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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 firstname.lastname@example.org 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!
Feet ... do we ever really stop to think how amazing our feet are! They take us everywhere, carry us around day to day and yet more often than not we take them for granted. It's only when they start to protest and cause us pain that we seek help and advice ... and sometimes not even then!
Did you know there are 26 bones in the foot? That's a lot for the brain to control! The purpose of all these bones is to give us options when walking on a variety of different surfaces, these options allow us to adapt to the surfaces we stand on, that is if the bones, soft tissue structures and brain are all able to adapt. Unfortunately, years of 'abuse' often realists in our feet being less adaptable than we would like, stiffening up, poor arch control, poor tendon strength, bony compression - the lost goes on. Basically ... discomfort, it's our feet finally protesting and letting us know we are not treating them well!
So what does a foot want? What would keep our feet happy?
Generally feet like variety, they don't like to be stuck in the same shoe day in and day out. They like to use their mobility, their variability and their skill set, which means allowing them to walk on a variety of different terrain and in a variety of different footwear! They like to be stretched, strengthened, wobbled and moved in all which ways and at the end of the day they like to be rewarded with a pedicure (oh no wait ... that's just my feet, not a general rule of thumb!)
They like supportive (but not too supportive) footwear. They like the rest of the body to work with them, allowing loads from the ground to be transferred up the kinetic chain. They like to be kept strong yet supple, flexible yet controlled and dynamic yet steady!
SO how does one give one's feet all this? PILATES ... what better form of movement than Pilates to keep your 26 foot bones, and all their soft tissue attachments and neuromuscular connections moving well!
Want to know more ... ask one of our friendly Physiotherapists or Pilates instructor, they are a wealth of knowledge and would love to get you started on the road to you maintaining happy feet today!
INITIAL CONSULTATION (SINGLE AREA) $133.90
INITIAL CONSULTATION SENIOR PHYSIO (SINGLE AREA) $156.90
INITIAL CONSULTATION (MULTIPLE AREAS) $207.10
INITIAL CONSULTATION SENIOR PHYSIO (MULTIPLE AREAS) $235.35
PHYSIOTHERAPY FOLLOW UP (60 MINS) $133.90
PHYSIOTHERAPY FOLLOW UP SENIOR PHYSIO (60 MINS) $156.90
PHYSIOTHERAPY FOLLOW UP (45 MINS) $103.50
PHYSIOTHERAPY FOLLOW UP SENIOR PHYSIO (45 MINS) $121.30
PHYSIOTHERAPY FOLLOW UP (30 MINS) $73.22
PHYSIOTHERAPY FOLLOW UP SENIOR PHYSIO (30 MINS) $85.70
INITIAL APPOINTMENT $125.50
PILATES PRIVATE $125.50
PILATES SEMI PRIVATE (2PPL) $65.90
PILATES SEMI PRIVATE (BLOCK OF 5) $319.03
PILATES SEMI PRIVATE (BLOCK OF 10) $593.10
PILATES STUDIO (3PPL) $49.15
PILATES STUDIO (BLOCK OF 10) $442.45
60 MINUTES $125.50
45 MINUTES $94.15
30 MINUTES $62.75
PILATES CLASS $26.15
PILATES CLASS (BLOCK OF 5) $120.30
PILATES CLASS (BLOCK OF 10) $209.20
PILATES CLASS (BLOCK OF 20) $376.50
PILATES CLASS (BLOCK OF 50) $784.50
PILATES MONTHLY UNLIMITED $199.00
At BPS we know that when you bring a friend to class it's not only your friend that benefits, you do to!
Research shows that training with friends is not only more fun, but it also;
- increases your serotonin levels when compared with those who are training alone
- makes you more committed and therefore more likely to reach your goals
- improves your capacity for learning and retaining new information (which when it comes to Pilates is super helpful!)
So - to help you stay committed and reach your goals, every time you bring a new friend to class BPS will give you YOUR class on us.
Take control of your class and appointment bookings at BPS by using the MindBody App
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.