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!
Feeling The Pinch?
The Stubborn Shoulder Impingement SyndromeDo you get a sharp, debilitating pain in your shoulder when you are performing tasks like brushing your hair, putting on certain clothes or showering? During these movements, where you raise your arm out to the side and then upwards over your head, do you alternate between no pain and pain? For example, during the first part of the moment you don’t feel any pain, and then suddenly your shoulder “catches” and there is sharp pain, followed by no pain again as you continue to move your arm upwards. These are all signs of a condition called Shoulder Impingement Syndrome (SIS), where the tendons of the rotator cuff muscles that stabilise your shoulder get trapped as they pass through the shoulder joint in a narrow bony space called the sub-acromial space. Impingement means to impact or encroach on bone, and repeated pinching and irritation of these tendons and the bursa (the padding under the shoulder bone) can lead to injury and pain. Shoulder complaints are the third most common musculoskeletal problem after back and neck disorders. The highest incidence is in women and people aged 45–64 years. Of all shoulder disorders, shoulder impingement syndrome (SIS) accounts for 36%, making it the most common shoulder injury. You shouldn’t experience impingement with normal shoulder function. When it does happen, the rotator cuff tendon becomes inflamed and swollen, a condition called rotator cuff tendonitis. Likewise, if the bursa becomes inflamed, you could develop shoulder bursitis. You can experience these conditions either on their own, or at the same time. The injury can vary from mild tendon inflammation (tendonitis), bursitis (inflamed bursa), calcific tendonitis (bone forming within the tendon) through to partial and full thickness tendon tears, which may require surgery. Over time the tendons can thicken due to repeated irritation, perpetuating the problem as the thicker tendons battle to glide through the narrow bony sub-acromial space. The tendons can even degenerate and change in microscopic structure, with decreased circulation within the tendon resulting in a chronic tendonosis.
What Causes Shoulder Impingement?Generally, SIS is caused by repeated, overhead movement of your arm into the “impingement zone,” causing the rotator cuff to contact the outer tip of the shoulder blade (acromion). When this repeatedly occurs, the swollen tendon is trapped and pinched under the acromion. The condition is frequently called Swimmer’s Shoulder or Thrower’s Shoulder, since the injury occurs from repetitive overhead activities. Injury could also stem from simple home chores, like hanging washing on the line or a repetitive activity at work. In other cases, it can be caused by traumatic injury, like a fall. Shoulder impingement has primary (structural) and secondary (posture & movement related) causes: Primary Rotator Cuff Impingement is due to a structural narrowing in the space where the tendons glide. Osteoarthritis, for example, can cause the growth of bony spurs, which narrow the space. With a smaller space, you are more likely to squash and irritate the underlying soft tissues (tendons and bursa). Secondary Rotator Cuff Impingement is due to an instability in the shoulder girdle. This means that there is a combination of excessive joint movement, ligament laxity and muscle weakness around the shoulder joint. Poor stabilisation of the shoulder blade by the surrounding muscles changes the physical position of the bones in the shoulder, which in turn increases the risk of tendon impingement. Other causes can include weakening of the rotator cuff tendons due to overuse, for example in throwing and swimming, or muscle imbalances between the shoulder muscles. In summary, impingement usually occurs over time due to repetitive overhead activity, trauma, previous injury, poor posture or inactivity. When your rotator cuff fails to work normally, it is unable to prevent the head of the humerus (upper arm) from riding up into the shoulder space, causing the bursa or tendons to be squashed. Failure to properly treat this instability causes the injury to recur. Poor technique or bad training habits such as training too hard is also a common cause of overuse injuries. Over time pain can cause further dysfunction by altering your shoulder movement patterns which may lead to a frozen shoulder. For this reason, it is vitally important that shoulder impingement syndrome is rested and treated as soon as possible to avoid longer term damage and joint deterioration.
What are the Symptoms of Shoulder Impingement?Commonly rotator cuff impingement has the following symptoms:
- An arc of shoulder pain approximately when your arm is at shoulder height and/or when your arm is overhead
- Shoulder pain that can extend from the top of the shoulder down the arm to the elbow
- Pain when lying on the sore shoulder, night pain and disturbed sleep
- Shoulder pain at rest as your condition worsens
- Muscle weakness or pain when attempting to reach or lift
- Pain when putting your hand behind your back or head
- Pain reaching for the seat-belt, or out of the car window for a parking ticket
Who Suffers Shoulder Impingement?Impingement syndrome is more likely to occur in people who engage in physical activities that require repeated overhead arm movements, such as tennis, golf, swimming, weight lifting, or throwing a ball. Occupations that require repeated overhead lifting or work at or above shoulder height also increase the risk of rotator cuff impingement.
How is Shoulder Impingement Diagnosed?Shoulder impingement can be diagnosed by your physical therapist using some specific manual tests. An ultrasound scan may be useful to detect any associated injuries such as shoulder bursitis, rotator cuff tears, calcific tendonitis or shoulder tendinopathies. An x-ray can be used to see any bony spurs that may have formed and narrowed the sub-acromial space.
What does the Treatment Involve?There are many structures that can be injured in shoulder impingement syndrome. How the impingement occurred is the most important question to answer. This is especially important if the onset was gradual, since your static and dynamic posture, muscle strength, and flexibility all have important roles to play. Your rotator cuff is an important group of muscles that control and stabilise the shoulder joint. It is essential the muscles around the thoracic spine and shoulder blade are also assessed and treated as these too work together with the entire shoulder girdle. To effectively rehabilitate this injury and prevent recurrence, you need to work through specific stages with your therapist. These stages may include:
- Early Injury: Protection, Pain Relief & Anti-inflammatory Treatment
- Regain Full Shoulder Range of Motion
- Restore Scapular Control and Scapulohumeral Rhythm
- Restore Normal Neck-Scapulo-Thoracic-Shoulder Function, including posture correction
- Restore Rotator Cuff Strength
- Restore High Speed, Power, Proprioception and Agility Exercises
- Return to Sport or Work
- The information contained in this article 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.
Top 8 tips for exercising in the hot weather
- 1. Exercise Early or Late. It’s usually cooler in the early morning and late evening.
2. Light coloured clothing will help you to stay cooler
3. Wear fabric with moisture-wicking properties and loose clothing is better than tight.
4. Keep your fluids up: water or coconut water a good choices, try to drink every 15 minutes
5. Exercise in water: swim / surf or water running
6. Wear a hat and sunglasses
7. Stay our of the direct sun if possible
8. Listen to your body: STOP if you feel faint, dizzy or nauseous.
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.
Patello-femoral Knee PainAching knees affect 25 % of the population and are commonly caused by dysfunction at the patella-femoral joint (under the kneecap). It is typically aggravated by bending movements such as sitting, walking up and down stairs or hills, jumping and running. It is also common during adolescence as the long bones are growing faster than the muscles, tendons and ligaments putting abnormal stress on the joints.
- Unfortunately genetics have a part to play and this can’t be changes
- Faulty bio mechanics due to muscle imbalances
TreatmentTreatment is very successful and we will look at correcting muscle imbalances throughout your lower back, hip, pelvis and leg. This is done by manual techniques to the knee cap, massage, acupuncture, exercise and taping.
Falls Prevention – Balance
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.
- Unintentional falls continue to be the leading cause of injuries requiring hospitalisation in Australia.
Risk factors for falls
- 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 thisPhysical 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.
- 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.
RunningIt’s free and mostly anyone can do it but where do you start? Start with a S.M.A.R.T. goal. It needs to be specific, measurable, attainable, relevant and timely. Without a goal your chances of giving up are high! Make sure your goal is realistic – you don’t want to get injured or be deflated when you realise you can’t reach it. Don’t be too ambitious to start. Your goal will give you purpose and motivate you to be consistent with your running. Remember it is what we do most of the time that counts, not what we do occasionally. Running with a group, a friend or even your dog can keep you motivated. Eat well and drink plenty of water to fuel body and lastly be sure to have good supportive footwear.
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
Why do you love Pilates? I enjoy being able to strengthen and stretch out my body..... any chance to take off shoes is welcome! I have had first hand experience with immediate relief. What is the best thing about being a physiotherapist? I enjoy the mental Challenge of problem solving with clients in a vulnerable situation, helping them understand whats going on ans what we can do to assist. De – escalating someone who has thought the worst of their situation, Instilling in them optimism and confidence is a great outcome and good feeling. Why work at Pottsville and Cabarita physio? I have grow up in a small coastal village - I enjoy the friendly village feel. The vibe around town and in the clinic is fantastic. Over the past 4 years I have watched the growth of the town with this and the advancements in technology, The Clinic at Cabarita has come into its own. Best relaxation tip To relax I enjoy Surfing and gardening. I also enjoy spending time with my wife and Chocolate Labrador Raz. Our Fruit trees are pumping out the good stuff at the moment, when I get home I wander outside (after taking off my shoes!) and pick the fruit and enjoy. Its a great way to slow down and switch off after a full day. Best lifestyle tip Many people will know that I have been studying for my Masters in Physiotherapy, I have been practising during this time to take time out and have a surf or do something I love. If you are going to do post graduate study, my advice is to do it slowly, take your time. Favourite activity To go for a sunrise surf with friends. Favourite recipe My Nachos and Tacos .. I cook - however I'm the only one who likes it! A typical Sunday An early morning surf, followed by a bike ride with my wife to go and have Mexican!.. I do this every day... except for the Mexican... So wonderful living and working in paradise!