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  • Muscle Stretching

    Muscle Stretching

    The Benefits of Stretching We keep telling you to stretch before and after exercise, until you’re probably sick of hearing about it. But why? Well, there are a whole host of benefits to stretching, and they’re not just limited to exercise. Here are seven reasons to make sure that proper stretching is a regular part of your routine. 1) Reduced risk of injuryStretching warms up your muscles, increasing the range of motion, so they are less likely to be torn or strained during exercise. You are also less likely to experience pain or discomfort after exercise with a thorough warm up and cool down. 2) Increased flexibilityFlexibility not only improves your performance but is good for your overall health. Increasing your flexibility will also help to delay decreased mobility as you age. 3) Improved postureTight muscles, especially in the chest, back and hips, can cause poor posture, which can lead to pain or injury. Stretching keeps your body in better alignment and improves your posture. 4) Reduced stressYour muscles tighten in response to physical and emotional stress, and many of us hold tension in our necks, shoulders and upper backs. Stretching these muscles helps to release the tension and helps you to relax. Stretching also provides an opportunity for a moment of mindfulness to calm your mind. 5) Increased circulationStretching improves blood flow to your muscles and joints, which enables them to get more oxygen and nutrients. 6) Enhanced performanceA flexible joint can move through a wider range of motion with less energy, so stretching makes your body more energy efficient. By preparing your muscles for exercise through stretches, you are improving your performance. 7) Fewer headachesAs a great many headaches are caused by tension, releasing that tension through stretching can reduce the number of headaches you experience. If you’re interested in which stretches will suit you and want help putting a program together to compliment your activity habits, give us a call on 02 9922 6806. We’d offer to do the warm up on your behalf, but that’d be a stretch! See what we did there? Uploaded : 23 JUly 2021 Read More
  • Frozen Shoulder

    Frozen Shoulder

    What to do about a frozen shoulder Adhesive capsulitis, more commonly known as a ‘frozen shoulder’, is a painful condition that is characterised by stiffness and a loss of motion in the shoulder. What causes frozen shoulder, what can you do about it and how can you stop it from happening in the first place? Let’s take a look!  What is a frozen shoulder? The tissue that surrounds the shoulder joint and holds it together is called the capsule - when this becomes inflamed, this band of tissue becomes stiff, which restricts the movement of the shoulder. There is no clear cause of frozen shoulder, however hormonal imbalances, diabetes or a weakened immune system can make you more susceptible to joint inflammation. Long periods of inactivity following injury, illness or surgery also increase the chance of a stiff shoulder joint. What are the symptoms of a frozen shoulder? If you develop adhesive capsulitis, you are likely to experience symptoms in three stages across a period of approximately 1-3 years. Initially, the shoulder will be intensely painful, and any movement will cause pain. At this stage, movement begins to become limited. The discomfort often leads to avoiding moving the shoulder, which further increases the stiffness. When the shoulder is at its most stiff, pain may reduce somewhat, but movement becomes more difficult. Once the shoulder begins to “thaw”, the range of motion then improves. Many people say that the pain is worse at night and can keep them awake. How do you treat a frozen shoulder? Physiotherapy is the most common treatment for a frozen shoulder. A physio will help you to stretch your shoulder joint to recover the range of motion and will teach you a program of gentle exercises to do at home. While you’re waiting for your physio appointment, putting an ice pack on the shoulder for 15 minutes, several times a day, can help to reduce the pain. Another method, is to place a hot pack in your arm pit. This allows the heat to concentrate deep inside the shoulder joint, acting directly on the rotator cuff muscles. Both heat and cold stimulate heat shock proteins (HSP) which are the basic building blocks of life and the immune system. Hence, important in soft tissue repair as well as the modulation of the immune response. Taking a high concentration of EPA/DHA fish oil can reduce some of the inflammation and improve blood flow. Importantly, it's the 2000mg of the EPA/DHA which is the active ingredient of fish oil. Check the label of your fish oil for this concentration. Additionally, make sure their are low levels of mercury and other potentially toxic ingredients in your fish oil. Other anti-oxidant anti-inflammatories include tumeric, forest berries, etc. If you opt for an invasive procedure such as an injection then this must be done with imaging and go into the joint capsule. Sometimes, a severe subacromial bursitis can mimic a 'frozen shoulder' where an injection could be made there instead. Further differential diagnosis with a nerve condition from the cervical spine should also be undertaken, where a diagnosis of 'frozen shoulder' isn't clear. Normally, the history of gradually worsening, night pain and loss of range of movement with flexion at 60 degrees, abduction at 30-45 degrees, 1/4 external rotation and almost no internal rotation (hand behind back) is usually indicative of a 'frozen shoulder. Testing those movements with the head and neck in lateral flexion (side bending) could help to differentiate a neck pathology contributing to the clinical presentation. Frequently, their a familial (genetic) tendency to 'frozen shoulder'. Whilst teaching in Japan, I saw a lot of 'frozen shoulders' whereas during the 10 years in Switzerland I saw almost none.   Who is at increased risk of a frozen shoulder? The following people are at greater risk of developing adhesive capsulitis: Those over the age of 50  Women People with diabetes People with thyroid conditions People with cardiovascular disease Previous shoulder injury Anyone who has to remain still for long periods of time due to illness or surgery Anyone who needs to wear a shoulder sling for a long period of time following an injury  What can you do to prevent a frozen shoulder? As immobility is a major cause of a frozen shoulder, if you suffer an injury or illness that will keep you out of action for a while, speak to a physiotherapist about exercises that you can do safely to keep your shoulder moving. If you’re experiencing pain or loss of motion in your shoulder, give us a call on 02 9922 6806 or email us and we’ll talk to you about how we can help. Further reading on shoulder pathology : https://www.back-in-business-physiotherapy.com/we-treat/shoulder-problems.html   References 1. Mayo Clinic. 2020. Frozen shoulder [Onlinehttps://www.mayoclinic.org/diseases-conditions/frozen-shoulder/symptoms-causes/syc-203726842. Healthline. 2016. Frozen Shoulder [Onlinehttps://www.healthline.com/health/frozen-shoulder Uploaded : 23/07/2021 Read More
  • Foods for muscle recovery

    Foods for muscle recovery

    Foods for muscle recovery Do you workout a lot and are looking to maximise the effects of your exercise regime by eating the best food afterwards? If you look this up online, you’ll be hit with a million and one pages to read through, with many of them saying different things. It’s a bit of a minefield and can be con-fusing to the average Joe. Fear not, because here at Back in Business Physiotherapy we have great information at our fingertips and want to share it with you. We’ll keep this simple… No fancy scientific words here to confuse the brain. There are a few foodstuffs that are particular-ly important when it comes to improving your muscle recovery following a workout. The key play-ers here are protein, carbohydrates and water. Protein Protein is the building block of every cell in our body (it’s pretty important!). During a workout, the proteins that make up muscle cells break down. After theyhave broken down, the body goes through a recovery process whereby these muscle proteins are repaired, and some new cells are built. This is how our muscles get bigger. Eating a healthy source of protein after a workout can give the muscles the building blocks they need to recover and get stronger. Good sources of protein include eggs, chicken, fish, Greek or other high-protein yoghurts, and cottage cheese. Some people also opt for protein powders and bars to help them reach their pro-tein requirements. Carbohydrates Carbohydrates (aka ‘carbs’) are the body’s main energy source. The movement we do during a workout uses energy. Our muscles store energy so that when we need it to smash out a solid weights session (or any exercise of your choice), we have it there ready to go. After a workout the stores of energy are depleted, and we need to replenish them to ensure we have more in the bank for the next thing we want to do. Good sources of carbohydrate include dark green leafy vegetables (such as kale and spinach), sweet potatoes, fruit, rice, quinoa, and pasta. Water Our bodies are made up of approximately 70% water. It is literally everywhere in the body. For all the crazy chemical process that occur in the body every second, we need water to allow it to happen. During and after exercise, the body loses water through sweating. It is vital to drink plen-ty of water after exercising (as well as before and during… Just drink it all the time, pretty please) to make sure we stay hydrated and to maximise the recovery process. Better still, good sources of water are easy to find! We recommend starting with the tap in your kitchen! 😜 A helpful tip Evidence suggests that eating a post-workout meal combining a 3:1 ratio of carbs to protein will maximise your recovery. Try brown rice with grilled salmon and kale for a powerful, nutritious meal. And drink water before, during and after exercise. We also think you should give us a call to book an appointment, so we can have a more detailed chin-wag about this if you so desire. Call us on 02 9922 6806 today! Link to in-depth analysis on Sports Nutrition - https://www.back-in-business-physiotherapy.com/we-do/nutritional-supplementation.html References 1. Healthline. 2016. Post-workout nutrition: What to eat after a workout. [Onlinehttps://www.healthline.com/nutrition/eat-after-workout. [Accessed 04 June 2020]2. Webster-Gandy, J. et al. 2012. Oxford Handbook of Nutrition and Dietetics. 2nd ed. Oxford: Oxford University Press Uploaded : 29 June 2021   Read More
  • Shoulder Impingement

    Shoulder Impingement

    Injury blog: Shoulder impingement Do you have shoulder pain? Are you an office worker, professional athlete, hairdresser or full-time parent? These are just some of the types of people we see in the clinic who need help with shoulder pain. One of the most common complaints we treat here, at Back in Business Physio-therapy, is shoulder ‘impingement’ (aka subacromial impingement). “What is impingement?” we hear you ask. Read on to find out. Anatomy overview The shoulder is a pretty complex region of the body when it comes to anatomy and how it all works together to allow us to move. The connections between the arm bone ( humerus), collar bone ( clavicl’), shoulder blade ( scapula) and the rib cage, provide us with the perfect base for a limb that is able to move through an extremely wide range of motion… The most movement out of any other joint in the body. Having lots of movement is great because it means we can do lots of wonderful things like reach the back of our head to wash our hair and reach our backs too (like when tying an apron). In order to achieve this level of movement the shoulder has to be less sta-ble, and this leaves it prone to injury. The arm bone and shoulder blade form the ‘ball and socket’ part of the shoulder, where a large amount of the movement takes place. The ligaments between these bones are quite loose and a group of muscles, known as the ‘rotator cuff’ muscles, help to keep the ‘ball’ of the arm bone posi-tioned correctly over the ‘socket’ of the shoulder blade, as well as aid with certain movements, including rotation or turning of the arm. Small spaces… Over the top of the ball and socket joint sits the ‘acromion’, which is a bony prominence of the shoulder blade which creates a roof over the joint. Between the top of the ball and the bottom of the acromion is a small space known as the ‘subacromial space’. Some tendons of the arm mus-cles that create movement of the shoulder pass through this space on their way to their attach-ment site on the bones. There is also a ‘bursa’, which is a small sac of fluid which helps to keep movements around joints smooth and frictionless. There is quite a lot of tissue all crammed into one small space, and this is an important factor in the development of impingement.  Causes Common causes of shoulder impingement include:• Repetitive overarm throwing or other above-shoulder movements• Long-standing poor posture or poor movement patterns• De-conditioned or weak shoulder muscles from leading a sedentary lifestyle• Heavy lifting Anything that leads to the structures which pass through the subacromial space becoming irritat-ed and inflamed can cause impingement-related pain. Inflammation can lead to swelling of the tissues in the small space and when we move our arm up or out to the side, these tissues get pinched between the bones, and we feel pain. Any of the above-mentioned structures can be-come inflamed, but there is rarely just one tissue solely responsible. If the tendon of a rotator cuff muscle is inflamed, there is every chance the bursa will also be inflamed. Signs and symptoms Signs and symptoms of shoulder impingement include:• Pain with arm movements (particularly movement in front and out to the side of the body)• Pain with shoulder rotation• Pain that radiates down the outside of the upper arm• Reduced shoulder range of motion Treatment At the root of most cases of shoulder impingement is poor and inefficient shoulder movement. When you come to see us for treatment, we will look beyond the shoulder to other areas of the body, like the spine. The neck and mid-back areas of the spine are regularly restricted and need some help to move well again. Once the spine moves well, shoulder function improves too. The shoulder blade also needs to sit correctly over the rib cage in order for the ball and socket joint (and other joints) to work efficiently. Weakness of the muscles which stabilise the shoulder blade on the rib cage can lead to poor positioning of the blade during movement, so we will aim to improve this by giving you focused strengthening and stability exercises. A solid base = good, smooth movement. Through a combination of us using our hand techniques (like massage and joint mobilisation), progressive exercises and lifestyle changes, you can expect to see positive changes quite quick-ly. The end goal of ensuring your pain doesn’t return is always a lengthier process and requires dedication from yourself (and us) to make sure the changes we make early on stay in place for time to come. We are here to help you every step of the way. Shoulder pain? Call us today on 02 9922 6806 References 1. Brukner, P. et al. 2017. Clinical Sports Medicine. 5th ed. Australia: McGraw Hill Education2. Gilroy, A. et al. 2012. Atlas of Anatomy. 2nd ed. Stuttgart: Thieme Links - Rock Climbing and Shoulder Mechanics : https://www.back-in-business-physiotherapy.com/latest-news/305-rock-climbing.html  - Shoulder Stabilioty : https://www.back-in-business-physiotherapy.com/joint-stability-sp-161372761.html - Shoulder Problems : https://www.back-in-business-physiotherapy.com/we-treat/shoulder-problems.html Uploaded : 29 June 2021 Read More
  • Shoulder Labral Tears

    Shoulder Labral Tears

    Shoulder injury blog: Labral tear The shoulder is one of the most complex joints in the body. It is made up of a total of four joints, numerous ligaments, joint capsules, muscles and other soft tissues. Movement at the shoulder is a complicated process and it relies on the controlled function of all the involved muscles and joints for that movement to be efficient and complete. Our shoulders are the most mobile joints in the body which is great for us because it means as humans we get to partake in fun activities like throwing sports, gymnastics and dancing, as well as movements we generally take for granted like being able to do up our bra’s behind our backs. This wide range of movement is only possible because the shoulder is less stable when compared to other joints in the body, leaving the shoulder prone to injury. This blog specifically focuses on an injury that relates closely to the ball and socket part of the shoulder joint. If you are into throwing sports, you may be familiar with it… It’s called the labral tear. A bit of anatomy…There are two main ball and socket joints in the body, found at the shoulder and the hip. Both work where a rounded ‘ball’ of one bone fits into a hollowed ‘socket’ of another. At the hip (the strongest joint in the body), the socket is very deep, and the ball part fits quite snuggly into it. This is a very stable joint. The socket in the shoulder is very shallow by comparison, and the ball part is still quite large. This is what gives the shoulder its lack of stability. Both the shoulder and the hip sockets are deepened and supported by the presence of a labrum — a rounded soft-type of cartilage. In the shoulder, the labrum completely surrounds the rim of the socket creating a ring. The very top part of this ring also acts as the attachment site for one of the tendons of the biceps muscle — a powerful mover of the shoulder and elbow joints. How does a labrum tear? The main ways labral tears occur are: • Repetitive movements such as overhead throwing• Carrying heavy objects• Dropping and catching heavy objects A tear can occur over time as the tissues degenerate over time and become weaker, or it might be from one single, forceful event. In most cases there is usually a combination of both degeneration and a large force which becomes the ‘straw that breaks the camel’s back type of scenario. As the biceps tendon attaches to the socket through the labrum, any large force that pulls on the biceps tendon (like suddenly catching a heavy object) can lead to the tearing of the labrum itself. The most common type of tear occurs across the top of the labrum from front to back, and these are known as SLAP (i.e. Superior Labrum Anterior Posterior) tears. Signs and symptoms If you have sustained an injury to the labrum in the shoulder, you may notice any or all of the following signs and symptoms: • Pain during shoulder movement (especially overhead and behind back movements)• Restricted shoulder movement• Popping, catching or grinding during shoulder movements• Tenderness at the front of the shoulder Depending on how you were injured, how severe your symptoms are, and your personal circumstances regarding work and home life, you may be sent for some imaging to confirm the tear. The tests we perform in clinic when we assess you do not always give us all the information we need to determine the best plan of action. A combination of clinical tests and imaging may give us a clearer picture of what’s going on. Can it be treated by a physio? Yes, but this completely depends on the severity of the injury and what your goals are. In most cases it is recommended that conservative therapy from a physiotherapist is tried first. Many athletes who have a labral tear can return to playing to some capacity with a non-surgical approach. The treatment aims to return the shoulder to full, pain-free range of motion through hands-on massage, mobilisation and rehab exercises that focus on range, control and strength of the shoulder girdle. For severe tears, you may require the opinion of a shoulder specialist. A labrum is not great at healing itself and sometimes needs help from a surgeon to return to normal. A professional athlete wanting to return to sport may choose this pathway, but a non-athlete who has no desire to throw a ball seriously again may be able to avoid surgery altogether. If you have a diagnosed labral tear, or have recently injured your shoulder and need help, we recommend coming to us at Back in Business Physiotherapy where we can discuss the best course of action for you and your circumstances. References: 1. Brukner, P. et al. 2017. Clinical Sports Medicine. 5th ed. Australia: McGraw Hill Education2. Ireland, M. and Hatzenbuehler, J. 2018. Superior labrum anterior posterior (SLAP) tears. [Onlinehttps://www.uptodate.com/contents/superior-labrum-anterior-posterior-slap-tears. [Accessed 09 May 2020]. Uploaded : 24 May 2021 Read More
  • Mental Health

    Mental Health

    COVID mental health check-in With the coronavirus outbreak still affecting millions around the world, we thought it would be a good time to check-in and see how you are all going. The news is pretty grim at the moment and you may be finding yourself asking the question, “When will there be any good news?!” This day-to-day bombardment of the effect of the virus across the world is enough to get the happiest of people down. We’re here to make sure you are keeping your mental health in check. We ask you the question… What are you doing to look after your mental health? These have been difficult and stressful times for many of us. Some of us are starting to come out of strict lockdown restrictions, some of us are still feeling the effects, and many of us will feel these effects for some time to come. It’s good to talk If you are struggling on a daily basis and this pandemic has had a real effect on your mental health, you are not alone and help is out there. Being made to stay away from family members and friends is tough and some people, especially the elderly, will have found this extremely difficult at times. Please talk. A phone call or face-to-face video call (technology is great these days!) is a simple way to stay in touch with loved ones. Speak to someone close to you if you are struggling with personal circumstances. Getting a load off your chest is sometimes enough to make you feel relief, even if it doesn’t solve the root cause of the problem. We understand that your problems may run deeper than this and talking to a loved one is simply not enough. The good news is there are lots of great people out there who are trained to work through such things with people. And even if you cannot get a one-to-one session in person where you live, many mental health professionals including life coaches, counsellors and psychologists are running phone or video sessions with their clients. Enter ‘Telehealth’. . Alternatively, chat to your GP or give Beyond Blue a call on 1300 22 4636. Please do not suffer in silence. Simple tips for keeping your mental health in check Want some other ideas to help keep your mental health in check? Check out our list below for some go to’s: • Exercise: It’s simple and well researched. Exercise helps to maintain good mental health. Even in lockdown, find a space in the house or outside in the garden and just move. Squat, lunge, hop, skip, jump, dance… We don’t care what it is, just move regularly (and safely please!).• Eat well: Keep your diet clean and hydrate every day and you’ll be doing your bit to keep the body and mind functioning well. Vegetables and fruit of the green leafy and berry varieties are packed with nutrients that can help keep the brain healthy.• Go to time-out: No, we don’t mean the naughty step, more so a quiet place where you can be with your own thoughts without the distraction of TV, tablets and other types of media. Read a book, take a bath, give the eyes and ears a rest from it all. It may be hard to break your screen habit, but trust us... It’s refreshing!• Get out the colouring pencils: Yes adults, we are talking to you. Colouring is becoming a very popular ‘escape’ for millions of adults around the world. It has been shown to help reduce the effects of anxiety and stress. Get to your local book store or newsagent today, support local shops, and start getting creative (or if you’re unable to do so safely, order online). Our message today is simple. Life is sometimes hard, but there is always action you can take to reduce the impact this has on your mental health. Talk. Move. Relax Uploaded : 24 May 2021 Read More
  • Metatarsal Stress Fracture

    Metatarsal Stress Fracture

    Who is at risk from a metatarsal stress fracture? Regular, repetitive motions in the foot are the most common causes of metatarsal stress fractures, making runners particularly susceptible. If you have recently taken up running or are trying to run too far too soon, you are at an even greater risk of developing a stress fracture. Other sports, such as basketball, tennis, gymnastics and dance, that put a great deal of repeated pressure on the foot are also common causes. Whatever sport you are taking part in, you should always ensure you have the correct footwear and that it fits properly – as poor footwear increases the chances you will over-stress your metatarsals. Stress fractures can also occur as a result of a different injury entirely! For example, if you sustain damage to an ankle, knee or hip and don’t seek treatment, you may end up overloading your foot on that side to compensate for the pain elsewhere. Osteoporosis, vitamin D deficiency and certain foot problems can also lead to metatarsal stress fractures. What are the symptoms of a metatarsal stress fracture? If you do develop a stress fracture in your metatarsal you will likely experience pain in your foot that will be worse during activity but will lessen when you rest. You might also notice swelling at the top of your foot, and it may be tender to touch. There could also be some bruising or redness around the area. Some people will have balance problems or an uneven gait. What are the treatment options? If left untreated, stress fractures can develop into a complete break or lead to chronic conditions. If you suspect you have a metatarsal stress fracture, you must rest your foot. You can apply ice to ease the pain and elevate your foot to reduce swelling. Avoid tight or heeled shoes. Then make an appointment with us here at Back in Business Physiotherapy We will look at any immediate interventions that will help the healing process, such as wearing a moon boot for a short period to de-load and allow the bone to repair itself. Then we might suggest footwear modifications or advise on your exercise routine changes to prevent the issue worsening or recurring. If the stress fracture was caused by a previous injury, this will need to be addressed as well. If you’re experiencing pain in your foot, or any unexplained pains following a change in your exercise routine, give us a call on 02 9922 6806 or email us so we can check out what’s going on. See link to a clinical example https://www.back-in-business-physiotherapy.com/latest-news/266-stress-fracture-in-an-adolescent-foot.html References 1. OrthoInfo (American Academy of Orthopaedic Surgeons). 2015. Stress Fractures of the Foot and Ankle. [Onlinehttps://orthoinfo.aaos.org/en/diseases--conditions/stress-fractures-of-the-foot-and-ankle/ 2. Physio.co.uk. 2021. Stress Fracture of the Metatarsal. [Onlinehttps://www.physio.co.uk/what-we-treat/musculoskeletal/conditions/foot/stress-fracture-of-the-metatarsal.php Uploaded : 23 April 2021 ; Updated : 29 June 2021 Read More
  • Vascular System

    Vascular System

    What is the vascular system? Your vascular system is made up of the heart and blood vessels, which send vital elements around the body whilst removing waste products. The vascular system consists of the following: ● Heart - pumps blood around the body● Arteries - carry oxygenated blood away from the heart● Veins - carry deoxygenated blood back to the heart● Capillaries - deliver oxygen and nutrients to the organs and tissues around the body, and pass waste back to the circulatory system Why is it important? Without the vital work of your vascular system, you couldn’t survive. Every tissue in your body needs the life-giving blood delivered by your vascular system to do its job - even nerves need a constant supply of blood to maintain function. So, if something goes wrong with your vascular system, things go wrong everywhere. The vascular system carries highly important immune substances such as platlets.  There are numerous conditions associated with vascular system dysfunction, including several heart conditions, high blood pressure, vasculitis, varicose veins, blood clots and stroke. How can I look after my vascular system? These are some of the best ways to keep your vascular system happy and healthy: ● Regular cardiovascular exercise helps to keep your heart strong and improve blood flow throughout the body.● A balanced diet that includes fresh fruit and vegetables, lean protein and whole grains, and limits saturated fats, added sugars and sodium will support the health of your heart.● Smoking increases your risk of cardiovascular disease, so quitting is highly advisable.● Managing stress, for example with meditation, breathing exercises or yoga, will reduce the impact on your heart.● Sitting still for long periods of time can restrict blood flow, so make sure you get up and move around at least once an hour. Eating a diet that is high in cholesterol or fatty foods and living a sedentary lifestyle can lead to a build-up of plaque inside the arteries, which reduces the amount of blood that can flow through them! This means that organs and tissues will not receive enough of the nutrients they need, so eating well and getting regular exercise is a must! References 1. Healthline. 2020. What Makes Up Your Circulatory System and How Does It Work? [Onlinehttps://www.healthline.com/health/circulatory-system 2. Health Encyclopedia. 2021. Overview of the Vascular System. [Onlinehttps://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=85&contentid=P08254 Posted : 23 April 2021 Read More
  • Physio at home

    Physio at home

    5 Physiotherapy Treatments You Can Do At Home Want to look after your body like a physio? Whether you’re currently having treatment and want to complement that work, or you just want to keep yourself in the best possible condition, here are five ways that you can proactively take care of yourself from the comfort of your own home. 1. Stretches Stretching a particular muscle or muscle group improves elasticity and allows you to use the muscle more effectively to build strength. Stretches are therefore very important for increasing your control, range of motion and flexibility. If you are exercising, make sure you stretch before and after to reduce your risk of injury and improve your recovery time. 2. Foam rollers If you’ve developed stiff or tight muscles from exercising, using a foam roller can reduce soreness, release tightness or tension and decrease your recovery time. They can also be used to increase your core stability. You will need to hold your body above the roller, then slowly lower the area you want to target onto the roller. You can then roll gently backwards and forwards. It should cause mild discomfort, but don’t push it so far that it causes real pain as this could lead to injury. 3. Hydration Water plays a pretty important role in your body, enabling you to regulate your body temperature, lubricating your joints, assisting your kidneys to remove toxins, and delivering nutrients to cells to give you energy. Drinking enough water is vital, especially before, during and after exercise. 4. Spikey massage balls These small spikey balls can help relieve trigger points, which are hyperirritable nodules (little knots) in muscles that can occur all over the body. They can be caused by injury, over-exercising, poor posture or joint problems. Pressing the ball into the area and making small movements with it helps to release the trigger point, and the spikes stimulate your circulation. Like foam rollers, it’s important not to push too hard on these areas, so take it easy and book an appointment with us if you suspect you need a helping (physio) hand! 5. Clean diet What you eat has a huge impact on the wellbeing and performance of your body. A clean diet, one that avoids processed foods or those high in sugars or additives, is great for taking care of your physical health. For example, proteins support the building of bone, muscle and connective tissue; vitamin-rich fruit and vegetables support cell function; and omega-3 fatty acids help take care of your joints. When was the last time you took a good look at your weekly food intake to ensure you’re giving yourself a balanced meal each day? (Maybe now is the perfect time!) Want a more personalised plan for your physical wellbeing? Give us a call or email us and let’s have a chat about approaches to support your particular needs. Uploaded : 23 March 2021 Read More
  • Scoliosis

    Scoliosis

    Scoliosis: what it is and how we treat it Have you ever been told that carrying a heavy backpack on one shoulder or sleeping on one side can warp your spine? This isn’t necessarily the case (although carrying heavy backpacks incorrectly, certainly doesn’t do your back any good). There is, however, a condition called ‘scoliosis’ that can lead to the spine becoming unnaturally curved. It is usually first identified in childhood or adolescence, but can affect people of any age. What is scoliosis? Scoliosis is a condition that causes the spine to curve sideways and to rotate. It can be caused by other conditions, such as cerebral palsy and muscular dystrophy, or by issues elsewhere in the body, but the cause of most cases of scoliosis is unknown. In fact, around 80% of cases have no identifiable cause. There are two main categories of scoliosis: Structural scoliosis is where there is a physical curve to the spine. Functional scoliosis is where the spine appears to be curved, but this is a result of an irregularity elsewhere in the body, such as different leg lengths. Structural scoliosis is permanent, although symptoms can be reduced. Functional scoliosis, on the other hand, can often be resolved. Most cases of scoliosis are mild, and it may take a while to notice it at all. However, the more severe the curve, the more of an impact it will have on your life. Some cases can continue to worsen over time. In severe instances, the amount of space within the chest can be reduced, affecting lung function and restricting the heart’s ability to pump effectively. The curve of the spine can also impact other areas of the body, causing pain or muscle spasms elsewhere. Scoliosis symptoms Mild cases of scoliosis cause little or no pain, but there are other signs that you can look out for. The most common symptoms of scoliosis are: ● Uneven shoulders● Uneven waist● One shoulder blade sticking out more than the other● One hip sitting higher than the other In more severe cases, you may experience: ● Trouble breathing● Back pain● Muscle spasms Cases of scoliosis are often first spotted when a friend or family member notices that the person’s clothes are hanging unevenly, or that their spine appears curved when they see them changing or in swimming clothes. Most scoliosis patients will be identified as children or teenagers - commonly during growth spurts around the time of puberty. However, some cases of scoliosis may go undiagnosed well into adulthood, and some adults will develop degenerative scoliosis as they age. The impact of scoliosis Around 90% of instances of scoliosis are considered mild, and these are often thought to not need treatment as they cause little or no pain. However, even mild curvature of the spine can lead to other issues, such as: ● Difficulty maintaining balance● Uneven gait when walking or running● Loss of alignment in the hips● Reduced range of motion due to lessened flexibility in the spine● Muscle aches or spasms● Loss of stability, increasing the risk of injury or damage to tissues● Low self-esteem if the curve is noticeable or clothes appear uneven Therefore, it’s always worth looking into what treatment options are available if and when scoliosis is first noticed. Treatment for scoliosis In some instances, particularly those of children, it may be necessary to wear a back brace to prevent the curvature from worsening. Physiotherapists will then focus on developing an exercise routine to strengthen your muscles, increase your mobility and develop core stabilisation. Massage and hydrotherapy can also help to reduce pain and discomfort. German physiotherapist, Rudolph Klapp, from 1905, developed a form of 4 point exercise called 'Klappisches Kriechen' , and were first demonstrated at the International Sport Student meeting around the 1936 Olympics. To this day, this form of therapy is still utilized in the German speaking world. Having learnt this technique in 1988-1990 in Switzerland, I devloped a profound appreciation of exercises on the hands and knees, including those found in Hatha Flow Yoga. Additional methods of treatment include  myofascial trains mechanical traction muscle energy techniques rock climbing and bouldering In severe cases, surgery may be required, but this is becoming much less common practice due to advances in early detection programs and bracing treatments. Surgery is always a last resort if all other forms of therapy have not proven effective. References 1. Healthline. 2021. Everything You Need To Know About Scoliosis. [Onlinehttps://www.healthline.com/health/scoliosis 2. Spine-Health. 2017. Scoliosis Treatment. [Onlinehttps://www.spine-health.com/conditions/scoliosis/scoliosis-treatment Uploaded : 23 March 2021 Read More
  • Overuse Injuries

    Overuse Injuries

    The most common overuse injuries Overuse injuries occur when a particular part of the body is subjected to repeated demand over a long period of time. Activity that involves using the same motions over and over - particularly if these are ramped up too quickly, performed for extended periods or made using an incorrect or unsafe technique - can cause tissue damage. Below are some of the most common overuse injuries in different types of body tissue. Stress fracture A stress fracture is a small crack in otherwise normal bone that occurs when the bone has been subject to repeated impact. Stress fractures are most common in weight-bearing bones, such as the shin or foot. Often seen in runners, stress fractures can be a result of a sudden change in physical activity or increasing training without enough rest or recovery time in between sessions. To avoid stress fractures, follow a sensible training program that increases your activity gradually and allows plenty of rest time (ask a physiotherapist for advice if you’re unsure). You can also look after the health of your bones by eating a diet high in calcium and Vitamin D. Tendonitis or Tendonosis Tendonitis is irritation or inflammation of a tendon, caused by repetitive actions in that area. Activities like gardening, painting, cleaning, throwing a ball and playing tennis can cause tendonitis. To reduce your risk of tendonitis, try to build up your activity levels gradually rather than doing too much too soon. Take regular breaks and limit the amount of force you use in your actions. Tendonosis is considered more like a degenerative condition. Occurring more commonly in middle age and especially in men, due to higher levels of testosterone, leading to to 'drier' collagen fibres. Rather than inflammation, the tendon may show signs of swelling and necrosis. Blisters Blisters form to protect the skin and can be caused by repeated friction from rubbing or pressure. If you have ever had a pair of shoes that didn’t fit well or were stiff in certain places, you might have experienced a friction blister where they rubbed your foot or ankle. To avoid blisters forming, protect your skin from friction where possible (for example, by wearing socks, or wearing gloves if you are using tools that rub your hands). If you do develop a blister, keep it clean and dry and try to leave it alone as much as possible. Resist the temptation to pop it. Strained muscle Overstretching or tearing a muscle, by overusing it or using poor technique, can result in pain, inflammation and limited movement. Any muscle can be strained in this way, but it is most common in the lower back, neck, shoulder and hamstring. To reduce your risk of straining a muscle, warm up and cool down properly before and after exercise and get professional advice to ensure you’re using the correct technique. Poor posture can also strain your muscles, so consider the way you are sitting and standing, especially for long periods of time. Physiotherapists don’t just help you recover from injury - we also try to prevent you getting them in the first place. If you think you might be at risk from overuse injuries, give us a call on 02 9922 6806.  and we’ll discuss whether there are steps you can take to protect your body.  Proactive care may seem unnecessary at times, but it is the most pain-free (and affordable) way to manage injuries before they make themselves apparent. References 1. Oxford University Hospitals. 2018. Bone Stress Injuries and Stress Fractures. [Onlinehttps://www.ouh.nhs.uk/patient-guide/leaflets/files/41517Pfractures.pdf 2. WebMD. 2018. Tendinitis. [Onlinehttps://www.webmd.com/fitness-exercise/arthritis-tendinitis 3. Healthline. 2018. Muscle Strains. [Onlinehttps://www.healthline.com/health/strains#_noHeaderPrefixedContent Uploaded : 22 February 2021 Read More
  • Carpal Tunnel Syndrome

    Carpal Tunnel Syndrome

    Relieving Carpal Tunnel Syndrome Pain Carpal tunnel syndrome is a common condition, usually caused by repetitive movements in the wrist. You may associate it most with office workers who do a lot of typing, but there are a number of jobs and activities that can make you more susceptible. So, what exactly is carpal tunnel syndrome, and what can you do about it? What is carpal tunnel syndrome? The carpal tunnel is a narrow passageway in the wrist that allows several tendons and the median nerve to join the palm. Repetitive wrist motions can cause the tendons to become inflamed, or swollen, which puts pressure on the median nerve. The result is pain in the wrist or hand, as well as tingling, burning, itching or numbness in the hand and fingers. If left untreated over time, the median nerve can become severely damaged, leading to lasting numbness or weakness, so if you experience any of these symptoms it’s important to get them checked out. Who is at risk of getting carpal tunnel syndrome? Office workers who are required to do a lot of typing, causing them to regularly flex, extend and rotate their wrists, are at greater risk of getting carpal tunnel syndrome. However, any job that involves repetitive movements of the wrist can cause the same issue to occur. If you use vibrating tools or work on an assembly line where you are repeating movements again and again, you could have an increased chance of getting carpal tunnel syndrome. Similarly, activities that involve any repetitive motions of the wrist, such as racket sports or even knitting, can cause this painful syndrome. The condition is more common in women, and most often occurs between the ages of 45 and 64, although it can strike at any time. Obesity, certain inflammatory conditions (such as rheumatoid arthritis) and fluid retention (common in pregnancy and menopause) also increase your chances. So what treatment options are available? Treatment options Medication may be prescribed by a doctor to reduce the inflammation, and ibuprofen may reduce pain in the short-term. In severe cases, surgery may be required. However, here at Back in Business Physiotherapy we will do whatever we can to help you before the need for surgery arises. We can offer you lifestyle advice on how you might be able to reduce the likelihood of the issue recurring and suggest equipment that could protect your wrist if there are activities that seem to be causing the problem (such as an ergonomic mouse or keyboard). We can also help you with exercises to reduce the pressure on the nerve and strengthen the wrist. If you do end up requiring surgery, we will work with you during your recovery period, helping you to regain strength and motion in your wrist and hand. Side note: Poor posture can also contribute to carpal tunnel syndrome, so a physiotherapist may help you to improve the way you sit or stand for long periods of time (you just sat up straight didn’t you…😉) How can you reduce the impact of carpal tunnel syndrome? There are a few steps you can take to help prevent carpal tunnel syndrome, or to alleviate the symptoms: ● If your job involves repetitive wrist movements, make sure you take regular breaks and alternate tasks if possible, in order to reduce the strain on your wrist.● Use a relaxed grip and a low level of force (for example to hit keys on a keyboard) if possible. ● Keep your keyboard at elbow height or slightly lower and choose a mouse that doesn’t strain your wrist. ● An ice pack can help to reduce inflammation and relieve pain in the short term. There are also certain exercises that you can do to help look after your wrist. Here are a couple of examples. 1. Wrist bendRest your elbow on a table with your arm pointing straight up. Gently bend your wrist forward at a right angle and hold for 5 seconds. Then bend your wrist backward and hold for 5 seconds. Repeat 10 times. 2. Wrist flexHold your arm out straight in front of you, palm down, and bend your wrist down. Use your other hand to press the stretching hand towards your body and hold for 15 - 20 seconds. Then bend the stretching hand in the other direction and use the other hand to pull your fingers back. Hold for 15 - 20 seconds. Repeat 5 times. Depending on your situation and symptoms, a physiotherapist will be able to recommend specific exercises to suit your particular needs. If you’re experiencing symptoms of carpal tunnel syndrome, give us a call on 02 9922 6806 and we will do our best to help relieve your pain and get you feeling stronger as soon as we can. Now that’s something we can hi-5 to! References 1. Medical News Today. 2018. Carpal tunnel syndrome: What you need to know. [Onlinehttps://www.medicalnewstoday.com/articles/184337 2. Mayo Clinic. 2020. Carpal tunnel syndrome. [Onlinehttps://www.mayoclinic.org/diseases-conditions/carpal-tunnel-syndrome/symptoms-causes/syc-20355603 3. Chartered Society of Physiotherapy. 2017. Exercise advice: carpal tunnel syndrome. [Onlinehttps://www.csp.org.uk/public-patient/rehabilitation-exercises/carpal-tunnel-syndrome Uploaded : 21 February 2021 Read More
  • Headaches and Physiotherapy

    Headaches and Physiotherapy

    How can physiotherapists help with headaches? You might be surprised to learn that the answer is, quite possibly, yes! It just depends on what type of headache you’re experiencing - and there are a lot more than you might think! What different types of headache are there? There are more than 150 types of headache! What type you’re experiencing depends on the cause, the symptoms, the location and how often they occur. Some of the most common headaches include: ● Tension headache Usually caused by tension in the muscles of the shoulders, neck or face, tension headaches usually give a sensation of pressure all the way around the head, and can cause nausea and light sensitivity. ● Sinus headache These headaches are usually felt as deep, constant pain in your forehead, as well as your cheekbones and/or the bridge of your nose. Caused by sinus infections, they’re usually accompanied by symptoms like a runny nose, blocked ears, swelling in the face, fever and sinus pain. ● Dehydration When you become dehydrated, the brain temporarily contracts because of the lack of fluid, causing it to pull away from the skull. Which hurts. The pain can usually be felt all over the head and can be anything from a dull ache to an intense throbbing. So, keep up your water intake. ● Cervicogenic headaches These are caused by pain referred from tissues in the neck. They usually cause pain on one side of the head, from the base of the skull to the temple of the eye, and are aggravated by neck movements. ● Migraine If you’ve ever had a migraine, you’ll know it’s way beyond a standard headache. As well as a pounding, throbbing pain in the head, sufferers can experience vision disturbances, sensitivity to light, noise and/or smells, nausea or vomiting, dizziness or stomach pain. Migraines can last for several hours, or even days. ● Cluster headaches Causing intense burning or piercing pain behind or around one eye, cluster headaches can be so overwhelming that sufferers can’t sit still during one. They may cause swelling, redness or tears in the eye affected, and nasal congestion on that side. They’re called cluster headaches because they occur in groups - one to four times per day (lasting 15 minutes to three hours each time) during a cluster period, which can last from two weeks to three months. What can you do to reduce headaches? Depending on the type of headaches you are prone to, there are a few things you can do to try to reduce the frequency and intensity: ● Drink plenty of water● Make sure you’re getting enough quality sleep● Try to reduce your stress levels and make time for relaxation● Don’t skip meals and make sure to eat regular, healthy snacks to maintain your blood sugar levels● Notice if there are particular foods, drinks, smells or environmental factors (such as lighting conditions) that trigger headaches so that you can avoid these in future● If you are sitting at a desk for long periods of time, stretch your neck, shoulder and back muscles regularly● Warm up and cool down properly after exercise How can a physiotherapist help? The two main headaches that physiotherapists can help you with are tension headaches and cervicogenic headaches. In the case of tension headaches, a physio will relax and unlock the muscles, releasing the tension that is causing the pain. They will also look at lifestyle factors that might be contributing to the problem, such as stress, and help you to manage these. For cervicogenic headaches, the goal will be to address the neck issue at the root of the problem. This could involve manipulation, massage or mobilisation. They will likely teach you exercises to perform regularly, which will help to relieve the problem. Poor posture is a common cause of cervicogenic headaches, so your physio will also look at your posture and ask about your living/working space to address that problem. References 1. WebMD. 2020. Headache Basics. [Onlinehttps://www.webmd.com/migraines-headaches/migraines-headaches-basics2. Headache Australia. 2020. Headache types. [Onlinehttps://headacheaustralia.org.au/types-of-headaches/. [Accessed 19 Dec 2020] Uploaded 28 January 2021 Read More
  • What is a Physiotherapist and what do they do and treat?

    What is a Physiotherapist and what do they do and treat?

    Physiotherapy FAQ: answers to some of your most common questions We get asked a lot of questions about our work, and we know there are a few misconceptions and misunderstandings about physiotherapy out there. So, we wanted to answer some of the most common questions and set a few things straight! What is physiotherapy? Physiotherapy is treatment to restore or maintain mobility, function or wellbeing. Physiotherapists can help you recover from or manage an illness, injury or disability, and help you to prevent injury. We also help you to maintain general fitness and use physical approaches to support your overall wellbeing. What conditions does a physiotherapist treat? The most common reasons to see a physiotherapist are injuries, disability, pain, or other issues affecting your physical mobility. However, a wide variety of problems can have causes within the body that a physiotherapist can help with. Some conditions that physios treat, that you may not be aware of include: ● Headaches caused by muscle tension or neck problems● Dizziness caused by issues with the body’s balance system● Bladder or bowel incontinence caused by weak pelvic floor muscles● Coughing or breathlessness caused by certain respiratory disorders● Pregnancy and postpartum recovery to safely increase activity levels and strengthen weakened muscles● Weight management to identify potential barriers that are preventing weight loss● Symptoms of certain chronic diseases, such as hypertension, emphysema, diabetes, Parkinson’s, ALS and arthritis, can be mitigated or managed through physiotherapy Do you need qualifications to be a physiotherapist? Yes! You need a degree and thorough training. Ongoing learning and regular upskilling is also required to maintain registration with our professional body. What does physiotherapy involve? Physiotherapists use a wide range of techniques and tools to help you with your issue. These include and are not limited to the following: 1. Hands-on techniques These are the physiotherapy techniques you’re probably most aware of and involve directly helping to restore movement to the affected area. Examples of hands-on techniques we frequently use are: ● Joint mobilisation● Joint manipulation● Massage● Soft tissue techniques 2. Exercise Physiotherapists will often work with you on exercises to strengthen your muscles, increase your range of movement and improve function. These exercises may be performed during your session, and you will most likely need to continue them at home between appointments. 3. Taping Physiotherapists may tape or strap areas to relieve pain, enhance stability or prevent further injury or damage. 4. Additional therapies Many physiotherapists are trained in additional therapies that can relieve pain, improve movement and promote healing, such as: ● Acupuncture● Hydrotherapy ● Ultrasound - using high-frequency sound waves to stimulate blood circulation and cell activity● Transcutaneous electrical nerve stimulation (TENS) - an electric current delivered to a specific area to relieve pain 5. Education and advice Physiotherapists look at the body as a whole, not just the particular issue at hand. That’s because your body works as a whole, not in separate parts, and different areas can impact one another. Therefore, we’ll look at your overall wellbeing and see what issues might be connected. We’ll also look at lifestyle factors that might be contributing to your problems, and advise you on how you can make changes to prevent further issues. We can also provide advice on avoiding injuries in the future as well as general wellbeing information. Will I need to get undressed for my appointment? We will most likely need to look at the area causing the trouble, so you may need to reveal that part of your body. Where that is will depend on how much clothing you need to remove. We recommend wearing comfortable, loose-fitting clothing to allow us to treat with ease, and to allow you to be able to do any exercises or movements that are necessary for a successful treatment session. Should I see a physiotherapist or a doctor? If you are in pain or struggling with a particular condition, you might not be sure who to see. Physiotherapy will often work alongside medical treatment, and we will refer you to a doctor if we think they are better placed to help you or that you would benefit from seeing a doctor as well. If in doubt, just give us a call and ask! Uploaded : 28 January 2021 Read More
  • What’s new in 2021?

    What’s new in 2021?

    What’s new in 2021? Three activities for you to try. Good riddance 2020, hello 2021! As we say a grateful goodbye to what we can probably all agree has been the worst year in a long time, we’re starting a brand-new year filled with hope and possibility. 2021 brings fresh starts and fresh opportunities for all, making this a perfect time to try something new! Here are three suggestions for activities to unlock your potential in 2021. Paddle boarding This has become a real craze in recent years, and if you’ve ever given it a go you probably understand why. Getting out on the water is great for your mental wellbeing, promoting a sense of relaxation and calm. It can be done on almost any kind of water, so you don’t have to live close to the ocean to get involved. Pros: Paddle boarding is a workout for your whole body, but is particularly good for your core strength, arms and abs. It’s a low-impact workout, so won’t put strain on your joints. As if that wasn’t enough, it even improves your cardiovascular health, reducing the risk of a stroke or heart attack. Cons: Paddle boards are pretty big - usually around 10 feet long - so they can be pretty hard to store and transport. Inflatable paddle boards solve that problem, but they can bounce on rough water and take more energy to push. Plus, you have to pump them up. Reminder to wear plenty of sunscreen and drink lots of water while you’re out on the board to avoid sunburn or dehydration. Alternative: Don’t fancy standing up on the water? Kayaking has many of the same benefits, and you get to sit down while you’re doing it! Win-win! Dance fitness Dance is a great way to exercise without even realising you’re doing a workout - you’ll be having too much fun. There are so many different types of dance class designed to give you a workout, so whether you prefer something upbeat like Zumba or salsa that will increase your aerobic fitness and work your muscles, or something more controlled like ballet that builds your core strength and tones your whole body, you’ll find something to suit you. Pros: Dancing is a workout for the whole body, and a great way to meet new people. It improves your coordination, flexibility and balance, and it even gives your brain a workout as learning and remembering the steps is good for your cognitive function. Cons: Certain types of dance, such as ballet, can be tough on your joints, particularly your knees. Make sure you have the appropriate footwear for the style of dance you’re doing and you’ll be off to a flying start! The repetitive movements can also cause strains, so make sure you warm up before class and cool down properly afterwards. Alternative: If dance isn’t your thing, trampolining has a very similar impact on your body and is also loads of fun! Climbing Climbing can take a variety of forms, whether you prefer an indoor bouldering wall or a countryside rock face. Bouldering is easily accessible for beginners, and there is plenty of scope for you to expand your activities as your skill increases. Climbing works your whole body and vastly improves your strength. Pros: Climbing particularly strengthens your hands, forearms, biceps, back and shoulders. Your upper body strength will improve before you know it. You’ll also find your abs, glutes, thighs and calves get a pretty good workout too. There is a great community around the activity, so you’re likely to make new friends when you get involved. Cons: Not one for anyone with a fear of heights! It also takes a long time to build up the upper body strength required to get really good, so be prepared to be a beginner for a while. Climbing can also be tough on your joints and tendons, and can lead to arthritis in the hands for regular climbers. You also run the risk of falls, bumps and scrapes, and the tougher climbs you do, the more dangerous the activity becomes.      See also : https://www.back-in-business-physiotherapy.com/latest-news/305-rock-climbing.html for further information on exercises for rock climbing. Alternative: If you want to keep a bit closer to the ground, gymnastics, circus or pole classes also improve your strength and helps build your muscles. Uploaded : 11 December 2020   Read More
  • Tennis elbow vs golfer’s elbow - what’s the difference?

    Tennis elbow vs golfer’s elbow - what’s the difference?

    Tennis elbow vs golfer’s elbow - what’s the difference? Tennis elbow and golfer’s elbow. Two causes of elbow pain that are associated with sports, even though you don’t ever need to play either sport to experience one of these conditions. Both involve inflammation of the tendons that attach to the elbow, and are caused by repetitive motion of the arms and wrist. But what are the differences between them, and how can you tell which, if either, you have? Below we have shared the main attributes, symptoms, causes and treatments for each elbow condition, as well as what you can do to help prevent both. What is tennis elbow and golfer’s elbow? The most noticeable difference between the two conditions is the area of the elbow that they affect. Tennis elbow causes pain in the outside of the elbow and forearm. This is due to strain to the extensor carpi radialis brevis and extensor digitorum tendons of the forearm, which extend and stabilise the wrist. Golfer’s elbow on the other hand, will cause pain on the inside of the elbow and forearm as the inside tendons of the forearm (which flex your wrist and contract your fingers when you grip something) have been overused. Tennis elbow is most common in people aged 30-50, whereas golfer’s elbow predominantly affects people over the age of 40. Symptoms Both conditions will cause pain in your elbow that usually radiates down your forearm. In tennis elbow, this pain will begin on the outside of your elbow, whereas in golfer’s elbow you will feel the pain on the inside of your elbow and arm. There are a few other signs and symptoms which are common in each condition: ● Pain when you reach for, grasp or lift something● Weakness in your forearm or a weak grip● A dull ache when resting Causes Both elbow conditions are caused by repetitive movements which overuse certain muscles and tendons. ‘Overuse’ is considered to be high-level activity of 30 minutes or more, performed three or more times per week. However, the movements that cause each condition are different. Tennis elbow can be caused by impact motions, such as hitting a ball with a tennis racket (or badminton racket or baseball bat) and throwing motions (javelin and discus throwers are prone to the condition). Repetitive lifting or turning of the wrist can also lead to tennis elbow, making plumbers, painters, builders and hairdressers particularly susceptible. Regular typing can have the same effect. Golfer’s elbow is predominantly brought on by repeated lifting movements, especially where the elbow is extended and the palm is face down. Gardening, digging, assembly line work and throwing a ball are common causes, and if you are lifting weights with a poor technique then you are more at risk of this condition. The shoulder, neck and ribcage can also contribute to tennis and golfers elbow like symptoms. Neural irritation may require joint mobilisations to the cervical and thoracic spines, as well as a home programme of neural mobilisation exercises. Additionally, altered bone alignment in the elbow and wrist can create dysfunctional biomechanics leading to tennis and golfers elbow symptoms. Mulligans Movement With Mobilisations (MWM) can help eleviate symptoms. Treatments The good news is that both tennis elbow and golfer’s elbow are very treatable. There are a few things that you can do at home to reduce the pain: ● Rest your arm● Apply ice to reduce the inflammation● Take anti-inflammatory painkillers, such as ibuprofen (always check with your doctor first) However, both conditions can take weeks or even months to recover from, and can worsen if not treated effectively. Your best course of action is to see a physiotherapist, who can help you with exercises to stretch and strengthen the forearm muscles and reduce strain on the inflamed tendons. Your physio will also advise you of how you can adjust your arm movements in future to avoid this happening again. Prevention Although we’re more than happy to help you with your elbow pain, we’d ideally like you not to experience it in the first place. Here are a few steps you can take to prevent tennis and golfer’s elbow: ● Regular stretching and strengthening exercises for the muscles of your forearm● If your job involves the kinds of movements discussed above, talk to your manager about safety precautions that can be put in place● Take regular breaks from any repetitive arm motions and stretch your muscles● If you are performing regular sports activities, make sure your technique is correct and seek professional coaching or advice to improve your movements and check that your equipment is appropriate for your needs If you are experiencing pain in your elbow, do not leave it until further damage has occurred. Get in touch with us straight away by calling 02 9922 6806 and we can start your road to recovery.  References 1. Orthopedic Institute of Pennsylvania. 2020. Tennis Elbow vs Golfer’s Elbow Explained. [Onlinehttps://www.oip.com/tennis-elbow-vs-golfers-elbow-explained/#:~:text=Tennis%20elbow%20presents%20with%20pain,or%20tingling%20in%20your%20fingers. [Accessed 25 11 2020] 2. NY Orthopedics. 2015. Tennis Elbow vs Golfer’s Elbow. [Onlinehttps://www.newyorkorthopedics.com/2015/08/21/tennis-elbow-and-golfers-elbow-the-causes-symptoms-treatments/. [Accessed 25 11 2020] Uploaded : 11 December 2020 Read More
  • Preventing injury with physio and yoga

    Preventing injury with physio and yoga

    Preventing injury with physio and yoga   Are you in a constant battle with your body to stay injury and pain-free? Maybe you’re having the same conversation with yourself over and over about how you need to be kinder to yourself, eat cleaner, and get stronger and more flexible? When you don’t have the right ingredients making up your life, this can be a difficult task to undertake. Luckily, there is an answer. Many people will visit a physiotherapist after they injure themselves. A common occurrence is to then part with the physio sessions once the pain has gone away and the person is back to their normal lifestyle. On many occasions, we see these people back in the clinic again within 3-6 months, often with the same problem rearing its ugly head. This is because pain-relief and return to function is only the beginning of the recovery and rehab phase. To avoid these repeat visits to us for the same issue time and time again, rehab should be seen through (and continued) until you are back to baseline PLUS giving yourself some “extra in the tank.” Making a real change to the body in the way you move, how frequently you move, and how strong you are takes a long time. Many injuries are years in the making and cannot be reversed in a few treatment sessions alone. So, how about having your knowledgeable physio see you through to that 110% mark so next time you take to the field, not only will you not be afraid of injuring yourself again, but you’ll be able to put more into your performance (on and off the field) than you did before. Visiting your physio on a regular basis, regardless of whether you are injured or not, is a great way to PREVENT injury, as you’ll have a movement and health expert with you at every step of the journey. There are many benefits of seeing a physio regularly for injury prevention. These include: • Having a qualified health practitioner who is able to seek out movement problems before they present to you as pain and disability• Having your very own sounding board for any frustrations you may have with your body• Knowing you have the best person to treat and provide lifestyle advice based on the most up-to-date evidence-based research• Having an expert practitioner who is able to assess, implement a short and long-term plan, and then re-assess along the way where required to ensure you are reaching your goals We understand regular treatments can be costly,but staying healthy and injury free is a much better option then constantly being plagued with injury, or possibly ending up with a life-changing, chronic condition that requires ongoing medical costs. Put it this way, why not use your private health cover to prevent injury, rather than to treat it once it arises and impacts your life? What else can I do? There are many healthy options out there that can supplement the good work you do with your physio. Not everyone is game for following strict exercise regimes set by their practitioner. A different outlet may be required, and we are trained to recognise these patients and are always supportive of any choice a patient makes if it is going to benefit their mind and body. A very popular exercise choice is yoga. Yoga has been practiced by millions of people for thousands of years (3000+ years to be more accurate!) and provides a whole body, or holistic approach to health. That is, it’s good for the mind, body and spirit. The beauty of yoga in modern times is that it is widely accessible, has different forms for different tastes, and can be enjoyed by all regardless of age. Some of the proven benefits of yoga include: • Improved flexibility and body-wide strength• Improved heart and lung health• Improved sleep cycles• Effective weight management• Effective control of stress, anxiety and depressive disorders• Effective pain management (including chronic pain states)• Enhanced overall quality of life The list goes on. We think all of these qualities perfectly complement what we are trying to achieve in our treatment plan for you. Considering trying yoga after reading this? Speak to us next time you are in the clinic, and we’ll be able to recommend a local yoga studio to try. Bonus yoga benefit… It’s a social affair, so take a friend or family member with you and you can both reap the benefits, and enjoy a coffee after class! (And ahem… please pass on our details to them too) 😉  References 1. Physiopedia. 2020. Physical activity and injury prevention in adolescents. [Onlinehttps://www.physio-pedia.com/Physical_Activity_and_Injury_Prevention_in_Adolescents. [Accessed 05 Nov 2020] 2. American Academy of Orthopaedic Surgeons. 2020. Yoga injury prevention. [Onlinehttps://orthoinfo.aaos.org/en/staying-healthy/yoga-injury-prevention. [Accessed 05 Nov 2020] 3. Harvard Health Publishing. 2015. Yoga - benefits beyond the mat. [Onlinehttps://www.health.harvard.edu/staying-healthy/yoga-benefits-beyond-the-mat. [Accessed 05 Nov 2020] 4. Woodyard, C. 2011. Exploring the therapeutic effects of yoga and its ability to increase quality of life. International journal of yoga. 4 (2). 49-54. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3193654/ Uploaded : 5 December 2020 Read More
  • Healthy Heart

    Healthy Heart

    Your guide to a healthy heart We all know how important it is to look after our heart. If you want to live a long and active life, you need to be kind to it every day. But how kind are you to yours? Statistics suggest that many of us need to be doing a whole lot more, as cardiovascular diseases are the number one cause of death globally every year. Nearly 18 million people lose their lives annually as a result of cardiovascular diseases, accounting for approximately 31% of all deaths. Cardiovascular disease is an umbrella term used to describe any disease relating to the heart and blood vessels, including coronary heart disease (CHD) and cerebrovascular disease (e.g. stroke), as well as others. Some of the risk factors for cardiovascular disease are changeable and others are not. These include:  Non-changeable factors • Advancing age• Gender – As this affects males more than females• Having a family history of heart disease Changeable factors • High blood pressure• High cholesterol• Being a smoker• Drinking alcohol excessively• Being overweight or obese• Lack of physical activity• High stress levels Your road to a healthy heart So, what can YOU do about it? The good news is, no matter where you are in life, no matter what age, you can do something today to improve your heart health. The following are some of the most important things to consider when working towards having a healthy cardiovascular system. Keep a healthy weight Being overweight or obese is one of the modifiable risk factors that is easiest to change. You just need to ensure you are doing two things… Exercising regularly and eating a healthy, balanced diet. How many of us know this, but fail to get on board consistently? We’re all a little guilty from time to time, aren’t we? Exercise has many body-wide benefits that are too long to list in this blog but challenging your heart through exercise regularly each week is a great way to help control blood pressure and cholesterol levels. Did you know that going for a 30-60-minute brisk walk each day is all you need to keep the heart in check? There are so many other options when it comes to exercise though… Cycling, swimming, aerobics, team sports, martial arts. As well as helping you maintain a healthy heart, your body will benefit from increased flexibility and strength, and a clearer mind. Combine regular exercise with a good diet and you will be winning on the weight front if you persist. There are many foods out there that hold ‘cardio protective’ properties. Meaning these foods help you reduce the risk of developing cardiovascular disease if eaten regularly as part of your balanced diet. Some of these foods include: • Those high in Omega-3 fatty acids (including oily fish, walnuts, chia seeds, flaxseed oil)• Red wine (when consumed in moderation)• Dark chocolate and green tea (due to their antioxidant content)• Fruits and vegetables (make these a big part of your diet!) Other handy tips include: • Replacing salt with herbs and spices during cooking• Reducing intake of foods high in saturated and trans fats which can raise cholesterol levels and lead to clogged arteries. This in turn increases risk of stroke and heart attack. Avoid eating cakes, chips/crisps and pastries excessively. Do not smoke Smoking directly damages your blood vessels which quadruples your risk of heart attack and stroke. Our advice to you is plain and simple… If you do not smoke, keep it that way. If you are a smoker, do whatever you can to begin quitting today. Quitting smoking is tough and needs to be done correctly. Speak to your doctor today for help and advice. The day you smoke your last cigarette immediately decreases your risk of cardiovascular disease and early death. Learn how to manage your stress levels Chronic stress is a major contributor to increased heart rate and blood pressure. Learning to control your stress levels can help to alleviate the effect this has on the cardiovascular system. Physiotherapists can offer advice on ways to manage stress. Some of the most popular forms of stress management include: • Regular exercise• Breathing and relaxation exercises• Meditation (including mindfulness-based cognitive therapy, as well as other forms)• Seeing a doctor, psychologist or life coach Educate yourself and get checked by your doctor regularly as you age The bottom line is your heart health is your responsibility. You must act to ensure cardiovascular disease doesn’t become a part of your life. You have a wealth of resources at your fingertips. We (and other health professionals) are here to help guide you to optimal health. We thoroughly recommend you regularly check-in with your doctor, especially as you advance through to your later years, to make sure everything is functioning well.  References 1. World Health Organisation. 2020. Cardiovascular diseases. [Onlinehttps://www.who.int/health-topics/cardiovascular-diseases/#tab=tab_1. [Accessed 07 Nov 2020https://www.heartfoundation.org.au/heart-health-education/keeping-your-heart-healthy. [Accessed 05 Nov 2020https://www.healthline.com/health/healthy-heart-tips. [Accessed 05 Nov 2020https://www.heart.org/en/health-topics/heart-attack/understand-your-risks-to-prevent-a-heart-attack. [Accessed 07 Nov 2020https://www.heart.org/en/healthy-living/healthy-lifestyle/how-to-help-prevent-heart-disease-at-any-age. [Accessed 05 Nov 2020] Uploaded : 3 December 2020 Read More
  • Diabetes - Type 1 vs Type 2

    Diabetes - Type 1 vs Type 2

    Diabetes - Type 1 vs Type 2 The 14th November 2020 marked the 29th World Diabetes Day. Since its conception in 1991, World Diabetes Day has been the principal worldwide campaign that raises awareness of the disease diabetes mellitus (DM). This year’s theme focuses on ‘The nurse and diabetes’, and how pivotal a role nurses play in supporting those living with this condition. Do you understand diabetes? Are you familiar with its effects on the human body? If the answer is no, this blog is for you. Facts Here’s a few startling facts about DM… In 2019, nearly 465 million adults had a DM diagnosis worldwide. This figure is predicted to increase to nearly 580 million by the year 2030. In the same year, the disease took the life of 4.2 million people with healthcare costs totaling more than $760 billion. This equates to approximately 10% of the total global spend on all healthcare, which is a huge figure! It also puts into perspective just how big a problem DM is across the planet. What is diabetes mellitus? Diabetes is a chronic, metabolic disease. The word ‘metabolic’ derives from ‘metabolism’, which refers to the body’s ability to breakdown food into energy. With DM, the problem lies with the body’s ability to breakdown sugar (in the form of glucose) into energy for the body to use. When we eat food, the body breaks it down into smaller pieces. Some of these smaller pieces are in the form of glucose, our body’s main energy source. Once in the blood, it travels around the body, being dispensed to all cells, so all of our bodily processes can be carried out and function correctly. The body uses a hormone called insulin to help in the process of converting glucose into energy, ready for use by our cells. Insulin is produced by the pancreas, an organ that is part of our digestive system. In DM, the pancreas either doesn’t produce insulin at all, or it does not produce enough good quality insulin, meaning there is nowhere for the glucose to go but stay in the blood. As a result, the glucose levels rise, which then leads to symptoms of DM. Types of DM There are three main types of diabetes: • Type 1 (DM1): An autoimmune form of the condition, meaning the body’s immune system attacks and destroys the cells of the pancreas that are responsible for producing insulin. People with DM1 must rely on a synthetic form of insulin, usually injected by the person several times a day, in order to control blood sugar at safe levels. Sometimes an insulin pump is fitted which negates the need to inject. • Type 2 (DM2): The most common form of the disease. With DM2, the pancreas either does not produce enough insulin, does not produce effective insulin, or the cells of the body do not react to insulin correctly. In the early stages, this form of the disease can be effectively managed by exercising regularly, eating healthily and making necessary lifestyle changes. Over time, the disease progresses, and people may require medication in the form of tablets, and eventually insulin injections, like with DM1. • Gestational: A form of DM that develops during pregnancy and usually resolves once the baby is born. Women who are overweight, 40+ years of age, and have a family history of DM2 are more at risk of developing this condition. This blog will mainly focus on the differences between DM1 and DM2. We will discuss gestational diabetes in more detail in a future blog. Effects of DM on the body The short and long-term effects of DM1 and DM2 are the same. The short-term effects of DM1 tend to come on quickly and may be fatal if not controlled promptly. Some of the shared and more immediate symptoms of DM1 and DM2 include: • Excessive thirst and hunger• Increased urination• Tiredness and fatigue• Skin infections and slowly healing skin wounds• Visual disturbance, including blurred vision• Mood swings• Headaches• Weight changes (DM1 is usually associated with unexplained weight loss, whereas DM2 is usually associated with progressive weight gain) If DM is not managed well, long-term complications of the disease relate to problems with the cardiovascular, kidney, nerve and visual systems of the body. This leaves a person susceptible to developing: • Heart attacks and/or stroke• Kidney disease• Poor nerve function• Ulcers that affect the limbs• Blindness Poorly managed diabetes is a common cause of limb amputations (due to the resultant poor blood flow and nerve function) and there is a strong association between diabetes and anxiety and/or depression. The key to managing DM in any form is an early diagnosis. The beauty of seeing a physiotherapist regularly is that we are constantly monitoring your conditions and general health. If we suspect there may be an underlying problem that needs medical attention, we will discuss this with you and help direct you to the right person to ensure you receive the correct diagnosis and treatment. Diseases like diabetes are usually diagnosed under supervision of your GP. If you have any questions relating to DM, and how this may affect your ability to exercise, please speak to your practitioner next time you are in. We hope you found this blog informative and interesting. The key to managing disease and injury is to first understand it. If you have any questions, let us know and we’ll be happy to put your mind at ease!  References International Diabetes Federation. 2020. World Diabetes Day. [Onlinehttps://worlddiabetesday.org. [Accessed 07 Oct 2020]. World Health Organisation. 2020. Diabetes. [Onlinehttps://www.who.int/health-topics/diabetes#tab=tab_1. [Accessed 07 Oct 2020]. Diabetes Australia. 2020. What is diabetes. [Onlinehttps://www.diabetesaustralia.com.au/about-diabetes/what-is-diabetes/. [Accessed 07 Oct 2020]. Uploaded : 17 November 2020 Read More
  • Foam rolling: Pros and cons

    Foam rolling: Pros and cons

    Foam rolling: Pros and cons New foam roller and wondering where to start? Have a read of this, and you’ll feel more informed. And if you still aren’t convinced or have more questions, feel free to ask us next time you are in the clinic and we will discuss it with you in person. For now, let’s keep on rollin’. Head into any sports store and there is a good chance they’ll have some foam rollers for sale. Foam rollers are widely available and have been used as a therapy aid by millions of people for years since first coming on the market in the 1980s. What is a foam roller? Foam rollers are usually cylindrical in shape, very lightweight, and range in length and firmness from long to short and soft to hard. Their design and use is simple. You simply lie the roller on the ground, choose a body part, place it on top and start rolling. But what are the actual benefits of foam rolling? Are there any potential side effects? Or negative impacts? Let’s take a look… History Foam rollers were originally used by practitioners that followed the Feldenkrais method of treating the body. Early practitioners used the rollers as a way of providing support to the body and would get their patients to stand on the rollers during balance exercises. Use of rollers progressed over the years. In 1987, their use as a self-massage tool was pioneered by physical therapist, Sean Gallagher. They are now used by millions of people across the globe, including gym goers, weightlifters, gymnasts, athletes and many others, as a tool to massage and release tight muscles. Pros Some of the benefits of foam rolling include: • Reducing muscle pain (including the management of certain pain syndromes like fibromyalgia)• Increasing range of motion around a joint• Making muscles more responsive to stretching• Relaxation• It’s a relatively safe way to self-massage tight muscles Cons Due to their widespread availability, foam rollers can be purchased by anyone, even though they may not be a suitable tool to use for that particular person. There are certain conditions and circumstances where use of a foam roller could be detrimental or damaging to a person’s body. Foam rolling exercises load and stress the underlying tissues, including nerves, skin receptors, blood and lymphatic vessels, as well as bones. People with conditions including advanced diabetes mellitus, lymphedema, varicose veins and severe osteoporosis should avoid this form of exercise, unless advised otherwise by a medical professional. When recovering from a muscle strain, a foam roller may be a handy thing to have around, but rolling over a torn muscle should be avoided in the early stages of injury and until you’ve been given the all-clear by your therapist. Rolling over an acutely torn muscle could hinder the repair of the muscle and at the very least would be incredibly uncomfortable and painful. Please note that scientific evidence supporting the use of foam rolling for therapeutic reasons is sparse and caution should be taken by anyone who uses them. Our advice to you is to ask your trusted physiotherapist if it’s suitable for you. We have the expertise to guide you in the right direction and if it’s a great option for you and your body, we’ll give you the thumbs up to rock’n’ROLL! References 1. Healthline. 2019. What are the benefits of foam rolling? [Onlinehttps://www.healthline.com/health/foam-roller-benefits. [Accessed 06 Oct 2020https://www.health.harvard.edu/staying-healthy/should-you-add-foam-rolling-to-your-workout-routine. [Accessed 06 Oct 2020https://www.researchgate.net/profile/Juergen_Freiwald/publication/308392869_Foam-Rolling_in_sport_and_therapy_-_Potential_benefits_and_risks_Part_1_-_Definitions_anatomy_physiology_and_biomechanics/links/57eb7bee08ae91a0c8d4004b/Foam-Rolling-in-sport-and-therapy-Potential-benefits-and-risks-Part-1-Definitions-anatomy-physiology-and-biomechanics.pdf Uploaded : 17 November 2020 Read More
  • Rock Climbing

    Rock Climbing

    Climbing and musculoskeletal considerations by Martin Krause Good climbers use a combination of strength, endurance and flexibility. Power is developed by the arms through an upward throwing action of the arms, which instigates efficient eccentric muscle lengthening decelerating forces (rather than concentric - muscle shortening). Additionally, they are able to facilitate kinetic energy across the chain of movement from toes through the legs and pelvis into the trunk and torso. Ideal posture Ideal climbing involves extended arms to hang from thoracic extension, lateral flexion and rotation hip external rotation knee flexion and slight heel rise to develop power through the legs "An inch is a mile" In climbing, 'an inch is a mile' refers to delicate foot and hand placement where body length through the elongation of the thorax with thoracic ring elevation. The shoulder blade needs to elevate and allow the thorax to hang from it.  Restrictions of thoracic rotation results in excessive contralateral gluteal contractions. Inadequate shoulder flexion due to limited thoracic ring extension can cause reduced contralateral gluteal activity Gorillas on the Cliff Climbers can develop a 'gorilla-like' posture due to over emphasis on grip arm flexion a '6 pack' Since the abdominal muscles cross the lower 6 ribs, sufficient trunk core stability should not compromise the mobility (especially rotation) of the thorax. Excessive development of the low thoracic - upper lumbar erector spinae can create reduced gluteal muscle strength, reduced diaphragmatic breathing, increased psoas major tightness and reduced core stability. Postural problems associated with climbing could lead to musculoskeletal injury Climbers may develop a gorilla-like appearance due to the unique nature of the sport Gorilla-like appearance alters the centre of gravity of various limb and trunk segments this may lead to shoulder injuries, headaches, neck, arm and back pain Stomach crunches or 'curls' may cause tightness of the rectus abdominis ("6 pack") and external obliques at the expense of weakness of the transverse abdominis muscle increased thoracic kyphosis (rounded back) reduced diaphragmatic lateral expansion which contributes to the gorilla posture resulting in altered thoracic biomechanics which affects active SLR and active PKB suggesting reduced lumbopelvic rhythm (gluteal : hamstring timing) reduced strength in the lumbo-pelvic-hip musculature reduced gliding of the myofascial trains extending from the superficial front line of the latissimus dorsi to the superficial back line of the thoracolumbar fascia and the gluteals  Myofascial Trains Arm elevation normally results in contralateral gluteal and transverse abdominal activity in the 'wall plank' position Power = strength, speed and flexibility Training should involve functional movement patterns, whereby some muscles are used as stabilisers whilst others are used as mobilisers. The deeper lying endurance muscles tend to be the stabilisers and are frequently found to cross only one joint or work in an area of limited movement. The mobilising, power muscles, tend to be the 'energy straps' crossing more than one joint and conferring kinetic energy to the movement system. A balance between mobility and stability needs to be attained. Overhead reaching This requires extension and rotation flexibility in the thorax, as well as front of shoulder and chest flexibility. Balanced with this flexibility should be strength in the serratus anterior so that the thoracic rings can 'hang off the arms'.     The serratus anterior inter-digitate with the abdominal muscles which cross the lower 6 ribs. So, as the upper rib cage and thoracic rings elevate upwards, an eccentric lower thoracic ring stabilisation must take place to bring the semi squat power of the legs into play. Development of the scapular stabilisers An interplay with the muscular slings, their stabilisers and mobilisers comes into play.    The shoulder joint has a shallow socket which provides a surface for the large 'ball' (same size as the hip!) to interface. To maintain stability, the rotator cuff muscles need to provide consistent support and pressure around a centre of rotation. Since these muscles are attached to the scapula (shoulder blade), the shoulder blade requires correct and consistent orientation, otherwise the rotator cuff function is rendered useless (see example below if only the rhomboids [Rh] were used).    Read more about stability elsewhere on this site Excessive and prolonged reaching results in tight serratus anterior and pectoral (chest) muscles contributing to excessive strain on the blood vessels, nerves and joints of the shoulder - neck - arm complex (TOS = thoracic outlet syndrome) creates excessive low thoracic erector spinae activity contributing to loss of costal expansion, as well as reduced diaphragmatic rhythm has been associated with impingement in the supraspinatus (superior rotator cuff and subacromial bursa) muscle leading to discomfort in the shoulder with loss of muscle power during activities above shoulder height Acromioclavicular and sternoclavicular (collar bone joints) joints may become inflamed Overhead reaching can result in excessive strain on the back and shoulder blade muscles cause the rhomboids and levator scapulae to become long and weak facilitates the latissimus dorsi to become short and strong scalene muscle tightness, rib elevation and circulations compromise, similar to Thoracic Outlet Syndrome (TOS)     Training - the trapezius muscles requires synergistic (complimentary) action by the latissimus dorsi erector spinae (back) oblique and transverse abdominal muscles (not the "6-pack"!!) - the deltoid muscle requires synergistic action by the internal oblique and transverse abdominal muscles contralateral gluteal activation lumbar erector spinae activity - the serratus anterior needs synergy with the external obliques intercostals diaphragm - should replicate the combination of muscle synergies in the most climbing functional way as possible.   - arm strength requires gluteal strength   Bridging exercises with the Swiss Gym ball and elastic tubing allows functional activity which stretches the pectoral girdle and "6 pack" strengthening of the abdominal, spinal and shoulder blade muscles dynamic stability of the pelvis and hips allowing enhanced freedom of movement on the cliff face   "Prone bridging" allows abdominal, pelvic, trunk and arm control to be trained   Supine bridging can be used to develop gluteal and lower abdominal strength, especially when done, one legged. with the thighs consistently parallel. Whilst modified planks and side planks can be used to develop arm, gluteal and abdominal strength simultaneously. The following example from a client with pelvic pain demonstrates the muscle synergies required, across the body, and in particular around the pelvis, for functional integrity.    These exercises and modified versions of these can be used to improve climbing ability and agility. Functional exercises In climbing, ideally there are three points of contact, meaning that three points are either statically or dynamically stabilising whilst a limb is moving off the rock. The following describes a series of exercises for stability whilst moving various body parts Modifications can be made into climbing patterns, such as semi squat rather than sitting To reduce a "poked chin" the deep neck muscles need activation and the thoracic rings require elevation through Alexander technique and lateral diaphragmatic breathing   Clinical observations Clinically, people fall into two broad categories - the hypermobile or the hypomobile. Hypermobile people generally work with their ballistic power generating muscles, using inertia to stabilise. These ballistic muscles can be long and strong but also long and weak if they haven't been appropriately conditioned. Hypomobile people tend to use their slow twitch endurance muscles and have short tight ballistic muscles. General rule of thumb is that 'floppies' need to work on endurance and stability, whereas 'stiffies' need to work on their flexibility and ballistic power. It is also possible to have hypermobile soft tissue (lax joints) but tight protective overlying muscles. Floppies tend to be good at 'pulling' into themselves, whereas 'stiffies' tend to be better able to push away. Ideally, individuals should work at what they aren't naturally endowed with to gain a 'musculoskeletal' protective balance. Frequently, one finds the 'floppies' in the yoga class and the stiffies in the pilates class when it really should be the other way around. Interested readers should read the Joint Hypermobility Syndrome and Ehlers Danlos Syndrome section elsewhere on this website. Too much pulling, with too little stability can lead to shoulder subluxation and even posterior dislocation. These shoulders need to have the soft tissue at the back of the shoulder 'buffed up' and be very conscious of 'scapula setting' when commencing movements. Ideally, muscle synergies are developed where the nett gain of all muscles working at their most efficient level to gain a mutually beneficial movement outcome is what is desired. In such a scenario, the distinction between agonists and antagonists, postural muscles and ballistic muscles becomes superfluous, let alone one body part being dominant over another. Interested readers should read 'game theory' and 'deterministic chaos' elsewhere on this site    Voluntary Posterior Shoulder Subluxation : Clinical Presentation A 27 year old male presented with a history of posterior shoulder weakness, characterised by severe fatigue and heaviness when 'working out' at the gym. His usual routine was one which involved sets of 15 repetitions, hence endurance oriented rather than power oriented. He described major problems when trying to execute bench presses and Japanese style push ups.  https://youtu.be/4rj-4TWogFU In a comprehensive review of 300 articles on shoulder instability, Heller et al. (Heller, K. D., J. Forst, R. Forst, and B. Cohen. Posterior dislocation of the shoulder: recommendations for a classification. Arch. Orthop. Trauma Surg. 113:228-231, 1994) concluded that posterior dislocation constitutes only 2.1% of all shoulder dislocations. The differential diagnosis in patients with posterior instability of the shoulder includes traumatic posterior instability, atraumatic posterior instability, voluntary posterior instability, and posterior instability associated with multidirectional instability. Laxity testing was performed with a posterior draw sign. The laxity was graded with a modified Hawkins scale : grade I, humeral head displacement that locks out beyond the glenoid rim; grade II, humeral displacement that is over the glenoid rim but is easily reducible; and grade III, humeral head displacement that locks out beyond the glenoid rim. This client had grade III laxity in both shoulders. A sulcus sign test was performed on both shoulders and graded to commonly accepted grading scales: grade I, a depression <1cm: grade 2, between 1.5 and 2cm; and grade 3, a depression > 2cm. The client had a grade 3 sulcus sign bilaterally regardless if the arm was in neutral or external rotation. The client met the criteria of Carter and Wilkinson for generalized ligamentous laxity by exhibiting hyperextension of both elbows > 10o, genu recurvatum of both knees > 19o, and the ability to touch his thumb to his forearm Fingers, elbows and wrists are also common places for climbing injuries. Taping can be particularly useful in protecting and unloading tendinous structures. Conclusion Seek guidance from your physiotherapist as the ultimate aim is to improve your power-weight ratio without inducing an injury. An optimal combination of strength, stability, and mobility needs to be acquired across the the entire body. The following videos should give you an insight of some of the things which are possible. Laterality of thought, improvisation and proper progression of exercise should allow refinement of climbing technique as well as reduce the risk of injury. Hip stabilisation and thoracic mobilisation  Several exercises exist which stabilise the hip and shoulders whilst mobilising the thorax.  Swiss Ball exercises can also be used to improve thoracic ring stability Thoracic strengthening regimes should be instigated to maintain the ring alignment Stretching regimes - 'don't let the tail wag the dog' Many people stretch their limb muscles. However, if the thorax is the 'driver' of limb muscle tension, then the thorax needs to be nullified beforehand and/or involved in the process of stretching. For example both hamstrings and quadriceps can be stretched with lateral flexion and lateral breathing of the diaphragm. Classic moves out of yoga such as the 'down dog -> high plank -> warrior pose -> triangle' can involve rib cage movements. Don't forget the calf muscles!   Summary of leg, back and shoulder exercises Front, back, inside, outside and spiral 'slings'   References Shoulder stability : https://www.back-in-business-physiotherapy.com/shoulder.html Hypermobility : https://www.back-in-business-physiotherapy.com/we-treat/ehlers-danlos-syndrome.html Joint Stability : https://www.back-in-business-physiotherapy.com/stability.html Game Theory and Cortical Resources : https://www.back-in-business-physiotherapy.com/health-advocacy/exercise-and-the-immune-system-during-covid-19.html Pelvic - Hip - Lumbar stability : https://www.back-in-business-physiotherapy.com/we-do/muscle-energy-techniques.html Thorax : https://www.back-in-business-physiotherapy.com/we-treat/thorax.html  Conceptualised whilst working and living in the mountains of Switzerland and the Blue Mountains, west of Sydney, NSW, Australia (!988-2001) Uploaded : 13 October 2020  Updated : 11 December 2020 Read More
  • Hip pain in the elderly

    Hip pain in the elderly

    Hip pain in the elderly Joint pain in the elderly population is a common complaint, with women being affected more often than men. There are several causes of hip pain amongst the elderly. We’ve put together this quick-fire list to inform you of what can cause hip pain in our senior citizens. Joint disease One of the most common causes of hip pain in the elderly is joint disease that leads to degeneration of the joint surfaces and results in a poorly moveable joint. The most common condition affecting the hip is osteoarthritis (OA), affecting approximately 25% of the population. The hip is a weight-bearing joint and through a lifetime has to withstand a great deal of force passing through it on a daily basis. Many factors in a person's life can lead to the onset and progression of OA in the hip joint. An injury to the hip earlier in life can kick start a process of early degeneration leading to poor movement and the development of pain as a person journeys through the second half of life. Other factors that may lead to the development of hip OA include obesity and or poor exercise regimes (or lack of exercise altogether). Other forms of joint disease that can cause hip pain include rheumatoid arthritis (RA), gout and pseudogout. Bursitis The word ‘bursitis’ means inflammation of a bursa. A bursa is a small, fluid-filled sac found throughout the body around joints and areas of high movement to reduce friction. There are several bursae found around the hip. These are usually located between a bone and tendon (or other tissues) and help to maintain smooth-moving joints. Weakness or long-standing dysfunction of the gluteal and other hip-related muscles (often seen in the elderly) can lead to compression of the bursae which increases the load on them. Over time and repetition of movement, the bursae can become inflamed and cause pain, often felt on the bony, outside part of the hip. Bursitis can be treated with hands-on therapy and exercise prescription aimed at strengthening and improving movement at the joint. Frequently, bursitis has a immune-metabolic origin. Clinically, I noticed this when working with young elite Swiss sports people back in the early 1990's, that they could suddenly develop bursitis which invariably involved some sort of predisposing immune compromise. Commonly, this involved a case of diarrhea or a cold or similar, in the 6 weeks prior to the onset of the bursitis. I've continued to notice this trend across the spectrum of ages and physical activity in the decades since. A similar trend exists for tendinopathy as well. where scientific research has demonstrated invasion of immune and fatty substances. Moreover, the bursitis and tendinopathy usually co-exist. Please see the shoulder section of this website for details on the latter and see the section on immune system and chaos for the former.  Importantly, the gut biome should be consider in either case. The use of pro-biotics may be considered, such as sauerkraut, acidophilus, etc  Tendinopathy Tendons join muscles to bones. As we age, the health of our muscle and tendon tissue declines and the efficiency of movement is affected. Similarly to bursitis, long-standing muscle dysfunction because of a failing hip joint can place excessive load on the tendon which attaches the muscle (e.g. the gluteal muscles) to the thigh-bone. If strengthening of the muscles and tendons is not achieved in the early stages of injury or disease, the fibres that make up the tendon become degenerated and deranged, resulting in a condition known as tendinopathy. This affects the tendon’s ability to withstand high loads passing through it and can lead to pain, regularly felt before and after exercise or movement. Long standing tendinopathy can lead to a tear which is common in older persons and can be the cause of much disability. Lower back dysfunction This is a very common cause of hip pain in the elderly population. As we age, our spines and the various tissues that play a pivotal role in its functioning can become degenerated. If a degenerated bone or joint in the spine presses on a nerve coming out of the spine, it can lead to a phenomena known as ‘radicular pain’. This is pain that may be felt in the hip (or other areas of the lower limb) but actually the problem lies in the lower back. Fracture Due to the increased rates of conditions including osteoporosis (loss of bone mass) and sarcopenia (loss of muscle mass), we are more prone to falling as we get older. A fall onto the outside of the hip can easily result in a fracture of the neck of the thighbone, close to where it attaches into the pelvis. As with any bone fracture, pain is a common symptom. A hip fracture may require surgical intervention and can greatly impact the health of an elderly person with increased risks of infection and death posing a real threat. If you have hip pain and are concerned, please call us today on 02 9922 6806 to book your appointment immediately. Stay safe everyone! Uploaded : 2 October 2020 Read More
  • Meniscus tears

    Meniscus tears

    Injury blog: Meniscus tears Hello readers and welcome to another of our monthly health blogs. This month we take a look into the world of knee meniscus injuries. Studies from the US report approximately 61 in every 100,000 people experience a knee meniscus injury every year. You are more susceptible to injuring a meniscus in your knee if you participate in sports such as football (all forms), basketball, netball, skiing, baseball and wrestling. There is also a high rate of meniscus injury seen in those who work in the military on active duty. Essentially any job or sport that requires lots of squatting and kneeling can leave you open to an injury of this kind. But what is a meniscus? Anatomy The meniscus are found inside the knee joint, nestling nicely between the thigh and shinbones. They are crescent-shaped pieces of toughened tissue (a type of cartilage) and there are two in each knee. One sits on the outside part of the knee joint (i.e. lateral meniscus) and one sits on the inside part (i.e. medial meniscus). They act as shock absorbers to the various loads and forces that pass through the knee during movement. They also have a slightly wedge-shaped appearance being thicker around the outside compared to the inside, and this provides a deepening of the joint surface to allow for a more snug-fit joint. The top of the shinbone is quite flat compared to the very rounded ends of the thighbone… The meniscus help to stabilise this slight mismatch of joint surfaces. Causes of a tear The most common cause of a meniscus tear is an excessive or forceful twisting of the knee whilst the foot is planted on the ground. This might happen as a result of landing awkwardly from a jump, or from the force of another person or opponent’s body acting on the knee. During this type of movement, if the force is too much for the meniscus to withstand, tearing may occur. The medial (inside) meniscus tends to be injured more than the lateral (outside) meniscus. This is because the medial meniscus attaches to other structures inside the knee joint, leaving it less mobile to forces acting on it compared to its lateral counterpart. Signs and symptoms The experience of a meniscal tear will vary from person to person depending on the cause. A young footballer who has been injured during a tackle with high forces involved will likely present in a great deal of pain with a swollen and restricted knee. Injuries sustained in this way are likely to be more severe with associated ligament injuries as well. On the flip side, an older person who has been gardening for the weekend spending lots of time squatting and kneeling may present to the clinic with a very different picture. There may be no high force movement involved, but instead the tear has occurred due to degenerative changes that have occurred to the cartilage tissue. Symptoms in these types of injury are less likely to be so acute and may only appear 24-48 hours down the line. Signs and symptoms you might expect from a meniscal tear may include any or all of the following: • Pain when walking, squatting or jumping• Restriction of the knee joint with or without swelling• Knee joint locking• A popping or clicking sensation (often following an episode of locking)• A feeling that the knee may give way • Tenderness around the line of the knee joint where the tear has occurred Diagnosis and treatment The first thing to do if you have injured your knee is to see a physiotherapist as soon as possible. A painful, swollen, restricted and inflamed knee following an incident is a sign something is not right, so seek help quickly. We will ask questions about what has happened and examine your knee closely. Some people will be able to move around well, others with a severe injury may be more limited. The management of meniscal tears will vary depending on how the injury happened (i.e. are we also dealing with a ligament injury?), and the age and goals of the patient. In some instances, we might suspect a small tear and a patient is presenting with pain but has good overall movement and doesn’t have any of the more severe symptoms such as locking or giving way. In these cases,; we’d use hands-on treatment and exercise prescription in order to strengthen the knee and restore full function through massage, mobilisation and whole body movement. In instances where we suspect a large tear and a patient is presenting with high amounts of pain, restriction and locking and/or giving way in the joint, we may first need the assistance of some imaging or surgery (i.e. an arthroscope) to determine the severity and clear the knee of any large tears. Some tears require removal of the cartilage tissue whereas some can be repaired. The surgeon will always try to retain as much of the meniscus as possible to reduce the impact on knee mechanics following recovery and for the future. Regardless of the initial management, rehabilitation will aim to: • Reduce pain and increase range of motion to the knee• Improve strength of the quads, hamstrings, calves and other knee and hip related muscles• Return to sport or previous duties as soon as possible without risking further injury Seeing us as soon as possible will help to limit complications and help get you back to 110% (we always like to get you back fitter than you were before the injury!) at the earliest possible opportunity. Whether your goal is to garden or return to kicking goals, we can help get you there. Call us today on 02 9922 6806 to book your appointment. And squat! Uploaded : 27 September 2020 Read More
  • Sacroiliac Pain - imaging and stability testing exercises

    Sacroiliac Pain - imaging and stability testing exercises

    Sacroiliac Pain - musculoskeletal physiotherapeutic clinical reasoning using imaging and stability testing exercises The sacroiliac joint (SIJ) is designed to transfer the load from along muscle energy straps of the limbs into the torso. The torso, hip and pelvis are constructed into a series of slings (front, back, side, inside and spiral) which supports those structures receiving the load. Consider a person lying in a hammock and you have an analogy, for skeletal support, by the soft tissue structures of the body. Andre Vleeming described these 'slings' in the 1990's and body work practitioners such as Ida Rolf (and Thomas Meiers) referred to myofascial trains in the 1970's. As such, a series of exercises can be used to assess and treat stability across the SIJ. People interested in the 'energy straps' across the lower limb should look at 'inverse dynamics' elsewhere on this site. Inverse Dynamics Those interested in 'hands on' treatment of pelvic dysfunction should look at : https://www.back-in-business-physiotherapy.com/we-do/muscle-energy-techniques.html elsewhere on this site  Uploaded : 19 September 2020 Read More
  • Tips for sleeping like a baby

    Tips for sleeping like a baby

    Tips for sleeping like a baby Do you consistently struggle to get a good night’s sleep? Well lucky for you we’ve compiled a helpful little guide to getting the best Zzz’s’s possible. It’s easy to get caught up in life and develop nasty habits that can affect our body’s ability to get itself prepared for lights-out time. Read on for tips on taking control of your sleep. • Create a routine: Routine equals consistency. If it’s possible, try to stick to a routine of going to bed at the same time every day. This would ideally run throughout the whole week, including weekends. There will always be occasions where you won’t be able to stick to this… meals out, parties, etc. But when that happens, try to get straight back into your routine as soon as possible. Your body will respond well to routine and you may find falling asleep easier once you are locked into a pattern. Think about including some relaxation time each night where you snuggle up with a book or drink a soothing cup of chamomile tea. • Create the ideal environment: What is your bedroom doing for you? Is it too hot or too cold? Temperature is important for creating the ideal sleep environment. The Sleep Foundation recommend a room temperature between 15.5 – 19.5 degrees Celsius for optimal sleep. Also, think about keeping your bedroom as noise and light-free as possible. And of course, a comfortable pillow and mattress to support your body is a must! We can help find a suitable option when it comes to pillows and mattresses. Chat to us next time you’re in the clinic. • You get out what you put in: Try to avoid smoking, drinking alcohol and eating a hearty meal before bed. Aim to eat your last meal a minimum of two to three hours before you hit the sack. All of these things can lead to disturbed sleep and increase the risk of wak-ing up tired the next day. The saying sticks… you get out what you put in! • Bedroom = sleep: This is a big one. Technology is finding its way into our bedrooms more and more. For many people it’s the only time they get to switch off and check their social media accounts or catch up on emails. But we recommend avoiding screens. Keep your bedroom for sleep and sleep only. If you have to use a screen before bed, set aside time earlier in the evening to get this work done. The light given off by tablet or phone screens stimulates the brain, when in reality, you should be trying to relax, allowing it to switch off. • Avoid daytime naps: We all know how nice it is to have a little siesta during the day. But there is logic in the assumption that if you struggle to sleep through the night, removing your daytime nap could help to regulate your night-time sleep pattern. • Exercise regularly: Emerging research into the effect of exercise on sleep shows that light-to-vigorous exercise helps a person to fall asleep faster and improves the overall quality of sleep. It is thought that exercise helps to increase the amount of deep sleep you get, as well as helping to de-stress the mind to allow for a more relaxed cognitive state. We suggest not trying to implement all of these at once. Why not pick just one or two changes and work with them for a few weeks. It may take some time to find what works best for you. References1. Help Guide. 2019. How to sleep better. [Online]. Available from: https://www.helpguide.org/articles/sleep/getting-better-sleep.htm. [Accessed 15 Jul 2020]2. SleepFoundation.org. 2020. Healthy sleep tips. [Online]. Available from: https://www.sleepfoundation.org/articles/healthy-sleep-tips. [Accessed 15 Jul 2020]3. Johns Hopkins Medicine. 2020. Exercising for better sleep. [Online]. Available from: https://www.hopkinsmedicine.org/health/wellness-and-prevention/exercising-for-better-sleep. [Accessed 27 Jul 2020] Uploaded : 25 August 2020 Read More
  • Hip flexor injury: Contusion vs strain

    Hip flexor injury: Contusion vs strain

    Hip flexor injury: Contusion vs strain Hey everyone! This month we are drawing focus on injuries that affect our hip flexor muscles. Injury to the hip flexor muscles can lead to pain felt in the front of the thigh region, as well as the hip and groin. Hip flexor injuries are common in sports, including football (all forms), basketball, hockey and athletics. What are your hip flexors? Your hip flexors are a group of muscles that move the thigh forwards and outwards, in front of the body. The main muscles involved in the movement of hip flexion include: • Rectus Femoris (one of the quadriceps muscles)• Iliacus and psoas (pronounced ‘so-ass’ — collectively known as the ‘iliopsoas’ muscle)• Tensor Fascia Latae (or TFL)• Sartorius• Some of the groin muscles known as the ‘adductors’ The most commonly injured hip flexor muscle is the rectus femoris muscle (pictured above). This is the muscle that runs from the pelvis, down the centre front of the thigh, to below the knee. This muscle not only flexes the hip, but also extends (or straightens) the knee. Types of injury The most common injuries of the hip flexor muscles (i.e. rectus femoris) include contusions and strains. Contusion: A contusion is an area of skin and underlying tissue that has been damaged by a blunt force trauma. This may come in the form of an opponent’s knee during sport, or an object like a hockey puck striking the thigh. A contusion is also known as a ‘cork’’. The impact of an object causes the tiny blood vessels under the skin and in the muscles to break and bleed. The blood collects into a space around the impacted muscle fibres creating a pool of blood. A bruise appears on the skin where the impact has occurred. Strain: A strain is a tearing of muscle fibres usually caused by a force too great for the muscle to withstand. This may occur during an explosive movement including kicking, jumping or running. Strains are either partial (where some muscle fibres tear and others remain intact — known as Grade 1 or 2 strains depending on severity) or complete (where every muscle fibre tears — known as a Grade 3 strain or in the old nomenclature Grade 3 partial complete full thickness tear, grade 4 complete tear. The latter is still commonly used in calf tears). Strains most commonly occur at the location where the muscle merges into a tendon. In the case of the rectus femoris muscle which runs vertically down thigh, strains usually occur at either the hip-end or the knee-end of the muscle. It can be difficult to distinguish between a contusion and a strain as many of the signs and symptoms are similar. A thorough case history which takes down information including how the injury occurred and how it developed over time can help your physio come to an accurate diagnosis. Signs, symptoms and features The following table compares the features seen with a typical contusion versus a strain: Treatment The way we treat a contusion and a strain are very similar. The length of treatment tends to increase for more severe strain injuries, but the principles of treatment are largely the same. As with any acute injury, the first line of treatment is to control the bleeding and swelling under the skin. This includes protecting the body part from worsening injury, loading the part appropriately (i.e. being on crutches vs full weight-bearing), ice, compression and elevation of the affected body part. Gentle stretching and contraction of the affected muscle is allowed if tolerable. The next stage is to get the knee and hip joints back to full, pain-free range of motion. We can help here with some hands-on massage and joint mobilisation. We’ll kick up the stretching and increase the amount of strength training too. You should be able to use an exercise bike and go swimming at this stage, but we’ll advise when you can do it safely. When you are back to full weight-bearing exercises with full range of motion, the aim is to progress strength and flexibility exercises gradually over a period of weeks. These will include a combination of agility, jumping and balance exercises. When you reach your exercise goals, we’ll advise when return to training/full sport participation is appropriate… If that’s what your ultimate goal is. The most important thing is to ensure the return to sport/activity does not happen too soon. Strains commonly recur, usually as a result of rushed or incomplete rehabilitation before returning to the sports field. So… taken a hit or felt a tear? Give us a call on 02 9922 6806. If you need help with a hip flexor injury, please do not hesitate to get in touch immediately. Early treatment is always preferred over the waiting game. With our help, you’ll be back hopping, skipping and jumping your way to a gold medal in no time at all. References 1. Healthline. 2019. Understanding hip flexor strain. [Online]. Available from: https://www.healthline.com/health/hip-flexor-strain. [Accessed 15 Jul 2020].2. Brukner, P. et al. 2017. Clinical Sports Medicine. 5th ed. Australia: McGraw Hill Education3. Margo, K. et al. 2003. Evaluation and management of hip pain: An algorithmic approach. The Journal of Family Practice. 52 (8). Available from: https://mdedge-files-live.s3.us-east-2.amazonaws.com/files/s3fs-public/Document/September-2017/5208JFP_AppliedEvidence1.pdf Uploaded : 25 August 2020 Read More
  • Whole Body Vibration

    Whole Body Vibration

    Whole Body Vibration (WBV) by Martin Krause In 2009, we (Alfio Albisini and myself) published the first book (DOI: 10.1016/B978-0-7020-3173-1.X0001-4) on the therapeutic application of Whole Body Vibration (WBV). Since that time, new research has described, some new and novel mechanisms and effects of WBV. Introduction Most human movement involves low amplitude, moderate frequency vibration (<1g, 30-90Hz). Such mechanical loading results in what is termed mechano-transduction. The transition of a mechanical load to a hormonal response, involves the stimulation of hydroxyapatite crystals (interspersed amongst a collagen matrix), which in turn has an influence on osteoclastic (bone mineral resorption) versus osteoblastic (bone mineral forming) activity. As such, the use of WBV therapy, in the treatment of osteoporosis in the frail elderly, or young individuals with osteogenesis imperfecta, has become popularised in recent decades. Additionally, within the fitness industry, entire gym programs exist, which incorporate WBV machines (e.g. Galileo), to improve strength and agility. Although, superimposing exercises on WBV is very popular, the effect of 4 weeks of heavy strength training, superimposed with WBV, have shown equivocal results, when examining corticospinal neuronal drive (Weigal AT & Kidgell DJ 2012 The Scientific World Journal Article ID 876328  https://doi.org/10.1100/2012/876328 ). Twelve participants (6 male and 6 female aged between 18 and 27) performed four sets of six to eight repetitions at 80% of 1RM, with three minutes recovery between sets. WBV was set at 35hz and 2.5mm displacement. It may well be, that WBV has more obvious effects on people with greater functional impairment. One investigation, in poeple with strokes found, the effect on muscle strength and balance and gait function, were small. However, the effect for bone metabolism and spasticity were moderate, suggesting that WBV training may provide a safe, alternative treatment method for improving the symptoms of stroke (Park YJ 2018,BioMed Research International Article ID 5083634 https://doi.org/10.1155/2018/5083634 ). Mechanisms It has been suggested that WBV works via at least two mechanisms. The first, traditional mechanism, was a direct influence on muscle mechanics. It was thought that the stimulation of working muscles stimulated the hydroxyapatite crystals and hence the osteocytes in the bone, thereby ameliorating osteopenia and osteoporosis. The more contemporary thought, is that WBV has a direct influence on the stimulation of the osteocalcin, residing on the bones, which in turn acts on the muscles, preventing or ameliorating sarcopenia, which then provides the functional strength needed for weight bearing activities and sporting accomplishments. It could obviously be both, where a cycle exists, of one influencing the other. If this were the case, then in functionally impaired people, the direct influence of the vibration on the bone will be more critical to muscle mass than in the athletic environment, where the exercises themselves, accompanied by the vibration, has a more profound direct effect on muscles, over the indirect effect from the bone? Frail elderly and athletes Apart, from the therapeutic effects on the bones and muscles of the frail elderly, WBV has also been used to improve sporting performance, in athletes, through the stimulation of muscle. At lower frequencies (<20Hz) WBV is thought to help with muscle relaxation and hence can be used during stretching routines. WBV has also been used to improve explosive strength and postural control thereby enhancing athletic performance (Fort A, et al 2012, J Strength Cond Res. 26, 4, 926-36). At higher frequencies (30-50Hz), it's been used as an adjunct to plyometric (box jump) strength training, as it is thought, that each oscillation, is the equivalent to a jump, at a neurophysiological (muscle spindle receptor - spinal cord) level. The addition of functional exercises, to the passive WBV stimulation, probably brings higher center motor control in to play. In fact, investigators have demonstrated enhanced descending modulation after 10 minutes of WBV, as well as reduced spinal cord reflex activity in the soleus muscle (Krause A et al 2016 J Musculoskelet Neuronal Interact., 16, 4, 327–338). In another investigation, it was shown that WBV, during squat exercise, compared to no WBV, led to a corticospinal facilitation concomitant with intracortical modulation, thus describing increased intracortical inhibition and diminished intracortical facilitation (Mileva KN et al 2009, Exp Physiol., 94, 1, 103-16). One could assume that these results represent enhanced motor control. WBV has also been used, in a variety of other settings, to improve implant adherence to bone, in people with bone softening (Zhaoug et al 2015 Bone, 71, 17-24, https://www.sciencedirect.com/science/article/abs/pii/S8756328214003652) , used in neurological conditions, such as stroke (Tankisheva E, et al 2014, Arch Phys Med Rehabil., 95, 3, 439-46). and cerebral palsy (Ahlborg L, et al 2006, J Rehabil Med.,38, 5, 302-8), to improve balance and muscle spasticity, to improve gait after spinal cord injury (Ness LL, et al 2009, Gait Posture. 30,4, 436-40), as well as being used to improve cosmonauts musculoskeletal health, after prolonged space missions. Children with haemophilia 30 children (aged 9-13 years) with haemophilia. were divided into 2 groups, comparing standard physiotherapy to WBV (30-40Hz, 2-4mm amplitude, 15 minutes, 3 x wk for 12 weeks) in conjunction with standard physiotherapy. Researchers found that children in the vibration training group showed significant improvement in all outcomes including quadriceps strength, bone mineral density, and functional capacity, which was evaluated using a six-minute walking test. Children in the vibration training group were able to walk an average of 325 meters in six minutes compared to only 290 meters in the standard physiotherapy intervention group (El Sharmy S 2017 J Musculoskelet Neuronal Interact, 17, 2, 19-26). Osteocalcin Traditionally, bone has been considered an inert structure. Purely, providing the frame where upon muscles exert their work, through the bony levers. However, contemporary evidence suggests that bones are more than mere mechanical levers, where in fact the reverse applies, whereby bone acts on muscles. It's been suggested that bone remodelling is an energy intensive process which requires a sensor and regulator of energy needs. This hypothesis led to the demonstration a few years ago that osteocalcin, an osteoblast-derived protein, was a hormone regulating glucose and energy homeostasis (Lee NK (2007) Cell, 130, 456-469). Such an energy system, would suggest a gut-bone and a muscle gut axis. Indeed, gut-derived hormones such as glucagon-like peptides 1 and 2 and serotonin have been shown to regulate both bone remodelling and energy homeostasis (Henriksen DB et al (2009), Bone 45, 833-842; Ma, X et al (2013) Bone Miner Res, 28, 1641-1652; Sumara, G et al (2012) Cell Metab.,16, 588-600; Yadav, VK et al (2009) Cell 138, 976-989) Osteocalcin (glutamate derived decarboxylated structural protein), resides on the surface of bones, and has several interactions with organs, thus making bone an endocrine organ. Animal models, have shown that reduced osteoclacin leads to type II diabetes, obesity, and hypertension (Moser SC et al 2019, Front. Endocrinol., 10, January   https://doi.org/10.3389/fendo.2018.00794).  Matthieu Ferron & Julie Lacombe (2014) https://www.researchgate.net/profile/Mathieu_Ferron2 Additionally, the review (Moser et al 2019) suggested that reduced osteocalcin affects male fertility, muscle mass (especially in the presence of sarcopenia), cognitive ability, brain development and inflammation. Even, suggestions of effects on tumours has been entertained. Apart from the effect of osteocalcin, on insulin sensitivity, described above, additionally it has been shown, in vivo mice experiments, that osteoblasts have Glut 4 receptors metabolically involved in glucose absorption, at a rate similar to that seen in muscle (Li Z et al 2016, Endocrinology, 157, 11,4094-4103). Presumably, WBV can have a direct effect on osteoblasts as well as osteocalcin, suggesting a dual mechanism of action? Moser et al 2019. Front. Endocrinol., 10 January | https://doi.org/10.3389/fendo.2018.00794 WBV, insulin sensitivity, inflammatory markers and DNA injury in white blood cells Investigators (Yin H et al 2015 Springerplus, 4, 578, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4628131/), using an animal model, demonstrated profound effects, of WBV, on markers of inflammation and glucose metabolism/sensitivity. Improved Glucose Sensitivity Reduced Inflammation Indication of DNA injury in white blood cells markedly reduced in WBV Conclusion Since publishing our book in 2009, both human and animal research has shed more light on some of the significant beneficial effects of WBV. Furthermore, the mechanism by which it has such an effect, seems to reside within bone itself and osteocalcin in particular. Further research is still required to establish dose - responses in various population groups, from the frail to elite athletes. Never-the-less, currently, stimulation <20 Hz is considered to improve muscle relaxation. Stimulation in the range 30-50 Hz improves muscle power. Stimulation at higher frequencies (>1g and >50Hz) needs to establish a risk-benefit ratio in various population groups. Currently, when considering dose,  we suggest a familiarisation period of 2 weeks, with short duration sessions (10-20 minutes), incrementally increasing these up to an hour in healthy population groups. A similar strategy can be employed during rehabilitation, so long as functional outcomes are being monitored, whereby incremental increases in dose, are reflected through demonstration of continued improvement. Individual technique and fitness levels, as well as the morphology of the person (muscle mass, floppy vs stiffy) will considerably influence the selection of dosage and the tolerability of the WBV stimulus.   References https://www.sciencedirect.com/topics/medicine-and-dentistry/whole-body-vibration https://www.elsevier.com/books/using-whole-body-vibration-in-physical-therapy-and-sport/9780702031731 Uploaded : 23 July 2020 Updated : 26 July 2020 Read More
  • The twists and turns of torticollis

    The twists and turns of torticollis

    The twists and turns of torticollis Hello readers and welcome to our August 2020 blog. This month’s topic is a neck condition known as ‘Torticollis’. You may have also heard this condition referred to as ‘wry neck’.  What is Torticollis? Torticollis is a painful neck condition where one of the strong muscles on the side of the neck shortens, causing the head to twist and tilt out of its normal position. The muscle we are referring to is the ‘Sternocleidomastoid’, or SCM for short. It’s easy to locate this long ‘strap’ muscle… Turn your head to the left and the SCM pops out on the right-side of the neck. Trace a line from the base of your skull just behind the ear, down to the top of your breastbone and you should be able to feel the muscle. Although the name is a bit of a mouthful, it perfectly describes the at-tachment points for the muscle on the body: • Sterno- refers to ‘sternum’ which is the name of your chest / breastbone• Cleido- refers to ‘clavicle’ which is the name of your collar bone• Mastoid- refers to the ‘mastoid process’ which is a bony lump found behind the ear at the base of the skull There is a SCM muscle on each side of the neck. This muscle helps you to:• Turn your head to the opposite site• Touch your ear to your shoulder• Bend the neck forward• Tilt the head backwards• Breathe (it is an ‘accessory' muscle for breathing - kind of like a little helper to the main breath-ing muscles) Types and causes There are two main types of torticollis—congenital and acquired.Congenital torticollis means the condition is present at birth. This problem can develop in the mother’s womb if the baby’s head is held in an awkward position, or if the blood supply to the muscle is disrupted. Sometimes the bones in the neck do not develop properly and become fused together, this can also lead to a rare type of torticollis called Klippel-Feil Syndrome. Acquired torticollis means the condition develops after birth. The condition is common in both children and adults. Acquired torticollis can be caused by injury to the muscle, or the nerve that supplies electricity to the muscle. In the majority of cases, the cause is completely unknown. As with congenital forms, there are some rarer acquired types, including ‘spasmodic’ torticollis. This type is also known as ‘cervical dystonia’ and is a form seen in adults where all the usual symp-toms are seen, but may also come with a jerking type motion of the head caused by spasms in the SCM muscle. Signs and symptoms The signs and symptoms of torticollis depend on the type, but the main features include: • Neck pain and/or stiffness• An inability to move the head in the usual way• A tilted head to one side• Swollen and tender neck muscles• Uneven shoulder height• Headaches Treatment Parents reading this who have experienced torticollis with their newborn or young child will prob-ably remember the stress that comes with seeing their helpless little human with a seemingly un-changeable head position. It really is quite unsettling. The good news is that for the majority of cases, some focused regular stretching is all that’s needed to correct the head position and re-store the muscle to its full length. Young children usually respond very quickly to hands-on treatment. Some of the rarer congenital forms of torticollis can also be treated in a similar way, but these forms may also require the opinion of a surgeon who can perform a procedure to lengthen the muscle. As with a lot of conditions, surgery is a last resort and will only be considered when all non-surgical treatment techniques have failed. Other treatment techniques used for torticollis include:• Massage of shortened and tight muscles• Heat pack therapy to increase blood flow and relax tight muscles• Joint mobilisation and manipulation For people who live with a permanent or chronic torticollis, other complications are common. These include difficulties carrying out activities of daily living, depression, social isolation and chronic pain. Treatment should be from a multidisciplinary approach. This means that as well as seeing your physio for hands-on therapy, your doctor, psychologist, friends and family will all play a part. If you or a family member are struggling with torticollis, or a neck issue of another kind, please call us here at Back in Business Physiotherapy on 02 9922 6806 to arrange a convenient time to come in for a consultation. We’d love to help unravel the twists and turns of your torticollis and get your neck feeling relaxed and happy Uploaded : 20 July 2020 Read More
  • Injury blog: Shoulder impingement

    Injury blog: Shoulder impingement

    Injury blog: Shoulder impingement Do you have shoulder pain? Are you an office worker, professional athlete, hairdresser or full-time parent? These are just some of the types of people we see in the clinic who need help with shoulder pain. One of the most common complaints we treat here, at Back in Business Physiotherapy, is shoulder ‘impingement’ (aka subacromial impingement). “What is impingement?” we hear you ask. Read on to find out. Anatomy overview The shoulder is a pretty complex region of the body when it comes to anatomy and how it all works together to allow us to move. The connections between the arm bone ( humerus), collar bone ( clavicle), shoulder blade (scapula) and the rib cage, provide us with the perfect base for a limb that is able to move through an extremely wide range of motion… The most movement out of any other joint in the body. Having lots of movement is great because it means we can do lots of wonderful things like reach the back of our head to wash our hair and reach our backs too (like when tying an apron). In order to achieve this level of movement the shoulder has to be less stable, and this leaves it prone to injury. The arm bone and shoulder blade form the ‘ball and socket’ part of the shoulder, where a large amount of the movement takes place. The ligaments between these bones are quite loose and a group of muscles, known as the ‘rotator cuff’ muscles, help to keep the ‘ball’ of the arm bone po-sitioned correctly over the ‘socket’ of the shoulder blade, as well as aid with certain movements, including rotation or turning of the arm. Small spaces..... Over the top of the ball and socket joint sits the ‘acromion’, which is a bony prominence of the shoulder blade which creates a roof over the joint. Between the top of the ball and the bottom of the acromion is a small space known as the ‘subacromial space’. Some tendons of the arm muscles that create movement of the shoulder pass through this space on their way to their at-tachment site on the bones. There is also a ‘bursa’, which is a small sac of fluid which helps to keep movements around joints smooth and frictionless. There is quite a lot of tissue all crammed into one small space, and this is an important factor in the development of impingement. Common causes of shoulder impingement include:• Repetitive overarm throwing or other above-shoulder movements• Long-standing poor posture or poor movement patterns• De-conditioned or weak shoulder muscles from leading a sedentary lifestyle• Heavy lifting Immune metabolic compromise can also affect the tendon-bursa complex. These include high cholestereol, diabetes, irritable bowel syndrom, etc Anything that leads to the structures which pass through the subacromial space becoming irritated and inflamed can cause impingement-related pain. Inflammation can lead to swelling of the tissues in the small space and when we move our arm up or out to the side, these tissues get pinched between the bones, and we feel pain. Any of the above-mentioned structures can be-come inflamed, but there is rarely just one tissue solely responsible. If the tendon of a rotator cuff muscle is inflamed, there is every chance the bursa will also be inflamed. Signs and symptoms Signs and symptoms of shoulder impingement include:• Pain with arm movements (particularly movement in front and out to the side of the body)• Pain with shoulder rotation• Pain that radiates down the outside of the upper arm• Reduced shoulder range of motion Treatment At the root of most cases of shoulder impingement is poor and inefficient shoulder movement. When you come to see us for treatment, we will look beyond the shoulder to other areas of the body, like the spine. The neck and mid-back areas of the spine are regularly restricted and need some help to move well again. Once the spine moves well, shoulder function improves too. The shoulder blade also needs to sit correctly over the rib cage in order for the ball and socket joint (and other joints) to work efficiently. Weakness of the muscles which stabilise the shoulder blade on the rib cage can lead to poor positioning of the blade during movement, so we will aim to improve this by giving you focused strengthening and stability exercises. A solid base = good, smooth movement. Through a combination of us using our hand techniques (like massage and joint mobilisation), progressive exercises and lifestyle changes, you can expect to see positive changes quite quick-ly. The end goal of ensuring your pain doesn’t return is always a lengthier process and requires dedication from yourself (and us) to make sure the changes we make early on stay in place for time to come. We are here to help you every step of the way. Shoulder pain? Call us today on 02 9922 6806 Uploaded : 3 July 2020 Read More
  • Shoulder injury blog: Labral tear

    Shoulder injury blog: Labral tear

    Shoulder injury blog: Labral tear The shoulder is one of the most complex joints in the body. It is made up of a total of four joints, numerous ligaments, joint capsules, muscles and other soft tissues. Movement at the shoulder is a complicated process and it relies on the controlled function of all the involved muscles and joints for that movement to be efficient and complete. Our shoulders are the most mobile joints in the body which is great for us because it means as humans we get to partake in fun activities like throwing sports, gymnastics and dancing, as well as movements we generally take for granted like being able to do up our bra’s behind our backs. This wide range of movement is only possible because the shoulder is less stable when compared to other joints in the body, leaving the shoulder prone to injury. This blog specifically focuses on an injury that relates closely to the ball and socket part of the shoulder joint. If you are into throwing sports, you may be familiar with it… It’s called the labral tear. A bit of anatomy… There are two main ball and socket joints in the body, found at the shoulder and the hip. Both work where a rounded ‘ball’ of one bone fits into a hollowed ‘socket’ of another. At the hip (the strongest joint in the body), the socket is very deep, and the ball part fits quite snuggly into it. This is a very stable joint. The socket in the shoulder is very shallow by comparison, and the ball part is still quite large. This is what gives the shoulder its lack of stability. Both the shoulder and the hip sockets are deepened and supported by the presence of a labrum — a rounded soft-type of cartilage. In the shoulder, the labrum completely surrounds the rim of the socket creating a ring. The very top part of this ring also acts as the attachment site for one of the tendons of the biceps muscle — a powerful mover of the shoulder and elbow joints. How does a labrum tear? The main ways labral tears occur are: • Repetitive movements such as overhead throwing• Carrying heavy objects• Dropping and catching heavy objects A tear can occur over time as the tissues degenerate over time and become weaker, or it might be from one single, forceful event. In most cases there is usually a combination of both degeneration and a large force which becomes the ‘straw that breaks the camel’s back type of scenario. As the biceps tendon attaches to the socket through the labrum, any large force that pulls on the biceps tendon (like suddenly catching a heavy object) can lead to the tearing of the labrum itself. The most common type of tear occurs across the top of the labrum from front to back, and these are known as SLAP (i.e. Superior Labrum Anterior Posterior) tears. Signs and symptoms If you have sustained an injury to the labrum in the shoulder, you may notice any or all of the following signs and symptoms: • Pain during shoulder movement (especially overhead and behind back movements)• Restricted shoulder movement• Popping, catching or grinding during shoulder movements• Tenderness at the front of the shoulder Depending on how you were injured, how severe your symptoms are, and your personal circumstances regarding work and home life, you may be sent for some imaging to confirm the tear. The tests we perform in clinic when we assess you do not always give us all the information we need to determine the best plan of action. A combination of clinical tests and imaging may give us a clearer picture of what’s going on. Can it be treated by a physio? Yes, but this completely depends on the severity of the injury and what your goals are. In most cases it is recommended that conservative therapy from a physiotherapist is tried first. Many athletes who have a labral tear can return to playing to some capacity with a non-surgical approach. The treatment aims to return the shoulder to full, pain-free range of motion through hands-on massage, mobilisation and rehab exercises that focus on range, control and strength of the shoulder girdle. For severe tears, you may require the opinion of a shoulder specialist. A labrum is not great at healing itself and sometimes needs help from a surgeon to return to normal. A professional athlete wanting to return to sport may choose this pathway, but a non-athlete who has no desire to throw a ball seriously again may be able to avoid surgery altogether. If you have a diagnosed labral tear, or have recently injured your shoulder and need help, we recommend coming to us at Back in Business Physiotherapy where we can discuss the best course of action for you and your circumstances.  Upload : 2 June 2020 Read More
  • COVID mental health check-in

    COVID mental health check-in With the coronavirus outbreak still affecting millions around the world, we thought it would be a good time to check-in and see how you are all going. The news is pretty grim at the moment and you may be finding yourself asking the question, “When will there be any good news?!” This day-to-day bombardment of the effect of the virus across the world is enough to get the happiest of people down. We’re here to make sure you are keeping your mental health in check. We ask you the question… What are you doing to look after your mental health? These have been difficult and stressful times for many of us. Some of us are starting to come out of strict lockdown restrictions, some of us are still feeling the effects, and many of us will feel these ef-fects for some time to come. It’s good to talk If you are struggling on a daily basis and this pandemic has had a real effect on your mental health, you are not alone and help is out there. Being made to stay away from family members and friends is tough and some people, especially the elderly, will have found this extremely diffi-cult at times. Please talk. A phone call or face-to-face video call (technology is great these days!) is a simple way to stay in touch with loved ones. Speak to someone close to you if you are struggling with personal circumstances. Getting a load off your chest is sometimes enough to make you feel relief, even if it doesn’t solve the root cause of the problem. We understand that your problems may run deeper than this and talking to a loved one is simply not enough. The good news is there are lots of great people out there who are trained to work through such things with people. And even if you cannot get a one-to-one session in person where you live, many mental health professionals including life coaches, counsellors and psychologists are running phone or video/telehealth sessions with their clients. Alternatively, chat to your GP or give Beyond Blue a call on 1300 22 4636. Please do not suffer in silence. Simple tips for keeping your mental health in check  Want some other ideas to help keep your mental health in check? Check out our list below for some go to’s: • Exercise: It’s simple and well researched. Exercise helps to maintain good mental health. Even in lockdown, find a space in the house or outside in the garden and just move. Squat, lunge, hop, skip, jump, dance… We don’t care what it is, just move regularly (and safely please!).• Eat well: Keep your diet clean and hydrate every day and you’ll be doing your bit to keep the body and mind functioning well. Vegetables and fruit of the green leafy and berry va-rieties are packed with nutrients that can help keep the brain healthy.• Go to time-out: No, we don’t mean the naughty step, more so a quiet place where you can be with your own thoughts without the distraction of TV, tablets and other types of media. Read a book, take a bath, give the eyes and ears a rest from it all. It may be hard to break your screen habit, but trust us... It’s refreshing!• Get out the colouring pencils: Yes adults, we are talking to you. Colouring is becoming a very popular ‘escape’ for millions of adults around the world. It has been shown to help reduce the effects of anxiety and stress. Get to your local book store or newsagent to-day, support local shops, and start getting creative (or if you’re unable to do so safely, order online).....or do an amazing puzzle. They are addictive!!! Our message today is simple. Life is sometimes hard, but there is always action you can take to reduce the impact this has on your mental health. Talk. Move. Engage. Relax. Enjoy and stay safe. The Team from Back in Business Physiotherapy Uploaded : 2 June 2020 Read More
  • Injury blog: Abdominal hernias

    Injury blog: Abdominal hernias

    Injury blog: Abdominal hernias Mention the word ‘hernia’ and most people will think of something painful sticking out of the belly region. You’ll be pleased to know this is not always the case. Many cases are completely pain-free and are only noticeable on a person when they are in a particular position. At other times there may be no other visual sign that a hernia even exists! Read on for more information... What is a hernia? A hernia is a protrusion of the abdominal contents (i.e. intestines) through a weakened or damaged part of the muscle or tissue that holds it in place. Hernias are commonly found in the abdominal region of the body; that area between the bottom of the rib cage and the hip / pelvic area. Abdominal hernias can be broken down into two locations: • Abdominal wall location: Hernias that occur through the wall of the abdomen on the front of the belly region• Groin location: Hernias that occur lower down in the abdomen around the groin region  Abdominal wall location There are a few different types of abdominal wall hernias with the most common being: • Incisional: These hernias occur in and around a scar or ‘incision’ left over from a previous abdominal surgery. During surgery, the muscles of the abdominal wall are cut to allow the surgeon to access the inside of the abdomen. This leaves a weakened area of the wall which is a potential site for herniation to occur. This type of hernia accounts for approximately 10-15% of all abdominal hernias. • Umbilical: This is a protrusion at the belly button which is regularly seen from birth. Over time these usually dry up and disappear altogether. It is possible to get these hernias as an adult too, usually as a result of being overweight or pregnant. • Epigastric: There is a tough, fibrous piece of tissue that spans from the tip of the rib cage to the pelvis in the mid-line of the body known as the ‘Linea Alba’. This forms an area of muscular attachment of the abdominal muscles. Due to a weakness in the abdominal wall above the belly button, a hernia can occur. This is common in infants, but again may happen later in life. Groin location • Inguinal: This is the most common type of abdominal hernia accounting for approximately 75% of all cases. The opening for this hernia is a region known as the ‘inguinal canal’ which allows for the testicles and spermatic cord to descend into the scrotum during male development. After this event, the canal should tighten, but in some males the muscles responsible for this do not respond as well as expected, leaving an area of weakness. As females do not forego this part of development, it rarely affects women. • Femoral: There is a space in the floor of the abdomen for a vein and artery to pass through and down into the leg, known as the femoral canal. In females this canal is wider which results in this type of hernia being more common in women than men. It accounts for approximately 10-15% of all abdominal hernias. Treatment Treatment of abdominal hernias depends on the severity and symptoms associated with them. Sometimes with a hernia, the abdominal contents inside them can become trapped and ‘strangled’, ’which can lead to loss of blood supply and ultimately death of tissue. These complications can possibly be fatal if left untreated. In these cases, and with most uncomplicated cases, surgery is the best course of action to ensure a full recovery. There is also a place for physical therapies like physiotherapy. Physio is particularly helpful following a surgical procedure to aid with strengthening of the abdominal muscles and surrounding area, supporting the area and reducing the risk of re-herniation. Scar tissue following surgery can affect our ability to move efficiently, however exercise as well as hands-on therapy can help to reduce the effect of this. If you have an abdominal hernia and would like advice on how to manage it, please get in touch today by going to our online booking website https://www.myhealth1st.com.au/find/physiotherapists/nsw/nsw-region/north-sydney/back-in-business-physiotherapy or by calling us on 02 9922 6806 to book a face-to-face or Tele Health appointment. If you require the opinion of a doctor or specialist, we'll ensure you are placed in the best possible hands. References 1. MSD Manual. 2020. Hernias of the Abdominal Wall. [Online]. Available from: https://www.msdmanuals.com/en-au/professional/gastrointestinal-disorders/acute-abdomen-and-surgical-gastroenterology/hernias-of-the-abdominal-wall. [Accessed 08 April 2020]2. Melbourne Hernia Clinic. 2018. What is a Hernia? [Online]. Available from: http://hernia.net.au/what-is-a-hernia/. [Accessed 08 April 2020]3. MedicineNet. 2020. Hernia (Abdominal Hernia) 9 Types, Symptoms, Causes and Surgery. [Online]. Available from: https://www.medicinenet.com/hernia_overview/article.htm. [Accessed 08 April 2020]4. Healthline. 2019. Everything You Want to Know About a Hernia. [Online]. Available from: https://www.healthline.com/health/hernia. [Accessed 08 April 2020] Uploaded : 28 April 2020 Read More
  • Connective Tissue Disease

    Connective Tissue Disease

    Connective tissue disease Hello readers and welcome to our next blog instalment. This month it’s Connective Tissue (CT) Disease. There are many different CT disorders, with too many to cover in one blog, so we’ve written a bit of an overview so you can learn the basics. The big question we hear you ask is “What is connective tissue?”. Connective tissue is the stuff in our bodies that holds all of our cells together. It's a bit like glue. It has a special role, allowing our skin and other tissues to stretch and then return back to their original state. You can kind of think of it like an elastic band that stretches and recoils over and over. Connective tissue is made of protein, and the main examples in the body include collagen and elastin. Connective tissue disease can pretty much affect any part of our body. Our bodies are made up of trillions of cells (approximately 37.2 trillion!) which all require some form of glue to ensure we are held together in our human form. There are diseases that affect our skin, muscles and tendons, ligaments, bones and cartilage, blood and blood vessels, eyes and more! Types of disease To make things a little easier to get your head around, we can break CT diseases into two categories: • Inherited diseases: These are diseases passed down to us in our genetic make-up. Most of these diseases occur due to a mutation of a single gene.• Autoimmune diseases: These are diseases where our bodies create antibodies that fight against our own tissues. In this case, it’s the connective tissues that our body is fighting against. Inherited diseases Here’s a brief overview of a few inherited CT diseases: • Ehlers-Danlos Syndrome (EDS): A group of 13 differing conditions that affect collagen in the body. Common symptoms include very mobile joints and excessively stretchy and fragile skin. People may also experience heart and lung problems as well as weakened blood vessels. https://www.back-in-business-physiotherapy.com/we-treat/ehlers-danlos-syndrome.html • Marfan Syndrome: A condition that affects the production of the protein Fibrillin-1 in the body. Symptoms are widespread, affecting the blood vessels, heart, bones, joints and eyes. Marfan Syndrome affects approximately 1 in every 5000 people. • Osteogenesis Imperfecta: Also known as 'Brittle Bone' disease. This is a condition that affects collagen (specifically Type I) and leaves bone more fragile and prone to fracture. Other signs and symptoms include a blue tinge to the whites of the eyes, hearing loss and weak joints and teeth. Autoimmune diseases Here’s a brief overview of some autoimmune CT diseases: • Rheumatoid Arthritis (RA): This is not to be confused with the more common Osteoarthritis (OA). RA is a condition typically associated with inflammation of the small joints of the body, like those found in the hands, feet and wrists. Joints become hot, red, swollen, painful and stiff as the body fights against the tissues that line and surround the joints. Over time, the joints go through degenerative change and may appear deformed. This condition may also cause inflammation around the lungs and heart, as well as affecting many other systems of the body. • Systemic Lupus Erythematosus (SLE): A condition that causes inflammation of the skin, joints and various organs of the body. Symptoms are widespread and include a butterfly shaped rash on the face and nose, light sensitivity, mouth ulcers, kidney disease and mental illness including memory loss. • Scleroderma: A group of conditions that lead to the thickening and scarring of the skin, organs and blood vessels. People may also experience Raynaud’s Phenomenon; a condition where the blood vessels in the fingers and toes go into spasm resulting in a lack of blood flow to the area. This will look like areas of white and blue over the skin with numbness being another symptom. It is not uncommon for people with one autoimmune CT disease to show signs and symptoms of other autoimmune diseases too. In these instances, a person is referred to as having Mixed Connective Tissue Disease (MCTD). Many people with these overlapping conditions go on to receive a firm diagnosis of SLE or Scleroderma later in life. We hope you found this blog a helpful tool for learning about CT diseases. If you have a CT disease or want to know more information on a particular condition, feel free to ask us next time you are in the clinic or through Tele Health. Have a great month and stay safe everyone.  https://www.myhealth1st.com.au/find/physiotherapists/nsw/nsw-region/north-sydney/back-in-business-physiotherapy References: 1. Healthline. 2018. Diseases of Connective Tissue, from Genetic to Autoimmune. [Online]. Available from: https://www.healthline.com/health/connective-tissue-disease. [Accessed 08 April 2020]2. National Geographic. 2013. How Many Cells are in Your Body? [Online]. Available from: https://www.nationalgeographic.com/science/phenomena/2013/10/23/how-many-cells-are-in-your-body/. [Accessed 08 April 2020]3. Arthritis Foundation. 2020. Mixed Connective Tissue Disease. [Online]. Available from: https://www.arthritis.org/diseases/mixed-connective-tissue-disease. [Accessed 08 April 2020] Uploaded : 28 April 2020 Read More
  • Physiotherapy, Exercise, Chaos and the Immune System (during COVID-19)

    Physiotherapy, Exercise, Chaos and the Immune System (during COVID-19)

    Deterministic Chaos Theory, Exercise, Physiotherapy Reasoning and the Immune System (during COVID-19) by Martin Krause B.Appl.Sci. (Physiotherapy); M.Appl.Sci (Manipulative Physiotherapy), Post Grad Dip Hlth Sc (Exercise and Sports), Post Grad Cert Hlth Sc (Education) Known Knowns, Known Unknowns, Unknown Unknowns - the latter is what we need to recognise Since the onset of COVID-19 many of us have asked why are there so few antivirals? The answer boils down to biology, and specifically the fact viruses use our own cells to multiply. This makes it hard to kill viruses without killing our own cells in the process. So how do we ensure cell survival, whilst priming the immune system to make antigens for its defence system. What does this even mean? Can exercise be an answer to reduce the extent of our immune response if exposed to COVID-19? Will knowing why exercise is good for our immune system motivate people to exercise more? During this time of crisis, we've been told to exercise. Exercise for physical and mental well-being. Whether in partial 'lock down' or 'full lock down' or 'opening up', exercise is still important. But Why? How do chaos theory and non-linear dynamics explain movement and the immune system? The following represents a synopsis of my past research in the field of biomechanics, pathomechanics, neurophysiology, cognition, immunology, sarcopenia and my current interest in chaos. The slides are from a Keynote presentation I made in Rome in 2005. We were born from the chaotic fire of genesis. Laws of thermodynamics dictate our existence. Evolution of heat shock proteins (HSP) means that we are our immune system. Today, human multi-cellular life is still totally dependent on our unicellular ancestors and their componentry. Trillions of species and bacteria in the gut (flora) and skin alone, associated with immune substances, attest to the importance of unicellular life in the immune system. The abundance of energy species in the gut suggests a nexus with one of the organs most in need of energy, the skeletal muscle. Importantly, muscle cells have more mitochondria than most other cells, so they can readily produce work for movement. Consequently, muscles are an energy system and an immune endocrine organ. Notably, the development from unicellular to multi-cellular life needed movement. A commonality of cellular movement and macro-muscular movements exist. Physiotherapeutic and training interventions must consider the health of the immune system and its ability to deploy and be re-deployed. Training should avoid becoming 'stale' by having enough variety (chaos) to create perturbations in the immune system which induce up and down regulation of immune componentry. Physiotherapy should be innovative and creative, whereby the physiotherapist additionally considers immune-cognitive aspects of pain and inflammation, when people seek physiotherapeutic intervention after/during a change in their training regime and/or commencement of unaccustomed exercise, or in the presence of immune compromise. Index 1. What is a stressor? 2. COVID-19 3. General Adaptation Theory 4. Nasal Heat Shock Proteins 5. Heat Shock Proteins (HSP) pictures 6. Damping Ratios 7. Sympathetic N.S. & Chaos 8. Butterfly Effect & Chaos 9. Chaos theory and Physiology 10.COVID-19 Clinical Presentation 11.Infection & HSP 12.HSP70 viral response (1) 13.Muscle-Immune response 14.Matzinger's Danger Hypothesis 15.Classes of HSP 16.HSP72 and HSP27 and muscle 17.Extracellular HSP 18.Aging, HSP and CK 19.Age, COVID-19 & thrombocytes 20.COVID-19 and Platelets 21.Pulmonary emboli 22.Exercise & Respiratory Tract 23.Exercise and Resp Tract Infections 24.HSP viral response (2) 25.HSP-90 26.Mechano-transduction & heat 27.Actin-Myosin Cross Bridge 28.Entropy 29.Bicycle Cadence and Entropy 30.Eccentric Contractions 31.Eccentric Exercise & Immune Markers 32.Sarcopenia 33.Muscle Glutamine 34.Muscle Immune Conversion 35.Over-training 36.Chaos Theory 37.Deterministic Chaos & Immune System 38.Maths & Deterministic Chaos  39.Uncontrolled Manifold Hypothesis 40.Game Theory 41.Cortical Resources 42.Exercise induced disease 43.Anti-Carcinogenic Effect of Exercise 44.Allostasis 45.Neural Componentry & Chaos 46.COVID-19 and Allostasis 47.Recovery & Sleep 48.Psychology & Immunity 49.Diet 50.Gut-Muscle Immune axis 51.COVID-19, gut and lungs  52.Dosage of Exercise 53.Motivators to Exercise and to eat  54.Leptin, Diabetes and X's  55.Leptin and Diet 56.Exposure 57.Musculoskeletal Physiotherapy  58.Conclusion 59.Justification 60.Links Many of the things an Australian trained Musculoskeletal Physiotherapist does has to do with oscillations. Everything from joint oscillations, therapeutic ultra-sound, to repetition in exercise to Whole Body Vibration (WBV) therapy involves an obvious form of oscillation. Other less obvious forms of oscillations occur within muscles, within whole body immune systems and across body musculoskeletal systems. The following argues that the expression of oscillations can determine the health and well being of a person beyond simplistic notions of biomechanics, pathology and repair. What is a 'stressor' and why is muscle considered an endocrine immune organ? The sympathetic nervous system has traditionally been assigned the responsibility for the 'freeze, fight or flight' stress response. Regardless of mechanism, the call to action goes to muscles. Culturally, we generally consider a muscular person as the 'picture of health'. Yet, what resides and moves within muscle is as important as the work those muscles produce.  When we exercise, the body adapts to a stressor, which is calorific, metabolic, physiological, immune and psychological. Phylogenetically, heat shock proteins (HSP) evolved from uni-cellular to multi-cellular life, and 'exercise' (physical activity) was associated with survival skills, such as food acquisition and defence (self-preservation). Interestingly, those same mechanisms can be 'fine tuned' to improve the age of your immune system. If we can get or maintain muscle bulk, we can maintain a reservoir of protein for immune function. If we can maintain adaptive processes to mechanical trauma and inflammation, we have a fighting chance of using similar processes to launch an appropriate immune response, fight infection, prevent cell death (apoptosis) and muscle-organ failure (cachexia).  What is the mechanism behind an 'appropriate' immune response? What sets the system in motion (perturbation) and what 'dampens' it? How do the laws of thermodynamics and conservation of energy apply? What is the predicted 'chaos' in the system and how do the immune and sympathetic nervous system act as oscillating 'manifold' for chaos to 'unfold' and 'refold'? COVID-19 In March 2020, of those patients who test positive for COVID-19, approximately 14% develop severe disease requiring hospitalisation and oxygen support and 5% require admission to an intensive care unit. 10% to 20% of severe patients develop acute respiratory distress syndrome (ARDS) during 8–14 days of the illness with complications including sepsis and septic shock, multiorgan failure, including acute kidney injury and cardiac injury (Yang et al, 2020). Older age and co-morbid disease (cardiovascular disease, diabetes, chronic respiratory disease, hypertension, cancer) are associated with higher mortality rates during COVID-19 infection. There is low quality evidence to suggest exercise has no impact on the rate and duration of acute respiratory infection but may provide a small reduction in severity of symptoms. Increasingly evident, COVID-19 appears to be a disease of the vasculature, especially in the young, where thrombus formation, multi-organ inflammation and cytokine storms are evident. By October 2020, therapeutics directed at multiple organs and using anti-viral, symptom moderation medication, as well as anti-body experimental treatments have been used to improve survival rates, by reducing the severity of the disease. At this point in time, a vaccine for the spike protein is non-existent. Research in exercise immunology suggests moderate exertion may decrease the risk of acute respiratory infection in healthy adults but lacks assessment of its reliability (https://www.cebm.net/covid-19/does-physical-exercise-prevent-or-treat-acute-respiratory-infection-ari/).  However, we do know that regular exercise attenuates the afore-mentioned co-morbidity. Additionally, low evidence means we should pursue the (construct validity) evidence if 'face validity' is evident. The following describes muscle as an immune organ, exercise as an 'adaptor' of that organ, based on immunological principles (from non-linear and linear mechanics) such as heat shock proteins (HSP), cytokines and platelets, importance of 'outliers' based on 'deterministic chaos' as associated with exercise, the sympathetic nervous system, as well as the gut-muscle axis associated with 'energy species'. Stress and the General Adaptation Syndrome The general adaptation syndrome (GAS) model of stress posits three stages to stress: alarm, resistance and exhaustion. In the alarm stage, the nervous system releases stress hormones to facilitate a freeze-fight-flight response. When a stressor is ongoing, like the COVID-19 pandemic, returning to homeostasis is more difficult. In the second stage — resistance — the individual’s allostatic load ideally returns to baseline. But many people will not, especially in the prolonged stress of a pandemic. Physicians should consider that patients reporting symptom exacerbations (of pre-existing issues), during this time, may benefit from stress mitigation techniques, including: Diaphragmatic breathing Guided imagery Mindfulness Limiting media exposure Progressive muscle relaxation Physical activity These techniques may include holistic approaches such as Yoga, Progressive Resistance Exercise (PRE), and endurance training. In the third stage, called exhaustion, people become overwhelmed from the ongoing stressor. This is where prolonged dysfunction can occur, and in which identifying a coping strategy becomes more difficult for the person. One would hope that intervention occurs during the second stage, when acceptance of behavioural modification is more likely. Furthermore, it is hoped that the general population remains active for life, even in the post COVID-19 era. The following is an overview of why exercise is so important, for the immune system, by using a 'deterministic chaos' theoretical approach to protect against chaos. Nasal Heat Shock Proteins Heat Shock Proteins (HSP) are found in virtually all living organisms, from bacteria to humans. They are a class of proteins which react both to heat, cold and oxidative stress. Since unicellular life, these small protein chains, have developed with evolution, and despite the complexity of multi-cellular life, they still have an important fundamental role to play in human survival. Incredibly, this, evolution, means that complex multi-cellular life, can still recognise their unicellular ancestor counterparts! Frequent confrontation of the host (human) immune system, with conserved regions of HSP, which are also shared by various microbial pathogens, can potentiate antimicrobial immunity. However, long-term confrontation of the immune system with HSP antigens, which are similar in the host and invaders, may convert the immune response against these host antigens and promote autoimmune disease. Since COVID-19 is thought to have an 'auto-immune' mechanism and has a profound impact on the airways, in symptomatic individuals, the following is an example of nasal mucosa HSP responding to heat stress. Nasal HSP's 1 hour after heat shock stimuli (Min et al 2020 International journal of medical sciences 17(5):640-646)  Heat Shock Protein - what they look like Small HSP (mycobacterium) by Kim, K.K., Kim, R., Kim, S.H.(1998) Nature 394: 595-599 PubMed: 9707123 DOI: 10.1038/29106  HSP 27 by Michael H. Chiu, Chunhua Shi, Matthew Rosin, Zarah Batulan, Edward R. O’Brien (2019) HSP 72 by Osipiuk, J., Gu, M., Mihelic, M., Orton, K., Morimoto, R.I., Joachimiak, A., Midwest Center for Structural Genomics (MCSG) 2010 Damping ratio To understand energy systems we must also understand 'oscillation control' by examining 'simple harmonic motion' (SHM) in terms of linear dynamics (kinetic and potential energy ) of a mass spring and it's 'damping ratio'. Simply stated, if you hang a mass off a spring and pull down on it and let it go, in the absence of plastic deformation, the mass will 'overshoot' back and forth several times before resuming its original position. That is, it experiences a restoring force proportional to its displacement. Depending on the weight of the mass and the thickness of the spring, the non-optimised system may experience overdamping or underdamping (Wikipedia).    A lower damping ratio implies a lower decay rate, and so very underdamped systems oscillate for long times. Importantly, this model applies to energy systems and hence obeys the law of thermodynamics. Traditionally, health was considered in terms of predictability. Consistent heart rate was considered good, irregular heart rate as bad. Unfortunately, it isn't quite so simple. In fact in terms of training concepts, low resting heart rate and how quickly the heart rate can oscillate with demand is used to diagnose if an athlete has become 'stale' or said in another way is in a state of 'over-training' or enhance physiological and/or psychological stress. Hence, in the light of these confounding 'beliefs', a more complex system (model) needs to be employed, involving random perturbations of an oscillatory system, if random 'outliers' are to be incorporated into our understanding of health. Simplistic versions of sympathetic vs parasympathetic tone balancing the autonomic nervous system do not explain complexity. It is difficult to reconcile that the parasympathetic vagus nerve controls all thoracic and abdominal organ function and alone counters all 'chaos' of sympathetic nervous system activity, where the latter activity has a multitude of redundancy and interacts in multiple dimensions with an interlaced muscle-gut immune system complex. The sympathetic nervous system is the tight rope, the trapeze artist, the dancer, the orchestra, forged from the fire of genesis and the evolution of heat shock proteins. To understand the development of the muscle-gut immune system complex we must understand its uni-cellular componentry. Using Alexandr Lyapunov theory of stability, in non-linear dynamic systems, the oscillations near the point of origin (equilibrium) are determined by exponential decay.  That is, if the solutions that start out near an equilibrium point Xe, stay near Xe forever, then Xe is Lyapunov stable. More strongly, if Xe is Lyapunov stable and all solutions that start out near Xe converge to Xe, then Xe is asymptotically stable (As an illustration, suppose that we are interested in the properties of a function f(n) as n becomes very large. If f(n) = n2 + 3n, then as n increases, the term 3n becomes insignificant compared to n2. The function f(n) is said to be "asymptotically equivalent to n2, as n → ∞". This is often written symbolically as f(n) ~ n2, which is read as "f(n) is asymptotic to n2 "). The notion of exponential stability guarantees a minimal rate of decay, i.e., an estimate of how quickly the solutions converge. The idea of Lyapunov stability can be extended to infinite-dimensional manifolds (chaos theory), where it is known as structural stability (in mathematics, this is a fundamental property of a dynamical system which means that the qualitative behaviour of the trajectories is unaffected by small perturbations), which, in this case concerns the behaviour of different but "nearby" solutions to differential equations. Later, this will be applied, not only to EMG analysis of muscle activity, but also to cytokine interactions, from nearby solutions Sympathetic Nervous System and Deterministic Chaos The sympathetic nervous system (SNS) has, as previously stated, traditionally been associated with the freeze-fight-flight response - you fight the lion or run from the lion. A reaction to a 'danger signal' (Matzinger). However, there is a lot more to it. Never-the-less, this example describes a bi-directional nervous system, one which is driven by 'motor curiosity' and wanting to arouse sensory stimuli, whilst the other is reacting to 'sensory stimuli'. Frequently, these moments are described as an 'adrenalin rush' associated with fear, excitement and tremor. The greater the chaos and tremor in the system, the greater the perturbations and the greater the damping needed in the system. Ideally, what drives the system also dampens it. Otherwise, at 'extremely high frequencies' we would only 'freeze'. Clinically, some people believe, that right hemisphere dominant tremor tend to have a higher component of irrationality and hypervigilance, whereas left hemisphere dominant tremor may have a more rational generator of tremor. However, this simplification ignores cross-hemispheric communication systems. It is important to note that in health systems, it's the odd asynchronicity in the system which attests to it's health. That is the chaos, 'outlier', in the system. This control by chaos is relative, it's a ratio, it's a magnification, it defines itself and it 'dampens' itself. Furthermore, the outliers define what it isn't! Hence, 'deterministic chaos'. When looking at 'fractals', you can have an infinite length in a finite space. Bifurcation upon bifurcations, getting smaller and smaller ad-infinitum but within a finite space! For example, the length of the coastline of the United Kingdom is known to an error margin of + 10-20% depending on how closely one looks at it (ie at what magnification ratio or scale). As we examine the movement system, we frequently see tremor at each end of the spectrum. With fine delicate movements and with movements which require a lot of force we see a tremor.  In scenarios of many repetitions and fatigued muscles, they gradually cramp up and lose their oscillatory fidelity. This can be considered as an energy or metabolic constraint. In novel tasks, we see more rigidity in movements, due to increased muscular activity, resulting in reduced freedom of movement. In the latter scenario, cognitive constraints arise at a conscious and sub-conscious level, where learning becomes important to improve the degrees of freedom, reduce the amount of muscle tension and hence lower the rigidity in the system. Are degrees of freedom, and hence variability, important for the immune system? A system dependent upon ratios of heat shock proteins, pro and anti inflammatory cytokines, immuno-globulins, lymphocytes, neuropeptides, short fatty acid chains, metabolism, descending noradrenergic and serotonergic pathways and even a balance between 'innate' and learned 'adaptive' immune responses, occurring within and acting upon, the largest endocrine organ of the immune system, skeletal muscle. Is it a coincidence that the spinal cord looks like a butterfly?  Butterfly effect and chaos theory - from Wikipedia In chaos theory, the butterfly effect is the sensitive dependence on initial conditions in which a small change in one state of a deterministic nonlinear system can result in large differences in a later state. The term, closely associated with the work of Edward Lorenz, is derived from the metaphorical example of the details of a tornado (the exact time of formation, the exact path taken) being influenced by minor perturbations such as the flapping of the wings of a distant butterfly several weeks earlier. Lorenz discovered the effect when he observed that runs of his weather model with initial condition data that was rounded in a seemingly inconsequential manner would fail to reproduce the results of runs with the unrounded initial condition data. A very small change in initial conditions had created a significantly different outcome. The idea that small causes may have large effects in general, and in weather specifically, was earlier recognized by French mathematician and engineer Henri Poincaré and American mathematician and philosopher Norbert Wiener. Edward Lorenz's work placed the concept of instability of the Earth's atmosphere onto a quantitative base and linked the concept of instability to the properties of large classes of dynamic systems which are undergoing nonlinear dynamics and deterministic chaos.   Chaos theory and physiology What happens if the 'flapping wings of the butterfly' dampen or calm 'the tornado on the other side of the planet'? In terms of the human organism, chaos theory refers to 'deterministic chaos'. This means that if one knows the initial conditions (state) of the system exactly, then the dynamical trajectory will be the same every time it is initiated in that condition (state). If, however, two states are 'infinitesimally' apart, then the trajectories are such that it makes it impossible to predict the future dynamics (chaos).   Oscillatory dynamics is the prerequisite for many complex phenomena and the onset of chaotic dynamics. Chaos refers to complex, apparently unpredictable, dynamics that even simple deterministic dynamical systems can produce. A universal way to achieve chaos is by driving a nonlinear oscillator by an external periodic signal. When the external driving signal has low amplitude oscillations, it can entrain or synchronise the nonlinear oscillator. As the amplitude of oscillations is increased, the range of frequencies for which it can entrain becomes larger—these expanding synchronisation regions of the external amplitude–frequency parameter space are called Arnold tongues. Such entrainment/synchronisation has been observed in many different physical systems, from fluids to quantum mechanical devices, and now also in biological processes, such as cell cycles, and gene (transcription) regulatory dynamics in synthetic populations. The dynamics gets even more complex as the amplitude of the external driving signal increases further. First, Arnold tongues start overlapping, which means the nonlinear oscillator can exist in more than one entrained state with different frequencies (termed modes), and even small amounts of intrinsic or extrinsic noise can cause it to hop between these modes. Such mode-hopping has been observed in immune system (p53 tumour suppressor) and in gene transcription of the oscillatory NF-κB system, when driven by a periodically varying Tumour Necrosis Factor (TNF) signal of sufficiently high amplitude. When the external amplitude is increased even further, then chaotic dynamics is predicted (Heltberg et al 2019 Nat Commun 10, 71 https://www.nature.com/articles/s41467-018-07932-1.pdf) Shareable link https://rdcu.be/b4sU7 Nat Commun 10, 71 (2019). The significance of this is, that NF-κB is a major transcription factor which regulates genes responsible for both the innate and adaptive immune response. Upon activation of either the T- or B-cell receptor, NF-κB becomes activated through distinct signalling components. TNF is a major inflammatory cytokine player, found in skeletal muscle (MSK), produced by macrophages/monocytes during acute inflammation and is responsible for a diverse range of signalling events within cells, leading to necrosis or apoptosis. The protein is also important for resistance to infection and cancers. Furthermore, other immune ratios or interactions, based on maths and physics, are predicted, which will hopefully lead to a better understanding of why physiotherapists should encourage people to exercise muscle as a vaccine for the immune system. This discussion will include interactions between Interleukin IL-6 (pro inflammatory) driving IL-10 (anti-inflammatory) t-cell CD4+ : CD8+ ratio, HSP 27 and HSP72 HSP 10 and HSP 60 HSP 60 and HSP 70 HSP 90 as well as examining the gut biome and muscle - brain axis in terms of energy, resources and game theory.  COVID-19 Clinical Discussion: 1 May 2020 The following is an abstract from an online clinical forum. It serves here to illustrate the terms used in the discussion, including 'cytokine storm' (inflammatory substances), 'viral burden', 'anticoagulants' (clot busters) and 'immunosenescence' (immune dysfunction/compromise) which have been pervading posts to this forum, about COVID-19. Bear these terms in mind for later discussion. Hence, as stated, the following dissertation will consider cytokines (inflammatory substances), platelets and HSP in relation to muscle as an endocrine organ of the immune system and examine the link with the gut biome, and in particular, the energy species within the gut, as it relates to the immune system, but also as those energy species relate to movement adaptation, within the musculoskeletal system. "We are what we eat" and "healthy mind healthy body" are common sayings which will become abundantly clearer when examining the gut-brain-muscle axis. Chaos theory as it relates to ratios, synchronous to asynchronous periodicities, and magnification of movement and inflammatory markers in response to variable 'healthy' physical demands are postulated to act as a 'muscle - immune shock absorber' when confronted by pathogens. Infection - a bimodal HSP reaction of host and pathogen When entering the host from the environment, a microbial pathogen is confronted by several changes, some of which are highly stressful. These include alterations in temperature, pH, and pO2. Moreover, the pathogen is exposed to natural host resistance mechanisms such as phagocytosis by professional phagocytes. Once engulfed by phagocytes, the pathogen is confronted with reactive oxygen and nitrogen intermediates, attack by lysosomal enzymes, and depletion of Fe2+. To protect itself against the host, the pathogen activates various evasion mechanisms including its own HSP synthesis. Infection is therefore a bimodal process determined by the host and pathogen. During infection, the pathogen as well as the host increase their HSP production. Induction of host HSP synthesis in response to an encounter with a pathogen has at least two major causes. First, infected macrophages are confronted with antimicrobial mechanisms which they have activated themselves during infection. Efficient protection against their own effector molecules (e.g., reactive radicals) becomes vital for macrophage survival. Second, once inside a phagocyte, many microbes, especially those which persist in the host, interfere with intracellular host cell metabolism. Not surprisingly, many of these pathogens are potent inducers of HSP synthesis in mammalian cells (see Ulrich Zügel, Stefan H. E. Kaufmann (2019) https://cmr.asm.org/content/12/1/19 DOI: 10.1128/CMR.12.1.19). They say, 'in life we never should forget where we came from'. This appears true for HSP, where the HSP of a multicellular host recognises and react to the HSP of unicellular pathogens. A reflection on the evolution of life on earth. Heat Shock Protein (HSP) 70 and the viral response Virus infections induce heat shock proteins (described in detail below) that in turn enhance virus gene expression. An intriguing concept is that HSP within pathogens activate HSP within the host. This phenomenon is particularly well characterized for 70 kDa heat shock protein (HSP70). However, HSP70 is also readily induced by fever, a phylogenetically conserved response to microbial infections. When released from cells, HSP70 can stimulate innate immune responses through toll like receptors 2 and 4 (TLR2 and 4). In their review, researchers (Mi Young Kim and Michael Oglesbee 2012 Cells. 2012, 1, 3,: 646–666. doi: 10.3390/cells1030646) examined how the virus-HSP70 relationship can lead to host protective innate antiviral immunity, and the importance of HSP70 dependent stimulation of virus gene expression in this host response. Beginning with the well-characterized measles virus-HSP70 relationship and the mouse model of neuronal infection in brain, they examine data indicating that the innate immune response is not driven by intracellular sensors of pathogen associated molecular patterns, but rather by extracellular ligands signalling through TLR2 and 4. Specifically, Kim & Oglesbee (2012) addressed the relationship between virus gene expression, extracellular release of HSP70 (as a damage associated molecular pattern), and HSP70-mediated induction of antigen presentation and type 1 interferons in uninfected macrophages as a novel axis of antiviral immunity. The reported antigen presentation and cross-presentation and in vitro HSP cytokine functions are a result of molecules bound to, or chaperoned by, HSPs but not a result of HSPs themselves (Tsan MF1, Gao B.2009 J Leukoc Biol.85, 6 :905-10. doi: 10.1189/jlb.0109005). Notably, intra- (IC) and extracellular (EC) HSP 72 are thought to have different functions. IC HSP 72 confers cellular protection from subsequent stressors, while EC HSP 72 has a whole-body systemic role in antigen presentation and immunity. An acute exercise bout stimulates an increase in both IC and EC HSP 72. Long-term training and improved fitness increase the rate of availability of IC HSP 72 in response to stress. Other factors that affect HSP 72 production include environmental factors, exercise mode, duration and intensity, age, Estrogen, and anti-oxidant and glycogen availability. Additionally, other HSP such as HSP27 play a role in conserving HSP72 function. Importantly, the functions and roles of HSP 72 depend on the tissue of origin (brain, muscle, etc). Ratios of HSP's will be discussed later in the context of muscle-exercise-immune responses and is represented in the following schematic (bear in mind HSP70 are a class of HSP's which include HSP72) and ubiquitin is from another class of HSP which are very small (8.5kDa) and have been highly conserved throughout the evolution of life. Similarly, the gut biome will be discussed in terms of 'energy species' and a HSP 10 and HSP 60 synergistic function. Ratios of CD4+:CD8+ appear to be critical when discussing health and disease; as will the consideration of how an acute, but not chronic, pro-inflammatory cytokines (IL-6) stimulate anti-inflammatory cytokine (IL-10) response. Muscle-immune response So, what is the role of Heat Shock Protein (HSP) in the immune system? Simply stated, early in life, we have an innate immune system, the one we are born with. It acts to protect us. It's first exposure and reaction to exposure is in the birth canal, where the cervix lining acts to induce a protective mechanism to exposure of the world. Our first 'adaptive immune response'. Antibodies are formed from exposure to antigens. These antibodies are formed from RNA into DNA, by cleaving off small protein chains from long protein chains (telomeres). It's a bit like cutting a small piece of tail off the long protein chain. We do this throughout life, with the  aid of HSP's. However, as you can imagine, those long protein chains eventually become shorter and are finite. Hence, it's important to maintain our protein reservoir in our bodies by finely tuning how much and when proteins are cleaved, unfolded and refolded or deemed as useless by HSP. Since muscle consists of 90% protein, it becomes abundantly clear that we should protect it's bulk and function by training it, when healthy, and using it's reservoir of protein immune components during or after a disease. The above schematic (Krause 2004) illustrates immune reactions occurring within muscles. Immune responses are a complex interaction of cytokine signalling. Cyto = cell, Kine = movement. These signalling reactions occur in the brain, gut, liver, kidneys, thymus and muscle, in response to a perceived-safety danger signal (Matzinger 1994, review by Martin Krause 2004). Fine tuning of the cytokine reaction is important through a direct muscle cytokine 'micro-trauma' mechanical mechanism and indirectly through 'energy cycling' including metabolic mechanisms, including oxidative stress (REDOX) induced HSP. Furthermore, a multitude of cognitive stimuli can also influence (positively and negatively) the immune system. Notable, HSP must respond to the laws of thermodynamics. In the context of COVID-19, it has become apparent that those critically ill patients, have cytokine flooding in their lungs. That is, they have an uncontrolled (auto) immune response which has been referred to as a 'cytokine storm'. Additionally, there also appears to be a delayed immune response in younger individuals relating to inflammation of blood vessels and clot formation. Further, extremely low oxygenation (<50%) has been reported suggesting hypoxic metabolic stress, potentially not to dissimilar to when we exercise, only in the later we can in most cases cease the exercise without undue effects. A notable exception is Rhabdomyolysis (which is a condition in which skeletal muscle tissue dies, from over-exertion or pathogens, releasing substances into the blood stream that cause kidney failure) discussed elsewhere on this site. It will be argued that previous 'fine tuning' of the cytokine response, through exercise induced neuro-immune perturbations, leaves the host, not necessarily less susceptible to infection, but more prepared to deal with heat stress, platelet reactions as well as the infection itself. Matzinger's Danger Hypothesis - from Wikipedia  In 1994 a new immunologic model was suggested by Polly Matzinger. She suggested that the immune system does not distinguish between self and non-self, rather, it discriminates between dangerous and safe by recognition of pathogens or alarm signals from injured or stressed cells and tissues. According to this theory, the most important stimulation of immune response are normal tissues. When tissue cells are distressed because of injury, infection and so on, they start to secrete or express on their surface so called "Danger signals". "Danger signals" are also introduced into extracellular space when stressed cells die by immunologic not-silent cell death such as necrosis or pyroptosis (highly inflammatory form of cell death, as opposed to apoptosis, controlled cell death). This model also suggests that, despite their potential immunogenicity, neoplastic tumours do not induce significant immune responses to induce the destruction of the malignant cells. According to the danger model, the immune surveillance system fails to detect tumour antigens because transformed cells do not send any danger signals which could activate dendritic cells and initiate an immune response. "Danger signals" are normal intracellular molecules that are not found in the extracellular space under physiological conditions. The danger model has evolved over the years. "Danger signals" include DNA, RNA, heat shock proteins (HSPs), hyaluronic acid, serum amyloid A protein, ATP, uric acid and also cytokines like interferon-α, interleukin-1β, CD40L and so on.  The "danger model" suggests that, upon cellular necrosis, cryptic molecules in normal cells might be liberated from the cytoplasm into the tissue microenvironment, new molecules might be expressed on the surface of killed cells, or new molecules might be synthesized by cells undergoing necrosis. In comparison, the damage associated molecular pattern "DAMP model" suggests that any non-functional molecules (regardless of their cellular location; extracellular or intracellular) that were denatured, oxidized, or had disintegrated quaternary structures might have unique biophysical patterns such as low water-solubility or stretches of polyanions on their surface. "Danger signals" and DAMPs are together with pathogen-associated molecular patterns (PAMPs) called alarmins and they are recognized by pattern recognition receptors (PRRs) of antigen presenting cells (APC). PRRs include Toll-like receptors (TLR), nucleotide oligomerization domain (NOD)-like receptors, retinoic acid inducible gene-I (RIG-I)-like receptors and C-type lectin-like receptors.[12] They are not only at the surface of these cells, but we can find them in cytoplasm and incorporated in the membrane of endolysosomes. Stimulation of PRRs leads to activation of APC cell to process antigen, upregulate expression of costimulatory molecules and present antigens to T helper cells. The danger model is a new perspective on adaptive and innate immunity. In the past innate immunity was suggested to be a minor part of the immune system — in contrast, adaptive immunity was thought to be the most important and effective part of the immune system. According to the danger model there is no adaptive immunity without the innate part. This is because APCs like dendritic cells are essential for activation of T lymphocytes and B lymphocytes, which after activation produce specific antibodies. In the case of dendritic cells deficiency, like in common variable immunodeficiency (CVID), patients suffer from hypogammaglobulinemia and from primary or secondary defects in T-cell functions. Häggström, Mikael (2014). "Medical gallery of Mikael Häggström 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.008. ISSN 2002-4436. Public Domain. or By Mikael Häggström, used with permission. - Image:Lymphocyte_activation.png, Public Domain, Link (Matzinger, P . "Tolerance, Danger, and the Extended Family". Annual Review of Immunology. 12 (1): 991–1045. doi:10.1146/annurev.iy.12.040194.005015. PMID 8011301.   https://www.ohtn.on.ca/polly-matzinger-recaps-65-years-of-immunological-theory-in-one-diagram/ Classes of Heat Shock Proteins (HSP) Heat shock proteins (HSP) play an important role during exercise and subsequently induced immune responses (Krause 2002). Phylogenetically, HSPs are the basic building blocks of life. Small protein chains of around 8–43 kDa for HSP 27 class and 72kDa for HSP 72 ranging up to 110kDa. HSP72 is abundant in muscle. HSP 27 has been shown to be released in response to muscle damage during novel or acute eccentric (muscle lengthening) exercise, whereas HSP 72 is released in response to metabolic and thermal stress, during endurance exercise, in both untrained and well trained individuals. Additionally, HSP 27 is thought to aid in the repair process of HSP 72 as well as in the repair of contractile protein myofilaments themselves (Folkerson M 2018 http://oru.diva-portal.org/smash/get/diva2:1234179/FULLTEXT01.pdf).  The relevance of the latter will become apparent when examining eccentric muscle contractions later in this treatise. HSP 60 is found abundantly in the gut and in the mitochondria of skeletal muscle, in rodents. It has been demonstrated, in rodents that HSP 60 is greater in slow twitch endurance muscle, as well as in the vastus lateralis of endurance trained men (reviewed by Mattias Folkesson 2018). HSP 60 and HSP 10 will be discussed later when considering the immune system, energy species and the gut biome.   Hence, HSP's have an important cellular function, commonly referred to as a 'chaperone'. The fate of proteins with non‐functional conformations after stress exposure may be either to re‐obtain the functional conformation, form aggregations with other misfolded proteins or become degraded. HSP's play a helper role in shifting the equilibrium in the direction of more functional proteins or degradation of damaged proteins. This can occur in an ATP-dependent or independent manner, meaning the latter doesn't require the normal oxidative metabolism to function, as muscle contraction does.  HSP had an important, stress induced, evolutionary and ecological role. As stated, it continues to play a vital role, as it's chaperone function acts to stabilise/modify exercise induced muscle damage, including micro-trauma. Additionally, HSP's play a role in apoptosis or cell death in sedentary individuals. Essentially they react to 'stressors' which can be temperature (hot and cold) and oxidative. Importantly, these ubiquitous molecular chaperones can prevent the irreversible aggregation of denaturing proteins. Specifically, to maintain protein homeostasis, HSP complex form a first line of defence against protein aggregation, with a variety of non-native proteins in an ATP-independent manner and in the context of the stress response. In vertebrates they act to maintain the clarity of the eye lens, and in humans HSP mutations are linked to myopathies and neuropathies (Haslbeck & Vierling 2015 J Mol Biol Apr 10; 427, 7: 1537–1548). Indirectly, HSP's act on the immune system by maintaining muscle bulk, which provides the environment in which cytokines can act and where proteins can be used to build antigens for an immune response. That is, reported antigen presentation and cross-presentation, activation of macrophages and lymphocytes, and activation and maturation of dendritic cells as well as in vitro HSP cytokine functions, are a result of molecules bound to or chaperoned by HSPs but not a result of HSPs themselves (Tsan MF & Gao B.J Leukoc Biol. 2009 Jun;85(6):905-10). Another, more intriguing speculation, is that the HSP of the pathogens themselves activate the innate human immune response in the presence of fever greater then 2-3 C (reviewed by Hasday JD & Signh IS 2000 Cell Stress Chaperones, 5, 5, 471–480). Regardless, an increase in core bo