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From Missing 1/3 of the Season With Injuries to a Full Season Plus Finals
Nick and Andre are 2 AFL field umpires that were referred to our clinic by word of mouth last year (July 2022) due to recurrent calf injuries. They both had similar presentations, with multiple calf tears over several years, which would often occur more than once in the same season. Each time, they would have to miss 3-4 games while they were recovering and rehabbing their injuries. The cost to both of them was lost income, as well as loss of conditioning and opportunities to progress as umpires and secure finals positions. The emotional cost was also significant, with a loss of confidence in their bodies, and a sense of frustration and confusion…”why does this keep happening?”
The management of each injury was with standard sports medicine protocols, including MRI scan to confirm a tear and the grade, rest/deload, local Physiotherapy ( including massage, dry needling, ice, electrotherapy modalities) and a graduated strength and conditioning program and return to sport.
So why wasn’t this approach working for them and why were they having recurrent calf injuries?
Taking a Broader Whole Body Approach
To work out why Nick and Andre were having recurrent calf strains, we had to use a whole body problem solving approach known as the Ridgway Method. The team have all had extensive training in this method over the last 10 years.
This involved performing a whole body assessment looking for muscle knots, joints that don’t slide and nerves that don’t glide. It also involved assessing posture, strength, motor control and importantly a running video analysis.
The main principles of the Ridgway Method are:
- Where you feel your pain may not be where the problem is located.
- The structure that produces the biggest and most consistent gains in movement restrictions connected to your problem, is likely to be a primary contributor to the condition.
- Behavioural change and motor control are important to reduce load on the primary contributor.
The main test movements we noted that were most guarded and restricted with both Nick and Andre were:
- Lumbar flexion
- Thoracic rotation
- Hip flexion
- Hamstring length
For both of them, there was one side of their body that was most restricted, and this did correspond to their symptomatic side.
After whole body assessment and treatment trials to find the best structures to continue to work on, their body charts looked like this below. These charts only show the unhappy structures that when trial treatment was performed, improvements in key tests were observed.
We found the most dysfunctional structures that made the best gains in the movements signs for both Nick and Andre were actually remote from their calfs! In fact they both had segments in their lower back that were very stiff and painful, and working to release these made significant improvements in their movement signs and also released tension in their calf muscles. We labelled these segments, both from the front (anterior) aspect of their lumbar spines, the PCF or primary contributing factors to their calf conditions. For Nick their was also a secondary contributor in the thoracic spine, and for Andre the secondary contributor was the right sacro-iliac joint (SIJ).
So if working on these lumbar segments made the best improvements in key movement tests and also released calf muscle tension, why were these joints so stiff and problematic?
We performed a number of other tests, including strength tests and a video analysis of their running techniques.
Both Nick and Andre had some postural and control issues that we had to correct.
For Nick it is was about being too extended through his thoracic spine, with some rib flare. Nick also ran like this, with his chest up, which loaded his thoracic spine, and put him more in a lordotic posture which increased load on the lumbar spine. Nick also had some strength deficits in the left hip abductors and adductors, hip flexors and latisimus dorsi muscles, as well as poor gluteal activation.
For Andre, he stood in anterior pelvic tilt with knees locked back into extension. He ran with an anterior tilt also and an increased forward lean. This loaded up his lower back and SIJ. Andre also had a left limb apparent shortening, and we had to provide a heel lift for his left leg to regain symmetry through his hips. This was likely the reason his right SIJ was being loaded and had become stiff. Andre also had strength deficits in his right hip abductors and reduced gluteal activation also.
For both Nick and Andre, there were some mindset obstacles we had to address, which were mainly based around a loss of confidence in their bodies and a fear of re injury.
The calf injuries were then just a symptom of a more central problem, which when identified and treated with all contributing factors addressed also, resulted in no more calf strains and greater confidence in their bodies for both Nick and Andre.
After going through the Ridgway Method problem solving process late last year, implementing all the strategies we identified to be specific for both Nick and Andre, and adjusting their training, they have both made it through the 2023 season without missing any games. Yes, there were a couple of hiccups, but not with calf issues. Mid season, Nick got bowled over by a ruckman during a game, which jolted his body. Andre had an episode in his right lateral leg from a period of increased sitting. We were able to manage both of these incidents and keep Nick and Andre on track.
They both umpired in the finals and went as far as the preliminary final Carlton vs Brisbane at the GABBA (16th September, 2023), which is further than they have gone any any previous year… a real success story!
Other Factors That Contributed to Their Success
- Both Nick and Andre were dedicated professionals, who attended all appointments including tune up sessions, followed through on all advice, and worked hard to keep their bodies in the best state.
- They both had a team of support people around them, including AFL medical and physio staff, masseurs and pilates instructors, and their partners.
- After meeting with their strength and conditioning coach in August 2022, their running training was modified to increase the amount of easy volume in their program. The research based 80/20 rule was adopted, where the percentage of high intensity training above 80% maximal heart rate represents a smaller fraction of their overall running. This is important for recovery from harder sessions/games and building resilience and conditioning in soft tissues. The amount of easy running (long slow running) was tracked and measured.
- The AFL changed the amount of umpires per game from 3 to 4 during the 2023 season, which meant that each umpire had less ground to cover during a game.
In summary, this highlights the benefits of using a whole body problem solving approach for any injury, particularly persistent or recurrent conditions. The whole body is interconnected in ways that we are still coming to terms with, and local pain, eg in the calf in this case, can have a remote cause or primary driver, in this case, the lumbar spine.