Should we stretch?

As a child of the 1980’s, my recollection of P.E. classes at school seem to be dominated by endless ballistic stretches with kids bobbing up and down touching their toes in time with ‘Let’s Get Physical’ (or maybe it was ‘Xanadu’), doing star-jumps and burpees & stretching quickly and rapidly. Contrastingly, when we played sport in those days I can’t remember once being told to stretch, warm up or warm down before or after training or games!

In the 1990’s whilst studying physiotherapy, the tables were turned – we were taught that long, sustained stretching pre-sport was of limitless benefit, and told to avoid ballistic or quickfire stretching. And then over the last decade, ballistic stretching, burpees and even touching your toes has made a comeback, and a lot of people argue that sustained stretching is useless! So, should we stretch or not, and if so, how should we be stretching?

Let’s take a step back firstly.

Break down the aim of stretching into two groups – 1) warming up for activity, and 2) loosening tight muscular structures (muscles, tendons and the structures they join onto):

  1. The kids and P.E. teachers of the 80’s can pat themselves on the back for the former, as ballistic or fast, jerky stretching, is actually quite helpful as a warm up for specific activity. For example, if you are playing a kicking sport, then rapidly kicking your leg 10-20 times as a warm up is probably a much better way of stretching the specific kicking muscles than doing a sustained hamstring stretch. The same goes for trunk twisting actions pre-golf, and upper limb movements pre-throwing.

 

  1. And the latter type also has benefits, with the premise being that loosened muscles perform better and are less prone to injury. Also, looser muscles provide less tension on their adjoining joints and tendons, so that should lead to less stress and reduced injury risk on those structures too. Most physios and sport science professionals would agree on this basic premise, but to clarify further, this will really only be helpful when you have tight muscle groups in isolation; e.g. tight quadriceps (front of thighs), hamstrings (back of thighs), calves and pectorals (front of chest).

The evidence points to both types of stretching being useful for their purposes, however both types are much more effective after a 5-10 minute warm up (just enough to get a light sweat or increased breathing rate).

But what if these tight muscle structures don’t exist in isolation, as with most people? For example, tight calves or hamstrings are rarely tight for no reason – they are usually combined with tight ‘neural’ structures (for simplicity think nerves and their attachments that run from your lower back and meander through muscle and other tissue down your legs), weak opposing muscles (quadriceps), poorly operating core muscles and even pronating or rolling-in feet.

In this instances when there are other factors involved or chronic ongoing tightness, it is likely that there is a systemic cause of the muscle tightness, and whilst stretching may be helpful to relieve some of the symptoms, it is unlikely to be beneficial in preventing risk of injury.  A physio assessment should provide some answers to the cause, and a course of treatment may involve hands-on therapy (myotherapy/remedial massage, mobilisation, dry needling), strengthening exercises, orthotics and yes, even stretching!

 

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Sarcopaenia

One of the best ways to keep healthy as we age, and to live longer, is to maintain our muscle mass. I’m sure everyone over 60 can attest to the loss of strength as they age, but did you know that age-related muscle loss begins in our mid to late 30’s? It varies from person to person, and due to a few other factors which I’ll get into in a minute, but you can almost guarantee that once you hit your 40’s, your muscle mass will continue to diminish by about 5% each decade until …bang! It starts accelerating at some point after 60, and for some people right on 60.

This naturally occurring phenomenon is called Sarcopaenia.  It’s a bit like Osteopaenia’s little brother in terms of public perception. But in fact this muscle loss contributes to a far greater public health outcome than Osteopaenia (the forerunner to osteoporosis). This is because maintaining muscle mass benefits not only your feeling of strength and being physically able, but also improves metabolism to reduce the risk of Type II Diabetes and cardiovascular disease. It also helps to prevent falls and physical injuries as we age, which can often act as a catalyst to further reduced mobility and psychological well-being in the elderly.  

So how can you resist this natural force helping to push you into the dust sooner than expected? Strangely enough, by doing exactly what our old friend Barnaby Joyce said when a sugar tax was recently mooted – get out and exercise more, and eat well (actually he said stop eating so much if you are fat but that’s possibly another article in itself). But the magic tip is to start this ‘exercising and eating well’ fad early enough in life as to halt the acceleration of Sarcopaenia. Yes it’s never too late, but if you can up your exercise level in your mid to late 30’s, at an age when most of us have stopped playing sport and begin to feel like there are not enough hours in the day to exercise, then you will give yourself the best chance at being healthy and more physically able later in life.

And back to my physio hat – if you are beginning an exercise program from scratch, don’t let injuries and soreness slow you down. Get some professional advice and core strengthening exercises from a professional to help you on your way.

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Fear Avoidance Behaviour

Fear-avoidance behaviour is a theory that evolved in the 1980’s that continues to both gain momentum and create debate about the nature of musculoskeletal pain.

We all experience acute pain at some stage or other. Yet whilst most will recover from a painful episode once the initial symptoms settle, some will spiral into a chronic pain pattern that negatively influences not just their physical health but also eventually their emotional, psychological and even their economic well being.

The fear-avoidance behaviour model states it is overly fearful people who go on to develop chronic pain. It is thought that these fears arise from an initial injury or painful episode involving actual soft tissue damage, yet once the injury has healed the person continue to associate those movements with the pain. This can lead to disengagement with a range of meaningful activities from sport, hobbies, social contact and work, leading to disability and depression. And more pain. A vicious cycle indeed.

Opponents of the model have long decried it’s simplicity, yet new evidence appears to be emerging that places this model in a more modern setting. Professor Lorimer Mosely from The University of South Australia is leading the charge. Most notably he hypothesised recently that those who perceive expected musculoskeletal pain to be uncontrollable are most likely to develop chronic pain, such as people with fibromylagia. And those who perceive it to be controllable yet still avoid the behaviour are likely to develop avoidance behaviours that are specific to that particular task or movement only.

This provides some interesting cues to practitioners on how to both identify at risk people at an early stage of injury and treat those who are suffering from chronic pain. It underlines the need for early intervention for spinal pain and injuries from science based practitioners, and the restoration and reinforcement of normal movement patterns to avoid the chronic pain spiral. And for those already suffering from chronic pain, reducing painful stimulus with hands-on therapy is very important. Yet it must be interlinked with exercise that reinforces normal movement patterns and the awareness of normal movement. Physiotherapists are well placed to deal with these issues, and many utilise Clinical Pilates for this very reason. There are many ways  for people to engage in restorative movement and they should seek their health practitioners advice on how to go about this rather than put up with chronic musculoskeletal pain.

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Headache relief

Headache is one of the most common illnesses in Australia, with around 15 per cent of us taking painkillers for a headache at any given time. Because headaches are so common, most people think they are a normal part of life. However, a persistent headache is a sign that something is wrong.  The continual use of pain medication to combat headaches is akin to removing the warning light that alerts you to a problem in your car!  Medication doesn’t solve your headache, it simply offers a short term solution to dull the pain.

Tension headaches and migraine are the most common forms of headache and cluster headaches are most rare.  Other types of headache include sinus headache, rebound headache and exertion headache.
Headaches can result due to a variety of reasons including stress, poor posture, accidents, medications, environmental factors such as strong odours & pollution and dietary irregularities.

Perhaps one of the most overlooked cause of migraine and tension headache is due to nerve irritation in the upper neck caused by poorly functioning spinal joints – cervicogenic headaches.  Since the nerves of the upper neck supply areas of the scalp and face, irritation to these nerves can and often lead to headache.

Cervicogenic headaches can easily be distinguished from other types of headache by a physiotherapist, and treatment to relief symptoms is usually fast extremely effective and fast.

By carefully restoring proper movement to the spinal joints of the neck, your physiotherapist is able to significantly reduce the presence of nerve irritation and muscle tension helping to alleviate the cause of your headaches. Commonly people with Cervicogenic headache often have weakened postural muscles through their upper back and shoulder blade region, which is akin to weakened ‘core’ muscles in the lower abdomen in people with low back pain. Additionally many headache sufferers will have increased tension through jaw and temporal muscles of the skull, which are easily assessed and treated.

Your physio can then teach you exercises to improve the endurance and strength of your postural muscles, or stretches to relieve tight muscles, which will help to prevent headaches in the future. Sometimes this preventative stage can take much longer than the relief treatment itself, as your body needs to relearn good postures and you in turn become more aware of how you are moving, sitting or standing.

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To Sit or To Stand?

There is a new phenomena hitting physio practices across the country, and you might be part of it. It’s called the ‘Since I’ve been using a standing desk at work my <insert lower body part here> hurts’  phenomenon! OK maybe that’s an exaggeration, but just like Nintendo thumb from years ago, and iPad neck from not long ago, we are seeing a burst of standing related musculoskeletal and circulatory disorders related to prolonged standing in previously sitting workers.

The research on using standing desks, rather than sitting all day, is mostly very positive. There are obvious benefits to improved metabolic rate, leading to reduced weight gain compared with sitting, less pressure on the lower back and a whole range of loosely associated wellbeing improvements from mood to cholesterol.

However, anecdotally we have seen a rise in overuse type conditions of the hip, knee and ankle and exacerbations of circulatory issues such as varicose veins from this current office trend. When we walk for instance, our feet and lower limb movements have evolved to transfer weight economically across a range of joints, and the increased muscle use helps pump fluid throughout the body and back to the heart, thereby improving metabolic flow. When we stand for prolonged periods, there is an increase in metabolic rate compared to sitting, but the musculoskeletal and circulatory benefits are vastly reduced if a worker stands with uneven weightbearing (yes you, leaning on one leg!), stands with poor footwear or for long periods on hard surfaces, or stands for prolonged periods without movement.

So if you are experiencing discomfort with your standing desk, don’t give up. Instead, try alternating postures every thirty minutes between sitting and standing, or even better, walking. Do focus on improving your core and postural strength – tell yourself to stand as tall as possible, activate your deep core muscles and position both feet firmly on the ground. Do wear supportive shoes and do stand on an anti-fatigue surface rather than a hard floor. And do seek treatment on stiff or sore hips and knees before they cause you to go back to sitting for good. Oh, and stop leaning on one leg when you stand!

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Winter flaring up old aches & pains?

Have you ever felt your knee ache on a colder than usual evening, or an old ankle injury stir up when a storm rolls in? Remember your granny complaining about her rheumatoid playing up in her hands in winter? Turns out, she wasn’t lying and you aren’t imagining things. Humans really can sense some changes in temperature and atmospheric pressure in our joints, especially in an injured or arthritic joint. And there is also evidence that migraine headaches are more frequent on rainy and overcast days.

 

However it is likely not as simple as the cold weather producing pain. It was thought in recent years that barometric pressure drops, as in when a cold front rolls in, causes changes in fluid levels in joints, particularly in inflamed or arthritic joints. But if this were the case, we would feel joint pain every time we drive up Mount Dandenong. More likely, it is that nerve endings which have previously carried pain signals, i.e. from an old injury or a joint that flares up occasionally, ‘misbehave’ when the body’s temperature starts to drop slightly. The theory is that the blood vessels around these peripheral nerves constrict in order to preserve blood flow to vital organs, just in case the body temperature keeps dropping. The constriction of these blood vessels around the nerves amplifies any signal in those nerves, including pain memories that are somehow either stored within the nerves themselves or, more likely, at the neuroreceptors within the spinal cord or brain where the nerves interact. Pretty weird stuff. And, obviously hard to quantify. Hence why it is still a theory.

And also, colder weather usually means less activity and less daylight hours for activity.

Regardless of the cause, luckily for us there are known treatments to counteract the cold. And guess what – they mostly involve getting or staying active! If you ‘feel’ the cold, then your body is telling you to start moving and get active. If your muscles and joints are too tight and sore to exercise outside, then exercise indoors and try non-weightbearing exercise like pool exercise, exercise bikes or gym classes. And yes those stretchy compression supports really do help achey joints and muscles, as does direct heat therapy from heat packs and hot water bottles. So rug up, stop complaining and start moving!

 

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Dodgy knees, what’s the best treatment?

Dodgy knees, degeneration knees, gammy knees – we all get them, it’s just a matter of when and how bad. Knee degeneration usually involves the wearing out of the meniscus (the cartilaginous padding between the bones) and the articular cartilage (the harder, thinner cartilage that lines the bones which form the joint). When these structures deteriorate, quite often a chain reaction occurs: the joint space decreases, there is a decrease in normal levels of joint fluid which help to lubricate the joint, bony joint surfaces can rub together causing uneven wearing and inflammation, and finally pain and restriction of movement result.  

This is typical of how a degenerative knee presents in a clinical setting.  A healthy individual shows some levels of degenerative knee disease on radiograph between the ages of 40 to 50. However, early degeneration is not uncommon in the 20 to 40 age group, particularly in a sporting population. Another big factor that we see, and which is often overlooked, is the effect of biomechanics of the knee joint during gait and running. People with overpronating feet, or with hips which turn in due to weak hip and core muscles, commonly put increased stress through their knee joint with every step they take. This effect worsens when the loads are increased during running, squatting, lunging, stairs, hills and with carrying excess weight.  And worsens further with poor footwear or a job that requires prolonged weightbearing.

So what can be done? Up until the last few years, arthroscopic surgery was the main treatment option for those with pain and restriction. This involves a surgical procedure to trim frayed or torn parts of the cartilage, remove bony spurs and add fluid back into the joint. Yet in 2013, Finnish researchers found that arthroscopic surgery was no better than sham surgery, whereby just fluid was injected into the knee, plus physiotherapy. Also in 2013, a major US study published in the New England Journal of Medicine found that in general there was no benefit to arthroscopic surgery compared with physiotherapy in treating meniscal tears or degenerative knees. Added to that the risks of any surgery or risks of wound infection, then the choice becomes much plainer.

It begs the question as to why health funds continue to pay rebates of thousands of dollars to surgeons for these procedures yet cap physiotherapy treatment at far lower values, when the evidence for either is the same with far lower risk factors associated with physiotherapy treatment. The strength of the AMA in lobbying health funds and Medicare cannot be underestimated.

Physiotherapy treatment for degenerative knees involves strengthening the muscles that support the knee, and addressing biomechanical factors such as feet, weak hip and core muscles and tight muscles in the lower body.

So if your GP or surgeon suggests an arthroscope for degenerative knee pain or meniscal injury, do yourself a favour and suggest you’d like to try the conservative option first.

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Which is healthier: Cardiovascular exercise or Strength training?

So you’ve decided to start an exercise program, and your overall aim is to improve your health, though you would also like to lose a few kilos. You could start running, cycling, swimming, join a gym, do some Pilates, yoga, hire a personal trainer ….. the list is endless! So what is the best form of exercise for overall health?

Let’s loosely define the forms of exercise first:

Cardiovascular (CV) exercise as anything that keeps our pulse rate elevated for a prolonged period of time – think walking, running, cycling or swimming for starters. Traditionally these are thought to be better methods of exercise for fat burning and to improve cardiovascular health, reducing risk of heart and cardiovascular disease, Type II diabetes and so on.

Strength training is basically anything that involves repetitive actions involving some form of resistance, with the resistance commonly being weights (machine or free), body weight, springs or resistance bands.

In the past, strength training was purely for people wanting to build muscle strength, bulk or endurance. And cardiovascular exercise was also thought to be a better way to burn fat and improve cardiovascular and general health.

Now let’s update the assumptions with some more recent facts.

Strength training will help to improve bone density and strength, and can also improve joint stability, balance and strength. CV exercise can help to only maintain bone density if it is done in weightbearing (walking, running). So strength training is essential for those who want to improve their bone or joint strength.

Strength training has a greater impact on weight loss over time due to increase in muscle. Muscles require more energy to maintain than fat, and, very simply, increasing your muscle mass will increase the rate at which you burn calories even at rest. This effect is at its greatest within thirty six hours post a strengthening workout, but can be largely maintained with strength training three to four times weekly.

Both forms of exercise can help with mood, reducing stress and the risk or the effects of depression. And both forms of exercise can help with improving memory and thinking, and carry the same risk of injury.

So if we combine traditional thinking with more recent knowledge, then an exercise program for any age group should combine both CV exercise and strength training. If your goal is purely for cardiovascular benefits to reduce cholesterol and blood pressure, and to help reduce stress, the traditional CV exercise is best for you. But if you want to have the additional benefits of increased weight loss and stronger bones and joints, then you should focus more on strength training with some CV exercise added in. Gym classes and boot camp type activities can be perfect for this as they combine both forms of exercise.

And always remember – more pain is not always more gain. Give your body a day off to rest and recover when beginning a new form of exercise, and seek physiotherapy or medical attention if your soreness or injury persists.

 

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How that little back pain can turn into a big problem & what you can do about it!

Did you know that 80% of people will suffer back pain at some stage in their life, 65% of people will have time off work due to lower back pain and 10% of people will suffer an ongoing disability due to back pain?

And that the risks of developing chronic long term injury or experiencing a severe episode increases substantially with each episode you experience?

However, the good news is that about two thirds of all back pain episodes are either preventable or treatable with exercise and physiotherapy.

The most preventable back pain episodes are those that are due to sedentary postures and lifestyles. Upon awakening one may sit to have coffee or breakfast before sitting to drive to work. When arriving at work the corporate employee will often sit at a desk or in meetings until lunch. Lunch involves more sitting, before sitting at the desk to finish the workday. Then of course there is the commute home and another sit-down meal.

From an anatomical viewpoint, the weightbearing structures such as discs and vertebral joints in your lower back take almost twice as much weight in sitting compared with standing, and even more if you slightly hunch, bend forward or sit with your legs inclined due this pulling your pelvis into a backward tilt.

In addition, the hamstring (back of thigh) and illiopsoas (hip flexor) muscles are shortened from the many hours of sitting, and, more importantly this causes further strain on the lower back and reduces the ability of the core muscles to work properly.  

With each episode of back pain, the tighter structures get tighter and the weaker structures (i.e. the core muscles) get weaker. Generally speaking, the core muscles will switch off in an acute phase of lower back pain and even after just one episode someone can end up with long lasting core muscle weakness unless they specifically strengthen these muscles again. And of course, the weaker the core muscles, the higher the risk of another bout of lower back pain!

For the sedentary worker specific exercise are key for preventing lower back pain as well as reducing the risk of heart disease and diabetes. Relief from back pain caused by sitting or sedentary lifestyle is as easy as a trip to the physio who will help prescribe stretching and strengthening exercises, and may recommend a few sessions of hands on treatment and/or Clinical Pilates to mobilise and strengthen the spinal structures.

But I’m Active, and My Back Still Hurts

Athletes and those with active jobs on the other hand are not sedentary, so why the lower back pain?

Any weight-bearing sport or exercise that involves running, jumping, or rapid dynamic movements produces tension on the lower back. When these activities are repeated over time without properly stretching and releasing these tight muscles overuse injuries may occur. The same occurs to people whose occupations involve repetitive physical tasks, such as tradespeople, massage therapists and computer workers.  

Stretching and releasing these muscles that are used repetitively with massage, dry needling and other hands on techniques, along with a tailored strengthening or Clinical Pilates program, is the key for this type of worker or athlete with back pain.

Physiotherapists at Dandenong Ranges Physiotherapy are all experienced in treating a wide variety of people lower back pain, from all sorts of musculoskeletal causes.

 

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Myotherapy at Dandenong Ranges Physiotherapy

Myotherapy at DR Physio

We have three experienced myotherapists on our team and between them can offer appointments from Monday through to Saturday including after hours. Myotherapy is ideally suited to chronic muscular aches and pain associated with everyday tasks, though myotherapists are also adept at treating high level athletes with muscular soreness and injury. Appointments are usually one hour in length, with half hour appointments also available. Rebates are available on most private health extras plans.

What is Myotherapy?

Myotherapy is an extension of remedial massage,  and is used to treat or prevent soft tissue pain and restricted joint movement. The philosophy of myotherapy is founded on Western medical principles including anatomy, physiology and biomechanics.

Myotherapists undergo a higher level of training compared with remedial massage therapists, especially with regard to injury and rehabilitation,  and draw on a broader range of tools and techniques. They are therefore more adept at diagnosing and treating a broader range of ailments, and are able to safely prescribe exercises for strengthening, postural improvements and flexibility.

All of our myotherapists utilise techniques such as deep tissue massage, trigger point therapy, stretching, myofascial (soft tissue) dry needling & cupping amongst others.

 

Myotherapy can be used to treat a wide range of disorders including:

  • overuse injury such as tennis elbow, shin splints and tendinitis
  • myofascial pain
  • sports injuries involving muscular strains & tightness
  • tension headache
  • pain caused by poor posture
  • muscular pain associated back and neck ailments
  • joint pain, such as shoulder impingement syndrome and rotator cuff tendinopathy

Symptoms of soft tissue pain

Pain that is caused by muscle tissue or muscle fascia (myofascia) is called myofascial pain. Symptoms can include:

  • deep and constant aching
  • muscle tightness
  • sore spots in the muscle (myofascial trigger points)
  • reduced joint mobility
  • stiff joints
  • numbness
  • recurrent tingling, prickling or ‘pins and needles’ sensation
  • unexplained tiredness.

Benefits of Myotherapy

  • Drug free non invasive natural pain relief.
  • Enhances the function of muscles and joints, improving range of movement and general body tone.
  • Reduces pain, swelling and stiffness.
  • Minimises the need for muscle relaxants and/or pain killers.
  • Myotherapy may also produce a dramatic increase in mobility, flexibility and stamina.

If you think you would benefit from myotherapy please give us a call to book in your appointment 9751 0400.

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