Who here has been to the doctor complaining of joint pain, got sent for a scan that showed signs of arthritis, in which the doctor quickly blames it for your pain? It was once thought that the reason why our joints become sore and painful is because of arthritis, making the joints grind on each other as we move. It is true to a small extent, but it does not mean that we need to stop moving or use it as an excuse.
A lot of patients I speak to in the clinic always tells me the same story, “I have arthritis in my knees, so I can’t walk too far”, or “My back has arthritis that is why I can’t garden for too long”. This is by far not true at all. Having arthritis does not stop you from enjoying life, you telling yourself you “can’t” is what is stopping you from enjoying life.
But before we continue lets explain what arthritis is. Arthritis is a common term to describe joint pain due to changes in the joint itself. The most common form is called Osteoarthritis (OA) which affects the whole joint, from the cartilage, ligaments and to the bone itself. There is no cure for arthritis but there are many ways to manage it.
Often Doctors tend to diagnose OA via a system developed in the 1960’s which uses X-rays to determine the severity of OA, rather than symptoms the patient is presenting. However recent research has shown that there is not a strong relationship between what is found on film to the amount of pain and disability a patient experience, as once believed.
Not all is lost, however contrary to what simple logic tells us to do, we need to continue moving to get better. Since OA causes us to lose integrity within our joints, we need to then strengthen the structures that surround the joint to prevent unnecessary mechanical load through the joint. You can think of your muscles surrounding the joint are like shock absorbers. The stronger the muscles the better it is at absorbing the force so that you can protect your joints.
All of the current literature on all types of OA points to an active approach, by exercising and having a healthy lifestyle. We understand that sometimes being active and exercising can be painful but that does not mean we need to stop, it should not define us. What we need is to seek proper advice from movement specialists such as a physiotherapist or an exercise physiologist who knows how to modify exercises to make it more comfortable, and to progress it in a safe and enjoyable manner.
What about surgery you ask? Well recently in 2018 the British Medical Journal (BMJ) held an expert panel on the matter and concluded that they strongly discourage knee surgery and strongly support conservative treatment for degenerative knee conditions such as OA. “Patients and their health care providers must trade-off the marginal short-term benefit against the burden of the surgical procedure”. I understand that with this panel spoke about knee OA, but we can extend this for all joints in the body.
I guess the take home message here is think of arthritis like a speed bump, you approach it slowly, take your time to go over it. It does not stop you in your tracks.
There are only two certainties in our life, and aging is one of them. There is no way to avoid it but there are ways to slow it down or delay some of the nasties that come with age. However, there is one miracle cure that can slow and prevent aging, and that is exercise. As we age there are a myriad of changes that occur to our body and mind some of them include:
Changes to our cardiovascular system:
As we age the most common thing to occur in our hearts is stiffening of our blood vessels, meaning your heart must work harder to pump blood. This means that you are at a higher risk of having a heart attack or high blood pressure.
Changes to our cognition
Contrary to popular belief dementia is part of healthy aging, however it can become an issue when its happens too early or too severely.
Changes to muscle mass
Sarcopenia is a condition which causes gradual muscle wastage as we age. It is something that we can not inherently avoid without actively seeking preventative measures.
Changes to our balance
As we age, we become more unsteady on our feet leading to an increased risk of falls.
Changes to bone mass
In women after menopause, the reduction in eostrogen leads to a drastic decline in bone mineral density; making the bone more brittle.
Yet all is not doom and gloom! You can delay or even prevent of all the above with regular exercise. According to the American College of Sports Medicine (ACSM) participating in 150-300minutes of easy to moderate exercise per week we can combat all of the above. Easy to moderate exercise includes briskly walking the dog, leaving the car at home and walking to public transport and joining a recreational sports team.
A recent study conducted by the University of Birmingham in 2018 looked at groups of elderly individuals who participated in regular physical activities and compared to their peers, they exhibited an immune system and cholesterol levels of a younger person.
To be honest, most of this is common knowledge, but to practice it in a practical and safe manner requires knowledge and expertise. If you have decided to embark on your fitness journey for the first time, or if you have started but keep getting injured, it is best to consult your movement specialist, whether it is a physiotherapist or an exercise physiologist.
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Summer is well and truly here and it is time for us to get moving. This means more chances of injury. So how do we protect ourselves?
It’s a common belief that a 5-10minute warm up protocol prior to an event will reduce our chances of having an injury. It has been drilled into our psyche since we were young and continues to this day. We often attribute to any injuries we sustained to “oh I was not warm enough”, or “yeah I should have stretched more”. However, this may not be the case, but before we dive into this topic lets talk about why we stretch in the first place.
Stretching has two distinct effect on our muscles, the first, influences the elasticity of the muscle and the second influences the excitability of the muscle. Looking at the elasticity component, a sustained slow passive stretch can increase the elasticity of the muscle, allowing greater range of motion within our joints. Regarding neural effects of stretching it has been shown to decrease motor neuron excitability, a fancy word term for muscles relaxation. The correct dose of stretching varies between muscle groups, but the general rule of thumb is either a 4x90s or a 5x60s stretch per muscle group, totalling 5 minutes to have an adequate effect.
On the flip side prolonged passive stretching can cause strength induced strength loss to a muscle, where after a bout of stretches the muscle becomes weaker. This induced strength loss is dependent on the type of stretch that is applied, with dynamic stretches.
Currently the research shows that stretching does not reduce the risk of injury, however in certain sports that require large ranges of motion such as ballet or gymnastics, a proper pre-game stretch routine is vital, so that you can reach those ranges. In practical every day activities such as running or going to the gym, activities that does not require large ranges, stretching seems to have little to no effect on injury prevention.
In saying that I am not against stretching, I am against pre-game stretches, I am all for routine stretches as part of your exercise routine to promote joint flexibility. Coming back to what I said earlier about the correct dose, 5 minutes of stretching is needed per muscle group to increase length. Doing a 5-10-minute routine prior to a game does not even come close to what is needed to have an effect.
So how do we protect ourselves?
Well here are a few easy tips to prevent yourself from getting injured this summer:
· Do not bite off more than you can chew
o If you have never ran a 10km fun run before, don’t do it.
· Train appropriately for your event
o Strengthen the muscles that is appropriate to your task.
· Do not play through pain
o Pain is your body telling you to slow down
· Wear the right gear
o This is a no brainer, wear appropriate fitted protective gear such as helmets, knee pads, etc.
· Increase flexibility
o Stretching exercises should be incorporated into a daily fitness plan, not a last ditch effort.
· Take breaks
o By having frequent rest period, you can drastically reduce the risk of injury. When you are tired you are not performing optimally leading to injuries.
There is wide spread confusion between the two terms and some health practitioners tend to throw these two words interchangeably. However there is a marked difference between the two and the approach that we use to treat it is vastly different. A tendinitis, with the prefix 'itis' infers that there is some inflammation within the tendon itself, whereas a tendinopathy occurs due to an overload of the tendon, where it cannot adapt and it becomes irritated and painful.
Tendinitis is the inflammation of the tendon, usually from an acute or sudden tensile force which causes micro tears within the musculotendinous junction (where the muscle meets the tendon) causing inflammatory cells to rush to the area, whereas tendinosis/tendinopathy is a degeneration of the tendon due to chronic overuse, without allowing the tendon to heal adequately.
The most important thing to take away from this is that most of the time when we experience what we think as an “inflammation” of the tendon, it is not, it is more likely that you agitated it by working harder and longer than usual causing a tendinopathy. Many of us fall in that trap hole of using non-steroidal anti-inflammatory drugs for our tendon pains. This can have the opposite effect in fact since NSAIDS have been shown to inhibit collagen repair making it worse.
So does that mean we need to rest the muscle?
Intuitively resting seems like the best response to an acute injury, however, going against what is logical we actually need to load the tendon more. Well not more, but with the correct load. According to research when we exercise, with the correct load, we promote collagen restructuring. What is collagen restructuring you ask? well, imagine a healthy tendon like a piece of rope, all of the fibers are all in line with each other running parallel, in an angry and unhappy tendon these fibers sometimes crisscross and go in all different directions, in turn making the tendon weak. With exercise, we can rearrange the fibers and make it more optimal to withstand loads.
But it hurts when I do my exercises? Won't it get worse?
Yes that is a very good question, it is true that pain is our body’s way of telling us something odd is going on however in the case of tendinopathy’s having a little bit of pain when we do the correct exercises. In fact with certain exercises with the correct, dose and repetition it can actually reduce pain. Current research shows that phase 1 exercises such as isometric exercises have shown to reliably reduce pain.
So what should I be avoiding when I start having these pains?
· Resting completely
o Like I spoke earlier resting or just praying that the pain may go away is not the best course of action, by resting you reduce the tendons ability to take load, meaning when you go back to do the task it is no weaker.
· Having passive treatments
o Treatments that do not address the need to progressively increase the tendons ability to take load, are generally, useless, it may give short term pain relief but will not address the underlying issue. Treatments like ice and eletro-therapy are band-aid solutions.
· Injection therapies
o Current literature do not heavily support the idea of injection therapy such as PRP into the tendon. It is always best to try and have non-invasive treatments first before jumping straight to injections. Injections do not address the tendon weakness, it merely masks the pain.
· Stretching your tendons
o By stretching tendons we can actually add compressive loads that we know are harmful to the tendon, an alternative if your muscles are tight is to massage to loosen them up
· Massaging directly on the tendon
o Like I mentioned above massaging an already irritated and angry tendon does not serve to make it better
· Getting unnecessary scans for your tendons
o The pictures of your tendons with ultrasound or MRI can frighten you. The words used by doctors such as degeneration and tears can make you second guess if you should be loading the tendon at all. However there is a mountain of evidence to suggest that degenerated tendons, or partially torn tendons can tolerate loads, and can adapt.
The take home message is that an exercise based rehabilitation is the best treatment for tendon pain. Whenever in doubt go visit your local qualified health professional expert such as a physiotherapist to guide your rehabilitation and point you on the right track.
Injured in a motor vehicle accident or at work? At BPS we specialise in rehabilitation for both motor and Workplace accidents. We will closely work with the participating insurance company and doctor to ensure a fast and speedy recovery.
Let’s talk hydration!
We can go for three minutes without air, three days without water and three weeks without food. So, staying continuously hydrated seems to be a no brainer. Water serves as an integral part of the body and has important roles such as:
· Carrying nutrients and oxygen to your cells
· Regulating blood pressure
· Aiding digestion
· Preventing constipation
· Cushioning joints
· Maintaining electrolyte balance
· Regulating temperature
A common rule that many of us try and follow to stay hydrated is to drink 8 cups of water a day. But where did this rule come from? Well the myth that we need 8 glasses a day likely originated from a study conducted by the U.S food and nutrition board in 1945, where they recommended 2.5 litres of water a day. People took on board that advice without taking into consideration that the fluid recommendation included water that was naturally contained in food. People continued to follow this adage, even though till this day there is no research to show that 8 glasses is the optimal amount.
Maybe instead of following this old and arbitrary rule, why don’t we trust in what has worked for us for thousands of years, our body’s thirst response. We should let our body guide us, drink when you are thirsty and don’t ignore what your body is asking. Yes in certain conditions we need to drink more so than usual, such as when you have a urinary tract infection or diarrhea, or in some medical conditions we need to restrict fluid intake such as people with congestive heart failure, but let your general practitioner decide on that.
Using the colour of your urine is a more robust way to look at your hydration needs. Your urine should be light yellow, if it looks like water you’re drinking more than you need, if it is dark yellow or even orange you need to drink more.
Staying hydrated whilst exercising
While the risk of dehydration is well known and documented, it is possible to become overhydrated during exercise leading to a condition known as exercised associated hyponatremia (EAH). EAH is mainly associated with sporting events lasting more than 2 hours, so sports such as hockey, basketball and soccer would not be at risk. Hyponatremia is a condition where there is low salt concentration. During prolonged exercise excessive sodium loss can occur through sweat, coupled with many athletes consuming more water than is needed causes the concentration of salt levels in our blood to drop leading to EAH.
In 2002 the dangers of overhydration became known when a 28-year-old collapsed during the race and died two days later due to EAH. In subsequent years Harvard Medical School conducted studies and found that around 13% of Boston marathon runners had hyponatremia, with the strongest predictor of hyponatremia was due to excessive fluid intake. In fact, athletes who collapse from heat illness during exercise are often quite well-hydrated.
So how do we avoid this? Well because sodium is lost in sweat, it is very important for those are preparing for a marathon to get adequate sodium before, during and after exercise, especially if they continually drink water. As a safeguard during intensive prolonged exercise drinking fluids that contain sodium can help. However drinking sports drinks can only help slightly, with EAH mainly related to the total fluid intake during exercise.
The key is to simply drink when you feel thirsty, this be during exercise or day to day life. It isn’t necessary to stay ahead of your thirst. Try and have a glass of water with each meal and use the colour of your urine to decide whether you need another glass of water.
Improving your balance as you age
Balance is a complicated thing. It involves information from our eyes, inner ears and nerve endings around our body in our joints and muscles all being co-ordinated by our brain to help us stay upright. We also need good muscle strength. As we age there is a natural decline in all these areas. If any of these are not functioning properly we can lose our balance, simply when walking or trying to stand up. Balance is necessary to maintain an independent and autonomous life.
We know the risk of falling increases as we age and that these falls can sometimes have devastating consequences. Studies show that one in three people over 65 (and not living in a nursing home) experience a fall at least once a year and 10-15% of these result in a serious injury like a fracture. Not only does a fall often immobilize someone for a period of time but it can also significantly affect their confidence.
And it’s not only as we age. Lack of exercise, alcohol, neuropathy (nerve damage) in the legs, obesity, even wearing the wrong glasses can interfere with balance.
So how do we improve our balance. Can we improve our balance and by how much? Balance can be measured which means improvements can be easily seen. Tests are based around an individual’s current fitness and mobility levels. Baseline information is taken and an exercise programme is given for a period of time before retesting.
Exercise provides many advantages in improving balance and quality of life. Researchers say that while strength and cardiovascular training are important and should be done several times a week, exercises designed to improve your balance are even more critical and should be practiced every day.
Here are some simple balance exercises to try out at home.
- Sit to Stand – Sitting upright in a chair with your knees bent to about 90 degrees and your feet under your knees. Put your arms out in front and stand up using your leg muscles. Return slowly to sitting. How many of these can you comfortably do?
- Single leg stance – Start by standing with your feel hip width apart. Transfer your weight to one leg and lift the other leg in front of you a little. Try to hold that position. How long can you hold on each leg.
- Heel to Toe walking – think of walking on a tightrope. Put your arms out to the side and place one foot directly in front of the other. Walk forwards repeating this with each leg. One heel goes directly in front of the other foot. Try to look ahead and not down.
- Lunges – This is a little more advanced and therefore will need more consideration and ability. Start in the standing position with your hands on your hips. Place one leg forward and bend both knees so the back knee is moving towards the ground. Try to bend the front knee so the thigh gets to a horizontal position if you can. From there, push up and back to the standing position. Repeat to the opposite side. Is this exercise easier on one side?
It’s important to maintain a good centre of gravity when doing these exercises. Imagine someone walking up a hill. Often they lean into the hill when in fact they should lean away from the hill and more over their feet. The same is true for all exercises. Be aware of your body position relative to your feet.
When thinking about your centre of gravity its always easier if you understand your personal biomechanics. Injuries and habits overtime often cause us to develop movement patterns that aren’t the best for us. The last exercise, the lunge, can often display this. A detailed assessment by an appropriately trained health professional can give you information that will help to tailor your exercises even more specifically.
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Ever heard of sleep hygiene?
Sleep hygiene is the term used to describe good sleeping habits. But first lets talk about why it is important to sleep in the first place.
In regard to rehabilitation, sleeping can be seen as part of our recovery process. When we sleep we release something called human growth hormones or also known as HGH. HGH is a complex protein produced by our brain and it is the driving force of a child’s maturation and part of the repair and restoration process of our body.
During deep sleep or also known as REM sleep, we secrete HGH throughout our body to allow us to grow and repair. By having inadequate sleep you can halt this process. Hence part of the rehabilitation after an injury is to have adequate sleep.
Having a lack of good sleep can also halt your performance, even if you train hard in the day and eat all the right foods, by having insufficient sleep it can really hinder your athletic abilities. According to a research conducted on elite athletes, by having a sufficient nights rest you can:
- Improve reaction time
- Reduce injury rates
- Better accuracy and sprint times
Besides from the sporting advantages of sleep, having a good night’s rest can also boost your health by:
- Keeping you slimmer
- Studies time and time again have shown a direct relationship between lack of sleep and obesity. It’s been shown that people who get less than 7 hours of sleep a day tend to gain more weight and have a higher risk of obesity compared to those who get more than 7 hours. Its been proposed that sleep deprived people have altered levels of leptin and ghrelin hormone, hormones that are responsible for regulating our hunger.
- Boosting your mental well being and immunity
- Chronic sleep deprivation have been linked to mood disorders such as anxiety and depression.
- Preventing diabetes
- Studies have shown that people who sleep for less than 5 hours a night have a significantly higher chance of developing type 2 diabetes.
- Increase fertility
- Lack of sleep can disrupt our body’s secretion of reproductive hormones leading to an increase likelihood of infertility.
- Prevent heart diseases
- Chronic sleep deprivation has been closely linked with an increase risk of cardiovascular impairments, causing increases in blood pressure and certain levels of chemicals linked with inflammation, putting more strain on the heart.
However not all is lost, we can easily reverse this by catching up on sleep or repaying your sleep debt. This won’t happen with a single early night, if you have had months of restricted sleep it’ll take weeks to recover. Start by adding a few hours of sleep a night can slowly pay of, for those who have been sleep deprived for months expect to bank up to 10 hours of sleep a night.
To ensure quality sleep we need to make sure our sleep hygiene is squeaky clean. By having good sleep hygiene we can ensure quality sleep to start paying back our sleep debt. Here are some easy tips to ensure good sleep hygiene:
- Have a sleep routine
- One of the best ways to ensure a good nights sleep is to train your body to sleep and wake up at the same time every day, even on the weekends This regular rhythm will calibrate your circadian rhythm, promoting healthy bodily function.
- Get up and try again
- If you have not been able to fall asleep within 20minutes of laying in bed, try and get up and do something calming and boring until you feel sleepy, then return to bed. Try and find a task that is not too stimulating because this can have the opposite effect of making you more alert.
- Caffeine and nicotine are stimulants which helps you stay awake and alert, try and avoid these substances 6 hours prior to heading to bed.
- It is true that alcohol does calm you down and make you sleepy, but it instead it can interrupt y our circadian rhythm by causing you to wake up in the middle of the night. Alcohol has also been shown to disrupt our REM sleep and cause breathing troubles during sleep.
- The bed should only be reserved for sleep and the occasional you know what, this to associate bed with sleep. If you use your bed as a place to watch TV, read a book or work your body will not learn this connection.
- It is best to avoid naps during the day to make sure that you are tired when it is bed time. If you can’t make it through the day without a nap try an make it so that the nap is less than an hour and before 3pm.
- Develop your own ritual to tell your body that it is time to go sleep, this can be as simple as doing a bit of meditation, stretching or having a warm cup of milk.
- Having a warm shower/bath before bed time can raise your body temperature causing you to feel sleepy. Research has shown that sleepiness is associated with a drop in temperature.
- Regular exercise has been shown to promote quality sleep
- A healthy, balanced diet will help you to sleep well, but also the timing of when you eat is important. Some people find it very difficult to sleep on an empty stomach so having a light snack can help, but a heavy meal before bed can interrupt sleep. Milk is often recommended since it contains tryptophan which acts as a natural sleep inducer.
- Make sure that your bed and bedroom are suited for sleep. A cooler room with enough blankets to keep you warm is the best way to get a comfortable sleep. Low levels of light and noise is also crucial. Having an eye mask or ear plugs can.
Lana Johnson is BPS Tensegrity owner and head physiotherapists as well as head Pilates instructor across all three of BPS practices;
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