For the boys…Do I even have a pelvic floor?

I was recently referred to this magazine article in an American digital mag. Pelvic floor dysfunction is often thought of as a ‘woman’s thing’, but as this article explains, men can suffer from the range pelvic floor troubles too, from incontinence to pain in the testes and deep pelvis to poor sexual function. Again and as with the women, these are not normal and warrant further investigation. There are even a handful of male physiotherapists specialising in men’s pelvic floor dysfunction in Sydney who are out there to help. Check out Stuart Baptist in the CBD.

http://www.voxxi.com/pelvic-floor-dysfunction/

Further Reading for ‘discovering’ Your Pelvic Floor

On the topic of all things women (sorry boys), I’ve found you a great website and book worth checking out from Queensland women’s health physiotherapist, Mary O’Dwyer. Her experience managing all things women and pelvic floor make for a fun, yet sensitive approach to managing and treating pelvic floor problems such as stress or urge incontinence and pelvic girdle pain.

I found the book easy to read. Following her ‘exercises’ and ‘explorations’ were, I’d admit, a little confronting, yet very useful and insightful.

Subscribe to her newsletters or facebook for weekly reads. Share it with your girlfriends.

http://www.holditsister.com

‘Hold it Mama: The Pelvic Floor and Core Handbook for Pregnancy Birth and Beyond’ by Mary O’Dwyer (2011)

ABC’s Tonic Program – Exercise and Neurological Disease

There is recent evidence out there that only 150 minutes of exercise per week of cardio vascular exercise can halt the decline in cognitive ability as is seen in Alzheimer’s disease, Parkinson’s disease and dementia. This exercise only needs to be aimed at an intensity level of a brisk walk or higher. There are several factors that could explain this finding, from increased oxygenated blood levels to the brain as a effect of exercise or changes in enzyme levels in the brain that are known to cause dementia. Watch the first story in this episode of Tonic to learn more.

http://www.abc.net.au/news/2012-11-14/tonic-series-5-episode-1/4367170

Get your sciatic nerve moving

As you may be aware, nerves and associated neural tissues need to be mobile, just as muscles and joints do. We know that nerves that slide and glide well in the body are also well nourished nerves with great blood supply. This means happier, less sensitive nerves. And this often means reduced hyper-activity of the electrical impulses that fire along the nerves to your brain, contributing to the pain response decided by your brain centres.

So, let’s get sliding!

The Starting Position:

The focus:

• Sit on your mat or floor with your legs out straight in front of you. If you have tight hamstrings, let your knees bend a little so that you are comfortable.

• Place your arms around your thighs as if to give your legs a little hug. This will bend and roll your spine forward into flexion.

• You may feel a stretch here in either the legs or spine-don’t worry, this is very normal.

• Keep your breathing deep, relaxed and consistent**.** Picture your nerves sliding up and the down the back of your leg and back with these movements in each direction.

• Really focus on the movement occurring only at your ankles and neck as you keep the rest of your body nice and still and in that flexed forward posture. Don’t forget to relax your shoulders too.

The Movement:

• To slide the sciatic nerve up and down in the leg, start by putting your chin slowly down onto your chest. Do you feel a stretch here, perhaps in your neck, mid back or legs?
• This is the little pull on your nerve structures.
• Now keeping your legs as straight as you can and spine rolled forward in that hug position, slowly lift your chin off your chest and pull your feet back as far as you can from the ankles.
• This should bring on a stretch down the backs of your legs. Do you feel this?
• This is the sciatic nerve stretching. Repeat this sequence up to 10 times slowly. Imagine you are ‘kicking your head off.’

Tip:

Try adding this to your leg stretches – those buttocks, hips and hamstrings. It’s a perfect way to end your stretch session and keep your nerves smiling.

Set your goals and don’t be afraid to go after them!

I am often asked “how do I get fitter?” or “how can I ever get to carrying the shopping without my neck pain?” or “how can I learn to sit longer at my computer comfortably?” The consistent answer I give to all of these questions is “pacing”.

Pacing is defined in the Oxford Dictionary as ‘to do something at a slow and steady rate in order to avoid overexertion.’

You can use this technique to achieve your goals. Most people –including yours truly- find that they are in limbo with often no clear goals. Or even if they do have clear goals, no way in which to tackle them head on. Fitness goals, strength goals, activity goals, running or swimming time goals. So before we start using this pacing technique, we have to really think about what our goals are. I’m included here.

Ok, let’s take the goal of improving your fitness without worsening your pain. Pacing, as defined above, means the art of doing a bit more -but not a lot more- every day so you gradually build up strength and stamina and get fit. People say that the mantra “pace it, don’t race it” is a good way of remembering the tip.

Before we discuss the best pacing strategy let’s look at 2 common relationships people have with exercise and activity when they are in pain. The first is ‘the slow decline’. This is the person who quite naturally stops an activity or exercise when the pain starts. They wait till later and have another go. However with time the pain starts with less and less activity.

The second is ‘the boom or bust’ pattern. This is the person who tries to get a whole task done, push through, ignore the pain and keep going despite the pain. After this, they can’t do anything. They might need rest for days before having another go. Improvement in fitness, strength or tolerance is minimal.

So here’s a guide on how to get your pacing diaries established and your journey to greater activity and fitness started.

Step One: Write down your personal exercise and activity goals.

Everyone’s goals will be very different. But think about what you would like to be able to do more of. Perhaps it is to sit for 1 hour so coffee with the girls doesn’t hurt your neck? Or perhaps it is to walk up the long flight of stairs without stopping at Martin Place train station? Or to walk 5 kilometres, 3 times per week? Or to run the City to Surf without stopping? Or perhaps to beat your 10 kilometre run time by 2 minutes?

Try to have 1 or 2 goals going at a time and remember that the goal posts need to keep moving. You will eventually achieve these goals because after reading this, you will know how to get started and to safely attain them.

Step Two: Find your safe baseline on which to build.

Your correct baseline is all about finding the amount of your goal-related activity that you can do safely and without falling in a heap. Like your goals, baselines will be different for everyone. It’s personal. But as an example, you might say that you can walk for 30 minutes and definitely won’t have a flare up of your sore hip or back, and won’t take a week to recover. You remember that last week, you were absolutely shot after your hour long walk on the weekend. In this example, your safe walking baseline is 30 minutes.

Using the walking the stairs at Martin Place example, you know from your stairs at home that you are puffed and need to pause after 20 steps. You feel dizzy and very puffed out after the whole flight of 25. 15 is easily and consistently manageable. I would suggest a baseline here of 17 or 18 steps.

Step Three: The only way is up!

Now you need to plan your progression (in advance). Using time as a guide, choose small increments to increase your baseline. For example, you could choose to walk for an extra 5 minutes each week from your 30 minute baseline, or try to walk up an extra 2 steps without stopping each week.

When you complete the set amount of activity and are feeling good, don’t be tempted to push on beyond your planned progressions. Stick to the plan and be patient. Knowing that you will only be doing a small, ‘safe’ extra amount each time will decrease the threat level for your brain. This makes it less likely that your brain will become over protective and try and use pain to stop you from moving or working towards those goals.

As a general guideline, do not increase your progressions by more than 20% of the last level achieved. This way you will remain ‘safe’ and yet slowly trek upwards to your goal.

Step Four: Always keep going and reward yourself.

Remember, we all have our ‘bad days’ where things may hurt a little, or you feel unusually tired. If you do have a little flare up at any stage during your planned progressions, don’t freak out. It’s good to know that your brain is looking out for you! Your brain is doing its best to protect you and this pain does not mean that you’ve caused any damage. It’s ok to rest for a day. Now go back one step to what you know you did before with no troubles and resume your pacing program. Try not to stop altogether. You’ve probably gone so far and to start again at the beginning would be more than a little frustrating and upsetting.

And don’t forget to acknowledge your achievements with a reward. An imaginary pat on the back, a few quiet encouraging words to yourself, an ice cream, that favourite magazine or new dress! Take time to reflect on your goal attainment and reset those new ones.

Physiotherapist, Lorimer Moseley talks pain.

Research over the past decade has shown that in the management of chronic pain, education and knowledge about pain provides best long term outcomes, particularly if coupled with an exercise based program for these individuals.

Lorimer Moseley, a most wonderful physiotherapist, trained at Sydney Uni and left the world of manual therapy very early on in his career to find answers to his highly inquisitive side. He has since pursued a career in research, writing and speaking about the brain and specifically, its very important role in pain. He holds a PhD and is now the Professor or Clinical Neurosciences at the University of South Australia in Adelaide.

Spend the 24 minutes watching this youtube clip of him recently speaking in Sydney. You will not be disappointed and it may even change the way you look at pain forever. Knowledge is a powerful thing.

http://www.youtube.com/watch?v=RYoGXv22G3k

If you’d like to explore this topic more, he is the co-author of the book ‘Explain Pain’(2003), written with David Butler (another brilliant physiotherapist), and has written his own book named ‘Painful Yarns’(2007). You can also visit www.noigroup.com for all things pain.

This will really get those buttocks going!

This is a fantastic exercise as it is performed in standing which is when we need both the muscles around the knee and buttock working to give us stability. Even more important if you spend a lot of time power walking or running.

The starting position:

Stand next to the wall with your right shoulder at the wall. Place the stability Chi ball between your right knee and the wall. Stand on your left leg so that your foot is straight, your left knee is in line with your 2nd/3rd toe and your hip. Find your neutral pelvis by tilting the pelvis backwards and forwards and resting in the middle position. Think tall with the spine and neck. Use your right hand on the wall for support to help keep your trunk straight.

The movement:

Standing on the left leg, squash the Chi ball with your right knee. The control to counteract the pressure pushing you away from the wall is provided by your left buttock muscles. This primarily is your gluteus medius muscle, very deep and in the upper portion of your buttock. Hold your pelvis still as you perform a ¼ squat on your left leg and return to standing. During the squat maintain the knee in line with the 2nd/3rd toe. Repeat 8 times then swap sides.

Your focus:

Try to maintain your pelvis in a neutral position and keep it level across the hips. Also keep tall and try to avoid allowing your trunk to fall to the side. Keep your waists long and even! If you are maintaining this, your trunk postural muscles and core muscles will be really working in addition to challenging those thighs and buttocks.

Remember that strong legs and buttocks support your trunk!

Katrina

Be Pro- active and prevent injury.

Image: Physicalliving.com from article: “Building Blocks of Becoming a Strong Resilient Runner”. Click here for article. 

Melanie’s Tips for runners and walkers to lower your injury risk

Over the years of my clinical experience as a physiotherapist I have seen many running injuries and have come up with “maintenance exercises” to try and reduce the number of running injuries. The same can be applied to walking.

Exercise is very beneficial in many ways and disrupting the routine with an injury doesn’t help.

So, prevention is always best. Follow these 5 easy exercises regularly up to 3 times per week to maintain your body for walking and running.

Calf stretch.

The muscles that take a battering during walking and running are absolutely your calves! Try this stretch by standing on the ball of your foot on the edge of a step with your heel hanging off the back of the step. Slowly lower your heels while holding onto the railing and hold here for 1 minute. Repeat with your knee bent to stretch the smaller deeper calf muscles. This can be done on both legs at the same time or one at a time. Remember to align your knee over your second toe as you stretch.

Calf Massage.

Nerve (neural) structures within muscle can also become tight and may not release with a stretch. Sitting on the floor with your leg bent out on front of you. Using cream on your thumbs push both thumbs into the middle of the upper calf and run them down in a straight line towards the ankle. Use as much pressure as you can tolerate. Try 15 times. I would not advise to do this one immediately prior to running. Repeat on the other leg.

ITB releasing.

The ilio-tibial band (ITB) is quite difficult to stretch. It is a muscle that runs from the outside pelvis to your outer knee, crossing the hip. It is typically tight in those that walk and run a lot. As it is difficult to find a position for stretching, I recommend releasing the fibres instead.

There are 2 ways of doing this. Firstly, massage. Sitting on your bed, using your knuckles and cream, press into the side of the thigh and run your knuckles down towards the outside of your knee. Use as much pressure as you can tolerate and try this for 30 seconds then repeat on the other side. This one is quite easy to do after the shower. Secondly, you could use a foam roller. These are easy and fantastic. Lie on top of the foam roller on your right side with the side of your right thigh resting on the roller at your hip. Bend your left knee and place it in front of the right leg for stability. Keeping your right leg straight and using your hand for support roll yourself along the foam roller until it is at your right knee. Then roll back up to the thigh. Repeat for 30 seconds and try on the left side.

The gluteus medius muscle of the buttock is extremely important for control of your sideways hip and pelvic movement each time you bear weight on your leg. It is also an integral in controlling your thigh stability for good knee mechanics below. Try the Clam exercise or single leg squatting to strength and build control here.

The clam.

Lying on your left side with your knees bent, feet in line with your bottom and shoulder. Find your neutral pelvis and make sure the hips are stacked on top of each other. Lift your top knee while keeping your feet together without rolling the hips backwards. Think about the leg being heavy and lifting it with only the bottom. Aim for 2 sets of 8 and repeat on the right side.

For a harder more functional exercise, try the single leg squat which is our exercise of the week outlined below.

Core strength.

Last but not least, activating your ‘core’ -the diaphragm, pelvic floor, transversus abdonminus (TA) and multifidis muscles - are key to maintain stability of your pelvis and spine as you shift your weight from side to side and twist the trunk with running and walking.

To assist in you picturing this ‘core’ system imagine the following: your pelvic floor muscles are shaped like a hammock running from your pubic bone to your tail bone right between the legs. Your TA acts like a corset from the front of the abdomen and wraps around deep in the waists towards the spine. These deep abdominal fibres interlink with your deep spinal multifidis muscle, stabilising one spinal vertebra on the adjacent.

Try this simple exercise to increase your awareness of these muscles working together. Lie on your back with your knees bent in a neutral pelvic position. Take a breath in and as you exhale lift through your pelvic floor muscle and deepen the navel towards the spine. Relax as you take a breath in and repeat this activation each exhale. Make sure your buttock muscles are relaxed and you stay in a neutral pelvis position.

Your exposure to our exercises at The Fix Program aims to challenge these ‘core’ muscles in many varying positions – standing, squatting, when using your arms, or on the mats. Your job now is to be that little more aware of them when out for your walking or jogging session.

Take the time to be a little more pro-active and prevent injury and pain. Have fun!

Mel

In part 1 of our opinion on barefoot running we took a look at the scientific and anecdotal evidence that is floating about on both minimalist and shod running. As you may have read, there is no real conclusive evidence on what works best for your body.

This edition we will explore the implications of the research on your running - if you are a runner. But I would say the same could be said if you are a walker too.

So, here are my personal feelings on the topic. I am married to an avid runner, so I can’t help but soak up his excited feelings for the barefoot stance. It does make some sense that we were born to run without shoes and that the evidence for the wearing of shoes has shown little greater benefit as far as injury reduction is  concerned over the past 4 decades. But of course, being a physio and therefore a scientist of sorts, I can’t help but trawl trough the evidence to feel confident in giving
advice based around the research on this subject.

However, as I dabble in running, not long ago I found myself at a local oval, taking off my shoes and socks and running barefoot! This wasn’t my intention, but then, here I was with my shoes off running laps around the oval. And what a feeling! I felt amazing- that feeling of the cool grass between my toes, feeling the natural  spring in my stride and legs working hard as I picked up the pace on those few laps. I could even say that I was ‘buzzing’ after the experience.

Perhaps this is why some runners are so absorbed and passionate by barefoot and minimalist running. I guess in that small experience, I understood the passion better. And, without the OK from the ‘scientific evidence!’  Why don’t you give it a try? Remember, small amounts of exposure to begin, such as 1 or 2 laps of
an oval. Enjoy the sensations of the earth between your toes and notice the changes in your running style and muscle activations as you do.

These changes in running style felt with running barefoot, such as shorter stride lengths, faster cadence, mid to forefoot ground striking can all be applied to your running styles when wearing shoes. Why not become aware of your own running biomechanics and try the following changes on your next jog?

1. Cadence.
This is defined as your strides or steps per minute. A higher cadence will shorten your stride length, encouraging a mid to forefoot strike pattern on the ground and improve running efficiency. It will also improve your body’s natural shock absorption patterns and muscle strength in the lower limbs as outlined in part 1. Aim for a cadence of 90- 92 steps per minute. If counting is the last thing you feel like doing, why not count your number of steps in 15 seconds and times by 4? Much like taking your pulse rate.

2. Mid- to fore-foot ground strike.
Running to a higher cadence will do this for you, but there are other tricks to help you to achieve this. Imagine that you are running quietly, or running on a slippery ground surface such as ice. This will bring your ground strike forward on the foot and encourage strengthening of the small intrinsic foot muscles in your arch, the plantar fascia and other muscles across the lower leg. Again, do this slowly with small graduations in exposure, so that your muscle and other connective tissues have a chance to adapt and not inflame.

And what about for the walkers of you? There is no reason why walking barefoot around the oval or on the sand of a beach would not have the same effects for strengthening and balance in your feet and legs.

Give it a try!

Arguments for running sans shoes

Advocates of minimalist running claim barefoot running is better for the bones and joints of the body, allowing you to run the way nature intended. After all, humans have been running for millions of years as a matter of sheer survival and, without shoes! It has only been over the past 40-50 years that the big brand athletic shoe companies have sold the idea well for wearing shoes with cushioning, motion control and all the other gimmicks. This period of time has demonstrated no significant decline in running-related injuries despite the footwear. Barefoot advocates hypothesize that modern running shoes are an abnormal addition to our own human design.

Barefoot running and shod running show a difference in running mechanics and style. Barefoot runners use a forefoot-to-midfoot type of strike instead of the heel-to-forefoot strike that is seen with runners who wear shoes. This forefoot striking pattern works the muscles in the foot and the lower leg differently to try to cushion the foot strike. It also shortens the stride, which affects the stress from impact with the ground. This increase in intrinsic supportive muscles use of the foot and arch, better absorbs the impact of each strike to the ground, decreasing the impact on joints higher up the chain- the knees, hamstrings, hips and backs.

Other claimed benefits of barefoot running are increased proprioception, better balance and increased efficiency over running the same distance as shod running. This included less oxygen consumption, lower heart rates and reported feelings of tiredness amongst the athletes within the research trial.

Arguments for running with shoes

The jury is still out on the medical community’s stance in the barefoot running discussions. For instance, the American Podiatric Association is still undecided on their position, but do emphasise the risks.

Barefoot or minimalist running is so new that there are no studies on long-term effects such as trauma to soft tissue in the lower limbs, trauma to nerves, the impact on sensory issues in the feet and muscles. Transitioning from having worn shoes to barefoot has many concerns. These are due to the dramatic changes in biomechanics of the foot and lower limb as already discussed and include the incidence of stress fractures in the feet, tendinitis such as plantar fasciitis and Achilles tendonitis and skin lesions.

The beauty of running in shoes is that shoes can be matched to your foot type. Orthotics can be prescribed to successfully aid a better foot motion and assist with pre-existing knee, hip and back niggles. This has been seen time and time again with athletes over the years. Shoe advocates argue that if you have been running without injury, why change what isn’t broken?

Where can I read more on this topic?

There are countless news articles, research papers and books springing up regarding minimalist running. This list below is just a few.

Born to Run: Arguably the book that started it all and a great read.

http://www.nytimes.com/2011/11/06/magazine/running-christopher-mcdougall.html?pagewanted=all

Next edition we will explore the implications of this movement on running technique and how this can help you with your performance as a runner.