All Posts tagged physio

Prevent falls, promote health

Prevent falls, promote health

Falls cause 2/3rds of deaths due to unintentional injury in the elderly, which is the 5th leading cause of death of people over 65 years of age.

A fall by an elderly person can be defined as “a situation in which the older adult falls to the ground or is found lying on the ground” or “any unintended contact with a supporting surface, such as a chair, counter or wall”. (Shumway-Cook & Woollacott 2017)

We have your health in mind, and the prevention of such an adverse event, in our best interest and priority. We have decided to write a blog post to provide you with information to help minimise your risk of falling and increase your chances to lead a fit and healthy aging process.

The following list presents risk factors that are relevant to individual factors that increase the chance of falling:

Muscle weakness
History of falling
Walk with a limp
Poor balance (feel wobbly when walking)
Use of a walking aid (e.g. walking stick or frame)
Poor vision
Arthritis
Depression
Poor cognition (e.g. memory/ ability to problem solve)
Age greater than 80 years old

Are any of the symptoms listed above relevant to you?

It is difficult to attribute ageing as the sole reason for the development of the traits listed above, as older adults of the same age can demonstrate physical function ranging from physically elite to entirely dependent on others for all activities of daily living. However, there are some common trends of declining function to do with the neuromuscular system which occur in older adults, and although age may not be the main cause for these changes in the systems of postural control, it is likely, increasing age has a detrimental effect.

The aspects of the systems of postural control potentially detrimentally affected by age include:

Muscle strength
Range of motion
Static balance (ability to remain stable when you are not moving)
Dynamic balance (ability to remain stable with movement)
Reactive balance control (ability to sequence movement, time muscle activation and adapt to changing tasks and environmental demands
Anticipatory balance control (the ability to stabilise the body before performing a movement)
Sensation (the ability to detect change in the external environment through vision, hearing, touch, ability to sense vibration, and proprioception, or the ability to sense where your body is in space)

It is also necessary to comment on the loss of bone density associated with increased age (>50 years old). A loss of bone density increases your risk of fracture when falling and is something everyone can and should actively work to minimise.

Our Physiotherapists are pleased to guide you and minimise your risk of falling. Therefore, we have developed a very simple home exercise program for all readers, using equipment all should have access to, to enable you to take action to reduce your risk of developing risk factors of falling and consequently your overall risk of falling, immediately!!:

Sit to stand (to increase muscle strength)

Sitting upright in a chair
Lean forward with hands on chair
Push through arms and heels keeping back straight
Squeeze your buttocks to stand as tall as possible
Repeat 15 squats
Perform 3 x daily

Thoracic extension (to increase range of motion)

Sitting on a chair which has a high back
Place a rolled towel horizontally behind your shoulder blades
Place both hands behind your neck and interlock your fingers
Touch elbows together
Bend backward to a comfortable position and hold for 30seconds
Perform 3 x daily

SLS (to increase static postural control)

Standing next to a stable object
Place one hand on the stable object
Lift one leg off of the floor to form a L-shape
If you are confident and safe, take your hand off of the chair
Hold for 30 seconds
Repeat on the opposite leg
Perform 3 x daily

SLS – Eyes closed (to enhance sensation especially proprioception)
As above, however once stable, close your eyes and hold for 30 seconds

Tandem stance (to increase static postural control)

Standing next to a stable object
Place one hand on the stable object
Place one foot directly in front of the other, so that your toes of the back foot are touching the heel of the front foot, forming in a straight line
If you are confident and safe, take your hand off of the chair
Hold for 30 seconds
Repeat with the opposite leg in front
Perform 3 x daily

Tandem walking (to increase dynamic postural control)

Continue to get into the position as above, however, continue walking – like you are walking on a tightrope! (We recommend alongside the kitchen bench for safety precautions)
30 minutes of walking daily (to increase bone density, dynamic postural control anticipatory balance and importantly cardiovascular fitness – or heart and lung health!!)
This program is very basic and does not cover all of the aspects of postural control. Please make an appointment with one of our physiotherapists to extend your exercise program, so that we can make it more tailored to your needs and more interesting. We will use modern, exciting equipment and more fun movements!!

Finally, the following listed items are external factors that also increase one’s likelihood of falling. They are known as secondary factors and are easily controlled:

Stairs
Throw rugs
Slippery surfaces
Poor lighting
Clutter in the home
Uneven pavement

Please take a moment to consider how you can minimise your risk of falling through controlling these listed items, for example placing non-slip mats in the shower, reducing clutter in frequently used walkways, having a bedside lamp to use when going to the bathroom in the middle of the night.

We hope you have found this blog helpful and please do call us for any questions or comments.

Reference:
Chapter 9 Shumway-Cook, A & Woollacott MH 2017, ‘Aging and Postural Control’, in M Nobel (ed.)Motor Control: Translating Research into Clinical Practice, 5th edition, Wolters Kluwer, Philadelphia, pp. 206- 228.

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Hip Bursitis

Hip Bursitis

What is it?

Hip bursitis is a fairly common condition, and involves inflammation of the bursae around the hip joint. The bursa are small fluid-filled sacs, and are present to reduce the friction between tendons and the bone and ensure that everything is able to move smoothly. However they can become inflamed and painful with overuse, trauma and incorrect muscle use or weakness. There are many, however the bursitis we most commonly see is the Trochanteric Hip Bursitis. The trochanteric bursa cushions the outside of the hip against the gluteal muscles (especially gluteal maximus) and the Iliotibial Band (ITB). It is the most commonly injured as these are muscles very commonly used and therefore give the bursa a lot of work!

What are the causes?

As mentioned earlier, there are a few key causes of bursitis:
Overuse (or muscles around the area) and repetitive stress – eg. With frequent running, jumping, squatting
Trauma – e.g. a fall directly onto the outside of the hip (where there isn’t much padding)
Incorrect muscle use and muscle patterns, causing altered biomechanics of the lower limb – this can also include weakness of the core muscles
Weakness in the deeper gluteal muscles (Gluteus Medius and Minimus), and tightness in the Iliotibial Band (a band that runs down the outside of the thigh). As a result of the weakness in the deeper gluteal muscles, the gluteus maximus (biggest gluteal muscle) is forced to work more than it should, and so places more pressure in the bursa, which over time causes irritation and inflammation, and pain.

Interestingly, there are recent studies to suggest that hip bursitis does not often occur on its own, and that there is commonly some element of Gluteal pathology – especially tendinopathy of the Gluteus Medius (the main stabilising glute muscle). This may be the causative reason for weakness in this area, however it is not known yet as to which comes first – the bursitis, or the tendinopathy.

What are the signs and symptoms?

Commonly, sufferers will have a sharp pain on the side of their hip (worst directly over the bony outer part of the hip, and often tender to touch). This pain may extend down towards the knee, or even upwards towards the lower back. In fact, as the lower back, hip and knee are so closely linked, it is not uncommon to see problems in all areas along with hip bursitis, including pain, stiffness and restricted movement of these areas.
Sometimes there will also be a visible swelling over the outside of the hip, or even just the feeling of swelling.
There is often difficulty lying down on the side (due to the direct pressure), or even on the unaffected side (due to the stretch). This may cause trouble with sleeping.
Walking is also aggravating, especially first thing in the morning, or after a busy day. A limp may be present. There may also be pain with sitting cross-legged, or rising out of a chair after sitting for a while.

What are the treatment options?

There are several options when it comes to improving pain and keeping the bursitis away.
Physiotherapy – this is highly successful for treating trochanteric bursitis. Initially, treatment will involve techniques to reduce the pain and swelling (eg. Ultrasound, ice, gentle massage, acupuncture, taping). Following this, your physiotherapist will aim to return full range of motion of the affected hip (and also lower back, knee if affected), correct any muscle imbalances around the hip and restore full function of the stabilising hip and core muscles, and work to eliminate any excess tightness that may be contributing to the problem. Due to the nature of trochanteric bursitis, and the danger of it recurring, a long-term program may be required.

Ice – due to the inflammatory nature of trochanteric bursitis. Ice for 15 minutes at least once per day, and also after aggravating activities
Anti-inflammatory medications
Cortisone Injections – this involves injecting a corticosteroid (anti-inflammatory) along with a local anaesthetic into the bursa in order to settle the inflammation and stimulate healing. A guided injection (usually via ultrasound) is preferred as it will assist with needle placement. Cortisone injections can be very helpful, however repeat injections have been shown affect tendon health detrimentally – it would be wise to discuss side effects with your GP.

What can I do to help?

If sleeping is a problem, it can be improved in the short term with a pillow between the legs, to level out the hips when laying on the unaffected side.
Driving can be aided by sitting slightly higher (so your hips are not as bent). This may involve lifting the seat (in newer cars), or simply sitting on a pillow. Do make sure you can still reach the pedals & drive safely however!
There are several helpful exercises that will assist in recovery and strengthening. These will ideally be performed after the initial healing phase is completed (that is, when the pain and swelling have diminished). These exercises should be performed within your comfort levels, without causing pain.

Seated gluteal stretch

Sit on edge of chair, cross one foot over the other knee, SIT UP TALL, and lean forwards
There should be a comfortable stretch in the buttocks, or even down the side/back of the leg
Hold 20 seconds, repeat 3 times each leg

Lying gluteal stretch (Single knee to chest)

Lying on your back, slowly bring one knee up towards the opposite shoulder as far as comfortable.
You should feel a gentle, comfortable stretch in your lower back, or buttocks
Hold for 10 seconds, repeat 5 times

Bridging

Start on your back with knees bent (no pillow is best)
Slowly roll pelvis/hips off floor, followed by one vertebrae at a time
Aim to lower down, one vertebrae at a time
Try 10 repetitions

Prone Knee Bend

Start by lying on your tummy, feel the front of your hips on the floor.
Bend one knee to 90 degrees and then slowly lift thigh off floor (the front of your hips should stay firmly on the floor)
Once lifted, straighten your leg in the air, then slowly lower your straight leg
Repeat 10 times each leg

Clamshells

Start lying on your side with knees bent slightly. Make sure your shoulders, hips and feet are in a straight line.
Keep your feet together, back still and gently open your knees apart.
Repeat 10+ times on each leg, or until fatigue
* This exercise is especially helpful as it targets the Gluteus Medius

Advanced Clamshells

As above, make sure your body is aligned well.
This time, lift your feet up, keep your lower knee on the floor and lift your knees apart.
Repeat 10+ times on each leg, or until fatigue

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How Can I Prevent Back Pain?

How Can I Prevent Back Pain?

How Can I Prevent Back Pain?

The latest research tells us that often people have never had a physical trauma to cause back pain like a car accident, falling, or lifting something heavy. There are usually a combination of factors that cause back pain which could include overuse, poor posture or other stressors.

Keeping in mind everyone is different, here are some expert tips:

Exercise! you can’t escape it, exercise is important for so many reasons, but a big one is preventing back pain. Muscles are meant to move. If you aren’t in good shape, you’re more likely to hurt your back and feel pain when you do even simple movements, such as getting out of the car. Exercise helps keep your joints fluid and your muscles strong.

Core & glute strength a regular strength-training routine that focuses on training your muscles to work together can help support your spine. Core muscles include your pelvis, lower back, hips and abdomen. Strong, activated glute muscles help protect your back from activities such as lifting a heavy object.

Eat well healthy eating habits can keep your weight down. Being overweight can put added strain on all of your joints, especially your spine.

Posture awareness be aware of how often you slouch over your laptop and iphone when texting. Take the time to take a break from long periods in front of the computer with a simple walk around the block or some hip-flexor stretches.

Reduce stress stress can impact your level of pain. Stress causes you to tense your muscles and constant tension can cause back pain. Take up a hobby or regular activity that helps you relax.

Sleep style for most, sleeping on your back can put pressure on your spine, pop a pillow under your knees to reduce this. If you’re a tummy sleeper, put a pillow under your pelvis. Side sleeping is generally the best way to go (but everyone is different!)

Lower back pain can be debilitating and can have a major effect on your daily life and work activities. Don’t let that happen to you, put in place some positive things today.

Physiotherapists are experts in the assessment of musculoskeletal injuries, especially spinal related pain, that’s why we can help you. We can help you with a strengthening home/gym-program for whole-body awareness, strength and posture improvements.

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Running and Osteoarthritis

Running and Osteoarthritis

Does running accelerate the development of osteoarthritis?

There are so many misconceptions about running and how bad it can be for your joints. You may have heard many friends and family members comment on this and they may have even tried to convince you to stop running and go swimming instead. Here is what the scientific research tells us so far:

Osteoarthritis (OA) is a musculoskeletal condition that involves degeneration of the joints and impact during weightbearing exercise such as running and may contribute to joint loads. There is very little evidence however, that running causes OA in the knees or hips. One study reported in 1985 by Sohn and Micheli compared incidence of hip and knee pain and surgery over 25 years in 504 former cross-country runners. Only 0.8% of the runners needed surgery for OA in this time and the researchers concluded that moderate running (25.4 miles/week on average) was not associated with increased incidence of OA.

In another smaller study of 35 older runners and 38 controls with a mean age of 63 years, researchers looked at progression of OA over 5 years in the hands, lumbar spine and knees (Lane et al. 1993) . They used questionnaires and x-rays as measurement tools. In a span of 5 years, both groups had some participants who developed OA- but found that running did not increase the rate of OA in the knees. They reported that the 12% risk of developing knee OA in their group could be attributed to aging and not to running. In 2008, a group of researchers reported results from a longitudinal study in which 45 long distance runners and 53 non-runners were followed for 21 years. Assessment of their knee X-Rays, revealed that runners did not have a higher risk of developing OA than the non-running control group. They did note however, that the subjects with worse OA on x-ray also had higher BMI (Body Mass Index) and some early arthritic change in their knees at the outset of the study.

Is it better to walk than to run?

It is a common belief that it must be better to walk than to run to protect your joints. In a recent study comparing the effects of running and walking on the development of OA and hip replacement risk, the incidence of hip OA was 2.6% in the running group, compared with 4.7% in the walking group (Williams et al 2013). The percentage of walkers who eventually required a hip replacement was 0.7%, while in the running group, it was lower at 0.3%. Although the incidence is small, the authors suggest the chance of runners developing OA of the hip is less than walkers.
In the same study, Williams and colleagues reinforced that running actually helped keep middle-age weight gain down. As excess weight may correlate with increased risk of developing OA, running may reduce the risks of OA. The relationship between bodyweight and knee OA has been well-established in scientific studies, so running for fitness and keeping your weight under control is much less likely to wear out your knees than being inactive and carrying excess weight.

Is there a limit?

Recent studies have shown that we should be doing 30 minutes of moderate exercise daily to prevent cardiovascular disease and diabetes. But with running, researchers still have not established the exact dosage of runners that has optimal health effects. Hansen and colleagues’ review of the evidence to date reported that the current literature is inconclusive about the possible relationship about running volume and development of OA but suggested that physiotherapists can help runners by correcting gait abnormalities, treating injuries appropriately and encouraging them to keep the BMI down.

We still do not know how much is “too much” for our joints. However, we do know that with age, we expect degenerative changes to occur in the joints whether we run or not. Osteoarthritis is just as common as getting grey hair. The important thing is that we keep the joints as happy and healthy as possible.

How do you start running?

If you are not a runner and would like to start running, walking would be a good way to start and then work your way up to short running intervals and then longer intervals as you improve your fitness and allow time for your body to adapt. Therefore, running in general is not bad for the joints. It does not seem to increase our risk of developing OA in the hips and knees. But the way you run, the way you train and how fast you change your running frequency and distance may play a role in future injuries of the joints.

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