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World Diabetes Day – Physio Tips

World Diabetes Day is a nominated day of awareness, featured around a yearlong campaign of diabetes education and prevention, engaging millions of people worldwide.

Type 2 Diabetes Mellitus (T2DM), or non-insulin dependent DM, is a lifestyle related disease that is rapidly increasing throughout the population at an alarming rate. Centered on the basis of poor glycemic control, T2DM has many lifestyle components involving both diet and physical activity. There is much research indicating that there is a greater likelihood to developing the disease with an insufficient amount of physical activity, otherwise a highly sedentary life. As little as 210 minutes of moderate intensity exercise, or 125 minutes of high intensity exercise per week has been shown to improve cardiovascular fitness, and body composition profiles in people with T2DM or pre-diabetes, as well as reduce the cardiovascular risk profile in those without, along with improving glycemic control.

Pilates is a great way to increase your physical activity through low impact exercises. Based in a studio, Pilates aims to strengthen and lengthen muscles to support everyday activities, along with improving core strength and postural awareness. Pilates programs can vary in intensity and can be specifically tailored to suit any individuals level of fitness and goals.

Due to the high incidence of co-morbidity in those with T2DM, it is also recommended that individuals be assessed by a Physiotherapist prior to the implementation of exercise programs, and that they be designed and delivered by appropriately qualified individuals such as Physiotherapists and Exercise Physiologists.

How to improve cycling technique

With the recent publicity cycling has gained you may have decided to increase or begin your participation in the sport.  As physios we see a lot of injuries from cycling, not only the ones inflicted by cars, but also overuse or poor technique injuries.

Often patients present to us following an increase in training or a change in technique to improve power and speed.  A misguided conception is that the more time spent on a bike the better the cyclist will become.  While this is somewhat true, focusing on technique rather than hours on the bike might prove to be more worthwhile.

Good cycling technique involves understanding how muscles work most efficiently.  A muscle’s ability to develop power is dependent on the length tension relationship.  Put simply a muscle at its shortest or longest length has difficulty optimally generating tension.  A muscle works best at its mid-length.

When related to the cycling action the quads and gluteals are at an optimum during the push phase to generate power .  Likewise the hamstrings and calf muscles work optimally across the bottom of the revolution, not on the upstroke. The drive for the upstroke or pull phase comes from the opposite leg.

A common mistake when increasing speed is to use the dominant leg to push and pull the pedal creating poor efficiency and possibly resulting in injury.  When training to increase speed the cyclist should work on increasing the push phase on both the dominant and non-dominant leg as well as the pull of the hamstrings across the bottom of the revolution not when the knee is bent back behind (as illustrated below).

Specific exercises can assist in training the strength and power generation of the gluteals, quads, hamstrings and calves.  If you want to kick start your cycling prowess or just wanting to prevent injury come in and we can discuss your technique and tailor an exercise program to improve your speed and aid injury prevention.

Are your glutes weak?

One of the largest and most powerful groups of muscles in the human body is located in the buttocks. Consisting of the gluteus maximus, gluteus medius and gluteus minimus — collectively known as “the glutes”. These muscles are important to most of the body’s active movements. If they are weak or underdeveloped, bad posture and numerous health problems can result.

How do “glutes” become weak?

1. Inactivity  as we spend most of our day sitting on them
2. Following an injury (low back, hip, knee or ankle) the glutes can ‘turn off’ to prevent further compression or pain
3. After an episode of pain we will avoid movement because we are scared they will cause pain.  This leads to decreased use of muscle.

Some very common conditions that we see in the clinic that can be directly related to glut weakness include:

1. Trendelenburg sign which can lead to injuries to the lumbar spine, sacroiliac joint (SIJ), greater trochanter bursa, overactivity of piriformis and tensor fascia lata (TFL)
2. “Knocked knees” can lead to injuries to the patellofemoral joint, patella tendon and fat pad.
3. Same-sided shift of trunk (lateral flexion of trunk) can lead to injuries to the lumbar spine due to increased disc and facet joint compression or SIJ due to increased shear forces.

Physiotherapy can improve glut strength

Our physios can conduct a thorough assessment to establish which glut muscles are weak and prescribe an exercise program to improve recruitment, strength and endurance.  This includes specific muscle training to help recruit muscles and improve control and strengthening exercises to assist in strengthening and improve efficiency of the muscle.

Strengthening exercises of the “glutes” can help to reduce any secondary problems associated with the weakness by helping with stability and function of the joints.  The gluteus medius and minimus are important lateral stabilizers of our pelvis.  The major purpose of this is to prevent tilting of the pelvis.  This is important as it allows our swing foot to clear the ground when walking and provide a stable base for our lower back.  The glut max is our power muscle giving us strength to get out of a chair, climb up stairs and sprint up hills.

So get your butt into gear this summer (your body will thank you)!

Are your bones strong enough?

A recent article in the Sydney Morning Herald reported a third of Australians over 65 years are doing no exercise, and many more are not doing enough to improve strength, co-ordination and balance.  The Australian Journal of Science and Medicine in Sport published a study that revealed the older population mostly took part in aerobic activities such as walking, which is beneficial to cardiovascular fitness but does little to protect the exerciser against falls or loss of bone mass.

Osteoporosis is a chronic, progressive disease and is one of the most common metabolic bone diseases in people over 65. It has been most frequently recognized in elderly women, although it does occur in both genders, all races, and age groups. It is characterised by low bone mass and deterioration of bone tissue, with a consequent increase in bone fragility. Unfortunately the disease often does not become apparent until a fracture occurs (usually from a fall).

Another term that is linked with osteoporosis is osteopenia. Osteopenia refers to a bone mineral density (BMD) that is lower than normal but not low enough to be classified as osteoporosis. Bone mineral density is a measurement of the level of minerals in the bones, which shows how dense and strong they are.

Physiotherapy can help to reduce your risk of osteoporosis by improving your strength, flexibility, posture, and balance. Spinal bone mineral density (BMD) is linked with the strength of the back extensors; therefore, maintaining and strengthening the back extensors should be emphasized.

Regular weight-bearing exercises are essential for the maintenance of bone mass  and should be encouraged in all patients, including children and adolescents. Exercise also improves agility and balance, thereby reducing the risk of falls.

Cheer on the Aussies during the London Olympics

With the London games well underway, the athletes are primed and ready to go but the big question is are you?

With 38 sports and with thousands of athletes competing full throttle to win that coveted gold medal we’re sure that you will have an interest in at least one sport. With all sports can come the disappointment of injury; which unfortunately occurs in us amateur athletes as well. Below is a look at a couple of sports that you or your kids may participate in socially that will feature throughout the next 17 days of Olympic competition.

SWIMMING

Our swimmers are regarded as some of the world’s best, but with the many km’s in the pool, injuries can occur with one of the most common shoulder injuries being impingement. This is when the tendons of the rotator cuff become compressed in the space just below the tip of the shoulder. This produces a sharp localised pain which can lead to further tearing and degeneration of the tendons should it be left untreated. As like most injuries it can be brought about by a poor stroke technique, increased training load, or reduced muscle strength around the shoulder girdle to name a few.

Initially treatment would involve avoiding aggravating activities .i.e. freestyle stroke and apply ice for pain relief to the area. Following this period we would start to address any contributing issues that may exist such as muscle tightness, reduced strength & finally correct any poor biomechanical or technique issues.

A majority of shoulder injuries from swimming can be prevented with correction of stroke technique and altering your training load in the short term.

GYMNASTICS

Gymnastics produces spectacular jumps, flips and spins but injuries can occur if you’re not careful while performing these routines.

Ankle sprains often occur following tumbling or landing from jumps and leaps that sometimes require aerial movements. Ankle sprains tend to only involve a ligament but can occasionally cause a fracture. Our initial management usually includes active rest, ice, compression & elevation. Ankle strengthening exercises are also recommended and upon return to training strapping may help prevent these injuries recurring.

Wrist pain in gymnastics is brought about by repetitive high impact weight bearing particularly with tumbling, cart-wheeling and flips. Wrist pain can either be acute where there has been an incident (which a fracture may need to be excluded) or gradual due to repetitive movements such as hand-standing. Depending on the nature of the injury we would recommend that you do a lot of strengthening work around your wrists and consider the use of braces or taping to support the wrist and prevent any further injury.

CYCLING

Just off the back of the tour de France, the men’s and women’s road race will showcase London to the world. For all those budding cyclists either riding competitively or socially you need to not only look out for the traffic on the road to prevent any injury but also look after yourself. Whatever type of cycling you do be it on or off road, mountain biking or BMX racing you can fracture bones, strain muscles, and even dislocate joints if you aren’t careful.
Some common injuries to joints include:

Knee:

–        Anterior knee pain

–        Ligament damage

–        Patellar tendinopathy.

Hip and low back:

–        Low back pain

–        Groin strains

Ankles and feet:

–        Achilles Tendinopathy

–        Calf tears or strains

–        Ankle sprains

Most of these injuries may be due to overuse of certain structures but some can be a result of an accident. The prevalence of these and many other injuries can be reduced with a good posturing and a combination of core and strength exercises.

RUNNING

Running demands the athlete to deal with high impact forces through the knee, shins and feet. These forces can overload the muscles, ligaments and tendons supporting our body due to a variety of reasons but commonly through increased training loads, running on hard surfaces & poor foot biomechanics.
Shin splints are a very common condition that we see which is when the muscles at the front of your leg become overloaded. We recommend an initial rest period including icing and NSAID’s. Soft tissue treatment can also be commenced to reduce any tightness that exists.
Long-term management is important because if this becomes chronic in nature it may lead to extended periods off running, which we all don’t want.

We recommend a management program which includes a combination of lower limb strength and stretching exercises, dry needling and correcting any biomechanical abnormalities.

So, enjoy cheering on the Aussie’s during the Olympics and should you have any concerns or questions about any injures acquired during you chosen sport during this Olympic period please don’t hesitate to call us on (02)8065 6902