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  • Osteoarthritis


     What causes hip osteoarthritis? Osteoarthritis is a result of a gradual degeneration of the cartilage that lines the ends of bones that join to form joints. There is no one specific cause. Almost any joint in the body can develop osteoarthritis, but load-bearing joints (such as the knees, hips and spine) are the most susceptible. One in ten people over the age of 65 will experience hip osteoarthritis, although it can develop from the age of 45 (it is highly unlikely, but not impossible, to develop earlier). If you have a family history of osteoarthritis, have had a hip injury or hip function problems in the past, are overweight or have a job that involves long periods of standing or heavy lifting, then you are at increased risk of osteoarthritis. What are the symptoms of hip osteoarthritis? Hip osteoarthritis thins the cartilage of the hip joint and makes the surfaces of the hip joint rougher. This can lead to pain and swelling in the area. People with hip osteoarthritis often experience at least some of the following: ● Progressively increasing pain in the hip● Pain felt with movement (although it may ease off with continued movement) and at rest● Pain that is aggravated by cold weather● Pain in the groin or thigh that radiates to the buttocks or knees● Stiffness of the hip or a “locking” sensation in the joint● Decreased range of motion or an affected walking pattern (i.e. limp) However, approximately 50% of patients with hip osteoarthritis do not have these symptoms, so any changes in your movement as you get older are worth getting checked out, just in case. How can hip osteoarthritis be treated? One of the most effective ways to treat osteoarthritis is with exercise. We can work with you to develop an exercise program that will strengthen the muscles around your hip, stabilise and protect the joint, increase your range of motion, improve your posture and reduce any additional strain on the joint. We will also take a look at the physical activities you are doing day-to-day, and advise you how best to structure them so that you are keeping your hip moving but not overdoing it. It’s important to keep moving when you have osteoarthritis, but breaking up physical tasks into chunks rather than doing too much at once can help to reduce the pressure on your joints. There may also be insoles, walking aids or other forms of supportive equipment that we can recommend to take stress off your hip, as well as changes to your lifestyle and home/work set-up that may help. Manual therapy and massage are also frequently used to reduce pain and increase movement. Massage may include myofascial trains and dry needling to improve the 'slings' across the hip and pelvis. Additionally, Muscle Energy Techniques are also employed aiming to re-align the pelvis and hips. When it comes to osteoarthritis of any kind, the sooner you get treatment, the better. In the worst-case scenario, hip osteoarthritis could require surgery or even a total hip replacement. So come and see us early before the pain gets too severe. How can hip osteoarthritis be prevented? The sooner you start to look after your hips, the more you can reduce your risk of developing osteoarthritis. Here are a few things you can start doing right now: ● Regular exercises to strengthen the muscles around the joint and stretching to improve mobility will help to protect the hip from degeneration. ● Make sure you always use the correct technique to lift heavy items, and don’t lift excessive loads. ● Maintain a healthy weight, as obesity puts strain on your hips. ● If you are sitting for long periods of time, ensure that your chair provides adequate support and that your hips are slightly higher than your knees. Try to avoid crossing your legs. Take regular breaks to move around. Do lots of 'buttock ups' Diet Diet can be very useful in preventing and ameliorating osteoarthritis. Simple weight loss programs such as the 16 : 8 diet (fasting 16 hours whilst eating lunch and dinner), can lead to weight loss, but may also be aimed at reducing cholesterol. As we know cholesterol can block the arteries. As the joints are at the end of the circulatory chain, then even minor blockages can be a problem. we also know that many tendinosis/bursitis in the hip may be due to immune-metabolic compromise. Supplementations have been controversial, however 1000mg of EPA/DHA fish oil have been recommended, as have New Zealand green lip muscles, forest berry and cherry anti-oxidants. Apart from the anti-oxidant properties, fish oil has an effect on blood viscosity. Additionally, if glucosamine is taken, the minimal dose is 1200mg glucosamine with 800mg MSM and 800mg of Chondroitin. However, the latter may have an effect on any thyroid issues. Further Reading : References 1. Physiopedia. 2021. Hip Osteoarthritis [Online OrthoInfo. 2021. Osteoarthritis of the Hip [Online  Uploaded : 25 November 2021 Read More
  • Sleep


    Have yourself a sleepy little Christmas The most wonderful time of the year is nearly upon us… and for some of us, that means sleepless nights! A U.K study revealed that on average, we lose 21 hours of sleep in the week leading up to Christmas, and U.S research found that 53% of parents lose sleep over the festive period, with 70% getting less than six hours on Christmas Eve. And that’s just the adults. We know sleep is incredibly important for our overall physical and mental health, so what can we do to get more rest during one of the most exciting (and sometimes stressful) times of the year? 1. Introduce wind-down time Alcohol and watching TV are two things guaranteed to disturb your sleep. But festive drinks and seasonal movies are staples at this time of year. We also spend a lot of time on our phones, keeping in touch with friends and family. Try to stop drinking and turn off all screens an hour or two before bed, to give your brain and body time to wind down. You can make this part of a calming nighttime routine, including elements like a hot bath, some light stretching, reading a book or listening to relaxing music to help you prepare to drift off. 2. Get organised Two of the biggest causes of seasonal insomnia are excitement about everything that’s coming up and worry about how to organise it all. Organise as much as you can in advance. Make lists of what you need to do and any deadlines for when you need to do it. Start buying and wrapping presents early and start to prepare food in advance where you can. You can also make writing your next day’s to-do list part of your nighttime routine, so that all your thoughts about tomorrow aren’t racing around in your head when you’re trying to settle down to sleep. 3. Move your body When you’re rushing around trying to get everything prepared for the holidays, your exercise routine can easily fly out the window. Exercise helps you to sleep better and deeper at night, and helps you to feel more energetic during the day. Try to get at least ten minutes of vigorous activity each day, even if it’s just a brisk walk. The good news is, dancing around your living room energetically to Christmas songs totally counts! 4. Take time out The festive period can be a hectic time, with lots of demands on you physically and emotionally. Amongst everything that’s going on, take some time for yourself. Try to put aside just five or ten minutes in the day to practice mindfulness or meditation to calm, rest and focus your mind. References 1. Banbury Guardian. 2012. Are you getting enough sleep over the holiday break? [Online SleepCycle. 2018. Parents sleep less and drink more during the holidays [Online Uploaded : 25 November 2021Sl Read More
  • Postural Orthostatic Tachycardia Syndrome (POTS)

    Postural Orthostatic Tachycardia Syndrome (POTS)

    Postural Orthostatic Tachycardia Syndrome (POTS) POTS is a condition of exercise intolerance in positions other than the horizontal. Clients will often present, complaining of symptoms of dizziness in standing, whilst feeling comfortable in sitting and lying down. In the older person it can be a result of cardiovascular deconditioning where the Heart Rate and Stroke Volume do not produce enough cardiac output (CO=SVxHR). In the younger individual, it may present as part of a condition from a different aetiology. In people who have suffered a Whiplash Associated Disorder (WAD) - anterior sympathetic cervical ganglia, or in a person with concussion, POTS symptoms may arise. Additionally in people who have Ehler Danlos Syndrom (EDS) or Joint Hypermobility Syndrome (JHS) POTS like symptoms due to autonomic dysregulation may present with POTS at any stage of life. Any thoracic ring issues which affect the peripheral sympathetic ganglia may also result in POTS like symptoms. Essentially, a person may have low blood pressure and elevated heart rate (Tachycardia) as a compensatory mechanism. POTS is frequently misdiagnosed and requires a tilt table and blood pressure monitoring to aid in the differential diagnosis. Causes of POTS interesting to physiotherapy include cardiovascular autonomic dysregulation, where tachycardia occurs due to decreased stroke volume from low blood volume (hypovolemia). Exercise conditioning results in increased stroke volume. However, all factors of exercise prescription need to be addressed including hydration and diet. sympathetic peripheral neuropathy where the calf blood vessels don't vasoconstrict sufficiently. Additionally, the calf muscles don't produce enough venous return to effectively act as the second 'pump' of the body. Exercise conditioning in supine (Pilates and Yoga) may be particularly useful for the venous return.  hyperadrenergic activity in standing (increased noradrenergic activity).Yoga (stability) and Alexander style activity with a meditation component. Feldenkreis may also be useful for mind-body awareness joint hypermobility (EDS and JHS) with specific physiotherapeutic interventions See Fu & Levine (2019) for a detailed review  The Children's hospital in Philadelphia has simplified the Dallas POTS exercise program to that which follows. Chronological factors Where a person begins will depend on their current condition. Months 1-4 you should only exercise in a horizontal position, here are examples:o Recumbent bikingo Rowing Ergometero Swimming laps or kicking laps with a kickboard Month 4 you can begin to use the upright bike if it is available Month 5 is when you can begin further upright training (elliptical or treadmill) Use the calendars as a week by week guide. You may need to move training sessions around, but please complete all of the recommended training sessions within that 7 day period. You will need to do this in order to move forward to the next week. One requirement is that after Maximal Steady State’ workouts you must always complete a ‘Recovery’ workout the next day. A ‘Recovery’ workout is when you do anything active, but keep your heart rate below the zone prescribed. Examples of recovery workouts include: low cycling at a low level on the recumbent bike- Using a kickboard to leisurely kick laps in the pool Taking a walk outdoors Playing in the yard Anything active that gets you moving continuously for the prescribed amount of time If for some reason you miss a period of workouts (illness, injury, etc.) then you should go back in the calendar and repeat the workouts. For example: If you miss more than 2 cardio workouts then repeat the full week If you miss a week, back up and repeat 1 week If you miss more than 2 weeks, you should restart from the beginning of the month that you are currently in. If this is too hard then you may need to back up further. The program gets progressively more difficult. When you take time off, you lose some of your hard-earned conditioning so it is important to repeat workouts. You may also need to return to horizontal modes of training (i.e. recumbent bike, swimming, rowing) before moving forward in the program again. TIPS: Use the equipment you have access to and can tolerate training on, but starting with one horizontal mode of training is key. Rowing with the rowing ergometer is preferred because it mimics open water rowing. People who row in the open water tend to have the largest,strongest hearts out of all competitive athletes. Rowing is great to strengthen your heart muscle! If you are unsure how to use it ask someone toshow you. Keep the workouts spread out throughout the week. This is more beneficial than bunching them up and then taking several days off fromexercising. Try not to take more than 2 days off from exercising. This is KEY!! If you cannot complete all the sessions for that week, you need to repeat that entire week again before moving forward. The Basics of the Strength Training The strength training sessions prescribed should take you 20-30 minutes to complete. All weight training should be done using body resistance or onseated equipment. If you are unfamiliar with strength training then you should consult with a trainer to help you use proper form and technique oneach machine. It is recommended that you keep a log of your exercise. The strengthening exercises are mainly for the lower body and core, and thisis intentional. Lower body muscles act as pumps when they contract (as you are walking about in daily life) to return blood to your heart. Increasedmuscle mass in your legs means more blood returned with each step you take. TIPS:  Strength training can make you sore in the beginning (especially 1-2 days after the workout).  Some people find that they can only get to the gym 3-4 days a week. It is fine to do your strength training at the end of your cardio workouts instead of on separate days, if you prefer. If this causes you to become symptomatic then you should try to perform on separate days. Take at least a day off between strength training workouts. You need to allow your muscles at least that day to recover and to build muscle. We do not recommend the use of free weights until you have been able to build your strength and are able to perform with good form. If you have joint hypermobility then you should consult with a physical therapist prior to beginning your exercise program. The therapist can teach you how to protect your joints when you exercise  Exercises The Basics of the Horizontal to Upright Cardio Training Months 1-3 = Horizontal or Seated training When beginning this exercise program you need to use equipment where you are seated or horizontal in position because upright positions will likely make your symptoms worse. Examples include: o Recumbent bikeo Rowing ergometero Swimming (or kicking with a kickboard)o Seated stepper machine Month 4 = Upright bike Month 5= Upright exercise - Elliptical (begin without arm motion and then add after a few weeks)- Treadmill walking (no incline at first) Month 6-8 = Upright Training - Add in use of arm motion on the elliptical and incline on the treadmill- Make more challenging during this time as tolerated Jogging and stair stepping can be tried only after you have performed either elliptical with use of arms or treadmill walking on an incline and did not have an increase in symptoms. You do not ever have to jog if you do not want to. Warm Up and Cool Down: - Can be done on any piece of equipment and should NEVER be skipped.- At the end of your warm up you should have your heart rate approaching the target heart rate range for your workout.- For the cool down, simply remove all resistance from the piece of equipment you are using and slow down. In the beginning, your heart rate will take a long time to recover, but as you train more it will lower more quicklyTry performing stretching during or after your 10 minute cool down is complete. You should hold each stretch for 30 seconds and repeat 3-4 times on each side. Only stretch to the point where you begin to feel resistance. It should feel a little uncomfortable, but it should not hurt. Supine Exercises Exercises lying on your back, allow the blood pressure to remain even throughout the body. It also enables you to be able to build strength without cardiovascular compromise. The standing exercise for calf muscles should be done, when tolerated to aid the calf blood flow pumping mechanism. Mixed Postural Exercises     Upright Exercises Leaning forward, pivoting through the hip in exercise 2 and 3, will lead to better hamstring, gluteal and quadriceps engagement. The Sideways Lunge should only be down once the Reverse Lunge is perfected. The use of a slider on the floor and progressing from reverse lunge, to diagonally sideways lunge and eventually sideways lunge may need to proceed lunges with steps and certainly before forward lunges. Aim, is to re-orient the motor learning systems to efficiency of movement both metabolically and mechanically. Monitoring your Heart Rate We recommend you purchase a heart rate monitor set (a watch with a chest strap) to monitor your heart rate during cardio exercise training soyou can exercise in the proper heart rate zones. These can be found online or at a large sporting goods store. You do not need to purchase anexpensive model. Each cardio workout is prescribed to be within a specific heart rate range (see Training Guidelines sheet from your healthcareprovider), and it is important that you complete the workout in that heart rate range. You may notice that your resting heart rate decreases withtraining. Or, it could be unchanged, but your heart rate response to upright posture is lower.TIPS:• Some monitors work even while swimming in the pool.• If you ever question what the monitor is reading (equipment can go bad or need new batteries), simply feel your pulse at your neck or wrist andcount the beats for 15 seconds and multiply by 4 (heart beats per minute). If you are unsure how to take your heart rate this guide can help you:§ Long Term Maintenance Cardio Training Months 6-8 of training is different for each person. Some people choose to maintain the level of training laid out in Month 5 forever, but we recommend trying to push forward. After you have completed the program you should continue to exercise to maintain what you have worked for. During this time you can use whatever modes you enjoy most. High intensity interval training, is a fancy name for the training that begins in calendar Month 6. It has been shown to provide great benefits to the heart and lung’s response to exercise for healthy individuals and several patient populations. We have found it to be beneficial to patients with POTS when it is introduced at a time when they are ready for it and responding well to their training. Here is an example of this training- Step 1: 10 minute- warm up to get your HR up to Base Pace zone- Step 2: 1 minute- go “all out”, hard and fast, increasing the resistance and speed on the mode you are using, and trying to get your HR upto your race pace zone- Step 3: 1 minute- remove all resistance, slow down, and actively recover. Take this time to get a drink, but keep moving on the piece of equipment. It doesn’t matter what your HR gets down to.- Step 4: Repeat steps 2 and 3 for two to three more trials- Step 5: 10 minute cool down- Step 6: 20 minute Recovery workout. TIPS: • Begin with the upright bike, rower, or elliptical as these are safer than the treadmill for interval training. Try to treadmill only when you are ready.• You can add any strength training you want, and try other things like yoga, aerobics classes, returning to competitive sports as you feel able (we do not recommend any exercise in the heat).• Consider yourself on a path to wellness and do what you feel you can do! We often hear that symptoms continue to decrease with long term training.• Remember each patient progresses through the program to upright exercise at a different pace and that is okay! What to Expect Getting Started This program is not an easy fix to having POTS, and if exercise made everyone feel better in a matter of weeks, everyone would be doing it. The real results will be seen after several committed months of training. The first month may be very difficult, and you may feel increased fatigue during this month. This is not surprising, so do not give up! You are challenging your system to do things it CAN do, but is not USED TO doing. The second month may still be tough. The hope is that you’ll feel less fatigue, begin to sleep better, and suffer from fewer POTS symptoms in your daily life than you did before beginning the training. This is the goal!!! TIPS: • Your commitment and mental toughness are key.• When you begin with a new mode of training, it is not uncommon to feel increased fatigue. Listen to your body. Push forward when you can, or repeat a week if you feel you need to.• If you are anything like the individuals we’ve met with POTS, you probably do not feel good most of the time, and have tried several other things to make your condition better, Here is the question we are proposing to you: Why not give this program your utmost effort for 3-5 full months before deciding if it helps you or not? Remember the benefits of training occur after months of training and not just days or weeks.• Write down a list of things you want to resume in your life, tape it to your bathroom mirror, and read it every day. Read it especially on the days you do not feel like going to the gym -  allow it to help motivate you to get your quality of life back.• Get a workout buddy if you need one! They can’t follow your heartrate zones, but they can work out with you!• Ensure your family is on board with supporting you in this journey. Help them understand you may feel more tired in the beginning, but the hope will be to feel better in the long run.• Family support is important, but YOU need to be the one to take the responsibility to make this change happen. Exercise as Your Lifelong Therapy If you feel that exercise is helpful for you in any way, maintaining exercise will then be important for you to keep the benefits and continue to see further improvements in your health and quality of life. Furthermore, you will experience the benefits of regular exercise in many other areas of your life and health, as well. Many patients successfully resume caring for their children, full-time work, full-time school, or enter college when previously they thought that these things might be impossible. We sincerely hope that this is the case for you as well. Keep in mind that according to the American College of Sports Medicine (ACSM) every healthy adult should perform 30-60 minutes of exercise more days than not. Most of ourpatients adopt exercise as part of their daily personal hygiene program. Some patients feel that daily exercise is needed to avoid developing symptoms again. If you have an illness, setback, or quit exercise, and realize that you felt better while training, this is actually a good sign! Do not be discouraged. You have a good response to exercise and you know that it makes you feel better! Just start again. You likely need to begin with horizontal modes of training, but you will know how to progress yourself through the program again.  Physiotherapy Physiotherapy can consist of 'hands on' mobilisations of the spine, thoracic rings, myo-fascia as well as guidance and feedback on exercise execution and progression. Additionally, the application of lumbar mechanical traction can lead to mobilisation of the thorax and it's peripheral sympathetic ganglia. Moreover, the post traction exercise protocol, reinforces the mode of action of the postural stabilisers and spinal mobilisers before a person gets up from the treatment table.   Post Traction Exercises are essentially those described above, whereby abdominal and bridging exercise in supine are complemented with oscillations of the pelvis and hips. From Supine, exercises in side lying, then in 4 point kneeling, are followed by isometrics in sitting and finally oscillatory movements in standing, including the wall plank, queen mum and Alexander breathing exercises.  Supine exercises can also include Pilates style hip and core stability, as well as simple cycling. These have some cardiovascular conditioning effect as well as promote blood flow from the calf. Uploaded : 15 November 2021 Read More
  • Types of Exercise

    Types of Exercise

    What types of exercise are there? and what are the differences?   If you’re looking to introduce more exercise into your routine, you might be a bit confused by all the different exercises out there. Which ones should you be doing? We’ve created this guide to help you make sense of it all!   What types of exercise are there? There are four main types of exercise that you need to know about: ● Aerobic exercise - a workout that speeds up your heart rate and breathing● Strength exercises - building muscle mass● Stretching - maintaining flexibility● Balance exercises - improving your, well… balance! Aerobic exercise Aerobic exercise has a lot of all-round health benefits, and everyone should aim for 150 minutes of moderate intensity or 75 minutes of high intensity aerobic exercise every week. Some of the benefits of aerobic exercise include:● Improved heart health and reduced risk of heart disease● Lower blood pressure and reduced risk of heart attack or stroke● Weight management● Reduced blood sugar levels and reduced risk of type 2 diabetes● Improved brain function and reduced risk of dementia● Improved mood and reduction of depression and anxiety You can get aerobic exercise from walking, running, cycling, swimming, dancing or specific aerobics classes. Strength exercises Strength training isn’t just for body builders - as we age, we all lose muscle mass, so it’s important to build it back up. Muscle strength is vital for a number of everyday tasks, like carrying shopping, picking up heavy objects, and even standing up from a chair or walking up stairs. Strength training helps to:● Stimulate bone growth, reducing your risk of fractures or osteoporosis● Reduce stress in the lower back and joints● Improve posture● Manage chronic conditions like arthritis, back pain, diabetes, heart disease and depression● Make you - surprise! - stronger Some examples of strength training include free weights, weight machines at the gym, resistance training, and body weight exercises (such as push-ups, pull-ups, planks and squats). It’s a good idea to get advice from a physiotherapist before you introduce a strength training routine, particularly if you have any health concerns. Stretching Stretching is vital for reducing the risk of injury from other types of exercise, and can be a valuable part of injury recovery, but it also has a lot of benefits of its own. Regular stretching lengthens your muscles, which helps to prevent muscle cramps and pain, muscle strains, joint pain, and falling. It also keeps you flexible, which increases your range of motion and enables you to do everyday activities like bending down to tie your shoes. There are a huge number of different stretches you can do that all target different areas, so have a chat with us to figure out the best ones for you. Balance exercises As you get older, the systems within your body that control your balance begin to break down. Balance exercises are important to help to reduce the risk of falls and keep you steady on your feet. A physiotherapist will help you determine your current level of balance ability, which is really important for figuring out which exercises you need. Exercises like standing on one foot, walking on uneven surfaces, leg lifts or standing knee lifts can help with balance, but your physio will recommend the ones that will best suit you and tell you how to do them safely. We can help you with advice on the types of exercise that you need, particular exercises that you can do and the right techniques to get the most out of your routine (and avoid injuries). Give us a call or email us.  References 1. Brukner, P. and Khan, K. 2017. Clinical Sports Medicine. Australia: McGraw Hill Education2. Harvard Health Publishing. 2019. The 4 most important types of exercise [Online Medical News Today. 2019. What are the benefits of aerobic exercise? [Online 4. Mayo Clinic. 2021. Strength training: Get stronger, leaner, healthier [Online  Uploaded : 4 November 2021 Read More
  • Skier's Thumb

    Skier's Thumb

    What is Skier’s Thumb? The terms Skier’s Thumb and Gamekeeper’s Thumb both refer to injury of a ligament at the base of the thumb. The ligament is called the ulnar collateral ligament (or UCL). Whilst Gamekeeper’s Thumb refers to a chronic condition caused by repetitive stress to the UCL (think using a wrench or wringing out cloths), Skier’s Thumb is an acute injury, usually caused by a fall. What causes Skier’s Thumb? Skier’s Thumb usually occurs when a person falls on an outstretched hand whilst holding something - ski poles will do it, which is how the injury got its name. However, football, hockey, basketball and rugby can also be culprits. Falling from a bike or motorcycle is actually the most common cause, and even a firm handshake can sometimes be enough to rupture the UCL! The force of impact while the thumb is extended is what causes the damage. What are the symptoms of Skier’s Thumb? Skier’s Thumb accounts for 86% of all injuries to the base of the thumb, so it’s a common problem. If you’ve developed Skier’s Thumb, then you’re likely to experience the following: ● Pain at the base of the thumb or in the web space between your thumb and index finger● Swelling at the base of the thumb● Tenderness to the touch● Weakness in your grip● Bruising around the thumb● Pain in the wrist (referred pain from the injury site) How is Skier’s Thumb treated? How your injury is treated will depend very much on the severity. Mild injuries may only require stretching and pain relief techniques. More serious injuries might require immobilisation for a period, whilst very severe cases may need surgery. When you come to see us, we’ll assess the damage and determine whether the ligaments have been torn or just stretched - and if they have been torn, to what degree. Elevation and cold compresses can help to reduce swelling and bruising, and if necessary, we will apply a thumb cast to immobilise the joint while it heals. Once the cast comes off, we can show you exercises to help build your strength and flexibility in the joint. If you do require surgery, we will help you afterwards to regain the function in your thumb and grip, and to shorten your recovery time as much as possible. If left untreated, damage to the UCL can lead to long-term weakness and joint instability. So, make sure you get it checked out! How can Skier’s Thumb be prevented? If you’re a regular skier, sports player or (motor)bike rider, there are a few things you can do to reduce your risk of Skier’s Thumb: ● Make sure you’re using the proper technique for any equipment, like ski poles, hockey sticks or carrying a ball - get instruction from an expert● For skiers, you can train yourself to release your pole as you fall, meaning you’re less likely to land on an extended thumb - you can also get special gloves to help with this● Wearing ski gloves or sports gloves can protect your thumb joint in case of impact References 1. Physiopedia. 2021. Skier’s thumb [Online]2. Brukner, P. and Khan, K. 2017. Clinical Sports Medicine. Australia: McGraw Hill Education Uploaded : 4 November 2021 Read More
  • Exercise and Ageing

    Exercise and Ageing

    Exercise and Ageing - a personal perspective and literature review Martin Krause What constitutes successful ageing? Maintenance of health, both cognitively, psychologically and physically. Remaining engaged with people, being curious, regular endurance and strength training, as well as getting out into nature. Ideally exercise is a life long undertaking. The following is a personal perspective of my own professional and private experiences from elite and professional sport to treating centenarians, in a private practice setting, as a physiotherapist. Hopefully, my personal perspective doesn't appear to be an exercise in narcissism, but rather an expose of my thoughts and feelings on successful ageing.. I have exercised almost all my life. I grew up in a household without a car. My parents bought their first car in the 1980's after I had finished school. My grandfather also didn't own a car. He walked everywhere. When I visited him in Germany, in the 1970's, a 30km walk was a normal thing to do. We even caught trains to some distant place and walked back through forests and along quiet country lanes. Unfortunately, he passed away at 73 years of age. His son, my father, is currently 83 years old, and also seems to have this long distance walking ability, as does his cousin in Germany who, at 84, just spent the previous European summer walking in the Dolomites and Alpes, 20-30km per day, which even involved going up 3000m mountains. So what is the elixir of successful ageing?  South Tyrol Active transport Having grown up, always being reliant on 'active transport', I became a great believer in running and cycling everywhere I could. I discovered long distance cycle touring and orienteering around 13 years of age. Around 14 years of age, a friend and I commenced pack cycling in the school holidays, catching over-night trains several hundred kilometres away and cycling home from various places in Australia - in both heat/drought and cold (snow in the Blue Mountains).  Cycling up to 300km in a day and doing Alpine marathons and 100km trail runs, as a young adult, in Switzerland. Sport took me all over the world, to see incredible places, and meet amazing people. Some of these people were astonishingly old, such as Swiss and Swedish centenarians doing orienteering in the sleet and snow of the Czech Republic, others were dour Colombians and Cubans, who in their 70's, decided to accompany me for parts of my cycling trips, let alone the guy with just one leg - a below knee amputee, in Cuba, who rode with me for a couple of hours, telling me about his grandchildren! Genetics or epi-genetics? Genetics or epi-genetics? My mother died of throat cancer at 79 years of age, whereas my grandparents died of heart failure. On both sides of my family there was a mixture of ancestors dying both old and young (great aunts and uncles dying in their 30's and 40's). My mother and grandmother survived death marches and the camps at the end of WWII, and they lived to around 80, whereas, their siblings, who were spared 4 years of terror and deprivation, lived into their 90's. Notable, they were all still active as they aged, either riding their bicycles to do the shopping or still getting farming awards for the districts (Norfolk, UK) biggest pumpkin. What they seemed to have in common, is that they also didn't seem to over-consume, in terms of calorific intake. However, they all had type II diabetes and very high blood pressure problems as well as chronic low back pain. Cognitively, they were still 'sharp' well into their 90's. Psychologically, they were a generation who grew up with hardship, expected little, and were grateful for every day, seeing 'life itself' as a bonus.  Endurance vs Short Distance Intensity Now, I'm closer to 60 than 50. I still ride bicycles and run. However, long distance endurance activities have given way to short sharp fast activities. I took up 11 aside football (soccer) at 50 years of age, downhill Enduro mountain biking around a similar time. Traditional rock climbing is the most endurance oriented activity I do, which I took up in my mid 50's, as well as bouldering and some sea kayaking. My bike training involves 90 minutes of steep hills, to coincide with 90 minutes of football. Speed over endurance, seems to mean that the occasional adventure race of cross country marathon distances, only requires this speed training activity. At soccer, I'm still one of the fitter and faster ones in the O35 category, meaning I'm playing against people up to 20 years younger, albeit in a low division. This was not what I had expected when I was younger as I was taught, at university, "as you get older, your wear out", Tell that to my 98 year old client, with a rotator cuff injury (from a decade of lifting his wife in and out of the wheelchair), whose doing 'down facing dog' and high planks from yoga! Hatha Flow Yoga is another thing I took up in my 50's, where flexibility and stability meets deep breathing calm intensity.    Cardiovascular deficit is thought to be a common mechanism of different types of cognitive decline. Retinal fundus photography has been proposed as a measure of cognitive decline, as narrow arterioles and wider venular diameters is associated with reduced cognitive dysfunction (with/without dementia). In a longitudinal 6 month trial, using marathon running and chronic exercise adaptation from acute bouts of exercise, investigators were able to demonstrate positive changes to arterial vasculature, as well as cognitive function. Importantly, neither acute exercise nor regular exercise fosters these adaptations, on their own, however it is the combination of the two, which stimulates vascular changes and cognitive function (Roeh et al 2021 Med Sc Sp Ex, 53, 10, 2207-2214), The effect of exercise on blood pressure Cardiorespiratory Fitness (CRF) and Muscular Strength (MS) are independently associated with reduced odds of having high Arterial Resistance (AS) in older adults (Albin et al 2020 Med Sc Sp Ex, 52, 8, 1737-1744). Both 'fit and weak' as well as 'unfit and strong' groups demonstrated reduced AS. Moreover, an additive affect seems to occur combining greater strength with better cardiovascular fitness. These results need to be treated with caution as low BMI in the 'fit and weak' group may actually be a pre-cursor to chronic disease. Investigations, I undertook into Sarcopenia, strongly suggest, that the maintenance of muscle mass is critically important, to the immune and metabolic systems, as the protein reservoir residing in muscles can be used by the immune system, whilst the muscles themselves act as a metabolic 'glucose sink' via glut 4 receptor sites. See elsewhere on this site for further information.  Respiratory resistance training has also been advocated for reducing AS. Investigators found that when compared to the control group, systolic and diastolic blood pressure decreased significantly with unloaded breathing by means of 7.0 mmHg (95% CI 5.5 to 8.5) and 13.5 mmHg (95% CI 11.3 to 15.7), respectively (laboratory measures). With loaded breathing, the reductions were greater at 18.8 mmHg (95% CI 16.1 to 21.5) and 8.6 mmHg (95% CI 6.8 to 10.4), respectively. The improvement in systolic blood pressure was 5.3 mmHg (95% CI 1.0 to 9.6) greater than with unloaded breathing. Heart rate declined by 8 beats/min (95% CI 6.5 to 10.3) with unloaded breathing, and 9 beats/min (95% CI 5.6 to 12.2) with loaded breathing (Jones CU, et al 2010. An inspiratory load enhances the antihypertensive effects of home-based training with slow deep breathing: a randomised trial. Journal of Physiotherapy 56: 179–186). Read further.. From a personal perspective, higher intensity exercise seems to improve my muscle strength and agility, whilst encouraging deeper breathing. Flow style Hatha Yoga also encourages deeper breathing along with muscular stability and flexibility. I find that, when comparing the beginning to the end of a yoga session, I feel I'm breathing three times deeper!! Kayaking adds to my thoracic flexibility and abdominal length and strength, thereby freeing the diaphragm, whose myofascial attachments, to the hip flexors, allows for protective mobility around the abdominal aorta and vena cava. However, I still grapple with blood pressure issues. BMI Body mass index seems to also play a pivotal role. Too much weight versus not enough weight - endomorph vs ectomorph. Too little muscle mass versus too much 'puppy fat'. In my early 20's, when i was highly competitive, with elite orienteering and road cycle racing, my ideal body weight was 73kg and when I wasn't as fit, it went down to 69kg. Now I hover around the 76kg range, whilst being 188cm (6'3'') tall. We know that belly fat increases insulin resistance. We also know optimal exercise improves the power to weight ratio. Optimal Exercise What constitutes optimal exercise? In my experience, there is nothing healthy in elite exercise. Blinded one eye dogged determinism to achieve some form of 'singularity' at an 'event horizon' certainly is seen as a noble attribute, steeped in the history of 500 Spartans fighting an entire legion of Romans, gold medals at the Olympics and other heroic feats of athleticism. Whilst, creating a great story, which can mobilise an entire generation to become active, as was seen in Spain after the Barcelona Olympics, it can come at a price in some athletes. During the Sydney Olympics, I was talking to the dentist at the Olympic Village Medical Clinic and he stunned me, when he told me that some of the American athletes had borderline scurvy and gum disease let alone poor teeth. He felt that, although they were often on college scholarships, they were trained hard, and only good for one Olympics!!. Only good for one Olympics is what Charlie Walsh, the legendary Australian track cycling coach, said in Adelaide (2009), as the toll on the body, was too severe to expect more than an Olympics and maybe a World Championships out of an athlete. High Desert, Argentina 1990 - on the way to Passo de Aguas Negras I started long distance cycle touring, or pack cycling, at 12 years of age. At 26 years of age, school friends and I cycled half of South America on the very first versions of Mountain Bikes. Altitudes of up to 5000m, temperature in access of 50C during the day, below zero at night, bikes weighing 30-40kg, due to the need to carry spare parts, food for up to 10 days, water for 2-3 days. An amazing experience on the back of a lifetime of endurance training. We now know, that such extremes can lead to heart damage (Cardiomegaly), stress fractures, skin cancers, excessive weight loss, etc. I remember a client, the late Hilton Harris, who I had known in Wentworth Falls, in the Blue Mountains. He was 99, and still played 10 rounds of golf. He even bought a house at the top of the 2nd fairway. He told me that the secrete to musculoskeletal longevity were a 'good pair of boots and a good pair of socks' and don't do anything in the extreme. Another 97 year old client, the late Mr McAlpine, was still playing competitive lawn bowls and he felt that 'active exercise had to be interactive'. Dolf, the 95 year old Swiss Orienteer took up serious, regular, cross country skiing in his 60's, because a doctor told him that it would be good for his chronic low back pain. He even went as far as to buy a farm house in Kandersteg to do so. He was recently interviewed on Swiss National Television. Currently, I have an ex Naval Admiral, who at 98 years of age, is looking to buy a treadmill for his home, and whom I've gotten to a point where he is doing 'down facing dogs', high planks and 'up facing dogs' from yoga for his rotator cuff injuries. He was on a British Battle Cruiser. The Repulse, which was sunk off Singapore, 3 weeks before it fell to the Japanese in WW!!. He has a remarkable attitude to life. What I find with the current half a dozen or so centenarians whom I'm treating, is that they are cognitively incredibly astute, can hold a conversation, still have that curiosity to learn new things and are socially adept and active. None of them had easy lives, surviving war and the great depression. The late Margaret Palmer, was still travelling the world until 98 years of age. At 95 she went to French language school for a month in Strasbourg. The teacher even took her to an Etappe of the Tour de France. At 96, I suggested she go to Hakone hot springs in Japan - which she entertained but ended up going to Hamner Springs in New Zealand instead. Muscle memory Muscle memory is something which has been often talked about, but remained only anecdotally proven. I came to fatherhood, late in life. I was 40 when my son arrived. Because, my wife and I, were surrounded by much younger people, we adapted our physical activity to accommodate the younger mindset. When my son was 5 years of age, I commenced coaching his soccer team, which I did till he was 12. During that process of teaching kids every trick, I realised that, although I wasn't a good player when I was young, I was very good at learning how to do things when I was older. Attention to detail and technique are some of the benefits of teaching. This lead me into playing full 11 aside soccer at the age of 50. In the same year, when I turned 50, I participated in the Quebrante Huesos cycling Etappe in the Pyrenees, with Angel and an ex Tour de France cycling buddy of his, from Barcelona. I cycled back to Barcelona over 5 days after the event. Some 800km and 17000m of climbing later I decided that long distance cycling was no longer for me. Although a great and unforgettable experience, where I met lots of really interesting people, both on the road and in hotels, I'd realised this was too much. Many of the French people I met were curious about 'le Kangaroo avec la sac a dos'. Quite often I was seriously late for the Plat du Jour, where in one instance, the barman looked at me and said 'I suppose you'll eat anything!". He made me the worlds biggest baguette and in the same establishment, I met a young couple from New York, whom at a whim, bought charter flight tickets to an airport near Barcelona so they could walk the entire length of the Pyrenees. The girl was the instigator of their adventure, full of expression and excitement and wanting to know more about my adventure, whereas the boy looked like he was about to die.  Ironically, I was probably looking at my own reflection, because how he looked, was the exhaustion I was feeling. I will never forget that moment, which is etched into my memory.  Muscle memory is probably a combination of neurophysiological-cognitive factors as well as muscle - immune peptides. Researchers have found that exercise induces different molecular responses in trained and untrained human muscle (Moberg et al 2020 Med Sc Sp Ex, 52, 8, 1679-1690). Their findings demonstrated that several key regulatory genes and proteins involved with muscle adaptation to exercise are affected by previous training history. I consider the human evolution out of Africa as a classic example of using our muscles to propel us forward, hunt and gather, whilst encountering new pathogens and dealing with injuries on the way. Could the long distance cycling experience, or the objective of ageing, also be a journey of survival? The interactivity of group activity, leading the cycling peloton amongst friends may presumably drive the immune response, whilst the gym workout, maintains the strength needed for the endurance activities to take place? Fine tuning the immune response of muscles through exercise Community . Hunter and Gatherer - Nomads Cognitive decline Arresting cognitive decline is a key ingredient to successful ageing. Dr Phil Cremer, neurologist at RNSH, has often told his clients to walk every day to help prevent cognitive decline. Exercise is perhaps one of the best preventatives of cognitive decline due to the thermogenic nature of it's activity. The Laws of Thermodynamics, conservation of energy, and oxidative stress are all at work within the musculoskeletal system. Together with the brain and gut, these sensors unleash the most powerful immune regulatory system. The human gut has more species and biota than there are stars in the universe. The muscle energy metabolism establishes a symbiotic relationship with the gut energy biota, whilst the brain drives the muscles in the need for the acquisition of food. In our 'hunting and gathering' days, this was all nicely balanced out, today we can order our groceries and even pre-prepared food, on-line.  Essentially, stress of hunger and hence hunting, was dealt with, by the immune system interacting with the brain, muscles and gut. How does the immune system deal with stress in the modern world and without physical and interactive social activity, is it this, which drives cognitive decline? Group activity, exercise and cognitive responses The more we feel cognitively and physically in control within our environment, the 'Goldilocks' sweet spot of stress can be found. Allostasis is our ability to adapt to various psychological and physiological stressors. Cycling through extreme heat and altitude in South America with some dehydration and calorific compromise might be just such an allostatic process, whereby, in my case. I adapted nicely due to my prior training background and because I was with friends. Whereas, my OTT Pyrenees cycling experience, I actively sort out company, as the trip back to Barcelona was on my own. I wonder whether my mother, at 6 years of age, would have survived on her own, if she weren't with her 8 year old brother and later their mother during WWII? Their mother definitely wanted to end their lives by jumping into an ice crater (January 1945), created by a bomb on the frozen river, only that her children protested 'wir wollen leben' - we want to live. Exercise activates key cellular energy sensing pathways which can directly and indirectly influence other hallmarks such as glutathione (GSH), and vascular endothelial growth factor (VEGF). Brain Derived Neurotrophic Factor (BDNF) release improves glial cell activation and modulation of inflammation, increases neurogenesis and neuronal connectivity, improves neural stress response, calcium homeostasis and DNA repair. Furthermore, habitual exercise improves regulation of oxidative stress and general central nervous system mitochondrial function and regulation (Wahl D et al 2021 Novel Strategies for Healthy Brain Aging. Ex Sp Sc Re, 49, 2, 115-125). Aerobic fitness and cognition As mentioned earlier, a lot can be learnt through the assessment of the eyes. Spontaneous eye blink rate (sEBR) mediates the association between aerobic fitness and executive function through pre-frontal aerobic efficiency via a brain dopaminergic functional pathway (Kuwamizu et al 2021, Med Sc Sp Ex, 21, 7, 1425 -1433). Stress makes us blink! Orienteering is a very good sport where the demands of moving through terrain are both physical and mental. Belonging to an orienteering club is like belonging to a big family. Moreover, people can do this sport into their 90's.  Read more ... Contextual memories, health, allostasis and muscular immune response Successful ageing isn't for the faint hearted. A myriad of musculoskeletal and health issues can arise, as well as questions of ones own self-worth in a tribe. From my anecdotal and professional experience, I would be inclined to say that the best way to age successfully, is through group physical activities which are cognitively engaging, stimulate the muscle-immune-brain-gut axis and take people on a journey of self discovery and ideally involve nature. Uploaded : 30 September 2021 Updated : 07 November 2021 Read More
  • Osgood-Schlatter Disease : Osteochondritis Dissecans

    Osgood-Schlatter Disease : Osteochondritis Dissecans

    Osgood-Schlatter disease Despite the name, Osgood-Schlatter Disease (OSD) is not a disease at all - it’s a common knee injury that affects children and teenagers. If you thought that “growing pains” were an old wives’ tale, then think again. Growth spurts in adolescence can cause a number of painful conditions, and OSD is one of them. What is Osgood-Schlatter Disease? Children have a lot of growing to do, which means their bones, muscles and tendons have a lot of growing to do too! To enable this process, many of the bones have a growth plate, which is a soft area of cartilage at the ends of long bones. The shinbone is one such bone. During puberty, when the muscles, bones and tendons are all growing at different rates, the tendon that connects the shinbone to the kneecap can pull on the growth plate at the top of the shinbone. Since this is also a time when children are particularly active - playing sports, playing with their friends, and generally running around and jumping about at any opportunity - the tendon can be further stretched by frequent repetitive movements. All of this causes swelling and irritation, known as Osgood-Schlatter Disease. In 1903, an American orthopaedic surgeon called Robert Osgood and a Swiss surgeon called Carl Schlatter both independently described the condition, and it was named after them both. What are the symptoms of Osgood-Schlatter Disease? OSD usually affects children between the ages of 10 and 15. It is more common in boys than girls and can happen in one or both knees. If your child has OSD, they will likely experience some or all of the following symptoms: ● Pain in their knee that gets worse with physical activity● Pain in their knee when running, jumping, squatting, kneeling, walking upstairs, or walking up hills● Tenderness around the knee● Swelling below the kneecap How is Osgood-Schlatter Disease treated? If left untreated, the pain from OSD can last a very long time. The good news is that OSD will go away altogether once your child stops growing, but until then it can cause a great deal of discomfort, so it’s important to give your child the best possible treatment while it’s occurring. Rest is important, and your child will most likely be advised to either limit or modify their level of sports activity for six to eight weeks. After that time, they may continue to participate in their normal activities as long as they rest if the pain becomes too severe and the pain subsides after a day of rest. If it doesn’t, they’ll need to be checked out. You should also watch out for any signs of limping or difficulty walking after activity. Ice application after activities can reduce the pain, and stretching the quadricep and hamstring muscles is important. As this condition is caused by excessive pulling of the tendon on the bone, stretching should be gentle and only done when advised by your physio. Foam rolling may also be effective as a form of self-massage for the leg muscles when at home. Your physio can help your child with exercises to strengthen the quadricep and hamstring muscles, and a stretching and warm-up/cool-down routine for sports activities. Our goal is to keep your child active and moving with as little pain as possible. References 1. Physiopedia. 2021. Osgood-Schlatter’s Disease [Online 2. Johns Hopkins Medicine. 2021. Osgood-Schlatter Disease [Online Kids Health. 2019. Osgood-Schlatter Disease [Online Uploaded : 23 September 2021 Read More
  • What is a ligament sprain?

    What is a ligament sprain?

    What is a ligament sprain? A ligament sprain is usually caused when a joint is suddenly forced beyond its usual range of movement and the ligament fibres are stretched too far. In some cases, the ligament can be torn. This might be the result of falling, twisting, or sustaining a blow to the area. The most common location for a ligament sprain is the ankle, but they can occur anywhere. What is the difference between a sprain and a strain? You might hear these terms used interchangeably by amateur diagnosticians, but sprains affect the ligaments while strains affect muscles and tendons. They both cause pain, though, so it can be difficult to tell the difference when all you know is that it really hurts! How will I know if I’ve sprained a ligament? Sprains can look and feel like a break, particularly if they are severe, so it can be difficult to tell the difference between the two. You will likely experience: ● Pain● Swelling● Bruising● Limited and/or excessive movement of a joint Some patients report hearing or feeling a “pop” at the time of the injury. What should I do about it? You’ll need POLICE - no, not the ones in blue uniforms, these ones: Protection - avoid further damage to the area through rest and, if necessary, specialist equipmentOptimal Loading – early movement to stimulate healingIce - applying an ice pack for 10 minutes can reduce swelling and relieve painCompression - the use of a compression bandage can help to avoid further swelling Elevation - keeping the area raised reduces swelling and allows waste removal from the injury site A physiotherapist will be able to help you with all of this, as well as supporting you with hands on treatment, exercises, and equipment to relieve pain, restore movement and prevent future injuries. So, your first port of call should be to book an appointment to get diagnosed early and start the recovery process with as little time wasted as possible. References 1. Physiopedia. 2021. Ligament Sprain [Online Brukner, P. et al. 2017. Clinical Sports Medicine. 5th ed. McGraw Hill Education: Australia Uploaded : 23 September 2021 Read More
  • Orthotics


    Orthotics Orthotics can either be “off-the-shelf” standard items that are ready made and adjusted for the patient’s particular size - or custom-made, particularly in cases of more complex injuries or changes to multiple joint structures. Reasons to use orthotics There are a few reasons that your physiotherapist might recommend the use of orthotics. Generally speaking, orthotics are designed to either stabilise a body part, or assist that body part in movement. For example, if a joint is not in a functional position, then orthotics may be used to help it to function better, recover and to prevent further injury during the recovery process. Types of orthotics There are several types of orthotics. Commonly, they can be divided into soft and hard. Both can be molded, but it is more common to mold the hard ones. Both can have inserts, wedges, domes, etc, glued to them. Some are moulded after taking a cast of the foot whereas others are designed after foot platform analysis of weight distribution across the sole of the foot. Commonly, a video is also taken of the rear of the foot at push off. Try soft orthotics first. Inexpensive and frequently enough to fix the problem. Some conditions that might require orthotics include: Back pain - if this is caused by foot or leg problems that are causing uneven gait, then orthotics might help you to walk more evenly and reduce the pressure on your back Arthritis - orthotics can help with positioning of the joints to relieve discomfort Bursitis - when the fluid-filled sacs in the heels and toes become inflamed, they cause a great deal of discomfort which orthotics can help to reduce Ankle sprain – an orthotic might provide support to prevent further injury while you recover and to allow you greater movement Achilles tendonosis - take tension off the achiilles tendon esp at the insertion of the heel and it's bursa Inside knee pain - reduces the amount of rotation on the inside of the knee as the first joint of the foot is a 'ball and socket' joint. Outside hip pain and bursistis - again aids in control of rotation  Common mistakes with orthotics Orthotics can be incredibly valuable tools in your recovery, but only if they’re used correctly. There are a few key mistakes that people regularly make, so we want to help you avoid them! ● You need to wear them in gradually It will probably take two to three weeks to get completely used to wearing your orthotics and, except in serious cases or unless your physiotherapist tells you differently, you will need to gradually build up the amount of time you wear them each day rather than wearing them full-time from the offset. ● You must follow your physiotherapist’s instructionsWe know it can be a hassle to have to put that wrist support on every time you play sport, but it really is important. You need to wear the orthotics in the right way, at the right time, for the right amount of time, or they may not work as effectively as they could. Your physiotherapist has given you those instructions for a reason, so it would be advised to follow them as best as possible. ● Don’t give up on them as soon as you’re feeling betterBecause it can be a hassle to keep putting them on, or because people don’t think they look particularly attractive, or because they might not be incredibly comfortable, many people are keen to ditch their orthotics as soon as possible. But just because the pain has subsided doesn’t mean the problem’s gone away. If you give up on them too soon, the problem might come back or get worse. So don’t put them away until your physiotherapist gives you the go-ahead. When you’re experiencing pain, we’re happy to talk you through all the different treatment options available, including what types of orthotics might work for you alongside our hands-on and movement / exercise-based treatments (but only if needed of course!). Give us a call on or email and we can discuss your choices. Take a look at my research - barefoot running vs orthotics : EMG and joint angle analysis read more.........see link below see Uploaded : 26 August 2021 Read More
  •  Plantar fasciitis

    Plantar fasciitis

     Plantar fasciitis If the plantar fascia becomes acutely inflamed, this is a condition called plantar fasciitis (‘itis’ = inflammation in scientific talk). This is most common in runners, and accounts for around 10% of runner-related injuries. The repetitive movement of the foot in running, particularly when you run on hard surfaces, makes this band of tissue highly susceptible to overuse. New runners who try to do too much too soon, or those who suddenly change their running regime, can also excessively strain or tear the plantar fascia. Plantar fasciosis This is a degenerative condition, which is caused by the plantar fascia deteriorating under repetitive stress. This is almost like a second stage plantar fasciitis, where if you leave the initial symptoms untreated, the condition can progress to a chronic issue where degeneration of the tissues is the main feature. Any cause of a plantar fascia problem that develops from an acute to a chronic stage can fall under the label of plantar fasciosis. Just like running can cause fasciitis, it too can lead a person into fasciosis if left for too long. Other causes include being sedentary, overweight and regularly wearing high heels for prolonged periods. People who have excessively flat or arched feet are also at risk of developing these problems . What are the symptoms of plantar fasciopathy? Whichever type of plantar fasciopathy you have, you are likely to experience similar symptoms. These include: ● Heel pain, particularly when walking after a long period of inactivity (a classic symptom includes pain on taking those first steps in the morning after waking from sleep)● Tenderness in the heel area● Difficulty bringing your toes towards your shin● Pain when climbing stairs or walking on hard surfaces If the pain in your foot occurs shortly after a sudden increase in activity, then it’s very likely to be plantar fasciopathy, but let us take a look at you and we will be able to let you know exactly what is happening. Plantar fasciopathy is most common in people aged between 45 and 65 and is slightly more common in women than men. But anyone can experience it at any time. How do we treat plantar fasciopathy? If left untreated, plantar fasciopathy can cause pain for a very long time (most cases last at least six months), and, because the pain can cause you to alter the way you walk, there is a chance of further, potentially more serious, damage being caused. So, it’s best to see a physiotherapist as soon as possible. Some form of rest or alteration to your normal routine is important, particularly for plantar fasciitis, and we’re likely to tell you to take a temporary break from running or other sports that may lead to continued excessive load being placed on the tissues, and ultimately, delayed healing. We can massage the arch of the foot and other areas of the body including anywhere from the low back to the foot, to help relieve the pain and restore some movement. There are also a number of stretches and strengthening exercises that we can work with you on to help rehabilitate the plantar fascia and any other underlying causes. We may also recommend shoe inserts, orthotics or night splints to support the area while it recovers. Read more...... In the vast majority of cases, treatment and time will be enough to combat the issue. However, in more severe cases, we may explore options such as shock-wave therapy and various types of injection into the local area of tissue. We will always aim to follow a conservative approach before making use of more invasive techniques. If you think you might be suffering from plantar fasciopathy, or you want to avoid experiencing it in future, give us a call or email to find out what we can do to help. A tight calf and Achilles issues can also be a contributing factor : read more......... Uploaded : 24 August 2021 Read More
  • 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 :   References 1. Mayo Clinic. 2020. Frozen shoulder [Online Healthline. 2016. Frozen Shoulder [Online 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 - References 1. Healthline. 2016. Post-workout nutrition: What to eat after a workout. [Online [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 mobilisa