Physiotherapy

Ditch the Detox

Detox is a popular buzzword in the world of health and wellness. These diets claim to clear toxins from our body, increase energy, boost immunity, improve digestion and facilitate rapid weight loss. Sounds too good to be true, right? That's because it is. 

 

Healthy adults have amazing inbuilt mechanisms to remove toxins from our bodies each day. Our liver, gastrointestinal tract, kidneys, lungs, skin and immune system are constantly working to remove unwanted substances. It's fair to say detox products and regimes are largely a marketing gimmick, seeking profit for a process your body can manage solo. 

 

These diets involve fasting, elimination of entire food groups and reliance on commercially prepared detox products. Due to the restrictive nature of these diets it is difficult to meet nutritional needs when detoxing, which may compromise our immune system and digestive processes over time. There's also no scientific evidence to suggest these regimes will increase energy levels, in fact many people experience lethargy due to inadequate nutrition. Finally, we know any weight lost via these programs will return, and long term engagement in dieting behaviour is the biggest predictors of weight gain. 

 

If you're looking for a way to feel more energised and healthy, skip the detox diet; instead, honour your appetite, choose a variety of food across and within the key food groups, hydrate, cut down on alcohol, participate in activity you enjoy, make time for self-care, and rest as needed. 

 

 

MEGAN     Dietician  Megan Bray   B Exercise & Nutrition Sciences., M Diet St., APD.   Megan one of the Dietitians at the Movement Team and is passionate about challenging the way society approaches dieting. She has clinical interests in weight management, chronic disease, and eating behaviour. Megan also has experience in research and aged care.

MEGAN

 

Dietician

Megan Bray

B Exercise & Nutrition Sciences., M Diet St., APD.

Megan one of the Dietitians at the Movement Team and is passionate about challenging the way society approaches dieting. She has clinical interests in weight management, chronic disease, and eating behaviour. Megan also has experience in research and aged care.

The issue with Tendinopathies

When thinking about injured body parts, bones and muscles often get all the attention. A different type of structure exists all over our body and is often the actual cause of our pain. This structure is a tendon. Tendons attaches our muscles to our bones and are absolutely key in allowing us to move as they transmit the force our muscles create onto our skeleton! 

Diagram of tendons and liagments

Diagram of tendons and liagments

When tendons get injured however they are probably one of the hardest structures to treat. This is mainly due to a lack of understanding about how tendon’s adapt and respond to change. 

As well as just transferring force from muscles to bones, tendons are actually able to store and release elastic energy. This function is especially important in athletic performance. Tendons (very large versions) are what allow a kangaroo to spring along so efficiently!  

 

How to know if it is a tendon that you hurt?

Tendons adapt very slowly to new loads, so if you have developed pain associated with a recent increase (or new) activity, it is possible that your tendon rather than your muscles are the structure that is struggling with your new activities! To be sure that your tendon is what is at fault takes close questioning and assessment. Often tendon pain is one that seems to come back over and over again and I’m guessing quite a few of you have experienced this or at least know someone who has!

 

Patients often get frustrated in the process when it comes to returning to pain free activity, because your tendon injury either hasn’t been explained well enough, or the practitioner doesn't quite understand tendon pathology well enough to best assist you. I’m hoping today to bridge that understanding gap and give an insight into the treatment of tendinopathies.

Dr telling patient a tendonitis joke.

Dr telling patient a tendonitis joke.

 

Please Note! The next section is going to get a bit technical. If you have previously had or currently do have a tendon injury (or you are a health professional) this section is well worth reading. If you would like to skip the details and just see how to get things fixed… jump to the bottom!

 

Tendinopathy is a broad term that encompasses painful conditions occurring in and around tendons in response to overuse. The previous term tendinitis worked on a old paradigm that inflammation was involved in tendon injury however more recent studies show painful tendons are devoid of inflammatory cells. What that means is that dysfunction here doesn't follow normal inflammatory/histological processes that we may find with muscle or bony injury and has no clear end-point. Instead, the pathology involves complex and ongoing non-inflammatory alterations in the tendon matrix and cells. It is essential to understand this, as it underpins how we choose to treat and assess the injury.

 

Loading changes are the primary stimulus that appears to drive the tendon response towards pathology.  Repetitive energy storage and release and excessive tendon compression appear to induce pathology.

 

Most tendinopathies in the body usually occur at what we call the enthesis - this is the point at which the tendon inserts onto the bone. The only exception to this is a mid-portion achilles tendinopathy. At the enthesis, there are two main factors which influence the amount of stress that happens at the tendon:

1) tensile load from the loading through collagen fibres of the tendon when there is muscle use and 2) compression load around a bony insertion point (as most insertions work around a bony pulley - e.g. heel bone of the achilles).

In mid-portion achilles tendinopathy - tensile load is the biggest factor leading to tendon pathology - mainly the stretch-shorten storage and release of energy (e.g. jumping).

 

Loading a tendon causes matrix and cell deformation, and depending on the type and amount of load, the cell responds by producing matrix proteins (mainly collagen). Exercise increases collagen production that may contribute to increased tensile strength of a tendon however, there appears to be a fine line between load that stimulates a positive tendon response and load that triggers a negative response. Due to this, tendons are SLOW TO ADAPT TO CHANGE!! This is critical to understand why tendon rehabilitation takes so long, and also why a sudden change in training can cause pain in the first place. Tendons take up to 3 days after a bout of loading to respond to that load. If we load it too quickly before that point, then we can easily send the tendon over the edge.

 

Researcher Physiotherapist Jill Cook and colleague Craig Purdam have done extensive research into tendon pathology and rehabilitation. Just google their names with ‘tendinopathy’ and you’ll find pages and pages of research on the topic by these two. After overload in a tendon they propose a three stage tendon pathology continuum:

1) reactive phase -  this is an acutely overloaded tendon. At this early stage, the tendon can revert to normal if the overload is discontinued or there is sufficient time between loads for the tendon to recover.

2) disrepair phase -  this is essential failed healing and results from ongoing load to a reactive tendon, causing structural disorganization of the internal tendon substances resulting in some separation of the collagen and reducing its loading capacity.

3) degenerative phase -  progression to extreme changes to a disordered internal structure, cell death and little collagen. These patients will usually have times when are pain free and will continuously recur over and over again.

Figure 1 from Cook & Purdam (2009) 

Tendonopathy flow chart.

Tendonopathy flow chart.

 

STOP NOW IF YOU SKIPPED THE GOOD BIT!

 

So what can we do if you come in to see us?

 

Firstly lots of questions will be asked to find out what increased loading has placed the tendon over the edge. We will also try and figure out whether it is more a compression or tensile loading issue in your case. This allows us to guide treatment and create conditions in which to create comfort and allow relative de-loading of the tendon. We also need to find out a bit about your previous history, current training loads, previous training loads etc, which allows us to ascertain whether there are other intrinsic factors at play they may need to be addressed concurrently. A good Physio will ask a lot of questions! So be patient with us, as this will assist us in helping you!

 

Now it is important to note that research has shown the gold standard treatment option to return to function is through exercise intervention. This will get you 80% of the improvement. Remember there is no inflammation component so things designed to treat inflammation may not be helpful.

 

Other treatments like massage, dry needling, joint mobilisation etc, are usually adjunctive and help the remaining 20% but only will not improve the condition alone! Specific exercises need to be done for this to get better. And the process will be slow! People managing this themselves usually progress too quickly or they go the complete other end by stopping all activity. 

Now when we say de-load, this does not mean stop everything! Completely unloading a tendon is actually more detrimental than good because tensile load stimulates collagen production and directs its alignment as well as preserves muscular and whole body functional capacity.  There are numerous ways to reduce load without stopping all activities. Relative rest means that the person may be able to continue playing or training if it is possible to reduce the amount of stretch-shortening happening or the total weekly training hours performed etc.

 

Your Physio will know what constitutes low, medium and high tendon loading activities and can guide you appropriately in this area. Because tendons do not like change and are slow to adapt we can only change one factor at a time in your rehabilitation progressions. Whilst it is easy to get frustrated with the slowness of these progressions, it is important to remember that when something takes some time to come on, it will also take some time to come right also.

Yoga's thoughts on tendonitis.

Yoga's thoughts on tendonitis.

Side notes: 

 

Pathology on medical imaging is not related to pain!  A lot of people have pathology on imaging but have never had pain - this is one reason some people can get tendon ruptures without ever getting pain in that tendon! Conversely some people have severe pain without any changes on imaging. Therefore imagining isn’t always of benefit for us a practitioner, but your history is likely to be more of benefit and will guide treatment more.

 

Research is still unclear on what causes pain in tendinopathy. Tendon pain can be easily changed without a change in tendon pathology. Physiotherapy techniques can improve your pain symptoms in one session which is great, however this is not enough time for a change in pathology to happen. Physiotherapy therefore can provide a great window of opportunity to use that time to increase the loading capacity of the tendon. For example, when leading up to an event, this may assist in providing pain free or at least pain reduced training sessions as guided by your Physiotherapist.

 

Another point to note is that patients usually don't present at the clinic until they are in the disrepair and degenerative stages. In these stages because tendon structural changes are already taking place we are unlikely to change the underlying pathology. We can still get your tendon loading capacity up and improve your pain and function, however in the early stages we have greater chance of returning the tendon back to normal structure.

 

My Advice!!!

So my advice would be if you have tendon pain - get in early! It may save you months of hard work and future pain episodes! Know the process will be slow, and that graduated exercise program is the only way to improve your tendon function.

 

Chari

 

 

 

 

 

How to Best Help a ‘Clumsy’ Child!

How to Best Help a ‘Clumsy’ Child!

I actually don’t like the word ‘clumsy’. ‘Clumsy’ is not a definitive thing. As a label ‘clumsy’ only gives us negative information… and not even useful negative information! As a label it doesn’t help us improve; it doesn’t motivate us to be better; all it does is tell us we are not good at something.


Why is Exercise Good for Type 2 Diabetes Mellitus?

We all know that exercise is good for us, we hear it time and time again in the media, but never has it been more important than now. Especially as the rates of obesity are on the rise, and with it other associated lifestyle diseases. One lifestyle related disease, the focus of this blog, is type 2 diabetes mellitus. But what is type 2 diabetes? Why is exercise good? How much, and is there anything I need to consider?

Jackie Chan wondering confused by what to do

Jackie Chan wondering confused by what to do

Well…. I’m glad you asked!

What is Type 2 diabetes?

T2DM is a progressive disease where by the body over time develops a resistance to insulin. 

Insulin is the major cellular mechanism for transport of glucose into skeletal muscle where it is stored as glycogen, or used to produce energy. As the body becomes resistant, more insulin is produced over time to facilitate this process until eventually the cells in the pancreas, responsible for insulin production, become exhausted. Not good! What is required at this point in time is an exogenous (external) source for this process to continue.

Diagram of diabetes

Diagram of diabetes

So my pancreas is exhausted. Now what do I do?

This is where exercise can assist. Muscle contraction also draws glucose into the muscle cell without the reliance on insulin. Using separate signalling pathways, these two processes eventually both lead to the same transporter protein, which transports the glucose into the muscle cell. 

So think of it like this, the more you use your muscles, whether it be walking, riding, jumping, skipping, weights etc. the more you are pumping glucose into the muscle without working the pancreas into overtime. This assists in blood glucose/glycaemic control. A bout of exercise often has a carryover effect on blood sugars of 24hours. 

How exercise is beneficial for those with diabetes

How exercise is beneficial for those with diabetes

How much exercise should I do?

Exercise and Sports Science Australia have released the following position statement when it comes to exercise recommendations for T2DM.

“Based on the evidence, it is recommended that patients with T2DM or pre-diabetes accumulate a minimum of 210 min per week of moderate-intensity exercise or 125 min per week of vigorous intensity exercise with no more than two consecutive days without training. Vigorous intensity exercise is more time efficient and may also result in greater benefits in appropriate individuals with consideration of complications and contraindications. It is further recommended that two or more resistance training sessions per week (2–4 sets of 8–10 repetitions) should be included in the total 210 or 125 min of moderate or vigorous exercise, respectively. It is also recommended that, due to the high prevalence and incidence of comorbid conditions in patients with T2DM, exercise training programs should be written and delivered by individuals with appropriate qualifications and experience to recognise and accommodate comorbidities and complications.”

One of the greatest moments in life is realising that 2 weeks ago, your body couldn't do what it just did

One of the greatest moments in life is realising that 2 weeks ago, your body couldn't do what it just did

Things to consider.

When exercising with diabetes, it is important that you check your blood sugars pre and post exercise, as well as monitor signs and symptoms of hypoglycaemia (a dropping of blood sugars below safe levels presenting in dizziness, confusion, slurred speech and nausea which can lead to a coma or death if unattended). A normal range is 4-8mmol. However, personally I prefer that a diabetic exercising in the movement room, has a post blood sugar reading higher than 6. This accommodates the consideration that the body is still working at a higher metabolic rate for a short time post exercise, and acts as a buffer from dangerously low levels until the body returns to its resting state.

Doctor pun about blood sugar

Doctor pun about blood sugar

Other comorbidities to which the ESSA guidelines refer are heart disease and hypertension to name a few. These also require close monitoring until a safe exercise capacity can be established without risk of causing a serious event. Complications associated with diabetes are things such as peripheral neuropathies, where an individual can experience altered sensation, more commonly in the lower limbs. This can affect balance and sensitivity. So it is important to consult your GP, as well as an exercise physiologist to establish a safe exercise program that will improve your quality of life. 

MIKE

 

Michael Pegg

Exercise Physiologist

B.ExSci&Nut, M.ClinExPhys, AEP, ESSAM

Michael is a masters qualified Exercise Physiologist with 5 years of clinical experience. During this time he has successfully applied exercise protocols to treat neurological, metabolic and cardiopulmonary disease.

Do standing desks stack up?

It is well researched and well known that prolonged sitting, as a form of inactivity, can be detrimental to both musculoskeletal and general health. Even if you go to the gym for an hour in the mornings, you can undo all of that hard work by sitting on your butt for eight hours of the working day. 

It is estimated that 60-70% of our waking hours are spent in a sedentary position. That’s a whopping three quarters! Sitting for 8 hours at work, the commute from home, screen time .. it all adds up quickly! 

Thanks to google images for this one...

Thanks to google images for this one...

So if sitting is bad… lets just stand!

One of many strategies that many workplaces have been implementing to help their employees be more active are standing desks. 

You may have heard about them, or perhaps even used them at work, but for those of us not in the know they’re just a desk that is higher than normal so you can stand rather than sit. Ideally, the height of the tabletop should be roughly at elbow level. So they constitute more of a workplace culture change rather than a technological advancement! 

Standing desks have been shown to have great outcomes for employers because they improve productivity, reduce time away from work due to illness or injury and tend to lead to happier, healthier workers. 

Surely it’s not that simple…

The implementation of standing desks in workplaces has not always been a story of happiness and productivity though! Some employers have completely turfed seated desks in favour of standing desks. So instead of eight hours of sitting and a sore neck, employees now stood for eight hours and had sore lower backs and feet instead*! It really shows that too much of anything can have a negative effect. 

The middle ground is a variable height desk, or a sit-stand desk. They allow the user to alternate between sitting and standing as they feel the need. There are various models of these desks, which begin at about $300 for a manually variable desk that sits on top of your current desk, right the way up to fully automated electronic and programmable versions for several thousands of dollars. Experts recommend doing your research before buying in to anything to make sure it suits your needs, your body frame and the work you need to do. 

Image of man working with an adjustable desk

Image of man working with an adjustable desk

Stand, Sit, Sit-Stand… whats the best for your body?!

If you are thinking about switching from a sitting desk to a standing or variable height desk, there are some things you can do to smooth the transition. If you are normally an 8 hour a day sitter… you should begin by trying to incorporate no more than two hours in a day of standing and light walking (like to the printer and back again). There might be some initial tiredness or discomfort as your body adjusts, but you should not just accept pain. If you are experiencing discomfort or prolonged fatigue don't just put up with it! Review your posture, change your timing, move more and consider having your standing position reviewed or assessed. 

Once comfortable with this, then aim for four hours in the day where you are active or standing, which should equate to roughly half your time at work. This is a gradual process. Be patient and stick to it! Remember that there are more options than just sitting or standing also… perhaps different types of chairs, kneeling, squatting, or lying are options for you and your workplace. 

Trust your body!

"Trust yourself, no matter what anyone else thinks"

"Trust yourself, no matter what anyone else thinks"

When you move your body more, it will thank you! Just by taking the scenic route to the water cooler or a stroll during lunch you’ve dropped your risk of developing heart disease, diabetes and some cancers. Congratulations! 

Isabelle.

TMT Physiotherapist

 

The facts in this article are drawn from a consensus statement published in 2015 from experts in England and Australia. You can find it here. http://getaustraliastanding.org/pdfs/BJSM_Expert%20Statement%202015_06.pdf


For more palatable reading of those facts and more information on the topic, head to getaustraliastanding.org 

Infant Milestones: Worth stressing about?

Infant Milestones: Worth stressing about?

Especially in the first two years, parents are very often on the receiving end of the ‘how are they?’ and ‘are they doing x yet?’ double. Instead of x, insert any key milestone or achievement. Are they rolling yet? Are they sitting yet? Are they talking, crawling, eating, smiling, walking, or drawing yet?

You've decided to exercise more, now what?

You've decided to exercise more, now what?

We are bombarded with so much information on what is the best form of exercise, how often to do it, when to do it, why to do it aaaaand the list goes on….. and on. It can be pretty confusing at the best of times, but especially so if regular exercise is not your forte. So lets simplify things a little.