Osteoarthritis is commonly considered a normal part of the aging process due to several reasons. Why? And why are some of us more prone to this process?

• Firstly, the prevalence of osteoarthritis increases with age. As we grow older, the wear and tear on our joints accumulate over time, leading to the degeneration of the cartilage that cushions the joints. This gradual breakdown is a natural consequence of the stresses and strains our bodies experience throughout a lifetime of movement. Put simply, the thinning and wearing of the cartilage is a sign of a well used joint, and not much else. (Like my big toe joint from flexing to it get to the ground to correct my Pilates students!)

• Secondly, the molecular and cellular mechanisms involved in osteoarthritis development align with the aging process. The ability of cartilage to repair itself diminishes with age, as the production of new cartilage cells slows down, and the existing cells become less efficient at maintaining the structural integrity of the joint.

• Other factors such as genetics, obesity, joint injuries, and certain occupations can contribute to the development of osteoarthritis. These factors tend to accumulate over time, making the likelihood of osteoarthritis higher as individuals age.

If osteoarthritis is a normal part of aging, why are we all affected differently?

While osteoarthritis is considered a normal part of aging, it does not mean that everyone will experience it or that its impact cannot be managed. It comes down to our lifestyles and our genes. Lifestyle modifications, exercise, weight management, and appropriate medical interventions can help alleviate symptoms and slow down the progression of the disease.

Did you know, that according to Sports Medicine Australia* (SMA), up to 70% of all runners sustain some kind of running ‘niggle’ over any 12 month period of time? Not surprisingly, most occur in the lower body. 

• 42% are to the knee
• 17% to the foot and ankle
• 13% to the lower leg, such as the calf and shin
• 11% to the hip and pelvis.

Typically, these injuries occur due to training errors, such as increasing the load, the frequency, or the speed too quickly. In addition,  an inappropriate or lack of any cross training for strength and conditioning means our bodies start to break down due to the repetitive nature of the running action. This brings about tissue overuse injuries, and if you’re a runner, I bet you have been there, just like me with my Achilles tendinopathy!

The most common overuse injury noted in runners, is ‘runner’s knee’ - also called patello-femoral pain (PFP). This is pain felt anywhere over or around the knee cap or patella. Iliotibial band friction ( pain and ache at the outer knee), plantar fasciitis (like standing on glass under the heel), tibial stress syndrome ( feels like shin stress fractures, but is not) and Achilles tendon issues also force many runners to the sidelines. 

But..these niggles should never be the end of a running career for those who love getting out there on the roads, parks and trails. 

Physios who run (like me!) are excellent at being your ‘body coach.’ For all injuries, there is a means to keep you exercising with reduced loads. This allows for any inflamed tissues to settle, but to also become stronger and adapt throughout the healing process to prevent re-injury once you return to your beloved running. What’s involved?

• Start by assessing the whole person. Injuries and overuse in the knee and lower leg can often stem from the trunk, the pelvis or the hip.There is much evidence out there^ highlighting the important role of hip awareness and strengthening in the prevention of ongoing runner’s knee issues. 

• Use all treatment options to help settle the inflamed body part. Massage and other soft tissue techniques, alignment techniques, sports taping, dry needling to name a few.

• Establish a graduated training program as soon as possible. This can happen even in the first weeks of an injury. This may initially involve cross training, cycling or swimming, with a gradual re-introduction of walk/run intervals after healing is well underway ( think 4 weeks). 

• Tissue loading and strength adaptation is essential. How can we make your tissues stronger and better equipped to deal with your running loads? After all,why did you injure in the first place? This rehab is the best part! Plyometrics and running specific dynamic loading, added to proximal hip strengthening will get you back and with decreased risk of re-occurence.

 Catch any running niggle early. As a runner, you know when things don’t feel quite right. Book in to see Katrina at The Fix Program.

References:

*https://sma.org.au/resources-advice/running/

^Thomson C, Krouwel O, Kuisma R, Hebron C. The outcome of hip excercises in patellofemoralpain: a systemic review(2016)

‘Shin splints’ pain is a common cry from many a runner, from your novice to your elite. It is not so much a diagnosis, but rather a general term or the region of the pain. Causes can vary across all tissues in the lower leg - the muscles ( medial aspect), the bone (tibia), the blood vessels (compartment syndrome) or nerves.

• Muscular causes.

This is the most common and is often due to the ‘too much, too soon’ effect of training, or an imbalance caused by weakness and tightness of the lower leg. The tibialis posterior muscle running down the length and attaching to the back of your shin/tibia can become inflamed due to over loading, causing a pulling on the bone. The tibial bone can feel bruised, and the muscle will feel sorest typically at the lower half of your shin. This pain, initially sore when you begin a run, will usually get better with distance. 

What’s really going on? Poor biomechanics is the culprit here, whether it be from your foot over-pronation, ankle and calf stiffness, to unsupportive footwear, or an internal torsion of your upper leg due to hip imbalanced weakness. The right targeted and individualised progfam of strength and mobility to correct ans control these forces will get you back on track.

• Bony causes.

Bone bruising and stress fractures scare the daylights out of most runners. This occurs when the level of stress being placed through them is greater than the rate at which the bone cells adapt and strengthen. An area of bone weakness can occur and become microscopic cracks if training were to continue. This pain is exquisite and very focal. A stretch of 1-2cm of the tibia or shin would be extremely tender. This pain gets worse with activity and can even ache at rest and through the night.  

Whats’ really going on? As with the muscular issues, biomechanics and over training increase the risk of stress fractures. Ignoring the warning signs such as tender bone, aches at night can lead to a stress fracture. Running surfaces such as running on concrete, running on a camber, or running around a track can also over load the tibia. Unfortunately, up to 12 weeks rest from running, a strength and mobility program to target imbalances and a graduated return via the Nordic anti-g trainer will see a runner put in the hard yards to get back.

• Nerve and vascular causes.

Irritated and compressed nerves and blood engorgement issues i the calf and lower leg can also cause shin pain. These should be excluded if the presentation is not typical for the more common muscular and bone causes. Further testing, investigations and scans are often warranted here, and your amazing physio would be able to advise you if they feel this is necessary after assessing you.   

With any of your running niggles, whether it be your back, pelvis, hip, knee or lower leg, insist your physio assesses you thoroughly. A holistic assessment of your posture, strength, running biomechanics and training plans will help you to get back to what you love and with reduced risk of re-injury.

✅When it comes to everyday posture, try not to work too intensely in the level of activity of your postural, trunk and core muscles.
Postural muscles such as the deep abdominal corset, the diaphragm or the spinal muscles need to work all day for you, and they are therefore only needed at low levels of intensity. Think endurance, and not the sprint!

“Floating” up in your posture conjures a graceful and effortless energy.

✅Float up through your waists.

✅Float and imagine space in between each of your 12 ribs.

✅Float through the back of your neck to the base of your skull.

Don’t you love it?

Build postural strength to float effortlessly and without fatigue with our Pilates classes in our Sydney clinic, or at home online when you like, where you like, anytime.

#posturalawareness #posture #goodposture #pelvis #trunk #neckpain #backpain #sittingposture #standingposture #physiotherapy #thefixprogramonline #thefixprogramsydney

There are many considerations before lacing up the shoes and heading out for your first runs. These include:

👉your birth outcomes

👉your leg and hip strength

👉your pelvic floor health, strength and endurance

👉your hormones ( are you still breastfeeding?)

👉your support of your pelvis and spine (integrity of your inner core strength)

👉your pre-natal and pregnancy exercise levels

👉your body and fitness type.

Moore et al (2021) published a study with tests as guidelines for strength required for running. Here are the tests for running specific tasks. You can try them at home if you think you’re near to these measures. Can you achieve these without pain, bladder leakage, pelvic floor heaviness or abdominal dragging?

✅can you walk for 30 minutes?

✅can you stand balanced on one leg for 10 seconds or more?

✅can you jog on the spot for 60 seconds or more?

✅can you bound or skip for 10 metres?

✅can you hop on the spot 10 times or more?

These tests are no means exhaustive. There are many other tests assessing strength, balance, running specific and pelvic floor muscles control.

Find a physiotherapist who can assess and help you return to any sport after have your baby. She will be the expert in safe and timely guidance back to what you love doing - no recipes, completely individualised just for you! The Fix Program’s Mums&Bubs classes and post natal physio are the perfect lead into your running return after pregnancy and birth!

#runningmums #returntorunning #postnatalexercise #postnatalrunning #postnatalpelvicfloor

👉 What is a tendon?

Tendons are rope like, extremely strong structures connecting your muscles to the bone. They are made of strong lines of collagen, all sitting in parallel, making the strength of these extremely tough. They are everywhere, like the rotator cuff tendons at the back of the shoulder, the biceps tendon at the shoulder joint, the patella tendon at the knee cap, the hamstring tendon to your sit bone or behind the knee or the Achilles tendon to your heel.

With the work they have to do, injury is common (yep, like me with my Achilles, running and being a little older - but that’s another whole post on menopause and tendon health). Too much load, too fast a build in a new activity, poor biomechanics, a weak muscle, hormones. All of these things can create a weakness, poor collagen regeneration or recovery and over time, tendonitis or tendinopathy in any tendon of the body.

👉 What’s the difference between tendonitis and tendinopathy?

Tendonitis is an inflammation of the tendon. Tendinopathy is the degeneration of the collagen making up the tendon (and will always have a component of tendonitis going on also in the background).

Both are treated similarly, with very slow and graduated strengthening and pain management strategies alongside such as ice, massage, biomechanics improvement and training changes to incoorporate more time for regenerating collagen. Physiotherapists are highly trained in the latest evidence based research in the managing of tendon injuries and rehabilitation. 

This is often an extremely slow road! Pace it! Don’t race it!

#tendoninjury #tendons #achillestendon #hamstringtendon #patellatendon #supraspinatustendon #tendonitis #tendinopathy #physiotherapy #physio #paceitdontraceit #thefixprogram #thefixprogramsydney #thefixprogramonline

Knee pain affects 1 in 5 people in Australia, with the incidence increasing steadily with age. Osteoarthritis and overuse of the structures around the joint account for a huge slab of these.

But what about knee pain with running? Is it really true that running is bad for your knees?

OK, granted the load through your knees is greater with running than with walking, but how do other activities stack up? Here are the approximate forces that pass through the knee for each activity. This is according to 2 studies  - Lenhart et al. (2014) and Sanchis-Alfonso et al. (2016)

• Walking on level ground - 0.5 x body weight
• Cycling on level ground  - 1.5 x body weight
• Stairs, both up or down - 3-4 x body weight
• Running  - 4-8 x body weight
• Squatting unloaded  - 7-8 x body weight
• Jumping - 20 x body weight

I really believe that running gets a bad rap for the reason knees become sore, or why, for some, running is never given a good chance. Like any tissue in our body, our knees can adapt to the loads and stresses we put on them. How do we do this? With:

• exercise and indiviualised programs to correct, control and restore pelvic, hip and lower leg imbalances and bio-mechanics
• graduated programs of running, practicing the ‘pace it, don’t race it’ method
• cross training and running specific strengthening, where loads are controlled but delivered to the knee to adapt and become more resilient to the loads we ask of them when jogging.  

There is no one perfect recipe for exercise when it comes to knees and running. We are all different and  the way we move is so varied. Thorough assessment, holistically looking at each moving part, running analysis and breakdown, training program adaptations are all crucial in getting knees happy to play their part with running. This, thrown in with a persistent and motivated runner-to-be, can become the runner without the dodgy knees.  

If you really desire to lace up the shoes and start jogging, get your knees to a good running physio!

If you are a new Mum and are super keen to lace up the joggers and head for a jog, take the time to ask whether your body is truly ready. You may be 6 weeks after labour, your OB may have given you the green light, but what about your leg strength, your pelvic floor health and your fitness? Are you really ready to go running?

There are many considerations before lacing up the shoes and heading out for your first runs. These include:

👉 your birth outcomes

👉 your leg and hip strength

👉 your pelvic floor health, strength and endurance

👉 your hormones ( are you still breastfeeding?)

👉 your support of your pelvis and spine (integrity of your inner core strength)

👉 your pre-natal and pregnancy exercise types and levels

👉 your body type.

Moore et al (2021) published a study with tests as guidelines for strength required for running. Here are the tests for your pelvic floor recovery and strength after pregnancy and birth. You can try them at home if you think you’re near to these measures.

✅can you achieve 10 quick on/off ( or lift up/drop down) contractions?

✅can you hold 10 maximum pelvic floor contractions for 6 seconds, each all being equal?

✅can you hold a gentle contraction for a full minute, continuing your breath? ( 30% contraction effort)

These tests are no means exhaustive. There are many other tests assessing strength, balance, running specific and pelvic floor muscle control.

See our other recent posts for more running preparation advice for new Mums.

#runningmums #returntorunning #postnatalexercise #postnatalrunning #postnatalpelvicfloor

✅“Widen gently across the collar bones!” If you’ve heard this at your posture or Pilates classes, this anatomical picture may help you in visualising why you are being asked to do just that.

✅ Notice how the collarbones here stretching from your breastbone to your shoulder tip. By focusing on lengthening across her, you will help to place your shoulders and shoulder blades in a better alignment and posture.

✅ This cue also allows for you to gently build endurance to work against the effects of gravity and the slumped shoulder postures. This is done by the subtle yet ongoing work of your upper back and shoulder blade muscles.

✅ This means happy days for your trunk posture, your shoulders, your neck and upper back!

If you feel you are too stiff and tight across your chest or upper back to achieve this, see a physiotherapist. Pilates classes and posture-based exercise will help you achieve the endurance and strength required to maintain these postures right throughout your day.  

 #mindfulposture #thecollarbones #pilates #clinicalpilates #thefixprogram #thefixprogramonline #physiotherapy #physio

Returning to running as a new Mum cannot be rushed.

There are many considerations before lacing up the shoes and heading out for your first runs. These include:

👉your birth outcomes

👉your leg and hip strength

👉your pelvic floor health, strength and endurance

👉your hormones (are you still breastfeeding?)

👉your support of your pelvis and spine (integrity of your inner core strength).

Moore et al (2021) published a study with tests as basic guidelines for leg strength as required for running. Here are the tests for hips and leg strength. You can try them at home if you think you’re near to these measures and to see if you are run ready as far as your strength goes:

✅can you achieve 20 single leg pelvic bridges?

✅can you achieve 20 single leg sit to stands?

✅can you achieve 20 single leg calf raises?

✅can you achieve 20 side lying leg lifts?

These tests are no means exhaustive. There are many other tests and considerations with your balance, running specific and pelvic floor muscle control. Moore et al (2021) also list these.

Check out our other posts abut the other aspects needed to start your jogging journey after pregnancy. And for further targeted and individualised advice and planning, our physios are here for you and your exact return to running.

#runningmums #returntorunning #postnatalexercise #postnatalrunning #postnatalpelvicfloor