November 24, 2017
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A Pain in the Butt: Managing a Proximal Hamstring Tendinopathy

Written by Jonathan Tan, Senior Physiotherapist at LifeCare Point Walter.

In the early stages of my physiotherapy career, one of the conditions I seemed to have more difficulty managing was buttock pain, specifically a proximal hamstring tendinopathy. A typical patient would walk in complaining of both a figurative and physical ‘pain in the butt’ when running, walking and often just sitting. They were typically a middle-aged runner, trying to increase their training load in preparation for some running event like the HBF Run for a Reason. They would complain of a dull aching pain just below their buttock when warming up which would subside during the mid-portion of their run, begin to aggravate towards the end, before coming on stronger than Michael Jordan in game 6 a couple of hours later.

One probable reason for our poor track record with this condition is that telling a runner to stop running is like telling a smoker to just stop smoking – running is addictive! Then comes the question, how much can they still do? However, after explaining the pathology behind the problem and the requirement to alter running load we can usually come to some sort of compromise.

Over the past year I’ve had some better (far from amazing) results with slight adjustments to my own approach and following evidence-based management, which I thought I’d share.

Firstly, we need to confirm that there actually is a hamstring tendinopathy and exclude other causes of buttock pain (i.e. lumbar spine referral, hip joint pain, neural structures). Once we have our diagnosis, we can get going.

Man grabbing leg.jpg

 

TYPICAL CLINICAL PRESENTATION OF PATIENTS WITH HAMSTRING TENDINOPATHY

·       Pain after exercise and the following morning

·       Often pain free at rest and initially causing pain in upper thigh/buttock with activity

·       Buttock pain improves following warm-up

·       Can often still complete a full training session in the early stages

·       Local tenderness of the proximal hamstring tendon affected (semitendonosus, semimembranosus, biceps femoris)

·       Commonly aggravated by running, walking (worse on incline) and prolonged sitting

WHAT IS A TENDINOPATHY?

We could discuss this for hours, so I’ll keep this short and simplified for you the patient’s perspective.

Cook and Purdam (2009)

Cook and Purdam (2009)

Cook et al (2009) describes the pathology of a tendinopathy as a continuum. Every day we load our tendons to some degree (in this case walking and running). Ideally we want our tendons to be stiff and strong. Optimal levels of load on the tendon will result in adaptation to strengthen the tendon and accommodate for the load being applied to it. However, if the load applied is too excessive or there are sudden changes in load e.g.

·       Running every day and not allowing sufficient recovery from fatigue

·       Suddenly increasing running distance too quickly

·       Changing running shoes

Then the tendon responds by thickening portions of the affected tendon causing pain. This is NOT an inflammatory problem, rather it’s called a reactive tendinopathy.

From this point the reactive tendinopathy can settle with adjustments in load, treatment and exercise which we will discuss later. However, if the excessive load continues to roll on, the tendon may then reach a point where it begins to breakdown (tendon disrepair) or further to the point it becomes much harder to treat (degenerative tendinopathy).

REASONS FOR DEVELOPING A HAMSTRING TENDINOPATHY

The most common tendinopathy seen in middle to long distance runners is an Achilles tendinopathy. So what puts the runner at risk of developing a hamstring tendinopathy? Some potential reasons may include:

·       Decreased gluteal activation (overloading the hamstring muscle group)

·       Decreased hamstring muscle activation

·       Longer stride length

  • This is issue that seems to come back to the thought that our hamstrings need to be as flexible as possible to minimise injury and improve performance (which is not necessarily the case).
  • Having a shorter stride length with good hamstring control during the swing phase will prevent the hamstrings from contracting from a lengthened position and provide a spring effect, which is more energy efficient for running.

MANAGEMENT

Acute

  • REST

o   At this point, some times it is best to just rest and let that acute flare-up settle down

  • HEAT

o   Although this goes against the typical acute injury management acronym RICE, a tendinopathy is not inflammatory in nature. 20 minutes with a heat pack on your buttock/hamstring will be fine

  • ISOMETRIC EXERCISES

o   There is evidence to support that isometric resistance training can reduce tendon pain immediately for up to 45 minutes (Rio et al 2015)

o   Delaying the beginning of an eccentric exercise regime (discussed next) and spending up to 2-3 weeks focusing on isometrics to get the pain under control seems to be working quite well with a number of patients I've seen more recently.

o   Isometric exercise can be utilised as a form of analgesia

o   Start these around day 3 after the initial acute flare

o   5 x 45 seconds at 70% of MVC

Isometric Exercises.png

1. Lift your unaffected leg off the floor

2. Use your affected leg to push down through your foot and lift your bottom up off the floor

3. Hold this position for 30-45 seconds if you can

4. Generally your buttock / hamstring pain should improve as you continue to perform the isometric exercises

Eccentric Strengthening

Eccentric strengthening has been the backbone of tendon rehabilitation for a number of years now. Eccentric exercise has been proven to alter tendon pathology potentially resulting in an improved ability of the tendon to absorb load (Alfredson & Cook, 2007).

Eccentric strengthening exercise involves loading the affected tendon only through the 'lengthening' phase of the exercise involved.

·       ECCENTRIC BRIDGE

o   4 sets of 12-15 reps

Eccentric+Bridge.png

1. Set your feet and knees shoulder width apart

2. Lift your bottom up

3. Raise your unaffected leg while keeping your bottom up

4. Slowly lower yourself back down controlling with the affected leg

·       ECCENTRIC BRIDGE WITH ROLLER

o   4 sets of 12-15 reps with smooth control of hip/knee extension

Eccentric+Bridge+on+Roller.png

1. Start with feet and knees shoulder width apart on roller

2. Lift bottom up off floor using just your affected leg

3. Slowly roll the foam roller away

4. Slowly roll the foam roller back to it's starting position and lower your bottom

Incorporating The Full Chain

·       GLUTE ACTIVATION

o   The gluteal muscles should be the primary muscle group producing extension at the hip when running. Having under active glute muscles may result in overload of the hamstring muscle group, as the hamstring compensate by acting as a hip extensor.

o   These are a couple of exercises that could be included in your rehabilitation program.

Full Chain.png

·       HOPPING

o   I recently attended a great lecture from Mr James Debenham and Dr Merv Travers that discussed the theory of the entire lower limb as a spring, made up of 3 small springs at the ankle, knee and hip.

o   Ideally we want our spring to be ‘stiff’

o   Hopping and skipping exercises aim to improve the ease at which our body can leave the ground and continue to propel us forward

LOAD MANAGEMENT

Managing load is a fine balance between preventing injury and maximising performance. The figure below represents the balance between protein synthesis and protein degradation.

Magnusson et al. (2010)

Magnusson et al. (2010)

Based on this diagram we can see that 24 hours after running, the tendon is still at a point of net degradation. Continuing to run day after day as the body is fatigued will result in ongoing degradation of the tendon. However, at 48 hours following running the tendon is at a point of net synthesis.

Basically you should be running every second day as this is the point where the tendon is at its safest point for you to continue training and to continue strengthening your tendon.

Ultimately we need to individualise load management based on your level of running, running goals and the point at which you sit on the tendinopathy spectrum.

A FINAL THOUGHT

A question I kept coming back to was why the management of an Achilles tendinopathy was proving more consistent and effective than the management of a proximal hamstring tendinopathy. One thought I had was that those with an Achilles tendinopathy get a chance to completely unload the Achilles when sitting down. Those with a hamstring tendinopathy are often constantly reminded of their pain when sitting.

If one of the patients risk factors for the hamstring tendinopathy in the first place was poor gluteal bulk and strength (causing overload of the hamstring tendon during hip extension), this lack of cushioning is likely continuing to aggravate the hamstring tendon as it’s compressed between the ischium and the chair. Another reason to ensure you continue to strengthen your gluteals as part of your rehabilitation. Maybe having a big bum isn't such a bad thing!

If you're experiencing any pain as described above please see your local LifeCare Physiotherapist. You can book an appointment at your closest clinic by clicking the button below.

 

References
Alfredson H., Cook J. (2007). A treatment algorithm for managing Achilles tendinopathy: new treatment options. British Journal of Sports Medicine, 41(4): 211-216. doi: 10.1136/bjsm.2007.035543
Cook, JL. & Purdam, CR. (2009). Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. British Journal of Sports Medicine, 43(6). Retrieved from bjsm.bmj.com/content/43/6/409.short
Magnusson, SP., Langberg, H. & Kjaer, M (2010) The pathogenesis of tendinopathy: balancing the response to loading. Nat Rev Rheumatol, 6(5): 262-8. doi: 10.1038/nrrheum.2010.43.
Rio, E., Kidgell, D., Purdam, C., Gaida, J., Moseley, GL. & Cook, J (2015) Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy. British Journal of Sports Medicine, 49(19): 1277-83. doi: 10.1136/bjsports-2014-094386.

 

November 24, 2017
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Lower Back Pain: It’s OK to Bend

Written by Jonathan Tan, Senior Physiotherapist at LifeCare Point Walter

Low back pain is a very common problem that most people will experience at least once in their lifetime. However, one of the biggest misconceptions in society surrounding low back pain is that we should avoid bending, particularly when experiencing a flare up.

In some cases this may be true, for example:

  • In acute low back pain when forward bending significantly flares pain
  • In cases of radicular pain when bending significantly aggravates leg pain or neurological symptoms such as pins & needles

However, although in both cases avoiding forward bending may be beneficial in the early stages, it’s important to progressively regain normal lumbar flexion. Continuing to avoid flexion is likely to become a barrier to a full recovery.

So let’s say you’ve just strained your back. You went to pick a piece of rubbish off the floor and suddenly felt a strain across your lower back. Over the next hour the pain progressively increased and your back began to feel tighter and tighter. The pain is moderate to severe with forward bending, prolonged sitting and particularly when getting up from sitting to standing. What now?

WHEN IS IT SAFE TO START BENDING?

Early in my physiotherapy career, I would likely have advised to continue moving and walking regularly through the day, avoid prolonged sitting, use a heat pack and avoid forward bending for 1-2 days.

To look at things very simply, I think in this acute situation things can go one of two ways. Gentle repeated flexion (bending) may aggravate the pain or it may actually relieve it when performed in supported and less threatening positions. 

Here are a couple of exercises to try day 1-2:

SEATED LUMBAR FLEXION

Seated Lumbar Flexion.png

CHILD'S POSE

Child's Pose.jpg
Child's Pose 2.jpg

SO HOW DO I KNOW WHETHER TO CONTINUE BENDING OR TO AVOID IT?

When performing the exercise (let’s say seated lumbar flexion) what happens? It’s normal to expect the movement to be painful initially, however if the pain is mild to moderate I would say it’s safe to continue.

Gently and progressively work further into flexion, without sustaining the position for any longer than a couple of seconds.

If the pain continues to get worse – STOP!

  • This may suggest it’s still too early to begin bending to this degree
  • It may be a good idea to apply some strapping tape to the lumbar spine for a couple of days to avoid any excessive flexion. We can come back to this exercise / test later.

If the pain starts to ease and you notice you can progressively move further – Keep Going!

  • If things are feeling better, why stop?
  • We still want to set a limit, in case you have a delayed pain response
  • To keep it simple aim for 3 x 10-15 repetitions a few times in the day

WHAT IS THE BEST POSITION TO SIT?

In acute low back pain, prolonged sitting is quite often an aggravating activity. However, again I think too much emphasis has been put on avoiding flexion and bending the spine when sitting. Sitting upright forces the lumbar erector spinae muscles to activate and a lot of endurance is required to maintain this position for long periods of time. If these muscles are already in spasm, sitting too upright may further aggravate pain. We need to relax these muscles.

Sitting at your desk

If you're experiencing low back pain, sit in the position that is most comfortable for you. If relaxing your low back muscles and slightly slumping is relieving, than go for it. Maybe sit with a pillow to prevent you from slumping too far, but enough to still let you actually relax! It's more likely the long periods of time in sitting that aggravate the problem, so try to get up and walk around regularly.

WHAT’S ACTUALLY HAPPENING?

In acute low back pain, the only musculoskeletal structure that has the capacity to cause such a dramatic decrease in lumbar flexion range in a short amount of time is muscle. Our muscles will go into spasm as a protective mechanism to avoid us from moving too far into a painful position. However, muscle spasm will often happen in the absence of any significant structural pathology e.g. large disc protrusion, therefore chasing an improvement in lumbar flexion early may well be quite safe.

Muscle spasm itself can cause a lot of pain both from the muscle as a source of pain as well as the compressive load this muscle spasm applies to the spine. Progressively relaxing this muscle spasm through normal movements can be very effective.

PROGRESSION - WHY AM I STILL STIFF?

It is important to continue to bend and improve our lumbar flexion range. Following a lumbar strain, many people continue to say they are experiencing stiffness in their back. Why is this though? It's reasonable to expect our muscles should have relaxed and returned back to their normal length by then. Our vertebrae certainly can't degenerate to that extent in such a short period of time.

Here's a link to an interesting article I read which may help to explain why many people continue to feel stiff - https://www.nature.com/articles/s41598-017-09429-1

Stanton et al (2017) performed a study that found a 'feeling of back stiffness' correlated poorly to biomechanical measures of back stiffness. Rather, many people develop a protective response to avoid movement to prevent provocation or injury. 'Feeling stiff' is an important predictor of disability but if this is primarily driven by a fear of movement, this must be addressed. 

In most cases, pain does not indicate you're doing damage. It's important to regain your movement!

FINAL THOUGHT

The main point I want to make here, is that it’s safe to bend. In the acute stage of low back pain, I think our brains perceive forward bending in standing as serious no-go. Likely because the strain occurred initially with this movement or because we’re less stable than in sitting or on all fours. Bending in a more supported position like sitting may help to modify that neuromuscular response to spasm and actually recover faster.

Keep in mind, this may not apply to everyone with low back pain. When there is clearly a strong inflammatory process or dominant neuropathic pain, avoiding bending may be best.

In any case it’s best to speak to your physiotherapist when this type of pain occurs. If you are experiencing lower back pain, you can book an appointment with a local LifeCare physiotherapist by clicking the button below.

November 24, 2017 -->

10 Exercise Tips to Maximise Your Workout

Originally posted by LifeCare Point Walter.

With 24/7 gyms popping up all over the place, the health department increasing their emphasis on exercise promotion, everyone trying to get their beach bodies set for summer and the warm weather making any kind of exercise that bit more appealing, more and more people will start hitting up the gym and pounding the pavement.

As everyone begins to emerge from their winter exercise hibernation, we will slowly see the usual suspects start to fill LifeCare clinics:

·         The Hibernators: Now that you can go for a run without fear of frostbite or getting drenched, there will be plenty of people who will try to resume their exercise routine from the end of last summer after not doing much over the winter and find out the hard way that they aren’t as fit as they were 6 months ago

·         The Weekend Warriors: Sportsmen who finished their winter sport a few months ago, had a great off season, and then start training 3 times a week for pre-season, which inevitably results with them burning out their legs

·         The Beach Bodies: The approaching summer means long days at the beach are just around the corner and the masses will start flocking to gym to regain their beach bodies after a long winter. Unfortunately many will realise that lifting heavy things with poor technique or without a well-planned workout routine is a sure fire way to sustain an injury.

·         The Revellers: along with the easily preventable injuries, there will always be the token few after Christmas and New Years who get a little too involved in the holiday fun and end up with a PAFO (pissed and fell over) injury. Such injuries include rolled ankles and sprained wrists from falling down stairs in heels, pulled muscles from unrealistic physical challenges and “mystery injuries” where people are sore in multiple areas but have no idea of what happened.

·         The High Achievers: This group consists of the few people who maintained good exercise habits over winter and have found that after 6 months of training their performance has plateaued and they are unsure how to reinvigorate themselves and their exercise routine.

Many people (including myself) have fallen into at least one of these categories over the last few years and will know how annoying it is to have injury ruin your summer exercise. To ensure this doesn’t happen to you this year or you want to maximise the results of the exercise you are currently doing, check out the following simple exercise tips:

GET YOUR PREPARATION RIGHT!

1.   SET GOALS

Before you even go near your runners and jump head first through the gym doors, you need to ask yourself a few important questions: Why are you doing it? What do you want out of it? How is it going to fit into your daily routine? Once you have an idea about what you want to achieve, you can set some SMART (Specific Measureable Achievable Realistic Timely) goals so you have something to aim for. If you know what you want to achieve and when you want to achieve it by, you have that extra motivation to push yourself that much harder.

SMART+Goals.jpg

2.  SLEEP

Sleeping is like plugging your phone into the charger: It recharges your body, and gives it time to update and perform repairs on anything that’s damaged. If you don’t get enough shut eye, your body’s battery will slowly run further and further down until you have nothing left. It is hugely beneficial for a plethora of reasons including; improving your productivity at work or whilst studying, maintaining a healthy immune system, ensuring you have enough energy to run as far and train as hard as possible and reducing your risk of sustaining an exercise-related injury. Each individual’s sleep requirements are different, so someone might only need 6 hours sleep to function properly and the next person might need 10. Make sure you’re getting enough sleep for YOU.

3.  ENERGISE

If you want to perform well, you need to make sure you have the energy stores in your body to draw on when the going gets tough. Carbs get a bad rep but they are the primary source of energy for your body and are essential to load up on before a workout.

Protein provides the building blocks for new muscle to form allowing you to become bigger, stronger and faster. To optimise your muscle’s growth and repair and the overall effectiveness of your workout, you should already have protein in your system prior to exercising to ensure it is readily available once you’re done.

Eating immediately before any type of exercise is not recommended (unless you don’t mind the taste of it coming back up), so make sure you're eating your last main meal at least a couple of hours before your workout. If you’re a morning exerciser, have a small breakfast and a snack rather than a full English breakfast!

4.   DRINK UP!

If you’re anything like me and you start sweating even thinking about exercise, let alone 30 minutes into a run, take note! Sweating is one of your body’s key thermoregulation strategies (stops you from overheating) and without it our body would start to shut down in the middle of an exercise session, which would be pretty inconvenient to say the least. The harder you work, the more heat energy is produced by your muscles and the more sweat you will produce. Some of the WAFL players I have worked with previously were losing between 1-2 litres of water per hour during their pre-season games.

Keep Hydrated When Working Out

To ensure your body can effectively keep your core temperature down and allow you to work out harder for longer, you need to be fully hydrated in the lead up to a session. Most people will have learnt the hard way that sculling a bottle of water prior to running isn’t such a great idea, so to reach optimal hydration levels you need to up your drinking the day before. In the hour before a workout you shouldn’t be drinking more than a glass of water otherwise your stomach won’t have time to process it.

As a basic rule, if your urine isn’t clear in the lead up to a big workout, you simply haven’t drunk enough water.

MAKE THE MOST OF YOUR SESSION!

5.    DO THE RIGHT TYPE OF WARM-UP

A proper warm-up before exercise is essential and will improve your muscle’s output and reduce your risk of injury, however if you do the wrong type of stretching the reverse will happen! Static stretching (holding a stretch for a period of time to improve the length of the muscle) is one of the most common forms of stretching and has been shown to increase the risk of injury and prevent the muscle from working at its peak.

The best type of warm-up is a dynamic warm-up which includes activity-specific exercises (running/jumping/ball handling skills etc) and dynamic stretching (stretching whilst moving). For more information on stretching and warm-ups go to "Stretching the Limit of Injury Prevention"­­­­­

6.    DO THE RIGHT TYPE OF EXERCISE

By this point you should have set a few goals and know exactly why you are exercising and know what areas you want to improve in. If you want to bolster your fitness or get bigger and stronger, you need to make sure the type of exercise you are doing is tailored to meet your goals.

The key to any type of exercise is to challenge yourself. After each run you should not be able to take another step. After each set at the gym you should not be able to crank out another repetition. If you get to the end of your session and you still have fuel left in the tank why not sprint the last 200m or just keep lifting the weights until you literally can’t do any more. You’ll have a much greater sense of achievement if your body gives out before your mind does.

Type of exercise.jpg

7.   TAKE A BREATHER!

In conjunction with your primary exercise days, you need to ensure you are having adequate recovery sessions. Rest days are an important component to any exercise routine, especially with weight programs, but rest days don’t mean you should just sit on the couch and binge on Netflix. After a big session at the gym, your muscles will be slightly damaged (the healing of which is what makes them stronger) and they won’t be ready for another solid workout the next day. Compliment your main sessions with a different type of exercise. If you smash out a big weights session on Monday, why not go for a run on Tuesday and then get back to the gym on Wednesday. If you’re training for the city to surf, throw in a long ride a couple of days a week. Don’t feel guilty about having a day where you just go for a casual stroll now and again to give both your body and mind a chance to recharge, because there’s no point in diving head first into an exercise routine and burning yourself out after the first month.

OPTIMISE YOUR RECOVERY!

8.   NUTRITIONAL RECOVERY

-     Rehydrate: As mentioned above, your body can lose tremendous amounts of fluid during exercise, especially if you're working hard on a hot day. Your body can only hold so much water so even if you drank a heap prior to exercising, chances are you will still be dehydrated once you’ve finished. It’s not uncommon to keep sweating for a good 30 minutes after a big workout as your body keeps working on getting your core temperature back down.

Sports drinks like Gatorade, Powerade etc are idea because they replenish the electrolytes and salts lost when you sweat as well as the fluid, but there’s nothing wrong with simply sculling a big bottle of water when you get home and sipping on a water bottle for the rest of the day.

-     Refuel: Your muscles need an energy source to work and will deplete your stores of carbohydrates, fats and proteins in order to keep pumping. Once your workout is finished your body uses the same energy stores to repair itself, which means if you’ve used up your energy supply during your exercise and haven’t replenished them, you’re recovery is going to be severely compromised.

Ideally you should re-stock your reserves within half an hour of finishing exercise, so taking a protein shake in the car with you to have on the way home from the gym or having one in the fridge ready for after your run will ensure your body can kick-start its recovery process ASAP.

9.   BODY RECOVERY

Just because you’ve walked out the doors to the gym or the final siren has sounded and you’ve had your protein shake doesn’t mean you can sit back and relax just yet. If you’ve gone for a hard run or ride, make sure you take 5-10 minutes walking around to help flush some of the blood and waste products out of your legs and leave you feeling fresher the next day. If possible get down to the local pool where the compression and cool temperature of the water will make this process more effective. If your muscles are feeling tight add some stretching in as well.

If you play a contact sport like footy or rugby, or even a non-contact sport like netball (which if you’ve played it you know you're going to cop a couple of elbows), you may end up with some bumps, bruises and/or muscle tweaks which need to be addressed immediately after the game.  The RICE principle is the easiest, simplest and most effective acute management process for most injuries.

RICE.jpg

10. IF IN DOUBT, ASK THE PROFESSIONALS!

Most of the time if you’ve sustained an injury whilst exercising you will know about it, even if you're in denial about it. Pain is your body’s way of telling you to seek help so make sure you listen to it! A bit of soreness after a big session is normal but if you're still hobbling around after a couple of days make sure you get yourself seen to. If your sporting club or gym has a trainer or physio down there have a chat to them or head down to your local physio or GP. The sooner you get seen to and started on a rehab program the less time you’ll spend out of action, so if in doubt, get checked out!

 

November 2, 2017 -->

Physiotherapy and women’s health

Did you know that there are Physiotherapists who specialise in women’s health and continence? 

Unfortunately it’s a well-kept secret and many women only find out about these specialist services after problems start occurring, after childbirth or a GP referral. 

Women face a range of complex health issues over and above injury, trauma or illness and the stage of life challenges associated with middle or old age. Menstruation, menopause and pregnancy and its related conditions can also significantly affect the body. Most women assume that they must live with these conditions, as there is little or nothing that can be done to influence them other than medical/operative intervention. In many instances, that is not the case.

Some of the issues that can be positively impacted by physiotherapy include:

  • Bladder and bowel dysfunction, including incontinence
  • Pelvic pain 
  • Painful intercourse
  • Pelvic floor muscle dysfunction
  • Pelvic organ prolapse and
  • Prenatal and postnatal issues including mastitis, lower back pain or abdominal muscle separation.

In fact, a specifically trained Women’s Health & Continence Physiotherapist can not only help better manage these conditions and any related health challenges, they are often integral to the treatment program, working alongside GP’s and specialists as part of the treatment team. What’s more, they can often help patients avoid surgery down the track. 

All Women’s Health & Continence Physiotherapists have post graduate training in the range of health issues faced by women throughout every stage of their life. They identify and address specific health problems and use a variety of non-surgical treatments. 

Appointments cover a thorough assessment of the concern and an in-depth discussion about the most effective treatment technique recommended for your particular health issue. Diagnosis and treatment plans are created in line with the latest evidence-based practice, and are delivered in a safe and supportive environment. Treatment may involve simple exercises, ultrasound or massage and follow up rehabilitation activities may be recommended such as a guided exercise program or clinical Pilates.

For example, a physiotherapy session for urinary incontinence might include:

  • Practical tips and ways to reduce urinary frequency and urgency 
  • Information about diet changes that can be made to avoid irritating the bladder
  • An exercise program to strengthen the pelvic floor muscles.

The recommended program will help the patient identify, exercise, re-train or repair internal muscles such as those in the pelvic floor, and ultimately help to improve their quality of life.

At many LifeCare practices, we have specially trained Physiotherapists who can help with women’s health and related issues. We also help with advice about safe fitness alternatives for those people affected by, or at risk of, pelvic floor muscle dysfunction and offer classes and programs including:

  • Pregnancy education 
  • Pool exercise classes
  • Clinical Pilates
  • Individual exercise prescriptions.

Oh, and we bet you didn’t know there were physios specifically trained for men’s health issues did you? There are, but that’s another story - stay tuned.

If you would like to make an appointment at your closest LifeCare practice, simply click the button below.

November 1, 2017 -->

5 Tips to avoid running injuries this year

Written by Aidan Rich, APA Sports Physiotherapist at LifeCare Ashburton

There are so many reasons to get into running - whether it is to see the health benefits that come with it, you've made a New Years resolution that you're finally coming around to, or you genuinely enjoy the activity - regardless of what your reasons are, we're going to take you through some simple ways to reduce the risk of a running injury.

Author of this article, Aidan Rich, running the marathon leg (PB 3.08) during the Ironman Western Australia Triathalon.

Author of this article, Aidan Rich, running the marathon leg (PB 3.08) during the Ironman Western Australia Triathalon.

1. Keep most of the running ‘easy’. Most of your running should be at a comfortable pace where you can maintain a conversation and this may mean incorporating some short regular walk breaks.

Keep the ‘hard’ running to 15-20% of your distance for the week at most, for example if you are running 40 km per week, 6-8km only should be at a faster pace. 


A sample program for a 40km/week runner might be:

  • Tuesday 8-10km including 4 x 1km hard with 90 seconds jog in between
  • Wednesday 6km Easy
  • Thursday 8km including 8-10 x (1 minute hard, 1 minute easy)
  • Sunday long run 16-18km

2. Vary the running environment. Your body is fantastic at adapting and does this best when exposed to lots of different stimuli. Do some running on hills, flats, grass, gravel and maybe some trails. Just be careful with too much running too quickly on the road or the athletics track as these have higher forces on the body.

3. Gradually increase your training load. Running is a high impact sport and increasing too quickly can cause problems with tendons, bones and joints.

Increasing by 10% per week is a common rule of thumb, and recent research has shown this to be a good measure of risk of injury

Change in training load per week.

(ref: Gabbett 2016)

How do you measure training load? One of the best ways is to use RPE method (Rating of Perceived Exhaustion), a 0-10 scale that starts at 0 (no effort at all) to 10 (maximal effort).  For example, a 40 minute run at an RPE of 5 would give 200 units of work. To avoid building up your running too quickly, aim to increase your load by no more than 10% each week. 

4. Get lots of sleep! Sleep is the number one recovery tool, with many studies showing a strong link between sleep and performance/injury risk.  Start creating good habits to maximise your sleep such as limiting caffeine later in the day, and minimizing use of screens within 1-2 hours of bed time.

5. Use rest days. If you are relatively new to running, it’s best to have at least 2 days of no running per week. Running one day on, one day off is often a good starting point. More intermediate runners may have their no running days after a hard session (such as intervals or a long run).  
Adding in some light cross training (such as cycling or swimming) can be a great way to actively recover as well as build cardiovascular fitness without the impact that running involves.

Get your comprehensive running assessment completed at your closest LifeCare clinic.

November 1, 2017 -->

Clinical Pilates Vs ‘Regular’ Pilates

Written by Laura Anderson, Physiotherapist and Pilates Instructor at LifeCare Ashburton

Pilates is a form of exercise that is suitable for just about anyone. It uses a system of exercises designed by Joseph Pilates in the 1920s and is designed to improve strength, posture, flexibility and overall physical fitness.

Pilates is offered in a range of different class settings, which can sometimes make it confusing when trying to choose the right option for you. Clinical Pilates classes are run by experienced physiotherapists with postgraduate training in the Pilates methodology, which means they have extensive knowledge of musculoskeletal anatomy and rehabilitation from orthopaedic and sports medicine conditions. This difference is important as most Pilates instructors don’t have such in-depth knowledge and understanding of the human body.

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Some of the advantages of choosing Clinical Pilates over ‘regular’ Pilates (such as a gym based Pilates classes) are:

  • Clinical Pilates classes are small - a maximum of 4-5 per class allowing for plenty of 1:1 attention
  • Importantly, each participant gets an individualised program specific to their needs.
  • Private Health insurance can be used to claim on the cost of the class.

Prior to commencing Clinical Pilates, a thorough assessment is undertaken to understand how your body moves and to develop a personalised Pilates program. We understand that everybody’s goals are different, so it is important that you have a tailored program that is specific to what you want to achieve. The beauty of these individualised programs is that they are dynamic - there is the ability to alter them from week to week if any issues arise or if your goals change.

Most Lifecare clinics offer Clinical Pilates on site within spacious studios which comprise of all the latest Pilates equipment including reformers and trapeze tables. The classes are run by experienced physiotherapists, which means that you will receive specialised guidance and advice on your technique.

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Pilates continues to be a popular exercise option for people of all types due to its versatility. Pilates can be of great benefit if you are:

  • Recovering or undertaking rehab from an injury or surgery: Pilates can help to regain lost strength, balance and motor control. It’s a great way to transition back to sport or to return to your everyday activities.
  • Employed in a typical office desk setting: prolonged sitting often leads to poor posture, which in turn can result in back or neck pain. Pilates can help correct your posture and also to stretch out those sore or tight areas.
  • A Sports enthusiast/athlete: Pilates can help to fine-tune the skills required for all sports. It can add that extra dimension to your current training program, and increase sports performance. Plus, it’s a great way to help prevent injuries.
  • Pre- or post-natal: Pilates can be tailored to suit women who are pregnant to help manage the physical changes involved with pregnancy and prevent pregnancy-related symptoms like back pain. Pilates also has a big role with post-partum recovery and can help women strengthen their pelvic floor.
  • Social interaction: Pilates are a fun way to meet like-minded people who enjoy working out in a fun environment.
  • Maintaining strength after 50: Strength and balance often decrease after this age however appropriate exercise can dramatically slow the losses and in some cases reverse them!  Pilates provides an opportunity to improve strength without the sometimes intimidating environment of a gym.

It’s easy to see why so many people are drawn to Pilates –it’s just so versatile! If you’re not already doing Pilates, book in today and let us help you start achieving your goals!

May 22, 2017 -->

Mount Pleasant has moved!

LifeCare Mt Pleasant Physiotherapy has moved.

Now located on the first floor at 896 Canning Hwy in Applecross, we are now directly above the Canning Bridge Medical Centre.

Our wonderful team of Physiotherapsist: Leigh Ray, Moulina Sahai, Tom Valentine and Sarah Davies  have all settled into their newly renovated Centre, and are enjoying the additional space and Therapeutic Exercise area.

 LifeCare Mt Pleasant Physiotherapy is open 6 days a week

NEW PHONE NUMBER: 9364 2012

We had a great Opening Ceremony in conjunction with the Canning Bridge Medical Centre, complete with Ice Cream Van, Coffee and BBQ, and even the Cutting of the Ribbon.

For more information call 9364 2012.

May 22, 2017 -->

Ground Breaking

LifeCare opened one of the very first Sports Medicine & Physiotherapy Centres in WA in the late Eighties.

Located in the Ground Level of the St John of God Subiaco Medical Centre, this clinic offered Sports Medicine, Sports Physiotherapy, Podiatry, Radiography and Hydro Therapy, 7 days a week.

This Centre was “Ground Breaking” in the Services provided to Perth’s Sporting Population.

Some 30 years later, it seems it is now the site of a different type of “Ground Breaking”.

The old St John of God Medical Centre in Subiaco where this started has been demolished.

Luckily LifeCare Wembley is still providing 7 days a week Sports Physiotherapy, as well as Pilates Podiatry and Hydro Therapy, 7 days a week, over the road at 202 Cambridge St – 9489 6266. http://www.wembleyphysio.com.au/