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Worried About How Your Child Walks or Runs?

Image result for Feet turned Inwards walking

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

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

The Causes of Pigeon Toe

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

There are three potential causes of pigeon toe:

1. Metatarsus varus or metatarsus adductus

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

2. Internal tibial torsion

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

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

3. Femoral anteversion

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

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


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

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

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

Treating pigeon toe

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

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

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

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

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

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

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

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

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


Is Your X-Ray or Scan Doing You More Harm Than Good

Image result for X Ray, CT AND MRI Scans

X-rays, ultrasound, CT and MRI scans can be very valuable for identifying serious medical conditions such as fractures, spinal cord injuries and other specific lesions. However, once "serious problems" are ruled out by a radiologist, evidence shows that minor findings may not just be of no value in helping to explain the majority of aches and pains, they may be psychologically harmful especially when they tell patients that they have arthritis, degenerative disc disease, disc bulges, tendon tears and more.

Everyday thousands of Australians become confused and distressed by medical imaging that doesn't match the source or cause of their particular pain or problem. These people have been shown to have more doctor's visits, more lasting pain, more disability and a lower sense of welbieng.1, 2, 3

Here are a few important facts regarding medical imaging that you must be aware of to prevent yourself being fooled by your X-Ray or diagnostic scan.

Lumbar Spine - Lower Back
It is well established that most imaging findings, particularly degenerative changes, correlate poorly with clinical presentation.

Studies have shown that lumbar disc degeneration is present in 40% of individuals under the age of 30 and present in over 90% of people between the ages of 50 to 55.8

Another study showed that amongst healthy young adults aged 20 to 22 years with no back pain, 48% had at least one degenerative disc and 25% had a bulging disc.9

Leading physicians at the department of Neurosurgery in California strongly recommend AGAINST the routine use of MRI for low back pain as they have NO LINK between degenerative changes seen on x-rays or MRI's and low back pain.10

Other research findings include:

1. Individual neuro findings on MRI (disc herniation, root compression etc.) don't provide definitive link to LBP (Endean et al. 2011; Shambrook et al. 2011)

2. MRI does not improve clinical outcomes in the absence of red flags (Chou et al. 2009)

3. Early imaging does not positively impact clinical outcomes (Graves et al. 2012)

4. Inappropriate imaging can lead to misdiagnosis, inappropriate management decisions, potentially unnecessary surgery, poor outcomes and greater financial, social, psychological and physical costs (Flynn et al. 2011; Haldeman et al. 2012)

5. Spine MRI in primary care often leads to surgical assessment - yet MRI cannot discriminate surgical vs. non-surgical cases (You et al. 2012).

Translation: Do not panic if your x-rays shows "problems" with your discs; they simply are normal changes that occur from the age of 20 onwards.

Thoracic Spine - Mid / Upper Back
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. Amazingly, 29% of these healthy young people had a disc bulge that was actually deforming and pressing on the spinal cord, yet they had no signs or symptoms. 6,7

Translation: Do not panic if your x-ray or MRI shows "problems" with your discs; they are simply common and NORMAL findings.

Cervical Spine - Neck
An MRI study of healthy adults and seniors found that 98% of all men and women with no neck pain had evidence of "degenerative changes" in their cervical discs.

A 10 year study compared the MRI's of healthy people to those with whiplash injuries. Immediately and 10 years later both groups had similar MRI's with 75% having disc bulges.5

There was also a recent study where they MRI'd the SAME patient in 10 facilities and got COMPLETELY different reports from all of them - not good!

Translation: The majority of all healthy adults get neck degeneration (arthritis and disc bulges meaning they are a NORMAL aging process! Therefore, neck arthritis and mild to moderate disc bulges can only be a reasonable explanation of your neck pain if they match your clinical examination.

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 addition, in those 60 and older with no shoulder pain or injury, 50% (half) of them had rotator cuff tears on their MRI's that they didn't know about.16

A study of professional baseball pitchers showed that 40% of them had either partial or full thickness tears yet had no pain while playing and remained pain free even 5 years after the study.17

Translation: Do not panic if your ultrasound and/or MRI shows a rotator cuff tear; it is not necessarily associated with your shoulder pain!

There is only a weak association between joint space narrowing as seen on x-rays and actual symptoms.11

In fact, one study showed that 77% of healthy hockey players who had no pain, had hip and groin abnormalities on their MRI's.12

Translation: Do not panic if your x-ray or MRI shows cartilage tears or narrowing; it is not a sign of permanent pain or disability.

Studies have shown that when x-rayed, up to 85% of adults with no actual knee pain have x-rays that show knee arthritis. This means that there is little correlation between the degree of arthritis seen on x-rays and actual pain.13

In fact, one study showed that 48% of professional basketballers had meniscal (cartilage) "damage" on their knee MRI's.

Translation: Do not panic if your knee x-ray or MRI shows degeneration, arthritis or mild cartilage tears; it is NORMAL!

Although there is an association with plantar fasciitis and heel spurs, it should also be known that 32% of people who have no foot or heel pain have a heel spur visible on x-ray.15

Translation: One third of all people have a heel spur and yet have no pain.

After reviewing this research you might be thinking that x-rays and diagnostic scanning are useless in identifying sources and causes of the majority of injuries and diseases. Not so. Diagnostic imaging techniques are valuable tools in assisting with diagnosis and healthcare management.

However, x-rays and scans are just one set of tools that provide unique insights that must be considered in the wider context of physical assessment and evaluation, as well as the social, psychological, nutritional status of a person. Only when all these factors have been considered, can an optimal healthcare management plan be devised and implemented to achieve the best health outcomes possible for you.

If you have an injury or pain that you would like to get better as quickly and completely as possible, please call Bodywise Health on 1 300 bodywise (263 994) and receive a no obligation, complimentary injury assessment and advice.

In this session, you will discover the source and cause of your problem as well as the number one thing that you can do to help yourself get better.

References for Diagnostic Imaging of Musculoskeletal Injuries

1. Kendrick D, et al. The role of radiography in primary care patients with low back pain of at least six weeks duration: A randomised (unblended) controlled trial. Health Technol Assess.2001: 5(30);1-69.

2. Ash LM, et al. Effects of diagnostic information, per se, on patient outcomes in acute radiculopathy and low back pain. AJNR. Am. Neuroradiol. June 2008. 29 (6):1098-103.

3. Modic MT, et al. Acute low back pain and radiculopathy: MR imaging findings and their prognostic role and effect on outcome. Radiolog. 2005 Nov; 237 (2) 597-604.

4. Okada E, et al. Disc degeneration on MRI in patients with lumbar disc herniation: comparison study with asymptomatic volunteers. Eur. Spine J. 2011 Apr;20(4):585-91.

5. Matsumoto M, et al. Prospective 10 year follow-up study comparing patients with whiplash associated disorders with asymptomatic subjects using magnetic resonance imaging. Spine. (Phila Pa 1976) 2010. Aug 15;35(18):1684-90.

6. Matsumoto M, et al. Age related changes of thoracic and cervical intervertebral disc. Spine. (Phila Pa 1976) 2010. Jun 15;35(14):1359-64.

7. Wood KB, et al. Magnetic resonance imaging of the thoracic spine. Evaluation of asymptomatic individuals. J Bone Joint Surg. Am 1995 Nov;77(11): 1631-8.

8. Cheung KM, et al. Prevalence and pattern of magnetic resonance imaging changes in a population study of one thousand forty three individuals. Spine. (Phila Pa 1976) 2009. April 10;34 (9):1934-40.

9. Takatolou J, et al. Prevalence of degenerative imaging among young adults. Spine. (Phila Pa 1976) 2009. Jul 15;34(16):1716-21.

10. Chou D, et al. Degenerative magnetic imaging changes in patients with chronic low back pain: A systematic review. Spine. (Phila Pa 1976) 2011. Oct 1;36 (21 Suppl):S43-53.

11. Chu Miow Lin D, et al. Validity and responsiveness of radiographic joint space width metric measurement in hip osteoarthritis: A systematic review. Osteoarthritis Cartilage. 2011 May;19(5):543-9.

12. Silvis L, et al. High prevalence of magnetic imaging findings in asymptomatic collegiate and professional hockey players. Am J. Sports Med. 2011 Apr;39(4): 715-21.

13. Bedson J, Croft PR. The discordance between clinical and radiographic knee osteoarthritis: A systematic search and summary of the literature. BMC Musculoskel. Disord. 2008 Sep 2;9:16.

14. Kaplan LD, et al. Magnetic resonance imaging of the knee in asymptomatic professional basketball players. Arthroscopy. 2005 May;21(5):557-61.

15. Johal KS, Milner SA. Plantar fasciitis and the calcaneal spur. Fact or Fiction? Foot Ankle Surg Am. 2012 Mar; 18(1):39-41.

16. Sher JL et al. Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg Am. 1995 Jan;77(1):10-5.

17. Connor PM, et al. Magnetic resonance imaging of the asymptomatic shoulder of overhead athletes: A 5 year follow up study. Am J. Sports Med. 2003 Sep-Oct;31(5):724-7.


The Truth About How to Fix Your Tendon Problems

clinical pilates brightonElbow tendonAchilles TendonKnee Tendon

Busting Myths for Tendon Problems

Myth One - Eccentric exercise is the best exercise for rehabilitating tendon.

Whilst eccentric exercise (strengthening exercise where the muscle is lengthening) is the most researched, evidenced based program that is used, world renowned tendon specialist Professor Jill Cook from Latrobe University states that upon reflection, eccentric exercise by itself is deficient because it doesn't address the specific requirements of a person. They may be OK for the middle aged male runner, but they aren't that great for the younger sprinter or for the older person.

More importantly, eccentric exercise doesn't address the strength deficits of the muscle or of the body in general and they don't address the new research findings of the brain's and nervous system's deficiency in activating the muscle. Therefore, eccentric exercises by themselves are quite deficient in being able to restore full function.

What is the best treatment program for tendon problems?
The best treatment for tendon problems is really tailoring a program that best matches each person's individual wants, needs and requirements. For example, a young sprinting athlete with a hip tendon pain will have a different program to an older woman with the same condition.

Likewise a shoulder tendon problem will have a different program to an elbow tendon or an Achilles tendon problem. And even further from this, an Achilles tendon problem where the pain is in the mid portion of the tendon, the same as if the pain is at the insertion (attachment) and you can't treat either the of these the same as if the problem is in the covering of the tendon (peritendon).

This is why people need to be treated so individually. The purpose of treatment is to restore function to the level that a person wants. Anything after this is a bonus.

What are the key principles in tendon treatment?

The key principles include:
1. Promoting muscle strengthening which can only be achieved with strengthening exercises that involve both shortening and lengthening of the muscle. If you have good muscle strength, this will protect your tendons as well as other structures;

2. Having the ability to restore and release energy in the tendon if you are a higher level athlete;

3. Ensuring that the whole body is working efficiently and effectively with good mechanics;

4. Correcting faulty functional movement patterns.

What stages are involved in tendon rehabilitation?
To restore people back to high level function is a four stage process. For a person who doesn't need to meet high level athletic demands, they will not need to go through all four stages.

Stage 1 involves using isometric exercise (strengthening exercise where the muscle is contracting but there is no movement at the joint) to reduce pain and the brain's inhibition to activating muscle;

Stage 2 involves implementing a good strength program for the muscle/tendon unit as well as all other associated parts of your body. For example, the higher up your leg that you go, the more that you need to restore below the problem. If you have an Achilles problem, it is mainly calf that needs to be restored. If you have a knee tendon problem then the quadriceps and calf will also need to be restored. And finally, if you have a hip tendinopathy, it is glutes, quadriceps and calves that need to be restored.

In particular, you need to restore the strength of your anti-gravity muscles and then depending on their activity level, you need to restore the spring. As the tendon act like springs, you need to make them work again especially with the faster the movements and energy storage movement.

Stage 3 involves adding to this is endurance. For example, if someone wants to play football, they not only need to have a great general body strength and control and a great set of springs, they also need to spring repeatedly and therefore their tendons must have great endurance. It is this lack of endurance, or the capacity of the tendons to tolerate prolonged stress, that failure occurs.

Stage 4 involves adding spring strength and endurance. This is why tendons often take so long to get better. They often present extremely debilitated and damaged. There often has been long term pain with the tendons being robbed of their energy, endurance and muscle strength and bulk. And all of this needs to be restored, before the tendon can be made resilient enough to cope with the stresses that a person want to place upon the tendon in the activities that they want to get back to.

People who leave treatment early will often find that their pain will return in a couple of weeks because the tissue is only as good as the load that is placed upon it. And this is the same for tendon, muscle and bone. This means that if tissue hasn't been restored to a capacity that is needed in an activity or sport it will fail again. It's just physics. You cannot continue to load a tendon greater than what is has been trained to do. It isn't rocket science and just self-evident.

Physiotherapy should the first treatment of choice because tendons need exercising and correct loading. Physiotherapy shouldn't come after medication, injections or other intervention.

Myth Two - Tendon problems always involve inflammation

Tendon problems were originally thought to be an inflammation of the tendon (i.e. Tendinitis) in the 1970's until a fantastic study showed that tendon pain was primarily due to degeneration rather than inflammation.

Of course, like any other tissue, there will be some inflammatory markers and there will be some inflammatory cells because it's a tissue that is injured. However, inflammation is not the driving process. It is not the thing which is creating the pain and it is not the thing which is creating the ongoing pathology.

What causes the pathology is due to the over-loading of the tissue either on a prolonged or a short term basis. What causes the pain seems to be the tendon cell releasing pain chemicals.

If a person has an acute injury and ice doesn't help, then don't waste your time putting ice on the injury. Spend your time doing exercise. If ice does help, this is an indication that the injury probably has some peritendon (sheath covering the tendon) involvement. Therefore, ice and anything else which you perceive to be helping can be used along with exercise that has the correct loading. The evidence however, is that rest, ice, compression and elevation won't help you.

Myth Three - Once the tendon is pain free and you have returned to sport you don't need to do your exercises any more.

It is important that you understand that even if your tendon is pain free and you have returned to sport that the pathology in the tendon is still there.

Tendons don't heal even if the pain goes away. Once a tendon, always a tendon. If you do the right things your tendon will stay pain free. If you don't do the right things, your tendon will become painful again.

In addition to this, your brain is still inhibiting the activation of your muscles, because it is worried that you are going to re-injure your tendon again. Consequently, this means that if you return to sport and you stop your strength training, your muscle strength will decrease markedly if you stop your exercises and you will be prone to re-injuring yourself.

To prevent re-injury, it is important that you continue with your strength training exercises at least twice each week for at least a year following full recovery and then you may have a chance to give up the exercises.

For elite athletes they need to continue with their strength exercises 3 times a week for the rest of their careers. This is because these strengthening exercises are acting like an insurance policy. If you can stay strong, you keep your tissue (muscle and tendon) capacity up, you will be less likely to get into trouble again.

Because of your brain protective inhibition on your muscles and tissues, it means that when you have been injured, when you return to sport, you won't run, jump, twist, turn or just move quite the same way that you did before your injury. Therefore, the first season following a major injury is a building season. Following this you will need to do a really good pre-season and the second season back will be a "cracking" season.

It can take this long to be able to use your tendon as a spring and be sure that it is not going to cause your pain.

Myth Four - The tendon will get better quickly

It is critically important that you are educated regarding your tendon pathology.

You need to see how much swelling there is, how much muscle bulk you have lost, how your tendon store energy and how badly you hop.

You need to understand how your tendons react to pathology and how pain is caused and how we need to build capacity.

You need to understand that once a tendon, always a tendon and though you can become pain free and you will be able to return to sport, we want you to be able to play as well as you can.

You might be a bit sore the day after sport, but you will be able to train the day after this.

Understand that unless you are prepared to buy in to a 3 to 6 months rehabilitation process (and sometimes longer), there is no point in starting. You need to understand how long it will take and why, so that you can work with your tendon and your body to achieve the best outcome. Unfortunately there is no quick fix.

If you have tendon problem and you want to get better as quickly as possible, call Bodywise Health on 1 300 Bodywise (263 994) for a no obligation, complimentary assessment and advice.

You have nothing to lose except your pain!

Until next time, stay Bodywise,

Michael Hall
Bodywise Health

Professor Jill Cook; Busting Tendon Myths Conference; San Diego 2016



Why Hamstring Strains Occur and How to Prevent Them

clinical pilates bodywise health

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Until next time stay Bodywise,

Michael Hall
Director Bodywise Health

1. T. Pizzari, Risk factors for hamstring injury: An updated systematic review and meta-analysis, Journal of Science and Medicine in Sport, Volume 19, Supplement, December 2015, Page e9, ISSN 1440-2440,

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

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

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

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


Why female athletes are more prone to knee injuries and what you can do about it

physiotherapy in brighton

What a wonderful start to the Women's Australian Rules Football season. It's been fortunate that the injury toll has been keep largely in check. There have been a few exceptions, namely:

  1. Natalie Plane from Carlton with her high-grade ankle sprain
  2. Meg Downie from Melbourne with a hamstring rupture
  3. Stephanie De Bortoli also from Melbourne with an Achilles tendon tear
  4. Brianna Green, a Fremantle player fractured her collarbone

There have been two major knee injuries reported to have occurred during the season so far. Sophie Armitstead with a meniscal tear of the same knee she's previously had an ACL reconstructed and Kim Mickle who ruptured her ACL.

But what is this 'ACL'?
The Anterior Cruciate Ligament is a rope-like structure that supports your knee from the inside. In some ways, it is the last structure that prevents your thigh bone and leg bone separating during not only high force activities but also day to day activities, like walking down stairs. In addition to the structural support offered, it is also considered to give information to the brain about how you are moving from the stretch and pull it undergoes as you move. Ideally, the joint and ligament is protected by strong muscles around the joint that can absorb most the force.

What puts the ACL at risk?
Somethings are out of our control, like the weather. There have been some weather conditions, that lead to a dry field, that have been seen to increase the risk of an ACL injury1.

Regrettably being older or having a previous knee injury also increases the risk of an ACL injury.

A higher grade of football was noted to contribute to an increased risk, but these players were also generally older and had previous injuries.

Gender is also a very interesting element of ACL risk. It has been found that females have an increased risk of ACL ruptures in several sports. These sports include wrestling (4 times the risk, compared to males), basketball (over 3 times the risk, compared to males), soccer (around 2.5 times the risk, compared to males), rugby (nearly 2 times the risk, compared to males) and lacrosse (only slightly higher risk)2. That study was done before the Women's AFL took off, so it did not include females playing AFL as a comparison. It was also interesting to see that AFL had similar ACL injury rates to soccer and basketball.

Fortunately, there are somethings that we can do to help reduce the risk. Increased weight and the associated higher Body Mass Index (BMI) have also been reported as putting the ACL at more risk of a rupture1. So, eating healthy and maintaining a good balance of regular physical activity has yet another advantage!

What should I do?
Most ACL injuries in AFL matches occur without contact. This would suggest that there are elements that could be worked on to reduce the risk of an ACL rupture.

Fortunately, research has backed this up3. Specific movement strategies and muscle groups have been identified as areas that players can work on to effectively reduce their risk of rupturing their ACL3.

If you are an AFL player or play one of the sports mentioned above, it would be worthwhile booking an appointment with a Bodywise Health Physiotherapist to assess your strength and movement patterns.

This allows the physiotherapist to prescribe an individualised exercise program aimed at reducing your risk of an ACL rupture and the expensive surgery and rehabilitation that goes along with it.

For further information on how you can prevent knee injuries or for a FREE assessment, please call 1 300 BODYWISE (263 994).

Until next time, stay happy and be Bodywise,

Michael Hall
Bodywise Health


  1. Orchard, John et al. "Intrinsic And Extrinsic Risk Factors For Anterior Cruciate Ligament Injury In Australian Footballers". The American Journal of Sports Medicine 29.2 (2001): 196-200. Web. 3 Mar. 2017.
  2. Prodromos, Chadwick C. et al. "A Meta-Analysis Of The Incidence Of Anterior Cruciate Ligament Tears As A Function Of Gender, Sport, And A Knee Injury-Reduction Regimen". Arthroscopy: The Journal of Arthroscopic & Related Surgery 23.12 (2007): 1320-1325.e6. Web.
  3. Cochrane, Jodie L. et al. "Characteristics Of Anterior Cruciate Ligament Injuries In Australian Football". Journal of Science and Medicine in Sport 10.2 (2007): 96-104. Web.

Concerned about your child’s backpack?

brighton physiotherapy bodywise health

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

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

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

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

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

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

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

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

Why you should be concerned

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

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

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

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

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

Loading a Backpack

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

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

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

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

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

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

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

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

Wishing you and your family the best of health,

Michael Hall
Bodywise Health

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

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


The Truth About Back Surgery


Back pain – it can rip your life away from you making your every position, movement and activity excruciatingly painful beyond your imagination. You can’t sleep. Dressing yourself is difficult if not impossible and going to the toilet can be agonizing. The constancy of your pain can wear you down to the point where your whole world is consumed by “the pain”.

If that’s not enough the confusing array of information, advice and treatment options offered by often well-meaning people can often compound your sense of disillusionment and powerlessness.

Everyone you speak to has a different opinion or magic cure. Friends will often tell you about their “guru” therapist that you must see. Therapists will give you many and varied diagnoses and treatments all promising to “fix” your problem. Doctors may send you for X-rays, CT scans and MRI scans but often the long words of these technical reports heightens your fears that something is seriously wrong and that hope of a cure for your pain is fading.

And then under the advice of your treating health professional you undergo any number of different treatments including nerve blocks, epidurals, radiofrequency neurotomies, prolotherapy and intradiskal electrothermal therapy, unbeknown to you, that most of these treatments offer at best between 30-60% of short term pain relief. 1,2,3,4

Is it no wonder that Australia is following America’s lead with spinal surgery increasing at 10% a year?5 In America, experts estimate that nearly 600,000 people opt for back operations each year. Yet, a new study in the journal Spine shows that in many cases that even surgery can backfire, leaving patients in more pain.

Researchers reviewed records from 1,450 patients in the Ohio Bureau of Workers’ Compensation database who had diagnoses of disc degeneration, disc herniation or radiculopathy, a nerve condition that causes tingling and weakness of the limbs. Half of the patients had surgery to fuse two or more vertebrae in hopes of curing low back pain. The other half had no surgery, even though they had comparable diagnoses.

After two years, just 26 percent of those who had surgery returned to work. That’s compared to 67 percent of patients who didn’t have surgery. In what might be the most troubling study finding, researchers determined that there was a 41 percent increase in the use of painkillers, specifically opiates, in those who had surgery.

The study provides clear evidence that for many patients, fusion surgeries designed to alleviate pain from degenerating discs don’t work, says the study’s lead author Dr. Trang Nguyen, a researcher at the University of Cincinnati College of Medicine.

Unfortunately, for most patients with bad backs, there is no easy solution, no magic bullet. Pain management experts — and some surgeons — say that patients need to scale back their expectations. With the right treatments, pain can be eased, but a complete cure is unlikely.

27 million adults with back problems

A recent report by the Agency for Healthcare Research and Quality, a federal organization, found that in 2007, 27 million adults reported back problems with $30.3 billion spent on treatments to ease the pain. While some of that money is spent on physiotherapy, pain management, chiropractor visits, and other non-invasive therapies, the majority pays for spine surgeries.

Complicated spine surgeries that involve fusing two or more vertebrae are on the rise. In just 15 years, there has been an eight-fold jump in this type of operation, according to a study published in Spine in July. That has some surgeons and public health experts concerned.

For some patients, there is a legitimate need for spine surgery and fusion, says Dr. Charles Burton, medical director for The Center for Restorative Spine Surgery in St. Paul, Minn. The indications for spinal surgery include:

• Nerve root compression resulting in persistent toileting problems, leg pain or numbness, tingling and muscle weakness;
• Persistent pain due to instability of a single intervertebral segment.

“But the concern is that it’s gotten way beyond what is reasonable or necessary. There are some areas of the country where the rate of spine surgery is three or four times the national average.”

Despite the fact that over 250,000 lower back fusions are performed every year in the USA, there is no evidence to support this operation for discogenic back pain.6,7

Burton and others recommend that patients get a second opinion when back surgery is recommended for the treatment of back pain without neurological symptoms, such as sciatica, especially if other treatments haven’t been suggested first.

“We are very successful at improving leg symptoms," says Dr. William Welch, vice chairman of the department of neurosurgery at the University of Pennsylvania Medical Center and chief of neurosurgery at Pennsylvania Hospital. “We are less successful at treating back pain.”

Source of pain is often hard to pinpoint

The reason, Welch says, is that it’s often hard to pinpoint the exact cause of someone’s back pain. Even MRIs can be misleading because abnormalities, such as degenerating discs, can be seen on scans for virtually everyone over the age of 30 regardless of whether they have pain.

Even when the surgery is a success, it rarely dispels 100 percent of back pain, Welch says. And while many surgeons are careful about which patients they recommend for spine operations, some are not so discriminating, says Dr. Doris K. Cope, professor and vice chair for pain medicine at the University of Pittsburgh School of Medicine. “It’s a case of, if you have a hammer, everything looks like a nail,” she explains.

In general, the best results come about through a combination of approaches, Cope says. Each strategy may reduce pain by just 10 or 20 percent, but those percentages can add up so ultimately the patient’s pain is cut back by as much as 70 or 80 percent.

Proven strategies for treating lower back pain involve:
• Taking the load off the pain sensitive tissues and structures by getting into the most pain free positions as possible;
• Reducing inflammation with cold packs or medication;
• Protecting against re-injury with the use of tape or bracing;
• Promoting healing by reducing tissue tension with “hands on” techniques along with easy pain free, mobility exercises and heat treatment;
• Targeted stretching and strengthening exercises to correct muscle imbalances and joint alignment;
• Correction of posture, functional movement patterns (habits) and sporting techniques to prevent irritation of body structures and tissues;
• Core stabilisation exercises to build a strong, stable platform upon which whole body strengthening can be built;
• Functional strengthening to build your body’s capacity to cope with daily physical demands.

It is important that you understand that healing any tissue takes about 6 weeks and involves and a well-recognised progression through phases of healing. For example, the Bleeding Phase can last from 6-24 hours, Inflammatory Phase 2-5 days, Proliferation / Regrowth (framework) Phase 5 to 14 days, the Remodelling Phase 2 to 6 weeks and the Maturation Phase from 6 weeks to up to 12 months and beyond.

It therefore makes sense that if each of these phases are optimised, physically, nutritionally and psychologically and the actual causes of your back pain are corrected, then healing should not just be possible, but inevitable.

It is often quoted that it takes about 4 weeks to strengthen your muscles and at least 4 weeks to correct your posture or movement habit. So whilst not a quick fix, understanding that if you follow an evidenced based rehabilitation system that has been proven deliver results over time, you too can also achieve sustained improvement, through a progressive rehabilitation and conditioning program that will prevent re-injury and optimise your physical capacity.

If you are interested in learning about a 7 step plan that thousands of people have experienced relief through, call 1 300 BODYWISE (263 994) for a FREE Assessment and Recovery Action Plan. This plan will detail the specific steps that you need to take to on your road to recovery. Wishing you the best of health.

Yours sincerely,

Michael Hall
Director Bodywise Health

P.S. If you are in pain and you want relief, don’t put off getting effective treatment any longer.
Call 1300 BODYWISE (263 994) for a FREE, No Obligation back assessment and advice. You have absolutely nothing to lose except your pain and a healthier, happier life to gain.

1. Dreyfuss P. Hallbrook B, Pauza K et al. Efficacy and validity of radiofrequency neurotomy for chronic lumbar zygoapophysial joint pain. Spine (Phila Pa 1976)2000 25(10):1270-7.
2. Van Kleef M, Barendse GA, Kessels A et al. Randomised trial of radiofrequency lumbar facet denervation for chronic low back pain. Spine (Phila Pa 1976) 1999:24(18):1937-42.
3. Yin W, Willard F, Carreiro J et al. Sensory stimulation-guided sacroiliac joint radiofrequency neurotomy: technique based on neuroanatomy of the dorsal sacral plexus. Spine (Phila Pa 1976) 2003;28(20):2419-25.
4. Pauza KJ, Howell S, Dreyfuss P et al. A randomised placebo controlled trial of intradiscal electrothermal therapy for the treatment of discogenic low back pain. Spine j 2004:4(1):27-35.
5. IA Harris, ATT Dao. Trends of spinal fusion surgery in Australia: 1997 to 2006 - ANZ journal of surgery, 2009 - Wiley Online Library
6. Carragee EJ. The surgical treatment of disc degeneration: is the race not too swift? Spine J 2005:5(6):587-8.
7. Deyo RA, Nachemson A, Miirza SK, Spinal fusion surgery – the case for restraint. N Engl J MED 2004:350(7):722-6



10 Facts to Save Your Back

Body wise 291011-159-Edit-Edit

For those of you who have severe lower back pain, only you know how debilitating it is. Only you know how it affects every part of your life. You can’t sleep, you can’t get comfortable and even standing to walk to the toilet can be excruciating.

But probably the most frustrating thing about severe lower back pain, is that no one else can see it and or feel it. No one else can share your pain and really know how frightening it is.

Everyone you speak to has their own piece of advice. You should walk. You should apply heat. You should see my guru therapist.

Information can be overwhelming. Doctor Google it seems, has only made it more confusing. Many news websites and newspapers carry blogs on lower back pain. The problem is that almost all authors have not treated a single person with back pain and if they have, they are not at the “coal face” or in the trenches helping people like you daily to cope, to have hope and to see the possibility of a way out of the haze.

Whilst articles may be “evidenced based”, the information is so general that it can be dangerous. To lump everyone who has severe back pain into the same boat maybe downright reckless. A disc herniation is not the same as a joint sprain or canal stenosis. To say to everyone who has severe lower back pain, you just need to get up and walk or that it will just get better on its own, can be both cruel and misleading.

To help you, here are 10 facts that you need to know to help you manage your back pain.

  1. Back pain that has come on for no reason, is constant, keeps you awake and doesn’t change, indicates that your back pain is inflammatory in nature and you need to see your doctor immediately

  2. Whilst you may not remember a specific incident that brought on your back pain, there is almost always a cause. Not understanding this, can lead to you re-aggravating your back injury, the number one reason, why many people don’t get better.

  3. If your pain is throbbing, constant and wakes you at night, apply cold packs in a damp tea-towel for 15 minutes a minimum 6 times each day (and up to hourly) for at least 3 to 5 days (be sure to check your skin every 5 minutes for adverse reactions). If your pain is more like a general soreness, is intermittent and you are able to sleep soundly, apply comfortable heat.

  4. See your doctor to find out which medication can help you cope best. Research has now shown that there is little or no evidence that paracetomol and other over the counter anti-inflammatory medications such as Ibuprofen actually help. And be aware that prolonged use of anti-inflammatory medication has been shown to delay healing

  5. In contrast, there is evidence that “hands on” therapy performed by physiotherapists and other manual health professionals does offer benefit. But again you need to understand that this benefit is likely to be short term if the underlying cause isn’t addressed

  6. We are told “not to take back pain lying down” and to stay moving, but what movement? Lying down might be the only position that reduces your pain. If so, get into the most comfortable position possible, apply cold packs for 15 minutes at a time hourly (helps to reduce inflammation and pain)Generally, there will be a direction of movement that provokes your pain and a direction of movement that eases it. Move gently and slowly in the direction that eases your pain and perform as many of these movements (perhaps 6-12 hourly) as you can as long as they are pain free. At the first hint of an increase in pain or a reduction in form, stop. If you always stop before pain, the chances in making your problem worse are minimisedIf you are lying down, you need to get up and go for a short walk every one to two hours to reduce the pressure in your back. If walking is painful, a back brace and walking with elbow crutches often relieves the pain

  7. Back pain is more common in smokers. Smoking has been shown to reduce blood flow to all parts of your body, including your back, meaning that it is unable to stay healthy and resilient to the stresses that are applied to it every day. This leads to injury, inferior healing, deficient recovery, chronic inflammation and constant pain – not just in your back but your whole body

  8. Staying positive and improving your nutrition, sleep and stress levels will all help you to overcome your back pain. Understanding that your body’s natural default mechanism is to heal and then allowing it to do so by nurturing the most healing environment possible will lead to a quicker and better recovery.

  9. X-Rays and scans (including CT and MRI scans) are often a waste of your money because they:
    •        a. frequently show up completely unrelated abnormalities that can be both scary and confusing;
    •        b. don’t influence or change your treatment: and 
    •        c. they expose you to radiation which can increase your cancer risk.

Having said this, it is important to get further investigations if you have been injured in a trauma involving a forceful knock or blow. Additionally, if your signs and symptoms are worsening (and not improving within a week), you are feeling unwell and losing weight or have pain, numbness, tingling, pins and needles or loss of power in your bladder, bowel or legs. These are medical emergencies and it is critical to see your doctor or health professional as soon as you can.

10. Your back pain will only get better, if you address the cause of your problem. This means changing, if only slightly, the way that you move that has caused the problem in the first place. Whilst “hands on” treatment often provides only short term relief and rehabilitative exercise medium term relief, fixing the cause of your pain will give you permanent relief. It is this package of “hands on” therapy, rehabilitative exercise and posture and movement correction that the evidence has shown is the best way to achieve long lasting relief and sustained physical improvement.

If you have back pain and would like help to get rid of it, call 1 300 bodywise (1 300 263994) to organise an initial gap-free assessment and treatment so that you can begin your road to recovery.

All of us here at Bodywise Health look forward to helping you,

Yours sincerely,

Michael Hall

Director Bodywise Health


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

rehabilitation centres melbourne

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Other treatment tips for Overtraining Syndrome

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

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

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

Be Bodywise and enjoy the best of health.

Best wishes,

Michael Hall
Bodywise Health

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

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


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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Be Bodywise and enjoy the best of health.

Best wishes,

Michael Hall
Bodywise Health

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



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

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


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