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Knee Osteoarthritis: Myths vs Facts

Knee Osteoarthritis: Myths vs Facts

First, let’s start out by outlining what osteoarthritis is. Osteoarthritis is a very common condition, affecting the entire body, but mostly the articular cartilage (cartilage which covers the ends of bones). Cartilage has a smooth surface, allowing bones to slide easily on each other with movement. In the knee joint, there are also some extra shock absorbing pads called menisci between the bones. Over a lifetime, there is normal wear of the menisci and thinning of the cartilage cartilage. In some people, this is accelerated due to previous injuries sustained earlier in life (ligament injuries, etc.). This process is what leads to osteoarthritis.

In an older population, a loss in meniscal health is coupled with thinning of the cartilage of the knee, referred to as osteoarthritis. Traditionally, this has been thought of as a ‘wear and tear’ disease, leading many to think that they cannot exercise and should not be physically active. This is in fact wrong, where cartilage needs moderate load through physical activity for optimal health. Exercise should be the first line of management in any scenario of meniscus injury or knee arthritis. Only failing this, should surgery be considered1.

I’ve got knee osteoarthritis. What do I do now?

So, you have developed knee pain and your MRI shows degenerative changes in your cartilage and meniscus, and osteoarthritis in your knee, what do you do now?

If you’ve been diagnosed with this condition then you might have experienced the all too common merry-go around with scans, appointments with various health professionals and a number of different treatments. This blog will help dispel some of the myths around knee osteoarthritis and help you on the road to recovery.

KNEE OSTEOARTHRITIS MYTH 1: My scan will show exactly what is causing my knee pain

Emerging pain research has shown that scans are poorly related to pain and disability. The degree of cartilage damage, meniscal degeneration or arthritis does not correlate to pain levels. On average, we know that 20% of people with pain-free knees have meniscal tears. This research study also showed that 19% of people (almost 1 in 5) over the age of 40 had a meniscal tear, with most of these people functioning with no pain. We also know that this number substantially increases in people who have had major knee injuries earlier in life (i.e. ACL ruptures)2. This has also been demonstrated in other parts of the body, with research showing that up to 50% of people aged over 40 years will have asymptomatic (pain-free) disc bulges in their spine and up to 90% of people over 60 years will have findings of disc degeneration. This research suggests that these findings are a normal part of pain-free aging, much like the wrinkles on your skin and changes in your hair3.

KNEE OSTEOARTHRITIS MYTH 2: I shouldn’t exercise my knee as it will worsen the damage in my knees

Well designed and implemented exercise relieves pain and does not harm or damage the knee joint cartilage and meniscus. In fact, weight bearing exercises are vital to deliver nutrition to the joint surfaces/cartilage and integral to reducing pain. The belief that therapeutic exercise may harm the knee joint is still common in people with knee osteoarthritis. This leads to decreased activity levels due to fear, which in turn has negative effects for the health of the knee. It is important that your knee pain is being managed based on your current levels of strength and control, so that an appropriate and individualised exercise program can be developed. Evidence suggests that people do just as well, if not better, with physiotherapy treatment compared with surgery.

KNEE OSTEOARTHRITIS MYTH 3: Surgery is required for all cases of osteoarthritis

Due to the mismatch between the degree of meniscal/cartilage damage, arthritis and pain, findings on xrays and scans alone should not be the reason for surgery. Arthroscopic (keyhole) surgery is a frequently offered management option for arthritic knees and meniscal tears, commonly provided to ‘clean out’ the joint. The rationale for removing damaged meniscal tissue is based on the concept that the meniscus is the primary source of pain in arthritis, where commonly this is not the case, despite scan findings4. In part, this explains why not all people respond favourably to knee arthroscopy.

As mentioned above, meniscal tears are common in symptom-free middle-aged and older populations without signs of knee osteoarthritis on xray5. More recent medical practices would actually suggest that there is little to no indication for the use of arthroscopic surgery in established knee osteoarthritis. Research has demonstrated that knee arthroscopy is no more effective than placebo (fake) surgery6. This research showed that if a patient underwent a knee arthroscopy or  fake knee surgery (placebo) they would present similarly in terms of levels of pain AND function up to 2 years after surgery. Having surgery is not the only option, regardless of how severe your knee pain is.

 

Knee Osteoarthritis – Know the facts.

It’s time to change the narrative around knee pain, and the facts are:
• Rest and avoidance makes pain worse
• Graded exercise is safe and helpful
• Pain does not equate to damage, but is moreso a reflection of the sensitivity of the knee
• Unhelpful beliefs and catastrophising can reduce confidence, lead to reduced physical activity and further deterioration of your knee health
• Muscle weakness is a big contributing factor
• Lifestyle factors such as a lack of sleep, lack of physical activity, weight gain and poor nutrition can have negative influences on pain

If surgery isn’t an option, where does this leave me?

There is emerging evidence from La Trobe University in Melbourne suggesting that exercise often yields better results than surgery and pain killers. Regular, structured exercises have shown to have a much greater pain-relieving effect than commonly used pain relief medication. In one trial with over 13,000 participants in Europe, patients experienced less pain, better physical function and better quality of life following 12 weeks of structured, twice weekly exercise sessions1. Fewer people were taking painkillers compared to before the start of the program. Well dosed and programmed therapeutic exercise is vital for knee health and the life-long management of physical disability related to osteoarthritis.

I am already physically active, but my knee pain isn’t going away

There is a difference between being physically active and exercising. Physical activities target cardiovascular qualities of health by increasing heart rate when exercising. Exercise/strength training is a type of physical activity carried out with a specific purpose of getting you strong and improving function. Walking is great exercise but usually isn’t specific enough to improve strength. Instead, targeted strength exercises such as squatting out of a chair with purpose (i.e. with optimal joint and body position) is more likely to improve your function and pain.

Strengthening exercises help reduce pain through different factors. A good understanding of the anatomy of the knee will help explain this. The knee is a joint between two bones, the femur (thigh bone) and tibia (shin bone). The ends of each bone are lined by smooth cartilage, which allows for sliding of the bones during movement. The capsule surrounds the joint, securing it and containing synovial fluid, a lubricant providing nutrients to the cartilage. The function of the cartilage is to allow smooth movement of the bones on each other and to shock absorb and spread load over its surface.

Exercise is all important when it comes to knee cartilage health. Think of cartilage as a wet sponge. When loads are applied, fluid is pressed out of the sponge. When loads are removed, the sponge sucks the fluid back in. When we exercise, load presses down onto our cartilage. The cartilage absorbs the shock and fluid squeezes out into the articular capsule. Once loads are removed, the cartilage sucks the fluid back in from the surrounding area. This mechanism is what delivers nutrition to the cartilage, necessary for healing, pain reduction and improved shock absorption7.

What type of exercise is best for my knee?

Keeping the above information in mind, exercises that target functional movements (such as squatting) and emphasise good alignment in your joints will be best. Supervised exercise, to ensure good quality execution are required to load the knee in an optimal manner. Quality is more important than quantity!

 

The team at PhysioTec are experienced Physiotherapists with expertise in exercise prescription. We will work with you to provide a plan and structured exercise routine to improve your pain and function.

Kevin Doan is a qualified APA Sports & Exercise Physiotherapist. Call 3342 4284 to book an appointment with Kevin.

 

References

1. Skou, ST & Roos, EM (2017) Good Life with Osteoarthritis in Denmark (G:LAD): evidence-based education and supervised neuromuscular exercise delivered by certified physiotherapists nationwide. BMC Musculoskeletal Disorders, vol. 18:73, pp. 1-13

2. Guermazi, Ali, Niu, Jingbo, Hayashi, D, Roemer, FW, Englund, M, Neogi, T, Aliabadi, P, McLennan, CE & Felson, DT (2012) Prevalence of abnormalities in knees detected by MRI in adults without knee osteoarthritis: population based observational study (Framingham, Osteoarhtirits Study). BMJ, vol. 345, pp. 5339

3. Brinijkji, W, Leutmer, PH, Comstock, B, Bresnahan, BW, Chen, LE, Deyo, RA, Halabi, S, Turner, JA, Avins, AL, James, K, Wald, JT, Kallmes, DF & Jarvik, JG (2014) Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol, vol 36, no. 4, pp. 811-6

4. Pihl, K, Ensor, J, Peat, G, Englund, M, Lohmander, S, Jorgensen, U, Nissen, N, Fristed, JV & Thorlund, JB (2019) Wild-goose chase, no predictable patient sub-groups who benefit from meniscal surgery: patient-reported outcomes of 641 patients 1 year after surgery. BMJ, vol. 0, pp. 1-11

5. Thorlund, JB (2017) Deconstructing a popular myth: why knee arthroscopy is no better than placebo surgery for degenerative meniscal tears. BJMS, vol. 51, pp. 1575

6. Moseley, JB, O’Malley, K, Petersen, NJ, Menke, TJ, Brody, BA, Kuykendall, DH, Hollingsworth, JC, Ashton, CM, Nelda, MPH & Wray, NP (2002) A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee. The New England Journal of Medicine, vol. 347, pp. 81-88

7. Bricca, A, Juhl, CB, Steultjens, M, Wirth, W & Roos, EM (2018) Impact of exercise on articular cartilage in people at risk of, or with established, knee osteoarthritis: a systematic review of randomised controlled trials. BMJ, vol. 0, pp. 1-9

Whole-Body Strength Training for Cyclists

Whole-Body Strength Training for Cyclists

As a cyclist, you’re constantly joking about only needing “legs and lungs”. The goal of a cyclist is to be as light as possible, with the highest amount of power to weight ratio coming from the legs, pushing into the pedals. That is why there are plenty of memes out there of cyclists with stick thin arms and torso, but with massive quads and hamstrings, and titles such as “Don’t miss leg day!”. Jokes aside, imbalances such as these can have a potentially detrimental effect on your long-term health. Strength training for cyclists is key for injury prevention and performance.

As cycling is a relatively low weight-bearing sport, it is beneficial for cyclists to engage in additional loaded strength training to address a variety of issues from bone density to muscular balance. Obviously, strength demands differ between cyclists – a road cyclist, track cyclist, mountain biker or BMX rider will all have very different needs, but the tips I share below can be used a general guideline, across all types of cycling.

 

 

Strength training for cyclists are a great addition to your training routine

Strength and conditioning programs should be kept as simple as possible. As often is the case, it is the simple stuff that works best and has stood the test of time.  The programs I recommend to a lot of my patients, typically contain the exercises below.

Sample workout
Compound Push (Knee Dominant) Back Squat/ Goblet Squat
Upper Body Push (Horizontal) Dumbbell Chest Press, Bench Press
Upper Body Pull (Horizontal) Bent over rows, Seated rows
Compound Pull Offset/Single Legged (Hip Dominant) Offset Romanian Deadlift, Offset Trap Bar Deadlift
Trunk Stability (Anti Rotation) Pallof Press, Plank + KB drags
*One of the Compound movements needs to be single legged or offset Work in 3 sets of 5-8 repetition with 2 RIR (Reps in Reserve)

By utilising a full body routine such as this, all the major components of the body will be covered, and even if a session is missed, you’ll know you are always covering the full body in each session. Optimally, you would want to engage this routine two times a week for adequate loading-for-strength benefits.

Compound movements are multi-joint movements which utilise multiple groups of muscles at the same time. Utilising a multi-joint movement under adequate weight helps to develop the ability to generate force through those joints. For a cyclist, the ability to generate better force in the hips and knees, coupled with bike specific training, may lead to an increase in power production.

I also added a note in the table to ensure one of the hip or knee dominant exercise needs to be either single legged or offset. Single leg/offset work is often underutilised, but is a very effective tool for stability. It also assists with restoring any imbalances you may have developed over the years, either through injuries or poor habits. I recommend that single-sided work be done towards the back end of the exercise session, as you would not often use as heavy weight. What’s more, doing single-sided work with a bit of fatigue from all the previous work sets will really challenge ones stability under appropriate weight.

The Importance of Upper Body Strength for Cyclists

For a cyclist, upper body work is not hugely important from a max strength or bulk point of view, however having good muscle tone in the upper body musculature is important for general well-being in everyday life. You don’t want to be “that” cyclist who is strong in the legs but weak with poor tone in the upper body, “that” cyclist who injures the neck or shoulder lifting a bag of groceries. Dependent on what field of cycling, some streams like track cycling and BMX may require a bit more upper body bulk and strength compared to road cycling and mountain biking.

Don’t forget to switch it up!

For a bit of variation in your workouts, you can alternate your sessions by switching the compound hip/knee dominant work around so you can focus the heavier work on the other compound exercises whilst offset/single leg work on the other. This will create a nice balance in loading for different movement patterns. I would try to do the heavy and double legged compound work at the start of the session and do the single leg or offset compound movements towards the mid or latter end of the session. Also for upper body work you can switch between horizontal movements like bench press and bent over rows with vertical upper body movements like overhead dumbbell press and lat pull down. See example in the table below.

Sample Variation
Compound Pull (Hip Dominant) Traditional deadlift, Trap-bar Deadlift
Upper Body Push (Vertical) Dumbbell Overhead Shoulder Press, Barbell overhead press
Upper Body Pull (Vertical) Lat Pull Down, Chin Ups
Compound Press Offset/Single legged (Knee Dominant) Bulgarian Split Squat, Lunges
Trunk Stability (Rotation) Woodchop, Medicine ball trunk rotations
*One of the Compound movements needs to be single legged or offset *Work in 3 sets of 5-8 repetition with 2 RIR (Reps in Reserve)

Hopefully what I have covered here about strength training for cyclists will be helpful as a starting point for a simple strength and conditioning program. As always, check in with your strength and conditioning focused allied health professional to determine if these recommendations are suitable for you.

The best advice I can give is, keep it simple and sustainable. The session need not be super long in duration – aim for 30-45 minutes to be done with your program. Over time, as you develop more experience and build up a repertoire of exercises you are familiar with, in each of the categories, you will be able to interchange exercises that are similar in each category to keep your work out fresh and engaging.

 

As with undertaking any new program or form of exercise, if you have any medical concerns, please check with your doctor. Or, should you need some tailored advice for strength training for cyclists – come see us here at PhysioTec.
Eric Huang is a qualified physiotherapist who specialises in cycling related pain and injuries. He has a passion for all things cycling, is a competitive cyclist himself, and runs his own cycling crew. Call 3342 4284 to book an appointment with Eric.

 

References:

Nicols JF, Palmer JE, Levy SS (2003) Low bone mineral density in highly trained male master cyclists. Osteoporos Int. 14:644-649

Rønnestad, B.R., Hansen, E.A. & Raastad, T. In-season strength maintenance training increases well-trained cyclists’ performance. European Journal of Applied Physiology. 110, 1269–1282 (2010)

Westcott, Wayne L. PhD. Resistance training is medicine: effects of strength training on health. Current Sports Medicine Reports: July/August 2012 – Volume 11 – Issue 4 – p 209-216

Louis, J., Hausswirth, C., Easthope, C. et al. Strength training improves cycling efficiency in master endurance athletes. European Journal of Applied Physiology. 112, 631–640 (2012). https://doi.org/10.1007/s00421-011-2013-1

 

Shall we dance? The health benefits of dancing at any age

Shall we dance? The health benefits of dancing at any age

Patients often ask me, “what is the best form of exercise?”. The answer I usually give is “The kind you enjoy”. My reasoning is, if you enjoy doing something then it is far more likely you will find the time to do it – an opinion supported by research1. So, if the gym isn’t your cup of tea, you don’t fancy a jog around the neighbourhood or it’s too cold for a swim – have you thought about dance as a form of exercise? Enjoyment is merely one reason to dance – once you hear about all the health benefits of dance, you’ll be shimmying back for more!

Dancing is great for fitness

Dance as exercise really is the allrounder when it comes to physical health benefits2. Studies show dance classes are as good for you, if not better, than other forms of structured exercise3. With so many types of dance available, you’re almost certain to find one you’ll enjoy. You can begin dancing at almost any age, so whether you’re 5 or 95, interested in ballet or belly-dancing, tap or tango, read on and see how dancing can help improve your health and wellness!

Cardiovascular improvement

Most of us know that physical activity and getting our heart pumping can help improve the function of our heart and lungs. The Australian government guidelines for exercise recommends adults participate in 2 ½ to 5 hours of moderate intensity physical activity (you can talk but not sing during the activity) or 1 ¼ to 2 ½ hour of vigorous activity (can’t say more than a few words without stopping for breath) each week4. A US intergenerational program showed both children and adults can reach their target heart rates through dance5. By incorporating ballet classes or line dancing lessons a couple of times a week and enjoying the petite allegro or Boot Scootin’ Boogie, you can gain the wonderful heart-pumping benefits that dancing can provide6.

Muscle strength and endurance

Ever admired the toned legs of a ballet dancer or the stamina of couples competing on dance tv shows? You too can enjoy strengthening your lower limbs and improve your endurance by attending regular dance classes.  Studies show that regardless of the type of dance, if you attend 3 hour-long classes a week, you’ll likely develop stronger legs and improved endurance in just 12 weeks7.

Balance and posture

Most everyday activity, such as walking, has us travelling in fairly straight lines without too much change in the level of our heads. Even when you’re at the gym – be it on a treadmill, stair climber or stationary bike – your movement is fairly limited. Dance on the other hand has us moving in all directions – forward, backward, sideways – often covering a lot of area. In addition to moving more in all directions, dancing often includes turns, jumps and sometimes even floor work.  When you’re performing that tango turn or jazz pirouette, you’ll be challenging your balance and dynamic postural control. This makes most forms of dancing ideal for improving our balance, and helping reduce the risk of falls, particularly as we age7,8,9.

Mobility and flexibility

We know that staying active and moving the joints is beneficial to joint health but there is some perception that dancing, particularly ballet, can lead to wear and tear on the hips.  This has not proven to be the case with an Australian study showing no difference in hip joint changes between professional ballet dancers and other athletes10. In fact, movement of the limbs during dance can help maintain flexibility, strengthen joint supporting muscles and keep the joints healthy9. Dance lessons have also been shown to help people with mobility issues, such as those with Parkinson’s disease. Recent research revealed regular dance classes improved the functional ability of people with Parkinson’s making it easier for them to move and get around11.

Dancing engages the brain and has “feel good” benefits

Not only do we see physical benefits in those who regularly participate in dance lessons, but dance can also give your brain a boost and improve your emotional wellbeing.

Memory and attention

If you’ve already attended a dance class, you’ll know how challenging remembering the combination of steps and movements can be. Perhaps you’ve also marvelled at more experienced classmates and their ability to pick up steps quickly or remember the choreography. Learning a dance sequence is like doing mental push-ups or a physical crossword for the brain, and the more you dance the better you’ll become. Challenging the brain to remember the steps and putting them all together in movement improves our “brain plasticity” and helps build our grey and white matter. In fact,  dancing improves our brains function much better than conventional exercise and can help stave off age-related mental impairments like poor memory and attention12.

Mental health and social connection

While those of us getting older will be especially keen on the mobility and memory benefits that dancing provides, there are also emotional benefits for people of all ages. Dancing can be a great way for adolescents (or people of any age) to deal with emotional distress.

A recent study found that teenage girls showed less nervousness, anxiety and and even reported less headaches and stomach aches while attending regular dance classes13.  Other studies have show similar benefits; A 12 week dance course lowered depression in a group of university students14 and a group of 60 – 82 year old’s reported improved social activities and networks through dance classes15. Regardless of dance style, people of all ages and cultural groups report a greater sense of happiness, social connectedness and life satisfaction through dance participation15.

Dance is great, whatever your age

Now that you know dancing can significantly improve balance, strength, endurance, mobility, memory and wellbeing, why not take a look to see what dance classes are available near you? Many dance schools offer classes for all ages including beginner classes for adults or those returning after a long hiatus. So grab a friend, sign up for a class and get moving!

(And if you’re isolating – there’s never been a better time to dance like nobody’s watching!)

 

As with undertaking any new form of exercise, if you have any medical concerns, please check with your doctor. Or should you feel worried about a particular physical issue – unsure if you can boogie with a “bad knee” or practice ballet with a bunion – come see us here at PhysioTec. We’ll do a thorough assessment and provide you with some individualised exercises and advice in preparation to really enjoy and gain the most from your dance classes.

Joanne Manning is a qualified physiotherapist with a special interest in dance rehabilitation and injury prevention. Call 3342 4284 to book an appointment with Joanne.

 

References

1. Dishman, R. e. (2005). Enjoyment Mediates Effects of a School-Based Physical-Activity Intervention. Medicine & Science in Sports & Exercise, Volume 37 – Issue 3 – p 478-487 doi: 10.1249/01.MSS.0000155391.62733.A7.

2. Hwang PW, B. K. (2015). The Effectiveness of Dance Interventions to Improve Older Adults’ Health: A Systematic Literature Review. Alternative Therapies in Health and Medicine, 21(5):64-70.

3. Fong Yan, A. C. (2018). The Effectiveness of Dance Interventions on Physical Health Outcomes Compared to Other Forms of Physical Activity: A Systematic Review and Meta-Analysis. Sports Medicine, 48, 933–951.

4. Government, A. (2021, March 30). Factsheet: Adults 18-64. Retrieved from The Department of Health: https://www1.health.gov.au/internet/main/publishing.nsf/Content/fs-18-64 years

5. Schroeder K, R. S. (2017). Dance for Health: An Intergenerational Program to Increase Access to Physical Activity.  Journal of Pediatric Nursing, 37:29-34.

6. Gronek P, W. D. (2020 ). A Review of Exercise as Medicine in Cardiovascular Disease: Pathology and Mechanism. Ageing and Disease , Mar 9;11(2):327-340.

7. Rodrigues-Krause J, K. M.-O. (2019 ). Dancing for Healthy Aging: Functional and Metabolic Perspectives. Alternative Therapies in Health and Medicine, Jan;25(1):44-63.

8. Wallmann HW, G. C. (2008). The effect of a senior jazz dance class on static balance in healthy women over 50 years of age: a pilot study. Biological Research for Nursing, 10(3):257–266.

9. Joung HJ, L. Y. (2019). Effect of Creative Dance on Fitness, Functional Balance, and Mobility Control in the Elderly. Gerontology, 65(5):537-546.

10. Mayes S, F. A. (2016 ). Professional ballet dancers have a similar prevalence of articular cartilage defects compared to age- and sex-matched non-dancing athletes. Clinical Rheumatology, 35(12):3037-3043.

11. Carapellotti AM, S. R. ( 2020). The efficacy of dance for improving motor impairments, non-motor symptoms, and quality of life in Parkinson’s disease: A systematic review and meta-analysis. PLoS One, 15(8):e0236820.

12. Rehfeld K, L. A. (2018 ). Dance training is superior to repetitive physical exercise in inducing brain plasticity in the elderly. PLoS One, Jul 11;13(7).

13. Mansfield L, K. T. (2018). Sport and dance interventions for healthy young people (15–24 years) to promote subjective well-being: a systematic review. BMJ Open, 8:e020959.

14. Akandere M, D. B. (2011). The effect of dance over depression. Coll Antropol , 35:651–6.

15. Sheppard A, B. M. ( 2020). Promoting wellbeing and health through active participation in music and dance: a systematic review. International Journal of Qualitative Studies in Health and Well-being, 15(1):1732526.

Music is Physical – The importance of exercise for musicians

Music is Physical – The importance of exercise for musicians

As a musician, you are likely to spend much of your time practicing. But how much time do you devote to keeping fit? Everyone knows that exercise is good for a person’s health, however did you know that fitness and exercise for musicians can also improve your performance?

In this blog, we discuss being fit to play

Fitness and exercise improves performance

Fitness for PerformanceSports medicine and performance research has well established that being fitter and stronger is probably going to mean you perform better, get injured less and have a longer career. Sportswomen and men do not get fit from playing sport – they get fit to play sport.

Professional sports have millions of dollars invested in strength and conditioning programs, GPS tracking of on-field movements and intensity, injury surveillance, early management and strict recovery protocols. They even have a fully or partially employed team of doctors, physios, exercise physiologists, strength coaches, psychologists, massage therapists, nutritionists and specialists, all on speed dial!

In the performing arts sector, the dance world has embraced these concepts to some extent, but it’s really only in the past 10-15 years that we have seen dancers “cross training” using weights, modern physical conditioning science and recovery techniques. Professional companies measured the cost of injuries and then implemented more stringent balances between dance floor time and body (and mind) care time!1 Dancers are learning that you can’t just dance and expect to be fit to dance.

But what about training and exercise for musicians?

Musicians, generally, have not embraced these concepts. Unlike dance, a musician’s physical appearance has not historically been important to the final product of the artistic performance. Hence, the physicality of one’s body has not been in the forefront of musicians’ training.

Demands of instrumental musicThe physical demands of instrumental performance are often only considered when things start to hurt. A study from Germany2 indicated the average age of onset of pain related to playing, in professional orchestral musicians, was 35. This indicates a realm of physical performance that is low load, high repetition – pain creeps up on you and can ‘suddenly’ take over your career or passion. There are no high impact injuries nor torn muscles from sudden explosive force (like dance or sport), but research3 shows that over 80% of professional orchestral musicians in Australia have had pain related to playing, that has interfered with or stopped them playing. Most musicians rely on the “gig economy” – with no guaranteed income, worker’s compensation or income protection insurance. So realistically, pain and injury will hurt more than just their bodies.

Music is physical.

Yes, music can be expressive, creative, therapeutic and passionate but to create music on any instrument (even digitally) musicians need to use their body as well as their mind. Musicians of all levels and ages will benefit from:

  • being fitter and stronger
  • physically warming up before playing
  • eating to perform, and
  • having a recovery protocol for after playing

In short – condition, prepare, play, recover (CPPR).

Exercises musicians can do to increase fitness levels

It’s easiest to break down your physical condition into two areas – cardiovascular fitness and strength. The latest W.H.O exercise guidelines4 recommend a minimum of 150 minutes a week of moderate intensity exercise (most people can get that fast walking) and 2 additional strength training sessions involving major muscle groups. I suspect some reading this will not be achieving that minimum.

Get fit to play musicAny gains in fitness or strength are made by challenging your body to respond to a load just greater than it is used to – challenging but achievable. You have to start low and slow, and build up to your target. Musicians should understand this concept as no one starts playing with a concerto – one must first learn the scales.

General cardiovascular fitness is gained, depending on your physical ability, by activities like walking, running, swimming or boxing, but all should be approached carefully and built on gradually.

Likewise, to gain body strength, start slowly and build gradually. Simple bodyweight exercises like calf rises, squats, bridges, dips and push ups (start on the wall or a bench) are enough to get you going and improve your general strength. From there you can progress to resistance bands or weights and just see the difference it will make to your playing endurance –  reduced fatigue, less pain – and often, improved performance!

Balance exercises are a very interesting area and can be surprisingly beneficial, particularly in the older musician. The ability to transfer body weight either standing or sitting can be an important part of injury reduction and also performance enhancement.

Is a warmup necessary for musicians?

A general body warmup before playing will increase the local muscle temperature and many people comment how it mentally places them in a performance space as well. Simple arm circles, body twists and leg swings are an easy way to start a routine that of course will flow into warmup on your instrument.

Recovery strategies are rarely seen amongst the musicians I have worked with (until I work with them!) Hydration (water), nutrition, some simple stretches and mentally ‘winding down” are proven sports practices based on a large body of research. Sleep is a huge area of current research and in musicians is currently rarely measured nor discussed.

CPPR – condition, prepare, play, recover.

Most musicians just play – until they can’t. Embracing sports science principles can not only minimise pain or injury, but improve performance and prolong careers.

For more information on fitness and exercise for musicians, pain or injury management or other aspects of musicians’ physical demands, call 3342 4284 to book an appointment with David Peirce at PhysioTec.

 

References

1. The “Cost” of Injuries in a Professional Ballet Company.
Ruth Solomon,B.A., John Solomon,Ph.D., LyleJ. Micheli, M.D., and ErnestMcGray, Jr. Medical problems of performing artists Dec 1999

2. Frequency, severity and predictors of playing-related musculoskeletal pain in professional orchestral musicians in Germany Steinmetz et al January 2014

3. Musculoskeletal pain and injury in professional orchestral musicians in Australia.
Bronwen Ackermann 1, Tim Driscoll, Dianna T Kenny Medical problems of performing artists 2012

4. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med: first published as 10.1136/bjsports-2020-102955 on 25 November 2020.

Bone Building Exercise for Osteoporosis

Bone Building Exercise for Osteoporosis

Building Bone – the foundations

Osteoporosis is a common disease in Australia. Osteoporosis affects over one million Australians, and is more common among women than men. It is a condition where the bones become weak, fragile and brittle. When bones lose minerals (such as calcium) faster than the body can replace them, this leads to a loss of bone density, which in turn, leads to an increased risk of fractures. Even a small bump or fall can cause a fracture. The most common sites for these fractures are the wrist, hip and spine (Osteoporosis Australia, 2014). Bone building exercise for osteoporosis is essential for optimising bone health.

Osteoporosis is likely under-reported, as many people typically have no symptoms at all until they experience a bone fracture, usually after a fall. Osteoporosis can be diagnosed with a simple and painless scan, known as a bone density test.

WHO is most at risk?

Factors that increase risk of developing Osteoporosis are:
(Osteoporosis Australia, 2014)

  • Your gender, women are more likely to develop osteoporosis than men
  • Increasing age. The older you get, the higher the risk
  • Race – you are at greater risk of osteoporosis if you’re of Caucasion or Asian descent
  • Peri and post-menopausal women, due to the rapid decline in oestrogen levels during menopause
  • Family history of osteoporosis
  • Medical history
    • Prolonged corticosteroid use
    • Thyroid conditions
    • Coeliac disease, inflammatory bowel disorder, due to malabsorption
    • Eating disorders,  severely restricted food intake and being underweight can weaken bone
    • Some medications for breast/prostate cancer, epilepsy and some antidepressants
  • Lifestyle factors
    • Smoking
    • Excessive alcohol consumption
    • Dietary factors
    • Little or no physical activity
    • Weight – both ends of the spectrum (thin body build or excessive weight)

WHAT can we do about it?

There are several interventions for osteoporosis management and prevention (outlined below).

We will focus mainly on bone building exercise for osteoporosis and the three important Bs – body, bones and balance.

Body, BONES & Balance – WHY exercise is important for bone density

Exercise is vital for both the treatment and prevention of osteoporosis. Regular, ongoing, physical activity and exercise has been shown to help maintain and improve bone mineral density (Osteoporosis Australia, 2014) (Sözen, T et al., 2017).

Bone is living tissue and this means it responds to exercise by getting stronger, as muscles do (NIH, 2019). Even when we are young, the exercise we do contributes to peak bone mass and therefore the more active we are, the higher the peak bone mass (NIH, 2019), (Sözen, T et al., 2017). Sometime during our 30s, this bone mass peaks and then we can begin to lose bone (NIH, 2019). Regular weightbearing exercise can help build your bone stock in your youth and prevent bone loss and maintain muscle strength and balance throughout your life. Exercise is especially important for someone diagnosed with osteoporosis.

There are specific exercises that are better bone building exercise for osteoporosis . These are called osteogenic exercises. These exercises help to improve bone strength due to a certain amount of impact or strain placed on them. Generally these exercises include resistance based or weight bearing exercises – exercises where your feet are on the ground and gravity is adding to the load through your bones. Swimming for example, would not be the best choice as an exercise to improve bone density, as there is very little gravitation loading or weight placed on your bones. Your bones react to the weight on them by building themselves up and getting stronger. Exercise examples include, but are not limited to, weighted squats and lunges, jumping, landing and stamping (Montgomery, G., et al., 2019). Impact loading can be tailored to the individual and gradually progressed from simple, safe landing techniques, to more challenging tasks once good skill and confidence in early tasks has been achieved.

It’s never too late to start a bone-building exercise program, even if you already have osteoporosis. You may worry that a bone building program may cause or aggravate a problem you may have, like back or knee pain. A professionally designed exercise program, customised to your individual circumstances, will allow you to strengthen your bones and muscles and improve your balance and coordination while minimising risks of aggravating pre-existing pain or injuries. In most cases, a customised program will have the added benefit of assisting you with these additional musculoskeletal problems.

So, no time like the present! Time to move that body and build those bones!

 

PhysioTec provides a unique and specialised group program based on the most current research available. It is designed to increase bone health and density through weight training. Our program incorporates posture and body awareness training along with balance and proprioceptive exercise aimed at reducing the risk of falls, joint overload and injury. Body – Bones – Balance (Body integration – Bone strength – Balance control) incorporates a group warm up followed by a targeted station-based exercise program that stimulates the whole body, with a special focus on improving health and strength of bones, muscles and tendons and optimising dynamic balance. Before entry into the program, you will have a detailed assessment with a physiotherapist who will individualise your starting program.

Read more information about our class here.

What exercises can I do at home after having a baby?

What exercises can I do at home after having a baby?

The experience of bringing a new baby home is exciting and wonderful. But this period can also be terrifying for a new mother, and at times, isolating. It’s a word we have been hearing so much of lately, but for other reasons – “Stay at home. Self-isolate. Social distance”. The concept of this is hard for anyone, more so for a new mother. As new mothers, we rely on getting out of the house and being social with our family, close friends and mother’s groups for support. We rely on access to our medical and allied health professionals so that we can look after ourselves and in doing so, care for the new baby we have brought into this world. Even though Covid restrictions are now easing,  it can still be challenging to leave the house with a new baby in those first weeks or months, for reasons other than the essentials. Looking after yourself and getting into some regular exercise might be low on your list of priorities.

 

Exercising from home

While the recent Covid crisis has been challenging, especially for new mums, this crisis has produced a tremendous surge in online exercises and exercise programs. We are lucky to have technology and the online platform to access exercise programs from home, however new mothers wanting to start exercising need to be cautious in selecting exercises. Some exercises place extra load on the abdominal muscles or pelvic floor which new mums need to avoid soon after having a baby, as these can have adverse results. Getting professional guidance before embarking on an online exercise program is vital.

At PhysioTec, we have two Women’s Health physiotherapists, Megan Power and Irene Li, who can assist you through this uncertain time. If you can’t make it to the clinic in person, we are able to provide an online ‘Telehealth’ video consultation. We will take a thorough history inclusive of your pregnancy and birth experience. We will also look at your posture and a variety of movements. From this we will give evidence-based advice and, if appropriate, recommend a personalised exercise program you can do safely at home.

We can address any of the following during a consultation:

  • Pelvic floor muscle and function
  • Abdominal separation
  • Safe exercise options/exercises to avoid
  • Pelvic pain

We also offer an App for your exercise program and this includes video, audio and text description. It also allows in-app messaging to stay in touch with your physiotherapist.

 

The Importance of the Pelvic Floor Muscles

Like any other muscle in our body, the pelvic floor muscles may be weak, too active, a source of pain and can also be different side to side. These muscles, along with connective tissue, support the pelvic organs. In women, these are the bladder, uterus and bowel. The pelvic floor is important for prevention and management of prolapse, management of urinary incontinence and also for its role in sexual function. Following childbirth, the pelvic floor needs time to recover and then we can start to gradually build up strength and coordination of these muscles again.

The main recommendation of the most current guidelines state that pelvic floor muscle training is associated with a reduction in prenatal and postnatal urinary incontinence (Mottola MF, et al., 2018). These exercises can be performed daily HOWEVER, it is crucial that women seek instruction from a knowledgeable health professional  to ensure proper technique in order to obtain the best outcomes/benefits from performing these exercises. This is especially the case for women who have never trained these muscles.

 

What about running?

In March 2019, three highly experienced physiotherapists – Tom Goom, Gráinne Donnelly & Emma Brockwell combined their areas of expertise to release a paper on returning to running after childbirth and the guidelines for this population. The main findings were that women in the post-natal period benefit from an individualised assessment and guided pelvic floor rehabilitation in order to prevent and manage pelvic organ prolapse (Hagen, S et al., 2014), manage urinary continence (Bø, 2003) (Dumoulin, C et al., 2018) (Price, N et al., 2010) and improve sexual function.

 

Based on expert opinion, the following suggestions were made:

  • Return to running is NOT recommended at all prior to 3 months post-childbirth OR beyond this time point if any symptoms of pelvic floor dysfunction are identified before or after attempting a return to running
  • Pelvic health, load management and strength testing should be assessed in order to establish if a patient is ready to return to running in the post-natal period
  • Additional factors that should be considered in the postnatal evaluation are weight, fitness, breathing, psychological wellbeing/status, abdominal separation, breast support and feeding, running with a buggy and relative energy deficiency in sport (RED-S)

 

How can a Physiotherapist help me?

At PhysioTec, our physiotherapists who specialise in Women’s Health can address your postnatal concerns and advise you on the safest exercises, individually tailored to your symptoms and current capacity. If you are wishing to return to a level of activity similar to pre pregnancy, your physiotherapist is able to guide you on load and intensity and how to graduate safely back to full activity. We are passionate about what we do and our continuity of care. We are here (in person at Tarragindi or online via TeleHealth) to help and provide you with the best advice and support!

Book Online or call us on 3342 4284 to speak to us today!

 

References

Bø, K. (2003). Is there still a place for physiotherapy in the treatment of female incontinence? EAU , 145-153.

Dumoulin, C et al. (2018). Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews(10).

Hagen, S et al. (2014). Individualised pelvic floor muscle training in women with pelvic organ prolapse: a multicenter randomised controlled trial. 282(9919), 796-806.

Mottola MF, et al. (2018). 2019 Canadian guideline for physical activity throughout pregnancy. British Journal of Sports Medicine, 52, 1339-1346.

Price, N et al. (2010). Pelvic floor exercise for urinary incontinence: A systematic literature review. Maturitas, 67(4), 309-315.

 

4 tips for pain relief when you’re stuck at home

4 tips for pain relief when you’re stuck at home

1. Manage your stress

The effect of the COVID-19 pandemic has been devastating worldwide. We are lucky in Australia that the spread of illness is now being well contained. However, the social distancing measures have not come without a significant cost for many businesses, their employees and our way of life. Higher levels of stress are common and in the coming weeks, parents will also be juggling home schooling and many people will experience pain working at home.

Stress has a direct and marked impact on pain levels, so if you experience pain working at home and your normal achy neck or back is worse than usual, stress may be playing a substantial role. Often one of the first things you notice when stressed, is muscle tension developing around the neck and shoulder region. You may also feel tension developing in the lower back, particularly if you are sitting rigidly on the edge of your chair. Be sure to sit back in your chair and relax, allowing the chairback to support you.

When you are feeling overwhelmed or feeling tension and pain build in your neck or back, try some relaxed deep breathing. It can work wonders!

 

2. Optimise your home working environment

Many workers have had no choice but to make a rapid transition to a home-office, with less than ideal ergonomic set up. Pain working at home can result.

Good Desk Set Up

Problem: Using a laptop or tablet for prolonged periods will mean a poor neck angle and substantial increases in loads on the joints and muscles of the neck and upper back.

Solution: Organise an external monitor and/or keyboard, to ensure you can look straight ahead at your screen. These were in very short supply but are available again now.

Problem: Your desk and/or seat height may not be suitable.

Solution: Most people won’t want to invest in a new home set up for this temporary situation. But you can improve the situation usually with pillows, back supports, footrests and even bricks to alter the height of a low desk!

Aim to avoid situations where:
a. your knees are higher than your hips
b. your elbows are bent more than 90degrees

If you need a wedge cushion, decompression cushion or a back support, you can drop by the clinic to pick one up or we can organise delivery.

One of our physiotherapists can also check out your home working environment via a Telehealth video consultation.

 

3. Continue (or start) your Physiotherapy Rehabilitation Program

Don’t let this golden opportunity pass you by! Often our patient’s lives are so busy with all the events they must attend for work or family, that their home exercise program goes by the wayside. This makes it difficult to fully overcome a persistent pain issue.

Now is the time to attend studiously to your home program and get on top of those problems once and for all. This will help control pain working at home and it’s also very important for athletes to use this time to maintain or improve conditioning to avoid injuries when returning to sport.

Our physiotherapists are now transitioning back into the clinic after a short break with COVID-19 social distancing, so you can:

  • organise a check up on your program,
  • address a problem you have been meaning to attend to for ages or
  • put a plan in place to maintain your conditioning to prevent injury when returning to sport or your regular physical activity

PhysioTec Physitrack

We can provide assistance either in the clinic or with our telehealth service.

Telehealth is a video consultation. It allows us to assess your movement, check exercise technique, and tailor an exercise program for home. If you do not have an existing diagnosis for your painful condition, we’ll take a thorough history and step you through a variety of tests. This will help us determine what the main problem is.

The telehealth consultation also includes a free app with an individualised program. These exercises have video, audio and text descriptions available. On top of this, the in-app features also include tracking so you can check off your exercises daily and a messaging system to keep in touch with your physiotherapist.

Read more about Telehealth here.

 

4. Engage in regular exercise

We already know the important benefits of exercise, some of which include:

  • Positive effects for mental health
  • Weight control
  • Improved sleep quality
  • Prevention and management of a variety of health problems
  • Physiological benefits for the body, such as improving strength and mobility, which in turn help us to maintain independence.

Additionally, and perhaps most importantly right now, we know that regular physical activity decreases the risk of a person contracting a communicable disease (such as viral and bacterial infections). It enhances the ability of a person’s immune system to control itself. (Campbell & Turner 2018, Dominski & Dominski, 2020). Therefore continuing, maintaining or starting an exercise program is encouraged.

While the gyms and Pilates studies are closed, your options are to exercise outside or at home. There are many free exercise classes available online, but for those with previous injuries, be cautious. Some of these low-quality programs will not be suitable and may aggravate your condition or produce a new one.

Our physiotherapists can check your home exercise technique easily with telehealth , helping you control pain working at home. If you have gym equipment at home, Eric Huang, our strength and conditioning physiotherapist is very happy to check your lift technique and provide some ideas to vary or progress your program.

Eric Huang Telehealth Physiotec

Did you know?

Our Pilates instructors are also providing a high-quality Online Pilates service. Each class is run by one of our qualified Pilates Instructors and lasts approximately 40minutes. The classes focus on strength and conditioning exercises with the aim of keeping you moving and helping you maintain good functionality.

Physiotec Online Pilates_2020

Those who have already started these classes with Alice or Lisa have been loving them! Each class is limited to 4 people, and exercises are adapted for every client’s condition or physical fitness. The small class sizes also allow the instructor to monitor your form and posture, thus maximising your performance and safety.

Classes are priced at $20 per session, sold in packs of 5.

Call us on (07) 3342 4284 or contact us today to book in your free class trial!

 

 

References

Campbell, J. P., & Turner, J. E. (2018). Debunking the myth of exercise-induced immune suppression: redefining the impact of exercise on immunological health across the lifespan. Frontiers in immunology, 9, 648.

Dominski, F., Dominski, B. (2020). Exercise and Infectious Diseases – Covid-19. British Journal of Sports Medicine Blog, March 17, 2020.

Pregnancy, pelvic pain & safely returning to running

Pregnancy, pelvic pain & safely returning to running

Pregnancy is an exciting and special time but it can also come with a lot of questions. Whilst Google gives us access to a wonderful world of information, it can lead to more questions and sometimes concerns. This article will discuss the effect of pregnancy on the mother in terms of pelvic pain and the pelvic floor and returning to running after pregnancy, backed up by evidence and research. It is important to remember that not any one pregnancy is exactly the same!

Pelvic Pain & Exercise during Pregnancy

Based on various studies, approximately 50% of women experience low back pain or pelvic girdle pain (pubic, buttock, tailbone, pelvic floor regions) during pregnancy and 25% continue to have this pain 12 months after delivery (Davenport MH, et. al., 2019).

A panel of experts looked at 32 studies, which included a total of 52,297 women without absolute or relative contraindications to exercise (Davenport MH, et. al., 2019). For the absolute and relative contraindications, please click here. From this, it was found that physical activity during pregnancy decreased the severity of low back, pelvic and lumbopelvic pain. (Davenport MH, et. al., 2019). This is both during the pregnancy and in the early postpartum period. The exercise components of these studies included yoga, aerobic exercise, general muscle strengthening and a combination of resistance and aerobic training (Davenport MH, et. al., 2019).

Another study by Owe et. Al (2016) looked at 39, 184 pregnant women who had not previously given birth. This study found that exercising up to five times weekly prior to pregnancy was protective against pelvic girdle pain and also those women who reported participating in high impact exercises prior to pregnancy had the lowest risk of pelvic girdle pain during pregnancy. (Owe KM, et. al, 2016).

The most current guidelines state that an accumulation of 150 minutes of moderate intensity exercise each week is recommended in order to achieve the health benefits and reduce risks of pregnancy complications (Mottola MF, et al., 2018).

Pregnancy & the Pelvic Floor

In relation to the pelvic floor, the main recommendation part of the most current guidelines state that pelvic floor muscle training is associated with a reduction in prenatal and postnatal urinary incontinence (Mottola MF, et al., 2018). These exercises can be performed daily HOWEVER, it is crucial that women seek instruction from a trained health professional (such as a women’s health physiotherapist) to ensure proper technique in order to obtain the best outcomes/benefits from performing these exercises. This is especially the case for women who have never trained these muscles.

Returning to Running after Pregnancy
More recently (March 2019), three highly experienced physiotherapists – Tom Goom, Gráinne Donnelly & Emma Brockwell combined their areas of expertise to release a paper on returning to running postnatal and the guidelines for this population. The main findings that were included in the paper were that women in the post-natal period benefit from an individualised assessment and guided pelvic floor rehabilitation in order to prevent and manage pelvic organ prolapse (bladder, bowel or uterus descending into the vagina) (Hagen, S et al., 2014), manage urinary continence (Bø, 2003) (Dumoulin, C et al., 2018) (Price, N et al., 2010) and improve sexual function.

Based on expert opinion only, the following suggestions were made:

• Return to running is NOT recommended at all prior to 3 months post-natal OR beyond this time point if any symptoms of pelvic floor dysfunction are identified before or after attempting return to running
• Pelvic health, load impact management and strength testing should be assessed in order to establish if a patient is ready to return to running in the post-natal period
• Additional factors that should be considered in the postnatal evaluation are weight, fitness, breathing, psychological wellbeing/status, abdominal separation, breast support and feeding, running with a buggy and relative energy deficiency in sport (RED-S)

How we can help you at Physiotec:

It is imperative to see your physiotherapist before commencing physical activity, especially if planning a pregnancy, already pregnant or in the post-natal period.

Here at Physiotec, your women’s health physiotherapist can:
1. assess your pelvic floor muscles to ensure you are using them correctly
2. assess and address other areas of concern such as low back pain or pelvic pain
3. advise you on the safest exercises during pregnancy as well as into the post-natal period
4. perform a physical assessment to determine whether you are ready to return to running or other exercise after pregnancy 
5. perform a running assessment to ensure that your technique places minimal loads on your pelvic floor and joints following pregnancy

You might also like to join one of our Pilates classes to stay strong or build strength and control before, during or after your pregnancy.

Bibliography

Bø, K. (2003). Is there still a place for physiotherapy in the treatment of female incontinence? EAU , 145-153.
Davenport MH, et. al. (2019). Exercise for the prevention and treatment of low back, pelvic girdle and lumbopelvic pain during pregnancy: a systematic review and meta-analysis. British Journal of Sports Medicine, 53, 90-98.
Dumoulin, C., Cacciari, L. and Hay-Smith, EC. (2018). Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews(10).
Hagen, S., Stark, D., Glazener, C., Dickson, S., Barry, S., Elders, A., Frawley, H, Galea, MP, Logan, J., McDonald, A., McPherson G., Moore KH, Norrie, J., Walker, A., Wilson, D. (2014). Individualised pelvic floor muscle training in women with pelvic organ prolapse: a multicenter randomised controlled trial. 282(9919), 796-806.
Mottola MF, et al. (2018). 2019 Canadian guideline for physical activity throughout pregnancy. British Journal of Sports Medicine, 52, 1339-1346.
Owe KM, et. al. (2016). Exercise level before pregnancy and engaging in high-impact sports reduce the risk of pelvic girdle pain: a population-based cohort study of 39 184 women. British Journal of Sports Medicine, 50, 817-822.
Price, N., Dawood, R. and Jackson SR. (2010). Pelvic floor exercise for urinary incontinence: A systematic literature review. Maturitas, 67(4), 309-315.

Physical Activity & Pregnancy

Physical Activity & Pregnancy

Physical Activity & Pregnancy

The Facts, the Figures & the False Conceptions

If you are pregnant or planning a pregnancy and you are unsure about the current guidelines for physical activity and what is safe, this is a must read! An excellent team of experts have appraised over 27,000 manuscripts and abstracts (Davies G & Artal R., 2019) in order to bring us the most up to date information and guidelines on physical activity during pregnancy.

THE FACTS:

Physical activity during pregnancy:

  • DOES NOT increase the risks of structural or functional birth defects which stem from in the womb (Davenport MH, et al., 2019)
  • Has a significant effect on reducing the severity of low back pain, pelvic girdle pain and lumbopelvic pain. (Davenport MH, et al., 2019)
  • Decreases the chances of using instruments during delivery (Davenport MH, et al., 2019)
  • Reduces the chances of depression during pregnancy as well as the severity of symptoms. Unfortunately, this does not apply to the post-natal period. (Davenport MH, et al., 2018)
  • Reduces the risk of excessive weight gain during pregnancy as well as weight retention postpartum. (Ruchat S, et al., 2018)
  • Results in a small increase in the mother’s body temperature which is safe for the baby. (Davenport MH, et al, 2019)
  • Effectively reduces the risk of developing gestational diabetes mellitus, gestational hypertension and pre-eclampsia. (Davenport MH, et al., 2018)
  • Reduces the odds of having abnormally large babies (Davenport MH, et al., 2018)

Additionally…

  • There is no association between physical activity during pregnancy and increased risk of miscarriage or perinatal mortality (stillbirth or deaths in the first week of life) (Davenport MH, et al., 2019)
  • There is not enough evidence to inform us if lying on our back to exercise is safe or if it should be avoided altogether during pregnancy (Mottola MF, et al., 2019)
  • There was no association found between exercise during pregnancy and complications with the newborn baby or harmful childhood outcomes (Davenport MH, et al., 2018)

THE FIGURES & RECOMMENDATIONS

(Mottola MF, et al., 2018)

  • An accumulation of 150 minutes of moderate intensity exercise each week is recommended in order to achieve the health benefits and reduce risks of pregnancy complications
  • Exercise over a minimum of 3 days per week, however daily exercise is encouraged
  • Variety is key in order to achieve greater benefits
  • Pelvic floor muscle training can be performed daily in order to reduce risk of urinary incontinence
  • Exercising flat on the back should be modified if the pregnant women is experiencing light headedness, nausea or feeling unwell
  • TAKE HOME MESSAGE: All women WITHOUT contraindications should be participating in physical activity during pregnancy

THE FALSE CONCEPTIONS

  • Exercise will harm the baby. The evidence has shown that there are no increased risks of miscarriage or a small baby when undertaking physical activity during pregnancy
  • Heart rate should be below 140 beats per minute. This is an outdated guideline from the 80s and there was no evidence to even support this guideline, it was based on expert opinion.
  • Exercise needs to be at a gym or with group fitness. Lots of studies that were looked at were walking programmes. Additionally, moderate intensity physical activity can include gardening, mowing the lawns and some household chores.

Other considerations for physical activity & pregnancy

There are other considerations specific to the mother during pregnancy and physical activity. These include, but are not limited to, the pelvic floor and risk of overload/prolapse as well as pelvic pain. If you are planning a pregnancy/already pregnant and have a history of pelvic pain or pelvic floor concerns, it is important to see your physiotherapist before commencing physical activity. Here at Physiotec, your women’s health physiotherapist can assess your pelvic floor muscles to ensure you are using them correctly, assess and address other areas of concern such as low back pain or pelvic pain and advise you on the safest exercises during pregnancy as well as into the post-natal period. You might also like to join one of our Pilates classes to stay strong or build strength and control before, during or after your pregnancy.

Download more information on Physical Activity during Pregnancy here

Try Torpedo Perturbation Training at PhysioTec

Try Torpedo Perturbation Training at PhysioTec

Perturbation Training

See one of our Physiotec staff, Colm Coakley, demonstrating some perturbation training using the CorMax Torpedo. Half filled with water, the Torpedo becomes an unstable load which your muscles need to figure out how to control. Consequently, it provides a great dynamic stability challenge! Also, due to the ever-changing stimulus, it keeps the nervous system guessing.  This requires the system to continually change the way muscles are stimulated to respond.

In response to pain, or sometimes due to excessive training in very rigid unvarying patterns eg like regularly holding a rigid plank for 2+minutes, the nervous system can begin to recruit muscles in very confined, ‘primitive’ patterns. This can lead to a loss of normal efficiency and load sharing-load sparing in muscle recruitment patterns. As a result, this can also potentially contribute to pain, injury and a loss of athletic performance. At Physiotec, we are always exploring and embracing strategies that can help our patients get the best out of their bodies and their lives. Come & join one of our highly qualified physio’s in an innovative and challenging workout.