What is knee osteoarthritis?

Osteoarthritis (OA) is the most common form of arthritis (Vioreanu, 2014). OA is a degenerative, ‘wear and tear’ type condition while largely effects the protective cartilage in the joint which may affect the the ability of the knee joint to take weight during upright activities like walking and climbing stairs. Symptoms can also include achy pains, sometimes sharp from either the inner or outer knee, sometimes both. You may also feel a stiffness or weakness in the knee which may affect your confidence. Other problems may include intermittent swelling, fully straightening or bending the knee as well as feelings of ‘crepitus’ or grinding (Vioreanu, 2014). The incidence of OA tends to increase with age, with over 50% of the population having OA by the age of 65 (Vioreanu, 2014).

What can be done to help – what do the medical experts suggest?

The National Institute for Clinical Excellence have published updated guidelines in 2014 suggesting:

Why is the warmup and cooldown so important?

The warm-up prepares the body for exercise and should be tailored for the specific exercise that will be undertaken. For football, both general and specific exercises should be performed.

The warm up may involve

1. General exercise jogging or cycling for 5-10 minutes to warm the muscles and enhance circulation in preparation for stretching
2. Gentle static stretching of key muscle groups such as the hamstrings, calves and hip flexors which are held for 20-30 seconds and repeated 2-3 times. It is also important to stretch/mobilise the spine gently, especially the ‘twisting’ movement.
3. Low level resistance exercises to ‘wake up’ important core stabilising muscles which will help support the back, hips and legs during training.
4. Once the muscles are well warmed up, more vigorous dynamic stretches can be performed carefully under supervision of the coach so as to avoid injury.

The cool down is important to safely restore the body back to its resting state. This may include:

As part of our new Pilates term in November, we are adding a weekly ‘Falls Prevention Class’ which will take the form of a 60 minute exercise class aimed at improving general strength, balance, mobility and physical activity. The class will be run by a Chartered Physiotherapist who is trained in tailoring therapeutic exercise for all age groups.

Why a Falls Prevention Class?

The proportion of the population over the age of 60 years is growing rapidly and is likely to continue to grow in the coming years [1]. More than 33% of community-dwelling people aged over 65 years unfortunately will experience a fall at least once a year, while 50% of those will have recurrent falls [2,3]. As age increases, the rate of falls can increase up to 60% [2,4]. Falling can badly effect confidence, reduce a persons feeling of independence and possibly result in isolation, with around 1 in 10 older people who fall becoming afraid to leave their homes for fear of falling again [5].

What is a Point Stimulator?

The point stimulator is similar in appearance to a large pen, it is a handheld device. The model we use in the clinic is the Pointer Excell 11 which we have found to be very effective and reliable.

The tip of the point stimulator, similar to the tip of the pen, sends a gentle current through the needle and into the muscle. This may enhance the sensory effects of dry needling which promote blood flow, healing and have local analgesic effects. The point stimulator also causes small micro-contractions within the muscle which may have additional mechanical effects as well as allowing accurate confirmation that the correct muscle is being needled.

Benefits of using the point stimulator are:

It can be used to ensure that the needle is inserted into the correct muscle so it is useful as a diagnostic tool.

It can also be used as a treatment tool by directly stimulating the needle for 2-10 second bursts with a 5 second rest in between for approximately 1-3 minutes, depending on the treatment dose and client’s response. Clinically this is particularly effective for reducing muscular tightness and deactivating painful myofascial trigger points within muscles.

What is the Quadratus Lumborum (QL)?

The Quadratus Lumborum is a quadrangular shaped muscle which attaches to the bottom rib, the verterbrae in your lower back and the top of your pelvis. It acts as a stabiliser of the lower back and can laterally flex the spine. It extends your lower back when working with the other side and it aids forced exhalation, for example when coughing.

Why is it relevant?

Myofascial trigger points in the QL muscle often mimic symptoms of discogenic low back pain i.e. back and leg pain caused by a problem such as a ‘slipped disc’. However 32% of such presentations have been shown to have QL muscle myofascial dysfunction as their primary issue, rather than a disc problem.

image courtesy of Wikipedia

What is Electro Acupuncture?

Electro Acupuncture (EA) is where an electric current is passed through the acupuncture needles. In the clinic there are two types of devices used – the Cefar Acus4 and ETO ES130 EA devices.

What are the Electro Acupuncture devices?

The EA devices are small and portable devices with leads that attach to the needles in order to transfer the current from the machine to the needles. The wires are comparable to jump leads which are used to restart a car engine just on a much smaller scale and with a much more gentle current! In comparison to the point stimulator it provides constant input into the muscle for 10-20 minutes again depending on the treatment dose required and the nature of the condition being treated.

We now have our Strength & Conditioning studio successfully up and running at the clinic.

I have been working with a diverse range of clients, a variety of ages and fitness levels here in the studio. My main goal for my clients is to reduce the risk of injury or reinjury when returning to sports and everyday activity. My clients’ goals thus far have included increasing core stability, weight loss, improving postural control, enhancing lower body strength, increasing balance, along with many others.

Sessions generally begin with a warm up on the bike, followed by a combination of aerobic, strength and flexibility exercises and finally a cool down of stretches. The combination of exercises depends on the goal of the client.

Where is my Coccyx?

The coccyx is the anatomical term used for tailbone which is the bone at the very bottom of your spine, so in your buttock region. The pelvic floor muscles as well the gluteus maximus muscle have attachments into the bone. There are also numerous fibrous ligamentous attachments in this area as well to the sacrum which help hold the bones together and keep them stable.

What causes pain in this region?

Pain in the tailbone region may be referred to as coccydynia and is most commonly is caused by a traumatic event. For example a fall onto the backside or during childbirth. This can cause bony bruising or a fracture of the bone. It can also cause inflammation which can lead to pain and discomfort. Other causes can be degeneration or wear and tear of the joint which links the coccyx to the sacrum or possibly other surrounding joints which can be often overlooked. Instability i.e excess or poorly controlled movement in the joint can also cause sensitivity and pain in the area. Pain in this area may also be referred pain from tight muscles containing trigger points for example the buttock or pelvic floor muscles. 'Sciatica' can also cause pain the tailbone region. In rare cases pain in the coccyx area can be due to tumors and infections.

Image courtesy ofWikipedia

Studies have shown almost 80% of people experience low back pain at some point in their life. Most episodes settle within 4-6 weeks with a course of physiotherapy allowing for a quicker recovery and a reduced likelihood of recurrence and chronicity.

There are body structures which may cause back pain either directly or indirectly, along with help form the central nervous system. These may include overly tense muscles which may contain trigger points, faulty nerves, sensitive joints which may be moving too much or may be 'stiff', possible wear and tear in the joints in the spine or direct injury where a joint in the spine was sprained or fractured or damaged. Back pain may also arise from organ's such as the kidneys, blood vessels and tumours which makes a thorough examination by a medically trained professional essential.

Firstly, what is the sympathetic nervous system?

The sympathetic nervous system (SNS) is a part of the autonomic nervous system (ANS) which is that part of the nervous system which controls most of our automatic bodily functions. In other words those that take place without us having to ‘think’ about them like pumping of the heart and breathing.

Most of our organs are under control of the ANS as well as other physiological functions such as the release of hormones and chemicals needed to keep the body operating smoothly. The ANS is also an important regulator of stress in the body and can affect how we think and feel at an emotional level (Hallman, 2013).