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Injuries in Street Dancers. A Guide to Injury Recovery & Prevention.

Injuries in Street Dancers. A Guide to Injury Recovery & Prevention.

Street dance encompasses many different styles of dance, all with their own unique history, culture, and evolution over time. PhysioTec’s dance physiotherapists regularly assess and develop dance injury prevention and management programs for dancers. This blog will highlight some common street dance injuries and what you can do to prevent or recover from these injuries if you are a street dancer. Research in this area has been emerging gradually as many of these styles are relatively new in comparison to other genres. Street Dance styles appearing in research so far has included hip hop, breaking, popping, locking, house, and krump.

COMMON STREET DANCE INJURIES

Street Dance styles have originated from different scenes including streets and clubs, with these various styles being expressed through freestyle, cyphers, grooves, and choreography. Street dance is increasing in popularity as these dance forms appear more and more across social media and competitions. Physical demands are becoming higher, and dancers are expected to have high levels of fitness, strength, agility, coordination, and motor control to meet the unique demands of each genre.1

Hip hop dancers have a similar injury incidence rate to gymnasts, and this rate of injury is higher when compared to modern dance and ballet. This highlights the importance of prevention strategies as this has been found to greatly influence the number of injuries sustained over a dancer’s career.2

 

COMMON INJURIES IN STREET DANCERS

KNEE INJURIES IN STREET DANCERS

Knee injury comes in at number one as the most common injury in street dancers, accounting for 42% of all street dance injuries.3 Street styles involve dancing techniques that require quick and intricate footwork – twists, sudden changes in direction, moving the body into unnatural positions and deep squats. Some hip hop components are quite acrobatic in nature and require dancers to land or stomp with great force. The risk of knee injury is therefore relatively high when considering the volume of rotating and jump landings with either flexed or extended knees.

It is common for dancers to have a dominant side which poses a challenge when it comes to group performances where dancers are required to perform in unison. Dancers with a larger preference for one side increase their risk of knee injury as there will likely be a lack of strength on the non-dominant side.4

Knee injury risk in street dancers is also increased during lengthy performances as the muscles gradually become more fatigued and efficiency in controlling the knee joint subsequently reduces. Choreographers are of course more interested in the way a move looks, than how it feels to the dancer, meaning that some moves may be particularly challenging for the knee, placing this joint at greater risk of injury.5

LOWER BACK INJURIES IN STREET DANCERS

Lower back injury is the second most common injury in street dancers (32%).3 Dance techniques in street styles often involve a combination of footwork and fluid movement from upper body grooves which require use of core muscles and trunk control. All turns, jumps, and landings require dancers to have high levels of control around the back and hips.6

Lower back injuries in street dancers are most commonly reported to be linked to the way the muscles around the back, pelvis and core activate and coordinate, with altered muscle strength and/or behaviour potentially increasing risks of injury. Risk of lower back injury is increased during high-impact, repetitive loading involved in street dance training and performance.7

ANKLE INJURIES IN STREET DANCERS

Ankle injury ranks as the third most common injury in street dancers (15%).4 This should come as no surprise due to the volume of jumping, hopping, and variations in landing involved in street dance. Factors that increase the risk of ankle injury in street dancers include poor technique, inadequate muscle control around the ankle and/or dynamic balance but may also occur from external factors such as performing on an uneven surface, unsupportive footwear or contact with another dancer.8 It is essential to address these external factors to reduce the risk of sustaining an ankle injury in street dancing.

 

TYPES OF STREET DANCE INJURIES

Street dancers have been found to injure themselves mostly by overuse (50%), landing (42%), twisting (36%), or slipping (31%).9 Dancers predominantly experience more overuse and chronic injuries due to poor technique, strength, and balance.10

When looking specifically at breaking, dancers are most likely to injure their wrist (69%), finger (61.9%), and knee (61.9%). Injury mechanisms are typically joint sprains, muscle strains and tendon injuries.11 It is important to consider breaking as a potentially high-risk dance sport.

It has been found that even when breakers sustain severe injuries, they only allow a limited time for recovery before returning to training.12 A lack of recovery and rehabilitation will increase the risks of developing an ongoing issue. A new injury might also occur due to the dancer needing to protect the injured or weakened area, moving extra forces to a nearby body part.

 

WHAT CAN I DO TO PREVENT OR RECOVER FROM STREET DANCE INJURIES?

There are several ways of preventing dance injuries from occurring, or assisting in injury recovery.

1. WARM-UP BEFORE STREET DANCE TRAINING OR PERFORMANCES

WARM-UP BEFORE STREET DANCE TRAINING OR PERFORMANCESPrevention is key. No matter how big or small a performance, a dancer in any style should conduct an adequate warm-up. This involves increasing the heart rate with cardio exercise such as running on the spot, jumping and hopping. This cardio can be followed by dynamic lengthening of the muscles to ensure they are warm, and the body has been moved through the ranges it will need to move through during training or a performance. Dynamic warm ups are preferred over passive stretching (holding a sustained stretch), as sustained stretching can reduce the natural reactivity needed for dynamic actions in street dance.

It is important that dancers work together with their family, dance teachers, and health professionals as a team, to ensure dancers are taking care of their body properly and staying healthy. If the dancer is in the middle of a busy training period in preparation for competitions and routine rehearsals have become the focus of training, the dancer should take it into their own hands to warm themself up prior to class. This is a crucial time as dancers will know training volume increases and so does the level of expected performance, meaning it is not the time to stop conditioning the body and warming up correctly.

2. BALANCE TRAINING FOR STREET DANCERS

BALANCE TRAINING FOR STREET DANCERSResearch has found balance and proprioception (awareness of body position in space) to be a key component of injury prevention, as this helps control large forces that cross the joints.5 Positive effects can be seen from quick balance training of 4-15 minutes per session conducted twice a week.13

For street dancers, balance training needs to be more than simply practising standing on one leg or on a wobble board. Our dance physios can provide balance programs specific for the challenges of dancing.

 

3. STRENGTH AND CONDITIONING FOR STREET DANCERS

Strength and Conditioning for Street DancersStreet dancers should add strength and conditioning to their weekly routine to complement their dance training. The aim is to increase the muscles’ ability to maintain the capacity to perform the tasks required in dance, and to reduce the impact of training and performance on the body.8

It is always best to consult a physiotherapist prior to commencing a strength and conditioning program. Our dance physios aim to identify any risk factors for injury and provide a targeted exercise program to assist the dancers training and performance.

 

4. REST & RECOVERY FOR  DANCERS

REST & RECOVERY FOR DANCERS

It is also extremely important for dancers to reduce fatigue and receive adequate nutrition to sustain the body during training sessions and performances to prevent injury.6 Adequate recovery time should be allowed between training and exercise sessions.

 If a dancer does unfortunately become injured, it is vital that they do not simply push through severe pain, as we often see happening within the dance culture. Dancers must allow sufficient time for their injury to heal. Dancers are encouraged to seek advice from a physiotherapist on when they may return to dance or if they will need a graduated return to their training program.

For advice on prevention of dance injuries, or for rehabilitation and treatment of dance injuries, make an appointment with Rhianna or Joanne today. Call 3342 4284 to book.

 

References

  1. Grˇci´c, V.; Mileti´c, A.; Kuzmani´c, B. Construction of Tests for Evaluating the Level of Hip Hop Performance. Res. Phys. Educ. Sport Health 2015, 4, 57–60.
  2. Uršej E, Zaletel P. Injury occurrence in modern and hip-hop dancers: a systematic literature review. Zdr Varst. 2020;59(3):195-201. doi: 10.2478/sjph-2020-0025.
  3. Ursej E, Sekulic D, Prus D, Gabrilo G, Zaletel P. Investigating the prevalence and predictors of injury occurrence in competitive hip hop dancers: prospective analysis. Int. J. Environ. Res. Public Health 2019, 16, 3214
  4. Kimmerle, M. Lateral bias, functional asymmetry, dance training and dance injuries. J. Dance Med. Sci. 2010, 14, 58–66.
  5. Knight, K.L. More precise classification of orthopaedic injury types and treatment will improve patient care. J. Athl. Train. 2008, 43, 117–118.
  6. Russell JA. Preventing dance injuries: current perspectives. Open Ac­cess J Sports Med. 2013;4:199-210. doi: 10.2147/OAJSM.S36529.
  7. McGill, S.M. Low Back Disorders, 3E; Human Kinetics: Champaign, IL, USA, 2015.
  8. Hrysomallis, C. Relationship between balance ability, training and sports injury risk. Sports Med. 2007, 37, 547–556.
  9. Ojofeitimi S, Bronner S, Woo H. Injury incidence in hip hop dance. Scand J Med Sci Sports. 2012;22(3):347-55. doi: 10.1111/j.1600- 0838.2010.01173.x.
  10. Lee, L.; Reid, D.; Cadwell, J.; Palmer, P. Injury incidence, dance exposure and the use of the movement competency screen (Mcs) to identify variables associated with injury in full-time pre-professional dancers. Int. J. Sports Phys. Ther. 2017, 12, 352–370.
  11. Cho, C.H.; Song, K.S.; Min, B.W.; Lee, S.M.; Chang, H.W.; Eum, D.S. Musculoskeletal injuries in break-dancers. Injury 2009, 40, 1207–1211.
  12. Kauther MD, Wedemeyer C, Wegner A, Kauther KM, von Knoch M. Break­dance injuries and overuse syndromes in amateurs and professionals. Am J Sports Med. 2009;37(4):797-802. doi: 10.1177/0363546508328120.
  13. Gebel, A.; Lesinski, M.; Behm, D.G.; Granacher, U. Effects and dose-response relationship of balance training on balance performance in youth: A systematic review and meta-analysis. Sports Med. 2018, 48, 2067–2089.
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

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.

Muscles and Ageing – Use it or Lose it

Muscles and Ageing – Use it or Lose it

We all know the importance of maintaining bone strength as we get older, and the importance of bone strength in maintaining independence, and reducing our falls and fracture risk. But what about muscle strength?

In a previous blog, we discussed low bone density and its strong correlation to falls risk. In this blog, we will talk about the health of muscles and tendons and their role in our physical function.

Sarcopenia – What is it?

Sarcopenia is the generalised loss of muscle strength as we age – or specifically, reduced muscle mass and strength. It’s normal to experience some muscle loss as we get older; however sarcopenia is severe age related muscle loss. It’s estimated that sarcopenia affects almost a third of older adults living in the community, varying by age and ethnicity (Daly & Maier, 2019).

Sarcopenia more commonly affects older adults, but can also present itself earlier in life. Muscle mass starts to decline around the age of 30, but the loss of muscle tissue progresses more rapidly when a person reaches their 60s (Volpi, Nazemi, & Fujita, 2010).

 

Symptoms and Causes of Severe Muscle Loss

According to De Pietro (2017), while ageing is the predominant cause of sarcopenia, there are other contributing factors, for example:

  • Inactivity. Living a sedentary lifestyle increases a person’s risk of developing sarcopenia
  • Poor nutrition. Sufficient protein and calorie intake is important in maintaining muscle mass
  • Hormonal changes. As a person ages, there are changes in the production of the sex hormone (testosterone) and growth hormones, which affects muscle growth and mass

People with sarcopenia generally experience weakness and loss of stamina, which hinders their ability to perform physical activities. And this decrease in physical activity leads to even further muscle loss (Thorpe, 2017) .

Signs of Sarcopenia
Source: (Thorpe, 2017)

Why is maintaining muscle mass important?

Muscle loss is associated with a higher risk of fractures due to an increased likelihood of falling, as reduced muscle strength may influence the ability to control the body during the a fall (Hsu, Wei-Li et. al, 2014). Scientists have shown a close relationship between falls and muscle weakness of the buttock, thigh and ankle muscles (MacRae, PG et. al, 1992) (Hsu, Wei-Li et. al, 2014).

Sarcopenia can have a significant impact on a person’s everyday life, and affect their ability to perform basic tasks, such as climbing stairs, lifting objects, and walking.

How to fight age-related muscle loss

There are two main things we can do to fight Sarcopenia:

1. Nutrition

Proper nutrition is essential to treating sarcopenia, and can even prevent or delay the condition. In 2008, the Society for Sarcopenia, Cachexia, and Wasting developed nutritional guidelines for the prevention and management sarcopenia (Dorner & Posthauer, 2012).

The guidelines state that protein intake is an important dietary consideration – studies have shown the correlation between dietary protein and muscle mass. Some easy ways to increase your protein intake (Lillis, 2019), depending on food intolerances and choices, include:

  • Introduce plant proteins to your diet, such as legumes and nuts
  • Eat more dairy, such as cheese and Greek yoghurt
  • Eat more lean meat
  • Try a protein shake

Another recommendation from the guidelines is the supplementation of vitamin D, as low levels of vitamin D levels are associated with low muscle strength (Dorner & Posthauer, 2012).

2. Exercise

Apart from the obvious benefits of exercise – feeling good, weight control, helping to boost energy, promoting better sleep and helping to prevent and manage a variety of health problems – the related improvements in strength and mobility help us to maintain independence. Additionally, exercise improves quality of life, especially in the areas of physical function such as balance and reducing pain related to musculoskeletal conditions (Hsu, Wei-Li et. al, 2014).

Fight muscle loss with resistance training

While both resistance and aerobic training can improve overall health and wellbeing, the only proven method for the prevention and management of sarcopenia is progressive resistance training. Resistance training focuses on exercising large muscle groups, using an external force. In a progressive training program, the challenge of the exercise including use of weights and number of repetitions are altered over time, based on your individual capabilities.

Examples of progressive resistance training are:

  • Bodyweight exercises such as simple squats, lunges and step ups
  • Exercises using external resistance such as hand weights or resistive bands
  • Either strength and conditioning/gym type exercise or Pilates training

 

At  Physiotec, one of our major areas of interest is rehabilitation of those with hip and pelvic pain and injury, who generally have associated muscle weakness around the hips and sometimes the whole legs. We are passionate about restoring healthy hip muscles and see first-hand the improvements in quality of life and functional capabilities of people who engage in a tailored exercise programme. One study has also found that there is an association between reduced size of the deeper hip muscles  (gluteus medius and minimus) and the risk of bone fractures related to falls (Chi, AS et. al, 2015). There is also a relationship between muscle weakness, painful knee or hip osteoarthritis and an increased risk of falls  (Doré, AL et. al, 2015).

A final thought..

We may not be able to stop the ageing process in its track, but with regular exercise and resistance training, as well as proper nutrition, people can prevent sarcopenia from developing, or slow the progression of the condition.

 

Physiotec physiotherapists are able to develop a targeted and specialised program for you, using evidence from the most current research available. These programs are specifically designed to target individual areas of muscle weakness or other concerns such as falls risk or difficulty with everyday tasks or recreational/sporting activity. Our programs may incorporate posture and body awareness training along with balance and proprioceptive exercise aimed at reducing the risk of falls, joint overload and injury. For others, the focus may be on reconditioning after an injury or surgery and getting you back to all those things you need and love to do.

For more information about developing a program just for you, call 3342 4284 to book an appointment with one of our physios.

 

Bibliography

Chi, AS et. al. (2015). Association of Gluteus Medius and Minimus Muscle Atrophy and Fall-Related Hip Fracture in Older Individuals Using Computed Tomography. Journal of Computer Assited Tomography, 00, 1-5.

Daly, R., & Maier, A. B. (2019, July 9). The muscle-wasting condition ‘sarcopenia’ is now a recognised disease. But we can all protect ourselves. Retrieved from The Conversation: https://theconversation.com/the-muscle-wasting-condition-sarcopenia-is-now-a-recognised-disease-but-we-can-all-protect-ourselves-119458

De Pietro, M. (2017, July 21). Sarcopenia: What you need to know. Retrieved from Medical News Today: https://www.medicalnewstoday.com/articles/318501

Doré, AL et. al. (2015, May). Lower Limb Osteoarthritis and the Risk of Falls in a Community-Based Longitudinal Study of Adults with and without Osteoarthritis. Arthritis Care and Research, 67(5), 633-639.

Dorner, B., & Posthauer, M. (2012, September). Nutrition’s Role in Sarcopenia Prevention. Retrieved from Today’s Dietitian: https://www.todaysdietitian.com/newarchives/090112p62.shtml

Hsu, Wei-Li et. al. (2014). Balance control in elderly people with osteoporosis. Journal of the Formosan Medical Association, 113(6), 334-339.

Lillis, C. (2019, June 25). What are the best ways to eat more protein? Retrieved from Medical News Today: https://www.medicalnewstoday.com/articles/325552

MacRae, PG et. al. (1992). Physical performance-measures that predict faller status in community-dwelling older adults. Journal of Orthopaedic & Sports Physical Therapy, 16, 123-128.

Runge, CF et. al. (1999). Ankle and hip postural strategies defined by joint torques. Gait & Posture, 10(2), 161-170.

Thorpe, M. (2017, May 25). How to Fight Sarcopenia (Muscle Loss Due to Aging). Retrieved from healthline: https://www.healthline.com/nutrition/sarcopenia

Volpi, E., Nazemi, R., & Fujita, S. (2010). Muscle tissue changes with aging. Retrieved from National Center for Biotechnology Information: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2804956/

 

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.

How can we prevent dance injuries ?

How can we prevent dance injuries ?

One of the most common questions I get asked as a physiotherapist with a special interest in dance rehabilitation and injury prevention is, “How can we prevent dance injuries?”.

GOOD QUESTION!

It’s a very valid question considering:

  • the rate of injury in young and adolescent dancers is higher than that reported in young soccer players or gymnasts
  • the injury rate of dancers aged between 9 -18 years is even higher than that of professional ballet and contemporary dancers!4,7

Why do dance injuries occur?

First, let’s take a look at why dance injuries happen.

The reason for young dancers reporting more injuries than their counterparts in other sports is partly due to growth spurts in this age group, coupled with the high physical demands of dance. There are also numerous other factors that have been identified as risks for injury. Some are intrinsic – related to the individual such as growth, hormones or previous injuries1 – and others are extrinsic or external, such as environmental factors like dance floors, equipment or training load.2 Research on both intrinsic and extrinsic risk factors, and their relationship to dance injuries is a growing area of research and hence, more information will continue to emerge.

There does seem to be a growing consensus that the majority of dance injuries in ballet dancers is due to overuse3,6,9. Dancers are familiar with the repetitive nature of dance training – having to repeat a move over and over again in order to learn and perfect a new skill or piece of choreography. This can prove somewhat tricky to manage among aspiring young dancers. In addition to this, the rigors of dance can increase at particular times of the year4, and we certainly see more injured dancers here in clinic around exam and performance periods.

What are the most common injuries for dancers?

In young dancers of ballet, tap, jazz, hip hop, contemporary, ballroom and Irish dancing, it may be no surprise that the lower limb (leg) is most commonly injured. This includes the knee, ankle and foot – with rate of occurrence in that order – followed by the hip and spine. Ligaments tend to be the most commonly injured soft tissue, with muscles and tendons making up about 30% of injuries, while bone injuries make up around 20% of all injuries.5

Acute versus chronic dance injuries

Traumatic injuries are usually referred to as acute injuries, while injuries relating to overuse are often longer lasting or slowly developing injuries, referred to as chronic injuries. Research has shown that the majority of injuries sustained by young ballet dancers are of the ‘overuse’ type, with more than three quarters of all injuries falling into this category.6 With overuse-type injuries, the dancer is usually unable to pinpoint exactly what caused the injury and often reports pain increasing over time. Tendinopathy and bone stress reaction/stress fractures are examples of this type of injury, typically caused by repetitive stress and/or overloading.  Other causes of chronic injuries can be structural or genetic in nature, such as hyperextended knees usually seen in the hypermobile population.

Acute injuries are usually a result of an “accident”. Examples of an acute injury are a slip on the floor or landing poorly from a jump, resulting in a muscle strain or ankle sprain.

So, what can we do to help prevent dance injuries?

Accidents do happen, however the majority of dance injuries can be prevented, and there are ways of reducing a dancer’s risk of injury.15 Some of the ways we can help reduce the risk of dance injuries are:

Dance Screenings or Dance Profiles

Dance screenings have long been performed by qualified physiotherapists to identify areas of weakness or concern, with the aim being to prevent dance injuries. Pre-pointe assessments or pre-pointe profiling (a term we prefer) is a good example. Although there is not a great consensus as to what elements and tests can accurately predict who is more likely to be injured, it is highly beneficial in identifying possible risk factors and facilitating improvements in strength and technique.

Screening dancers should not be limited to girls wishing to progress onto pointe. Research shows male dancers sustain dance injuries at the same rate as females, and as they mature, male dancers require higher levels of dance strength and flexibility. It is therefore a logical course of action that, during the important period of growth and adolescence, young men undertake a dance profile to identify any potential injury risks and develop appropriate and individualised training goals.

A good time of year to undertake a screening is during the school holidays. During this period, the student usually has more time to address any strength or flexibility deficits that may have been identified by the physiotherapist. They can use the extra time over the holidays to focus on these areas and begin the year a step ahead.

Check out the dance environment for potential injury risks

Acute injuries are sometimes a result of an environmental factor, and are therefore preventable. For example, purpose-built dance floors are an extremely important factor for keeping a dancer safe. Checking the floors for spills or items that may cause injury is another way of preventing accidents. Wearing properly fitting clothing and professionally fitted shoes appropriate to the style of dance can also help prevent environment-related injuries.

Always warm up before dancing

It is vital that dancers warm up before class, rehearsal or performance – skipping a warm up can lead to injury. The goal of a warm up is to raise the heartrate, warm up the muscles and mobilise the joints. This should be a gradual process conducted in phases. First a light sweat should be achieved by raising the heartrate and getting the big muscles working, for example, jogging, skipping or lunges. Then, dynamic stretches should be done.

It’s important, especially for young dancers, to understand that static stretches should not be done in early warm up. Static stretches should instead be left for the end of class, during cool-down.

Keep your body Dance-Fit with an individualized dance conditioning and exercise program

Individualized conditioning programs have been shown to reduce the rate of injury in professional dancers.7 These types of programs are created using information obtained during the dance profile, and takes into consideration the dancer’s history and previous injuries. Historically, supplementary strength and conditioning programs were avoided by ballet dancers,  who were concerned that this type of training would result in reduced flexibility or a non-aesthetic physique. There is, however, little evidence supporting this theory, and this opinion has now mostly been replaced by integrating elements from sports research showing the benefit of such programs8 with a dance-specific approach. Physiotherapists, especially those with extensive dance knowledge, are perfectly placed to guide  young dancers in their supplemental training.

Get enough rest and monitor your loading to help prevent dance injuries 

Finally, and of great importance to young dancers, is rest and load management. Since research shows ‘overuse’ as the main cause of injury in young dancers, monitoring their loading is of paramount importance.9-10 Young athletes who train in the same sport for more hours per week than their age (in years), were shown to have 70 percent more overuse injuries13. Furthermore, a 2014 study showed that young athletes who had less than 8 hours of sleep each night were more likely to sustain injuries than those who slept 8 hours or more.14

 

So, a short answer to the question of how to prevent dance injuries is….

Ensure the young dancer has a healthy dance schedule, has been screened for deficits and potential injury risks, and has an individualised conditioning program.

The dancer, as well as their family, dance teachers and health professionals, all need to work together to help the young dancer remain as injury-free and healthy as possible!

For more information about PhysioTec’s Dance Physiotherapy services, including dance screenings and pre-point profiling, injury rehabilitiation or dance-specific strength and conditioning, click here or call 3342 4284 to book an appointment with Joanne Manning.

 

References

  1. Kenny SJ, Whittaker JL, Emery CA. Risk factors for musculoskeletal injury in preprofessional dancers: a systematic review. Br J Sports Med. 2016;50(16):997–1003.
  2. Russell JA. Preventing dance injuries: current perspectives. Open Access J Sports Med. 2013;4:199–210.
  3. Leanderson C, Leanderson J, Wykman A, Strender LE, Johansson SE, Sundquist K. Musculoskeletal injuries in young ballet dancers. Knee Surg Sports Traumatol Arthrosc. 2011;19(9):1531–5.
  4. Prevention of Injuries in the Young Dancer (Contemporary Pediatric and Adolescent Sports Medicine). Springer International Publishing. Kindle Edition.
  5. Fuller M, Moyle GM, Hunt AP, Minett GM. Injuries during transition periods across the year in pre-professional and professional ballet and contemporary dancers: a systematic review and meta-analysis. Phys Ther Sport. 2020 Apr 3;44:14-23.
  6. Shah S, Weiss DS, Burchette RJ. Injuries in professional modern dancers: incidence, risk factors, and management. J Dance Med Sci. 2012;16(1):17–25.
  7. Steinberg N, Aujla I, Zeev A, Redding E. Injuries among talented young dancers: findings from the U.K. Centres for advanced Training. Int J Sports Med. 2014;35(3):238–44.
  8. Faigenbaum AD, Kraemer WJ, Blimkie CJ, Jeffreys I, Micheli LJ, Nitka M, et al. Youth resistance training: updated position statement paper from the national strength and conditioning association. J Strength Cond Res. 2009;23(5 Suppl):S60–79.
  9. Prevention of Injuries in the Young Dancer (Contemporary Pediatric and Adolescent Sports Medicine). Springer International Publishing. Kindle Edition.
  10. Allen N, Nevill AM, Brooks JH, Koutedakis Y, Wyon MA. The effect of a comprehensive injury audit program on injury incidence in ballet: a 3-year prospective study. Clin J Sport Med. 2013;23(5):373–8.
  11. Ekegren CL, Quested R, Brodrick A. Injuries in pre-professional ballet dancers: incidence, characteristics and consequences. J Sci Med sport. 2014;17(3):271–5.
Reducing falls and fractures in osteoporosis

Reducing falls and fractures in osteoporosis

Good balance is vital for reducing falls and fracture in osteoporosis. Balance is particularly important for those living with osteoporosis, where the risk of fracture is much higher than for those with good bone density. Fractures in older people can also have a big impact on mobility, independence and quality of life.  There are a number of factors that can increase the risk of falls.

Factors that increase the risk of falls:

  • Older age
  • Poor muscle strength
  • Poor balance
  • Previous falls
  • Reduced ability to walk and move around with ease
  • Poor vision
  • Trip hazards, particularly at home

          (Osteoporosis Australia Medical & Scientific Advisory Committee, 2019)

While of course there is nothing we can do to change our age, there is much that can be done to improve muscle strength and balance. A history of recurrent falls needs to be investigated as the more falls you have had, the more likely you are to have further falls. Medical causes of poor balance, such as low blood pressure, inner ear problems and possible effects of some medications should be investigated by your doctor. A physiotherapist can assess muscles strength and balance. The home should also be assessed for trip hazards. Did you know that 50% of all falls occur around the home?  (Osteoporosis Australia Medical & Scientific Advisory Committee, 2019). All these potential factors need to be assessed and addressed when reducing falls and fracture in osteoporosis.

How do we minimise the risk of falls?

There are several ways we can reduce the risk of falls:

  • A targeted exercise program
  • Optimising nutritional intake
  • Addressing medical conditions and medications
  • Ensuring a safe home environment
    (Osteoporosis Australia Medical & Scientific Advisory Committee, 2019) (Australian Government, 2011)

Exercise for Bones Osteoperosis

Exercise

Physiotherapists can assist with implementing a falls prevention program. This includes a combination of balance and strength training. We will take a closer look at falls prevention programs below. Physiotherapists can also assist with managing conditions such as hip, knee and foot arthritis which may cause episodes of giving way, increasing risks of falls. Arthritis may also reduce activity levels and muscle strength, again increasing risk of falls.

Nutrition for Bones Osteoperosis

Nutrition

Nutrition is an important factor in falls and fracture prevention. A diet deficient in nutrients such as calcium and Vitamin D can reduce ability to increase bone density. A nutrient rich diet is also important for falls prevention due to its effect on strength, mobility and brain function. Intake of alcohol also has effects on reaction time and steadiness.  It is therefore important to eat a well-balanced diet consisting of a variety of foods including fruit, vegetables, dairy and whole grains, and moderate intake of alcohol.

Medical for Bones Osteoperosis

Medical

There are many medical conditions that may influence balance. These include medical conditions such as blood pressure issues, arthritis or depression, as well as short term conditions or illnesses, for example the flu, infections, or recent surgery. It is important to check in with your regular doctor to address these conditions. A review of your medications is also a good idea to ensure these medications are not impacting on your balance.

Home House for Bones Osteoperosis

At Home

Minimising risk in the home is vital as half of all falls occur at home. A health professional can provide suggestions to help you with this. See some general tips below.

 

Ways to reduce the risk of falls at home:

  • Ensure your rooms are brightly lit, especially near steps or routes you may use at night
  • Installing handrails and using non-slip mats
  • Removing clutter and trip hazards (e.g. loose cords, maintaining outside pathways)
  • Replace carpets with holes or worn areas

 

Exercise for reducing falls and fracture in osteoporosis

There is mounting evidence that exercise alone can reduce the risk of falls (Sherrington, C et. al, 2011). One recent study looked at a balance training program incorporating strengthening exercises with proprioceptive (body awareness) training (Miko, I et. al., 2017). In other words it used an “inside out” approach to training – people in the study worked on improving function of the deepest muscles around their trunk and pelvis first. They then progressed to the next phase which involved maintaining good control around the trunk and pelvis while using larger, more superficial muscles during arm and leg exercises. The final, functional phase aimed to achieve automatic stabilisation of the body whilst performing higher level dynamic exercises involving greater balance challenges. The study found that there were significant improvements in measures of balance and also a reduction in falls in postmenopausal women with established osteoporosis. You can read more about the importance of osteogenic exercises for the management and prevention of osteoporosis in our previous blog.

Exercise for Osteoperosis

Because exercise is so important to bone health, confidence and overall health, 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, also incorporating 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.

Read more information about our class here.

References

Australian Government, D. o. (2011). Don’t fall for it.

Miko, I et. al. (2017). Effectiveness of balance training programme in reducing the frequency of falling in established osteoporotic women: a randomized controlled trial. Clinical Rehabilitation, 31(2), 217-224.

Osteoporosis Australia Medical & Scientific Advisory Committee. (2019). Osteoporosis Australia.

Sherrington, C et. al. (2011). Exercise to prevent falls in older adults: An updated meta-analysis and best practice recommendations. NSW Public Health Bulletin, 22(3-4), 78-83.

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.

TeleHealth Physiotherapy- Here to Stay

TeleHealth Physiotherapy- Here to Stay

COVID-19 brought plenty of changes to our lives in 2020, including the way we deliver physiotherapy at PhysioTec. Telehealth allowed our physiotherapists to continue providing tailored treatments and essential support during the lockdown period, via online video consultations. If you are new to Telehealth and would like to learn more, click here.

The uptake of TeleHealth was quick, with many people appreciating the flexibility and convenience of online healthcare. This is why we believe that, at PhysioTec, Telehealth has a continuing role to play in the future of physiotherapy. Here are some examples of how Telehealth benefited our patients during and outside this unusual period.

*Respecting patients’ privacy, names of the cases below are not real.

Scenario 1:

John*, a 68-year-old man living in rural Queensland, had been suffering from pain in the side of his hip for a number of years. The distance from a physiotherapist, particularly someone experienced with more persistent hip pain, made it difficult for him to get the help he really needed. His pain was gradually worsening over time.

When the COVID restrictions were introduced, John wasn’t able to continue seeing his local therapist and his hip pain worsened, keeping him awake at night. John, desperate for a solution to his pain, did some research on the Internet and came across a clinic in Brisbane (Physiotec) with physiotherapists who specialise in the management of hip pain. In the past, John would never have considered accessing help in Brisbane due to the long drive, but this new Telehealth opportunity allowed him to access someone with expertise in his problem area, without having to leave his own home.

After his initial Telehealth session, John was diagnosed with gluteal tendinopathy and provided with a treatment plan, an exercise program and access to “PhysiApp”, an online platform where he was able to view his prescribed exercise videos. This allowed him to feel confident in what he needed to do and get on with a targeted and effective rehabilitation program.

 

Scenario 2:

Mary*, a 46-year-old full time office worker, had intermittent flare-ups of buttock pain due to a history of proximal hamstring tendinopathy. Mary enjoys long distance running in her spare time, and her goal was to improve her running distance, without aggravating her buttock pain.

Mary decided to give Telehealth a try as she had a very busy schedule – this way she could get professional advice without leaving her house or sitting in traffic. Through Telehealth, Mary was able to perform physical tests under the physiotherapist’s instructions; and her physio was able to identify areas of improvement for Mary. Mary was provided with tailored strengthening exercises and she noticed improvements after two TeleHealth sessions. Mary then only needed monthly TeleHealth checkups to progress her program and ensure she was achieving her goals. In between Mary’s monthly reviews, she keeps in contact with her physio via “PhysiApp” regarding her exercise progress. Telehealth allowed Mary to actively manage her condition while pursuing her running goals and minimising time spent away from home or work.

 

Scenario 3:

Vanessa, a 29-year-old new mum experienced sharp, sudden lower back pain that was exacerbated with all movements except lying down. Vanessa needed the care of a physio but found it difficult to leave the house with a 3-month-old baby. With the back pain, she would have struggled to drive and move the baby in and out of the car. Vanessa decided to use Telehealth so she could easily and conveniently access physiotherapy from home.

During her TeleHealth consult, Vanessa was taken through an interview and physiotherapist-instructed self-assessments. Vanessa’s lower back pain was confirmed to be musculoskeletal in nature. She was provided with education and advice on how to best manage her pain at home. Gentle exercises were prescribed to help reduce Vanessa’s muscle spasm and optimise her movements. Vanessa’s partner expressed interest in helping her recovery. During the following Telehealth session, the physiotherapist was able to instruct on massage techniques and give real-time feedback.

These days, Vanessa alternates hands-on face to face treatments and Telehealth consults as she thinks they make a good combination for her pain management. Her exercise program has been progressed and the higher level exercises are easily checked via Telehealth, with the live video of Vanessa and her physio side-by-side providing excellent visual feedback.

 

What does the existing evidence tell us about Telehealth?

Modified physical examination, in the case of Telehealth, consists of virtual self-assessment. For hip-related conditions, research evidence has found that this form of modified examination is not inferior to the traditional in-clinic examination (Owusu-Akyaw, Evanson, Cook, Reiman, & Mather, 2019). The same result was seen in diagnosing chronic conditions in other areas, such as the lower back, knee and shoulder (Cottrell, et al., 2018). One unique benefit of Telehealth is that it allows the physiotherapist to conduct a real-time assessment within the home or work environment, where problems may be occurring. This helps in the development of very specific and meaningful strategies for each individual’s unique situation.

There is also an increasing body of research showing the effectiveness of Telehealth in the treatment of a variety of musculoskeletal conditions. One such study by Cottrell, Galea, O’Leary, Hill, & Russell (2017) showed that the treatment outcome in pain and physical function is comparable to the outcomes of conventional in-clinic treatments. Even in patients who underwent surgery like total hip replacement, evidence showed a high level of patient satisfaction with Telehealth, without compromising rehabilitation results (Nelson, Bourke, Crossley, & Russell, 2020).

 

Telehealth: Convenient online healthcare, from anywhere

Telehealth greatly improves access to physiotherapy services and expert advice. It allows clients who live in rural or regional areas, or those with mobility issues or disabilities, to receive quality care without the need for long commutes over vast distances. TeleHealth is also ideal for those who are time-poor, who have inflexible schedules or who are unable to travel due to their pain or disability.

Whether you have just developed a problem or you require ongoing support in managing an ongoing health condition, Telehealth could be a useful and convenient way of accessing physiotherapy.

Eric Huang Telehealth Physiotec

If you are interested in giving Telehealth a go, call us on 3842 4284 for more information. We are looking forward to seeing you online!

 

Bibliography

Cottrell, M. A., Galea, O. A., O’Leary, S. P., Hill, A. J., & Russell, T. G. (2017). Real-time telerehabilitation for the treatment of musculoskeletal conditions is effective and comparable to standard practice: a systematic review and meta-analysis. Clinical Rehabilitation, 625-638.

Cottrell, M. A., O’Leary, S. P., Swete-Kelly, P., Elwell, B., Hess, S., Litchfield, M.-A., . . . Russell, T. G. (2018). Agreement between telehealth and in-person assessment of patients with chronic musculoskeletal conditions presenting to an advanced-practice physiotherapy screening clinic. Musculoskeletal Science and Practice, 99-105.

Nelson, M., Bourke, M., Crossley, K., & Russell, T. (2020). Telerehabilitation is non-inferior to usual care following total hip replacement — a randomized controlled non-inferiority trial. Physiotherapy, 19-27.

Owusu-Akyaw, K. A., Evanson, R. J., Cook, C. E., Reiman, M., & Mather, R. C. (2019). Concurrent validity of a patient self- administered examination and a clinical examination for femoroacetabular impingement syndrome. BMJ Open Sp Ex Med.

 

 

Developed hip pain during your covid isolation? Avoid these 3 exercises!

Developed hip pain during your covid isolation? Avoid these 3 exercises!

Have you developed some new aches and pains or aggravated some old ones after following free online exercise classes? Or perhaps you have increased your normal activity level by doing more walking, running, stair or hill climbing to try and stay fit and healthy during the COVID-19 restrictions. At Physiotec, we have seen an increasing number of people who have developed or aggravated their hip pain during the covid-crisis. In fact, pain over the outer side of the hip is one of the most common problems we see. This is usually related to a condition called gluteal tendinopathy, also sometimes referred to as trochanteric bursitis.

There are some challenges with going it alone with a new exercise program. If you do have a pre-existing or new injury, how do you know:

  • which exercises or programs are the best options for you?
  • what are the correct techniques to use?
  • how do you make the exercise harder or easier if you need to?
  • how do you alter your program if you develop pain?

If you are struggling with any of these challenges, a physiotherapist can assist with either a telehealth or face-to-face consultation. For many painful conditions, good education and advice will help you stay active while minimising the risk of pain or injury.

For specific hip conditions such as gluteal tendinopathy or trochanteric bursitis, many factors influence the health of the tendons and bursae at the side of the hip. Either too much or too little stimulus may result in changes in tendon health and consequently, your ability to perform normal activities without pain. Too little load may be associated with a sedentary lifestyle where the muscles and tendons aren’t working enough. Too much load may be associated with a quick increase in activity (either a new or existing activity). Particular sustained positions or repetitive movements may also contribute to reduced tendon health or the development of pain over time.

3 Exercises to avoid when you have gluteal tendinopathy

 

So, who is most affected with this condition and why? 18% of the population aged over 50 suffers with this type of hip pain, and women are 3 times more likely to develop the condition than men. While the causes are often multifactorial, a change in hormones is thought to contribute to the development of tendon changes. A common story we hear from our patients is that there was an onset of pain associated with a combination of the following:
• Peri or post menopause and the associated hormonal changes
• Weight gain during this time, and
• A sudden increase in activity levels to counteract the weight gain

It should be said that changes in the health of tendons and bursae are not necessarily painful. Pain may develop if weakened tendons are unable to cope with their workload. Pain is often triggered by sudden increases in activity levels, where the tendons have not been given adequate time to adapt to the new loads. Examples include taking up a new sport or activity, or returning to activity after illness, injury or pregnancy. Going on holidays and walking lots of hills or stairs or for long distances along the beach may cause a problem. Sudden loads on the tendon during a slip or fall can also result in pain and injury, or a gain in weight may add more load to these tendons that support your bodyweight when standing on one leg.

How do you know if you have a gluteal tendinopathy or trochanteric bursitis?

Pain over the side of the hip due to gluteal tendinopathy or trochanteric bursitis

Do you have pain over the side of the hip with any of the following?
• Lying on your side
• Walking up hills or stairs
• Standing on one leg
• Sitting in low chairs especially with crossed legs
• Getting up from chairs and during the first steps

If you answered yes to most of these, you may have gluteal tendinopathy or trochanteric bursitis. The good news? Education and exercise provided by a physiotherapist provides an 80% success rate, with significantly better outcomes than a corticosteroid (cortisone) injection or a wait and see approach (i.e. basic advice and monitoring the condition)*. The even better news? Dr Alison Grimaldi was instrumental in the development of this successful program and all physiotherapists at Physiotec have been trained in the protocol.

We are now back in clinic for face to face consultations – if you have flared or developed hip pain (or any other pain), give us a call to book in! We are also still offering Telehealth consultations for those who are continuing to isolate or those who find it more convenient to attend an appointment ‘virtually’. You can read more about our Telehealth service here.

 

*Mellor R, Bennell K, Grimaldi A, Nicolson P, Kasza J, Hodges P, Wajswelner H, Vicenzino B., 2018. Education plus exercise versus cortico- steroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. BMJ. May 2;361:k1662. doi: 10.1136/bmj.k1662.