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What to do if you get injured

Knee RICE

By Michael Hall

There is no doubt that your treatment in the immediate 24 hours following an injury has the biggest impact on how long and how well it may take you to recover from an injury. Weeks and sometimes months can be saved from your recovery time if you receive optimal, acute injury management. So, if you want to achieve the best outcome, it is critical that you get this initial management right.  The following is a guide on how to get the best results.

The Bleeding Phase - Perhaps the MOST Important Phase of Healing

“The most important time in the treatment of acute soft tissue injuries is in the 24 hours immediately following injury”.1

When you injure soft tissues, the blood vessels are also often damaged. Blood then pools around the injured tissues causing swelling which stops oxygen exchange, leading to further tissue damage. This bleeding phase may last from just a couple of hours for less vascular tissues such as ligaments up to 24 hours from crush injuries (corked) to muscle.

Consequently, the most important thing that you can do at this stage is to reduce bleeding and swelling at the site of injury. The best way to do this is summarised in the letters PRICER and HARM:

Protection

Ice

Compression

Elevation

Referral

Protection

Protection of the painful or injured body part is essential to prevent re-injury. This can be best achieved through unloading or at least partially immobilizing the injured area through the use of taping, braces, slings, cam walkers and crutches. Even supporting your injured arm with the uninjured arm can work. Part of the value of using these aids is that not only will they stop you from aggravating your own injury, but they will also alert others to the fact that you are injured and therefore need to take care around you.

Rest

Following injury, you should cease activity to limit bleeding and swelling to reduce the size of the scar in injured soft tissue.2

Ice

Ice or cold treatment is used to slow cellular activity.3 It has been proven to reduce bleeding, inflammation and tissue death as well as accelerate early muscle regeneration.2,4,5 It has been our experience at Bodywise Health, that most people don’t achieve optimal results because the ice/cold pack are not cold enough.

For best results, place an ice or frozen gel pack in a damp tea towel and strap it in place with moderate compression. Check your skin every five minutes to ensure that there are no adverse reactions such as whiteness or crispiness of the skin. Remove the cold pack immediately if this occurs.

The most effective method for reducing pain immediately following an injury (ankle sprain) has been found with Intermittent ice (cold) application.6 This involves 10 minutes of ice, 10 minutes of rest and then 10 minutes of ice every two hours over the initial 24 to 48 hours.

More usually ice is applied for 20 minutes continuously every two hours for at least six hours following injury. 4,6,7

At Bodywise Health however, we have achieved faster recoveries and better results with applying ice for 15 minutes every one to two hours for two to five days or at least until the severe pain and inflammation (signs-heat, redness, swelling) have settled down.

Please note, ice should not be applied if you have impaired circulation or if you suffer from an allergy to cold. In addition, you must take care when applying ice as prolonged applications can cause ice burns and nerve damage.8

Compression

Compression not only supports injured tissue, it also reduces bleeding, swelling and scarring and aids healing by improving circulation. It should be applied during and after ice application from the time of injury for perhaps up to two to three weeks post injury. The compression bandage must be firm but comfortable and begun a hands breadth below the injury extending to a hands breath above the injury with each layer overlapping the previous layer by one half.

Elevation

Lifting (elevating) your injury above your heart is also minimizes bleeding and swelling.2 Elevating arm injuries is best achieved by using a sling or even the opposite arm. Likewise, leg injuries should be elevated above the pelvis by lying down and using a chair, pillow or bucket to raise the leg.

Referral

The greatest impact for limiting tissue damage and optimizing injury outcomes lies in the first three to five days following an injury. At Bodywise Health, we have found that the sooner we can assess and effectively treat an injury (i.e. same and / or next day), the better the repair, the faster the recovery and the better the outcome that people achieve, without exception.

In the first 72 hours after being injured, you must also avoid HARM-ful factors. These include:

Heat packs, heat rubs and hot baths (showers) as these will increase bleeding, swelling, tissue destruction and inflammation at the injured site.

Alcohol as it may mask pain, reduce muscle function and impede recovery.9

Running/moderate activity will cause further damage.

Massage/vigorous soft tissue therapy as this will also cause further swelling and bleeding.

There is no doubt that immediate, effective treatment is the best way for you to limit the financial, time, stress and opportunity cost of an injury. So if you want to save money, if you want to save time and if you want to get your life back as quickly as possible, make the most of this time. It could save you weeks and months of treatment.

If you are injured and would like to know what is the best and fastest way to get better, please call 1 300 BODYWISE (263 994) for your FREE assessment and advice.

I hope that this helps.

Kind regards,

Michael Hall

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).

Further information and advice can be accessed through:

  1. Sports Medicine Australia at http://sma.org.au 
  2. The Australian Pain Management Association at http://www.painmanagement.org.au
  3. The Australian Physiotherapy Association at www.physiotherapy.asn.au/DocumentsFolder/Advocacy_Position_Pain_Management_2012.pdf
  4. Arthritis Australia at http://www.arthritisaustralia.com.au
  5. The Victorian Arthritis Association at http://www.arthritisvic.org.au

References

  1. Brukner and Khan and Colleagues. Clinical Sports Medicine. McCraw Medical. 4th Edition, 2012.
  2. Jarvinen TAH, Jarvinen TLN, et al. Muscle Injuries: optimizing recovery. Best Prac Res Clinis Rheumatol 2007;21(2):317-31.
  3. Bleakley C, McDonough S, MacAuley D. The use of ice in the treatment of acute soft tissue injury. Am J Sports Med 2004;3(1)251-61.
  4. Bleakley CM, O’Connor S, Tully MA et al. The PRICE study (Protection, Rest, Ice, Elevation): design of a randomized controlled trial comparing standard versus cryokinetic ice applications in the management of acute ankle sprain(ISRCTN13903946) BMC 2005;33(5).745-64
  5. Jarvinen TAH, Jarvinen TLN, et al. Muscle Injuries biology and treatment. Am J Sports Med 2005;33(5)745-64.
  6. Bleakley C, McDonough S, MacAuley D. Crotherapy for acute ankle sprains: a randomized control study of two different icing protocols. Br J Sports Med 2006;40(8):700-5
  7. MacAuley D. Ice therapy: how good is the evidence? Int J Sports Med 2001;22(5):379-84
  8. Moeller JL, Monroe J, McKeag D. Cryotherapy-induced common peroneal nerve palsy. Clin J Sport Med 1997;7(3):212-16
  9. Suter PM, Schultz Y. The effect of exercise, alcohol or both combined on health and physical performance. Int J Obes 2008;32(S6):S48-52.
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Probably THE most important factor in reducing your mechanical pain

Posture Pain

Gravity is the enemy. Have a look around you and you will see its force. People stooped, heads forward, rounded shoulders and curved backs.

Now think about the tasks that you do every day. You sleep, you sit, you cycle, you drive, you work at a computer, you cook, you clean, you do almost everything in a bent forward position. You may even stand and walk in a slightly forward leaning position.

Is it no wonder then that if you look at people who are in pain or old, that they are stuck there?

Your posture is one of the most important factors in determining not just your physical health, but also how well you feel, how young you look and how well you are able to perform every-day tasks.

Poor posture is related to tension headaches, upper and lower back pain, shoulder pain, hip pain, knee pain, foot pain, myofascial pain, you name it. It is also associated with depression and responsible for the forward stooped appearance that we see in so many elderly people.

With such far reaching consequences, fixing your posture is one of the quickest and easiest ways of not just helping you recover from physical pain, but of avoiding and preventing it in the first place.

What is posture and in particular, what is good posture?

Posture “refers to the relative arrangement of segments of the body” (Norkin & Levangie 1983). Ideal posture may be defined as “that state of muscular and skeletal balance which protects the supporting structures of the body against injury or progressive deformity”. Under such conditions, your “muscles will function most efficiently and the optimum positions are afforded for the thoracic and abdominal organs.” (Posture Comm of Am Academy of Orthopaedic Surgeons 1947.)


Categories of Posture
As mentioned, posture may also be divided into two categories: static and dynamic posture. Static posture refers to the arrangement or alignment of the body parts whilst the body is at rest, whilst dynamic posture refers to this alignment during movement.

Static posture will therefore directly affect dynamic posture or in other words, the starting position for any movement must affect the precise alignment of the parts during that movement. By definition therefore, good static posture is a prerequisite for good dynamic posture as precise maintenance of correct alignment during movement cannot occur, if the body parts are not correctly aligned in the first place.

But why is posture important?
Posture is important because:

1. It determines the amount of stress on the different tissues and systems of the body which directly relates to the development of pain syndromes and injuries, and also,

2. It determines effectiveness and efficiency of movement and therefore the influences the performance levels of all physical tasks.

Essentially, good posture thereby minimises the abnormal or excessive stresses on the body and optimises the performance of all physical tasks.

2 Postural Patterns in Life
You have 2 postural patterns in life.Posture photo

1. A bending, turning inward pattern. Have a look at people who stoop (e.g. image on the left). The head is forward, the chest is depressed, the shoulders  are rounded, the upper back curvature is increased and hips are bent and the person looks old and stooped.

2. A straightening, turning outward and opening up of your body. In contrast with the image on the left, the person on the right is upright. They look tall. Their head is in line with their shoulders, their chest is lifted and their back has a normal S shaped curve.

Typical Faulty Postures and Related Pain Syndromes
If good posture minimizes excessive or abnormal forces, poor posture exacerbates abnormal or excessive stresses leading to many and varied physical conditions. Some of these include:

Head forward posture (ear lobe in front of shoulder)
- Headaches
- Neck pain (due to disc bulges, facet joint irritation)
- Osteoarthritis of the neck
- Vertebral artery signs such as dizziness, blurring of vision and ringing in the ears

Rounded shoulders and increased mid back curve
- Thoracic spine and rib pain
- Upper back muscle strains
- Shoulder pain
- Decreased rib expansion and therefore limited breathing

Flat back posture
- Low back pain with sitting, bending etc.

Increased low back inward curve
- Low back pain with walking, standing etc.

Turning in and Bent Hips
- Hip osteoarthritis
- Buttock pain (Gluteus Medius Tendinopathy; Trochanteric Bursitis)
- Knee pain (Knee cap pain, Knee arthritis)
- Ankle pain (sprains)
- Foot pain (Plantar Fascitis)

What is good posture and how is it assessed?
The standard way for postural alignment to be assessed is by using the plumb line test where the alignment of the body in standing is assessed in relation to a plumb line positioned above the body (Muscle Testing and Function by Kendall and Kendall).

From the side, a plumb line placed just in front of the outside ankle bone should pass through:
- ear lobe
- bodies of the cervical vertebrae
- tip of the shoulder
- divide the chest in half
- bodies of the lumbar vertebrae
- slightly behind the hip joint
- slightly in front of the knee joint
- slightly in front of the outside ankle bone (lateral malleolus)

From the front, the plumb line should divide the body into two symmetrical halves. The head, shoulders and hips should be level, and also the hip, knee and ankle joints should be equidistant from the line of gravity.

A caveat to this, is that Kendall and Kendall in Muscle Testing and Function state that it is normal for a person’s for the dominant side shoulder to be lower and for the dominant side hip to be higher. Consequently, for this to occur, a scoliosis must be present. They state that the reason for this is due to the increased muscle bulk and the asymmetry of limb usage of one side compared to the other.

Can you do anything to improve your posture?
Absolutely! First and foremost, before deciding whether any intervention is necessary let alone whether it is going to be of benefit, an accurate and comprehensive evaluation must be performed. This obviously will involve an assessment of postural alignment, but also it must take in account other factors such as the habitual postures and movements, as well as an assessment of muscle bulk, tightness and strength, joint mobility, balance and coordination.

Posture Pro – A great tool for assessing posture and bodily stress.posture-pro2
At Bodywise Health, our computerized posture assessment tool called Posture Pro not only gives you an accurate, objective measure of your posture, but it also is able to calculate the stresses on your neck, back, shoulders and legs, and whether they are abnormal or not.

It is a great predictor of whether you will suffer from an injury or pain in any of these areas. Reducing, stopping and preventing your pain often then goes hand in hand with correcting your posture.

Correcting your posture may involve more than just sitting and standing up straight
Correcting your posture and the abnormal stresses involved is a simple matter of using “hands on” techniques to loosen specific stiff joints and tight muscles, whilst using precise strengthening exercises to “shorten” lengthened, weak muscles. In effect, your muscles are used like guywires as the exercises effect is to muscle bind you back into better alignment.

Once gained, this new mobility and strength can then be incorporated with better awareness (reinforced with postural taping), to ensure that correct posture becomes a habit which is maintained over time.

Quick tips on improving your static posture
In the meantime, some quick tips for immediately improving your posture include:
1. Stand “tall”, lifting from the top of your head and from the middle of your chest;
2. Sit with a lumbar roll cushion in the small of your back and relax backward;
3. Strengthen the muscles that hold you up against gravity.

Quick tips on improving your dynamic posture
1. Learn to squat on each foot, keeping your knee over your second toe and without holding on;
2. Progress this to stepping down a step keeping your knee over your second toe;
3. Progress this to hopping, running and cycling keeping your knee over your second toe;
4. Run in a slightly bent forward position.

These posture improvement strategies will have the effect of lengthening your spine and stopping your body from “giving way” under the long term ageing effect of gravity.

Correcting your posture in this way is one of the quickest and best ways that you can permanently reduce your pain and improve your health. I hope that this helps.

Until then,

Best wishes,

Michael Hall
Director
Bodywise Health

For more information on how Bodywise Health can help you to improve your posture so that you may prevent chronic neck and back pain, 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 GP. For more information, please call Bodywise Health now on 1 300 BODYWISE (263 994).

 

 

 

 

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How to Prevent Injury and Perform at Your Best

Running Image

I was at the Ironman Triathlon over the weekend and whilst I have great admiration for each competitor’s drive and self-discipline, I was amazed at how many people had terrible posture and poor movement patterns. Many of the cyclists had excessive curvature of their back, inadequate hip bending and their knees were turned inwards close to the bar. Many of the runners also were hunched over, with excessive turning in of their knees and turning out of their feet.

Injuries waiting to happen

In effect, all these people are just injuries waiting to happen. Why? Because the one thing that most determines if you will suffer from a physical injury is your technique. Your technique for swimming, your technique for cycling, your technique for running, walking, standing, sitting, everything.

The way to know if your pain is due to a posture or movement habit

These are the sorts of pains and physical problems that come on for no apparent reason. They just seem to appear and you can’t quite put your finger on it as to why. Any physical problem that has come on out of the “blue”, is likely to be due to a faulty posture or movement habit.

You see, it is not often what you do but how you do it that will cause you pain and problems. Poor technique doesn’t just lead to poor performance, it leads to injury as the excessive or abnormal stresses generated cause cellular irritation, inflammation, pain and tissue breakdown.

The problem for you is that many of these techniques are habits, ingrained in you from the day you were born. Most of the time you don’t even know that you are doing them.

Think about it. Many people have devices which record how many steps they take, with the target being 10,000 steps a day. How many times do you move your head, bend over, cross your legs, lean forward, sit down and stand up? Thousands upon thousands of times. And how long do you spend looking at computer screens, TV screens and smart phones? Potentially, hours upon hours.

What you may not realise is that many of the positions and movements you do each day, you do every day, in the same way, at the same speeds, in the same directions. These are called habits and you have been doing then since the day dot. They are part of your very fibre, bound up in the very way that you perceive yourself and the world around you. They are also as unique to you as your voice and fingerprints.

Poor habits = Poor health, Good habits = Good health

Now, can you imagine if you do each of these activities in a slightly “faulty” way. Perhaps you sit at a computer leaning forward, or turn your head to look at the computer screen which is off to one side. Perhaps people approach you from one side or you find yourself twisting one particular way time and time again.

If you are a gardener, builder or cyclist, it has been proven that you will finish up with a flattened lower back (Claus 1996). In other words, your body will adapt to your daily activities, much the same way that an athlete’s body will adapt to their training program. In effect, your body will reflect not just what you do, but more importantly how you do things.

Magill and associates (1992) showed that if you stretch a soft tissue (e.g. sit slouched) for 20 minutes that it takes longer than 40 minutes for full recovery. And yet, we may hold certain, “stretched” positions for hours (e.g. gardening), over-stretching tissues and never letting them recover. Is it no wonder that these tissues develop over stretch weakness that may then lead to over-stretch strain (tearing of fibres)?

Your body will follow the path of least resistance. This means that the muscles that you use more will get stronger, whilst those that you move less will get weaker.  Its the same for joints, as those that you move most will get more mobile, whilst those that you move less will get stiffer.  This reinforces and perpetuates the joint mal-alignment and muscle imbalance.  It also causes compensation to occur, often at the least desirable joint, in the least desirable direction, leading to pain and dysfunction.

“Hands- on” treatment techniques whether they be from a physiotherapist, chiropractor, osteopath, massage therapist, acupuncturist, are essential as they "loosen up" specific stiff joints and tight muscles.  However, "hands on" techniques will generally give just short term relief as they generate just short term changes in joint mobility and soft tissue tension, thereby alleviating symptoms for the time until the tissues become irritated again. Likewise, corrective exercise alone will generally give just medium term relief as while they may correct muscle imbalance, they won't correct the posture or movement which is causing the actual problem. To achieve long term, sustained relief, you must correct the posture, movement or activity which is causing the problem. 

How to fix these problems for good

To turn these problems around, the first thing you need to do is become aware. Listen to your body. How does it feel as you do or just after doing a particular activity? Does it feel abnormally tight, stiff, tender or achy? Does it grate, lock, click or give way? All these are signs that an activity may be doing you harm and are often a precursor to symptoms. These signs are to be distinguished from normal exercise muscle soreness which should last about 24 hours and indicates that your soft tissues are adapting to the exercise “stress”. Pain longer than this, probably means that you have exercised too hard and / or have sustained some sort of tissue damage.

So what is good technique?

Good technique refers to the optimal alignment and function of all the body systems, structures and tissues so that the highest level of performance is achieved and a person’s physical, psychological and spiritual health is enhanced.

5 Tips for achieving good technique

  1. Listen to and work with your body. Become aware of what feels good and what doesn’t feel good. Use mirrors or other biofeedback tools to check your form and stop the activity when you notice that your technique has become “faulty”. Make adjustments and then test to assess what works and what doesn’t work. Then keep doing what works and refine the process through practicing to improve everything that you do.
  2. Become informed by reading books, blogs and articles. Watch films that educate you in how to perform better. Attend seminars or join groups that have the same values, goals and interests.
  3. Get an assessment. You don’t know what you don’t know. In other words, you may have no idea that the way that you are doing something is potentially causing your body and health damage, let alone detracting from your performance and results.
  4. Get a coach. Whether it be by yourself or with a group, a qualified coach who is knowledgeable, competent and has a track record of results will be able to help you avoid technique and training mistakes that may lead to injury.
  5. Use equipment and training techniques that enhance your health and performance.

Your technique determines everything. Poor technique pretty much will guarantee you injury. Good technique will not only minimize your chances of suffering from an injury, but also means that you may swim better, cycle faster and run easier. So not only will you spend less time on the injury sidelines, you will have more fun doing what you love.

I hope that this helps.

Next week, I will share some quick and easy tips on how you avoid the most common injuries and / or if you are injured, how to recover faster from them.

Until then,

Best wishes,

Michael Hall

If you are concerned about your physical and nutritional health and would like to reduce or prevent pain, please call Bodywise Health on 1 300 (BODYWISE) 263 994 to book your FREE Physical or Nutritional assessment.

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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What the AFL season can teach you about injuries and how to prevent them.

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By Michael Hall,

We all want to avoid injury and get the best out of our bodies, don't we? And like all elite sports, the AFL provides some real key lessons in how you can achieve your physical best. Here are 10 tips for getting the best out of your body.

1.Be prepared

The Hawks were simply better prepared for a physically and emotionally demanding match. Rather than a disadvantage, it seems that the exhausting game against Port Power, was actually a blessing in disguise. The hardness at the ball, the speed of the game and the intense one on one contests, gave the Hawks a “taste” of what to expect.

It’s the same with you. For you to be able to reach your potential, you must prepare your body and your mind through “conditioning”. In other words, you must “train” so that you can get the most out of your body and life, without getting injured.

Training allows you to measure the load that you place on your body, so that you can create adaptation of your body.

Because the training environment is controlled, forces above and beyond what’s required in your sport and life activities can be safely placed upon your body for a specific time. This strengthens your body further so that it has a reserve capacity to cope with the demands likely to be placed upon it.

For a FREE trial of Clinical Pilates, please call Bodywise Health on 1 300 (BODYWISE) 263 994

However, to begin “training” safely, it is recommended that you begin with the next point first. That is....

2. Get a Physical Health Check from your doctor or health professional

It seems obvious, but before you take on a particular event, it’s important that you check that you have the structural, biochemical and psychological capacity to endure such a challenge. In a very short time, you can gain a snapshot as to any risks you may have or potential problems that you may face. By knowing these up front, you can deal with them before they ever become an issue. Some of these factors include:

* Heart arrhythmias which may lead to heart attacks;

* Excessive triglycerides or high concentration of low density lipoproteins (LDL’s) which are a risk for heart attacks and strokes;

* High blood pressure which is a risk for stroke;

* Excessive upper back outward curvature (kyphosis) is a risk factor for upper back pain, shoulder pain (Rotator Cuff syndrome) and chest pain (costo-sternal pain);

* Decreased lower back inward curvature (lordosis) is a risk factor for low back pain;

* Excessive turning in at the hips, inadequate balance, excessive turning in at the knees (knocked knees) and flattening (pronated) feet are risk factors for buttock pain (gluteus medius tendinopathy, piraformis syndrome or trochanteric bursitis), as well as knee pain (knee cap pain or knee osteoarthritis), ankle pain (inside calf shin splints, anterolateral impingement syndrome) foot pain (plantar fasciitis) and even toe pain (hallux valgus);

* Other physical inadequacies which include abnormal hip extension, ankle dorsiflexion which can lead to back, hip, knee, ankle and foot pain.

3. Start slowly and progress slowly

The biggest mistake most people make when training for an event is that they start too hard and too fast. What you must understand is that it takes up to six weeks and beyond for your body to adapt to the stimuli that training provides. Therefore in the early (2 to 3 weeks) stages, the principal that less is more certainly applies. Get to know your body and begin to gain an understanding of what it is capable of and where your tolerances lie.

If you are a beginner, start aerobic training for 10 minutes once to twice every other day at an intensity which enables you to speak in sentences and progress to 20 minutes increasing sessions by three to five minutes per week as you comfortable.

4. Use High Intensity Interval Training to get better, faster results

At the three to four week mark, after a five minute warm up pace, increase your intensity so that to being able to speak in words for 30 seconds. Then slow down and allow yourself to get your breath back. Repeat this process for the 20 minutes of your training.

At the six to eight weeks stage, increase your intensity to greater than 80% of maximum effort for 20 seconds. Then slow down and to go get your breath back and repeat this process for the duration of your training. This type of training called High Intensity Interval Training (HIIT) drives change and adaptation in your body’s cells, burning more kilojoules, fat accelerating your fitness and health improvement.4 A study, published in Cell Metabolism, showed that when healthy but inactive people exercised for even just a brief time, there was an immediate change in their DNA. While the genetic code remains the same, the intense exercise triggers important structural and chemical changes that lead to a re-programming for strength and fat burning.

In another study, recreational cyclists were able to double their endurance capacity in just two weeks by doing just three sessions of sprint interval training each week. (Note: To minimize the chance of impact injury, it is recommended that this HIIT be performed on a exercise bike with swimming or perhaps running up hill).

The American College of Sports Medicine recommends 20 minutes of more vigorous activity three days per week, noting that HIIT workouts tend to burn an extra 6-15 percent more calories compared to other workouts, thanks to the calories you burn after your exercise.

From here on vary your training time, intensity, volume, duration, surfaces and rest periods based upon periodisation concepts. For example, one day you might walk/run/cycle on the flat, another day you might do hills and on another day you might run on the sand or in waist deep water. For more information contact Bodywise Health on 1 300 BODYWISE (263 994).

5. Include corrective and capacity building exercise.

The day in-between should be reserved for correcting any muscle imbalances and relative joint stiffness before building your body’s capacity for exercise.

Your physical assessment will identify what muscles are relatively weak and tight and what joints are relatively stiff as well as faulty posture and movement patterns. Without correction, exercising will simply reinforce excessive or abnormal stresses on the body leading to “breaking down” of tissues and eventually injury and pain.

Because much of our lives are spent in activities that involve prolonged periods of sitting (e.g. computer, cycling etc.), bending (e.g. laboring, gardening etc.) and / or working in a slightly bent forward position (e.g. working at any bench, running etc.), typical exercises might include stretching and strengthening your muscles through full range in directions that are the opposite to our every day postures and movement patterns.

People sometimes comment, “But I am in a physically active occupation”. Whilst this is better than being sedentary, these occupations still don’t build your capacity. Rather, over time your ability to keep going still physically decreases. The reason is that as these activities are performed over days, physical stress is being applied to the body’s tissues for long periods of time. This is catabolic (breaking down) to muscle, tendons and bones leading to overuse syndromes such as tendinopathies and stress fractures. Hence, many of these injuries could potentially be avoided if you strength trained every other day.

For best strength results, train with free and cables weights and NOT on machines. Free weights and cable loading strengthens and neurologically trains your stabilizing muscles, joint capsules, joint and muscle receptors better preparing you for physically demanding and unpredictable activities. Also, vary your exercises every month to keep your body and your brain guessing. Changing your exercises, keeps your brain and body in a state of alert and readiness for action.

For a FREE physical health check or injury assessment, please call Bodywise Health on 1 300 263 994 (BODYWISE).

6. Focus on technique

It is amazing when watching people do fun runs, cycle events or swimming challenges, how many are doing these with poor techniques. Poor technique equates to excessive or abnormal stress being put on body tissues. As the loading on their body structures increase with increasing training volume, intensity and duration, so does their risk of injury as tissues break down under the excessive or abnormal forces.

So get your running, cycling, swimming, golf technique etc. assessed to ensure that your activity is being performed with a maximum amount of efficiency and effectiveness. If these activities are not being performed optimally, then not only will you not achieve the best possible result, you are literally breaking down and wearing out your body at an abnormally fast pace. In the end this can only mean injury and pain. Much better to prevent it starting before it ever occurs.

For a FREE physical health check or injury assessment, please call Bodywise Health on 1 300 263 994 (BODYWISE).

7. Balance the load on your body

Loading on your body involves four variables: Intensity, Volume, Duration and Rest. If any of these variables together as a group or individually cross a loading threshold, injury will occur. Understand that low intensity stress, applied frequently for a long period of time with no rest can be as damaging as doing too much intense exercise too soon.

The key is in knowing where the injury threshold is crossed and this is why we rely on treatment and training principals to the body’s build capacity whilst avoiding injury. This is easy to do in the gym because we record the training load and its effect. For example, three to five sets of eight to twelve repetitions 80% or more of the maximum amount you can lift in one go every other day, is generally recognised as a strength training guide.

However, it’s much more difficult in everyday life to know if we are crossing an injury threshold because we generally don’t measure how much we sit, how much we bend, how much we turn to one side etc. and even if we did, the effects may not manifest themselves for years.

One method for finding out if your overtraining or becoming ill involves taking your pulse for one minute each morning upon waking. After a week, you will know what your average resting pulse is. Then if your pulse increases by more than 10%, this is an indication that you are overtraining or becoming unwell.

Dr. Ainslie Meares, an Australian Psychiatrist and the father of meditation in Australia, recommended two, 10 minute sessions of “stilling” the mind and body each day. There are now many studies which have proven the beneficial effects of meditation. So whether it is just being quiet, prayer or meditation, stopping your body and brain’s busyness for 10 minutes twice each day could go a long way to enhancing your health and preventing injury.

“Listening to your body” and becoming aware of what it is telling you is the starting point for change. Measure your training (and your life) and take note of its effects. Notice when you are feeling stiff, tight, achy etc. and try and determine what activity and its load has caused this. Then change it. You might change the intensity, time or tempo of the activity or the rest periods. Back off and rest when you are feeling fragile both physically and / or mentally and then begin again when you feel able. By becoming conscious of how your body is feeling and taking remedial action, you will very likely prevent many potential injuries and illnesses before they ever occur.

8. Recover well

One training variable that is often not considered by the average weekend warrior is rest and recovery. It’s no coincidence that often AFL footballers are pictured standing waist deep in the water the day after a football match and certainly, swimming and water activities are perhaps amongst best activities for recovery. But there is more to consider than just standing in water.

Often following any unfamiliar activity, your body will feel “sore”. This “soreness” is indicative of an inflammatory reaction, where the white blood cells of your immune system break down the affected tissue so that it can be rebuilt stronger and with increased capacity to withstand the forces when they are again applied. The recovery time for this to occur generally takes about 48 hours. If the same stimulus is applied before complete recovery occurs, the tissue is weakened, reducing your exercise capacity and your ability to stay injury free.

Bodyflow is an advanced technology (available at Bodywise Health and for home rental) that further accelerates this process. By electrically stimulating the smooth muscle within the walls of the small veins (vessels that take blood back to the heart), blood pooling is prevented, swelling is reduced and recovery enhanced. Used by many AFL clubs as well as the English Olympic team, Bodyflow has been shown to hasten the recovery process, enabling more effective training to begin sooner thereby enabling the potential for better results. The beauty of Bodyflow is that you can use it in the convenience and comfort of your own home to “treat” yourself.

Lymphodema and remedial massage are also a critical in recovery. It is no coincidence that many athletes receive remedial one, two and perhaps more times each week to facilitate recovery. This massage is not a luxury but an essential component of an overall strategy to prevent injury and improve results. Like Bodyflow, lymphodema massage removes swelling and improves circulation.

However remedial massage goes further. Very often tissues that are irritated, tight and / or restricted, that people are not aware of, are “sensed” by skilled remedial massage therapists and alleviated, again heading off potential injury. The more intense the activity, training or sport, the more frequently massages are generally given and the more that they are adapted to address the specific needs of the tissue, person and activity.

As you increase your training consider having a remedial massage at least monthly if not sooner. It can be a great way to optimize your physical and emotional health. Again “listen to” and be “guided by” your body and don’t leave it too late.

9. Get adequate sleep

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.

Recommendations for a good night sleep include:

* Get to sleep by 10.30pm to enable adequate physical repair and body detoxification.

* 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.

* Avoid caffeine in the afternoon; (caffeine inhibits adenosine, sleep molecule of the brain which aids in getting to sleep)

* Avoid alcohol as this tends to keep sleep light which is not optimal for repair and restoration.

* 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).

* Warm milk contains tryptophan and may assist in getting to and maintaining a deeper sleep.

* 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.

* 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.

* Sleep in pitch blackness as this assists in the pineal gland in production of melatonin, the sleep hormone.

* Exercise at least 20 to 30 minutes, 5 days each week as this stimulates the production of Adenosine, the sleep molecule.

* Get at least 15 minutes of sun light each day to optimize Vitamin D production.

* 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.

* Move all electromagnetic devices away from your bed as far as possible.

* Get to bed at the same time each day;

* Read something calming or do something restful whilst in bed (e.g. listen to something relaxing), not watching TV.

10. 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:

* 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).

* Adequate amount of zinc, magnesium, vitamins B3 and B6 and chromium which aid muscle recovery and prevent injury.

* Reducing grains and avoid refined simple carbohydrates (especially refined flour and sugars) to decrease blood sugar and insulin spikes which cause inflammation;

* 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.

For a FREE physical health check or injury assessment, please call Bodywise Health on 1 300 263 994 (BODYWISE)

The AFL season provides you with some great life lessons. Implementing these teachings into your own life can help you be more, live more, achieve more so that you can have more of what life has to offer. Why would you want any less? Why go through another day in injury or pain or with less than optimal energy and conditioning to live fully and freely. Every day is your “Grand Final”. You never get to relive it. Seize today and begin working towards better health and a better life.

For a FREE physical health check or injury assessment, please call Bodywise Health on 1 300 263 994 (BODYWISE)

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 1 300 263 994.

References

1. Chadwick V, Ford A and McPhee R. A Practical Guide to Nutrition for Allied Practitioners (Level 1) Course Notes May 2014

2. Sahrmann SA. Diagnosis and Treatment of Movement Impairment Syndromes, 2002

3. Heyward C. Advanced Fitness and Exercise Prescription. Human Kinetics. 6th Edition, 2010.

4. The Leader, September 8, 2014

5. Cell Metabolism March 7 2012: 15 (3); 405-411

6. J Appl Physiol (1985). 2005 Jun; 98 (6): 1985-1990

7. The American Journal of Sports Medicine PDF

8. Chek P. Program Design; Choosing Reps, Sets, Loads, Tempo and Rest Periods, Correspondence Course Manual 1995

9. Brukner and Khan and Colleagues. Clinical Sports Medicine. McCraw Medical. 4th Edition, 2012.

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How to avoid a Hip Replacement.

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By Michael Hall,

Here’s the latest research on how to avoid a hip replacement.

If you want to avoid or at least delay a hip replacement, recent research published in November 2013, indicates that you can.

In this study conducted in Norway, 71 patients with hip osteoarthritis (as verified by X-rays and scans) were divided into exercise / information group and an information only group. The exercise group underwent 12 weeks of a physiotherapy supervised exercise therapy program, performed 2-3 times each week.

It was found that those people who participated in the exercise therapy program had a “significantly higher 6 year cumulative survival of their native hip to total hip replacement” and therefore “has the potential to reduce the need for or postpone surgery in patients with hip OA (osteoarthritis). This finding supports that recommendation that exercise therapy should be considered a first-line therapy and offered to patients with OA.”1

Living well with arthritis is one thing, but preventing it is even better. To help me explain how you may be able to do this, let’s delve a little deeper.

So what is arthritis?

Arthritis is often referred to as a single disease. In fact, it is an umbrella term for more than 100 medical conditions that affect the musculoskeletal system, specifically joints where two or more bones meet.

Arthritis-related problems cause inflammation and damage to joint cartilage (the tissue that covers the ends of bones, enabling them to move against each another) and surrounding structures. This can result in joint weakness, instability and deformities that can interfere with the most basic daily tasks such as walking, driving a car and preparing food.

While there are about 100 forms of arthritis, osteoarthritis is the most prevalent accounting for 51% of cases in Australia, and it is this form of arthritis that we will refer to in this article.

What causes osteoarthritis?

There are many causes of osteoarthritis. These include:

1.Incorrect biomechanics (excessive or abnormal forces on the joint surfaces) due to faulty postures and / or movement habits;
2.Joint trauma (e.g. car accident) associated with injury or surgery and incomplete or inadequate rehabilitation;
3.Congenital or genetic causes (e.g. Hip dysplasia, Chronic Juvenile Arthritis, Ante-verted / Retro-verted hips);
4.Diseases (e.g. Perthes disease, Slipped Epiphysis etc.);
5.Lifestyle, occupational and sporting factors (e.g. squash);
6.Excessive weight (e.g. obesity);
7.Poor diet, leading to nutritional deficiencies (e.g. Rickets)

What does hip osteoarthritis “feel” like?

Hip osteoarthritis is characterised by a gradual onset of deep hip or groin ache that can be referred down the inside or front of the thigh. The hip is also stiff on getting out of bed in the morning or standing after a period of sitting. As the hip degenerates, the pain often becomes worse at the end of the day and also becomes more constant at rest and at night.

How is hip osteoarthritis diagnosed?

Hip osteoarthritis can generally be easily diagnosed. On an x-ray, there is reduced joint space (leading to a “short” leg) as well as bony protuberances, called osteophytes, at the joint edges. Clinically, all movements of the hip are markedly limited (The normal hip movement ranges are 1200’s flexion (bending forwards), 100’s extension (moving leg backwards) and 450’s internal/external rotation (turning the hip inwards and outwards), with the most common faults being limited hip rotation as well as hip flexion contractures (shortening of the muscles at the front of the hip which bend the leg up) reflecting the overuse of these muscles and perhaps the underuse (and therefore weakness) of the hip and leg push-off muscles (e.g. gluteus medius/maximus, quadriceps and calf muscles).

As the hip becomes stiff (especially in extension or moving the leg backwards with walking), the lower back compensates by moving more, leading to exaggerated pelvic rotation and excessive lower back extension and potentially irritation and pain. As the gluteal muscles further weaken, the body begins to sway from side to side with walking to help lift the leg through. This is called a Trendalemberg gait pattern.

How do every day postures and movements contribute to osteoarthritis?

There are a number of faulty postures, movement patterns and abnormal or excessive forces (e.g. obesity) which may lead to hip osteoarthritis. These include walking with your feet turned in, excessive sitting and standing with your hips in a flexed position. All these postures and movements patterns lead to tightening of the muscles and structures at the front of the hip (as well as weakness of the muscles at the back and sides of the hip), forward tilting of the pelvis, hip joint compression and stiffness.

Can the effects of hip osteoarthritis be prevented or at least minimised?

There are a number of effective techniques and exercises which may reduce hip pain and increase hip movement, strength and have you walking and moving better. Whilst there is no cure for arthritis, if the joint structures stop being irritated (and inflamed), they will become less painful, less stiff and more flexible, allowing for improved movement and function.

If the primary characteristics of hip arthritis are tight hip flexors, reduced hip mobility in all directions (especially hip extension and rotation), weak hip gluteal muscles, then the primary aim of any treatment and training program is to lengthen the hip flexors, restore hip mobility (especially hip extension and rotation) and strengthen gluteus medius and maximus.

The best results are achieved with a combination of “hands on” techniques, corrective exercise and postural / functional movement optimisation.

To lengthen the hip flexor muscles (ilopsoas and tensor fascia latae), soft tissue massage release, dry needling and PNF stretching techniques are all effective. To mobilise or free up the hip joint is best achieved with a combination of traction and rotation mobilisation “hands on techniques.

To maximise mobility, exercises such as hanging your leg over a step with a 2-3 kg weight around the ankle and then rotate the leg inwards and outwards within pain limits, can be used to reinforce “hands on” traction techniques. Stretching the hip flexors is also important and can be achieved through lunging stretches or sliding your affected leg out along the floor whilst holding the other knee to your chest as you lie on your back.

To correct your standing posture and enhance your ability to walk, you must strengthen your gluteal muscles as well as your “lower” abdominals, quadriceps and calf muscles. Best outcomes are achieved with a precise strategy of meticulous isolated strengthening each muscle group and then integrated muscle strengthening with other associated muscles before progressing into correct function such as standing balance, squatting, step stepping and perhaps even hopping.

It is not often appreciated, but optimal strengthening and conditioning of muscles involves careful attention to detail of exercise positioning, “patterning”, activation, timing, loading, repetition, sets, holds, recovery periods, nutrition, sleep/rest quality, psychological stress/tension levels etc. And when there is pathology involved such as with hip osteoarthritis or in fact any physical problem, these factors become even more important.

As with all injuries and or physical problems, if the original cause(s) is not corrected, the signs and symptoms will always return no matter what “hands on” techniques or exercises have been performed.

Do you sit for prolonged periods of time and stand bent forward or walk with your feet turned in or wide apart? Do you cycle with your knees turned in close to the bar on your bike? Do you walk or run or stand from sitting with an inadequate push-off or squat with your knees together?

All of these faulty postures and movement patterns, lead to muscle imbalances, relative joint stiffness, faulty joint alignment and potentially osteoarthritis or many other pain syndromes such as osteoarthritis of the knee (especially kneecap or patellofemoral joint), ankle (e.g. anterolateral impingement syndrome), foot joints (e.g. sub talar and mid tarsal joints) and even toe joints (e.g. hammer toes).As this research shows, the most important point is that hip osteoarthritis along with many other degenerative muscle / joint syndromes are potentially preventable or at least able to be minimised.

However, to do this requires optimal posture and movement patterns and then a physical capacity building exercise program that resists the degenerative forces of ageing, gravity, ergonomics and everyday occupational and functional routine movement patterns.

If you want to prevent or minimise the effects of osteoarthritis, this is where you need to start!

To prevent and / or solve any physical problems starts with awareness that comes from an assessment. If you want to optimise your physical health status or are concerned that you may be at risk of developing hip osteoarthritis or any other physical pain syndrome, please feel welcome to contact us here at Bodywise Health for a FREE assessment. We would be delighted to perform a detailed and thorough examination and set you on the right path to optimising your physical potential so that you can get the most out of your life.

For a FREE hip assessment or walking evaluation and advice, please call 1 300 BODYWISE (263 994).

References

1. Svege I, Nordsletten L, Fernandes L & Risberg MA; Annals of Rheumatic Disease. Published online first: November 20, 2013. Doi:10.1136/annrheumadis-2013-203628

2. Ganz MD, Leunig MD at al. The Etiology of Osteoarthritis of the Hip; Clinical Orthopaedics and Related Research. 2008; 466 (2): 264-272.

3. Tepper S, Hochberg M; Factors Associated with Hip Osteoarthritis: Data from the First National Health and Nutritional Examination Survey. American Journal of Epidemiology 1993

4. Brukner and Khan and Colleagues. Clinical Sports Medicine. McCraw Medical. 4th Edition, 2012.

5. Sahrmann SA. Diagnosis and Treatment of Movement Impairment Syndromes, 2002

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 1 300 263 994.

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How strength training can build muscle in oldr adults

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By Michael Hall,

50 or over? Want to stay independent? Here’s how

If you are 50 or older, research indicates that you will lose an average of 0.18kg of muscle per year. It is widely acknowledged that this loss of muscle leads to physical deterioration, functional decline, loss of independence and reduced quality of life. There is evidence however, that resistance exercise can prevent or slow muscle loss in older people. Despite this, the research up until now has been vague and confusing as to how much exercise and what type of exercise works best for older adults. A recent study published in Medicine & Science in Sports & Exercise 2011, is one of the first to analyze the effect of different training programs on lean body mass and across different age groups.

In the study, 49 different training programs were analysed from 1990 to 2009. To be part of the study, people had to be at least 50 years of age and untrained. A total of 1357 people participated with an average age of 65.5 years and the programs ranging in length from 10-52 weeks (average 20.5 weeks).

The exercise programs consisted of exercising two to three times per week, at an average intensity of 74.6% of 1RM (the maximum amount that can be lifted in 1 repetition). Each exercise session consisted of an average of 8 different exercises, being performed 10 times (repetitions) followed by a 110 second rest period and with a total of 20 sets per session. Most of these studies corresponded with the guidelines of resistance exercise for older adults as recommended by the American College of Sports Medicine.

Overall, there was an increase of 1.1kg per person. The study showed that the greater the amount of training, the greater the increase in muscle. The study also showed that the younger the person, the more muscle that was gained. Therefore, for optimal results, older adults should begin resistance exercise as early as possible. A higher training volume appears to be better for adaptive purposes.

The study found that most of the resistance exercise programs simply increased the amount of load lifted over the trial period (i.e. the intensity increased); however, studies involving younger age people followed a periodization model of progression in intensity, volume and more. This indicates that single set/fixed volume exercise programs may not be as effective in increasing muscle in older adults and that these should include a systematic progression of training volume.

This study gives a valuable insight as to the factors that are most effective in helping healthy older adults maintain or increase their muscle mass. It shows that the current exercise guidelines for older adults might be too cautious and that adjusting them in the light of this review is likely to improve the health and lifestyle benefits achieved.

Bodywise Health Comment

1. Your program must be safe.

First, it is recommended that you get a medical clearance from your doctor and then to begin a program under the supervision and instruction of a health professional. This is especially important if you are a beginner or have a physical impairment (e.g. arthritis, osteoporosis etc.).

When beginning, start slowly and progress slowly. It is wise to begin at lower intensity (e.g. 60-80% of the load that can be lifted once) with more repetitions (8-20) and fewer sets (e.g. 2) for the first 4-6 weeks of training.

2. Your program must be effective.

For best results, it must focus on resolving the physical deficits that have been identified in your initial examination. Generally, your body will adapt to the postures and movements that you do most in life. As one physiotherapist once said, “People, who sit in a chair for prolonged amounts of time, eventually become a chair”. The initial examination must therefore be precise and comprehensive enough to determine not just the source of biomechanical problems (stiff/short muscles, restricted joints etc.) but the cause of the problems (e.g. faulty posture and incorrect movement patterns because of weakness, tiredness or lack of awareness etc.). Resolving physical deficits involves optimising the parts (increasing the control and strength of muscles, freeing stiff joints etc.) as well as addressing the whole (improving posture, correcting movement habits and fixing work settings etc.). Essentially, it involves bringing the body back into ideal biomechanical alignment by increasing the control of stabilising muscles, the strength of prime mover muscles, and the length of muscles that are tight, short or stiff.

It is important to begin with activities that test your balance and muscle stabiliser control, as this forms the foundation upon which strengthening can take place. For this reason, clinical pilates and exercises involving balance, free weights or cables are recommended. By improving joint control, they make every day activities easier and help to protect against physically challenging or unexpected activities.

Your body is extremely efficient with adapting to exercise. Consequently, conditioning exercise programs can lose their effectiveness quite quickly depending on the type of exercise and the condition of the exerciser. To ensure exercise programs remain optimally effective, these programs need to be modified every four weeks for beginners, every three weeks for regular exercisers and every two weeks for elite athletes. The instructing health professional must have an understanding of correct loading (i.e. how much load is effective to produce results without being too much to cause injury or too little to have no effect). Knowing the physiology of muscle is also important. Fast twitch fibres respond best to short amounts of higher intensity exercise (and are primarily responsible for the increase in muscle size), and slow twitch which respond better to lower intensity, higher volume/increasing time exercise. Consequently, better results will be achieved if the intensity, amount and duration of the exercises is in sync with the type of muscles being exercised.

3. Your program must be fun.

Let’s face it; if you don’t enjoy an exercise program, the chances are that you won’t continue with it. It is important that whatever you enjoy doing that your program fits in with this. If you like to walk or run at home alone, then doing some balance, stabilisation, strengthening and stretching exercises on a swiss ball or foam roller at the end of your walk or run would be ideal. If a gym is what you prefer, then go for it. Or if enjoy something a little more personal, then clinical pilates might be the way to go. The key is to give an exercise program a trial for four to six weeks. If you don’t like it then or haven’t got the results that you want then try something else. Eventually you will find something that you enjoy and which works for you.

4. Your program must be convenient.

Life is so busy these days that fitting something else in might be difficult. If doing your program is easy and convenient however, you are more likely to stick at it. And if you stick at it, you are more likely to see results which then become self reinforcing.

At Bodywise Health, we specialize in providing conditioning exercise programs that are designed to prevent injury as well as to correct or rehabilitate physical problems. So if you are concerned about becoming weaker or if you suffer from arthritis, osteoporosis, back or neck pain, Bodywise Health can provide you with a program to help you get your strength and life back.

References:
1. Peterson MD, Sen A & Gordon PM. Medicine & Science in Sports & Exercise 2011; 43(2): 249-258

For more information or for an appointment, please call Bodywise Health on 1 300 263 994.

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 GP. For more information, please call Bodywise Health now on 1 300 263 994.

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Knee surgery Vs Physio

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By Michael Hall,

Got knee pain? Think surgery is the answer? New research shows you might need to think again.

You have knee pain and you just want to get it better in the best, fastest way possible, right? Surgery would have to be the logical answer, given that it repairs the faulty structures and “fixes” the problem. Besides, it what all the AFL teams resort to when one of their players have got a knee “problem”. New research and multiple studies indicate that this may not always be the best course of action.

Knee surgery no better than sham?

The latest study was conducted in Finland on 146 patients with degenerative (wear and tear) menisci (cartilage) tears. The menisci are crescent shaped fibro cartilage disc structures that sit between the femur (thigh bone) and tibia (shin bone). They have two purposes, one to act as a cushion between the bones and two, to increase the surface contact of the bones and thereby provide increased stability to the knee joint. The classic way that they get torn is if you twist when your knee is bent. However, over time your menisci can also develop tears, especially if you have arthritis. Arthroscopies involve surgeons trimming these torn menisci and sucking out the “debris”. It is assumed that the tear is the cause of pain and that by smoothing out the jagged edges, the pain will go away.

In this study, patients were divided into two groups, one who received standard surgery and the other sham surgery, or surgery where surgeons made an incision under epidural anaesthetic, but didn’t do anything to the cartilage.

The result? One year later, both groups had the same outcomes, that of reduced knee pain. The researchers had to conclude that knee arthroscopies were no better than sham surgery.

Proven! – Physiotherapy may be just as good as knee arthroscopic surgery

This result has been confirmed by four previous studies, two proving that physiotherapy provides just as good outcomes as arthroscopies for knee pain:

1. In 2013, a study comparing the functional outcomes of physiotherapy against surgery and physiotherapy, found that physiotherapy alone provided just as good results as surgery and post operative physiotherapy.

2. In 2008, Kirkley and colleagues found the same result. That is, after comparing medical and physiotherapy with arthroscopic surgery for osteoarthritis (OA) of the knee, researchers concluded that medical and physiotherapy outcomes in terms of pain and stiffness were equal to those provided with surgery.

3. In 2002, in a landmark study in Texas, Moseley and colleagues compared arthroscopic surgery with sham surgery (i.e. the surgeons just made cuts in the patients’ knees) on 180 patients. They found no difference in self reported pain and function in a 24 month follow up.

4. In 2012, Bohensky and colleagues examined the results of all elective knee arthroscopies for patients 20 years or older with osteoarthritis of the knee from 2000 to 2009 in Victoria. They concluded that “despite the evidence questioning its effectiveness, there has been no sustained reduction in arthroscopy use for people with a diagnosis of OA.”

Given that arthroscopic surgery for knee OA cost Victorian taxpayers 180 million dollars last year, it would seem that this 180 million dollars could have been reduced.6 And this is not to mention the possible complications of superbug infections, medical mistakes, the risks involved with a general anaesthetic and the fact, the you are likely to need ongoing physiotherapy treatment for at least another six weeks.

Arthroscopic surgery an option, but perhaps NOT the first option

The evidence is clear. The management of meniscal tears depends upon the severity of the injury as well as the physical demands of the person. The reason for this is that the outer part of the meniscus has a blood supply and therefore can heal if it is damaged. In contrast, the inner, central part of the meniscus doesn’t have a blood supply and consequently cannot heal.

Hence, for small meniscal tears or osteoarthritic knees, physiotherapy has been shown to provide as good if not better results for much lower cost and much reduced risks. For optimal results to be achieved however, physiotherapy techniques and modalities must be combined specifically to optimise each stage of the healing process. Specifically, techniques must be directed towards protecting against re-injury (e.g. taping, bracing, crutches), reducing inflammation (e.g. Rest, Ice, Compression, Elevation), minimising swelling (e.g. Bodyflow), and then promoting healing and enhancing the tissue repair (e.g. Lipus Ultrasound). At the same time, function must be optimised with graduated movement (e.g. knee straightening and bending), strength (especially gluteal and quadriceps muscles), hip/knee control (with standing balance, squatting, walking, step-ups etc.) and functional/sporting activities (e.g. hydrotherapy, hopping, running etc.).

So when should you seek surgery?

Surgery is more likely to be indicated if you have sustained your injury with a severe twisting movement and are unable to continue with your activity. Other factors that may indicate whether surgery is required is if you knee is locked or has severely limited movement, has a palpable clunk or pain on minimal bending and / or there has been minimal improvement after three weeks of physiotherapy.

The final word

Please don’t misunderstand, surgery is a treatment option, but whether it should be the first or last treatment option depends upon the severity of the injury, the physical demands of the person and the outcome of physiotherapy management. Whether you have osteoarthritis or a less severe torn meniscus, physiotherapy and exercise has been shown to be just as effective as arthroscopic surgery and perhaps even more so in some cases. And with risks of anaesthetic reactions, superbug infections, drug reactions and medical complications, surgery costing about $2,000 compared to less than $1,000 for a typical course of physiotherapy, both the costs and the benefits line up heavily in favour of physiotherapy as being the treatment of choice for knee osteoarthritis and less severe meniscal tears.

For a FREE knee assessment or walking evaluation and advice, please call 1 300 BODYWISE (263 994).

References

1. Sihvonen, R, Paavol M, Malmivaara A, Itälä A, et al. for the Finnish Degenerative Meniscal Lesion Study (FIDELITY) Group N Engl J Med 2013; 369:2515-2524
2. Katz JN1, 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 May 2;368(18):1675-84.
3. Kirkley A, Birmiingham TB, Litchfield, RB, et al. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med 2008; 359: 1097-1107.
4. Moseley JB, O’Malley K, Petersen NJ, et al. A controlled trial of arthroscope surgery for osteoarthritis of the knee. N Engl J Med 2008; 359: 1097-1107.
5. Bohensky MA, Sundararajan V, Andrianopoulos, N, de Steiger, R, et al. Trend in elective knee arthroscopes in a population-based cohort, 2000-2009. MJA. 2012; 197 (7) 399-403.
6. Brukner and Khan and Colleagues. Clinical Sports Medicine. McCraw Medical. 4th Edition, 2012.

For more information or for an appointment, please call Bodywise Health on 1 300 263 994.

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 GP. For more information, please call Bodywise Health now on 1 300 263 994.

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Carbs, Weight Loss and Metabolism

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By Michael Hall,

Personal Healthcare

Type 2 diabetes has tripled over the past 10 years and 61% of Australians are now overweight or obese (ABS statistics) and this at a time when apparently it is well known that the best methods for controlling weight involve lifestyle changes in diet and exercise. Clearly something is wrong. Thirty years ago, the Lausanne group showed that carbohydrates in food were a minor contributor to fat accumulation in obesity (1-3). This supported the dietary recommendations at the time – that most of the diet should be made up of carbohydrates, with fat being limited to 30% and protein to the 10-20% range. The worsening health status however, indicates that either:

1. People are not complying with the dietary recommendations, or;
2. These recommendations are not appropriate.

A review has recently been published that re-examines the evidence for low-carbohydrate and Paleolithic diets with reference to the current and proposed dietary guidelines.

Results

Low-Carbohydrate Diets:

  • A number of recent intervention trials have shown that it is advantageous to consume a low-carbohydrate diet with regards to body weight and metabolic control.
  • Nordmann et al. (4) demonstrated that low-carbohydrate diets were at least as effective as low-fat diets for weight loss.
  • Two studies comparing the Atkins, Ornish, and Zone diets on metabolic risk factors and weight loss over one year concluded that low-carbohydrate diets were favourable for weight loss and improvement of cardiovascular risk factors.
  • The OmniHeart trial compared 3 diets:
    • The first consisting of 15% protein, 58% carbohydrate, 27% fat;
    • The second where 10% of energy from carbohydrate was replaced with protein and consisted of 25% protein, 48% carbohydrate, and 27% fat;
    • The third where 10% of calories from carbohydrate was replaced with unsaturated fat and consisted of 15% protein, 48% carbohydrate, 37% fat.
  • The results indicated that the diets where 10% of calories from carbohydrate were replaced with either fat or protein resulted in lower systolic and diastolic blood pressures, further improved blood lipid concentrations, and further reductions in cardiovascular risk compared to the first diet.
  • In another study, Reaven found that reducing carbohydrate and replacing it with unsaturated fat resulted in improved cardiovascular disease risk factors.
  • Other short-term studies along with new research reported on the ABC pm program on 17/11/11 has reinforced that a high-protein diet increases a feeling of fullness and leads to reduced spontaneous eating as well as lower body weight, and body fat. These diets have also shown improved insulin sensitivity, glucose control, and decreased leptin concentrations in overweight and obese subjects.

Paleolithic Diet

  • The Paleolithic diet (5) provides a macronutrient distribution in the range of 19-35% protein, 22-40% carbohydrate, and 28-58% fat.
  • Even though this diet was relatively high in fat, it would have included high levels of mono- and polyunsaturated fatty acids and a much lower omega-6/omega-3 ratio than current Western diets do.
  • Recent studies of the Paleolithic diet have shown that it provides the health benefits of reduced blood pressure, decreased insulin after a meal and glucose responses to an oral glucose tolerance test, and improved blood lipid profiles.

Conclusion

  • These results indicate that diets that involve reducing (NOT eliminating) carbohydrate intake with a corresponding increase in protein or unsaturated fat can result in lower systolic and diastolic blood pressures, improved blood lipid concentrations and reductions in cardiovascular risk.

Bodywise Comment

First, it must be said that these studies are just that studies and anyone, especially if you have a medical condition must seek advice from your doctor or health professional before undertaking a new diet or eating plan. High protein diets can be dangerous for people some people including children, athletes (or very active people) as well as people who have high blood pressure or gout. High protein diets can also cause some severe health complications including constipation, diarrhoea, bad breath, headache, kidney problems and colorectal cancer.

The Dietary Guidelines for Australians states that to “prevent weight gain: be physically active and eat according to you energy needs”. Some people now argue however, that manipulating the amounts of different types of food in one’s diet can assist reducing the overall calorie intake, reducing body fat and weight whilst also lowering blood pressures, improving blood lipid concentrations, and reducing cardiovascular risk. These studies support this position.

The Great Carb Debate

On the face of it, it would seem that the answer is to reduce carbohydrates and increase proteins and unsaturated fat in our diets. However as with so many things in life, it isn’t quite that simple.

Do grains make us fat?

Advocates of high protein/carbohydrate diets argue that grains make us fat. This flies in the face of the fact that we have eaten grains for thousands of years and it is only in the last 20-50 years that being overweight and obesity has become epidemic. In that time, grains have been refined down to make white flour or white rice from which we make breads, cereals, biscuits and cakes. When digested, the individual sugars (principally glucose) from these refined grains are absorbed into the blood stream very quickly causing a large increase in blood glucose. How quickly glucose enters the bloodstream after eating forms the basis for the glycemic index (GI). Foods that cause a large rise in blood glucose have a high GI and those that cause a low rise have a low GI. From a blood glucose standpoint (high GI), white flour is much worse than sugar. After eating cakes, biscuits and other foods that contain flour and other refined grains, blood glucose levels ‘spike’. In response, the pancreas floods the bloodstream with the hormone insulin. Insulin is a storage hormone and stimulates the storage of incoming fat, carbohydrate and protein into muscle, liver and fat cells. The body runs much better when the level of glucose in the blood stream is kept constant. Protein and unrefined carbohydrates (i.e. low GI foods), reduce the rise in blood glucose following a meal, and therefore reduces the subsequent amount of insulin released to deal with the meal. Less insulin means less fluctuation in blood glucose and less likelihood that you will hungry 1-2 hours after eating. Refined grains and processed foods blood glucose to rise too high. Eating food that contains primarily proteins and fats causes blood glucose levels to fall too low. Neither is good.

Refined carbs are the problem

Today, the main problem is that our excessive high carbohydrate / GI diets overload the system, so that either not enough insulin is released or the body’s cells have become desensitised to insulin. Both of these problems mean that glucose is not absorbed into the body’s cells, which leads to high levels of blood glucose and diabetes.

Glucose ‘spikes’ and high levels of insulin after eating high GI foods have been shown to cause damage to blood vessels, inflammation, as well as be a risk for cardiovascular disease. Consequently, if you have any inflammatory condition or cardiovascular disease, it would be a good idea to avoid high GI foods and choose low GI ones instead. Low GI foods include most unrefined grains and fruit. The table lists some common low and high GI carbohydrate foods:

Traditional low GI foods Modern high GI foods

Stone ground bread

Sourdough breads

Heavy grainy breads

Porridge, oats and some muesli

Legumes (lentils and beans)

Most fruit

Rye, barley, quinoa

Cracked wheat, buckwheat

White bread

Regular wholemeal bread

Most white rice

Most breakfast cereals

Most snack bars and biscuits

Potatoes, chips and French fries

Scones, cakes, pikelets, pancakes

Bagels and crumpets

(source: www.glycemicindex.com)

Important points in the great carb debate

  • Wholegrains, legumes (beans) and pulses (lentils) provide essential nutrients and fibre that our bodies need;
  • Wholegrains, legumes and pulses and are cheap and convenient making them easy to include in modern time poor lifestyle;
  • Carbohydrates are essential for optimal thinking (e.g. memory and concentration) as well as exercise and bowel health;
  • The earth’s resources could not support the world’s population if our diets became mainly meat based;
  • Hunter-gatherer man (paleolithic diet) ate more fruit and vegetables as well as parts of animals that we no longer eat. It is difficult if not impossible to replicate a paleolithic diet;
  • The GI is a great instrument in helping us choose better carbohydrates;
  • You can choose not to eat or reduce grain foods but you must seriously increase your uptake of other plant foods.

The healthiest diets for optimising weight control recommend:

  • A modest increase in lean protein and vegetables, with a complementary modest decrease in unrefined carbohydrate and fruits;
    • At mealtimes, try dividing your plate into 2/3’s vegetables, 1/3 protein ;
  • Getting your protein from lean meats, fish, chicken, eggs, legumes and nuts;
    • Best include: game meats (e.g. venison, kangaroo), oily fish (salmon, mackerel), chicken / turkey breast, free range eggs, low fat milk and pro-biotic yoghurt, seafood;
  • Getting your carbohydrates mainly from vegetables, with a less amount from unrefined grains and fruit;
    • Best vegetables include: kale, asparagus, broccoli, Brussel sprouts, Asian greens, spinach, rocket, endive, cabbage, capsicum, mushrooms etc.
    • Best grains include: barley, beans, lentils, oats, muesli, quinoa, bulgur wholemeal pasta and breads including grainy sourdough, pumpernickel, stoneground and wholemeal etc
    • Best fruit include: apricots, pomegranates, berries (raspberry, blueberries etc.), citris (oranges etc.), kiwi fruit, papaya
  • Have smaller portions and eat smaller meals (perhaps ½ -2/3’s meal size) more frequently (6 times /day);
  • Eat slowly and when relaxed, putting down your knife and fork between mouthfuls;
  • Drinking plenty of water (e.g. bodyweight in kgs x 0.033 = amount in litres to be drunk each day – reference Paul Chek);
  • Eat fresh foods as much as possible (aim for 1/3 of your vegetables raw);
  • Where possible, eliminate/limit processed foods especially those with flour (unrefined grains) excessive sugar, especially fructose (aim for less than 10%, i.e. less than 10g per 100g)as well as excessive salt;
  • Choose low-fat options when possible (aim for less than 10%, i.e. less than 10g per 100g);
  • Allow yourself occasional treats;
  • Listen to your appetite and enjoy your food.

For more information or for an appointment, please call Bodywise Health on 1 300 263 994.

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 GP. For more information, please call Bodywise Health now on 1 300 263 994.

Research Reference:  Nutrition 2010; (26) 141–145.

Other References:

  1. Acheson KJ, Flatt JP, Jequier E. Glycogen synthesis versus lipogenesis after a 500 gram carbohydrate meal in man. Metabolism 1982; 31:1234–40.
  1. Acheson KJ, Schutz Y, Bessard T, Anantharaman K, Flatt JP, Jequier E. Glycogen storage capacity and de novo lipogenesis during massive carbohydrate overfeeding in man. Am J Clin Nutr 1988; 48:240–7.
  2. Acheson KJ, Schutz Y, Bessard T, Ravussin E, Jequier E, Flatt JP. Nutritional influences on lipogenesis and thermogenesis after a carbohydrate meal. Am J Physiol Endocrinol Metab 1984; 246:E62–70.
  3. Nordmann AJ, Nordmann A, Briel M, Keller U, Yancy WS Jr, Brehm BJ, Bucher HC. Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta-analysis of randomized controlled trials. Arch Intern Med 2006; 166:285–93.
  4. Eaton SB, Eaton SB III. Paleolithic vs. modern diets—selected pathophysiological implications. Eur J Nutr 2000;
  1. McMillan Price, Joanna & Davie, Judy. Star Foods. ABC Books, 2008.
  1. Chek, Paul.  How to Eat, Move and Be Healthy. California: C.H.E.K. I nstitute, 2006
  1. Tickell, John.  The Great Australian Diet. Melbourne. 2004
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Want to prevent osteoporosis

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By Michael Hall,

Want to prevent osteoporosis? Find out how with the latest research.

A new study published today in Proceedings of National Academy of Sciences has revealed that the concept of “use it or lose it” when it comes to bone health, may not be quite so true after-all.

The study of major league baseball players’ pitching arms proves that the strength of your bones in later life is determined by the quality of exercises that you do in your youth.

In the study, researchers measured the cross sectional size, torsional strength, bone mass and bone mineral density of the humerus (the upper arm bone), in 103 professional baseball players at various stages of their career.

They discovered that the cross sectional area, a key determinant of bone strength, even decades after players stopped playing baseball.

In fact, in comparing baseball players who continued to play against those who completely stopped once their careers were over, they found that even former players in their nineties, who hadn’t thrown a ball in fifty years, still retained more than half the throwing related increase in bone size and around one third the bone strength as those who continued to play. Players who continued to play not only maintained their bone size, but also the bone strength.

These findings suggest that to increase and maintain bone strength throughout life, that it is important to focus on exercise which applies resistance and loading to the skeleton, especially early in life. They provide evidence that the more bone that is “banked” up until the mid 20’s (when bone strength peaks), the more a person may be protected from osteoporotic fractures later in life.

graph

But what are the best type of exercises? Evidence indicates that the best exercises are ones that involve:

1. Higher impact;
2. Strength training;
3. Fewer repetitions and sets;
4. Variety.

For pre-menopausal women, evidence indicates that that high impact exercise only strengthened the hips and not the lower back. Only when high impact and strengthening exercises were combined did the bones of both the hip and low back get stronger.

For post menopausal women, again only a combination of high impact exercise (etc. jogging, walking and stair climbing) and strength training were found to be effective.3 Walking has been found to have no effect for strengthening of the bones in the lower back and only a little at the hips which is probably not clinically significant .

Another study of 180 men (aged 50-79 years) with low bone mass over 18 months found that combining the drinking of fortified milk plus strength training three times each week, achieved the best results for both strengthening of the bones of the lower back and the hips.

A Cochrane review found however that to reduce the rates of falls, these exercise programs must be combined with balance retraining, an individual risk assessment, along with home safety modifications performed by an occupational therapist. Vitamin D supplements, falls education and hip protectors at home, were all found NOT to be effective in reducing the risk of falls or preventing hip fractures.

Whilst you may not have control over some risk factors for osteoporosis such as being female, Causasion/Asian with a small body build, delayed puberty or early menopause and prolonged use of certain medications (e.g. corticosteroids, heparin, immune-suppressives, anti-epileptics and others), there are many factors that you do have control over. These include not exercising, smoking, excessive alcohol use, low body weight, low calcium intake, decreased strength and poor balance.

Like all things in life, prevention is better than cure. In many ways, if you focus on the things that you can control, and control them perfectly, many of the adverse health effects associated with ageing become less of a risk. The choice is up to you. Get a clearance from your doctor or health professional and then begin an exercise program (combining impact, strength training and balance), stop smoking, reduce your alcohol intake and enjoy a diet with adequate calcium and vitamin D (plus correct sun exposure).

At Bodywise Health, we have put together the perfect osteoporosis and falls program by combining Clinical Pilates with strengthening exercises and balance training. If you are worried about being or becoming osteoporotic or have a fear of falling, then this program is designed to give you the confidence and security you need to enjoy living an active and full life.

For a FREE clinical pilates trial or physical assessment, please call 1 300 BODYWISE (263 994). Please note, due to limited places, this offer is open to the first 30 people.

References

  1. Warden, S.T., Roosa, S.M., et al (2014) Physical activity when young provides lifelong benefits to cortical bone size and strength in men.Proceedings of the National Acedemy of Sciences of the United States of America.http://dx.doi.org/10.1073/pnas.1321605111
  2. Martyn-St James & Carroll J Bone Miner Metab 2010
  3. Martyn-St James & Carroll BJSM 2011
  4. Martyn-St James & Carroll Bone 2008; Bonaiuti et al Cochrane Review 2003;
  5. Kukuljan et alJ Clin Endocrinol Metab 2011
  6. Gillespie et al Cochrane Database Syst Rev 2012

For more information or for an appointment, please call Bodywise Health on 1 300 263 994.

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 GP. For more information, please call Bodywise Health now on 1 300 263 994.

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What works best for Low Back Pain

core
By Michael Hall,

What is the best treatment for Low Back Pain - Yoga, Stretching or a Self-Care Book?

Chronic low back pain (LBP) is a common problem that seems to have many different treatment solutions. But which one works best? A recent study (October 2011) set out to determine whether yoga, conventional stretching exercises or a self-care book is the most effective intervention for helping people with chronic low back pain.

In the study, a total of 228 adults with chronic low back pain were randomized to 12 weekly classes of yoga (92 patients) or conventional stretching exercises (91 patients) or a self-care book (45 patients). Questionnaires were used at the beginning, 6, 12, and 26 weeks by interviewers unaware of treatment group, to measure the outcomes.

The results indicated that Yoga classes were more effective than a self-care book, but not more effective than stretching classes, in improving function and reducing symptoms of chronic low back pain. These benefits were found to last for least several months. From this study it can be concluded that movement or staying active assists in helping people with LBP.

Bodywise Health Comment

Low back pain (LBP) is common and frustratingly difficult problem to cure. In fact, more than 70% of people report LBP during their lifetime. X-rays, CT scans and MRI scans often don’t correlate with the pain and symptoms reported and a definitive diagnosis is only made in 10-15% of cases. What’s more, the treatment approaches are many, with most often lacking proof. No wonder the public is confused.

There is no doubt the mechanisms behind low back pain (LBP) are complex. Research has shown that the brain “anticipates” movement and activates the deep core abdominal and back muscles to pre-stiffen the spine before the body moves (Hodges and Richardson 1996). These muscles hold the joints in ideal alignment and prevent potentially damaging movement. However, it has been shown that within 24 hours of a back injury, these muscles (i.e. transverses abdominus and multifidus) stop working effectively and even begin to waste away (Hides JA et al Spine 2001). Even the functioning of the brain changes in response to back pain (Schimdt-Wilcke et al 2006). Furthermore, it has been found that even if a person stays active (e.g. swims) and the pain does go away, the functioning of the brain and these muscles do not return to normal without specific training (Tsao et al 2009). With specific training however, there is evidence that the brain and deep core muscles begin to revert to normal within two weeks. And the protective effect of these exercises is lasting, with only 30% (compared with 84%) likely to suffer a recurrence within one year.

The connection between exercise and the treatment of LBP is not new. In fact, a review performed in July 2011 of 83 studies on the on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain concluded that only exercise therapy, multidisciplinary treatment and behaviour modification “are the only conservative treatments that should be used in daily practice in the treatment of chronic LBP”. This is not to say that other interventions don’t work, but that they don’t have a proven, lasting effect when used in isolation. In reality, this never occurs as modalities and techniques are always used in combination to enhance the effect of each intervention. For example, modalities such as cold packs, heat, ultrasound and electrical stimulation often reduce pain and muscle spasm so that joint mobilisation and manipulation is made more effective at freeing up joints and relaxing muscle. And joint mobilisation or manipulation can enhance the benefits of exercise therapy which aids in improving posture, movement habits and function and so on. Given that the evidence for treating LBP is conflicting, a physiotherapist may have to try different modalities and combinations of modalities to determine what works best for a particular patient. In reality, the best evidence that a particular management strategy is effective for a particular patient is whether or not the patient improves.

5 Top Tips for Dealing with Low Back Pain

1. Seek treatment early. Early intervention is the key to preventing pain from becoming chronic, costly and recurrent;

2. Undergo a thorough assessment. This is critical to identify the stage of healing and the sources / causes of the back pain, as well as to understand perceptions, beliefs and coping mechanisms;

3. Understand the nature of the problem and what the best strategy is for “fixing” it;

4. Implement a strategic management approach that:

a. addresses pain and the stage of healing;

b. targets the structures at fault,

c. specifically trains core muscles so that they regain their normal functioning;

d. corrects posture and improves movement habits;

e. addresses other concerns (e.g. home life, work life, work station set up etc); and

f. progresses conditioning to above and beyond the stresses likely to be encountered in everyday life so a reserve capacity is created to protect against challenging, unexpected activities and unguarded movements;

5. Incorporate these principals into the way that you live. In other words, live in a way that puts ideal stresses on to your body (i.e. sit correctly, stand correctly and move correctly), eat and exercise for optimal functioning and deal with physical and psychological “insults” quickly, comprehensively and completely so that healing can occur and the issues are fully resolved.

References:
1. Karen J. Sherman, PhD, MPH; Daniel C. Cherkin, PhD; Robert D. Wellman, MS; Andrea J. Cook, PhD; Rene J. Hawkes, BS; Kristin Delaney, MPH; Richard A. Deyo, MD, MPH Arch Intern Med. Published online October 24, 2011. doi:10.1001/archinternmed.2011.524

For more information or for an appointment, please call Bodywise Health on 1 300 263 994.

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 GP. For more information, please call Bodywise Health now on 1 300 263 994.

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Bodywise Health

364 Hampton St,

Hampton

Victoria. Australia 3188

03 9533 4257

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