Keep moving with kneecap painPain 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:
- Choose exercise activities that gradually expose the knee to greater stresses.
- Modify your current exercise program to reduce the stress on the knee joint.
WHY YOUR DOCTOR SHOULD REFER YOU TO AN EXERCISE PHYSIOLOGISTWe 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
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).
- Band / Cable shoulder internal & external rotations
- Weighted Ball accelerations/ decelerations
- Single and double hand Palloff press
- Swiss Ball DeadBug
- Cable weighted step & rotate
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
- 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
- And much more!
Don’t Get into Deep Water with Swimming InjuriesSwimming 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:
- Muscle imbalances
- Stroke technique issues
Exercise and Different Types of CancerEvery 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.
- 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.
- 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
- 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.
The Chain of CommandYour 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 SpinePay 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 PainYour 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 IssuesOne 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)
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|
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 CHRONICAcute 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).
TREATMENTTennis 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.