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Science of breathing
We all know the importance of breathing. Your body needs a constant flow of oxygen to the muscles and brain to keep functioning, or else, we will surely pass away. Breathing is an automatic function of the body which is controlled by our brain. Because it is so automatic, we often don't take the time to focus on our breathe to allow it to give us the best results. For example, when we feel stressed it can have a huge impact on our breathing rate as it changes our pattern of breathing as part of our flight or fight response.
Under stressful conditions, we will start taking shallow and rapid breaths from our shoulders and chest, rather than our diaphragm to move air. This style of breathing can disrupt the balances of gasses in the body as well as many other functions. Now, compare that to when we are feeling relaxed... we breathe slowly through our nose in an even and gentle way, filling up the lungs and body with plenty of oxygen. By deliberately practising a relaxed breathing pattern you can control your nervous system and take charge of some of the body’s involuntary bodily functions, which can include;
- Lowering blood pressure and heart rate
- Balanced levels of O2 and CO2
- Reduced muscle tension
- Reduced stress hormones in the blood
- Increased feelings of calm and wellbeing
Types of breathing:
This is not common knowledge but there are 4 distinct styles of breathing which are available to us:
If our diaphragm does not descend as we take a breath in, the chest must accommodate. This is one of the most common form of breathing, which causes shallow breaths.
Is where we breathe into the top third of our lungs, which is where our lungs are the smallest. Clavicular breathing is accomplished by raising our collar bones and shoulders whilst keeping the rest of the torso motionless. Clavicular breathing is the shallowest form of breathing and does not allow the body to oxygenate effectively.
Is a strange breathing occurrence where the chest wall to contract during inhalation and expand when exhaling, opposite of how it should move. This form of breathing is an indicator of respiratory problems.
This is where we utilize our diaphragm which is our primary respiratory muscle. On every inhale the diaphragm will descend causing our belly to protrude, and with every exhale our belly shrinks. Ideally diaphragmatic breathing would be the best form of breathing, but why? Not only does breathing through our bellow allows the air to travel deeper into our lungs, where there is an abundance of blood vessels to oxygenate our blood, but it can serve as a secondary purpose to help reduce anxiety.
Stimulating the Vagus nerve and deep breathing
The Vagus nerve is one of the most complex pairs of cranial nerves that originate from the brain. It transmit information to and from the surface of the brain to the tissues and organs. The four key functions of the vagus nerve are:
- Special sensory i.e. taste
The function we will be glossing over would be the parasympathetic drive. Our nervous system can be divided into two distinct systems, the sympathetic and parasympathetic system. To simply put it, the sympathetic system increases our alertness, energy, blood pressure, heart rate and breathing rate, whilst the parasympathetic system does the opposite, by decreasing it. These two systems work in tandem to help regulate our body in a state of equilibrium.
Diaphragmatic breathing has been shown to stimulate our vagus nerve which lowers our stress response. It can help keep in check our ‘flight or flight’ response if it gets out of hand. Hence it induce a sense of calmness if performed, by lowering our blood pressure, heart rate and breathing rate.
Time to stimulate our vagus nerve!
It’s good health hygiene to take a moment out of our stressful and compact day to spend a bit of time to ourselves and unwind. Many of us take short and shallow breaths into our chest, it may be just because we are unaware. With this technique you can learn how to take bigger breaths, and unwind.
- Find a nice quiet area, get comfortable. Either lay down on your back with your head under a pillow, or you can sit in a chair with your shoulders, head and neck supported against the chair.
- Breathe in slowly through your nose and allow your belly to fill with air
- Breathe out through your lips, using your lips to control the rate at which the air is coming out
- Place one hand on your belly, and one on your chest
- As you breathe in slowly, visualize filling up the lower part of your lungs just above your belly button like a balloon. Your hand should slowly rise as you breathe in slowly.
- As you breathe out slowly allow the air to escape your belly, using your lips as a gateway. Imagine yourself blowing out 100 candles, one by one, slowly extinguishing the candles.
- The hand on your chest should remain pretty silent, with most of the movement occurring in your belly
Now that you're breathing correctly and feeling relaxed, you're ready to take on the world!
Deep dive – Intermittent fasting is it fad or fiction?
Many Australians claim to watch what they eat and even try to improve their eating habits. Many swear by diets ranging from the lemon detox to the Atkins diet to help them shed their winter weight, ready for summer. Today I will have a deep dive with a new and emerging way of managing your weight called intermittent fasting to see whether its just another fad.
The science of Fasting compared to a caloric restricted diet
The Minnesota starvation experiment looked at the physiological response of a caloric deficit diet. Conducted in 1944 it was one of the pioneer studies looking to understand the effects of starvation, due to the upcoming food shortage resulting from post WWII. For 3 months participants ate a diet of 3200 calories per day and for 6 months they ate only 1500 calories per day. The food that was given were high in carbohydrates like turnip, bread and potatoes, meat and dairy products were rarely given. After the 6 months of only 1500 calories per day all of the participants had the following complaints:
- Constantly cold
- Cardiovascular endurance dropped drastically
- Core body temp dropped
- Strength dropped by an approximate 20%
- Lost all interest in activities, and had an unnatural obsession with food
- Intense hunger
Compare this to Angus Barbieri, a Scottish man who in 1964 successfully fasted for 382 days. He lived on tea, water, coffee and vitamins and lost an astonishing 125kg from an original weight of 250kg, also setting the world record for the longest fast. He did this whilst exhibiting no negative symptoms and was able to walk around and ambulate freely. A case study on him published by the Dundee University, department of medicine concluded that his fast showed no ill effects. There were no complaints of mind-numbing hunger and he kept the weight off for several years. This case study further laid down the foundation for research to come.
These two studies show drastic differences between 2 methods of caloric deficits, with vastly differing effects.
Dr Jason Fung, a world leading expert on intermittent fasting and a practicing nephrologist, states that compared to fasting restricting calories can cause more muscle loss and less weight loss.
Hunger- Need or want?
Contrary to popular belief the longer we starve ourselves the less hungry we get, but why? Hunger is regulated not by our need for calories but by a hormone called ghrelin, which regulates our hunger levels and is closely related to weight gain. A study at the medical department in Vienna saw participants fasting for 32 hours, with their ghrelin levels measured every 20 minutes. Overall ghrelin levels didn’t seem to rise throughout the fast. However, it was found that ghrelin levels were lowest just before waking up, and rose approaching lunch, dinner and breakfast time, as if the body has learnt to expect food at those particular times. Ghrelin levels however tends to spontaneously drop 2 hours following a spike. This spontaneous loss of hunger can be experienced by the vast majority. I have personally experienced this spontaneous loss of hunger many times, especially when I am at work, really focused on what I am doing, and pushing food towards the back of my mind. Pretty quickly I forget about eating and am only hungry until after work or dinner time.
This is important for those who are going to start a fast or participate in intermittent fasting. It’s a good reminder that we will have waves of hunger throughout the day but if we can persevere and fight the hunger it will subside spontaneously, and definitely won’t get worse.
Where does the body get energy from when we fast?
When we fast and restrict ourselves from eating, we start utilizing stored energy. This utilization of stored energy is called ketosis. Ketosis is a metabolic state whereby which our bodies uses our stored energy (fat) instead of external carbohydrates for energy. For this reason, many people use ketosis for weight loss. Not only does it have a weight loss benefit, but it also helps with mental and physical efficiency.
A simple way to enter ketosis is to either limit yourself to around 50g of carbohydrates and not consume too much protein, or just not eat.
In the metabolic state of ketosis our resting energy expenditure (REE) or colloquially known as ‘metabolism’ rises. According to Dr Jason Fung, he showed that over a course of 4 days your REE increases, with an increase of approximately 11% by day 4. Human growth hormone, a vital hormone within human’s responsible for growth actually increases significantly after the 2ndday of fasting.
A case study looking at Tim Ferris, who participated in a controlled fasting experiment under strict conditions, allowed the process of ketosis to kick in quickly. At the end of the 7 days he lost 0 muscle mass. The strict conditions included no food intake, water intake only and light exercises of brisk walking up to 4 hours a day, promoted the state of ketosis the quickest. The proposed increase in human growth hormone may be the reason why Tim Ferris did not suffer any muscle mass loss.
Now comparing fasting to a calorically deficit diet. By eating small amounts of food you are effectively eating just enough to keep the body out of ketosis, priming the body’s metabolism for burning carbohydrates. This causes you to be in a state of perpetual hunger, not allowing your metabolism to click over to utilize stored energy, but still relying on exogenous energy (food).
By continually relying on small amounts of food for energy we will continue to rely on insulin to help regulate our energy. This is a double-edged sword since insulin inhibits the body’s ability to use internal energy stores (fat), but also helps the body to move energy into our cells. In this state we have no methods to use our stored fat as energy. On top of not being able to rely on eating enough food to get energy the body will do what ever it can to maintain function by reducing metabolism and breaking down muscles for energy. This can be why in the Minnesota starvation experiment participants had lost so much muscle mass and was in a constant state of hunger.
Intermittent Fasting – Where does this all fit?
Sadly, we cannot fast indefinitely. There will be a time where our body will need to rely on food, but we can do this without breaking the benefits of fasting. This is where intermittent fasting comes into play. By restricting our calorie intake to a certain time in the day and fasting the rest we essentially allow ourselves to lower our insulin levels between meals, far enough that we allow the body to be able to burn fat.
Dr Monique Tello, a lifestyle physician from Harvard Medical School, suggests these 3 tips for beginners to start intermittent fasting:
- Consider a simple form of intermittent fasting. Limit the hours of the day when you eat to am ~ 8-hour window. You can make it earlier (7am – 3pm) or later (10am – 6pm), but not in the evening before bed.
- Avoid sugars, refined grains. Instead eat a balanced diet of fruits, veggies, beans, lentils, whole grains and healthy fats. If you need inspiration look at the Mediterranean style diet.
- DO NOT SNACK between meals. Let your body burn fat first between meals. Be active throughout the day.
Not everyone can adhere to this type of diet, and diets are in nature itself is a short-term thing. For you to sustain a long-term benefit from this style of diet, it has to be a lifestyle change. If you think this is something you can incorporate into your lifestyle and sustain over a long period of time, great! Do it! If not, consider something else.
Dr Deborah Wexler, Director of Massachusetts General hospital for Diabetes and an associate professor at Harvard medical school, comments “there is evidence to suggest that the circadian rhythm fasting approach, where meals are restricted to an 8-10-hour period of the daytime, is effective”. However, she generally recommends that people “use an eating approach that works for them and is sustainable to them.”
Before any major dietary changes please consult your physician first. With intermittent fasting it is not recommended for people with:
- Advanced diabetes
- History of eating disorders
- Pregnant or breast feeding
We hope that this has given you a greater insight to the world of fasting. If you have any feedback, or have tried fasting for yourself and would like to share your experience, please feel free to reach out to us on our Facebook Page!
It is common knowledge that calcium is good for our bones, but do we know why it’s important to keep our bones healthy? Well the simplest way to think about bone health is how hard our bones are, so the harder our bones the healthier it is. The hardness of the bones is called bone mineral density (BMD) and it can be measured using a machine called a DEXA scanner. As our bone mineral density lowers it causes our bones to become more brittle and susceptible to fractures, this disease is called osteopenia/osteoporosis.
Our Bone Bank
Our bones are constantly in a state of change from the day we are born till the day we die. It is constantly remodelling, with bits of old bone being removed and replaced by new bone. You can think of your bone as a bank account, where you deposit and withdraw bone tissue. Most of the deposits are made from the day you are born till when you’re about 20 years old, with girls peaking a little bit earlier at 18 years. To ensure the most deposits are made it is paramount that your child has a healthy and balanced rich in calcium and vitamin D, and engaging in regular physical activity.
As we hit adulthood our deposits dramatically take a nosedive and we withdraw more than we deposit, this causes our bones to become brittle overtime. This is normal, however for those who’s ‘bone bank’ is low this constant withdrawing can cause them to develop osteopenia and soon osteoporosis at an earlier time than intended.
Is there any other way I can make more deposits?
There are many ways we can impact our BMD in our later years. There are lifestyle changes you can do to drastically improve your BMD and reduce the risk of developing osteopenia or osteoporosis. Currently exercising is one of the best methods to help maintain and improve our BMD.
Like muscles, our bones react to exercise, when we put load through our muscles it can get stronger, same thing goes for our bone. Matter of fact our bones love being under stress so much that NASA is currently having an issue with their astronauts in space where there is no gravity, meaning no stress on the bones, causing them to rapidly lose their BMD and not being able to be mobile back on earth.
That is why it is important for not only kids to participate in sports or regular physical activity but people of all ages. Here are some great examples of sports that are good for our bone health:
- Basket ball
- Lifting weights
- Jump ropes
Early-onset osteopenia and osteoporosis
Even though osteopenia and osteoporosis are considered a disease that older people get, it can occur in younger people as well. This is due to several factors such as:
- Life style factors
- Eating disorders
- Excessive alcohol consumption
- Certain rheumatic diseases
- Inflammatory diseases
Take home message for today is to try and constantly deposit as much as we can into our bone bank to ensure we keep our bones and strong as possible, so that in the future if there was any trauma we can rest assured that our body’s will be protected.
Attention to all mums & mothers to be!
Recently a new article has been published by the American College of Sports Medicine in 2019 looking at the effects of exercise during pregnancy on the motor development of 1-month old infants. What they found was that if expecting mothers participated in an average of 45 minutes of supervised exercise 3 days a week, it was shown to give a significant boost to their infants motor control functions at 1 month.
So why does all of this even matter? Well childhood obesity across all developing nations is at an all-time high, with 29% of Australians being obese with an average BMI of 27. This increase in obesity can be attributed to a decrease in physical activity and poor motor skills during childhood, according to a study conducted in 2015, hence early intervention to promote better motor skills can attenuate this increase in obesity. It is also have been shown that children who develop movement skills early on in their developmental cycle are more likely to move and remain physically active throughout their childhood, into adulthood, which could decrease the incidence of obesity and obesity related illnesses.
Other benefits of exercising include:
- Reduced delivery times
- Reduced gestational weight gain
Before we all set off and start exercising furiously, it is important to be seen by a movement specialist before embarking on your exercise journey during pregnancy. This will allow you to see which exercises are suitable and will not put you at risk of injuring yourself. Seeing a health specialist such as a doctor, physiotherapist or exercise physiologist is highly recommended to ensure you have a smooth process throughout your exercise program!
The number of Australians undergoing ACL reconstruction in the past 15 years has risen to more than 70%, with the greatest increase amongst children under 14. The rupture of an ACL typically occurs in sports that require agility, when someone changes direction quickly leading to an excessive force through the ligament, rupturing it, such as soccer or AFL.
Australia has the highest reported rates of ACL injury and reconstruction in the world, but do we really need all of these reconstructions?
First we need to address why health care practitioners and the lay public believe surgery is needed after a rupture. This question has so many sides to cover and the question itself could be its own post doctorate thesis, but lets try and break it up into sizeable chunks.
First of all the role of the anterior cruciate ligament (ACL) is to prevent and stabilise the knee against twisting motion. If we lack this stability we can not engage or participate in activities that cause our knee to twist, so why not try and replicate the function of an ACL through surgery? This was the prevailing view in modern medicine, however this idea is now being flawed. Most of the research looking into ACL reconstructions never compared a reconstruction to a structured rehabilitation program, but to different types of ACL surgeries and different graft types. Of the 412 gold standard, randomly controlled trials (RCT) looking at ACL reconstruction, only 1 actually compared surgery to rehabilitation. This single RCT in 2013 found that “clinicians and young active adults should consider rehabilitation as a primary treatment option after an acute ACL tear”.
The belief that the ACL cannot repair itself due to lack of blood flow has been recently debunked with evidence emerging from 3 separate studies spanning from 1994, 2002 and 2012. It is found that if left alone the ACL can heal, despite popular belief that this was impossible.
There is an abundance of fear mongering in the mass media when a player injures their knees on the field, with commentators always speculating the worst, assuming the athlete has injured their ACL and will require surgery and need 9-12months of rehabilitation. By continually pushing this false narrative towards the lay public it will skew the perception of young athletes making them think that they need an ACL to compete at an elite level.
Can you return to pivoting sports without surgery?
Just because we do not have an ACL, does not mean our body can’t adapt to it. Through intense strengthening, neuro-muscular control, balance and sports specific training you can prime your body to be more than adequate to compensate for a lack of structural stability, ultimately making the ACL redundant. If you don’t believe this, have a look at the case of an English premier league player who returned to play without surgery after 8 weeks of a full thickness tear and remained problem free (Weiler et al 2015, Weiler 2016).
So when is surgery viable?
This is a very hard question to answer due to the lack of evidence. Traditionally we have been heavily biased around early ACL reconstructions so it’s hard to give a clear answer. However the evidence suggest that surgical vs non-surgical intervention has the same outcomes. A recent large review in 2016 showed that there was no significant difference between surgery and non-surgery at 2 to 5 years post injury. I guess the take home message is having surgery is not the end all and be all solution to getting back into pivoting sports and careful consideration for conservative treatment on a case by case basis is needed.
A large population of people over the age of 45 have a condition in the knee called knee osteoarthritis or also known as knee OA, where the cartilage in the knees are worn away causing bone on bone contact between the thigh bone and shin bones. Complaints include joint swelling, joint stiffness and most common one, pain.
The word Osteoarthritis describes a condition that causes wear and tear of your joints, and in the case of the knee, it’s the wear and tear of the cartilage that separates and helps cushion our knees. In knee OA, not only does the cushion/cartilage gets worn but the soft tissue that surrounds our bone and the ligaments around it, which ultimately can lead to pain and loss of function.
Early on in the 2000’s it was once thought that Knee OA was a condition that was inevitable resulting from a long and active life but research has shown that knee OA is a complex process with many causes, and some experts say that it is not an inevitable part of aging. By looking at the contributing factors we can mediate the risk and drastically reduce the chances of and delaying the onset of knee OA.
- Maintain a healthy weight
- Excessive weight is one of the biggest predictor of knee OA, this is due to the fact that extra kilo’s put extra stress on the knees and hips. Each kilo you gain puts an extra 4 kg of force through your knees, and over time this added force can really wear out your knees.
- Mechanical stress is not the only reason why our cartilage decides to kick the bucket early. Systemic inflammation can trigger the early break down of cartilage tissues. Fat cells produce these inflammatory cells which will speed up the degenerative process. So by reducing your weight not only do you reduce the overall mechanical load through the legs but also reduce the systemic inflammation.
- Control blood sugar
- High levels of blood sugars within the body may be a huge contributing risk factor for knee OA. The high levels of blood sugar causes an influx of insulin to circulate through the body triggering systemic inflammation leading to early cartilage loss. Looking at population consensus data, Overseas research shows that more than half of diabetics have some form of OA.
- Get physical
- The gold standard for treatment and prevention of knee OA is getting fit. It is also one of the best ways to keep joints healthy. Contrary to popular belief cartilage cells thrive under pressure, meaning they need to be stimulated or else they will just wither away. Getting fit also fixes the previous 2 factors in delaying knee OA. You do not need to join a gym however just start by taking a little walk, although, if you do feel some sort of pain, listen to your body and take frequent breaks.
- Play it safe
- Once a joint is injured in some way it is nearly 7 times more likely to develop OA compared to a joint that has never been injured, this number jumps up dramatically if the joint needs to be operated on. It is nearly unavoidable to prevent injuries we can do things to mitigate the risk. Use protection when possible and have adequate training for it. Playing your sports once or twice a week is not adequate training.
Looking at Australia we have an ever growing aging population, with increasing rates of obesity, it is paramount to start thinking about how we can prevent knee OA. According to professor David Hunter from the university of Sydney, who is a world leading OA expert, “GP’s in the past have recommended glucosamine or anti-inflammatories to manage or prevent knee OA, but now evidence shows that the safest and most effective way of treatment is exercise, with many cases of OA can be assisted with diet and lifestyle changes. The new guidelines outline the importance of long-term management of the condition, with a focus on non-surgical interventions, and recommend that medication and surgery should be used as a last resort. Studies have shown that surgeries provide little gain for the patient, with risks and high costs, and opiods can be ineffective for pain management but have severe side effects such as risk of dependency.”.
“People living with osteoarthritis are encouraged to have informed conversations with their GP about preventive care like physical exercise and weight loss,” added Professor Hunter, who is University of Sydney's Florance and Cope chair of Rheumatology.
So what is the current guidelines in treating people with knee OA?
Currently there 100’s of “cures” or treatment for knee OA ranging from using glucosamine tablets to ingesting shark cartilages. However these treatments have shown little effect in and does not address the overall holistic nature of knee OA. The only one tried and true method of preventing and managing knee OA is structured exercise, with medication as adjunct treatment in the management of pain relating to knee OA.
The main role of exercise is improve physical function and reduce pain. By increasing our muscle strength around our knees we reduce the actual load that goes through the knees. You can think of your muscles as shock absorbers, with more muscle strength and better motor control you can absorb more forces with your muscles, instead of them going through the knees. Every person is different so in order to get the right exercises you need to be assessed by a qualified health professional such as a physiotherapist to prescribe the right exercise and dose.
If you are unable to get to a health professional or if you are hesitant to do land base exercises, its best to try and start walking around or doing some gentle exercises in the pool. This way it puts less strain through the joints and it is more comfortable.
The take home message for knee OA would be that its never too late to change! Exercise, whether it be as simple as walking in the pool to hitting it hard and safe at the gym will be of GREAT benefit. Even more effective is exercise done with perfect technique! If your interested in one of the many classes run at BPS by experience Physiotherapist and experts in biomechanics ... ie perfect technique ... please give us a call on 8544 1757 or drop us an email at email@example.com we would be happy to guide you in the right direction for your specific situation!
Scoliosis is a condition that causes a curvature of the spine, the classical look of a scoliotic spine is where it is curved from side to side forming an ‘S’ shape, compared to a straight line.
There are two types of scoliosis one detected at birth which is called congenital scoliosis and the other is called idiopathic. The most common type of scoliosis is idiopathic which means the exact cause is unknown. Idiopathic scoliosis is generally picked up between the ages of 3-10, with most idiopathic scoliosis being rarely painful, since the angle of the curvature of the spine is small.
Children who present with mild scoliosis are monitored regularly with X-rays to make sure that the curvature isn't increasing, usually treatment is simply wearing a brace to prevent the curvature from worsening.
Functional scoliosis is another subset of scoliosis that occurs during adulthood, often in response to an injury or asymmetrical activities such as playing tennis or baseball. The curvature of the spine develops due to one side of the body being over used and the other side under used, usually functional scoliosis can be corrected with appropriate treatment and exercise since it is muscular based.
Signs and symptoms of scoliosis?
- Uneven shoulders
- Pain around areas of imbalances
- Bending to one side (listing)
- One shoulder blade being more prominent than the other
In severe cases of scoliosis it can cause drastic issues to our heart and lungs since it compresses our thoracic cage not allowing us to breathe properly and making harder for our heart to pump.
Early detection of scoliosis is vital for a growing child, diagnoses in its early stages ensures a wider range of options for treatment and slowing the progression since children’s bones are not yet fully calcified, allowing a more conservative approach, instead of surgical ones.
Treatments for scoliosis:
- Medical intervention – Experts say that with congenital scoliosis best practice involves early surgical intervention to prevent the development of severe local deformities and secondary structural deformities that would require more extensive surgery later. Most of the surgery for congenital scoliosis happens during adolescence but there are newer techniques being developed that allows better spinal alignment at an earlier age.
- Physical therapy – Physiotherapy is used to treat milder forms of scoliosis, mainly idiopathic scoliosis to maintain aesthetic appearance and avoid surgery. The main role of physiotherapy in idiopathic or congenital scoliosis is to:
- Maintain muscular endurance and strength
- Increase range of motion throughout not only thoracic spine, but shoulder, neck and hips
- Improve or maintain respiratory function due to thoracic restrictions through education or breathing techniques
- Educate on ergonomical corrections and positions
- Build good neuromuscular control of the spine
So far there is good evidence for an early intervention program for children, adolescents or adults that have mild scoliosis. The ‘wait and see approach’ for children is not recommended and getting professional help from a quailed movement specialist is always recommended.
At BPS we specialise in the diagnosis and treatment of all of the above mentioned forms of Scoliosis, if you have any questions or concerns please don't hesitate to give us a call on (02) 8544 1757
During pregnancy we experience many different kinds of sensations, some pleasant and some ... not so. Many of us experience some sort of back pain during our pregnancies. The good news is that it’s natural and that your baby is growing! It is very common with occurrences as high as 60-70%. There are a plethora of reasons for back pains during pregnancy but some of the most common include:
During a healthy pregnancy, women are expected to gain anywhere between 12-25kgs. This added weight on the spine in such a quick amount of time may cause lower back pain due to the increased load the spine has to support.
Due to bub sitting right inside our uterus, it can cause a shift in the centre of gravity forward. This shifting centre of gravity can change the way you move and put strain through your body.
During pregnancy the body produces a hormone called relaxin which allows the separation of the pelvis to accommodate the child during child birth. This increased laxity within the pelvis can cause pain
As the baby grows the belly has to accommodate for this growth too. The abdominal muscles will separate in the centre. This separation may worsen back pain.
Emotional stress can cause hypersensitivity and increased tension in your back. You may feel more back pain when you are going through stressful periods of your pregnancy.
Physiotherapy is a good way to help prevent and manage ongoing back pain during pregnancy. A physiotherapist can identify the particular muscle that is causing you pain and can give you management strategies on how to cope with it. Soft tissue and joint mobilisation techniques have been shown to drastically reduce pain as well. As well as being hands on, a physiotherapist can prescribe ad cater specific exercises that will reduce your back pain, they can also recommend what type of external support to use during severe flare ups.
Did you know that lower back pain is the 5th most common reason for people to visit their doctor! This always strikes me as weird as generally speaking your Physio is a better bet when you have musculoskeletal pain than your GP. Did you also know that lower back pain will affect around 70% of people throughout their lifetime. That a lot!
Low back pain is usually categorized into 3 categories: acute, sub-acute and chronic. Acute low back pain is an episode of back pain that is less than 6 weeks, sub-acute is between 6-12 weeks and chronic is anything more than 3 months. However it is often not so clear cut as this. Many episodes of lower back pain feel as though they might run together, or 'flare up' at different points throughout the year. Its important to understand your body - your back and what factors are contributing to your symptoms, in order to best prevent forte episodes.
The prognosis for anyone with an acute episode is fairly good, with most resolving in 8 weeks, with around 50% of people resolving spontaneously in the first two weeks.
The exact cause of low back pain is often very difficult to identify, in fact there are numerous possible causes of back pain from muscles, soft connective tissues, joints, ligaments, cartilage and even blood vessels. Depending on the circumstances chronic stress, depression and obesity has been linked with the onset of acute and even chronic back pain. However, just because it is difficult, doesn't mean it should be overlooked. It's important you work with your Physio / healthcare professional to ensure a clear picture of what is causing your back pain is established.
Managing back pain:
The best advice for the treatment of acute back pain is to continue to remain active as tolerated. Continuing everyday activities may sound counterintuitive but if we stay at home and cooped up in bed we tend to get more stiff. By being active we can promote blood flow and nutrients flowing to the area and reducing muscular tension. Here are some things we can do to manage an acute episode:
1. Stretches – There is no reason not to completely avoid stretches. All stretches if done correctly are good. However stretching should not cause more severe pain.
2. Heat or ice – Local application of heat or ice can reduce pain. Neither is better or worse for the situation, all dependent on your preference
3. Medication – Paracetemol or anti-inflammation drugs can be used to help ease the pain. These classification of drugs are known as analgesics which dampen the central nervous systems ability to pick up pain signals. These medications should be used only as prescribed by your doctors since some anti-inflammatory drugs can have some side effects.
4. Physical therapy – Physical therapy can give you great relief and advice on how to further manage your pain. A good physio will diagnose the pain generating structure. Possibly use some manual therapy early on to help relieve symptoms. They can cater a specific stretch and exercise program to help you get through it. They can also identify possible triggers and help devise a plan to prevent another episode from occurring.
If you or someone you know is suffering with lower back pain, encourage them to seek help. It doesn't have to be a debilitating injury and with the right advice it can be overcome!
DRA is the acronym for diastasis of the rectus abdominal muscles, which is the separation that occurs during pregnancy to the abdominal muscles, to allow the baby to grow. This DRA occurs usually in the second and third trimester of pregnancy and can remain post pregnancy. It is suggested that post-natal DRA can lead to lower back pain and pelvic instability, and even develop urinary incontinence
The “acceptable” level of separation is less than 2 fingers at the level just below the belly button. You can check how much separation you have with this simple test:
1. Lay down on a hard surface with your knees bent and place a small cushion under your head.
2. Slide your fingers down towards your belly button and sink your fingers into your belly as you pass your belly button
3. As you pass below your belly button slowly sink 3 of your fingers into your tummy feeling your tummy muscles touch the side of your finger
4. Lift your head and bring your chin towards your chest to tighten the abdominals
5. Feel your abdominals squeeze your fingers, slowly remove each finger until you can feel your abdominals slightly pressing on the side of your fingers
6. Whatever fingers remain is approximately how many cm of separation you have
7. It is good to check the area just above and below your belly button too
The categorization of DRA is as follows:
· Normal < 2 fingers
· Mild DRA 2-3 fingers
· Moderate DRA 3-4 fingers
· Severe DRA > 4 fingers
Is there a way to manage this?
YES!!! The best ways to manage DRA during and post pregnancy involves movement education ie learning how to reconnect with your body and allow the deep muscles of your core to learn to work as a team once more. In more sever circumstances external supports may be useful and of course as a last resort surgery is an option.
While activity modifications can be useful in the short term and involve learning how to get in and out of deep chairs and bed, in the long term it is essential to relearn how too effectively and efficiently control and move your body. Exercises that help this learning journey include Pilates - for a more detailed outline of a Pilates journey post pregnancy please read our 'Exercise After Pregnancy' - these sessions will educate your on gentle core activation and pelvic floor exercises and ensure you are doing these exercises correctly!
External supports can help mimic the function of the abdominals, simple supports such as tubi grips and recovery shorts have been known to help.
It is always advised to seek our professional help when it comes to the management and education of DRA at BPS we have a variety of experienced women's health physio's who can help your with finding a solution that works for you, if you would like more information please don't hesitate to ask us a question here!