Gentleman, this is an article for you. Who loves to stride up the thousand steps? Lift in the gym or get stuck into manual labour at home? Who pauses to think about protecting their lower back or if their legs are up to the task? And who stops to think about their pelvic floor? Whoa!! Yes, this article is going to shine a little light on the nether regions!
Research into male pelvic health has about 20 years to catch up to that of females. And while a female pelvis garners much attention what do we know about the male? Pelvic floor muscles are vital to maintain support and control of bladder and bowel and play a huge role in sexual function.
We know that prostatic enlargement can cause bladder dysfunctions such as frequency, urgency, slow or interrupted urine flow and even bladder obstruction. Surgery for prostate cancer inevitably results in urinary incontinence and many men struggle to get out of bed without leaking let alone see themselves mowing the lawn or playing a round of golf.
To make things more devastating neural trauma after prostate surgery leads to Erectile Dysfunction (ED) with nerve regeneration painfully slow, if at all. And ED is not just reserved for the post prostatectomy patient as up to 40% of over 40year-olds have some dysfunction which escalates to around 70% of 70year-olds.
We also know that Chronic Pelvic Pain syndrome, or Chronic Prostatitis, is the most common urological diagnosis in men under 40 years. That it may affect 2-14% of the population and that tight or overactive pelvic floor muscles are often a contributor to symptoms.
Enough of the bleak picture. What can be done to assist men with leakage, pelvic pain or ED?
There is strong evidence that specific pelvic floor muscle training with a Physiotherapist before and after prostate surgery can significantly reduce the severity and duration of incontinence. A study in the UK found that pelvic exercises helped 70% of men with ED regain normal or significantly improved erectile function. And that bladder training together with pelvic floor down-training or ‘reverse kegels’ can help manage painful symptoms of bladder pain syndrome and prostatitis.
Let’s get the conversation started regarding Men’s Health issues and increase awareness that help is available.
Please register your interest in an upcoming informal discussion on Men’s Pelvic Health on Wednesday 20th November at Form & Practice stir Olinda, or book into see Jen Vardy at Olinda or Mount Evelyn on 9751 0400.
Gold coin donation only, for Movember – raising awareness and funds for prostate cancer, testicular cancer, men’s mental health and suicide prevention.
Clinical Strengthening at Olinda and Clinical Exercise (Pilates) & GlA:D at Mount Evelyn
Some new offerings at Olinda studio:
Clinical Strength classes: Monday and Wednesday 7pm, Friday 5.15pm
Youth Clinical Strength & Conditioning: Monday, Wednesday and Friday 4.30pm
For September 2019 only, we are offering FREE Initial Clinical Strength Assessment (normally $115) before going into classes.
FutsalOz Mount Evelyn upstairs:
Clinical Exercise (Pilates): Tuesday and Friday 9.15am
GLA:D for Knee and Hip arthritis: Tuesday and Friday 10.15am
Check our services pages for descriptions.
All of these are run by physiotherapists, are eligible for group physiotherapy rebates on private health insurance and require an Initial Assessment.
Youth Strength training
There is clear evidence that strength or resistance training can be a worthwhile and beneficial activity for children and adolescents, with some of the many documented positive outcomes including improved strength, power and speed; stronger bones; reduction in injury rates & increased sports performance.
And whilst a growing number of youths are participating in resistance training programmes in schools, gyms and sports training facilities, most parents still wonder at what age should children start resistance training, and what precautions should be taken so that training is safe for their growing bodies?
A common misconception about strength training in children is that exposure to loads greater than their own bodyweight can cause damage to their bones and muscles, however there is no evidence to support this.
The risk of injury resulting from resistance training, weightlifting and plyometrics is not any greater than other sports and activities in which children and adolescents are regularly involved in.
The risk of harm to a child undertaking resistance training is actually more related to the level and quality of supervision, or the lack of, rather than the resistance training per se. Inadequate professional supervision leads to poor exercise technique and inappropriate management of training loads.
Resistance training can start at as little as 6 years of age, provided the child can follow clear instructions and appreciate the dangers present with training. This is something as physiotherapists we often do without the child or parent even knowing – adding in bodyweight and resistance band exercises at home to rehabilitate injuries for instance.
Before beginning resistance exercises, specific criteria to measure strength with bodyweight tasks should be met. These vary depending on age and sex, and these criteria should be strictly adhered to by an adequately qualified supervising professional. The professional should meet youth training guidelines imposed by strength and conditioning governing bodies in Australia such as ASCA (Australian Strength & Conditioning Association) and have a strong knowledge of developmental anatomy & physiology and injury rehabilitation.
The dosage and resistance level of exercises should depend on the age and skill level of each child, and should be highly individualised to the inherent biomechanical attributes and goals of each child. This means that programs should be tailored to reduce risk of injury depending on each child’s musculoskeletal attributes, & also to their sport-specific, activity-related or general goals in wanting to begin resistance training.
Strength & conditioning programmes designed and supervised by qualified professionals who have an understanding of youth resistance training guidelines as well as the physical and psychosocial uniqueness of children and adolescents appear to be an effective strategy for reducing sports-related injuries in young athletes, & can contribute to developing healthy lifestyle choices in young people.
To kickstart your child’s resistance or sports performance program, enquire about D.R.Physio’s new Youth Strength & Conditioning Classes in Olinda with ASCA trained physiotherapists starting September 16 2019.
The World Health Organisation (WHO) recommends for all adults over 18 who are able to, should perform:
- 150 minutes of moderate intensity exercise or 75 minutes of vigorous exercise per week, or a combination of.
- Muscle-strengthening (resistance training) involving major muscle groups on 2 or more days a week.
For additional benefit, the WHO recommends that people should consider increasing the level of moderate exercise to 300 minutes and/or vigorous exercise to 150 minutes per week.
Bouts of aerobic exercise should be in at least 10 minute blocks.
The benefits of resistance training cannot be underestimated either, with a recent study stating that performing 3 sessions of aerobic exercise and 2 sessions of resistance training per week provides more cardiovascular benefit that performing 5 sessions of aerobic exercise per week*.
The above holds for both adults 18-64 and for those aged 65 and over, with the benefits to those aged over 65 including:
- lower rates of all-cause mortality, coronary heart disease, high blood pressure, stroke, type 2 diabetes, metabolic syndrome, colon and breast cancer,and depression;
- are likely to have less risk of a hip or vertebral fracture;
- exhibit a higher level of cardiorespiratory and muscular fitness; and
- are more likely to achieve weight maintenance, have a healthier body mass and composition.
Adults who currently do not meet the recommendations for physical activity should aim to increase duration, frequency and finally intensity as a target to achieving them. The assistance of a qualified health professional such as a physiotherapist can be vital for this group of people in achieving good outcomes.
The American College of Sports Medicine go further to recommend neuromotor exercises two or three days a week, & suggests participating in activities like yoga and Pilates. Functional resistance movements involving a significant degree of balance and multiple muscle groups might also help fulfill the recommendations for neuromotor exercise. Our very own GLA:D exercise classes fit the bill for combining strength, balance and neuromotor exercises for people with knee and hip Osteoarthritis.
Children 5-17 years should participate in 60 minutes of moderate to vigorous intensity daily physical activity.
Amounts of physical activity greater than 60 minutes provide additional health benefits. Most of the daily physical activity should be aerobic. Vigorous-intensity activities should be incorporated, including those that strengthen muscle and bone such as running, jumping or weightbearing sports, at least 3 times per week.
Appropriate practice of physical activity assists young people to:
- develop healthy musculoskeletal tissues (i.e. bones, muscles and joints);
- develop a healthy cardiovascular system (i.e. heart and lungs);
- develop neuromuscular awareness (i.e. coordination and movement control);
- maintain a healthy body weight.
Children Physical Activity: https://www.who.int/ncds/prevention/physical-activity/factsheet_young_people/en/
Adults 18-64 Guidelines for Exercise: https://www.who.int/dietphysicalactivity/factsheet_adults/en/
Adults >64 Guidelines for Exercise: https://www.who.int/dietphysicalactivity/physical-activity-recommendations-18-64years.pdf
You just got up, the room is spinning, you feel like throwing up, you are more dizzy than you have ever been and the day hasn’t even started.
Benign Paroxysmal Peripheral Vertigo, or BPPV, is a common reason for intense and debilitating dizziness. It is characterised by a feeling of the room spinning or “vertigo”, symptoms worsening on head movement but lasting for less than 1-2 minutes each time and a sudden onset. BPPV can be commonly confused for other inner ear pathologies like vestibular neuritis (an infection of the fluid in the ear) or much more serious conditions like a stroke. However, when diagnosed correctly, BPPV can be managed effectively by a physiotherapist.
Our inner ear system has an important role in regulating our balance and sense of position in space. Each ear has a set of 3 semicircular canals which contain floating crystal-like calcium carbonate material, known as otoconia. These otoconia, or crystals, move within the ear with respect to gravity inside the semicircular canals. This movement of the floating crystals happens each time we move our heads to give us a sense of movement, the right ear working in tandem with the left ear.
However, when the crystals float out of the correct canal into a different one it does not belong in, the wrong messages regarding our sense of movement are sent to the brain. This results in BPPV and the feeling of severe vertigo.
Physiotherapists use the Hallpike assessment as the gold standard test to determine if the patient truly has BPPV. If this is confirmed, the Epley manoeuvre is performed on the patient where it uses gravity to tip the crystals back into the correct canal. The Epley manoeuvre often results in an almost immediate improvement but usually the procedure will need to be performed regularly but the person themselves at home, or with a physio, over a 3-4 day period until symptoms fully settle, depending on the patient.
BPPV is highly treatable but it is very important to have an assessment with a Physiotherapist or Doctor to ensure that the dizziness you are experiencing is not another more serious condition requiring different medical intervention.
Jen Vardy, Pelvic Health Physiotherapist @ Drphysio Olinda & Mt Evelyn
Having a baby is a time of incredible joy and exhilaration and a time to adjust to motherhood, sleep deprivation and the amazing changes a woman’s body has undertaken in growing, carrying and birthing a little one. New mums are usually keen to return to exercise and all the activities they loved doing before baby but are often unsure how to safely begin.
Runners are often a different story. They are usually itching to get back on the trails for both the exhilaration of the run and the mental break from newborn life. However, they may not be aware of the impact of running on their recovering bodies both in the now and also in the future. Fortunately, to help support postnatal women to return to running safely there are new guidelines based on the best available current evidence (1). The guidelines have been produced by three passionate UK based Physiotherapists who have sought extensive collaboration from leading international Health Professionals. They recommend that there is no one size fits all approach and that most women should wait until at least 12 weeks postnatally before a graduated return to the pavement.
Some women will cringe at waiting this long but consideration must be given to the high impact loads of running and the physical, psychological and hormonal factors of postnatal recovery.
Running produces a sudden rise in intra-abdominal pressure and acknowledged increased ground reaction forces of around 1.5-2.5 times bodyweight. Postnatal women have weakened lower limb muscles following pregnancy and childbirth and poor ability to absorb such dramatic elevations in pressure. Abdominal and pelvic floor muscles are also recovering post both birth and if such forces are transferred to these vulnerable muscles they will struggle to maintain continence and organ support. No new mum wants to encounter bladder or bowel leakage or an onset of prolapse symptoms.
The stakes are high for a mum wanting to return to running. Throw in sleep deprivation as the new norm which causes a reduction in muscle protein synthesis. And breastfeeding and its increased energy requirements, and no wonder the guidelines recommend every mother should access a pelvic health and physical assessment with a specialist Physiotherapist.
Until Medicare funds such a postnatal screening assessment for every new mum this may not always be achievable. Best practice should at the very least include starting an appropriate exercise program early which includes specific pelvic floor and abdominal muscle training and education to ready the running mum for herappropriate time to return to running.
- Goom, T., Donnelly, G., & Brockwell, E. (2019). Returning to running postnatal – guideline for medical, health and fitness professionals managing this population.