Category: Exercise

Exercise as the first line of osteoarthritis treatment

30/4/2021

Have you or someone you know been told that exercise is bad for osteoarthritis? Have you had to give up your hobbies because of joint pain? Then this is an important article that could make the world of difference to you!

An estimated 2.2 million Australians suffer from osteoarthritis and an estimated 30% of people aged above 50 experience hip or knee pain (1).

Shunning exercise because of osteoarthritis has significant negative mental and physical impact. Avoiding exercise can actually lead to more joint problems.

This doesn’t even include the other chronic illnesses related to not exercising, which include type 2 diabetes, cardiovascular disease, and dementia.

Did you know all of these illnesses are associated with chronic low-grade inflammation? This is reduced by exercise, and with that the risk!

Thankfully, science knows the benefits of exercise and movement in people with hip and knee osteoarthritis are substantial and supported by high-quality evidence. Exercise has been shown to not only reduce pain and disability of osteoarthritis but are also effective in preventing at least 35 chronic conditions and acting positively on at least 26 chronic conditions, with one of the potential working mechanisms being exercise-induced anti-inflammatory effects. It’s worth noting too, that this is not only unique to osteoarthritis and exercise has been successfully used in younger and middle-aged patients with knee injuries.

Remember, Osteoarthritis is a condition that effects the whole joint (joint lining, bone and soft tissues) and it occurs when the cartilage that cushions the ends of bones in your joints undergoes normal age-related changes. Normally, damaged cartilage is constantly being repaired as old cartilage is degraded. When the balance between degradation and repair is thrown off, cartilage thinning occurs. As a result of cartilage thinning, the joint has more friction causing a joint to become inflamed.

So how does movement help? What we know about joints is that they have no nerves or blood supply and that they are nourished from synovial fluid via dynamic load e.g. Walking/physical activity. On top of this, the muscles surrounding the joint get stronger with exercise and provide dynamic stability to the joint which can help offload some of the pressure going through the joint itself. Extensive research into the topic has proven that movement not only improves symptoms and physical function, but also reduces intake of painkillers and sick leave (2).

Below are some of the biggest myths we see coming through the door of our clinic and the scientifically based answers we give.

BY Ok, so what exercise should I do? Scientific research into the topic has found that on top of strengthening and cardiovascular exercise a type of training method called neuromuscular exercise has been shown to be effective. The neuromuscular training method, based on biomechanical and neuromuscular principles, aims to improve sensorimotor (body awareness) control, and achieve compensatory functional stability which counter any sense of being unstable on your limb. A more detailed explanation is that sensorimotor control is the ability to produce controlled movement through coordinated muscle activity, and functional stability is the ability of the joint to remain stable during physical activity (3).

Luca and Jayce are both GLA:D® accredited and experienced in running the Danish designed GLA:D ® neuromuscular exercise programme that combines strength, cardiovascular fitness and neuromuscular control.

To find out more about our GLA:D® programme call the clinic on 9533 5305 or visit our dedicated information page by clicking the button below.

CLICK HERE FOR GLA:D INFORMATION PAGE

References
1. AIHW. (2021). Retrieved from https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/osteoarthritis/contents/what-is-osteoarthritis
2. BMC Musculoskelet. Disord. (2017), 18(1).
3. BMC Musculoskelet. Disord. (2010), 11(1).
4. J. Orthop. Sports Phys. Ther. (2018), 48(6).

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Here is how you are slowing down your stress fracture healing.

5/3/2021

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Do you experience shin pain with activities such as running? Is your shin tender to touch, and maybe even swollen? Sure, the pain settles down with rest, but it never goes completely, and you feel like it may be getting worse.

Tibial stress fractures are common overuse injuries effecting up to 20% of athletes and people new to running. Tibial stress fractures are caused by repetitive loading on your tibia (shin bone) over time. Tibial stress fractures are often seen in running and jumping sports and can be linked to an increased volume or intensity of training workload. This could be an athlete trying to increase intensity for an upcoming event or an average person trying to get back into running.

If left without intervention, the shin pain will get worse and continue to reoccur. The longer treatment gets delayed, the longer the road to recovery will be. This will lead to your runs or hobbies becoming more painful and less enjoyable, which is the last thing you need!

Normal healthy bone is constantly monitored and repaired by the body depending on how much load is being put through it during day to day activities. In almost all cases the body is able to adapt to the load being put through the bones and repair any micro-trauma that has occurred in the bones. A stress fracture happens when micro-trauma occurs in a frequency and volume that the body cannot keep up with and new bone cannot be laid down to repair micro-trauma of the bones. Continued loading allows for the merging of multiple cracks to the point of the shin becoming painful. If the load being put through the bone is not reduced, in some scenarios, the stress fracture can continue until complete fracture occurs (1).

When you see us, your physiotherapy management will be tailored to your presentation and symptoms. The first priority of treatment will be to allow the stress fracture to heal. This initial healing process will involve a period of modified loading to reduce the forces going through the healing bone.

We understand that you will want to maintain your fitness and strength, and we will do this by tailoring an exercise program based on your presentation. Your program will likely include substituting aggravating activities with more appropriate exercises such as cycling, elliptical training or swimming to maintain your current level of fitness.

Once pain is under control your physiotherapist will decide when to gradually return to sport and if a strength and conditioning program might be appropriate. Rehabilitation and strengthening are extremely important to reduce the likelihood of re-injury.

References:

J. Orthop. Surg. Res. (2016), 11(1).

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The most common misunderstandings about SCIATICA that can make it worse!

13/11/2020

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Do you or someone you know suffer from radiating back or leg pain?

Sciatica is a frequently occurring condition that has been estimated to effect 5 in 1000 people (1). Sciatica is most commonly caused by a herniated lumbar disc where the nerve root is compressed by the disc. The nerve can also be compressed by bony changes occurring around the spine. Regardless of the cause, the nerve is still undergoing compression, and combined with inflammatory and immunological processes seems to be the important cause of sciatica pain.

Sciatica can be a pain in the buttock, literally! Left unmonitored and untreated it can be debilitating and things like walking and sleeping can become difficult. This can affect quality of life and lead to low mood, which often leads to a vicious cycle rather than the road to recovery. On top of this, sciatica pain is known to make things like bending, twisting, coughing and even sitting painful, making even the simplest of tasks to be unbearable.

A recent study found that patients with low back pain who saw a physiotherapist early, had significantly lower out of pocket healthcare costs and decreased use of opioids than those who saw physiotherapist later or not at all (1). When you consult with us, we will work with you to provide an adequate explanation of the nature and prognosis of sciatica. In the early stages, international guidelines suggest that bed rest is not recommended unless pain is significantly disabling. In fact, we will work with you to keep you physically active and doing activities that are important to you. We will combine activity with nerve relief manual therapy and nerve easing position and movements for you to do at home.

Once relief has been achieved, treatment will be more recovery focused, and involve muscle memory tasks and goal specific rehabilitation.

Physiotherapy uses a combination of evidence-based research, clinical experience and clinical training to diagnose and treat your presentation of sciatica. For examples of exercises that can be used, remembering that every sciatic presentation is an individual one, check out this exercise video for sciatica below: