All Posts tagged Physical exercise

Osteoarthritis treatment

Osteoarthritis treatment

There is a common belief that there is not much you can do for osteoarthritis because the joint damage has already occurred and can’t be reversed. However it is often the inflammation of the tissue surrounding the joint and instability from the weakened tissues that lead to pain from an arthritic joint.

Our physiotherapists may be able to help you decrease the inflammation and pain around the joint and get you moving again. Here is some information about osteoarthritis and how we can help.

What is osteoarthritis?

Arthritis is a name for a group of conditions that cause damage to the joints in our body, usually causing pain and stiffness

Osteoarthritis is one of these conditions and it affects the whole joint, including bone, cartilage, ligaments and muscles

It is most prevalent in the joints of the hips, knees, neck, lower back, fingers and big toe, but can occur in any joint

It is degeneration of the joint structures, namely the cartilage (protective cushioning on the bony surfaces) and its underlying bone surfaces
Bony growths or spurs commonly known as osteophytes are common in osteoarthritis
Ligaments and muscles around the joint also deteriorate in osteoarthritis
It normally affects a joint on one side of the body i.e. it doesn’t normally occur bilaterally like other arthritic conditions

There are other arthritic conditions you may have heard of such as rheumatoid arthritis, juvenile arthritis, and ankylosing spondylitis.

Signs and symptoms

Joint pain
Joint stiffness
Swelling of the joints
Symptoms usually develop and worsen gradually over months or years
Affecting ability to carry out normal daily activities
Clicking/grinding in the joint
Loss of flexibility in a joint
What causes osteoarthritis?
Previous joint trauma/injury
Being overweight greatly increases your risk
High joint stress/repetitive use/heavy loads
There is an increase risk as you age and there is more ‘wear and tear’ on the joints


Arthritis can be diagnosed by taking a thorough history and physical examination
X-ray can help confirm a diagnosis – you may need to see your doctor to get a referral


Our physiotherapists can help you with:
Strength and exercise programme
Joint mobilisation/soft tissue techniques
Aids or braces
Weight loss programme
Medication and joint supplements – your doctor can guide you on the best options
Surgical options such as joint replacement
Pre-operative rehabilitation has been shown to improve outcomes post-operatively, so if you are requiring surgery come and find out how you can help speed up your recovery with pre-hab

Some hints for the colder months

Cold weather can exacerbate joint pain and joint stiffness. Remembering a few common sense tips can help people with osteoarthritis survive cold weather:
Dress warmly and layer up
Exercise indoors to stay motivated and warmer
Use a heated pool for exercise – talk to your physiotherapist for local options and classes
Ensure your vitamin D levels are adequate
You don’t have to wait for the warmer months to reduce pain associated with osteoarthritis! Book an appointment with a physiotherapist online 24/7,


NEJM says Physio as effective as surgery!

NEJM says Physio as effective as surgery!

A New England Journal of Medicine (NEJM) study showing that physical therapy is just as effective as surgery in patients with meniscal tears and arthritis of the knee should encourage many health care providers to reconsider their practices in the management of this common injury, according to the American Physical Therapy Association (APTA).

The study, published March 19, showed no significant differences in functional improvement after 6 months between patients who underwent surgery with postoperative physical therapy and those who received standardized physical therapy alone.
“This study demonstrates what physical therapists have long known,” explained APTA President Paul A. Rockar Jr, PT, DPT, MS. “Surgery may not always be the best first course of action. A physical therapist, in many cases, can help patients avoid the often unnecessary risks and expenses of surgery. This study should help change practice in the management of symptomatic meniscal tears in patients with knee osteoarthritis.”

According to lead physical therapist for the trial and American Physical Therapy Association (APTA) member Clare Safran-Norton, PT, PhD, OCS, “our findings suggest that a course of physical therapy in this patient population may be a good first choice since there were no group differences at 6 months and 12 months in this trial. These findings should help surgeons, physicians, physical therapists, and patients in decision-making regarding their treatment options.”

Researchers at 7 major universities and orthopedic surgery centers around the country studied 351 patients aged 45 years or older who had a meniscal tear and mild-to-moderate osteoarthritis of the knee. Patients were randomly assigned to groups who received either surgery and postoperative physical therapy or standardized physical therapy. Within 6-12 months, patients who had physical therapy alone showed similar improvement in functional status and pain as those who had undergone arthroscopic partial meniscectomy surgery.

Patients who were given standardized physical therapy — individualized treatment and a progressive home exercise program — had the option of “crossing over” to surgery if substantial improvements were not achieved. Thirty percent of patients crossed over to surgery during the first 6 months. At 12 months these patients reported similar outcomes as those who initially had surgery. Seventy percent of patients remained with standardized physical therapy.

According to an accompanying editorial in NEJM,”millions of people are being exposed to potential risks associated with a treatment [surgery] that may or may not offer specific benefit, and the costs are substantial.” Physical therapist and APTA member Mary Ann Wilmarth, PT, DPT, MS, OCS, MTC, Cert MDT, chief of physical therapy at Harvard University, said, “Physical therapists are experts in improving mobility and restoring motion. The individualized treatment approach is very important in the early phases of rehabilitation in order to achieve desired functional outcomes and avoid setbacks or complications.”
Journal Reference:
Jeffrey N. Katz, Robert H. Brophy, Christine E. Chaisson, Leigh de Chaves, Brian J. Cole, Diane L. Dahm, Laurel A. Donnell-Fink, Ali Guermazi, Amanda K. Haas, Morgan H. Jones, Bruce A. Levy, Lisa A. Mandl, Scott D. Martin, Robert G. Marx, Anthony Miniaci, Matthew J. Matava, Joseph Palmisano, Emily K. Reinke, Brian E. Richardson, Benjamin N. Rome, Clare E. Safran-Norton, Debra J. Skoniecki, Daniel H. Solomon, Matthew V. Smith, Kurt P. Spindler, Michael J. Stuart, John Wright, Rick W. Wright, Elena Losina. Surgery versus Physical Therapy for a Meniscal Tear and Osteoarthritis. New England Journal of Medicine, 2013; 130318220107009 DOI: 10.1056/NEJMoa1301408


Bike Fit 101

Bike Fit 101
Bike Fit Tips for Healthy Cycling
Bicycle-related pain and injuries are commonly associated with poor bike fit. If you have pain related specifically to cycling, you might have a bike fit problem.
Bike Fit Basics
•Keep a controlled but relaxed grip of the handlebars.
•Change your hand position on the handlebars frequently for upper body comfort.
•When pedaling, your knee should be slightly bent at the bottom of the pedal stroke.
•Avoid rocking your hips while pedaling.
Problems and Possible Solutions
Problem: Anterior (Front) Knee Pain
Possible causes are having a saddle that is too low, pedaling at a low cadence (speed), using your quadriceps muscles too much in pedaling, misaligned bicycle cleat for those who use clipless pedals, and muscle imbalance in your legs (strong quadriceps and weak hamstrings).
Problem: Neck Pain
Possible causes include poor handlebar or saddle position. A poorly placed handlebar might be too low, at too great a reach, or at too short a reach. A saddle with excessive downward tilt can be a source of neck pain.
Problem: Lower Back Pain
Possible causes include inflexible hamstrings, low cadence, using your quadriceps muscles too much in pedaling, poor back strength, and too-long or too-low handlebars.
Problem: Hamstring Tendinitis
Possible causes are inflexible hamstrings, high saddle, misaligned bicycle cleat for those who use clipless pedals, and poor hamstring strength.
Problem: Hand Numbness or Pain
Possible causes are short-reach handlebars, poorly placed brake levers, and a downward tilt of the saddle.
Problem: Foot Numbness or Pain
Possible causes are using quadriceps muscles too much in pedaling, low cadence, faulty foot mechanics, and misaligned bicycle cleat for those who use clipless pedals.
Problem: Iliotibial Band Syndrome (ITBS)
Possible causes are too-high saddle, leg length difference, and misaligned bicycle cleat for those who use clipless pedals.

Exercise and the Brain: A winning team

Exercise and the Brain: A winning team

“The best way to improve mental performance, is to improve physical performance” – Tim Ferriss¹

So, how does exercise improve learning and memory?Learning requires repeated connection and communication between neurons in a process known as long term potentiation¹.

“Long term potentiation: The strengthening of brain cells’ capacity to send signals across a synapse for the purpose of learning and memory.“ – John Ratey M.D., from ‘Spark’.²

The more repeated this firing across a synapse, the stronger the connection becomes.

“Neurons that fire together, wire together.” – Dr. Daniel Siegel.³

With the example of learning a new language, nerve cells that are recruited in learning a new word will fire a glutamate signal across the synapse.²Without practice, the original synaptic connection will diminish, and the signal will weaken.²The end result, is you’ll forget. On the other hand, regular practice and firing of this new neural connection will strengthen the synapse. The synapse will actually grow in size, and this will improve the ability of the synapse to fire in the future.² And guess what? You’ll remember!

What parts of the brain are involved in memory? One area of the brain that we often read about in terms of memory is the hippocampus.The process of learning, however, involves many more areas of the brain working together.² When the brain receives an incoming stimulus, there is an emotional intensity assigned to it (limbic region), and it is considered amongst past experiences, as well as the social and environmental context, before being formed as a new memory in the hippocampus.The pre-frontal cortex is the decision maker of the brain . It sequences this information, and is able to make a rational decision or judgement about any particular scenario before it settles as a formed memory in the hippocampus.

Coming back to the hippocampus, research has shown that it is particularly vulnerable to degenerative disease.⁴Studies have shown that the hippocampus can literally shrink in size, during the course of degeneration such as dementia.²

The positive, though, is that research has also shown that cardiovacular exercise, as well as routine cognitive challenges (e.g., problem solving, learning a new language) can increase the size of the hippocampus.²

This is another example of neuroplasticity.

Brain-derived neurotrophic factor (BDNF) is crucial for the health of our nervous systems, and it massively increases during cardiovascular exercise.²BDNF is thought to play a really important role in learning, and has been found in lab studies to be present in the hippocampus.²Researchers have found that if BDNF is added to neurons in a petri dish, the neurons sprouted new branches (dendrites), which could be thought of like fertiliser for long term potentiation (learning).²BDNF also helps with synaptic connections, binding to receptors at the synapse and strengthening the neural signal.²

So how much, and what kind of exercise is effective?Unfortunately it still isn’t exactly known what is an ideal type and duration of exercise for improved learning and memory.²

Going by the recommendations of the World Health Organisation⁵, these are guidelines for general health:

Children aged 5-17 years

1.At least 60 minutes of moderate to vigorous intensity physical activity each day.
2.Any extra exercise will provide additional benefits.
3.Should be mostly aerobic exercise. Vigorous-intensity activities should be included, for safe and appropriate muscle strengthening, at least 3 times per week.

Adults aged 18-64 years:

1.At least 150 minutes of moderate-intensity aerobic exercise activity, or at least 75 minutes of vigorous-intensity aerobic activity in one week. (Or a comination of moderate and vigorous intensity activity).
2.Aerobic activity should be at least 10 minutes in duration.
3.For additional health benefits, adults should aim for double the above mentioned recommendation (300 minutes moderate intensity, or 150 minutes of vigorous activity, or combination, per week).
4.Muscle strengthening involving major muscle groups on 2 or more days a week.

Adults aged 65 years and above:

1.At least 150 minutes of moderate-intensity aerobic physical activity, or at least 75 minutes of vigorous-intensity aerobic physical activity throughout the week (or equivalent combination).
2.Aerobic activity should be at least 10 minutes in duration.
3.For additional health benefits, adults should aim for double the above mentioned recommendation (300 minutes moderate intensity, or 150 minutes of vigorous activity, or combination, per week).
4.Balance and falls prevention for older adults with poor mobility, 3 or more days per week.
5.Muscle strengthening involving major muscle groups on 2 or more days a week.
6.When older adults cannot do the recommended amounts of physical activity due to health conditions, they should be as physically active as their abilities and conditions allow.

For anyone being treated for any medical condition, discuss these with your medical practitioner before starting a new exercise program.

For more detailed recommendations, please see the World Health Organisation’s website.

Dr Ratey suggests combining the benefits of cardiovascular exercise (e.g., 60-70% of maximum heart rate) with skill-based, non-aerobic exercise. This will depend on what each person enjoys, and will be able to be consistent with.²

Examples would be tennis, basketball, surfing, or any other activity that challenges both strength, balance, fine motor control, and cardiovascular endurance. This will help challenge and develop different areas of the brain, such as the cerebellum and basal ganglia.


•Exercise can play an important role in counteracting the neurotoxic effects of prolonged stress.

•Cardiovascular exercise encourages an increase in neurotransmitters, proteins, and hormones that help with neurogenesis and nervous system health.

•Cardiovascular exercise has been shown to considerably improve cognition and long term memory, by strengthening synaptic connections and encouraging neurogenesis (nerve cell growth).

•A combination of strengthening, fine motor skills, and cardiovascular activity seems to be a good way of challenging and developing different areas of the brain.


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