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

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By Michael Hall,

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

1.Be prepared

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

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

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

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

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

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

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

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

* Heart arrhythmias which may lead to heart attacks;

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

* High blood pressure which is a risk for stroke;

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

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

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

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

3. Start slowly and progress slowly

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

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

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

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

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

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

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

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

5. Include corrective and capacity building exercise.

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

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

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

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

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

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

6. Focus on technique

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

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

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

7. Balance the load on your body

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

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

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

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

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

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

8. Recover well

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

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

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

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

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

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

9. Get adequate sleep

Adequate sleep means at least 7 hours of good quality sleep each night. Deep sleep is simply essential for renewal, recovery and repair – the essential elements of good health. It is important for the immune system, and it reduces the risk of heart disease, cancer, diabetes, depression, obesity and improves concentration. The Chinese body clock and circadian rhythm indicates that there are various times of the day that the body is more likely to be performing certain functions.

Recommendations for a good night sleep include:

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

* Eat early and avoid a large meal with refined carbohydrates (e.g. sweets, pastries etc.) that will cause a blood sugar spike and cause you to wake up when the blood sugar drops.

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

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

* Avoid intense exercising just before bed (exercise raises cortisol levels which breaks down tryptophan, an amino acid needed for the manufacture of serotonin and then melatonin, the sleep hormone).

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

* Stretching on a mat in the 20 minutes before going to bed, is an ideal way to reduce joint stiffness and muscular tightness, thereby promoting better relaxation and rest.

* Dim lights, avoid stimulating activities (computer, TV, suspense novels etc.) and reduce temperature to between 16 and 18 degrees in the hour or two before bed.

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

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

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

* Write down a plan of the next day’s activities before going to bed to free your mind of tasks that need to be done.

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

* Get to bed at the same time each day;

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

10. Optimise your nutrition

It makes sense, that optimal recovery, repair and regeneration can only take place if you have adequate amounts of the optimal nutrients.

This means at least:

* 0.8 grams of protein each day per kilogram of your body weight if you are sedentary and up to 1.7 grams of protein per kilogram for athletes involved in football and power sports (note taking > 20 grams protein at one time results in oxidation).

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

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

* Reducing omega 6 fatty acids (e.g. processed foods, animal fats = pro-inflammatory) and increasing omega 3 fatty acids (3-4 fish meals each week, nuts etc. = anti-inflammatory and promotes cellular repair). The ratio of omega 3 to omega 6 should be 2-4: 1.

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

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

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

Please note:

• Rebates are available through your private insurance extras cover;

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

References

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

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

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

4. The Leader, September 8, 2014

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

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

7. The American Journal of Sports Medicine PDF

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

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

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How to avoid a Hip Replacement.

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By Michael Hall,

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

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

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

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

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

So what is arthritis?

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

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

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

What causes osteoarthritis?

There are many causes of osteoarthritis. These include:

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

What does hip osteoarthritis “feel” like?

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

How is hip osteoarthritis diagnosed?

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

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

How do every day postures and movements contribute to osteoarthritis?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

References

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

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

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

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

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

Please note:

• Rebates are available through your private insurance extras cover;

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

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How strength training can build muscle in oldr adults

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By Michael Hall,

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

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

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

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

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

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

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

Bodywise Health Comment

1. Your program must be safe.

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

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

2. Your program must be effective.

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

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

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

3. Your program must be fun.

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

4. Your program must be convenient.

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

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

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

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

Please note:

• Rebates are available through your private insurance extras cover;

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

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Knee surgery Vs Physio

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By Michael Hall,

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

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

Knee surgery no better than sham?

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

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

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

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

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

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

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

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

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

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

Arthroscopic surgery an option, but perhaps NOT the first option

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

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

So when should you seek surgery?

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

The final word

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

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

References

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

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

Please note:

• Rebates are available through your private insurance extras cover;

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

Read more...
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