back of the heel that feels worse when the area is squeezed
• Heel pain that gets worse after running or jumping, and feels better after rest. The pain may be especially bad at the beginning of a sports season or when wearing hard, stiff shoes like soccer cleats.
• Trouble walking
• Walking or running with a limp or on tip toes

 
The best treatment is simply rest. Your child will need to stop or cut down on sports until the pain gets better. When they are pain free, have them build up their playing time gradually.

Your doctor may also recommend:

• Ice packs or non-steroidal anti-inflammatory drugs
• Supportive shoes and inserts that reduce stress on the heel bone (or heel cups).
• Stretching and strengthening exercises with the help of a physical therapist

 
References:
Kathleen B. O'Brien, MD. Reviewed June 2013. Sever’s Diesease. http://kidshealth.org/en/parents/severs-disease.html#

Roy Benaroch, MD. Reviewed  December 2014. What is Sever’s Disease. WebMD. http://www.webmd.com/children/severs-disease-kids-teens?page=1

​Launay, F. 2014. Sports-related overuse injuries in children. Orthopaedics & Traumatology: Surgery & Research 101 (2015) S139-S147. Elsevier