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Gluteal Tendinopathy – By Nicholas Musso

What is Gluteal Tendinopathy? 

The gluteal tendons are the fibres that connect the gluteal muscles to your hip. Gluteal tendinopathy is an injury or pathology of these tendons, most commonly it is a result of repeatedly overloading the tendon. While pain may come on suddenly, tendinopathies actually develop over a period of time, and pain will most often come at a later point. Because of this, tendinopathies are considered to be overuse injuries rather than acute injuries and are usually managed differently. For further general information on tendons and tendinopathy please refer to the “What is a tendon and tendinopathy” blog.

What are the symptoms?

Gluteal tendinopathy usually causes pain and tenderness on the outside of the hip, as well as loss of full movement and reduction in strength in the hip muscles. Pain can be local to the hip or spread further down the outside of the leg.

You may also get pain during certain activities which place more load on the tendon, these include:

  • Climbing stairs
  • Standing on one leg
  • Crossing your legs
  • Standing up from a chair
  • Lying on your side (particularly at night time)

Your pain may also increase with more demanding tasks such as jumping and hopping. Your physiotherapist will also be vigilant for determining there may be other causes for your hip pain.

What are the risk factors?

Gluteal Tendinopathy is primarily seen in post-menopausal women, with some researchers suggesting that 25% of women after the age of 55 will experience it at some point due to changes in anatomy and bioechanics. However, anyone can develop gluteal tendinopathy, it is not an age or gender-specific injury.

If you have had a previous injury (e.g. to the knee or ankle), the muscles surrounding those areas may not be working optimally even though the injury itself has healed. This can lead to increased stress being placed on physical structures further up or down the body (such as the gluteal tendon) which is overloaded and gradually increases in symptoms.

It is not uncommon to see people present with Gluteal Tendinopathy following a large increase in the amount of exercise being completed without being prepared for the increase in load i.e. mid-way through a sporting preseason, or in late January with a New-Years resolution spike in exercise. Runners who train on hills are particularly at risk.

How is it diagnosed?

A physiotherapist will be able to complete a comprehensive assessment of your problem area including taking a detailed history, previous medical and injury history, as well as a full physical assessment to determine the diagnosis and true cause of your problem.

It is unlikely that you will require a scan, as researchers have found that there is a poor link between findings on scans and pain symptoms. However, in rarer cases, your doctor or therapist may request an ultrasound or MRI scan if they suspect that your problem will require longer-term management.

What are my treatment options?

Physiotherapy will include a variety of treatment options, however the most important treatment is exercise therapy. This may seem counterintuitive as it is excessive loading that caused these symptoms, however load is also the answer! More specifically, it is putting the right amount of load through the tendon and gradually increasing the capacity of the tendon that is essential for promoting proper repair. While this is the primary treatment for promoting long-lasting improvement, physiotherapy treatment will also be focused on relieving the painful symptoms. There are a variety of techniques that may be suitable for you, including:

  • Icing
  • Medical management as prescribed your GP or pharmacist
  • Shockwave therapy
  • Rest from activity if required
  • Modification of current activity (i.e. load management)
  • Managing lifestyle factors that may be contributing to your pain such as climbing stairs,
  • Stretches (stretches may not always be useful and may sometimes increase your pain, these will be prescribed as the therapist deems suitable)

Book an appointment today for your assessment!

Blog by Nicholas Musso (Physiotherapist)

Type 2 Diabetes Mellitus & Exercise – Blog by Christie Mellerick (Accredited Exercise Physiologist)

 Diagram of diabetes

Type II Diabetes Mellitus (T2DM) affects 85-90% of all people with diabetes. Even though T2DM more commonly affects older adults, there are becoming more younger adults and children that are developing the condition. T2DM is a disease which results from a combination of genetic and environmental factors where the body develops a resistance to insulin. Insulin is responsible for up taking glucose (sugar) in the body system, meaning that when you have T2DM you end up with elevated blood sugar levels. Although there is genetic predisposition to the occurrence of T2DM, the risk is greatly increased when you have any of the following factors:

• Physical inactivity
• High blood pressure
• Increased waist circumference
• Obesity
• Family history of T2DM
• Poor dietary habits

Importance of Exercise for Diabetics

Exercise and increasing physical activity levels can help you to reduce the risk of T2DM by almost 60%. When you become resistant to insulin, exercise can play a very important role in the management of your T2DM. As you exercise, whether it be strength or aerobic training, the muscles are contracting and acting as a pump which draws glucose into the muscle cells therefore decreasing the blood glucose levels in your system. The effects of exercise on blood glucose levels can be prevalent for the next 24hours, highlighting the importance to monitor your blood glucose levels both pre and post exercise.

Below are some further benefits to regular exercise:

• decrease waist circumference
• decrease the risk of cardiovascular disease
• maintain/increase strength
• optimise heart and lung function
• improve functional capacity and independence
• improve mental health and wellbeing

Exercise Recommendations

Type of Exercise Intensity Duration Frequency
Cardiovascular/Aerobic
(planned) Moderate to Vigorous (should be able to talk but not sing)
RPE: 13 30minutes Most days of the week. No more than two consecutive days without planned exercise.
Resistance/Strength Training Moderate to Vigorous
RPE: 13-15 30minutes
8-10 exercises
2-4 sets
8-10repetitions
2-3 x/week.

Did You Know?

If you have T2DM you are eligible for our T2DM Group Exercise Program at Total Physiocare run by our Accredited Exercise Physiologist (AEP). This program consists of 1 x initial assessment and 8 x 1hour group exercise sessions with our AEP. The program runs for an 8week period and is completely funded by Medicare meaning you are not out of pocket; all you need is a referral from your GP.

If you have T2DM and are wanting to optimise your T2DM management make an appointment at Total Physiocare with our Accredited Exercise Physiologist by contacting one of our clinics at Total Physiocare Heidelberg, Reservoir and Footscray

Book an appointment today for your assessment!

 

Bariatric Surgery & Exercise – Blog By Christie Mellerick ( Exercise Physiologist)

Bariatric surgery involves reducing the size of the stomach with either a gastric sleeve, through removal of a portion of the stomach (lap sleeve gastrectomy) or gastric bypass surgery. Long term studies identify the procedure as the cause of long term weight loss as well as improving the profiles of chronic conditions such as diabetes, decreasing associated cardiovascular risk factors such as high blood pressure and high cholesterol. Research has also shown that additional to the association of bariatric surgery and long term weight loss, those who have undergone bariatric surgery have significantly reduced mortality rates and reduction of associated risks of developing cancer, cardiovascular disease, endocrinological disorders, musculoskeletal issues, infectious diseases and respiratory conditions (Christou et al., 2004).

 

Importance of exercise post Bariatric surgery

To optimise your bariatric surgery an appropriate exercise routine is just as important as a well balanced diet. Exercise for patients post bariatric surgery can lead to further measureable health improvements such as weight loss, decreased load on joints, reduction of risk factors and overall improved wellbeing. Not only can exercise enhance your health outcomes post bariatric surgery it can promote and maintain weight loss whilst maintaining and increasing muscle strength.

In a study conducted by Coleman et al., (2016) it was found that those who engaged in a combined exercise program for 6months following surgery displayed improvements in health outcomes. The combined program incorporated both structured group exercise classes and home exercise programs. Participants who engaged in this model displayed improvements across the following; aerobic capacity (6-minute walk test), strength (arm curl), balance, mobility, coordination (timed up and go) and flexibility (sit and reach).

Exercise guidelines 2-4 weeks post surgery

At this stage after surgery you should be walking daily in aim of achieving 30minutes per day. You may begin with some low impact mobility and strength exercises and increase walking duration as tolerated. Exercises such as single leg raises, hamstring stretches and shoulder rolls are a good way to increase flexibility at your joints and muscles.

Exercise guidelines 4-6 weeks post surgery

During this stage after your bariatric surgery it is important to begin building up your cardio exercise and begin incorporating strength exercises. Strength/resistance based training at least twice a week can assist in weight loss, as well as maintaining and increasing muscle strength for healthy bones and joints. Research has shown that implementing an exercise program consisting of aerobic, strength and flexibility components was most effective for improving patients’ functional status post bariatric surgery (Coleman et al., 2016).

Guidance from a Professional

An Accredited Exercise Physiologist (AEP) can assist you in optimising your health outcomes post bariatric surgery by providing you with a structured and tailored exercise program best suited to you. An AEP can help you with some of your specific needs post bariatric surgery, some examples may include:

  • Arthritis or joint pain that has not been relieved by initial weight loss
  • Poor mobility and/or flexibility which may be limiting your activity levels
  • An understanding of specific metabolic changes following bariatric surgery and exercise prescription that is suitable
  • Peripheral neuropathy in patients with diabetes as a result of poor glycaemic control before surgery, resulting in poor balance and control
  • Loss of muscle and bone density associated with rapid weight loss
  • Exercise prescription suitable for diet specific to bariatric patients post surgery.

If you are ready to transform your life and optimise your health outcomes post bariatric surgery, get started today and make an appointment at Total Physiocare with our Accredited Exercise Physiologist by contacting one of our clinics.

Book an appointment today for your assessment!

Blog by Christie Mellerick (Exercise Physiologist)

Back Pain Myths

Around 1 in 6 Australians suffer with back pain each year (Australian Institute of Health & Welfare, 2017). Socialising, working or doing the things that you love may become demanding  due to back pain which can in turn have a big impact on life; retiring early, loss of independence and a feeling of confinement. This is avoidable!! And changing thinking around misconceptions of back pain can be a starting point.

Challenging myths

  • Persistent back pain can get better. Scans are not routinely requested because often imaging results do not change management strategies
  • Back pain is rarely caused by something being out of place, spines do not “crumble” and discs do not “slip”
  • Bed rest is not helpful; it can cause stiffness of joints, muscle shortening and general deconditioning alongside building a fear of pain associated with moving and exercising
  • Surgery is rarely needed and is not a quick fix. For example, there is more and more research surfacing to show that surgical treatment does not provide faster relief from back pain symptoms in patients with lumbar disc herniation at a long-term follow up when compared with patients managed in physiotherapy (Gugliotta et al, 2016; Jacobs et al, 2011; Lequin et al, 2012).
  • Stress, low mood, worry and poor sleep influence back pain. Learning about what pain means and where it comes from can help with management – ask your physiotherapist to explain pain science to you
  • Belts, corsets, orthotics and many other gadgets should not be routinely used
  • Traction is not routinely offered as an effective treatment. Manual therapy may be used as a part of a treatment plan including exercise and education
  • Continuing to go to work with modified duties and a return to full duties plan is helpful
  • A “quick fix” is usually not possible and a long-term management plan is more effective
  • Spines are strong structures and can manage bending, lifting and daily stresses
  • A back reactivation programme may include strengthening, stretching, conditioning of the entire body and an education component. This is important to build a strong and stable body however it can take a long time to gain strength and condition, so it should be persevered with for at least 6 weeks. It should also be progressive and you may feel muscle soreness after exercising

How can I help my back pain?

  • Staying active – find something that you enjoy doing on a regular basis. Discuss with your physiotherapist how to integrate back into your hobbies
  • Aiming to avoid relying on medication, scans and surgery unless all other options have been tried – exercise programmes take time to work so give it time to take effect
  • Sleeping, relaxing and looking after yourself – try mind maps including things that empower you and lifestyle factors which you feel may contribute to back pain. Devise strategies to increase activities which empower you and decrease activities which hinder you . You can discuss this with your physiotherapist
  • Create short-term goals with a timeframe in mind to increase activity step-by-step which contribute towards a bigger end goal
  • Developing a better understanding about what pain means – pain is often associated with damage however this is not necessarily the case. Pain is produced by the brain so it can persist after tissues have healed. Your physiotherapist can explain this to you in further detail
  • Developing thinking strategies – the pain and anxiety areas of the brain sit closely and signals can become mixed meaning anxiety may cause more pain which may cause more anxiety and so a vicious cycle is entered . Psychological therapy can be effective in the treatment of back pain as a part of a treatment plan
  • Varying posture and moving in a confident and relaxed way – the spine is designed to move so bracing due to pain is not helpful.
  • Do not fear bending and lifting – the spine is a strong and stable structure, lift in a way that makes you feel comfortable. Repetitive heavy lifting should be 50:50; half squatting and half bending. Avoiding these manoeuvres may even weaken the back. If the load is more than you can manage, seek help from somebody else
  • You should seek medical attention if you have acute back pain with progressive leg weakness or abdominal pain
  • Seek advice from a physiotherapist for information specifically tailored to your back pain, to help you to integrate back into your daily activities as quickly as possible and to learn back reactivation exercises to reduce frequency of reoccurrence as early as possible

Book an appointment today for your assessment!

Blog by Lauren Palmer (Physiotherapist)

Why Breathing is important by Louise Holland

Without stating the obvious reason of without breathing we wouldn’t be alive. But the breathing system and our diaphragm is much much more than just that.

If your breathing is not normalised, then no other movement pattern can be (Hewitt 1980).

 

The diaphragm attaches/ connects to many parts of our body – Lumbar spine muscles including quadratus Lumborum (back) and Psoas muscle (front), the Phrenic nerve (which supplies also your neck or Cervical spine area), ribcage muscles and sternum.

As you Inhale – the ribcage elevates and extends out shortening the diaphragm and the pelvic floor lengthens (wee out) and expands our tummy (core muscles).

As you exhale – the ribcage rotates back inwards, lengthening the diaphragm and shortens (tightens the pelvic floor) and core muscles.

When we are in pain – physically or emotionally we lose the ability to lengthen our diaphragm. We resort to ‘fight or flight’ mode, increased heart rate, vasoconstriction, mouth breathing, increased respiratory rate and increased ventilatory volume. We revert to breathing through our mouth and begin to lose the optimum of rest and digest with our body and its tissues.

Excessive Inhalation – Muscles used:

  • Calf muscles shorten (Achilles, plantar fascia, calf tightness, cramping, knee pain)
  • Quadriceps shorten (causes arching in lower back, knee pain)
  • Low back muscles tighten (Arch back – compress the spine, makes it difficult for ribcage to move freely IE running)
  • Pelvic floor muscles lengthened (on permanent stretch becoming dysfunctional)
  • Upper trapezius muscle shortens (tight neck, tension headaches, disruptive to normal shoulder mechanics)
  • Gluteal, hamstrings, abdominals and deep neck flexor muscles are all lengthening and disengaged.

IMPORTANT TO NOTE: when we feel our hamstrings are tight – majority of the time they are stretched long and tight and don’t have the capacity to recoil back in to a shortened position and engage and create a muscle motor output. Therefore stretching your hamstrings will not solve the issue in some cases.

 

 

Exhalation – muscles used:

  • Pelvic floor shortens NATURALLY
  • Trans Abdominus (core muscle) “sucks in” NATURALLY
  • Gluteal Muscles shorten NATURALLY
  • Hamstrings shorten NATURALLY
  • Abdominals shorten NATURALLY
  • Deep neck Flexors Shorten NATURALLY
  • Hip and Shoulder Joints Range of Motion increases
  • Less Compression on the Lumbar spine

Simple Exercises to begin in your Daily life:

  • To begin nasal breathing, tongue to the roof of your mouth and lengthen your exhale as long as you can
  • Generally, a ratio of 3:6 works
  • Begin in static relaxed positions first, then try incorporating it in movement such as walking.

Your Chronic pain whether in your back, neck, shoulder can be intensified due to altered breathing patterns. So, you can see how powerful our breathing can be to alleviate pain symptoms/ tension within our body. Drop into one of our clinics now for a review of any chronic condition you may be suffering with and along with movement exercises, hands on techniques we will incorporate breathing exercises to fully benefit you through your injury.

Book an appointment today for your assessment!

Blog By Louise Holland (Physiotherapist)

Introducing the GLAD program to Total Physiocare – Blog by Christian Bonello

GLA:D program for hip and knee arthritis – What is it?

The GLA:D® program (Good Life with Arthritis: Denmark) is an education and exercise program developed by researchers in Denmark for people with hip or knee osteoarthritis (OA) symptoms.

OA is the most common lifestyle condition affecting individuals 65 year of age and older, but can also affect those as young as 30.

Current national and international clinical guidelines recommend patient education, exercise and weight loss as first line treatment for osteoarthritis. In Australia however, treatment usually focuses on surgery and the GLA:D Australia program offers a better and safer alternative.

Background of the GLA:D program

Research from the GLA:D® Denmark found that patient reported symptoms reduced by 32% after partaking in the program. Other favourable outcomes included less pain, reduced use of pain killers, and less sick leave or absenteeism. GLA:D® participants also reported high levels of satisfaction with the program and increased their levels of physical activity 12 months after starting the program. Similar results have also occurred via the GLA:D Canada Program.

This program is unique in that the education and exercises provided can be applied to everyday activities. By strengthening and correcting daily movement patterns, participants will train their bodies to move efficiently, prevent symptom progression and reduce their pain.

What does GLA:D involve?

The GLA:D program is an eight week intervention and includes education and exercise, based on the latest evidence in osteoarthritis research. The program is supervised by a certified GLA:D physiotherapist, with the aim to help patients manage their OA symptoms.

GLA:D® Australia training consists of:

  • An initial appointment with a GLA:D certified physiotherapist explaining the program and collecting data on baseline functional ability
  • Two education sessions where you will learn about OA, how the GLA:D intervention improves joint stability and can reduce symptoms, and ongoing management following the program
  • Group neuromuscular training sessions which occur twice a week for six weeks to improve muscle control of the joint.

GLA:D® Australia is being unveiled in private and public hospitals and physiotherapy clinics.

Can I participate in GLA:D Australia ?

GLA:D® Australia is a program for all individuals who experience any hip and/or knee osteoarthritis symptoms, regardless of severity or x-ray reports. You may participate in the GLA:D® Australia program if you have a hip or knee joint problem that resulted in visiting a health care provider.

You may not be eligible to participate in the GLA:D® Australia program if you have

  • Other sources of knee pain including; tumor, inflammatory joint disease, result of hip fracture, soft tissue or connective tissue problems
  • Inflammatory conditions that are more pronounced than osteoarthritis problems (for example chronic generalized pain or fibromyalgia)
  • are not able to understand english

If you have queries in regards to the eligibility criteria please feel free to contact us.

You do not need a referral from your Doctor to partake in the GLA:D program. However you may be eligible for a rebate from Medicare for some of the cost of the program, if deemed appropriate by your GP.

FIND OUT MORE:

The GLA:D program will commence across Total Physiocare sites in May 2017. Please contact you closest clinic via phone or email for further information or to register your interest.

Why not give it try today and book an appointment today for your assessment! 

Blog by Christian Bonello (Physiotherapist)