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.
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
Smile: you are less likely to catch a cold if you are happy and relaxedLet it go: anger creates a stress response that affects your hormones, neurotransmitters and gut flora (where 80% of your immune cells live)
Walk in the park, bush or beach: spending time in a green space boosts immunity by switching on the para sympathetic nervous system (rest and repair state)
Yoga or Pilates: bending and twisting is a natural immunity booster
Bounce: get on the trampoline or rebounded to flush the lymphatic system
Massage: even a self massage 5 minutes per day prior
Breathe: slowly and gently. Your breathing should be silent and invisible.
Spend some time in the sunshine
Move: don’t sit for more than 1-2 hours at a time
Pelvic and Pubic Pain in Pregnancy
What cause it?The ligaments holding the pelvic bones together become soft and stretch due to hormones (relaxin). This leads to an unstable pelvis. Pain or instability can occur at any of the pelvic joints
- The pubic bone at the front can separate from 2 – 3 mm, this starts from as early as 8 weeks, it can separate as far as 10 mm and this is when symphysis pubis dysfunction is diagnosed.
- The joints at the back (sacroiliac joints) also stretch making this joint unstable which causes pain and dysfunction
- Pain in the front or back of the pelvis, groin, buttock, thigh, hip and lower back
- Difficulty walking or a waddling walking pattern
- Pain when standing on 1 leg
- Pain when turning or twisting
- Rolling in bed
- Clicking/clunking sounds from the pelvis
- Pain when opening your legs
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.
Remedial Massage and its effects on FasciaWhat is fascia? Fascia is a type of connective tissue that essentially holds us together. It is composed of mostly collagen and elastin. The fibres of collagen are the longest and strongest form of protein molecules found within body, they can hold up to ten thousand times their weight. Collagen provides the tensile strength and structural integrity of the connective tissue. Whereas the elastin fibres allows the connective tissue to stretch, providing flexibility and the capability to absorb shock. These fascial fibres sit in an extremely receptive transparent fluid base that is interwoven in many directions all over the body. Types of Fascia:
- Compartment fascia – surrounds individual muscle fibres, muscles, and muscle groups.
- Superficial Fascia – the fascia that lies just under the surface of the skin.
- Fascial sheaths – Superficial fascia that covers joints providing support and stability.
- Visceral fascia – surrounds each organ.
- Myofascial meridians/slings – bilateral systems of receptive connective tissue. These fascial slings relate to how we sense ourselves and how we move through life.
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.