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Keep moving with kneecap pain

Keep moving with kneecap pain

Pain in the front of the knee, around the kneecap can be a common issue in people presenting to Physiotherapy. This issue can be caused by an irritation of the patellofemoral joint, the joint between your kneecap and the base of your thigh bone. Often pain can occur in this joint when running, walking up or down stairs or during other exercise such as squatting. Pain in this area often relates to pressure on the kneecap as it articulates with the bottom of your thigh bone – your femur. The force on this joint is mainly influenced by two things: the amount of force being produced by the quadriceps muscles on the top of your thigh, and the amount of knee bend or flexion that occurs when the joint is under load.

Here are a few strategies you could implement to reduce your patellofemoral pain whilst continuing to exercise:

  1. Choose exercise activities that gradually expose the knee to greater stresses.
  There is a systematic review by Hart et al. (2022) that has looked at the average reaction force that different activities place on the patellofemoral joint in healthy individuals. Walking: 0.9x body weight Descending stairs: 2.8x body weight Ascending stairs: 3.8x body weight Running: 5.2x body weight Squatting: 1 – 18x body Looking at these averages, a good way to try and reduce the load on the patellofemoral joint could be to target start with a low loading exercise such as walking and gradually progress to stairs and then running. As you can see, there is a very large variability in the loads that are placed on the knee during squatting movements. Therefore, if you can minimise the amount of knee bend during your squats, you may be able to reduce your knee pain.
  1. Modify your current exercise program to reduce the stress on the knee joint.
  We know that the joint reaction force will increase with greater knee bend. Choosing squat variations that limit your knee from bending more than 90 degrees could allow you to maintain lower body strength whilst reducing your pain. Choosing exercises that are double-legged rather than single-legged may reduce the tendency of your knee to track inwards, which may help to settle your patellofemoral pain. If you are a runner, increasing your step rate may help you to settle your knee pain and keep you running. If you keep the same running pace, an increased step rate will reduce your stride length, which reduces the amount of knee bend through the weight-bearing portion of the running cycle. This can then reduce the reaction force in the patellofemoral joint, and it will be easier to maintain better alignment through your hips to avoid a scissoring pattern. Then once symptoms have settled you can begin gradually re-expose the knee to more loads over time so that it can get used to it. As with many areas of the body, this advice is generalised and may not be affective for individuals with varied anatomy and movement patterns. Try a few of these strategies, and if you’re still having issues with your knee pain, we’d be happy to help you here at the clinic. Reference: Hart, H. F., Patterson, B. E., Crossley, K. M., Culvenor, A. G., Khan, M. C. M., King, M. G., & Sritharan, P. (2022). May the force be with you: understanding how patellofemoral joint reaction force compares across different activities and physical interventions—a systematic review and meta-analysis. British Journal of Sports Medicine, 56(9), 521–530. https://doi.org/10.1136/bjsports-2021-104686

WHAT CAN AN EXERCISE PHYSIOLOGIST DO FOR YOU?

12.01.21

WHY YOUR DOCTOR SHOULD REFER YOU TO AN EXERCISE PHYSIOLOGIST

We all know we should exercise, and the science is clear, exercise is medicine. The following explains what an Exercise Physiologist is and why your doctor might refer you to one.   What IS AN EXERCISE PHYSIOLOGIST? Accredited Exercise Physiologists (AEPs) are university-qualified allied health professionals. They specialise in designing and delivering safe and effective exercise interventions for people with chronic medical conditions, injuries or disabilities. Services delivered by an AEP are also claimable under compensable schemes such as Medicare and covered by most private health insurers. When it comes to the prescription of exercise, they are the most qualified professionals in Australia.  

WHAT CAN AN EXERCISE PHYSIOLOGIST DO FOR YOU?

  EXERCISE TO IMPROVE YOUR MENTAL HEALTH Mental illness can have an impact on a person’s cognitive, behavioural and social functioning. Those with a mental illness often struggle to engage in their regular work, social and physical activities which can further impact the illness. Mental illness includes anxiety, depression, schizophrenia, bipolar affective disorder and personality disorders. There is mounting evidence that suggests exercise is an effective treatment method for people suffering from acute and chronic mental illness, with some studies suggesting that exercise is just as effective, if not more effective than pharmacological intervention in alleviating depressive symptoms.   EXERCISE TO MANAGE CHRONIC PAIN AND ILLNESS  Chronic pain is pain that persists beyond the expected healing time of an injury. Unlike acute pain which is caused by tissue damage, chronic pain is less about the structural or tissue damage and more about the sensitivity of the nervous system and ‘non tissue related factors’. Significant research has shown that exercise is an essential component in the treatment of chronic pain. Studies have shown that it can be an effective way to reverse this downward cycle of deconditioning and worsening pain, and gradually over time help those with chronic pain engage more in activities of enjoyment and essential activities of daily living with greater ease.   EXERCISE TO REDUCE YOUR RISK OF FALL AND IMPROVE YOUR BALANCE Falls can result in permanent disability, restriction of activity, loss of confidence and fear of falling, all of which reduce quality of life and independence. There is now good evidence that exercise can prevent falls in older people by decreasing a number of key risk factors. For example, exercise can improve muscular strength, balance, balance confidence and walking speed, as well as psychological factors such as mental ability and mood.   EXERCISE TO INCREASE YOUR MUSCLE MASS AND BONE STRENGTH Osteoporosis occurs when bones lose minerals, such as calcium, more quickly than the body can replace them, leading to a loss of bone thickness (bone density). Any bone can be affected by osteoporosis, but the most common sites are the hip, spine, wrist, upper arm, forearm or ribs. Exercise can help bones modify their shape and size so they become stronger and this can prevent injuries. Exercise also increases muscle strength and improves balance which can help reduce the risk of falls.   EXERCISE TO CONTROL YOUR DIABETES OR PREDIABETES Diabetes mellitus is a metabolic disease indicated by an elevated fasting blood glucose level due to deficiencies in insulin secretion or inability to use insulin. Everybody benefits from regular exercise but for people with diabetes mellitus (Type 1 or 2) exercise can play a vital role in the management of their condition. Exercise cannot reverse the damage to the cells in the pancreas that leads to the decreased production of insulin. Exercise can improve the way the muscles respond to insulin, which, in turn, helps regulate the blood glucose level for some hours after the exercise. Exercise also increases glucose uptake by the muscles and can lower the dose of insulin required by improving the body’s response to insulin.   EXERCISE TO IMPROVE OUTCOMES DURING CANCER TREATMENT AND BEYOND Cancer is developed when abnormal cell function occurs.  can develop within all parts of the body and can invade surrounding and distant sites by spreading through the blood vessels and lymphatic systems. If diagnosis and treatment are not administered in the early stages of the disease, cancer can be life-threatening. The potential benefits of exercise during and after treatment are significant and research has proved its effectiveness. Exercising during chemotherapy can help ease side effects, such as fatigue and nausea, and can help to boost the immune system of those undergoing cancer treatments.   Our Accredited Exercise Physiologist at Pottsville and Cabarita Physiotherapy will take you through a full screening to assist in prescribing you the appropriate program to achieve your goals in a safe manner. You can book an appointment with our Exercise Physiologist Sammy here  or call 6676 4000

Cricket Season!

Summer is on its way, which means so is the emergence of the iconic Aussie summer sport cricket. You will even see our Senior Physio / resident athlete Kai Allison playing for the Pottsville cricket club this summer! The demands of the sport of cricket can be variable depending on whether the player involved is a speed or spin bowler, and whether they field infield or outfield. For those who are bowling fast or consistently throwing from the boundary, the forces needed from their shoulders to generate speed on the ball are very high and with repetition this can lead to injury if the players shoulder musculature isn’t ready for the task. That is common sense, right?! To do difficult tasks with your shoulders they need to be strong. What is not common sense is the impact that the players ability to create forces through their lower body and trunk will have on their ability to bowl or throw with speed. With specific training of stepping patterns and trunk rotation patterning and strength, we can significantly reduce the risks of shoulder injuries in the overhead throwing athlete as well as improve performance. Studies published by Oyama et. al (2009) and Richardson et. al (2015) showed that with poor control of stepping patterns and trunk rotation sequences there is an increase in electromyographic activity in the muscles of the rotator cuff and all of the stabilisers of the shoulder blade, as well as an increased external rotation range of motion in the cocking phase of the throw. That is technical talk to say that the amount of force going through your shoulder muscles is increased and the positions that your have to get into to achieve force in the throw are more precarious if you don’t have good control of your trunk and stepping patterns. The other way to look at the information from the studies above is that we are able to reduce the forces through our rotator cuff (deep shoulder muscles) by adding rotation and stepping patterns which is great for injury prevention and performance, but it also suggests that if we are trying to specifically drive rotator cuff and scapular adaptation from our training, then we need to train them in isolation. So the take away from the above info is that for building strong and resilient shoulders in the overhead athlete we need to be training both isolated rotator cuff / scapular muscle strengthening AND full body stepping + trunk rotation + shoulder rotation strength and patterning. The other major aspect of maintaining shoulder health is throwing athletes is the ability to control acceleration and deceleration of our upper limb at the start/end of the throw. This wont just happen by itself with regular strength exercises, we need to be specific with our training. That’s a lot of information about WHAT to do, so lets go through some examples of HOW to go about it. The following exercises are a non-exhaustive example program of some ways to target the goals above (I will put a video of these on our Instagram and Facebook in case the photos and explanation don’t make sense).

  1. Band / Cable shoulder internal & external rotations
With these exercises we need to be working on strength through range of our shoulder joint, and to be more specific to the throwing motion they need to be completed in a range of different shoulder positions. The classic position for these is elbow by your side with the rotation, but that alone wont drive change in a throw. Other suitable positions to work on these rotations include 90degress of glenohumeral abduction, and also in 90degress of glenohumeral flexion + neutral horizontal adduction (see the pictures and these positions will make a lot more sense). These will be good at building general rotator cuff strength and can be great as a warm-up exercise.  
  1. Weighted Ball accelerations/ decelerations
This exercise is a little trickier to complete solo and is best done in pairs (unless you’re really tricky and bounce the ball from a wall). One person in the pair is doing the acceleration/deceleration exercises and the other is being an assistant and throwing the ball into the right place to catch. I like to do these in a kneeling lunge position, however you can do them in sitting or standing too. The assistant will throw the weighted ball to the athlete at just above shoulder height, and the athlete’s goal is to catch, control and recoil the ball back to their partner.
  1. Single and double hand Palloff press
Despite looking very similar, the outcome and goals of these exercises is quite variable. I have put them together in this program as I like to complete them in a superset with both exercises. The amount of external load being used will be significantly less for the single hand compared to the double. The goal of the single hand version is to be active through the muscles in the back of your shoulder/ shoulder blade while your arm is in a position out in front, whereas the double hand version becomes an anti-rotation exercise for the muscles of your trunk. While being less specific to the throwing motion, these are both great for learning to activate and control the muscles needed in the throwing pattern. When done well, it will look like you aren’t doing much, as the goal is to only move from the shoulders and limit movement from the rest of your body.  
  1. Swiss Ball DeadBug
The target of this exercise is to learn/practice simultaneous activation of the muscles that we will use in the trunk rotation to create momentum before we get to the shoulder rotation. We need to be pressing downwards into the swiss ball with our arms and upwards with our thighs, then maintain this contraction as we take away the opposite hand and leg. The remaining contact points will ensure that we are active through the hip flexors on one side, through the trunk/abs to the opposite shoulder. This is exactly the force transfer we need when patterning our throwing.
  1. Cable weighted step & rotate
In the deadbug we have worked on activation, now this is putting activity into motion. Start slow and work on the step into the activation pattern created in the deadbug, then following through with the hands. This exercise can be completed slowly with moderate resistance for motor patterning, or with lighter weights and more speed to be more specific to the true throw. As mentioned earlier, this is a sample program of some of the many appropriate ways to achieve the goals mentioned in the first part of the blog. As every person/athlete is individual, their program should reflect this so if you need assistance or help with any of the above exercises, or others you are doing in your strength work don’t hesitate to contact us for assistance.

What is an exercise physiologist?

What is an exercise physiologist?

An Accredited Exercise Physiologist (AEP) is a university qualified allied health professional who specialises in the delivery of exercise and lifestyle programs for healthy individuals and those with chronic medical conditions, injuries or disabilities.   AEPs possess extensive knowledge, skills and experience in clinical exercise delivery. They provide health modification counselling for people with chronic disease and injury with a strong focus on behavioural change.   Working across a variety of areas in health, exercise and sport, services delivered by an AEP are also claimable under compensable schemes such as Medicare and covered by most private health insurers. When it comes to the prescription of exercise, they are the most qualified professionals in Australia.   What makes AEPs different to other exercise professionals?
  • They are university qualified
  • They undertake strict accreditation requirements with Exercise and Sports Science Australia (ESSA)
  • They are eligible to register with Medicare Australia, the Department of Veteran’s Affairs and WorkCover, and are recognised by most private health insurers
  • They can treat and work with all people. From those who want to improve their health and well-being, to those with, or at risk of developing a chronic illness
Why should you see an AEP? AEPs are the experts in prescribing the right exercise to help you prevent/manage your chronic disease, help you recover faster from surgery or an injury, or help you to maintain a healthy lifestyle.   AEPs can help treat and/or manage:
  • Diabetes and pre-diabetes
  • Cardiovascular disease
  • Arthritis and osteoporosis
  • Chronic respiratory disease and asthma
  • Depression and mental health conditions
  • Different forms of cancer
  • Musculoskeletal injuries
  • Neuromuscular disease
  • Obesity
  • And much more!
    What makes AEPs even more special is they know how to set goals and maintain motivation, these are two aspects that will most commonly see people fail at exercise. What to expect when seeing an AEP?   During an initial consultation with your AEP, you will undertake a comprehensive assessment in order to develop an exercise plan based on your unique requirements. This session will likely be a fair few questions about your health and history. A lot of people are concerned about what to wear to this appointment. We always say wear comfortable clothing as you may be asked to do a range of movements and bring some comfortable walking shoes as you may need to complete an aerobic assessment. After this session, you will be provided with a plan of action. Working with an AEP can be a truly rewarding process and they can make a hugely positive impact to your life. Our AEP, Sammy, has special interests in the areas of Cancer and Exercise, Osteoporosis and Clinical Pilates. To make a booking with Sammy our AEP  please call 6676 4000 or 6676 4577.  

Don’t Get into Deep Water with Swimming Injuries

Don’t Get into Deep Water with Swimming Injuries

Swimming is one of the most popular sports in the world. We swim in the sea, pools, lakes, streams, rivers and even ponds. And given 70% of the Earth’s surface is water, we’re not short of opportunities. And while swimming is considered a ‘low-impact’ sport due to the fact that the water supports a large percentage of, more than 84% of regular swimmers suffer from some type of overuse type injury caused by swimming. Why? The main reason is the high repetition number and forceful nature of the shoulder revolutions which takes our shoulder joint through its full range of motion (which is one of the greatest of all our joints), against resistance, over and over again. And as 50-90% of the power generated to propel you forward comes from the shoulders, you can see why they are the most frequently injured joint. However, swimming also puts stress on your back, to hold you level in the water; on the neck when raising your head out of the water to breathe and if you favour breaststroke as a stroke, there’s added pressure from the unnatural twisting motion on the knees. So, despite it seeming to be a low-impact sport, swimming actually carries a surprisingly high risk of injury. Let’s take a look at those injuries, why they happen and what you can do about them. Swimming injuries generally stem from two sources, and often these sources will combine:
  1. Muscle imbalances
  2. Stroke technique issues
Muscle Imbalances Our everyday posture, particularly if you spend a lot of time sitting at desk or in a car, or generally not moving around, creates all sorts of muscle imbalances from short hamstrings, tight muscles around the neck, back and shoulders. We unconsciously adopt a curved forward upper back, round shoulders and chin poke, which not only add to shoulder problems in swimmers but neck pain too. Poor posture is the biggest culprit of short tight trapezius and pectoral muscles and weak anterior (front) neck and upper back muscles. These muscles can be painful and develop trigger points which are hyperactive spots in the muscle, commonly referring pain and causing headaches. Tight muscles may also limit your neck movements. Good posture ensures good alignment of the joints and ligaments which allows for optimal contraction of your muscles and off-loads underlying structures. Stroke Technique This a big topic to cover because it depends what stroke you’re swimming mostly with and what kind of injury you may have but issues include: a wide, swinging arm recovery which requires excessive internal rotation, causing impingement on the joint; thumb in first with hand entry, which again causes excessive internal rotation in the shoulder and a dropped elbow or straight arm pull through which creates a long lever and overloads the shoulder. What does all of this mean to you? You shouldn’t swim? You should reduce your training or change your sport? The bottom line is that the benefits of swimming - whether it’s for general fitness and physical activity, the desire to win competitions, or just to find your quiet place for stress relief - far outweigh the risk of injury.

   

Exercise and Different Types of Cancer

Exercise and Different Types of Cancer

Every four minutes an Australian is diagnosed with cancer. Cancer can have a devastating effect on people’s lives – not just their physical and mental health, but also their family, work and social life. Exercise is commonly accepted as important in maintaining good health and reducing the risk of chronic disease. A growing body of research has shown exercise to be a very effective medicine for people with cancer to take in addition with their anti-cancer treatments. Depending on the cancer, the stage of disease, and time since diagnosis, will help to determine which exercise would be best suited to you. Listed below are some benefits and information on exercise effect in common cancer sites.   Breast Cancer Breast cancer is the most common form of cancer among females. Treatment typically involves surgery, radiation, chemotherapy, hormonal therapy or a combination of the above. These treatments can be successful at removing cancer cells and tumours, often they lead to physical side effects that may affect your function and require some modifications to exercise.
  • After breast surgery, pushing exercises may be difficult, along with reaching with arms over the head. It is recommended to include upper limb flexibility and range of motion exercises before strengthening to reduce the risk of injury, improve upper body functioning, and have greater long-term benefits.
  • Radiation and surgery can cause damage to lymph nodes, which can result in lymphedema. It was thought that exercise exacerbates lymphedema symptoms, but recent evidence suggests that exercise is safe for those with lymphedema and may even improve symptoms. The process of muscle contraction can return fluid flow back through the nodes and reduce swelling.
  • Another common side effect of treatment is a decrease in bone mineral density and loss of muscle mass, leading to an increase in risk of falls and fractures. Resistance training is recommended to increase bone mineral density, muscle mass and overall strength.
  Bowel Cancer Bowel cancer is the third most commonly diagnosed cancer in Australia. Lifestyle choices can affect risk of bower cancer, and there is convincing evidence to suggest that being physically active can reduce the risk of bowel cancer. Treatment depends of whether the disease has spread or is likely to spread. Treatment for bowel cancer can include surgery, chemotherapy and/or radiation depending on the severity of the tumour.
  • Exercise during and after treatment improves overall strength and function, reduces frequency and severity of treatment related side effects, and helps to maintain a healthy body composition.
  • Exercising with a colostomy bag is no reason not to exercise. A clearance from your GP is recommended for those with stomas prior to participation in certain types of exercise. Contact sports are not recommended due to risk of injury. Resistance exercise should be started at a low resistance and gradually built up over time to reduce the risk of a hernia at the stoma site.
  Lung Cancer Lung Cancer is the leading cause of cancer related death among men and women. There is a strong relationship between smoking and lung cancer, with smoking accounting for almost 90% of cases. Treatment of the disease is dependent on the severity and progression of the disease and can include surgery, chemotherapy, radiation, immunotherapy, or a combination of treatment.
  • Exercise is safe for people with lung cancer and can help to manage side effects of lung cancer treatments. Exercise in the weeks before lung cancer surgery can improve outcomes and reduce complications. Exercise post-surgery can improve recovery time and reduce time to return to ADL’s
  • Recommendations for exercise for those with advanced lung cancer are to remain as active as possible and avoid long periods of inactivity – a little bit is better than none
  • Exercising after lung cancer can help to reduce shortness of breath and reduce risk of return of cancer or chronic disease
  Prostate Cancer Prostate cancer is one of the most common cancers among males. Some of the treatments have debilitating side effects affecting both physical and mental capability. Exercise is both safe and effective for those who have survived prostate cancer. A combination of resistance training and aerobic training can reduce and almost reverse the treatment-related side effects.
  • One of the most common treatments for prostate survivors is androgen deprivation therapy (ADT). The side effects of this can be a reduction in testosterone levels, decreased bone mineral density, muscle atrophy, fatigue and insulin resistance. Prostate survivors undergoing ADT who complete regular resistance and aerobic based exercise regularly can expect to see improvements in muscular strength, physical function, and quality of life.
  • Prostate cancer survivors can also experience losses in bone mineral density and muscle mass, usually as a result of ADT coupled with physical inactivity. This leads to an increase in fall and fracture risk. Progressive resistance training is recommended to restore bone mineral density, improve muscle mass and overall function.
For more exercise recommendations or for an assessment with an Accredited Exercise Physiologist you can contact Pottsville and Cabarita Physiotherapy on (02) 6676 4000 or (02) 6676 4577.

Back Pain: The Chain of Command

Back Pain

The Chain of Command

Your spine is essentially the chain that forms the ‘backbone’ of your entire body. Without it you would be a blob of muscles, organs and soft tissue piled on the floor. Your spine commands respect because it is the pillar that supports your body, allows you to walk, stand and sit, as well as touch and feel; because it forms the canal connecting the nerves from your body and limbs, to your brain. While your heart may be the vital organ that keeps you alive, without your spine you wouldn’t be able to move. There are three natural curves in your spine that give it an "S" shape when viewed from the side. These curves help the spine withstand great amounts of stress by distributing your body weight. Between the bony vertebra are spongy discs that act as shock absorbers. The lumbar spine (or lower back) connects the thoracic spine to the pelvis, and bears the bulk of your body's weight. Your spine is not rigid though. It allows movement through the intervertebral joints connecting the bony vertebra. These joints allow you to twist, to bend forward and backward, and from side to side. Large groups of muscles surrounding the spine, pelvis, hips and upper body all interact to allow for movements like walking, running, jumping, and swimming. However, there are also muscles deep in your body that work constantly just to maintain your posture when you’re sitting and standing. It is essential that all elements of the spinal ‘chain’ work harmoniously together to ensure fluid movement without overloading structures resulting in injury and pain. Any link in the chain that becomes ‘stuck’ will not only affect that spinal level but also the movement and strength of the chain above and below it. If the muscles around the spine are uneven in strength and length (flexibility) this too can affect the ‘chain’, altering the alignment and motion of the links. Taking care of your spine now will help you lower the chances of experiencing back pain later. Many of the steps you can take to improve the overall health of your spine involve nothing more than practicing better body mechanics, or how you move and hold yourself, when you do daily tasks and activities.

Taking Care of Your Spine

Pay attention to early warning signs or pain. Although back pain is very common and nearly every person will experience at least one episode of back pain in a lifetime, it is essential to address any symptoms promptly. It has also been shown in studies that early treatment and rehabilitation can prevent recurrent bouts of back pain and prevent the development of chronic lower back pain which can be very debilitating, stressful and depressing. It can affect your ability to work, play sport, socialise and sleep, all of which can further compound your pain cycle. Your back pain could be due to inflamed ligaments, damaged intervertebral discs, nerve irritation, bony formations on the spine, muscle imbalances such as weakness or a lack of flexibility, leg length differences, or muscle strains, to name just a few. Even the way we move (or don’t move) at work, school or sport can all be an underlying cause to the current pain.

How Pottsville and Cabarita Physiotherapy Can Help with Back Pain

Your physiotherapist can treat the pain or stiffness experienced from back pain using massage, soft tissue mobilisation, spinal manipulation, heat, acupuncture and other devices. It is important that you, together with your physiotherapist work through a rehabilitation program (specific exercises and stretches) to correct underlying muscle weaknesses, flexibility issues, and the  sequence in which the muscles around your spine work to provide stability.  A physiotherapist can also give you advice on correcting posture / technique for work and sport. Chat to us today about what we can do to help Ph: 0266764000 / 02667644577

Back Pain and Sleep Issues

One of the most common issues back pain sufferers experience is sleep disruption so we have put together an interactive Back Pain and Sleep Guide to help you banish those sleepless nights and wake up feeling refreshed. The guide includes:  
  • 6 Strategies for Improving Your Sleep
  • 8 bedtime stretches to relieve back pain (with video links)
  • Sleeping positions that will help relieve pain (with links to videos)
  • 7 Yoga Poses that will help cure most back pain issues
  • A morning stretch routine that will help ease pain from a restless night (with videos)
  Click this link to find out more and download the guide Disclaimer: This information is intended as general guidance and information only and should not be relied upon as a basis for planning individual medical care or as a substitute for specialist medical advice in each individual case. https://www.facebook.com/pottsvillephysiotherapy  

Exercising for Bone Health – What type of exercise and how much should you be doing?

 

Exercising for Bone Health – What type of exercise and how much should you be doing?

Exercise is important for bone health and osteoporosis - whatever your age or wellness and whether you have broken bones in the past or not. Being physically active and exercising will help you in so many ways and is very unlikely to cause you a fracture. The main thing is to remember is that the worst thing you can do is nothing. After a diagnosis of osteoporosis or if you have risk factors, you should do more exercise rather than less. If you have spinal fractures or other broken bones you may need to modify some exercises to be on the safe side, but generally exercise won’t cause you to have a fracture. For exercise to be most effective at keeping bones strong you need to combine weight-bearing exercises with impact and resistance exercises. What is weight bearing exercise with impact? You are weight bearing when you are standing, with the weight of your whole body pulling down on your skeleton. Weight bearing exercise with impact involves being on your feet and adding an additional force or jolt through your skeleton – anything from walking to star jumps.   What is resistance exercise? Resistance training increases muscle strength by making your muscles work against a weight or force, placing stress on the muscle and related bones. You can use different forms of resistance including free weights, weight machines or body weight.  It is best to target specific muscle groups around areas that are susceptible to osteoporotic fractures, including the hips and the spine. How much and how often should I exercise to promote bone and muscle strength?
Osteoporosis - no fractures Osteoporosis – after a fracture has occurred Osteoporosis – Frail and elderly
Weight bearing exercise with impact About 50 moderate impacts on most days (jumps, skips, jogs, hops etc) 20 minutes lower impact exercise on most days (brisk, walking, marching stair climbing, gentle heel drops) Avoid prolonged periods of inactivity. Stand up for a few minutes every hour
Resistance exercise ·         On 2-3 days of the week (non-consecutive days) ·         Aim for 20-30 minutes of muscle resistance exercise working on exercises that target legs, arms and spine ·         Exercises should progress in intensity and weight over time, and exercise routines should be varied
    Leisure walking on its own is not recommended as an adequate strategy for bone health, although it has benefits for general health and fitness. Swimming and cycling are also considered low impact sports that are not specifically beneficial for bone health. If you have or know any-one who has Osteoporosis or has risk factors, we currently run an exercise program specifically designed to improve bone health and reduce fracture risk. Better Bones and Balance is run by our Exercise Physiologist who is trained in prescribing individual exercises for improving and maintaining optimal bone health. For further information call Pottsville and Cabarita Physiotherapy on (02) 6676 4000 or (02) 6676 4577.  

Tennis Elbow (Lateral Epicondyalgia)

Tennis Elbow (Lateral Epicondyalgia)

  If you have tennis elbow you can experience pain when performing gripping tasks or resisted wrist/finger extension. Pain can also be present when your forearm muscles are stretched. There is probably tenderness directly over the lateral epicondyle, the bony bump on the outside of the elbow, and tender points (trigger points) in the forearm muscles. In some cases, you may also experience neck stiffness and tenderness, and possibly also signs of nerve irritation like numbness and tingling. Most elbow movements are pain-free despite the surrounding area being painful.

WHO IS AFFECTED?

  You don’t have to be a tennis player to suffer from tennis elbow. It is caused by the repetitive movements and the gripping actions common in tennis hence the term ‘tennis’ elbow. However, it may also occur in other activities requiring repetitive gripping actions. Tennis elbow can therefore stem from daily activities such as using scissors, cutting meat, carrying grocery bags, gardening, manual work that involves repetitive turning or lifting of the wrist, such as plumbing, or bricklaying, and typing.

ACUTE VS CHRONIC

  Acute tennis elbow, also known as lateral epicondylitis, is an injury to structures involved in extending (straightening) the wrist and fingers at the site where the forearm muscles attach to the bone via the extensor tendon. It occurs when more force is applied to that area than the normal healthy tissue can handle. For example:
  • Unaccustomed hand use such as starting the tennis season,or increasing the frequency or amount of time playing tennis too quickly. Sometimes just a weekend of home DIY may trigger it
  • Excessive gripping or wringing activities, possibly a new racket or different grip size
  • Poor forearm muscle strength or tight muscles
  • Poor technique (this may be a poor tennis shot).
  Chronic (ie. longer term) tennis elbow is associated with degenerative changes in the tendon. While a sudden acute flare up of tennis elbow may have some inflammation or swelling, chronic tennis elbow generally doesn’t involve inflammation and is instead associated with changes in the nerves and blood supply to the tendon.   Unfortunately, rest as a treatment is rarely helpful. If left untreated, tennis elbow can last anywhere from 6 months to 2 years and can have a serious effect on your sport, daily activities and work. Physiotherapy is effective both in acute and chronic tennis elbow, and there are several things you can do to help in recovery and prevention.  

TREATMENT

  Tennis elbow should be diagnosed by a physiotherapist or doctor. A history is taken, and tests performed. Referred pain from the neck and reduced nerve mobility can mimic tennis elbow. The physical therapist must check your neck and clear it from any involvement in your elbow pain. An ultrasound scan or MRI are the best tests to identify tendon damage,but are often not necessary.   Physical or manual therapy treatments than can help include:
  • Massage therapy to relieve pain and stretch tight muscles and structures
  • Manual therapy can mobilise joints in the elbow and around the neck to ensure normal function
  • Taping and braces are beneficial in reducing pain in the elbow and supporting the muscles when you return to sport n Ice and ultrasound therapy may be used to reduce inflammation.
  • Dry needling can also be effective for pain relief, releasing trigger points in the muscle and promoting tissue healing
  • Exercise therapy should be prescribed to strengthen and balance the muscles of the forearm. While stretches help to lengthen tight muscles.
  Other treatment options may include injections, which should only be considered if the exercises have not helped. Surgery can be carried out under local injection (subcutaneous tenotomy) with a 95% success rate and no reduction in grip strength.   You need to try and prevent tennis elbow from occurring or recurring, which unfortunately it has a tendency to do, which means finding out what caused the injury and addressing these issues with the help of your therapist.

Don’t Let Yourself Be Sidelined by Tennis Injuries

Don’t Let Yourself Be Sidelined by Tennis Injuries

  Tennis is one of the most popular sports throughout the world, with approximately 75 million participants worldwide. It is a sport that you can play at every age and at every level. Children can start playing from the age of 4, using softer, slower balls and smaller rackets on modified courts to make the game easier and more fun, gradually progressing to regular rackets, balls and courts. Older players can start the sport at any age and can continue playing all their life. Whether you are looking for the competitive club league tennis or a more social game amongst friends, tennis is an excellent sport with loads of health benefits. Tennis is a fun and social (as well as competitive) way to add to your weekly activity goals.

Here are some amazing benefits of participating in regular activities like tennis:

1.    Increased brain power From alertness to tactical thinking, tennis enhances the neural connections in your brain. Kids who play tennis regularly get better grades at school. 2.    Better hand–eye coordination Playing tennis involves regular skills that all contribute to good hand–eye coordination. You can improve your agility, balance, coordination, reaction time and more. This can benefit you in injury prevention where improved balance and agility can help protect against rolling an ankle or tripping and falling often resulting in sprains or Colles fracture of the wrist or worse a hip fracture in older age. 3.    Reduced stress Tennis involves physical, mental, social and emotional challenges, which increase your capacity to deal with stress. Or simply running around smashing some balls may help you to blow off some stress too! 4.    Strong heart Compared with other sports, tennis players have the lowest incidence of cardiovascular disease. Playing just 3 hours a week will reduce your risk of heart disease by 56%. 5.    Higher fitness levels Playing tennis on a regular basis (2–3 times/week), either singles or doubles, meets the global exercise recommendations and leads to increased fitness levels. Tennis is an excellent interval training technique - running, stopping, burst of activity then rest between points or games (which elevates and then lowers heart rate repeatedly through a match) which is proven to be hugely beneficial in improving fitness levels and in cardiovascular conditioning too. The effect is not only seen in elite players but with recreational tennis too. 6.    Leaner body Tennis is an excellent and fun way to burn calories and lose weight. An hour of singles play can burn 580–870 calories. A lower body weight has immense benefits in preventing and managing cardiovascular diseases including diabetes, and a lighter frame will reduce loading on your back and joints reducing joint pain and possible arthritis in older age. 7.    Strong bones Playing tennis on a regular basis leads to stronger, healthier bones. This effect is strongest in those who play tennis from an early age, but even if you start playing tennis later in life you can benefit from the positive effect on your bones. This is applicable to both women and men combating the development of osteoporosis a.k.a. brittle bones with ageing. 8.    Strong leg muscles Playing tennis strengthens your leg muscles, which helps maintain your mobility and independence in old age.

The Secret is Staying Injury Free

But these health benefits won’t be very fruitful is you are sitting side-lined because of injuries and while some injuries are quick to repair, others can take a couple of weeks and others may be more stubborn, taking 6 weeks or more. What’s more frustrating, and unfortunately very common, is the risk of re-injury. One of the greatest risk factors for an ankle sprain or a muscle strain (tear) is having suffered from a previous sprain or strain. Nearly 2/3rds of tennis injuries are chronic overuse injuries, many of which are caused by poor technique, incorrect equipment use and lack of physical conditioning

Acute injuries, like an ankle sprain or calf strain, although sudden and unpredictable can also be prevented with adequate preparation and appropriate conditioning. Chat to one of our friendly staff for more information on how to prevent common tennis injuries and stay in the game longer!