How to manage hip and knee osteoarthritis - What's the latest?

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Did you know that Australians living with Osteoarthritis is expected to rise from 2.2 million in 2015 to almost 3.1 million by 2030?

So what can you do about it?

The Royal Australian College of General Practitioners recently updated their guidelines for management of hip and knee osteoarthritis.

Little to our surprise, the interventions that come with strong recommendations based on available evidence for managing these conditions include EXERCISE and WEIGHT MANAGEMENT.

What is Osteoarthritis?

Osteoarthritis the most common form of chronic arthritis that is characterised by joint pain, stiffness and swelling, and mainly affects the hands, knees and hips.

Osteoarthritis frequently occurs in people aged over 55 years, however younger people can also be affected.

What are the risk factors?

Risk factors for OA include:

  • Joint injury

  • Being overweight or obese, and

  • Older age

 

How can you manage Osteoarthritis best? What does the evidence say?

Lifestyle, lifestyle, lifestyle. We are seeing a recurring pattern here. In short, regular exercise and weight management are the interventions that are strongly recommended for people living with osteoarthritis.

Regular exercise is strongly recommended as a key factor for relieving pain and improving function in people with knee and/or hip osteoarthritis. This includes muscle strengthening exercises as well as walking and Tai Chi.

Weight management is strongly recommended for people with knee and/or hip OA who are overweight or obese.

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How can you get help to develop an exercise program for osteoarthritis?

An exercise program that is tailored specifically to you and your level of function is a key aspect of helping to manage osteoarthritis. It is not a once size fits all approach, particularly when it comes to proper programming for strength and cardiovascular endurance. This is where the help of a physiotherapist or exercise physiologist will help. 

The RACGP suggests the following;

Clinicians should prescribe an individualised exercise program, taking into account the person’s preference, capability, and the availability of resources and local facilities.

Realistic goals should be set. Dosage should be progressed with full consideration given to the frequency, duration and intensity of exercise sessions, number of sessions, and the period over which sessions should occur.

Attention should be paid to strategies to optimise adherence.

Referral to an exercise professional to assist with exercise prescription and provide supervision either in person or remotely may be appropriate for some people.

Exercise has many other health benefits that can assist in managing lifestyle diseases and optimising health. See post here.

What does it all mean?

In conclusion, what this means is that there is plenty that you can do in order to optimise your function and quality of life. Exercise, particularly strength training and weight management are strongly recommended in the management of osteoarthritis.

Getting advice from a physiotherapist or exercise physiologist will help in getting started on the path back to better health.

 

 

What is an over-active pelvic floor? Women's Health Wednesday

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This week charlotte, our women's health physio in sutherland, explains AN OVER-ACTIVE PELVIC FLOOR?

Like any muscle in the body it is important that the pelvic floor can both contract and relax.

If you think of your bicep muscle this needs to be able to contract to pick something up and relax to put something down. Imagine if the bicep was contracted all day long, it would be really hard to use your arm functionally and your bicep muscle would not work efficiently. Especially when strength is needed, the pelvic floor is the same.

Some women have pelvic floor muscles which have difficulty relaxing and remain constantly contracted. This however does NOT mean they are strong, imagine how tired they would be when you need them! 

OVER-ACTIVE ≠ STRONG

 

What are the symptoms of an over-active pelvic floor?

Symptoms will vary from person to person, but often include:

  • Pain with sex

  • Pain with using tampons

  • Pain with pap-smears

  • Pelvic or back pain

  • Difficulty emptying bladder or bowel (constipation)

  • Incontinence

  • Increased sensation of needing to urinate

 

Who is at risk of an over-active pelvic floor? 

People who tend to have a higher risk for an over-active pelvic floor include:

  • People with an overactive bladder, this is due to always needing to squeeze their pelvic floor to minimise leaking

  • Strong athletic women with strong outer core muscles

  • People with anxiety

  • Sedentary work/life style (poor posture can shorten the pelvic floor muscles)

  • Mouth/chest breathers

 

What is the treatment for an over-active pelvic floor?

Our initial treatment will always look at the way you breathe!

If you imagine your core and trunk muscles as a box, your pelvic floor is the base of your core with your transverse abdominus being the walls and your diaphragm muscle (breathing muscle) being the ceiling.

It is really important that all aspects of your core are working efficiently. If you are always breathing through your mouth, with a chest pattern of breathing the pelvic floor does not have a chance to relax.

Diaphragmatic breathing or “belly” breathing is essential as this allows the pelvic floor to descend and relax. 

 

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Can I still do pilates with an over-active pelvic floor?

Yes! However more focus should be on the strength of your muscles (not including your pelvic floor initially) therefore you should not actively contract your pelvic floor during initial pilates sessions. 

As symptoms decrease, we start to add in a graded strengthening program for you pelvic floor

4 VERY GOOD REASONS TO MOVE EVERYDAY (THIS SHOULD HELP WITH THE EXCUSES)

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DID YOU KNOW THAT Physical inactivity is now identified as the fourth leading risk factor for global mortality?

That's right, the fourth leading risk factor of global deaths is NOT moving enough. Sounds bizarre I know, but as a population, we have become well adapted to the conveniences of the modern world. Whether it's commuting, working, leisure time, home time etc. It is all based around more convenience and less movement, less labour, less physical activity and less exercise.

The World Health Organisation recommends that all healthy adults aged 18–64, without a specific medical reason not to, should participate in;

  • at least 150 minutes of moderate-intensity aerobic physical activity each week or; 
  • at least 75 minutes of vigorous-intensity physical activity throughout the week or;
  • an equivalent combination of moderate- and vigorous-intensity activity, and;
  • muscle-strengthening activities which should be done involving major muscle groups on 2 or more days a week.
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Adults aged 18–64 should do at least 150 minutes of moderate-intensity physical activity each week
— World Health Organisation

So while 150 minutes might sound like a lot of time across the week, it's not.

Simply, it's 30 minutes across 5-days. Throw in a couple of strength sessions and you have a recipe (with strong evidence) to:

1. Improve brain health

Physical activity has been shown to increase brain size, improve memory and decrease dementia risk. In Australia between 2006 to 2015, dementia has moved from the fourth to the second leading cause of death. 

2. Improve heart and lung health

Ischaemic heart disease,  a condition that affects the supply of blood to the heart, has remained Australia's leading cause of death over the past decade.

Exercise and physical activity improves heart and lung function and decreases your cardiovascular disease risk.

3. Improve mental health and wellbeing

In Australia in 2014-15, around one in twenty Australians reported having both an anxiety-related condition and a mood (affective) disorder, such as depression.
Physical activity and exercises has been shown to be effective in decreasing the risk of depression and helps improve mental wellbeing.

4. Improve musculoskeletal health

Physical activity and exercise helps increase bone mineral density, decreases the risk of osteoporosis and fracture and improves muscular strength and fitness.

The take home message is really just to move. Find ways in your day, things that you like and things that you will want to do to get the body moving. 

If you like pilates, do pilates.

If you're more a yogi, do yoga.

If you like the gym, get to the gym.

If you're a hiker, a rock-climber, a surfer, a sprinter, tai-chi'er or a jiu jitsu practitioner - then do that!

Just make sure you're moving your body, it thrives on it. It allows your brain to light up it's synapses, to move or stabilise joints and use its strength to lift and carry things, to accomplish a difficult task or to simply have fun.  

Over time, with some capacity building, some strength progressions, some time in the game, you will see the benefits. 

Get moving!

 

Did you know? Australia has launched the FIND YOUR 30 campaign that encourages Australians to find their 30 minutes of physical activity each day to lead a healthier and happier life. 

 

Sources: 

  1. World Health Organisation
  2. Australian Bureau of Statistics - Dementia
  3. Australian Bureau of Statistics - Mental and Behavioural Conditions
  4. Find your 30 
 

Lisfranc Injuries

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What does a French surgeon and gynaecologist have to do with this week's Flow Knows?

Well you would have heard his name thrown around a fair bit since Collingwood's Daniel Wells, sustained a left Lisfranc injury that required surgery in round 12.

The Lisfranc joint refers to the joints at the base of the five metatarsals and the articulations with the tarsal bones in the foot.

Injuries can range from ligament sprains to complete tears with differing degrees of separation and displacement. 

The 2 main mechanisms of injury are a direct crush force to the midfoot, or an indirect force.

The indirect mechanisms usually occurs from a fall backward with the foot trapped, a longitudinal compression or a fall on the point of the toes. 

Clients typically present with difficulty weight-bearing, running and walking on toes after an acute mechanism or injury.

It's important to note, that while Lisfranc injuries are uncommon in the general population, they are the second most common foot injury in athletes and require a high amount of clinical suspiscion in presentations where midfoot pain lasts greater than 5 days. This is due to the disastrous consequences if left untreated. 

Treatment will depend on the severity and amount of instability present. In lower grade injuries, with no separation, conservative management with a period of non-weightbearing in a CAM boot can be recommended. For higher grade injuries with instability and separation, a surgical approach is usually favoured.