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Busting pregnancy exercising myths!

Everyone has an opinion on what you are and aren't allowed to do whilst pregnant. Some of this is useful however some of it is based off someone's opinion on breakfast TV or from a pregnancy/baby website. Now the scary thing is that these facts may have no or out-dated research backing.

We have come a long way in our understanding of exercising whilst pregnant. Up until 1985 pregnancy was considered almost like a disease state and that women should more or less refrain from doing anything strenuous. In 1985 due to mounting pressure from conservative groups and active women groups the American College of Obstetricians and Gynaecologists (ACOG) came out with a list of recommendations as to what they deemed to be safe. At this stage the advice given was based primarily off their personal experiences and opinions rather than evidence. This was when the "not exercising above 140 beats/minute" and "not exercising for longer than 15 minutes" was introduced.

Myth 1: You can only exercise if you were exercising prior to falling pregnant.

FALSE

The latest release from the ACOG recommends for women to participate in 20-30minutes of exercise most to all days of the week. The type of exercise can be modified if medically required. Exercise produces positive effects on improving/maintaining the woman's physical fitness, reduces the risk of gestational diabetes and improves psychological well-being.  

There have even been several studies showing the benefit of exercise prior and during pregnancy for reducing the risk of pre-eclampsia. Pre-eclampsia is a serious disorder relating to high blood pressure and excessive protein in the urine. In severe cases it increases the risk of a stillborn baby and can cause end organ changes for the mother. It is though that exercise improves placenta growth and vascularity, prevents/reduces oxidative stress, reduces inflammation and corrects defects in the lining of blood vessels. The research conducted varies with what is the optimal intensity for exercising however they all recommend starting to exercise in the first trimester to get the maximum benefits.

Myth 2: You can't exercise on your back.

FALSE (with consideration)

Lying on your back may cause compression of the inferior vena cava (main blood vessel bringing blood back to your heart) from the weight of the pregnant uterus sitting on top of it. This may ultimately lead to a lower heart rate for the mother. One study conducted on women who were 39 weeks pregnant found that only 10.9% had changes in their heart rate lying on their backs and this change nearly always coincided with a Braxton-Hicks contraction. This might suggest that when the uterus is more solid and tense it can  compress the blood vessels. This study also interestingly found that women moving from lying on their back to their left side had the greatest drop in heart rate. A different study found that exercising on your back (leg lifts or cycling) at 31 weeks pregnant increased your heart rate with no negative effects on blood supply to the baby. 

So blood flow is rarely an issue and when it is impeded it is usually associated with Braxton-Hicks contractions. The most likely outcome from exercising on your back is that  your uterus will move more into your thorax and diaphragm making you work harder to breathe. So if you feel short of breath or uncomfortable exercising on your back you should either limit or avoid this depending on the severity of your symptoms. 

Myth 3: You can't exercise too hard otherwise your body will overheat.

FALSE

Raising your core body temperature above 39 degrees during neural tube development may increase your risk for neural tube defects (i.e. the development of the brain, spine or spinal cord with common issues being spina bifida and anencephaly). However the neural tube is formed during the 35-42 days after the last menstrual period. This is the stage where you are probably either not aware you are pregnant or just finding out. After this time there is no risk of developing neural tube defects. 

Exercising at 60-70% of your VO2 max (measure of maximum volume of oxygen used) in a controlled environment for 60 minutes doesn't increase the core body temperature above 38 degrees. To put this exercise into a more understandable level, it is exercising at above 75% of your maximum heart rate and you would have difficulty talking due to shortness of breath whilst exercising.

Potentially you may be able to push your body temperature higher if doing strenuous exercise like a marathon or in extreme weather conditions but no research has yet been conducted on this. If in doubt (due to us living in a fairly warm corner of the world) try to exercise in a climate controlled environment like a gym or not outside on days when Mackay feels like it has been converted into the devil's inferno.

So if you are pregnant and want some advice on exercising please make sure you get good advice. The ACOG acknowledge that even though bed rest is commonly prescribed it is rarely needed. I can personally say that labour and then caring for your child is no easy feat so the fitter you can be before hand the better you will be able to handle it. 

Bø, et al (2016) Exercise and pregnancy in recreational and elite athletes: 2016 evidence summary from the IOC expert group meeting, Lausanne. Part 1 - exercise in women planning pregnancy and those who are pregnant. British Journal of Sports Medicine, 50(10), 571-589.

Ibrahim, et al (2015). Effect of maternal position and uterine activity on periodic maternal heart rate changes before elective caesarean section at term. Acta Obstetricia et Gyneocologica Scandinavica, 94(12), 1359-1366.

Jeffreys, et al (2007). Uterine blook flow during supine rest and exercise after 28 weeks of gestation. Obstetric Anaesthesia Digest, 27(2), 93-94.

The American College of Obstetricians and Gynaecologists: Committee on Obstetric Practice (2015). Physical activity and exercise during pregnancy and the post partum period. The American College of Obstetricians and Gynaecologists, number:650.

Why do some people not get better after a knee replacement?

The most common orthopaedic surgical procedure in the western world is a knee arthroscope. This is despite high quality evidence showing that for anyone who doesn’t experience locking in their knee this surgery is no better than placebo. Once we extend past this surgery I would guess the next most common surgery (especially in the public health system) are knee replacements. But if you go talk to a group of oldies there will be mixed reviews as to who has gotten better, worse or not changed following a knee replacement.

So let’s look into what factors are known to co-exist with knee osteoarthritis.

1.     Limitations to daily functioning especially with tasks like stair climbing, walking and housekeeping.
2.     Strength deficits around the hip and knee leading to increased internal joint forces and loads.
3.     Decreased social participation.
4.     Decreased cardiovascular fitness.

  

I believe some of the short falls with knee replacements is that they only address what occurs at the joint surface. They don’t address muscle changes, internal joint loads, cardiovascular fitness or social interaction.

Pain is a very complex concept and it is important to remember that pain is an output from the brain based on the brain’s interpretation of what is going on in the body. So that message may be based off receptors in the joint surfaces but it may also be based of receptors in the muscles, connective tissue, past experiences, etc. Stress, anxiety and depression tend to then amplify these messages as they enter the brain.

One study found that a knee replacement is only likely to have a positive effect on pain if the patient suffers from pain with movement and no pain at rest. There is even a study showing that women are more likely to have poor pain and functional outcomes after a knee replacement adding a gender consideration to the cause of pain. So if we only address the joint surface we might be missing most of the problem.

I feel the problem arises with x-rays and imaging. Now imaging can be a really useful tool but it’s results need to be considered in combination with what the patient is complaining about and how they are presenting. As a health professional we should never base our diagnosis 100% on an x-ray/CT/MRI/etc. Multiple studies have shown that degenerative changes are commonly seen even in the absence of pain. So a terrible looking knee x-ray might not actually relate to the patient’s pain. You might know someone who had pain in one knee but the scan showed that the other side was worse despite them not having pain in that knee.

The next problem that happens is a lack of a thorough physical assessment of the knee either by the physiotherapist, GP or orthopaedic surgeon. Sometimes regardless of who assesses you, your age and x-rays will have you thrown into the arthritic group which are then given general advice to remain active and put off surgery until you can’t function anymore. Or perhaps exercise therapy is offered in a very general sense such as a group hydrotherapy program or a generic handout. Alternatively if you are age appropriate you are wheeled into the operating room without much further thought.

But the exciting thing is that there is emerging research on the benefit of structured conservative treatment. One study compared a 12 week program of neuromuscular exercise, orthotics, education and dietary advice to usual care (which was the same education delivered in a booklet). They found that 12 months later the 12 week program group had significantly improved in regards to their quality of life and daily functioning. Other studies have also shown the benefits of exercise for reduction of pain and increase of function, especially for land based exercise compared to hydrotherapy.

In regards to all this strengthening we then need to expand the area we look at. All too commonly a receive a referral for quads strengthening for someone with knee arthritis. However current research shows us that those with painful knee arthritis have significant weakness in their hips and altered biomechanics with tasks like walking. So as a physiotherapist it is very important to look beyond the knee and address the person as a whole and not just an arthritic knee.

So how do we get better outcomes with surgery? “Pre-habilitation” is gaining momentum in surgeries such as ACL reconstructions. They find by doing “pre-hab” patient’s are being able to either put off surgery or are having better post-operative outcomes than those who receive no pre-operative treatment. So my opinion is that patient’s with sore knees need to have a thorough assessment from the bra strap down assessing any dysfunction and it’s relationship to their current pain. Then high quality treatment needs to be provided. This may mean manual treatment but also a minimum of 12 weeks to address any strength deficits. After this, even if the patient requires a knee replacement, their strength around their hips and knees will have improved, their cardiovascular fitness will have improved and they may have had some changes to their functioning ability. All of these factors would only benefit the patient post-operatively leading to a quicker recovery and greater post-surgical satisfaction.

Deasy, et al (2016). Hip strength deficits in people with symptomatic knee osteoarthritis: a systematic review with meta-analysis. Journal of Orthopaedic and Sports Physical Therapy, 46(8), 629-639.

Fransen, et al (2015). Exercise for osteoarthritis of the knee: a Cochrane systematic review. British Journal of Sports Medicine, 49(24), 1554-1557.

Lundblad, et al (2012). The value of pre-operative grade of radiographic and histological changes in predicting pain relief after total knee arthroplasty for osteoarthritis. Knee Surgery, Sports Traumatology, Arthroscopy, 20(9), 1815-1821.

McAlindon, et al (2014). OARSI guidelines for non-surgical management of knee osteoarthritis. Osteoarthritis and Cartilage,  22(3), 363-388.

Mehta, et al (2015). Do women have poorer outcomes following total knee replacement? Osteoarthritis and Cartilage, 23(9), 1476-1482.

Skou, et al (2015). The efficacy of 12 week non-surgical treatment for patients not eligible for total knee replacement: a randomised controlled trial with 1 year follow up. Osteoarthritis and Cartilage, 23(9), 1465-1475.

 

 

Hip bursitis - to rehab, inject or forget?

Patients who have pain on the side of their hip are often told they have bursitis. A lot of people may first see their GP about this which usually results in having an ultrasound done on the hip and then maybe a cortisone injection. If they fail to respond to this some may get referred onto physiotherapy but many are just told to put up with the pain. 

Over the years the name for the condition has changed a lot. In fact we no longer call it hip bursitis but rather greater trochanter pain syndrome (GTPS). Your greater trochanter is part of your thigh bone which sits prominently on the side of your hip so the name just refers to pain in this region. Technically bursitis is an incorrect term as the "itis" part of the word implies that there is inflammation in the area which we can not technically determine just from it looking bigger on ultrasound (bursas naturally thicken and change with age and we can't technically say there is inflammation without taking a sample to test for inflammatory markers). Between the hip bursitis and GTPS phases of names we also had gluteal tendinopathy which implies that there is something wrong with the tendon. This is much more likely than the inflammation of the bursa and I would say that a large proportion of GTPS is related to the gluteal tendons (where your bottom muscles attach to your hip).

So who is more likely to get GTPS?

Unfortunately it's mainly females between 40-60 years old. Tendinopathy in general (in shoulders, elbows, hips, etc) is more common in an obese population and also if there is a sudden change in activity level. Now a change in activity level may not necessarily mean joining the gym. It can be something as simple as going on a holiday and doing more walking than normal (especially if it is on an uneven surface like sand or cobblestones) or doing a big house clean up before all the family turns up for Christmas. Pain is commonly felt on the outside of your hip and is aggravated by lying on it and sitting in low chairs (e.g. lounge chairs or car seats) but not aggravated by putting on your shoes and socks (this has been specifically linked to hip osteoarthritis and not GTPS).

Now what to do?

Well unfortunately we have discover in recent years that cortisone injections actually weaken the tendon and can lead to eventual rupture of the tendon. PRP injections (platelet rich plasma) are a new trend which may prove beneficial in years to come but unfortunately the research is currently not overly supportive. When I asked sports doctors for the Cowboys and Kangaroos about his opinion on PRP injections he felt that it may be appropriate if all other conservative options have failed but it currently doesn't have great research or clinical backing saying it is helpful. 

So what can physiotherapy do?

It is important to address the person as a whole. So if you are overweight look into diet changes to help modify this. If you are a bit boom and bust with your activity level we need to determine something that you can safely perform without aggravating your condition. Exercise wise the research shows that heavy isometric contractions (so tensing your muscles without moving) produce a strong analgesic/pain relieving effect. This is usually the first thing to do. I like getting patients lying on their backs, knees bent up so their feet are on the bed and pushing out into a belt wrapped around their knees. Other modifications can help to - sleeping on the other side with a pillow between your legs, avoid sitting in low chairs, sit on a cushion in a car to lift you up a bit, etc. These changes should help to reduce the pain to a steady 0-3/10. Then we can start to slowly build up the muscle strength and endurance to produce lasting effects. 

Image from: Grimaldi and Fearon (2015)

With the right management GTPS or "hip bursitis" is quite easy to treat conservatively with roughly 90% of sufferers responding to conservative management alone. So if you are suffering with hip pain come in and let us get you on the road to recovery. 

Fearon, A.M., et al (2013). Greater trochanteric pain syndrome: defining the clinical syndrome. The British Journal of Sports Medicine, 47(10), 649-653.

Grimaldi, A., et al (2015). Gluteal tendinopathy: a review of mechanisms, assessment and management. Sports Medicine, 45(8), 1107-1119.

Grimaldi & Fearon (2015). Gluteal tendinopathy: integrating pathomechanics and clinical features into it's management. Journal of Orthopaedics and Sports Physical Therapy, 45(11), 910-922.

Reid, D. (2016). The management of greater trochanteric pain syndrome: a systematic literature review. Journal of Orthopaedics, 13(1), 15-28.

 

When should I worry about my headache? 

Cervico-genic headaches, migraines, tension headaches and other more sinister headaches. Which one do I have? Who can help me? What can I do to get better? What if something really bad is happening?

People who don’t get headaches probably don’t understand how horrible they can be. But the hard thing is knowing what kind of headache you have and who can help. As a physio our job is also to try and figure out what kind of headache you have, whether we can help or if maybe something more sinister is happening.

Now let’s get the nasty ones out of the way. If you ever experience a severe thunder clap like headache please go straight away to the emergency department as this symptom is closely linked to problems with the blood vessels supplying your brain and is a medical emergency.



Figure 1: Above left shows pain distribution for dissection of the internal carotid artery. Above right shows pain distribution relating to extra-cranial vertebral artery dissection. (Taylor and Kerry, 2010).

Also headaches that are unlike any other, if you are over 50 and experience your first ever headache or are woken from your sleep due to a headache (not that you wake up at your normal time and notice you have a bit of a headache) you should go and see your GP as again this could be related to blood supply to your brain. Everything might be fine and your headache might be related to a completely non-sinister cause but it is always best to rule out the nasties.

Now the less life threatening ones…

When I’m doing education sessions for my physios I find a table is always helpful.

 

Cervico-genic headache

Migraine without aura

Migraine with aura

Tension type headache

Location

One side without side-shift

Pain running from back of head to temple

+/-  neck pain

Normally pain on one side of head but can change sides

Normally pain on one side of head but can change sides

Both sides of head at once

Nature

Dull pain

Pulsating

+/- nausea and/or vomiting

+/- photophobia and phonophobia

Pulsating

+/- nausea and/or vomiting

+/- photophobia and phonophobia

+/- numbness

Tight pressing band that is not pulsating

No nausea or vomiting

May have either photophobia OR phonophobia

Aggravated by

Neck movements, neck postures, neck trauma

Hormones, foods (chocolate and red wine common), medication, activity

Hormones, foods (chocolate and red wine common), medication, activity

Stress

Not attributed to physical activity

Disabling?

No

Yes

Yes

No

Duration

Days (until neck is resolved)

4-72 hours

5-60 minutes

30min – 7 days

Can physio help?

Yes

No unless you also have a cervico-genic headache present

No unless you also have a cervico-genic headache present

Evidence wise no but clinically we find some people can get relief from some mobilisation, massage, heat and stretches (?Helps with stress?)

If you aren’t sure what type of headache you are having or if you have many types of headaches and want to figure out which one is which, our physios are highly trained in diagnosing the different types of headaches. We are able to accurately assess the upper 3 joints in your neck and your deep neck flexors which contribute to cervico-genic headaches. If you have a jaw pain (which can also sometimes cause headaches) we can help determine if this is contributing to it as well. But most importantly we are highly trained in recognising the sinister headaches and can make sure we rule these out and refer you on if necessary.  Come in and try us out today.

Amiri et al (2007). Cervical musculoskeletal impairment in frequent intermittent headache. Part 2: Subjects with concurrent headache types. Cephalagia, 27(8), 891-898.

Headache Classification subcommittee of the International Headache Society (2013). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalagia, 33(9), 629-808.

Jull et al (2007). Cervical musculoskeletal impairment in frequent intermittent headache. Part 1: subjects with single headahces. Cephalagia, 27(7), 793-802.

Taylor and Kerry (2010). A system based approach to risk assessment of the cervical spine prior to manual therapy. International Journal of Osteopathic Medicine, 13(3), 85-93.

 

Chronically tight hamstrings? 

Hamstring weakness is something that is commonly overlooked. All those years ago when I was a fresh-faced undergraduate, hamstrings were evil muscles that were commonly overactive and just needed to be stretched and neglected as far as strengthening went. This mentality was further reinforced in my first few years of practicing when the focus definitely fell on strengthening gluteus medius (side bottom muscles) above and beyond everything else. Unfortunately a decade of focused bottom strengthening in the physio world hasn’t turned everyone into Beyonce yet.

But what about these constantly tight hamstrings? They can cramp, tear and really limit us in life? If you go to the gym for the first time you will most likely end up with sore and tight muscles the next day. So imagine if your hamstrings thought a hard work out was just doing your normal walking around during the day. They would get tight too. So just like the gym if you get stronger you should feel less tightness and it should take heavier and harder exercises to cause the tightness.

Now I think where physios/personal trainers/exercise physiologists get short sighted is we only tend to assess hamstring strength with knee flexion (bending) and not with hip extension (mainly because that’s where we worship the bottom muscles and ignore everything else). Bourne et al (2016) completed a nice study showing which muscles were being activated in commonly prescribed hamstring exercises. They found that knee flexing exercises like hamstring curls and Nordic hamstring exercises use more of your inside leg hamstrings (semimembranosus and semitendinosus).  Alternatively straight knee bridging, deadlifts and hip extension exercises preferentially used the outside hamstrings (bicep femoris).

So it is really important that we assess the strength of both sides of your hamstrings as weakness in one could be contributing to pain in your lower back or leg. Then as we address this weakness the muscle will feel less tight as it will have the strength and endurance to keep you moving all day long.

If you think your hammys need a looking over or you want us to have a look at your back or leg pain call 07 49 999 773 and one of our great physios can help you out.

Bourne, M.N., et al (2016). Impact of exercise selection on hamstring muscle activation. British Journal of Sports Medicine. Published online, 1-9. 

 

Hydrotherapy - when is it needed? 

I have been very busy this year with completing my Master of Musculoskeletal Physiotherapy. As part of my studies I have been required to complete 160hrs of clinical placements – the bulk of these have been consulting in public health orthopaedic screening clinics. As part of my assessment of these patients on the orthopaedic wait lists I ask them what they’ve tried in the past and whether it has helped or not. Now unfortunately the answer to this question has been really disheartening to me. Hearing about other private physiotherapists treatments that are not evidence based and have in essence been wasting these poor patient’s time and money. Inappropriate use of hydrotherapy has been one of the stand outs especially in Mackay.

Now don’t get me wrong, I love hydrotherapy and you can get great results in certain patient populations. By exercising in the pool you can decrease the load on your body – belly button depth makes you roughly 50% weight bearing. This can been really useful for people post surgery who have restricted weight bearing protocols to follow. In addition the reduced weight can mean that people with arthritic lower limb joints can perform cardiovascular exercise allowing them to loose weight (which would further decrease the load on their joints when on land). For those with a neurological problem like a stroke, traumatic brain injury, spinal cord injury, cerebral palsy, etc it can give them greater freedom to move that they can’t achieve on land.

In the case of low back pain the evidence isn’t that great. A systematic review performed in 2009 found there was no difference between hydrotherapy and other land based physiotherapy interventions. In the long term, this review found that the other interventions provided greater effects than hydrotherapy. Even the low back pain clinical practice guidelines from 2012 reported no superior value to hydrotherapy over other interventions. In fact they found that high intensity exercise aiming to improve fitness and strength had a positive effect on chronic low back pain.

Now research always has it’s limitations – it’s hard to definitively know for certain in an experiment set up that parachutes save lives as you can’t ethically throw people out of a plane without a parachute to see what happens. I think hydrotherapy in the first few weeks following an acute disc injury (bent over, can’t straighten up, hurts to cough and sneeze, just happened) helps with pain management (especially if the pool is sufficiently heated). However all patients still require a thorough assessment to determine the source of their pain. Then all patients need to be progressed into land based exercises performing similar movements at similar weights to what they would do in day to day life.

So is hydrotherapy good – yes but for certain people. Can it help with low back pain – yes for a few weeks but exercises need to be progressed to land based functional activities to help effectively strengthen and prevent relapses. (Side positive note is that hydrotherapy is very effective in helping with back pain related to pregnancy and reduces days of work missed due to pain)

If you have any further questions about whether hydrotherapy is appropriate for you or what other interventions might help your pain – hands on treatment, exercises, pilates, gym, etc – our physio’s would be happy to answer them.

Delittle, et al (2012). Low back pain: clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the orthopaedic section of the American Physical Therapy Association. JOSPT, 42(4), 1-57 

Waller, et al (2009). Therapeutic aquatic exercise in the treatment of low back pain: a systematic review. Clinical Rehabilitation, 23(1), 3-14

Posterior Shoulder Internal Impingement

Posterior Shoulder Internal Impingement is a relatively common shoulder problem. Unfortunately for people with this problem, it continues to be one of the most commonly misdiagnosed shoulder problems. In addition to this, the commonly prescribed exercises for rotator cuff pathology or subacromial impingement actually aggravate posterior shoulder internal impingement. The pain is felt around the back of the shoulder when your arm is cocked back like you are about to throw a ball. Most of the research is done on throwing or overhead athletes however I have seen this condition arise in trades-people who frequently have to work in odd restricted spaces to mother’s who are frequently reaching back into the back seat of the car.

Unfortunately scans aren’t often useful with diagnosing this condition. X-rays and ultrasounds tend to focus on more arthritic issues or problems with the front or side of the shoulder. An MRI can sometimes shed a bit of light but they too can be inconclusive. Diagnosis is primarily based off the patient’s description of their pain, pain location and what movements aggravate it. 

Posterior Shoulder internal impingement responds well to physiotherapy and targeted exercises. If the patient has been performing a lot of exercises turning their arm out which is also painful, it can take several weeks for the pinching irritation to settle down. This can be incredibly frustrating for patients who have diligently followed all exercise advice only to find out it could have been aggravating their problem.

If you have any further questions or think you may have posterior shoulder internal impingement, then call us today on 49 999 773 so we can help you out.

 

Heel pain... Plantar fascitis... Heel spurs...

 

Heel pain is a really common complaint. Some research suggests that 42% of those older than 65 have foot pain. Plantar fascists commonly makes it really painful to take those first few steps in the morning and to walk after any period of rest. A Google search will tell you to massage the arch of your foot with a golf ball or frozen water bottle, wear supportive shoes and maybe even take a trip to a podiatrist to get a pair of orthotics. These are great strategies and they can help some people. However, my experience is that for every person who gets a good effect from orthotics there is someone who doesn't. And then those who do really well with orthotics usually don't like the fact that wearing their orthotics means not being able to wear "pretty shoes".

Research shows that heel pain is more common in those who are obese, work on their feet all day long and are relatively inactive. Usually the pain starts after the person increases their activity level such as working longer hours or starts exercising to lose weight. Now if you are trying to lose weight that is great and we don't want anything to get in the way. Physiotherapy can help by assessing your whole body to make sure there are no weak links putting more stress on your feet. Common examples are improving your strength around your hips so you can slow your foot down more before impact and keep you better balanced over leg. We can also help locally with taping up your foot, massage and shoe advice to manage the pain in the short term. 

If you have heel pain - especially if it's a tricky one - we'd love to see it. Just give us a call and we'll help you get back on your pain free feet. 

Osteoporosis – is it a big deal or just part of aging?

Our bones are in a constant state of reabsorption and remodelling. This means that we naturally break down our bones a bit and put down new fresh bone cells. This helps to keep our bones healthy. As we age the ratio of break down to new bone starts to change with less new bone being formed. This is quite popularly linked to women who have been through menopause (either naturally or induced from hysterectomy surgery), those who have a long history of steroid based medication, recipient’s of organ transfers and deficiencies in calcium and vitamin D.  

Current medicine views osteoporosis as a disease rather than a side effect of aging. Unfortunately there are a few studies out there that show that the opinions of GP’s and patients is that osteoporosis isn’t a big deal and many don’t worry about it until they start to get fractures due to their bones being so brittle. There is good research out there that the combination of osteoporosis medication and active weight bearing exercise is the best at improving bone strength when compared to medication alone or no intervention.  

The hard thing is that what exercises, how hard and how much is often not done right. You need to be doing fairly intense exercise. In the elderly community the most appropriate form of exercise is usually at the gym using weights. The program should be hard enough that you are quite fatigued at the end and couldn’t lift another weight. As much as it is nice to talk and laugh with exercise you should be working hard enough that talking and laughing are out of your mind. The beauty of this type of exercise is that it helps with other issues such as weakening muscles, heart health, diabetes, weight loss, etc.  

If you have any concerns about your bone health come in and have a chat with one of our physios. If you already go to the gym bring in your program to your consultation and we can look at ways of improving. Prevention is much better than waiting for the fracture that will then affect your quality of life. Call 49 999 773. 

OUCH!!! I’ve pulled a hammy

Hamstring strains and tears are among some of the most common non-contact muscle injuries for many sports. They tend to occur the most just before the end of the swinging phase of the leg during running. This is when your hamstring is in a lengthened position as well as contracting to slow the leg down. Hamstring strains happen most commonly in the lower portion of the thigh near the knee however they can happen up high near your bottom too. The higher the strain is tends to mean the longer the recovery time.

There have been lots of theories as to the best way to rehabilitate hamstring tears especially since relapses are so common. To date the best program seems to be based on a progressive agility and trunk stability exercise program. This includes a combination of hamstring lengthening, trunk stabilising and balance exercises. Examples of these are side planks, windmills and foot catching exercises. If you have questions about your hamstrings please call us today on 49 999 773 so we can get it fixed and stop it from coming back.

 

 

 

Rectus Diastasis – Splitting of the tummy muscles

Rectus diastasis is a condition we most commonly see in women after they have had a baby. It is the lengthening on the linea alba which is a line of connective tissue that sits between the 2 rectus abdominus / 6 pack muscles. Your linea alba is actually a combination of connective tissue from several tummy muscles including your external and internal obliques as well as your transversus abdominus (more commonly know as your core tummy muscle). So despite the scary description, it is not that your muscles have actually torn apart but more that everything has stretched out due to your growing uterus and baby.

Most separations resolve themselves within 4-6 weeks. Women that have had multiple pregnancies and/or large babies tend to be most at risk of developing a large separation. Persisting separations can lead to back and pelvic pain as well as issues with incontinence. Some women try to do sit-ups not long after giving birth however this exacerbates the issue as it doesn’t address all your abdominal muscles.

The great thing is that with some specific exercises you can improve the fascia and strengthen the surrounding muscles. If you have had a baby and have any concerns it is best if you come in for an assessment by a physiotherapist. Assessment at Elite Physiotherapy Mackay includes a combination of measuring any gap with a small sit-up as well as assessing your transversus abdominus and pelvic floor function using a real time ultrasound machine (just like the one they used to look at your baby in your belly). A six weeks Pilates course is then a great way to get those other tummy muscles firing as well as get your whole body fit for caring for your new bub. Call us today.

 



Ribs… who would have thought they could cause so many problems

Your rib cage makes up a large part of your body. It has a role in breathing, protecting vital organs like your heart, twisting your back plus an attachment spot for a lot of muscles that also connect to your neck, upper and lower back, shoulder blades and pelvis.

In the past as a physio we have tended to focus more on all these other areas and probably only pushed on ribs if someone had sharp catching pain with breathing. However we now know that rib’s can do more than just pain with breathing. In fact they restrict your upper back movement more than your upper back joints do. We have had some amazing results with treating ribs on patient’s with long term shoulder/arm pain, chronic neck pain and headaches and even stubborn low back pain. So if you have an ache that just won’t go away, or have had a couple of big knocks to your chest in tackles, then a few quick pushes on the right rib might be the answer to your problems. Call today on 49 999 773.

 

DO YOUR RUN LIKE AN ELEPHANT?

When we do running assessments in the clinic our ears tend to tell us something is wrong before our eyes do. We listen to how you come back onto the ground. Some people land heavy on one side. Some people land heavy on both sides. If I hear someone running really heavy (even if I’m not treating them) my initial thought for injures are knee pain, heel pain, shin splints and ankle pain. Occasionally we also see people (usually over 30 years old) who get neck pain from their heavy running. The hard thing is to figure out why they are running like an elephant. It could be due to things in their legs – stiff hips, poor hip muscle strength, not enough knee bend with running. Or it could be due to poor control of their torso or even that the swinging of their arms knock them off balance.  

Like most things it is usually a combination of the above. The good thing is when heavy hitting runners come in with niggles not major pains we can usually do a few modifications, keep them running, stop the niggles and usually improve their speed and endurance. If this sounds like you or you are sick of hearing your running buddy pounding the pavement then call up today on 49 999 773. 

 

 

 


Do you really know what a great functioning body feels like?

It’s amazing when your whole body is functioning properly. The funny thing is that most people don’t actually know what it feels like. My lovely receptionist has been doing our BOUNCE back program for the last 5 weeks to give her a better insight into the services we offer. She has been a diligent gym goer and exerciser for years and with no major complaints of pain. On our last BOUNCE back session we ran through the correct way to squat (which is a necessary action for us all to get on/off chairs/toilets/etc). A couple of days later my receptionist turned up for work super excited saying that she had done a big leg session at the gym and for the first time ever didn’t have any post exercise soreness in her hamstrings, calves and back muscles. She had even been able to do more than she could normally do and felt she could have done a heavier weight too.

This is the terrible fact is that so many of us put up with tightness, stiffness, cramping and so on when just a simple alteration or change can make a huge difference. The main culprits we find are hamstrings, calves and your upper traps around your neck. So if you think you are suffering unnecessarily or unaware, call us on 49 999 773 for an appointment today.

 

 

Whoa dude, I’m spinning out…

Dizziness is a tough thing to figure out as a patient. One thing that might make you dizzy is your blood pressure – when you stand up after lying down you get a bit giddy. Another might be a side effect of medication. Both of these types of dizziness are best managed by your GP.

However as physiotherapists we too deal with some dizzy patients. Less common are those suffering with BPPV (benign paroxysmal positional vertigo). This is a problem in your inner ear where the sensory fibers are touched in an irregular way. This is a very specific dizziness for certain directions and movements and has an acute onset that is quite severe.  Treatment is quite simple and gives instant relief for most people in one session.

The other more common type of dizziness we deal with is that from your neck. There are a few technical tests we do to try and differentiate between your neck, inner ear, blood pressure, medication, etc. How your neck can make you feel dizzy can be quite confusing and is quite different between people. It can be due to your neck being quite stiff and the joints not being able to send messages to your brain about movement so that your brain can match it with the information from your eyes and inner ear. It might also be because the coordination between your neck and eye muscles isn’t very good.

The scary thing is this is quite common and most people just put up with it. So if you get dizzy make sure you let your physio know so they can figure out whether or not they can help you.

 

R U OK? 

Thursday 12th September is R U OK? Day. This is a day to help encourage interaction between people, providing a support network and helping others seek help. Mackay is a town that is prone mental health issues – shift work and working away from home effects family life, mining down turns and financial burdens, injuries and the stress of not being able to work due to these and many more. As physiotherapist we are by no means psychologists however we see with nearly every patients the effect of their mental health on their recovery. Heaps of research has been done which shows those with a good support network cope better with any health issue whether it be pain, heart disease, diabetes, cancer and so on. So reach out to someone this week or if you are suffering yourself either have a chat with your GP or directly go and seek a psychologist to help you.

 http://www.youtube.com/watch?v=nxvDMlvqJ1w

Are your injuries looking forward to life after the grand final?


With grand final day quickly approaching some of your bodies must be sighing relief is in sight. Many of us struggle along with our injuries during the season that sometimes leaves you limping across the finish line. Funnily enough most of us seem to do this every year with almost the same injury. Then because you stop stressing that poor hamstring or knee or shoulder out it starts to feel better. That is until the next season where you have to nurse it all over again.

The best time to get your problem sorted is when your training load is less and when you have no pain. If your physio doesn’t have to treat the inflamed and sore bit they can just look at the bigger picture of why it is happening. Also if your training load is less you are less likely to be aggravating it again and again plus you have more time for physio and rehab exercises. A good physio is one that can see the fault even if you aren’t grimacing with pain. So after your grand final game be sure to give us a call on 49 999 773 to make sure that you will be playing at your best next year (and feeling good in the meantime).

 

Why does my knee feel really sore but the x-ray says everything ok?

 

If you are around 50 and getting knee pain your doctor will most likely send you for an x-ray. More often than not through natural aging processes there are some osteoarthritic changes in knees that old. So most people get thrown into the osteoarthritis heap and usually told either by their GP or orthopaedic surgeon to put up with it until they can’t move. However as physios we have seen heaps of knees and heaps of x-rays and rarely does the severity of pain match the severity of osteoarthritis. Sometimes we can even see x-rays showing severe arthritis and the person has no knee pain. In a study of 5000 participants they found that 25% of those with knee severe osteoarthritis had no knee pain.

A recent study has shown that these findings in the clinic are a worldwide trend. They found that certain factors were likely to have knee pain regardless of arthritic state. These factors were:

  • being female
  • widespread pain
  • general health complaints
  • parents or siblings with osteoarthritis
  • morning stiffness

So now if you are female you might feel a bit depressed about your knees. However since pain is an output from your brain there are lots of things you can change. By having a specific exercise program to change your muscle recruitment is a great first step. But you must think of your body as a whole – uncontrolled blood pressure issues will effect oxygenation and healing in the area, poor diet will not provide the right energy for muscles to work and recover, sedentary lifestyle encourages postural, insulin, cardiovascular, etc issues. But don’t feel overburdened by your knees. Come in and have a chat with one of our physios about YOUR knee and start the ball rolling with expert advice.

 




It’s Tradies
National Health Month!!!

It is a fact of life that we all have to work to make money. But what happens when you get injured and can’t work anymore. Tradies are a group of people who can sustain quite serious injuries however they are more likely to ignore it and just soldier on. 10 tradies are injured badly per week that results in 3650 tradies every year on workers compensation. But these are only the tradies that report injuries or the ones that injure themselves at work. A lot of our actions at work have effects on our bodies that can hurt us even when we aren’t away from the workplace. This includes poor flexibility, poor postural strength, poor stress management and poor diet which effect the health of all parts of our body.

If you are one of these tradies soldiering on with aches and pains, call up Elite Physiotherapy Mackay today on 49 999 773 to get assessed by a physio. Sometimes the solution is simpler than you think and the earlier we can start attacking a problem the better your recovery.

 

Recovery and Rehab...

 

How many times can you recall hearing of someone who returned from injury too soon, just to aggravate the same issue again? It is a difficult thing to determine when a player is ready to return to full training and games. There are numerous factors at play: tissue healing, fear or apprehension and physical preparation (are just some that come to mind).

Medical knowledge can quite accurately determine tissue healing – so most tissues return to full structural stability between 6-12 weeks – so why can it be so easy to aggravate again? This is where the integrity other structures can come into play. While allowing for the initial injury to heal has power or strength been lost due to inactivity? Most often YES, as rest is required to allow appropriate healing.

So recovery from injury can leave us more susceptible to further injury – if we do nothing about it. So what to do?? The answer is rehabilitation – get the whole system operating as it was pre-injury. Physiotherapists can guide you through the rehabilitation process by varying exercises in terms of speed, range of motion and complexity. The rehabilitation process can begin while tissue healing is occurring, to have you back on the field early and fully confident that you are ready for the return. 

Damn that knee pain!!!

Knees are a funny joint – not very pretty and have a bony cap out the front.  However there is a lot going on in there.  It’s not just bone to bone – there is cartilage, ligaments, muscles, the joint capsule and connective tissue all around – so many potential areas for concern.

To make things more challenging we can’t just look at the local structures, as the knee is middle of the lower limb chain and is influenced biomechanically from the hip and foot (not forgetting the rest of the trunk that also loads from above).

Quite often we see clients who come in with knee pain that is due to excessive stresses being placed on the knee.  Braces and strapping can be a useful option in the short-term to de-load the stressed structure, but long-term the best results are achieved by addressing the biomechanical issues and looking beyond the knee.  Our bodies are quite amazing and adaptable and learn to cheat quite quickly – but if taught a more ideal way to move through exercise (plus repetition – so practice at home) we can learn to move well again.

If you have knee pain that is not improving it might pay to get a thorough assessment completed by one of the physios at Elite Physiotherapy Mackay.

 

April 2013 - What is bursitis?

Bursitis is a fairly common diagnosis that gets thrown around there. People receive all kinds of treatments for it - physio, cortisone injections, orthotics, etc. But you also hear of it never really going away. Or cortisones wearing off. The other major question is "what is bursitis".

Bursas are fluid filled sacks all around our body to provide cushioning. Sometimes these bursas can become inflamed. Any "itis" means something is inflamed so in the case of BURSITIS it means an inflamed bursa.

But why do they get inflamed in the first place? And if it is just inflammation why isn't it cured with an anti-inflammatory. The best way I can explain this is imagine when you walk that you slam your right heel really hard into the ground every step. Eventually you will get sore under your heal with some inflammation and maybe even some bruising. If I gave you a cortisone injection into your heel (which is a really strong anti-inflammatory) we would expect the inflammation to go away. But if you stand up and start slamming your heal into the ground again the swelling will come back. This is where physio looks at why the problem is there in the first place. We do this by getting a detailed history as well as looking at your whole body and how you move. Even if you've just had an injection and are pain free this is the best time to see why it happened in the first place and stop it from happening again.

If this sounds like something relevant to you or a friend please give us a call on 49 999 773.

March 2013 - You can run but can you run well?

Running - the most natural thing out there or is it. We develop the ability to run as a kid but we don't all seem to run the same. If you go down to the football field and watch the little kids running around you'll have all kinds of runs. The penguin where you don't move your arms and keep them by your side. The egg beater where you flick your legs out to the side. Or there is just everything going everywhere.

Eventually we refine our running style but if it is really the most natural thing ever why do we get so many injuries. Shoes often get the blame however the prevalence of running injuries has actually increased since the invention of sports shoes. Females are also likely to have a running injury every 12 months.

The truth is that alot of the time how we refine our run isn't all that great. We are spending more time sitting, inventions such as ipads and laptops tend to mean we have worse posture when sitting, in Mackay you are more likely to drive everywhere rather than walk due to the heat or rain. All these things contribute to poor muscle recruitment, stiffer joints, poorer balance, etc.

The good news - running styles are usually quite easy to change. All we need to do is figure out which part of your body needs to be corrected to have the best effect on your whole run. More often than not this is actually changing the way you use your arms. But give us a call  on 49 999 773 and we'll video you and figure out what your correction is.

February 2013 - Are scans really helpful??

 

Every now and then clients ask us if physiotherapists can refer for scans such as x-rays, ultrasounds and MRIs.  The short answer is yes we can – but is it really necessary??

 

As physiotherapists we are concerned with the big picture, not just the area of pain.  How did the injury occur?  How do the joints and muscles around the area of pain move and function?  Could it be pain referred from another region?  There are many factors that influence the decision to refer for a scan.  Can we gather enough information from our examination of you to diagnose a likely cause?  In almost all cases the answer is yes!

We need to understand the purpose of a scan and what the different scans are good for.  For example – X-rays look at bone, so are useful after trauma such as a fall, but gradual onset pain is less likely to be caused by a boney issue.  Yes there can be spurs and signs of arthritis, but just because it is there does not mean it is the source of your pain, those changes develop over months and years, and are unlikely to have suddenly changed in the last week to start giving you pain.

We also need to remember that scans take a snapshot of that moment in time.  Our bodies are great at repair and adaptation – this is what they are designed to do.  A disc bulge shown on an MRI can reduce in size overtime, just because it is there does not mean it has to cause pain.  Most scans require the client to remain still, so if your pain occurs on movement how sure can you be that the structure identified on the scan is responsible for the pain on movement?  I’m sure most people can think of someone they have come across that has had treatment (such as an injection) on a structure identified on a scan, but did not get any relief.

Think of a muscle strain – this can be picked up in a physical examination and also using ultrasound.  Does knowing the size of area affected change how the injury is managed, or influence healing time?  In most cases no – an experienced clinician can give you a close estimate from the physical findings and are able to treat it appropriately or refer on in extreme cases.

So are scans really necessary?  Are we just looking for a quick fix and a structure to blame rather than addressing some of the other factors that can be influencing the pain?  As clinicians we should only be referring for scans where it is indicated from the history, rather than when we get frustrated that the road to recovery is taking a while and looking for something else to blame.

 

January 2013 - Pilates

pilates - Elite Physiotherapy Mackay

 

Many people have heard of Pilates, but there is plenty of confusion as to what Pilates is.  It does not help that there are a variety of styles out there!!  Simply put Pilates is a form of exercise, which usually involves moving one part of the body, while stabilising through another.  The benefits of Pilates can be a very long list but most commonly people associate Pilates with increased flexibility and improved stability.

The style of Pilates we have embraced at Elite Physiotherapy Mackay is Clinical Pilates.  This form of Pilates is based on the idea that everyone has a movement preference and by being properly assessed and matched with your movement preference greater outcomes can be achieved.  This can be why if you have tried Pilates in the past you may not have seen the results you were expecting – no two bodies are the same and the same exercises are not appropriate for everyone.

When correctly matched, the right Pilates exercises will assist to decrease pain, increase movement and improve function – usually with immediate results.  With continued practice these results can be maintained.

Come see the difference a Clinical Pilates program can make to the way you move and feel!!