What is Osteoporosis?Osteoporosis is a condition in which the bones lose calcium, become fragile and tend to fracture readily. It is most common in women over 40 years of age. Your doctor may organize a bone density scan to see if you have, or are at risk of developing osteoporosis.
What causes Osteoporosis?Throughout life bone tissue is very active and is constantly being ‘remodelled’. Microscopic amounts of bone are continually being removed and reformed. The bone continues to thicken until your early 20’s, this is your peak bone mass. After about 40 or 50 years more bone is removed then laid down, and gradually the density decreases. During menopause the decline in oestrogen levels results in an accelerated bone loss.
Who is at risk?
- Over 40 years old
- Family history
- Women after menopause
- High intake of alcohol, salt, caffeine
- Sedentary lifestyle
- If you have dieted during your life and limited intake of calcium rich foods.
Exercise and OsteoporosisResearch shows that regular lifelong weight bearing exercise and light weight training has a positive effect on bone density. Swimming and cycling although good for your fitness are not as beneficial as walking, dancing, tennis or gentle weight bearing circuit classes. Bone is a living tissue and responds to the stress of weight bearing exercise by becoming stronger. You need to aim for at least three sessions per week. IT IS NEVER TOO LATE TO START, even if you are past your peak bone mass, exercise will reduce bone loss and help delay the progress of Osteoporosis. Pottsville Physiotherapy Fit for Life circuit classes incorporate weight bearing exercise, light resistance training and balance / coordination training to help maintain your bone density, improve your posture and balance and help prevent falls. Exercise to avoid: If you have been diagnosed with osteoporosis you will need to avoid excessive twisting, bending, heavy lifting, jolting, dynamic sit ups, and high impact activities such as running and jumping.
- Warm up first
- Slow and controlled movement
- Don’t hold your breath
- Do not push into pain
- Your doctor may prescribe medications i.e.- hormone replacement therapy
- Diet and or supplements to ensure adequate calcium intake (your doctor or a dietician can advise you on this)
- Lifestyle factors—quit smoking, decrease salt, alcohol and caffeine intake (these all limit calcium absorption)
How much calcium do I need?Young adults - 800-1200mg per day Menstruating women - 800-1000mg per day Men - 800 Pregnant/lactating women - 1200mg per day Post menopausal women(no oestrogen) - 1500mg per day Post menopausal women(oestrogen) - 1000 - 1200mg per day Adults over 65 years - 1500mg per day Food Amount Calcium (mg) Low fat milk 1 glass (250ml) 405 Soya beverage 1 glass 365 Yoghurt 200g 330 Whole milk 1 glass 300 Hard cheese 1 slice (30g) 285 Canned sardines inc bones (50g) 275 Processed cheese 30g 190 Oysters 10 190 Tofu 100g 130 Almonds 50g 125 Baked beans 1 cup (240g) 108 Canned salmon, inc bones 100g 90 Cottage cheese 100g 60mg Broccoli 60g 15mg Pottsville and Cabarita Physiotherapy 6676 4000 visit www.osteoporosis.org.au
Have you been diagnosed with Parkinson’s disease and worried about what the future holds?Do you want to optimise your quality of life now and in the future? Parkinson’s disease is a debilitating disorder, where nerve cells in a part of the brain that produce dopamine are affected. The nerve damage affects the brain’s control of the muscles, which causes shaking (tremor), increased muscle stiffness, slowed movements and balance problems. Parkinson’s disease also affects your thinking abilities, especially the ability to control and regulate behaviour, and may cause anxiety and depression. Drugs can control the symptoms in most patients, but unfortunately only for a limited time.
How can exercise help?Exercise benefits the health and wellbeing of people with Parkinson’s disease in many ways. By increasing fitness, exercise protects against many complications of the disease. For example, better mobility may improve quality of life and prolong independent living. Exercise may also have positive effects on mood and improve brain function and make drug therapy more effective. It also provides a means by which individuals can actively participate in the management of their disease. Walking speed in people with Parkinson’s disease is related to muscle strength in the legs, so exercise programs focuses on increasing leg strength are beneficial. Programs using resistance training like Clinical Pilates, increase muscle mass and strength, and also improve step length, walking speed and walking distance. Rhythmic stimulation of the brain via the eyes or ears while walking can help, and balance training combined with resistance training (like Clinical Pilates) can improve balance and stability. ‘Cueing exercises’ involve walking while listening or seeing cues that mimic the rhythm of walking. These exercises can help improve your walking movements and overcome difficulty with gait initiation and freezing. ‘Dance’ provides exercise to music that can facilitate functional and expressive movement. It also provides important social interaction and can lead to improvements in perceived quality of life. ‘Dual tasking’ exercises, where a secondary task (like counting backwards) while walking can help. These exercises usually try to improve one aspect of walking at a time.
The Parkinson’s Program we run at Pottsville and Cabarita Physio caters for individual abilities and incorporate all the above factors.
What is Clinical Pilates and why has it made such an Impact?Clinical Pilates has been shown to reduce the onset, persistence and recurrence of pain by addressing the neuromuscular dysfunction it is associated with. Clinical Pilates is largely concerned with training local spinal and pelvic stabilising muscles to work efficiently throughout functional activity. It is particularly important in the rehabilitation of spinal pain amongst other motor control problems and is associated to what researcher’s term “specific stabilisation exercises” or “motor control exercise”. With the latest research emerging, evidence-based Physiotherapists have re-evaluated their management of low back pain with a shift towards this type of exercise rather than focus on strength and endurance, which is perhaps more appropriate in the advanced stages of rehabilitation. CLINICAL PILATES involves the following components which are particularly helpful to aid in the rehabilitation of low back pain:
- Teaches co-activation of Transversus Abdominis (TA), Pelvic Floor (PF) and Multifidus (MF) muscles
- Teaches correct muscle activation patterns
- Trains local and global stability systems
- Trains neutral stability before end range stability
- Progresses static stability to dynamic
- Direction specific
Experiencing knee pain while walking, running, squatting, kneeling, going up or down stairs or slopes?
You may have a condition known as Patellofemoral pain syndrome.Patellofemoral pain syndrome is one of the most common knee complaints of both the young active sportsperson and the elderly. Patellofemoral pain syndrome is the medical term for pain felt behind your kneecap, where your patella (kneecap) articulates with your thigh bone (femur). This joint is known as your patellofemoral joint Patellofemoral pain syndrome, is mainly due to excessive patellofemoral joint pressure from poor kneecap alignment, which in time, affects the joint surface behind the kneecap (retropatellar joint). Physiotherapy inventions help strengthen one’s quadriceps and hips, which subsequently aids in restoring the biomechanics of the patellofemoral joint. Physiotherapists are able to advise and design customised exercise programs to improve the strength of your knee and leg muscles and help you maintain good general fitness. If you are experiencing patellofemoral pain, or any pain in your knee and joints, it is important to have your condition assessed by a physiotherapist. Patellofemoral pain typically develops because of 1 of 3 different reasons 1. Excessive pronation of the foot (flattening of the arch). It doesn't matter if you have high arches or flat feet, it depends on how much your arch flattens from non-weight baring to weight baring. This can be addressed in the short term with the use of orthotics but a strengthening program of the muscles that support your arch is recommended. 2. Weak quadriceps (weak thigh muscles). The quads are the largest muscle group in the body that we use to extend our knee. Important for walking, running, squatting, and climbing stairs. We can test your maximum isometric contraction and compare it to your unaffected side to see if this is a contributing factor and address any deficit with an appropriate strengthening program. 3. Weak hip abductors (gluteal muscles). Gluteus medius and minimus help to keep our pelvis level while walking and running. If your opposite hip dips then the knee you are standing on will drift inwards causing poor alignment of the patellofemoral joint. This deficit can be picked up with good observation skills and strength testing.
Osteoarthritis and supplementsOsteoarthritis is a common inflammatory condition characterised by joint pain. See below example. Osteoarthritis affects 2.1 million Australians. The prevalence is higher in women and joint symptoms are experienced by more than 25% of people aged 65 years or older. Osteoarthritis is particularly burdensome, on individuals and on the healthcare system and is the main reason for knee replacement surgery. This is of great concern considering the projected rise in the aging population. In recent years, omega 3 fatty acids (from fish oil), glucosamine and chondroiten have increased in popularity. Research into these and osteoarthritis is showing some promising results, however more research is still needed. Should you take these supplements if you have Osteoarthritis?? You can as there is some worthwhile evidence but it should form only a small part of your management plan. Score your pain on a scale of 1-10 before taking the supplement, then after 3-6 months score your pain again to see if there has been any change. If you are taking chondroitin it is recommended that you take a supplement containing 800mg such as BioOrganics glucosamine 750g and chondroitin 400mg. There is much stronger evidence to show that dietary induced weight loss (>10% of body weight) and physical exercise such as strength training and aerobic exercise can have a moderate to large improvement in pain, function and quality of life. In addition, learning effective pain – coping skills have been shown to have positive outcomes not only for pain but also for function, stiffness and disability.
Upper Crossed Syndrome
What is it? And how can Remedial Massage help?Upper Crossed Syndrome (UCS) is an extremely common musculoskeletal imbalance of the upper body. It is usually caused by poor posture or repetitive tasks in prolonged standing or sitting positions. As a consequence certain muscles become chronically tight, while others become long and weak. This muscular imbalance results in rounded shoulders/upper back, winging/tipping shoulder blades, and a forward head position with a poking out chin. The muscles affected in this common syndrome are the Pectoralis Major and Minor muscles in the chest, the Sub-Occipital muscles at the base of the skull and Upper Trapezius and Levator Scapulae in the upper shoulder/neck which all become overactive, short and tight. This excessive shortening of muscles causes an imbalance between muscles groups. Muscles such as Mid-Lower Trapezius, Rhomboids and Serratus Anterior of the upper back and the deep cervical flexors in the neck therefore become underactive, long and weak. The musculoskeletal imbalances of UCS can result in an array of pain or discomfort presentations. For example mid- upper back pain/tightness, neck pain/tightness, headaches, or pins and needles down the arms, just to name a few. Also overtime if untreated, these muscular imbalances can affect the position of the skeletal system leading to other chronic conditions such as shoulder instability, shoulder impingement and shoulder bursitis. Luckily Remedial Massage and correctly prescribed exercises can dramatically help with this condition. Remedial Therapists can use their skills in soft tissue work to release the tight, short and overactive muscles, and can give simple homework stretches/exercises. This is extremely important for while these large powerful muscles such as the Pecs or Upper traps remain tight, it is very challenging to properly strengthen the weak muscle groups. Remedial Therapists can also use techniques to stimulate the long, weak and underactive muscles encouraging them to activate and strengthen. Remedial Massage can be used as an effective complementary treatment for UCS, alongside Physiotherapy allowing the exercises prescribed by Physios to be most effective. If you feel like you relate to any of these symptoms, don’t wait, find the time to care for yourself and book some Remedial treatment today so you can move and feel your best!
10 Steps to manage Chronic Pain
- Be Realistic
- Get Involved
- Learn Relaxation and the Value of Distraction
- Recognise Thoughts and Feelings
- Safe Movement
- Set Priorities
- Set Realistic Goals
- Know your Basic Rights
- Rediscover Hope
By using these strategies you will find that you can:
- Regain control
- Increase your sense of wellbeing
- Step out of the pain – tension – stress cycle
- Begin to get your needs met
- Lessen suffering
What is a fall?The World Health Organisation defines a fall as "inadvertently coming to rest on the ground, floor or lower level, excluding intentional change in position to rest in furniture, wall or other objects". Falls in older people cover a wide range of events, including:
- trips on raised obstacles (eg. loose rugs, cords, mats) or uneven surfaces (eg. footpaths, roads)
- slipping on wet or highly polished surfaces
- tumbles and stumbles down steps or stairs
- falling off a ladder or stepladder
- falling over in a shopping centre or while using public transport.
What a fall is not:
- Falls in older people are not accidents. Similarly, falls are not an inevitable or unavoidable part of life. The causes of a fall can usually be identified and the sequence of events leading up to the fall can be predicted and therefore can be prevented. o Unintentional falls continue to be the leading cause of injuries requiring hospitalisation in Australia.
Risk factors for fallsPhysical inactivity
- Physical activity has been shown to be the most promising falls prevention strategy, both as a single intervention and as a part of a multi-factorial approach.
- Research shows that specific exercises such as Tai Chi, balance, gait training and strength building group classes or individualised in-home programs reduce falls risk by 12% and the number of falls by 19%.
- These interventions can also increase the time before a person falls for the first time. A physical activity program should be specific for individuals and include exercise that challenges balance at a moderate to high extent with a attendance twice weekly.
What you can do to prevent a fall ?Physical activity is key to preventing falls and improving well being! A holistic program including:
- Proprioceptive retraining – challenging your body on unstable surfaces such as wobble discs and bosu balls helps to retrain your ability to recognise where your body is in space.
- Strengthening – a full body strength program including lower limb, upper limb and core strengthening will help to mitigate the loss of muscle mass common in the older population.
- Exercises such as squats, bridges, push ups and calf raises are useful examples of this.
Other modifiable risk factors for fallsIncontinence
- Problems with bowel and bladder control can impact on an older person's ability to stay active, healthy and independent.
- Incontinence, urinary frequency and assisted toileting have been identified as falls risk factors for residents in residential aged care facilities.
- Physiotherapy can assist with incontinence.
- Sore, aching or tired feet make it difficult for an older person to stay active and independent, and can affect the way they walk.
- Some types of footwear such as slippers, thongs or scuffs, and wearing socks without shoes can increase the risk of falls
- Low vision, impaired vision, a change to vision or vision affected by medication can increase the risk of an older person falling. Vision impairment ranks sixth in the world's major causes of loss of wellbeing, and the prevalence of vision loss increases with age.
- There is strong evidence that falls risk is increased by medications which act on the central nervous system, such as those used to treat depression, sleep disorders and anxiety.
- For those using these medications to assist with sleep disorders and anxiety related health issues, there is a need for longer term support and use of non-pharmacological alternatives such as relaxation, reducing caffeine intake, increasing physical activity and meditation in the first instance. Home safety
- The relative risk of falls can be reduced by 20% in those with a history of falling by an occupational therapist conducting a thorough home risk assessment and arranging the recommended modifications.
- Tidying up behind you and not leaving objects on the floor can also help to prevent falls.
- Nutrition is an important factor in falls prevention, as frailty results from a loss of muscle mass and strength, neuromuscular impairment, immobilisation and malnutrition.
- Older Australians are at risk of developing nutritional health problems due to reduced energy needs and a decreased ability to absorb nutrients.
Falls can be prevented!Staying healthy and active, maintaining strength and balance, identifying falls risk factors and improving home safety will help to minimise the risk of falling. Talk to your physiotherapist today about minimising your falls risk factors or join our fit for life program.
The popularity of golf has increased substantially over the past few years with an estimated 55 million players worldwide. With increased accessibility and participation rates, the sport of golf offers up a diversity of player profiles, ages and levels of experience. Golf is generally considered to be a moderate risk activity with respect to the development of injury. Up to 80% of all golfing injures are due to overuse with the remainder resulting from trauma or contact. The most common areas for injuries in golfers include:
Low back and trunkInjuries represent the highest incidence of injury affecting up to 1/3 of golfers. Due to the increased rotational forces placed on the spine during the golf swing and the asymmetric nature of the swing, the back is subject to increased forces and potential for injury.
Upper limb injuries are far more common than lower limb injuries.
- Shoulder injuries are usually related to overuse and are due primarily to increased rotary forces (internal and external rotation) at the beginning and at the end of the swing. Common injuries include rotator cuff pathology, AC joint pain and shoulder instability.
- Elbows are the second most frequently injured area. Overuse injuries to the tendons of the medial epicondyle (golfer’s elbow) and lateral epicondyle or (tennis elbow) are common. Interestingly, tennis elbow is 5 times more common than golfer’s elbow among amateur players - likely a result of poor biomechanics such as over-swinging.
- Wrist and hand injuries can result from blunt force with the ground or overuse. Fractures, subluxations and tenosynovitis are most commonly seen.
Lower limb injuries are much less frequent and can be attributed to both the swing as well as the walking loads between holes.
- Hip injuries are often a result of the increased rotational forces placed on the hip during the swing. Soft tissue injuries to the groin and gluteals have been noted, as well as trochanteric bursitis.
- Knee pain is often associated with meniscal injury due to the twisting moments placed on the knee during the swing. Osteoarthritis of the knee can also be aggravated during the swing or when walking.
- Foot and Ankle pain are less common, with ankle sprains and plantar fasciopathy of note.
- The main risk factor associated with injury is a lower handicap (increased proficiency) likely due to the increased hours spent training and playing golf – think overuse and/or over training.
- An age of >50 years old was also observed as in increased risk factor, primarily due to the physiological changes associated with ageing.
- Other factors increasing risk of injury include lack of warming-up, reduced mobility/flexibility and poor physical conditioning.
- Muscular imbalances have also been shown to increase injury risk, particularly during intense play or with high practice hours.
- Collision injuries are most commonly related to contact with golf balls and clubs and in some instances, the golf-cart!
- Poor swing mechanics and incorrect grip and set-up.
- Evidence exists for the implementation of a holistic training program to reduce golf-related injuries.
- Flexibility with specific focus on the shoulder and hip (particularly the hip flexors);
- Mobility particularly of the thoracic spine;
- Core stability to support the large rotational forces of the spine during swing;
- Balance to provide a solid foundation for the swing;
- Resistance exercises with particular focus on large muscle groups and scapular stabilisers.
- An adequate warm-up prior to commencing play e.g. dynamic stretching including trunk rotations and knees to chest.
- Assessment and correction of any muscular asymmetries or range of motion deficits;
- Optimisation of swing biomechanics by a golfing coach.