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Why ‘Lean Muscle Mass’ Is So Important

Posted on 30th September 2016 by

As it’s International Day For Older People, it’s a good chance to focus on what helps people stay fit, healthy and active into the later years. We all know that it’s important to eat well, stay active, avoid too much alcohol, not smoke and to try and maintain a good body weight.

However, although there’s a big focus on body weight, what doesn’t get much attention is how much lean muscle mass you have or should have.

What is lean muscle mass?

Lean Muscle Mass Lean muscle mass is the amount of muscle that makes up your body composition. So you could have 2 people who look fairly similar from the outside or weigh the same, however, if you analysed the muscle mass of both people, one could have a much larger muscle mass and one a lower muscle mass underneath the skin.

Take a look at the images on the left. In the middle picture is the cross section of the leg of a sedentary 74 year old. You will see their thigh bone in the centre, surrounded by their quadriceps muscles (thigh muscles) and then the outer layer is fatty tissue. In the bottom picture, you can see that a 70 year old triathlete has in contrast a huge proportion of muscle mass (almost similar to that of the 40 year old in the top picture) and minimal fatty tissue.

Why does it matter? 

The amount of lean muscle mass that you have contributes to your overall lean body mass. Lean body mass is very important. It’s not just about looking great or being stronger, sufficient amounts of lean body mass are actually critical for building a healthy life over the long-term.

  • Lean body mass is associated with your Basal Metabolic Rate (BMR), the amount of calories you burn at rest. The greater amount of Lean Body Mass you have, the greater your BMR will be. This means that people with greater amounts of Lean Body Mass will have a greater energy expenditure while doing nothing, helping to avoid calorie imbalances, and ultimately, obesity.
  • If you become ill or are stressed, your body’s nutritional demands increase as your immune system gets to work. An essential part of your immune system working well is protein. All this protein can’t come from food alone, so your immune system also relies on your protein reserves or your lean body mass. So, in short if you have a better lean body mass your body will find it easier to fight illness, infection or stress.
  • Having a good lean body or muscle mass more specifically, helps protect against bones becoming weaker or thinner. Osteoporosis and frailty in later life put older people at great risk as they lead to falls and fractures. What is beneficial about optimising muscle mass is that you can increase bone strength and density.

In the medical field, loss of muscle mass is known as Sarcopenia. This is defined as the age-related loss of skeletal muscle mass and is a well-established factor associated with decreases in muscle strength and impaired mobility. The potential consequences of sarcopenia are frailty, physical disability, loss of independence and the depression that can accompany this; and the reduced ability to cope with major illnesses.

Subsequently, preventing the loss of or building lean muscle mass is a really crucial part of looking after your body.

What can I do to improve lean body mass?

The earlier you can start developing or optimising your lean muscle mass the better, because as you age, it gets harder to improve muscle mass. However, the good news is, it’s never too late to start!

Diet

Diet plays a huge part. It’s outside the scope of this blog to explore the dietary factors, but if you want to look into this further, this website is a great resource and also has a database of professionals.

Movement & exercise!

There’s no easy way to improve lean body or muscle mass, it needs investment. Although cardio exercise like running, walking or swimming are great for improving and maintaining the health of your heart, lungs and circulation, to improve lean muscle mass you have to include specific types of exercise or activity to your routine. The best thing to do is some form of resistance training, so using light weights to exercise your muscle and build up strength and lean muscle mass. You can also do things like cycling, Pilates or yoga. Everyday activities like gardening, housework, shopping and childcare can also be pretty strenuous and will help too.

If you’re a little older and are worried about hitting the gym or starting exercises on your own, maybe think about seeing a Personal Trainer for some guidance or otherwise look for an exercise class specifically targeted for older people. At goPhysio, we will be relaunching our Positive Steps classes very soon. These classes are specifically designed for older people and led by a physio to target strength, flexibility and balance. If you’d like to register your interest in these classes, then do get in touch and we’ll let you know when they are due to re-start.

 

 


Growing Pains? Knee Pain in Kids and Teens

Posted on 27th September 2016 by

Growing pains?

Many children experience aches and pains as they grow which are typically written off as ‘growing pains’, told there is nothing that can be done and that they will ‘grow out of it’.

There is some truth to this; during a growth spurt the bones will lengthen first and then the muscles adapt and lengthen to keep up and there can be a period of discomfort around the joints whilst this happens.

However in young sporty children these ‘growing pains’ may well indicate a traction apophysistis (growth plate injury) that needs to be carefully managed to avoid long-term problems and ensure a quick return to sport.

What is a traction apophysitis?

This happens when the muscles are pulling on the growing part of the bone that hasn’t fully fused yet Osgoods Schlatters – like a rope pulling on cement that hasn’t hardened. If this area is overloaded by repeated, forceful muscle contractions, inflammation, pain and microtrauma to the growth plate will result.

This usually happens in very active sporty children who typically play 10+ hours of sport a week – especially kicking, sprinting and jumping activities like football, basketball and gymnastics. It always occurs during a growth spurt and is thought to affect around 20% of 9-16 year olds.

The main areas affected are the knee (Osgood-Schlatters disease) giving pain below the knee cap, or the ankle (Severs disease) giving pain above the back of the heel. Both conditions are associated with tightness of the muscles surrounding these joints pulling on their respective growth plates.

What can be done about it?

Rest, ice and anti-inflammatories can be helpful but most kids won’t want to wait months and months for their bones to stop growing before they return to sport, particularly if they are a budding athlete.

Will stretching help?

If the muscles are tight why don’t we just stretch them?

Well this actually pulls on the area where the muscle attaches to bone, potentially making it worse, not better!

So in response to this dilemma the Strickland protocol has been developed by a Physiotherapist to address the cause of the pain (tight muscles pulling on the growth plate) and to help guide return to sport and activity.

What is the Strickland Protocol?

The Strickland Protocol involves:

  • Applying a specific type of massage towards the insertion of the muscle to improve a muscle’s length and reduce its tightness, which reduces the pull on the tendon attachment – this needs to be done for a minimum of 2 minutes a day.
  • Once underlying tension is taken out of the muscle, helping it to catch up in length with the bone, the attachment site seems to repair in double quick time.
  • Once the child feels no pain in stretch position, we replace massage with stretches, safe in the knowledge that it should be able to cope with the loading of stretches.
  • Massage is continued in parallel with stretches to speed up process of elongation.
  • Rest from aggravating activities is essential – for a minimum of 3 weeks we recommend nothing more strenuous than walking, otherwise this delays healing substantially!
  • An important aspect is the involvement of the parent / guardian as the protocol cannot be done without their help & cooperation, as it will be them that performs massage on daily basis.
  • This is followed by sport-specific rehab and addressing a biomechanical or technique issues as we guide you back to sport.

Does it work?

YES! It has a 95% success rate in 3 weeks when correctly adhered to!

How can goPhysio help?

If your son or daughter is suffering with knee pain (or pain at their heel), you may have been to see your GP who has advised you that there is nothing that can be done, your child just needs to rest. However, we have found that by using this treatment protocol we can effectively help children get back to what they should be – running round, doing sports and having fun!

What we can do to help you and your child is assess the problem thoroughly to make sure we’re confident with the diagnosis. We will then advise you on the best course of action. The great part is that the treatment is pretty simple, with our guidance you can carry out the programme at home – we’re here to provide extra support and advise on progress as and when you need it.

If you want to find out more about the common injuries that growing young people experience and steps you can take to manage such issues, Physiotherapist, Sarah is running a free talk on Thursday 5th April at 5pm, titled Adolescent Injuries and Growing Pains. This is part of a series of free informative events we are hosting this year. Get your free ticket to the Adolescent Injuries and Growing Pains Seminar here.

 

 


Do we need a Dr-Patient ‘culture shift’?

Posted on 22nd September 2016 by

I read with interest this week about a new scheme in Wales where patients are being urged to take more control of decisions about the care and treatments they receive. The scheme, Choosing Wales Wisely, aims for a more equal doctor-patient relationship.

Central to the scheme, are 4 questions that patients should ask when seeing their Dr.

Questions to ask your doctor

Although there are fears that this move may be in an effort to cut costs, I think it’s a great initiative for patients to be inspired to take more responsibility for their own care and also explore alternatives, not just taking a single Doctor’s advice and recommendations as gospel.

The questions that this initiative proposes patients ask are certainly very valid.

If you’re suffering with musculoskeletal (MSK) pain, so issues with joints, muscles and other soft tissues, the all too common advice of take painkillers and rest just isn’t good enough. The majority of our patients at goPhysio are told this when they see their GP. Frustratingly, so many are also told that physio won’t work so don’t recommend it.

Yet, there are so many treatment options that would mean people recover faster and don’t suffer with a repeated cycle of injury. The long term benefits of this is not relying on painkillers, staying in work, being able to keep active and so the consequential health benefits of this…….the list goes on!

So, with patients being inspired to actually ask Dr’s what there options are, it may encourage Dr’s to have a broader and more open view of the valid options.

Another common misconception held by people with MSK problems is that only a scan or X Ray will actually reveal what’s going on and this is often re-enforced in a medical setting. However, research has demonstrated that this isn’t true. Many studies have found there to be changes on X Ray or scans in people with no symptoms at all and visa versa, there to be no symptoms in people with physical changes on imaging.

By patients questioning

Do I really need this?

This could avoid waiting for unnecessary and costly imaging, that actually won’t change the best treatment or management options. More often than not, treatment is the same irrelevant of what a scan or X ray shows.

A very powerful question is

What can I do to help myself?

People who take responsibility for their care are generally more likely to follow a treatment programme. So, rather than be a passive recipient of care or medication and wait for someone to ‘fix’ them, people can be empowered to help themselves.

This is a great move and people really want the right information, to be empowered with some knowledge and be directed to the right sources. There are lot’s of places to look yourself online, but without knowing the validity of the information, you can be afraid that it’s not the right thing to do. So, with a little guidance on this, patients could access relevant resources that may help them manage the problem themselves.

A core part of our management of MSK conditions at goPhysio is enabling and educating patients to help themselves. So tailored advice, an exercise programme and information about their condition. This really is key to a patient’s overall care and recovery.

Read more about the scheme here and there is also a page dedicated to managing back pain, which 8 out of 10 people will suffer with at some point in their lives.


Should I plank during pregnancy? goPhysio Advice

Posted on 21st September 2016 by

There was a great question today over on twitter that I saw,

Should I keep doing planks now I’m pregnant?

Exercise during pregnancy is great. There are so many benefits, which we covered in a previous blog. But what’s important is that you do the right exercise for you and the stage of pregnancy you are at.

Planks probably aren’t the best type of exercise for you to do whilst pregnant. There are so many alternative exercises that are more suitable and appropriate that would still work the areas that a plank does. Many of these are Pilates based, working on deep abdominal and pelvic muscles but in a much gentler way. The trouble with a plank is that it’s a fairly intense exercise and puts a lot of strain through your abdominals.

This work your abdominals really hard (the point of the exercise!) but your abdominals are already undergoing so many physical changes that planking may put too much exertion through them. The problem with doing inappropriate exercises is that you put yourself at greater risk of developing issues such as Diastasis Recti or pelvic girdle pain.

The general rule of thumb with exercise in pregnancy is if you’re already taking part regularly in an exercise pre-pregnancy, then it’s usually safe to continue this during pregnancy. So, if planks are a regular part of your exercise routine and you already have excellent strength and control in these areas, then modifying this exercise as part of your routine is likely to be OK. Just bear in mind the bigger your bump gets, the more strain those muscle are under. Most importantly, listen to your body. Don’t do anything you don’t feel comfortable with and if in any doubt, seek advice from a suitably qualified professional.

The safest option is to join an exercise class that specifically focuses on pregnancy, under the guidance of a specially trained professional you can be rest assured that you are giving your changing body the best workout.


The Doctor Who Gave Up Drugs

Posted on 16th September 2016 by

I love a great documentary that investigates and highlights issues in health & wellbeing. This week, BBC’s Dr Chris van Tulleken challenged GP’s to see if they could reduce the amount of pills they prescribe on The Doctor Who Gave Up Drugs.

The increase in the prescription of drugs to solve common medical complaints is frightening. Dr van Tulleken describes the problem as

“A tsunami of drugs”

The healthy person in a normal lifetime consumes up to 100,000 pills. Yet, much of the science actually says the drugs don’t work. The programme obviously acknowledges that medication is often essential and the progress that has been made in this field saves lives. However, for so many conditions there are alternative approaches that can actually be more effective.

The programme featured a lady who’d been suffering with shoulder and back pain for the last 20 years. This lady had been taking painkillers for 20 years, increasingly more in the last 2 years. However, despite her cocktail of drugs, she still suffered with ongoing pain. She said she’d tried physio and exercises but admitted she’d given the little commitment. Her husband’s comment was that she’d

“Rather pop a pill than do exercises”

Dr van Tulleken carried out a little test, where he unknowingly and gradually replaced her pain medication with placebo drugs. It made absolutely no difference, so irrelevant of whether she was taking painkillers or not, her pain levels varied.

She was encouraged to do some carefully prescribed exercises under supervision, and ended up not taking any painkillers and more importantly than that had hope that she wouldn’t have to live with pain. What people don’t commonly know is

“Exercise is a painkiller”

Many people just want the easy answer. Both GP’s and patients are choosing the easy option, prescribing and taking drugs. But there are alternatives and physiotherapy is such a great one. The power of exercise, activity and from our view the reassurance we provide is phenomenal. Often people are scared to move, frightened of exercising, thinking that it’ll do more harm. But what we provide is time, education and  support to help people do the right exercises.

No, it’s not the easiest solution. It takes time, it takes some investment and commitment. Things may get a little worse before they get better and it can be a bit of a rollercoaster at times. But alternatives to drugs have to become more recognised and a first point of call instead of reaching for the prescription pad.

goPhysio Twitter Testimonial

Would be interested to hear your thoughts on this programme if you watched it or any experiences of reliance on painkillers you’d like to share.

 


Back Pain Myth 3 – A scan will tell me exactly what’s wrong

Posted on 12th September 2016 by

To coincide with World Physiotherapy Day, the Chartered Society of Physiotherapists (CSP) have produced a series of evidence based myth busters to tackle the common myths surrounding back pain.

The CSP are busting myths about back pain and reinforcing what the latest evidence says is best for your back.

Back Pain Myth 3 – A scan will tell me exactly what’s wrong

There is a large and growing body of research that shows that not only do results of scans correlate poorly with symptoms in people with Low Back Pain, but also that most people without Low Back Pain have changes on scans and x-rays that do not cause any symptoms at all.

For these reasons and more, imaging alone isn’t capable of telling us exactly why someone is experiencing pain.

Of course this does not mean that all MRI scans are irrelevant in all cases, but it does mean that they are not always necessary or helpful. In fact, there is evidence to suggest that in some cases, having a scan can make situations worse.

Myth Busters Back Pain 3


References

Teraguchi et al, (2013) Prevalence and distribution of intervertebral disc degeneration over the entire spine in a population-based cohort: the Wakayama Spine Study.

Videman et al, (2003) Associations Between Back Pain History and Lumbar MRI Findings
Cheung et al, (2009) Prevalence and Pattern of Lumbar Magnetic Resonance Imaging Changes in a Population Study of One Thousand Forty-Three Individuals.

Endcan et al, (2011) Potential of MRI findings to refine case definition for mechanical low back pain in epidemiological studies: a systematic review.

Brinjikji et al, (2015) MRI Findings of Disc Degeneration are More Prevalent in Adults with Low Back Pain than in Asymptomatic Controls: A Systematic Review and Meta-Analysis

Webster et al, (2010) Relationship of early magnetic resonance imaging for work-related acute low back pain with disability and medical utilization outcomes.


Hospital Open Day: Inspire Young Minds

Posted on 9th September 2016 by

Hospital Open day

I absolutely love taking my children to the Southampton General Hospital Open Day. I still remember being taken there by my Mum when I was very young and it was my experiences at the open days that sowed the seed of curiosity about working in a health care profession. My dreams were realised as I became a physiotherapist and even though my role now at goPhysio isn’t directly clinically based, my times spent working in many hospitals and different healthcare settings have left a significant imprint in my memory.

I am still moved by the differences we make to people’s every day lives through physiotherapy and am proud to be part of the profession.

The hands on activities and behind the scenes glimpses at the open day can really inspire young minds. The human body is truly fascinating and the people who do so much when it isn’t working right, for whatever reason, are amazing. Whether or not you have children to entertain, I’d thoroughly recommend adding this event to your diary.


Cycle to Work Day 2016

Posted on 9th September 2016 by

Cycle to Work Day is a national event, which aims to encourage everyone to take to two wheels and cycle to work for just one day. It’s on 14th Cycle to Work Day 2016September this year, and you can pledge your miles by visiting www.CycleToWorkDay.org.

There’s the chance to win some fantastic prizes too:

  • Pledge now to ride on the day at www.CycletoWorkDay.org and be automatically entered to win one of three Merida bikes and other bike goodies.
  • Enter the 12 Day Prize Countdown. It starts on the 2nd of September, just follow Cycle to Work Day on Facebook and Twitter to take part.
  • Last but not least, you can enter another exclusive draw to win a bike by sharing a photo you on your bike on 14th September using the #CycleToWorkDay

Don’t forget, cycling to work is great for your health, saves you money on travel and is a great way to de-stress at the end of a long day! If you don’t normally cycle, why not hit the streets on September 14th feeling safe in the knowledge that you’ll be one of thousands experimenting with 2 wheels and riding to work that day!

TREAT YOUR BIKE TO A FREE HEALTH CHECK

Free Bike Health Checks are available between 1st – 14th September. Hundreds of local bike shops across the UK are offering the check to celebrate Cycle to Work Day – think of it as a MOT for your bike. A trained professional will assess your trusty steed and give it a simple rating of either Green, Amber or Red. As you might expect, Green indicates your bike is in tip-top condition, Amber or Red means it is advisable to book your bike in for a service before you tackle your commute – safety is paramount!

Find a local participating retailer here: www.cycletoworkday.org/retailer-finder


Back Pain Myth 2 – I should avoid exercise, especially weight training

Posted on 9th September 2016 by

To coincide with World Physiotherapy Day, the Chartered Society of Physiotherapists (CSP) have produced a series of evidence based myth busters to tackle the common myths surrounding back pain.

The CSP are busting myths about back pain and reinforcing what the latest evidence says is best for your back.

Myth 2 – I should avoid exercise, especially weight training

Exercise is generally accepted amongst all respected authorities to be the best modality for treating low back pain in both the acute and chronic phases.

Studies have shown great benefits and long-term safety of various types of exercises, including high load resistance training.

Interestingly, no one type of exercise proves to be better or worse, so simply do what you enjoy and can tolerate! Gradually build up as your confidence and ability improves.

If you’re not feeling confident about exercising with or when you’re recovering from or had back pain, why not try a specialist class like our Active Backs. This class is specifically designed for people who have had or have back pain.

#StrongerForLonger

Back pain myth


References

O’Sullivan and Lin (2014) Acute low back pain Beyond drug therapies; Pain Management Today, Volume 1, Number 1.

Steele et al (2015) A Review of the Clinical Value of Isolated Lumbar Extension Resistance Training for Chronic Low Back Pain; American Academy of Physical Medicine and Rehabilitation Volume 7, Issue 2, Pages 169–187.

Searle et al (2015) Exercise interventions for the treatment of chronic low back pain: a systematic review and meta-analysis of randomised controlled trials; Clinical Rehabilitation 2015, Vol. 29(12) 1155 –1167.

Bjorn et al (2015) Individualized Low-Load Motor Control Exercises and Education Versus a High-Load Lifting Exercise and Education to Improve Activity, Pain Intensity, and Physical Performance in Patients With Low Back Pain: A Randomized Controlled Trial; Journal of Orthopaedic & Sports Physical Therapy, Volume:45 Issue:2 Pages:77-85.

Pieber et al (2014) Long-term effects of an outpatient rehabilitation program in patients with chronic recurrent low back pain; Eur Spine J 23:779–785.

Vincent et al (2014) Resistance Exercise, Disability, and Pain Catastrophizing in Obese Adults with Back Pain; Med Sci Sports Exerc. 46(9): 1693–170.

Smith et al (2014) An update of stabilisation exercises for low back pain: a systematic review with meta-analysis. BMC Musculoskeletal Disorders 15:416 DOI: 10.1186/1471-2474-15-416

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Back Pain Myth 1 – Moving will make my back pain worse

Posted on 8th September 2016 by

To coincide with World Physiotherapy Day, the Chartered Society of Physiotherapists (CSP) have produced a series of evidence based myth busters to tackle the common myths surrounding back pain.

The CSP are busting myths about back pain and reinforcing what the latest evidence says is best for your back.

Myth 1 – Moving will make my back pain worse 

Although it is true that some movements can be uncomfortable when you have back pain, it is well established that returning to movement and work as soon as you are able, is better for recovery and preventing recurrence than bed rest.

This is not a new concept by any means, but it is an unfortunate misconception which is continues to endure, due in part, to the complex nature of pain.

#MotionIsLotion

Back pain myth


References 

Balagu, F. et al., 2012. Non-specific low back pain. The Lancet, 379(9814), pp.482–491.

Darlow, B. et al., 2015. Easy to Harm, Hard to Heal. Spine, (August 2016), p.1.

Picavet, H.S.J., Vlaeyen, J.W.S. & Schouten, J.S.A.G., 2002. Pain catastrophizing and kinesiophobia: Predictors of chronic low back pain. American Journal of Epidemiology, 156(11), pp.1028–1034.

Pincus, T. et al., 2002. A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain. Spine (Phila Pa 1976), 27(5), pp.E109–20.

Swinkels-Meewisse, I.E.J. et al., 2006. Acute low back pain: Pain-related fear and pain catastrophizing influence physical performance and perceived disability. Pain, 120(1-2), pp.36–43.

Waddell, G., 1993. Simple low back pain: rest or active exercise? Annals of the rheumatic diseases, 52(5), p.317.

Wynne-Jones, G. et al., 2014. Absence from work and return to work in people with back pain: a systematic review and meta-analysis. Occupational and environmental medicine, 71(6), pp.448–56.