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10 Secrets to Turbo Charging Your Strength Training Program

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In this age of blogs, podcasts, TV shows, radio programs, magazine articles and Dr Google, it is amazing just how many people perform strength exercises which are at best doing little to enhance their strength and at worst, making them more injury prone. So here are 10 principles that you can use to enhance your strengthening exercise program so that you can "Get Better, Stay Better and Live Better".

Principle 1 - No Pain No Gain Is a Myth - Train But Not Into Pain
Understand that pain means danger and to change how you are doing something or you will cause injury. To train into pain is not only foolhardy but it doesn't work. Why? Because your brain will inhibit and / or impede your muscles from contracting so that you don't injure yourself. This is called "pain inhibition". A great example of this is watching an arm wrestle. Often there will be a great struggle between opponents until one person's arm suddenly gives way.

High intensity strength (load) training should only be used by people who have been training for more than one year or with people who have trained up to this intensity during rehabilitation from injury (e.g. eccentric training for tendinopathies). It should never be used people in the acute stage of injury, beginners and / or with children (until well into adolescence).

Respecting pain is especially important when treating injuries. Use pain as your guide and remember if you always work short of pain, you will be unlikely to flare-up your injury. Having said that, there is no doubt that a progressive strengthening (loading) program is one of the key stimulants to tissue remodelling and maturation. This means that strengthening and placing tension on a repair becomes important towards the end of the proliferation phase of healing (about the 10 - 14 day mark) to align and strengthen healing fibres along lines of force.

Principle 2 - Stabilise First
"You can't shoot a canon from a canoe." In other words, you can't perform strong, dynamic movements off a flimsy and unstable base. And there are many reasons why supportive, stabilising muscles stop working as well as they should.

Remember, these are the small muscles that attach closely around each joint to hold the joint surfaces in optimum contact so that they form a strong, stable platform. The more stable your platform, the more resistance or weight that you can lift and the stronger you will get.

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

To stabilise, "pre-tension" or contract all the muscles around your joints to what is maximally comfortable. Even better, position yourself correctly by having your knees slightly bent, feet apart and on a slight diagonal. Then, stabilise your whole body by drawing your stomach in, your pelvic floor up and slightly tuck in your chin.

Principle 3 - Isolate
As mentioned above, pain, swelling and general deconditioning, can all act to stop muscles from being effectively activated. And just because you perform a movement, doesn't mean that these muscles start working again. They need to be "woken up". Research has shown that not only do these muscles need to be trained specifically to begin working normally again, but that if they're not, people will begin to substitute other muscles and use incorrect strategies for movement which may eventually lead to injury.

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

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

Principle 4 - Activate
The more nervous impulses that enter a muscle and the more effectively and efficiently muscle fibres are activated, the faster your muscles will adapt and get stronger.

Here are a 5 of tips to engaging your muscles better.
1. "Tension" or contract your muscle first to what is maximally comfortable.

2. Hold the muscle at this maximum tension throughout the movement and do not allow it to be turned on during shortening of the muscle and off during the lengthening of the muscle.

3. Perform the movement slowly engaging the muscle with maximum tension and use holds at different parts of the movement.

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

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

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

Principle 5 - Use Feedback
Mirrors are not just there to show you how good you look! Visual feedback along with the voice and touch actually play a crucial role in ensuring the correct technique, maximum activation and optimal performance that is needed for the best results.

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

It has been said that to learn a new skill requires about 300 to 500 repetitions and can take about a month. However, to correct a poorly performed skill with a better technique can take about 3,000 to 5,000 repetitions. Learn how to perform exercises and activities correctly the first time. It can save you weeks and months of poor results as well as the possibility of injury.

Principle 6 - Integrate
For better transfer of strengthening over to everyday life, isolated strengthening exercises must be followed strengthening exercises that use these muscles in functional activities. Muscles must work in co-ordination to perform an activity to achieve a result and the only way to improve at these functional activities is to practise and progress them.

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

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

Principle 7 - Automate
You can't live by thinking about activating every single muscle during every single movement. To live effectively, correct muscle activation and movement have to occur automatically and without thinking. This means that you must train your brain as much you train your muscles through performing these exercises with varying speeds, directions, amplitudes and on varying surfaces, progressing from very stable to unstable.

You must keep your brain guessing by progressively reducing feedback to the point that your brain is literally anticipating and automating muscle co-ordination and movement without the need to think about contracting muscles consciously.

Break the seven Primary Movements into their component parts and then combine them again and progress them with ever increasing levels of co-ordination, speed and agility demands. Activities such as learning to balance standing on one leg. Then progress this by standing on your toes, then squatting, hopping first up and down and then at different angles and speeds whilst catching a ball. You are only limited by your imagination.

Principle 8 - Think Anti-Gravity
There's one thing for sure as you get older and that is that it will get more difficult for you to be up straight. Take note of the posture of our senior citizens and you will get an idea of where you are heading.

There are many reasons why people might be bent forward; genetics, habits, occupations, poor balance, may all play a role. And sometimes inadvertently you can make things worse through your strengthening program. As you only see and focus on the front of your body (chest, abdominals), this means that you are more likely to strengthen the muscles that by actually pull your body further downward and inward.

It then doesn't become too difficult to know what muscles you need to strengthen; the front of your neck, your upper and lower back, your buttocks, quads and calves. If you biased your strengthening towards these areas, you will enhance your ability to be up straight as well as perform anti-gravity activities such as standing from sitting, walking up stairs and climbing.

Principle 9 - Measure, Adjust and Progress Strength Your Training

There is an old saying, “You can only manage what you measure”. Unless you take initial and ongoing measurements, you won’t have any criteria to know if what you are doing is helping or not.  You won’t really have any idea as to what is working and what isn’t and therefore you won’t have any guidelines as to how to refine your strength training to give you the best results. 

And yet, only if the effect of your strength training is monitored and measured, can it be appropriately adjusted and progressed.   

It has been said that the definition of insanity is doing the same thing over and over again and expecting a different result.  And yet, this is exactly what people do.  It doesn’t make sense to waste your time and money on doing the same thing over and over again for no change.  

If you have a strength and / or health outcome that you want to achieve, you must first define what the result that you want to achieve is, set a path for achieving your goal (Recovery Action Plan), test frequently to ensure that you are on track and make training adjustments as circumstances change to ensure that your training is maximally effective.

Principle 10 - Have Fun

Whilst exercise takes effort and energy, it doesn't have to be and shouldn't be boring. Find activities that you love to do and add some resistance and holds to them. Get outside and enjoy the great outdoors. Rock climbing, stair / ramp climbing (1,000 steps) and walking / jogging with strength interval stations can all be great fun. Mix it up. Explore different locations and different surfaces. Ever tried to walk or jog in soft sand? Go trail walking or running. Find a friend to share your training with and you might just double the fun. Not only is variety optimally beneficial for your body, it is healthy for your mind as well.

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

If you want to overcome injury, if you want to eliminate pain, if you want to get your health and your life so that you can begin enjoying your life more, call Bodywise Health on 1 300 BODYWISE (263 994) for a complimentary*, no obligation assessment and Recovery Action Plan from one of our expert physiotherapists.

We look forward to helping you get your life back.

Until next time, Stay Bodywise,

Michael Hall
Physiotherapist, Director
Bodywise Health

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

* For complex or chronic conditions, you may qualify for the CDM (Chronic Disease Management) 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).


How to turn back your body clock, 
become pain-free and,
regain your strength and agility, 
in as little as 6 weeks
 Does This Sound Like You?
You’ve had a nagging pain in your back, neck, shoulder, knee or some other part of your body for at least a couple of weeks if not months.  You either can’t remember how it came on or it came on with the most minor of movements like getting out of the car, gardening or reaching forward to pick up something.  It’s not getting better.  You check out Dr Google.  There seems like it could lots of possibilities.  Perhaps it’s this problem or that.  You don’t what to get it wrong or do the wrong thing. 
You go and see your doctor who doesn’t even look at where you hurt but says to take these medications and that your pain will get better in time.  You take the medications.  They help take away your pain – for a short time.  But in the process they bind you up and make you feel awful.  
You go back to see your doctor who sends you for an x-ray, ultrasound, CT or MRI scan.  The scan costs a couple of hundred dollars but at least you will find out what the cause of your pain is right.  Wrong! The scan findings are grim. You have arthritis, degeneration, a bulging disc, a torn tendon or “bone on bone”. Then you find out that often at least 40% of people who have no pain have these same findings.  What’s going on?  
You return to your doctor who wants to send you to an orthopaedic surgeon.  Hang on.  Who said anything about surgery?  You don’t want surgery.  It involves going to hospital, being put under a general anaesthetic, pain, medications and weeks if not months of recovery,  all with the high possibility of staph infections and complications.  
You ask your doctor is there something else you can do.  Your doctor tells you that you could try a cortisone or PRP injection. What you’re not told is that there is little or no evidence for these injections and that at best they offer short term relief and at worse can make your condition worse as without your pain, you continue to re-injure your problem. It seems like a quick and easy fix, so you think that you will give it a go.  You rock up and have the injection perhaps under the guidance of ultrasound. It’s painful, but not as painful as the thousand or so dollars that it costs.  Thank goodness, after a few days you finally begin to feel some relief.  Pity it lasts just a few weeks, before your pain returns.
You begin to feel a pang of desperation. Time is marching on.  Perhaps you won’t get better.  You’ve spent hundreds, if not thousands of dollars, seen a number of doctors and medical specialists and still no result.  In fact, your pain is the same and / or worsening.
You speak to your partner or friends and they tell you that they know a chiropractor, osteo, physio or massage therapist who can help you.  But you’re not sure about chiropractors.  You’ve heard stories about getting cracked and people getting hurt.  Then someone else says to go and see their osteo and another says to go a see their physio.  What’s the difference?  Who do you trust?  You’re worried that you might end up on some never ending cycle of treatment and you don’t have the time or money for that.  You just want to get better and get back to normal without having to take medication or see a therapist for the rest of your life.  It all seems so confusing, so hopeless.  

Why You Haven’t Got Better and What You Need To Do About It!
Let’s face it, we all want a quick fix.  There is nothing better than the miracle cure where you get up off the bed and say “I’m better!”  And it does happen - occasionally.  It takes no work, it takes no effort, it is great value for money and it’s quick.  But as opposed to what modern medicine might have you believe, it is the exception rather than the rule.Why?  Because it takes time for body tissues to heal, for treatment /training effects to occur and for new correct physical habits to become engrained.  In other words, it takes work, discipline and perseverance.  But on the plus side, the benefits can include a lifetime of being pain-free, stronger, more agile and with an increased capacity to perform everyday tasks.  Worth it don’t you think?  So why don’t people get better?  The mistakes includes:
Not reducing bleedingNot many people recognise this, but “bleeding” is the first phase of healing. Following bleeding, a number of substances are left which later become the platform for the adhesion of cells.  The problem with bleeding, is that if left unchecked, it can reduce blood flow and prevent oxygen, nutrient exchange as well as limit waste removal.  
Also, the more blood that seeps into the tissue, the more blood that has to be broken down by the immune system (more on this next) and therefore the longer that this takes, thus slowing down the whole process.
Not controlling inflammation (Demolition Company)“Inflammation”, it gets so much bad press. Anyone would think that it was evil and that we should get rid of it.  And yet, inflammation is an immune response that is essential for healing.  You see, your immune system has two purposes.  
The first purpose is to defend the body against infection or anything that may do damage.  The white blood cells do this by eating and ingesting the substance.  
The second purpose is to act like a demolition company. When the tissues of the body have been injured and damaged, the white blood cells use this same process to remove the damaged cells. It is a breaking down process where the white blood cells of your body “ingest” the damaged cells.  Ask anyone. Is it easier to build a new house on a cleared block of land, than it is to renovate a broken down house and they will always say that it is easier to build on cleared land.  It’s the same for your body.  It is much easier to lay down new tissue with all the debris removed than to try a build on top of fragmented remains.  As such, inflammation is critical for healing to take place.  
So why do we take ant-inflammatory medication?  Because inflammation is a process which is prone to overshoot and in so doing begin to “break down” healing and healthy tissue.   It therefore needs to be controlled, otherwise it can delay and even prevent healing.
Not creating a healing environment (Construction Company)Repairing and regenerating your body is akin to building a house.  You need the right conditions, the right workers and the right materials.  Trying to building on shifting sand, during a cyclone, with unskilled people and without concrete, wood and steel is prone to failure.
Similarly, expecting the body to heal when you have raging inflammation (breaking down cells), a flood of swelling, re-injury occurring, poor nutrition (inadequate protein, vitamin C and continuing to take ant-inflammatory medication), and while you are feeling stressed, depressed (cortisol), tired (not sleeping) and sick, is just not realistic.
To heal optimally, your body needs the right environment.  This means controlling inflammation, minimising swelling, reducing tissue tension, preventing re-injury, optimising load, priming blood flow, enriching nutrition and enhancing your stress levels is critical.  And these processes must be continually monitored and adjusted for so that your healing environment remains optimal for facilitating the best, fastest repair possible.
Continuing to re-injure your injury (Picking the scab)Think about it.  Your body’s natural default is to heal.  Cut yourself and it heals.  So why is your back, neck, shoulder, hip, knee injury or any other injury any different? If you continue to pick a scab, does a wound heal?  No.  Then why do we expect an injury to heal if we keep hurting it?  It doesn’t make sense and yet this is exactly what often happens every day.  
In fact, we aid and abet re-injury by taking pain medication and removing this one indicator that alerts us that we are re-injuring our bodies.  Pain is good (at least initially) in that it tells us to change our behaviour so that we stop hurting ourselves.  Without it, we would injure our bodies and not even know it (this is what happens with leprosy).  
We don’t want to experience pain, because it is doesn’t feel good.  But this is exactly the point.  It is doesn’t feel good so that we change what we are doing.  However, instead of altering our behaviour (which takes work and may be inconvenient), we stop listening to what our brain is telling us, try to ignore it and in the process continue to hurt ourselves.
Getting only passive treatmentBy passive treatment, I mean treatment where you don’t have to do anything.  It is treatment which is done to you.   Whether you get just hands on treatment from a physio, chiro, osteo, remedial massage therapist, will likely achieve just temporary improvement (days).  Likewise medication, injections, dry needling, acupuncture and even surgery may achieve short term results (days to weeks).  Why?  Because you haven’t dealt with the cause of your pain.  
We know that the cause of 97% of back pain is mechanical.  This means that it is due to excessive or abnormal physical forces acting on your back which are beyond your body’s capacity to adapt in a healthy way.  This leads to cellular irritation, inflammation, tissue break down, swelling, stiffness and pain.
If your back pain is caused by the fact you have a stiff ankle, knee or hip and that you twist awkwardly every time you get out of the car, using passive treatment is not going to fix the cause.  Passive treatment will alter your internal body forces (and biomechanics) for a short time only before you aggravate your back again as you get out of the car.  
The same goes for anytime where one part of your body is not moving optimally.  In these instances, another part of your body has to move differently from which it was designed to do to compensate for the not ideal movement elsewhere.  This will always lead to excessive or abnormal forces on your body.  It then becomes not a question of if you will develop a pain syndrome, but when you will develop a pain syndrome.  The variables of the intensity, volume (number of times) and duration of the abnormal or excessive forces as well as the adequacy of recovery your own personal characteristics (age, health, nutritional status, weight etc.), will simply determine how quickly you begin to feel pain.   But you will feel pain.  It is guaranteed.  
There are times however, when you may have a structural and an anatomical problem like having one leg longer than the other, excessively flat or arched feet or a disc herniation which is pressing on a nerve.  These do require structural as well as behavioural solutions like orthotics, surgery and behaviour modification.
Don’t get me wrong.  Passive treatment is important for helping to create a healing environment. It helps to reduce swelling, control inflammation, unstiffen stiff joints, loosen tight tissues and relax you both locally (where the injury is) and more holistically.  And when you think about it, you tend to feel best and healthiest when you feel relaxed.  Passive treatment lays the foundations.  You still however, need to build your framework.  
Only doing exercisesNone of us doubt the benefits of exercise.  It has been stated, that if exercise were a drug, it would be the greatest drug ever developed, with more far reaching, positive effects on the body that any other medication ever developed.  
However exercise can also be damaging.  Performing the wrong exercise, in the wrong way, at the wrong intensity and at the wrong time, can worsen an injury.  Getting back to the cut analogy, a sprain is simply a tear of a ligament or joint capsule (tissue holding a joint together), whilst a sprain is a tear of muscle or tendon.  If you have a cut or tear, what would happen if you pulled it apart?  It would re-tear again wouldn’t it?  So why do we stretch muscle strains?  Yes, following stretching you do feel good for a short time, as the lengthened tissue has reduced tissue tension.  However, if you follow the long term history of people who just stretch, you will find that they never tend to get better.  
Stretching lengthens tissue and any lengthened tissue has a tendency to be weak and to lead to poor dynamic control (alignment) of joint surfaces and instability, thereby setting you up for more problems. 
Similarly, attempting to over-ride your brain and strengthen inhibited muscles (muscles which the brain is trying to shut down to protect you) and go too hard, too early can also aggravate an injury.  
Additionally, strengthening the wrong muscles such as prime mover muscles (big, powerful muscles which attach a long way away from the joints that they move) as what Keiser training tends to do without first developing the platform upon which these muscles pull, is like “shooting a canon off a canoe”.  The movement produced will be weak, ineffective and potentially injurious.
Finally, strengthening the wrong muscles can lead to further muscle imbalances and worsen faulty postures and movement patterns, thus perpetuating the causes of an injury or creating other problems.  
Yet, the evidence indicates that exercise is an essential part of recovery.  As passive treatment is likely to lead to short term improvement, exercise is likely to medium term improvement (weeks to months). And so, if exercise is to be optimally employed as a treatment modality, there must be some strategy or guideline behind what, how and when it is employed.  Doing exercise for exercise sake is not going to give you permanent results.  Sustained results will only be achieved when exercise is fused with function to correct what are often the causes of posture / movement based problems in the first place and that are the faulty postures / movements themselves. 
Only doing movement / posture trainingIf the cause of most physical pain syndromes are excessive or abnormal forces due to faulty postures or movement patterns, then it makes sense that if you concentrate on correcting your posture and movement patterns then you will fix the cause of the problem.  And truly that is the end goal.  
However, if you don’t have the passive treatment first to facilitate healing and restore joint mobility and then do exercise work to re-establish muscle control, strength and endurance, then no amount of wanting to correct your posture and movement will work because:
1. Your injury is unlikely to have healed optimally;2. You won’t have the joint mobility or muscle control to adopt new correct postures and movement patterns;3. You won’t have the muscle strength and endurance to maintain new correct, postures and movement patterns;4. You won’t have something preventing you from adopting faulty habits and reminding you to perform them correctly.  
And if don’t perform the correct postures and movements for at least 3,000 to 5,000 times or at least for 3 to 6 weeks, they won’t become engrained enough to become habits that you do without thinking.  Over time, you are likely to revert back to your old incorrect habits and thereby causing your problem to re-occur.
Not sleepingIf you are anyone who is in chronic pain if they sleep, their answer is generally no or poorly.  Sleep is critical for the body to heal, renew and refresh.  Without it, all functions of the body begin to be adversely affected. The nervous system becomes more hypersensitive.   You don’t digest food as well.  Your immune system becomes activated causing inflammation. A “Fight or Flight” response is triggered. All these reactions are the opposite of what should be happening when you are asleep and that is growth and repair.  In this environment, healing becomes almost impossible.
Over stressedClosely related with not sleeping is being “over stressed”.  Stress causes the release of the hormone cortisol.  Cortisol and adrenalin both activate to stimulate the body to be ready for action in the Fight or Flight response.  Blood is shunted away from the digestive system to the muscles.  You breathe quicker. Your pulse races. You become more alert.  You may perspire.  Again, all these responses are the opposite of what is needed (at least initially) for growth and repair.
Not eating correctlyThis is one of the most over-looked aspects of healing, despite eating and food being a national past time.  And yet, ensuring that you are having the correct nutrients may have have a profound effect on the rate and quality of your healing. The opposite is also true.  Eating foods that increase inflammation or which provide no building blocks for tissue repair, may prevent, slow or at least impair healing.
Taking advice from too many people It’s a common problem.  If you are injured or in pain then it seems everyone you come into contact with will offer you advice whether you have asked for it or not.  Comments such as, “Oh, I have had your problem and this is what worked for me”; or, “I know this therapist and they are a guru”; or, “I read recently that this is the best way to treat your condition”.  
If you go to 5 different health professionals and it is likely that you will get 5 different diagnoses and treatment plans.  And if all else fails and you are not completely confused, you’ve always got Dr Google.
So how do you know who and what to believe?  First and foremost, you need to understand that you are unique and therefore you need to have you and your unique circumstances taken into account.  Dr Google can never do this!  It can only be adequately accomplished by having a comprehensive professional assessment and examination.  
Forget all the do-gooders.  Whilst their intentions may admirable, their advice may do you more harm than good.  In the end, they don’t have the experience nor the knowledge to adequately advise you.  Seek advice from someone who has is qualified, has stood the test of time and has a proven track record in getting results.  

Getting the wrong investigations at the wrong timeX-rays, ultrasound, CT and MRI scans are important, but they must be taken in context or they can be more confusing than helpful.  
With lower back pain, it is well established that most imaging findings, particularly degenerative changes, correlate poorly with clinical presentation.
For example, MRI studies of healthy adults with no history of upper or low back pain found that 47% had disc degeneration, 53% had disc bulges and 58% had disc tears in their thoracic spine.  
For shoulder pain, MRI studies of adults who have no shoulder pain show that 20% have a partial rotator cuff tear and 15% have a full thickness tear.  In those 60 and older with no shoulder pain or injury, studies have shown that 50% (half) of people have a rotator cuff tears on their MRI’s that they didn’t know about.
With hip scans it has been established that there is only a weak association between joint space narrowing as seen on x-rays and actual symptoms.
It is a similar story for knees, with studies showing that up to 85% of adults with no actual knee pain have x-rays that show knee arthritis.  Another study showed that 48% of professional basketballers without knee pain had meniscal (cartilage) “damage” on their knee MRI’s.
There are times however, when it is critical to have further investigations.  These times include:
1. If there has been a history of trauma or external force causing an injury, investigations are needed to shed light on the full extent of the injury;2. If your assessment points to a more sinister cause of your problem (e.g. cancer; inflammatory diseases; visceral issues; frank pressure on a nerve);3. If you are not getting better or there has been no improvement in your condition within 3 weeks of treatment.
These research findings indicate that x-rays and scans must be taken in context and be interpreted in the light of your circumstances, your history and your physical examination.  
Only then can x-rays, scans and further investigations bring the full truth on source and cause of you problem as well as a potential treatment solution.
Getting treatment from too many different health professionalsLike getting advice from too many people, getting treatment from too many health professionals can waste your time and money as one treatment might against another treatment.
This is particularly the case when these health professionals are from similar backgrounds.  For example, let’s say you are seeing a physiotherapist who is providing you with stabilisation exercises because they believe that it is uncontrolled movement which is causing your problem.  Improvement is slow, so you begin to see a chiropractor who believes that your back is “out” and so begins to perform spinal adjustments.  These two treatment techniques provide outcomes which are the direct opposite of each other; stabilisation exercises provide stability and adjustments promote mobility.  So who’s right?  You will never know because the effects of one treatment might cancel out the effects of the other treatment therefore providing you with no result.  What’s more, you won’t be able to determine what’s working and what isn’t.
The one time that it might be better to get treatment from more than one health professional is if the health professionals involved are working together as a team and with a treatment strategy to deliver you complementary techniques so that you achieve a faster result.  For example, a physiotherapist might deliver a physical strategy, a dietician a nutritional strategy and a psychologist a mental strategy.  Together, they may be to deliver you a better, faster result than if they worked alone.  
Generally though, it is better to follow through treatment with one health professional before switching to another.  How long should you wait before you switch?  Ask the health professional.  Only then can you hold them to account and know if you are wasting your time and your money.  For me, I generally tell my patients that I expect to experience significant improvement within three weeks for moderate conditions and six weeks for severe conditions.  If they haven’t, I refer them to someone else who I believe might be able to assist them further.
Having no strategic treatment plan for achieving the results that you wantIt was Winston Churchill who said that “He who fails to plan, is planning to fail”.  
But let me ask you this question?  When was the last time that you were provided with a written treatment plan detailing the source and cause of your problem and a road map to getting better complete with milestones, a timeline and an achievement date?  My guess is never or rarely.  And yet, if you don’t have any strategic plan to get better, treatment may then become a hotch potch of treatment techniques, delivered with a scatter gun approach.  
If there is no written strategic treatment plan, there is no forethought about how to achieve both short term (this session) and long term (completely better) goals in the best, fastest way.  With no written plan, how can any consideration be given to what treatment techniques, in what combination and with what timing that may be applied synergistically to magnify the individual effects of each technique to achieve a better result in two thirds or perhaps half the time?  How can you understand and know the big picture of how you can help with your own recovery, if you are not sure where you are going?  The simple answer is you can’t.
The more common scenario is for a treatment technique to be applied in the hope that it helps and if it doesn’t, something else will be tried.  And this approach is repeated until hopefully something works.  There are so many specialists all dealing with the own area of specialty but oblivious to the possibility that other parts of the body may be causing pain or dysfunction in their specialised area. Is it no wonder that often problem returns after a short time?
The body is made up of many systems all working together to produce a result, that is enabling you to live, survive and thrive in a changing and unpredictable world.  Treating the body as separate compartments at best will provide you with short term improvement and at worst no improvement at all.  To achieve the best outcome possible, you need a written strategic treatment this question plan, period. 
Not measuring the effect of your treatment programAnother reason why people don’t get better, is they have no idea what is working and what isn’t.  There is another old saying, “You can only manage what you measure”. Unless initial and ongoing measurements are taken, you won’t have any criteria to know if intervention is helping or not.  You won’t really have any idea as to what is working and what isn’t and therefore you won’t have any guidelines as to how to refine your treatment to give the best results. You may have a vague idea that something might be helping, but you won’t be able to identify accurately what it is.  You may be in fact wasting your time focusing on treatment techniques that have little or no positive benefit and you won’t know it.
Not adjusting and progressing your treatment programFollowing closely behind not measuring your treatment program is not adjusting or progressing your treatment program.  And yet, only if the effect of treatment is monitored and measured, can it be appropriately adjusted and progressed.   
Worse still, many people attend for the same treatment over what can sometimes be many years for little or result.  If you have a health outcome that you want to achieve, you must first define what the result that you want to achieve is, then set a path for achieving your goal (Recovery Action Plan), measure frequently to ensure that you are on target and make treatment adjustments as circumstances change.
As the saying goes, the definition of insanity is doing the same thing over and over again and expecting a different result.  And yet, this is exactly what people do.  It doesn’t make sense to waste your time and money on doing the same thing over and over again for no change.  



How to Know When to Return to Sport

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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).

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.
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.


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).
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.

How to Rescue Your Arthritic Knee from a Knee Replacement

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Until next time, Stay Bodywise.

Best Wishes,

Michael Hall

Physiotherapist, Director Bodywise Health

Please note: 

* Rebates are available through your private insurance extras cover;

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

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


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