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Recovery Tip

Did you know that your core muscles, which are the deepest layer of your tummy muscles, should work at all times to brace and protect your back? These muscles switch off due to pain and it takes 50,000 repetitions before they work automatically again to protect your back!

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Latest updates from LePhysique Physios

Tuesday
Feb022016

Frozen Shoulder

It’s something that everyone has heard of but not too many people know what it is. Frozen shoulder is a common term for a condition called adhesive capsulitis.

 

There are three stages to Frozen Shoulder (FS):

Freezing Stage (1)

This is the first and most painful stage of the FS cycle. In this stage, there is rampant inflammation in the capsule or ligaments of the shoulder. This causes adhesions – for the ligaments that make up the capsule to stick to themselves.

Usually this is at the bottom of the capsule, as you can see here. The most common directions of shoulder movement that are restricted because of this are flexion (raising your hand in front of you), abduction (raising your hand to the side) and external rotation (moving your forearm away from your body, with your elbow by your side).

 

A common sign of this stage is that when the movement is restricted, it gets gradually more painful until the end of the movement, which is most painful. This makes it tricky for your physiotherapist, because this also mimics other conditions and injuries of the shoulder. That is why a proper comprehensive analysis of the shoulder is required.

 

In this stage, the main forms of treatment involve preserving the range of motion of the shoulder and strength of the shoulder muscles, and decreasing pain. Anti-inflammatories are particularly effective in this stage of FS. Hands-on treatment and electrotherapy for pain, and an at-home exercise program for movement and strength are the main forms of treatment in the Freezing stage.

 

Frozen Stage (2)

This is where the shoulder is truly ‘frozen’. The inflammation gradually recedes, and the pain lessens. However, the range of motion restriction remains. People in this stage of FS have limited movements, but no pain at the end of the movement – the arm just doesn’t move any more.

Treatment in the Frozen stage usually consists of improving range of motion while respecting pain levels. However, a lot of people find they get pretty frustrated with physiotherapy in this stage of the disease because it can be very difficult to make even small improvements. According to research on FS, regular hands-on treatment is not any better than a self-management program in this stage of the disease.  It’s important to maintain communication with your physio so they can monitor your progress and adjust your program accordingly.


Thawing Stage (3)

This is the final and most productive stage of a FS. In this stage, there is no inflammation so pain is usually at a reasonable level – until your physio gets their hands on you!

Hands on treatment for this stage of FS consists of breaking down those pesky adhesions in the shoulder capsule. This involves pushing the shoulder into the end of range, and then pushing a little further to break down the scar tissue and collagen cross-bridges that are restricting the shoulder. It sounds pretty painful (because it can be) but it is incredibly effective in regaining range of motion for the final stage. Some patients find that over-the-counter pain medication about 30 minutes before their appointment helps to tolerate the treatment and it’s after effects.

Your physio will also upgrade your exercise program, relatively quickly, during this stage of the healing process. By regaining range, we are able to challenge the shoulder muscles in more ways and regain other important things like strength, joint-position sense and improved timing of muscle activation (neuromuscular control). This helps get you back to your old self, with a fully functional and pain free shoulder, as fasts as possible.

 

How Long Does a Frozen Shoulder Last?

Most of the research agrees that the full three stages of a FS is finished within 18 months to 2 years after the patient first presents to a health professional. The length of time of the individual stages varies from person to person.

 

Who gets a Frozen Shoulder?

There are a few risk factors for developing FS, but there are no hard and fast answers about who gets it. FS can develop in one or both shoulders, at the same time or one after the other. The good news is, it doesn’t seem to affect the same shoulder twice.

Risk factors include:

-       Female gender: for every 42 males affected, there are 58 females

-       Age: 40-65 years

-       Recent surgery or trauma

-       Hormonal/Metabolic disease: e.g. diabetes, thyroid disease

-       Cardiac diseases

-       Neurological disorders: e.g. stroke, Parkinson’s

-       Malignancies i.e. cancers

-       High cholesterol

-       Some medications

-       Dupuytern’s contracture (a musculoskeletal condition of the hand/last two fingers)

 

What causes Frozen Shoulder?

Well, we’re not really sure. There are a few theories as to why FS happens. Some theories focus on an inflammatory driver of the contracture whereas others focus on a fibrosing driver. 

 

How do we fix Frozen Shoulder? 

The unknown aetiology is partly why scientists find it so hard to decide which treatments are best for a FS.

 

Physiotherapy treatment is usually referred to in the literature as ‘conservative management’, because it doesn’t involve an “intervention”.

Some of these are called

-       Rest

-       Educating the patient about the condition

-       Pain relief (e.g. medications)

-       Joint mobilisation

-       Thermotherapy (e.g. heat packs)

-       Massage

-       Exercises

-       Acupuncture/Dry Needling

-       Laser therapy

 

Other treatments of a more surgical nature include

-       Oral or injected corticosteroids

-       Capsular distension (where a surgeon uses saline solution to blow up the capsule like a balloon, which breaks the adhesions)

-       Manipulation Under Anaesthetic (where a surgeon knocks you out and pushes your arm way up above your head, to break the adhesions)

-       Nerve blocks (a surgeon injects an anaesthetic into the nerve, to make it and everything is supplies go numb)

-       Arthroscopic capsular release (where a surgeon cuts into the capsule to release it)

Tuesday
Dec222015

MUSCLE OF THE MONTH - Serratus Anterior

Serratus anterior (sir-ah-tus an-teer-e-er)

 

Where is it

You’ll find your serratus anterior underneath a few layers of superficial muscles, under the arm. You can see it peeking out in this picture here.

 


 

Origin

The serratus anterior is made up of nine or ten finger-like slips of muscle that begin on the first eight to nine ribs. There are usually nine to ten slips though, and it is common for there to be two slips arising from the second rib. Variations occur naturally throughout the human species.

 

Insertion

The slips travel up and around the rib cage to finish on the underside of the inner edge of the shoulder blade. 

 

 

Action & Function

Serratus anterior is a crucial muscle in shoulder function. When the serratus contracts, the shoulder blades are pulled forward around the rib cage. This movement is called protraction. Because of the angle of the pull, the shoulder blade is also upwardly rotated a little bit.

When the serratus anterior is switched on in conjunction with it’s antagonist (opposite function muscle) the rhomboids, they work against each other and end up stabilising the shoulder blade. This is probably serratus’ most important function. It means that the shoulder blade is a stable base for the arm to move from allowing for more powerful movement.

 

Supply

This muscle is supplied by the long thoracic nerve, which travels around the ribcage along the length of the muscle.

The arteries that supply blood to the serratus anterior are the lateral thoracic artery for the upper section of the muscle and the thoracodorsal artery for the lower section.

 

Fun Fact

Serratus anterior is often referred to as the ‘Boxer’s Muscle’. This is because athletes who box often spend a lot of time with their shoulder blades forward around their ribcage (scapular protraction) when in a defensive position.

In addition, boxers tend to have very low body fat percentage meaning the serratus is quite visible when the arm is extended e.g. during a swing at another opponent

Monday
Dec142015

The Importance of Physical Activity

Every second year, the Australian Physiotherapy Association has a conference that highlights the latest research in every area of physiotherapy. In 2015, this conference was held on the Gold Coast and was called CONNECT 2015.

 

I read a wonderful summary of the opening speech, which I’ve copied here for you:

(InMotion magazine, December 2015, page 29)

 

Food for Thought

Connect 2015 officially commenced with a thought-provoking address from University of South Carolina’s Professor Steven Blair, who elaborated on the core focus of his 40-year research career – energy balance.

 

‘Many people often ask me: ‘what’s the best exercise?’ I have the perfect answer to that: it’s the one you will do. Or it’s the one that you can get your patients to do.’

 

Providing the opening keynote presentation at CONNECT 2015, Professor Steven Blair was quick to underline the preponderant role than an individual’s physical activity level has on their overall health.

 

‘Inactivity causes more deaths than smoking. That’s how big it is. And, in my opinion, a lot of the published data on the topic is an underestimate,’ he said. ‘It is a bigger health problem than diet is, that’s for sure.’

 

Expanding on this statement, Steven asserted that while he doesn’t ifnore an unhealthy diet as a risk factor, the health benefits gained from a quality physical lifestyle far outweigh those derived from a healthy diet.

 

‘It has been said by a number of US scientists that if you drink a bottle of coke, you have to walk three miles to burn off that energy. Well how far do you have to walk to burn off a banana? Or an apple? Or anything you eat?

 

‘It always astonishes me how many professors and researches overlook such a simple thing when they look at how much a person has to walk to burn off 150 calories. It does depend a little bit on your body size; body size is a big determinant of resting metabolic rate.’

 

Supporting his viewpoint by running delegates through some of the findings from his comprehensive research history, it was evident that Steven’s investigative focus on energy balance, intake and expenditure has heralded cardiorespiratory fitness as being the key physical characteristic encompassing health.

 

Drawing on his objective laboratory data, which includes large-scale studies focusing on cardiorespiratory fitness and mortality in both men and women, Steven focused on the low impact that an individual’s healthy eating index has on their health and mortality.

 

‘An unhealthy eating index doesn’t predict mortality risk on those who are considered ‘high fit’. Additionally, if you are ‘low fit’, a healthy eating index doesn’t appear to have a whole lot of advantage,’ he said.

 

In contrast, Steven was adamant that the benefits derived from a healthy physical lifestyle were tenfold.

 

‘If one can get out of the bottom 20 per cent – that is, the definition we have been using in our studies for ‘low fit’ – and get into the next 40 per cent of the distribution, there are just so many benefits.’

 

I looked into some of Professor Blair’s work and the results really are compelling. These are all very large studies with long-term follow up so their findings are quite powerful. Here are some snippets:

 

“… study published by Blair et al. (34), the mortality rate over a 5-year period was inversely related to the fitness level. In this study, subjects were stratified into five levels of fitness according to the maximal exercise test results. The greatest decline in the mortality rate was observed when individuals with very low fitness (level 1) were compared with those who exhibited modest levels of physical fitness (level 2). With such a modest increase in fitness, the risk ratio for death declined from 3.44 to 1.37 in men, and from 4.65 to 2.42 in women.” [i]

 

“Normal body mass index (BMI) is associated with lower mortality and may be achieved by physical activity (PA), healthy eating (HE), or both. We examined the association of PA and HE with mortality and incidence of heart failure (HF) among 2040 community-dwelling older adults aged ≥ 65 years with baseline BMI 18.5 to 24.99kg/m2 during 13 years of follow-up in the Cardiovascular Health Study.

Among community dwelling-older adults with normal BMI, physical activity regardless of healthy eating was associated with a lower risk of mortality and incident HF, but healthy eating had no similar protective association in this cohort.” [ii]

 

“We assessed the effects of the four newly defined American Heart Association (AHA) lifestyle factors on mortality by examining the association population attributable fractions (PAFs) of these factors.

Assuming a causal relationship between smoking, low fitness and mortality, avoidance of both would have prevented 13% of the deaths in the current population. Preventive interventions to increase physical activity and stop smoking would most likely promote longevity.” [iii]

Note that ‘population attributable fractions’ is the percentage of outcomes (i.e. death) that can be directly related to a specific risk factor (in this study they were smoking, low physical fitness, poor diet and high BMI)

 

“We studied physical fitness and risk of all-cause and cause-specific mortality in [men and women] who were given a preventive medical examination. Physical fitness was measured by a maximal treadmill exercise test. Average follow up was more than 8 years … Age-adjusted all cause mortality rates declined across physical fitness quintiles … Attributable risk estimates for all-cause mortality indicated that low physical fitness was an important risk factor in both men and women. Higher levels of physical fitness appear to delay all-cause mortality primarily due to lowered rates of cardiovascular disease and cancer.

The results presented herein show a strong and graded association between physical fitness and mortality due to all causes, cardiovascular disease, and cancer. The findings are consistent for men and women, and hold after adjustment for age, serum cholesterol level, blood pressure, smoking habit, fasting blood glucose level, family history of [chronic heart disease], and length of follow-up. Strengths of the study are a maximal exercise test, participants free of known chronic disease at baseline, wide range of physical fitness, objective end points (mortality), a large sample (13,344 men and women) with extensive follow-up experience … and a large enough sample of women to permit meaningful analyses. We believe that this is the only study of physical fitness and health that meets all these criteria.”[iv]

 

You can see that Professor Blair’s life’s work has been about researching the impact of physical fitness versus the impact of healthy eating on important outcomes like mortality, and there are consistent results in the very large groups that were studied making the evidence quite convincing.

 

 

 


[i] Hainer, Toplak & Stitch. 2009. Fat or Fit: What is more important? Diabetes Care. 32 (Suppl 2), S392-@397

[ii] Abdelmawgoud, Brown, Sui, Fonarow, Kokkinos, Bittner, Aronow, Kheirbek, Fletcher, Blair & Ahmed. 2015. Relationship of physical activity and health eating with mortality and incident heart failure among community-dwelling older adults with normal body mass index. ESC Heart Failure. 2 (1) p20-24

[iii] Sui, Li, Zhang, Chen, Zhu & Blair. 2013. Percentage of Deaths Attributable to Poor Cardiovascular Health Lifestyle Factors: Findings from the Aerobics Center Longitudinal Study. Epidemiology Research International. 2013 DOI: http://dx.doi.org/10.1155/2013/437465

[iv] Blair, Kohl, Paffenbarger, Clark, Cooper & Gibbons. 1989. Physical Fitness and All-Cause Mortality: A Prospective Study of Healthy Men and Women. JAMA. 262 (17), p2395-2401

Monday
Dec142015

The Importance of Physical Activity

Every second year, the Australian Physiotherapy Association has a conference that highlights the latest research in every area of physiotherapy. In 2015, this conference was held on the Gold Coast and was called CONNECT 2015.

 

I read a wonderful summary of the opening speech, which I’ve copied here for you:

(InMotion magazine, December 2015, page 29)

 

Food for Thought

Connect 2015 officially commenced with a thought-provoking address from University of South Carolina’s Professor Steven Blair, who elaborated on the core focus of his 40-year research career – energy balance.

‘Many people often ask me: ‘what’s the best exercise?’ I have the perfect answer to that: it’s the one you will do. Or it’s the one that you can get your patients to do.’ 

Providing the opening keynote presentation at CONNECT 2015, Professor Steven Blair was quick to underline the preponderant role than an individual’s physical activity level has on their overall health.

‘Inactivity causes more deaths than smoking. That’s how big it is. And, in my opinion, a lot of the published data on the topic is an underestimate,’ he said. ‘It is a bigger health problem than diet is, that’s for sure. 

Expanding on this statement, Steven asserted that while he doesn’t ifnore an unhealthy diet as a risk factor, the health benefits gained from a quality physical lifestyle far outweigh those derived from a healthy diet.

‘It has been said by a number of US scientists that if you drink a bottle of coke, you have to walk three miles to burn off that energy. Well how far do you have to walk to burn off a banana? Or an apple? Or anything you eat?

‘It always astonishes me how many professors and researches overlook such a simple thing when they look at how much a person has to walk to burn off 150 calories. It does depend a little bit on your body size; body size is a big determinant of resting metabolic rate.’

Supporting his viewpoint by running delegates through some of the findings from his comprehensive research history, it was evident that Steven’s investigative focus on energy balance, intake and expenditure has heralded cardiorespiratory fitness as being the key physical characteristic encompassing health 

Drawing on his objective laboratory data, which includes large-scale studies focusing on cardiorespiratory fitness and mortality in both men and women, Steven focused on the low impact that an individual’s healthy eating index has on their health and mortality.

‘An unhealthy eating index doesn’t predict mortality risk on those who are considered ‘high fit’. Additionally, if you are ‘low fit’, a healthy eating index doesn’t appear to have a whole lot of advantage,’ he said.

In contrast, Steven was adamant that the benefits derived from a healthy physical lifestyle were tenfold.

‘If one can get out of the bottom 20 per cent – that is, the definition we have been using in our studies for ‘low fit’ – and get into the next 40 per cent of the distribution, there are just so many benefits.’

 

 

I looked into some of Professor Blair’s work and the results really are compelling. These are all very large studies with long-term follow up so their findings are quite powerful. Here are some snippets:

 

“… study published by Blair et al. (34), the mortality rate over a 5-year period was inversely related to the fitness level. In this study, subjects were stratified into five levels of fitness according to the maximal exercise test results. The greatest decline in the mortality rate was observed when individuals with very low fitness (level 1) were compared with those who exhibited modest levels of physical fitness (level 2). With such a modest increase in fitness, the risk ratio for death declined from 3.44 to 1.37 in men, and from 4.65 to 2.42 in women.” [i]

 

“Normal body mass index (BMI) is associated with lower mortality and may be achieved by physical activity (PA), healthy eating (HE), or both. We examined the association of PA and HE with mortality and incidence of heart failure (HF) among 2040 community-dwelling older adults aged ≥ 65 years with baseline BMI 18.5 to 24.99kg/m2 during 13 years of follow-up in the Cardiovascular Health Study.

Among community dwelling-older adults with normal BMI, physical activity regardless of healthy eating was associated with a lower risk of mortality and incident HF, but healthy eating had no similar protective association in this cohort.” [ii]

 

“We assessed the effects of the four newly defined American Heart Association (AHA) lifestyle factors on mortality by examining the association population attributable fractions (PAFs) of these factors.

Assuming a causal relationship between smoking, low fitness and mortality, avoidance of both would have prevented 13% of the deaths in the current population. Preventive interventions to increase physical activity and stop smoking would most likely promote longevity.” [iii]

Note that ‘population attributable fractions’ is the percentage of outcomes (i.e. death) that can be directly related to a specific risk factor (in this study they were smoking, low physical fitness, poor diet and high BMI)

 

“We studied physical fitness and risk of all-cause and cause-specific mortality in [men and women] who were given a preventive medical examination. Physical fitness was measured by a maximal treadmill exercise test. Average follow up was more than 8 years … Age-adjusted all cause mortality rates declined across physical fitness quintiles … Attributable risk estimates for all-cause mortality indicated that low physical fitness was an important risk factor in both men and women. Higher levels of physical fitness appear to delay all-cause mortality primarily due to lowered rates of cardiovascular disease and cancer.

The results presented herein show a strong and graded association between physical fitness and mortality due to all causes, cardiovascular disease, and cancer. The findings are consistent for men and women, and hold after adjustment for age, serum cholesterol level, blood pressure, smoking habit, fasting blood glucose level, family history of [chronic heart disease], and length of follow-up. Strengths of the study are a maximal exercise test, participants free of known chronic disease at baseline, wide range of physical fitness, objective end points (mortality), a large sample (13,344 men and women) with extensive follow-up experience … and a large enough sample of women to permit meaningful analyses. We believe that this is the only study of physical fitness and health that meets all these criteria.”[iv]

 

You can see that Professor Blair’s life’s work has been about researching the impact of physical fitness versus the impact of healthy eating on important outcomes like mortality, and there are consistent results in the very large groups that were studied making the evidence quite convincing.

 


[i] Hainer, Toplak & Stitch. 2009. Fat or Fit: What is more important? Diabetes Care. 32 (Suppl 2), S392-@397

[ii] Abdelmawgoud, Brown, Sui, Fonarow, Kokkinos, Bittner, Aronow, Kheirbek, Fletcher, Blair & Ahmed. 2015. Relationship of physical activity and health eating with mortality and incident heart failure among community-dwelling older adults with normal body mass index. ESC Heart Failure. 2 (1) p20-24

[iii] Sui, Li, Zhang, Chen, Zhu & Blair. 2013. Percentage of Deaths Attributable to Poor Cardiovascular Health Lifestyle Factors: Findings from the Aerobics Center Longitudinal Study. Epidemiology Research International. 2013 DOI: http://dx.doi.org/10.1155/2013/437465

[iv] Blair, Kohl, Paffenbarger, Clark, Cooper & Gibbons. 1989. Physical Fitness and All-Cause Mortality: A Prospective Study of Healthy Men and Women. JAMA. 262 (17), p2395-2401

Monday
Nov302015

Muscle of the Month - Gastrocnemius

Gastrocnemius (gas-trock-knee-me-us)

 

Where is it?

This is the muscle that makes up the bulk of your calves! Gastrocs come in all shapes and sizes, some are quite short, others are longer. Some can grow to quite a size!

 

  

Origin 

There are two heads of the gastroc – medial (inner) and lateral (outer). They both start on the back of the thigh bone.

 

Insertion 

The two gastrocnemius muscle bellies become one tendon, and that tendon joins with the tendon of the muscle below it called Soleus which becomes the Achilles tendon

Action

Calf raises! When you are standing, and rise up on to your toes you are using your gastrocnemius! It also plays a pretty big roll in ankle stability, which is why it can get a bit sore after walking across soft sand or cobblestone.

 

 

Supply

The gastrocnemius muscle is supplied by the sural arteries of the calf and the tibial nerve. 

 

Fun Fact

The Achilles tendon is named after the Greek god Achilles, who was an amazing warrior. It was said that his body could withstand anything. He helped to win the Battle of Troy, but was wounded towards the end of the fight by an arrow to the heel that ultimately killed him. These days, we use the term ‘Achilles Heel’ to talk about someone’s weakest attribute. 

Friday
Nov272015

Mechanotransduction

 

Mechanotransduction - Why does physio work?

Physiotherapists have a lot of good knowledge that helps patients to recover from injury, manage disease and achieve their functional goals. But what is really going on when a physio puts their hands on a body? What changes are happening to make healing happen?

The complex answer is ‘mechanotransduction’. This fancy word describes the phenomenon when cells respond to mechanical loading (the forces that go through our bodies as we move, like compression, shear, tension, torsion and bending). 

 

So how does that work?

Mechanotransduction has three stages. Let’s use a construction analogy to help explain.

Imagine a construction site inside a studio apartment, within a block of flats. The room is divided into sections by wooden beams holding the roof up, and there is a worker standing in each section.

Tenants on the floor above start jumping on the roof, causing the roof to buckle a little and the wooden beams to wobble.

 

1)   Mechanocoupling

Our construction workers are worried their rooves might fall down, because there are people upstairs jumping around. The forces coming down on the worker’s section are stressing them out. They know something is happening, so they switch the light on in their section.

In this situation, our workers are like the cell nucleus or the ‘brain’ of each cell. The physical squishing of each cell alerts it that force is moving through it, which causes the cell to produce a signal (the light).

 

2)   Cell-to-cell communication

Each of our workers is worried about the other workers in the sections surrounding their own, so they lean between the beams and go ‘Hey! Switch your light on, let everyone else know something is going on.’ Suddenly, lights are going on all over the apartment, including upstairs!

The cells that have been under loading tell other cells that they’re under loading too, creating a tissue-wide response. These distant cells think they’ve been under load, even though they haven’t.

 

3)   Effector cell response

The light we’ve been talking about? It’s a light to let the workers know to start mixing concrete, creating building blocks and to start fortifying the walls of their individual sections. So it’s started! Wall fortification is going on all over the construction site. But don’t forget, the lights have gone on inside the adjacent apartments, the stairwell and the shop on the ground floor. Suddenly everyone is fortifying the walls throughout the building.

Cells create proteins. In this instance, the cell signal for mechanical loading creates the proteins that fortify cell walls and strengthen the matrix that the cells are living in so that they’re better able to distribute loading through the tissue with minimal damage or deformation.

An extra-cellular matrix is like the ‘extra’ parts of the building, the walls and floors that separate each apartment from each other (as opposed to the internal walls of each apartment which divide sections, cell walls). It means all the non-living pieces of a tissue (proteins) that come together to create structure for the living parts (the cells) to organise themselves into.

 

So are we always fortifying walls?

The answer to that is complicated too. The musculoskeletal system is like any other system in the body. It responds to what it’s being told by the brain, and the brain gives instructions based on what is happening inside and outside the body.

Additionally, there is always building and tearing down of structures in the body. But what matters is the ratio of construction to destruction.

If the structure, let’s say a bone, is getting a lot of cell signalling and protein production because it’s being loaded, there needs to be some breakdown of the matrix to keep it organised and make way for new matrix for the type of loading being experienced most.

 

Our construction workers are building their fortified walls, but we haven’t quite checked on their progress.

 

The type of loading we’re talking about in this analogy is compression. When the people upstairs are jumping around, they’re compressing the walls being built.

 

 

In this photo, a thigh bone (femur) has been chopped in half. You can see that towards the outer surface the bone is much thicker (labelled compact bone), allowing for more force to go through the bone before failing (breaking, fractures). The middle of the bone is more honeycomb-like, to keep the total weight of the bone down. 

In bones that don’t get a lot of loading, the walls aren’t very thick. This means that if there is a sudden loading (like when you fall over) they’re more likely to fracture, because they’re not very strong. However if you’re active, and your bones are more accustomed to that specific type of force, then the chances of the bone being damaged by that force is much less.

We can see these changes in other types of tissues too, for example tendons. In the top photo, the fibres are all collagen and flowing in the same direction. You can imagine taking each end and stretching them apart like a rubber band, to have them nice and springy.

 

In the photo below, the collagen fibres are disorganised and there are a lot of tendon cells in the mix (the purple dots). Imagine stretching this tendon out; it wouldn’t have a lot of give, would be brittle, and would probably snap pretty quickly. It’s not very good at its job.

 

 

 

Okay great. So what does that mean for physio?

Physiotherapy is useful to many people, for a variety of conditions. To cut a long story short, your physio has extensive training in how the human body works and in how the naturally occurring processes in the body can be manipulated, becoming advantageous for clients. When you visit a physiotherapist, they will prescribe a variety of self-care activities, exercises, postural corrections and other therapies to influence how your body maintains itself, to improve its function and reduce any pain that may be present.

In terms of mechanotransduction, physiotherapists are expertly equipped to help you gently load different structures in your body to build up the strength for load bearing without overwhelming those structures into becoming painful or failing. This is done in a way that is measured, safe and prevents complications for other structures in the body. 

Thursday
Nov192015

Sleep Hygiene and Pain

A good night’s sleep isn’t just for getting rid of those under-eye circles. It can give you energy for the day, a positive mood and even lower your risks for things like mental health issues [i],[ii], heart disease [iii],[iv], being injured or dying in a traffic accident[v],[vi] and even helps you to live longer[vii].

Research has shown that sleeping well decreases pain in both health people, people suffering from acute injuries and people who suffer from chronic pain[viii].

Chronic pain can create a nasty catch-22 with sleeplessness. When you have pain, it means that your sleep time is decreased and your quality of sleep is poor. This means tiredness the next day, which can make you irritable and can amplify your pain experience. More pain, less sleep. Repeat until exhausted.

 

So how can we break the cycle?

Dr Michael Nicholas, a clinical psychologist from the University of Sydney’s Pain Management Research Institute, talks about the ways in which we can all get better sleep, here:

 

 

 

Maintaining activity levels can go a long way to helping you sleep soundly, but there are more things you can do to make sure you fall asleep quickly and stay asleep throughout the night. These habits are called ‘sleep hygiene’.

Things you can do to improve your sleep hygiene include (but are not limited to)

  • Not consuming caffeine in the four hours before bed
  • Turning off all screens at least two hours before bed
  • Only getting into bed for sleeping and sex
  • Maintaining a regular bed time and wake up time
  • Exercising earlier on in the day, rather than later
  • Maintaining good quality sleepwear, bedding and pillows

 

How does your sleep hygiene stack up? Take the quiz here: http://www.queendom.com/tests/access_page/index.htm?idRegTest=728
(You don’t have to create an account, unless you want to save your results)

 

Happy snoozing readers!

 


[i] Tanaka, Taira, Arakawa, Masuda, Yamamoto, Komoda, Kadegaru & Shirakawa. 2002. An examination of sleep health, lifestyle and mental health in junior high school students. Psychiatry and Clinical Neurosciences. 56 (3) 235-6.

[ii] Luik, Zuurbier, Hofman, Van Someren & Tiemeier. 2013. Stablity and Fragmentation of the Activity Rhythm Across the Sleep-Wake Cycle: The Importance of Age, Lifestyle and Mental Health. American Journal of Epidemiology. DOI: 10.1093/aje/kwu245

[iii] Gottlieb, Redline, Nieto, Baldwin, Newman, Resnick & Punjabi. 2006. Association of Sleep Duration with Hypertension: The Sleep Heart Health Study. Sleep. 29 (8), 1009-1014

[iv] Davidson, Mostofsky & Whang. 2010. Don’t worry, be happy: positive affect and reduced 10-year incident coronary heart disease: The Canadian Nova Scotia Health Survey. European Heart Journal. DOI: http://dx.doi.org/10.1093/eurheartj/ehp603

[v] Papadelis, Chen, Kourtidou-Papadeli, Bamidis, Chouvarda, Bekiaris & Maglaveras. 2007. Monitoring sleepiness with on-board electrophysiological recordings for preventing sleep-deprived traffic accidents. Clinical Neurophysiology. 118 (9), 1906-22.

[vi] Young, Blustein, Finn & Palta. Sleep-Disordered Breathing and Motor Vehicle Accidents in a Population-Based Sample of Employed Adults. 1997. Sleep. 20 (8), 608-13.

[vii] Dew, Hoch, Buysse, Monk, Begley, Houck, Hall, Kupfer & Reynolds. 2003. Healthy Older Adults’ Sleep Predicts All-Cause Mortality at 4 to 19 Years of Follow Up. Psychosomatic Medicine. 65 (1), 63-73.

[viii] Smith & Haythornthwaite. 2004. How do sleep disturbance and chronic pain inter-relate? Insights from the longitudinal and cognitive-behavioural clinical trials literature. Sleep Medicine. 8 (2),  119-32. 

Friday
Nov062015

What happens when you crack your knuckles?

Researchers at the University of Nebraska Medical Centre have gotten together to pull each other’s fingers, and find out what happens when we crack our kncules[i].

These researchers used “cine MRI” which is like an MRI movie, to see inside the joint while it was being cracked and try to figure out what was going on.

The finger of the volunteer was slowly pulled on (distracted), until a ‘crack’ sound that we’re all familiar with was heard. Here’s the video replay:

 

So what’s happening?

 

This is consistent with what you see from the outside when you crack your knuckles. The joint surfaces are difficult to pull apart until they crack, at which point they ‘give’ and the joint separates.

Now, there are still a lot of questions about joint cracking. We’re not really sure why joints are easier to move once they’ve cracked, why they stiffen up again, what purpose it serves in terms of joint health or whether it’s beneficial or harmful at all.

Current research suggests that knuckle cracking is not harmful to joint health[ii]. Habitual knuckle cracking is not shown to have any strong links to an increased rate of developing joint problems, no matter how long you’ve been cracking your knuckles for. However, there are only a few studies each with a few hundred people, and the evidence is all self-reported. So we really don’t know enough to make a definitive decision just yet.

In 2011 Dr. Donald Unger was awarded the Medical category Ig Noble Prize for taking the research into his own hands. He published a paper in 1998[iii] that described how he would methodically crack all the knuckles on only his left hand everyday for more than sixty years. He has never had a problem with either of his hands!

 

 

So enjoy that satisfying knuckle crack!

 

 


[i] Kawchuk, Fryer, Jaremko, Zeng, Rowe & Thompson. 2015. Real-Time Visualization of Joint Cavitation. PLOS ONE. DOI: 10.371/journal.pone.0119470. Retrieved from http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0119470

 on the 04.11.2015

[ii] de Weber, Olszewski & Ortolano. 2011. Knuckle Cracking and Hand Osteoarthritis. JABFM. DOI: 10.3122/jabfm.2011.02.100156. Retrieved from http://www.jabfm.org/content/24/2/169 on the 04.11.15.

[iii] Unger. 1998. Does Knuckle Cracking Lead to Arthritis of the Fingers? Arthritis and Rheumatism. 41 (5). p949-50

Wednesday
Oct282015

Nutrition for Building Muscle

Many people want to grow their muscles to look and feel good, and have heard that protein is a key to that, but all the advice about when to take protein supplements, where to get the protein from, how much and how effective it is can be very confusing. Do you have questions about protein supplementation for your exercise program? Read on!

 

Image retrieved from http://www.essence.com/sites/default/files/images/2014/06/23/strong-muscles_400x295_23.jpg on 28/10/2015

A recent article from the journal ‘Frontiers in Physiology’ has discussed the current research surrounding protein supplementation and resistance exercise (RE) in regards to muscle hypertrophy (making muscles bigger).  You can find the original article here:  http://journal.frontiersin.org/article/10.3389/fphys.2015.00245/full[1]

***

Firstly, a little about protein. Protein is constantly turning over in the body. There is always muscle protein synthesis (MPS) and muscle protein breakdown (MPB), but it’s the rates at which these occur that are important. If your MPS is higher than your MPB you’ll have overall growth, and inversely if the breakdown is higher than synthesis you’ll have muscle shrinkage.

When humans rest, the net muscle protein turnover is in the red – we tend to decrease our muscle mass when we’re laying around doing nothing. That’s why it’s so important to remain active!

Research also shows that supplemental protein increases muscle protein synthesis (MPS) to bring the net rate of protein turnover into a positive overall state. Resistance training also brings about a positive turnover state (more so than protein), and that when the two are combined the effect is greatest.

 

DOSAGE How much protein should I take?

Combining the results of many studies, researchers have shown that the optimal amount of protein seems to equal about 0.4g of protein for every kg of lean muscle mass or body weight, per meal. This is a moderate to high dose.

0.4g/kg/meal

However, researchers have also found that the amount of protein you ingest doesn’t seem to matter after approximately 20g per meal. They hypothesise that muscles get ‘full’ and seem to reject what it doesn’t need. Any extra protein that isn’t used for muscle repair/growth is ‘burned’ like calories, turned into urea and excreted in urine.

Other studies show that high to very high doses of protein can both stimulate protein synthesis (MPS) and suppress protein breakdown (MPB). However, the effect of this suppression for breakdown in skeletal muscle is very small and it is likely that the overall drop in MPB is due to suppression in non-muscle tissues. To avoid this, the authors recommend that you stick to a moderate to high (~20g) dose to avoid messing with the other body systems.

 

TIMING When do I take my protein?

Resistance exercise (RE) alone has been shown to increase muscle protein synthesis (MPS) in the first 24 hours after exercises. This is called the ‘anabolic window’, and you may have heard that term before. This is the same in first-time gym goers and veteran exercisers. It doesn’t seem to change.

We know that RE sensitizes muscles to protein. Muscles get better at using protein to build themselves up with practice (training). But should we stimulate this with protein before, during or after RE?

Researchers have shown that the effects of taking protein differ for these different time periods. If protein is taken before or during exercise, the muscles get ‘full’ quicker because the protein stores haven’t been used up as much rather than if the exercise was complete, ‘emptying’ the muscle. Therefore, protein uptake for an increase in MPS seems to be greatest post-RE.

A meta-analysis (a study looking at lots of studies combined) seems to show that protein is most effective if it’s taken immediately after exercise, rather than a few hours later, if you’re looking for big muscles. However, the effect was small when compared to the amount of protein taken (the amount is more important than when you take it).  The authors of that study suggested that in the period immediately post-exercise, the three Rs (3Rs) are most important: Rehydrate (fluids), Refuel (carbohydrates) and Repair (protein).

But what about taking all my protein at once, rather than lots of little bits through the day? A few studies have shown that a large dose is better, and others have shown medium-sized doses (“intermediate”) or smaller doses over a longer period (“pulsed”) are superior. However, the authors of this review suggest an intermediate approach to keep muscles topped up with protein, to maximise the “muscle fullness” effect without going over and metabolising protein into urea.

 

Image retrieved from http://gymgeek.com/wp-content/uploads/2014/09/drinking-protein-shake.jpg on the 28/10/2015

 

Sleep

What about during the night? Sleeping for eight hours induces a state of relative fasting. It’s why we’re so hungry for breakfast in the mornings! We’ve spent all night regenerating and repairing, and our bodies are looking for some more ingredients for those processes.

A recent study showed that young men who took drank a protein shake just before bed had better muscle protein synthesis during the night, than a group who didn’t get a shake. However, the limitation to this study is that the men who didn’t get a night-time dose of protein didn’t get that dose at all; the men who were getting the before-bed dose were getting more protein than the control group, so it’s difficult to say for sure whether it was the extra protein or the time it was taken that made MPS higher.

A second limitation with this study is that the amount of protein was given didn’t even come close to the amount recommended for muscle hypertrophy (growth), so it’s difficult to say if the effect would have been better if that was the case. In addition, another meta-analysis showed that the effect of protein on hypertrophy was pretty small (lots of protein only means a little more muscle bulk) so it’s pretty impressive that the before-bed protein dose showed such great results.

 

TYPE Where do I get my protein from?

There are three main sources of protein supplements: soy (from soya beans), casein (from milk) and whey (a by-product of making cheese from milk).  Soy proteins are often used as a replacement for animal proteins in vegans, because it’s 100% plant-based and there is no chance of there being lactose in it for those who are intolerant. However whey and casein seem to be most popular in those without dietary restrictions.

There are benefits and downfalls to each type of protein. They all serve a purpose. We’ve tried to summarise the findings in this table[2] [3][4].

 

Soy

Whey

Casein

Source

Soya beans

By-product of turning milk into cheese, concentrated and dried out

Milk

Timing

Slow acting –
2-3 hours

Very fast  –
20 mins

Slow acting –
3-4 hours

Peak

Very low

High

Low

Pros

Great for vegans and lactose intolerant

Increases muscle protein synthesis

Decreases muscle protein breakdown

Cons

More readily ‘burned’ like calories, instead of being used as food for muscles  

Contains lactose

Contains lactose

Advice

Consume in moderation

Consume immediately after RE

Consume within the anabolic window (3 hours)

 

Each type of protein has it’s own benefits and pitfalls. It seems a combination of the two or more is best for growing big muscles. Don't forget that lean red meat, poultry and fish are exellent dietary sources of protein as well! 

 

CARBOHYDRATES AFTER EXERCISE Should I mix my protein with carbs?

The idea behind adding carbohydrates to protein intake post-RE is to boost insulin production. Insulin is the hormone released by the pancreas, which regulates the uptake of glucose (energy) from the blood into the cells of the body. Glucose is needed in skeletal muscle and fat stores to break down what they’re holding for energy.

Studies show that ingesting carbohydrates stimulates more insulin to be released, than with just ingesting protein. In addition, insulin and protein together stimulate MPS and slightly decrease MPB. However, the MPS increase isn’t as strong if this is post RE.

We know from previous research that ingesting carbs after a workout helps to attenuate muscle breakdown, because we’re giving the body a preferential source of energy. But carbs don’t boost MPS like protein does. So adding carbs to protein intake after exercise doesn’t increase synthesis, but it can help to negate the effects of muscle breakdown (as long as protein intake is adequate) meaning the overall turnover rate of muscle could potentially be more positive. Not much insulin is needed to reach optimal levels of MPS, and this can be achieved with adequate protein intake. At this point in time, carbs post RE are recommended for replenishing glycogen (energy) stores, but the authors of this paper have concluded that there are not enough strong experimental studies to definitively say that carbohydrates significantly impact the overall rate of turnover for muscle.

 

Image retrieved from http://www.muscleandfitness.com/sites/muscleandfitness.com/files/chicken_2_0.jpg on 28/10/2015

TRAINING STATUS Does protein get more/less effective if I’m a gym regular?

When compared to untrained participants, trained individuals had lower peaks of MPS and MPB, resulting in less overall muscle turnover. A study in 2008 had participants only train one leg, using the other leg as the rested ‘control group’. After 8 weeks of training one leg, a short burst of exercise produced a longer MPS response in the untrained leg. This suggested that training negated the length of time that protein synthesis was stimulated for, rather than the peak of the stimulation. Other similar study protocols have produced similar results, suggesting that the training effect shows efficiency of the protein synthesis rather than a second dampening force coming into play. However, the authors refer to Damas et al, 2015[5] for their comprehensive review of the effects of training on MPS post-RE.

Summarized: there is quite a lot of evidence to show that protein improves MPS after RE, but there isn’t so much showing how that changes for individuals who are trained. There is a little bit of evidence to suggest that intensely training athletes might benefit from high doses of protein for their immune system function or to gain weight for weigh-classed sports (e.g. boxing, martial arts, etc.).

As mentioned before, the response of stimulating protein synthesis seems to reach a maximum at about ~0.25g/kg (usually about 20g total) in both trained and untrained individuals. Whether this holds true for whole body RE, remains to be seen. The authors of this paper refer two comprehensive reviews on this topic[6]. They suggest that athletes who perform a majority of their exercise as RE may benefit from higher protein doses, in the range of 1.3-1.8g/kg/day. They caution though that a good training regime is often a mixed one and so they refer back to the ‘3R’ rule discussed earlier.

 

RESISTANCE EXERCISE How should I train?

Previous research has already established that resistance exercise has the greatest impacts on MPS and overall muscle turnover. However, the way in which RE training is carried out can impact the size of that effect.

In a study of trained men who received whey protein post RE, those who lifted weight for longer (12 seconds per rep) had better MPS than those who lifted the same weight for shorter times (2 seconds per rep). Muscle electromyography (measuring the amount of electrical activity in a muscle) showed that those who were in the long-lift group had more muscle activity and it is assumed higher levels of fatigue. The theory is that with increase time under tension, more motor units were recruited and therefore higher amounts of protein synthesis were needed post RE.

The authors of this study recommend that weights should be lifted until contractile failure is reached – not just fatigued (the inability to produce maximal force), to produce muscle growth.

Let’s say you have 100 motor units in a muscle. To lift a weight with that muscle, you might need 10 motor units worth of strength. If you hold that weight for a long time or do a lot of repetitions, those 10 units are going to run out of energy and fail. However, the muscle overall won’t fail, because another 10 units will be recruited to power the holding of the weight.

When heavier weights are lifted, more units are required. When they’re held for long periods, they fatigue more easily. Therefore, the authors of this article have suggested using increased time under tension and high loads (70% of one repetition maximum weight) to produce enough contractile failure to promote muscle growth.

However – the authors also note that low-load and high-load RE has similar effects on MPS. If this is the case, is high-load RE really that much better than low-load? More research is needed to find a definitive answer.

There are many meta-analyses (similar to reviews, this study type collates the data from many different smaller studies to analyse the overall effect) are in agreement when it comes to RE. They suggest that the effects of exercise volume (load (kg) x sets x reps) and the frequency (number of sessions in a week) are the most important variables for building muscle. There are many other factors that can influence building muscle, but the authors of this article believe that these co-variables can be controlled for and positively influenced by working to contractile failure.

 

Image retrieved from http://www.diyhealth.com/wp-content/uploads/2012/07/resistance_exercise_image_title_hcumj.jpg on the 28/10/2015

CONCLUSION

Protein consumption is an integral part of a balanced diet. It allows many essential processes to occur in the body for healing and general wellbeing, including the maintenance of muscular health. Protein can come from various sources, and should be consumed as according to the weight of lean muscle mass in your body, shortly after exercising. For a well-rounded approach, this post-exercise nutrition should be combined with plenty of fluids and some carbohydrates to restore the energy depleted by the exercise undertaken.


[1] Morton, McGlory & Phillips. 2015. Nutritional interventions to augment resistance-training induced  skeletal muscle hypertrophy. Frontiers in Physiology. http://dx.doi.org/10.3389/fphys.2015.00245

[2] Eric Satterwhite, 11 September 2015. Should I take casein or why protein? Bodybuilding.com http://www.bodybuilding.com/fun/satternorton.htm

[3] Locke Hughes, 30 May 2013. Get the scoop on protein powders. Shape Magazine.  http://www.shape.com/blogs/fit-foodies/get-scoop-protein-powders

[4] Bos et al, May 2003. Postprandial kinetics of dietary amino acids are the main determinant of their metabolism after Soy or Milk protein ingestion in humans. The Journal of Nutrition. 133 (5), 1308-1315.  Retrieved from http://jn.nutrition.org/content/133/5/1308.long

[5] Damas, F., Phillips, S., Vechin, F. C., and Ugrinowitsch, C. (2015). A review of resistance training-induced changes in skeletal muscle protein synthesis and their contribution to hypertrophy. Sports. Med. 45, 801–807. doi: 10.1007/s40279-015-0320-0

[6] Phillips, S. M., and van Loon, L. J. C. (2011). Dietary protein for athletes: from requirements to optimum adaptation. J. Sports Sci. 29, S29–S38. doi: 10.1080/02640414.2011.619204
and
Phillips, S. M., and Winett, R. A. (2010). Uncomplicated resistance training and health-related outcomes: evidence for a public health mandate. Curr. Sports Med. Rep. 9, 208–213. doi: 10.1249/JSR.0b013e3181e7da73

Monday
Sep282015

Pilates

The Pilates method has become a more and more popular form of exercise in recent years, but it actually is more than a hundred years old.

 

History:-

Joseph Pilates was born in 1880, and was a very sick child. According to reports, he had a fascination with exercise and making himself stronger to avoid illness. In World War I he was involved with rehabilitating prisoners, and eventually became involved with several private clients, including dancers. Joseph moved to New York, just before WWII, to open a studio and work with elite dancers to improve their trade and rehabilitate injuries. During this time, Pilates devised a number of machines and contraptions to help his clients train.

Joseph worked in peak physical condition until an injury in a studio fire severely affected his health at the age of 87, in 1967. His wife Clara continued to teach his work for another decade, and then his students continued to teach his method after her death a decade later.

In modern times, there are two streams of the Pilates method. The Traditional Pilates method is based on Joseph’s teachings as they stood in the early 20th century. Many of his ‘contraptions’ remain unchanged, and are based on the prisoner hospital beds and trapezes that his clients came into contact with on a regular basis.

Contemporary Pilates has combined the principles of Joseph’s method and modern-day anatomical and functional research and knowledge. It is what is taught in most group classes, and focuses on ‘core stability’.

 

Principles:-

Relaxation is incredibly important for those practicing Pilates for a number of reasons. It allows participants to fully engage their minds in the present activity, and for their bodies to retrain effective and efficient movement patterns. Relaxation of non-key muscle groups during exercise allows for increased mobility, and control over the body. Holding unnecessary tension is a common cause of pain.

Concentration ties in closely with relaxation. Body awareness is crucial to being able to re-calibrate your nervous system’s map of your body’s movement through space, which is important for improving movement patterning in everyday life. This process can be difficult when learning the Pilates method, but eventually becomes easier and then automated, like any new skill.

Alignment is important for avoiding injury during exercise. However alignment is not a static concept – it adapts as your body moves through different positions and reacts to different forces acting on it. Alteration of one element (eg. Moving a limb) affects other elements in the system (your body), so the maintenance of good alignment has to constantly adapt to those changes.

Centring is the concept that the physical centre of your body is where you draw all the power to move your body from. Joseph Pilates referred to this as his ‘Powerhouse’, referring to his abdomen, lower back and buttocks. In Contemporary Pilates, we know that the ‘Powerhouse’ or ‘core stability’ is drawn from specific muscles deep in the abdominal cavity, including transversus abdominus, multifidus and the pelvic floor.

Breathing during Pilates exercises focuses on the most efficient form of drawing breath, called bibasal breathing. This is where the ribs expanding does most of the work to suck in air (opposed to letting the belly rise and fall, called abdominal breathing). This frees up the abdominal muscles to focus on movement and improves their efficiency. The most important thing is keeping air moving – don’t hold your breath. Then, working on breathing efficiently like described.

Coordination and flowing movements are one of the trickiest things about practicing Pilates, once the basic principles are learnt. It entails combining all the previous principles at once, and applying them to specific movements and postures. These are principles that come with practice.

Lastly, Stamina is the ability to perform the exercises through a progression of increasingly difficult conditions. Once a sufficient level of control over a movement is achieved consistently, your Pilates instructor may choose to improve your stamina by adding a resistive force (like an elastic resistance band) to your movements.

 What is ‘Core Stability’?

Put simply, core stability is the ability for an individual to maintain a low-level contraction of deepest stabilising muscles (deep tummy, deep back and pelvic floor muscles) of their abdominal cavity during activities. This also means being able to isolate these deep muscles from the superficial (shallow) ‘mover’ muscles of the abdomen. These mover muscles should only be recruited for movement – not stability.

All Pilates exercises should begin with a mindfulness of the core’s stabilising muscles, and maintenance of their activation throughout the movement. Foundation level exercises focus on training to ablity to ‘layer-on’ and ‘layer off’ the superficial mover muscles over the deep stabilising muscles.

Your Pilates instructor will talk to you about your core, and maintaining neutral spinal alignment during exercise to give your stabilisers the best chance of activation.

---

Would you like to know more about Pilates? Our physiotherapist Isabelle is qualified as a matwork instructor. She is available for individual Pilates consultations, and is working towards setting up regular, small group Pilates classes. Watch this space!

 

To book your consult with Isabelle today, click the ‘Book Online’ button at the top of the page. 

Monday
Sep212015

Deep Neck Flexors and Neck Pain

Neck pain is a very common complaint in a physio practice. It can be incredibly debilitating. The worst part though, is that it always seems to come back! The recurrent nature of neck pain means that we see people time and time again.

Rehabilitation of the deep stabilising muscles of the neck is key to improving the function of the neck as a whole in the long term. When pain is felt, a phenomenon called ‘pain inhibition’ is the body’s natural default; muscles being switched off to avoid further perceived ‘damage’. The tricky part is that these muscles don’t automatically switch back on when the pain is gone. 

Scott, 2009. Retrieved from http://mikescottdpt.com/2009/12/27/i-am-mikes-deep-neck-flexors/ on the 07/09/2015.

Deep neck flexors are a sleeve of muscles behind the throat and in front of the spine, which keep the building blocks (bones) of the neck stacked on top of each other. By bringing the centre of gravity of the skull back on top of the shoulders, the head exerts the minimum amount of force onto the neck and upper back as possible.

 

Are you guilty of ‘text neck’? It can increase the weight of your head by up to six times!

Bever, 2014. Retrieved from http://www.washingtonpost.com/news/morning-mix/wp/2014/11/20/text-neck-is-becoming-an-epidemic-and-could-wreck-your-spine/ on 07/09/2015. 

You can imagine that if these blocks aren’t stacked perfectly on top of each other, they’re going to have a tendency to slide away from each other due to gravity.

Good posture can make you taller!

rpm-therapy.com (2001). Retrieved from http://rpm-therapy.com/2011/silicon-valley-syndrome/ on 7/09/2015

Luckily, we have ligaments to stop the tower of bones completely toppling over. Relying on these ligaments all the time can be painful though, putting a lot of stress through the joints in your neck and upper back. So it’s very important to have functioning stabiliser muscles!

These muscles need specific and subtle training, as shown in multiple research papers over recent times. Your physiotherapist has special equipment to objectively test the strength and endurance of the deep flexor muscles, and the expertise to show you how to effectively continue training at home.

 

CPRecognition, 2014. Retrieved from https://www.youtube.com/watch?v=rVx5xIIPZTg on 07/09/2015.

Many people seek treatment from their physio for neck pain, but often stop coming back or doing their exercises once their immediate pain is gone. However this leaves you at a significant risk for recurrence of pain. The deep neck flexors do not automatically start working again when the pain goes. They need rehabilitation for long-term success, beyond pain management! 

 

Friday
Sep182015

Bulging Discs

It has become common practice in the last ten years for medical professionals to image painful low backs. Some of these styles of imaging include a plain film x-ray or Magnetic Resonance Image (MRI). However, there is powerful new evidence to suggest that this is unnecessary.

Low back pain can be caused by a variety of things. These structures include the discs, facet joints, muscles, ligaments and nerves. 

Image retrieved from www.lumbarspine.net/curve.gif, (18/09/2015)

There are many tests that physiotherapists can do to determine which structures are causing your pain. The lumbar discs are often blamed for low back pain, because they’ve been shown to appear as damaged on scans in people who have pain. However, recent research has shown that there are plenty of ‘bad’ discs in people who don’t have any symptoms as well.

This table is from the study was published in the American Journal of Neuroradiology in 2014. It shows the results of a systematic review, which is a type of study that brings together the results of a lot of smaller studies and combines them. 

In the column down the left, different types of spinal degeneration are listed, against age of the people imaged across the top of the table. Besides facet degeneration and spondylolisthesis, each of the types of degeneration are about discs.

You can see in the table, that 37% of 20-year-olds have disc degeneration. That’s one in three people!

Learning from this, we now know that disc degeneration can cause pain, but it occurs in people who have never had pain. Degeneration is a normal process of ageing and begins from a very young age. Therefore, we can deduce that in people who do have pain and a disc bulge, the disc bulge may not be the main driver of their pain.

If you have lower back pain, come in and see us. We’ll be able to assess your individual situation and let you know which treatment and management options are best for you. We like to treat the person, not the picture! 

 

- Isabelle

Thursday
Jan022014

Do you have the right pillow?

If we want to take good care of our necks, there is not piece of equipment more important than your pillow. Many of us already know the importance of having a good quality supportive mattress, and yet will grab any old sack of feathers to support our head and neck.

Aside from it’s importance in helping you to feel comfortable while you sleep, your pillow also cradles your neck from 6-10 hours every single day of your life (or 4-5 hours for other parents of young kids out there!) Regardless of how long you sleep, your pillow can have a massive effect on neck pain and discomfort, upper back pain and headaches. It is vitally important that your pillow is the right shape and height and provides enough support to care for the delicate muscles and joints of the neck. 

After extensive personal research (of trying what seemed like a hundred different pillows) Mimi Le has discovered a winner – the Dunlopillo Therapillo. It is a contoured profile pillow made from premium polyurethane foam (memory foam). Because of the contoured shape, this pillow provides support to the natural curvatures of the cervical spine. This is essential to take pressure of our joints and allow our neck and shoulder muscles to relax while we sleep. The memory foam is excellent because it moulds to your natural shape to ensure correct spinal alignment, but does not become deformed or misshapen over time. There is also multiple heights to cater to side-sleeping, back-sleeping and differing body sizes. The pillow is also endorsed by the Australian Physiotherapy Association and made in Australia.

Many of you will have already heard Mimi exclaim excitedly “This pillow has changed my life.” I have also started using the same pillow and immediately noticed a significant improvement. I often used to spend the night changing positions frequently, and then wake in the morning with dull headaches and tight neck muscles. I thought this must have been because of my job as a physiotherapist, leaning over the treatment beds all day. But since changing pillows I have no longer had those problems.

Neck pain often requires additional treatment and there are other factors including posture, alignment, movement patterns and muscle tightness that can cause or contribute to neck pain and injury. However, if you wake in the morning with neck discomfort or headaches or experiencing similar symptoms throughout the day, then it is vital to consider if you are using the right pillow. Even if you are experiencing unrest during sleep, difficulty getting comfortable or changing positions frequently during the night, then a pillow change is and investment well-worth considering. 

We were so impressed with the pillow that we now stock the pillows in our physiotherapy practice. If you are interested in the pillow or just have questions about your current pillow then call us at Le Physique Physiotherapy or talk to us at your next treatment session.

 

Thursday
Jan022014

Dry Needling

Dry Needling

Dry needling is a technique commonly utilised at Le Physique Physiotherapy. So why do we choose to use needling and what effects does it have on the body?

What is needling and acupuncture?

Needling and acupuncture has been used as a treatment for thousands of years, having its origins in ancient Chinese medicine. There are many different types and styles of needling, but in most cases it involves the insertion of fine needles into specific points around the body. Traditional acupuncture uses specific points organised into meridians, which correspond to various internal organs. Dry needling focuses on insertion into targeted points in muscles and other soft tissue.

Needling in its various forms has been used for many different human ailments ranging from muscle and joint pain to digestive disorders to depression and anxiety. Some even use it in late pregnancy to try and induce labour! As physiotherapists, the style of needling we employ is focussed on its physiological effects on muscles (length and strength) and also pain modulation via its local, spinal and central effects on the nervous system. By inducing a local muscle fibre response and activating certain neural pathways, we can cause changes in biomechanics and take pressure of painful structures.

Local Effects (what happens right around the spot that is needled):

Without going in to too much depth into the neuromuscular physiology, when a needle is inserted it basically causes:

-       Increased local blood flow

  • The lack of blood flow and oxygen to tight areas of muscle can be a source of pain. Blood flow is also important for delivering nutrients for healing and carting away the toxic waste products!

-       Stimulation of afferent nerve fibres (sensory nerves)

  • This can decrease pain via the pain gate theory (stimulation of one nerve signal can help block the transmission of other signals like pain). This is the same reason we rub our finger after we have shut it in the car door!

-       Decreased muscle tone (muscle relaxation)

  • This allows freedom of movement, blood flow and helps to take away that uncomfortable feeling of tightness in muscles.

-       Increased delivery of endorphins and endorphin receptors

  • Endorphins are the happy hormone! It also decreases your perception of pain.

-       If the needle is inserted into a muscle trigger point (a hyper-contracted segment of muscle, aka a muscle knot), then it sometimes elicits a twitch response in the muscle, which is followed immediately by a release in the tension of that band of muscle.

 

Central Effects (what happens away from the site of the needle):

- Needling can also have effects on the level of the spinal cord that corresponds to the area being needled.  These changes help to partially block incoming pain signals at that level of the spinal cord and can provide effective pain relief.

- There can also be effects in the brain, which activates descending pain inhibitory pathways to help modulate incoming pain signals. This effectively means that the brain can send down a signal to block some of our perception of the pain.

 

Benefits:

Using the above mechanisms, needling can assist in treating ailments by:

-       Waking up inactive muscles

  • This can help stimulate muscle recovery, activation and strength

-       Releasing tight muscles or trigger points (Loosen you off)

-       Reducing pain

-       Improving healing (via improved circulation)

-       Changing movement patterns and biomechanics

  • This can help reshape your posture and help you move in a healthier way. We often use it to improve postural scoliosis (also known as non-structural or functional scoliosis).

 

What will I feel during and after needling?

            As the needle is inserted you will feel a mild prick. Depending on the area being needled you may then feel a twitch or grab of the muscle followed by a deep dull ache around the needle site. This ache usually subsides very quickly within minutes, but on some occasions it can last from up to 24-48 hours. This ache is usually easily distinguishable from your usual symptoms, and is a natural part of the process in causing change in the muscles. Sometimes you may feel very little at all.

            In most cases you will also notice an immediate change in your symptoms whether it is increased range of movement, improved alignment or decreased pain. Others have noted to have a very restful, good night sleep!

Some examples of common conditions we treat with needling.

  • ·      Lower back pain 
  • ·      Knee pain & injury 
  • ·      Osteoarthritis (Knees, Hips, Backs, Shoulders)
  • ·      Shoulder pain and rotator cuff dysfunction
  • ·      Tendonitis (Achilles, Patella, Tennis elbow and others)
  • ·      Ligament strains
  • ·      Headaches
  • ·      Neck Pain and neck and shoulder tightness

 And the list could go on! Basically there are very few conditions that can’t be helped by needling.

Is it safe? 

There are risks to every procedure, but your physios are highly trained professionals. They will discuss the potential risks with you, and you can then make an informed decision about whether you would like to go ahead with the needling or not. There is no pressure to say yes! 

Please let your physio know immediately if you have a bleeding disorder (eg haemophilia) or blood borne infection (HIV, Hep B, etc), are taking anti-coagulants (eg Warfarin), are pregnant, have had a lymph node dissection, have a joint replacement, breast implants or a cardiac pacemaker. These will influence how your practitioner approaches your treatment, and factor into whether the potentials benefits are worth the potential risks in your individual case. 

Blood donors please also note that you can only donate plasma for the 4 months following a dry needling treatment for safety reasons. Please check the Australian Blood Donor website for their most up-to-date information. 

 

What now?:

If you have that painful niggle that’s not going away, come in for a physio session and try some needling. We will never use needling alone as a whole treatment session. We have found that it is most effective when used in conjunction with other therapy techniques.

So next time you’re in for a physio appointment, ask us if needling would be beneficial for you (if we don’t ask you first!).

Whether we decide to needle or not is based on each individual presentation and of course your personal preference.

Tuesday
Nov192013

What is correct head/neck posture?

Posture education is very important in the prevention and treatment of neck pain.
 

Poor neck and shoulder posture is very common. A forward head / rounded shoulder posture not only makes us look like a hunchback, it increases the load on the neck joints and muscles. In fact, moving the head forward by just 2-3cm increases the load on the neck by about 5kg! So if you sit at your computer at work with your head forward 5-6cm (which is common) its like having a 10kg weight sitting on top of your head all day!

Depicted below is a very simple exercise to help you test your neck posture and practice correcting it. 

Instructions:

1) Stand with heels, bottom and shoulders up against a wall. A lot of people may find that their head is sitting forward.

2) Bring head backwards to touch the wall by growing taller and tucking chin backwards.

3) Hold here for a few minutes to get used to the position.

4) Practice the movement forward and backwards and also practice correcting when sitting at a desk, standing, sitting in the car etc. Make it become normal for you!