Menu

1300 bodywise (263 994)

How To Eliminate Physical Deterioration With One Exercise

Pilates 2 02 CC
 
“Don’t get old”. It’s a comment that I hear almost daily as people complain of the aches and pains that seem to accompany ageing. 
 
But it’s a comment that doesn’t just come from people in their senior years. Increasingly, people in their twenties and younger are complaining of “ageing” aches, pains and injuries.  
 
Injuries that were once seen in people older than the age of 50 are now appearing in secondary and sometimes primary school students.
 
Children as young a 8 have presented with neck pain, upper back pain and / or lower back pain that is often associated with a stooped, froward bent posture pain.
 
All of these postures are seen in elderly people and are indicators of physical ageing.
 
These are also postures that are related to excessive tablet, phone and computer use. 
 
You can now understand the tidal-wave of physical problems that is coming with the introduction of these new technologies.
 
That’s why it is so important to deal the physical effects of ageing. Because the aches and pains that come on for no apparent reason are often lead indicators to more severe “ageing” problems down the track.  
 
Whilst the prospect of getting older may not be inspiring, the beauty of ageing is that it is largely predictable. And if ageing is predictable, then it means that you have an opportunity to influence how you age.
 
You see, you often hear about the brain being “plastic”. Books such as “The Brain Which Changes Itself”, points to your brain’s ability to adapt and re-wire itself in response to not just your changing reality but your changing perception of reality.
 
What you don’t so often hear about is that your body is “plastic” too. It would be just as valid to write a book on “The Body Which Changes Itself”. 
 
In other words, as your brain adapts to changes in life, so too does your body. Not only that, but changes in the brain cause changes in the body and vice versa.  
 
If you have ever seen someone who has suffered a head injury, spinal cord injury or even someone who is stressed and anxious and you will see that their body has changed in response to these injuries and even their perceived environment. There is even an association between posture and depression. To read the full article, click here
 
The reason is that changes in the nerve impulses and hormonal input into body tissues and structures changes the composition of your body tissues and structures. 
 
In fact, every physical, nutritional and even psychological force has an effect on your body. One look at the amazing body transformations that accompany physical, nutritional and psychological training in shows such as "Ninja Warrior" or "Extreme Makeover" and it is immediately evident as to how malleable your body is.
 
Here in lies your hope. The fact that your body and your health is so pliable to the forces that are applied to it, means that you can use these forces to help you can overcome injury.
 
The bad news is that ageing is impossible to stop. The good news is that whilst ageing is impossible to stop, the adverse effects of ageing can be minimised and sometimes reversed if you know what they are going to be and what forces you need to apply.
 
A word of warning though. You must deal with these adverse changes early enough before they become structural and very resistant if not impossible to change.
 
 
Why Ageing Occurs
 
At each moment in your life, your cells are continually dying and replicating themselves. Ageing occurs, because each replication is not exactly perfect. Therefore, over time, minor defects and faults are built into the replicated cell. Ageing is therefore not a disease or a pathology but a natural process. To read more, pleaseclick here
 
 
The Physical Effects of Ageing
 
It’s easy to see the physical effects of ageing. One just has to observe the elderly people around you. 
 
There are 7 classic and postural changes.
 
  1. Head forward posture = Stiff neck joints; Tight/stiff neck extensor muscles and weak/stretched deep neck flexors.
  2. Rounded upper back = Stiff upper back Joints and weak/stretched upper back extensors.
  3. Forward movement of the shoulders = Tight/stiff chest muscles; Weak/stretched middle shoulder blade muscles.
  4. Flat lower back = Stiff lower back joints and weak back extensor muscles.
  5. Bent hips (in flexion) = Stiff hips, tight/stiff hip bender muscles and weak glute muscles.
  6. Bent knee (in flexion) – Stiff knee joints, tight/stiff hamstrings and weak/stretched thigh (quadriceps) muscles.
  7. Flattened (pronated) feet = Stiff ankle joints, tight/stiff calf muscles, weak foot muscles and excessively mobile foot joints.
 
 
How to Reverse the Effects of Physical Ageing
 
To reverse the effects of physical ageing must involve a holistic approach.
 
Physically, it must mean freeing up the stiff joints of your neck, upper back, shoulders, lower back, hips, knees and ankles.  
 
This is best achieved with hands on joint, muscle, nerve and soft tissue freeing up techniques.
 
Exercises are simply not specific enough to target individual joints. What tends to happen with exercise, is that the joints which are more mobile will move first whilst other joints that don’t move will get stiffer,thereby perpetuating the problem.
 
The positive effects of hands on techniques must be reinforced with very precise exercises that both stretch the tight/stiff joints and muscles whilst strengthening weak/stretched muscles.  
 
We know that if you stretch any tissue for 20 minutes that it takes at least 40 minutes for it to return to its pre-stretched characteristics. We also know that you can shorten a muscle by exercising it in a shortened position. What these techniques effectively mean is that you can muscle-bind your body to change its shape and alignment. 
 
The great news is that achieving this outcome doesn’t have to involve multiple exercises. The reason for this, is that if you strengthening one muscle on one side of a joint through full range then you must also be stretching the muscle on the opposite side of that joint.
 
For example, if you strengthen your deep neck flexor muscles (to reverse the forward head posture), you will decompress and stretch the muscles and joints at the back of you neck.
 
If you strengthen your upper back and shoulder blade muscles (to straighten your upper back), you will stretch your chest muscles.
 
If you strengthen your lower back muscles (to normalise the curve in your lower back), you will stretch your upper abdominal muscles and hamstrings.
 
If you strengthen your glute muscles, you will stretch your hip benders (flexors).
 
If you strengthen your front thigh muscles (quadriceps) then you will stretch your hamstrings.
 
 
The One Exercise that Can Reverse the Adverse Postural Effects of Ageing
 
I have had the privilege of treating an amazing lady called May. I treated May regularly from the age of 98 to when she passed away at 108. In that 10 years, we were able to achieve the amazing feat of May never having to go to hospital or a nursing home (except for respite or non-physical conditions). For the full story, please click here
 
Knowing that it was more difficult for May to move from position to position and that she couldn’t do a lot of different exercises, I devised one exercise that addresses all of the adverse postural changes of physical ageing.
 
Knowing that May would be lying in bed twice a day (morning and night), her exercise was this. Lying on her back with her feet hip width apart and her arms by her side, she was instructed to tuck her chin in slightly, turn her hands outward as well as turn her feet outward before pulling them back.
 
Then tightening her buttock muscles and pushing down with her arms and her heels, she slowly lifted her buttocks off the bed to a comfortable height for 5 seconds, held it up for 5 seconds and then lowered for 5 seconds before repeating this movement.  
 
May started with 5 of these movements morning and night and progressed up to 10. 
At this point, May progressed the exercise by spread her feet and arms slightly wider apart and returned to doing 5 movements again. She then progressed the number of times that she performed this movement up to 10 again before repeating this procedure.
 
This is a great exercise because it retracts the neck, straightens the upper back and shoulders, restores the lower back curve, stretches the front of the hips, strengthens the thigh muscles and stretches the calves.
 
Do this every morning and night and you will notice a difference, guaranteed.
 
One caution though! Before you begin doing this exercise, it is advisable to be assessed by a physiotherapist here at Bodywise Health to ensure that arching your body will not cause any pain or aggravate any condition. There are pathologies such as Canal Stenosis or Spondylolythesis where arching your back will make your pain worse.
 
Retarding and / or reversing your physical ageing process can be as easy as doing some easy exercises in bed, morning and night. 
 
If a 108 year old lady can do it, so can you. 
 
Happy exercising!
 
Wishing you the best of health and life.
 
MICHAEL HALL
Director, Physiotherapist
Bodywise Health
 
For more information on how Bodywise Health can help you to overcome your pain, please call Bodywise Health on 1 300 BODYWISE (263 994).
 
Please note:
 
  • Rebates are available through your private insurance extras cover;
 
  • For complex or chronic conditions, you may qualify for the 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).
 
References Available on Request
 
Read more...

How to Reverse Ageing, Prevent Osteoarthritis and Stay Active, Agile and Independent

Interview 008

It’s the holy grail of healthcare. How to turn back the effects of time on your body so that it doesn’t wear out and / or “groan” from the cumulative strain of a lifetime of life forces.

Imagine ageing without any associated physical pain. To contemplate such a possibility is almost absurd.

And yet, in theory and proven in real life, this possibility can become reality.


An Amazing Story About an Amazing Person

Let me explain.

May presented for treatment of her lower back pain at the age of 98. From her assessment, it was clear that May experienced back pain when she was sitting. Consequently, I recommended that May place a lumbar roll (back cushion) in the small of her back while she was sitting.

May then informed me that none of her chairs had a back on them as she only sat on stools. In other words, the cause of May’s lower back pain was the fact that she sat on stools with a slouched posture. Once corrected, her pain resolved within a couple of weeks.

It was then that I asked May “How would you like never to have to go into hospital or into a nursing home for the rest of your life?” to which May replied “Yes please”.

So we set about implementing a treatment program that would address and counter all the physical effects of ageing – the stooped posture, the specific muscle imbalance, joint stiffness, loss of balance and the faulty performance of everyday activities.

And you know what? We achieved it! Who would have thought that I would be treating May on and off for another 10 years. In that time, she never went to hospital (except for unrelated non-physical conditions) and never went to a nursing home (except for occasional respite).

Even more amazing was that May never had a hip replacement, nor a knee replacement and up until the last month of her life, she was still going out and playing bingo three times a week and catching up with her grand-children and their friends every Saturday for lunch.

What’s more, May lived at home independently at home until she passed-away surrounded by her family and friends.

It’s an incredible story about an incredible person. For me it was an absolute privilege and a great learning lesson.

Now, you might say that May had great genes and that might be the case. But, I like to think that the treatment program that we implemented also positively impacted May’s physical health so that she could stay mobile, independent and be able to perform her every day activities without limitation or pain.

Her story changed my perspective that getting old didn’t have to mean becoming disabled and dependent.

How could it be possible though to live to 108 and not need a joint replacement, let alone remain active and independent?


The Secret to Preventing, Reversing or At Least Slowing Ageing

The answer has to do with your body’s ability to heal and adapt to physical forces.

You see, your body is constantly changing with the forces being applied to it. Apply force that is within your body’s physiological limits and it will adapt positively by getting stronger, more resilient and / or more flexible. Apply forces that are outside its physiological ability to cope, it will cause breakdown of tissue. Apply no force and your body will waste away.

Your body actually lays down tissue wherever and whenever stress is applied and removes tissue whenever stress is taken away. Stress muscles, they get bigger. Remove stress from muscles, they get smaller. That is why it is often said “use it or lose it”.

The key to preventing, reversing or at least slowing osteoarthritis and the “ageing” of joints has to do with a concept called “The Path of Instantaneous Centre of Rotation”.

Many of the joints in your body are “ball and socket joints”. One end of the bone is like a ball that fits inside the hollow socket of the adjacent bone. And what “The Path of Instantaneous Centre of Rotation” means is that the axis around which the ball moves is perfectly located in the centre of the socket at any and every instant, no matter what position the joint is in or what movement your body is performing.

In this scenario, your prime mover muscles act like guidewires, pulling on your bones to move your body whilst your stabilizing muscles constant, precise tension keeps your joints in optimal alignment.

If one muscle is used more often as with performing a routine movement, it is likely to get stronger and pull earlier than the surrounding muscles. Likewise, if you stretch soft tissue for 20 minutes such as if you adopt a slouched posture, it will take at least 40 minutes for that tissue to regain its normal, pre-stretch characteristics.

Both these “adaptive” processes lead to muscle in-coordination, faulty bony alignment, joint stiffness or instability, inflammation and tissue breakdown. Once this process has begun, it is perpetuated and reinforced as these postures and movements become habits.

On the other hand, a variety of stresses such as what occurs with different postures and movement patterns, leads to ideal joint alignment and muscle balance.

Think about it this way. Imagine that your spine is the rim on a bicycle wheel and the spokes are your muscles. Pull too hard on one of the spokes and the rim is pulled out of shape. To pull the rim back into alignment, you need to tighten the loose spokes and loosen the tight ones.


How to “Reverse” Ageing

The same is true for your body. To “pull” your body back into ideal alignment, you need to tighten (strengthen) the loose muscles and loosen (stretch) the tight ones.

Likewise, your stiff joints need to be “freed up” with hands on techniques and your unstable or hypermobile (excessively mobile joints) need to be stiffened through the use of taping, bracing or by improving the control of your stabilising muscles.

Therefore, if you know the degrading effects of ageing (just have a look at the elderly people around you), then it becomes obvious what joints you need to free up (e.g. back, hips, knees and ankles), what muscles you need to strengthen (e.g. mid and lower back, gluteal and calf muscles) and what postures and movements (e.g. sitting, standing, squatting, walking) that you need to correct to reverse this process.

To reverse the ageing means to reverse this process of becoming stooped, stiff and dysfunctional. To achieve this isn’t necessarily difficult, but it does take a disciplined and graduated program of “hands on” techniques, specific muscle training and posture and functional movement correction.

No one technique or facet of treatment or training will achieve this end result by itself. It must involve a sustained, coordinated approach for at least 4 to 6 weeks.

Why? Because it takes at least 4 weeks for muscles to strengthen and for new posture and movement habits to form.


Do You Have a Software or Hardware Problem?

Having said all of this, you might be unable to achieve ideal forces on your body, simply because of the way that your body is.

You may have been born with one of many physical variations such as a long leg, a twisted spine, a bent back, a flat back, a Pidgeon chest, curved shin bones, high arched or flat feet.

In this case, you have a hardware or structural problem and no amount of treatment or training is going to absolutely correct this. Treatment and training may help bring your body back within normal limits, but it will never “perfect” your body’s\ alignment or mechanics.

For a structural problem, you need a structural solution such as an orthotic, a brace and sometimes even surgery. Although, in most cases, it is safer, cheaper, safer and more effective to start with the least invasive approach first. Surgery should be the last option when all else fails.

These structural variations may be genetic and therefore may be something that you can’t do much about.

However, in many cases, you may have a software problem. By this I mean that it may be a your core stability, body co-ordination, posture and movement habits as well as your diet, self-identity, perception and / or your way of thinking that lead to physical pain and ageing.

Left untreated for long enough and these software problems can become hardware problems as your body adapts to life forces and these adaptations become fixed.

This is why it is always better to be seen earlier rather than later and to have a complete and professional physical and functional examination to determine causes and identify sources of your pain and / or dysfunction.

How you age to a large extent is up to you. What will you choose? To stay active, independent, involved and connected or to become disabled, dependent and dysfunctional.

The choice is yours.

I hope that this helps.

If you have any questions or would like any advice, instruction or perhaps a complimentary, no obligation physical or injury assessment, please call 1 300 BODYWISE (263 994).

In the meantime, I wish you the best of health and life.

Michael Hall
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).

References Available on Request

Read more...

2 Myths That Will Prevent Your Full Recovery

Body wise 291011-191-Edit-Edit CC
 
It is amazing!  
 
Today, we have more health apps, exercise gadgets, computerised movement machines and wellness technology for every man, woman and child than at any time in human history.  
 
Instantaneously, we can know everything from how many steps we have taken, to how many kilojoules we have burned, to how we slept, to our resting and exercise heart rates.
 
We have a pill or supplement for everything, whether it be to improve our health before we were born, to increasing our libido, improving sleep, building muscle, lowering stress, you name it.
 
We have more gyms, health clubs, personal trainers, exercise physiologists, boot camps, pilates studios, dance studios, gym studios, spin clubs, sporting clubs than ever.  
 
Likewise, there are more doctors, physiotherapists, osteopaths, chiropractors, myotherapists, remedial massage therapists, acupuncturists, podiatrists, Alexander Technique therapists, Feldenkrais practitioners, dietitians/nutritionists and naturopaths per capita than ever.1 And yet, the number of people getting scans, taking pain medication and having joint replacements, PRP injections and cortisone injections has never been higher.2
 
Take note as you drive or walk around any suburb and you will find a plethora of health-care places. Anyone would think that we are the sickest, most in pain, most dysfunctional generation of people, ever.
 
What is going on? Despite these so called health advances, the incidence of physical and mental illness and injury is not improving.3
 
And if you don’t care now, you will when your healthcare and life / income protection insurance premiums, as well as your taxes (Medicare rebate) go through the roof in an attempt to cover the explosion in healthcare costs that is happening and likely to increase in the future.  
 
Possibly the two greatest untrue myths of this crisis are our quick fix mentality and our blinkered, isolationist approach to healthcare.  
 
Let’s face it, modern sports medicine would have you believe that to get better you need to get a scan, have surgery and voila, you will be better.
 
Often, we are left with the impression that tissues and structures have magically healed. And it leads to the logical conclusion that we should also expect the same miraculous cure if we get injured.  
 
Very rarely however, is there any mention of the extent of the injury, the amount of treatment (often many times each day), ongoing injections and pain medication that an athlete may be taking as well as what the long term effects of the injury might be. 
 
Implied in this myth is that pain is the enemy. Pain medications, injections and even surgery tend to give the sense that pain must be avoided at all costs. And yet, legitimate pain is an essential aspect of healing. Why? Because legitimate pain, or pain that is logical, reasonable and purposeful, changes behaviour, in a positive way that facilitates healing. In fact, there is no more potent changer of behaviour than pain. 
 
Legitimate pain is like the warning lights on your car dash-board. Like these warning lights, legitimate pain indicates that something may be wrong. With your car you know that if you keep driving you risk doing major damage to your car.  
 
However, unlike our car warning lights, when we experience pain, we often try to ignore or repress it so that we can keep going, putting us at risk of further injury. And then, we wonder why our injury hasn’t healed and / or has worsened. It just doesn’t make sense.
 
Understand that the longer that you have had your problem and the more severe that it is, then generally the longer that it may take to get better.  
 
Hence, it is probably unrealistic to expect that if you have had your pain for longer than 3 weeks or longer, that it going to be better in one or two sessions. The reason is that not only has your injury not healed, but your body, brain (neural pathways) and even the way that you live, have already begun to adapt to your injury. 
 
In addition, treatment needs to be intense enough to create and reinforce a positive change. Even if you are seen for one hour a week, there are 167 other hours where the pressures of life can so easily undo all the benefits of your treatment. 
 
This is especially true in the first couple of weeks where healing may be more “fragile” and hypersensitive to stress. Consequently, treatment initially must be more intense to protect you from re-injury and then taper as you experience a progressively longer lasting result. 
 
To achieve any result however, your active participation in your recovery is absolutely vital. Without it, it is likely that your recovery will either be delayed or impeded.
 
If you need to use pain or other medication to control inflammation or to enable you to cope and function, then please do so under the guidance of your doctor. Know that this medication is not the end result, but a means to an end in your journey to be pain and limitation free.
 
The other untrue myth relates to our blinkered, isolationist approach to healthcare.  Becoming a specialist enables a health care professional to charge a lot more money. It also gives the impression that a health professional who has “specialised” in an area of the body, must be good at what they do. After-all they are a specialist. They must know more detail about the area of the body that they have studied than a generalist who just knows a little of everything.  
 
However, the evidence is that very rarely do physical problems in your body occur in isolation. For more information, please read The Surprising Cause of Pain 
 
In fact, it is possible that every mechanical pain felt in one part of your body might be caused by a seemingly unrelated tissue or structure in another part of your body. And the danger is that a specialist health professional, knowing just one area of your body well, doesn’t consider incorrect function in other areas of the body or even in the way that you live that may have led to the pain.
 
Over the last ten years or so, there has been a revolution in our understanding of the brain’s involvement in the experience and perpetuation of pain. Whilst once the brain was thought of as a receiver of pain, now it is known that after some time the brain may become a transmitter and perhaps even a magnifier of pain. 
 
Consequently, a major thrust of treatment has focused on normalising your experience of pain by accepting and embracing legitimate physical and psychological pain as a necessary aspect of healing and recovery.
 
Now, it is understood, that it is not your muscles, nor your nerves, nor your joints, nor any one tissue or structure that may be at fault. It may actually be all of these tissues and structures and more that may be contributing to your pain or problem based upon how you move and live.
 
Preventing and recovering from physical injury isn’t necessarily difficult, but it does take work, discipline and even sacrifice.
 
Every-day, I see classic examples of the falseness of these two myths.  
 
For example, just yesterday, Sue presented complaining of left and right foot big toe pain. She informed me that a couple of years ago she had bunions and neuromas (swollen, inflamed nerves) removed from the inside of her big toe.
 
When I looked at her feet and the way that she walked, immediately I could see her problem. Despite having her bunions removed and been given orthotics, Sue’s “bunions” were returning. In addition, her big toes were pushing inwards, squashing all of her other toes.  
 
Sue walked with her feet turned out and wide apart. The two possible reasons for this are lack of balance and poor hip strength, which were then confirmed on testing. 
 
Not only is walking with your feet wide apart inefficient and tiring, it means that Sue’s body weight is falling inwards. As a consequence, Sue’s thighs tended to roll inwards causing flattening of her feet (pronation) and leading her to push off the inside of her big toes with every single step.  
 
Walking like this then leads to foot pain, ankle stiffness, calf and outside thigh tightness, weakness of her quadriceps and buttock muscles, instability of her core and osteoarthritis of her feet, ankles, knee, hips, back and even her neck. No wonder Sue was in pain!
 
Fixing Sue’s problem is not hard, but it does take work. It involves, freeing up her hips and ankles, increasing her core, hip and thigh strength, improving her standing balance and correcting the way that she walks. Orthotics would also be helpful in accelerating and sustaining her progress.  
 
The bottom line is deal with your pain, actively. Address the sources and the causes of your pain. Be pro-active and disciplined in following through with a specific treatment strategy that will deliver you the result that you want.  
 
With your therapist, develop a strategic treatment plan complete with aims, actions, milestones and a timeline. Then monitor your progress. Celebrate your improvement and make adjustments where necessary to ensure that you stay on track. 
 
The modern world has duped us all into believing that injury prevention and recovery involves some magical pill or miracle technique. It is so appealing because it doesn’t take effort, costs little and is highly convenient.
 
But these are false myths. Injuries do not occur for no apparent reason and they do not tend to occur in isolation.
 
Your aches and pains, as well as any other signs or symptoms such as swelling, clicking, tightness, grating, is your body’s way of telling you that something may not be quite right.  
 
Don’t dismiss these warning signs. Learn about them, understand them and address them quickly and comprehensively. This is the best way for you to achieve the best, fastest result possible.  
 
The real question is, “Are you willing to do the work?” no matter how inconvenient, uncomfortable or time consuming it might be.
 
Because if you are not, then just be aware that you may be wasting your money, time and your life with costly, temporary, band-aide solutions, that may in fact lead to a worsen of your problems. In the end, it may cost you and all of us a lot more than just dealing with the causes of your problem in the first place.
 
The choice is yours.
 
If you have any questions or would like advice on any signs or symptoms that you might be experiencing, please call Bodywise Health on 1 300 BODYWISE (263 994).
 
I wish you the best of health and life.
 
Michael Hall
Director, Principal Physiotherapist
Bodywise Health
 
For more information on how Bodywise Health can help you to overcome your pain, please call Bodywise Health on 1 300 BODYWISE (263 994).
 
Please note:
  • Rebates are available through your private insurance extras cover;
  • For complex or chronic conditions, you may qualify for the 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).
 
References Available on Request
Read more...

5 Secrets to Overcoming Your Injury

 
If you are like me, you want to avoid injury. And if you do get injured, you want the best, fastest, most complete recovery possible. After all, the financial, time and life costs of not getting better can be immense, affecting adversely every aspect of your life - your physical and mental health, your relationships, your work, your home life, everything.
 
But what if you had to know just 5 critical pieces of information to get better? Recovering from injury wouldn’t be such a mystery. Suddenly, getting better may become less costly, less time consuming and less frustrating.
 
These 5 critical pieces of information form the basis upon which we, physiotherapists decide the treatment strategies which are most likely to give you the best, fastest healthcare outcomes.  
 
These pieces of information are the sign-posts which direct what treatment modalities and techniques we use, when we use them and how we use them, to ensure that you experience the best results.  
 
If followed, these secrets virtually ensure that you will get better no matter what. To find out what they are, please read on.
 
 
Secret Number 1 – Where Is Your Pain or Physical Problem?
 
I say “pain” because this is almost always these reason why people attend for healthcare. They have a pain which stops them from doing something that they love to do.  
 
However, your physical problem might also be one of weakness, stiffness, tightness, clicking, grating or the feeling of instability. All of these signs and symptoms are legitimate reasons to seek professional treatment, especially if they are not going away and / or are worsening.
 
Where you have your problem is a key question because it enables you to hypothesise as to what tissues and structures might be the possible source(s) of your pain. 
 
In other words, answering the “where” question helps you to answer the “what” question.
 
Asking the “Where” question also helps you to explore other possible associated pain or problem areas.  
 
Do you have some discomfort in your neck or back even though your main concern is pain radiating down your arm or leg?  
 
Is there a relationship between signs and symptoms in what seem to be unrelated areas of your body? To read more on this, please click The surprising cause of your pain. 
 
 
Secret Number 2 – How Did Your Pain or Physical Problem Start?
 
It is really important to know how your signs and symptoms have started.  
 
Was there a trauma where you hit or were hit by something such as in a car accident or in a fall to the ground?
 
Was it a specific movement or activity that you felt something “go” such as when you swung a golf club or got out of the car?  
 
Or did your signs and symptoms come on for “no apparent reason”. You may have a vague idea of when, but you can’t remember exactly how your signs and symptoms started.  
 
If you suffered a trauma, where there was some kind of external force that caused your injury, then almost always it is a good idea to have an x-ray or scan to check the extent of the damage. This is because it is really difficult to quantify the forces involved. What might seem to be the most minor force can cause extensive damage.
 
If there was a specific activity or movement that caused your injury, this gives an indication as to the amount and direction of forces that were involved, the structures or tissues that might be injured and the extent to which they might be damaged. 
 
When your injury is examined, these structures are then stress tested to determine if they are indeed damaged and by how much.  
 
The direction of injuring force is also important as this indicates what further forces are likely to re-injure that structure or assist in healing.  
 
If you can’t remember when or how your signs and symptoms came on, then we need to do some “detective work”.  
 
Generally, signs and symptoms that start for no apparent reason indicate that there may be something “wrong” in the way that you are living that is the cause of your physical problem.  
 
It is often difficult to identify the causes of a pain, because often it is not so much what you do which is the culprit, but how you do it. How you stand. How you sit. How you get out of a chair. How you walk. How you…do anything, is unique to you. 
 
Your brain and your body then adapts to these repeated postures and movement patterns. Nerve pathways are reinforced. Muscles that are used more get stronger. Joints that are moved more, get more mobile. Joints that are used less get stiffer. And all these body changes not only perpetuate your physical habits, they actually make them stronger and more likely to happen again.
 
Doing a slightly “faulty” automatic posture or movement occasionally might not cause any issues. But doing them daily, weekly, monthly, yearly, will eventually cause you a physical problem, guaranteed.
 
Ultimately, how your signs and symptoms have come on hints at whether your problem is mechanical, inflammatory or insidious. In other words, is your problem generated from your interaction with the external forces of the world or are they generated internally.  
 
Is in fact your brain, nervous system, immune system and / or other body processes generating the pain as in the case of Rheumatoid Arthritis, Osteoporosis or Cancer? Yes, physios do screen for cancer.
 
 
Secret Number 3 – When Did Your Pain or Physical Problem Start?
 
If knowing where your pain is gives clues as to what structures might be the source of your problem and how your injury started gives clues as to the cause of your injury, then knowing when your injury started can give clues as your injury’s current phase of healing as well as the amount of repair that may have already taken place. 
 
For example, whilst there is some overlap and variability as to the different phases of healing, a general timeline might be:
  1. Bleeding Phase: 6 to 8 hours and up to 24 hours or beyond
  2. Inflammatory Phase: The first day or two post injury through to its peak at 2-3 weeks and decreases thereafter through to a matter of several months post trauma.
  3. Remodelling or Maturation Phase: Recent evidence indicates that the remodelling phase may start at around 1-2 weeks and may last up to 2 years.
 
Factors that affect your healing rate include:
  1. The type of tissue involved (muscle faster than ligament faster than tendon)
  2. The injury severity (Grade 1 faster than Grade 3 injuries)
  3. Your age (younger = generally faster healing)
  4. Your general health (e.g. diabetes results in compromised healing)
  5. Your nutritional status (e.g. inadequate protein intake)
  6. Your stress levels (greater stress = slower healing)
  7. The medication you take (anti-inflammatories delay healing)
  8. Whether you smoke (smoking impedes healing)
 
Knowing the phase of healing and the healing rate of the different types of tissue, also directs the type of intervention that need to be given to achieve optimal healing.  
 
For example, during the bleeding phase, Rest, Ice, Compression and Elevation is indicated to limit bleeding and excessive swelling.
 
During the inflammatory phase gentle movement in elevation may be indicated to facilitate waste product removal and facilitate the delivery of oxygen and nutrients to the repair
 
 
Secret Number 4 – What is the Behaviour and Irritability of Your Physical Problem?
 
Physiotherapists also want to know if your pain or problem is getting better, same or worse.  
 
As your body’s natural state is to heal, if your problem is not getting better, we need to find out why. 
 
Are you re-aggravating (re-injuring) your problem?  
Is inflammation breaking down the healing tissue and if so why?  
Are any of the above factors impeding your healing response?
What other factors might be acting as roadblocks to your healing and how can you remove them?
 
If your injury is worsening, you need to see a health professional immediately to have it assessed and get remedial intervention.
 
Physiotherapists also use a concept called Irritability to determine how assertively techniques should be applied to achieve the best and most long lasting effect from each treatment. 
 
This concept refers to the amount of pain caused (on a 1 to 10 scale, 0/10 = no pain, 10/10 being the worst pain you could imagine), and how long it lasts with regard to the intensity and duration of the force that caused the response in the first place.
 
For example, if you gardened for 8 hours and following experienced 15 minutes of back discomfort at a pain level of 2/10, we would say that your injury is not irritable. This would be an indicator that more assertive treatment is unlikely to lead to a flare-up.
 However, if you bent over to pull up a weed and then experienced 10/10 pain which lasted for two days, this would indicate that your condition is highly irritable and as therapists we would need to be very careful and gentle in out treatment intervention.
 
 
Secret Number 5 – What Postures, Movements or Activities Aggravate Your Pain?
 
Along with knowing how your pain or problem started, knowing the factors that aggravate and ease your pain tends to indicate why your condition started and the direction of force that will both help and or hurt you. Obviously, you want to do more of what helps and avoid what hurts your injury to enable your condition to heal.
 
Applying too much force too soon (including exercising too hard) will re-injure your injury.  
Judging when and how much force to apply to optimise tissue repair takes great knowledge, experience and skill. Even then, it is easy to get wrong.  
What you need to know is that at 1 month of healing, the tensile strength of collagen is around 40% of its original pre-injury strength and at 1 year it reaches 70%. The absence of pain is therefore no indication that your injury is 100% better. It can take years.
 
Knowing where your pain or problem gives clues as to what the possible sources of your pain or problem.
 
Knowing how your problem started gives clues at why your pain or problem has started.
 
Knowing when your problem started gives clues as to how long it may take for your injury to get better.
 
Knowing the behaviour and irritability of your problem gives clues as to what and how much intervention can be applied.
 
Knowing what factors aggravate or ease your pain, gives clues at the direction of forces that need to applied to facilitate healing and prevent re-injury.  
 
Please note that whilst this information gives the principles of treatment, it is general in nature and does not address your personal, unique circumstances. If you do have any questions or concerns, please seek individual advice and get be assessed and examined by a qualified health professional.
 
At Bodywise Health, we have treated over 14,000 people and delivered over 100,000 treatments over 21 years. We would be delighted to help you overcome any pain or physical problem that may be holding you back from getting the most out of life.
 
For a complimentary assessment, advice and a personalised strategic treatment plan to get you better, please call 1 300 BODYWISE (263 994). 
 
Wishing you the best of health and life.
 
Michael Hall
Director, Principal Physiotherapist
Bodywise Health
 
For more information on how Bodywise Health can help you to overcome your pain, please call Bodywise Health on 1 300 BODYWISE (263 994).
 
Please note:
  • Rebates are available through your private insurance extras cover;
  • For complex or chronic conditions, you may qualify for the 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).
 
References available on request

 

Read more...

Why You Need More than a Diagnosis To Get Better

Body wise 291011-17-Edit-Edit-Edit

It has been said that “Treatment without diagnosis is malpractice”.

And it is true that in todays’ practice of modern healthcare, diagnosis provides the over-riding foundation which directs both the type, amount and sequencing of treatment interventions.

Our obsession with diagnosis is evidenced by the explosion of diagnostic tests that are performed every year.

However, not only can the increase in CT and X-ray scans pose a health risk, they can be misleading. Consequently the surge in CT and MRI scans has failed to boost diagnostic rates.

And yet, even if CT, MRI and ultrasound scans did increase the accuracy of your diagnosis, this may not be enough to improve treatment outcomes.

The reason is because while x-rays and scans might tell you what the source of your problem, they do not tell you the cause. In other words, they give you the what, but not the why.

And although it is important to know which structure or tissue is the origin of your pain or problem, it is perhaps more important to know why. Because unless the cause of your ailment is corrected, your problem will always return even if you replace the injured body part.

I spoke about this phenomenon in my blog The Surprising Cause of Pain. In modern healthcare, we strive to name your diagnosis. That by putting a label on your condition, we can somehow better encapsulate, understand and manage your ailment. However, in so doing, we risk becoming blinkered to other possible sources, causes and implications of your injury.

Being given a diagnosis often gives the impression that it is just one tissue, one structure or one body part that is at fault, when in reality, it is often many tissues, structures and body parts that contribute to the cause of your physical problem.

A case in point is osteoarthritis. Osteoarthritis refers to inflammation and the subsequent breakdown of the surface covering of the bone ends at joints. What perhaps is not so well known is that along with this, the underlying bone begins to breakdown.

Bony projections (called osteophytes) form at the joint margins.

The membrane lining the inner part of the joint (synovial membrane) becomes inflamed and swollen causing excessive fluid to be secreted.

Joints become red and swollen.

The capsule and ligaments that hold joints together may become lax.

Muscles either spasm or become flaccid causing muscle imbalance and joint mal-alignment.

Nerves become hypersensitive and restricted.

Connective tissue (fascia) becomes taut and fibrotic.

Blood flow may be compromised.

The surrounding environment may become acidic.

Even your brain can become stressed, sensitized, reactive and magnifier of your pain.

And so the cycle of chronic pain begins and is perpetuated.

And this is not even to mention the incorrect motion in other parts of the body which may have led to the abnormal or excessive forces that caused the osteoarthritis in the first place.

The same goes for any injury whether it be a muscle strain, a joint sprain, disc injury, tendinopathy, bursitis or other condition.

I had a classic case of this a couple of weeks ago. Ann was suffering with intense inside right knee pain that came on “for no apparent reason” a couple of weeks before. So painful was Ann’s knee that I had to see her at home because she was unable to put weight on her right leg to walk.

Ann reported that she had had an MRI which revealed a burst Baker’s cyst (fluid filled sack behind the knee). This finding didn’t match Ann’s knee pain as a burst cyst would generally lead to pain, tightness and swelling behind the knee and Ann’s pain was on the inside just below the knee joint.

On examination, Ann’s right knee was indeed red, swollen and exquisitely tender on the inside of the knee just below the joint line. This corresponded to a different inflamed bursa (fluid filled sack called the Pes Anserine Bursa).

After applying cold packs and teaching Ann how to use crutches so that she didn’t weight bear on her right leg, Ann left to have another MRI for confirmation. This MRI revealed that she had a torn inside cartilage and this was the diagnosis that was given to Ann as a cause of her pain.

So Ann then underwent an arthroscope to “repair” this inside cartilage. To my surprise however, Ann returned to me two weeks later. Despite having an arthroscope, Ann’s pain hadn’t changed. In effect, the arthroscope may have corrected a condition, but this condition wasn’t the source of Ann’s pain.

On retrospect, I shouldn’t have been surprised, as again the MRI didn’t match Ann’s signs and symptoms; that of redness, swelling and intense pain just below the joint line on the inside of Ann’s knee over the area of this bursa.

Furthermore, on close questioning, it became clear that Ann’s knee pain was being caused by the way that she was sitting. So Ann was put on intense program to treat the inflamed joint tissues (synovium), fascia (connective tissue) nerves, muscles and bone surfaces. Ann was also shown how to sit and walk without aggravating her knee.

Two weeks later Ann left for overseas with minimal pain.

For the best, fastest, most complete recovery, it is essential that all the implications, complications and contributions to your ailment are adequately addressed, treated and resolved.

This is referred to as the Bio-Psycho-Social Model of Healthcare. It refers to the fact that the best outcomes will be achieved only when all the Biological, Psychological and Social factors have been taken into account and solved.

For optimal healing and recovery you must treat the muscle, the joint, the connective tissue and the nervous system.

You must correct the biomechanics, posture and movement patterns.

You must optimise the psychological and social environment to enhance recovery.

Yes, a diagnosis is important. But even more important is that the “diagnosis” given from an investigation such as an x-ray or scan is confirmed by a comprehensive assessment and professional clinical examination.

It is then critical, that all the information gained is used to devise a treatment strategy or Recovery Action Plan that treats and corrects both the source and cause of your problem.

This is the only way to achieve the best, fastest, most complete recovery possible.

If you would like any help with any aspect of Getting Better, Staying Better and Living Better, please don’t hesitate to call us here at Bodywise Health on 1 300 BODYWISE (263 994).

We would love to help you get back to living freely and without pain.

Wishing you the best of health and life.

Michael Hall
Physiotherapist
Director, Bodywise Health


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

Please note:
· Rebates are available through your private insurance extras cover;
· For complex or chronic conditions, you may qualify for the EPC (Enhanced Primary Care Program) allowing you to receive 5 allied health services each calendar year with a referral from your GP. For more information, please call Bodywise Health now on 1 300 BODYWISE (263 994).

References available on request

Read more...

Arthritis Latest Research Gives You New Hope

Interview 008
 
 
If you suffer from Osteoarthritis or Rheumatoid Arthritis, recent research offers you new hope. 
 
New research published in the Journal Pain Practice, August 2017 indicates that it is inflammation and especially neuro-inflammation (inflammation of the nerves) rather than degeneration that is the cause of arthritis, especially osteoarthritis.
 
Inflammation is an immune response critical for healing. During this process, white blood cells are activated to break down and ingest damaged cells, thereby clearing the area for the laying down of new tissue.
 
The problem is that constant, long term irritation (greater than 6 weeks) from external forces (e.g. excessive physical loading) and internal forces (e.g. chemical / nutritional and psychological / stress / depression) can cause over-stimulation of your immune system so that it begins to breakdown undamaged or healing tissue, thereby impeding healing.
 
Nerves are like the communication and power lines in our body. They serve to give feedback to the brain (and spinal cord) as to what is happening from both inside and outside the body and then they provide the conduit for impulses to the body’s tissues (e.g. muscles) so that the body can respond.
 
Like power lines, they need to be able to mobile and to move as your body moves so that they don’t get tugged, caught or pressed on. If they do, then the result will be adverse reactions such as pain, pins and needles, numbness and even loss of power.
 
Nerves in particular can have a magnifying effect on the pain experienced with inflammation. Not only do they become over-sensitive to stimuli, they also become restricted in their mobility. This leads to nerve tension, irritability, soft tissue tension (e.g. connective tissue, muscle), joint restriction and stiffness and faulty postures and movement patterns, further perpetuating the problem.
 
Not only that, but your brain which initially acts as a receiver of pain then after about six weeks can become a transmitter of pain beginning and perpetuating the cycle of chronic pain.
 
However, what this new research means for you is that if you can reduce the inflammatory process, you may be able to limit and perhaps even turn around this destructive process.
 
How do you do that? Here are some tips.
  1. If your pain is consistently from certain physical postures, positions, movements or activities you need to:
  2. Avoid or at least change the way that you perform these behaviours so that they become non painful.
  3. Unload the structure which is hurting with tape, bracing, sling, crutches etc. to the point that stress has been alleviated.
  4. Apply a cold pack for 10-20 minutes (check the skin every 5 minutes for adverse skin reactions) and repeat at least 6 times a day for 3- 5 days. The emphasis on cold packs is especially important towards the end of the day.
  5. Depending on the severity and the irritability of the tissue (how much stimulus causing how much pain for how long it lasts), dictates how much movements is possible. The key is to keep movement pain-free, easy and not stressful for at least 1-2 weeks to remove inflammatory chemicals and aid healing.
  6. Specific neural mobility techniques and exercises may have a profound effect on increasing nerve mobility and reducing nerve irritability and inflammation.
 
Nutritionally you need to:          
  1. Eat complex carbohydrates and low GI foods. Reduce you intake of simple, refined carbohydrates such as anything with white flour and white sugar. Refined carbohydrates cause the hormone insulin to spike which causes inflammation.
  2. Reduce Omega 6 fatty acids such as animal fats as these are pro-inflammatory and increase Omega 3 fatty acids (oily fish, flaxseed 3 to 4 times each week) as these are anti-inflammatory. The ideal ratio is 4-2:1. The current western diet is about 20:1
  3. Avoid trans-fats that contain hydrogenated oils such as many fried foods, pastries, cakes, biscuits and margarine. These are inflammatory.
  4. Reduce the intake of your food which creates an acidic environment inside your body by reducing your intake of sugar, red meat and animal products, alcohol, coffee, soft drinks) and increasing your intake of vegetables (especially green) and filtered water (2 litres per day).
  5. Avoid any food which gives an inflammatory or allergic reaction. How do you know? Listen to your body. Any time you feel lethargic, irritated, “foggy”, tired or sleepy after a meal? Do your nails tongue, hair, teeth, eyes, skin, lips, mouth, muscles and stools have any adverse changes?
  6. Eat high quality protein (>0.8 gms/kg per day).
  7. To reduce inflammation and improve healing take a daily pro-biotic and fish oil 6-9 gms/day, 1 ½ teaspoons or 8 capsules or 1 quality krill oil capsule.
  8. For natural pain relief take quercetin 600-1000mg/day Rutin, Bromelin, Curcumin.
 
Psychologically you need to:
Better manage stress so that you have a sense of control, of being in the moment, are sleeping well and are well connected with other people. 
 
It is beyond the scope of this blog to go into detail with management strategies. Suffice to say that if you are feeling stressed, out of control, not coping and or things are affecting adversely your everyday life then seek help from your GP or a qualified psychotherapist.
 
Whilst arthritis can be painful and debilitating, this new research offers you hope. 
 
In particular, the concept of reducing nerve inflammation through nerve mobility techniques may provide a powerful treatment to restoring joint health.
 
If you are having or have had treatment for arthritis, ask your health professional to assess and treat your nerve mobility. It may just be the key to getting you better.
 
If you would like any help with any aspect of Getting Better, Staying Better and Living Better, please don’t hesitate to call us here at Bodywise Health on 1 300 BODYWISE (263 994). 
 
We would love to help you get back to living freely and without pain.
 
Wishing you the best of health and life.
 
Michael Hall
Director, Physiotherapist
Bodywise Health
 
For more information on how Bodywise Health can help you to overcome your pain, please call Bodywise Health on 1 300 BODYWISE (263 994).
 
Please note:
  • Rebates are available through your private insurance extras cover;
  • For complex or chronic conditions, you may qualify for the EPC (Enhanced Primary Care Program) allowing you to receive 5 allied health services each calendar year with a referral from your GP. For more information, please call Bodywise Health now on 1 300 BODYWISE (263 994).
 
References available on request

 

 

Arthritis Latest Research Gives You New Hope

 

If you suffer from Osteoarthritis or Rheumatoid Arthritis, recent research offers you new hope. 

 

New research published in the Journal Pain Practice, August 2017 indicates that it is inflammation and especially neuro-inflammation (inflammation of the nerves) rather than degeneration that is the cause of arthritis, especially osteoarthritis.

 

Inflammation is an immune response critical for healing. During this process, white blood cells are activated to break down and ingest damaged cells, thereby clearing the area for the laying down of new tissue.

 

The problem is that constant, long term irritation (greater than 6 weeks) from external forces (e.g. excessive physical loading) and internal forces (e.g. chemical / nutritional and psychological / stress / depression) can cause over-stimulation of your immune system so that it begins to breakdown undamaged or healing tissue, thereby impeding healing.

 

Nerves are like the communication and power lines in our body. They serve to give feedback to the brain (and spinal cord) as to what is happening from both inside and outside the body and then they provide the conduit for impulses to the body’s tissues (e.g. muscles) so that the body can respond.

 

Like power lines, they need to be able to mobile and to move as your body moves so that they don’t get tugged, caught or pressed on. If they do, then the result will be adverse reactions such as pain, pins and needles, numbness and even loss of power.

 

Nerves in particular can have a magnifying effect on the pain experienced with inflammation. Not only do they become over-sensitive to stimuli, they also become restricted in their mobility. This leads to nerve tension, irritability, soft tissue tension (e.g. connective tissue, muscle), joint restriction and stiffness and faulty postures and movement patterns, further perpetuating the problem.

 

Not only that, but your brain which initially acts as a receiver of pain then after about six weeks can become a transmitter of pain beginning and perpetuating the cycle of chronic pain.

 

However, what this new research means for you is that if you can reduce the inflammatory process, you may be able to limit and perhaps even turn around this destructive process.

 

How do you do that? Here are some tips.

 

If your pain is consistently from certain physical postures, positions, movements or activities you need to:

1.     Avoid or at least change the way that you perform these behaviours so that they become non painful.

2.      Unload the structure which is hurting with tape, bracing, sling, crutches etc. to the point that stress has been alleviated.

3.     Apply a cold pack for 10-20 minutes (check the skin every 5 minutes for adverse skin reactions) and repeat at least 6 times a day for 3- 5 days. The emphasis on cold packs is especially important towards the end of the day.

4.      Depending on the severity and the irritability of the tissue (how much stimulus causing how much pain for how long it lasts), dictates how much movements is possible. The key is to keep movement pain-free, easy and not stressful for at least 1-2 weeks to remove inflammatory chemicals and aid healing.

5.     Specific neural mobility techniques and exercises may have a profound effect on increasing nerve mobility and reducing nerve irritability and inflammation.

 

Nutritionally you need to:          

1.     Eat complex carbohydrates and low GI foods. Reduce you intake of simple, refined carbohydrates such as anything with white flour and white sugar. Refined carbohydrates cause the hormone insulin to spike which causes inflammation.

2.     Reduce Omega 6 fatty acids such as animal fats as these are pro-inflammatory and increase Omega 3 fatty acids (oily fish, flaxseed 3 to 4 times each week) as these are anti-inflammatory. The ideal ratio is 4-2:1. The current western diet is about 20:1

3.     Avoid trans-fats that contain hydrogenated oils such as many fried foods, pastries, cakes, biscuits and margarine. These are inflammatory.

4.     Reduce the intake of your food which creates an acidic environment inside your body by reducing your intake of sugar, red meat and animal products, alcohol, coffee, soft drinks) and increasing your intake of vegetables (especially green) and filtered water (2 litres per day).

5.     Avoid any food which gives an inflammatory or allergic reaction. How do you know? Listen to your body. Any time you feel lethargic, irritated, “foggy”, tired or sleepy after a meal? Do your nails tongue, hair, teeth, eyes, skin, lips, mouth, muscles and stools have any adverse changes?

6.     Eat high quality protein (>0.8 gms/kg per day).

7.     To reduce inflammation and improve healing take a daily pro-biotic and fish oil 6-9 gms/day, 1 ½ teaspoons or 8 capsules or 1 quality krill oil capsule.

8.     For natural pain relief take quercetin 600-1000mg/day Rutin, Bromelin, Curcumin.

 

Psychologically you need to:

Better manage stress so that you have a sense of control, of being in the moment, are sleeping well and are well connected with other people. 

 

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

 

Whilst arthritis can be painful and debilitating, this new research offers you hope. 

 

In particular, the concept of reducing nerve inflammation through nerve mobility techniques may provide a powerful treatment to restoring joint health.

 

If you are having or have had treatment for arthritis, ask your health professional to assess and treat your nerve mobility. It may just be the key to getting you better.

 

If you would like any help with any aspect of Getting Better, Staying Better and Living Better, please don’t hesitate to call us here at Bodywise Health on 1 300 BODYWISE (263 994). 

 

We would love to help you get back to living freely and without pain.

 

Wishing you the best of health and life.

 

Michael Hall

Director, Physiotherapist

Bodywise Health

 

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

Please note:

·       Rebates are available through your private insurance extras cover;

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

 

References available on requestArthritis Latest Research Gives You New Hope

 

If you suffer from Osteoarthritis or Rheumatoid Arthritis, recent research offers you new hope. 

 

New research published in the Journal Pain Practice, August 2017 indicates that it is inflammation and especially neuro-inflammation (inflammation of the nerves) rather than degeneration that is the cause of arthritis, especially osteoarthritis.

 

Inflammation is an immune response critical for healing. During this process, white blood cells are activated to break down and ingest damaged cells, thereby clearing the area for the laying down of new tissue.

 

The problem is that constant, long term irritation (greater than 6 weeks) from external forces (e.g. excessive physical loading) and internal forces (e.g. chemical / nutritional and psychological / stress / depression) can cause over-stimulation of your immune system so that it begins to breakdown undamaged or healing tissue, thereby impeding healing.

 

Nerves are like the communication and power lines in our body. They serve to give feedback to the brain (and spinal cord) as to what is happening from both inside and outside the body and then they provide the conduit for impulses to the body’s tissues (e.g. muscles) so that the body can respond.

 

Like power lines, they need to be able to mobile and to move as your body moves so that they don’t get tugged, caught or pressed on. If they do, then the result will be adverse reactions such as pain, pins and needles, numbness and even loss of power.

 

Nerves in particular can have a magnifying effect on the pain experienced with inflammation. Not only do they become over-sensitive to stimuli, they also become restricted in their mobility. This leads to nerve tension, irritability, soft tissue tension (e.g. connective tissue, muscle), joint restriction and stiffness and faulty postures and movement patterns, further perpetuating the problem.

 

Not only that, but your brain which initially acts as a receiver of pain then after about six weeks can become a transmitter of pain beginning and perpetuating the cycle of chronic pain.

 

However, what this new research means for you is that if you can reduce the inflammatory process, you may be able to limit and perhaps even turn around this destructive process.

 

How do you do that? Here are some tips.

 

If your pain is consistently from certain physical postures, positions, movements or activities you need to:

1.     Avoid or at least change the way that you perform these behaviours so that they become non painful.

2.      Unload the structure which is hurting with tape, bracing, sling, crutches etc. to the point that stress has been alleviated.

3.     Apply a cold pack for 10-20 minutes (check the skin every 5 minutes for adverse skin reactions) and repeat at least 6 times a day for 3- 5 days. The emphasis on cold packs is especially important towards the end of the day.

4.      Depending on the severity and the irritability of the tissue (how much stimulus causing how much pain for how long it lasts), dictates how much movements is possible. The key is to keep movement pain-free, easy and not stressful for at least 1-2 weeks to remove inflammatory chemicals and aid healing.

5.     Specific neural mobility techniques and exercises may have a profound effect on increasing nerve mobility and reducing nerve irritability and inflammation.

 

Nutritionally you need to:          

1.     Eat complex carbohydrates and low GI foods. Reduce you intake of simple, refined carbohydrates such as anything with white flour and white sugar. Refined carbohydrates cause the hormone insulin to spike which causes inflammation.

2.     Reduce Omega 6 fatty acids such as animal fats as these are pro-inflammatory and increase Omega 3 fatty acids (oily fish, flaxseed 3 to 4 times each week) as these are anti-inflammatory. The ideal ratio is 4-2:1. The current western diet is about 20:1

3.     Avoid trans-fats that contain hydrogenated oils such as many fried foods, pastries, cakes, biscuits and margarine. These are inflammatory.

4.     Reduce the intake of your food which creates an acidic environment inside your body by reducing your intake of sugar, red meat and animal products, alcohol, coffee, soft drinks) and increasing your intake of vegetables (especially green) and filtered water (2 litres per day).

5.     Avoid any food which gives an inflammatory or allergic reaction. How do you know? Listen to your body. Any time you feel lethargic, irritated, “foggy”, tired or sleepy after a meal? Do your nails tongue, hair, teeth, eyes, skin, lips, mouth, muscles and stools have any adverse changes?

6.     Eat high quality protein (>0.8 gms/kg per day).

7.     To reduce inflammation and improve healing take a daily pro-biotic and fish oil 6-9 gms/day, 1 ½ teaspoons or 8 capsules or 1 quality krill oil capsule.

8.     For natural pain relief take quercetin 600-1000mg/day Rutin, Bromelin, Curcumin.

 

Psychologically you need to:

Better manage stress so that you have a sense of control, of being in the moment, are sleeping well and are well connected with other people. 

 

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

 

Whilst arthritis can be painful and debilitating, this new research offers you hope. 

 

In particular, the concept of reducing nerve inflammation through nerve mobility techniques may provide a powerful treatment to restoring joint health.

 

If you are having or have had treatment for arthritis, ask your health professional to assess and treat your nerve mobility. It may just be the key to getting you better.

 

If you would like any help with any aspect of Getting Better, Staying Better and Living Better, please don’t hesitate to call us here at Bodywise Health on 1 300 BODYWISE (263 994). 

 

We would love to help you get back to living freely and without pain.

 

Wishing you the best of health and life.

 

Michael Hall

Director, Physiotherapist

Bodywise Health

 

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

Please note:

·       Rebates are available through your private insurance extras cover;

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

 

References available on requestArthritis Latest Research Gives You New Hope

 

If you suffer from Osteoarthritis or Rheumatoid Arthritis, recent research offers you new hope. 

 

New research published in the Journal Pain Practice, August 2017 indicates that it is inflammation and especially neuro-inflammation (inflammation of the nerves) rather than degeneration that is the cause of arthritis, especially osteoarthritis.

 

Inflammation is an immune response critical for healing. During this process, white blood cells are activated to break down and ingest damaged cells, thereby clearing the area for the laying down of new tissue.

 

The problem is that constant, long term irritation (greater than 6 weeks) from external forces (e.g. excessive physical loading) and internal forces (e.g. chemical / nutritional and psychological / stress / depression) can cause over-stimulation of your immune system so that it begins to breakdown undamaged or healing tissue, thereby impeding healing.

 

Nerves are like the communication and power lines in our body. They serve to give feedback to the brain (and spinal cord) as to what is happening from both inside and outside the body and then they provide the conduit for impulses to the body’s tissues (e.g. muscles) so that the body can respond.

 

Like power lines, they need to be able to mobile and to move as your body moves so that they don’t get tugged, caught or pressed on. If they do, then the result will be adverse reactions such as pain, pins and needles, numbness and even loss of power.

 

Nerves in particular can have a magnifying effect on the pain experienced with inflammation. Not only do they become over-sensitive to stimuli, they also become restricted in their mobility. This leads to nerve tension, irritability, soft tissue tension (e.g. connective tissue, muscle), joint restriction and stiffness and faulty postures and movement patterns, further perpetuating the problem.

 

Not only that, but your brain which initially acts as a receiver of pain then after about six weeks can become a transmitter of pain beginning and perpetuating the cycle of chronic pain.

 

However, what this new research means for you is that if you can reduce the inflammatory process, you may be able to limit and perhaps even turn around this destructive process.

 

How do you do that? Here are some tips.

 

If your pain is consistently from certain physical postures, positions, movements or activities you need to:

1.     Avoid or at least change the way that you perform these behaviours so that they become non painful.

2.      Unload the structure which is hurting with tape, bracing, sling, crutches etc. to the point that stress has been alleviated.

3.     Apply a cold pack for 10-20 minutes (check the skin every 5 minutes for adverse skin reactions) and repeat at least 6 times a day for 3- 5 days. The emphasis on cold packs is especially important towards the end of the day.

4.      Depending on the severity and the irritability of the tissue (how much stimulus causing how much pain for how long it lasts), dictates how much movements is possible. The key is to keep movement pain-free, easy and not stressful for at least 1-2 weeks to remove inflammatory chemicals and aid healing.

5.     Specific neural mobility techniques and exercises may have a profound effect on increasing nerve mobility and reducing nerve irritability and inflammation.

 

Nutritionally you need to:          

1.     Eat complex carbohydrates and low GI foods. Reduce you intake of simple, refined carbohydrates such as anything with white flour and white sugar. Refined carbohydrates cause the hormone insulin to spike which causes inflammation.

2.     Reduce Omega 6 fatty acids such as animal fats as these are pro-inflammatory and increase Omega 3 fatty acids (oily fish, flaxseed 3 to 4 times each week) as these are anti-inflammatory. The ideal ratio is 4-2:1. The current western diet is about 20:1

3.     Avoid trans-fats that contain hydrogenated oils such as many fried foods, pastries, cakes, biscuits and margarine. These are inflammatory.

4.     Reduce the intake of your food which creates an acidic environment inside your body by reducing your intake of sugar, red meat and animal products, alcohol, coffee, soft drinks) and increasing your intake of vegetables (especially green) and filtered water (2 litres per day).

5.     Avoid any food which gives an inflammatory or allergic reaction. How do you know? Listen to your body. Any time you feel lethargic, irritated, “foggy”, tired or sleepy after a meal? Do your nails tongue, hair, teeth, eyes, skin, lips, mouth, muscles and stools have any adverse changes?

6.     Eat high quality protein (>0.8 gms/kg per day).

7.     To reduce inflammation and improve healing take a daily pro-biotic and fish oil 6-9 gms/day, 1 ½ teaspoons or 8 capsules or 1 quality krill oil capsule.

8.     For natural pain relief take quercetin 600-1000mg/day Rutin, Bromelin, Curcumin.

 

Psychologically you need to:

Better manage stress so that you have a sense of control, of being in the moment, are sleeping well and are well connected with other people. 

 

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

 

Whilst arthritis can be painful and debilitating, this new research offers you hope. 

 

In particular, the concept of reducing nerve inflammation through nerve mobility techniques may provide a powerful treatment to restoring joint health.

 

If you are having or have had treatment for arthritis, ask your health professional to assess and treat your nerve mobility. It may just be the key to getting you better.

 

If you would like any help with any aspect of Getting Better, Staying Better and Living Better, please don’t hesitate to call us here at Bodywise Health on 1 300 BODYWISE (263 994). 

 

We would love to help you get back to living freely and without pain.

 

Wishing you the best of health and life.

 

Michael Hall

Director, Physiotherapist

Bodywise Health

 

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

Please note:

·       Rebates are available through your private insurance extras cover;

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

 

References available on request

 
 
Bodywise Health
364 Hampton St
Hampton, Victoria, Australia, 3188
 
Read more...

The Surprising Cause of Pain

low-back-pain

When treating physical pain, there is one question that is rarely asked and even more rarely answered. Why? Why have I got back pain? Why have got neck pain? Why have I got knee pain? Even if a diagnosis is made and it is known to be the source of pain, no one ever asks “Why is my disc painful?” Why is my tendon painful? Why do I have arthritis?

Every day people tell me that they have been told that they have an injured tissue or structure and that they need to have medication, a cortisone injection, denervation, surgery or other passive technique in the hope that these interventions will solve your problem.

But unless you know why these tissues and structures have become painful, then your chances on getting permanent pain relief are at best remote. It is like putting a band-aide over a cut and then you keep cutting the area. You have simply “masked” the pain for a short time. Once the “effects” of the intervention have worn off, the structures will become painful again as you keep aggravating the damage or irritated tissue.

This point was born out in a research article titled “Effects of manual therapy and exercises targeting the hips in patients with low back pain” that was published in the Journal of Evaluation in Clinical Practice, January 2017.

This article indicates that low back pain and hip pain are becoming increasing associated and that together they cause greater pain at each site than if the back pain or hip pain existed in isolation. As yet, it hasn’t been determined which causes which. In other words, does low back pain cause hip pain or hip pain cause lower back pain.

But perhaps more importantly, what has been found is that treating and freeing up the hip has resulted in reduced lower back pain.

The bigger issue that this raises is the concept of regional interdependence. This means that even seemingly unrelated parts of your body can cause pain and injury in other parts of your body.

As physios, we know that stiffness of your ankles, knees and hips as well as tightness and weakness of your leg muscles can cause back injuries such as disc bulges, arthritis and stenosis. Why? Because stiffness in your leg joints will cause you to twist in your back every time you squat, get out into/out of the car or on/off a low chair.

Likewise, weakness in your leg muscles will mean that instead of squatting, you will bend at your back every time you need to reach low or pick something off the floor. This is not to say that you shouldn’t bend at you back. It is to say that you shouldn’t bend so much and that bending at your back hundreds if not thousands of times a day because you can’t squat will eventually lead to a back problem.

The more that these incorrect movement patterns become practiced, the more that they become habits leading to muscle imbalances, joint mal-alignment, joint irritation, stiffness and eventually more pain.

A quick scan test to see if your legs might be contributing to your back pain is a Squat Test. Stand with your feet pointing directly forwards, hip width apart. You should be able to squat all the way down to your heels and not allow your feet to turn outwards. If you can’t then this test is indicating that your leg joints are either stiff or your leg muscles are weak. This means that every time you get in / out of a car, or on / off a seat, you are likely to be compensating at your back.

Other commonly associated areas of your body that can cause pain include excessive turning in of your hips causing knee and foot pain, a stiff mid-back and weakness in your leg muscles can causing elbow and shoulder pain or poor hearing and vision leading to neck pain.

This is because one area of your body will try and compensate for other areas of your body that may not be doing their job optimally and it is these areas of compensation which so often become painful as they are trying to perform functions that they are not designed to do.

Another way of beginning to understand what the cause of your pain is, is to identify what you are doing or what have you just done when your pain comes on.

Are you sitting, getting out of the car, gardening or putting on shoes and socks, in which case it maybe bending and / or the way that you are performing these activities which are likely to be the cause of your pain. Or are you walking, in which case it may be arching your back or something to do with placing weight on your legs that may be the cause of your pain.

Then we get to be detective. What is it about these activities and the interactions of your body which is causing your pain? Are your calves so tight that they pull you backwards as you stand, causing you to bend slightly forwards to compensate and it is this constant slight bend forwards that then causes a disc bulge which leads to your lower back pain?

What’s even more frustrating is that these faulty ways of “being” have become such ingrained habits that you may have no idea that they are doing you harm until it’s too late and you are injured and in pain.

Many people will say that their parents had the same problem or that they were born this way. And it is true that you may have unique physical structural characteristics that may cause problems. One long leg, excessively arched or flat feet, twisted, bowed or knock kneed knees, turned in or out legs, an excessively curved or flat back, tall pelvis, a wide pelvis and / or wide shoulders, pigeon chest and so on, all have particular physical effects that can lead to pain and loss of function. Some might need a structural solution such as orthotics, bracing or worse-case scenario, surgery.

The way that you then perform your daily activities will often make the effect of these “variations” worse. This is because it takes awareness, discipline and perseverance to correct the detrimental effects of these physical forces on your body.

As your body follows the path of least resistance, it is so much easier to “go with” these forces than to oppose them. This means that not only will any negative effects be perpetuated, they will worsen over time making a chance of complete recovery more and more remote.

However many times, even these physical variations and incorrect movement patterns can be adequately addressed with “hands on” treatment, movement correction and physical training.

“Hands on” treatment by itself however, is not intense enough to create any sort of lasting improvement as it causes just a short term change in soft tissue tension levels and joint mobility.

In addition, exercise training by itself is also inadequate, because it is not specific enough to create change or increased mobility at the specific areas which have become stiff.

And finally, posture and movement retraining by itself is also inadequate because joints may be too stiff or unstable and muscles may lack the strength, endurance, co-ordination and control for ideal postures and movement patterns to be adopted in the first place.

To achieve permanent pain relief and sustained improvement in your ability to live pain-free and without limitation, requires a program of “hands on” techniques, corrective rehabilitative exercise and optimal posture / movement pattern retraining.

And yet, this program will also be adequate, if it is not intense enough to change the excessive or abnormal mechanics and the postural movement habits that have created them, permanently.

Treatment / training once a week is simply not going to be intense enough. There are at least 167 other hours during the week, when all the benefits from treatment can be undone.

It takes at least 4 weeks for your muscles to get stronger and at least 3 to 6 weeks for you to develop new, correct posture and movement habits. treatment / training must therefore be at least 2 to 3 times a week for at least 4 to 6 weeks to get a result. But the beauty of this approach, is that once you have achieved an improvement, it is more likely to be permanent.

Not only does this mean that you will prevent further flare-ups and the possibility of re-injury, you will actually perform every day movements better, with more freedom, strength, control and confidence as well as with less fatigue.

Even better, you will have increased your capacity for living, giving you a reserve capacity that will enable you to perform unfamiliar activities or to keep going safely when physically challenged.

Whilst this approach does take more effort, time and work than passive approaches, the benefits of being set free to live without limitation and without the need for medications, injections or surgery are worth it.

Until next time, Stay Bodywise,

Michael Hall
Physiotherapist
Director Bodywise Health

Reference:
Bade M, Cobo-Estevez M, Neeley D et al. Effects of Manual Therapy and Exercise Targeting the Hips in Patients with Low-Back Pain – A Randomized Controlled Trial; Journal of Evaluation in Clinical Practice 2017; 23(4): 734-740. doi: 10.1111/jep.12705. Epub 2017 Jan 27.

Read more...

How To Make Your New's Resolution Stick

 

 Pilates 1 02



Ah yes, January 3 and probably most people have already failed in their New Year's Resolutions. If your one of them, don't be disheartened. You are working against the forces of neuro-anatomy, neuro-physiology, neuro-psychology, physical forces and both overt and covert social pressure.

There is no doubt that as we start the New Year, many of you have the best intentions to make this year better than the last. To lose weight, get fitter, become more organised, be more effective and enrichen your relationships, might be just some of your hopes for this year.

And yet, even with the best of intentions, you need to know is that will-power by itself often won't work. Why? Because for however many years that you have been alive, you have been reinforcing nerve pathways in your brain, physical and physiological adaptations in your body as well as social and environmental constructs that will all work to maintain the status quo. Even your self-perception holds you back. The exponential growth in lap-band surgery is a testament to this.

You see, your brain and your body don't have delete buttons. You can't simply just erase memories and start again. Your thoughts, words, actions, experiences and perceptions, all leave a trace "memory". As I so often say in the workshops that I present, you are a reflection of the way that you live. You reflect not just what you do but how you do it. In many ways, we are manifestations of our habits. So to change a habit we essentially have to change ourselves. Not easy to do.

As a physio, I know that many aches, pains and physical problems that people suffer is a result of incorrect postures and faulty movements habits that people have been doing all their lives. These lead to excessive or abnormal forces on body tissues and structures, creating micro-trauma which leads to tissue irritation, inflammation and tissue breakdown or degeneration.

I know that if I ask someone to stand differently or move differently, I have "Buckley's" chance of them doing what I have asked. They can may be do it for a day or two but not forever. And yet, if I am to help someone achieve a permanent pain relief or a permanent improvement of their health status, this is what needs to happen.

One of my key learnings is that pain is the potent driver of human activity. You see it all the time. What do you do if you have hurt your leg? You limp. And if you limp for long enough, even if your leg gets better, you will continue to limp. Essentially, limping has become the way that you walk. So how do I stop you from limping? I teach you how to walk correctly with crutches so that you never learn to limp in the first place.
.
This principle of pain to drive change can also be used to your advantage. To help correct posture and movement, I tape people. This not only supports the injured tissue, hastening healing, but also makes it uncomfortable to stand or move incorrectly. The new correct posture and movement then creates new behaviours which begin to forge new neural pathways in your brain. If the new, correct behaviours can then be reinforced over the next four to six weeks they can become lifelong habits, enabling you to experience less pain, better performance and greater energy, for the rest of your life!

So the question is, as you begin the year full of hope of keeping your New Year's resolution, what is your "tape"? What is your pain and how do you use that to your advantage? Is it the threat of the loss of your health, the loss of relationships, the loss of time, the loss of your ...? Is it that you will be held to account by your accountability partner, whether that be a family member or friend?

Whatever your "tape" is, it always pays to take stock of where you are at, so that you can measure and track your improvement over time. Your improvement then becomes your reward and serves to motivate you, creating a groundswell of momentum propelling you towards your goal.

To help you determine your baseline physical health status, we are offering FREE Physical Examination for the month of January.

If injury or pain is holding you back from beginning your quest for better health, then we will throw in an injury assessment for FREE. So what do you have to lose except another year of your life not living to your full potential?

Call 1 300 BODYWISE (263 994) to book your FREE Injury and Physical Assessment today. It might just be the best New Year's Resolution that you could make.

We look forward to helping you get your life back.

Until next time, Stay Bodywise,

Michael Hall
Physiotherapist, Director
Bodywise Health

Please note:
* Yes, Bodywise Health is open throughout the holiday period;

* Rebates are available through your private insurance extras cover;

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

Read more...

10 Secrets to Turbo Charging Your Strength Training Program

Pilates 2 01

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).


REGENOLOGY


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.  

 

Read more...

How to Know When to Return to Sport

Self Monitoring 01

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

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

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

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

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

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

The Science behind Recovery

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Special Tests for Return to Pre-Injury Activity

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

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

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

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

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

The Importance of Ongoing Rehab

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

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

A Final Word

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

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

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

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

We look forward to helping you get your life back.

Until next time, Stay Bodywise,

Michael Hall
Physiotherapist, Director
Bodywise Health

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

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

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

Read more...
Subscribe to this RSS feed

Bodywise Health

364 Hampton St,

Hampton

Victoria. Australia 3188

03 9533 4257

Log In or Register

fb iconLog in with Facebook