October 2019 – Should we re-evaluate how we look at Posture?

By Joel Wallace

We are surrounded by talk around posture.

This includes how we should stand, how we should sit, how posture is the cause of our pain and the amazing new devices we should get to instantly fix it. At work we often told about the correct ergonomic set up to prevent posture pain, we are told about how we should or shouldn’t move and lift to prevent injury.

It’s very easy to take this information as fact, with OH&S reinforcing this, and many health professionals feeding into it with treatment plans about correcting posture and switching on and off different muscles.

Interestingly, looking at the evidence available, very little of what we hear is well supported by research and is often contrary to evidence based advice.

A great journal article, ‘Sit up Straight’ – Time to Re-evaluate’, has recently been produced looking at the research and what it actually says when it comes to posture.

Below are 7 key points that that the authors concluded.

There is NO single ‘correct’ posture

Despite common posture beliefs, there is no strong evidence that one optimal posture exists or that avoiding ‘incorrect’ postures will prevent back pain.

Differences in postures are a fact of life

There are natural variations in spinal curvatures and there is no single spinal curvature strongly associated with pain. Pain should not be attributed to relatively ‘normal’ variations.

Posture reflects beliefs and mood

Posture can offer insights into a person’s emotions, thoughts and body image. Some postures are adopted as a protective strategy and may reflect concerns regarding body vulnerability. Understanding the reasons behind preferred postures can be useful.

It is safe to adopt more comfortable postures

Comfortable postures vary between individuals. Exploring different postures, including those frequently avoided, and changing habitual postures may provide symptomatic relief.

The spine is robust and can be trusted

The spine is a robust, adaptable structure, capable of safely moving and loading in a variety of postures. The common warning to protect the spine is not evidence-informed and can lead to fear.

Sitting is not dangerous

Sitting down for more than 30 minutes in one position is NOT dangerous. However, moving and changing positions can be helpful, and being physically active is important for your health.

One size does not fit all

Postural and movement screening does not prevent pain in the workplace. Preferred lifting styles are influenced by the naturally varying spinal curvatures and advice to adopt a specific posture or to brace the core is not evidence-based.

 

The full article can be found in full at: Journal of Orthopaedic & Sports Physical Therapy, 2019 Volume:49 Issue:Pages:562–564 DOI:10.2519/jospt.2019.0610.

 

 

 

 

 

 

September 2019 – How to Fix your Lateral Hip Pain

By Catherine MacRae

I was inspired to write this blog after listening to a recent webinar by Tom Goom (www.running-physio.com) on ‘Lateral Hip Pain – 5 Mistakes that are ruining your results’

Chances are, if you are suffering with lateral hip pain (pain at the side of your hip), you may have Gluteal Tendinopathy. It can manifest as a severe, disabling pain directly over the Greater Trochanter (the bony prominence at the side of your hip), but can be successfully treated with an individualised treatment plan. So what should you expect from physiotherapy intervention with this particular problem?

  • Decreasing ‘Compression’ of the Tendon:

Gluteal Tendinopathy can be provoked by ‘compression’ of the Gluteal tendon insertion point at the bony Greater Trochanter. So our first goal is to decrease time spent in positions that increase this compression. It occurs when the hip is brought into positions of Flexion (Knee towards chest), adduction (Leg across the body), or Hip External Rotation (Outward Hip rotation). Examples of common ‘Compression’ positions are; crossing your legs in sitting, Gluteal stretches, Side sleeping with the affected limb upper most and across the body, and standing ‘hanging’ with hip off to the side.

  • Modifying Activities:

Tendinopathy is often related to an overload episode, where the load that you are applying to the tendon, outweighs its capacity to cope. A reactive response then occurs within the tendon, which leads to pain and inflammation. Activities that involve the tendon going through its’ Stretch shortening cycle (SSC) may need to be modified. This is where the tendon behaves like a spring, stretching then shortening to store and release energy. With the Gluteal Tendons these activities are usually walking & running. In the short term, you may have to modify the intensity and frequency of these activities, to assist in settling pain.

  • Low Level Activation Exercises:

Research has also shown that low level Gluteal activation exercises can assist with pain. With one of the main goals being to improve and maintain Tendon strength, starting to activate the Gluts in a tolerable way, not only starts the rehab pathway, but also can be relieving. Isometric exercise (Holding a static muscle contraction) has been found to reduce pain for up to 45 mins after a single session, and avoid any reduction in muscle strength. (Rio et al 2015)

  • Education:

Managing tendon pain is complex and one of our main goals as physiotherapists is to provide our patients with the confidence and the tools to take control of their rehabilitation. In fact a recent study has highlighted the importance of education as an essential part of Gluteal tendinopathy management.

Visual abstract, showing the study population, design and primary outcomes.

BMJ 2018;361:k1662

LEAP trial: Mellor et al 2018

204 patients with Gluteal tendinopathy were randomly assigned to 3 treatment groups; A program of education on load management, plus exercise (14 sessions over 8 weeks), A Corticosteroid injection, and a ‘wait and see’ group. The results showed that the Education group had better outcomes at 8 weeks and 52 weeks.

BMJ 2018;361:k1662

The Key Education messages that we want to get across to our Tendon pain clients are:

  • Tendons are Strong and Resilient, and will adapt and become even more robust with appropriate loading.
  • Pain is a reaction to increasing Loads and not necessarily Tissue Damage.
  • Our goal is to find the ‘Sweet spot’ with exercise and activity. Too little equals weakness and de-conditioning, and too much aggravates symptoms.

Progressive Rehabilitation Program:

Once we have determined what your individual goals are, a graduated Tendon loading program with be implemented, based on getting you to where you want to be.

As mentioned earlier, this may start with Isometric low level activation exercises, but gradually increase to heavy loading while monitoring for any irritability. Then, progressing to more challenging functional positions (e.g. Single leg squats, Single leg control, Fast movements, impact movements), and finally loading back into ‘compressive’ positions.

Once goals are achieved, a maintenance plan is an important final step. It will allow you to sustain the Tendons capacity to cope with load, and live well and Move well!

References:

  • Tom Goom (running-physio.com): Lateral Hip Pain – 5 Mistakes that are ruining your results.
  • Rio et al 2015: Isometric Exercise induces analgesia and reduces inhibition in Patella Tendinopathy.
  • Mellor et al 2018: Education plus exercise versus corticosteroid injection uses versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial
  • Cook & Docking 2015: “Rehabilitation will increase the ‘capacity’ of your …insert musculoskeletal tissue here….” Defining ‘tissue capacity’: a core concept for clinicians

January 2019 Newsletter – Benefits of Exercise Physiology

Benefits of Exercise Physiology

In Australia close to 60% of people do not meet physical activity guidelines. This has played a major factor in the increased rates of obesity, metabolic disease and numerous other conditions. Along with the preventative aspect of exercise, research has shown that exercise is just as effective or more effective than common medications that you might be already taking.

Exercise has been shown to reduce the risk of type 2 diabetes by almost 60%. This can help keep your blood sugar levels lower and more stable throughout the day. When compared to common medications exercise can actually be more effective – reducing not only the chance of you requiring medication but also your reliance on current medication.

Likewise, exercise has been shown to decrease the amount of fatal heart attacks by up to 50%, improve the breathing of those with lung disease by 70% as well as all the extra benefits of an active & healthier lifestyle.

Like any medication, the correct dose is required not only make the intervention safe but to obtain optimal outcomes. This includes things like the intensity, type, frequency and duration of the exercise. Exercise should be prescribed in a way that considers precautions, medication effects and the condition itself. This is where the role of an Accredited Exercise Physiologist comes in.

Accredited Exercise Physiologists (AEP’s) specialise in clinical exercise prescription and the delivery of exercise and lifestyle medication programs for people who are at risk of, or living with chronic disease. An EP consultation can help guide the way you exercise during a class or at home, ensuring the correct exercise dose and volume or can assist you in managing many common conditions.

Some of the conditions our AEP’s can help treat and/or manage are:

  • Obesity
  • Diabetes
    • – Including the 8 week program under Medicare
  • Impaired glucose tolerance
  • Asthma
  • Hypertension
  • Pre and post surgery
  • Osteoporosis
  • Lower back pain
  • Depression
  • Postural imbalance
  • Cerebral Palsy
  • Arthritis
  • COPD
  • Fibromyalgia
  • Falls and poor balance
  • Cancer
  • Occupational Injury
  • Multiple sclerosis
  • Cardiovascular disease
  • Stroke

If you think you or someone you know might benefit from Exercise Physiology, please contact us on 03 9825 2697 for further information.

December 2018 Newsletter – Health Insurance

Changes to Pilates rebates through Private Health Insurance will take effect from 1st April 2019. These changes mean that Pilates classes taken by a Pilates Instructor will no longer be funded, as part of a reform to eliminate rebates for non evidence based natural therapies.
This reform will NOT impact Motion Health Body Clinic classes.
In order to comply with the reforms, classes and individual sessions must meet the following criteria:
  • Individualised assessment and continuous reassessment
  • A program of exercised-based interventions specific to the patient, addressing any health concerns of the patient
  • High quality clinical notes that reflect Physiotherapy or Exercise Physiology practice

As our Body Clinic classes meet all these criteria, you will still be able to claim rebate for these classes through your private health fund. Clients will need to undertake regular reassessments to continue to meet these criteria; this will also allow our practitioners the opportunity to discuss with clients in depth how their exercise and health concerns are progressing and how we can continue to assist clients to reach their goals. Clients will be reminded when they are due for reassessment.

Whilst we can confirm that classes at Motion Health with an Exercise Physiologist or Physiotherapist will continue to be claimable through your private health, we are unable to inform you of what your rebate will be. If you are unsure what your rebate is for classes, you can find this information by contacting  your private health insurer and quoting the below item codes, they will be able to inform you exactly how much you get back per class throughout the year.

  • Body Clinic with a Physiotherapist: Item #505
  • Body Clinic with an Exercise Physiologist: Item #502

If you have any further questions regarding the health reforms please don’t hesitate to speak to reception or send us an email at info@motion-health.com.au

November 2018 Newsletter – Chronic Pain Management

Chronic pain is usually defined as a type of pain that persists longer than 12 weeks or, beyond the healing time of a normal injury. It differs to acute pain which is usually caused by tissue damage and alerts us to an injury. Chronic pain may begin with an initial injury or it may be related to illness and is associated with increased sensitivity of the nervous system.

Evidence indicates that exercise is an essential component of managing chronic pain even though that may seem like the last thing you’d want to do! Many people avoid exercise due to the false belief that it will cause a flare up. By maintaining a regular exercise routine, de-conditioning and worsening pain can be prevented.

Types of exercise recommended to manage chronic pain include:

Strengthening Exercises
To help build strong muscles
Improve joint function/bone density (helps to protect against injury)
Maintaining flexibility and balance (important as we age)
Cardiovascular Exercise
Low impact activities (such as walking, biking, swimming, yoga and Pilates) provide oxygen to your muscles and boost energy levels as well as reducing pain and stiffness.
Stretching and Relaxation 
Stretching helps to increase flexibility and loosen stiff muscles. Incorporating stretching into an exercise plan can help to reduce stiffness associated with chronic pain.

We always recommend consulting an exercise professional to help with the management of chronic disease. If you need further help or information, please contact us on 03 9825 2697

Source: chronic pain and exercise http://exerciseright.com.au/chronic-pain-and-exercise/

September Newsletter – Greater Trochanteric Pain Syndrome – A pain in the behind

What is GTPS
Greater Trochanteric Pain Syndrome GTPS is common cause of hip pain affecting the outer portions of the hip, thigh, or buttock regions of the body. People experiencing GTPS commonly report painful symptoms over the posterior aspect of their hip joint or buttocks when sitting or standing for Long periods of time, climbing stairs or lying on the affected side.

What is the source of the pain:
GTPS is an umbrella term that encompasses inflammatory or degenerative changes to the gluteal muscle tendons and/or inflammatory responses to the gluteal bursae . Previously people with the symptoms were often given the narrow diagnosis of hip bursitis and treated with cortisone injections into the bursea alone. The classification of GTPS takes a more expansive approach and includes the often involved tendons to the glute medius and glute minimus tendons where they attach onto the top of the thigh bone.

What are the symptoms of GTPS:

The main symptoms reported by people experiencing GTPS include pain to the outside of the gluteal muscles or side of the thigh that is typically described as a deep ache type pain. It may progress gradually over time or be brought on by a traumatic event such as a fall onto the affected side.
Aggravating activities Of GTPS pain include:
Pain when walking/running
Pain when sitting particularly in low chairs for long periods of time
Pain when standing for prolonged periods of time
Pain when walking up/down steps
Pain when lying on the affected side

What are the treatment options for GTPS:
Physiotherapy in the form of Deep Tissue Massage, stretching and strengthening provides the front line treatment of GTPS.

If you have any concerns, please give Motion Health a call on 03 9825 2697

References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4761624/

October Newsletter – Exercise Considerations for the Pelvic floor

pelvic floor physiotherapy

The pelvic floor refers to the group of muscles that run from the pubic bone at the front of the pelvis to the coccyx (tailbone) at the back of the pelvis. This group of muscles play an important role within the body. The pelvic floor is responsible for voluntary control of urine, faeces and flatulence, sexual functions and maintaining support of the pelvic organs such as the uterus in women and the bladder and bowel in both men and women. It also very importantly forms part of our deep core system along with the diaphragm and the transverse abdominus (deep abdominals) and multifidus (deep spinal muscles). During exercise the pelvic floor, diaphragm and deep abdominal and spinal muscles work in a coordinated manner to control the pressure within the core system in response to load.

In the ideal situation, the coordination of pressure within the abdomen happens automatically. When lifting a weight, the muscles of the ‘core’ work together well- as you lift the load, you exhale (diaphragm ascends), the pelvic floor should contract and the deep abdominals and spinal muscles contract to provide support for the spine. In this scenario, the pelvic floor muscles respond appropriately to the increase in abdominal pressure. If the pelvic floor is not working optimally, a loss of function can result.

Common symptoms of pelvic floor dysfunction include:
– Accidentally leaking urine when you exercise, laugh, cough or sneeze
– Needing to get to the toilet in a hurry or not making it there in time
– Constantly needing to go to the toilet
– Finding it difficult to empty your bladder or bowel
– Accidentally losing control of your bladder or bowel
– Accidentally passing wind
– Pain in your pelvic area
– Painful sex.
– A prolapse:
– in women, this may be felt as a bulge in the vagina or a feeling of heaviness, discomfort, pulling, dragging or dropping
– in men, this may be felt as a bulge in the rectum or a feeling of needing to use their bowels but not actually needing to go

(Source: Pelvic floor first – http://www.pelvicfloorfirst.org.au/pages/how-can-i-tellif-i-have-a-pelvic-floor-problem.html)

The pelvic floor can change at different stages of life and can sometimes become weakened and not work optimally. Some of the groups of people that may commonly experience pelvic floor dysfunction include: pregnancy, post natal, menopause, people on hormone replacement therapy, people completing frequent high impact activities (heavy lifting, jumping), chronic coughing/sneezing.

If you have any of these symptoms, we recommend contacting a Pelvic floor Physiotherapist to assess your individual condition. Once you know what you need to work on then our qualified practitioners can assist you work towards your goals and maintain the health of your pelvic floor.

August Newsletter – Tradie Health

A tradies’ health is their most important tool, yet Australian tradies experience some of the highest rates of injury and time off work compared to other workers. In fact, 3 in 5 serious workplace injuries involve a tradie, despite tradies making up only 30 per cent of the Australian workforce. The Australian Physiotherapy Association is encouraging all tradies, their employers and families to think about their health and take a few simple steps to prioritise their wellbeing at work.

Physically demanding trade jobs can cause and exacerbate a range of injures. It’s not surprising that tradies are overrepresented in workplace statistics compared to other workers. The average time off work due to serious workplace injury is 5-6 weeks, which is time many tradies simply can’t afford.

To help reverse these statistics, we need to take a good look at the workplace culture and practices of many tradies and encourage them to focus more on their health and safety. Quite simply, tradies rely on their bodies for work—their bodies are their primary work tool. If it breaks down or becomes incapacitated through injury or chronic illness, they can’t work to their full ability.

If you know a tradie who needs some attention, give Motion Health a call on 03 9825 2697

July Newsletter – National Diabetes Week 8 -14th July

diabetes week

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

Type 1 Diabetes Mellitus – T1DM
In T1DM the body is unable to produce insulin due to compromised cells in the pancreas. This results in elevated blood glucose levels (BGL), as the body without insulin is unable to absorb and use the glucose for energy.

Type 2 Diabetes Mellitus – T2DM
T2DM is often known as lifestyle diabetes, and is a permanent health condition that occurs as a result of sustained elevated blood glucose (sugar) levels. Over time the body becomes increasingly glucose intolerant as the body is not able to produce sufficient amounts of insulin to regulate blood glucose levels.

Some things to know about diabetes:

Excess weight and sedentary lifestyle are two of the main risk factors for T2DM. Over 80% of people diagnosed are considered to be overweight or obese.

Abdominal weight dramatically increases your risk of diabetes. Weight held around the midsection is a major risk factor and can impact on the function of your vital organs. The highest risk occurs when waist circumference is over 94cm for males and 88cm for females.

Diabetes can lead to complications and further chronic conditions. Both type 1 and 2 diabetes increases one’s risk of developing further complications and/or conditions. This can be reduced with correctly prescribed exercise.

Lifestyle modification can be just as effective as medication. Studies show that diet and exercise interventions can work just as well as some common medications. It is also important to note that while taking medication, exercise is still required to manage BGLs.

Accredited Exercise Physiologists (AEP) are expertly trained to help manage diabetes. AEPs are the peak allied health professional to prescribe exercise for diabetes and other chronic conditions. An AEP will be able to tailor an individual management plan, by completing a thorough assessment, including medical history, medications, and necessary GP correspondence.

At Motion Health we have Exercise Physiologist’s who can help you mange your diabetes, whether through 1:1 sessions, group classes or as part of our type 2 diabetes management group. You may even be eligible for a Medicare rebate or rebate through your private health.

May Newsletter – Winter Motivation

Winter is finally upon us. The days are colder and daylight hours are getting shorter. It is also the time of year where exercise tends to take a back seat to more inviting options such as a warm fire place or a good movie. It is important to maintain some form of regular physical activity at all times of the year. In winter there tends to be a higher incidence of illness due to viruses such as the common cold. Physical activity can have positive benefits on our immune system. Moderate intensity exercise has been associated with a 1/3 reduction in contracting an upper respiratory tract infection compared with individuals that had an inactive lifestyle (Nieman et al. 2011). This is in addition to the other benefits of exercise such as improved strength, mobility and psychological aspects such as quality of life.

There are many options for exercise these days that don’t involve being prey to the outdoor elements. You can do aerobic based activity such as exercise on a treadmill, elliptical trainer or stationary bike as well as strength based activities such as weight training, Pilates or Yoga. Here at Motion Health we can offer a number of indoor based options for exercises. Our group classes utilise a variety of equipment including traditional Pilates reformers, wunda chairs and trapeze table as well as gym equipment such as cables, dumbbells, kettlebells and stationary bike. So whatever your needs, let us help you find your movement and support you through a warmer, healthier winter.

Give reception a call on 03 9825 2697 if you’d like more information about any of our services.

Reference:
Nieman DC, Henson DA, Austin MD and Sha W (2011) Upper respiratory tract infection is reduced in physically fit and active adults. British Journal of Sports Medicine 45:987-992.