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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.

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.

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.

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.

Why should I exercise during and after Pregnancy

Why should I exercise during and after Pregnancy

For Mums and Mums to be…

Have you ever experienced some pain in the pelvis  or in the hips during or after pregnacy?

Poor pelvic control or instability is a condition more common in women and is most likely to occur during or post –pregnancy.  During pregnancy, a hormone called relaxin is released in the body to allow the ligaments to stretch to accommodate the fast growing baby. With another human being growing rapidly, the pelvis does undergo an increase in loading, which some women cope with a little better than others – this can be due to genetic factors such as natural pelvic and ligamentous structure, or the background muscle conditioning you had prior to the pregnancy.

DON’T WORRY THOUGH…. remember that “instability” does not mean your pelvis is physically out of place but rather your muscles around the pelvis are not providing adequate’ force closure’ or mechanical compression or support around the pelvis while the ligaments are lax.

Who is more at risk of developing Pelvic pain due to pelvic instability?

Research has shown that  women who are involved in strenous work, or have a previous history of low back pain and a history of lumbo-pelvic (lower back and pelvis) pain during previous pregnancies are at risk. Although, direct trauma to the pelvis such as a fall can also result in pelvic instability.

How can Physiotherapy Help?

Use of Physical Aids

Physiotherapy can help by identifying the cause of the pain around the pelvis, whether it is originating from the lumbar spine or from pelvic instability. Off loading the pelvis may be important in reducing the symptoms such as using crutches or walking sticks. Tape or pelvic/abdominal belts  can also provide some compression around the pelvis, assisting with stability in the shorter term.

Postural and Movement Education

Being aware of movements or postures that may overload the pelvis, and optimising muscles support around the lumbar spine and pelvis are the most  important factors in managing this condition. Some specific advice on what movements or positions you may need to avoid or adjust can make a big difference in avoiding pain aggravation.

Specific and Appropriate Strengthening Exercises

Improving activation of the deep supporting muscles around the pelvis is also extremely important for providing dynamic control, so

despite laxity in the ligaments, your muscles can assist in compensating for the reduced support that ligaments can give during your pregnancy. Using real time ultrasound to train deep abdominals and pelvic floor muscles, and some of the deep hip/pelvic muscles are beneficial to someone who has pelvic instability. This is followed by a progressive strengthening program matched to the needs of the individual. Your physiotherapist can recommend appropriate Pilates and Pilates-based exercises as well as monitor your progress throughout your pregnancy and even after your pregnancy.

Transversus Abdominis Ultrasound At Rest
Ultrasound retraining of the abdominal wall – Transversus abdominis

If you are suffering from pelvic pain due to instability, see a Women’s Health Physiotherapist and get some good advice on pain management, training in deep muscle activation and an appropriate exercise program.

Image Courtesy of keerati of freedigitalphotos.net

References:

Vleeming et al. (1992). An integrated therapy for peripartum pelvic instability. A study of the Biomechanical effects of Pelvic Belts. American Journal  of Obstetrics. 166 (4): 1243-1247

Wu et al. (2004). Pregnancy-Related Pelvic Girdle Pain (PPP)I: Terminology, Clinical Presentation and Prevalence. European Spine Journal. 13:575-589

Back into the Spring of Things

Back into the Spring of Things

Back into the Spring of Things: How to get back on track after the lull in the Winter

In winter, it is normal to feel less motivated with exercise and physical activity. Now that the days are getting longer and nights are shorter we can help you get into the spring of things! Research has shown that being active has many health benefits and helps decrease your risk of chronic disease. But if you don’t know where to begin, here’s a list of activities that are inexpensive and fun, especially if you do them with friends, to help you get started:

Outdoor Activites

Gladwell and his colleagues in 2013 reported that exercise performed outdoors helped increase levels of physical activity and decreased the rate of perceived exertion – that is, for the same amount of energy burnt, it felt easier to exercise outdoors than indoors. Psychological benefits of exercising outdoors include improvement in mood and reduced stress levels. Outdoor activities are not only confined to thrill seeking activities but also include simple activities such as walking or cycling around the neighbourhood, around the park or hiking or trail-riding in the bush. Green exercise is good exercise! Trade the treadmill walking for outdoor walking near the river or amongst the trees.

Walking & Running

An outdoor activity such as walking, especially one that accomplishes 10,000 steps a day, can help reduce the risk of developing chronic diseases such as cardiovascular disease, obesity and diabetes (Brown et al 2006) and in a study done in Rockhampton where they walked 10,000 steps for 15 weeks, it was found that the participants reported improved well-being and fitness levels. Using a pedometer to track the number of steps has been found to be effective in increasing physical activity (Chan et al 2004) and significantly decreases Body Mass Index (a measure of determined by height and weight) and blood pressure (Bravata et al 2007). Walk to work if you can and incorporate it to your daily activities.

If walking on the streets is not exciting enough then hiking or nordic walking (walking while using poles) also benefits resting heart rate, exercise capacity and improves quality of life of people with various diseases (Tschentscher et al 2013).

You then may be able to progress to increasing your pace and start adding some jogging or light running intervals to increase the intensity of the exercise. If you have never been much of a runner though, it might be a good idea to visit www.mylocalnews.ie and to have a running assessment and get some instruction on good form and training techniques from your physiotherapist. Always progress a new activity slowly, and if you do develop niggles anywhere, don’t ignore it, pop in for a check-up and advice so we can keep you on the road.

Back into the Spring of Things - beach_running

Cycling

Is your work near your home? Then ditch the car and ride the bike. In Brisbane city, we have access to public bicycles and they are situated in different, easy access locations around the city. Just like walking, researchers have found strong evidence for fitness and health benefits and moderate evidence for risk factors for cardiovascular disease (Oja et al 2013).

Did you know that countries such as Netherlands and Germany have included promotion of safe walking and cycling in their campaign for improving public health (Pucher, Dijkstra 2003). Just recently in July, the Australian Walking and Cycling Inc (AWCC) was formed and it is the only national forum in Australia that has focused on research and promotion of mobility in Australia. They have recently joined forces with the Heart Foundation, which aims to prevent premature death caused by cardiovascular disease in Australia. Be part of the movement! Live long!

mountain_biking

Clinical Pilates

Now, if you are limited by time or musculoskeletal injury, Pilates is a good way to get active if grunting in the gym and crossfit are not your thing. Pilates-based exercise and functional strengthening have been very popular in recent years, especially for people who enjoy performing slow, controlled movement. In fact, for rehabilitation, this form of controlled movement retraining and strengthening under the guidance of a physiotherapist, can provide an ideal foundation for return to normal daily activities and for dynamic higher level sports or work tasks. There is evidence that Pilates helps improve functional ability and decrease pain in people with chronic low back pain (Wajswelner et al 2012). It can also help improve dynamic balance (Johnson et al 2007) which would be beneficial both if you are feeling a little unsteady on your feet, or for higher level sporting activities where balance and control is critical for performance and injury prevention.

As we mentioned above, green exercise is good exercise. You get the best of both worlds with the outdoors all around with our Pilates classses. Try it out.

barrel exercise annie

Now we have given you something to think about, have you decided what activity you would like to spring back into? Once you have decided, set a goal and train for it.

Here are some useful links to activities around Australia for events you may be interested in:

https://www.runningcalendar.com.au/

http://www.cycling.org.au/Events/Events-Calendar

If you are still not sure where or how to start, come and see one of our highly trained physiotherapists to help you spring back into action.

References:

Bravata et al (2007). Using Pedometers to increase Physical Activity  and Improve Health: A Systematic Review. The Journal of the Americal Medical Assoc. 298 (19)

Brown et al (2006) 10,000 Steps Rockhampton: Evaluation of a Whole Community Approach to Population Levels of Physical Activity. Journal of Physical Activity and Health 1:1-14

Johnson et al (2007). Effects of Pilates-based exercises on Dynamic Balance. Journal of Bodywork and Movement Therapies . 11 (3)

Oja et al (2103) Health Benefits of Cycling: A systematic Review. Scandinavian Journal of Medicine and Science in Sports. 21(4)

Pucher,Dijkstra (2003). Promoting Safe walking and Cycling to Improve Public Health: Lessons from the Netherlands and Germany. American Journal of Public Health . 93(9)

Tschentscher et al (2103).Health Benefits of Nordic Walking. American Journal of Preventive Medicine . 44(1)

Wajswelner et al (2012). Clinical Pilates vs. General Exercise for Chronic Low back pain: Randomized Control Trial. Med Sci Sports Exerc . 44 (7)