Our Ask A Physio series is a collection of micro blogs aimed at giving a basic understanding to some frequently asked questions. If you have an injury or are experiencing discomfort please book for an assessment, or contact reception for more information.
Ideally ASAP! A bit like an issue with your car or house, the sooner we can get you doing the right things, the better chance we have of getting you back to normal sooner. Particularly when it comes to sport and exercise, we’ve got good research showing that the first 72 hours can make your recovery a lot faster or slower.
If it’s an injury or issue you’re really familiar with from previous experience, then you’ll already know the routine for the first week. In that situation I usually tell people to manage it how they’d manage a stomach bug; do what you know for the first 48 hours. If you’re not getting anywhere doing what you know, then check in with us.
If in doubt you can always book for a free 15min phone consult with one of our Physiotherapist!
Compiled by our Masters trained Physiotherapist Chris Smith. To book an appointment with Chris, or read his Meet the Team profile CLICK HERE.
Fibromyalgia is a condition characterised by widespread pain in the muscles and connective tissues for 3 months or more. It is defined as a syndrome due to the collection of symptoms rather than a disease, as there is currently no identifiable cause within the medical field.
It often runs in families and people with Rheumatoid arthritis, lupus and Ankylosing spondylitis are more likely to develop it. However, it is not a condition of the joints or an inflammatory condition. There are many hypotheses for why it may develop, although none of these have been proven and accepted yet. For example psychological trauma or prolonged stress may affect how the body's pain signals react, potentially leading to a sensitised pain system. Another suggestion is a widespread and chronic raised inflammatory response in the body.
As many as 1 in 50 people may develop fibromyalgia at some stage in their life and it is most common between ages 25-55. It affects 9 women for every 1 man, but it can also affect children.
- Widespread pain and stiffness: heightened sensitivity to touch/pressure, common trigger points include neck, shoulders, chest, hips, & knees.
- Fatigue, insomnia and poor sleep.
- Difficulty with concentration (Fibro fog)
- Changes in mood, anxiety and depression.
- Gastrointestinal problems.
How is it diagnosed?
There is no gold standard for fibromyalgia diagnosis. Various criteria have been suggested over the years since 1990, however the most recent were updated in 2016. These include:
- (1) Generalized pain, defined as pain in at least 4 of 5 body regions, is present.
- (2) Symptoms have been present at a similar level for at least 3 months.
- (3) Widespread pain index and symptom severity scales. These are outcome tools that clinicians used to measure pain location and severity.
What are the management options?
There is no cure for fibromyalgia. Management should be aimed at relieving symptoms and improving function. Everyone's symptoms will be different, therefore treatment approaches will need to be individualised. However, they are likely to include both medical and self-care approaches.
Medication may be useful, but active approaches to relieving stress including mindfulness, meditation, yoga and psychological support may be helpful. Reducing stress triggers in your life may also be beneficial, rather than merely managing stress when it occurs. Graded exposure to exercise is also recommended. In addition to this, looking at lifestyle and sleep hygiene may be important as one of the major symptoms is sleep disturbance and fatigue. A recent study from 2017 demonstrated that the agreed treatments between international expert groups on the topic were exercise, cognitive behavioural therapy, and certain antidepressant drugs such as amitriptyline.
As physiotherapists with expertise in persistent pain, we are well placed to support and educate fibromyalgia patients about their condition in addition to producing an individualized exercise and rehab program that may be beneficial. Our training also provides us with a good knowledge of the impact your psychological system can have on any pain condition. If we feel you need more expert talking therapies as part of your management we can signpost to the correct psychology services.
So if you think or know of anyone with fibromyalgia come in and see one of us to see how we may be able to help you.
When you consider it takes up to 40 weeks or more to create a tiny human, you would think mothers would relax and give their bodies time to restore. Instead, according to a 2014 survey of 1,500 women in the United Kingdom, 40 per cent of new mums feel pressured into losing weight quickly. A 2015 study by the American journal Obstetrics & Gynecology found that 75 per cent of women don't achieve their pre-baby weight one year post-birth, while UK-based research revealed it takes an average of 19 months to get close to pre-pregnancy weight.
In my experience I see a huge number of women who have returned to exercise too soon, and too intensively - meaning they've come to see me with aches and strains on their pelvic floor function. Mothers must remember that you have just performed one of the most incredible things – developing and giving birth to a tiny human. Time and patience are vital.
Respect for the healing process is key. If you had an uncomplicated, natural delivery, you might feel tender for five weeks or more, and it is advisable to wait until your six-week, post-partum check-up before returning to gentle exercise. A caesarean section can require six to 12 weeks' recovery, depending on your body, and you should always wait for the green light from your doctor before starting any physical activity.
After six weeks for a natural delivery or eight to 10 weeks for caesarean section, you can start gentle low-impact exercise, such as cycling, cross trainer, Pilates, yoga and light weights. Avoid high-impact exercise such as running and aerobics until four to six months after giving birth. Exercise on your hands and knees or in bridge position should also wait until after six weeks.
Consider the first three months after birth as the 'fourth trimester' – a time of rest, recovery and irreplaceable moments with your newborn. Eat to nourish your body rather than trying to lose weight and under no circumstances try diet pills, liquid diets or other weight-loss products, which can be harmful to you and your baby if you are breastfeeding.
Blood lost during and after delivery can also lead to iron deficiency, which exacerbates the chronic fatigue that new mothers often experience. Fill up on iron-rich food such as free-range, grass-fed organic beef, dark green, leafy vegetables and dark beans such as kidney or aduki beans, and avoid too many raw foods (unless in easily digestible green juice or smoothie form) as these require more energy to process.
Breastfeeding mums who are tempted to cut calories to lose weight should also be aware that you need, in general, up to 500 more calories a day to support the process. Lactogenic foods can help with milk supply issues, try consuming things like moringa [add to smoothies to help mask the taste], oatmeal, brewer's yeast, salmon and fenugreek seeds.
I recommend booking in for a Women's Health physio appointment after your six week check-up. At this appointment we can check your pelvic floor function, discuss any developing aches and pains, discuss specific exercises for you to do/avoid, and give you some general piece of mind over your body changes.
We also have a number of specialty pre / post natal pilates classes. These group sessions are tailored for individual abilities and allow you to exercise safely and encourage movement through your body. To join a pregnancy, or mums & bubs class we do require you to have a 1-1 prep session first just to make sure you're not in any pain, and to identify any potential complications.
Our reception team is happy to discuss with you your best options and to assist with booking. 093664480 or firstname.lastname@example.org
If you’re in doubt, it’s probably best to see a physiotherapist first. Massage is a maintenance and self care tool, but it might not get to the reason behind why you feel an area needs some attention. If an area feels stiff or sore, seeing the physio will allow them to assess and diagnose the issue, and figure out if massage is appropriate. Often people can jump into a massage a bit too early, and end up making their issue worse.
Once your issue is stable and safe, then asking your physio if you're ready to see a massage therapist can really help with longer term maintenance. It’s often a nice reward for a job well done after a month of diligent rehab. As with all hands on treatment, remember that the massage is a cherry on the top of your plan, the bulk of your management should be homework!
Absolutely, there’s a reason that they are such a staple in so many different fitness environments. One big reason why massage, manipulation and other types of manual therapy get criticised is that you don’t want to build too much of a dependence on other people to manage your aches and niggles, so foam rollers allow you to take some of that power into your own hands.
Massage in some form or another has been used in sport and exercise at least as far back as the Roman gladiators, and for good reason. Self massage with foam rollers can be used to improve recovery times after workouts, to lengthen restricted muscles and even to copy the “cracking” or “pops” that you get to free up a stiff spine. Similar to other types of exercise kit, if you’re not already comfortable with foam rollers, make sure that you check in with a physiotherapist or good personal trainer to show you a few techniques before you bring them into your weekly routine.
Pilates may sound intimidating, but it's actually the most accessible way to build strength and mobility for better posture, balance and flexibility.
If you’ve wanted to try Pilates but something has been holding you back, now’s your time to sign up. Pilates offers plenty of benefits, no matter your fitness background. The technique cultivates body awareness to support everyday movements that are efficient and easeful.
Pilates is a full-body exercise method that consists of low-impact exercises on a Mat, Reformer, Cadillac or Chair. With equipments system of pulleys and springs, handles and straps - the apparatus can provide either resistance or support depending on your needs. You can do Pilates with or without equipment, but no matter what, expect the moves to involve slow, precise movements and breath control. The method emphasises core strength, proper postural alignment and muscle balance.
Pilates is named after its creator, Joseph Pilates, who developed the method in the 1920s. Joseph Pilates believed mental and physical health were closely connected.
A Pilates routine generally includes low-impact flexibility and muscular strength and endurance movements. Exercises aim to promote proper posture and movement patterns as well as balance, flexibility and strength.
Pilates has something to offer people of all ages from beginners to athletes. There are countless ways to modify and adapt Pilates exercises, depending on your age, physical ability, and level of fitness. The exercises are designed with modifications so that people of all levels and abilities can stay safe while being physically challenged.
We love getting people moving. We offer a variety of Pilates classes morning, noon and night out of our boutique Newmarket clinic. This includes mat, equipment classes, and specialty classes for pregnancy and post-natal. We keep the classes small to make sure everyone is completing the exercises safely and effectively. The classes are suitable for all levels as the instructor will provide variations on the exercises to suit your level.
We have experienced Physiotherapists and Pilates Teacher taking the classes so you can find the right class for you. We ask everyone that joins the classes to have a 45 minute 1-1 session prior to starting. Here you will discuss your goals and what you want to achieve. You will be shown how to find your neutral spine, how to engage your pelvic floor and deep abdominals, along with a few basic moves. You will then start a graduated Pilates exercise program that is individualised to your body and needs. Depending on your experience we may advise that you have at least 2-3 one-on-one sessions with a Physiotherapist or Pilates Teacher before proceeding on to a class.
It was once said by the US Chief Medical Officer that if exercise was a pill it would be a billion dollar industry. This is not an understatement, physical activity really is the equivalent of a wonder drug, and without the negative side effects of many of its pharmaceutical counterparts. Exercise has been demonstrated to have positive impacts on multiple body systems including the cardiovascular, gastrointestinal, musculoskeletal and neurological system.
Cardiovascular - Regular physical activity increases the efficiency of the specialised heart muscle allowing it to pump oxygenated blood to all your body tissues easier. Regular physical activity also leads to increased lung capacity, increased number of functioning alveoli in which gas exchange occurs and improved strength of respiratory muscle including the diaphragm and intercostal muscles. All this allows for improved function of the cardiorespiratory system and increased cardiovascular fitness.
Musculoskeletal - Regular physical activity can have positive impacts on various soft tissues including bone, muscle, ligament and tendon. Increased mechanical stress on soft tissue causes cells within these tissues to increase production of collagen leading to increased tensile strength of these tissues. This process is known as mechanotherapy and can be used to explain why tissues increase strength in response to mechanical load and why exercise prescription is such a key part of a rehabilitation program with a physiotherapist. Likewise gradual increase in mechanical loading can increase bone density so long as sufficient opportunity is allowed for rest and bone cell production in between loading cycles. In relation to muscle regular exercise provides a training stimulus which leads to an increase in the ability of the nervous system to recruit more muscle cells to provide a contraction, leading to increased strength. An increase in muscle size (hypertrophy) is due to increase in muscle cell size following repeated bouts of exercise, followed by sufficient rest.
Neurological - Physical activity has been associated with reduced risk of alzheimer's, dementia and improved cognitive function, likely due to improved vascular supply to brain tissue. Regular physical activity is also associated with improved mental health and reduced rates of anxiety and depression. Exercise leads to the release of various endorphins and neurotransmitter chemicals responsible for improving mood and reducing pain. In addition to the likely hormonal and chemical contribution to improved mental health with exercise, it can also improve self-efficacy and provides opportunity for social interaction with others, a factor which is important in managing mental health. Exercise also has been demonstrated to regulate appetite and sleep pattern.
Given the range of body systems on which exercise helps the human body it is not surprising that it has been shown to help in the management of various medical conditions such as obesity, Type II diabetes, stroke, cardiovascular disease, anxiety and depression in addition to a variety of musculoskeletal conditions such as arthritis, spinal pain and tendon issues to name a few.
Recommendations for exercise:
The World Health Organisation (WHO) are the global experts in managing the health of humanity. Given that lack of physical activity and preventable health conditions is seen as a crisis by the WHO, it's not surprising that in 2020 they reviewed their guidelines for physical activity. For adults aged 18-64, at least 150–300 minutes of moderate-intensity aerobic physical activity are recommended weekly or 75–150 minutes of vigorous-intensity aerobic physical activity. In addition to this, adults should also do muscle-strengthening activities that involve all major muscle groups on 2 or more days a week.
Research shows that it takes on average 66 days to create a new habit forming behaviour, although this number varies widely between individuals (see here). Furthermore, in terms of fitness, after 2-4 weeks people start noticing changes in their strength and fitness when exercising. However, changes in body composition and muscle size more often take 12 weeks on average.
So, if you stick past the first month then your strength and fitness should improve, stick past the 2nd month and the exercise should become a habit. Once things are a habit they become a lot easier to maintain as part of managing our long-term health.
Type of exercise:
There are no suggestions for specific types of exercise. The key is finding something you enjoy and can stick to to make it a habit and part of your life in order to prolong and manage your health throughout your life. Get creative, do what you love! If you don't know where to start or are nervous, get myself or any of the physiotherapists or personal trainers at Auckland physiotherapy to help you. We also offer pilates classes which keep you healthy and moving and are fun at the same time. Win, win!