Arthritis – Understanding Your Aching Joints

Arthritis
Arthritis is a condition affecting the joints, where the quality of the joint surface degrades and can lead to stiffness, tenderness, and swelling. There are several types of arthritis, the most common being Osteoarthritis (OA), affecting 1 in 5 Australians over the age of 45, or 1 in 3 people over 75 years old. OA is a multifactorial condition, with many contributing factors that lead to a decline in joint health. There are also other types of arthritis that can be due to autoimmune processes; like Rheumatoid Arthritis or Psoriatic Arthritis, so it’s important to be correctly diagnosed to get the care you need.

What is Osteoarthritis?
People commonly think of OA as “wear and tear”, but that isn’t entirely accurate. In fact, cartilage can respond quite well to load, as seen in studies of recreational runners that have shown their joint health to be superior to their inactive counterparts. Rather than just mechanical load on a joint (i.e. running, jumping, etc), OA is primarily caused by metabolic processes (i.e. chemicals, hormones and proteins in the blood) which can be directly improved with healthy lifestyle choices, such as diet and physical activity.

Osteoarthritis Management
People with arthritis often reduce their physical activity in an attempt to minimise the “damage”. They may start walking less and even cease the leisure activities they love most. But what they’re really sacrificing is cardiovascular health, mood, mental wellbeing, bone density, muscular strength, and increasing their risk of a variety of chronic conditions. And because OA has an important metabolic component, staying active can actually improve joint health!

There are several factors that can be utilised to assist in OA management.

  • Managing load; working out what activities stir up the joint pain and decreasing or modifying how they are undertaken.
  • Diet; healthy foods can assist in maintaining good metabolic function and decreasing inflammation, managing weight and boosting energy levels.
  • Pacing; having adequate rest and recovery between bouts of activity. This includes breaking up one long activity such as vacuuming the house, into shorter bouts with rest breaks or rest days in between.
  • Graded exposure; starting with a tolerable amount of activity and very gradually increasing your exposure to the activity, as tolerance rises.
  • Resistance training; build up muscle strength, balance and movement quality to decrease joint forces during activity

To learn more about Pacing and Graded Exposure, read our blog “Simple Tips for Living with Osteoarthritis”. For more information on the causes of Osteoarthritis and how to overcome it, read our blog “6 Golden Rules for Osteoarthritis Management”.

Overuse injury – The what, why’s and how’s answered.

What is an overuse injury?

An overuse injury, sometimes referred to as a chronic injury, refers to an injury that is associated with repeated stress or micro-trauma over time. Unlike an acute injury, such as an ankle sprain, over use injuries typically have no specific incident that caused the pain, rather it will typically gradually worsen with activity with a steady increase in pain. Common overuse injuries include tendinopathies, bursitis, stress fractures/bone stress and shin splints.

It is common to see overuse injuries in the athletic population however they can be seen in all population groups – whether your 10 years old starting netball for the first time, 37 and trying to return to a loved past time or 71 and wanting to start walking more, you must know your limits. Overuse injuries are often related to activities that require repetitive stimulus such as long distance running, swimming, occupation demands such as typing and computer mouse use.

What causes an overuse injury?

An overuse injury will occur for a number of reasons and is related to a break down of tissue structure when the load input exceeds the tolerable level for that specific tissue. Common causes of overuse injuries can include:
• A sudden and/or significant increased load; including but not limited to increased intensity of training, increased hours of training, increased frequency of training
• A change to training conditions; including but not limited to addition of hills, change of footwear, change of training surface
• Return to activity after period of inactivity – e.g. start of sporting season return to walking after surgery etc.
• Inadequate rest periods – leads to increased muscle fatigue and therefore increase load/reliance on tendons, bones and other structures.

How to prevent an overuse injury?

Given that the biggest and arguably only cause of an overuse injury is overload it goes without saying that the best chance at preventing an overuse injury is to follow a progressive loading program and avoid going in too hard too soon.

When starting a new exercise routine or looking at increasing your current training regime it is crucial to have a graded and steady increase. This may look like short periods of work in combination with periods of rest when starting running/walking/swimming or other exercise routines. Ensuring you take regular rest days in the early stages of beginning an exercise routine to allow for adequate muscle recovery is another vital key in reducing your risk of overuse and injury.

If you are an avid exercise goer and looking to increase or alter your current regime following the guidelines of progressive overload will limit placing too much demand on your body systems too soon. Progressive overload can be applied by changes to duration/intensity, frequency, exercise technique/execution or external load – in any of these cases an incremental increase of no more than 10% is advised to reduce the risk of overload and injury.

In the case of overuse injuries in day to day life or with work place demands consideration may given to desk ergonomics and/or technique of repeated movements to attempt to reduce strain on specific body parts that may be at risk over overuse.

How to treat an overuse injury?

Unfortunately due to the slow progression and repeated micro trauma of overuse injuries it is often too late for preventative measures by time your pain develops. If you develop pain that you believe may be an overuse injury it is important to seek medical advice to ensure you receive advise specific to your injury and needs.

When visiting your healthcare provider (Osteopath or Myotherpaist etc.) you can expect your practitioner to assess your tolerance to specific loads and determine a management plan to get you back on your way to achieving your goals. Things that may be considered in your long-term management may include:

• Resting without or without the use of a brace or aid if severely intolerant to load.
• Reducing provocative loads and activity – this may look like a 50% decrease in kms walked/run, or reducing frequency of sessions in the gym
• Limiting spring like loads such as jumping that place a large load through injured areas
• Implementing a exercise/rehab regime specific to your goals.

It is important to note that in all cases of overuse injury LOADING with exercise is essential for long-term recovery and prevention of re-injury. An exercise regime tailored to you is likely to include the following:

• Isometric exercises – those that involve holding a sustained position for an allocated time frame e/g. wall sits/planks etc.
• Isotonic exercise – those that involve moving a body part through its range of motions with or without external forces/load
• Plyometric/return to play – If your goals require you to return to sports/high levels of exercise your program will progress to a sports specific return to play plan
that will involve explosive efforts

glute bridge demo

In all cases you can expect a program to progress through different stages in line with what you are hoping to achieve and usually takes between 6-12 months for adaptations to occur – Rest assured this does not mean your pain will persist for this period of time!

In conjunction with a loading program your practitioner will work with you to reduce and manage your pain. This may be done through the use of braces/taping, manual therapy (such as soft tissue massage), Ice, Dry needling and/or anti-inflammatory medications.

When indicated your practitioner will also work to find underlying bio-mechanical imbalances or deficiencies in surrounding areas and guide you with the steps required to address these also – This may include looking at your hip when dealing with an Achilles (lower leg) tendinopathies.

Please note that this advice is generalised and we encourage you to seek further advice if you think you may have an overuse injury – For more specific advise or to get started on your journey to recovery from an overuse injury book an appointment with one of our qualified practitioners today!
Book an appointment online here today!
Tennis Elbow – in the non-tennis playing individual!
Tame Your Achilles Tendon Pain!

Simple Tips for Staying Active with Arthritis

Living with Arthritis

Living with persistent joint pain can make exercise seem like an impossible mission. However, movement is one of the best things you can do for a joint that has some arthritic changes. To better understand what arthritis is and what causes it, visit our previous blog “6 Golden Rules for Osteoarthritis“.

Motion is Lotion, Movement is Medicine

For too long the public have been led to believe that joints degrade as we age, and the more punishment you put it through, the more it degrades. However, movement is good for the joint.

  • Compression (eg: the impact on the knee during running and walking) stimulates growth of the good protective cartilage linings in the joint.
  • Movement can help with maintaining weight, which can help with reducing the load.
  • Building strength and muscle mass can help distribute the forces across the whole limb, rather than relying on the joint to take the weight.
  • Learning good movement patterns gives your body more options, so that it doesn’t rely on one joint too frequently.
  • Healthy lifestyle can decrease inflammation and have a direct improvement on pain and joint health.

Pacing

The key to exercising or doing daily tasks is pacing. Pacing means slowing down and doing less. If you’ve been in pain for a long time, or if you’ve been less active than in previous years, then it’s unlikely that you can do the same amount of physical activity. It’s about breaking up tasks into a series of smaller bouts. If your goal is to vacuum the house, you may need to do it one room at a time, having a rest in between each – whether that’s for a few minutes, an hour, or a day.

Graded Exposure

The second key component to increasing your pain-free activity is graded exposure. Graded exposure means steadily increasing your exposure to a given task or physical activity. If you’ve been vacuuming one room per day for the last 2 weeks and it hasn’t stirred up your joint pain, then you’re likely ready to increase to 2 rooms per day. After a couple more weeks you can likely do 3 rooms, then in another fortnight doing half the house. Over a period of weeks and months, you can slowly expose your body to the task that was once flaring it up.

Try This

Walking is often an aggravating activity, but usually people have an amount they can cope with before pain sets in. Think about your baseline, can you walk your block? Maybe walking to your letterbox is as far as you can handle? Whatever is your current yardstick, do that consistently for 2 weeks and then slightly increase the time or distance by 5-10%. Every 1-2 weeks increase your time and distance, ensuring you have lots of rest and recovery to complement it.

Runner Older

6 Golden Rules for Osteoarthritis

Osteoarthritis (OA) is an incredibly common condition that can affect anyone, but is usually more prevalent in people over the age of 40, or with previous joint injuries. The joints may feel stiff, make clicking or grating noises, and can become aggravated with activity. Source: Arthritis Australia

Osteoarthritis myths

It is a condition that sparks a lot of anxiety and fear, because for eons we’ve been told scary stories about this musculoskeletal boogeyman. You’ve probably heard it’s a “wear and tear” condition, along with other scary descriptors such as “bone on bone”, “degeneration”, “bone spurs”, etc. But those descriptions are both inaccurate and inappropriate. For the majority of people living with osteoarthritis, they are able to do just that; go on living! It may seem counterintuitive, but exercise and movement is perhaps the greatest medicine available for your stiff and sore joints.

Okay, not the boogeyman, what is it?

In OA the joint space does become narrower, as the cartilage that lines the bone becomes thinner. But it isn’t load and exercise that “wear and tears” the cartilage, in fact osteoarthritis is often less common in runners! Research shows us now that rather than just mechanical load on the joint (i.e. running, skiing, tennis, basketball, etc), it is caused primarily by a biological process (involving hormones, chemicals, proteins, etc).

Why does it hurt?

knee pain

All right, I can hear what you’re saying; “who cares why it happens, it still hurts when I use it!”, so allow me to explain. Understanding your pain is the key to reintroducing exercise in a safe and helpful way. The origin of your pain isn’t the cartilage itself – it doesn’t have any of the nerve endings that sense and transmit pain. It’s not the bone either – again, no nerve endings! Pain is an incredibly tricky phenomena that is best explained to you by a health professional with knowledge of your specific circumstances, I highly recommend talking to any of the Osteopaths or Myotherapists at Peninsula Osteopathy + Allied Health. Pain doesn’t indicate the level of change within the joint. Pain does not equal damage. Have you ever had a papercut? Ouch! Stubbed your toe on the coffee table? Stepped on a runaway Lego block? You get my point… Pain is an alarm, warning you of the potential for danger, but it’s not an alarm you’d rely on daily to get out of bed.

There are three main structural origins of pain in OA. Firstly, the periosteum, a thin tissue that covers the bone like Gladwrap. Second, the synovium, the tissue that encapsulates the joint, like a balloon. And lastly, inflammation and oedema, this is the influx of chemicals and hormones designed to heal the area. All three of these can contribute to pain in varying amounts, but there are other pain factors to address with your health practitioner, such as; sleep, stress, diet, mood, activity levels, comorbidities, and more!

What can I do about it?

After an OA diagnosis, people often try to minimise the “damage” by reducing their exercise, walking less and even ceasing the leisure activities they love most. But what you’re really sacrificing is your cardiovascular health, mood, mental wellbeing, bone density, muscular strength, and increasing your risk of a variety of chronic conditions. Exercise can improve the metabolic factors associated with your condition and allow you to move more efficiently. A progressive reintroduction to exercise, guided by a health professional, can improve your osteoarthritis and reduce your risk of other conditions.

6 Golden Rules

1. Talk to a health professional
The Osteopaths and Myotherapists at Peninsula Osteopathy + Allied Health can provide a thorough assessment of your condition, function, mobility, and strength. They can accurately diagnose your condition and answer any questions you may have about it. They can help to address lifestyle factors that may be contributing to your pain. They can provide expert manual therapy to ease the aches and pains associated with your condition. And they can help guide a progressive and individualised plan to get you up and moving!

2. Reconsider your X-Rays
X-Rays, MRIs and other images are useful tools for identifying sinister conditions, however it can often be alarming to see the different changes to our body on an image. Unfortunately, findings on imaging often correlate very poorly to pain and function1. People with no pain can have drastic irregularities on their images, and others in great pain can show next to nothing! Talk to your practitioner about what your images mean for you.

3. Aerobic exercise
This type of exercise involves raising the heart rate and is where a lot of the cardiovascular health benefits come from. Start small, doing a little more than you currently do, and gradually increasing it – under the guidance of your health professional. Walking, jogging, swimming, and cycling are great aerobic activities, but the best exercise is the one you enjoy doing. Maybe you used to play tennis, or maybe you want to get into golf, there is no shortage of ways to raise your heart rate and get moving.

4. Resistance exercise and balance
Moving your body against resistance and trying not to fall over. There are many bodyweight exercises that can achieve this, and with the addition of a few resistance bands or small weights, you’d never have to step foot in a gym if you didn’t want to. Again, speak to a health professional to learn which exercises will suit you, how to do them, and how often.

5. Diet and lifestyle
Familiarising yourself with Australia’s Dietary Guidelines can help guide you on the types of foods you should be eating on a regular basis. Diet and metabolism affects the hormonal and chemical processes that can increase joint pain and other health conditions. The odd Tim-Tam won’t hurt, you’d be shocked to see the food cupboard in the POAH tea room, but eating well as regularly as possible will go a long way to your health.

6. Don’t let pain rule you
If you wait for pain to dissipate completely before you begin exercising, you might never exercise. It is normal to feel some discomfort after increasing your activity levels, if your pain levels are tolerable and stable – within 3-4/10 – you shouldn’t fear continuing your exercise regime.

References
Guermazi, A., Niu, J., Hayashi, D., Roemer, F. W., Englund, M., Neogi, T., … & Felson, D. T. (2012). Prevalence of abnormalities in knees detected by MRI in adults without knee osteoarthritis: population based observational study (Framingham Osteoarthritis Study). Bmj, 345.

Jaw Pain? Look no further!

The letters TMJ stand for temporo-mandibular joint, the joint attaching your jaw to your head. You can feel it moving in front of your ears when you open and close your mouth.

Your jaw region contains muscles, bones, joints, ligaments and membranes which all play an important role in jaw function. Dysfunction or irritation to these structures can cause pain. Pain in the jaw can also be from distant structures, for example upper neck pain can refer to the face or even pain originating from the heart can be experienced as facial pain.

Problems with your TMJ can present as:

– Clicking or popping with jaw movement
– Locking with opening or closing of your mouth
– Pain with chewing, talking or yawning
– Tender points on muscles around the jaw
– Clenching of teeth throughout day or night

Treatment for TMJ dysfunction depends on the cause. If it is due to postural or muscular problems, osteopathic treatment can help to reduce your symptoms and relax any jaw muscle spasms you may be experiencing. Your osteopath may teach you some exercises or stretches to do after treatment, which will aim to help further reduce your discomfort. Jaw pain can be complex and may require a multi faceted approach. If symptoms persist you may require a referral to an orthodontist, or if problems are related to stress, implementation of stress management techniques may be required.

If you feel like any of the above symptoms are describing what you may be feeling, give us a call and we will do all we can to help!

3 TOP TIPS FOR YOUR HIPS

Hip Anatomy and Impingement syndrome:

The hip joint forms a solid connection between the lower limb and pelvic girdle, thus meaning it is designed for stability and weight-bearing rather than to offer a large range of mobility. The joint is a ball and socket joint formed between the thigh-bone (Femur) and the pelvis (acetabulum) and gains its stability from large supporting ligaments and muscles.

In the healthy hip joint the femoral head is able to glide smoothly within the socket of the acetabulum however this can be impaired in patients who suffer from femoral acetabula impingement syndrome (FAI). Hip impingement or FAI is a condition in which the structure of the hip joint become modified causing an impaired capability of the femoral head to move freely and smoothly within its socket. Typically this will present as stiffness or tightness of the thigh, hip or groin, poor ability to flex the hip past a right angle and pain in the groin or front of the hip when flexing the knee towards the chest, running/cycling or sitting for periods of time.

FAI commonly arises from high impact sports or exercises that involve a large amount of jumping, changing direction and recurrent movement of the hip joint outside its normal range (such as football, dancing and golf) placing excessive and abnormal load through the hip joint. The stress of ongoing excessive load can lead to either a thickening of the femoral neck (CAM lesion) or deepening of the hip socket (PINCER lesion), or a combination of both which over time can result in damage to the cartilage of the hip joint.

In other cases FAI can be present from birth and be largely asymptomatic until later in life.

What are my treatment options?

In some cases surgical intervention may be required for successful treatment of FAI however there are many conservative measures that can be taken to improve hip functionality and reduce symptoms associated with FAI.
Osteopathic treatment may be able to assist in reducing symptoms of FAI. It is not uncommon with FAI for the muscles of the hip, pelvis and lower back to become tight acting on further limiting the range of motion available at the hip joint. Treatment of soft tissue massage and muscle stretching techniques can be used to help relax and lengthen these muscles, assist in reducing inflammation and ultimately reducing pain.

Exercise based rehab focused around promoting hip mobility may also assist in the ongoing management and reduction of symptoms – Here we have provided you with 3 of our favorite at home stretches and exercises to give a try!

1. Kneeling hip flexor stretch

2. Pelvic bridges

3. Hip adduction stretch (Frog stretch)

If you are currently suffering from hip or groin pain and would like further personalised advice on treatment and management options feel free to contact the clinic today to discuss whether Osteopathy or Exercise Physiology may be able to get you back into what you love doing!

Say good bye to headaches and get on with your day!

Headaches describe any pain to the head or face and are one of the most common conditions amongst Australians, with 20-25% of adults suffering from chronic tensions type headaches.
Headaches can occur at any age and seriously weigh you down and interfere with your day-to-day life.
The good news is headaches are generally not serious, and can be easily treated. However, we recommend you consult with your doctor if you are suffering from any of the following:
• New type of headache that appears suddenly and is getting worse
• Symptoms of slurred speech, confusion, weakness in your limbs and drowsiness
• Headache that comes on suddenly when coughing, sneezing, laughing or movement
• Headache following serious trauma to the head or neck

Why do I have it?

If you have recently started a new medication or been involved in a traumatic incident resulting in a bump or knock to the head, it is likely that your headache has occurred as a secondary response to this. It is important to consult with your doctor in these circumstances.
Quiet often it may seem as though your headache has come on for no apparent reason and you can’t seem to figure out why, but there are a number of things that can lead to headaches. Typically when the muscles and joints of the neck become tight and aggravated this causes inflammation and stress that may manifest as a head ache and will often feel like tension or a pulsating feeling in the front, side or base of the head.
Common reasons that cause the neck to become aggravated and cause headaches include poor posture – particularly with desk based jobs and students, stress, poor/lack of sleep and eye strain/squinting.
Other causes of headaches include dehydration, skipping meals/poor nutrition, caffeine withdrawal and hormonal imbalances.

How long until I get better?

The time it will take for your headache to get better will depend on the cause of your headache. Once we determine the cause of your headache, it is easier to estimate how long till you will get better. With appropriate management and advice you can often say goodbye to your headaches within 2-4 weeks.

How do I get better?

Increase your fluid uptake. When you first feel a headache coming on drink plenty of water! Often a headache is our body’s way of telling us that we need to drink more water.
Rest – Getting plenty of rest is beneficial for both your physical and mental health and so can contribute to reducing your headaches. Allowing time to get adequate sleep and rest may help to reduce physical symptoms of headaches as it allows our body to recover. It may also assist in reducing stress within the body that may be resulting in maintaining persistent headaches.
Heat helps to encourage nutrient flow to tissues of the body and promotes muscle recovery. Therefor applying heat to the base of the skull at the end of a busy day can have lasting benefits in the treatment of headache disorders.
If you are still finding it difficult to shake those headaches, Osteopathic treatment may be beneficial. An Osteopath may be able to use a range of techniques including soft tissue massage, joint stretching and movement to address and correct postural imbalances that may contributing to your headaches. An osteopath may also be able to provide you with advice on correct desk set up, stretches and exercises to have you back on the road to recovery and on your way to a headache free life. Typically it may take 2-4 weekly treatments to get on top of your headaches, followed by 2-3 fortnightly – monthly reviews.
If you require more specific advice relating to your headaches or aren’t having success with the above consult with your health care professional.

What can I do to stop it coming back?

There are a number of at home stretches and exercises that you can perform to reduce your likelihood of experiencing headaches we have outlined a few below for you to try.
Taking regular breaks whilst sitting at a desk for work and/or study is essential in maintaining and preventing your headaches. Taking 30 seconds to stretch out the muscles in your neck will help to keep the muscles in a healthy state and contribute to overall neck mobility.
Whilst sitting at your desk for work or study try to pull your shoulder blades back and down towards the ground to assist in achieving optimal posture.
Keeping mobility through the mid back and neck assists with keeping joints healthy, and may decrease your headaches. A simple exercise to maintain mobility in these regions is the cat and camel exercise. This is performed on all fours and involves alternating between drawing the spine to the ceiling to form a “hump” (like a camel), and drawing the spine towards the ground and looking up to the roof (like a happy cat).
As most of us spend majority of our time at our work stations, having an independent assessor come in to evaluate your desk/station set up to ensure it is in a way the best benefits your health. An optimal work-station set up will limit extension through your neck and therefore decrease strain through the muscles at the back of the neck. This can easily be achieved by altering computer screen height, desk and chair height. A workplace ergonomic assessment can be organised with assistance from a healthcare professional.

The osteopaths at Peninsula Osteopathy + Allied Health are all qualified to assess the cause of your headache, and can offer treatment and management advice! Call us on 5253 2345 or book online today!

Is your low back holding you back? Here’s how to manage it!

Managing your low back pain

Most of us have had some sort of low back pain before. From a minor ache and tightness that resolves in a couple of days to more intense, sharp pain that can take a little bit longer and be much more intimidating and frightening!

Regardless of the severity and the duration, there are a few things you can do to make sure that the pain doesn’t linger and affect your life anymore than it has to.

These are some tips we end up saying to the majority of people who present to us with various types of low back pain.

But of course, if there are more serious symptoms like pins and needles, numbness and weakness in your legs then it is important you seek a healthcare professionals opinion.

Keep moving and stay at work

This is probably the most important thing that you can do. Movement is the best medicine for any episode of low back pain. Go for gentle walks and do some gentle stretches. Keep that back moving. Also returning to work and if needed, returning with modified duties improves your chance of recovery and decreases how long your low back pain will hang around for. Some activities may need to be modified to make them easier for you to do and your healthcare professional can help you with this.

Use heat, not ice

A lot of confusion about whether to use heat or ice exists in the community. Of course it depends on the type of your back injury, but generally in acute back injuries or in back injuries that have lasted a long time there is unlikely to be much inflammation, so icing the affected area is unlikely to help. Using heat instead can help relax and decrease the tension in those tight back muscles and help you feel and move better.

Hands-on treatment can help

Your healthcare professional (osteopath etc.) can give you information on what is happening, why you are in pain, recognise if something more sinister is going on and educate you on what you should and shouldn’t do. They can also help relieve some of those aches and pains and give you stretches and exercises to help keep you moving.

Some medications may help, but try conservative treatment first

A great adjunct to movement and hands-on treatment is the addition of certain medications. Speak to your doctor or pharmacist about what may be suitable for you, dependent on your past medical history and complaints. This may not be a long-term option so it is important that medication is used in conjunction with some of the other strategies we have mentioned above.

Stay positive

Above all else, stay positive. Most episodes of more acute low back pain settle within a few weeks and rarely have a longer lasting impact on your quality of life. Keep moving, modify a few things and let the body do its job. Our bodies are amazing at healing themselves and some things just take time.

For personalised advice regarding your low back pain come in and see one of the PO+AH team to help you on your recovery.