Latest PhysioWorks News

How to Thank Your Mum this Mothers Day

Mon, 30 Apr 2012 01:53:00 GMT

Every Mum deserves a treat. Luckily you can thank her this Mothers Day with a great idea that your Mum will really appreciate!

If your Mum seems to have everything already... stress and soreness included, then PhysioWorks has a soothing solution for you to help her!

This year, if your Mum needs (or would simply just LOVE) a high quality massage, there are some great gift voucher deals available between now and Mothers Day.

Buying a thoughtful and practical gift for her special day has become very difficult. A massage gift voucher is just the ticket for your Mum.

Check out our Mothers Day Massage Specials here.

Drop into either of our northside clinics or phone us today at Clayfield (3862 4544) or Sandgate (3269 1122) to arrange your gift vouchers or run through the great offers.

The Common Ankle Sprain

Mon, 30 Apr 2012 00:58:00 GMT

Acute ankle injuries are a common problem seen by your Physiotherapist, particularly in fitness programs where rapid changes of direction are required. The most important aspect of managing injury in this region is ensuring a correct diagnosis.

The key issue is deciding on whether the injury involves damage to the ankle ligaments only, or a more complex injury involving possible fractures or your syndesmosis (high ankle sprain).

Your ankle consists of three joints:

talocrural joint (ankle joint) – a hinge joint between the bottom of the tibia and the top of the talus
inferior tibiofibular joint – this is the joint between the distal parts of the tibia and fibula
subtalar joint – this is the joint between the talus and the calcaneus (heel bone)

There are three major ligaments on the lateral side of the ankle. These are the:

anterior talofibular ligament (ATFL),
calcaneofibular ligament (CFL) and,
posterior talofibular ligament (PTFL).

The medial side of the ankle is supported by the strong, fan shaped medial or deltoid ligament, which runs from the medial malleolus down to the navicular, talus and calcaneus.

Due to the relative weakness of the lateral ligaments and the instability of the lateral side of the ankle it is much more common to sustain an inversion injury (where you roll onto the outside of the ankle) than an eversion injury (where you roll onto the inside of the ankle).

As with all traumatic injuries it is essential the client is examined by your physiotherapist as soon as possible.

Your physiotherapist will evaluate the extent of the injury, outline an approximate timeline for rehabilitation, as well as excluding any more serious problems such as fractures, high ankle injuries and dislocations.

Pain free ankle mobilisation exercises are commenced following the application of ice and compression, these gentle range of motion exercises are performed for 5-10 minutes each hour with the ice/exercise cycle repeated as often as possible.

Depending on the extent of the injury the patient may need to be non weight-bearing for the first few days or in some cases, weeks. You may require a walking boot or crutches.

After the initial injury protection phase, it is important to commence flexibility, partial and then full weight-bearing exercises with normal gait (walking pattern) to assist in the restoration of your full pre injury range of motion, and function, plus prevent long term ankle stiffness.

Under the direction and guidance of your treating physiotherapist, a functional rehabilitation and strengthening program is commenced as soon as symptoms allow.

Common exercises used at this time include balancing drills, agility exercises and return to sport programs.

It is important for your safe and quick return to sport that you don’t overstress the healing scar tissue. Your physiotherapist is the best person to guide your exercise regime.

If you require further advice, please contact your physiotherapist.

More information about Sprained Ankles...

What is Achilles Tendonitis (Tendinitis)?

Mon, 30 Apr 2012 00:56:00 GMT

Achilles Tendonitis is a term that commonly refers to an inflammation of the Achilles tendon or its covering. It is an overuse injury that is common especially to joggers and jumpers, due to the repetitive action and so may occur in other activities that requires the same repetitive action.

Tendons are the tough fibres that connect muscle to bone. Most tendon injuries occur near joints, such as the shoulder, elbow, knee, and ankle. A tendon injury may seem to happen suddenly, but usually it is the result of many tiny tears to the tendon that have happened over time.

Health professionals may use different terms to describe a tendon injury. You may hear:

Tendinitis (or Tendonitis): This actually means "inflammation of the tendon," but inflammation is rarely the cause of tendon pain.
Tendinosis: This refers to tiny tears in the tissue in and around the tendon caused by overuse.

Most experts now use the term tendinopathy to include both inflammation and micro-tears. But many doctors may still use the term tendinitis out of habit.

Achilles tendonitis is an overuse injury that is common especially to joggers and jumpers, due to the repetitive action and so may occur in other activities that requires the same repetitive action.

Achilles tendonitis may be felt as a burning pain at the beginning of activity, which gets less during activity and then worsens following activity. The tendon may feel stiff first thing in the morning or at the beginning of exercise. You will often feel a tender swollen area in the tendon.

Anatomy

The calf muscles of the lower leg become the Achilles tendon. This is the prominent tendon at the back of the heel, which attaches to the heel bone.

These muscles are responsible for actions such as pointing the toes and standing tiptoe. They are greatly involved in repetitive activities such as walking, jogging, hopping and aerobics.

What Causes Achilles Tendonitis?

Over-training or unaccustomed use – “too much too soon”
Sudden change in training surface – e.g. grass to bitumen
Flat (over-pronated) feet
High foot arch with tight Achilles tendon
Tight hamstring (back of thigh) and calf muscles
Toe walking (or constantly wearing high heels)
Poorly supportive footwear
Hill running
Poor eccentric strength

Most tendon injuries are the result of gradual wear and tear to the tendon from overuse or ageing. Anyone can have a tendon injury, but people who make the same motions over and over in their jobs, sports, or daily activities are more likely to damage a tendon.

A tendon injury can happen suddenly or little by little. You are more likely to have a sudden injury if the tendon has been weakened over time.

What are the Symptoms of Tendinopathy?

Tendinopathy usually causes pain, stiffness, and loss of strength in the affected area.
The pain may get worse when you use the tendon.
You may have more pain and stiffness during the night or when you get up in the morning.
The area may be tender, red, warm, or swollen if there is inflammation.
You may notice a crunchy sound or feeling when you use the tendon.

The symptoms of a tendon injury can be a lot like those caused by bursitis.

What's the Worst that Can Happen with an Achilles Tendonitis?

The worst case scenario is a total rupture of the tendon.

Treatment in this case usually requires surgery, plaster or a walking boot for at least six weeks.

Most of these injuries take six months or more to adequately rehabilitate.

The best advice is to seek early advice from your physiotherapist to do all you can to avoid this nasty rupture happening in the first place.

How to Treat Achilles Tendonitis

Achilles tendonitis is one of the most common problems that we see at PhysioWorks and it is unfortunately an injury that often recurs if you return to sport too quickly – especially if a thorough rehabilitation program is not completed.

Your calf muscle is a large powerful group of muscles that can produce sufficient force to run, jump and hop. Your achilles tendon attaches your calf muscle to your heel bone. It is a tendon or non-contractile soft tissue structure, which does have a different level of blood supply and function, which does alter the rehabilitation from a calf muscle tear.

Researchers have concluded that there are essentially 7 stages that need to be covered to effectively rehabilitate these injuries and prevent recurrence – these are:

Phase 1 - Early Injury Protection: Pain Reduction & Anti-inflammatory Phase

As with most soft tissue injuries the initial treatment is RICE - Rest, Ice, Compression and Elevation.

In the early phase you’ll be unable to walk without a limp, so your Achilles tendon needs some active rest from weight-bearing loads. You may need to be non or partial-weight-bearing, utilise crutches, a wedged achilles walking boot or heel wedges to temporarily relieve some of the pressure on the Achilles tendon.

Your physiotherapist will advise you on what they feel is best for you.

Ice is a simple and effective modality to reduce your pain and swelling. Please apply for 20-30 minutes each 2 to 4 hours during the initial phase or when you notice that your injury is warm or hot.

Anti-inflammatory medication (if tolerated) or creams, and natural substances eg arnica may help reduce your pain and swelling. However, it is best to avoid anti-inflammatory drugs during the initial 48 to 72 hours when they may encourage additional bleeding. Most people can tolerate paracetamol as a pain reducing medication.

As you improve a compressive bandage or supportive taping will help to both support the injured soft tissue and keep excessive swelling from pooling. Keep your foot elevated above your heart (where possible) to allow for gravity to help drain your swelling.

Phase 2: Regain Full Range of Motion

If you protect your injured Achilles tendon appropriately the torn tendon fibres will successfully reattach. Mature scar formation takes at least six weeks.

During this time period you should be aiming to optimally remould your scar tissue to prevent a poorly formed scar that will re-tear in the future.

It is important to lengthen and orientate your healing scar tissue via massage, muscle stretches, neurodynamic mobilisations and eccentric exercises.

Signs that your have full soft tissue extensibility includes being able to walk without a limp and able to perform Achilles tendon stretches with a similar end of range stretch feeling.

Phase 3: Restore Eccentric Muscle Strength

Calf muscles work in two directions. They push you up (concentric) and control you down (eccentric).

Most Achilles injuries occur during the controlled lengthening (eccentric) phase.

Your physiotherapist will guide you on an eccentric calf strengthening program when your injury healing allows.

Phase 4: Restore Concentric Muscle Strength

Calf strength and power should be gradually progressed from non-weight bear to partial and then full weight bear and resistance loaded exercises. You may also require strengthening for other leg, gluteal and lower core muscles depending on your assessment findings.

Your physiotherapist will guide you.

Phase 5: Normalise Foot Biomechanics

Achilles tendon injuries can occur from poor foot biomechanics eg flat foot.

In order to prevent a recurrence, your foot will be assessed. In some instances you may require a foot orthotic (shoe insert) or you may be a candidate for theActive Foot Posture Stabilisation Program.

Your physiotherapist will happily discuss the pros and cons of both options to you.

Phase 6: Restore High Speed, Power, Proprioception & Agility

Most Achilles tendon injuries occur during high speed activities, which place enormous forces on your body (contractile and non-contractile).

In order to prevent a recurrence as you return to sport, your physiotherapist will guide you with exercises to address these important components of rehabilitation to both prevent a recurrence and improve your sporting performance.

Depending on what your sport or lifestyle entails, a speed, agility, proprioception and power program will be customised to prepares you for light sport-specific training.

Phase 7: Return to Sport

Depending on the demands of your chosen sport, you will require specific sport-specific exercises and a progressed training regime to enable a safe and injury-free return to your chosen sport.

Your PhysioWorks physiotherapist will discuss your goals, time frames and training schedules with you to optimise you for a complete return to sport. The perfect outcome will have you performing at full speed, power, agility and function with the added knowledge that a through rehabilitation program has minimised your chance of future injury.

Summary

There is no specific time frame for when to progress from each stage to the next. Your injury rehabilitation status will be determined by many factors during your physiotherapist’s clinical assessment.

You’ll find that in most cases, your physiotherapist will seamlessly progress between the rehabilitation phases as your clinical assessment and function improves.

It is also important to note that each progression must be carefully monitored as attempting to progress too soon to the next level can lead to re-injury and frustration.

For more specific advice about your Achilles tendon injury, please contact your PhysioWorks physiotherapist.

Contact PhysioWorks or Book Online

Read Full Article on Achilles Tendonitis

What is a Rotator Cuff Injury? Where is it? What Goes Wrong?

Fri, 20 Apr 2012 05:15:00 GMT

Injury to your shoulder rotator cuff is very common shoulder injury.

What is your Rotator Cuff?

What are the Common Rotator Cuff Injuries?

Where is your Rotator Cuff?

What Commonly Goes Wrong with Your Rotator Cuff?

What is Rotator Cuff Impingement Syndrome?

What is the Impingement Zone?

What Causes Rotator Cuff Impingement?

What are the Common Rotator Cuff Treatments?

Calf Muscle Tears: How to Treat & Prevent

Fri, 20 Apr 2012 00:57:00 GMT

Pain that occurs in the calf muscle on the lower part of the leg often is the result of a pulled or torn calf muscle. This is called a calf strain or a calf pull. It occurs when part of the muscle of the lower leg (gastrocnemius or soleus) is torn away from the Achilles tendon.

A calf strain is similar to an Achilles tendon tear or rupture, but occurs higher up in the back of the leg. A sign of a calf strain is similar to that of an Achilles tendon rupture. You may think you've just been hit in the leg and hear a "pop." There is sudden pain at the back of the leg, pain, swelling or bruising in the calf muscle, and you have difficulty standing on the toes.

This injury happens during acceleration or changes in direction. The torn calf muscle may spasm, and contract forcefully. The toes will point down. Bruises show up in the foot and ankle due to pooling of blood from internal bleeding.

Calf Strains may be minor or very severe and physician grade the injury according:

Grade 1 Calf Strain : The muscle is stretched causing some small micro tears in the muscle fibres. Full recovery takes approximately 2 to 4 weeks.

Grade 2 Calf Strain : There is partial tearing of muscle fibres. Full recovery takes approximately 4-8 weeks.

Grade 3 Calf Strain : This is the most severe calf strain with a complete tearing or rupture of muscle fibres in the lower leg. Full recovery can take 3-4 months and, in some instances, surgery may be needed.

More Information about Calf Muscle Injuries

When is it BEST to have Your Pre or Post-Sporting Event Massage?

Fri, 20 Apr 2012 05:17:00 GMT

If you're considering a pre or post-event sports massage, then your timing is important for maximum benefit.

Discover more information about Pre and Post-Event Massage here...

Who is Alex Clarke?

Fri, 20 Apr 2012 00:24:00 GMT

Alex Clarke graduated as a Physiotherapist in 2005 from the University of Queensland. Alex joined the PhysioWorks team in 2007, and has subsequently been constantly updating his knowledge with post-graduate education.

You'll find Alex to be an enthusiastic and caring physiotherapist with a passion for biomechanics. He utilises his knowledge of sporting biomechanics to better understand the injury process, what has caused it, and to expedite your injury rehabilitation.

From 2010 Alex has been working with the Australian Catholic University to educate the next generation of physiotherapy students. Alex is also the physiotherapist for a number of sporting teams PhysioWorks supports, including the Northside Wizards basketball. He has been the consultant physiotherapist with Foxtel’s Football Superstar TV series.

Alex has had a long association with representative sport including swimming and gymnastics, both as a participant and a coach. Alex continues to participate in regular sports that include: touch football, swimming, water polo, triathlons and marathon running.

Alex's Special Interests :

Shoulder Injury Rehabilitation
Hip Injury Rehabilitation
Acute and Chronic Low Back Pain & Injuries
Core Back Stability Retraining using a Real-Time Ultrasound Scanner
Neck Pain
Vertigo and Balance Conditions
Ankle and Knee Injury Rehabilitation
Overuse Running Injuries
Biomechanical Analysis
Dry Needling

... and more!

Alex is a Registered Physiotherapy Provider with:

All Private Health Insurance Funds
Workcover
Australia Post
InjuryNet
Medicare
Department of Veterans' Affairs
CTP & Sports Insurers

How to Book Your Appointment with Alex Clarke

Phone 3862 4544

Book-Online @ Clayfield PhysioWorks

How to Prepare Your Immune System for Winter

Fri, 20 Apr 2012 00:58:00 GMT

Those colder months may seem like a little while away but they creep up quickly!

Prepare yourself and your immune system for winter with these few handy tips:

Stock up on anti-oxidants – berries, citrus fruits, green leafy and orange vegetables, green/herbal teas; all of these foods help to strengthen the immune system and get it ready for defence!

Continue drinking at least 2L of water per day – this is important because although we may not perspire as much in the colder months, our bodies still need a certain amount of water to function healthily and 2L is usually enough for most people.

Don’t sleep in! – Continue to get up in the morning (or in the afternoon) and exercise for 30 minutes at least 5 days a week. Exercise has proven benefits to boost immunity and also mood (which is generally low at this time of year due to the temperature).

Everything in moderation still stands – just because we feel colder doesn’t mean we need more warm food (hot chocolate’s, etc…) If you feel like you need something to warm up your insides, go for a cup of tea (herbal, etc), a warm glass of skim milk, or even lemon juice squeezed into warm water. Or, even better, do some exercise!

For more specific advice tailored for your needs please contact Rachel Haddow, our Nutritionist and Dietitian.

CLAYFIELD - Phone 3862 4544 or Book Online

SANDGATE - Phone 3269 1122 or Book Online

Happy Easter!

Fri, 30 Mar 2012 03:27:00 GMT

Happy Easter!

The PhysioWorks team wish you a safe and relaxing Easter.

Shoulder Bursitis - What is Subacromial Bursitis?

Tue, 27 Mar 2012 02:29:00 GMT

A bursa is a fluid filled sac that helps to reduce friction in joint spaces. You have several shoulder bursae. Your subacromial bursa is the most commonly inflamed of the shoulder bursae.

Subacromial bursitis is a common cause of shoulder pain that is usually related to rotator cuff tendonitis, impingement or dysfunction.

Subdeltoid bursitis is less commonly inflamed shoulder bursa.

What Causes Shoulder Bursitis?

Shoulder bursitis can be caused by a repeated minor trauma, such as overuse of the shoulder joint and muscles or a single more significant trauma such as a fall.

In overuse type injuries, bursitis is often associated with impingement and tendinitis/inflammation of the rotator cuff tendons.

More information and How to Treat Shoulder Bursitis.

4 Common Causes of Heel Pain

Tue, 27 Mar 2012 03:21:00 GMT

Suffering Heel or Foot Pain?

You may not be aware that your heel is a cushion of fat that protects the foot structures: heel bone, muscles and ligaments. Heel pain is a very common foot complaint.

Common injuries include plantar fasciitis, heel spurs, fat pad injuries and Sever’s disease.

Plantar fasciitis is inflammation of the ligament that runs the length of the foot, commonly caused by overstretching, flat feet or muscle weakness. It results in pain under the heel, particularly after rest or when walking and running.

A heel spur is a bony growth where the plantar fascia inserts into your heel bone. It is the result of a chronic plantar fasciitis or delayed healing that causes bone to grow within the ligament.

The fat pad is normally injured by repeated landing trauma and can occasionally be a precursor to a stress fracture of the heel bone.

Sever’s disease is caused by stress on the growth plate in the heel bone and is common in active 8 to 13 year olds.

Anyone can suffer from heel pain, but certain groups seem to be at increased risk, including:

Middle aged men and women
Active people eg running sports
People who are very overweight
Children aged between 8 and 13 years
Pregnant women
People who stand for long periods of time.

What Commonly Causes Heel Pain?

Some of the many causes of heel pain can include:

Abnormal walking style (such as rolling the feet inwards)
Obesity
Ill-fitting shoes eg narrow toe, worn out shoes
Standing, running or jumping on hard surfaces
Recent changes in exercise program
Heel trauma eg. stress fractures
Bursitis (inflammation of a bursa)
Health disorders, including diabetes and arthritis.

How is Heel Pain Treated?

Most heel pain is caused by a combination of poor biomechanics, or muscle weakness or tightness. The good news is that heel pain can be effectively managed once the cause is identified.

Most heel pain can be successfully treated via:

pain and pressure relief techniques
biomechanical correction eg orthotics, taping, foot posture exercises
muscle stretches and massage
lower limb muscle strengthening
proprioceptive and balance exercises to stimulate your foot intrinsic muscles.

If you think that your footwear or sports training schedule are potentially causing your heel pain, then we are happy to inspect your footwear to see if it is a match for your foot; or discuss your training regime to see if you are doing too much.

If you have any further questions about your heel pain, please ask your physio or check out the following link.

More information about Heel Pain & Injuries

Who is Sebastian Macleod?

Tue, 27 Mar 2012 03:22:00 GMT

Sebastian Macleod is one os our fantastic remedial massage therapists consulting at Clayfield PhysioWorks.

Sebastian aims to get to the root of your symptoms via expert use of a wide range of techniques including Swedish massage, deep tissue massage, myofascial release, trigger point therapy and sports massage to create a great massage experience.

Since finishing his Remedial Massage Therapy Diploma at the Australian College of Natural Medicine, Sebastian has lent his expertise to several massage, sports physiotherapy and chiropractic clinics. His professional interests include structural biomechanics and conditions caused by postural dysfunctions (and how to correct them!).

A session of remedial massage therapy with Sebastian includes a thorough assessment, your wonderful massage and an explanation of the various contributing factors to your muscular condition. If needed, Sebastian also takes the time to explain stretching and strengthening exercises to help improve your muscular imbalances and posture at the end of the session.

You'll love Sebastian’s superb massages as well as his friendly and caring nature.

As Sebastian is a registered remedial massage therapist, private health insurance rebates are available.

What are the Common Massage Techniques?

Tue, 27 Mar 2012 03:22:00 GMT

A quality massage therapist will have an array of massage tools and techniques to assist you. These massage techniques can include the following:

Longtitudinal Gliding

Longtitudinal gliding is a basic but effective massage technique administered in the direction of the blood flow. It aids the fluid dispersion from the injury site, and thus helps reduce inflammation and swelling. It is also very useful in relaxing tight muscles.

Kneading

Kneading can be performed in different ways and is described by the part of a hand used to accomplish the massage, eg thumb kneading and palm kneading. The pressure used must vary according to the purpose of the massage and the bulk of the tissues under treatment. The rhythm and rate of the movement are equally important as the pressure is applied intermittently.

Myofascial Releases

Myofascial release is manual technique for stretching the fascia with the aim to balance the body. Fascia is located between the skin and the underlying structure of muscle and bone, it is a seamless web of connective tissue that covers and connects the muscles, organs, and skeletal structures in our body. Injuries, stress, trauma, and poor posture can cause restriction to fascia, and the goal of myofascial release is to release fascia restriction and restore its tissue.

Trigger Point Therapy

Trigger point therapy is a bodywork technique that involves the applying of pressure to tender muscle tissue in order to relieve pain and dysfunction in other parts of the body. Trigger points are active centres of muscular hyperactivity, which often cross-over with acupuncture points. You will also find that your muscular "knots" are commonly trigger points.

Deep Transverse Frictions

Transverse friction is a transverse connective tissue therapy applied directly by the fingers. Transverse frictions use an oscillating pressure applied across the direction of the tissue fibres. This technique is used mainly on tendon or ligament injuries to help break down thickened, pain-producing scar tissue. If these lesions are not reduced then they are likely to cause further irritation, and degenerate more quickly than they should.

Compression Massage

Rhythmic compression into muscles used to create a deep hypremia and softening effect in the tissues. It is generally used as a warm-up for deeper, more specific massage work. Sports massage utilises compression massage.

Cross-Fibre Massage

Cross-fibre friction techniques applied in a general manner to create a stretching and broadening effect in large muscle groups; or on site-specific muscle and connective tissue, deep transverse friction applied to reduce adhesions and to help create strong, flexible repair during the healing process.

Swedish Massage

Swedish massage techniques include: long strokes, kneading, friction, tapping, percussion, vibration, effleurage, and shaking motions.

The usual sequence of techniques are:

Effleurage: Gliding strokes with the palms, thumbs and/or fingertips
Petrissage: Kneading movements with the hands, thumbs and/or fingers
Friction: Circular pressures with the palms of hands, thumbs and/or fingers
Vibration: Oscillatory movements that shake or vibrate the body
Percussion: Brisk hacking or tapping
Passive and active movements: Bending and stretching

PNF Stretches (proprioceptive neuromuscular facilitation)

PNF techniques combine passive stretching and isometrics with your muscle alternatingly stretched passively and contracted. The technique targets nerve receptors in the muscles to extend the muscle length.

First, the relaxed muscle is stretched by a partner, ones own body weight against the floor, a wall, or similar resistance.
At the point, where no further stretching seems possible, the stretch is held for up to 30 seconds. However, during this period, the muscle should be contracted as much as possible.
Finally, when the muscle gets relaxed again, it should be immediately stretched farther, which is then easily possible again.

This technique of alternating stretching and contracting can be repeated several times, in order to stretch a bit further each time.

Your PhysioWorks massage therapist is a professional who understands was is right for your body. If you have any questions as to what is best for your body, please call us to discuss your massage requirements.

More information about Massage Styles...

Osteoporosis: It's Starts When You're a Kid! Plus… Tips to Increase your Bone Density.

Tue, 06 Mar 2012 02:02:00 GMT

Here's a transcript of an interview between Dr Norman Swan and Prof Robin Daly regarding Osteoporosis.

Full audio and transcript is available here.

Norman Swan: Now to dem bones and the epidemic of osteoporosis in both men and women, as we age. The problem of bone thinning goes right back to childhood and Australian research is finding that exercise is a critical part of building and maintaining healthy bones at all ages. But not just any exercise.

Robin Daly is Professor of Exercise and Ageing at Deakin University in Melbourne.

Robin Daly: Childhood is a particularly important time where we accrue bone mass and that exercise is probably the most effective tool to really get a large clinically significant gain in bone mineral density.

Norman Swan: You mean delaying the time in adulthood where you get your first fracture?

Robin Daly: That's right if we can increase bone mass by about 10% we can delay the development of osteoporosis by 13 years and potentially reduce fracture risk by 50%.

Norman Swan: And when do we reach our peak bone mass?

Robin Daly: That's a difficult question, it seems to be a little bit site specific but it's around about 18 to 25 years of age.

Norman Swan: What have you found?

Robin Daly: What we've found is that with regard to exercise for children we know that "weight bearing exercise" is particularly important and weight bearing activities include sports such as tennis, basketball, football, soccer and we know that those are particularly osteogenic and can improve their bone density.

Norman Swan: And osteogenic meaning bone building?

Robin Daly: Bone building that's right. And the other activities, we know that school based physical education programs that incorporate weight bearing exercises or jumping activities, hopping, skipping and even for very short periods ranging from 3 to 12 minutes, again they are osteogenic and can result in an increase in bone density.

Norman Swan: Now it's not just bone density it's bone strength so what do we know about the things that increase bone strength?

Robin Daly: Bone strength takes into account the size of the bone, the geometry of the bone as well as the mass. And so bone strength is a stronger predictor of fracture than just bone mass alone.

Norman Swan: And what kind of exercise does that?

Robin Daly: Again it's the moderate to high impact weight bearing activities, hopping, skipping, jumping, activities which might be up to three to five times bodyweight which particularly load around the hips and the legs and even the spine.

Norman Swan: And how important is it to change direction in the exercise, in other words to get different stresses on the bone rather than just jumping up and down in a vertical position?

Robin Daly: That's a very good point, it's not just the magnitude of the loading it's actually the novelty or the multi-directional activity of exercises which is particularly important. So our recommendations are focussing on not only just increasing high impact activities but changing direction and doing activities which the bones are typically not accustomed to and then they might respond in a positive manner.

Norman Swan: So how much exercise for how much gain in childhood?

Robin Daly: At least 30 minutes of weight bearing exercise but we do have evidence very short, intense programs which might only be 3 to 5 minutes which might include anywhere between 50 and 100 jumps can result in an increase in bone density.

Norman Swan: How high?

Robin Daly: It might be 20 centimetres off the ground.

Norman Swan: What about running, is the impact of your foot hitting the ground when you're jogging enough to build your bones?

Robin Daly: We've looked at the impact forces from running and they are typically around 2 to 3 times bodyweight. Now most people think that you do a lot of impact loads so you should improve your bone density, but your bones have little sensors in them which pick up the loads, if they get used to doing those type of activities they no longer have to adapt and get stronger.

Norman Swan: So you've got to surprise your bones.

Robin Daly: And bones like stress.

Norman Swan: So what do we know about adults?

Robin Daly: In adults it's a little bit different. In adults we know that the focus is more on maintenance of bone density. With healthy adults we can encourage weight bearing exercises with muscle strengthening exercises to stop the loss in muscle mass which occurs with age.

Norman Swan: Is jumping important there too?

Robin Daly: Yes, especially for adults between 20 and 50 years of age, we know that they can tolerate jumping impact type activities and they are particularly effective for improving bone density around the hip. In terms of the spine, which is another common fracture site, resistance training exercises are lifting weights which stretch the muscles around the vertebrae are particularly effective for maintaining bone density of the spine.

Norman Swan: You've got an experiment in that?

Robin Daly: Yes, we've done a few experiments in older men. We did an 18 months trial where we asked community based men to undertake resistance training and exercise three times per week interspersed with weight bearing impact type activities.

Norman Swan: So just be more specific about the exercise.

Robin Daly: They lifted weights which were focussing on the muscle groups around the hips and the spine, hip abduction, hip extension, leg press type exercises and then for the back muscles rowing pulleys, lat pulldowns to load the spine. And then they did two or three targeted weight bearing exercise where they might have done hops, skips, jumps or bench step ups, they did it three times a week and they were asked to train for about 45 minutes.

Norman Swan: And the results?

Robin Daly: Over the 18 months period we saw significant increases in both their spine and their hip bone mineral density, we looked at some measures of bone strength around the hip and again we found significant increases in the hip bone strength. Importantly we also saw increases in their muscle mass, their muscle strength and we measured various measures of muscle performance such as their balance and gait and we saw significant improvements compared to those who didn't do the exercise.

Norman Swan: Now one of the things that happens is that people feel triumphant when they just do any exercise but the evidence has increasingly shown you've actually got to move along, progress. What's the story with progression?

Robin Daly: The biggest challenge we face in terms of getting the best benefits out of exercise is to ensure that the activities become progressively more difficult over time. When people first start an exercise program it's important just to get them accustomed to the activities and doing them safely and properly and that usually takes three or four weeks. Once you become accustomed to the exercise it's important to challenge the musculoskeletal system so we do this progressively by either increasing the weights or changing the direction of the movements if it's impact type exercise and then after a three month period we introduce new exercises and then they start at a lower level again and then they get progressively more difficult over time.

Norman Swan: Now if you haven't got the money to go to the gym or you haven't got a personal trainer how do you do that for yourself?

Robin Daly: We've done trialled home-based exercise programs where you can incorporate again weight bearing impact activities into your daily life, whether it's if you went out for exercise you can incorporate jumping activities and you don't need a lot of jumps. Again in the older adults we've shown programs where you might only need between 50 to 100 weight bearing impact loads, specific targeted impact loads for the hip and the spine to improve your bone density. And in terms of resistance training it's a little bit more challenging; you really need a gym to get the progressive overload. There are lots of programs in the community and in home- based programs where you can use rubber bands and resistance-type equipment but you tend to plateau after a three month period. So for purely muscle mass, muscle strength gains the gym is the best approach.

Norman Swan: And you found that walking is pretty useless for your bones?

Robin Daly: Yes, walking is not what we call osteogenic because your bones are typically accustomed to walking. We've looked at a number of different trials from around the world and even our own data showing that walking to actually improve your bone density is not particularly effective and it's not particularly effective for reducing your risk of falls as well because it just doesn't challenge the system high enough. Walking is great for your heart and great for your cardiovascular system but it's not necessarily great for your bones.

Norman Swan: Take me from the sitting position to activity, you've got to start with walking haven't you?

Robin Daly: For people that have been previously sedentary the first step would be to get them active and walking is a great activity to get people active. And we try to get people quite quickly progress up to brisk walking. Brisk walking tends to result in higher forces and there is some evidence that regular brisk walking can help maintain your bone density. Once you become sufficient with your brisk walking and you've got an adequate level of function and performance you can then progress to different types of activities into your program whether it's short periods of impact exercise or running. We don't want to discourage exercise per se and we want people to become more active and walking is a very easy activity that anyone can quickly do at no cost at all. But if we're concerned about osteoporosis we need to progress further than just doing walking alone.

Norman Swan: And is there any risk if say you're 75 and you've got sore knees?

Robin Daly: There's not particular risk, I mean for these high risk people the first step would be to do more challenging balance exercises where you might be standing on one leg or doing activities which challenge your balance - things like eyes open, eyes closed, trying to walk in a straight line and so forth. It's putting you at the edge of your balance so you're not going to fall over but you know you feel like you're going to fall over and you've got to do this in a safe environment obviously but it helps you challenge your various parameters which includes balance.

Norman Swan: And how does calcium and vitamin D affect this?

Robin Daly: We've shown that to get the maximum benefit out of exercise on your bone health you need to maintain an adequate calcium intake.

Norman Swan: Now if you look at something like Pilates, they focus on slow exercises to get your strength, some people say it should be fast, some people say that you should have interval training, slow followed by fast. What's the evidence here when it comes to the sort of exercises you've been talking about?

Robin Daly: The physiology behind Pilates or how it's actually performed would suggest that it is probably not particularly good for bones. Whether it improves falls or function performance I'm not sure. One of the key aspects we've been studying recently is the concept of muscle power and muscle power represents the ability to produce force quickly. So if you're thinking of when you are on a train or a tram and it takes off all of a sudden you've got to quickly move your leg to stop yourself from falling - that's an example of muscle power. For older people we train the neuro muscular system to try to improve their muscle performance and their speed of movement to stop them falling over.

Norman Swan: Get that power going. That's Robin Daly who's Professor of Exercise and Ageing at Deakin University in Melbourne.

I think you'll agree that's a very interesting interview that could suggest that your current exercise regime is not helping you to tackle or avoid osteoporosis as well as you could.

If you'd like more specific advice regarding osteoporosis and the best exercises for you, please ask your physiotherapist.

How Poor is Your "Hip Core"?

Tue, 06 Mar 2012 02:01:00 GMT

What do you mean by “Hip Core”?

While most people now understand the importance of good core muscle control to fix back pain and improve sporting performance, it has not yet transferred to regions other than your back.

This article will focus on the importance of your “hip core” in the prevention or resolution of hip and groin pain.

What’s Your “Hip Core”?

You probably won’t find too many articles referring to your hip core as yet. It is known in the medical world as your “deep hip stabilisers”, and hasn’t been around long enough to be given a major PR overhaul.

However, your “hip core” does exist and is very important for controlling your hip, pelvis and upper leg, especially during one leg stance, walking, running, jumping and kicking. Which, when you think about it, affects all of us everyday!

What Happens?

Just like most people have trouble ‘switching on’ their abdominal core muscles due to previous back pain, pregnancy, post-child birth or sports injuries, the same applies to the deep hip muscles.

These deeper muscles tend to ‘turn off’ to a degree because of the pain or injury and usually struggle to properly ‘turn back on’ for a long period of time. This leads to ongoing pain or other problems developing throughout your hip and leg.

As a result your body compensates by:

increasing the workload of the larger hip and buttock muscles causing muscle fatigue, knots and tightness.
causing you to adopt a poor pelvic and lower back joint posture due to weakness.

Ultimately this means that other back and hip muscles tend to tighten up to try and stabilise your wobbly hip. This leads to secondary injuries.

Unfortunately the long-term results can include a collapsing hip during walking or running, and an increased likelihood of joint stress and damage predisposing you to premature degenerative arthritis and pain, not only in your hip, but in your knee, back or ankle as well!

Problems with Hip Core Retraining

Other than not having a trendy name yet, the hip core can be successfully retrained but it is more difficult to identify which muscles they are. Plus, you will have variable hip core ability on your left compared to your right.

Just like with lower back core exercises it is important not to progress too quickly. If you overload the muscle it will simply stop working or lose control, leading to increased chance of injury.

What to Do?

If you have suffered hip or groin pain that continues to niggle, it may well be due to a “poor hip core”. Your doctor may have diagnosed you as having trochanteric bursitis, which is a secondary injury caused by hip instability. While an injection may help ease the short-term symptoms, they tend to recur because your “hip core” responds to corrective exercises - not injection!

If this is case, then please contact us to have your hip core assessed. Your physio can do a full hip and pelvis assessment and start you on remedial treatment straight way.

PhysioWorks has designed a corrective “hip core correction” program to help you overcome hip and groin pain quickly. Plus, for those who have difficulty feeling your correct muscles working, we can use an ultrasound scanner to visually help you find your hip core and see them in action.