How to help your baby from almost there to walking there!
We have recently talked about ‘cruising’ and its value as an often overlooked infant motor skill.
The Lancet has recently published a wonderful review article (March 2018, What low back pain is and why we need to pay attention. Hartvigsen J, et al.) and we wanted to share some of the key points!
Do you suffer from 'not stretching' guilt?
Do you ever feel sore after exercise and think...'if only I did more stretching!'...
So many of us have been taught the importance of stretching from a young age... but is stretching really the must do that we believe it is?
Check out Jasleigh's short and sharp blog on the impact of stretching on injury prevention, performance, recovery and sporting technique...
As an adult you may have worked out a great way of running, but you probably have not.
Yesterday we had the pleasure of being involved in the Samford Fun Run! It was a great event for an excellent cause and it was so wonderful to see well over 400 people running and walking their way around Samford!! Running an event like this might be fun for some, but it is definitely not easy. In this article we ask the question... do we need to think more about how we run?
Running as an activity has a wide following. Almost 250,000 Australians are registered runners for Parkrun, a network of free weekly 5km events across the country. Major fun run events continue to grow in participants and number. Conversely in a 2015 Australian study of over 9000 people, almost 80% of adults were classified as having ‘low-sedentary’ activity lifestyles (1.2.3).
While running is only one form of physical activity, it is a cheap, accessible, and generally safe. Unfortunately though for those who don’t run regularly, it is often intensely unpopular.
It is remarkable how often you will hear people say “oh but I’m not a runner” or more simply “I don’t run”.
So are people actually ‘runners’ or 'not runners’?
There is no doubt that in the adult population some people find running much easier than others. Sometimes this is to do with the amount of actual running they have practiced and their general cardiovascular fitness, but for others it might be because of a bio-mechanical advantage they gain (or miss out on) from some combination of physical structure, muscle strength and motor pattern efficiency.
The good news is that many of these factors are not set in stone by our genetics!
Running is actually a skill!
We are not born knowing how to run. As young children we gradually learn to control our own body. Genetic features, like being particularly tall or short influence how we learn to move, but so do many many environmental features. In this early phase of life we learn to run more by trial and error than by some idealistic design.
Most running athletes spend huge amounts of time and effort focussing on improving their running technique and form. To maintain this form while running they need to build strength, body awareness and tissue resilience.
In the study mentioned above, only a dismal 18.6% of people met the recommendations for muscle-strengthening activities. Not many people are able to get better at running by just running more. The quickest and most significant improvements in running ability are often a result of technique and strength improvements. A planned and gradual increase in training load is then required to build up your cardiovascular fitness and your bodies ability to recover quickly.
Regular running with poor biomechanics or rapidly increasing training volume can have significant consequences. 'Overuse injuries' associated with running are very high, injuries are frequently the reason people quit running, and if not picked up quickly these injuries can be frustrating to recover from. Additionally, evidence for choosing footwear correctly is slim and awareness of running technique is generally poor.
So it can be helpful then to think of running as a skill rather than a genetic right. It is not feasible or really even possible to identify a 'recipe like' list of what you need to do to be a better runner. The key to your improvement might be to do with your technique, strength, mobility, training practices, footwear, medical conditions or very likely a combination of a number of factors. So if you want to improve your running (from whatever level you are currently) it may well be worth talking to your local Physiotherapist, Medical Professional or Running Expert to help identify your potential areas for improvement in this wonderful skill!
B.Phty (Hons), G.D. Paed. Neuro. Rehab.
Tim has 9 years of Physiotherapy experience and is an expert in Paediatric (Baby’s and Children’s) Physiotherapy. Tim’s the person to see if you have any concerns about your baby or child’s movement skills or development.
Tim is co-owner and director of The Movement Team. Tim also holds an Advanced Physiotherapist position within a Child Development Service in the public health sector.
Tim has worked across the breadth of paediatric health (acute hospital, disability care, developmental, community and private clinics) and has completed numerous national and internationally recognised education courses in topics including developmental orthopaedics, high risk infant management, respiratory functioning and infant movement.
Tim's formal training consists of:
Bachelor Physiotherapy (Hons) - University of Queensland
Graduate Diploma Paediatric Neurological Rehabilitation - University of Western Australia
Tim additionally holds the following positions and memberships:
Chairperson of the Queensland Paediatric Physiotherapy Clinical Network 2013 - present
National Paediatric Group Member - Australian Physiotherapy Association
The clinical information included in this article is of a general nature and might not apply to every family. Please see your local health professional for individualised developmental advice.
Hi this is Yanek here doing my bit for the Movement Team's Blog. We have had a great selection of blogs recently from the team and I must admit I was initially a bit stumped as what to write about next. The quality of the previous blogs has definitely set a high standard!
So I thought I would talk about something that I am exceptionally passionate about: Results-based Physiotherapy.
I am now 11 years into my Physiotherapy career which has spanned 2 continents and also a variety of Physiotherapy environments. I have worked in private practices, in sports clubs (from grass roots all the way up to the English Premier League) and in the complex rehabilitation environment with tri-service personnel in the British Armed Forces.
I am very proud of all of my previous work, though I must admit that the place where I have seen the most problems in terms of how Physiotherapy services are provided (and thus the results that clients get) is within private practice.
The Movement Team journey really started nearly 2 years ago now when Tim and I sat down and discussed both the problems we saw with Physiotherapy and also where it worked best.
It was our insights that Physiotherapy works best when:
When a Physiotherapy service is not working well, we do see some common issues, for example often the patient:
Physiotherapists have a wide ranging set of skills to help a variety of problems. We have been taught a wide breadth of skills across key areas of the human body including Neurological, Cardiothoracic, Musculoskeletal, Paediatrics, Geriatrics and a variety of subsets within.
In private practice most consultations take place within a clinical setting (i.e. in a room). Perhaps when therapists are limited to a small space they have difficulty using the breadth of our true skills and this has contributed to a perception that:
For me, to simply equate physiotherapy to hands on soft tissue work is simply incorrect. Physiotherapists have a wide spectrum of skills that range from education, to hands on soft tissue work, to teaching motor skills, to direct manual therapy...all the way through to high-end strength and conditioning. Additionally we have a huge range of assessment and treatment skills specific to various conditions and presentations.
An individuals expectation of Physiotherapy depends largely on their previous experiences. It is not uncommon for people coming to see our team to have an expectation that they will simply lay down, get treated and then be fixed. This is very rarely true and if this expectation is held, it can lead to some of the most frustrating sessions for both Physio’s and their patients.
A hands on approach is a great way to get things moving and also to alleviate short term pain- however a single hands on session is never going to create long term change and results for patients.
From a business perspective it's great for practice owners to have lots of patients coming back week on week getting “treated” despite the fact they are not making significant progress. Along with a nice health fund rebate this creates a great system of simply processing people, but it rarely has clients progressing well towards what they want: to be better, functionally improved and stronger.
Physiotherapy should be far beyond having a therapist place electrotherapy machines on someone, a heat pack and 10 minute massage and being told to come back next week. As Physiotherapists we have a great ability to help change peoples lives. We can help people be better at and do more of what they want and with less pain or risk of injury. I'm more than happy to admit that no one wants to spend more time than they need to at a physio practice, doctors surgery or hospital - regardless of how nice I think our clinic is!
So why is it ok to accept a standard of practice below what we know is possible. Especially when we know that there are models where it works really well (think of athletes and soldiers who can receive top level care that is goal based and progressive).
From a Physio's point of view, the ability to make the right decision for the right client is an extremely important skill to develop. When I was working at Tottenham Hotspur in the English Premier League (EPL), if my boss at the time asked me for a treatment plan for any of our players and I said “What I would like to see them a few times a week for 3 weeks and predominantly to focus on electrotherapy and massage. Then I'll see how things go...” I would simply have been out of a job within a few minutes and told politely to never come back.
When working with infantry soldiers wanting to get on the next tour of Afghanistan (who had to carry 40-80kg packs whilst taking enemy fire) if my Officer in charge asked how they were progressing and I said “well I have done some soft tissue work with them over 4 weeks” I would be endangering that soldiers career and also I would have a size 8 boot firmly placed somewhere on my anatomy and would swiftly be told “please make sure they are moving better and getting better” (The threat of endless burpees from the PTI’s would also be very scary!).
So if this is the expectation for athletes and soldiers, why do we sometimes accept a far lower standard for private patents? Is it just because we don't know we can expect better? I can guarantee that everybody would benefit and feel great for 6-12 hours after a hands on session with a Physiotherapist, and if thats what the patients need then that's great. But when we have the ability to help create significant and long lasting change (on top of feeling good for short periods)... shouldn't we do that!?
By taking this approach, you can visit a Physiotherapist who is an expert in movement and they can both treat your acute symptoms and take you all the way through to helping you with achieve great goals. Want to set a personal best with your squat and deadlift? Want to finish a work day pain free, or perhaps you want to improve your running technique so you can take part in the “Bridge to Brisbane”.
Proactive treatment instead of passive treatment can help a mother of 4 with a bad back and instead of simply settling her acute symptoms, it can address the cause of her back pain and avoid future flare ups! You could even take that further and help her build strength so she can out lift her husband.
Physiotherapy is one of the best ways to help people progress towards their movement goals. Those goals may be anything...they may be about reducing pain and symptoms from injury, preparing for an event, getting stronger, addressing secondary impacts of other health conditions, avoiding injuries, or even helping a child learn to move for the first time. A Physio then might be your initial treatment, your goal achievement coach, your chance to train with a true movement and exercise expert, or simply your chance to improve your physical being.
Physiotherapy is in the industry of creating change for our clients and patients. Its having a specific working hypothesis thats agreed with the patient who is fully involved with treatment and fully understands what's wrong with them.
We have several key things in place at The Movement Team to ensure this happens.
So in answer to my blog post headline, Physiotherapy isn’t simply a hands on massage that hurts, its not a 20 minute electrotherapy session, its not being given “stretches”, its not being treated along with 2/3/4/5 other people at the same time (whilst you still pay $70 plus), its not having no end point in treatment, nor is it being one of 20 clients your Physio is simply processing to help achieve the clinics “income and revenue targets”.
We pride ourselves at The Movement Team on thinking differently. We constantly challenge what we do and will not settle for the average or the status quo. Our belief is that our results are the only thing that keeps us busy and are the reason why people will refer to us.
Yanek has 10 years of Physiotherapy experience, across 2 countries, including invaluable experience working in the English Premier League (EPL), military rehab centres and private clinics.
Joint replacement surgery is becoming more and more common. With an ageing population and 1.8 million Australians suffering from osteoarthritis in 2013, it’s fair to say that the number of people getting joint replacement surgery is likely continuing to rise.
Physiotherapy assists people suffering with osteoarthritis with prehabilitation. Prehabilitation is just rehabilitation, pre-surgery! Prehab is a general term that describes three months of moderately intense exercise immediately prior to joint-replacement surgery with the aim of improving outcomes after the surgery.
After surgery, there are a few options for rehabilitation. One is to stay in the hospital and do your rehabilitation in a specialised rehab wing. Alternatively, if you’re deemed safe enough (i.e. steady enough on your feet) to go home with family or friends, you can complete the rehabilitation as an out-patient with a physiotherapist in the community. Completing a course of prehabilitation has been shown to decrease the number of people needing in-patient rehabilitation post-operatively, and to decrease the amount of rehabilitation input needed.
The prehabilitation or rehabilitation comes in various forms. Common types of exercises used are strength training, aerobic/cardiovascular training and hydrotherapy (exercise in the pool). Recently, exercises with slow deliberate movements, like yoga and Tai Chi, have also been shown to be effective in treating osteoarthritis. Exercise has been shown to improve pain levels, improve muscular strength of the hips, knees and back, improve the efficiency of the walking pattern & other functional tasks and improve quality of life for people who suffer from osteoarthritis3.
For years, surgeons have had rules about who they are willing to operate on. Usually, you’ll hear terms thrown around like ‘medically stable’ and ‘low risk’ (hopefully this is you!). This means consistently taking medications effectively to control other conditions like high blood pressure or diabetes. Surgeons are increasingly incorporating weight limits on their patients prior to surgery as well, as increased body weight has been shown to be a causative factor in osteoarthritis, particularly of the knee3. To do this, surgeons are suggesting that their patients try a course of prehabilitation to decrease their weight, improve their pain and function before considering surgical treatment options.
The Movement Team now has knee-specific and shoulder-specific prehabilitation training groups operating in addition to our general training groups. Essentially, we see a lot of the same injuries and conditions so we have created some small groups of (4-6) people who need guidance on similar injuries or conditions.
You don’t need to have a surgery lined up to join in!
Prehabiliation is a classic example of asking the question “What can I do?” when injured. So ask yourself- despite any limitations- what can you do today?
Isabelle is currently the 1st Team Physio for Samford Rangers. Isabelle has worked in private practice around Brisbane before finding her way to Samford and The Movement Team. Isabelle is a qualified pilates instructor and also has a huge passion for dance and all things movement.
Nutrition science is not without controversy, and the conversation surrounding dietary fat is no different. Let's chew the fat...
Firstly, a brief overview. We refer to fats in three general categories; saturated fat, trans fat and unsaturated fat. Intake of saturated fat (red meat, whole milk dairy and many commercially prepared foods) has long been associated with increased risk of heart disease. Trans fats (predominately found in processed foods) are also known to elicit negative cardiovascular effects. A diet rich in unsaturated fats (nuts, seeds, avocado, olive oil and salmon), however, is linked to improved blood lipid profiles and reduced cardiovascular risk. Fat is also extremely energy, or calorie, dense so it is often targeted for individuals seeking weight loss.
In our quest for a healthier, leaner population a generalised low-fat diet gained traction over past decades. This shift away from excessive fat intake sought to reduce rates of overweight, obesity and cardiovascular disease. While the sentiment was there the general public were not equipped with suitable low fat alternatives, and because fat is a haven for flavour our diets lacked without it. This gave way to diets high in refined carbohydrates, which included the likes of white bread, pasta, processed snack foods and added sugar.
As nutrition science evolved we learnt a lot more about the specific effects of dietary fat, and the health implications associated with excessive intake of refined carbohydrates. We now know refined carbohydrates generate an equal, if not greater, burden of disease when consumed in excess. We determined trans fats to be definitively unhealthy, and as a result significantly reduced these within the food supply. Saturated fats have been somewhat vindicated in recent years with evidence indicating some varieties (stearic acid and lauric acid specifically) have neutral effects on cardiovascular risk, although we still lack convincing evidence that they are helpful. Finally, we know eating unsaturated fats in place of saturated fats or highly refined carbohydrates improves blood lipid profile, and is a staple among some of the world's healthiest regions.
The bottom line? Fats are in. Prioritise olive oils, avocado, nuts and fatty fish, but don't demonise a great piece of steak and whole milk dairy products. Remember though, fats are simply one element of a healthy diet and lifestyle. Focussing on specific nutrients is not the key to a nutritious, health-promoting diet. Emphasise a diet of wholesome foods in sensible combinations instead. When we get the foods right, the nutrients take care of themselves!
As someone who is the same as every other human being- things can get put off. I, as I’m sure many of other people do, get great ideas and plans for things and think “one day” or “I’ll get around to it”, only for that day to never come.
Lately I’ve tried to get a bit better with myself and actually just do the things I plan on in my head. I know that while sitting there in bed or on the couch, probably binge watching a show on Netflix it may seem like a lot of effort and something that can wait, especially with that cliff hanger at the end of the last episode! But honestly, even just doing a little bit can go a long way.
In my last blog post: “My strength Journey (or start of)” I mentioned that I was planning to start training again, which I have done. Even though some days have been hard, (physically or mentally) they have made such a difference for me.
Over the last couple of months I have noticed quite a few changes in myself from the training, including less tightness and soreness throughout my body, feeling more positive, having better posture and more energy. I’ve also never been a long distance runner, but was pleasantly surprised by the one day every three months where I decide to go for a jog, that I could actually run a lot further than I used to be able to, all from just a bit of strength work!
I used to think that strength work was more just for people who wanted to get buff, I had no idea how much doing it myself would benefit me in such a short amount of time.
Seeing such satisfying results has made me start doing some of the other things that I’d always planned on doing in other areas of my life. Even if that’s just been a small step. I was recently told that if you aim high, then even if you miss you’ll still be somewhere near where you wanted to be and definitely not where you started.
Something I’ve been telling myself is to stop waiting for the right day or moment to do it, because it may not come around. Like I’ve said before, life happens, but if there’s anything I’ve learnt in the last couple of months it’s that if you put your mind to something, and even just by working a little bit towards it, it can amaze you how far you can get towards your goals.
I know this probably sounds like a cliché and something that is supposed to be all inspirational, but I just want to say how much making even the littlest of steps has benefitted me so much. And in the off chance this may help you to start even making the tiniest of steps to achieving your goals (whatever they are), well then that’s all I can hope for.
"Lucy is part of our administrative team. Give our clinic a call if you have any questions about how we might be able to help you! Our admin team are excellent in helping our clinicians and clients keep doing what they do best!"
Just go from sitting to standing and back again…sounds simple right? To get up from a seat. But for some it’s quite difficult.
This motion is one of the crucial elements in maintaining quality of life as we get older. The less we perform this action, the more we are reliant on aids to get us out of a chair, using our arms to pull ourselves up, changing our living spaces to accommodate (often a costly process), reliant on others to perform actions we once thought of as simple tasks, or worse yet, having to leave your home all together.
The muscles involved in a sit to stand are crucial for maintaining balance while standing and walking. This means having difficulty controlling getting up and down from the couch can be a warning sign for other, more risky difficulties. Reduced muscle mass in the lower extremities equates to less stability which means that an individual’s gait becomes wider and shorter. More simply, the way we walk is not fixed, if we have weak leg muscles, we walk more slowly and have to have our feet further apart to reduce the risk of falling over. Additionally a reduction in muscle mass in the hips and this change in body mechanics commonly contributes to overuse injuries such as hip, knee and lower back pain.
Over and over I have seen patients drastically improve their quality of life simply by practising ‘sit to stands’ every day. By performing this simple exercise you can improve your strength, reduce the risk of injury and make some simple things easy again. This can seem daunting, especially if this has been an almost impossible feat in the past. Here are some tips to help you start your journey to a better quality of life.
Let’s start with getting the technique right.
Start from the seated position. If you start here you know the seat will be there when you return. Your feet should be parallel to each other (or as close to parallel as possible), the knees should always stay over your heels, chin up, chest out, shoulders back while sticking the backside out to allow the activation of the back muscles to maintain posture. You should always be pushing through the heels. Try wiggling your toes when performing. This will tell you whether you are on the balls of your feet, or on the heels.
Don’t go too hard too soon!
A phrase that I commonly use is “avoid the plonk”. It’s important to maintain muscle activation through the whole movement and not cheat by letting gravity do all the work. If you ‘plonk’ on the way down, the way back up is likely to be hard work! ‘Plonking’ while lowering down into a seat is a sign that you were not able to (or out of the habit of) controlling your own weight. This will mean that you won’t be working the muscles, which is the whole point. So pick a height that means you are able to dictate the pace of the sit to stand. It may be high at first, and the range small, but you can always progress to a lower seat as the muscles strengthen over time.
Volume without pain
The more often you are able to perform the sit to stand on a weekly basis the more improvements you will see over a shorter space of time. It’s no use doing 5 sets of 15 on one day then being incapacitated for the rest of the week. This is meant to improve your quality of life not hinder it. Start with a very easy range that produces minimal muscle soreness but is still challenging. Look to increase these repetitions over time.
Start in front of the mirror
Perform the sit to stand in front of the mirror. What you are doing here is coupling how good technique looks with how it feels. As a result of giving yourself different forms of immediate feedback, mastery of the technique will be obtained much quicker. You won’t have to do this forever, but it is important in the beginning.
It’s important to make sure you feel safe when you perform a sit to stand. If you’re unsure of your ability, see an Exercise Physiologist to establish safe ranges of motion, rep ranges and any coaching of techniques that may be required. If practicing this movement causes pain or discomfort, perhaps the first person you need to see is a Physiotherapist. Either way, and whatever your starting point, it is never too late (or too early) to get stronger.
So stand up for yourselves!
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.
So, I took the dive and invested in a Fitness Tracker. My weapon of choice is a popular one, apparently: a FitBit Charge HR. I like it because it challenges me to compete against my past self. And so far, it’s working for me! (Also it’s great for letting my know someone is ringing me when my phone is on vibrate and hiding in the bottom of my handbag, but that’s another story.)
If like 2/3 of the Australian population you're either overweight or obese, are you doomed to a lifetime of poor health unless you lose those extra 10, 20 or 30kg? The short answer, NO!
As a society we've come to associate the increasing number on the scales with declining health and higher mortality rates. The weight of recent evidence suggests that perhaps we don't fully understand the big picture in terms of the relationship between weight and health. For example, almost all population based studies show that overweight or moderately obese persons live at least as long as people in the normal weight category! Many people then argue that if this group lives as long as their leaner counterparts surely overweight and obese people are comparatively less healthy, right? Wrong. When we take a closer look at the specific effects of fitness, physical activity, diet quality and weight cycling we see that these factors are more relevant than weight.
So what does this mean in practical terms? In essence this means you can make significant health improvements WITHOUT focusing on weight.
In terms of nutrition, it's about getting back to basics. Choose a varied diet, eat regularly and include plenty of wholegrain breads and cereals, vegetables, fruit, dairy and meat. Recognise that it's normal to enjoy cake, chocolate and wine. Eat mindfully, tap into your hunger and fullness levels, and avoid restrictive diets. These behaviour changes will allow you to settle at your most comfortable healthy weight. For some people, this will translate to weight loss, for others it may mean a change in body composition without weight changes, and for many it will require acceptance that your healthiest most comfortable weight will not be the 'goal weight' you had in mind (and that's perfectly okay).
While some of these concepts may sound simple, they are certainly not easy to fully embrace. I can only recommend that you seek help from your personal support team (health professionals, family and friends included), make gradual changes, and be kind to yourself. We are given only one body, so it seems absolutely absurd that many people spend the better part of their lives dissatisfied with their unique shape and size. Let go of the idea that weight loss equals health, and remember that your best weight is the one at which you are living the healthiest life you actually enjoy.
You can find some great information here from Linda Bacon- one of the pioneer's of the "health at every size" movement.
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.