Spinal pain treatment – move more often

 

Back and neck pain treatment

NU Moves Physio leads the way in evidence based treatment. We are constantly looking to the latest evidence to help our clients move better and feel well. Being located at The University of Newcastle means a lot of our clients are academics, students and staff. A few areas we commonly treat are back and neck pain, which many people attribute to postural or sitting loads at work or while studying.

The scientific understanding of this problem has definitely evolved over the last few decades and has now changed significantly from the old adage of ‘sit up straight and don’t slouch’ to the ‘move more often’ advice. Move more means varying your postures and positions rather than having to sit up straight all the time. It might be that you need slouch a little if you have been upright for a while or sit back in your chair and use your backrest to sit up tall if you have been slouching. Stand desks are great to get you out of your chair but not for standing all day. A mixture of sitting and standing changes your posture which is best.

This is notably advice based on research for lower back pain. A common mistake leading to neck pain is reaching too far whilst at a computer.  Neck pain is often also related to the stress and tension that we carry in our shoulders. Again the best advice is often to get up and move more – go for a walk or do some exercise for 30 mins aiming for a daily basis. If you are too busy to walk that is often the problem that needs to be managed.

Professor Peter O’Sullivan leads the way in back pain research and advises ‘your best posture is your next posture’. Simple spinal pain treatment – move more often!

If you have neck pain or back pain at work or study, get moving and if pain holds you back then contact us on 0249216879 or admin@numovesphysiotherapy.com.au

Stress Fractures In Football

Football Physio Newcastle

Stress Fractures In Football

As we move towards selection for next year’s club football sides there is a tendency for players to push harder to prove themselves. More training, higher intensity, less rest / recovery time plus there can be school soccer games added in there, not to mention lunchtime playground fun. One consequence of an imbalance in load versus rest time is stress fractures. The earlier the problem is diagnosed the better the outcome and given that stress fractures can unfortunately lead to prolonged periods of lost game time, it is an important topic in football health and wellbeing. We have previously published a blog regarding stress fractures in runners, which includes a detailed explanation of the cause, biological process, diagnosis and management which you can read about here.

This blog will focus on some common causative factors and the division of the “high risk” versus “low risk” types of stress fractures, as these are managed very differently. The risk relates to the specific location within a given bone rather than the likelihood of developing that type of stress fracture.

Stress fractures almost always occur in one of the following scenarios, or a combination of these.

  1. Increase in load on a region of the body in a given (often too short) time period
  2. Decrease in recovery time relative to loading time
  3. Decrease in the bone’s ability to repair / remodel following exposure to load.

Therefore, when volume of load increases the risk is higher, such as progressing to a higher competitive level of play, a busy period in the season with extra games and training sessions, an increase in training load such as during pre-season fitness training or even a change in training surface or footwear relative to the amount of loading. Conversely if the athlete’s load remains unchanged but they have a change in diet, energy input, illness or nutritional balance this can lead to an increased risk of injury.

High risk stress fractures generally involve a bony area where there is critical blood supply or an ossification centre (where the bone grows from). An example of these are the Femoral neck (hip), Navicular bone (midfoot), base of the 5th metatarsal (outside of foot) and the medial malleolus (inside of the ankle). These are considered high risk due to the possibility of a full fracture disrupting the only blood supply to this part of the bone, which can lead to ongoing problems. The high risk stress fractures are often managed initially with complete unloading / non-weight bearing and then closely monitored during the periods of activity reduction / relative rest including repeated imaging studies to track bony healing. In more severe cases these can require surgical management. High risk stress fractures often require orthopaedic specialist involvement in early management. Regardless of severity if a stress fracture is diagnosed we recommend assessment and advice regarding management with a sports physician specialist.

Low risk stress fractures are located in areas with good blood supply which are known to heal well with relative rest and progressive rehabilitation. These are more common in soccer and mostly found in the postero-medial tibia (lower inside of the shin) and in the metatarsals (the forefoot). This type of stress fracture can usually be diagnosed clinically but usually require imaging (MRI / Xray) to confirm type and severity.

Effective management of these injuries in soccer players requires good communication between the physiotherapist, sports physician, coaches and player, especially given the potentially longer period of recovery than most soft tissue injuries. It is important not to continue to play if a stress fracture is a possibility.

If you have any questions on the information in this blog or need assistance in diagnosis or rehab relating to soccer injuries, contact us on admin@numovesphysiotherapy.com.au or 49216879.

Winter Sports

Winter Sports Physiotherapy Newcastle

Going skiing or snowboarding these holidays?

Remember to keep up your strength training before heading off on your trip. This will allow you to ski/board for longer without fatiguing. More importantly, strength training will also reduce your risk of injury. Great ways to improve strength and fitness indoors this winter include yoga, spin classes, weight training, rock climbing and more.

Another great way to improve your strength is through Pilates. Our Pilates classes run on 7am Mondays, 6:30pm Mondays, 7am Wednesdays and 12:15pm Fridays. Pilates helps to improve physical strength, flexibility, posture, and enhance mental awareness. All these benefits will allow you to be stronger and safer on the snow – these equal more fun!

Staying active throughout the winter can sometimes be difficult. No matter how choose to keep active and get stronger, something is better than nothing! Buy yourself some new exercise clothes. Remind yourself of your fitness goals, or make new goals.

For more information on sports preparation.

Football Injury Prevention – Fifa 11+

football injury prevention

The football season is stepping into full swing once again, and it is important to know that football injury prevention via sports conditioning is effective. Developed in 2009 and rapidly utilised worldwide, the Fifa 11 + Injury Prevention Program has consistently demonstrated injury reductions of 30-50% when implemented at least twice a week. The Fifa 11 + is designed to improve lower limb and core strength, develop neuromuscular control and body awareness to significantly reduce injury.

The warm up program follows a progressive number of exercises from running, to strengthening and balance that is both individual and partner focused. The program identified the most common mechanisms behind common football injuries, such as rapid changes of directions with insufficient knee control and ACL rupture. Through a 3 part program it aims to address and change the factors that contributed to the injury mechanism – retraining movement patterns, body awareness, core strength and control.

So what does Fifa 11 + involve?

Part 1: Running exercises

Part 2: Strength, Plyometrics, Balance.

Part 3: High level running exercise.

In total, the Fifa 11+ only takes 20 minutes to complete, with minimal equipment and space requirements. It can be completed individually, or as part of a team, with a number of exercises partner focused to challenge proprioception, balance and agility.

The Fifa 11+ program is a tool we advocate for our football players over the age of 12. If you have any questions regarding the program, how you can implement it, or where to begin, feel free to email us. If you are serious about football then your team should be doing the FIFA 11+ before each training. For an individualised football training program, book an appointment with one of our physiotherapist’s.

Watch our Facebook and Instagram over the next month for video and comments on each of the exercises in Part 2 of the FIFA 11+.

Starting off 2018 Pain Free and Positive

42345147 - side view of smiling business colleagues looking at each other

With 2018 under way and the upcoming uni semester fast approaching and workloads increasing, it is important to consider how to best maintain our health and bodies at home and at work. Particularly for those of us on campus working long hours at desks, computers and various projects, a large risk is the onset of neck pain. Not only is this uncomfortable, but impacts on our day to day routine and often effectiveness at the tasks so important to us.

As campus gets increasingly busy, it’s more important than ever to keep moving, and keep an eye on our work related postures. Although pain often follows trauma, it is often a consequence of remaining too long in one posture, whether this is sitting or standing. This may be seated at the computer desk, looking at our phones, or standing and chatting to colleagues. Chances of injury or pain is then increased with any kind of stress that may be experienced throughout the day.

As a university physiotherapy clinic that has been on campus for 14 years, NU Moves understands the workplace demands on staff, including the regular postural demands and time constraints. We are also familiar with treating a range of resulting issues such as neck, arm and lower back pain. Manual therapy or exercise prescription are extremely useful tools that our qualified physiotherapists can use to get you on track to moving well and feeling great. A great goal to aim for in terms of movement is 30 minutes a day, and 150 minutes a week, whether this is walking to lunch, your car, or to grab a coffee.

If you are experiencing pain at work, or wanting to maximise your health and movement, NU Moves Physio can help. With post graduate qualifications and experience in musculoskeletal assessment, manual therapy, exercise prescription and outstanding problem solving, out physiotherapists are here to help. One on one treatment sessions involve a thorough assessment to determine what is causing your pain, and a treatment plan explained in depth, so you know how to approach improving your health from your first appointment.

Managing an acute injury – the first 48 hours

acute injury

Uh-oh I’ve pulled a muscle, what do I do? Firstly, please, don’t stretch an acute injury. This is likely to further tear a muscle and cause more bleeding.

Its winter sport pre-season training time again! Which means I’m about to see a bunch of active, healthy 20-40 somethings (and some really enthusiastic 50 somethings) with an acute muscle strain. I frequently see people 24-48 hours after the injury has happened. These go getters and weekend warriors have often done all the usual injury management recommendations, which is now P.O.L.I.C.E. by the way.

POLICE:

Protection – don’t keep playing through an injury. This will make your recovery period much longer, and cause more pain once you cool down.

Optimal Loading – Initially, minimal loading is ideal, then gradual increases in load. However amount and type of loading depends on the injury. So best get it checked out.

Ice – Analgesic (helps with pain), widely used. There is no research published on effectively reducing recovery time with ice.

Compression – Bandages, tubigrip, compression socks, skins! Etc. This helps to control swelling and slows inflammatory fluids leaking into all the surrounding tissue. This will then slow the recovery and increase periods of immobility.

Elevation – put your injured part, above your heart. Vessels that remove swelling work best with gravity assistance – so place them up high, you can’t fight gravity.

Once you have the initial management under control, it is important to get the injury assessed by a qualified physiotherapist. This is because the management program and time to return to play varies dramatically by injury site, mechanism, severity and sporting demands. This injury may require a completely different strategy to your last muscle strain or your teammates, even if it is the same muscle.

Unfortunately, poorly managed muscle injuries have the possibility of becoming a persistent problem. We will often see athletes with an old muscle injury that has reached the chronic injury stage. This then requires a long term targeted rehabilitation intervention. These are usually successfully rehabilitated but can take some time to improve, and can be frustrating for the keen athlete wanting to play at 100%.

The role of medication is a frequent question asked in the clinic. Non-steroidal anti inflammatory drugs (NSAIDs) such as ibuprofen or diclofenac are frequently used. It is a complex topic, but the take home message is that there may be a small improvement in recovery time. Allowing 48 hours before taking anti-inflammatories is ideal to reduce bleeding within the affected muscle. Unfortunately, these medications carry some potentially serious adverse effects, which can cause damage to the stomach, kidneys and cardiovascular system.

In conclusion, use the P.O.L.I.C.E. principles, get an assessment, get a plan and give your body the best chance to make a full recovery prior to returning to sport. If you are unsure about any of the above, please contact us on 4921 6879 or email admin@numovesphysiotherapy.com.au

 

Managing Recovery and Fatigue

Recovery and Fatigue

There is plenty being spoken about the health benefits of getting a good night sleep and we agree that if you sleep well it has a multitude of positive flow on effects on how we feel. Exercise is sometimes a means to providing an improvement to the quality of our sleep but excessive exercise can lead to general fatigue which can erode the desired overall health benefit. This article is a follow-on to our last blog on exercise addiction.

In this article we will refer to fatigue as a level of exhaustion or tiredness. One definition of fatigue is extreme tiredness resulting from mental or physical exertion illness. Whether you should continue to exercise when you feel fatigued depends on the severity and cause.

Some of the negative effects of exercising when fatigued are:

  • Lack of recovery time can increase risk of injury and becoming unwell
  • Doing too much when you aren’t medically well can prolong recovery from illness
  • Specific muscle fatigue in a certain muscle area from repetitive exercise increases the likelihood of musculoskeletal injury due to lack of variation in exercise program

Simple advice for when you feel fatigued is to consider your exercise routine as a cause relative to recent illness or an endurance exercise event. If you determine that your fatigue is not caused by anything but your regular exercise program then a reduction in exercise load is advised. If there is no obvious physical cause, consider whether stress or mental well-being might be a contributor and similarly consider the amount of quality sleep. Inadequate nutrition and energy intake can also lead to symptoms of excessive fatigue. Once you identify a cause then you are in a better position to work out what to do with your exercise routine.

Excessive amounts of exercise without adequate rest / recovery time is not recommended for healthy living nor for athletic or sports performance. Its worth a few minutes of thought.

Click the links to read our last two blogs in the series on the benefits of exercise on depression and when exercising can become a problem.

When is too much exercise a problem?

exercise problemExercise plays an important role in assisting in the management of mental well-being. Research exists that agrees with the idea that if we are regularly active the symptoms of depression may improve (Click here to read our previous blog on exercise and depression). If we then exercise harder, it sometimes makes us feel even better and this good feeling can both mentally and physically become addictive.

A recent practice article from Heather Hausenblas and James Smoliga in the British medical journal discusses ‘addiction to exercise’, where exercise is an essential element to every day. The discussion surrounding the difference between healthy regular exercise and an addiction to exercise is important especially when injury occurs, as a reliance on exercise is difficult to overcome.

Having a physio practice in a gym based environment means we have seen clients with a reliance on exercise to the point of it being an addiction. As a general observation it is more common now than 10 years ago, but a greater number of people have a level of awareness of their need to exercise. The greatest time of concern with exercise addiction relates to when injury occurs and the ability to exercise has decreased.

Managing an unhealthy reliance on exercise involves starting with reflecting on the motivation or reasons for needing to exercise. What are your goals for exercising? If an exercise addiction is present, then we do not need to stop exercising, but rather understand the reasons and work towards a healthy exercise routine with less risk of injury and improved health benefits. Hausenblas refers to it as reducing the rigidity of an exercise routine. If you are over-reliant on running, then we may try to change the exercise routine initially and replace a run with a swim. Gradually work towards a healthy volume of exercise is the goal.

If you are reliant on exercise and don’t feel you can stop then discuss it with your GP or a psychologist. Alternatively give us a call and we can discuss your exercise routine. We will not ask you to stop but can assist with strategies to start moving towards a healthy exercise routine.

Housenblas H, Shreiber K, Smoliga J. (2017): Addiction to exercise. The British Medical Journal. http://www.bmj.com/content/357/bmj.j1745

Depression and the Benefits of Exercise

Exercising for depressionExercise is a useful method of managing depression but is not a stand-alone treatment. There is research based reviews that support that exercise can reduce the symptoms of depression, and now a recent article by Harvey et. al in the American Journal of Psychiatry has found exercise / activity can prevent future cases of depression.

There are several features of the researcher’s interpretations that are useful. They concluded that exercise intensity was not relevant to the prevented cases of depression. This means that any exercise is better than no exercise. Just going for a walk is one of the simplest and easiest forms of exercise to start with. If you can’t walk due to pain or injury then we would encourage water based exercise or an exercise bike. Even a short walk will release endorphins to begin to make you feel better.

The findings of an 11 year prospective study were that as little as 1 hour of physical activity per week prevented 12% of future cases of depression. So if you are not currently exercising then just being active for 1 hour a week can help with depression. The recommended 30 minutes per day remains an ideal amount of exercise for healthy living (combining physical, cardiovascular and metabolic health) and if you achieve this you are way above the 1 hour per week required for assisting with depression.

The researchers did not find that exercise was not helpful in preventing future cases of anxiety. If you have anxiety or depression use the resources such as websites such as beyond blue and black dog institute and discuss it with your GP.

Click here to read the black dog institute’s fact sheet on exercise and depression.

Harvey et.al (2017). Exercise and the Prevention of Depression: Results of the HUNT Cohort Study: AJP in advance. doi: 10.1176/appi.ajp.2017.16111223,

Strength exercise – more evidence that it is worth doing

Strength Training

The reason for doing the recommended 2 strength based exercise sessions per week has been given another boost from a recently published study. Stamatakis et al analysed adults over 30 in the United Kingdom that were selected from a pool of 80,000 people completing an annual survey then further assessed via interview and questionnaires over a 9 year period.

Strength based exercise on its own has been shown to reduce diabetes risk and when combined with cardio exercise gave even greater benefits. This study looked at reductions in mortality that could be attributed to different types of exercise that is recommended by the world health organisation. Namely 150-300 minutes of cardiovascular exercise and 2 strength exercise sessions per week.

They found 36.2% of the sample group met only the aerobic exercise guidelines. 3.4% met only the strength exercise guidelines and 5.5% met both aerobic and strength exercises recommendations.

Participation in any form of strength exercise led to a 23% reduction in mortality from all causes and a 31% reduction in mortality from cancer. Combining the strength and aerobic exercise guidelines further reduced the rate of mortality than aerobic physical activity alone.
The definition of strength exercise included both gym and body weight exercises but they analysed whether one was better than the other. The study found bodyweight exercises gave the same benefit to gym-based activity. Previous studies have indicated that increasing muscle strength has been associated with reduced cancer mortality independent of aerobic fitness. Also higher muscle strength, as opposed to just participating in strength exercise led to reductions in mortality.

Meeting the strength exercise recommendations of twice per week was found to be as important as achieving the weekly aerobic exercise recommendations for health benefits and reducing the risk of mortality.

Summary:

  • Get into strength exercises even if it’s just body weight exercise
  • Make it challenging enough to increase your strength
  • If you are just starting out, don’t go too hard too fast or you may increase your risk of injury
  • If you are not sure what strength exercise program is suitable for you, let us know and we can help you get started on a program that is safe and effective to achieve your health goals

Stamatakis et al 2017, Does strength promoting exercise confer unique health benefits? A pooled analysis of eleven population cohorts with all-cause, cancer, and cardiovascular mortality endpoints. Am J of Epidemiology.