Online Physiotherapy - is it a new thing?

Feed your microbiome - how to get good gut health

astephj@gmail.com (Amanda Stephenson) — Sun, 10 Jan 2021 16:22:35 GMT

What is good gut health?

In recent years there has been increasing research into the digestive tract and the many ways in which it interacts with our body and brain. To have good gut health means that your gastrointestinial tract (oesophagus, stomach and intestines) is in the best possible. condition. This involves the gut microbiome - the microbes- a mixture of bacteria, viruses and fungi that live in our digestive system. They are important for good health and disease prevention and the higher level of good microbes (probiotics) in our biome the better.

What are the symptoms of poor gut health?

If your gut health is not optimal you may experience abdominal pain, discomfort, constipation, diarrhoea, heartburn or indigestion. Even if you have no symptoms it remains important to look after your gut as increasingly scientists are finding that gut health is a major factor in our immunity. Good gut health can also protect against type 2 diabetes, bowel cancer and heart disease.

Poor gut health can also have an effect on mood and mental wellbeing- due to the gut-brain axis. This is a two way communication network between the brain and the gut, linked by nerves, hormones and neurotransmitters acting as chemical messengers.

How can I improve my gut health?

Increase your fibre intake - we should consume 30g of fibre a day

Most people only manage about 18g of fibre a day. Eating a combination of soluble and insoluble fibre adds bulk and improves the transit time of food through the digestive system. Gut bacteria loves fibre, but it is recommended to increase your fibre intake gradually to avoid bloating. By eating a variety of fruit, vegetable, pulses, wholegrains and nuts your gut health will improve.

Sources of soluble fibre - oats, linseeds/flaxseeds, lentils, fruit and vegetables.

Sources of insoluble fibre - nuts, wholewheat flour, wholemeal bread, wheat bran, beans,cauliflower, green beans and potatoes

Seven great foods for your microbiome

Apples are high in pectin a prebiotic - one apple contains 4g of fibre

Oats are high in a dietary fibre called beta-glucan which can help lower LDL cholesterol if eaten regularly

Onions are a good source of prebiotics

Kefir is rich in probiotic bacteria and calcium. It can help restore your gut after you have taken antibiotics which can reduce good gut bacteria

Wholegrain carbohydrates such as w hol emeal bread and pasta and brown rice can easily increase your fibre

Lentils are full of soluble fibre which helps food transit through the digestive system

Fermented foods such as sauerkraut kimchi may improve intestinal health and as a result support the immune system and anti-inflammatory responses and improve levels of good bacteria in the gut.

Drinking plenty of fluids is great for gut health. 6-8 200ml glasses of water a day is recommended.

Professor Tim Spector, specialist in genetic epidemiology, writes in his book Spoon-Fed how artificial sweeteners and processed foods are bad for our gut health. He advises avoiding anything labelled as a “diet” food and especially anything containing artificial sweeteners which, he suggests, can trick our bodies into gaining weight.

Regular exercise

30 minutes of moderate activity ( moderate = going for a walk at a good pace but still being able to chat) five times a week helps regulate bowel movements and can help boost gut bacteria.

Calcium can boost the production of digestive enzymes which break down proteins, carbs and fats and helps the absorption of nutrients - so a small 30g snack of cheese, 120g yogurt or kefir for breakfast or 200ml of milk will help.

Should I take prebiotics and probiotics?

Prebiotics are non-digestible food compounds like fibre that feed the good bacteria and help digestion and nutrient absorption. You do not need to buy them in a pill - you can get them from wholegrains and fruit and vegetables such as asparagus, Jerusalem artichokes, onions, garlic and under-ripe bananas.

Probiotics are the good bacteria themselves such as Lactobacillus and Bifidobacterium species. If your yogurt is live they will be listed in the ingredients list. They are also found in fermented foods such as kimchi, kombucha, tempeh, kefir and sauerkraut (not all sauerkraut has live bacteria as some brands are pasteurised).

To boost gut bacteria we should eat both prebiotics and probiotics, whilst avoiding highly processed foods. Professor Tim Spector advises avoiding any food that comes in a packet with more than 10 ingredients listed.

Perimenopause, Menopause and Post Menopause

astephj@gmail.com (Amanda Stephenson) — Sun, 10 Jan 2021 12:38:04 GMT

Let's answer some questions!

Menopause was a word that was usually whispered and given all manner of euphemisms from "it's my age" to " personal moment" and " hot flush". Women often struggled through it and men tended to toddle off the pub or the shed or quite frankly anywhere to get away from it. Times are changing. In 2015 the then Chief Medical Officer Professor Dame Sally Davies stated that " Menopause should be discussed as openly as any other subject". Young people now learn about it in secondary school, which makes sense as their Mum's will go through it and half of them will experience it in later years.

There still remain some hurdles to discussing menopause - explaining symptoms to work colleagues or managers is difficult. Asking for 10 mins outside to cool down is no different to people racing outside for their cigarette break or their Starbucks fix. As with many things in life forewarned is forearmed - if you know about the symptoms and what can happen you will feel better prepared to manage it.

What is perimenopause?

Usually it happens between the age of 45-55. For 1 in 100 women it will start under the age of 40.

Perimenopause means "around menopause" and refers to the time during which your body makes the natural transition to menopause, marking the end of the reproductive years. Perimenopause is also called the menopausal transition.

Women start perimenopause at different ages. You may notice signs of progression toward menopause, such as menstrual irregularity, sometime in your 40s, some women notice changes as early as their mid-30s.

The level of estrogen — the main female hormone — in your body rises and falls unevenly during perimenopause. Your menstrual cycles may lengthen or shorten, and you may begin having menstrual cycles in which your ovaries don't release an egg (ovulate). You may also experience menopause-like symptoms, such as hot flushes, sleep problems and vaginal dryness. Your GP can discuss the treatments which are available to help ease these symptoms.

Once you've gone through 12 consecutive months without a menstrual period, you've officially reached menopause, and the perimenopause period is over.

Perimenopause symptoms

Irregular periods

As ovulation becomes more unpredictable, the length of time between periods may be longer or shorter, your flow may be light to heavy, and you may skip some periods. If you have a persistent change of seven days or more in the length of your menstrual cycle, you may be in early perimenopause. If you have a space of 60 days or more between periods, you're likely in late perimenopause.

Hot flashes and sleep problems

Hot flushes are common during perimenopause. The intensity, length and frequency vary. Sleep problems are often due to hot flashes or night sweats, but sometimes sleep becomes unpredictable even without them.

Mood changes

Mood swings, irritability or increased risk of depression may happen during perimenopause. The cause of these symptoms may be sleep disruption associated with hot flashes. Mood changes may also be caused by factors not related to the hormonal changes of perimenopause.

Vaginal and bladder problems

When estrogen levels diminish, your vaginal tissues may lose lubrication and elasticity, making intercourse painful. Low estrogen may also leave you more vulnerable to urinary or vaginal infections. Loss of tissue tone may contribute to urinary incontinence.

Decreasing fertility

As ovulation becomes irregular, your ability to conceive decreases. However, as long as you're having periods, pregnancy is still possible. If you wish to avoid pregnancy, use birth control until you've had no periods for 12 months.

Changes in sexual function

During perimenopause, sexual arousal and desire may change. If you had satisfactory sexual intimacy before menopause, this will likely continue through perimenopause and beyond.

Loss of bone mass

With declining estrogen levels, you start to lose bone more quickly than you replace it, increasing your risk of osteoporosis — a disease that causes fragile bones.

Changing cholesterol levels

Declining estrogen levels may lead to unfavorable changes in your blood cholesterol levels, including an increase in low-density lipoprotein (LDL) cholesterol — the "bad" cholesterol — which contributes to an increased risk of heart disease. At the same time, high-density lipoprotein (HDL) cholesterol — the "good" cholesterol — decreases in many women as they age, which also increases the risk of heart disease.

Problems with memory or concentration

Risk factors

Menopause is a normal phase in life which may occur earlier in some women than in others. Although not always conclusive, some evidence suggests that certain factors may make it more likely that you start perimenopause at an earlier age, including:

Smoking. The onset of menopause occurs one to two years earlier in women who smoke than in women who don't smoke.

Family history. Women with a family history of early menopause may experience early menopause themselves.

Cancer treatment. Treatment for cancer with chemotherapy or pelvic radiation therapy has been linked to early menopause.

Hysterectomy. A hysterectomy that removes your uterus, but not your ovaries, usually doesn't cause menopause. Although you no longer have periods, your ovaries still produce estrogen. But such surgery may cause menopause to occur earlier than average. Also, if you have one ovary removed, the remaining ovary might stop working sooner than expected.

Complications

Irregular periods are a hallmark of perimenopause. Most of the time this is normal and nothing to be concerned about. However, see your doctor if:

Bleeding is extremely heavy — you're changing tampons or pads every hour or two for two or more hours

Bleeding lasts longer than seven days

Bleeding occurs between periods

Periods regularly occur less than 21 days apart

Signs such as these may mean there's a problem with your reproductive system that requires diagnosis and treatment.

How will I feel during perimenopause?

Approximately 75% of women experience hot flushes, sweats, tiredness, poor concentration, memory deficits, brain fog or vaginal and bladder problems. But do not worry - they do not tend to happen all at once! Some symptoms will be more prevalent than others and will settle, go away and can return later on.Most women find that symptoms go away completely and some women hardy have any symptoms at all. There are also dietary and lifestyle changes that can help improve symptoms and the GP can discuss these and hormone replacement therapy with you.

It is very common to feel tearful due to the fluctuation of hormones, the stress of dealing with the symptoms alongside work and daily life. It is also common to feel anxious or depressed. Using mindfulness and breathing techniques can help ease anxiety but if you or those around you suspect worsening anxiety or depression then you should discuss this with your GP.

Can changing what I eat help?

Perimenopause can cause weight changes including weight gain. Reducing sugar and saturated fats, changing to complex carbohydrates such as wholegrains will make a difference. Adding plant oestrogens such as flax seed, rye and soy products may reduce your hot flushes a little. Eating a calcium rich diet (dairy, nuts, non-dairy alternative or spinach) can improve your bone health and ensuring you have sufficient Vitamin D ( oily fish – such as salmon, sardines, mackerel, trout. red meat, l iver and fish liver oil, egg yolks) especially in winter months when we cannot get out in the sunshine, will all help.

How can I keep healthy?

Good health throughout the menopause is important for your future health. Not smoking, eating a balanced diet, maintaining a healthy weight, limiting alcohol and doing regular weight bearing and resistance exercise will build the foundation blocks for good heart and bone health ( see my blog on osteopenia and osteoporosis). Stress reduction is also important so factor in regular time for relaxation and exercise.

Where can I get more information?

Led by specialist gynaecologist Dr Heather Currie www.menopausematters.co.uk is an excellent source of information

The British Menopause Society has information on women's health www.womens-health-concern.org and a list of menopause specialists searchable by postcode www.thebms.org.uk

For employers who want to support women through this life transition https://peppy.health/menopause/

Menopause : The One Stop Guide Kathy Abernethy, menopause specialist nurse www.kathyabernethy.com

What is post-menopausal?

Once your periods have stopped for a year, you are considered post menopausal. Menopausal symptoms can last around 4 years after your last period, although some women experience them for much longer.

Living with lupus

astephj@gmail.com (Amanda Stephenson) — Sat, 02 Jan 2021 16:50:27 GMT

Invisible symptoms

Lupus is an autoimmune disease that causes your body's antibodies to attack it's own organs and tissues, triggering inflammation and pain. It is estimated that 1 in 1000 people in the UK have lupus. 90% of people with lupus are female, usually aged 15-45 with a greater prevalence in Black and Asian women. It takes on average 6.4 years to be diagnosed with lupus, often with other diagnoses suggested along the way.

There are a large range of symptoms:

Skin rashes

Joint pain, stiffness or difficulty moving- especially in the morning and can take between minutes to hours to wear off

Joint swelling, warmth or tenderness to touch

Rashes from sunlight/UV light (including the classical "butterfly" rash on the cheeks and nose)hes from sunlight/UV light (including the classical "butterfly" rash on the cheeks and nose)

Flu like symptoms and or night sweats

Headaches, migraines

Fatigue (80-90% of people with lupus report this is their main symptom) - tiredness so severe it makes daily activities difficult

Brain fog

Dry eyes or mouth - sensation of sand in the eyes, regularly waking at night to drink water

Mouth or nasal ulcers - shallow or recurring ulcers or sores that won't heal

Unexplained weight gain or weight loss

Inflammation of the tissues covering internal organs with associated chest and/or abdominal pain

Seizures, mental illness or other cerebral problems

Kidney problems

Depression

Hair loss

Haematological disorders including anaemia

Swollen glands

Poor blood circulation causing the tips of fingers and toes to turn white then blue on exposure to cold (Raynauds)

Many of these symptoms can become worse if you are stressed. People are often diagnosed with anaemia, eczema, fibromyalgia. We recommend that you tell your GP about your symptoms and keep a log of your symptoms, note their frequency and severity. You should be referred to an autoimmune / rheumatology specialist

Research is still trying to find what causes lupus - as it's mostly women that are affected it is thought there is a link with female hormone changes - progesterone and oestrogen - during puberty, pregnancy and menopause. Viral infections, long courses of some medications and trauma can trigger lupus. Sunlight can cause a flare up of lupus which may indicate an environmental link. Lupus is often triggered in people where there is family history of lupus and/or other immune system illnesses such as arthritis, MS and rheumatism. Most recently autoimmune conditions have been linked to our bodies gut bacteria, the microbiome. Black and Asian women may be more at risk of developing severe lupus due to healthcare inequalities.

Whilst there currently is not a cure for lupus, there are several things you can do to help manage the condition from various sources including https://www.lupusuk.org.uk/manage-your-lupus/

Eat a Mediterranean diet ( no not pasta and pizza!), unprocessed food, lean meats, fish, olive oil, broad range of vegetables and fruit

Limit your alcohol intake

Try gentle exercise such as yoga

Join a support group for people with lupus

Become well-educated about lupus

Offset fatigue by rest and by pacing daily activities

Try to resolve stress, depression, pain or anger

Avoid exposure to direct sunlight and fluorescent lights

Be open with family and friends on lupus unpredictability

Develop new interests and skills if wished and if able

Ask for help from family, friends and health professionals

Lupus UK report that " Careful monitoring of the disease and a treatment programme with medication adjusted as appropriate enables the condition to be controlled , most patients being able to live a normal life span. Doctors will usually only keep the patient on high impact medication for as short a period as possible.

Non-steroidals, Aspirin etc - anti-inflammatory drugs (NSAIDS), used for patients who suffer mainly from joint/muscle pain. Aspirin, heparin or warfarin may be prescribed in the case of patients needing anticoagulation treatment.

Living with Pain

Anti-Malarials - these are of help in patients with skin and joint involvement and of some assistance with fatigue. The drugs may be sufficient for patients with moderately active lupus to avoid using steroids. Hydroxychloroquine has anti-inflammatory properties, some sun-protective features and gives some protection against clotting - mepacrine is also used.

Steroids such as prednisolone have been vital in the improvement in lupus care and in some cases are life saving. They have a profound effect on inflammation and suppress active disease. The dosage depends on the severity of the symptoms. Once the disease is under control the dosage might be reduced gradually and/or it might be possible for the patient to transfer to other medication. The side-effects of steroids are well-known and include possible weight gain, muscle weakness, and over time the possibility of osteoporosis. For more information go to:

Medicine Guide for steroids

Immunosuppressants - these drugs are widely used in more severe disease. The most commonly used are azathioprine, methotrexate and cyclophosphamide. Azathioprine is a milder drug and used for mild to moderate kidney disease, or where its difficult to reduce steroid dosage. Cyclophosphamide, usually given by pulse, is widely used for kidney disease and is very effective. Regular blood testing is required initially 2-3 weekly, subsequently 4-6 weekly whilst on such medication. For more information on these drugs go to:

Other drugs - Other drugs are less frequently used in lupus and include intravenous immunoglobulin (often used when the platelets are low) and cyclosporin A, the drug widely used in transplantation medicine to suppress rejection. For very severe skin disease in patients where pregnancy is not a consideration, thalidomide has proved an extremely powerful medication.

Non-lupus drugs - Various medications have helped improve the prognosis in lupus. These include a variety of improved blood pressure tablets and diuretics, anticoagulants (aspirin or warfarin) in those patients with a clotting tendency, anti-epileptic and anti-depressive medication. Skin creams include corticosteroids and newer, vastly improved sun-protection creams. There are now, in addition to standard calcium and vitamin D preparations, modern effective drugs for the prevention and treatment of osteoporosis."

"Exercise is an important part of taking care of yourself and your wellbeing. Just like everyone else, where possible, people with lupus need to exercise regularly or engage in some kind of movement. It’s very important to recognise that lupus affects everybody differently and so not everyone with lupus can do a wide range of exercises, but most people with lupus can take part in some form of activity. It is also important to realise that the amount of activity you can manage is likely to fluctuate as your lupus does." It is recommended that you check with your GP or autoimmune consultant which exercise is suitable for you.

Tips to avoid back pain

astephj@gmail.com (Amanda Stephenson) — Tue, 22 Dec 2020 17:57:33 GMT

Three tip to start with....

1. Do not avoid lifting heavy things

By avoiding lifting heavy items people are actually doing their back more harm, not putting sufficient load through the muscles causes deconditioning and stiffness. Fiona Wilson, associate professor of physiotherapy says "the back needs to be exposed to loads to become stronger. Proceed gradually, especially if you haven’t lifted anything heavy for a while. In studies on elite rowers, who load their l ower backs significantly in training, Wilson has shown that those who increase their training loads too rapidly are more likely to get back pain. Start lifting things such as shopping and books as part of your daily routine, and don’t be afraid to add weights as you get stronger,” she says. “Get used to carrying different loads in different ways.”

2. Don't avoid bending and twisting

The spine is designed to bend and twist - that's why it is a curve! Wilson says " It’s not always best to bend from the hips, keeping your back straight. This advice is to encourage the use of the muscles in the hips and legs to help with the bending,” Wilson says. “But if those muscles are weak, it won’t protect your back and, in fact, the spine is a more stable structure when it is curved.” Bending and twisting in a variety of ways within your comfort zone is the best approach.

3. Try this exercise - the prone windmill

Matt Roberts, a personal trainer, speaking in The Times says this simple exercise is great for engaging the upper back muscles and encouraging twisting of the back.

Start on all fours on the floor and raise your left arm towards the ceiling.

Turn your head to look at the straight arm as you raise it.

Lower the arm and perform a big rotation to take it underneath your torso as far as is comfortable.

Repeat this for 15-20 rotations before switching to the right arm.

Working from home? 4 out of 5 people develop musculoskeletal pain

astephj@gmail.com (Amanda Stephenson) — Tue, 22 Dec 2020 17:16:06 GMT

Poor home working methods may be causing discomfort for thousands of home workers

The charity Versus Arthritis surveyed 1040 remote workers. More than four out of five people who began home working during lockdown have experienced musculoskeletal pain - that is back pain, shoulder pain and neck pain. They found that 89% of staff had developed these conditions but had not mentioned it to their employer. Understandably people were reticent about complaining due to the ever increasing numbers of people being made redundant and faced with a new way of working many people did not know their rights when working from home. Remote flexible working can be easier to fit around childcare and offer opportunities to work for people with impairments and health conditions. However many people have worked longer hours in unsuitable conditions - up to 45% of staff did not receive equipment, advice or support from their employer for homeworking.

23% of staff said they experienced pain most or all of the time and 46% of staff had been taking pain relief more frequently than usual.

Over 50% of staff reported low back pain, 36% reported neck pain and 28% had experienced shoulder pain, only a third of staff had spoken to a medical or health professional during lockdown about their musculoskeletal pain.

If you have musculoskeletal pain it is important to seek medical or healthcare professional advice early to help resolve the symptoms and avoid taking time off work. It also reduces the risk of needing more invasive treatment when the condition has become a long term complaint.

One of the simplest things you can do when working from home is to get up from your kitchen/dining table/desk/sofa every 30 mins and have a walk about. Take your cuppa outside ( if the weather allows!) Musculoskeletal problems tend to develop from staying in one position for too long rather than sitting on the wrong sort of chair. Ergonomic desks/standing desks/ specialist equipment are generally very expensive and current research shows they may not be very effective at reducing shoulder, back or neck strain.

Taking steps to lower your stress levels can also reduce the likelihood of musculoskeletal pain - taking regular exercise, enjoying a warm bath, taking the dog for a walk or watching a comedy can all help.

If you are experiencing musculoskeletal pain Physio In The Sticks can help. We are available for home visits or online consultations 7 days a week www.physiointhesticks.co.uk 07398 495819. We frequently resolve musculoskeletal conditions in 1-3 appointments.

Bed rest - the deconditioning effects it can have on your body

astephj@gmail.com (Amanda Stephenson) — Sun, 06 Dec 2020 20:02:12 GMT

The knock on effects of bed rest are known as deconditioning syndrome and are one of the most under recognised and unreported side effects of a hospital stay. It is estimated that older hospital patients may spend up to 95% of their time in bed or sitting in a chair. Whilst recently editing this year's medical school resources I learnt some concerning facts.

Patients going into hospital....

with high mobility (that is you can walk about well and do all your daily activities) average 13% disabled at discharge
go in with moderate mobility (walking about with a stick, able to do some daily activities) average 35% disabled at discharge
go in with low mobility (walking about with a stick, usually rely on others to do most daily activities) average 71% disabled on discharge
65% patients over 90 years old lose the ability to do their daily activities
this functional decline is seen as early as day 2 of a hospital stay

Contrary to popular belief, bed rest is not a good way to recover from many illnesses and it can hinder recovery time, especially as it makes patients more susceptible to muscle wasting, weakness, pressure ulcers, poor digestion, constipation, loss of appetite, tiredness, lethargy, low mood and confusion.

Yes there are risks to moving about, especially if you have low/high blood pressure, previous history of falls, muscle weakness or joint pain but the risk of remaining inactive is usually higher. With a just few physio sessions, we can help people regain their muscle strength, improve their balance and return to previous levels of independence. Physio In The Sticks offer home visits at a time to suit you. If you would like help for yourself or a relative please call Amanda 07398 495819 info@physiointhesticks.co.uk

Home exercise equipment - the basics

astephj@gmail.com (Amanda Stephenson) — Sat, 21 Nov 2020 12:06:25 GMT

4 basic pieces of kit for home workouts

Following the stop-start nature of lockdowns and a new interest in keeping healthy for many - the home workout may be here to stay long term. There are advantages to a home workout - no membership fees, no travelling to a gym and easier to fit in a quick 10 minutes of exercise.

A few key pieces of equipment can help you get the most out of your time.

Resistance bands - these are very effective for back and shoulder exercises that involve pulling. They often can be bought in a budget-friendly set of three strengths - start with the easiest band and gradually increase to the harder band over several months.

Dumbbells -a single set of dumbbells can work nearly every muscle in your body. You can start with a couple of tins of baked beans or small bottles of water can be easier to grip. Different people can manage different weights but as a general rule any weight you can raise above your head confidently 5 times is ideal. Dumbbells can bought for £10-£25 for a basic set of 2-6kg.

Kettlebells - are great for functional resistance - which is basically means exercise which replicates your daily activity, such as carrying shopping and lifting heavy items. You can start with a rucksack with a few tins of beans inside. They are useful for one sided exercises to help you build strength on both sides of your body. They start at 4kg

Yoga mat - a non-slip mat with good cushioning is the best option. Good underside grip will prevent you from sliding when doing lunges and people with wrist or knee pain will appreciate a mat with a thickness of 6mm or more.

TRX band is a total body resistance band with handles which lets you use your body weight and gravity as resistance to build strength, balance, coordination, flexibility and joint stability. The TRX can replicate some of the exercises done on gym machines by looping it around a sturdy tree trunk or stair post.

Fibromyalgia

astephj@gmail.com (Amanda Stephenson) — Wed, 28 Oct 2020 16:12:27 GMT

What is fibromyalgia? What causes fibromyalgia?
It is a long term, common condition that can cause widespread pain for 3 months or more, which is made worse by continuing activity. Many people have flare ups when their symptoms suddenly become worse. Fatigue is usually the worst symptom, people may wake up feeling unrefreshed and being unable to think clearly or remember things is called "fibrofog".

Fibromyalgia is difficult to diagnose as symptoms vary widely and could be caused by other conditions such as an underactive thyroid gland or rheumatoid arthritis. There aren't any specific blood tests or scans that confirm a diagnosis of fibromyalgia - but your GP may suggest blood tests to rule out other conditions.

Approximately 4% of the population ( 1 person in every 25) may have fibromyalgia and yet relatively little is known about its causes. No specific cause has been found to date. The pain is not caused by inflammation or degenerative processess. Usually pain is felt when the tissues in our body are damaged such as a muscle strain or a ligament sprain or a broken bone. Fibromyalgia pain is different as it is not caused by damage to tissues, instead the way the nervous system processes pain is different. As it is not related to tissue damage it does not heal as quickly as a muscle or a bone and there is no simple way to stop the pain. Research has shown that people with fibromyalgia are more sensitive to physical pressure - a slight knock or bump for most people can be very painful for someone with fibromyalgia.

Researchers now think that people with fibromyalgia have increased sensitivity to pain. When brainwave studies were conducted they also found that people with fibromyalgia often miss the deep sleep cycle - this can be caused by pain from injury or from a medical condition such as arthritis, stress or depression. In fact when healthy volunteers were woken during their deep sleep cycles they started to experience the symptoms of fibromyalgia.

Some people found their symptoms started after a stressful event, illness or accident whilst others cannot think of any particular event.

Fibromyalgia does not cause any lasting damage to muscles or joints, but people with fibromyalgia need to keep active to avoid problems caused by deconditioning (muscle weakness).

Currently there is no cure for fibromyalgia, however there are medications and therapies that many people find helpful.

Physical therapies such as physiotherapy can help you improve your activity levels, functioning and quality of life. Specialist pain physiotherapists can be found in pain management groups alongside occupational therapists, pain consultants, psychologists, social workers and employment advisers. Pain management groups may not take all the pain away but they can help to lessen the impact of pain on your life.

What are the symptoms of fibromyalgia?

Widespread fatigue

Widespread pain

Sleep disturbance

Flare ups when symptoms get worse

Headaches

Irritability

Low mood

Irritable bowels

Forgetfulness

Poor concentration

Increased sensitivity to cold/sound/bumps

Tender joints and muscles

Restless legs

Dry eyes

Increased stress, anxiety and worry

How is fibromyalgia diagnosed?

Fibromyalgia is frequently difficult to diagnose as the symptoms are similar to other conditions such as rheumatoid arthritis or an under-active thyroid gland. There are not any specific blood tests, scans or x-rays that diagnose fibromyalgia and people with fibromyalgia may have normal results in these tests. Blood tests can be done to rule out other conditions which can support a diagnosis of fibromyalgia.

Fibromyalgia was previously diagnosed based on specific tender points in the body, but since 2010 if you have

-widespread pain that lasts 3 months or more

-fatigue and/or waking up unrefreshed

-thought processing problems, memory or thought processing

the health professional should consider these when making a diagnosis.

What can I do to help ease my symptoms?

Knowledge is power - learn about the condition so that you can understand it

Learn about physical and psychological techniques that can help lower your stress levels and reduce tension within your body.

Take steps to tackle any stress at home or at work

Follow a tailored, gradually progressed programme of physical activity - walking, swimming and cycling are all beneficial - start gently and increase activity slowly over weeks/months

Do not drink caffeine containing drinks (tea, coffee, cola, sports drinks) or alcohol in the evening - as these can make getting a good night's sleep difficult

Eat a balanced diet

Keep to a healthy weight

If you are a smoker, giving up is recommended

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Osteopenia and Osteoporosis

astephj@gmail.com (Amanda Stephenson) — Tue, 29 Sep 2020 19:58:06 GMT

What is osteopenia? What is osteoporosis?

In the UK over 3 million people have osteoporosis. Over 500,000 have hospital treatment for fragility fractures related to osteoporosis. Our genes determine our height and skeleton type but our bone health is related to our lifestyle choices over many years. Reduction in bone mass is a normal part of the ageing process - but it does not have to be. Women are at greater risk than men. The reduction of oestrogen following menopause causes women to lose bone mass more quickly for the few years after menopause. Women who experience early menopause (before 45 years of age) or who have had their ovaries removed are at greater risk. Younger women, children and men may still have osteoporosis. In the UK over 1/3 women and 1/5 men will have a fragility fracture in their lifetime and at age 75-84 the 10 year risk for having a fragility fracture is 24% women and 14% men.

Osteopenia is the stage of bone thinning before osteoporosis. Osteopenia does not necessarily lead to osteoporosis and your doctor may prescribe bone strengthening treatments to prevent further bone loss.

Osteoporosis is a combination of bone mass and bone quality reduction. As bones weaken the risk of fracture increases. The first time people may suspect osteoporosis is following a pain caused by a bone fracture, which can be the result of a low impact injury. Fractures to the wrist, neck of femur (part of the thigh bone that forms the hip joint) and spine (vertebrae) are common. Ribs, pelvic bones and arms are also seen frequently. Older adults may have a forward bent over or stooped posture that can indicate fractures of the spine (vertebrae).

There are many factors that increase the risk of osteoporosis:

1. taking high-dose steroid tablets for more than 3 months

2 medical conditions – such as inflammatory conditions, such as rheumatoid arthritis, or malabsorption problem such as coeliac disease

3. family history of osteoporosis – particularly a hip fracture in a parent

4. long-term use of certain medicines that can affect bone strength or hormone levels, such as anti-oestrogen tablets that many women take after breast cancer

5. having or having had an eating disorder such as anorexia or bulimia

6. having a low body mass index (BMI)

7. not exercising regularly

8 heavy drinking

9. smoking

10. absent periods for 6 months or more caused by over exercising or over dieting

11. low testosterone levels in men

12. overactive thyroid gland

13. disorders of the adrenal glands, such as Cushing's syndrome

14. disorders of the pituitary gland

15. overactivity of the parathyroid glands

16. long periods of inactivity or bed rest

You can find out if you are at risk of osteoporosis by doing the Royal Osteoporosis Society's online test https://stopatone.theros.org.uk/

How to help your bones stay healthy

Diet - ensure you have plenty of....

1. Calcium found in milk, cheese and other dairy foods, green leafy vegetables – such as curly kale, okra and spinach, soya drinks with added calcium, bread and anything made with fortified flour, f ish where you eat the bones – such as sardines and pilchards

2. Vitamin D From about late March/early April to the end of September, most people should be able to get all the vitamin D they need from sunlight. The body creates vitamin D from direct sunlight on the skin when outdoors. However, between October and early March we do not get enough vitamin D from sunlight.

Vitamin D is also found in a small number of foods including oily fish – such as salmon, sardines, herring and mackerel, red meat, liver, egg yolks, f ortified foods – such as some fat spreads and breakfast cereals. Another source of vitamin D is dietary supplements.

Exercise

The Royal Osteoporosis Society say that after a diagnosis of osteoporosis or if you have risk factors, you should do more exercise, rather than less. Being physically active and exercising helps you in so many ways, and is very unlikely to cause a broken bone. If you have spinal fractures or lots of other broken bones, you may need to modify some exercises to be on the safe side.There are three ways that exercise and safe movement help with bone health and osteoporosis:

Promote bone and muscle strength

Keep you steady

Care for your back

What types of exercise do I need to do for my bones?

Bones stay strong if you give them work to do. For exercise to be most effective at keeping bones strong you need to combine weight-bearing exercise with impact and muscle strengthening exercise. Variety is good for bones, which you can achieve with different movements, directions and speeds - in an activity like dancing for example. Short bursts of activity may be best, such as running followed by a jog, or jogging followed by a walk.

What is weight-bearing exercise with ‘impact’?

You are weight bearing when you are standing, with the weight of your whole body pulling down on your skeleton. Weight bearing exercise with impact involves being on your feet and adding an additional force or jolt through your skeleton – anything from walking to star jumps.

You can get weight bearing exercise with impact by taking part in some physical activity, sports or by doing specific exercises. Depending on what activity you do, the level of impact will vary. The following will help you to understand the difference between low, moderate and high impact exercise:

Low impact Walks, Brisk walking Marching Stair climbing Gentle heel drops Stamping

Moderate impact Highland dancing Jogging or running Team & racket sports Skipping & hopping Low level jumping Stamping

High Impact Basketball Volleyball Track events Star jumps Tuck jumps High level jumps

More physical activity information from the Royal Society of Osteoporosis can be found on their website www.theros.org.uk

Women : Exercise in your 40's, 50's and 60's

astephj@gmail.com (Amanda Stephenson) — Sun, 13 Sep 2020 19:13:22 GMT

What your body needs you to do.....

In your 40's levels of the growth hormone somatotropin begins to decline. Somatotropin stimulates fat metabolism (the storage and breakdown of fat), cell reproduction, regeneration and growth. This can lead to increased fat storage, reduced muscle mass, lower libido and energy levels ( oh joy!) In addition as perimenopause approaches levels of oestrogen and progesterone decline. When oestrogen declines fat lays down around your belly instead of on your hips and thighs. As we know belly fat is more concerning for increasing the risk of diseases such as Alzheimer's, stroke, heart disease, colorectal and breast cancer and Type 2 diabetes.

As muscle mass decreases and potentially activity lessens your metabolism starts to slow down which may cause weight gain. This tends to coincide with having the least amount of free time due to work and childcare responsibilities. However to lose weight does not mean endless hours on a treadmill. Increasing lean muscle mass with functional strength training is a great way to improve your fitness with limited time. Any functional movements that you do in your usual day such as pushing, pulling, walking, lifting, bending can increase muscle mass and even more so if you add some ankle or wrist weights or a back pack with a couple of bags of sugar/flour. High Intensity Interval Training HIIT is also a great way to fit in effective exercise that works multiple muscle groups at once and includes cardio work and it can take as little as 8 minutes. 3 sessions of HIIT a week plus 2 x 30 minutes sessions of strength training and you will feel ready for anything! Remember to include 2 rest days a week as recovery is as important as exercise. Swimming (when we can!) is a great exercise which uses a wide range of joint movements and improves cardiovascular fitness if done fast enough.

In your 50's - As we get older we may compare our abilities with how our bodes used to be - but really we should compare ourselves to yesterday not 10 years before! Due to added stress on ligaments and joints the key aim should be to maintain steady consistent training, rather than a sudden high impact exercise. It may help to track your activity to ensure a consistent level of exercise. Low impact exercise such as pilates, yoga, cycling and swimming are a good addition to walking, running, gardening and strength sessions.

The average age a UK woman experiences the menopause is 51. Your body stops producing oestrogen which most people know is very important for bone health but what is not so well known is it's role in protecting heart health. Therefore in our 50's it's key to maintain a healthy heart with regular cardiovascular exercise and keeping within a healthy weight range. As muscle mass declines 32% of women in their fifties experience pelvic floor disorders such as urge incontinence, when urine leaks as you feel a sudden, intense urge to pee, or soon afterwards or overflow incontinence (chronic urinary retention) – when you're unable to fully empty your bladder, which causes frequent leaking. This can be exacerbated by drinking too much caffeine (coffee, tea, cola), sweeteners (in drinks, diet foods) and acidic fruit juices (orange, grapefruit). Contrary to the multitude of incontinence product adverts on TV - it is not a problem you have to tolerate. A few sessions with a pelvic health/women's health physio who can give you some simple exercises to do at home such as pelvic floor exercises, dead bugs, bridging and bird dogs - should help resolve the problem. I have heard many women's pelvic health physios recommend the book Me & My Menopausal Vagina by Jane Lewis and the Pelvic Obstetric and Gynaecological Physiotherapy group have information at https://pogp.csp.org.uk/information-patients

Pilates is an excellent strength training exercise for women in their 50's, combining bodyweight resistance training, balance and flexibility. Using resistance bands and free weights for strength training exercises and weight bearing exercises such as running, zumba, tennis or netball are all great options for maintaining good bone health and muscle mass

In your 60's It's important to keep doing the same exercises as before but with adjustments that allow for how our bodies are changing. In this decade your cartilage thins and the "grease" for your joints, synovial fluid decreases. The hydration and elasticity of ligaments reduces which in combination may mean that you start to feel achy joints more. If you happen to have an MRI or xray of your joints do not be alarmed by the word "degeneration" - much like grey hair or wrinkles we can manage these signs of ageing. Exercise promotes the circulation of synovial fluid and brings nutrients, oxygen and blood to the joints - motion is lotion! Exercise also increases muscle mass which decreases the load on the joints. Bodyweight resistance exercise with balance exercises which load your joints evenly is excellent at this age - so Pilates fits this perfectly. Tai chi and yoga are also great for mobility, flexibility and balance.

Exercises which can be done easily at home with a sturdy chair such as calf raises, single leg balances and sit to stand are effective and can be found on the Chartered Society of Physiotherapy website www.csp.org.uk/publications/never-too-late-physiotherapy-advice-maintaining-strength-we-age

Whilst this may be the age that many women retire, it is important to maintain activity levels. A decent daily walk is a great, free exercise - people with low step counts were found to have greater issues with mobility and balance in their later years. Walking a few steps around the home may add up but it does not give the benefits of stride length and hip and shoulder girdle mobility of a brisk walk outside. Investing in some decent walking shoes/boots can make walking more comfortable than in wellies! If you don't like walking alone, a quick search on Google will find a walking group near you.

Chronic, persistent, long term low back pain - how to manage it

astephj@gmail.com (Amanda Stephenson) — Fri, 11 Sep 2020 13:06:36 GMT

4 out of 5 adults have back pain during their lifetime

Low back pain can develop gradually over time or be triggered by an everyday movement at home or at work. It is frequently caused by a combination of factors such as lack of exercise, stress, feeling run down and muscle strain or ligament sprain. Back pain can also be caused by sciatica, spondylosis or stenosis. Less than 1% of back pain is caused by a serious condition and health care professionals screen for these in their assessment.

There are two kinds of low back pain - acute and chronic/persistent.

Acute low back pain is incredibly helpful (though it may not feel like it at the time). It alerts us to a tissue injury to make us protect it from further damage. If you think of the nervous system like a burglar alarm - then pain is the loud noise it makes when it senses a problem. As the injured tissue heals it no longer requires protection and the pain lessens and then stops in less than 3 months.

Chronic or persistent low back pain pain is pain that lasts more than 3 months or reoccurs. Unlike acute pain it is not usually caused by tissue damage or injury. The pain response is caused by the body's nervous system becoming over sensitive - like when the burglar alarm is set off by the family cat or a spider crossing the sensor. The sensors would still trigger the alarm if a burglar came in but they also trigger when anything else moves and are more sensitive than we need them to be. We have nerves all over our body - they send messages about pressure, touch, temperature up the spinal cord to our brain. The brain receives the messages and adds it in with messages it has had before from previous experiences. It adds this in with messages about our current stress levels, our mood and our beliefs about the current situation and in a nanosecond it produces a pain response. The brain, the spinal cord and the brain can all become sensitive to chronic/persistent pain - without there being any harm or damage to your tissues.

HURT DOES NOT = HARM

I want to make it absolutely clear at this point - you are not imagining the pain - it is not "in your head" - it is very real - but may not be caused by a tissue injury. Researchers have now categorised this pain as completely different to the acute pain you get when you hit your thumb with a hammer. Once you understand pain you can take positive steps towards turning down the pain system's sensitivity levels.

To learn more click on the video above by the pain science researcher Professor Lorimer Moseley

What causes back pain? Myth busting.....
Lifting Heavy Weights

Contrary to popular belief lifting heavy weights does not cause back pain. Instead of avoiding lifting heavy items such as shopping bags, toddlers, hay bales you should gradually build up the weight you lift each day to strengthen it. Back pain is often caused by stiffness from inactivity and muscle deconditioning.

If you have not lifted any heavy things for a while then start by keeping the weight close to your body and progress slowly using everyday items such as a bag of shopping or a pile of books. People who go straight to lifting heavy weights may cause an injury and pain. Slowly and gradually is the key to success.

Twisting and Bending

People avoid twisting and bending as they have heard that it causes back pain - this is very outdated advice and the evidence suggests the opposite is true. Our backs have evolved to rotate, twist, extend, flex and bend and by going against the natural movement of the spine. In fact our spine is more stable when it is curved. The outdated advice of "bend at the hips and keep your back straight" does not avoid back pain or injury. The best option is to bend and twist within your own comfort zone.

To help improve your flexibility and strength you may like to try Pilates - I can highly recommend Pilates with Clare Palmer www.pilateswithclarepalmer.yondo.com Clare is a very experienced Pilates instructor and has videos that can be streamed at home.

Exercise

Research has shown us that lying down in bed or on the sofa does not help back pain - in fact it can make it worse as your back muscles decondition and become weak and your stamina levels reduce. When we do not move because of pain or when we try and move in a different way - the brain still receives a signal even when the pain has gone.

By trying to protect your back by moving around in a slow and cautious way is hard work for your spine - it makes the muscles overwork causing more aching and spasms. This adds more load on the joints and discs in your back which increases their sensitivity too.

If you have low back pain then physical activity and exercise is usually the way to resolve it. I don't mean that you need to run or join a gym (unless you want too!). If you have never exercised, if you haven't exercised for ages if you are near to 90 years old - it does not matter- there is some form of physical activity or exercise that you can do that will help. Exercise is good for keeping your joints healthy and improving your fitness levels and health.

When you do some physical activity and exercise your body releases endorphins which is a " feel good" hormone and a natural painkiller. The latest evidence shows that exercise can reduce back pain and that active people recover more quickly. When you are in severe back pain this can be difficult, but just keep trying to move around and increase it by a little each day.

The good side effects of exercise are feeling more in control of the pain, sleeping better, reduction in anxiety and stress, weight loss and an improvement in your feelings of well being. It does not require you join a gym or buy lots of expensive equipment - walking, gardening, cycling, swimming, yoga and pilates are all suitable levels of activity. If you struggle sticking to any regular activity choose one you enjoy and ask a friend to join you. You don't have to go to a class you can do them online too.

Pacing activity

When you feel low back pain during your daily activities such as walking, household chores, gardening or work you may think that this means you are causing damage and stop your activity. This is not a good way of helping yourself as it leads to avoiding activities and creates a less active lifestyle. It is not the activity that causes the pain - the intensity of the activity is the reason for the pain.

When you are having a good day it can be tempting to try and get a lot of things done which suddenly increases your activity level, by overdoing it this increases the pain and requires a longer rest period to recover. When you pace yourself you avoid these pain flare ups. By alternating activity and rest periods so that you have an even amount of activity and rest each day this allows you to continue you activities. By slowly increasing the activity over several weeks your body will adapt to the increased levels without raising the pain alarm.

Pain, mood and anxiety

People with chronic/persistent pain are highly likely to experience low mood, stress, worry and anxiety. Feeling low in mood can make pain feel worse and can lead to a viscious cycle of worsening mood and increasing pain. Hormones including adrenalin are released when you feel stressed and low in mood which also happens when you are injured. This results in your pain sensitivity increasing. Whilst we often dismiss cold sores or headaches as a result of feeling stressed or a bit run down we do not seem to consider a bad back can be triggered in the same way.

When chronic/persistent pain has prevented you from doing all the things you want to do, it is normal to become frustrated, angry, anxious or low in mood. It can also leave you without motivation to become active again which can lead to weight gain, increased pain and inactivity. Focussing on the pain and avoiding activity will only increase the pain level. Therefore it is important to keep being active and find ways to distract yourself from the pain, by doing something you enjoy. Walking whilst chatting to a friend is a good way to start.

Managing a flare up

When you have a sudden increase in pain it is known as a flare up - this can even happen when you have had no pain for a long time and been doing everything well. Overdoing activity or feeling run down often coincide with a flare up. Usually flare ups settle down with a few weeks of doing the right things.

When you are experiencing a flare up reduce your exercise by half, but keep moving about gently and gradually increase you activity daily. Breaking tasks up into manageable chunks with rest periods in between can help.

Follow your pharmacist or GP's advice about pain relief medication and when you need to take it.

Should I have a scan or an x-ray?

MRI scans and x-rays are usually unnecessary in most cases of low back pain. Scans and xrays just show the picture of your lower back at that time - it doesn't show your pain or everything associated with your pain. In fact the results of an MRI scan can mislead us to presume your pain is caused by something which isn't causing the pain. Take a look at the picture below which shows how many people without pain had a result from a scan 87% of people aged 20-70 had a disc bulge. A scan may lead to recommendations for more invasive treatments such as injections and surgery which most people do not need to reduce their low back pain. People who have had back surgery often do not experience major improvement in their symptoms after one year.

MRI scans are usually only needed if you have:

A loss of bladder or bowel control

Urinary retention ( unable to empty your bladder completely)

Altered sensation between your legs and/or around your genitals

Progressive loss of sensation and weakness in your legs

Hip Replacement Surgery Prehab

astephj@gmail.com (Amanda Stephenson) — Sat, 29 Aug 2020 14:23:55 GMT

Should I have hip replacement surgery or not?

The National Joint Registry reported there are approximately 160,000 knee and hip joint replacements every year. As the population and life expectancy increases this is likely to increase year on year. More and more people - almost a third- are having hip surgery before the age of 60. This is seen as an economic success as 60% of workers who had a hip replacement in 2016 returned to work. Getting these 18,500 people back to work saved the UK government £70.5 million in Job Seeker’s Allowance alone. Hip surgery before 60 does come with the higher risk of revision surgery. Data shows that people in general who have a new hip, have a 6.8% risk of revision (further surgery) within 13 years. But for women under 55, the 13-year revision rate is 13.5% and in men under 55 it’s 10%. This is generally thought to be due to younger hip replacement patients being more active than their older counterparts. Younger people are more likely to have a revision earlier therefore it is important that they weigh up the pros and cons of having an early joint replacement. People should also be aware of the optimum non-surgical treatment before deciding which route to take. people may demand surgery as they have been told about cam lesions and hip osteoarthritis following scans, much earlier than previous generations and equally they are not prepared to tolerate the pain or reduction in activity.

Hip replacements are performed after a very long period of joint degeneration. Our bodies can withstand the signs of ageing well - just as we have grey hairs and wrinkles on the outside, our joints continue to function well as long as we are active and maintain our muscle strength. However when everyday activities such as putting on your socks or walking become painful, hip surgery is often seen as the only option. Osteoarthritis is the most common reason for hip replacement. It was thought to be the unavoidable result of a long life but research shows it is much more complex condition with many causes. Symptoms come and go and people should have strategies to manage it. The National Institute for Health and Care Excellence (NICE) recommends education, exercise and weight loss as gold standard treatments for hip osteoarthritis. There is high-quality evidence for the benefits of conservative management, such as physiotherapy, weight-loss, non steroidal anti-inflammatory medication, strengthening and aerobic exercises, such as cycling and walking, can reduce pain and improve mobility. Some people may find that following a few physiotherapy sessions their pain levels decrease and their mobility improves sufficiently for them to delay surgery. With current concerns about Covid-19 this may help people manage their symptoms whilst waiting longer for surgery.

Physiotherapy can help in several ways. A painful osteo-arthritic hip can cause stiffness in the lower back, weakness in the knee muscles and foot muscles causing muscle imbalances and altered walking patterns. This can lead to a slow deterioration in overall physical fitness, mobility and strength before surgery, making it harder to return to normal activity post-operatively. By seeing a physio for a few session before hip surgery, you can regain muscle strength in your quadriceps, hip abductors, hamstrings, gluteal muscles and calf muscles - which will help you return to functional fitness (walking, getting up from a chair, getting in and out of bed, standing) much quicker after surgery. Pre-hip surgery prehab can reduce the amount of time you spend in hospital after surgery and reduce the amount of physiotherapy you need after surgery. Improving your muscle strength before surgery can also help you maintain your function whilst you wait for your surgery and also reduce your pain. By improving hip muscle strength you can ease the load on the joint and this in turn reduces the pain. Your physiotherapist can help build a a specific prehab program tailored to you following an in-depth assessment including biomechanics, functional ability, muscle strength testing and flexibility. 6-8 weeks of prehabilitation, is recommended but starting earlier can help to manage pain and stiffness.

A prehab programme will vary from person to person, depending upon their functional ability, balance level, pain level and other medical conditions. It may be that you need to do exercises lying down, sitting down or standing up. For younger, mobile hip surgery patients with none of the limitations mentioned above, a prehab plan may include:

Mini squat: With your feet hip width apart, slowly lower your body into a mini squat position (hips and knees at 45 degrees) while keeping your back straight and your knee caps over your second toes.

Heel raises: Holding onto a sturdy table/worktop in front of you, slowly raise your heels to lift up onto the balls of your feet. Slowly lower.

Glut Bridge: Lying on your back with your knees bent and feet flat on the ground, contract your buttocks while lifting your bottom off of the ground to align your chest with your legs. Slowly lower.

Hip Flexion: Lying on your back with your knee bent slide your heel up the bed to bend your hip and knee further in towards your chest as far as able. Slowly slide back down.

Standing Hip Abduction: Hold onto a chair beside you for support. Move your leg towards the outside without lifting your pelvis and slowly lower back down.

Standing Hip Extension: Holding onto a chair in front of you for support, push your leg backwards while keeping your knee straight and your body upright.

The amount of repetitions and sets of each exercise should be determined by your physiotherapist based upon your current presentation, rehabilitation goals, pain level and mobility. As you progress towards your surgery date, the physiotherapist will adjust your exercise programme and be able to advise you about post surgical rehabilitation.

Walk this way!

astephj@gmail.com (Amanda Stephenson) — Sat, 22 Aug 2020 15:38:52 GMT

Walking - the best exercise?

Hippocrates called walking " Man's best medicine". Walking is a free and commonly available exercise for many people. Researchers are increasingly finding that walking and spending time outdoors in green spaces benefits the body and the mind. Whether you enjoy a daily stroll to the shops or your dog demands a walk or you enjoy getting away from it all in the middle of nowhere - it's a big part of being a human being. From the start of humankind on earth we needed to walk to find water, food and safety to now when we increasingly use other methods to get about - our amount of walking, where and why we do it has changed.

When I was a kid, an older neighbour would go for a 3 mile walk every day (about 6000 steps for those of you with pedometers) in the rain, snow or sunshine - she lived to a ripe, old age and in her later years she remained independent and active. In practice, now I often ask people who have low back pain or shoulder pain, how far they walk in a day - it's usually well below 3000 steps a day. A good walk outside where you get decent stride length and an uninterrupted distance with natural arm swing is an excellent exercise for moving your lower limb joints, back and shoulders. However when we are busy or the weather's a bit "dreich" (dull or gloomy) walking is the last thing we want to do.

Just 20-30 mins 2-3 times a week can have great effects on our mood, immune system, sleep quality and quantity, stress levels and physical fitness. As someone who loathes getting hot and sweaty in a gym (there I'm a physiotherapist and I've said it!) I enjoy a walk down the valley to the stream to watch the dog and the kids jump in the water and my heart benefits from the walk back up the big hill.

Perhaps one of the good things to come out of Covid-19 lockdown situation is the time to go out for a regular walk. In May 2020 Living Streets livingstreets.org.uk launched a national walking month with tips how to walk for 20 mins a day. They have resources to help make walking more fun for families and individuals and podcasts all about walking.

What causes foot pain?

astephj@gmail.com (Amanda Stephenson) — Tue, 18 Aug 2020 14:37:44 GMT

Top of foot pain and bottom of foot pain - Causes and symptoms

Top Of The Foot

Gout is a sudden severe pain in any joint – usually the big toe with red, hot, swollen skin over the affected joint. Gout does not cause lasting damage to joints if you get treatment straight away. Ask for an urgent appointment or call 111 if the pain is getting much worse and you have a very high temperature (you feel hot and shivery). This could mean you have an infection inside the joint. Gout can be hard to diagnose as symptoms are similar to other conditions. Your GP may ask about your diet and if you drink beer or spirits. You might be sent for a blood test, ultrasound or X-ray. Sometimes a thin needle is used to take a sample of fluid from the affected joint to test. The tests will find out how much of a chemical called uric acid there is in your body. Having too much uric acid can lead to crystals forming around your joints and causing pain. If your GP diagnoses gout you should take any medicine you have been prescribed as soon as possible – it should start to work within 3 days, rest and raise the limb, keep the joint cool – apply an ice pack, or a bag of frozen peas wrapped in a towel, for up to 20 minutes at a time, drink lots of water (unless advised not to by a GP), try to keep bedclothes off the affected joint at night. You should not put pressure on the joint and try to avoid knocking it. Gout can come back every few months or years. It can come back more often if not treated. If you have frequent attacks or you have high levels of uric acid in your blood, you may need uric acid-lowering medicine.

Bunions Bunions are bony lumps that form on the side of the feet by the side of your big toes. Your big toe may be pointing towards your other toes or over your second toe and the skin may appear hard, red and swollen over the bunion Surgery is the only way to remove them, but there are things you can do to ease any pain they cause. You may also have pain along the side or bottom of your feet. This is usually worse when wearing shoes and walking. To help relieve the pain you should wear wide shoes with a low heel and soft sole, hold an ice pack (or a bag of frozen peas wrapped in a tea towel) to the bunion for up to 5 minutes at a time, try bunion pads (soft pads you put in shoes to stop them rubbing on a bunion) – you can buy these from pharmacies, ask the pharmacist about pain relief, try to lose weight if you're overweight. You should not wear tight, high heeled or pointed shoes.

Hammer Toe is a contracture (bending) deformity of one or both joints of the second, third, fourth or little toes, caused by a muscle/tendon imbalance. This imbalance, which leads to a bending of the toe, results from mechanical (structural) or neurological changes in the foot that occur over time in some people. This abnormal bending can put pressure on the toe when wearing shoes, causing problems to develop. It may be aggravated by shoes that do not fit properly. A hammertoe may result if a toe is too long and is forced into a cramped position when a tight shoe is worn. Occasionally, hammertoe is the result of an earlier trauma to the toe. In some people, hammer toes are inherited. Hammer toes usually start out as mild deformities and get progressively worse over time. In the earlier stages, they are flexible and the symptoms can often be managed with noninvasive measures. But if left untreated, they can become more rigid and will not respond to nonsurgical treatment. Because of the progressive nature, they should receive early attention. Hammer toes never get better without some kind of treatment. You may feel p ain or irritation of the affected toe when wearing shoes. You may find that you have c orns and calluses (thickened skin) on the toe, between two toes or on the ball of the foot. Corns are caused by constant friction against the shoe. You may also experience contracture of the toe, i nflammation, redness or a burning sensation. To help alleviate pain you should wear wide and comfortable footwear, avoid high heels, tight footwear or pointed shoes.

Stress Fracture When bone is unable to withstand repetit ive mechanical loading( such as long distance running), it results in structural fatigue and localized bone pain and tenderness in the foot bones. The pain is worse when putting weight on the injured area and the pain is relieved when resting, although as the condition progresses pain may still be felt at rest and at night. However not all stress fractures have these symptoms. Bone is a live tissue and is constantly remodelled, but if the bone tissue does not adapt to a load quickly a weak area can develop into a stress fracture. Less than 1% of the people develop stress fractures and with the correct management will heal within 6 weeks with a return to activities within 16 weeks. Sometimes a stress fracture will not heal as quickly or fails to heal and therefore requires surgery.

Extensor Tendinopathy is caused by swelling of the tendons over the top of the foot which can be caused by over loading the tendons or by tight lacing of footwear or tight shoes. Pain can be felt when pressing on the area or pointing the toes towards the ground., pushing off from the ground when you run, jump or dance. You may feel weakness and muscle spasm, have a reduced range of movement and difficulty balancing.

Posterior Tibial Tendinopathy The tibialis posterior is a muscle in the lower leg. The tendon from this muscle runs behind the inside bone on the ankle, across the instep and attaches to the bottom of the foot. The tibialis posterior is important as it helps to hold the arch of the foot up and stops the foot rolling over. Sometimes the tendon becomes stretched and inflamed and the arch of the foot flattens.

Anterior Tibial Tendinopathy Pain and often swelling is felt in the inside front of the ankle and the middle of the foot. This is most common aged 45+ years and it is aggravated by activities such as standing and walking.

Sinus Tarsi Syndrome Following an injury to the ankle or foot or overuse pain may be felt on the outside of the foot slightly forward from the ankle bone. It may be difficult to walk on unstable surfaces and there may also be a feeling of instability. It may also occur if the person has a flat foot (pes planus) or an overpronated foot, which can cause compression in the sinus tarsi. S and a feeling of instability or difficulty walking on unstable surfaces.

Bottom Of The Foot

Heel Spurs (Osteophytes) are bony bumps (bone spurs) that grow on the heel bone. They often form next to joints affected by osteoarthritis, a condition that causes joints to become stiff and painful. Heel spurs do not always cause symptoms but t hey can cause problems if they rub against other tissue such as tendons or muscles, restrict movement, compress nearby nerves. A physiotherapist may also be able to help you by recommending exercises that can strengthen the muscles surrounding the problem area, and by helping to improve your range of movement. There's usually no need to remove an heel spur unless it's irritating a nerve or restricting your range of movement or mobility.

Plantar Fasciitis is where you have pain and stiffness on the bottom of your foot, under your heel and arch. It can feel worse first thing in the morning when you step out of bed or when you have been sitting down for a while and get up to move. The pain may ease once you have been moving around for a while. Plantar fasciitis can make it difficult to lift your toes off the floor. To help your symptoms you can

put an ice pack (or bag of frozen peas) in a towel on the painful area for up to 20 minutes every 2 to 3 hours, wear wide comfortable shoes with a low heel and soft sole, use soft insoles or gel heel pads in your shoes, see a physiotherapist who can help you with some regular gentle stretching exercises and try exercises that do not put pressure on your feet, such as swimming. You should avoid walking or standing for long periods, do not wear high heels or tight pointy shoes, do not wear flip-flops or backless slippers, t ry not to walk barefoot on hard surfaces.

Tarsal Tunnel Syndrome starts when the posterior tibial nerve is compressed on its route past the inside of the ankle, beneath the a fibrous band called the flexor retinaculum. When the nerve is compressed it causes pain, tingling, a burning sensation, and sometimes occassionally numbness on the sole of your foot. The symptoms may also be aggravated by moving your ankle up and down. If you have flat feet (pes planus) you have an increased risk of developing this problem. This is because the change in shape of the rear foot, lead to both stretching and compression of the posterior tibial nerve. I t can also be caused if there is inflammation on the inside of the ankle. This may be from a previous injury or overuse of tendons. Sometimes it may be caused by a cyst or ganglion pressing on the nerve. You may also be more likely to have tarsal tunnel syndrome if you are diabetic or have arthritis. Initially it may help to reduce your activity, to allow the symptoms to settle naturally. If you would like to walk to maintain your fitness, avoid walking up hills and keep to flat ground. Avoid wearing flat shoes ( such as ballet pumps, flip-flops, backless slippers) and wear a pair with a 2cm heel ( not a mid or high heel), as this will help to reduce the compression on the nerve - trainers may be most comfortable. An insole to change the rear foot position when standing and walking can help to relieve the pressure on the nerve and therefore help with the symptoms.

Achilles Tendinopathy is an injury to the tendon that joins the calf muscles to your heel bone. You may feel pain, stiffness and sometimes swelling that makes it difficult for you to walk about or move normally. Standing on tip toe, jumping and climbing stairs can be particularly difficult. It especially affects people who do jumping and running exercises such as football, rugby, tennis and athletics. Achilles tendinopathy pain can come and go. It may be worse first thing in the morning or after you’ve done some exercise or activity. Your tendon may feel particularly stiff if you have not moved around for a while — sitting on the sofa or on a car journey. The stiffness usually eases when you start moving about again. You may feel a combination of these symptoms - increasing pain, usually at the calf or heel,

stiffness in the tendon, swelling at the back of your ankle, the tendon is tender to touch, a grating noise or creaking feeling (known as crepitus) when you move your ankle up and down. Sudden pain in your heel or calf may mean you have torn the tendon. This is called an Achilles tendon rupture. The tendon becomes swollen and sore, and you may even hear it snap. - it can sound like a low calibre gunshot If this happens, seek urgent medical advice. To ease the symptoms of Achilles tendinopathy you should rest the tendon by reducing or stopping the activity that started your symptoms. If your pain eases, you may be able to do some gentle stretches. If you can, carry on putting weight on your leg by standing up and doing some gentle walking. You should avoid uphill and downhill running until the pain has stopped. You can a pply cold packs or ice wrapped in a towel to ease the pain and reduce any swelling. An orthotic insole or gel heel cup in each shoe that lifts your heel slightly may reduce the stress on your Achilles tendon. Wearing well-padded and supportive shoes may also help. If your symptoms do not improve after a week, you may find it useful to see a physiotherapist for further guidance and rehabilitation.

Morton's Neuroma is where a nerve in your foot is irritated or damaged. This usually affects between your 3rd and 4th toes ( big toe is number one and little toe is number 5). The main symptoms are a shooting, stabbing or burning pain, feeling like a small stone is stuck under your foot. Some people may also have tingling or numbness in their foot. The symptoms may be worse when you move your foot or wear tight or high-heeled shoes and it often gets worse over time. You can try to rest and raise your foot when you can,

hold an ice pack (or bag of frozen peas) in a towel on the painful area for up to 20 minutes every few hours, wear wide, comfortable shoes with a low heel and soft sole, use soft insoles or metatarsal pads to put into your shoes, t ry to lose weight if you're overweight. You should avoid tight, pointed shoes. You should see your GP if the pain is severe or stopping you doing your normal activities, the pain is getting worse or keeps coming back, the pain hasn't improved after treating it yourself for 2 weeks, you have any tingling or numbness in your foot or if you have diabetes.

How to improve your balance - helping older people stay active

astephj@gmail.com (Amanda Stephenson) — Sun, 09 Aug 2020 18:17:53 GMT

Staying strong helps reduce the risk of falls

Many older people may have been less active during the Covid-19 lockdown, being unable to visit the shops or relatives can lead to more time sitting down and the knock on effect is the deconditioning of the muscles in our legs and hips which help us balance. We start losing muscle strength from the age of 30, losing 8% of our strength every decade, so by the age of 80 we have potentially lost 40% of our strength.

A fall within the previous year is the most significant factor for predicting current and future falls risk in older people (NICE, 2017). Recurrent falls is defined as two or more falls in one year, and having other medical conditions such as osteoarthritis, osteoporosis, diabetes, cardiovascular conditions and visual impairments all increase the risk of falls. 73% of older patients who had fallen had post-fall anxiety and 46% experienced a fear of falling that impaired their functionality, which may result in an increased risk of further falls.

Including strengthening exercises in your daily routine before you become frail or deconditioned can ensure you remain independent for as long as possible. Weight-bearing exercises such as these help you build muscle mass and preserve your bone strength. These exercises should be completed several times a week.

The Chartered Society of Physiotherapy have developed a simple set of exercises that can help older people stay strong and active at home. They don't require any special equipment - just a good sturdy chair and sensible shoes.

Strengthening your muscles will improve your mood, help you sleep, improve your overall health and well-being and importantly prevent deconditioning.

Getting started is easy, try out the strength and balance six exercises in the video below

1. Sit to stand

2.Heel raises

3. Toe raises

4. One leg stand

5.Heel toe stand

6.Heel toe walking

Important notes

Make sure the chair you're using is sturdy

Wear supportive shoes

If you experience chest pain, dizziness or severe shortness of breath, stop and contact a healthcare professional.

A slight soreness the day after is quite normal

DISCLAIMER: The activities described here should not cause any harm. They might not, however, be suitable for all people, particularly those at risk of falls and fractures. Consult a chartered physiotherapist or your GP before embarking on any new fitness regime, and if you do experience pain or discomfort as a result of any of the exercises, stop immediately.

How to treat whiplash while you find a physio

astephj@gmail.com (Amanda Stephenson) — Sun, 09 Aug 2020 10:42:03 GMT

What is whiplash? Physiotherapy for whiplash

Following an accident or playing a contact sport your neck, shoulders and upper back may feel OK. Initially your body responds with hormones including adrenaline to delay the pain but a few days afterwards pain may suddenly start. This can be very worrying and painful as well as preventing you from doing usual activities such as moving, driving or reaching out.

Looking for whiplash online may show you a mountain of information, some of which sounds very serious. However the majority of whiplash injuries are not serious and you can make a full recovery with the right physiotherapy treatment and advice.

What is whiplash?

Whiplash is when the body is unexpectedly propelled forwards and back again quickly like a whipcrack. The movement happens suddenly meaning there was no time to brace your body against the impact. This unexpected force can injure your muscles, tendons and ligaments in your neck, shoulder and upper back. Whiplash is common in car accidents but also in contact sports such as rugby, boxing, judo and football.

What are the symptoms of whiplash?

After the injury or accident, when you have been back at home and start to relax you may feel pain in the neck, shoulder and upper back. You may also have headaches and pain and numbness going down your arm. You may not be able to move your neck or shoulder in all directions and it may feel very stiff and sore.

When is whiplash serious?

If you feel dizzy, sick, nauseous, double vision, severe headache or have problems with your balance following the accident or injury you should seek urgent medical attention by visiting A & E.

As with any muscle, tendon or ligament injury there are different levels of severity

We use a grading system to diagnose whiplash and will check for any serious pathology or damage when we first see a patient.

Most people with whiplash have grade one or two.

Grade one whiplash is when you have some discomfort and pain, but no loss of movement.

Grade two is discomfort and pain alongside mobility issues and restricted movement.

Grade three whiplash is a more serious injury to the soft-tissues, pain, lack of movement and possible neurological (nerve) effects as well.

Grade four is a serious injury to the neck area with a possible dislocation or fracture

If you had medical attention at the time of the accident you may have been placed in a hard collar before they are seen in A&E.

This is just done as a precaution and not a sign that the doctors believe you have a serious injury.

Often in A&E the collar is removed without having an X-ray so try not to be worried if you get discharged without an X-ray.

There are other indications of a serious grade four injury which the doctors will have asked you about.

How long does it take to recover from whiplash?

Every incident of whiplash is different so the treatment and rehabilitation plan that I would develop with you is as individual as a tailored suit. Generally people who have good quality physiotherapy recover within 6-8 weeks. If you are not fully recovered or seeing minimal improvement by 12 weeks then you may be referred to a specialist.

I'm looking for a physio near me, but how can I manage the pain until I book and appointment?

You should book an appointment as soon as possible, so that your injury can be assessed and we can start with your treatment. I am open 7 days a week until 9pm and offer online consultations - which is quite handy if you can't drive! For the first 3 days follow these recommendations to manage the pain:

1. Rest – Avoid strenuous activities, such as going to the gym or heavy lifting. When you lie down make sure that you are supporting your neck and back on the sofa or with pillows.

2. Heat and ice – Many people find that this offers fast relief from the pain of whiplash.

Some people prefer ice and others prefer heat.

Leave the ice on for 5 minutes during the first three days after injury or heat on the area for up to 15 minutes and repeat roughly every two hours. Wrap the ice or heat in a tea towel to avoid causing any irritation to the skin.

3. Keep moving – You should rest the neck and shoulder area and avoid any activities that may cause further aggravation, but avoid complete bed rest or not moving your whole body.

Keep moving as much as you are able to within your pain threshold. This will help to keep blood flowing and mobility in your muscles.

4. Pain relief– You may need to take pain relief following the advice of a pharmacist or doctor.

5. Relax – Tensing and holding your posture in a certain way to guard your neck can prevent recovery and start to create bad patterns.

Whiplash pain relief tips

Try to relax if you can and think about your posture. Taking a warm bath or shower can help,. Try this relaxation exercise:

1. Lie comfortably on your back and place a pillow under your knees if you find this feels more comfortable.

2. Tense each body part for 3-5 seconds by contracting the muscle, then let go all at once and relax.

3. Work through the muscles in your upper body one at a time, starting with your scalp and moving down to your ears, face muscles and eventually your neck, shoulder and hands.

4. Try repeating this throughout the upper body for a few minutes, before relaxing completely.

How does physiotherapy help whiplash?

There are several ways that we treat whiplash and help our clients to make a full recovery.

At your first appointment I ask questions so that I can understand exactly what has happened to your neck and check for any serious pathology or injury. I look at your neck and shoulder ( yes I can do that online!) and how you can or can't move.

I will then develop with you a personalised treatment plan with advice and education about how to manage the injury. I also prescribe exercises for you to complete during our appointment and at home which is also an important part of the recovery process.

Looking after the older generation

astephj@gmail.com (Amanda Stephenson) — Fri, 07 Aug 2020 15:13:49 GMT

Helping the older generation to keep moving

Age UK say " Our bodies were made to move. It's a myth that getting older means an end to being active". Regular activity can lower your risk of heart disease, stroke, some cancers, depression and dementia. Moving more helps your thinking skills – like problem-solving, decision-making and remembering facts and words. Being active can lessen aches and pains, help you stay steady on your feet and boost your mood.

As we get older we lose about 1% of our muscle mass every year from approx 40 years of age. The decline in muscle strength and balance happens 3 times quicker particularly if we do not do regular activity. Older people who have been in hospital may have spent a lot of their time in bed or sitting in a chair. This can lead to loss of muscle mass and strength which makes moving about and doing daily activities independently more difficult once they are discharged. This can result in people being unable to go back to their home or needing extra care assistance. The greater the loss of muscle mass the more susceptible a person becomes to infections such as pneumonia and Covid-19.

If your mobility has reduced knowing the level of activity that's right for you, especially if you've just had a fall, an operation, or are living with a long-term health condition, can be difficult. www.physiointhesticks can help. We can assess your mobility and develop a simple, effective exercise plan with you either through an online physio appointment or a local home visit.

At www.physiointhestick.co.uk we can help by assessing your mobility and providing some simple muscle strengthening exercises that can be done in your home without needing any special equipment. We can also advise on how to prevent falls and how to make every day activities easier. We understand that losing your mobility can knock your confidence and make you fearful of moving - that's why physio's are key to helping restore mobility as we have extensive training in encouraging and motivating people to move.

Knee Osteoarthritis - myth busting

astephj@gmail.com (Amanda Stephenson) — Fri, 07 Aug 2020 14:05:39 GMT

Knee Osteoarthritis Facts and Myths

If you have been diagnosed with osteoarthritis you may have been led to believe that you should rest more and avoid certain activities or movements. You may be fearful that your mobility is reducing and you may worry that you might fall due to you knee giving way. Knee pain due to osteoarthritis can be helped with a few sessions with a physiotherapist. A physio can give you advice and education about osteoarthritis and build an exercise programme with you to strengthen the muscles in your knee and hip joints. By strengthening these muscles, the load on the knee joint is reduced and in turn reduces your pain and helps improve your knee stability. Contact us at www.physiointhesticks.co.uk and we can help you with an online physio appointment or a local home visit.

What is osteoarthritis?

Osteoarthritis is the most common form of arthritis and affects weight bearing joints such as the knee or joints that are used a lot in life such as in the hand. In a healthy joint, a coating of tough but smooth and slippery tissue, called cartilage, covers the surface of the bones and helps the bones to move freely against each other. When a joint develops osteoarthritis, part of the cartilage thins and the surface becomes rougher. This means the joint doesn’t move as smoothly as it should.

When cartilage becomes worn or damaged, all the tissues within the joint become more active than normal as the body tries to repair the damage. The repair processes may change the structure of the joint, but will often allow the joint to work normally and without any pain and stiffness. Almost all of us will develop osteoarthritis in some of our joints as we get older, though we may not even be aware of it.

However, the repair processes don’t always work so well and changes to the joint structure can sometimes cause or contribute to symptoms such as pain, swelling or difficulty in moving the joint normally.

Extra bone may form at the edge of the joint. These bony growths are called osteophytes and can sometimes restrict movement or rub against other tissues. In some joints, especially the finger joints, these may be visible as firm, knobbly swellings.

The lining of the joint capsule may thicken and produce more fluid than normal, causing the joint to swell.

Tissues that surround the joint and help to support it may stretch so that after a time the joint becomes less stable.

The main symptoms of osteoarthritis are pain and sometimes stiffness in the affected joints. The pain tends to be worse when you move the joint or at the end of the day. Your joints may feel stiff after rest, but this usually wears off fairly quickly once you get moving. Symptoms may vary for no obvious reason, or you may find that your symptoms vary depending on what activity you are doing.

The affected joint may sometimes be swollen. The swelling may be hard and knobbly, especially in the finger joints, caused by the growth of extra bone. Or soft, caused by thickening of the joint lining and extra fluid inside the joint capsule. The joint may not move as freely or as far as normal, and it may make grating or crackling sounds as you move it. This is called crepitus.

Sometimes the muscles around the joint may look thin or wasted. The joint may give way at times because your muscles have weakened or because the joint structure has become less stable.

It’s still not clear exactly what causes osteoarthritis. We do know it isn’t simply ‘wear and tear’ and that your risk of developing osteoarthritis depends on a number of factors:

Age

Osteoarthritis usually starts from the late 40's onwards. This may be due to bodily changes that come with ageing, such as weakening muscles, weight gain, and the body becoming less able to heal itself effectively.

Gender

For most joints, osteoarthritis is more common and more severe in women.

Obesity

Being overweight is an important factor in causing osteoarthritis, especially in weight-bearing joints such as the knee and the hip.

Joint injury

A major injury or operation on a joint may lead to osteoarthritis in that joint later in life. Normal activity and exercise don’t cause osteoarthritis, but very hard, repetitive activity or physically demanding jobs can increase your risk.

Joint abnormalities

If you were born with abnormalities or developed them in childhood, it can lead to earlier and more severe osteoarthritis than usual.

Genetic factors

The genes we inherit can affect the likelihood of getting osteoarthritis at the hand, knee or hip. Some very rare forms of osteoarthritis are linked to mutations of single genes that affect a protein called collagen. This can cause osteoarthritis to develop in many joints at an earlier age than usual.

Two factors that may affect the symptoms of osteoarthritis, but aren’t a direct cause of it are the weather and diet:

Weather

Many people with osteoarthritis find that changes in the weather make the pain worse, especially when the atmospheric pressure is falling – for example, just before it rains. Although the weather may affect the symptoms of your arthritis, it doesn’t cause it.

Diet

Some people find that certain foods seem to increase or lessen their pain and other symptoms. However, your weight is more likely than any other specific dietary factors to affect your risk of developing osteoarthritis.

Managing the symptoms of knee osteoarthritis

Although there’s no cure for osteoarthritis yet, there are treatments that can provide relief from the symptoms and allow you to get on with your life. These include lifestyle changes, pain relief medications, physical therapies

Physical activity

Many people worry that exercising will increase their pain and may cause further joint damage. However, while resting painful joints may make them feel more comfortable at first, too much rest can increase stiffness and weaken muscles.

You shouldn’t be afraid to use your joints. If pain makes it difficult to get started with exercise, you could try taking a painkiller such as paracetamol beforehand. And if you feel you’ve overdone things a bit, try applying warmth to the painful joint – or if it’s swollen, applying an ice pack may help.

If you haven’t done much exercise for a while you might want to get advice from a physiotherapist. They’ll be able to help you work out a programme that works for you. The most important thing is to start gently and build up gradually.

There are three types of exercise you should try to include:

Range of movement exercises

These exercises involve taking joints through a range of movement that feels comfortable and then smoothly and gently easing them just a little bit further.

Strengthening exercises

These are exercises performed against some form of resistance to strengthen the muscles that move and support your joints. You could use light weights, a resistance band or try exercising in water.

Aerobic exercise

This means any physical activity that raises your heart rate and gets you breathing more heavily. This type of exercise burns off calories, so it can help if you need to lose a bit of weight. It can also improve your sleep and help to reduce pain.

Walking, cycling and swimming are all excellent forms of exercise for people with arthritis. Or you could try an exercise bike or cross-trainer. Walking laps in the shallow end of a swimming pool is also great for strengthening leg muscles.

Hydrotherapy or aquatic therapy pools are warmer than normal swimming pools. The warmth is soothing and relieves pain and stiffness, while the water supports your weight but still offers some resistance for muscle-strengthening exercises.

How to manage painful osteoarthritic knees

Warmth and cold

Applying a hot-water bottle, wrapped in a towel to protect your skin, or a wheat-bag that you heat up in a microwave can help to ease pain. An ice pack, again wrapped in a towel to protect your skin, often helps to reduce swelling and discomfort. Ice can be applied for up to 20 minutes every couple of hours.

Splints and other supports

There’s a range of different splints, braces and supports available for painful joints. These can be particularly helpful if osteoarthritis has affected the alignment of a joint. It’s best to seek professional advice from a physiotherapist before choosing one, so you can be sure it’s suitable for your needs.

Footwear

Choosing comfortable, supportive shoes can make a difference not only to your feet, but also to other weight-bearing joints including the knees, hips and spinal joints. In general, the ideal shoe would have a thick but soft sole, soft uppers, and plenty of room at the toes and the ball of the foot. If you have particular problems with your feet, then it’s worth seeing a podiatrist for more specific advice.

Walking aids

If your leg sometimes ‘gives way’ then ask a physiotherapist to show you some exercises to strengthen the muscles in your knee and hip. Whilst you improve your strength a stick may help you feel less afraid of falling. When held in the opposite hand, it can also help to reduce pressure on a painful knee or hip. It’s best to get advice from a physio as your reason for using a stick will determine which side you should use it on.

Pacing yourself

If your pain varies from day to day, it can be tempting to take on too much on your good days, leading to more pain afterwards. Learn to pace yourself. If there are jobs that often increase your pain, try to break them down, allow time for rest breaks, and alternate with jobs that you find easier. Or think about other ways of doing a job that would cause less pain. It may help to keep a diary - jot down what you have done that day and how you felt later in the day and the next morning. It may give you an insight into what flares up your osteoarthritis.

Caring for yourself

The emotional effects of arthritis can have just as much impact as the physical symptoms. Severe or long-term pain that affects your daily life and possibly disturbs your sleep can affect your mood. From time to time, your arthritis may get on top of you. If you’re feeling low, talk to your GP, who can signpost you to the appropriate services. You can also call the Versus Arthritis helpline on 0800 5200 520, who will listen and offer emotional support.

Taken from Versus Arthritis and GLAD program

Recovering after Covid-19

astephj@gmail.com (Amanda Stephenson) — Mon, 03 Aug 2020 20:17:55 GMT

Advice to help you get back on your feet from the Chartered Society of Physiotherapy

Don’t feel worried or discouraged if it takes a while to get your energy and fitness back. The following advice is designed to help you on your road to recovery.

While rest is important to recovery, it is also essential that you are as active as you can be to rebuild your strength. This will also help your lungs to recover.

It is common that energy levels are lower after a period of illness, so it is important to start rebuilding your routine and activities slowly.

To start with, you may need to prioritise tasks you want to achieve each day, so choose goals that are important for you to achieve. For example, some people find getting dressed every day important, while others may want to get up and make a cup of tea.

Pace your activity throughout your day and rest between tasks if you need to. For example, shower and then rest to allow your breathing to settle before dressing.

Finding the balance between being active and resting may take time to get right, but building a daily routine can help you feel better. Try not rush or push yourself too hard, and don't feel discouraged if you experience a setback.

If you don't feel like your energy levels are returning, or activity is making you feel much worse, then speak to your GP or physiotherapist and ask them to assess you for post viral fatigue.

Feeling Breathless whilst recovering from Covid-19

There are many causes of breathlessness, and you may feel much more breathless than you used to before you were unwell, and some people may still have a chronic cough.

Resting for prolonged periods, whether in hospital or at home, can mean that your muscles may have become weaker and are not as ready to respond to exertion. It is this weakness that will contribute to your feelings of breathlessness.

Breathlessness tips

If you’re doing activities which make you feel breathless, try breathing in before you make the effort, then breathe out during the effort. For example, blow out as you step up.

Pursed lip breathing: breathe in gently through your nose, then purse your lips like you’re blowing bubbles or a candle out and breathe out through your pursed lips

Getting stronger and increasing your activity gradually will help you recover from Covid-19

A physiotherapist can help you with some strength exercises to start rebuilding your muscle strength. Physiotherapists recommended that you exercise little and often to start with, and build up to being more active.

Keep motivated

Think about the activities you find hard now and what you’d like to be able to do in the future. Set yourself small goals and keep a record of them. As you’re able to do more exercise, don’t forget to choose something you enjoy! You’re much more likely to stick at keeping active if you’ve picked something you love doing.

You know your body better than anyone else - if you are worried that things do not feel right, be sure to discuss your concerns with your GP or physiotherapist.

You can see a video of breathing exercises and recovery resources at https://www.csp.org.uk/public-patient/covid-19-road-recovery

Important information

The information on this page is designed for people who are recovering from Covid-19 and should be treated as complementary and secondary to recommendations you have received from a qualified medical professional.

If you have been discharged from hospital, you may also have a treatment plan or follow up physiotherapy sessions. If you have any concerns about rehabilitation or recovery, please speak to your physiotherapist, GP or healthcare professional.

If you think you may have coronavirus, please use the 111 online service to find out what to do next or call 111.

Sleep - are you getting enough?

astephj@gmail.com (Amanda Stephenson) — Sun, 02 Aug 2020 11:39:53 GMT

Am I getting enough sleep?

Only 17% of UK adults get the recommended 8 hours sleep a night. Just over half only manage 6 hours or less . Not getting enough sleep increases risk of diabetes and obesity. As a physiotherapist I often see people who have neck, back or shoulder pain and I always ask about their sleep. Our quality and quantity of sleep varies through out life. Going out socialising, working long hours or night shifts, studying, having a baby and daily stresses all affect how long we can sleep for and the amount of deep sleep we get.

Our body does much of its "spring cleaning" as we sleep - removing waste products from body and brain cells and healing damaged tissues. If we have poor quality sleep these processes are slowed down and are less effective. Our body responds to the fluctuations in light and dark. The cells at the back of your eyes send a signal to the master clock in your brain. The brain then sends signals to your hormone producing glands to regulate your body systems - letting you know when you are ready to wake up, eat and go to sleep. This is known as your circadian rhythm. If you get up at the same time every morning (including the weekend) and go to bed at the same time every night your circadian rhythm will thank you for it.

Sleep scientists recommend that exposing yourself to natural light in the morning is a great way to help the circadian rhythm. As we spend many hours indoors or in a car we do not get sufficient lux of light (measurement of light). Full sunlight gives 30,000 lux and going outside on a cloudy day gives 10,000 lux - whereas being indoors or in a car means we may only get 500 lux. Even when the weather is typically British winter the level of light you will get outside is 100 times greater than you have indoors. Light Meter is an app that can measure your daily light exposure. In 2014 researchers found that people who spent more time outside in the mornings had lower body mass indexes. In 2016 a study of 30,000 women found that people who smoked but spent a lot of time outdoors had the same mortality risk as people who did not smoke but spent a lot of time indoors.

A recent study August 2020 found that a 60 minute session of moderate intensity exercise, aerobic exercise, individual exercise done in the afternoon can reduce insomnia and improve sleep quality. Moderate intensity exercise includes :

Walking briskly (about 3½ miles per hour)

Bicycling (less than 10 miles per hour)

General gardening (raking, trimming shrubs)

Dancing

Golf (walking and carrying clubs)

Water aerobics

Canoeing

Tennis (doubles)

To encourage yourself to feel sleepier in the evenings, spend as much time as possible outdoors in the morning and afternoon and then stop your exposure to bright lights in the evening. Our brain cannot differentiate between morning light and the blue light on mobile phones, tablets and laptops. Bright light suppresses the secretion of melatonin, the hormone than prepares your body for sleeping. Looking at these devices in the 2 hours before bed sends a conflicting message to our brain. Use the built in filter or apps to reduce the blue light on your devices if you must use them otherwise turn them off and enjoy a relaxing bath or shower, meditate, do yoga or read a book. Keep the lighting dim or use candlelight. Equally sleep scientists have found that blocking out light from outside street lights, cars and security lights with some black out blinds or thick curtains can help improve our sleep. A tranquil, cool, dark clutter and tech free bedroom is a great start towards better sleep. Ideally your bedroom should be 16-18 degrees Celcius

Our brains respond well to the amber glow of a fire. Anyone who has been camping or has an open fire or a log burner will recall feeling sleepy earlier in the evening. Amber glasses have been used by some people for as little as an hour in the evenings to induce sleepiness. There is anecdotal evidence that if you need a night light for young children, using a red light may help them sleep for an hour longer than usual.

US scientists found that a hot shower 90 minutes before bed helped people to go to sleep 50% faster and increased their sleeping time by 15 minutes on average. Hot water is a vasodilator - it widens your blood vessels and helps your skin lose excess heat. This assists your body in lowering your core temperature which is an essential process to falling asleep.

If you like to stay up late, try spending more time outdoors in the morning which will make you feel alert earlier in the day and sleepy earlier in the day , which can reduce the amount of coffee you need to get going in the morning. Caffeine can remain in your system for 6 hours and it is known to disrupt sleep, so if you struggle to get off to sleep it can be helpful to stop drinking coffee after midday.

The Automated Morningness-Eveningness Questionnaire takes 5-10 minutes and gives you advice about your circadian rhythm type https://www.cet-surveys.com/index.php?sid=61524&newtest=Y

Rate your sleep health

Do you wake up feeling refreshed?

Do you wake up every day within 30 minutes of same time without using an alarm?

Do you fall asleep within 30 minutes?

Score

Never or rarely 0

Occasionally 1

Almost always 2

Score of 6 is excellent, anything below 6 identify the lifestyle factors and change two or three to feel the benefits of good sleep

What are the benefits of a good night's sleep?

Increased energy

Improved concentration and memory

Greater capacity to learn

Better ability to make healthy food choices

Improved immune system function

Improved “spring cleaning” in body and brain

Reduced risk of long-term conditions such as diabetes, leaky gut, Alzheimer’s

Increase life expectancy

Reduced risk of being overweight, migraine’s

Reduced stress, anxiety and depression levels

Getting up at the same time every morning will sync your body rhythms

15 ways to improve your sleep

1. Take an outdoor break in the morning

2. Enforce a strict “no caffeine after noon” rule

3. Turn off all devices - mobile phones, laptop, tablets, games console, TV ideally 90 minutes before bed ( I know, its hard! start with 30 mins and build up to 90 mins)

4. Set an alarm to tell you when it’s time for bed

5. Fit blackout blinds or thick curtains in your bedroom

6. Remove all screens from your bedroom

7. Consider opening your bedroom window. The perfect temperature for sleeping is 17°C/65°F

8. Eat earlier in the day before 7pm if possible

9. Exercise earlier in the day

10. Socialize earlier in the day

11. Buy red lights for night time lights

12. Buy amber glasses to filter blue light from screens

13. Don’t use your phone as an alarm clock

14. Use night time/twilight mode on your devices

15. Avoid vigorous activity in the three hours before bed

Is my posture causing my neck pain?

astephj@gmail.com (Amanda Stephenson) — Sat, 01 Aug 2020 18:01:14 GMT

The myth about posture.......

The amount of people with neck pain has increased greatly over the past 25 years which might lead you to think it is due to our posture - as we are using our mobile phones and working at computers even more. However the scientific evidence shows that increased stress, poor sleep and reduced physical activity seem to be greater factors in why you have neck ache or neck pain.

For many years people have been told that slouching, slumping, hunching over at a desk was bad posture. People were be encouraged to buy ergonomic desks, chairs and keyboards and health care professionals tried to correct people's posture. But evidence shows that ergonomic furniture has little or no impact on reducing the likelihood of getting neck pain.

Researchers found that people with neck pain were working in highly stressful jobs and had less sleep and poor quality sleep. As they were less physically active and had low mood they had higher stress levels and felt more muscle tension in their necks, eventually leading to neck pain.

Physiotherapists have known for a while that avoiding sitting in the same position for too long and taking some regular walks can help prevent people getting neck pain. Creating a relaxing bed time routine (we do it for our kids, why not take the same care of ourselves?) and getting a good night's sleep can be the key to reducing your neck pain.

Why do my wrists hurt when I'm typing?

astephj@gmail.com (Amanda Stephenson) — Tue, 28 Jul 2020 14:17:19 GMT

It could be carpal tunnel syndrome - do you have these symptoms?

Carpal Tunnel Syndrome can cause pain, tingling, numbness, swelling, weakness and clumsiness in the thumb, index, middle and ring fingers. Symptoms can become worse during the night than they are in the day.

These symptoms can be made worse if you have a pre-existing condition such as rheumatoid arthritis, diabetes, water retention, inflammation or wrist fractures.

Carpal tunnel syndrome affects more women than men, and is most common between the age of 40-65.

In carpal tunnel syndrome the median nerve is compressed as it passes through the carpal tunnel in the wrist. The carpal tunnel is already narrow as it contains the wrist bones and a thick ligament.

What can I do to reduce my symptoms?

Take regular breaks from repetitive tasks

Consider other ways a task can be done

Alternate heavier tasks with lighter tasks

Avoid prolonged gripping or pinching - loosening your grip when reading a book or when holding your phone

Change your computer station set up - your physiotherapist can review this for you

Use soft gloves or softer conforming handles to reduce vibration during activities such as lawn mowing or bike riding

See a physiotherapist for exercise and splinting advice

Why have I got creaky knees?

astephj@gmail.com (Amanda Stephenson) — Tue, 28 Jul 2020 14:16:03 GMT

Is it a sign of damage?

Creaky,popping or noisy knees is known as knee crepitus. It usually happens when the knee is bent - going up or down stairs, getting up from a chair or squatting. Generally, on its own crepitus is not a cause for concern (when Mr.PhysioInTheSticks gets up in the morning it sounds like someone is playing castanets). Although this can sound unpleasant, its not harmful and you can continue to do your usual daily activities.

There are several reasons for crepitus - weak or tight muscles around the knee joint are a common cause. Knee joints are lubricated with synovial fluid, studies suggest that everyday movements may cause pressure and volume changes in the fluid, causing the gases nitrogen, oxygen and carbon dioxide in the fluid to form a gas bubble to form and then pop. After a joint "pop" due to pressure and volume changes it takes about 20 minutes before that joint will "pop" again.

Crepitus is believed to be due to arthritis - but it often isn't. 99% of people without knee problems have noisy knees - there are many reasons joints make a noise but they are mostly non-arthritic. It is important to keep on moving as avoiding physical activity can lead to a loss of muscle strength which is a bigger problem.

10 Facts About Back Pain

astephj@gmail.com (Amanda Stephenson) — Tue, 28 Jul 2020 14:15:57 GMT

Let's debunk a few myths!

1. Back pain is not caused by a weak core

Weak core muscles do not cause back pain. In fact people with back pain often tense their core as a protective response - but that's like clenching your fist after you have sprained your wrist. Being strong is important when you need the muscles to switch on, but being tense all the time is not helpful. Learning to relax the core muscles whilst doing everyday tasks can be helpful.

2. Back pain is not caused by poor posture

How we sit, stand and bend does not cause back pain (and if your physiotherapist tells you otherwise - find a new one!) These activities may be painful. A variety of postures are healthy for the back. It is safe to relax during everyday tasks such as sitting, bending or lifting with a rounded back - in fact its more efficient.

3. Backs do not wear out with everyday loading and bending

The same way that lifting weights make backs stronger, moving and loading make the back stronger and healthier. So activities like running, twisting, bending and lifting are safe if you start gradually and practice regularly.

4. Getting older is not a cause of back pain

Although it is a widespread belief that getting older worsens back pain, research does not support this - and evidence based treatments can help you at any age!

5. Scans rarely show the cause of back pain

Scans are only helpful for a minority of people. Lots of scary sounding things can be reported on scans, such as disc bulges, protrusions, degeneration, arthritis. Unfortunately these reports don't say that these findings are very common in people without back pain and they don't predict how much pain you feel or how disabled you are. Scans can also change. Most disc prolapses shrink over time.

6. Pain with exercise and movement does not mean you are doing harm

When pain persists, it is common for the the spine and surrounding muscles to become sensitive to touch and movement. The pain you feel during movement reflects how sensitive your structures are - not how damaged you are. So it is safe and normal to feel some pain when you start to move and exercise. This settles down with time as you get more active. In fact exercise and movement are the most effective ways to help treat back pain.

7. Persistent back pain can be scary, but it is rarely dangerous

It can be distressing and disabling but its rarely life threatening and you are very unlikely to end up in a wheelchair

8. Persistent back pain is rarely associated with serious tissue damage

Backs are strong. If you have had an injury, tissue healing occurs within 3 months, so if pain persists past this time it usually means there are other contributing factors. A lot of back pain begins with no injury or with a simple everyday movement. These occasions may relate to stress, fatigue, inactivity, unaccustomed activity which makes the back sensitive to movement and loading.

9. Pain flare-ups do not mean you are damaging yourself

While pain flare ups are scary and painful, they are not usually related to tissue damage. The common triggers are things like poor sleep, fatigue, stress, tension, worries, low mood, unaccustomed activity or inactivity. Controlling these factors can help prevent exacerbations and if you have a pain flare-ups instead of treating it like an injury - try to stay calm, relax and keep moving.

1 0. Injections, surgery and strong drugs usually aren't a cure

Spinal injections, surgery and strong drugs like opioids aren't very effective for back pain in the long term. They come with risks and unhelpful side effects. Finding low risk ways to put you in control of your pain is key.

These back facts were developed after extensive evidence based research by Peter O'Sullivan, JP Caniero, Kieran O'Sullivan, Mary O'Keefe, Kevin Wernli, BJSM approved

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Online Physio - the new normal?

astephj@gmail.com (Amanda Stephenson) — Tue, 28 Jul 2020 14:15:41 GMT

Does online or telephone physiotherapy work?

The COVID-19 situation has forced many of us to work in different ways. In the space of a few weeks, the change to online shopping, ordering takeaways, Zoom meetings for work and online schooling have been a steep learning curve for everyone! It is now not unusual to chat to your relatives, see your GP and do a Pilates session all online. So why not physiotherapy?

In line with plenty of emerging evidence, a modern musculoskeletal physiotherapy session can be done online. Over 90% of muscle or joint problems such as back pain, whiplash, frozen shoulder, carpal tunnel syndrome, muscle strains or ligament sprains can be treated successfully online. The Chartered Society of Physiotherapy recommends the use of online and telephone consultations and in response to COVID-19 physios and their clients have embraced a new way of working and realised it provides excellent results - whilst social distancing too.

A recent study of 27,000 people found that online physiotherapy was as effective or more effective than traditional face-to-face appointments. Patients pain levels and their satisfaction with results were measured and compared. The convenience of having an appointment in the comfort of their own home, not needing to book time off work or find parking were also popular with patients. Another study of people with knee osteoarthritis for the Amercian College of Rheumatology found that as people were more comfortable and relaxed in their own home they were more able to focus on completing their exercises and more likely to do them regularly. The Journal of Physiotherapy 2020 found that hip rehabilitation after surgery was just as effective online as face to face.

Is it a new idea?

Online consultations have been used for many years and telephone consultations for over 40 years in rural and remote areas such as the Scottish Highlands, Australia and Canada.

Is it for everyone?

There are of course concerns about people who are " digitally excluded" but often people's relatives or neighbours have come together and managed to work around this. We can do a consultation with a smart phone or tablet or a standard telephone too.

There are some times when we cannot treat you online. With thorough health screening we may find a condition that requires emergency medical treatment or specialist referral. If this is the case we will advise you straight away and refer you to a healthcare practitioner who can help you.

But what about manual therapy- you can't do that online?

Like all healthcare professions, there are different opinions. At Physiointhesticks.co.uk in line with CSP guidelines and MSK Reform, we prefer to use treatments that are shown through decades of research to be effective and long lasting. Humans move in many different directions and therefore need to be as functional as possible in their rehab - this is known as active treatment. Treatments where you lie down and do nothing are passive treatments. You can only have joints "out of alignment" if hit by a ten tonne truck or an elephant - and then you would need one of those lovely orthopaedic consultants to pin,wire or plate you back together. If massage will benefit you then Physiointhesticks can recommend several qualified massage therapists. Modern physiotherapy involves a thorough assessment, listening to you carefully, tailoring an active treatment plan with you and getting you back to what you enjoy doing the most, as quickly as possible.