Other Injuries and Conditions
Why Should I Exercise As I Get Older?
Exercise is the single best thing you can do for your health!
Most of us know exercise is important when we are younger, but what about as we get older.
Researches shows that Exercises is equally important at all ages.
The benefits include:
- Reduces the risk of developing dementia (significantly more so than ‘mental activity’ such as crosswords or Sudoku).
- Improves balance and bone mineral density, reducing the risk of fractures.
- Reduces the risk of falls and injuries from falls such as fractured hips and other bones.
- Helps reduce blood pressure
- Reduces your risk of heart disease
- Helps to control chronic pain, including arthritis
- Maintains mobility and delays the requirements of a walking aid as we age.
- Maintains muscle strength for daily tasks
- Helps manage stress, improves mood and helps manage feelings of depression.
- Helps to regulate sleep.
Remember, appropriate exercise is safe for people of all ages and with all types of health problems. It should however, be tailored to the individual and specifically designed with specific objectives and goals in mind.
Physiotherapists are trained health professionals which can provide an individualised program for your requirements.
Why Do Joints Click
Manipulation of joints has been used as a treatment for back and neck pain for hundreds of years. Yet, most people do not understand what actually happens with a manipulation and how this affects joints.
Manipulation is a quick movement sometimes termed a “high velocity thrust” that results in a sound or “click”. This occurs when the two surfaces of the joint are rapidly separated or passed over one another but not when they are compressed together.
It is not joints grinding together, and is certainly not clicking joints “back into place”.
It is suggested that following manipulation there is a release of pressure within the joint. There is also evidence that there is a release of opiates (the bodies natural pain relievers), and this is responsible for the immediate pain relief often reported.
Manipulation can be an extremely useful tool in the treatment of joint pain, in particular spinal problems. However, if not combined with movement and exercise, manipulation can have limited benefits.
A manipulation causes a sudden change of pressure in a joint. It allows a skilled practitioner to isolate movement to a particular joint that may otherwise be difficult for the individual to move. This can be highly effective and beneficial.
However, this is now not enough. It has now been well established that joints require regular movement to maintain normal healthy mobility and function. Over time restriction or lack of regular movement can have severe consequences.
Regular Joint Movement and Exercise is Essential.
So, even though manipulation is moving a joint, it is only moving it once and usually has no significant long term benefit if used in isolation, and not in conjunction with movement and exercise.
A Physiotherapist may be required to assist the individual in achieving normal movement again with mobilisations and specific exercises, as well as manipulation.
So if you, like many others have found “a click” helps you, imagine how much better you would be if you added regular movement and exercise as well.
What To Do If Injury Occurs?
Have you ever been to a sporting ground and witnessed someone sprain their ankle? Or been told of a painful shoulder following a round of Golf, or set of Tennis? These and many other injuries can happen with any sporting activity, and even working in the back yard.
What is the best way to care for an injury?
Extensive Scientific Research has shown that early, intensive intervention is the best management for sports injuries, and indeed all soft tissue injuries.
What sort of treatment is the right thing to use on sports injuries?
Well it can be summed up in two words; RICER and HARM.
These steps will assist the recovery:
R – Rest; from activity and from increases in the heart rate.
I – Ice; used carefully for 20 minutes every 2 hours. But don’t make the injury too cold.
C – Compression; a firm but comfortable elastic compression bandage around the injury.
E – Elevation; raising the injury higher than the heart where comfortable and practical.
R – Referral; ensuring proper assessment and diagnosis of the injury occurred
Don’t do the following:
H – Heat; increases the circulation to the injury and the swelling.
A – Alcohol; increases the swelling around the injury.
R – Running; increases the circulation to the injury and can cause further damage.
M – Massage; increases the circulation to the injury.
In the first 48 hours always use the RICER techniques, and never “HARM” the injury.
Increasing the circulation will increase the swelling and make the injury worse. This technique of managing any soft tissue injury is internationally recognised, and provides a simple and easy to remember formula for treating all soft tissue injuries.
Referral in the very early stages is vital as the appropriate Sports Medicine Doctor or Physiotherapist can ensure accurate diagnosis and appropriate treatment.
It also means treatment can be provided when it is most effective; in the early stages. The difference between the injury receiving treatment in the first 6-12 hours and treatment a week later is significant and the recovery time increased.
Tendon Injury And Repair
Tendons are strong connective tissue in the body that attach muscle to bone. They are made up of mainly collagen and help to generate power as well as provide stability.
Tendon injuries or pathologies can be complex and hard to manage, people often have an initial injury/pathology which if repetitively aggravated can cause a breakdown of the tendon structure.
There are usually three ways tendons become irritated:
- Overload from an acute increase in exercise/activity without adequate time for the body to adapt
- A direct blow to the tendon which may cause an increase in swelling and pain as the body tries to protect the injured area
- Repetitive compression of the tendon (such as in the shoulder or ankle)
Tendon injuries have many names depending on the part which is injured or irritated. You may have heard your tendon pathology referred to as a tendinopathy or tenosynovitis. Your physiotherapist will be able to determine what stage of pathology your injury is at as well as the best way to manage it moving forward.
Early stage (reactive) will require a period of rest to allow the tissue to settle down and return to its normal state. Later stage (degenerative) will need to be loaded as early as possible to maintain the integrity of the tendon.
Tendon pathologies have 3 distinct phases, which will affect how they are managed. All tendons need to be loaded but how this is done and the volume will vary between individuals.
- Pain can last from a few days to a few weeks
- Very common in younger and athletic populations
- Tendon still intact and full resolution likely
- Needs to be rested from aggravating activities until rehab can commence (may start isometric exercises to reduce pain)
- Part of tendon structure may have started to break down
- If managed well can still expect full repair
- Not often seen clinically because reactive and degenerative tendons are mostcommon and painful
- Exercises will vary depending on if early or late stage disrepair
- Tendon structure break down but pain generally lasts for only a few days
- In this stage full healing of tendon may not be possible but rehab can help return individual to pain free and full function
- Often identified in older population and athletes who have had multiple reactive tendinopathies
- Need to be loaded up as soon as possible to strengthen intact tendon (combination of loaded isometric and eccentric exercises).
Soft Tissue Injuries
Soft Tissue Injuries are the most common injuries in Sport, and in life.
Physiotherapists and Sports Medicine Doctors/Physicians regularly deal with these injuries, and they rarely if ever result in the Surgery.
Our Centers and the Physiotherapists, and Sports Medicine Doctors regularly diagnose and treat Soft Tissue Injuries, and are important in getting people back to normal after this injury.
For more information contact us.
Pregnancy Fact Sheet
Pregnancy is a time of great change within a woman’s body, and can lead to many feelings or uncertainty, particularly as the baby grows and changes in the woman’s body become more apparent.
Pregnancy hormones cause a ‘softening’ of the ligaments, potentially leading to reduced joint support. This, along with the extra strain on the pelvic floor and abdominal muscles as the baby grows, generally results in less support of the lower back and pelvis. It is recommended to avoid high impact, jolting exercises.
Commonly the central vertical abdominal muscles stretch and separate at their midline. This is known as a Rectus Abdominis Diastasis. While it is important to maintain abdominal muscle strength during pregnancy, correct exercise technique is essential, as performing conventional sit-up type exercises may actually worsen this separation, potentially putting greater stress on the lower back and pelvic regions.
Exercising while on your back is not recommended after about 16 weeks of pregnancy, as this may cause a reduction in blood flow to the heart and head, leading to feelings of faintness and light-headedness. More importantly, the blood flow to the placenta and baby may decrease.
During pregnancy, extra strain on the pelvic floor muscles (PFM) may mean they don’t work quite as well as they should, possibly resulting in impairments in bladder and bowel function such as incontinence and reduced support of the pelvic organs, which may manifest as a pelvic organ prolapse.
We recommend a pregnancy assessment by a Physiotherapist with a Post-Graduate qualification in Continence and Women’s Health to assess the function of the PFM and abdominal muscles, and to advise on appropriate exercises to be continued during pregnancy.
Postnatal Period – Exercise
Many women are keen to return to exercises as soon as possible after the birth of their baby, but are often unsure where they should start or are simply unaware of the huge impact that pregnancy and childbirth will have on their body and how many of the changes of pregnancy persist into the postnatal period.
There is great variability amongst women in the time taken for the body to recover from the effects of pregnancy and childbirth and this will impact on the type of exercise that women should perform in the postnatal period.
The following are important considerations for postpartum exercise:
- The effects of pregnancy hormones persist into the postnatal period meaning that the joints of the spine, pelvis and wrists are particularly vulnerable to stress and strain, especially considering the time in a flexed forward and slouched posture with baby care activities
- The pelvic floor muscles (PFM) are weakened and stretched during pregnancy and vaginal delivery, and it has been reported that one in three women who have had a baby will experience some urinary incontinence. Ideally PFM exercises are performed during pregnancy to maintain strength and control and make it easier to start them working again after the birth.
The PFM play an important role in the control of continence and pelvic organ prolapse (POP), so any type of exercise that a woman is undertaking must take into account the state of the PFM. Indeed, performing exercises, particularly high impact or strong abdominal exercises may lead to or worsen the effects of stress incontinence or POP.
- The abdominal muscles also remain stretched for sometime after birth. Many women will experience a rectus abdominis diastasis (RAD) during pregnancy and it is important that this has returned to normal before attempting abdominal crunch-type exercises, along with other strong abdominal exercises such as planks and double leg raises.
It is generally agreed that the abdominal muscles are not strong enough to control the pelvis during this type of exercise for at least 8 weeks, and in the majority of women, even longer. Indeed performing crunches, and even getting out of bed incorrectly, may result in the worsening of a RAD.
Learning to correctly work the deeper abdominal muscles with the PFM will assist in:
- Gradually regaining strength in the trunk,
- Reducing a RAD
- Supporting the spine and pelvic regions.
Use of the real time ultrasound machine can be a useful way of assessing how the well the PFM and deeper abdominal muscles are working together in a variety of different positions. This can be particularly helpful further down the track when assessing whether the PFM are strong enough to commence stronger abdominal exercises.
We recommend a post-natal check up with a Physiotherapist with Post-Graduate qualification in Continence and Women’s Health to ensure that the PFM and abdominal muscles are working appropriately, particularly for those women who are concerned that they cannot feel their PFM working or who are experiencing any of the following:
- Leakage of, or difficulties controlling urine, wind or faeces,
- Vaginal or pelvic heaviness or a lump or bulge in the perineal area,
- Internal pelvic pain, for example during sexual intercourse,
- A feeling of bulging or a gap in the abdominal muscles.
Physiotherapy supervised Pilates is a good way of safely regaining strength, while focusing on specific problem areas and ultimately aiming for a total body workout.
Hydrotherapy classes are also an ideal low impact cardiovascular exercise option when returning to exercise after having a baby.
Postnatal Fact Sheet
A new baby in the family is a time of great change, especially if it is your first. It is a steep learning curve for most, as families adapt to the new addition; sleep is interrupted, there are nappies to be changed, extra washing to be done, all whilst getting to know your little bundle.
Looking after a baby is very demanding, both physically and psychologically. Mothers with new babies spend a lot of time in a flexed forward and slouched posture while they are feeding, changing, bathing and carrying their baby. Unfortunately at this time the joints of the spine and pelvis are particularly vulnerable to stress and strain due to the effects of pregnancy hormones, which may persist into the postnatal period.
Many women may also notice troubles with their wrists, due to the extra strain on them with various babycare activities. Weakness and lengthening of the trunk muscles will contribute to a lack of muscular support of the spine and pelvis, also making it difficult to maintain ideal body posture.
The pelvic floor muscles (PFM) and abdominal muscles are two groups of muscles which are affected by pregnancy and childbirth and will require particular attention postnatally.
The PFM are weakened and stretched during pregnancy and vaginal delivery. Ideally PFM exercises are performed during pregnancy to maintain strength and control and make it easier to start them working again after the birth. Generally PFM exercises can be started within the first 48 hours after the birth.
Initially it may be difficult to feel the muscles working, so it is best to aim for gentle contractions held for a short time. Begin practising while lying on your bed on your back or on your side with knees bent. Focus on tightening and gently lifting around your front and back passages, as if trying to prevent passing urine or wind, holding briefly and then relax the muscles. This will help to reduce swelling and bruising. Women who have had a caesarean birth should also practice their PFM exercises regularly.
As well as combining with the deeper abdominal muscles and deep back muscles to help support the trunk, somewhat like an in-built corset, the PFM play an important role in the control of continence and pelvic organ prolapse.
If you are concerned that you cannot feel your PFM working or if you are experiencing any of the following:
- Leakage of, or difficulties controlling urine, wind or faeces,
- Vaginal or pelvic heaviness or a lump or bulge in the perineal area,
It is recommended that you seek advice from a Physiotherapist with Post-Graduate qualifications in Continence and Women’s Health for a more detailed assessment of this region and a specific PFM exercise programme.
The abdominal muscles remain stretched for sometime after birth. Many women will experience a rectus abdominis diastasis(RAD) during pregnancy and it is important that this has returned to normal before attempting abdominal crunch-type exercises.
It is generally agreed that the abdominal muscles are not strong enough to control the pelvis during this type of exercise for at least 8 weeks, and in the majority of women, even longer. Indeed performing crunches may result in worsening the diastasis.
Learning to correctly work the deeper abdominal muscles with the PFM will assist in:
- Gradually regaining strength in the trunk,
- Reducing a diastasis
- Supporting your spine and pelvic regions.
Use of the real time ultrasound machine can be a useful way of assessing how the well the PFM and lower abdominal muscles are working together in a variety of different positions. This can be particularly helpful further down the track when assessing whether your PFM are strong enough for you to commence any upper abdominal sit-up type exercises.
There is great variability in how women recover their strength and control of this area. Women who have spinal pain or pelvic girdle pain may need to see a Physiotherapist for specific treatment, whereas those women who may be experiencing a more internal pelvic pain, for example during intercourse, are recommended to consult a Physiotherapist with Post-Graduate qualifications in Continence and Women’s Health.
A Post-natal check up with a Physiotherapist with Post-Graduate qualification in Continence and Women’s Health is recommended to make sure that you are on track with your PFM and abdominal rehabilitation. Physiotherapy supervised Pilates is a good way of regaining your strength safely, while focusing on your specific problem areas and ultimately aiming for a total body workout.
Pilates In The Postnatal Period
Many women are keen to return to their pre-pregnancy exercise routines following the birth. We recommend commencing Pilates six weeks after delivery following your post-natal check from your doctor. In this six-week period, your body will be gradually recovering from the birth regardless of whether it was a vaginal or caesarean delivery. During this time we recommend gentle walking, plus a focus on the pelvic floor muscles (PFM) and deep abdominal muscles. See our Postnatal Fact Sheet and Postnatal Exercise Fact Sheet for more information on the postnatal period.
On commencement of Pilates, whether you are an existing client or a new client, we recommend a one on one assessment with one of our Pilates Physiotherapists. Use of the real time ultrasound machine allows for assessment of correct activation of the PFM and deep abdominal muscles. It is very important that women are aware of how to correctly activate these muscles whenever any type of abdominal muscle exercise is performed to ensure adequate support of the pelvic organs.
As well as combining with the deep abdominal muscles and deep back muscles to help support the trunk, somewhat like an in-built corset, the PFM play an important role in the control of continence and pelvic organ prolapse.
If you are concerned that you cannot feel your PFM working or if you are experiencing any of the following:
- leakage of, or difficulties controlling urine, wind or faeces,
- vaginal or pelvic heaviness or a lump or bulge in the perineal area,
We recommended that you seek advice from a Physiotherapist with Post-Graduate qualification in Continence and Women’s Health for a more detailed assessment of this region and a specific pelvic floor muscle exercise programme.
As part of your Pilates assessment, the abdominal muscles will also be checked for presence of a rectus abdominis diastasis. Presence of a diastasis means that any abdominal muscle exercises must be modified and the diastasis regularly checked to ensure that it is resolving satisfactorily. It is also important that the diastasis has returned to normal before any type of abdominal sit-up type of exercise is attempted.
Women who are experiencing lower back or pelvic girdle pain will require specific exercises for the lumbo-pelvic region. Assessment with a Pilates Physiotherapist will help to determine specific focus areas for each client. Generally a combination of muscle re-training exercises along with mobility exercises and stretches is required.
Most postnatal women also require exercises to assist with maintaining a good posture. The reason for this is that so much time spent caring for a new baby is in the flexed forward position. This may lead to pain and dysfunction in the neck, upper back and shoulders, as well as the lumbo-pelvic region. Exercises to assist with improving posture may also be incorporated into a Pilates programme.
A postnatal Pilates exercise programme is recommended to help prepare you for more strenuous activities. Before returning to more strenuous exercise, you must be able to feel a firm and sustained PFM contraction which co-ordinates with any abdominal contraction ensuring adequate support of the pelvic organs. The PFM must also be able to relax following a contraction.
Any diastasis, which has occurred during pregnancy, should be resolved and the abdominal muscles must be strong enough to provide good back support. Your Pilates instructor will monitor your general strength and guide you to a return to previous activities.
Pilates And Pregnancy
Pregnancy is a time of great change within a woman’s body, however in a healthy uncomplicated pregnancy; exercise can continue to be safe and is generally recommended for most women.
Pilates can be a very beneficial form of exercise during pregnancy if you are conscious of the precautions to take and are knowledgeable about the effects that exercise may have on you and your developing baby. All pregnant women should have a medical clearance before commencing Pilates.
In most pregnancies, regular moderate intensity physical activity is encouraged; however some important considerations when exercising during pregnancy are detailed below
HOW CAN PILATES HELP DURING PREGNANCY?
As your baby grows, your posture will change. Most women will have an increase in the curve of their lower back as their abdomen grows and this, along with an increase in the weight of the breasts may cause extra strain on the spine. Alterations in your posture may contribute to certain muscles tightening and shortening and others lengthening and weakening.
Pregnancy hormones cause a ‘softening’ of your ligaments, potentially leading to reduced joint support. This, along with the extra strain on the pelvic floor and abdominal muscles as your baby grows, generally results in less support of the lower back and pelvis.
Commonly the central vertical abdominal muscles stretch and separate at their midline. This is known as a rectus abdominis diastasis. While it is important to maintain abdominal muscle strength during pregnancy, correct exercise technique is essential, as performing conventional sit-up type exercises may actually worsen this separation, potentially putting greater stress on the lower back and pelvic regions.
Extra strain on the pelvic floor muscles may mean they don’t work quite as well as they should, possibly resulting in impairments in bladder and bowel function such as incontinence and reduced support of the pelvic organs, which may manifest as a pelvic organ prolapse
Pilates can help to maintain the strength of the pelvic floor and abdominal muscles and minimize the adverse effects of the postural changes that result. As these movements are very precise, closely supervised instruction is important, since incorrect activation will not result in the desired outcome, or worse, may aggravate an existing problem or cause an injury. For this reason learning Pilates from a book or DVD is generally not recommended, especially when pregnant, as certain modifications will need to be made to many of the exercises.
IMPORTANT CONSIDERATIONS WHEN EXERCISING DURING PREGNANCY
- Avoid overheating. Your growing baby does not have the same ability to dissipate heat as you do. Consequently, if you become overheated when exercising, your baby can be put at risk. This is particularly true during the first trimester, when the most important growth, cell reproduction and formation are occurring. To avoid overheating:
– Give yourself breaks during your Pilates session to rest and cool off.
– Stay well hydrated. Ensure you bring a water bottle and drink plenty of water before, during and after your session even if you do not feel thirsty.
– Don’t use sweating as an indicator of how hot you may be getting, as your core temperature may rise disproportionately to the amount of perspiration.
– Avoid exercising in hot, humid conditions.
– Wear light-weight, loose fitting clothes – cotton is best,
– Avoid saunas and steam baths at all times during pregnancy. Your core temperature may be rising without an associated feeling of being hot.
- Avoid high intensity exercise. As your pregnancy progresses, your increased weight will add to the overload effect of exercise and you may need to switch to lighter resistance or easier versions of exercises you currently perform. A good guide is that you should be able to comfortably carry on a conversation throughout the session – referred to as the ‘talk test’. Make sure that you always exercise at your own pace and avoid holding your breath.
- When exercising, avoid rapid changes of position and stopping suddenly. Keep the feet moving to help the circulation and prevent leg cramps and faintness.
- With exercise pregnant women sometimes experience low blood sugar levels, resulting in light-headedness or faintness. Eat some form of carbohydrate before and after exercising to help keep blood sugar levels from fluctuating too much
- Limit the amount of exercise you do lying on your back from 16 weeks on. Exercising on your back (as when doing abdominal exercises) could cause a reduction in blood flow to your heart and head, causing you to feel faint and light headed. More importantly, the blood flow to the placenta and baby can decrease. If you do feel at all dizzy or light-headed when lying on your back, turn onto your side and rest.
- Modify your abdominal work. If a rectus abdominis diastasis is present, abdominal muscle exercises which involve lifting the head should cease. Throughout your pregnancy your abdomen should be monitored for any signs of a diastasis, and if present, regular checks should continue to assess the extent of separation.
- Perform pelvic floor muscle exercises. Strengthening these muscles will help to support your trunk and pelvis and also help to prevent impairments in bladder and bowel function such as incontinence and reduced support of the pelvic organs, which may manifest as a pelvic organ prolapse. When performing these exercises you should feel a squeeze and lift movement. If you are unable to feel the correct muscle action, or are experiencing any leakage, seek advice from a physiotherapist with further qualifications in Continence and Women’s Health.
- Wear a good supportive maternity bra.
- Stretch gently. Pregnancy hormones cause increased joint laxity, which may make you more susceptible to injury.
Be cautious and gentle with your stretching. Stop exercising and seek medical advice if you experience any of the following:
- Vaginal bleeding or leakage of amniotic fluid,
- Contractions or a decrease in the movements of your baby,
- Chest pain, dizziness, faintness or palpitations,
- Blurred vision, disorientation, or severe or continuous headaches,
- Muscle weakness or calf pain or swelling,
- Shortness of breath before exertion,
- Lower abdominal pain, tightness or cramping, back pain or pubic pain
- American College of Obstetricians and Gynecologists “Guidelines for exercise during pregnancy” 2003.
- Royal College of Obstetricians and Gynaecologists (2006) Exercise in Pregnancy (RCOG Statement 4).
PILATES AND YOUR PELVIC FLOOR MUSCLES
The pelvic floor muscles (PFM) act as a dynamic platform at the base of the pelvis, functioning both as a support mechanism for the abdominal organs and as an aid to bladder and bowel function. Well-trained pelvic floor muscles may contribute to orgasmic potential in women and erectile function in men.
PFM action is a ‘lift and squeeze’ movement: it is the action used to stop midstream urine flow and to stop the passage of wind. It is essential to perform this movement accurately to improve the muscles.
As part of a Pilates initial assessment with our physiotherapists, PFM activity may be assessed using real time ultrasound. During this assessment, the ‘lift’ component of a PFM contraction can be assessed via visualization of the movement of a full bladder.
During Pilates exercises, the PFM are activated in combination with the deep abdominal muscles, while maintaining a relaxed breathing pattern to ensure optimal support for the trunk.
Once you have found the correct PFM action, the next part of the strengthening process is to hold the contraction and repeat it. At first you may only be able to perform short holds, with difficulty maintaining the contraction as you continue to breathe in and out. The aim is to gradually increase the length of hold.
As well as sustained holds, practicing short, sharp, fast contractions will train the muscles to work in a different way. A real time ultrasound assessment will assist in determining how many contractions you should be performing per exercise session.
Women who are unsure as to whether they are performing PFM exercises correctly are advised to consult a Physiotherapist with further qualifications in Continence and Women’s Health for further assessment.
Pilates, Will It Help Me?
Pilates has received mixed reviews over many years depending on where you read about it. You may hear claims by many models, celebrities and entertainers that daily Pilates is the way they stay looking the way they do. Others report that Pilates cured/caused their back pain. Some want to know whether Pilates will help or worsen their pelvic floor function. What about their prolapse? Yet again, others ask – What exactly is Pilates?
So let’s start here: What is Pilates?
Pilates is a method of exercise developed by and named after Joseph Pilates, which targets the spinal, abdominal, and pelvic floor muscles, often termed ‘the core’. The focus is on body alignment, muscle balance and correct breathing technique, with the aim being to improve body awareness and control, strength and flexibility. Basically the emphasis is on an understanding of how to move and efficiency of movement.
Joseph Pilates originally developed a system of exercises during World War 1 to help rehabilitate injured soldiers. Later in his life he moved to the USA where he opened his own studio, which became popular with dancers, athletes and entertainers and hence was more widely known. He died in 1967, however Pilates has continued to be taught in many countries around the world and was introduced to Australia in 1986.
Many methods of Pilates have been established, each one slightly different to the next. Very broadly speaking, ‘Traditional Pilates’ methods tend to stick a little more closely to Joe’s original teaching whereas ‘Clinical Pilates’ often means that the exercises have been modified and take into account more recent research in the areas of musculoskeletal research. A good example here is the pelvic floor muscles. In Joe’s original exercises, there is no mention of these muscles, however we now realize the importance of the pelvic floor muscles in any form of exercise, particularly when exercising the abdominal muscles. In fact, the ‘hundreds’ exercise, often regarded as the signature Pilates exercise, and one of the first exercises done in a traditional mat class, would be contra-indicated for anyone with pelvic floor muscle dysfunction, including those with pelvic organ prolapse.
Generally Pilates is taught in 1 of 2 forms: Studio or Mat Class Pilates.
Mat Class Pilates:
- Is suitable for those who are not injured,
- All exercises are performed on the mat with everyone doing the same thing,
- Correct ‘core’ activation is assumed,
- Class sizes vary greatly depending on available space,
- Generally classes are specified as Basic/Beginner, Intermediate or Advanced,
- Specialty classes such as pregnancy or post-natal may be available,
- Some centres offer reformer classes where the same principles apply.Studio Pilates:
- Is suitable for those who are injured and have specific rehabilitation needs, or those who require modification of the basic exercises such as the elderly, women who are pregnant or in the post-natal period, even elite athletes,
- Utilises equipment such as the Reformer, Cadillac (also known as the Trap Table), Wunda Chair, Spine Corrector and possibly others,
- Has a low client/instructor ratio to ensure close supervision and correct technique
- Each client has an individual exercise programme which may be different at each session and progressed according to signs and symptoms
- Generally each client has an individual initial assessment to determine focus areas and to ensure correct core activation. Commonly the real-time ultrasound is used. This is a similar type of ultrasound to that which is used for pregnant women. It is a very useful way of assessing correct pelvic floor muscle activation and assessing how the pelvic floor and abdominal muscles work together. If a client has difficulty in performing a satisfactory combined pelvic floor and abdominal muscle contraction, then he or she maybe referred to a Physiotherapist who has extra training in Continence and Women’s Health
So, let’s get back to the original question: Will Pilates help or hinder back pain/pelvic floor muscle dysfunction/prolapse? Unfortunately the answer is: It depends! Like any form of exercise, the way that you perform Pilates is crucial to gaining benefits.
Some important considerations are:
- Correct core activation. This is particularly important with regards to the pelvic floor muscles. You must know that you are activating properly, and exercises must be prescribed that are appropriate for your level of function. If you are not performing an exercise properly you will not be gaining the maximum benefit from it, but more importantly you are at risk of causing damage. This can occur for a few reasons:
- Pushing downwards (bearing down) through the pelvic floor muscles instead of the correct action of squeezing and lifting up puts you at risk of developing a prolapse and impairments in bladder and bowel function,
- Performing abdominal exercises which are too loaded, especially those where the head is lifted or those which cause you to hold your breath. Basically what happens is that the abdominal muscles ‘overpower’ the pelvic floor muscles, putting them at risk as above
- In situations where the pelvic floor muscles are ‘overactive,’ the programme will be quite different to someone who simply has weak pelvic floor muscles. Continued holding of these overactive muscles may actually make the problem worse
- Thorough initial assessment. This is important to determine what your actual problem is. This will lead to developing a list of focus areas and your programme can be developed from there. This applies for problems in all areas – from back pain to pelvic floor problems.
If you consider the factors listed above, you can see why it can be difficult to gain benefits by simply following a DVD or participating in a very large mat class prior to any other form of Pilates.
So, in summary, Pilates can be a very helpful form of exercise as long as you are:
- Activating the right muscles correctly
- Performing exercises correctly that are appropriate for your level of function.
- Performing exercises which have been correctly prescribed to assist with your signs and symptoms.
The Pilates method of exercise offers a focused, well-controlled physical program for the whole body. While aiming to improve aspects such as strength, flexibility, co-ordination and posture, emphasis is also on helping clients to learn to gain control of their body for a more balanced and efficient way of moving. When taught by an appropriately qualified instructor, it is safe, effective and complements the medical management of many injuries.
Physiotherapy Pilates, which is taught by our physiotherapists is based on the original teachings of Joseph Pilates, however these original exercises have been modified to take into account specific client presentation. Our Pilates sessions are designed with a low client to instructor ratio to ensure close supervision of individualized programs.
The Pilates Conditioning Process
Pilates is often described as a conditioning process for the body, which strengthens from the inside out. This refers to the key feature of firstly isolating the deep postural muscles, which support the joints of the body and hold the body in good posture. These deep postural muscles are often referred to as the ‘core’ muscles which comprise the muscles making up the trunk cylinder.
These are the deep abdominal muscles, deep back muscles, pelvic floor muscles and the diaphragm. Activating these muscles correctly is very important before progressing to more advanced exercises. An initial consultation involving use of the real time ultrasound allows for assessment of the deep abdominal and pelvic floor muscles to ensure correct activation.
The outer ‘movement’ muscles are the muscles which often over-work to compensate for weakness in the deeper postural muscles. Many exercise programs continue to emphasize these muscles and may exacerbate existing imbalances, which can predispose to injury and pain. Our Pilates sessions aim to activate the postural muscles in the correct pattern, gradually building up their strength and endurance.
Pilates is about understanding how to move, not just improving the fitness components of movement and focuses on the quality of movement as opposed to quantity. This ensures correct execution of each exercise using the appropriate muscles. The emphasis is on creating long, lean muscles with strength and flexibility, with a focus on the functional aspect, which will carry over into the client’s daily living requirements and any sports or hobby interests.
Physiologically, it takes approximately 6 weeks for functional strength to improve, when attending 2-3 sessions per week. This applies to any strengthening program. It is very important to consolidate the basic exercises before progressing onto more advanced repertoire to ensure the correct muscles are used in the correct way at every stage. For this reason, the initial few sessions will be spent predominantly doing mat exercises.
Pilates aims to cover all aspects of conditioning, excluding aerobic fitness.
Pilates sessions will include exercises to address:
- Muscle strength and endurance
- Muscle flexibility and joint range of movement
- Posture, body awareness and balance
We encourage all our clients to include an aerobic activity in their weekly exercise regime such as walking, swimming and cycling for a well-balanced fitness program.
Key Focus Areas With The Pilates Method
Natural, comfortable diaphragmatic breathing is encouraged throughout the session. Generally the pattern discussed is to breathe in through the nose and out through the mouth. The exhale is usually performed on the effort phase of the movement, to help maintain deep abdominal control throughout each exercise.
A ‘neutral’ pelvis position allows for the best activation of the deepest abdominal layer (the transverse abdominal muscle also known as the TA), the pelvic floor muscles and the deep back muscles, known as the multifidus. The neutral pelvis position is where your two hip bones and pubic bone form a flat triangle which stays on the same horizontal plane in lying and the natural lumbar curve is maintained. In functional upright positions such as sitting and standing, these three bony points would all line up vertically.
Ideally the ribs should be held naturally, avoiding any excessive tension or lift.
The shoulder blades ideally will feel as though they are sliding down the back in a wide ‘V’ shape as you slightly open the chest. The muscles in the mid-back should feel as though they are working to pull the shoulders down in the ‘V’ which counteracts the very common tendency to tighten up in the upper shoulder/neck muscles.
The neck should feel a little lengthened at the base of the skull, which creates a very small nod of the chin. This is to encourage activation and strengthening of the deep neck stabilizers whilst maintaining correct postural alignment of the head and neck.
Principles of the Pilates Method
- Body Awareness
Understanding how your body should feel to do each movement. This also assists in reducing tension and strain.
Awareness of the optimal postural alignment of the body (neutral posture) ensuring balance and symmetry throughout the body along with optimal activation of the deep stability muscles.
The emphasis is on diaphragmatic breathing, with breath work coordinated with movement and avoidance of breath-holding.
This refers to the conscious control of the body with a focus on the muscle or region being exercised ensuring correct movement.
The centre was originally referred to by Joseph Pilates as the powerhouse of the body. More recently it has come to refer to coordination and control over those muscles making up the truncal cylinder. This principle focuses on the development of pelvic and scapular stabilization, and improving the endurance and quality of contraction of the stabilizers.
This refers to the control of all movements while maintaining background stability. It is the ability to maintain good postural control under increased load conditions.
- Flowing Movements
Working smoothly and with control while ensuring there is no jarring of joints at end of range.
A focus on the quality of movement and specific muscle control with the end result being a greater efficiency of movement.
Joseph Pilates was born in Germany in 1880. He became very sick as a child and vowed to overcome this illness through commitment to a disciplined and healthy lifestyle and to stay fit, strong and healthy throughout his life. As his health improved, Joseph became involved in many physical activities including boxing, diving, gymnastics, yoga, martial arts instruction and also circus performing.
Through his pursuits, Joseph recognized that the training for each sport was specific and could lead to a pattern of muscle imbalance and injury. He therefore aimed to create a unified and consistent system of exercise, which encompassed the best of both Eastern and Western approaches to physical and mental conditioning and which specifically addressed the development of core stability. He aimed to facilitate awareness of the self to bring body and mind together into a single, dynamic and well-functioning entity.
When World War 1 started, Joseph was working in England and was interned with other German nationals to the Isle of Man. It was here that he began creating exercises to rehabilitate the injured men in hospital, many of whom were confined to bed, by attaching springs and using small weights. He utilized this time to develop and refine his ideas on health, fitness, core stability and bodybuilding and achieved excellent results with soldiers.
After the war, Joseph was employed by the German Army as a Physical Trainer, however he soon tired of the confinement and rigidity of this position. He decided to move to New York, and met his wife, Clara, on the boat to the US. Joseph set up an exclusive conditioning studio in Manhattan and developed an extensive mat-work and equipment based repertoire. His work grew in popularity and was much sought after by professional dancers, athletes and entertainers. Joseph designed approximately 18 different pieces of exercise equipment during his lifetime. About 7-8 pieces of his equipment are still in use today.
Joseph’s original principles of developing core stability and muscular balance still remain as the underlying strength and uniqueness of his work. The work has effectively progressed and developed alongside current research, following his death in 1967. Pilates was introduced to Australia in the1980s and has steadily grown in popularity.
Pilates is now recognized throughout the world as an extremely effective programme for physical conditioning and rehabilitation.
Lower Limb Stretches
These exercises are designed to improve and maintain the length and mobility of your lower limbs and prevent further injury. Please ask your physiotherapist if you are unsure if you are doing these exercises correctly, or if you feel pain or extreme discomfort while doing any of these exercises.
Osteoporosis is a condition which affects bone strength and increases the sufferer’s risk of sustaining a fracture (broken bone). In osteoporosis bone strength decreases due to a reduction in bone mass. Bone tissue in our body is always being reabsorbed and at the same time new bone is being laid down. In osteoporosis, bone reabsorption is greater than bone formation, resulting in bone loss. Depletion of calcium is a key factor, as when calcium levels decrease, the rate of bone reabsorption increases. Vitamin D is also important as it is required for calcium absorption into the body.
Osteoporosis may be classed as either primary or secondary. Primary osteoporosis may occur at any age in either sex, however often occurs later in life and following menopause in women. This occurs because oestrogen levels decrease following menopause, causing bone reabsorption to exceed bone formation. Women are more likely to suffer from osteoporosis than men because their bones are generally smaller. Secondary osteoporosis is caused by medications (e.g. corticosteroids), diseases (e.g. celiac disease) or other medical conditions. Other factors which increase the chances of developing osteoporosis are smoking and excessive alcohol intake.
Osteoporosis is a very common condition; in India most of the men and woman are suffering from this disease and many women will sustain a fracture due to osteoporosis during their lifetime. It is a largely preventable disorder, so important to improve and optimise bone health throughout our lives to avoid this.
Signs and symptoms
It is often not until someone has suffered a fracture that they find out that they have osteoporosis. Symptoms following a fracture can be quite severe. Vertebral fractures in particular can cause chronic and disabling pain.
Prevention of osteoporosis is ideal, rather than treating the condition once it has developed. The way to prevent osteoporosis is to gain the highest bone mass possible when young, and then to reduce the rate at which bone mass is lost in later life. A greater bone mass protects against osteoporosis as the person can withstand some loss of bone mass before it severely affects bone strength. There is strong evidence supporting exercise and physical activity for increasing peak bone mass. Exercise should involve weight-bearing activities and resistance training.
Physical activity is required to maintain bone mass. In later life, adequate intake of calcium and vitamin D as well as exercise can work to slow the decline in bone mass. Exercise needs to be of moderate impact in order to assist in reducing the rate of loss of bone mass.
Recently, the benefits of exercise have been suggested to reduce the incidence of fracture by up to 50%. Regular exercise can increase muscle mass and strength, improve function, increase independence, improve quality of life, improve balance and significantly reduce the risk of falls. As falls are the major mechanism for causing osteoporotic fractures, reducing the risk of them occurring is extremely beneficial.
Physiotherapists are aware of the pathology behind osteoporosis and are trained in exercise prescription. Thus, Physiotherapists can tailor a safe and specific exercise program to the individual to work towards achieving these positive outcomes. Some Physiotherapy clinics have specific exercise classes for the older population to participate in which include all the elements needed to achieve the aforementioned outcomes.
Physiotherapists are also able to assist patients in areas such as pain management, mobility, and injury assessment and treatment.
Muscle Tendon Injuries
Muscle tendon injuries in sport, particularly contact sports are extremely common. So how do we manage these injuries more effectively to ensure a smooth transition back to competition? Firstly it is important to be aware that not all injuries are the same and consequently treatment varies.
A muscle can be bruised, this is commonly called a ‘cork’. Usually a result of a direct blow to the muscle which causes the muscle to bleed. This bleeding can occur at different sites in the muscle from just beneath the skin to under the lining of the bone.
Another common injury to a muscle is when the fibres of the muscle tear. This is commonly termed as a ‘strain’. Once again the site and severity of the strain can vary. The muscle can tear where its tendon attaches itself to the bone, in the tendon itself, where the tendon and muscle merge or in the bulk of the muscle. The tear may involve only a few muscle fibres or may result in complete disruption of a muscle or tendon eg, when an Achilles tendon ruptures.
A number of factors can lead to a muscle tendon injury:-
- Insufficient warm-up – hence the muscle is tight lacking ability to lengthen appropriately when the joints are moved.
- Poor muscle strength and general loss of body fitness.
- Variations in strength between muscles.
Forced muscle contraction in a bid to protect from an external force i.e. player to player contact.
- Early treatment is vital.
- Initial soft tissue management based on the R.I.C.E.R. principle.
- Being aware of what not to do by asking your Physiotherapist about the H.A.R.M. factors.
- Graduated safe return to the sporting arena.
Keeping People On Their Feet
Did you know;
- The average person walks about 8 kilometres per day?
- The foot accepts at least 120% of the body weight?
- Over a lifetime this is over 200 000 kilometres!
- A simple 5 kilometre run produces over 4500 foot strikes each with a force of 3 to 4 times the body weight!.
There is a wide variety of problems that can occur in a patients feet. Problems can include Corns and Calluses, Toe Nail Problems, arch and heel pain, pain in the ball of the foot, Claw and Hammer Toes, or even Tendonitis.
The challenge in treating these conditions is to keep them mobile whilst the problem is being fixed. You might even say they need to “Keep them on their toes”.
Detailed Assessment is required before treatment can commence, as subtle, problems can make a big difference with the forces placed on the foot.
Treatment of mechanical problems usually consists of controlling the inflammatory response, whilst correcting any problems found in the assessment.
This is a great example of when the Sports Medicine Doctor, Podiatrist and Physiotherapist may be involved. The Sports Medicine Doctor to oversee the Management and medication, the Podiatrist to provide the mechanical diagnosos and correction of the cause, and the Physiotherapist to help resolve the pain and inflammation.
The prescription of an orthotic follows the assessment of the foot, and the problem as determined by the Podiatrist. The Orthotics are manufactured and fitted specifically for the individual.
An orthotic device may be required. Sometimes all that is needed is a simple off the shelf type insole which may require modification. In other circumstances a specific custom made orthotic is required.
Advice on appropriate sporting footwear and specific exercise programmes is incorporated and modification of poor technique may also be required.
Incontinence Fact Sheet
This most commonly occurs with coughing, sneezing or other exertion, which is referred to as stress urinary incontinence. What you may not be aware of is that there is now a wealth of evidence that this common and possibly embarrassing condition can be effectively treated with pelvic floor muscle training, taught by a qualified Continence & Women’s Health Physiotherapist.
There are some misconceptions about urinary incontinence. It is usually seen as a ‘women’s issue’, and while it is more common in females, with a third of women suffering from incontinence, men still make up a large proportion of those affected. Also, many people may assume that this is only an issue for the elderly, however it has been found that incontinence actually peaks in middle age, in the fifth decade of life. Many women assume that if they haven’t gone through childbirth, or have had a caesarean delivery, that they would not be at risk of urinary incontinence, however unfortunately there are many other risk factors such as constipation, high impact exercise, heavy lifting in your job or at the gym, and chronic coughing and sneezing, that can also increase the chance of it developing. Stress urinary incontinence was reported in one study to affect over a third of young, fit women who had never had children.
Physiotherapists to the rescue!
A large study done at the University of South Australia has shown that physiotherapy proved effective for 84% of women who received pelvic floor muscle training and lifestyle advice with a qualified Continence and Women’s Health Physiotherapist. The ‘cure’ rate was still approximately 80% after 1 year, which is comparable to, or even better than, the ‘cure’ rate reported with surgery.
Researchers report that Physiotherapy management of incontinence is less invasive and has fewer side effects than surgical management, and is also considerably cheaper. The treatment in the study mentioned above was done over an average of five sessions.
It’s easy to seek help.
There are physiotherapists who have extra qualifications in treating issues to do with incontinence and other pelvic floor muscle dysfunction. Unlike seeing a specialist doctor, seeking help from a specially qualified physiotherapist does not require a referral. To ensure that you are booked in with an appropriate practitioner, make sure that the receptionist is aware that your appointment is for incontinence, or pelvic floor muscle training.
A Continence & Women’s Health Physiotherapist can assess you and implement an individualised exercise program, and teach you about modifying your daily activities and bladder and bowel habits to complement this.
Even if you already have a referral to see a specialist doctor about these issues, getting on the right track with a physiotherapy program while you await your specialist appointment will be invaluable to your long-term outcome. If you do require surgery, it is best practice to optimise your pelvic floor muscle function beforehand.
Urinary incontinence is not just a normal part of aging, it can be helped!
How A Dietitian Can Help You
A dietitian is able to assess the strengths and weaknesses of your diet and can be useful in the following areas:
– Weight Loss
– General Nutrition
– Eating Disorders
– Any other dietary related conditions.
– Weight Gain
– Sports Nutrition
– Blood Pressure
– Pregnancy Counselling
Food and nutrition is prone to many fads, myths and misconceptions which a dietitian can verify. You will benefit from a dietary assessment to ensure that you are eating correctly.
Counselling can be on a one-to-one basis. Your diet is analysed and a personal meal plan can be designed for you, taking into consideration all necessary information, i.e., age, sex, height, weight, body composition, type of sport, training schedule, home situation and cooking skills.
Computer analysis and the latest nutritional research is also available.
You can claim dietetic services on private health cover.
You may not be aware, but falls amongst seniors and the elderly population are a major problem in the community. In fact, it is so common that a third of people over the age of 65 will have at least one fall every year. If people of this age bounced straight back up again like my 2 year old, it wouldn’t be a problem. However, approximately 65% of falls in this age bracket result in an injury. Some of these are relatively minor, but 20% result in a visit to hospital. Some of these include serious injuries such as a hip fracture or head injury. The effects these injuries can have on our life can be drastic. The stats for hip fractures make for scary reading. Within 12 months of a hip fracture, 50% with have a permanent functional disability, 25% will require long term care and at least 10% will die!
So you can see, the potential for serious harm and loss of independence from a fall is huge in the older population. Luckily, we can do something about reducing this risk of falling. And there is a tonne of good quality evidence that supports this. The main things we can do to reduce our risk of falling are:
- Exercise – This is the single best intervention for falls prevention. It has been shown to reduce the risk of falls by 35% and also reduce injuries from falls by 35%. It needs to include exercises that work on strengthening, balance, flexibility and reaction time. Tai Chi and dancing are excellent forms of exercise as they include all these elements. Contrary to popular belief, walking alonedoes not reduce your risk of falling. The program also should ideally be tailored to the individual so that it is adequately challenging, whilst still being safe. Physiotherapists are the health professionals that can help you with an appropriate exercise program.
- Home Safety Assessment and Modification – particularly for those at a high risk of falling, a home assessment and environment modification is very effective in reducing the risk of falling. Depending on the individual circumstances, it may include interventions like the installation of non-slip mats, rails, ramps or the provision of a shower seat, as just a few examples. Occupational Therapists are the health professionals that provide this service.
- Vitamin D – The vast majority of over 65 year olds are vitamin D deficient. Vitamin D has a direct effect on muscle strength, balance and function. It also helps keep bones strong which reduces the risk of fractures. You do not need to be tested for vitamin D deficiency, and vitamin D supplements are available over the counter from pharmacies and are safe for everyone to take. Vitamin D supplementation has been shown to reduce falls risk by 19%.
- Reducing psychotropic medications – Taking multiple medications that affect our mental activity or mood can have a significant impact on our falls risk. Common medications such as sedatives, anti-depressants, heart medications, diuretics and opioids can all have an adverse effect. Obviously, reducing these medications needs to be discussed with your doctor.
- Foot care – Painful feet due to corns and calluses etc. will contribute to an increased risk of falls. Maintaining good health of our feet and wearing appropriate footwear is important in falls prevention.
- Vision – We rely on vision greatly to prevent us from falling. That is obvious. So it is important to have regular eye tests as we age, have any cataract surgery required and remember to wear any glasses prescribed to us. Interestingly, multi-focal lenses have been found to be associated with an increased rate of falls. It is recommended that for people still getting outdoors that single vision lenses and separate reading glasses are a safer option.
Ergonomics And Sitting At A Desk
One of the biggest Health Issues we face today is the amount we sit at desks and use computers. Not only does it affect Adults, but increasingly Kids are having problems as a result of poor sitting habits.
Apart from the decrease in Physical activity associated with sitting, the postures and habits we adopt can be a significant cause of back and neck pain, and headaches.
Our bodies were not designed to sit for long periods of time, and so if we do, we can gradually stress structures in the body that eventually cause pain.
Here are some helpful tips to help you if you sit for long periods of time in front of a computer:
- Get out of your chair as often as you can. Set a timer, set a reminder in your diary, put the printer/fax/photocopier on another desk so you have to walk to it.
- Regularly Exercise this will help to compensate for prolonged sitting.
- Move It Or Lose It: regularly stretch and turn and move you neck, upper back,shoulders, forearms, and lower back.
- Get a Laptop stand and separate mouse and keyboard: Laptops accentuate poor postures and will bring on problems more rapidly.
- Sit in the most efficient position As shown in the diagram below.
Common Overuse Injuries “Weekend Warriors”
Is a “Fun Run, game or sport” any Fun?
Pain and overuse injuries following a Run raises the inevitable question – is it worth it? Is the foot… back… calf… knee pain that comes from training really any fun? The answer is obviously no, but the health benefits of training far outweigh the negatives.
Regular exercise benefits most of today’s major health problems – from diabetes and heart health to depression and back pain. It’s a key element in the prevention and management of so many conditions.
Fun Runs provide a goal and motivation to train and achieve these benefits from exercise.
But what about the Pain?
The more common problems include calf pain, plantar fasciitis/heel pain and sore knees. These problems don’t have to stop anyone from training. Following some sensible and simple ideas can greatly assist the ‘weekend warriors’.
Recommendations to help keep people on track
- Gradual increases in training are easier on the body.
- Supportive cushioning shoes can help people go the distance.
- Avoid running on hard surfaces, where possible.
- A stretch and warm up helps prevent injury.
- Pain (that does not stop you) is not all bad – some advice from an exercise professional is important if ongoing exercise is important.
Most conditions will improve with specific treatment and changes in routine, without resorting to cessation of training.
On occasions, more active treatment from the Physiotherapist and/or Podiatrist is a good idea. This may include a stretching and strengthening program, or specific taping to support the injured/painful areas while they recover.
While rest can often settle the pain, relief may be temporary, so controlled training plays a vital part in the management of injuries.
- “I stretch my calf.” Most runners don’t stretch, particularly the calf muscles. Runners need to stretch both the soleus and gastrocnemius muscles, with two different stretches.
- “I wear good shoes.” Many runners’ shoes are worn out, or inappropriate. Replacing old shoes with well fitting, supportive ones can make a dramatic difference.
- “I have orthotics.” With the plethora of over-the-counter inserts available, many think these have the same benefit as a properly fitted orthotic. Look at them wearing the orthotic; if it does not hold the foot arch upright, it may not bebeneficial.
- “I don’t want an expensive orthotic if it may not help.” Simple supportive taping worn for a few days can give a very good indication if an orthotic device will assist that client.
- “It hurts so I stop.” Pain that comes on during running, but improves as they continue, is generally not a justification to cease training. In fact, exercise can often assist in the recovery. However, the problem should be properly examined to ensure it can be resolved.
Doctors and physiotherapists agree there is no doubt that keeping individuals exercising is important. Addressing injury concerns and preventing them can help make every day a ‘Fun Run’.
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