January Newsletter – Pregnancy & Exercise

Pregnancy is a time of many physical and emotional changes for women. Perhaps you are wondering whether or not you should be exercising during this time. Fortunately, there is a lot of research indicating that physical activity is not only safe but beneficial for expectant mothers. Exercise can help keep pregnancy weight gain in an acceptable range, reduce the severity of musculoskeletal pain, prevent or control gestational diabetes and reduce the risk of pre-eclampsia. Exercise may also assist mothers have less complications during pregnancy and labour.

During pregnancy, ligaments and tendons throughout the body stretch, both to accommodate the growing baby and to allow the baby an easier passage out during labour. This soft tissue laxity can lead to aches and pains, particularly in the lower abdomen, pelvis and lower back and possibly increase risk of injury. That doesn’t mean women shouldn’t exercise at all. If active prior to pregnancy, women can continue exercising at the same level although sedentary women should ease into activity slowly. It is recommended that all pregnant women should avoid certain types of activity such as contact sports, heavy lifting and high level balance activities.

Pregnant women are also prone to dizziness due to the rising hormones in the body that cause the blood vessels to relax and widen. This can cause blood pressure to be lower and temporarily cause dizziness. This is one important consideration for pregnant women engaging in exercise. It is important to choose an exercise intensity that will improve health without putting them or their baby at increased risk.

Every woman and every pregnancy is different. The severity and duration of pregnancy-related symptoms will vary depending on how far along into pregnancy a woman is as well as any co-morbidities that may be present. Medical clearance from a G.P or Obstetrician is recommended when a history of miscarriage or any existing medical conditions (e.g. Diabetes) is present. For the vast majority of expectant mothers though, exercise has many benefits and is an excellent way to withstand the rigours of pregnancy.

Pilates is an excellent choice of exercise for pregnant women. Some benefits that one may see from practicing Pilates during pregnancy include:

Improved postural control
Increased core and pelvic floor strength
Reduction of lower back and or pelvic pain
Increased endurance to withstand activities of daily living

Please contact us for further information on how we may be able you.

February Newsletter – Private Health Insurance Reforms

private health insurance reforms

Pilates Rebates

You may remember the government announcement late last year regarding a reform package for the Private Health Insurance sector.

Commencing April 2019, private health insurance will no longer cover natural therapies, including aromatherapy, Bowen therapy, Buteyko, Feldenkrais, herbalism, homeopathy, iridology, kinesiology, naturopathy, Pilates, reflexology, Rolfing, shiatsu, tai chi and yoga.

However the APA (the Australian Physiotherapy Association) have advised that members should not be unduly concerned about the removal of Pilates from the list of rebateable natural therapies. Any physiotherapist delivering a one-on-one or group consultation on any patient(s), whether it be classed as Pilates or something else, is unaffected by the PHI reform package. Their patients’ ability to claim for the service will be unaffected. The same will apply to accredited Exercise Physiologists.

The APA understands that physiotherapists who incorporate Pilates treatment into their overall management of patients do so with a full understanding and assessment of the patient’s condition, and with ongoing reassessments and modifications to the patient’s treatment as required.
Physiotherapist-instructed Pilates is one part of a wider range of treatment options utilised by our members in these instances, and is in line with the best practice, evidence based contemporary care that physiotherapists employ.

The reform package measures have been set with the understanding that there is a clear difference between physiotherapist-instructed Pilates programs and those used by other practitioners. As a result, physiotherapists utilising Pilates methods in their patient treatment plans will not be affected by these changes.

All of our staff here at Motion Health fall under the category of Accredited Physiotherapists and Exercise Physiologists.

March Newsletter – Diabetes & Exercise

Did you know that exercise can not only reduce your risk of diabetes by up to 60% but also plays a vital role in the management of the condition?

Type 2 Diabetes Mellitus (T2DM) is a permanent health condition that occurs as a result of sustained elevated blood glucose (sugar) levels. As a result the pancreas is required to release increasing amounts of the hormone insulin, which is responsible for keeping blood glucose levels normal. After many years of this cycle the pancreas is no longer able to produce sufficient amounts of insulin to regulate blood glucose levels, which begin to increase ever higher. These high levels of blood glucose cause damage to both small and large blood vessels and can lead to nerve damage in the peripheries (loss of sensation and circulation in the feet), eye damage and stiffened arteries. T2DM also increases the risk of developing other conditions such as cardiovascular disease.

Two of the main risk factors are excess weight and physical inactivity. Over 80% of people diagnosed with T2DM are considered to be overweight or obese. The highest risk occurs when waist circumference is over 94cm for males and 88cm for females. This is due to excess fat stores producing toxins which make insulin less effective. This is particularly the case when weight is held around the middle of your body, impacting on the function of your vital organs.

T2DM is managed through lifestyle modification, that is diet and exercise and if necessary through prescription medication. Keeping a blood glucose diary can also help you keep track of how you are managing your condition and learning how your body responds to exercise and different foods.

There is a range of different medication prescribed in regards to diabetes management. It is important to understand how your medication works and how it will relate to exercise. This will help you to avoid hypoglycaemic episodes (low blood sugar) and better understand when, how often and how intense you should exercise.

Exercise is a key component to lifestyle management of this condition. Aerobic and resistance training are both effective but in different ways. For example aerobic exercise has been show to improve insulin sensitivity – the hormone released in response to glucose intake to remove sugars from the blood. Resistance training helps increase muscle size increasing the amount of energy that can be stored in the muscle itself rather than the blood stream.

If you or anyone you knows has T2DM talk to an Exercise Physiologist at Motion Health. We have a T2DM group that is eligible for medicare rebates with a GP referral along with 1:1 and group exercise physiology session that can be structured to assist your diabetes management. If you already attend Motion Health speak to us about how this can be included in your current exercise classes.

December Newsletter – Benign Paroxysmal Positional Vertigo

vertigo

Benign paroxysmal positional vertigo (BPPV) is a condition characterised by episodes of sudden and severe vertigo when one’s head is moved around. Common triggers include rolling over in bed, getting out of bed, and lifting the head to look up. BPPV is caused by particles within the vestibular system of the inner ear. Usually, BPPV affects only one ear.

Vertigo may be used to describe feelings of dizziness, lightheadedness, faintness, and unsteadiness. The sensation of movement is called subjective vertigo and the perception of movement in surrounding objects is called objective vertigo.

The most common cause of dizziness is BPPV. Others include: Inflammation in the inner ear, Meniere’s disease, neck joint dysfunction, vestibular migraine and acoustic neuroma. Rarely, vertigo can be a symptom of a more serious neurological problem such as a stroke or brain haemorrhage. Under age 50, head injury is a common cause. Vestibular viruses can also play a role. BPPV can also be a result of surgery due to prolonged supine positioning and possible trauma to the inner ear.

The symptoms of BPPV can include:
Sudden episodes of violent vertigo which may last half a minute or more.
Dizziness and/or nausea.
Movements of the head trigger the vertigo.
The eyes may exhibit nystagmus.

BPPV is caused by otoconia (calcium carbonate crystals) moving from the maculae of the inner ear into the fluid-filled semicircular canals. The peripheral vestibular labyrinth contains sensory receptors in the form of ciliated hairs in the three semicircular canals and in the ear’s otolithic organs. They respond to movement and relay signals via the eighth cranial nerve. Visual perception such as gravity, position, and movements also receive signals from somatosensory receptors in the peripheral vestibules. With the displacement of the otoconia into the semicircular canals, these delicate feedback loops relay conflicting signals that can result in any symptom related to BPPV. It is thought that injury or degeneration of the utricle may allow the otoconia to dislodge and escape into the balance organ and interfere with the vestibular system, however most cases of BPPV are idiopathic.

There are two types of BPPV: one where the loose crystals can move freely in the fluid of the canal (canalithiasis), and, more rarely, one where the crystals are thought to be ‘hung up’ on the bundle of nerves that sense the fluid movement (cupulolithiasis). With canalithiasis, it takes less than a minute for the crystals to stop moving after a particular change in head position has triggered a spin. Once the crystals stop moving, the fluid movement settles and the nystagmus and vertigo stop. With cupulolithiasis, the crystals stuck on the bundle of sensory nerves will make the nystagmus and vertigo last longer, until the head is moved out of the offending position. It is important to make this distinction, as the treatment is different for each variant.

Once the healthcare provider knows which canal(s) the crystals are in, and whether it is canalithiasis or cupulolithiasis, then the appropriate treatment maneuver can be carried out.

Our physiotherapists at Motion Health are well placed to diagnose and treat BPPV using otoconia replacement techniques. Ascertaining whether or not there is a cervico-genic component to the patient’s symptom pattern is also important.

A test we commonly use to determine the unilaterality of BPPV is the Dix-Hallpike test.
To check for right side involvement, rotate the patient’s head to the right 45 degrees while in the long sitting position (this aligns the right posterior semicircular canal with the sagittal plane of the body).
The examiner grasp the patient’s head and quickly moves the patient to the supine position with the neck slightly extended (ear down position).

The examiner checks for nystagmus. If present, note the latency, duration, and direction (should not last more than 1 minute).

Once we have determined that the loose crystals can move freely in the fluid of the canal (canalithiasis),a commonly used treatment technique is the Canalith Repositioning Procedure or Epley manoeuvre. We may need to complete this manoeuvre over 1 to 3 visits in order to obtain complete resolution of symptoms.