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You’ve Injured Your ACL – Now What?

What You Need to Know:

An ACL injury is common in athletes of all levels but is more common among girls than boys.

An ACL injury is especially common in activities and sports with a lot of cutting, pivoting, jumping, and change of direction. Examples include football, hurling, soccer, basketball, and rugby to name a few.

The severity of ACL injuries is classified by grades 1, 2, and 3.

Either non-operative or surgical treatments may be recommended depending on the grade of ACL injury, the patient’s level of sport, age, and goals.

What is the ACL?

The anterior cruciate ligament (ACL) is one of the four major ligaments found inside and around the knee joint.

A ligament is a structure in a joint that holds the bones together and helps control movement or motion at a joint.

The ACL helps to make your knee stable and prevents the shinbone (tibia) from rotating and sliding in front of the thighbone (femur).  In other words, the ACL works to prevent the shin from moving too far forward.

Figure 1: Anterior Cruciate Ligament (ACL) anatomy in the knee joint
Figure 1: Anterior Cruciate Ligament (ACL) anatomy in the knee joint
What are the symptoms of an ACL injury or tear?
  • A “pop” in the knee at the time of injury
  • Swelling of the knee
  • Warmth and redness around the knee
  • Inability to bear weight on leg (though some have little or no pain)
  • Instability or buckling of the knee
What to Expect After Injury

The ACL can be injured or torn in several different ways. The ACL is particularly vulnerable to injury during sporting activity involving a sudden pivoting or cutting manoeuvre, or from impact when the foot is planted on the ground. The ligament can also tear due to work injuries or automobile accidents.

When an ACL injury occurs, you may hear a “pop” or feel a “popping” or “snapping” sensation in the knee. The amount of pain experienced during the injury is somewhat variable but can be severe. Some may have little or no pain.

Normally, the person is unable to continue playing their sport or activity and has the impression that a significant injury has occurred. It is typical for your knee to swell immediately afterwards, feel unstable and become too painful to stand and walk. Immediate swelling of the knee often develops at the time of injury. This usually starts within the first several hours after injury. The extent of swelling can be limited if the knee is immediately iced or splinted using a compression bandage. The severity of the injury varies and can range anywhere from a partial thickness tear to a full rupture.

Your Next Steps

Elevate the injured leg and ice the knee immediately after injury. This will help to reduce the amount of pain and swelling you might experience. Avoid taking anti-inflammatory tablets where possible to allow your body to start its natural healing process.

After injuring your knee, it is very important to book an appointment at a clinic you trust and have your knee properly assessed by a qualified health professional such as a Physiotherapist or an Athletic Therapist. At your initial appointment, one of our therapists here at the Pain and Performance Clinic Lucan will talk to you about what happened when the injury occurred and will use a series of clinical tests and measures to test the available movement and the structures in the knee. Your physio will either rule out the possibility of an ACL injury or confirm the suspicion of an ACL injury.

If your physio believes an ACL injury is likely, it is common to be referred for an MRI scan to confirm the diagnosis. Your therapist will start you off with a rehabilitation and treatment plan before you leave your initial physiotherapy appointment. Many individuals believe they need to rest completely until they receive the results of the MRI scan, but it is very important to start working on regaining the range of motion and movement in the knee joint even while the knee settles from the injury.

Frequent icing for 10-15min at a time during the first 24-72 hours is often recommended. Exercises used in this first phase of rehabilitation focus on regaining the ability to fully straighten the leg as well as improve your ability to bend your knee. A few examples of exercises used in this initial phase are included in the video titled “Early Stage ACL Exercises” which can be found on our Pain and Performance Clinic YouTube Channel.

We Discuss Your Options with You

Once the MRI results confirm the diagnosis and the severity of the injury, your therapist will discuss your treatment options with you. Surgery, known as ACL reconstruction (ACL-R) is a very common treatment for ACL injuries, yet it is not the only treatment option. ACL injuries, especially partial-thickness tears, can be treated without surgery.

The recommended treatment depends on the severity of the injury, your level of sport or activity, age, and your goals. For instance, individuals who tend to not require surgical repair and can rehabilitation their injury using only physio would typically be those who are older, not involved in any sport and are not experiencing instability at the knee (e.g., they do not feel like their knee is unstable or will give away).

In some cases, young, active individuals can rehabilitate the knee and recover from an ACL injury without surgery, yet this depends on the type of sport they play and if their injured knee feels stable. If surgery is recommended, your therapist will refer you to a sports medicine or orthopaedic consultant to seek their professional medical opinion.

Types of ACL Injuries

ACL tears are sprains and are graded by severity and are called sprains. A sprain is a stretch or a tear in a ligament.

A ligament is a structure in a joint that holds the bones together and helps control movement or motion at a joint.

Grade 1 (Mild)

A Grade 1 sprain of the ACL occurs when your ACL is overstretched, but not torn. If your knee is still stable, you likely have a grade 1 injury and will not need surgery. If no loss of function, recovery time can take as little as a few months before returning to sport fully.

Grade 2 (Moderate)

A Grade 2 ACL sprain is a partial tear. If you have a grade 2 sprain, your ligament is damaged. It is common to experience instability and pain at the knee, however, some individuals may not experience instability. Partial, or grade 2, ACL tears are the least common of the three types of ACL tears. Recovery time for a grade 2 ACL injury takes longer compared to a grade 1 injury. Return to sport and activity follows a phased return. Progression is dependent on when certain goals and outcome measures are satisfied.

Grade 3 (Severe)

A Grade 3 ACL sprain is a complete tear. This is the most severe type of ACL injury. In most cases, if you have a grade 3 ACL sprain, it is common to experience severe pain and instability in the knee. Recovery time and return to sport and activity follow a phased return and are dependent on when certain goals and outcome measures are satisfied. Recovery time can take roughly 9-12 months in most cases.

If your knee is unstable, surgery is often recommended. Should your knee feel stable, non-surgical options can be an option. If you suffer an ACL injury, it is important to seek medical care immediately regardless of the grade of your sprain. Your Physiotherapist or Athletic Therapist will evaluate your injury and provide you with the best course of treatment.

Treatment Options

Surgical reconstruction of the ACL is usually recommended for those who are younger (aged 30 years old or less) and active ­– either through playing sports, other forms of exercise, or physically demanding jobs.

Other factors that may lead to surgery being recommended would be the feeling of instability at the knee or a complex injury to the knee where other structures in the knee, such as the cartilage and/or collateral ligaments (e.g., the ligaments on either side of the knee such as the MCL or LCL) are also injured. With ACL tears, it is common to also have an injury to other structures within the knee.

Surgery is Not the Only Treatment Option

If surgery is recommended, your therapist will refer you to a sports medicine or orthopaedic consultant to seek their professional medical opinion. Many individuals that opt for ACL reconstruction (ACL-R) surgery often want to have the operation as soon as possible, however, it is VERY important to allow the knee to settle from the injury and regain both a good level of strength and function before surgery. Doing so can help make the surgery less painful as well as speed up your recovery post-surgery.

Despite ACL-R surgery being a very common treatment for ACL injury, it is not the only treatment option.

A common goal for the typical patient after ACL injury is to return to their pre-injury level of sport or activity, and there is a widely held belief that the patient requires an ACL-R to do so. Unfortunately, ACL-R does not guarantee a return to the pre-injury level of sport and activity.

There are consistent findings across several research studies that show that non-operative ACL patients (even elite athletes) do just as well, and in some cases, better than ACL-R patients in short-term and long-term outcome measures, including function, quality of life and return to pre-injury levels of sport and activity.

The Rehabilitation Process

The rehabilitation process for an ACL injury can be long regardless of the treatment route chosen. Rehabilitation needs to be thorough and you need to put in a lot of work ­– both in the gym and at home. The typical time to recover from a full rupture ACL injury ranges between 9 to 12 months.

The ACL rehabilitation protocol is broken down into 6 phases. Each phase has a list of goals and outcome measures that need to be satisfied at the end of each phase to move on to the next one.

Phase 1

The first phase is the Pre-Op/immediate post-injury phase. The pre-op/immediate post-injury phase focuses on injury recovery and readiness for surgery if opting for surgical reconstruction.

Phase 2

The second phase is the Post-Op phase. This phase focuses on recovery from surgery if surgical reconstruction was done.

Phase 3

The third phase focuses on regaining strength and neuromuscular control of the muscles at the knee as well as at the joints above and below (hips and ankles).

Phase 4

The fourth phase is when we start working on running, agility, jumping and landing. These are crucial skills that need to be mastered before returning to activity or sport.

Phase 5

The fifth phase is where we allow you to gradually return to sport and activity fully.

Phase 6

Many think the fifth phase is the final stage, however, the sixth phase focuses on reducing the risk of reinjuring your ACL.

All athletes with a history of ACL injury should continue with an ongoing ACL injury prevention program even while they continue to play sports. This final phase aims to improve neuromuscular control during standing, cutting, and landing tasks. This phase is ongoing and is done before playing any sport.

Parts 2 and 3 of this ACL blog series outline Phases 2 to 6 further.

Pre-Op Phase of Rehabilitation

If opting for surgery, it is important to allow the knee to settle from the injury and regain a good level of strength and function.

According to recent research, people who attain full range of motion, good quadriceps (muscles in front of your thigh) and hamstring (muscles at the back of thigh) strength, and minimal swelling before surgery have better outcomes up to 2 years post-surgery than those who do not.

Your Physiotherapist or Athletic Therapist will give you exercises and activities during this phase. These typically include regular icing of the knee to reduce swelling, range of motion exercises, low-impact aerobic exercise such as cycling, and a progressive strengthening regime.

Strength exercises should progress depending on your symptoms and the severity of your ACL injury.

As the pain and swelling reduce and the range of motion increases, strength exercises progress to include weighted exercises in the gym, such as step ups, deadlifts, squats, etc.

Exercises may also include jump and landing activities such as various hopping drills. Aggressive change of direction and activities involving rotation is avoided.

The 3 most important goals of the Pre-op Phase are:
  • Eliminate swelling
  • Regain full range of motion (straightening and bending)
  • Regain 90% strength in the quads and hamstring compared with the other side

Examples of exercises used in this Pre-Op phase are included in the video titled “Early Stage Exercises After Surgical ACL Reconstruction (ACL-R)” which can be found on our Pain and Performance Clinic YouTube Channel.

Should you suffer an ACL injury, it is important to seek medical care immediately regardless of the grade of your sprain. One of our Physiotherapists or Athletic Therapists will evaluate your injury and provide you with the best course of treatment.

If you think you’ve injured your ACL, call or email our Physio clinic in Lucan, County Dublin right away for an appointment.

Where You Can Find Us:

Pain and Performance Clinic Lucan

Hills Industrial Estate, Unit 3,

Lucan, Co. Dublin, K78 VA06

Phone: 086 787 6358



Appointments can be booked online through our website, by phone or by email.

What is Hip Impingement? What can I do?

If you are reading this blog post, chances are that you have been searching for answers regarding that frustrating pain you have been experiencing in the front of your hip.

While there are many things that may contribute to this type of hip pain, one of the most likely culprits is known as hip impingement, or femoroacetabular impingement (FAI).

It is often diagnosed in active people in their 20s, 30s, and 40s. Yet, it can occur in athletes and non-athletes alike. Hip impingement can limit performance, and sprint speed, and even make normal daily activities difficult to do. The symptoms of hip impingement can vary from person to person but tend to arise gradually, over days, weeks, and months.

Here are a few things you can look for:
  1. “Sharp” or a “pinching” pain in the hip crease or groin, and in some cases a stubborn “dull ache” in the back, bum, hip flexor, or thigh.
  2. Stiffness, weakness, and/or a decrease in the range of movement in the hip joint.
  3. Symptoms are felt most after sitting for long periods of time, during movements where your hip is near its end ranges such as during a deep squat, deadlift, going upstairs, or during sports that involve repetitive changes of direction and pivoting.
  4. Pain in the hip and groin can be intermittent and felt both during/after activity and/or at rest.
  5. In athletes, pain often affects performance and sprinting.

In some cases of hip impingement, hip pain and other symptoms may cause a person to walk with a limp. Some individuals may also experience a loss of balance, where balancing on the affected leg may be more difficult than balancing on the unaffected leg.

If this sounds familiar to you, you may be experiencing hip impingement or FAI. Rest assured that you are not alone. This is fixable!

FAI is a technical name that is used to describe naturally occurring differences, or changes, in the anatomy (or what we often call “morphology”) of the hip. These boney changes are normal yet can cause pain in some individuals. Not all individuals with these changes would experience symptoms or pain. In this blog post, we will help you understand how to manage symptomatic hip impingement with treatment and exercises!

Hip impingement involves a change in the shape of the surface of the hip joint. Your hip joint is a ball-and-socket joint, where the “ball” (femoral head) is the rounded top of the femur. This is commonly known as the thighbone. The “socket” is called the acetabulum and is part of your pelvis.


Hip Impingement
Figure 1: Hip and Pelvis Anatomy (front view)

There are 3 different types of bony changes to the hip joint that may describe your cranky hip. The first is known as Cam morphology. This happens when the femoral head (the “ball”) is shaped differently due to excessive bone growth. This part of your hip should be smooth and spherical; however, extra bone growth can form a bump on the “ball”, which can affect how the femoral head rotates (pointing the toes inward and outward) and moves in its socket. This type of hip impingement is more common in young men (Guyton, 2013).

The second type of hip impingement is called Pincer morphology. This occurs when excessive bone grows on the edge of the hip socket. This extra bone creates an overhang, making the socket deeper in certain places, which can prevent the femoral head from moving smoothly in its socket. If we were to think of your hip socket as a soup bowl, think that the bowl is deeper than desired.

The third type is called a Mixed morphology and is when there is a combination of the two. In this case, there could be extra bone growth both on the “ball” and around the “socket”. Learning these variances and the hip anatomy can help you to understand what may be going on inside your hip joint.

3 Types of Hip Impingement
Figure 2: 3 Types of Hip Impingement

Now, if you have one of these variances, it does not mean that you need to panic or feel like you are guaranteed to experience pain. Morphology does not equal pathology. In other words, this means that even though your anatomy may be slightly different from what a textbook may consider “normal,” these changes are common and do not always cause pain or impingement symptoms. In fact, studies show 30% of individuals without pain or symptoms can also have these bony changes on imaging! It also means that corrective surgery is not necessary in most cases.

How is hip impingement diagnosed?

During the initial appointment of your injury, your therapist will ask questions to gain a better understanding of your symptoms and will then use tests and measures during their assessment. If you do not experience symptoms, it is unlikely that you do not have hip impingement. Additionally, your therapist will also assess your hip range of motion and compare this to your non-affected hip. An emphasis is placed on hip internal rotation (pointing toes inwards) and hip flexion (bending of your hip). Along with your symptoms and clinical findings, imaging is necessary to confirm a diagnosis FAI. X-rays and an MRI may be performed to identify changes in the shape of your hip bones. Symptoms AND clinical signs, in addition to imaging findings, are all required to make the diagnosis. Again, this is because it is common to have changes on imaging without any symptoms.


What is the treatment for hip impingement?

Physiotherapy is the primary course of action here, however not all physiotherapy is the same, it won’t get better with manual therapy and needles, it has to be an exercise-based approach, so you need a physiotherapist who uses strength and conditioning as their main focus. Surgery should be avoided wherever possible and used only as a last resort. Physiotherapy for hip impingement focuses primarily on exercise rehabilitation, activity modification, and some manual therapy. Rest and stretching are not enough to recover from this type of hip injury. There are several reasons why surgery is not recommended. The first is because outcomes tend to be similar at the 8-12 months mark in those who only used physiotherapy versus those who had surgery. After 2-years, there is no significant difference between those who had surgery and those who did not. The second reason is that surgery does not guarantee a return to normalcy or sport. According to a 2018 study that looked at individuals who opt for surgery when diagnosed with hip impingement, roughly 57% go back to playing their sport at their pre-injury level, and only 17% return to their prior level of performance. Like other medical procedures, there are also more associated risks when opting for surgery. These can include infection, nerve injury, fracture, dislocation, and death to name a few. Studies have even identified a significant increase in seven types of comorbidities like chronic pain and sleep disorders in individuals between the ages of 18-50 years within 2-years after hip arthroscopy surgery. Another factor to consider is the monetary cost. Surgery has a higher cost and is more expensive than choosing to do only physiotherapy. Lastly, it is important to note that three to six months of physiotherapy must be done after having the surgery. In other words, the surgical procedure for hip impingement is not a quick fix for getting out of pain.

Regardless if you take the surgical or non-surgical route, the two main aspects of treatment we focus on are load management and activity modifications. In the clinic, we determine your baseline level of tolerable activity and create a plan that gradually progresses you towards your goals. Tolerable activity essentially means the amount and type of physical activity that you can comfortably perform. For example, if you are an athlete who is unable to play your sport or run, we work to maintain your fitness through activities that are tolerable such as walking, cycling, strength training, and any other activity that keeps you moving without aggravating your hip pain. A large component in the treatment of hip impingement includes exercise rehabilitation with a heavy focus of improving the available range of motion in your hip joint and increasing the level of strength in the muscles that surround your hip. In fact, many patients who experience hip impingement symptoms tend to have reduced levels of hip muscle strength and balance. Improving the strength of these muscles not only helps to make them stronger but helps to decrease both stiffness and pain, as well as increase sports performance. Rehabilitation should emphasize hip muscle strengthening 2-3 days per week for at least 3-months. If you are an athlete or have a goal to return to a sport that requires running, jumping, sprinting, cutting, kicking, or pivoting, these activities along with plyometric and sport-specific exercises must be gradually incorporated into your training and rehabilitation program to ensure that you are prepared to return-to-play. The process needs to be progressive and individualized. This means the treatment plan continues to challenge you as your symptoms improve and is unique and specific to you.

In summary

Hip impingement (FAI) is a motion-related disorder of the hip with a triad of symptoms, clinical signs, and imaging findings. Hip impingement can be slow to be diagnosed. Symptoms can be frustrating and really affect your ability to do daily tasks and sports performance.

In most cases, exercise rehabilitation is the first-line recommendation of treatment for recovery from this injury. An emphasis on load management and activity modifications is essential. Hip strengthening exercises should be performed at least 2-3 days per week for a minimum of three to six months. It is important to understand that if you are an athlete or have a goal to return to a sport that requires running, jumping, sprinting, cutting, kicking, or pivoting, these activities along with plyometric and sport-specific exercises must be gradually incorporated into your training and rehabilitation program to ensure that you are prepared to return-to-play. Lastly, doing the right things is key. Stretching and resting are not enough. Surgery should be avoided wherever possible and used only as a last report. Your treatment plan should progressive and specific to you.

Check Out our Youtube Video where Kait explains more about Hip Impingement, watch it here 

If you would like to find out more about your own hip pain, come see us in our Lucan Clinic, you can contact us here


Shin Splints

Shin Splints

What are Shin Splints?

Shin splints, also known as Medial Tibial Stress Syndrome (MTSS) are one of the most common musculoskeletal injuries found in runners. Shin splints are an overuse injury of the muscles and tissues in the lower leg. The muscles of the lower leg run along the length of the shin bone. In shin splints, the area where the shin muscles attach to the tibia or shin bone becomes irritated and inflamed, causing pain. This irritation is caused by repetitive stresses such as walking, running, or jumping. People most commonly experience pain on the inside border of their lower shin.

What are the symptoms of shin splints?

The most common symptom is pain that runs alongside the lower part of the inner shin bone. This pain can be dull and achy or feel like a sharp pain. The pain is also made worse with activities such as walking, running, or jumping and eases with rest. Their area along the inner shin may also be tender and sore to touch. The pain associated with medial tibial stress syndrome is not usually localized to one small pinpoint area but usually spans along with a distance of at least five centimeters.

One interesting thing to point out about shin splints is that sometimes the pain can be felt at the start of a run or activity but then the pain may reduce once you are warmed up. The pain can then return towards the end of the workout and last for a few hours or even days after finishing the run or activity.

How are shin splints diagnosed?

If you think you have shin splints and are unsure what to do about it, you should see a physiotherapist or other health care professional. A physiotherapist will conduct a thorough history and ask you about some of the symptoms mentioned above. They will also perform a physical exam and palpate the area of pain along with a number of other physical tests. They will be able to diagnose you.

However, if a physiotherapist suspects a stress fracture they will most likely order an X-ray or MRI. An MRI is more effective than an X-ray to help diagnose stress fractures as it shows the bone at a higher resolution.


 What is the cause of shin splints?

As mentioned, shin splints are an overuse injury. Runners and other athletes are often affected by this issue after there was a relatively sudden increase in their training loads. This increase in training load comes in various forms such as an increase in the volume, intensity, or duration of training. For example, you may have recently started to train for a marathon and decided to increase the duration of your long run on the weekends.

However, shin splints do not only affect runners and athletes. It can also affect walkers. For example, you may have gone on holiday or weekend breaks and drastically increased your daily step count.


What Should you do if you have shin splints?


1. Reduce your training volume

Shin splints are an overuse injury. This means that you will have to reduce your training volume for a period of time. This may not mean that you need to stop training entirely. Complete rest will not solve shin splints! Symptoms will reduce but the pain will come back once you start running again. How much you need to back away from the aggravating activity will be dependent on the severity of your symptoms.

Can you still run with shin splints? This depends. For example, if your pain is severe and sharp and you can even feel it when you are walking or hopping you should not run. However, if the pain is mild and improves once you warm up and remains only mild for an hour or so after your jog then you are probably fine to do some light jogging. You will require the advice and guidance of a physiotherapist.

It is clear that you should not ignore shin splints. Running through the pain or taking pain killers to get through training sessions will make the issue worse. You may develop a more serious injury such as a stress fracture and prolong your recovery time. You must reduce your training volume.

It is not all bad news. People with shin splints can often do other activities to maintain their fitness without aggravating their pain. For example, if you are a runner training for a marathon and reducing your running volume is stressing you out you will still be able to maintain your cardiovascular fitness with activities like swimming or cycling.


2. You need to get stronger


Shin splints are a really frustrating condition for people. Shin splints do not get better with rest, foam rolling, and stretching. Strength training is a really important part when it comes to getting over shin splints for good. You will need to build up the strength and capacity of the muscles local to the area. This means strengthening the muscles of your lower leg such as the shin, foot, and calf muscles. However, you will also benefit from strengthening the muscles further up the chain at your knee and hip such as the quadriceps, hamstring, and gluteal muscles.

If you would like to see Sean demonstrate some Shin Splint Rehab exercises you can check them out here. There we demonstrate some very effective exercises to strengthen the feet, calves, and shins such as the heel raise exercise or banded dorsiflexion exercise for shin splints. As mentioned you also need to strengthen your entire leg. Single leg exercises such as step-ups and lunging variations are great. So too are compound lifts such as the deadlift.


3. A gradual return to your normal training volume


One of the reasons people become very frustrated with shin splints and end up struggling with them for a very long time is because they do two things wrong. Firstly, they rest entirely and stop all activity. Their pain reduces however they have not actually solved the issue or prevented it from coming back once they return to their training. Secondly, once their symptoms subside, they pick up training back where they left off. They return to their normal training plan.

To prevent the pain from returning you must return to your normal training volume gradually. A general rule of thumb is to increase your total weekly mileage by no more than 10 percent week to week. For example, if you ran 5 miles total in your first week back from injury and had no recurrence of symptoms, then the next week you may aim to run 5.5 miles. If you are a runner you must not only take total weekly mileage into account. You must also consider the frequency of your runs per week, the time you allow for recovery, and the pace of the runs.

As a runner, it is a good idea to only ever focus on increasing one aspect of your training at a time. For example, if one week you decide to increase your weekend long run from 10 to 12 miles, it’s probably not a good idea to also increase the speed of your runs that week too.

If you would like to make an appointment with a Physio in our Lucan based Clinic you can do so here 

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6 Reasons to Exercise

6 of the best reasons to exercise!

As Physiotherapists and personal trainers at Pain and Performance Clinic Lucan, we have learned that it’s not always clear to people right away why exercise is so important.

You may have heard that “exercise is the best medicine” but oftentimes the reason WHY we should exercise can be forgotten about or taken for granted by fitness and health professionals. Understanding the benefits of exercising can be the difference between someone who quits on their fitness goals within a few weeks, and someone who builds the habit of moving daily leading to a change in their lifestyle, health, and overall attitude towards exercise. I would like to shed light on these all-important benefits so that you can learn how exercise can improve your life!

1) Look and feel better

Have you ever heard of a ‘runners high’ and wondered what it meant? Exercise releases ‘happy hormones in the body! It helps you to destress from the madness of everyday life and take some time to listen to your body! Thankfully it’s not just runners that get to enjoy this release of dopamine and serotonin, it’s anyone who participates in any extended exercise. Feeling better goes hand in hand with looking better!

When you feel good you look good and vice versa. Exercise can help your entire body look better. Whether that is by losing some excess weight through cardio or giving you more defined muscles with weight training. Our 1 to 1 personal training in Pain and Performance Clinic Lucan gives you the best of both! Something that can be kept a secret, however, is that strength training with or without weights allows your body to continue to burn calories throughout the day even after you exercise!

2) Increase energy and productivity

Life is hectic, busy, and pretty exhausting! Sometimes we can get so caught up in our work, looking after children or family, that over time our own energy levels can become super low, and everyday tasks can feel like climbing a mountain. Taking part in regular exercise even little amounts throughout the workday has been shown to increase energy and productivity levels. Instead of reaching for the afternoon pick me up from a coffee or a chocolate biscuit, taking 5 or 10 minutes to go for a walk or a lunchtime PT class will get you to finish out your day strong and give you the boost you need.

3) Reduce your risk of getting injured

Injuries typically occur when you do too much too quickly after too little for too long! Resistance training and sport-specific drills in our Personal training classes in Lucan will get your muscles and joints strong so that when you play your sport, whether that’s down at the local 5 a side or in Croke park, your body is primed and ready for the demands of your sport. Therefore reducing the risk of getting injured.

4) Exercise allows you to do the things that you enjoy

While getting your body moving, lifting heavy things off the floor, and getting a good sweat going feels amazing, it’s the effects that it has on your life outside of the gym that is truly fulfilling. Let’s say you love to go hiking with your friends every few weeks or months, but time after time, you feel your ankle or knee niggling at you within the first hour or you start to feel your legs tiring long before you’re ready to call it a day.

Perhaps you’ve recently become a first-time parent and you’re struggling to put down and pick your baby up from the cot due to nagging back pain. Or maybe you’re a grandparent longing to play with your grandchildren but that relentless shoulder pain is holding you back. Issues like this can put a dampener on your enjoyment and turn something you love doing into something you absolutely dread! Fortunately, with the right coach and exercise plan, problems like these can be dealt with head-on. Getting stronger and moving more is often just what people need to be able to better enjoy the things that they love.

5) Age-Related Decline

As we get older we are usually told that our muscles get weaker and joints become stiffer. These age-related changes can sometimes lead to reduced confidence and increased falls risk. Due to the increased aging population of the world, a large number of studies have shown that exercise is best for maintaining independence and quality of life. Thankfully, no matter what age we are we can always build muscle and strength. Personal training classes with our Physiotherapists in Pain and Performance can help you or your family members get stronger and more confident with everyday tasks. Age is just a number after all, so why not get a head start and get moving safely.

6) Exercise stops you from getting sore

More often than not, “pain” is the result of muscle weakness and not enough moving! For example, people tend to avoid moving their shoulders when they start feeling pain or discomfort. This leads to the shoulder muscles getting weaker, leading to more stiffness and pain-causing them to avoid moving it even more! This vicious cycle can repeat over and over until that person becomes fearful of “causing more damage” to their shoulder…which couldn’t be further from the truth! Relaxed movement and strength training lead to less stiff, less painful, stronger, and healthier joints and muscles. “If you don’t use it, you lose it.”

In a world where everyone is tracking how many steps they are taking each day and with social media pages proclaiming that their “revolutionary” training plan is what you need to get fit. It’s easy to forget that we simply need to move.

‘Exercise’ can be seen as a chore when it’s not enjoyed, but everyone can learn to love exercise when they find something that’s right for them. At Pain and Performance Clinic Lucan we want to help you get back to the exercise that you love or help you to discover something new. With our 1 to1 training, we tailor our sessions to your individual goals.

What is sarcopenia?

Sarcopenia is the loss of muscle and strength as you age. This process is the beginning of frail. One of the 5 indicators of frailty is a loss of strength. This loss of strength begins at different times for different people but often it starts to happen around the age of 30 if you are not exercising or doing any strength training. Once in your 40s, it is normal to lose about 1-2% of muscle mass and strength each year.

With this level of muscle mass loss if left unchecked 1 in 3 people will be at weakness levels that would indicate frailty by the age of 60. Frailty is defined as having 3 of the 5 indicators.

The 5 indicators of frailty are;

  1. Weakness,
  2. Fatigue,
  3. Slow gait speed
  4. Unintentional weight loss, and
  5. Low levels of physical activity

Having only one or two of these means you are technical “pre-frail”. But, chances are if you have allowed this loss of muscle and strength to lead to frail levels then you probably have 1 or 2 more indicators of frailty. Nobody wants to be seen as old and frail. Let alone be frail at the age of 60. If you have no indicators of frailty you are by medical definition “robust”. To me, this means you’ve aged well and aged successfully.

If gone unchecked then sarcopenia may mean you will have lost about 50% of your muscle mass by the age of 70. This muscle mass will be replaced by fibrous tissues instead.

Why am I telling you about sarcopenia?

Well, this loss of strength affects you on a daily basis. Things like getting out of a chair, going upstairs, or carrying shopping can become impossible tasks if you lose basic strength levels.

If severe enough it can be even more detrimental to our health by causing falls, fractures, and loss of independence.

When you are in your 20s, 30s, or 40s it may seem mad that I’m talking about these issues that are “old people’s problems” but tackling sarcopenia is a bit like a pension. If you leave saving for your pension until it’s too late then you won’t have the money to do what you want to do when you retire. Well, in much the same vein, if you don’t tackle sarcopenia now you’ll be too weak to enjoy your retirement.

Is sarcopenia reversible? Is sarcopenia preventable?

Yes and yes! Sarcopenia is reversible, and, sarcopenia is preventable. Thankfully sarcopenia is not inevitable. Yes if you do nothing you will lose muscle mass and strength. But, if you keep exercising, keep exercising, and strength train 2-3 times a week you can prevent and reverse the effects of sarcopenia. 10 weeks of strength training has been shown to increase muscle size by 4-5% and muscles strength by more than 100% and that’s in people over the age of 70. It’s never too late to start!

In fact, during the first 10-12 weeks of doing strength training in the gym, the main thing that changes is not your muscle/body composition but in fact, it is your strength levels. That goes for people of all ages.

Having more muscle will make you strong but there is also a neural effect to your strength. The nervous system can be trained in the gym much as the joints and muscles can. And, these neural adaptations are the main thing that brings about an increase in strength during the first 10-12 weeks of training.

This is also why very often you go to the gym for 2 or 3 months before anyone starts to notice. You may feel stringer initially but your friends or family won’t see the physical difference right away.

I don’t have time to spend hours in the gym…

The good news, it doesn’t take hour after hour of training to get benefits from strength training for sarcopenia. 30-40 minute sessions 2-3 times a week can make a world of difference to your health. Not only will strength training 2-3 times a week help with sarcopenia and muscle loss it will also help to improve your energy levels preventing fatigue. Low energy levels are another indicator of frailty that is preventable.

You don’t stop because you are old. You get old when you stop!

Strength training and exercise, in general, will help prevent 4 of the 5 indicators of frailty. While I’ve already spoken about how strength training reduces the impact of sarcopenia and improves your energy levels what it will also help is keeping your gait speed high. A slow gait speed is the third preventable indicator of frailty. Finally what you will need to do is supplement your strength training is more physically active if you aren’t already. Physical activity doesn’t mean going for hour-long runs, cycling up the Wicklow mountains, or doing 100 lengths in the swimming pool. Physical activity can be walking to the shops, taking the stairs, or getting off the bus a bit earlier. If you strength train 2-3 times weekly and stay active it will stave off frailty and all the issues that come with it.

“If exercise could be packaged in a pill, it would be the single most widely prescribed and beneficial medicine in the nation.”


The only indicator of frailty that isn’t directly related to strength training and physical activity is unintentional weight loss. Now, bad luck may play its part here and you can develop an illness that may mean you lose weight unintentionally because you are medically unwell. Nobody is to blame for this when it happens. Thankfully though many chronic illnesses can be prevented with physical activity, strength training, and proper nutrition. The more you keep fit as you age the less likely you are to develop diabetes, heart issues, have a stroke, get COPD, and so on.

If you want to speak to any of our expert staff about the right exercise to age healthily then you can contact us by phone, via email, or on any of our social channels. You also have the option to book a face-to-face consultation in our Lucan Clinics. If coming into the clinic isn’t possible for you we also offer video consultations via WhatsApp.

You can also read more on the benefits of Strength Training here

Do you suffer from arthritis?

Do you suffer from arthritis?

Coming into the winter months, we often see patients with flares of their arthritis. Osteoarthritis is common in Ireland. Osteoarthritis affects approximately 10% of the country. It is no wonder we see many arthritis patients in our clinic.

Arthritis is an issue that needs to be managed. There is no “cure” per se. But, with the right guidance arthritis can be kept at bay. You can recover to a point where your pain levels no longer leave you scared and you can do what you love again. Your recovery from arthritis will mean fewer flares. Or, just the less debilitating each flare is. The fewer flares there are. And, The less pain there is. The better it is for you!

In the clinic most people with arthritis are scared. They are scared because they believe that when there is a pain in their joints that they are causing more damage to the joint itself. This is not the case. Pain doesn’t always mean damage. Doing something that hurts the joint a bit is fine once that pain settles within 24 hours. I don’t want you to stop doing everything you love. But, I also don’t want you suffering from pain so there’s a balance we have to strike.

What’s the best way to treat arthritis?

Of course, there are many treatments for arthritis. Lots of these aid your recovery. But, what is the best treatment for arthritis?

Well, The NICE guidelines for treating arthritis have one “core” treatment. That core treatment for arthritis is exercise. What are NICE guidelines? Well NICE stands for; National Institute for Health and Care Excellence. Safe to say they know a thing or two about the treatment of arthritis.

Many of our patients have tried using exercise as a treatment for arthritis before. But, they have found their pain levels have increased and this puts them off. Often the issue with this isn’t the exercise itself. When it comes to treating arthritis you don’t just use any old exercise. We are talking about exercise as a treatment. This means there is a correct dose. And, that dose is different for every person.

To get the best benefit from exercise treatment for arthritis you need the guidance of a healthcare professional. Physiotherapists can help with this. When exercising you may get sore. But, a physio can help you differentiate between;

  1.  The right amount of muscle soreness that’s acceptable.


2. Joint pain that’s to be avoided. 

Will my recovery from arthritis be permanent?

Unfortunately, arthritis is a condition that is managed more than cured. There will be days when you don’t even remember you have arthritis, there will be days where it will flare and be sore again. The better you manage arthritis the longer you will go without pain. Exercise is one part of your recovery that can help. There are also things you can do or we can do to help with it.

Firstly, it is shown that heat therapy can be very good for arthritic joints. Heat therapy isn’t the cure. It’s not going to get rid of your arthritis. But, heat will help to alleviate your pain. Heat therapy is not something you need to go to a physiotherapist for. Some clinics offer and use heat packs as part of arthritis treatment. But, you can do this at home yourself quite easily. A hot shower, warm bath, or even the humble hot water bottle can work wonders to reduce pain from arthritis.

Along with exercise and heat, joint mobilizations can help to reduce your pain too. Unfortunately,  unless you live with a physio you’ll have to come into the clinic in order to get this done. What are joint mobilizations? The best way to think of these is, as stretches for the joint. Most stretches you feel in your muscles. These you will feel in your joints. They can be useful during a flare. Again they are the cure for arthritis. They help you recover from arthritic pain but they are just an assistant to the core treatment for arthritis. The core treatment for arthritis is exercise.

What also is shown to aid in recovery from arthritis is weight loss. Often times it’s not just the loss of weight that helps. But, the lifestyle changes needed to lose weight include strength training, physical activity, healthy eating, and good sleep. All of which are good for your joint health. 

What kinds of exercises are best for arthritis?

There is no one best exercise. You need strength training to have healthy joints. On top of that though it is best to find a type of exercise you enjoy that doesn’t aggravate your pain. Enjoying what you are doing exercise-wise gives you a way better chance of sticking to it. On top of exercise though being physically active regularly and often is key to treating arthritis.

What’s the difference between physical activity and exercise? Exercise is something structured like going for a run, going to the gym, or playing football. Physical activity is the movement you do throughout the day. While 30 mins of exercise are great to help your recovery from arthritis. Being physically active throughout the day in small bursts is also very beneficial.

Joints are made to move and moving them regularly is best. Think of your joints as a hinge on a door. A door that isn’t opened is prone to sticking and when it does open the hinge creeks. Doors that open and close regularly throughout the day rarely stick. Sitting down and resting to help your arthritic joints is more likely to make them rust. Getting up and moving as much as is tolerable is your way of putting a bit of WD40 into the joints.

I don’t have time to do physical activity.

Somebody once told me. “If something is worth doing it’s worth doing wrong”. This may sound odd because half of us are perfectionists. And, the other half is used to having had our parents or teachers give out to us with the old “if it’s worth doing, it’s worth doing right”.

The reason I say “if it’s worth doing it’s worth doing wrong” is because doing even 1 minute of exercise is worth far more than hours of intention. There are many ways you can fit in physical activity to your day no matter how busy you are.

If you don’t have time to get out for a walk before work. Why don’t you try hopping off the bus a few stops earlier and walking down to work from there? If you don’t get pain on the stairs take them instead of the lift. Walk to the shop instead of driving. Go to the coffee shop at the end of the road rather than next door. Sure even if every time you finish an episode of Netflix or the TV goes to an ad you could simply get up, walk to the door of whatever room you are in, and then sit back down that’s more activity than just sitting there.

I don’t have the motivation to do formal exercises.

Motivating yourself to start is the hardest part. But, there are a number of things you can do to help.

  1. Get a buddy. It’s easier to let yourself down than it is to let a friend down. Having a training partner can help motivate you to do more. Weather it’s a walking buddy or somebody that comes to the gym with you.
  2. Pick the right facility. Often what’s actually more of a barrier to strength training or exercising is the type of gym you join. You can often feel lost in a big commercial gym. If this is the case then try out a private training facility like ours in Lucan. We have 1 to 1 or 4 to 1 classes lead by physiotherapists. This may suit you better. Once you build confidence here then maybe you could try out a different place if you want to go it alone.
  3. Make a goal. If you are exercising to relieve your arthritic pain then you start to run away from the pain. It’s better to have a separate goal to achieve to keep you motivated.

How do I make the right goal?

Making a goal when you are in pain can be difficult. But, it’s important. When making a goal there are many different things different people will tell you to focus on. I feel when making a goal it is best to keep it simple. Now, this simple doesn’t mean easy or vague. “I want to get stronger”. That goal is simple. But, it is not easy to do. Also, it’s very vague.

Your goal needs to be.

  1. Specific.
  2. Measurable. And.
  3. Realistic.

Now if you want to get stronger how you set this goal is by picking something you aren’t currently strong enough to do and aiming for that. For example, if I had arthritis in my knee. And, it hurt me to do squats. Then an appropriate goal would be. I want to be able to squat.

Specific? Yes.. A squat is a specific exercise.

Measurable? Yes.. you either can or can’t squat.

Realistic? Yes.. one squat is a very realistic goal for somebody with arthritis in their knee.

What’s good about this goal is it can be broken down. Okay, you want to be able to squat. But, what would make that possible? More strength in your quads for starters. You can do exercises to strengthen the quads that don’t cause pain. More mobility in your ankles. You can do mobility work for your ankles and this will make it easier to squat as you get more mobile.

You will be able to focus on little wins that will contribute to your bigger goal. And what’s the best thing about this? Well, you’ve been focusing on your goal instead of your pain the whole time!

If you have any questions about the treatment of arthritis feel free to contact us for more information. You can contact us by phone., or any of our social media channels. Alternatively email us at

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