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10 Secrets to Turbo Charge Your Strengthening Program

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In this age of blogs, podcasts, TV shows, radio programs, magazine articles and Dr Google, it is amazing just how many people perform strength exercises which are at best doing little to enhance their strength and at worst, making them more injury prone. So here are 10 principles that you can use to enhance your strengthening exercise program so that you can "Get Better, Stay Better and Live Better".
 
Secret 1 -   No Pain No Gain Is a Myth - Train But Not Into Pain
 
Understand that pain means danger and to change how you are doing something or you will cause injury. To train into pain is not only foolhardy but it doesn't work. Why? Because your brain will inhibit and / or impede your muscles from contracting so that you don't injure yourself. This is called "pain inhibition". A great example of this is watching an arm wrestle. Often there will be a great struggle between opponents until one person's arm suddenly gives way.
 
High intensity strength (load) training should only be used by people who have been training for more than one year or with people who have trained up to this intensity during rehabilitation from injury (e.g. eccentric training for tendinopathies). It should never be used people in the acute stage of injury, beginners and / or with children (until well into adolescence). 
 
Respecting pain is especially important when treating injuries. Use pain as your guide and remember if you always work short of pain, you will be unlikely to flare-up your injury. Having said that, there is no doubt that a progressive strengthening (loading) program is one of the key stimulants to tissue remodelling and maturation. This means that strengthening and placing tension on a repair becomes important towards the end of the proliferation phase of healing (about the 10 - 14 day mark) to align and strengthen healing fibres along lines of force. 
 
Secret 2 - Stabilise First
 
"You can't shoot a canon from a canoe." In other words, you can't perform strong, dynamic movements off a flimsy and unstable base. And there are many reasons why supportive, stabilising muscles stop working as well as they should. 
 
Remember, these are the small muscles that attach closely around each joint to hold the joint surfaces in optimum contact so that they form a strong, stable platform. The more stable your platform, the more resistance or weight that you can lift and the stronger you will get. 
 

Pain, swelling, inactivity, poor postures, repetitive movements can all reduce the activation of these muscles leading to joint instability and potentially injury. Research has shown that these muscles do not begin working again without specific training. They must be specifically targeted and activated.

To stabilise, "pre-tension" or contract all the muscles around your joints to what is maximally comfortable. Even better, position yourself correctly by having your knees slightly bent, feet apart and on a slight diagonal. Then, stabilise your whole body by drawing your stomach in, your pelvic floor up and slightly tuck in your chin. 
 
Secret 3 - Isolate
 
As mentioned above, pain, swelling and general deconditioning, can all act to stop muscles from being effectively activated. And just because you perform a movement, doesn't mean that these muscles start working again. They need to be "woken up". Research has shown that not only do these muscles need to be trained specifically to begin working normally again, but that if they're not, people will begin to substitute other muscles and use incorrect strategies for movement which may eventually lead to injury. 
 
To isolate a specific muscle for strengthening, you need to know what the muscles attachments are as well as the precise movement that the muscle performs. For example to best strengthen your biceps, muscle on the front of your upper arm), you need to start with you hand turned with the palm facing backward and then turn to bring the palm forwards to the front of the shoulder as you bend your elbow only. 
 
Almost all muscles have a rotation component as well as an angle and direction at which they are best activated. Know these and you will better target that muscle for strengthening.
 
Secret 4 - Activate
 
The more nervous impulses that enter a muscle and the more effectively and efficiently muscle fibres are activated, the faster your muscles will adapt and get stronger. 
 
Here are a 5 of tips to engaging your muscles better
 
1. "Tension" or contract your muscle first to what is maximally comfortable. 
 
2. Hold the muscle at this maximum tension throughout the movement and do not allow it to be turned on during shortening of the muscle and off during the lengthening of the muscle. 
 
3. Perform the movement slowly engaging the muscle with maximum tension and use holds at different parts of the movement. 
 
4. Understand patterning. In other words, position your body to better activate the muscle. For example, if you hold your hand open and backwards whilst trying to perform a bicep curl, you will be less effective at activating the muscle than if you tension your fist and hold your wrist slightly forwards. 
 
5. Know how to use your breathing to assist with stabilising your body but not so much as to increase the pressure within your body to dangerous levels. Some authors have suggested that better results from strengthening may be achieved by breathing in during bending or closing down movements and by breathing out during straightening or opening up movements. 
Furthermore, if you hold your breath just to a catch point (most difficult point of the contraction) the increased abdominal pressure will assist in stabilising your spine. However, to prevent possible adverse effects of this pressure, you must breathe out just after this point to release this pressure. 
 
Secret 5  -   Use Feedback
 
Mirrors are not just there to show you how good you look! Visual feedback along with the voice and touch actually play a crucial role in ensuring the correct technique, maximum activation and optimal performance that is needed for the best results. 
 
This feedback can be gained from mirrors, a coach or partner and even your own fingers placed on then muscles that you want to contract. It is especially vital early on when learning an activity, as generally the more the better feedback, the better and faster you will learn. 
 
It has been said that to learn a new skill requires about 300 to 500 repetitions and can take about a month. However, to correct a poorly performed skill with a better technique can take about 3,000 to 5,000 repetitions.  Learn how to perform exercises and activities correctly the first time. It can save you weeks and months of poor results as well as the possibility of injury. 
 
Secret 6  -  Integrate
For better transfer of strengthening over to everyday life, isolated strengthening exercises must be followed strengthening exercises that use these muscles in functional activities. Muscles must work in co-ordination to perform an activity to achieve a result and the only way to improve at these functional activities is to practise and progress them. 
 
There are seven types of movements that are the basis for most of the activities that we do. They are bending, twisting, pulling, pushing, squatting, lunging and ambulation (walking / jogging / sprinting). I call them Primary Movements as they are the movement patterns that you need to be able to live and function optimally. 
 
To get better results, follow an isolated strengthening exercise with the functional strengthening of the muscle in a related everyday activity in which it is used. This will enable you not just to look better but to live better as you will have greater strength and co-ordination in the activities that you do every day. Examples of this might be to follow a knee extension strengthening exercise with a double or single leg squat. 
 
Secret 7  -  Automate
 
You can't live by thinking about activating every single muscle during every single movement. To live effectively, correct muscle activation and movement have to occur automatically and without thinking. This means that you must train your brain as much you train your muscles through performing these exercises with varying speeds, directions, amplitudes and on varying surfaces, progressing from very stable to unstable.
 
You must keep your brain guessing by progressively reducing feedback to the point that your brain is literally anticipating and automating muscle co-ordination and movement without the need to think about contracting muscles consciously. 
 
Break the seven Primary Movements into their component parts and then combine them again and progress them with ever increasing levels of co-ordination, speed and agility demands. Activities such as learning to balance standing on one leg. Then progress this by standing on your toes, then squatting, hopping first up and down and then at different angles and speeds whilst catching a ball. You are only limited by your imagination.
 
Secret 8   -  Think Anti-Gravity
 
There's one thing for sure as you get older and that is that it will get more difficult for you to be up straight. Take note of the posture of our senior citizens and you will get an idea of where you are heading. 
 
There are many reasons why people might be bent forward; genetics, habits, occupations, poor balance, may all play a role. And sometimes inadvertently you can make things worse through your strengthening program. As you only see and focus on the front of your body (chest, abdominals), this means that you are more likely to strengthen the muscles that by actually pull your body further downward and inward.
 
It then doesn't become too difficult to know what muscles you need to strengthen; the front of your neck, your upper and lower back, your buttocks, quads and calves. If you biased your strengthening towards these areas, you will enhance your ability to be up straight as well as perform anti-gravity activities such as standing from sitting, walking up stairs and climbing.
 
Secret 9   -   Optimise Recovery with Optimal Rest and Nutrition
 
Optimal Rest
Adequate sleep means at least 7 hours of good quality sleep each night. Deep sleep is simply essential for renewal, recovery and repair - the essential elements of good health. It is important for the immune system, and it reduces the risk of heart disease, cancer, diabetes, depression, obesity and improves concentration. The Chinese body clock and circadian rhythm indicates that there are various times of the day that the body is more likely to be performing certain functions.1

Recommendations for a good night sleep include:
                  1. Get to sleep by 10.30pm to enable adequate physical repair and body detoxification.
                  2. Eat early and avoid a large meal with refined carbohydrates (e.g. sweets, pastries etc.) that will cause a blood sugar spike and cause you to wake up when the blood sugar drops.
                  3. Avoid caffeine in the afternoon; (caffeine inhibits adenosine, sleep molecule of the brain which aids in getting to sleep)
                  4. Avoid alcohol as this tends to keep sleep light which is not optimal for repair and restoration.
                  5. Avoid intense exercising just before bed (exercise raises cortisol levels which breaks down tryptophan, an amino acid needed for the manufacture of serotonin and then melatonin, the sleep hormone).
                  6. Warm milk contains tryptophan and may assist in getting to and maintaining a deeper sleep.
                  7. Stretching on a mat in the 20 minutes before going to bed is an ideal way to reduce joint stiffness and muscular tightness, thereby promoting better relaxation and rest.
                  8. Dim lights, avoid stimulating activities (computer, TV, suspense novels etc.) and reduce temperature to between 16 and 18 degrees in the hour or two before bed.
                  9. Sleep in pitch blackness as this assists in the pineal gland in production of melatonin, the sleep hormone.
                  10. Exercise at least 20 to 30 minutes, 5 days each week as this stimulates the production of Adenosine, the sleep molecule.
                  11. Get at least 15 minutes of sun light each day to optimize Vitamin D production.
                  12. Write down a plan of the next day's activities before going to bed to free your mind of tasks that need to be done.
                  13. Move all electromagnetic devices away from your bed as far as possible.
                  14. Get to bed at the same time each day;
                  15. Read something calming or do something restful whilst in bed (e.g. listen to something relaxing), not watching TV. 1
 
Optimise your nutrition
It makes sense that optimal recovery, repair and regeneration can only take place if you have adequate amounts of the optimal nutrients. 

This means at least:
        1. 0.8 grams of protein each day per kilogram of your body weight if you are sedentary and up to 1.7 grams of protein per kilogram for athletes involved in football and power sports (note taking > 20 grams protein at one time results in oxidation).
        2. Adequate amount of zinc, magnesium, vitamins B3 and B6 and chromium which aid muscle recovery and prevent injury.
        3. Reducing grains and avoid refined simple carbohydrates (especially refined flour and sugars) to decrease blood sugar and insulin spikes which cause inflammation;
        4. Reducing omega 6 fatty acids (e.g. processed foods, animal fats = pro-inflammatory) and increasing omega 3 fatty acids (3-4 fish meals each week, nuts etc. = anti-inflammatory and promotes cellular repair). The ratio of omega 3 to omega 6 should be 2-4: 1. 1
 
Secret 10   -  Have Fun
 
Whilst exercise takes effort and energy, it doesn't have to be and shouldn't be boring. Find activities that you love to do and add some resistance and holds to them. Get outside and enjoy the great outdoors. Rock climbing, stair / ramp climbing (1,000 steps) and walking / jogging with strength interval stations can all be great fun. Mix it up. Explore different locations and different surfaces. Ever tried to walk or jog in soft sand? Go trail walking or running. Find a friend to share your training with and you might just double the fun. Not only is variety optimally beneficial for your body, it is healthy for your mind as well.
 
If there is one thing that we are all short on these days its time. Don't waste your time by doing ineffective, inefficient strengthening exercises. Use these techniques and strategies to enhance your program and you will enjoy the benefits of looking younger, feeling stronger and performing better in all areas of life. 
 
If you want to overcome injury, if you want to eliminate pain, if you want to get your health and your life so that you can begin enjoying your life more, call Bodywise Health on 1 300 BODYWISE (263 994) for a complimentary*, no obligation assessment and Recovery Action Plan from one of our expert physiotherapists.
We look forward to helping you get your life back.
Until next time, Stay Bodywise,
Michael Hall
Physiotherapist, Director
Bodywise Health
Please note: 
* Rebates are available through your private insurance extras cover;

* For complex or chronic conditions, you may qualify for the EPC (Enhanced Primary Care Program) allowing you to receive 5 allied health services each calendar year with a referral from your GP.

For more information, please call Bodywise Health now on 1 300 BODYWISE (263 994).



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How to Rescue Your Arthritic Knee from a Knee Replacement

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Overcoming arthritic knee pain and achieving knee pain relief is one of the greatest orthopaedic treatment challenges there is. Knee arthritis is the most commonly diagnosed cause of knee pain in people over 50 and achieving knee pain relief from knee arthritis is the main reason why people seek a knee replacement (Losina et al 2012, Nguyen et al 2011).

In 2010, 25,970 total knee replacements were performed in Australia, representing a 67% increase over the past seven years and a direct cost to the health system of $2.24 billion (consisting of $900 million in hospitalisation, $8.5 million on GP visits, $2.2 million on specialist visits and $1.4 million on other practitioners).

Despite this, 15-30% of patients report no or little functional improvement in the 12 months following a knee replacement and those people who have a knee replacement too early, report dissatisfaction with their knee replacements (Paulsen 2011).

Knee osteoarthritis can be confusing and frustrating
Pain from knee osteoarthritis can range from barely perceptible to unbearable. This is especially confusing when the amount off pain reported does not correlate with the severity of change found on X-ray (Cubukou et al 2012, Schiphof et al 2013). Likewise, most people over the age of 50 have structural abnormalities consistent with osteoarthritis on MRI but only one third have pain.

The Source of Knee Osteoarthritis Pain
As the cartilage covering the surface of bones where they meet each other (i.e. joints) doesn't have a nerve supply, it is unlikely that it is a source of pain. Other sources of arthritic knee joint pain that have been suggested are:
1. the underlying bone;
2. the synovial membrane (which lines the inner cavity of the joint);
3. the cartilages (or menisci which act as cushions within the knee joint);
4. the ligaments and joint capsule (which holds the knee together); and
5. the fat pad (which sits just under the bottom part of the knee cap).

There is bad news and good news if an MRI shows that you have a horizontal cleavage meniscal tear in your knee. The bad news is that you have torn the cartilage where it has a nerve supply and this can cause immense pain and discomfort especially while sleeping.

The good news is that where there is a nerve supply, there is a blood supply which means that if the appropriate conservative treatment is given, the tear can heal, albeit slowly (it can take up to 12 months).

If you decide to have an arthroscope (partial meniscectomy), research has shown that recovery takes the same length of time, but your knee will become a lot more arthritic, a lot more quickly compared to if you just stick with physiotherapy (Sihvonen et al 2013, Katz et al 2013).

The Causes of Osteoarthritic Knee Pain that You Can Change
Osteoarthritic knee pain increases as your weight increases and as your quadriceps muscle strength decreases (Nguyen et al 2011, Amin et. all 2009, Segal et al 2010. Therefore, the two most important changes that you can make to achieve arthritic knee pain relief is to reduce your weight and increase the strength of your quadriceps muscle.

Research has shown that it is not only knee pain but the fear of pain that can reduce your quadriceps muscle strength (Hodges et al 2009). Furthermore, middle aged people who have decreased quadriceps strength report increased knee pain and MRI scans show accelerated osteoarthritic changes in the knee (Wang et al 2012).

Incorrect knee joint alignment, poor quadriceps muscle control, faulty movement and excessive loading all lead to excessive or abnormal forces being placed upon the structures and tissues of the knee. This can lead to pain which further inhibits your quadriceps muscle strength thereby perpetuating and accelerating your knee degeneration. (Hayashi et al 2012, McConnell and Read 2014).

How to Achieve Arthritic Knee Pain Relief
For treatment to be successful, it must therefore involve:

  1. Reducing your knee inflammation and pain;
  2. Unloading the painful knee structures and tissues;
  3. Promoting healing
  4. Correcting joint alignment;
  5. Improving muscle control and strength especially that of the quadriceps muscle;
  6. Optimising your everyday postures and movements (e.g. walking) so that the most ideal forces possible are placed on your knee joint.
  7. Reduce your knee pain and inflammation

Inflammation is a breaking down process. It must therefore be limited for healing to take place. If you experience constant, throbbing pain and your knee feels warm apply cold packs (wrapped in a damp thin cloth) to your knee for 15 minutes at least 6 times a day (be sure to check your skin every 5 minutes for adverse reactions). Do this until the warmth, constant pain, night pain and morning stiffness in your knee recede.

Or if your knee pain is worse at the end of the day, apply a cold pack 3 or 4 times on the hour before you go to bed. This will help you sleep better and awake in the morning with less knee stiffness.

Unload your painful knee structures and tissues
You can unload your painful knee structures and tissues by:

  1. Reducing your weight. Research has indicated that this is the number one thing that you can do to achieve relief from arthritic knee pain;
  2. Avoiding painful positions, movements and activities (e.g. prolonged standing and walking);
  3. Using orthotics, wearing supportive shoes with good shock absorption, walking on softer surfaces (avoiding concrete, tiles or hardwood floors) and sitting down frequently (e.g. every 20 minutes);
  4. Taping and bracing your knee for added external support;
  5. Walking with elbow crutches for up to 2 weeks to enable reduce inflammation to recede and facilitate healing and repair.

Promote healing
To accelerate healing and optimise your knee's repair, employ "hands on" freeing up techniques, Bodyflow therapy (which improves circulation), Lipus Ultrasound (which stimulates the laying down of tissue), heat therapy (which increases activity) and easy pain-free movement, all of which have been proven to assist with healing.

Correct Joint Alignment
Your knee cap and knee joint alignment can be corrected by using "hands on" techniques to free up stiff joints and loosen tight soft tissues, applying tape or bracing to hold joints in correct alignment and then through targeted exercises that strengthen weak muscles and stretch tight, stiff soft tissues.

Improve the Control and Strength of Your Leg Muscles (Especially your Quadriceps)
Rehabilitation programs which improve the stability and strength of your core, hip and knee and which optimise the way that you move, have been shown to reduce knee pain for up to 12 months following physiotherapy. These programs have also been shown to improve the quadriceps muscle tone as well as the position of the knee cap on MRI scans (McConnell and Read 2014) indicating an increase in quadriceps muscle strength and therefore an improved dynamic stability of the knee.

Optimising your everyday postures and movements (e.g. walking)
Improving your balance and increasing your core, hip and knee muscle strength can ultimately lead to an improvement in everyday activities such as standing, rising from sitting, getting in and out of cars and walking.

And by "normalising" the forces on your knee during your everyday activities, the abnormal or excessive forces that cause the break down and irritation of the knee joint tissues and structures are eliminated.

Ultimately, these rehabilitation programs may help you avoid the need for a knee replacement or at the very least help improve your muscle function, mobility and quality of life thereby delaying your need for a knee replacement. They will also give you the best chance of an optimal outcome if you do have to have a knee replacement.

The evidence is clear. Specific physiotherapy treatment is a proven, safe, effective and lower cost alternative in helping you to attain knee pain relief from arthritis.

So if you do suffer from arthritic knee pain and you want the best, safest, most empowering way of overcoming your knee pain, you should consider a physiotherapy treatment program as your first option.

We might just be able to save our government's bottom line and you a lot of time and heartache.

If you have physical pain and would like a solution to your problem, please call 1 300 BODYWISE (263 994) for your FREE assessment and advice.

Until next time, Stay Bodywise.

Best Wishes,

Michael Hall

Physiotherapist, Director Bodywise Health

Please note: 

* Rebates are available through your private insurance extras cover;

* For complex or chronic conditions, you may qualify for the EPC (Enhanced Primary Care Program) allowing you to receive 5 allied health services each calendar year with a referral from your GP. For more information, please call Bodywise Health now on 1 300 BODYWISE (263 994).

References
1. Losina E, Weinstein AM, Reichmann WM, Burbine SA, Solomon DH, Daigle ME, Rome BN, Chen SP, Hunter DJ, Suter LG, Jordan JM, Katz JN. 2012 Lifetime risk and age of diagnosis of symptomatic knee osteoarthritis in the US. Arthritis Care Res
2. Nguyen US, Zhang Y, Zhu Y, Niu J, Zhang B, Felson DT. 2011 Increasing prevalence of knee pain and symptomatic knee osteoarthritis: survey and cohort data. Ann Intern Med. Dec 6;155(11):725-32
3. Access Economics, 2007. Painful Realities: The economic impact of Arthritis in Australia in 2007
4. Paulsen MG, Dowsey MM, Castle D, Choong PF 2011 Preoperative psychological distress and functional outcome after knee replacement. ANZ J Surg. Oct;81(10):681-7
5. Cubukcu D, Sarsan A, Alkan H. 2012 Relationships between Pain, Function and Radiographic Findings in Osteoarthritis of the Knee: A Cross-Sectional Study. Arthritis.;2012:984060. doi:10.1155/2012/984060
6. Schiphof D, Kerkhof HJ, Damen J, de Klerk BM, Hofman A, Koes BW, van Meurs JB, Bierma-Zeinstra SM Factors for pain in patients with different grades of knee osteoarthritis. Arthritis Care Res 2013;65(5):695-702.
7. Guermazi A, Niu J, Hayashi D, Roemer FW, Englund M, Neogi T, Aliabadi P, McLennan CE, Felson DT. 2012 Prevalence of abnormalities in knees detected by MRI in adults without knee osteoarthritis: population based observational study (Framingham Osteoarthritis Study). BMJ. 29;345:e5339.
8. Javaid MK, Lynch JA, Tolstykh I, Guermazi A, Roemer F, Aliabadi P, McCulloch C, Curtis J, Felson D, Lane NE, Torner J, Nevitt M. 2010 Pre-radiographic MRI findings are associated with onset of knee symptoms: the most study. Osteoarthritis Cartilage;18(3):323-8.
9. Felson DT, Parkes MJ, Marjanovic EJ, Callaghan M, Gait A, Cootes T, Lunt M, Oldham J, Hutchinson CE. Bone marrow lesions in knee osteoarthritis change in 6-12 weeks. Osteoarthritis Cartilage. 2012;20(12):1514-8.
10. Sihvonen R, Paavola M, Malmivaara A, Itälä A, Joukainen A, Nurmi H, Kalske J, Järvinen TL;Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med. 2013;369(26):2515-24
11. Katz JN, Brophy RH, Chaisson CE, de Chaves L, Cole BJ, Dahm DL et al. Surgery versus physical therapy for a meniscal tear and osteoarthritis. N Engl J Med. 2013;368(18):1675-84.
12. Dragoo J L, Johnson C, McConnell J 2012 Comprehensive Treatment of Disorders of the Infrapatellar Fat Pad Sports Med.1;42(1):51-67
13. Clements KM, Ball AD, Jones HB, Brinckmann S, Read SJ, Murray F. Cellular and histopathological changes in the infrapatellar fat pad in the monoiodoacetate model of osteoarthritis pain. Osteoarthritis Cartilage. 2009;17(6):805-12.
14. Amin S, Baker K, Niu J, Clancy M, Goggins J, Guermazi A, Grigoryan M, Hunter DJ, Felson DT: Quadriceps strength and the risk of cartilage loss and symptom progression in knee osteoarthritis. Arthritis Rheum 2009,60:189-198.
15. Segal NA, Glass NA, Torner J, Yang M, Felson DT, Sharma L, Nevitt M, Lewis CE: Quadriceps weakness predicts risk for knee joint space narrowing in women in the MOST cohort. Osteoarthritis Cartilage 2010,18:769-775.
16. Hodges PW, Mellor R, Crossley K, Bennell K. 2009 Pain induced by injection of hypertonic saline into the infrapatellar fat pad and effect on coordination of the quadriceps muscles. Arthritis Rheum. 15;61(1):70-7
17. Wang Y, Wluka AE, Berry PA, Siew T, Teichtahl AJ, Urquhart DM, Lloyd DG, Jones G, Cicuttini FM. Increase in vastus medialis cross-sectional area is associated with reduced pain, cartilage loss, and joint replacement risk in knee osteoarthritis. Arthritis Rheum. 2012;64(12):3917-25.
18. Hayashi D, Englund M, Roemer FW, Niu J, et al Knee malalignment is associated with an increased risk for incident and enlarging bone marrow lesions in the more loaded compartments: the MOST study. Osteoarthritis Cartilage. 2012;20(11):1227-33
19. McConnell J, Read J. 2014 OA-related knee pain: MRI changes following successful physiotherapy – a case series. Rheumatolgy S16: 008. doi:10.4172/2161-1149.S16-008

 

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Tendon Recovery Update - The Latest Research

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There is no doubt that tendon problems can be among the most frustrating injuries for people. Because tendons attach muscles to bone, tendon problems can therefore interfere with movements all over your body from lifting your arm (Rotator Cuff tendinopathy), to holding an object (tennis elbow) to walking (hip tendinopathy), to squatting (knee tendinopathy) and even to pushing off your foot (Achilles tendinopathy).

However, new research from Sydney and Glasgow is uncovering what is really going wrong with tendons and how well designed physiotherapy can deliver better outcomes than surgery.

What is tendinopathy?

Tendinopathy literally refers to tendon pain. It can be extremely debilitating, with at least 40% of all general practitioner consultations involving a tendon problem. Historically, tendon problems haven't been treated very well because the underlying disease process wasn't very well understood.

Who is at risk?

The typical person who tends to suffer from tendon problems is a person in their mid 40's to 50's who is moderately active. Initially, they experience pain following an activity which then becomes more constant often waking them from sleeping at night and worse at the end of the day.

With probing questions, it is often discovered that the pain is related to a repetitive movement. Classic examples of repetitive movement as the cause of tendinopathies include prolonged swimming, playing guitar or painting for shoulder tendinopathies, using the mouse, pruning and knitting for elbow tendinopathies and walking or running for Achilles tendinopathies.

The latest research and the latest discoveries

We've known for 30 years that instead of the tendon being pristine, white, type I collagen which is as strong as steel, the injury has transformed it into the more ragged, greyish, weaker and painful type III collagen. The only problem is that we haven't known why, until recently when it was discovered that the switch for dialing up or down type III collagen becomes dis-regulated.

What the recent research has shown, is that it is mechanical tension or specific strengthening exercises that can re-regulate this switch. The question is how much and how often should exercises be performed for optimal adaptation. Too little and the tendon degenerates (use it or lose it). Too much and the tendon breaks down further.

Professor Jill Cook at Latrobe University has shown that isometric exercises (strengthening exercises where the muscle develops tension but there is no movement of the joint) performed initially have been shown to reduce tendon pain and begin the process of remodeling the tendon.

What you need to do to get better and return to the activities that you want to do.

However to return to the sports and activities that you want to do, requires a whole lot more than just strengthening the tendon in an isolated way. Yes, you need to strengthen the tendon so that it can tolerate forces above and beyond the stresses that it will be placed under. But more than that, you need to strengthen associated muscles, correct sports and functional technique and finally you need to improve the tendon's endurance, so that it can tolerate these forces over and over again.

Failure to complete this extensive rehabilitation will result in just short term pain relief from your pain. It is simply physics. You cannot load a tissue beyond what it has been trained to tolerate and expect it not to break down.

If you suffer from shoulder, elbow, hip, knee or ankle tendon problems and would like some help to get rid of your pain and to return to activities that you love to do, call us here at Bodywise Health on 1 300 BODYWISE (263 994) for a Complimentary, No Obligations Assessment and Recovery Action Plan.

In your Complimentary, No Obligations Assessment session you will learn what the source and cause of your pain is and develop a Recovery Action Plan that will deliver you the best results in the shortest amount of time.

You will also discover:

* How to optimise the phase of healing;
* How to accelerate healing;
* How to get the best, strongest repair;
* How to perfect the performance of every day and sporting activities so that you achieve more efficient, effective results;
* How to have more energy;
* How to prevent the reoccurrence of your injury.
* What improvement to expect and when so that you can monitor your recovery and know that you are on track to achieve your goals in a forecast timeline.

If you have not achieved results in the past and you want to overcome your injury and pain once and for all so that you can get back to doing the things that you love to do, call us here at Bodywise Health on 1 300 BODYWISE (263 994) and take the first step to getting better, moving on from your pain and enjoying life.

We look forward to helping you.

Until Next Time, Stay Bodywise

Michael Hall
Physiotherapist
Director Bodywise Health

Reference:
The Health Report, Norman Swan, ABC

Please note:
* Rebates are available through your private insurance extras cover;

* For complex or chronic conditions, you may qualify for the EPC (Enhanced Primary Care Program) allowing you to receive 5 allied health services each calendar year with a referral from your GP. For more information, please call Bodywise Health now on 1 300 BODYWISE (263 994).

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Bulging Disc? Sciatica? Lower Back Pain?Here's how to Achieve Lower Back Pain Relief.

back-pain-mainJust hearing the words bulging disc, herniated disc or sciatica is enough to strike fear into the hearts and minds of all people. And rightly so, as a bulging disc or disc herniation causing sciatica can be an extremely debilitating and painful condition and if not treated correctly, can have a most disabling effect on your life. 
When describing this condition, it is not uncommon to hear people say that they have a "slipped disc" and have put their "back out". Whilst this is an incorrect over-simplification of this condition, it does suggest that something has slipped 'out' and needs to be pushed back "in". What this refers to is the inter-vertebral disc which can be a potent source of low back pain as they bulge, tear and split.

So what is a Bulging Disc or Herniated Disc?
Except in the cases of paraplegia or quadriplegia, it is impossible for a person to 'put their back out' as the vertebral bodies of the spine are held together by an inter- vertebral disc. This disc acts as a cushion and by deforming in all directions allows the spine to bend in all directions. 

In the middle of this disc is a paste/gel like substance called the nucleus pulposus. This substance acts as a fulcrum for movement and as the disc deforms, it evenly distributes the forces throughout the disc. Enveloping this nucleus is a fibrous casing called the annulus fibrosis. 

Research has shown that there are only two degrees of motion at each level between the 1st and 5th lumbar vertebrae and five degrees between the 5th lumbar and 1st sacral vertebrae. (Sahrmann 1997). Movement beyond this has been shown to result in tearing of the disc. Consequently, repeated minor trauma such as with bent, rotated postures may cause circumferential fissures in the annulus. As only the outer layers of the annulus receive a nerve supply, for a disc to become painful, a lesion must involve the outer third of the annulus. These defects then provide a potential pathway for the nucleus to seep into, causing the disc to bulge, split, tear and seep out. 

By a person's 30's, the nucleus pulposus tends to dry out and consequently true herniations tend to occur in people in their 20's (Bogduk and Twomey 1991). However, disc bulging in the older person can occur due to degeneration of the nucleus and failure of the annulus. Again this pathology is usually associated with repeated poor postures and movement patterns and can lead to spinal canal stenosis, an important source of low back pain. 

Incidence
The most common age for disc prolapses to occur is in the 25 to 45 year old age group. It more common in males at a ratio of 3:2 with the most common site for prolapse being between L5/S1 (46.4%) and the L4/5 disc being the most common transitional area (40.4%).


Other influencing factors leading to disc prolapse include;
1. Poor posture and movement patterns, leading to increased joint strain, wear and tear and eventually fatigue. 
2. Poor equipment and work station setup.
3. Congenital ill development - e.g. excessive spinal curvature
4. Trauma 
5. Joint malalignment 

Signs and Symptoms
The size, severity and direction of the disc injury as well as the associated structures affected, will determine the presenting signs and symptoms. Herniated discs may occur suddenly or gradually, as a result of a single major traumatic event or as the result of some minor event. Stories such as "I bent over" or "I reached forward" are not uncommon and are often associated with a dull ache or knife like pain either in the midline or off to one side. 

The lower back pain may initially be intermittent, but is worsened by sitting, bending and coughing/sneezing and often disturbs sleep. Generally, it is confined to the lower back region, but later may radiate into both or more often one leg. 

The distance of radiation is more indicative of the severity of injury rather than the structures involved and whilst irritation of the sciatic nerve cause pain, direct pressure on the sciatica nerve results in numbness, tingling, weakness and loss of reflexes. 

X-ray Features 
Whilst x-rays do not show soft tissue damage, they may indirectly show the effects of a prolapsed disc, by the presence of deformity, joint mal-alignment and flattening of the disc. Myelography, CT or MRI scans may also reveal a disc bulge or herniation.

Differential Diagnosis
Whilst pain associated with facet joint strains tends to be specific and isolated, disc prolapses pain tends to be more vague and diffuse. Bending which tends to aggravate disc prolapses tends to relieve pain associated with a spinal canal stenosis or spondylolythesis. In contrast, arthritic movements tend to be limited in all directions.

Treatment
Treatment of acute disc injuries will vary with the severity and extent of the person's symptoms. A bulging disc with or without sciatic nerve involvement, treatment may include short term bed rest, electrotherapy, traction, graduated mobilization as well as a prescription of extension exercises and sometimes the use of taping or a back brace. These may be used in conjunction with anti-inflammatory medication to provide further relief. 

It is important to avoid any movements or positions which aggravate your pain. McKenzie exercises may also be given along with 'hands on' and dry needling techniques to assist with pain reduction or to restore the mobility and promote an environment of healing.

Tissue healing may be further promoted through the use of electrotherapy, massage, joint and sciatic nerve mobilisation as well as back pain exercises to give sciatica pain relief. Spinal mobilisation and manipulation be combined with precise stretching and trunk stabilisation exercises to normalise spinal mobility and core control. 

As improvement continues, stabilisation is progressed from slow, controlled contractions to faster and more automated activities to more approximate lifestyle conditions. Both strengthening and aerobic conditioning may then be built on top of this stabilisation base to give maximum protection against re-injury as well as to facilitate a higher level of physical performance. 

Finally, lifestyle components such as work / home environments, equipment, as well as habitual movements and postures must also be addressed if optimal function is to be achieved and injury recurrence is to be minimised. 

I hope that this helps.

 
Until next time, Stay Bodywise,
 
Michael Hall
Director
Bodywise Health

 

 
To learn more as to how Bodywise Health can help you overcome back pain or for an appointment, please call Bodywise Health on 1 300 BODYWISE (263 994).
 
Please note:
  • Rebates are available through your private insurance extras cover;
  • For complex or chronic conditions, you may qualify for the EPC (Enhanced Primary Care Program) allowing you to receive 5 allied health services each calendar year with a referral from your doctor.   For more information, please call Bodywise Health on 1 300 BODYWISE (263 994).
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Is Your X-Ray or Scan Doing You More Harm Than Good

Image result for X Ray, CT AND MRI Scans

X-rays, ultrasound, CT and MRI scans can be very valuable for identifying serious medical conditions such as fractures, spinal cord injuries and other specific lesions. However, once "serious problems" are ruled out by a radiologist, evidence shows that minor findings may not just be of no value in helping to explain the majority of aches and pains, they may be psychologically harmful especially when they tell patients that they have arthritis, degenerative disc disease, disc bulges, tendon tears and more.

Everyday thousands of Australians become confused and distressed by medical imaging that doesn't match the source or cause of their particular pain or problem. These people have been shown to have more doctor's visits, more lasting pain, more disability and a lower sense of welbieng.1, 2, 3

Here are a few important facts regarding medical imaging that you must be aware of to prevent yourself being fooled by your X-Ray or diagnostic scan.

Lumbar Spine - Lower Back
It is well established that most imaging findings, particularly degenerative changes, correlate poorly with clinical presentation.

Studies have shown that lumbar disc degeneration is present in 40% of individuals under the age of 30 and present in over 90% of people between the ages of 50 to 55.8

Another study showed that amongst healthy young adults aged 20 to 22 years with no back pain, 48% had at least one degenerative disc and 25% had a bulging disc.9

Leading physicians at the department of Neurosurgery in California strongly recommend AGAINST the routine use of MRI for low back pain as they have NO LINK between degenerative changes seen on x-rays or MRI's and low back pain.10

Other research findings include:

1. Individual neuro findings on MRI (disc herniation, root compression etc.) don't provide definitive link to LBP (Endean et al. 2011; Shambrook et al. 2011)

2. MRI does not improve clinical outcomes in the absence of red flags (Chou et al. 2009)

3. Early imaging does not positively impact clinical outcomes (Graves et al. 2012)

4. Inappropriate imaging can lead to misdiagnosis, inappropriate management decisions, potentially unnecessary surgery, poor outcomes and greater financial, social, psychological and physical costs (Flynn et al. 2011; Haldeman et al. 2012)

5. Spine MRI in primary care often leads to surgical assessment - yet MRI cannot discriminate surgical vs. non-surgical cases (You et al. 2012).

Translation: Do not panic if your x-rays shows "problems" with your discs; they simply are normal changes that occur from the age of 20 onwards.

Thoracic Spine - Mid / Upper Back
MRI studies of healthy adults with no history of upper or low back pain found that 47% had disc degeneration , 53% had disc bulges and 58% had disc tears in their thoracic spine. Amazingly, 29% of these healthy young people had a disc bulge that was actually deforming and pressing on the spinal cord, yet they had no signs or symptoms. 6,7

Translation: Do not panic if your x-ray or MRI shows "problems" with your discs; they are simply common and NORMAL findings.

Cervical Spine - Neck
An MRI study of healthy adults and seniors found that 98% of all men and women with no neck pain had evidence of "degenerative changes" in their cervical discs.

A 10 year study compared the MRI's of healthy people to those with whiplash injuries. Immediately and 10 years later both groups had similar MRI's with 75% having disc bulges.5

There was also a recent study where they MRI'd the SAME patient in 10 facilities and got COMPLETELY different reports from all of them - not good!

Translation: The majority of all healthy adults get neck degeneration (arthritis and disc bulges meaning they are a NORMAL aging process! Therefore, neck arthritis and mild to moderate disc bulges can only be a reasonable explanation of your neck pain if they match your clinical examination.

Shoulder
MRI studies of adults who have no shoulder pain show that 20% have a partial rotator cuff tear and 15% have a full thickness tear. In addition, in those 60 and older with no shoulder pain or injury, 50% (half) of them had rotator cuff tears on their MRI's that they didn't know about.16

A study of professional baseball pitchers showed that 40% of them had either partial or full thickness tears yet had no pain while playing and remained pain free even 5 years after the study.17

Translation: Do not panic if your ultrasound and/or MRI shows a rotator cuff tear; it is not necessarily associated with your shoulder pain!

Hip
There is only a weak association between joint space narrowing as seen on x-rays and actual symptoms.11

In fact, one study showed that 77% of healthy hockey players who had no pain, had hip and groin abnormalities on their MRI's.12

Translation: Do not panic if your x-ray or MRI shows cartilage tears or narrowing; it is not a sign of permanent pain or disability.

Knee
Studies have shown that when x-rayed, up to 85% of adults with no actual knee pain have x-rays that show knee arthritis. This means that there is little correlation between the degree of arthritis seen on x-rays and actual pain.13

In fact, one study showed that 48% of professional basketballers had meniscal (cartilage) "damage" on their knee MRI's.

Translation: Do not panic if your knee x-ray or MRI shows degeneration, arthritis or mild cartilage tears; it is NORMAL!

Ankle
Although there is an association with plantar fasciitis and heel spurs, it should also be known that 32% of people who have no foot or heel pain have a heel spur visible on x-ray.15

Translation: One third of all people have a heel spur and yet have no pain.

After reviewing this research you might be thinking that x-rays and diagnostic scanning are useless in identifying sources and causes of the majority of injuries and diseases. Not so. Diagnostic imaging techniques are valuable tools in assisting with diagnosis and healthcare management.

However, x-rays and scans are just one set of tools that provide unique insights that must be considered in the wider context of physical assessment and evaluation, as well as the social, psychological, nutritional status of a person. Only when all these factors have been considered, can an optimal healthcare management plan be devised and implemented to achieve the best health outcomes possible for you.

If you have an injury or pain that you would like to get better as quickly and completely as possible, please call Bodywise Health on 1 300 bodywise (263 994) and receive a no obligation, complimentary injury assessment and advice.

In this session, you will discover the source and cause of your problem as well as the number one thing that you can do to help yourself get better.

References for Diagnostic Imaging of Musculoskeletal Injuries

1. Kendrick D, et al. The role of radiography in primary care patients with low back pain of at least six weeks duration: A randomised (unblended) controlled trial. Health Technol Assess.2001: 5(30);1-69.

2. Ash LM, et al. Effects of diagnostic information, per se, on patient outcomes in acute radiculopathy and low back pain. AJNR. Am. Neuroradiol. June 2008. 29 (6):1098-103.

3. Modic MT, et al. Acute low back pain and radiculopathy: MR imaging findings and their prognostic role and effect on outcome. Radiolog. 2005 Nov; 237 (2) 597-604.

4. Okada E, et al. Disc degeneration on MRI in patients with lumbar disc herniation: comparison study with asymptomatic volunteers. Eur. Spine J. 2011 Apr;20(4):585-91.

5. Matsumoto M, et al. Prospective 10 year follow-up study comparing patients with whiplash associated disorders with asymptomatic subjects using magnetic resonance imaging. Spine. (Phila Pa 1976) 2010. Aug 15;35(18):1684-90.

6. Matsumoto M, et al. Age related changes of thoracic and cervical intervertebral disc. Spine. (Phila Pa 1976) 2010. Jun 15;35(14):1359-64.

7. Wood KB, et al. Magnetic resonance imaging of the thoracic spine. Evaluation of asymptomatic individuals. J Bone Joint Surg. Am 1995 Nov;77(11): 1631-8.

8. Cheung KM, et al. Prevalence and pattern of magnetic resonance imaging changes in a population study of one thousand forty three individuals. Spine. (Phila Pa 1976) 2009. April 10;34 (9):1934-40.

9. Takatolou J, et al. Prevalence of degenerative imaging among young adults. Spine. (Phila Pa 1976) 2009. Jul 15;34(16):1716-21.

10. Chou D, et al. Degenerative magnetic imaging changes in patients with chronic low back pain: A systematic review. Spine. (Phila Pa 1976) 2011. Oct 1;36 (21 Suppl):S43-53.

11. Chu Miow Lin D, et al. Validity and responsiveness of radiographic joint space width metric measurement in hip osteoarthritis: A systematic review. Osteoarthritis Cartilage. 2011 May;19(5):543-9.

12. Silvis L, et al. High prevalence of magnetic imaging findings in asymptomatic collegiate and professional hockey players. Am J. Sports Med. 2011 Apr;39(4): 715-21.

13. Bedson J, Croft PR. The discordance between clinical and radiographic knee osteoarthritis: A systematic search and summary of the literature. BMC Musculoskel. Disord. 2008 Sep 2;9:16.

14. Kaplan LD, et al. Magnetic resonance imaging of the knee in asymptomatic professional basketball players. Arthroscopy. 2005 May;21(5):557-61.

15. Johal KS, Milner SA. Plantar fasciitis and the calcaneal spur. Fact or Fiction? Foot Ankle Surg Am. 2012 Mar; 18(1):39-41.

16. Sher JL et al. Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg Am. 1995 Jan;77(1):10-5.

17. Connor PM, et al. Magnetic resonance imaging of the asymptomatic shoulder of overhead athletes: A 5 year follow up study. Am J. Sports Med. 2003 Sep-Oct;31(5):724-7.

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The Truth About How to Fix Your Tendon Problems

clinical pilates brightonElbow tendonAchilles TendonKnee Tendon

Busting Myths for Tendon Problems

Myth One - Eccentric exercise is the best exercise for rehabilitating tendon.

Whilst eccentric exercise (strengthening exercise where the muscle is lengthening) is the most researched, evidenced based program that is used, world renowned tendon specialist Professor Jill Cook from Latrobe University states that upon reflection, eccentric exercise by itself is deficient because it doesn't address the specific requirements of a person. They may be OK for the middle aged male runner, but they aren't that great for the younger sprinter or for the older person.

More importantly, eccentric exercise doesn't address the strength deficits of the muscle or of the body in general and they don't address the new research findings of the brain's and nervous system's deficiency in activating the muscle. Therefore, eccentric exercises by themselves are quite deficient in being able to restore full function.

What is the best treatment program for tendon problems?
The best treatment for tendon problems is really tailoring a program that best matches each person's individual wants, needs and requirements. For example, a young sprinting athlete with a hip tendon pain will have a different program to an older woman with the same condition.

Likewise a shoulder tendon problem will have a different program to an elbow tendon or an Achilles tendon problem. And even further from this, an Achilles tendon problem where the pain is in the mid portion of the tendon, the same as if the pain is at the insertion (attachment) and you can't treat either the of these the same as if the problem is in the covering of the tendon (peritendon).

This is why people need to be treated so individually. The purpose of treatment is to restore function to the level that a person wants. Anything after this is a bonus.

What are the key principles in tendon treatment?

The key principles include:
1. Promoting muscle strengthening which can only be achieved with strengthening exercises that involve both shortening and lengthening of the muscle. If you have good muscle strength, this will protect your tendons as well as other structures;

2. Having the ability to restore and release energy in the tendon if you are a higher level athlete;

3. Ensuring that the whole body is working efficiently and effectively with good mechanics;

4. Correcting faulty functional movement patterns.

What stages are involved in tendon rehabilitation?
To restore people back to high level function is a four stage process. For a person who doesn't need to meet high level athletic demands, they will not need to go through all four stages.

Stage 1 involves using isometric exercise (strengthening exercise where the muscle is contracting but there is no movement at the joint) to reduce pain and the brain's inhibition to activating muscle;

Stage 2 involves implementing a good strength program for the muscle/tendon unit as well as all other associated parts of your body. For example, the higher up your leg that you go, the more that you need to restore below the problem. If you have an Achilles problem, it is mainly calf that needs to be restored. If you have a knee tendon problem then the quadriceps and calf will also need to be restored. And finally, if you have a hip tendinopathy, it is glutes, quadriceps and calves that need to be restored.

In particular, you need to restore the strength of your anti-gravity muscles and then depending on their activity level, you need to restore the spring. As the tendon act like springs, you need to make them work again especially with the faster the movements and energy storage movement.

Stage 3 involves adding to this is endurance. For example, if someone wants to play football, they not only need to have a great general body strength and control and a great set of springs, they also need to spring repeatedly and therefore their tendons must have great endurance. It is this lack of endurance, or the capacity of the tendons to tolerate prolonged stress, that failure occurs.

Stage 4 involves adding spring strength and endurance. This is why tendons often take so long to get better. They often present extremely debilitated and damaged. There often has been long term pain with the tendons being robbed of their energy, endurance and muscle strength and bulk. And all of this needs to be restored, before the tendon can be made resilient enough to cope with the stresses that a person want to place upon the tendon in the activities that they want to get back to.

People who leave treatment early will often find that their pain will return in a couple of weeks because the tissue is only as good as the load that is placed upon it. And this is the same for tendon, muscle and bone. This means that if tissue hasn't been restored to a capacity that is needed in an activity or sport it will fail again. It's just physics. You cannot continue to load a tendon greater than what is has been trained to do. It isn't rocket science and just self-evident.

Physiotherapy should the first treatment of choice because tendons need exercising and correct loading. Physiotherapy shouldn't come after medication, injections or other intervention.

Myth Two - Tendon problems always involve inflammation

Tendon problems were originally thought to be an inflammation of the tendon (i.e. Tendinitis) in the 1970's until a fantastic study showed that tendon pain was primarily due to degeneration rather than inflammation.

Of course, like any other tissue, there will be some inflammatory markers and there will be some inflammatory cells because it's a tissue that is injured. However, inflammation is not the driving process. It is not the thing which is creating the pain and it is not the thing which is creating the ongoing pathology.

What causes the pathology is due to the over-loading of the tissue either on a prolonged or a short term basis. What causes the pain seems to be the tendon cell releasing pain chemicals.

If a person has an acute injury and ice doesn't help, then don't waste your time putting ice on the injury. Spend your time doing exercise. If ice does help, this is an indication that the injury probably has some peritendon (sheath covering the tendon) involvement. Therefore, ice and anything else which you perceive to be helping can be used along with exercise that has the correct loading. The evidence however, is that rest, ice, compression and elevation won't help you.

Myth Three - Once the tendon is pain free and you have returned to sport you don't need to do your exercises any more.

It is important that you understand that even if your tendon is pain free and you have returned to sport that the pathology in the tendon is still there.

Tendons don't heal even if the pain goes away. Once a tendon, always a tendon. If you do the right things your tendon will stay pain free. If you don't do the right things, your tendon will become painful again.

In addition to this, your brain is still inhibiting the activation of your muscles, because it is worried that you are going to re-injure your tendon again. Consequently, this means that if you return to sport and you stop your strength training, your muscle strength will decrease markedly if you stop your exercises and you will be prone to re-injuring yourself.

To prevent re-injury, it is important that you continue with your strength training exercises at least twice each week for at least a year following full recovery and then you may have a chance to give up the exercises.

For elite athletes they need to continue with their strength exercises 3 times a week for the rest of their careers. This is because these strengthening exercises are acting like an insurance policy. If you can stay strong, you keep your tissue (muscle and tendon) capacity up, you will be less likely to get into trouble again.

Because of your brain protective inhibition on your muscles and tissues, it means that when you have been injured, when you return to sport, you won't run, jump, twist, turn or just move quite the same way that you did before your injury. Therefore, the first season following a major injury is a building season. Following this you will need to do a really good pre-season and the second season back will be a "cracking" season.

It can take this long to be able to use your tendon as a spring and be sure that it is not going to cause your pain.

Myth Four - The tendon will get better quickly

It is critically important that you are educated regarding your tendon pathology.

You need to see how much swelling there is, how much muscle bulk you have lost, how your tendon store energy and how badly you hop.

You need to understand how your tendons react to pathology and how pain is caused and how we need to build capacity.

You need to understand that once a tendon, always a tendon and though you can become pain free and you will be able to return to sport, we want you to be able to play as well as you can.

You might be a bit sore the day after sport, but you will be able to train the day after this.

Understand that unless you are prepared to buy in to a 3 to 6 months rehabilitation process (and sometimes longer), there is no point in starting. You need to understand how long it will take and why, so that you can work with your tendon and your body to achieve the best outcome. Unfortunately there is no quick fix.

If you have tendon problem and you want to get better as quickly as possible, call Bodywise Health on 1 300 Bodywise (263 994) for a no obligation, complimentary assessment and advice.

You have nothing to lose except your pain!

Until next time, stay Bodywise,

Michael Hall
Director
Bodywise Health

Reference
Professor Jill Cook; Busting Tendon Myths Conference; San Diego 2016

 

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Why female athletes are more prone to knee injuries and what you can do about it

physiotherapy in brighton

What a wonderful start to the Women's Australian Rules Football season. It's been fortunate that the injury toll has been keep largely in check. There have been a few exceptions, namely:

  1. Natalie Plane from Carlton with her high-grade ankle sprain
  2. Meg Downie from Melbourne with a hamstring rupture
  3. Stephanie De Bortoli also from Melbourne with an Achilles tendon tear
  4. Brianna Green, a Fremantle player fractured her collarbone


There have been two major knee injuries reported to have occurred during the season so far. Sophie Armitstead with a meniscal tear of the same knee she's previously had an ACL reconstructed and Kim Mickle who ruptured her ACL.

But what is this 'ACL'?
The Anterior Cruciate Ligament is a rope-like structure that supports your knee from the inside. In some ways, it is the last structure that prevents your thigh bone and leg bone separating during not only high force activities but also day to day activities, like walking down stairs. In addition to the structural support offered, it is also considered to give information to the brain about how you are moving from the stretch and pull it undergoes as you move. Ideally, the joint and ligament is protected by strong muscles around the joint that can absorb most the force.

What puts the ACL at risk?
Somethings are out of our control, like the weather. There have been some weather conditions, that lead to a dry field, that have been seen to increase the risk of an ACL injury1.

Regrettably being older or having a previous knee injury also increases the risk of an ACL injury.

A higher grade of football was noted to contribute to an increased risk, but these players were also generally older and had previous injuries.

Gender is also a very interesting element of ACL risk. It has been found that females have an increased risk of ACL ruptures in several sports. These sports include wrestling (4 times the risk, compared to males), basketball (over 3 times the risk, compared to males), soccer (around 2.5 times the risk, compared to males), rugby (nearly 2 times the risk, compared to males) and lacrosse (only slightly higher risk)2. That study was done before the Women's AFL took off, so it did not include females playing AFL as a comparison. It was also interesting to see that AFL had similar ACL injury rates to soccer and basketball.

Fortunately, there are somethings that we can do to help reduce the risk. Increased weight and the associated higher Body Mass Index (BMI) have also been reported as putting the ACL at more risk of a rupture1. So, eating healthy and maintaining a good balance of regular physical activity has yet another advantage!

What should I do?
Most ACL injuries in AFL matches occur without contact. This would suggest that there are elements that could be worked on to reduce the risk of an ACL rupture.

Fortunately, research has backed this up3. Specific movement strategies and muscle groups have been identified as areas that players can work on to effectively reduce their risk of rupturing their ACL3.

If you are an AFL player or play one of the sports mentioned above, it would be worthwhile booking an appointment with a Bodywise Health Physiotherapist to assess your strength and movement patterns.

This allows the physiotherapist to prescribe an individualised exercise program aimed at reducing your risk of an ACL rupture and the expensive surgery and rehabilitation that goes along with it.

For further information on how you can prevent knee injuries or for a FREE assessment, please call 1 300 BODYWISE (263 994).

Until next time, stay happy and be Bodywise,

Michael Hall
Director
Bodywise Health

References

  1. Orchard, John et al. "Intrinsic And Extrinsic Risk Factors For Anterior Cruciate Ligament Injury In Australian Footballers". The American Journal of Sports Medicine 29.2 (2001): 196-200. Web. 3 Mar. 2017.
  2. Prodromos, Chadwick C. et al. "A Meta-Analysis Of The Incidence Of Anterior Cruciate Ligament Tears As A Function Of Gender, Sport, And A Knee Injury-Reduction Regimen". Arthroscopy: The Journal of Arthroscopic & Related Surgery 23.12 (2007): 1320-1325.e6. Web.
  3. Cochrane, Jodie L. et al. "Characteristics Of Anterior Cruciate Ligament Injuries In Australian Football". Journal of Science and Medicine in Sport 10.2 (2007): 96-104. Web.
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The Truth About Back Surgery

low-back-pain

Back pain – it can rip your life away from you making your every position, movement and activity excruciatingly painful beyond your imagination. You can’t sleep. Dressing yourself is difficult if not impossible and going to the toilet can be agonizing. The constancy of your pain can wear you down to the point where your whole world is consumed by “the pain”.

If that’s not enough the confusing array of information, advice and treatment options offered by often well-meaning people can often compound your sense of disillusionment and powerlessness.

Everyone you speak to has a different opinion or magic cure. Friends will often tell you about their “guru” therapist that you must see. Therapists will give you many and varied diagnoses and treatments all promising to “fix” your problem. Doctors may send you for X-rays, CT scans and MRI scans but often the long words of these technical reports heightens your fears that something is seriously wrong and that hope of a cure for your pain is fading.

And then under the advice of your treating health professional you undergo any number of different treatments including nerve blocks, epidurals, radiofrequency neurotomies, prolotherapy and intradiskal electrothermal therapy, unbeknown to you, that most of these treatments offer at best between 30-60% of short term pain relief. 1,2,3,4

Is it no wonder that Australia is following America’s lead with spinal surgery increasing at 10% a year?5 In America, experts estimate that nearly 600,000 people opt for back operations each year. Yet, a new study in the journal Spine shows that in many cases that even surgery can backfire, leaving patients in more pain.

Researchers reviewed records from 1,450 patients in the Ohio Bureau of Workers’ Compensation database who had diagnoses of disc degeneration, disc herniation or radiculopathy, a nerve condition that causes tingling and weakness of the limbs. Half of the patients had surgery to fuse two or more vertebrae in hopes of curing low back pain. The other half had no surgery, even though they had comparable diagnoses.

After two years, just 26 percent of those who had surgery returned to work. That’s compared to 67 percent of patients who didn’t have surgery. In what might be the most troubling study finding, researchers determined that there was a 41 percent increase in the use of painkillers, specifically opiates, in those who had surgery.

The study provides clear evidence that for many patients, fusion surgeries designed to alleviate pain from degenerating discs don’t work, says the study’s lead author Dr. Trang Nguyen, a researcher at the University of Cincinnati College of Medicine.

Unfortunately, for most patients with bad backs, there is no easy solution, no magic bullet. Pain management experts — and some surgeons — say that patients need to scale back their expectations. With the right treatments, pain can be eased, but a complete cure is unlikely.

27 million adults with back problems

A recent report by the Agency for Healthcare Research and Quality, a federal organization, found that in 2007, 27 million adults reported back problems with $30.3 billion spent on treatments to ease the pain. While some of that money is spent on physiotherapy, pain management, chiropractor visits, and other non-invasive therapies, the majority pays for spine surgeries.

Complicated spine surgeries that involve fusing two or more vertebrae are on the rise. In just 15 years, there has been an eight-fold jump in this type of operation, according to a study published in Spine in July. That has some surgeons and public health experts concerned.

For some patients, there is a legitimate need for spine surgery and fusion, says Dr. Charles Burton, medical director for The Center for Restorative Spine Surgery in St. Paul, Minn. The indications for spinal surgery include:

• Nerve root compression resulting in persistent toileting problems, leg pain or numbness, tingling and muscle weakness;
• Persistent pain due to instability of a single intervertebral segment.

“But the concern is that it’s gotten way beyond what is reasonable or necessary. There are some areas of the country where the rate of spine surgery is three or four times the national average.”

Despite the fact that over 250,000 lower back fusions are performed every year in the USA, there is no evidence to support this operation for discogenic back pain.6,7

Burton and others recommend that patients get a second opinion when back surgery is recommended for the treatment of back pain without neurological symptoms, such as sciatica, especially if other treatments haven’t been suggested first.

“We are very successful at improving leg symptoms," says Dr. William Welch, vice chairman of the department of neurosurgery at the University of Pennsylvania Medical Center and chief of neurosurgery at Pennsylvania Hospital. “We are less successful at treating back pain.”

Source of pain is often hard to pinpoint

The reason, Welch says, is that it’s often hard to pinpoint the exact cause of someone’s back pain. Even MRIs can be misleading because abnormalities, such as degenerating discs, can be seen on scans for virtually everyone over the age of 30 regardless of whether they have pain.

Even when the surgery is a success, it rarely dispels 100 percent of back pain, Welch says. And while many surgeons are careful about which patients they recommend for spine operations, some are not so discriminating, says Dr. Doris K. Cope, professor and vice chair for pain medicine at the University of Pittsburgh School of Medicine. “It’s a case of, if you have a hammer, everything looks like a nail,” she explains.

In general, the best results come about through a combination of approaches, Cope says. Each strategy may reduce pain by just 10 or 20 percent, but those percentages can add up so ultimately the patient’s pain is cut back by as much as 70 or 80 percent.

Proven strategies for treating lower back pain involve:
• Taking the load off the pain sensitive tissues and structures by getting into the most pain free positions as possible;
• Reducing inflammation with cold packs or medication;
• Protecting against re-injury with the use of tape or bracing;
• Promoting healing by reducing tissue tension with “hands on” techniques along with easy pain free, mobility exercises and heat treatment;
• Targeted stretching and strengthening exercises to correct muscle imbalances and joint alignment;
• Correction of posture, functional movement patterns (habits) and sporting techniques to prevent irritation of body structures and tissues;
• Core stabilisation exercises to build a strong, stable platform upon which whole body strengthening can be built;
• Functional strengthening to build your body’s capacity to cope with daily physical demands.

It is important that you understand that healing any tissue takes about 6 weeks and involves and a well-recognised progression through phases of healing. For example, the Bleeding Phase can last from 6-24 hours, Inflammatory Phase 2-5 days, Proliferation / Regrowth (framework) Phase 5 to 14 days, the Remodelling Phase 2 to 6 weeks and the Maturation Phase from 6 weeks to up to 12 months and beyond.

It therefore makes sense that if each of these phases are optimised, physically, nutritionally and psychologically and the actual causes of your back pain are corrected, then healing should not just be possible, but inevitable.

It is often quoted that it takes about 4 weeks to strengthen your muscles and at least 4 weeks to correct your posture or movement habit. So whilst not a quick fix, understanding that if you follow an evidenced based rehabilitation system that has been proven deliver results over time, you too can also achieve sustained improvement, through a progressive rehabilitation and conditioning program that will prevent re-injury and optimise your physical capacity.

If you are interested in learning about a 7 step plan that thousands of people have experienced relief through, call 1 300 BODYWISE (263 994) for a FREE Assessment and Recovery Action Plan. This plan will detail the specific steps that you need to take to on your road to recovery. Wishing you the best of health.

Yours sincerely,

Michael Hall
Physiotherapist
Director Bodywise Health

P.S. If you are in pain and you want relief, don’t put off getting effective treatment any longer.
Call 1300 BODYWISE (263 994) for a FREE, No Obligation back assessment and advice. You have absolutely nothing to lose except your pain and a healthier, happier life to gain.

References
1. Dreyfuss P. Hallbrook B, Pauza K et al. Efficacy and validity of radiofrequency neurotomy for chronic lumbar zygoapophysial joint pain. Spine (Phila Pa 1976)2000 25(10):1270-7.
2. Van Kleef M, Barendse GA, Kessels A et al. Randomised trial of radiofrequency lumbar facet denervation for chronic low back pain. Spine (Phila Pa 1976) 1999:24(18):1937-42.
3. Yin W, Willard F, Carreiro J et al. Sensory stimulation-guided sacroiliac joint radiofrequency neurotomy: technique based on neuroanatomy of the dorsal sacral plexus. Spine (Phila Pa 1976) 2003;28(20):2419-25.
4. Pauza KJ, Howell S, Dreyfuss P et al. A randomised placebo controlled trial of intradiscal electrothermal therapy for the treatment of discogenic low back pain. Spine j 2004:4(1):27-35.
5. IA Harris, ATT Dao. Trends of spinal fusion surgery in Australia: 1997 to 2006 - ANZ journal of surgery, 2009 - Wiley Online Library
6. Carragee EJ. The surgical treatment of disc degeneration: is the race not too swift? Spine J 2005:5(6):587-8.
7. Deyo RA, Nachemson A, Miirza SK, Spinal fusion surgery – the case for restraint. N Engl J MED 2004:350(7):722-6

 

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10 Facts to Save Your Back

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For those of you who have severe lower back pain, only you know how debilitating it is. Only you know how it affects every part of your life. You can’t sleep, you can’t get comfortable and even standing to walk to the toilet can be excruciating.

But probably the most frustrating thing about severe lower back pain, is that no one else can see it and or feel it. No one else can share your pain and really know how frightening it is.

Everyone you speak to has their own piece of advice. You should walk. You should apply heat. You should see my guru therapist.

Information can be overwhelming. Doctor Google it seems, has only made it more confusing. Many news websites and newspapers carry blogs on lower back pain. The problem is that almost all authors have not treated a single person with back pain and if they have, they are not at the “coal face” or in the trenches helping people like you daily to cope, to have hope and to see the possibility of a way out of the haze.

Whilst articles may be “evidenced based”, the information is so general that it can be dangerous. To lump everyone who has severe back pain into the same boat maybe downright reckless. A disc herniation is not the same as a joint sprain or canal stenosis. To say to everyone who has severe lower back pain, you just need to get up and walk or that it will just get better on its own, can be both cruel and misleading.

To help you, here are 10 facts that you need to know to help you manage your back pain.

  1. Back pain that has come on for no reason, is constant, keeps you awake and doesn’t change, indicates that your back pain is inflammatory in nature and you need to see your doctor immediately

  2. Whilst you may not remember a specific incident that brought on your back pain, there is almost always a cause. Not understanding this, can lead to you re-aggravating your back injury, the number one reason, why many people don’t get better.

  3. If your pain is throbbing, constant and wakes you at night, apply cold packs in a damp tea-towel for 15 minutes a minimum 6 times each day (and up to hourly) for at least 3 to 5 days (be sure to check your skin every 5 minutes for adverse reactions). If your pain is more like a general soreness, is intermittent and you are able to sleep soundly, apply comfortable heat.

  4. See your doctor to find out which medication can help you cope best. Research has now shown that there is little or no evidence that paracetomol and other over the counter anti-inflammatory medications such as Ibuprofen actually help. And be aware that prolonged use of anti-inflammatory medication has been shown to delay healing

  5. In contrast, there is evidence that “hands on” therapy performed by physiotherapists and other manual health professionals does offer benefit. But again you need to understand that this benefit is likely to be short term if the underlying cause isn’t addressed

  6. We are told “not to take back pain lying down” and to stay moving, but what movement? Lying down might be the only position that reduces your pain. If so, get into the most comfortable position possible, apply cold packs for 15 minutes at a time hourly (helps to reduce inflammation and pain)Generally, there will be a direction of movement that provokes your pain and a direction of movement that eases it. Move gently and slowly in the direction that eases your pain and perform as many of these movements (perhaps 6-12 hourly) as you can as long as they are pain free. At the first hint of an increase in pain or a reduction in form, stop. If you always stop before pain, the chances in making your problem worse are minimisedIf you are lying down, you need to get up and go for a short walk every one to two hours to reduce the pressure in your back. If walking is painful, a back brace and walking with elbow crutches often relieves the pain

  7. Back pain is more common in smokers. Smoking has been shown to reduce blood flow to all parts of your body, including your back, meaning that it is unable to stay healthy and resilient to the stresses that are applied to it every day. This leads to injury, inferior healing, deficient recovery, chronic inflammation and constant pain – not just in your back but your whole body

  8. Staying positive and improving your nutrition, sleep and stress levels will all help you to overcome your back pain. Understanding that your body’s natural default mechanism is to heal and then allowing it to do so by nurturing the most healing environment possible will lead to a quicker and better recovery.

  9. X-Rays and scans (including CT and MRI scans) are often a waste of your money because they:
    •        a. frequently show up completely unrelated abnormalities that can be both scary and confusing;
    •        b. don’t influence or change your treatment: and 
    •        c. they expose you to radiation which can increase your cancer risk.

Having said this, it is important to get further investigations if you have been injured in a trauma involving a forceful knock or blow. Additionally, if your signs and symptoms are worsening (and not improving within a week), you are feeling unwell and losing weight or have pain, numbness, tingling, pins and needles or loss of power in your bladder, bowel or legs. These are medical emergencies and it is critical to see your doctor or health professional as soon as you can.

10. Your back pain will only get better, if you address the cause of your problem. This means changing, if only slightly, the way that you move that has caused the problem in the first place. Whilst “hands on” treatment often provides only short term relief and rehabilitative exercise medium term relief, fixing the cause of your pain will give you permanent relief. It is this package of “hands on” therapy, rehabilitative exercise and posture and movement correction that the evidence has shown is the best way to achieve long lasting relief and sustained physical improvement.

If you have back pain and would like help to get rid of it, call 1 300 bodywise (1 300 263994) to organise an initial gap-free assessment and treatment so that you can begin your road to recovery.

All of us here at Bodywise Health look forward to helping you,

Yours sincerely,

Michael Hall

Physiotherapist
Director Bodywise Health

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Why stretching can worsen an injury and what to do instead

670px-Stretch-for-a-Scorpion-in-Cheerleading-Step-1Stretching, it’s been a cornerstone treatment and training technique for decades. So ingrained and accepted has stretching been that for a long time its benefits pretty much went unquestioned. That was until a couple of years ago, when a 20 year review of the research revealed that pre-exercise stretching was ineffective at preventing or reducing the prevalence of exercise induced injuries. 

Given this, it is reasonable to question stretching’s effectiveness with injury treatment. You see, stretching has been promoted has having many benefits1 including:

  1. Increasing muscle and joint flexibility
  2. Increasing muscle relaxation
  3. Decreasing muscle soreness
  4. Improving circulation
  5. Preventing excessive adhesions
  6. Promoting a flexible and strong scar

Despite this, many of these benefits have not been fully investigated and / or proven.2

If you think about it, almost all physical injuries are due to some sort of breaking down of tissue. For example, a strain is a tear of muscle tissue and a sprain is a tear of the ligaments and / or capsule tissue that holds joints together.

Research has indicated that after about 5 days following an injury, a scaffolding or frame work of tissue is laid down randomly as a bridge over the damaged tissue.3 Initially, these fibres are fragile and easily broken if too much tension or stress is applied.

As the laying down of fibres tends to peak at about 3 weeks, these fibres become progressively more durable and mature. This means that applying tension to the healing tissue becomes progressively more important to align the fibres along the lines of force and ensure a strong and functional repair.4

Stretching, if applied before this phase of healing, may have a number of detrimental effects. These include:

  1. Re-injuring the healing tissue (overstretch strain) by tearing the new, fragile tissue repair;5
  2. Weakening tissue (overstretch weakness), making it more susceptible to re-injury;5
  3. Delaying healing by reducing blood flow;6
  4. Degrading the quality of tissue repair by impeding the nerve supply into the new tissue.7

In our experience at Bodywise Health, people will often state that they “feel” better for a short time following stretching. However, on closer questioning and analysis, it is often evident that over the longer term, the improvement in their condition has stalled.

What to do instead
Immediately following a soft tissue injury, ice and immobilisation should applied for the first few days following injury.9 Immobilisation enables a tissue framework to form across the injured tissue, knitting the damaged ends together and increasing the strength of the healing tissue so it can withstand greater muscle pulling (tension).9,11

After the first few days following injury, early active protected (using taping or bracing) movement into directions which are pain free and which don’t stress the injured tissue has been shown to have numerous benefits including improving circulation, preventing joint stiffness, reducing swelling, accelerating healing and stimulating a better, stronger tissue repair. 5,8,10

However, care must be taken when moving an injured tissue. Probably the number one cause why people don’t get better from injury or don’t get better as quickly as they should, is because they re-injure the damaged tissue. In the early stages, any movement must therefore be pain free and feel almost “too easy”. Progression in movement must only take place, after it has been established how much movement is safe for the injured tissue.

At about the 2 week mark, contracting the overlying stabilising muscles in the position of maximum comfort and below the threshold of pain has the benefit of aligning fibres and producing a stronger, healthier scar.11

It also prevents muscle wasting and begins conditioning the tissue repair to stress or force in a safe and measured way, thereby helping to protect it against re-injury.

As long as the injured tissue remains pain free, this strengthening program may be progressed first in the number a contractions applied and then with increasing movement, before increasing the loading force.

The specific exercise techniques and protocols that work best are beyond the scope of this article because they differ for different injuries and circumstances.

At Bodywise Health, we have found however that stretching as a treatment technique has most value if applied later in the treatment program, after the healing tissue is more resilient to force. At this point stretching can be important for remodelling the scar tissue into a flexible, strong repair as well as for restoring full bodily movement and function.

I hope that this helps.

Best Wishes,

Michael Hall
Director
Bodywise Health

For more information or for a FREE injury assessment and 2nd opinion, please call 1 300 BODYWISE (263 994)

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Bodywise Health

364 Hampton St,

Hampton

Victoria. Australia 3188

03 9533 4257

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