From pregnancy incontinence to pelvic pain to post natal weakness and prolapse.

As physios who treat women’s only pelvic floor problems, we are always overwhelmed by the lack of awareness out there amongst our female friends that this type of physio even exists! Also overwhelming is the lack of proper education and information out there about incontinence, sexual pain and prolapse which can actually be treated well by women’s health physios.

Ban those TENA incontinence pad ads!! Don’t put up with a leaky bladder, pelvic pain or sexual pain. Bladder and bowel control and wellness in women is our philosophy.

At The Fix Program, we have physiotherapists who are expert clinicians in the management of conditions unique to women. They have clinical expertise and excellent diagnostic and therapeutic skills. We specialise in the management of pelvic floor problems. We can help you if you have:

• Urinary incontinence or poor bladder control in pregnancy and beyond
• Bowel incontinence and constipation
• Over active bladder and urge incontinence (going to the loo more than 8 times per day, with ‘eye watering’ urgency sometimes associated with bladder leaks)
• Pregnancy and post-natal care (pregnancy incontinence, post natal pelvic floor weakness, pain, scar management after tearing, prolapse and sexual pain)
• Vaginal prolapse (also known as pelvic organ prolapse, where the bladder, uterus or bowel drop low into the pelvis)
• Painful sex or ‘vaginismus’
• Pelvic and lower back pain

We understand every woman’s pelvic floor physiotherapy needs are different.

OK, all assessments and most treatments will involve an internal vaginal examination. But as a woman, we hope this is tolerated just as we do with our PAP smears every few years. This, along with extensive questioning about your pelvic floor function and habits allow for the best diagnosis and then treatment. The internal examination will also allow for the physiotherapist to properly assess any weakness, spasm or change to your pelvic floor muscles and to assess for any degree of prolapsed (or descent) of your pelvic organs. All of this cannot be achieved externally.

Read more about pelvic floor disorders at our website.

Contact us to chat about any pelvic floor issues you may be experiencing, or to book an appointment at Broadway (within the Fernwood Fitness womens’ gym) or Sydney CBD.

You do not need a referral from a doctor to see us. HICAPS rebates available on all physiotherapy treatments, but check your individual private fund provider for eligibility.

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Knee pain troubles are rarely just about the knee. The hip and the foot are to blame!

Knee pain is such a common complaint- I would think that almost all of us have sometime suffered from pain in the knee- with running, walking, stairs, kneeling, the gym, or with all of the above!

In my time as a physio (over 20 years, mind you), I have seen the poor knee being almost like the piggy in the middle. The knee often suffers much pain and irritation from its location – by existing between problems of the hip region above and the foot region below.

The bully from above.

Weakness, instability and poor postures above at the hip and pelvis can alter how our weight and movement happens through the knee. These can include:

• Buttock muscle or ‘glute’ weaknesses.
• Tightness of the outer hip and hamstrings pulling down into the back of the knee.
• Twisting or not keeping the lower back and pelvis controlled with exercise, which then throws the thigh bone into poor alignments and stresses the knee down below.
• Weakness and a lack of balance of the thigh or ‘quads’ muscles which can cause a pulling of the kneecap from its preferred centre position on the front of your knee.

The bully from below.

The foot is the first to hit the ground when we walk or run and will send the forces from the ground up towards the knee. This can often not be too optimal. Problems here can include:

•  Feet arches that are too flat and rolling inward or too high and stiff.
• Tightness of the calf muscles and Achilles from all that high heel wearing!
• Movements of the foot which are compensated due to pain such as in the heel or in the big toe joint.
• Poor fitting shoes squashing up the foot, or old shoes that are not longer absorbing shock well.

The poor piggy in the middle.

As you can see and possibly feel yourself, the knee tries its best to cope with the bullies either side! It is pretty amazing and resilient at putting with some of this bullying, but over time, the knee decides it has had enough.

So, like most injuries of the body that are slow and happening gradually over time, it is the joint copping all the stresses that ends up giving up – pain, swelling, altered movement and generally an unhappy joint.    

Does this sound like you?

Your Fernwood and Fix Program physiotherapists are here to assess you from waist to toe, diagnosing the probable causes to knee pain. Knee pain responds extremely well to physiotherapy with fantastic outcomes when it comes to returning to exercise and a pain free knee.

Every knee is different, just as every body is different. With this in mind, careful assessment and targeted treatment , combined with an exercise program to correct the imbalances will get you back on track.

Contact us for an appointment and we can fix your knee pain.

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Draft term break timetable is subject to change. This timetable is for our Term 3 programs and will run for 10 weeks. First class will start Monday 18th July and our final classes will fall on Friday 23rd September, 2016.

Classes are recommended and scheduled for

• Beginners Pilates
• Intermediate and advanced Pilates
• Pregnancy specific Pilates
• Mums&bubs post natal Pilates, safe for you and with your baby.

• 

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Draft term break timetable is subject to change. This timetable will run for 2 weeks only in weeks commencing 4th and 11th July, 2016.

Classes are recommended and scheduled for

• combined intermediate and advanced classes
• pregnancy classes.

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It’s not just about ab exercises

As a physio treating a lot of hip, pelvis and back problems, I am always asked about core strength. Most will ask about it with reference to their gym or exercise programs, what is it, how to make it better and specific exercises to challenge it.

I always start with a picture not too dissimilar to this below. We all know that visualisation is an amazing learning tool. Picturing a concept or an idea can allow the brain to learn better. Seeing the deep muscles of the lower trunk and pelvis can help you to understand and even activate them better within your gym routines or even in everyday life.

At the gym.

If you use your imagination a little, the diaphragm, transverses abdominus (the deep ab layer), pelvic floor and multifidis would cover the surfaced of a cylinder - the ‘cylinder or piston of support.’ This muscular cylinder is only the beginning of wonderful postural support for your pelvis, spine and body. They can not only prevent back injury and pain, but also hip pain, knee pain and upper spine issues with posture. And even better, they make your movement more efficient. You will feel stronger.

The subtlety of this cylinder’s effect sometimes takes a lot of practice, and your physio can show you how. But here are some basic tips to get started.

• Breathe! The diaphragm is the first step in getting your core to switch on. Try to avoid holding your breath with effort and instead, focus on breathing ‘deep and wide’. You should feel a wonderful movement into the base of your ribs with this type of breath and try to aim for soft relaxed shoulders.
• Pelvic posture awareness! Think of your pelvis as the foundation for your spine. Know also, that if the pelvis is held well, your deep ab layer and your pelvic floor will be working to hold the pelvis there. Brilliant! To help with this, visualize your pelvis is like a deep bowl of water. Try to always keep it level so that it doesn’t spill. Try this as you stand, sit, squat, lunge or at spin class.
• Become aware of muscles activating. Again, there are quite a few ways to visualise these deep muscles switching on. Could you imagine your activating pelvic floor muscles to be an ‘elevator with doors closing and travelling up to level 1’? Or could you imagine that your deep abdominals activating feel ‘below your navel and between your pelvic hip bones’?

Through your day

Getting to know your core muscle system at the gym can greatly assist you with your everyday postures. Standing to wait for the bus, sitting at your desk, bending over or helping to lift a patient if a nurse. These are all times we may feel back or neck pain, but with a new awareness of your magical deep postural muscles, you may just beat that painful attack.

**Want more help?
**

These tips are just the start.

Contact us. For more assistance in helping you ‘find your core’ for your gym workout, to beat your back and neck pain, to prevent injury and to feel greater movement efficiency, our physios can assess and teach you more about yours.

For Fernwood appointments, call on 8005 2379, or email broadway@fixprogram.com

For York Street appointments, call on 9264 0077, or email sydneycbd@fixprogram.com

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We are thrilled to announce a new clinic opening…just for women

On June 1st 2016, we will be opening a brand new clinic at Broadway Shopping Centre. We will be located within the beautiful Fernwood Fitness Women’s Gym.

Our passion for the wellness of women will shine on at this new clinic, bringing you all The Fix Program expertise and care that you have been used to at York Street. We will be there with:

• our physiotherapy services for you. Whether it’s your postural pain or sport-related niggle, with our expert physio’s treating you, we’ve got you covered.
• our specialised women’s health physiotherapists, managing pelvic floor and physical problems unique to women. Incontinence, pelvic pain, pregnancy related issues, prolapse, and pessary prescription are our forte.
• our pregnancy physiotherapy services for the best for you and your baby. Helping you through pregnancy with safe and appropriate pregnancy Pilates classes and physiotherapy for pregnancy related pelvic girdle pain, back pain and other aches at this special time.
• our post natal physiotherapy services with Mums&Bubs Pilates classes, post natal pelvic floor and abdominal separation checks and advice before safely returning to your pre-baby exercise routines.

And this is just the start.

Where are we?

Shop LG03 Broadway Shopping Centre, Corner Francis & Bay Street, Broadway. p: 8005 2379, and the best part…there is 2 hours FREE parking within the shopping centre!

What do I do next if I wish to make an appointment?

Contact us. You don’t need a doctor’s referral to see our physiotherapists. We’ll be happy to chat about your needs.

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What makes The Fix Program a wonderful clinic for women?

Since 1999 we have taught thousands of women and men how to strengthen their backs, hips, pelvic floors and abdominals through a mix of Pilates, Yoga and core stability exercises. And yet we offer so much more.

As physiotherapists and women ourselves, we are passionate about the wellness of all women. We are expert clinicians in the diagnosis and management of conditions unique to women at all stages of life.

The active woman.

From niggly backs and hip pain, sore knees and feet, computer necks and headaches, we treat muscle and joint pain to get you back to what you love doing most. Massage, joint re-alignment techniques, postural awareness and exercise prescription are a start to how we achieve this. Education, empowerment and getting to the cause of the injury is our goal.

Incontinence, pelvic pain and painful sex, endometriosis and bowel troubles can also trouble the active woman. Bladder leaks with coughing, laughing, exercising or running is not normal and can be treated. Pain in the pelvis or when having sex is not normal. You do not have put up with it. Our Women’s Health physiotherapists are qualified to help you get back your pelvic floor function.

The pregnant woman.

In pregnancy, we want the best for you and your baby. Pelvic girdle pain, rib pain, back pain and other associated pregnancy aches can all benefit from physiotherapy. Pelvic floor weakness, abdominal separation and safe exercise while pregnant are issues we can help you with. You do not have to stop exercising just because you are pregnant. In fact, the right exercise can help with controlling gestational diabetes, cardiovascular health of mum, control weight gain and protect the spine and pelvis from the big changes seen in pregnancy. A strong body can support your changing posture and prepare you for labour and when baby arrives.

The new mum.

So, now that you have your baby, your body may still not feel quite right. Ongoing back and pelvic pain, upper back pain and pelvic floor issues such as incontinence and sensitivity are very common. When am I safe to exercise and what can I do? How do I bring back my belly separation and pelvic floor strength? Do I have, or am I a prolapse risk? What effect has breastfeeding on my hormones and return to exercise?

New mums are a special bunch and need special care. We can internally assess the pelvic floor function for any weakness or prolapse, manage abdominal separation, pains and aches, and educate and get you back to exercise and feeling in control of your body.

Every Woman.

It is well known that physios can help with muscle and joint injuries, postural pain, alignment and exercise. It is not widely known however that specialised physiotherapists can manage pelvic floor problems. At The Fix Program, we do just this. We can help you if you have:

• Urinary incontinence or poor bladder control
• Bowel incontinence and constipation
• Over active bladder and urge incontinence
• Pregnancy and post-natal pelvic floor weakness, scarring or pain
• Vaginal prolapse (also known as pelvic organ prolapse)
• Painful sex and pelvic pain.

Pelvic floor problems are more common than you think, and it is our mission and passion to get the conversation started. To seek help and to gain back pelvic floor control is life changing and sometimes takes a little bravery. Caring, sensitive and thorough assessment and management for each woman is our focus. We understand that every woman is different.

What do I do next?

Contact us. You don’t need a doctor’s referral to see our physiotherapists. We’ll be happy to chat about your needs.

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Surviving the shoe mine field by Julian from Sydney Running Centre

The question I have been asked the most over the last 15 years in the running shoe game is “so what’s the best running shoe?” It’s always so difficult to come up with a short answer to this question but I’ll give it a shot……“there is no such thing!”

 Good running shoe manufacturers build their range of shoes based on 2 key areas:

• Different foot types (such as is the foot high arch, low arch, wide or narrow?)
• The type of running/training you are doing (is the shoe for road or long distant racing, short fast running, long slow running, walking and so on?)

This means that within the huge range of shoes you will see on shop walls or advertised online, some will suit you down to the ground and others will be completely wrong for you. You cannot choose running shoes based on colour alone! You need to combine information from the 2 key areas mentioned above to help find the right shoe but this can be difficult because how does one know “what’s what” when it comes to running shoes?

A lot of people will search online and read forums and reviews on running shoes. Whilst this can sometimes be helpful, there is a lot of misinformation online about shoes which will often point you in the wrong direction. It is also hard to decipher the information because every brand’s advertising is aimed at convincing consumers that their products are superior to all others.

To find the right shoe…

 At the Sydney Running centre we know which shoes will suit your feet. How do we do it? We will ask questions such as:

• What kind of exercise will you be doing?
• What shoes have worked or not worked for you in the past?
• Are you carrying any injuries or niggles as a result of your exercise?
• Do you wear orthotics?

We will then have a look at your feet and walking gait to identify the shape of your feet, whether or not you pronate (roll in through your arches), supinate (roll out through your mid-foot) or neither (neutral). With all this info combined we will then recommend some shoes that are in the right category for you -usually 2 or 3 pairs.

The next step is to try them on, lace them up properly and have a walk around – like any shoe they need to feel comfortable to you. A good way to describe the way a shoe should feel is “comfortably firm” this means that you have a feeling of support from the back of the heel through to where the laces end and then enough wiggle room in the toes. “The piggies need to wiggle!”

I’ve found the right pair, but how long will they last now?

Another common question I get asked is “how long should shoes last?” Yet again it’s quite difficult to answer this as people wear shoes out at different rates. The best guideline I can give is this:

• If you use your shoes 3 times a week or more for exercise that involves impact on hard surfaces you should replace them every 12 months with 18 months being the absolute cut off. A 12 month old pair of running shoes can still be completely intact and have no obvious signs of excessive wear but the likelihood is that the cushioning in the shoe has compressed to a point that it will no longer provide the necessary shock absorption.
• Some people say they know their shoes are finished because they all of a sudden “feel it” in their knees.
• Running or walking around in shoes that are worn out is just as detrimental as wearing shoes that are not right for your foot type so it pays to get the right shoes and replace them before they start causing damage.  

The Sydney Running Centre has been operating in the Edgecliff Centre for over 15 years. Father and Son team Phil and Julian have a wealth of knowledge when it comes to running, walking, shoes and feet.

If you have trouble finding comfortable shoes then pay a visit to the Sydney Running Centre and mention this article to receive a 10% discount off the retail price.

http://www.sydneyrunningcentre.com.au/

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When arthritis is rheumatic

 

Last month we talked about the more common osteoarthritis and how the disease presents and is best managed. Osteoarthritis (OA) and rheumatoid arthritis (RA) are very different diseasesand are therefore managed quite differently. They are often confused when speaking about sore joints in the patient and general populations.

The cause of RA is not yet fully understood, although doctors do know that an abnormal response of the immune system plays a leading role in the inflammation and joint damage that occurs – the reasons are not known, but can involve genetics, hormones and the environment. Recent research has shown that people with a specific genetic marker called the HLA have a fivefold greater chance of developing rheumatoid arthritis than do people without the marker and this gene controls the immune response in the body.

Researchers continue to investigate other factors that may play a role, including infectious agents such as bacteria or viruses, female hormones (70 percent of people with RA are women), obesity or in response to stressful events.

The 5 features of rheumatoid arthritis

• RA is an auto-immune disease. This kind of condition causes the body’s immune system to attack itself. Normally, your immune system makes antibodies that attack bacteria and viruses, helping protect your body against infection. If you have RA, your immune system sends antibodies to the lining of your joints, where instead of attacking harmful bacteria, they attack the tissue surrounding the joint.

• Doctors and medical research haven’t really found a cause for RA. There has been a link to people who smoke or have a family history of this disease. It is not yet known what triggers the initial attack. Some theories suggest that an infection or a virus may trigger RA, but none of these theories has been proven.

• RA usually affects the smaller joints, such as those in the hands, feet, neck and wrists. Larger joints such as the hips and knees can also be affected.

• RA is three times more common in women than in men. This may be due to the effects of oestrogen (a female hormone). Research has suggested that oestrogen may be involved in the development and progression of the condition. However, this has not been conclusively proven. Children can also suffer from RA, called Juvenile Arthritis (JA).

• RA is characterised by periods of the disease being either dormant or in a time of ‘flare up’. With the joint lining being attacked and all inflamed at these flare up times, there is the presence of hot and swollen joints which are intensely painful to touch and to move. Pain is worst in the morning and can take hours to ease. It actually gets worse with rest and feels better with gentle movement or as the day progresses. RA can also affect the tear ducts, salivary glands the lining of the heart and the lungs, all being very red and sore.

Diagnosing and managing rheumatoid arthritis

In its early stages, RA may resemble other forms of inflammatory arthritis. No single test can confirm RA. To make a proper diagnosis, the rheumatologist will ask questions about personal and family medical history, perform a physical exam and order diagnostic tests. The doctor will examine each joint, looking for tenderness, swelling, warmth and painful or limited movement. The number and pattern of joints affected can also indicate RA, as this type of arthritis tends to affect joints on both sides of the body. This is unlike OA which tends to affect a joint here or there with no particular pattern.

Blood tests are critical to diagnosing RA as inflammation levels and other bio ‘markers’ can be found in bloods which can be used in addition to the other clinical findings to properly conclude that the arthritis is RA. These include rheumatoid factor (RF) or another anti-body (anti-CPP) which have been found in up to 80% and 70% of those with RA respectively.

Finally, investigations such as Xray, MRI or ultrasounds can assist with diagnosis that can show joint erosion, and narrowing or deformity of the affected joints. These scans are not independently conclusive as there can be the presence of RA in some persons without yet any changes to the joints that would show up on scanning.

Unlike OA, the treatment of RA relies heavily on aggressive drug therapy to stop the inflammatory process to put the disease into an ‘inactive’ or ‘remission’ state. The goals of rheumatoid arthritis (RA) treatment are to:

• Stop inflammation (put disease in remission) as early as possible
• Relieve symptoms
• Prevent joint and organ damage
• Improve physical function and overall well-being
• Reduce long-term complications.

Drug therapy initially includes anti-inflammatory for symptomatic relief and slowing of the inflammatory process, steroids and disease-modifying anti-rheumatic drugs, some which are also used to treat some cancers.

Non-pharmacological therapies involve a mix of rest in the highly inflamed periods and gentle exercise, stretches and strengthening to support the affected joints in periods when the disease is less active ad pain levels are lower. This is where your friendly physiotherapist would work with the patient, the rheumatologist, the current phase of the disease (active or in remission) to prescribe a specific exercise program. As with OA, the guidelines for exercise for RA are very similar, however with the RA patient, pain, inflammation and flare-ups are a primary concern. The guidelines are:

• There need to be the right balance between exercise and rest. Too much of the wrong exercise can load up the affected joints more and cause increases in pain, inflammation and long term joint damage. Too much rest and no exercise makes the joints also stiffen and the muscles around to weaken.
• All joints in the human body require synovial fluid and lubrication to stay mobile. This fluid will be secreted by the cells in your joint with the response to movement. So, move it, or lose it (as they say)!
• Too much heavy weight bearing exercise such as jogging, jumping, lifting can over load already painful eroded joints. Preventing repetitive joint loading tasks where possible, including kneeling, squatting or heavy lifting
• Muscular support and strength about the OA joints will make will offer support and shock absorption that would otherwise be transmitted into the painful joint. Good muscle condition is paramount. Pilates could really be a winner here!

Preventing arthritis

Rheumatoid arthritis cannot be prevented as it is an unlucky person who is afflicted with this auto-immune disease. If your joints are painful and there are many afflicted at the same time, referral to a rheumatologist specialised in RA would be recommended.

If you are worried about any joint pain you are having, speak to one of our physiotherapists at The Fix Program.

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Nutritionist Fumi discusses Irritable Bowel Syndrome (IBS) and the role of diet

 

What is IBS?

IBS stands for Irritable Bowel Syndrome. It is a condition of the digestive system, affecting one in seven Australian adults. IBS is characterised by a variety of uncomfortable symptoms including:

1. Abdominal pain
2. Wind (excess)
3. Constipation and/or diarrhoea
4. Bloating

What causes IBS?

The cause of IBS is yet unknown, but certain triggers have been identified and these include:

1. Food intolerance
2. Poor diet
3. Stress
4. Medication
5. Infection

How do I get diagnosed?

The symptoms of IBS are very similar to other gastrointestinal disorders, such as diverticulitis, inflammatory bowel disease, polyps, Coeliac disease, infection, and certain cancers. Therefore it is vital that you get a proper medical check if you suspect IBS in order to rule out the other possible causes.

A cure for IBS is yet to be developed, so the current primary treatment is to identify and avoid individual triggers. If you suspect dietary triggers, then trialling a low FODMAP diet has shown to significantly improve the unpleasant symptoms of IBS.

What is the Low FODMAP Diet?

FODMAPs are complex sugar/starches found in a variety of foods we eat. It stands for Fermentable Oligosaccharides Disaccharides Monosaccharides And Polyols. These FODMAPs are poorly absorbed in ALL people, however, those with IBS are thought to experience debilitating symptoms due the gut being hypersensitive compared to those without IBS.

The Low FODMAP Diet is the first phase of an investigation strategy. It should be followed for only 2-8 weeks. Subsequent challenges and re-introduction of individual FODMAPs are necessary in order to identify specific individual triggers and tolerance levels.

FODMAPs are in fact vital for health and wellbeing as they feed the good bacteria in the gut and contribute to bowel health. That’s why it’s vital for individuals to find the optimum balance for their FODMAP tolerance instead of sticking to a low FODMA diet life-long. Think of it like an ankle sprain: you give the ankle a few days of rest, then you slowly introduce rehab exercises to strengthen that ankle. That’s what we want to do with dietary management of IBS. You “rest” on the low FODMAP diet, then “rehab” as you proceed through challenges and liberalisation, so that you “strengthen” your tolerance to its optimal level.

Our Philosophy

Eat better, Get better, and Live better.

Food truly affects your everyday life. Your energy, mood, and performance… they are all affected by what you eat everyday. In today’s society where eating has somehow become the point of judgement and debate, it’s no surprise that people are so confused on what, when and how to eat.  

At Key Nutrition Solutions we like to keep things simple. We understand that each and every one of us has a unique body, lifestyle and nutrition requirements. We’re all different so of course each of us needs a unique plan. Key Nutrition Solutions respects your personal beliefs, lifestyle and life priorities, and we are committed to providing you the best food approach to health.

Our Dietitian

A dietitian. A home-cook. An adventurous foodie and an experienced ballet teacher. That’s Fumi, the directing dietitian at Key Nutrition Solutions. With her knowledge, profession and life-long involvement in food and dance, Fumi will provide you with the latest knowledge, scientifically proven strategies and practical advice to improve your performance, life, and wellbeing.

Fumi has suffered food allergies and intolerance herself, so she understands the pain and challenges you face when it comes to dealing with such “food problems”. She is passionate about helping others that suffer the same, and is always updating her knowledge and practice in this complex area of food and body interaction, so you are assured you get all the professional support you need.

http://www.keynutritionsolutions.com.au/

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