the movement team

Flat Heads... #3 To Helmet or Not?

Flat Heads... #3 To Helmet or Not?

What about Helmets?

One fairly common treatment option for head shape concerns are custom-made ‘remodelling’ helmets. It is not uncommon for parents to be very anxious about the prospect of this treatment and often parents arrive at therapy to report that their main goal is to avoid ‘needing’ a helmet.

Flat Heads... #2 Simple Steps for Improvement!

Flat Heads... #2 Simple Steps for Improvement!

Things a Parent Can Do At Home!

The best approach to managing or avoid a flat spot is to correct the reason it developed in the first place. Changing positioning and a baby’s movement patterns is the most effective early treatment of this condition

Flat Heads... #1. Ask The Right Questions!

Flat Heads... #1. Ask The Right Questions!

Start Here… Basic Definitions and Quesitons to Ask!

Any significant asymmetry in a baby’s head shape (where one side is very different to the other) should be considered a firm reason to look more closely and work out why that shape may have developed.

A Pain in the Back… Basic Truths for Every Person.

A Pain in the Back… Basic Truths for Every Person.

Fear of back pain is often very significant, however many of the commonly held beliefs in society about back pain are misleading and at times harmful.

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!

Is your baby about to 'skip' a milestone? Beware the 'Milestone Trap'!

Is your baby about to 'skip' a milestone? Beware the 'Milestone Trap'!

Is it a problem if your baby learns to walk before they have learnt to crawl? Is there something odd about your baby or is it something odd about ‘milestones’?

Running: It's not just one foot in front of the other!

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?

2016 Samford Fun Run -   photos taken by   Joep Buijs   info@joepbuijsphotography.com.au

2016 Samford Fun Run - photos taken by Joep Buijs info@joepbuijsphotography.com.au

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! 

2016 Samford Fun Run -   photos taken by   Joep Buijs   info@joepbuijsphotography.com.au

2016 Samford Fun Run - photos taken by Joep Buijs info@joepbuijsphotography.com.au

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.

Douglas Stewart - 2016 Samford Fun Run -   photos taken by   Joep Buijs   info@joepbuijsphotography.com.au

Douglas Stewart - 2016 Samford Fun Run - photos taken by Joep Buijs info@joepbuijsphotography.com.au

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!

2016 Samford Fun Run - photos taken by  Joep Buijs  info@joepbuijsphotography.com.au

2016 Samford Fun Run - photos taken by Joep Buijs info@joepbuijsphotography.com.au

Tim

 

TIMOTHY EFFENEY

PHYSIOTHERAPIST

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.

 

 

  1. http://link.springer.com/article/10.1007/s40279-015-0331-x What are the Differences in Injury Proportions Between Different Populations of Runners? A Systematic Review and Meta-Analysis Bas Kluitenberg et al.
  2. http://onlinelibrary.wiley.com/doi/10.1111/sms.12346/full The NLstart2run study: Incidence and risk factors of running-related injuries in novice runnersB. Kluitenberg et al.
  3. http://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-016-2736-3  The descriptive epidemiology of total physical activity, muscle-strengthening exercises and sedentary behaviour among Australian adults – results from the National Nutrition and Physical Activity Survey. Bennie et al.

What Physiotherapy Isn't

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.

Myself (with a touch more hair) and the rest of the coaching staff after winning the Puma Cup In the US. 

Myself (with a touch more hair) and the rest of the coaching staff after winning the Puma Cup In the US. 

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.

Tim was super excited when we finally nailed some of our core principals!

Tim was super excited when we finally nailed some of our core principals!

It was our insights that Physiotherapy works best when:

  • a clinician spends a good amount of time with a patient,
  • the Physio and client are working towards a specific goal that is driven by the patient, and not something vague like "to feel better",
  • the Physio has access to a wide range of equipment and space, and has the flexibility to utilise the full spectrum of physiotherapy interventions, and
  • when the entire service and team is focussed on creating change for the patient. 

When a Physiotherapy service is not working well, we do see some common issues, for example often the patient:

  • has little idea what is wrong with them and they don’t understand what is going on.
  • is not an active participant in the treatment process.
  • does not have a good plan and doesn't know an expected time-frame to get improvement.

What Physiotherapy Isn't

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:

Physiotherapy= Massage. 

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.

Messing around on the rings at the clinic.

Messing around on the rings at the clinic.

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!

The Acceptance of Lower Standards.

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.

Working with 2 coaching staff and also our Polish translator in Poznan.

Working with 2 coaching staff and also our Polish translator in Poznan.

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!).

What My OC's face would have been if I had told them my treatment plan!

What My OC's face would have been if I had told them my treatment plan!

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.

So What Is Physiotherapy?

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.

  • Our physio's are in charge of their own time with no time limits or patient limits set on them by the management. This allows each patient interaction to be treatment and result based, not one of a financial/business need. Your physio wont be telling you to come back to see them unless its absolutely needed.
  • We do not treat more than 1 patient at a time.
  • You will be hard pushed to find a TEN”s, Ultrasound or any other electrotherapy machine used at the clinic unless it has a clear an obvious goal attached to it. (There are many applications of electrotherapy which a very valid, however 90% of patients will benefit another type of intervention more!).
  • We have a fully stocked gym where you can do both early stage exercises all the way through to high end strength and conditioning and all equipment is from the best manufacturers in Australia who work with elite sports teams and cross fit gyms. For me a swiss/gym ball and pilates reformer doesn't cut it as a rehabilitation gym.
  • We do small training groups based on function- these are low cost and simple to get into and are led by our team.
Chari and Issy working in our gym with 2 clients. 

Chari and Issy working in our gym with 2 clients. 

  • We work one on one with people specifically to train for strength and performance improvements. I have 8 clients who solely see me for one on one training as they move towards a high level goal. Your health insurance can be used with a physiotherapist in our gym to help work towards your goals.

Think Different

IN CONCLUSION

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. 

Keep rocking!

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- What Can I Do?

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.

Chari teaching some balance exercises in one of our training groups.

Chari teaching some balance exercises in one of our training groups.

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. 

1. www.aihw.gov.au/media-release-detail/?id=60129543357

2. www.arthritis.org/living-with-arthritis/treatments/joint-surgery/preparing/prehab-surgery.php

3. www.ncbi.nlm.nih.gov/pmc/articles/PMC3612336/

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.

Issy utilising cutting edge hear technology to keep warm (AKA a cup of tea). 

Issy utilising cutting edge hear technology to keep warm (AKA a cup of tea). 

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.

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

 

 

 

 

 

Chewing The Fat

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. 

Image of some healthy fats

Image of some healthy fats

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!

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.

The Beauty of Doing The Small Things

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.

Meme of how watching netflix quickly passes hours!

Meme of how watching netflix quickly passes hours!

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 was about to go for a jog but it looks like it might rain so I'm gonna stay home and play it safe

I was about to go for a jog but it looks like it might rain so I'm gonna stay home and play it safe

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.

If we aim high and fall short we still achieve more than by aiming low and falling short

If we aim high and fall short we still achieve more than by aiming low and falling short

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

 

"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!"

 

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?