Benign Paroxysmal Positional Vertigo (BPPV)

Have you ever experienced a sudden sensation of spinning or dizziness when you roll over in bed or stand up suddenly? If so, you might have encountered a condition known as Benign Paroxysmal Positional Vertigo (BPPV).

What is BPPV and what are some of its symptoms?
BPPV is a common vestibular disorder impacting the inner ear, eliciting symptoms which include dizziness, unsteadiness, and feelings of nausea. It is commonly seen in people over the age of 65, however can affect people of any age. BPPV can be triggered when a person’s head or body is placed in a certain position. A common trigger is rolling over in bed or when going from lying down to standing. Symptoms are often experienced in intense recurrent bursts typically lasting between 20 – 60 seconds. Episodes of BPPV may resolve within a few weeks or months and at times may even reappear years later.

A breakdown of what BPPV means:

          Benign – meaning it is not a threat to your life.

          Paroxysmal – meaning the dizziness comes in short recurrent bursts.

          Positional – meaning the dizziness is provoked by certain body or head positions and or movements.

          Vertigo – the medical name assigned to the spinning sensation.

Whilst BPPV is not life-threatening it can have a significant impact on a person’s quality of life.

What causes BPPV?
BPPV occurs when crystals within the inner ear become dislodged disrupting our vestibular (or balance) system. As your head moves, the dislodged crystals also move causing incorrect messages to be sent to the brain and subsequently the eyes. This leads to the feelings of dizziness even after relatively small movements of the head. BPPV can be caused by; (i) head injuries, (ii) degeneration of the vestibular system associated with ageing and, (iii) damage caused by an inner ear disorder.  

Treatment options for BPPV

Brandt-Daroff Exercises
The Brandt-Daroff exercises are a series of movements one can perform to help manage certain types of vertigo such as BPPV. These exercises are designed to help through providing relief by dislodging and breaking up the crystals which form within the inner ear. The Brandt Daroff exercises have been shown to be a relatively safe exercise for individuals to try alone however they can elicit symptoms of vertigo and it is therefore recommended you have someone nearby when performing for the first time. Despite these movements possibly eliciting symptoms of vertigo it is important to persist with them for a prolonged time to determine whether or not it is effective for you.

How to perform the Brandt Daroff exercises:

1.       Start seated on the edge of a couch or bed.

2.       Turn your head 45 degrees to your left and lie down onto your left side simultaneously. Perform this part of the movement within 1-2 seconds.

3.       Once you are lying down with your head angled 45 degrees remain in this position for approximately 30 seconds.

4.       After 30 seconds slowly return back to a seated position and remain upright with your head facing forward.

5.       Repeat on the other side.

Lifestyle recommendation
If you experience BPPV you may consider;

          Being mindful of movements that may elicit symptoms.

          Use good lighting if you need to get up during the night.

          Sit or lie down upon dizzy spells.

          Continue with exercise and challenge your balance within a safe environment.

          Use a mobility aid if required to reduce the risk of falls.


Additional Treatment
Should your symptoms of BPPV continue for a prolonged time or become debilitating, consider booking in with a physiotherapist, audiologist, or other specialist who will be able to conduct specific maneuverers or supply additional exercises to help manage your vertigo. It can be important to seek help during early stages of symptoms to mitigate the risk of falls or injury. In extreme cases, surgery may be performed however non-invasive measures such as exercises and maneuverers should be conducted as a first line of defence. 

Diabetes and Exercise

Diabetes and Exercise

Diabetes Mellitus, commonly just known as diabetes, is a condition in which the body has the inability to convert sugars (glucose) in the blood into energy.

Having high levels of glucose in the blood affects the function of the pancreas, which is responsible for creating and releasing a hormone called insulin. Diabetes occurs when the body cannot produce the amount of insulin required to clear the glucose, or when the body has grown resistant to the inulin it is producing.

There are 3 main types of diabetes, all of which are complex and serious: Type 1 Diabetes, Type 2 Diabetes, Gestational Diabetes.

Type 1 Diabetes
T1DM is an autoimmune condition where the body attacks and destroys the beta cells in the pancreas – the cells that produce insulin. This means that there is no insulin in the body and insulin injections are required.

The onset of T1DM is generally earlier in life, with most having a diagnosis before the age of 30. In children, the onset is abrupt with symptoms being quick and obvious. In adults, the onset can be slower but is just as threatening.

It is unknown what causes T1DM, but it is not linked to any modifiable lifestyle factors. Environmental factors, such as exposure to certain viruses, and genetics are thought to be the main precursor to the disease. There is no cure to T1DM and it cannot be prevented. T1DM is a lifelong condition.

Type 2 Diabetes (T2DM)

T2DM is a progressive disease, in which the body gradually becomes resistant to the normal effects of insulin. Over time, the pancreas loses its effectiveness to produce and release the required amount of insulin to clear the glucose. The inefficiency of the pancreas’ insulin production leads to an imbalance of blood glucose and insulin in the blood stream and can eventually result in insulin resistance.

As well as modifiable lifestyle risk factors, there is also a strong genetic link associated with T2DM.

T2DM can initially be managed with lifestyle and diet modification, including regular physical activity. Over time, many people may eventually need medications to manage their diabetes, or those with more advanced disease progression may also require insulin injections.

Gestational Diabetes (GDM)
Gestational Diabetes (GDM) is a type of diabetes that occurs during pregnancy. In pregnancy, the placenta produces certain hormones that provide nutrition for the growing baby. While these hormones are essential for the baby, they can also block or reduce the effectiveness of the mothers own insulin production. This is called insulin resistance. Because of this, the glucose levels rise and GDM develops.

Once the pregnancy is over the blood glucose levels usually return to normal and the GDM disappears. Those who experience GDM during their pregnancy have a higher risk of developing T2DM later in life.

Diabetic Complications
If left untreated, diabetes can lead to serious health complications affecting the heart, kidneys, nerves and eyes. These complications develop gradually and will worsen over time with consistently uncontrolled blood sugars. Complications can become disabling or life-threatening if not treated appropriately. Some of the common complications include:

          Cardiac: most commonly heart attack, stroke

         Nerve damage (neuropathy) – leads to tingling, burning or numbness, mainly in the legs

          Kidney damage (nephropathy) – also known as kidney disease

          Foot problems – nerve damage can lead to amputation in serious cases

          Eye problems (retinopathy) – affects eyesight and can lead to blindness

Exercise for Diabetes
Physical activity is undoubtfully one of the best forms of medicine we can give to our bodies for overall health. Exercise is well known for helping many things including controlling weight, lowering blood pressure and cholesterol, strengthening muscles and bones, boosting mood and improving general well-being. For people with diabetes, exercise also has an added benefit of lowering blood glucose levels and increasing the bodies insulin sensitivity.

When you exercise, muscles use glucose from the blood as energy to fuel muscle contractions. The more movement you do, the more glucose is taken from the blood and ultimately, over time, this leads to lower blood glucose readings.

All forms of exercise have been proven to lower blood glucose levels including walking, running and bike riding. However regular resistance training has been proven to result in lowering and maintaining a more stable glucose profile.

As people with diabetes are at risk of other health complications such as heart and foot disease and nerve damage, it is important that your exercise is right for you. Exercise Physiologists are trained in the prescription of exercise for people with diabetes and can safely develop and administer an exercise program that is suitable for you.

If you are considering exercise to help with your diabetes management, talk to your GP to find out whether or not an exercise program could be suitable for you. Alternatively, you can call our clinic directly to find out more and book your initial appointment.

10 Exercises to do on the Plane to Avoid DVT

Winter is here and that means it’s time to hop on that plane and chase that sunshine! Often though, this involves a long haul flight and many hours sitting down. The limited leg room and inability to move around cannot only be uncomfortable, but can also lead to stiff, sore and cramped legs, as well as a risk of developing DVT. 

What is DVT?

Deep vein thrombosis (DVT) is a blood clot that develops in deep veins in the body, usually in the legs. DVT becomes life-threatening when the clot breaks off and moves through the blood stream causing an embolism. When travelling, there is always a greater risk of developing DVT due to the increased sedentary time over a long haul flight. This risk is heightened even more if you already suffer from varicose veins before flying.

Signs and symptoms of DVT can include:

– Swelling in the affected leg. Rarely this swelling is across both legs
– Pain in the leg. This pain often starts in your calf and can feel like cramping or soreness
– Red or discolouration of the skin
– A feeling of warmth in the affected leg

Fortunately, this does not mean you cannot fly at all, but there is a few precautions you should take to avoid the risk of serious complications. Some of these include trying to regularly stretch and walk up and down the isles to allow maximal blood circulation. There are a number of exercises you can easily complete while flying to lessen your risk of DVT:

Seated Plane Exercises:

Toe raises: Seated with knees bent, keep your heels on the ground and lift your toes and the front of your foot as high off the ground as you can.

Ankle circles: lift one foot off the ground. Rotate your foot around to draw big circles from your ankles. Repeat on both feet.

Shoulder rolls: sit in a relaxed position with your arms by your side. Slowly roll your shoulders in forwards and backwards motions.

Neck rotations: Next, rotate your head in clockwise and counter-clockwise motions. For an additional neck stretch, place your left hand on top of your head and gently pull it towards your left shoulder. Repeat on the right side.

Standing Plane Exercises:

Calf raises: hold onto the back of your chair for balance and stand up nice and tall. Lift up onto your tippy toes, hold for one second and slowly lower your heels back down.  

Quad stretches: hold onto the back of your chair and bend one knee, bringing your foot up towards your bum. Grab your ankle with your hand, pull your foot close to your bum and hold the stretch for 15-30seconds. Release and switch sides.

Walking: When the seatbelt sign is off, of course, take the opportunity to walk around the cabin every few hours at a minimum. Walking will ensure that the blood flow circulates normally from your feet back up to your heart and prevent risk of DVT.

Exercises That Might Look a Little Strange but are Great to do Anyway:

Squats: Standing up tall, bend your knees and squat down like you are going to sit in a chair. Keep your chest up tall then stand back up straight again.

Lunges: take a big step forwards and bend your knees, dropping your back knee down towards the ground. Push back up through your front foot and bring both feet back together again. Alternate legs.

Lumbar rolldown: now this one you can do sitting if you have the space. Tuck your chin to chest and rolldown from the top of your back to almost fold yourself in half so your hands come down towards your toes. Slowly unfold yourself and roll back up to a tall position.

Return to Exercise Post-Isolation

We are all going through extraordinary times currently with the impact that COVID-19 is having on our lives, the potential isolation periods that come with this and the interruption this causes to our lives – and exercise routines.

To ensure that we exercise and challenge our bodies in a safe way, it is extremely important that we respect the principle of ‘gradual progressive training loads’. In other words, not doing too much too soon which can result in an injury.

We’ve all been through the ‘too much exercise too soon’ scenario where we’ve run that half marathon we barely trained for, or lifted that extra 20 kg which we weren’t up to in the gym, and either injured ourselves or have re-aggravated a prior niggle. This can happen at the best of times when we are keeping active on a regular basis, but this risk greatly increases after a period of minimal activity.

Therefore, when getting back into your training routine after a period of lockdown or isolation (once you have recovered!), it is really important to ease back into things to give your body time to adapt. This will look different for everyone and involves a number of factors, including your prior exercise history and level of training, and past injury history. A nice starting point can be reducing your exercise load by approximately 30-40% in the first week of return to exercise. This could equate to running 4km twice weekly instead of 6km, or squatting 30kg at 3 x 10, instead of 50kg at 4 x 10.

From here, depending on how you feel you may want to repeat this same dosage for week 2, or feel comfortable to increase by an extra 10% for the next couple of weeks. The key is to NOT immediately return to your pre-isolation level of exercise straight away, and to GRADUALLY increase your activity back to your normal level over 3-4 weeks all going well.

Of course, the above scenarios are just examples and should be individualised to each person. If you have an injury history and are worried about returning to exercise, it can be a good idea to consult an expert in exercise and training loads, such as a Physiotherapist or Exercise Physiologist. From here, we can create a graduated plan that considers you as a person and your history.

Remember, slow and steady wins the race!

July 2019 – Acute Ankle Sprains

By Kirsty Allen

Acute ankle sprains are one of the most reported musculoskeletal injuries amongst the general population, with up to 70% of people reporting an ankle injury in their life time. Representing roughly 15% of all injuries reported, the highest rates of ankle sprains are typically reported in sports and activities that are characterised by running, cutting and jumping, such as basketball, football and volleyball.

Inversion injuries/lateral ankle sprains (ie. the ankle “rolling inwards”) make up for more than 85% of all ankle sprains. Among the general population, ankle sprains are typically influenced by age, with those aged between 10-19 being the most susceptible to injury, as well as a predisposition through previous ankle injuries. Those who have a history of even one ankle sprain have been found to be 2 times more likely to sustain further ankle injuries. Such a high re-injury rate may be due to poor rehabilitation and/or premature return to sport.

With this, there is a strong association between ankle sprains and the development of chronic ankle instability (CAI). CAI includes mechanical instability (ankle range of motion exceeds normal physiological limits) and functional instability (feeling like the ankle it going to “give way” either at rest or during activity).

After an acute ankle sprain, the individual is likely to experience pain, tenderness and swelling in the ankle, as well as only being able to partially weight-bear on the affected side. These symptoms may last from a few hours to a few weeks, depending on the severity of damage and the management of the injury.

Following an acute injury, it is important to seek professional medical advice to allow for proper management and recovery. A Physiotherapist or Exercise Physiologist will work closely with you to help reduce swelling, increase passive and active range of motion, improve strength and stability and re-develop motor control and coordination through the affected joint allowing for a safe return to sport. It is essential to begin rehabilitation early after injury, as starting exercises in the first week provides significantly greater outcomes to short term ankle function.

If you have recently suffered from an ankle injury, or have in the past and experience any of the above instability symptoms, call Motion Health on 03 9825 2697 to book an appointment with an Exercise Physiologist or Physiotherapist today.

June 2019 – Physiotherapy for cervicogenic headache

relaxation massage

By Adrian Pranata

Headache is a common problem in society and is one of the most common reasons one would seek medical help. There are myriad causes of headaches ranging from stress, hormone imbalance, balance and sight problems to serious medical conditions such as a stroke or brain tumour. However, headaches can also be caused by problems in the neck. Neck disorder-related headache is termed cervicogenic headache (CH). CH usually presents as a dull ache that is projected from the neck to the left or right side of the head, behind the ear and may radiate as far as the eye on the same side. CH can be very disabling and may last for a few hours but it can recur 1-3 times in a week.

People with CH have also reported additional symptoms such as ringing in the ears, dizziness and restrictions with neck movement. CH is more common in females and has been seen in individuals as young as 6 to 40 years of age. It has been thought that CH is precipitated by sustained posture (e.g., sitting and sleeping) and physical trauma (e.g., car accident). These precipitating factors can irritate the nerves surrounding the upper neck joints which in turn would irritate nerves in the brainstem – which projects the signal to the head region resulting in painful sensation away from the neck.

Fortunately, CH can be treated effectively by physiotherapy. Physiotherapy management of CH is supported by high quality scientific research – which includes treatments of the neck joints, postural assessment and correction, neck muscle retraining and stretches, nerve exercises and advice on healthy work and lifestyle. Thus, early physiotherapy assessment and intervention is integral to optimise CH recovery.

It is not uncommon that CH is associated with tight neck and upper back musculatures. This gentle stretch can help alleviate the aches associated with tight muscles around the neck and upper back:
1. Gently bend your head forwards with one hand whilst guiding your chin towards your chest with the other until you start to feel a stretch at the back of the neck.
2. Hold this position for 30 seconds and repeat 5 times daily.

If symptoms persist, Physiotherapists are available at Motion Health. Call 03 9825 2697 for further information.

May 2019 – Delayed Onset Muscle Soreness (DOMS)

By Monica Nguyen

Delayed onset muscle soreness (DOMS) is muscle tenderness and stiffness that usually starts 12-24 hours after the activity. Most of the stiffness/discomfort usually occurs 24 hours after and can even last for 3 to 5 days after the activity that caused it.
It is thought to be related to microscopic tears in the muscle fibres, which result from exercise that stresses the muscle tissue beyond what it is used to.
DOMS can result from taking part in a new physical activity or training harder than usual. The good news is that the next time you do that activity you are likely to experience less soreness and recover more quickly. Most cases of DOMS gradually subside and have no lasting effects.

While there is no way to cure the condition immediately, here are some treatments you can do to relieve soreness and accelerate recovery:

• Applying ice to the area to decrease inflammation.
• Resting the muscles so they have time to heal before attempting the same routine again.
• Active recovery: doing an easy, low-impact aerobic exercise such as walking to increase blood flow to the muscles.
• Massage.
• Stretching the muscles.

However, if the following applies to you then it is best to seek the advice of your physiotherapist or Exercise Physiologist:
 the pain is still present and not resolving more than 48 hours post-exercise.
 the pain came on during the exercise (not the day after) and was more sudden in onset.
 the pain is located in and around the joints and not just limited to muscles.
 there is swelling and discomfort in and around the joints.

For more info re DOMs, give Motion Health a call on 03 9825 2697 or have a chat with one of our practitioners next time you are in the Studio.

April 2019 – Lower Back Pain and Exercise

Motion Health Pilates

Lower Back Pain? Keep Moving
By Joel Wallace

Almost everyone at some point experiences back pain, and for some this might be a regular occurrence.

It is very easy to fear back pain and treat it differently to how we would other pains and aches. This may be for many different reasons but is often due to uncertainty, past experience or belief we will make it worse.

Surprisingly to a lot of people is that in most cases we don’t need to rush for ‘treatment’ and it quite safe to continue normal activities and exercise. Most episodes of lower back pain resolve themselves in around 6-8 days.

Some things to keep in mind about back pain are:

• Pain does not equate to damage

• The rate of spontaneous re-absorption of lumbar disc herniation’s is about 67%.

• Exercise has been linked with positive effects on the discs such as promoting regeneration and strengthening the inter-vertebral discs

• Isolated exercise such as ‘core’, transverse abdominal and glute exercises are not more effective than any other type of exercise for lower back pain

• Posture has not been shown by research to play a major role in the development of lower back pain

• Bending, and twisting has not been shown to be an independent cause of lower back pain or associated with pain intensity.

• On the other hand – Avoiding or being fearful of certain movements have been associated with ongoing lower back pain

For a helpful approach around exercise and lower back pain, see the below simple advice by Cor-Kinetic:

Don’t over complicate exercise & activity for back pain, use the following guidelines for your symptoms:

• Low levels of activity = increase activity a bit

• High levels of activity = reduce activity a bit

• Stiff movement = focus on relaxed movements

• Need higher levels of loading for sport/work = load them up

• Specific feared movements = grade the exposure to specific feared positions/movements

• Positions/activities that are painful beyond a tolerable level = its ok to back off for a bit (make sure to reintroduce them)

• Negative associations around exercise/activity = Make it fun, engaging & meaningful

• Bit of pain doing stuff = it’s ok

If you have any questions or want to know more speak to your Exercise Physiologist or Physiotherapist at Motion Health.

Remember that you don’t always need to rush for ‘treatment’ and that movement and exercise is good for you.