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How to Know When to Return to Sport

Self Monitoring 01

It's one of the more challenging judgement calls to make. When to return to sport or pre-injury activities. Unfortunately, like so many things in healthcare, it is not an exact science.

There are so many things that need to be considered; so many variables. Some of these include:
1. The structure or tissues injured;
2. The severity of your injury;
3. The type of activities that you might be returning to;
4. Your work, living and or playing environment;
5. Your physiological, physical, psychological and social circumstances.

It is estimated that 12-34% of hamstring injuries 1 and 3-49% of anterior cruciate ligament injuries 2 re-occur as a result of incomplete rehabilitation and premature return to sport and their pre-injury activities.

People often severely underestimate the time needed to be able to return to their pre-injury level of performance. Lack of knowledge, lack of experience and lack of perseverance, all play a role.

For example, when a group of runners and dancers were asked to estimate how long it would take for them to return to their activities, the runners replied four weeks and the dancers replied one week. The actual average return was 16 weeks for the runners and 50 weeks for the dancers 3.

For physiotherapists it is a challenge as well. Even if injured tissues should theoretically be healed, trying to determine when they are able to withstand the unpredictable stresses of life and sporting activities is difficult if not impossible.

The Science behind Recovery

The starting point for staging when you can return to pre-injury activities and sport is having an accurate knowledge of the theoretical time-frame that it takes for various tissues to heal. For example, your blood cells turnover every 120 days, your bone building cells every 3 months and your skin cells every 2-4 weeks 4.

The healing time will vary for different tissues and structures but is primarily determined by the blood supply to the area; your age; genes; your general health and nutritional status (e.g. abundance of protein, Vitamin C) and even medication (e.g. Anti-inflammatory medication such as Ibuprofen is known to delay healing).

Soft Tissue Healing as a Guide to Your Treatment
Following trauma and injury, your body will always go through the same phases of healing, the length of each varies depending on the type of tissue damaged, the severity of the injury and the intervening treatment. Healing can be divided into four broad phases which overlap considerably. These phases include:
1. The Bleeding Phase
2. The Inflammatory Phase
3. The Proliferation Phase
4. The Remodelling Phase

The Bleeding Phase
This phase occurs immediately following injury and can last anywhere from 6 to 24 hours depending on the type of tissue injured. In the bleeding phase substances are released which enable the adhesion of various cells. The complication of this phase is excessive bleeding and swelling. This excessive "clot" along with the damaged tissue needs to be removed, thus delaying the laying down of new tissue.

Excessive swelling also delays healing as excessive fluid pressure effectively prevents oxygen from being delivered to the injured cells, leading to increased cellular death and even more debris which has to be removed.

Consequently, it is critical that IMMEDIATELY following trauma or injury, treatment is begun to prevent excessive bleeding and swelling. Treatment such as compression, immobilization, lymphodema massage (massage that removes swelling) and unloading damaged tissue (e.g. crutches), if implemented in the first 24 hours by a competent physiotherapist, CAN SAVE YOU WEEKS IF NOT MONTHS OF TREATMENT.

The Inflammatory Phase
Likewise, the Inflammatory Phase is critical for healing. Inflammation has the classic characteristics of heat, redness, swelling, and pain (which is often constant, throbbing and can wake you at night).

Inflammation escalates rapidly a couple of hours following injury, increases to a maximal reaction at 1-3 days before gradually resolving over the next couple of weeks. Essentially during the Inflammatory Phase, the role of the body's immune system is to act like a demolition company, clearing the 'construction site' of debris and damaged tissue.

The complication of this phase, is that the inflammatory process gets out of control leading to an acidic environment, excessive protein breakdown and further cellular death. Consequently, treatment should include all the same modalities as in the Bleeding Phase with more emphasis on cold packs (15 minutes at least 6 times a day with emphasis on hourly cold packs at the end of the day), compression as well as optimal loading reduce swelling and decrease the activity of the inflammatory cells.

The Proliferation Phase
The Proliferation Phase involves the formation of repair material, which in the case of musculoskeletal injuries is mostly scar (collagen) material. At about day 5, the collagen is weak and easily broken with any chemical and physical stress. From day 6 to day 14, this scar tissue gradually becomes more durable to the point that the fibres have knitted and the defect has been bridged.

Consequently, treatment must be geared towards increasing and optimizing the activity of the cells laying down the repair. Warmth and electromagnetic stimulation (which increases cellular activity) along with hands on techniques and easy pain-free movements that optimizes tissue tension to enhance the repair.

The proliferation phase peaks at about 2-3 weeks, (less time for more vascular tissues) before winding down over the next 4-6 months.

The Remodeling Phase
The Remodeling Phase results in a quality, organized, functional scar that can behave like the parent tissue that it replacing. New evidence indicates that the Remodeling Phase begins as early as the first week. Initially, collagen fibres are laid down randomly. However, with the expert application of specific tension, these fibres become aligned along the lines of force.

Collagen molecules also have an electric charge and stress on collagen fibres produces a piezo-electric effect which may also help to re-orientate fibres.

Whilst it is unclear however how much tension is necessary or optimal, it seems that working to the point of discomfort but not into pain, may be a good guide as to what might be the most optimal tension for ideal adaptation.

From this point, gradual, controlled, progressive, specific loading has been found to accelerate early return to sport4. For optimal rehabilitation, this specific loading must be integrated into graduated functional strengthening, beginning with low level, safe, static and progressing to more physically demanding, dynamic, reflexive sport or functional specific activities.

These dynamic, reflexive, functional or sport specific activities can then become the tests which help to determine if you are ready to return to sport or your pre-injury activities.

Special Tests for Return to Pre-Injury Activity

For Shoulder Injuries - Throw and Catch
The throw and catch test consists of the throwing of varying weighted balls at different speeds and angles and durations until the action replicates as best as possible the intensity of the sport.

For all leg injuries - Balance standing on injured leg to progressing to hopping and then to running
These tests involve being able to maintain alignment of your hip bone, middle of your knee cap and 2nd toe with progressively more demanding, dynamic activities.

This alignment is consistent with ideal biomechanical forces being placed on our body tissues and structures and requires adequate core and leg muscle strength and control as well as sufficient hip, knee and ankle mobility.

All of these activities can be progressed in various ways for example by increasing the instability of the surface (e.g. duradiscs), increasing the depth of squat; height of the step as well as the distance, angle and speed of hopping and running.

Other special tests include:
1. Single leg hop
2. 6 Metre timed loop
3. Triple hop for distance
4. Cross over hops for distance
5. Running Drills

The Importance of Ongoing Rehab

Even once you have returned to pre-injury activities, you need to continue with an ongoing conditioning exercise program to ensure that your body is able to cope with the daily demands that you place upon it.

This conditioning exercise program must consist of strengthening exercises for the injured area and associated areas as well as balance and core stability activities. This needs to be completed at least twice weekly for at least four weeks following return to full activities.

A Final Word

There is no doubt that most people have large misconceptions about when they think that they are better and able to return to their full pre-injury activities. Understanding the process and timeline for healing is a starting point for staging the healing of tissues. This however must be supplemented by specific, injury related, objective testing and compared with the non-injured side and valid data.

Finally, it is important that you stay positive and remain engaged and connected with others and that you celebrate the milestones on your journey back to full health.

If you are injured or if you know of someone else who has a physical injury, seek or encourage them to seek treatment as soon as possible. It may just save you weeks if not months of pain, frustration and isolation.

If you are injured or in pain and want to get back to doing the things that you love to do, please call Bodywise Health on 1 300 BODYWISE (263 994) for a complimentary*, no obligation assessment and Recovery Action Plan from one of our expert physiotherapists.

We look forward to helping you get your life back.

Until next time, Stay Bodywise,

Michael Hall
Physiotherapist, Director
Bodywise Health

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

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

References
1. Arthrosc.2011 Dec27(12);1697-1705.
2. Sports Med. 2004;34(10);681-695.
3. Br J Sports Med.2006 June;40:40-44.
4.http://book.bionumbers.org/how-quickly-do-different-cells-in-the-body-replace-themselves/
5. The Phys Sport Med.2000 Mar;28(3);1-8.
6. Clinical Sports Medicine.2006,Revised Third Edition;Australia;McGraw-Hill.
7. Knee Surg Sports Traumatol Arthrosc.2010 Dec 18(12);1798-1803.
8. Phys Ther.2007 Mar;87(3):337-349.
9. Knee Surg Sports Traumatol Arthrosc 2006 14:778-788.
10. Psych App to Sports Inj Reh.Aspen Press 1997.
11. NZ J Physiother.2003 31;60-66.
12. J Sport Reh. 2012 (21);18-25.
13. J Athletic Train.2003 48(4);512-521.
14.http://www.dailymail.co.uk/health/article-1219995/Believe-lungs-weeks-old--taste-buds-just-days-So-old-rest-body.html

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Injured? Here's how to Know When You Need to Rest, When You Need to Move and When You Need to Seek Treatment

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OK, you have just been injured, what are you going to do, rest, stay active or seek treatment? It can be somewhat confusing to know what to do. There is so much misinformation and so many mixed messages. Natural instinct might be to rest as that is what you do when you are "sick". But you are not sick, you are injured. The purpose of this article is to draw on both the latest evidence and clinical experience to give you some guidelines on what is best practice management following an injury.
 
The Traditional Model of Treatment
 
The acronym R.I.C.E. (Rest, Ice, Compression and Elevation) was for a long time the benchmark for acute clinical care following injury. This was expanded to PRICER to include Protection and Referral to better address the essential need not to re-aggravate your injury as well as to encourage you to seek professional assistance so that you can minimise any possible complications and optimise your recovery.
 
But now the term 'rest' is being widely criticised as it can be interpreted to mean 'being inactive' and doesn't reflect the possibility of needing to load or move injured tissues and structures to facilitate the healing process.1,2 
 
Consequences of the Term 'Rest'
 
Bed rest, initially thought to be the safest approach in the treatment of acute musculo-skeletal injury (especially for acute low back pain4), has been found to cause further complications and disablement3 physically and psychologically. 
 
Not only may 'rest' result in increased swelling, poor circulation, slow, delayed and inferior tissue repair, but it may also lead social isolation, catastraphization and a sense of hopelessness.
 
A New Acronym and Treatment Approach
 
Recently, the British Journal of Sports Medicine published a new acronym, POLICE, (where Rest is replaced by Optimal Loading) as a treatment guideline. The POLICEacronym, still recognises the importance of Protection through the use of crutches, braces or taping for at least the first 3-6 days to prevent further bleeding, inflammation, damage and pain.
 
 
Likewise, Ice, Compression and Elevation are still considered essential in the initial stages of treatment.
How much loading that is optimal depends upon a number of factors including the degree of damage, the stage of healing, the irritability of the tissue (how much stimulus, causing how much pain for how long it lasts) as well as the expertise of a health professional. 
 
More severe, acute and sensitive injuries may require immobilisation for a time, to protect against re-injury and to allow for repair. However, the research is increasingly advocating early movement to reduce swelling, enhance circulation, maintain joint movement stimulate the formation of collagen fibre networks and facilitate their alignment along lines of force.
 
Scientists from the University of Tampere, Finland, stated that following a muscle tear, the limb should be immobilised initially for a scar to form before activity is commenced within the limits of pain7. Extended periods of restricting movement however, lead to the random laying down of fibres predisposing the tissue to again being injured and damaged when stress is re-applied3
 
Optimal Physical Stimulation - The Key to Accelerated Recovery and Optimal Repair 
 
Physical loading is not just critical for the stimulation, regulation and turnover of healthy, adaptable and strong tissues and structures. Physical loading also can accelerate healing. This is what researchers from the University of Queensland discovered when they applied controlled loading during fracture healing.
 
Another study at the University of Ulster, Ireland, found that exercises started in the first week following grade 1 and 2 ankle sprains "significantly accelerated tissue healing9.
 
For joint injuries and post-surgical cartilage repairs, early easy movement with low level optimal loading had been shown to reduce complications, accelerate healing and improve tissue repair5,10
 
For Achilles tendinopathy, researchers from the University of Emea, Sweden, found that specific loading of the Achilles tendon lead to decreased pain as well as improved Achilles tendon strength and function, 3.8 years after the training finished12.
 
Finally in another study, early quadriceps activation and progression in strength training was shown to reduce pain following knee injury13,14.
 
Consequently, if you want to accelerate healing, if you want to optimise repair and if you want to achieve the best most complete recovery possible, early, precise movement and loading under the expert supervision of a skilled health professional is critical. 
 
Why it is Better to Be Seen Sooner than Later
 
The sooner you see a qualified health professional skilled in the art of rehabilitation following your injury, the sooner you can begin optimising each stage of healing. Ultimately, this means faster healing, a better repair and a more complete recovery.
 
A skilled physiotherapist is able to ascertain the source and cause of your injury as well as grade its severity, irritability and the stage of healing. These are critical factors that uniquely influence the intensity and guide progression of your treatment. 
 
If you are injured or if you know of someone else who has a physical injury, seek or encourage them to seek treatment as soon as possible. It may just save you and them weeks if not months of pain, lack of function and frustration.
 
To overcome your injury or pain and reclaim your health, please call Bodywise Health on 1 300 BODYWISE (263 994).for a complimentary*, no obligation assessment and Recovery Action Plan from one of our expert physiotherapists.
 
We look forward to helping you get your life back.
 
Until next time, Stay Bodywise,
 
Michael Hall
Physiotherapist, Director
Bodywise Health
 
Please note: 
* Rebates are available through your private insurance extras cover;
* For complex or chronic conditions, you may qualify for the EPC (Enhanced Primary Care Program) allowing you to receive 5 allied health services each calendar year with a referral from your GP. For more information, please call Bodywise Health now on 1 300 BODYWISE (263 994).
 
References
1. B J Sports Med.2012,6 (4), 220-221.
2. Br J Sports Med. 2009, 43,247-251.
3. The Iowa Ortho J, 1995,15,29-42.
4. West J Med, 2000, 172 (2).
5. The Science and Practice of Manual Therapy, 2005. Elsevier Churchill Livingston London.
6. Rehabilitation Techniques, 2011, McCraw Hill, Singapore.
7. Aust J Phsyiortherapy, 2007, 53, 247-252.
8. Best Practice Res Clin Rheumatol, 2007, 231 (2), 317-331.
9. BMJ, 2010,340, cl1964.
10. The American Journal of Knee Surgery, 1994, 7 (3), 109-114.
11. Knee Surg Sports Traumatol Arthrosc 1999, 7: 378-81.
12. Br J Sports Med, 2004, 38, 8-11.
13. J Multidiscip Healthc, 2011, 4 383-392.
14. Med Sci Sports & Exerc, 2010, 42 (5) 856-864.
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Worried About How Your Child Walks or Runs?

Image result for Feet turned Inwards walking

Are you worried about seeing your child's toes point inward as they stand or walk? Whether you should be depends upon the cause of toe in postioning as well as the age of your child.

Pigeon toe or toe in walking is a common and often painless condition for children. Very often, it occurs in one or both feet in children under the age of 2. The condition usually corrects itself with no intervention. This type of pigeon toe often develops in the womb or is due to genetic birth defects, so little can be done to prevent it. Contrary to popular belief, there are no known shoes or orthotics that help prevent pigeon toe and no evidence to suggest that learning to walk in bare feet has any effect on the condition.

The Causes of Pigeon Toe

Pigeon toe may develop in the womb and often corrects itself.

There are three potential causes of pigeon toe:

1. Metatarsus varus or metatarsus adductus

With metatarsus varus or metatarsus adductus, the front of the foot is angled inward giving the foot a curved, half-moon appearance. This type of pigeon toe is common in babies who were breech in utero or whose mothers had less amniotic fluid. Occasionally, there is a family history of the condition.
Normally, the foot is abled to be straightened out by a doctor or healthcare professional once the child is born with no further treatment generally being required. Although its not imperative, a parent can also gently stretch the baby's feet a few times a day to help correct the shape.

2. Internal tibial torsion

Internal tibial torsion refers to the inward twisting of the shin bone or the tibia. This twisting of the shin bone often becomes noticeable as a child first begins to walk. It is generally not painful, but parents of children with internal tibial torsion tend to report that their child falls frequently. Like metatarsus adductus, the condition often resolves without the need for therapy, bracing or casting.

Sometimes however, in more severe cases and / or the shin does not straighten out by the time a child reaches 9 or 10 years of age, internal tibial torsion may require surgery to fix it. The procedure involves cutting through the twisted bone and reattaching it to make the foot straighter.

3. Femoral anteversion

This type of toe in positioning is very common affecting up 10 percent of children. Here, the thigh bone (femur) is excessively rotated inward in the hip joint. It is thought that this may be due to stress to the hips before birth. Normally this type of in-toeing resolves by the age of 8 years. If it continues after this age, an examination by a physiotherapist, doctor or other paedicatric health care professional is recommended to assess what might be the best course of action to correct the toe in positioning. Occasionally the neck of the thigh bone is angled in such a way as to increase the turning inward of the leg. At other times, this type of toe in standing and walking may be purely a habit that can be corrected with making the child aware of the fact that their feet are turned inward.

When to see a physiotherapist or doctor
Generally there is no urgent need to see a physiotherapist or doctor. However, if the toe in position is still apparent by the time your child reaches 8 years, or if it causes your child to fall more often than normal, a physiotherapist or doctor should be consulted.

Diagnosis

Diagnosis for pigeon toe can often be determined by a comprehensive physical examination. Occasionally, X-rays and other imaging may be necessary.
For metatarsus varus or metatarsus adductus, diagnosis is generally made very early, often during the newborn's post-birth examination. A skilled physical examination will identify that the positioning of the foot bones are cause whilst ruling out out other possible causes such as mal-alignment of the hip joints.

Internal tibial torsion generally apprears only as a child begins to walk and so the earliest diagnosis may be slightly before 1 year of age during a physical examination of the infant's legs. If diagnosed, the physiotherapist or doctor will take measurements of the legs.

Femoral anteversion is most often diagnosed when the child is between the ages of 4-6 years. This will normally start with a physical examination and a review of the medical history of the child and family.

Treating pigeon toe

Toe in positioning may be treated with time, normal growth and reassurance. If more therapy intervention is required treatment may include:

  1. Braces for the legs that slowly correct the position of the bones or feet
  2. Molds that correct the shape of the foot
  3. Specialized therapy that involves specific stretches and targeted activities that encourage the correct positioning of the feet during standing and walking. These activities often involve strengthening of the outside muscles of the hip and improving balance so as optimise walking and running.
  4. Finally surgery may be recommended as a last resort to correct the positioning of the bones that cause pigeon toe.

To fix these issues does require a comprehensive, co-ordinated approach. It is essential to assess whether there are any structural limitations or deficits preventing these children from walking correctly. Do they have an arched or flat back? Are their hips stiff? Are they knock kneed or bow legged? Do they have flat or highly arched feet?

Already these children's bodies have begun to adapt to this way of walking. This means that they are likely to have poor core stability, their outside hip muscles are likely to be stretched and weak, whilst their hamstrings and the muscles on the inside and outside of their thighs are likely to be tight and dominant. Their ankle joints are also likely to be stiff, their calf muscles tight and their foot muscles and plantar fascia weak and overstretched.

These children are also likely to have poor balance which requires that they walk with their feet wide apart making ambulation inefficient and tiring.

Correcting these kids walking pattern is easier said than done. Ultimately, it means loosening stiff joints, strengthening weak muscles and stretching tight soft tissues. It often requires balance retraining and learning to walk with feet less wide apart and a correct heel - toe contact. Taping, bracing and orthotics may all be useful in assisting and accelerating the rate of improvement.

Whilst all these interventions and techniques may sound over-whelming, they can be integrated into a concise, targeted program that usually delivers results within four weeks. It is worth it. Incorrect walking can cause a multitude of problems over your child's life culminating in multiple joint replacements.

It can cause children to be less active, less engaged and less connected. It can lead to a decrease in sports achievements. However, most devastatingly it can take away opportunities and limit your child's potential.

If you do have any concerns regarding your child's posture or movement including the way that they walk, please call Bodywise Health on 1 300 BODYWISE (263 994) for a free examination and advice.  It may save them a life time of physical and social problems.

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Why Hamstring Strains Occur and How to Prevent Them

clinical pilates bodywise health

Hamstring, Hammies, Hams, or if you're feeling fancy you can use their latin names. Keep in mind there are three muscles that make up the group of muscles called the hamstrings, they are biceps femoris, semimembranosus and semitendinosus.

This group of muscles is a notorious repeat offender for injuries, across numerous sports. AFL, soccer, rugby, cricket and baseball players are all frequently falling victim to the sharp pain in the back of the thigh that can mean anything from missing a few games to ending a career.

There have been a number of superstars with their futures in doubt due to the injury, just to name a few; Michael Clarke (cricket), Chris Judd (AFL), Jamie Lyon (NRL). And more recently Cale Hooker (AFL) was in doubt to play against Geelong in the last preseason game.

What puts someone at risk of a Hamstring Injury?
When all of the studies looking into risk of injury are combined we get a good overall picture of the elements that increase the risk that someone's hamstring will be injured.

As we noted with the ACL injuries (ACL injuries in females), there are a number of factors that contribute to an injury. Some of these we can influence and others are out of our hands.

The two big factors we cannot change that influence your risk of injury are age and previous history of hamstring injury (or previous ACL/knee injury)1.

Though if you haven't had a hamstring injury before, perhaps now is the best time to see a Bodywise Health Physiotherapist for a personalised preventative program.

The good news is there are a number of risk factors that we can improve on. These include muscle strength ratios, strength characteristics of the hamstrings and player endurance1.

Are there different types of Hamstring injuries?
The location of the tear can have a significant impact on the recovery process, especially the time and rehabilitation required to get back on the field.

When considering the location of a muscle tear it is important to appreciate the whole unit. The whole unit includes the bony attachments (both ends), the tendons (a flexible cord on either end of the muscle that transmits the force of the muscle contraction to the bones) and the muscle belly - the power generator. There is also an important transition of muscle to tendon towards either end. These different locations all heal at different rates and sometimes require different rehabilitation strategies.

The extent of the tear arguably will have an impact on the recovery process. Studies looking at imaging results have not consistently shown a clear correlation between the findings on scans like an MRI and the time to return to sport (RTS). Having said that, one can respect that a more substantial sized tear would require longer to repair the damaged tissue, but there are a number of factors that weigh in when considering returning to sport.

If you have been injured, a physiotherapist at Bodywise Health will be able to assess your hamstring and determine what type of injury you have or if further investigations are required.

What can be done to prevent an injury?
This is the most important section. If you have never had a hamstring injury before you want to be proactive in reducing your risk. If you have been unfortunate enough to have sustained an injury previously, you should be working hard to reduce your other risk factors.

There have been many studies looking at reducing the risk of injury. And the great news is there are many things that can be done to reduce your risk.

Your training program should include anaerobic interval training, sports specific training drills and lengthening exercises. Stretching especially while the muscle is fatigued, has also been shown to reduce injury risk. So a proper cool down is important2!

There are also specific exercises that have been shown to reduce the risk of a hamstring injury.

What can be done if I am injured?
Just as was seen in the preventative efforts, lengthening exercises have been shown to have a faster RTS time3. Additionally, agility and trunk strengthening offered slightly quicker RTS and lower re-injury rates, when compared to just strengthening/stretching3.

It was noted that more frequent stretching can still improve the range of movement faster, as well as allowing a faster RTS, suggesting that a home exercise program conducted frequently will be helpful. NSAIDs were not found to be helpful for recovery, PRP injections were also found not to offer benefit in RTS times3.

Sports focused exercises were also found to reduce the number of hamstring injuries sustained by AFL players4.

Unfortunately many of even the elite clubs are failing to adopt the 'evidence based' hamstring injury prevention measures. One study looking at elite soccer clubs in Europe had as many as 83.3% of clubs not following guidelines5.

So if you play a sport that involves running or kicking, get ahead of the competition and see a Bodywise Health Physiotherapist for an assessment and a preventative program. If you've sustained a hamstring injury either recently or a while ago, reduce the risk of re-injury by getting a preventive program.

For a complimentary injury assessment and advice, please call Bodywise Health on 1 300 BODYWISE (263 994).

Until next time stay Bodywise,

Michael Hall
Director Bodywise Health

References
1. T. Pizzari, Risk factors for hamstring injury: An updated systematic review and meta-analysis, Journal of Science and Medicine in Sport, Volume 19, Supplement, December 2015, Page e9, ISSN 1440-2440, http://dx.doi.org/10.1016/j.jsams.2015.12.401.
(http://www.sciencedirect.com/science/article/pii/S1440244015006465)

2. Verrall GM, Slavotinek JP, Barnes PG The effect of sports specific training on reducing the incidence of hamstring injuries in professional Australian Rules football players British Journal of Sports Medicine 2005;39:363-368.

3. Pas HI, Reurink G, Tol JL, et al Efficacy of rehabilitation (lengthening) exercises, platelet-rich plasma injections, and other conservative interventions in acute hamstring injuries: an updated systematic review and meta-analysis Br J Sports Med 2015;49:1197-1205.

4. Proske, U., Morgan, D., Brockett, C. and Percival, P. (2004), IDENTIFYING ATHLETES AT RISK OF HAMSTRING STRAINS AND HOW TO PROTECT THEM. Clinical and Experimental Pharmacology and Physiology, 31: 546-550. doi:10.1111/j.1440-1681.2004.04028.x

5. Bahr R, Thorborg K, Ekstrand J Evidence-based hamstring injury prevention is not adopted by the majority of Champions League or Norwegian Premier League football teams: the Nordic Hamstring survey Br J Sports Med Published Online First: 20 May 2015. doi: 10.1136/bjsports-2015-094826

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Concerned about your child’s backpack?

brighton physiotherapy bodywise health

With children returning to school in the next couple of weeks, helping them make the right start to the year is critical. It can help them avoid all the negative effects that go hand in hand with pain; loss fitness, decreased confidence and social withdrawal.

And with the incidence of back pain in adolescence approaching that of adults1, the muscle and bone problems associated with backpack use have become an increasing concern with school children2.
A study by Simmons College (Boston) professor Dr. Shelly Goodgold, has found that more than half of children in the study regularly carried more than the recommended 15 % of their body weight in their school pack packs.

The U.S. Consumer Product Safety Commission estimated that more than 3,300 children aged 5-14 years, were treated in emergency rooms for injuries related to backpacks in 1998; these numbers do not include students who went to their family doctor or health professional.

A study by Auburn University researchers (Anniston, Alabama, Pascoe et al.) stated that the most common symptom reported from backpack use is “rucksack palsy”. This condition results when pressure put on the nerve as it passes into the shoulder causes numbness in the hands, muscle wasting and in extreme cases nerve damage (Journal Ergonomics Vol. 40 Pg. 6 1997).

58% of orthopaedic health professionals polled in the USA reported treating children with back pain attributable to carrying backpacks. So if your child is complaining of neck, back, shoulder or arm pain, the cause might be an ill-fitting backpack. And despite the advent of tablets, notebooks and smart phones, it seems that if anything, school bags have become heavier, not lighter. 

Children are especially at risk of injury from backpacks as carrying too much weight in a backpack or an improper fit, can put undue strain in young muscles and bones that have not full developed.backpack2Here’s what can happen. As an overloaded backpack pulls the body backwards, your child may try to re-balance the body by bending forwards at the waist.

How much is too much?
Recent university studies indicate that if a backpack weighs more than 15% of a person’s body weight, it causes adverse effects on the neck as well as upper, middle and lower back which over time will lead to pain and physical problems.  In other words, it is recommended that the weight of the backpack should be no more than 15% of a person’s body weight.For a 50 kilogram child, that’s 7.5 kilograms.

Your child’s still developing muscle and bone systems can handle 15% without much chance of injury or permanent structural change. This weight can be carried without major postural changes occurring.
However an overloaded or incorrectly fitted backpack can cause the wearer to lean forward in an effort to compensate for the additional weight on their back.

Why you should be concerned

  1. There are two main reasons to be concerned about the weight of your child’s backpack.
  2. Holding this abnormal posture for long periods of time, can lead to a weakening of the neck, mid-back, low back and abdominal muscles.

As these muscles are developing, the risk is that they develop abnormally, setting up an abnormal posture for life. The top straps of the backpack which can compress the sensitive nerves and blood vessels as they pass from the neck through the shoulder area and into the arm.

This compression can lead to pain, tingling, numbness and even weakness in the arms and is called “rucksack palsy”.

What you can do
There are 3 things that you can do to ensure that your child is not at risk of injury from an unsafe back pack.
1. Select the correct backpack
2. Load the backpack properly
3. Adjust and wear the backpack correctly

Selecting a Backpack
1. The backpack should be no wider than the torso and not much longer than shoulder to hip.
2. Well-padded straps will distribute the load over a greater area, protecting the sensitive nerves and blood vessels as they pass beneath.
Some bag straps have adjustable air bladders and wait straps for a true custom fit.

Loading a Backpack

The guiding rule is that your child’s backpack should not weigh more than 15% of their body weight. Pack only what is needed for that day and stack the heaviest items closest to the back.

Wearing a Backpack
1. Adjust the straps for a snug fit.
2. Fit the backpack to the upper part of the back as a loose, low bag is more likely to compress the nerves and blood vessels of the neck and arm as well as strain the middle and lower back.
3. Never wear a backpack slung over one shoulder; not only can it compress nerves and blood vessels, but can also cause leaning to one side which may lead to twisting of the spine (scoliosis).

How to detect if there is a problem 
JJposture-webResearch has indicated that the use of computer photography is a valid and effect tool in detecting adverse postural changes that may occur with the wearing of a backpack.3

Bodywise Health has now acquired this technology so that you can identify quickly and easily if you or your child has a postural problem.

Once identified, simple techniques, exercises and strategies can then be implemented to correct joint stiffness, muscle imbalances and faulty postures and movement habits so that physical and health related postural problems can be avoided.

Prevention as the best cure
As with all health problems, the best cure is prevention or at least correction of a problem at the earliest possible instance.Getting a quick posture and / or backpack fitting check is an ideal way to stop problems before they start.

If you are concerned about your child’s posture; if you do worry about the weight of their backpack and you would like to correct the stresses on their body so that they don’t cause physical problems for the rest of their lives, the physiotherapists at Bodywise Health have the technology, knowledge, experience and skill to be able enable your child not only to make a great start to the year, but to enjoy life long better posture, better health and greater happiness.

If you would like further information or an appointment, please call 1 300 Bodywise (263 994).

Wishing you and your family the best of health,

Michael Hall
Director
Bodywise Health

P.S. For the next 2 weeks, Bodywise Health is offering FREE Posture and Backpack checks to you or your children. To get you FREE Posture and Backpack check, just mention this blog at the time of booking your appointment.

References
1. Skagg, D, Early S, D’Ambra P et al. (2006) Journal of Orthopaedics: 26: 3: 358-363.
2. Troussier B et al. (1994): Back pain in school children: A study among 1178 pupils. Scandinavian Journal of Rehabilitation Medicine 26: 143-145
3. Chansirinukor W. et al. (2001): Effects of backpacks on students: Measurement of cervical and shoulder posture. Australian Journal of Physiotherapy 47: 110-116.
4. Siambanes D et al. (2004): Influence of School Back Packs on Adolescent Back Pain. Journal of Pediatric Orthopaedics 24:2:211-217.

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How to know if you are over-training and what to do if you are

rehabilitation centres melbourne

If you are preparing for the Melbourne Marathon, no doubt your training has been in full swing. If however, instead of getting fitter and stronger, you are feeling more tired and lethargic and your performance is deteriorating, you may be suffering from Overtraining Syndrome. This is a disorder of the nervous and hormonal systems of the body which is caused by inadequate recovery of the body following intense training.1

Intense training = Intense Stress, Prolonged Training = Chronic Stress
You see, intense training puts intense stress on all the systems of your body. The emphasis of the body's functioning is shifted away from growth and repair to optimising physical performance. The need for energy stimulates the release of cortisol from your adrenal glands.

Cortisol, a stress hormone, stimulates all the physiological processes of your body to give you the "get up and go" to perform everyday tasks. It does this by causing your muscles to be broken down to release sugar for energy but at the expense of suppressing your immune and digestive systems.2

Stress = Tissue breakdown and suppression of Your Immune and Digestive Systems
Essentially, therefore training breaks down (catabolic process) your body's tissues so that they can rebuild (anabolic process) to be better, stronger or faster. The problem with overtraining syndrome is that your body's systems don't get sufficient time or have an adequate environment to regenerate before the next intense training stimulus is delivered leading to further breakdown and muscle weakness.

Any perceived demand for energy will cause the release of cortisol. We are the only living thing that can activate the stress response by thought alone.2 Work deadlines, home demands, financial stresses, relationship issues, poor eating habits and lack of sleep all cause the release of cortisol. Add to this an intense, prolonged training program and you can see how easily overtraining syndrome can develop. Disorders then occur when a person's perceived stress levels get beyond coping.

Initially, your adrenal glands are stimulated into producing increasing amounts of cortisol which may lead to metabolic disturbances such as:

  1. Lack of quality sleep (Important not to exercise at night as cortisol breaks down Tryptophan an amino acid that is an ingredient in Serotonin that is a precursor to melatonin the sleep hormone)
  2. Inability to concentration and sugar cravings (due to dysfunctional sugar regulation)
  3. Headaches (due to increased muscle tension)
  4. Loss of appetite and poor digestion (due to shut down of digestive enzymes)
  5. Gut disturbance – constipation or diarrhoea (Imbalance between good bugs Vs bad bugs)
  6. Malabsorption of essential nutrients (due to decreased gut permeability)
  7. Increased vulnerability to disease and infections (due to decreased number and function of immune cells)
  8. Sexual dysfunction and low libido (cortisol is made instead of sex hormones)
  9. Muscle weakness and aches and pain (cortisol made instead of testosterone)
  10. Heightened sensitivity to pain (cortisol impedes Serotonin production, the happy hormone that inhibits pain)
  11. Learning and memory impairment( as excessive cortisol damages the brain’s hippocampal cells)
  12. Exaggerated inflammation throughout your body.1

Eventually your adrenal glands become exhausted leading to insufficient cortisol being produced resulting in extreme fatigue.2

Diagnosis of Overtraining
Whilst there are many symptoms associated with overtraining, only a few have been shown to be valid and reliable indicators of this syndrome. These include:

  1. Performance deterioration
  2. Persistent, severe fatigue
  3. Decreased maximal heart rate
  4. Reported high stress levels
  5. Sleep disturbances
  6. Changes in blood Lactate threshold
  7. Elevated resting adrenaline levels1
  8. Other reported signs and symptoms for which there have been conflicting studies include:
  9. Increased early morning heart rate or resting blood pressure
  10. Frequent illness such as colds and chest infections
  11. Persistent muscle soreness
  12. Loss of muscle
  13. Moodiness
  14. Apathy, lack of motivation
  15. Loss of appetite
  16. Irritability or depression1

Many of the signs and symptoms of overtraining syndrome are remarkably similar to those of depression, fibromyalgia and chronic fatigue syndrome.1

Prevention of Overtraining
The most important factor in treating overtraining is preventing it in the first place. Having a correctly planned training program which incorporates adequate time for rest, recovery and regeneration as well as employing techniques to enhance recovery will go a long way to preventing overtraining.

Techniques such as ice baths, mindfulness meditation, remedial massage, exercise in water and Bodyflow therapy have all been proven to enhance recovery and regeneration.

Likewise, getting at least 7 ½ hours' sleep (and being asleep before 11pm!) as well as taking time out to laugh and enjoy life away from the pressures of your life are important to reducing the build-up of stress and tension that may lead to less than optimal health. 3

To prevent overtraining syndrome from a nutritional standpoint, you need to consume adequate amounts of:

  1. fluid (1.5 to 2 litres of water per day)
  2. protein (grams = body weight in kg x 0.9 x 1.5 each day if exercising at a high intensity 3-6 times each week)
  3. carbohydrates (7-12 g per kg of body weight each day)
  4. micronutrients such as activated vitamin B, magnesium (need to check zinc levels), iron and coenzyme Q104

At the same time, you should reduce your alcohol following exercise intake as this adversely affects muscle function and glycogen storage.1

Treatment of Overtraining Syndrome
Immediately after being diagnosed with overtraining syndrome, it is important to have complete rest and to sleep as much as possible over the next 48 hours. If acted on early enough, this may be sufficient for you to recover and perform at an even higher level (super-compensation).1

However, if this rest period does not reduce your tiredness, overtraining syndrome may be entrenched and it may take weeks or months to resolve. Treatment then consists of rest as well as nutritional and psychological support.

The starting point for all treatment programs is a comprehensive medical, nutritional and physical assessment. This will give clues as to the important factors that may have contributed to the development of overtraining syndrome such as viral illness, nutritional deficiencies, glycogen depletion, inadequate protein intake, sleep disturbances and anxiety / stress levels.

Viral Illness
Viral illness is a common cause of persistent tiredness in sportspeople. Prolonged intense exercise depresses your immune system, leaving you vulnerable to viral illness, especially chest infections.

If you have a viral illness with a raised temperature, it is important for you not to continue with intense training as it has the potential to either prolong your illness or cause a more serious illness such as myocarditis or post viral fatigue syndrome. Similarly, if you have a viral illness along with systemic symptoms such as muscle pain, training is prohibited.

If however, you have a mild temperature, light training that keeps your heart rate below 70% of your maximum heart rate (220 – age), may actually have a positive effect. To ensure that you are not at risk of worsening your condition, it is important to get a medical clearance before continuing with training if your general health is not 100%.

Nutritional Deficiencies
A common cause of tiredness among endurance sportspeople is depletion of iron stores. Menstruating women, adolescent sportspeople and athletes who diet are especially susceptible to iron deficiency due to either inadequate iron intake, increased iron loss and / or inadequate absorption of dietary iron.

If you have been training intensely and are suffering from tiredness and weariness, you would be well advised to seek a medical examination from a sports physician and have your iron levels checked as well as be tested for digestive and kidney function. Following this referral to a dietitian, nutritionist or naturopath may be required.

Gycogen depletion
Glycogen is the storage form of carbohydrate and the major source of energy for activity. Intense bouts of exercise drain glycogen stores and if they are not replenished prior to the next training session, they will become further depleted. If this pattern continues glycogen depletion will result leading to fatigue and a deterioration in sports performance.

In times of intense training, consuming at least 1-1.2g of carbohydrate per kg of body weight within the first hour immediately following exercise is especially important as this is when the rate of glycogen production is greatest.1

Finally, not only has it been shown that consuming carbohydrate during and following prolonged intense exercise prevents the depletion of energy stores, but it has also been proven that carbohydrate enhances the immune system’s ability to ward off infectious illness.

Protein Replacement
Protein replacement is critical for good health because prolonged intense exercise causes a substantial breakdown of muscle tissue, protein contains the building blocks (amino acids) which enable it to be rebuild in the next 24 hours and beyond. This process is optimised, if 10-20 g of high quality protein (containing the essential amino acids) is consumed within an hour following exercise. Eating protein after this time still promotes tissue regeneration, it just occurs at a slower pace.
Adequate protein replacement is also important to reduce pain and enhance sleep.1

The strategies listed for preventing overtraining syndrome will also assist in its treatment. Other treatment tips might include:

Other treatment tips for Overtraining Syndrome

  1. Avoid exercising if you have a virus and a high temperature. If you are not sure, seek a medical opinion
  2. Whenever you can, allow yourself to sleep in until 8 or 9am
  3. Take time out for massage, meditation, yoga and other relaxing activities to "quieten" your mind and body
  4. Avoid strenuous exercise at night as excess cortisol makes it difficult to sleep
  5. Take a nap in the afternoon if you are tired. 20 to 30 minutes is great value
  6. Avoid working late and burning the midnight oil
  7. Eat protein at every meal avoid high carbohydrate foods to optimise your insulin and blood sugar levels
  8. Eat 5 to 6 servings of vegetables each day and avoid fruit early especially those high in potassium
  9. Take fish oil to reduce tissue inflammation and prevent hippocampal damage
  10. Avoid hydrogenated fats, caffeine, chocolate, refined sugars, sugary drinks, processed foods and those that create allergic reactions
  11. Optimise vitamin D levels
  12. Get regular exercise2

It is important to realise that it is not just elite athletes who are at risk of overtraining. Even more vulnerable are people who lead highly stressed lives who then undertake intense, prolonged training programs. For these people it is especially important to organise their home, work and training schedules in ways which prioritise adequate rest and recovery.

"Listening" to your body, finding balance, training smarter not harder and understanding that "less may be more" may not only help you stave off overtraining syndrome as well as many other injuries and pain syndromes, they may just help you to achieve your "personal best". Good luck and until next time!

Be Bodywise and enjoy the best of health.

Best wishes,

Michael Hall
Director
Bodywise Health

For a FREE physical assessment and advice, 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).

References
1. Brukner and Khan and Colleagues. Clinical Sports Medicine. McCraw Medical. 4th Edition, 2012.
2. Chek, Paul. How to Eat, Move and Be Healthy. California: C.H.E.K. Institute, 2006
3. Chadwick V. Mcphee R. Ford A. a Practical Guide to Clinical Nutrition for Allied Health Professionals. May 2014
4. Chadwick V. How to Live a Life Without Pain. Global Publishing Group. 1st Edition, 2012

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Worried about your child's posture? Here's what you can do to help your child avoid a lifetime of pain

 good-vs-bad-sitting-habits

Worried about your child’s posture? New research indicates that you should be. Here’s what you can do to help your child avoid a lifetime of pain.

The rates of back pain are on the rise for children1 as well as adults despite the fact that we have more health professionals2, more health gadgets, more health information and more treatments, therapies, training programs and health promotions than ever before.

In fact, our physical health problems only seem to be worsening, with a recent UK study3 showing that up to 10% of 10 year old children have signs associated with bad backs and 9% already having at least one degenerative disc.

Something has changed! Whilst the researcher acknowledged that lugging heavy school bags, watching TV, playing video games and poor diets (obesity) have always had adverse effects on physical health, it is now thought that there is another factor at play with texting and excessive tablet use now being implicated.

In 2013, some 1.91 trillion text messages were sent in the US, according to CTIA, The Wireless Association4 Smartphone users spend an average of two to four hours per day hunched over their devices, which amounts to 700 to 1,400 hours per year that they are exerting this stress on their spines. School children may be even worse off, spending an additional 5,000 hours in this position, according to the study.

The term “text neck” has been coined to describe a group of physical conditions associated with excessive use of smart phones and tablets.

New York spine surgeon Kenneth Hansraj performed a study to assess the incremental effects of a forward-tilted head posture on the neck. He concluded that:

“Text neck” may lead to early spinal degeneration as excessive loading of the small bones, joints, muscles, nerves of the neck can result in muscle strain, pinched nerves, herniated discs and abnormalities to the neck’s natural curvature.5 This forward neck posture has also been linked to headaches, neurological problems and heart disease.

Others claim that the pressure on your neck and upper back doubles with every 2-3 centimetres of forward head tilt.6

As your head weighs about 4.5 to 5.5 kilograms and is balanced on two tiny joints of the first neck bone, it acts as a weight and cantilever on top of a highly mobile neck. Normally, the stresses that the weight of the head places upon the neck and upper back is reduced by the fact that the neck moves over 600 times an hour. However, if movements become repetitive or slouched postures are maintained for prolonged periods of time, stresses on the structures of the neck and back build up and eventually lead to stiffness and pain.

Children and adolescents are particularly vulnerable to the adverse effects of excessive tablet and smart phone use. The positions and movements that young people “practise” are likely to become lifelong habits. If young people spend their time in slouched postures then not only they will tend to default to those postures but as their young bodies grow, all their body structures and tissues will adapt to these positions, further reinforcing these habits and making them difficult if not impossible to correct without intensive treatment and training
Posture is More Than Just Physical
Posture has been shown to have powerful effect on your entire health and wellbeing, not only affecting your physical health but also influencing your thoughts, feelings, actions as well as how others perceive you. Posture can even affect your memory recall.7

“When sitting in a collapsed position and looking downward, participants in a study found it much easier to recall hopeless, helpless, powerless, and negative memories, than empowering, positive memories.

When sitting upright and looking upward, it was difficult and for many of the participants nearly impossible to recall hopeless, helpless, powerless, and negative memories and easier to recall empowering, positive memories...

Sitting up straight helps increase blood flow and oxygen to the brain, and according to some accounts, by up to 40 percent.”

Some of the wide ranging detrimental effects of poor posture include:
• Shoulder, neck and back pain;
• Degenerative disc disease;
• Tension headaches8;
• Excessive forward curvature (kyphosis) of your upper back;
• Depression, increased stress and diminished levels of energy9;
• Decreased libido10;
• Digestive issues such as constipation, acid reflux and hernias11;
• Restricted breathing;
• Cardiovascular irregularities (related to vagus nerve irritation)12,13


The Best Cure for Your Posture
The best cure for postural problems is to avoid poor positioning and movement patterns in the first place. This means being aware of maintaining good posture by standing up straight, sitting up straight up (and/ with a lumbar roll cushion in the small of your back) and moving from position to position without dropping your chest.

Beyond this, it means maintaining full mobility of all your joints as well as the strength of all your muscles especially in the opposite direction of the positions and movements that you perform routinely on a daily basis.

It also means not staying for too long in one position, but rather moving from one position to another at least every 30 minutes.

Tips for maintaining good posture
1. Use your eyes. When operating electronic devices, practice looking down at your device with only your eyes, instead of bending your neck—and try holding your device up higher. If you wear glasses, make sure your prescription is current.

2. Stand up as much as possible. You might want to experiment with a stand-up desk. You certainly don’t need to stand all day long but you are likely far better off standing as your posture and your likelihood of movement tends to improve. If you cannot work standing up, make an effort to interrupt your sitting frequently throughout the day. Stand up and walk when taking phone calls. It will help you feel better, have more energy and be more creative as well..

3. Walk more. Wear a fitness tracker and set a goal of walking 7,000 to 10,000 steps each day, which is more than eight kilometres. While you could probably walk this distance all at once, it’s best to spread it out evenly throughout the day, as much as your schedule will allow. Get in the habit of using the stairs and parking further away from entrances.

4. Take 30- to 60-second exercise breaks. Every 30 minutes, stretch gently into the opposite direction from the position that you have been in. If you have been sitting, this might mean stretching backwards over the back of a chair or standing up with your hands on your buttock and leaning backwards. Aim to hold the stretch for at least 10 seconds and do 5 of them at a time.

5. Anti-gravity Strength Training. Strengthen the muscles which move your body into the opposite direction of the positions and movements that you perform routinely. Doing this will help to relieve stress on body tissues and structures, restore joint mobility, correct muscle imbalances as well as build strength and endurance so that you can maintain an upright posture. To learn more about this, please call Bodywise Health on 1 300 BODYWISE (263 994);

6. Posture Training. The only way to achieve permanent results is to permanently correct posture and movement habits. To do this takes intense training, involving freeing up stiff joints, supporting and strengthening weak muscles whilst preventing the adoption of faulty postures and movement patterns with tape or bracing.

Research shows that to create a habit takes about 300-500 repetitions, but to correct a faulty habit takes about 3,000-5,000 repetitions or about 4-6 weeks of training. If correct postures and movement patterns are achieved, the benefit is a lifelong reduction in mechanical pain and problems.

However, the opposite is also true. If children start off with poor postures and movement patterns, they are more likely to suffer from physical, psychological, cardiovascular, respiratory and digestive problems for the rest of their lives.

This is why it is so important that children be shown correct posture and movement and be taught the detrimental effects of bad posture. Correcting your child’s posture and movements early will profoundly change their lives forever. If you notice your child is stooping or you have any concerns about their posture, please get this checked. It might just save them from a life of pain and misery.

Be Bodywise and enjoy the best of health.

Best wishes,

Michael Hall
Director
Bodywise Health

For a FREE posture check and advice, please call Bodywise Health on 1 300 BODYWISE (263 994)

References

 

1 BMC Pediatr January 2013 Surg Technol Int. November 2014 (full text)
2 Pattern Movements.  A Neurodevelopmental Approach to Conditioning. Correspondence Course. Paul Chek. 2003 Surg Technol Int. November 2014 (Pub Med)
3 Daily Mail November 6, 2014 
4 Fox News August 15, 2014
5 Washington Post November 20, 2014
6 CNN September 20, 2012 The Atlantic November 25, 2014
Medical Daily June 24, 2014

9 New York Times September 19, 2014
10 
11 Biofeedback Fall 2012
12 Medical Daily September 23, 2014
13 Livestrong February 6, 2014
14 Posturebly
15 Life Offbeat November 11, 2013
16 J Amer Coll Cardiol June 2001
17 Diabetologia November 2012
18 WebMD October 15, 2012
19 Br J Sports Med 2009

 

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Want to get stronger, faster? Here are 7 secrets and 5 tips that no one will tell you!

Pilates 2 04

I see it all the time.  It’s frustrating. People performing strength exercises which are at best doing little to enhance their strength and at worst, making them more injury prone.  So here are 7 secrets that you can use to enhance your strengthening exercise program so that you can perform better, live better and achieve more.

Secret 1                                  Stabilise First

“You can’t shoot a canon from a canoe.”  In other words, you can’t perform strong, dynamic movements off a flimsy and unstable base.  And there are many reasons why supportive, stabilising muscles stop working as well as they should. Remember, these are the small muscles that attach closely around each joint to hold the joint surfaces in optimum contact so that they form a strong, stable platform.  The more stable your platform, the more resistance or weight that you can lift and the stronger you will get.  

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

To stabilise, “clench” or contract all the muscles around your joints to what is maximally comfortable.  Even better, position yourself correctly by having your knees slightly bent, feet apart and on a slight diagonal.  Then, stabilise your whole body by pulling your stomach in, tightening your butt and pelvic floor up and tucking your chin in.

Secret 2                                  Isolate

As mentioned above, pain, swelling and general deconditioning, can all act to stop muscles from being effectively activated.  And just because you perform a movement, doesn’t mean that these muscles start working again.  They need to be “woken up”. Research has shown that not only do these muscles need to be trained specifically to begin working normally again, but that if they’re not, people will begin to substitute other muscles and use different strategies for movement which mayl eventually lead to injury. 

To isolate a specific muscle for strengthening, you need to know what the muscles attachments are as well as the precise movement that the muscle performs.  For example to best strengthen your biceps, muscle on the front of your upper arm), you need to start with you hand turned with the palm facing backward and then turn to bring the palm forwards to the front of the shoulder as you bend your elbow only. 

Almost all muscles have a rotation component as well as an angle and direction at which they are best activated.  Know these and you will better target that muscle for strengthening.

I see so many people trying to strengthen muscle with the wrong starting points, wrong actions and with poor control, all making these exercises less effective whilst at the same time potentially putting themselves at risk of injury.  If you are going to exercise and you want the best results, learn to do the exercise correctly the first time.  It will save you much time

Secret 3                                  Activate

The more nervous impulses that enter a muscle and the more effectively and efficiently muscle fibres are activated, the faster your muscles will adapt and get stronger. 

Here are a couple of tips to engaging your muscles better. 

The first is to “clench” or contract your muscle first to the maximum you can comfortably. 

The second is to hold the muscle at this maximum tension throughout the movement and not allow it to be turned on during shortening of the muscle and off during the lengthening of the muscle.

Further from this, the third tip is to perform the movement slowly engaging the muscle with maximum tension and use holds at different parts of the movement.  This might mean that with very heavy weight (and only if you have been training for longer than a year) that you are still trying to perform the movement explosively but because of the high resistance, that you can only move very slowly. 

The fourth tip is to understand patterning.  In other words, position your body to better activate the muscle. For example, if you hold your hand open and backwards whilst trying to perform a bicep curl, you will be less effective at activating the muscle than if you clench your fist and hold your wrist slightly forwards.

The fifth tip is to know how to use your breathing to assist with stabilising your body but not so much as to increase the pressure within your body to dangerous levels.  Some authors have suggested that better results from strengthening may be achieved by breathing in during bending or closing down movements and by breathing out during straightening or opening up movements. 

Furthermore, if the breath is held just to a catch point (most difficult point of the contraction) the increased abdominal pressure will assist in stabilising your spine.  However, to prevent possible adverse effects of this pressure, you must breathe out just after this point to release this pressure. 

Secret 5                                  Use Feedback

Mirrors are not just there to show you how good you look! Visual feedback along with the voice and touch actually play a crucial role in ensuring the correct technique, maximum activation and optimal performance that is needed for the best results.

This feedback can be gained from mirrors, a coach or partner and even your own fingers placed on then muscles that you want to contract.   It is especially vital early on when learning an activity, as generally the more the better feedback, the better and faster you will learn.

It has been said that to learn a new skill requires about 300 to 500 repetitions and can take about a month.  However, to correct a poorly performed skill with a better technique can take about 3000 to 5000 repetitions.  So better to learn how to do things correctly the first time.  It can save you weeks and months of poor results as well as the possibility of injury.

Secret 6                                                          Integrate

For better transfer of strengthening over to everyday life, isolated strengthening exercises must be followed strengthening exercises that use these muscles in functional activities.  Muscles must work in co-ordination to perform an activity to achieve a result and the only way to improve at these functional activities is to practise and progress them. 

There are seven types of movements that are the basis for most of the activities that we do. They are bending, twisting, pulling, pushing, squatting, lunging and ambulation (walking / jogging / sprinting).  I call them Primary Movements as they are the movement patterns that you need to be able to live and function optimally. 

So to get better results, follow an isolated strengthening exercise with the functional strengthening of the muscle in a related everyday activity in which it is used.  This will enable you not just to look better but to live better as you will have greater strength and co-ordination in the activities that you do every day. Examples of this might be to follow a knee extension strengthening exercise with a double or single leg squat. 

Secret 7                                                          Automate

You can’t live by thinking about activating every single muscle during every single movement.  To live effectively, correct muscle activation and movement have to occur automatically and without thinking. This means that you must train your brain as much you train your muscles through performing these exercises with varying speeds, directions, amplitudes and on varying surfaces, progressing from very stable to unstable.

You must keep your brain guessing by progressively reducing feedback to the point that your brain is literally anticipating and automating muscle co-ordination and movement without thinking at higher and higher levels of control. 

Think about the primary movements of bending twisting, pulling, pushing, squatting lunging and ambulation.  Break them down into their component parts and then combine them again and progress them with ever increasing levels of co-ordination, speed and agility demands.  Activities such as learning to balance standing on one leg.  Then progress this by standing on your toes, then squatting, hopping first up and down and then at different angles and speeds whilst catching a ball.  Or progress from kneeling on a swiss ball to standing, squatting, catching a ball on and so on. You are only limited by your imagination.

If there is one thing that we are all short on these days its time.  Don’t waste your time by doing ineffective, inefficient strengthening exercises.  Use these techniques and strategies to enhance your program and you will enjoy the benefits of looking younger, feeling stronger and performing better in all areas of life.  

Be Bodywise and enjoy the best of health.

Best wishes,

Michael Hall

Director

Bodywise Health

For a no obligation, FREE assessment for any injury or physcial problem that you might have, please call Bodywise Health on 1 300 BODYWISE (263 994)

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5 Reasons why working out on machines may put you at greater risk of injury and what to do instead

5 Reasons why working out on machines may put you at greater risk of injury and what to do instead

med x lumbar pic

 

By Michael Hall

Today, we have more technology, more health devices and exercise equipment than ever before. In particular, computerised strength training machines now promise you everything from protecting you against injury, to being the best type of strength training that there is!1 But do the claims really stack up in the light of the current health research. Read on to find out.

First a bit of background. This article refers to computerised and non-computerised strength training machines that control and direct movement and not to strength training equipment that uses cables, springs and slings.  This is important because your physical health is dependent on your core stability. Essentially this is the ability of your brain and body to utilize your muscular strength, endurance and control to maintain healthy working relationships of all your muscles and joints in all movements and under all conditions.2 And unlike what most health articles and marketing would have you believe, core stability does not just refer to the stomach region, but the stability of all your joints close to your trunk especially your neck, back, shoulder and shoulder girdle as well as your hips, pelvis, and upper leg.3

Global Vs Local Muscles

Over the last 30 years, advances in our understanding of the concept of core stability has led to a revolution in the rehabilitation and prevention of injury. The breakthrough came when it was recognised that muscles are differentiated in their makeup and function between global muscles and local muscles.4

Global muscles (called prime mover muscles) are larger longer muscles that attach further away from your joints. They are dynamic, phasic muscles in that they switch on and switch off and provide power and strength to movement.

Local muscles (called stabiliser muscles) are small muscles that attach very close to where your joints contact each other. These local stabiliser muscles are often called tonic or postural muscles because they are always switched on providing a low level (5% maximum voluntary contraction5), constant, directional tension to hold joints in ideal alignment.

Feed-forward Control - The Key to Injury Prevention

Even more amazing, it was discovered that these muscles actually contract before you move to counter-balance the pull of your large, global muscles. There is a feedforward or preceding command to the small muscles around your joints to “stiffen” your skeleton in preparation for movement.

Most movements within our bodies operate on this feedforward system.6 It seems that your brain and nervous system estimates the forces that are going to be applied to your body during the movement and prepares your muscles and joints in advance.

Joint stabilisation and body control should be sub-conscious and automatic. If it doesn’t occur before movement, excessive or abnormal forces will result and you will be more at risk of injury.6 And this is exactly what happens following injury or with restrictive, regimented and inadequate every day movements and training. The automatic, sub-conscious control becomes impaired and you begin to lack the background stabilisation of your body that protects you from injury.

5 Reasons why strength training on machines does not protect you from injury

  1. Machines primarily work your global, prime mover muscles. Whilst strengthening these muscles might improve the strength, tone and look of your outer muscles, they have relatively little effect on your local, stabiliser muscles, leaving you vulnerable to injury insufficient stabilisation. Computerised machines do not train your reflexes or stabiliser systems that protect you from unguarded, reflexive movements. Although you will feel stronger, you will still be at risk from quick, movements that you do without thinking because the background control has not been trained.
  2. Machines do not allow for functional movement, which is the type of movement that you do in everyday activities. Because machines dictate specific directions of movement, they do not allow your body segments to work together in a normal, functional way. Consequently, they don’t prepare you for and protect you from everyday life activities.
  3. Because machines are exercise isolated muscles in precise, predetermined directions, they are more likely to lead to muscle imbalances, incorrect postures and movement patterns, excessive or abnormal stresses and eventually to pain and injury.
  4. Whilst machines might train your muscles, they do not train your brain. In other words, they don’t train your nervous system’s anticipatory and sub-conscious control of your body. To improve your sub-conscious control, you must do sub-conscious training. Like many systems of your body, it is a “use it or lose it phenomenon”. Practicing and refining your balance reactions in every day functional activities will refine the feedforward control of the nervous system. Neglecting reflexive activities will cause your reactions to be inadequate and delayed, leading to worsening performance and the increased possibility of injury.
  5. Training on machines doesn’t provide the movement variety that is required in every day functional movements. You see, your body and your brain are very efficient at adapting to movement. This means that your body will get very good at doing machine based training, but this won’t transfer across to everyday activities.

Is lack of strength really the cause of your injury?

Most patients have attended Bodywise Health over the past year NOT because of some trauma but because of some insignificant, quick, unguarded movement that that have done without thinking. Statements such as “I just bent over to pick up a pen” or “I just reached forward to open the window” are all too familiar when people give their accounts as to how they sustained their injuries. In almost all cases, strength or the lack of it does not appear to be a factor as to the cause of their injury. It does not seem to be a strength issue, but rather a timing and control issue.  It is people’s lack of sub-conscious movement control that appears to be the common factor leading to the onset of their injuries.

Core Stability Vs Core Strength

Training on machines does not address these deficiencies, but rather compounds the problem because it reinforces global muscle strength at the expense of local stabiliser muscle control. In other words, whilst your power, dynamic movement muscles get stronger, the base upon which they work get weaker, leaving you vulnerable to quick movements and activities that you do without thinking.

Whilst health clubs, personal trainers and machine based rehabilitation centres often promote core strength as being paramount for optimal physical health, please understand that it is actually your core stability which is more important in protecting you from injury. Whilst core strength is a component of core stability, the more crucial components of core stability are the endurance of your muscles and your nervous system control.7

The term “core instability” implies lack of core control. Therefore, to improve your core stability you need to learn to stabilise better and the best way to learn to stabilise better is by “training” on progressively more “unstable” surfaces and then with increasingly more dynamic functional movements.

Some ideal unstable surfaces for training include swiss and bosu balls, pilates reformers, duradiscs, rockerboards, pools and even standing on one foot. The more unstable you are, the more you have to stabilise and the more you will train your brain and nervous system’s ability to protect you from injury.

What are you training for?

Training is highly specific. This means that the training effects gained in one activity do not transfer well over to other activities. Therefore, if you want to look good, want to perform well on machines and are not concerned with avoiding or preventing injury, then by all means “work out” on resistance machines.

However, if your main goals are to perform optimally and prevent injury in sporting or every day functional activities, then you must “train” your brain and body in these activities. Your brain and body only know movements, not muscles. Correct and improve the control of your movements and you will not just look better but you will stay better, perform better and live better as well.

Wishing you the best of health,

Michael Hall
Director
Bodywise Health

For more information on how Bodywise Health can help you to improve your core stability, please call Bodywise Health on 1 300 BODYWISE (263 994). 

References

  1. www.keiser-training.com.au/quality/keiser-training/works
  2. Panjabi MM. The stabilizing system of the spine. Part I. Function, dysfunction, adaptation and enhancement. J Spinal Disord 1992;5(5):383-9.
  3. Hodges PW, Richardson CA. Inefficient muscular stabilization of the lumbar spine associated with low back pain. Spine, 1996;21(22):2640-50.
  4. Richardson CA, Hodges PW, Hides JA. Therapeutic exercise for spinal segmental stabilization in low back pain – scientific basis and clinical approach. 2nd Edn. Edinburgh: Churchill Livingstone, 2004.
  5. Bergmark A. Stability of the lumbar spine: a study in mechanical engineering. Acta Orth Scand, 1989;230(Supp):20-4.
  6. Sahrmann SA. Diagnosis and Treatment of Movement Impairment Syndromes, 2002
  7. Chek P. Primal Pattern Movements. A Neurodevelopmental Approach to Conditioning. Correspondence Course 2003.
  8. Grakovestky, S. The Spinal Engine. New York: Springer-Verlag Wien, 1988.

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The Real Cause of Most Pain Syndromes and How to Prevent Them

back-pain-mainBy Michael Hall, 

With health statistics on so many fronts screaming crisis, it is no wonder why so many people throw up their hands and say that it is all too hard. Key findings from the First Results 2011-12 Australian Health Survey reveal that of the national health priority areas, the top long term health conditions experienced in Australia were:

  1. Arthritis – 3.3 million people (14.8%)
  2. Mental and behavioural conditions – 3.0 million people (13.6%)
  3. Asthma – 2.3 million people (10.2%)
  4. Heart Disease – 1.0 million people (4.7%)1

The prevalence of overweight and obese people over 18 has risen from 56.3% in 1995 to 61.2% in 2007-08 to 63.4% in 2011-12. This is of grave concern as obesity is linked with inflammation as fat cells (adipocytes) release inflammatory signalling molecules (adipokines)2. The result, obese adults are five times more likely to have high triglycerides (a predisposition to cardiovascular disease), seven times more likely to have diabetes and four times more likely to display signs of liver disease than normal weight adults.

Since the mapping of the human genome, there has been increasing hope that advances in genetic treatments may offer the greatest potential to our overcoming many of these chronic illnesses and pain syndromes. And with so much publicity being focused on genetic research as being the solution to our health problems, there may be tendency to think that we are just a product of our genes and that there is nothing that we can do to avoid the illnesses or injuries that afflicted our ancestors.

Yet, studies of identical twins have revealed that though people may have identical genes, the injuries and illnesses they experience may not necessarily be the same. How can this be if people have the same genetic profile? There must be other factors and control levers at play that influence the expression of genes. Research is beginning to uncover that the expression of genetic traits is due to complex, multitude of factors one of which is not only a person’s environment but the way that they perceive and interpret their environment. This means that people can and do have the possibility of influencing their health for better or for worse.

Intimately associated with our perception of our environment is our brain and body’s relaxation or healing response or our “fight or flight” response. In an environment of safety, love, nurturing and appropriate challenge, freedom and confidence predominate, which leads to better relaxation, sleep, digestion, growth, repair and expansion of our physical, mental and spiritual capacities. It is an anabolic or building up process of our minds, bodies and life.

With the “fight or flight” response, fear is the predominant emotion, as blood is shunted away from our gut to the muscles so that we can fight or flee. In addition, our immune system is mobilised to prepare us for injury. This process is called inflammation. The purpose of the immune system is to defend the body against attack by foreign bodies (e.g. viruses or bacteria) or act like a demolition company to clear a site of damaged tissue and debris so that new tissue can be laid down. In other words, it is a catabolic or breaking down response. Whilst this response is important in the short term for survival and healing, over the long term, a hyperactive, dysfunctional immune system will wreak havoc on our ability to stay healthy as normal tissue is “attacked” and our bodies become at war with themselves.

The characteristics of inflammation are constant often throbbing pain as well as heat, redness, swelling and night pain with the classic example of an inflammatory reaction being a mosquito bite. This in effect is the basis for most pain.

The stimuli which can lead to an inflammatory reaction can be grouped into three categories, those of:

  1. Mechanical stimuli
  2. Nutritional stimuli and;
  3. Psychological stimuli.

However, all of these categories have one thing in common; the applied stimuli which leads to inflammation is either excessive or abnormal and therefore beyond the body’s physiological ability to adapt.

There are four factors which dictate whether a stimulus might be excessive. These are:

  1. The intensity of the stimulus;
  2. The number of times the stimulus is applied (or volume);
  3. The duration of the stimulus;
  4. The recovery time between stimuli.

If any one of these variables by themselves or combined present a force that is over a tipping point, then an inflammatory reaction and pain will occur. The purpose of pain is to alert us to the need to change or stop the behaviour so that we can avoid further risk of injury. Taking away the pain with a pain killer may be doing us more harm than good as it is taking away the very mechanism that protects us from further danger.

The reason most people don’t get better is not because their body can’t heal, but because they keep aggravating their “injury”. Stop them from aggravating their “injury” and generally their problem will heal and their pain will reduce. Unfortunately, this is often easier said than done particularly in a society where we are progressively becoming less in tune with our body’s needs and “masking” or band-aiding issues is promoted ahead of dealing and working through problems.

Still, whether they be physical, nutritional or psychological stressors, if you can identify what the excessive or abnormal forces are and you are able to reduce these to within normal physiological limits, then you may be able to achieve a permanent reduction in your pain. The three areas of life in which you can do this include:

Biomechanical / Physical Pain
What differentiates mechanical pain from biochemical pain, is that it is related to certain body postures, positions or movements. Change your posture, position and / or movement and you will change your pain response.  This is in contrast to biochemical pain which is often constant, throbbing and unrelated to any movement or position.

Fixing mechanical pain is often relatively easy if the postural and movement patterns which cause and alleviate pain are consistent. Once the aggravating activities are identified, then eliminating inflammation and pain is simply a matter of changing the way person moves so that they don’t irritate the damaged tissue or structures.

Mechanical pain that is inconsistent raises the prospect that biochemical irritation and perceptual issues may be playing a role. And whilst this type of mechanical pain is harder and often takes longer to alleviate, it is still possible to achieve a substantial reduction in pain by reducing inflammation and tenderness with cold therapy, using “hands on” techniques to reduce soft tissue and joint tension and then unloading the irritated tissue / structure so that it can heal.

As long as the lesion is then protected from re-injury, there is no mechanical reason why it can’t repair. There are however nutritional and psycho-social reasons why a person may not get better which brings us to….


Biochemical / Nutritional Pain
It stands to reason, that if your body is to heal and be healthy, it needs the building blocks to make the necessary tissue for healing and repair. Without the essential nutritional elements, no repair is possible. What is shocking in this day and age, is that not only are many people not getting adequate nutrients for repair, but that their diet is actually sabotaging their health and healing response.

Let me explain.

What you eat can cause inflammation and lead to inflammatory diseases that include everything from pre-mature ageing, allergies, chronic pain, osteoarthritis, diabetes, fibromyalgia to Alzheimer’s disease, cancer, osteoporosis, depression, heart disease and more2. A diet of highly processed and refined carbohydrates, that is too low in omega 3 fatty acids (optimal ratio of omega 6 to omega 3 fatty acids is 2:1 to 4:1) and anti-oxidants and contains allergens and reactive foods or toxins will lead to inflammation and eventually pain. And a diet that is deficient in nutrients can cause specific health problems such as vitamin B12 deficiency which can lead to burning neuropathic pain.

So how do you know if you have a food allergy, reactive food or poor diet that may be causing inflammation? By listening to your body and taking note of any clues that it might be giving you. How do you feel after a meal and is your body displaying any signs of nutritional deficiencies? For example, do you feel lethargic, irritated, “foggy”, tired or sleepy after a meal? Do your nails have white markings (possible zinc or B6 deficiency), horizontal ridges and grooves (possible vitamin B or protein deficiency) or yellow vertical lines (possible deficiencies of keratin, calcium, magnesium, zinc, or sulphur). And what about your tongue, hair, teeth, eyes, skin, lips, mouth, muscles and stools? All these areas of your body can display specific, easily detectable signs that indicate your diet is lacking nutrients that may be leading to poor health, inflammation and pain.

The best place to start is with an assessment, especially if you are at all worried that your diet may have deficiencies that may be affecting your health adversely either now or in the future. Remember, many diseases show up only after years of neglect and could so easily have been prevented with strategies such as having more:

  1. High quality protein (at least 0.8gms for every kilogram of a person’s body weight);
  2. Oily fish (at least 3-4 meals per week);
  3. Complex carbohydrates by substituting wholemeal bread for bread for wholegrain sourdough or white rice for brown rice;
  4. Fruit and vegetables to supply antioxidants and alkalize your body;
  5. Filtered water (at least 2 litres daily, not with a meal if you are over 40) and less coffee, alcohol or soft drinks;
  6. Taking a probiotic daily as well as other supplements as indicated to correct any nutritional deficiencies and to enable your body to begin the journey back to full health.

These are just some of the many other quick and easy diet changes that can make a massive difference to your health. For more information or for an assessment, call us here at Bodywise Health on 1300 BODYWISE (263 994) and will be deighted to assist you and provide you with any additional informationthat you may want.


Emotional / Psychological Pain
Yes, how you think and what you feel can cause inflammation and pain. As Dr Craig Hassard says in the film The Connection, “If your brain is happy, then your body is happy”.3

Whilst the link between mind-body health has been recognised for more than 50 years, the past 10 years has seen an explosion in learning and evidence that indicates just how strong this link is.

What is fascinating is that it is NOT your reality, but how you perceive and interpret your reality that determines your health.

Research by Dr Lorimer Mosely at Oxford University using mirror therapy has shown that displaying a person’s healthy, normal hand has led to a reduction in inflammatory signs and symptoms of their affected hands by chronic regional pain syndrome. And projecting normal walking legs of amputees has eliminated their phantom pain.4,5

Emotions such as fear, anger, despair and sadness have so many far reaching consequences for your health. In life, they are absolutely appropriate when matched to the appropriate situation or circumstance. They can be absolutely critical for self-preservation in enabling you to adapt and survive when challenged by real threats to your safety and health. They often operate at an instinctual and reflex level as they are under the control of a more primitive area of our brains, the amygdala.

However, these emotions are meant to be turned on and then turned off. Problems arise when they become switched on so often by situations such those involving relationship difficulties, financial pressures and time constraints, that they become prolonged and "normal".  This then leads to a heightened state of tension, a hypersensitive nervous system, a less effective digestive system and a dysfunctional immune system and eventually to inflammation and pain. An example of this is depression which has a major inflammatory component.

The good news is that these emotions and thought processes can be overridden with hard work. Research has shown that the anteromedial portion of the prefrontal cortex (at the front part of the brain that deals with episodic memory, reasoning, attention, multitasking, task sets, decision making, cognition and processing of self-referenced information) can override the more reflexive, innate thought and behavioural processes.

There are many specific psychological therapies that can help people overcome inappropriate, instinctual mental and physical responses to everyday situations. A common denominator of successful approaches in achieving long term, sustained, independent improvement, is the active involvement of a person in their treatment along with the support and empowerment of an appropriately qualified health professional (psychologist etc. registered with The Australian Association for Cognitive Behaviour Therapy), with additional support as needed (e.g. family, friends etc.). Some of these approaches include:

1. Cognitive Behavioural Therapy;
2. Stress inoculation;
3. Stress desensitisation;
4. Meditation (Mindfulness, Emptying, Transcendental);
5. Relaxation training;
6. Biofeedback;
7. Neuro-Linguistic Programming (NLP).

It is beyond the scope of this blog to go into detail with each of these therapies. Suffice to say that if you are feeling stressed, out of control, not coping and or things are affecting adversely your everyday life then seek help from your GP or a qualified psychotherapist.

Whilst these different therapies, may use different techniques, their common purpose is to:

1. Empower you to reinterpret previously perceived stressful events in a more appropriate way and;
2. Impart knowledge and skills so that you can more effectively deal with and respond to these “stressful” situations in a healthier way.

These approaches also have in common the practice of techniques that interrupt your everyday thoughts followed by the active repetition (and learning) of better and more beneficial responses. Research has indicated that it takes about 300 to 500 repetitions to learn a new habit.6 However, to unlearn, correct and then re-learn a habit has been estimated to take about 3,000 to 5,000 repetitions.7 However long it may take you to learn how to initiate your own relaxation or healing response, it has been found that the more involved, engaged and emotionally connected you are with your responses, the faster and more complete your recovery.

Please understand that everything that you think, say and do, is a habit and a result of neural and immunological programming that has occurred both innately and via experience. Recovery lies with the fact that you can learn, grow, adapt and change in response to your changing world and circumstances.

Yes, it will take hard active work to change your “unhealthy” physical, nutritional and psychological habits and replace them with healthier ones, because in effect in so doing you are changing the neural programming that goes with each habit. To change a habit takes at least a month of reinforcing a new habit to such a degree, that it becomes the default, instinctive, reflex neural pathway and habit. It requires active involvement and commitment of a person as well as outside support, education, instruction, coaching, home-work and accountability. You are much more than just the product of your genes, your parent’s history or even your perceived “story” about yourself. Each and every day is your opportunity to forge a new path for your health and your life. Good luck in your journey.

If you are concerned about your physical and nutritional health, and would like to know if you have any deficiencies which may need correction, please call Bodywise Health on 1 300 263 994 (BODYWISE) to book your FREE physical health check or nutritional assessment.

For more information on how Bodywise Health can help you to overcome your 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).

Additional References:

1. Australian Health Survey, First Results, Australia, 2011-12
2. Chadwick V. Mcphee R. Ford A. a Practical Guide to Clinical Nutrition for Allied Health Professionals. May 2014
3. Harvey S. The Connection Mind Your Body 2014
4. Moseley G. Distorted body image in complex regional pain syndrome. Neurology 65 September 2005
5. Moseley G. Effect of sensor discrimination training on cortical reorganisation and phantom limb pain. The Lancet Vol 357 June 2001
6. Schmidt, R. Motor Learning and Performance 2nd edition. Champaign, IL:Human Kinetics, 2000.
7. Chek, P. Primal Pattern Movements. A Neurodevelopmental Approach to Conditioning, 2003

 

 

 

 

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364 Hampton St,

Hampton

Victoria. Australia 3188

03 9533 4257

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