We are experts at delivering evidence based clinical exercise prescription and lifestyle modification guidance. We skilfully and respectfully combine our expertise to inspire, educate and motivate our clientele as they face new obstacles and strive for change. We will achieve our goals by collaborating and developing our diverse skill sets, by being flexible in our thinking and behaviour, and being persistent. We will employ people who share our goals and who have the skills that we will support and enhance to achieve those goals.
24 Yuille St, Frankston South
Melbourne
Victoria
3199
Australia

OSTEOPOROSIS & EXERCISE

By Ben McGregor, Accredited Exercise Physiologist



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World Osteoporosis Day has recently been celebrated so it’s only fitting that we talk about the role of exercise in the prevention and treatment of osteoporosis and bone fractures.

What is Osteoporosis and Osteopenia?

Osteoporosis is a skeletal disease characterised by weak and brittle bones due to very low bone mineral density (BMD). Unlike the model skeletons we sometimes see at our GP’s office, bones do not stay the same forever, they change over our lifespan as well as due to environmental factors. Development of BMD is most potent during childhood and adolescence, and then it begins to peak around 35 years of age during adulthood.

Once our peak bone mass occurs, osteopenia begins to naturally take place throughout the subsequent decades into advancing age (50+) and this is where our ability to form new bones is slower than our ability to break down old bones. Unlike osteoporosis, osteopenia isn’t a disease, but a stage in our lives where our bone mass is lower than it once was when we were younger.

It is around this time where we should be vigilant about our bone health and see our doctor.

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Who gets Osteoporosis?

1 in 3 men and 2 in 3 women over 60 are affected by osteoporosis or osteopenia.

Despite its prominence, osteoporosis flies under the radar and is often undiagnosed until a fracture occurs. Even if you aren’t a woman or man over 50 years old, or if you haven’t experienced a fracture to the hip, spine or other sites of the body, you may still be at risk of osteoporosis due to a variety of potential factors.  

 Before referring for a scan, your GP may assess you for osteoporosis risk factors, these include:

  • Parental history of fracture or osteoporosis

  • Post-menopausal

  • Over 50 years of age

  • History of falls

  • Low physical activity or physical inactivity

  • Low body weight

  • Low muscle mass and strength

  • Poor balance

  • Smoking and drinking (over 2 standard drinks per day)

  • Anti-androgen therapy

  • Corticosteroid medication (taken over 3 months)

How does exercise help?

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Exercise and physical activity play a vital role in the development and maintenance of BMD. Our body is incredible in that it adapts to the demands placed upon it and the surrounding environment. The bones are no different. As mentioned previously, bones do not form and stay there forever, they are dynamic in nature and respond very well to external loads. Gravity is an external load our body is very much used to when standing upright (body weight). However, to experience bone growth and strengthening, we must place our bones under greater loading (2-4+ times body weight). This can be achieved through:

  • Walking

  • Running/ Sprinting

  • Jumping/ Power exercises

  • Strength/ Resistance training

Additional to promoting bone growth, these exercises also help strengthen the surrounding muscles of the bones, assisting us with stronger and quicker movements that can help prevent us from injuries and falls. Falls prevention is very important for osteoporotic bones, as they are too brittle and weak to withstand the impact of a fall, greatly increasing the risk of fracture. When we lose our balance, and begin to fall, we recruit certain strategies to help protect us from (serious) injury. If our legs are strong enough, coupled with good balance then we can quickly adjust our centre of gravity to remain upright. Hence, the inclusion of balance training is so important, focusing on improving our ability to stand upright and move dynamically and help prevent falls in the first place, decreasing the risk of fracture!

Well, I have osteoporosis/ osteopenia, what now?

With the help of an accredited exercise physiologist, an exercise program consisting of high impact training, resistance training and balance training to assist with falls prevention can be implemented to not only prevent and/or treat osteoporosis but also reduce risk of fracture.

Physical activity is a major piece of the puzzle, one that the team down at Pace Health Management would love to help piece together. For additional information or support, contact one of our Accredited Exercise Physiologists to help look after your bone health!

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Ben McGregor

 

 

 

 







Return to Work & Chronic Pain

By Josh McCarthy, Accredited Exercise Physiologist

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You’re constantly told that it’s all in your head or your injury is healed so you have nothing to worry about and you should be able to return to work. But despite all of that you still feel pain and its having a significant impact on your life. Understanding chronic pain and the changes that occur to the body is an important treatment strategy in return to work programs where pain is a limiting factor.

What is pain?

Pain is a protective mechanism which stops us injuring ourselves by producing a very unpleasant signal to the brain. An example of this would be when you place your hand on a hot plate, you move your hand quickly due to the unpleasant pain. If you move it quickly enough you are unlikely to have burned yourself.

In the short term, pain is very useful and serves us well but when pain is persistent and lasts more than 3 months it can become dysfunctional and be a hindrance to our wellbeing. This can be even more significant in the context of returning to work.

The impact of chronic pain on work

Chronic pain is responsible for an estimated 9.9 million absent days from work each year, which costs the economy $1.4 billion per annum, while the total cost of lost productivity is estimated at $11 billion per annum. Not only is there an economic and productivity cost associated with chronic pain, in 2007 it was estimated that there was a $7 billion direct health care costs. Implementing early intervention and adoption of evidence-based treatment could halve the economic cost of chronic pain.

How does exercise help?

All the research shows that exercise works best for chronic pain when it is delivered with education and knowledge about the individual’s condition, physical activity and pain. More specifically, exercise helps your body produces its own pain relieving medication (e.g. endorphins) that work like the pain medication doctors prescribe. After a bout of exercise your pain tolerance increases, things hurt less, and this can last for up to an hour depending on the exercise.

Additional benefits of exercise include:

  • Promote work specific strengthening to improve capacity and reduce reinjury

  • Maintain muscle mass and cardiovascular fitness

  • The nervous system winds down promoting relaxation

  • Reduced flare-ups

  • Improves mood and helps with anxiety and depression.

The most effective treatments for managing pain are active therapies rather than passive treatment such as massage, manipulation and braces. There is no ‘one size fits all approach’ that will fix pain, it’s about creating a individually tailored program. Any prescribed exercise program should be enjoyable, avoid excessive flare ups of pain and focus on consistency.

The best thing to do is to find an accredited exercise physiologist and other health professionals who understands and can explain pain. Be wary of any practitioner who claims to be able to fix your pain after treatment. It is likely that they do not fully understand the complexities of pain which will result in poorer outcomes.

 

References:

Exercise is Medicine Australia. Chronic Pain and Exercise. Retrieved August 20, 2018 from http://exerciseismedicine.com.au/wp-content/uploads/2016/11/2014-Chronic-Pain-FULL.pdf

Painful Facts. Retrieved August 20, 2018, from http://www.painaustralia.org.au/about-pain/painful-facts

 

TO FIND OUT MORE SPECIFIC STRATEGIES TO MANAGING CHRONIC PAIN AND RETURN TO WORK PROGRAMS, PLEASE CONTACT US ON INFO@PACEHM.COM.AU OR 9770 6770.

KNEE PAIN

By Vanessa Joyce, Accredited Exercise Physiologist

 

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Knee Pain

Exercise has consistently shown to be beneficial for those with knee pain resulting from varying musculoskeletal conditions including osteoarthritis, total knee replacements, ligament strains, meniscal injuries, patellofemoral pain and iliotibial band syndrome. The benefits of exercise and general guidelines for exercising with these common conditions will be explored below.  

 Patellofemoral pain

Patellofemoral pain (PFP) is a common cause of knee pain, most prevalent in physically active individuals between 15-30 years of age. The cause of patellofemoral pain is multifactorial, whereby altered alignment of the hip, knee and ankle joints causes excessive stress on the knee joint, leading to and pain surrounding the knee cap (patella). This pain is present during activities such as running, squatting and ascending and descending stairs. 

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As the contributing factors leading to patellofemoral pain are varied, a tailored exercise program involving specific stretching, releasing and strengthening to improve the altered alignment of the hip, knee and ankle joints should be prescribed. Excessive loading of the knee joint during exercise and daily activities should be avoided in order to prevent the exacerbation of knee pain and discomfort .

Iliotibial Band Syndrome

Iliotibial band syndrome is a common cause of knee pain, seen mostly in endurance athletes and runners. With repeated bending and straightening of the knee joint, the iliotibial band becomes irritated and inflamed, causing pain on the outside of the knee.

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High running /walking volumes and muscle imbalance through the hips, knees and ankle joints are the main contributors leading to the irritation of the iliotibial band. Treatment should involve activity modification, reduction in running volume, and prescription of a specific stretching and strengthening exercise program with a focus towards improving the strength of the gluteals. As the iliotibial band is inflamed through repeated knee bending and straightening, exercises involving these motions should be limited to avoid recurrence of pain.

Meniscus Tears/Repairs

The meniscus are tough cartilage located in the knee joint between the shin and thigh bone, responsible for distributing load and shock absorption through the lower limb.  As the thigh bone pivots on the shin bone, it can trap the meniscus, leading to tears. If symptoms are present during daily activities, the meniscal tear may need to be repaired through keyhole surgery.

A rehabilitation program for meniscal tears and repairs should focus on restoring range of motion and strengthening the quadriceps, particularly the vastus medialis obliquus (VMO; the key stabilising quadricep muscle). As pain is exacerbated by the forces of extreme knee bending and rotation, these motions should be avoided in your exercise program and in daily activities. 

 Anterior Cruciate Ligament reconstructions

The anterior cruciate ligament (ACL) prevents the thigh bone from moving forwards on the shin bone and rotation of the knee. It is commonly injured during knee hyperextension, rotation, deceleration, landing and high force contact at the knee joint. The decision the treat an ACL tear with surgery will depend on various factors, however it is common for a completely torn ACL to be surgically repaired. 

As there are a number of successful ACL rehabilitation protocols (for example; accelerated and gradual), your surgeon and treating exercise physiologist or allied health professional will provide direction on the most appropriate. Where reconstruction surgery has taken place, the rehabilitation program will depend on the type of graft used, type of surgery completed, the surgeon’s preferences and any other injuries which may influence the exercise program. The intensity and loading of range of motion, strengthening and functional exercises will be tailored with consideration to the tissue healing timeline in order to ensure safety and maximise outcomes.

 Total Knee Replacement

Total knee replacements are a successful surgical procedure to improve quality of life for those suffering severe osteoarthritis. After total knee replacements, exercise is prescribed to reduce pain and swelling, improve range of motion, strength, walking tolerance and allow a return to pre-surgery functional capacity.

 After surgery, stretching and mobility will commence to regain loss of motion in conjunction with muscle strengthening for the quadriceps. Education will be provided regarding techniques for positional changes such as lying to sitting, sitting to standing and standing to walking to ensure safety during these activities.

Individuals should also comply with using gait aids when prescribed (eg. 4 wheel walker and frames) and follow guidelines on their weight bearing capacity during rehabilitation.

 Osteoarthritis

Osteoarthritis is the most common form of arthritis and is characterised by progressive degeneration of the cartilage, narrowing of the joint space and surrounding muscle weakness. Osteoarthritis is frequently diagnosed in the knee joints and contributes to pain and impaired daily function.

Regular exercise, specifically aerobic conditioning, stretching and strengthening exercises which target the stabilising muscles of the knee and hip have been shown to improve the symptoms of osteoarthritis. Water based exercise has also been shown to reduced pain and discomfort and improve function. It is recommended that individuals with knee osteoarthritis avoid high impact and repetitive force type exercises such as running and jumping as the elevated joint load may cause joint swelling and pain.

Exercise prescription

Self-myofascial release (spikey ball and foam rolling), and stretching/mobility exercise for the hip, knee and ankle can assist the restoration of range of motion, reduce muscular tension and improve patella (knee cap) alignment which may be a contributing factor to knee pain. The gluteals, iliotibial hand, tensor fascia late, quadriceps, hamstrings and calves are commonly targeted muscles for stretching, myofascial release and mobility exercises when addressing knee pain.

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Strengthening of the quadriceps muscle group, primarily the VMO, will assist in stabilising the patella and improve its ability to maintain proper alignment during activity. Gluteal and core strength is also an integral part of any lower limb exercise program given their impact on knee alignment and pelvic stability in functional tasks such as walking. Improving the strength of remaining lower limb muscles (eg. hamstrings, calves, foot muscles) will also produce positive effects for knee pain through providing support to the knee in daily activities. Balance and proprioception exercises will be added to ensure safety in return to activity, improve muscular control and reduce risk of falls. Depending on client history and goals, plyometric and activity/sport specific exercises will commence following the strengthening phase of rehabilitation.

 It is important to remember that differing types of exercises (eg. closed vs open chain, isometric vs isotonic muscle contractions, eccentric vs concentric contractions) provide different stress to the knee joint and thus should be prescribed according to the pathology and its evidence based rehabilitation protocols. An exercise physiologist is a tertiary qualified health professional who delivers evidence based exercise prescription to assist the management of acute or chronic medical conditions, injuries or disabilities. Following an initial assessment, your exercise physiologist will prescribe, monitor and progress your tailored exercise program according to your specific condition, capabilities and goals in order to achieve optimal outcomes.  

For more information please contact PACE Health Management and speak to one of our team members. 

Ph: 9770 6770

 

Houglum, P. (2016). Therapeutic Exercise for Musculoskeletal Injuries, 4th edition, USA, Human Kinetics.

Anderson, M., Parr, G.P. (2013). Foundations of Athletic Training; Prevention, Assessment and Management, 5th edition, Philadelphia, Lippincott Williams & Wilkins.

Harmer, A.R., Naylor, J.M., Crosbie, J., Russell, T. (2009).Land-based versus water-based rehabilitation following total knee replacement: A randomized, single-blind trial. Arthritis Care & Research. 61(2):184-91.

López-Liria, R., Padilla-Góngora, D., Catalan-Matamoros, D., Rocamora-Pérez, P., Pérez-de la Cruz, P., Fernández-Sánchez, M., (2015). Home-Based versus Hospital-Based RehabilitationProgram after Total Knee Replacement. BioMed Research International. 2015, (Article ID 450421) 1-9

Focht, B.C., (2006) Effectiveness of Exercise Interventions in Reducing Pain Symptoms Among Older Adults With Knee Osteoarthritis: A Review. Journal of Aging & Physical Activity. 14(2): p. 212-235.

Wu, S.F., Kao, M.J., Wu, M.P., Tsai, M.W., Chang, W.W.,(2011) Effects of an osteoarthritis self-management programme. Journal of Advanced Nursing, 67(7), 1491-501.

Vincent, K.R. and Vincent, H.K.,(2012) Resistance exercise for knee osteoarthritis. American Academy of Physical Medicine and Rehabilitation, 4(5), S45-52.

 

 For more information and guidance on exercising with Knee Pain please contact us at PACE Health Management and speak to one of our exercise physiologists Ph 9770 6770.

 

 

 

FIBROMYALGIA

By Lisa Bufalino, Accredited Exercise Physiologist

 

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What is Fibromyalgia?

Amongst today’s current population there are 3-6 % of individuals suffering from a complex rheumatic disease, 75-90% of those diagnosed are females. What is the name of this debilitating condition?  Fibromyalgia Syndrome.

The exact cause of developing fibromyalgia is currently unknown.  The condition presents as musculoskeletal pain and general body fatigue, sleep disturbance, headaches, memory impairment, anxiety, depression as well as digestive problems. This very complex disease was initially classified based on widespread pain for at least 3 months; that is, pain on the left and right hand side of the body as well as below and above the waist. Typically, fibromyalgia is known to affect 11 out of 18 tender point areas throughout the body. These areas are inclusive of the occiput, lower cervical spine, trapezius, supraspinatus, second rib, lateral epicondyle, gluteal, greater trochanter and the knee.

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More recently a subjective approach to pain (the Widespread Body Pain Index and a Symptom Severity Scale that acknowledges memory issues, sleep disturbance and fatigue) has been used for diagnosis.

Living with Fibromyalgia:

Those who suffer from fibromyalgia are often left feeling frustrated and exhausted. The condition will impact levels of fatigue and muscle pain which can result in extremely reduced physical strength of the upper and lower body, resulting in the inability to complete their activities of daily living. Often the individual can have difficulty with tasks such as walking down the street, taking the rubbish out, gardening or even cleaning. Additional issues associated with fibromyalgia are as follows:

  • Sleep disorders

  • Gastrointestinal issues

  • Impaired cognitive function

  • Psychiatric disorders (e.g. anxiety and depression)

It is important to note that the debilitating symptoms of the disease can in turn affect social surroundings of family, friends and work life which may suffer as a result of the severity of their symptoms.

 How exercise physiology can help:

Quality of life for those with fibromyalgia can be improved not only by medication but with exercise. An exercise physiologist will take a physical therapy approach with a goal to manage and improve pain, fatigue, muscle weakness, sleep and overall health. In the bigger picture this will increase quality of life.

Due to the high prevalence of wide spread pain throughout the body there is often inactivity amongst this population. Recent studies have explored the effects of exercise in conjunction with connective tissue massage and found that this may be a superior way of improving pain, fatigue and sleep. Research has also indicated restoration and maintenance of strength, aerobic capacity, mobility, balance and functional abilities will all benefit from a combined exercise and massage method. Not to mention regular exercise will positively impact a depressed mood and the overall perspective of pain.

Even though exercise is probably the last thing an individual with fibromyalgia might feel like doing, if completed regularly it has the ability to work wonders.  Exercise will reduce pain and the amount of tender points throughout the body as well as increase strength and cardiovascular fitness which will improve the ability to complete daily tasks.

Appropriate exercises for those with fibromyalgia:

Individuals with fibromyalgia will benefit from a variety of regular, low impact exercise modes.  To improve fitness and reduce pain and fatigue, aerobic exercise is best suited. This includes modes such as:

  • Walking

  • Swimming

  • Water aerobics

  • Cycling

As muscle weakness is a common symptom for those with fibromyalgia, it is important to strengthen major muscle groups of the upper and lower body that are responsible for completing daily tasks.  This can be done by completing supervised resistance training with:

  • Therabands

  • Light weights

  • Own body weight

  • Cable/ gym machines

Research has also found that exercise that acts as a multicomponent intervention can be excellent for fibromyalgia. This type of exercise integrates the physical, psychosocial, emotional, spiritual and behavioral elements effected as a result of the symptoms experienced with fibromyalgia can be beneficial. This includes modes such as:

  • Tai Chi

  • Yoga

 

For more information and guidance on exercising with fibromyalgia syndrome please contact us at PACE Health Management and speak to one of our exercise physiologists Ph 9770 6770.

 

 

Wolfe, F., Smythe, H. A., Yunus, M. B., Bennett, R. M., Bombardier, C., Goldenberg, D. L., ... & Fam, A. G. (1990). The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology, 33(2), 160-172.

Wolfe, F., Clauw, D. J., Fitzcharles, M. A., Goldenberg, D. L., Katz, R. S., Mease, P., ... & Yunus, M. B. (2010). The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis care & research, 62(5), 600-610.

Wang, C., Schmid, C. H., Fielding, R. A., Harvey, W. F., Reid, K. F., Price, L. L., ... & McAlindon, T. (2018). Effect of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial. bmj, 360, k851.

The National Fibromyalgia Association (2018). Prevalence. Retrieved from   http://www.fmaware.org/about-fibromyalgia/prevalence/.

Celenay, S. T., Kulunkoglu, B. A., Yasa, M. E., Pirincci, C. S., Yildirim, N. U., Kucuksahin, O., ... & Akkus, S. (2017). A comparison of the effects of exercises plus connective tissue massage to exercises alone in women with fibromyalgia syndrome: a randomized controlled trial. Rheumatology international, 37(11), 1799-1806.

https://arthritisaustralia.com.au/managing-arthritis/living-with-arthritis/physical-activity-and-exercise/exercise-and-fibromyalgia/

 

MENTAL HEALTH & EXERCISE

Written By Ben Southam - Accredited Exercise Physiologist

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Mental Health has been thrust into the spotlight over the past few years and with good reason too. Recent statistics show that 45% of Australians will suffer a mental health condition in their lifetime while right now 1 million Australians are suffering depression while a further 2 million Australians are suffering from anxiety.

We continually see great work being done by organisations such as beyond blue & headspace which have changed the mindset of the general population and demonstrated that Mental health needs to be respected as a health condition similar to that of a torn ACL or type 2 diabetes instead of frowned upon like it may have been in the past. It is through this great work that new research and treatment options have become available to assist those suffering from depression and anxiety.

From this, further exploration has been done on the benefits exercise can play in improving mental health. Research has shown that exercise may be just as effective, if not, more effective than medication and psychotherapy at reducing symptoms associated with mental illnesses. During and after exercise, our body releases chemicals, including serotonin and endorphins, which act as our ‘feel good’ hormones, making us feel more energetic and positive.

So what else has research found?

  • Just one session of exercise can have the ability to lower anxiety, having similar effects to medication
  • Exercise can lower anxiety long-term and make you feel calmer and in control.
  • When suffering from depression, research has shown that exercise can halve a persons perceived feeling of depression and more than 40% of people will stay that way for at least 3 months.
  • Active individuals are also 45% less likely to develop symptoms of depression.
  • Improved mood and self-esteem
  • Decreased stress levels
  • Increased social participation and feeling of belonging
  • Improved sleep quality

As Exercise Physiologists we will always strive to assist all people in improving their quality of life and general “healthiness” by assisting people with their physical activities levels, knowledge of exercise benefits and health coaching. So how much exercise should be done?

Just 20-40 minutes of aerobic exercise (i.e. brisk walk, jogging, riding, swimming) can be enough to improve anxiety and mood for several hours. Non-aerobic activity (i.e. yoga, strength training and relaxation) has also been shown to reduce anger, depression and confusion. Exercising regularly (daily) will have a more positive effect on mental health.

Never exercised before or starting back up? Top tips:

  • Start small (15 minutes of walking per day) and build up gradually (to 30 min per day)
  • Select an activity you enjoy
  • Exercise with a friend or family member
  • Choose places that you are familiar with and don’t increase anxiety levels
  • Use a pedometer or other apps to count you daily steps. (aim for 10,000)

With new research continually coming out in regards to exercise benefits and mental health, it is time to identify that this modality should form a vital role in helping people manage mental health appropriately.

“Physical activity is the most natural and accessible means to improve mental health”

– Poirel et al 2017

Refer to the links below for more information on exercise and mental illness:

https://www.beyondblue.org.au

http://exerciseismedicine.com.au/wp-content/uploads/2016/11/2014-Depression-FULL.pdf

http://www.exerciseismedicine.org/assets/page_documents/EIM%20Rx%20series_Exercising%20with%20Anxiety%20and%20Depression_2.pdf

http://exerciseright.com.au/dementia-alzheimers-disease/

http://exerciseright.com.au/mental-health/