It's been hard to know exactly how to advise people after knee replacement exactly which exercise activities they could safely pursue. Even though you can hear stories of people doing all sorts of things with their replacements, what is the sensible course?
Our usual line is "Contact sports, squash, skiing, tennis, jogging and jumping are a bad idea. Good sports are walking, bowls, golf and swimming."
Recent research in the US has thrown this consensus into disarray. Researchers have used specially designed knee replacements which can measure the forces put upon them from the inside. This has shown up that golf, usually thought to be a low impact activity, may put much larger forces on an artificial knee joint that previously suspected.
For further information please go to The Physiotherapy Site.
Wednesday, April 16, 2008
Sunday, April 13, 2008
Why use hip abductor and adductor muscle gym machines?
I'm in the gym at least twice a week for an hour, doing a whole-body routine to keep up my muscle power and mass as time goes by. At 53 I want to make sure I don't lose muscle every year as I inevitably would if I didn't train at all.
I do a mixture of exercises, using machines, free weights and the gym balls.
However, as a physiotherapist I really can't see the point of the hip adductor and abductor training machines. You know, the ones the girls make a beeline for and spend some time on, imagining it's going to do good things for their buttock profiles.
Somebody looked at the movements of the hips and said "Hey, we can make machines to exercise the hip in-and-out movements!". So the hip abductor and hip adductor muscle training machines were born.
The hip muscles are very powerful and have to cope with stabilising the pelvis in weight bearing and with propulsion of our high body weight every day. This is called walking! Or running or jumping. The forces involved are very high as the muscles are either stabilising or contributing directly to the movement of our whole bodies.
On the machine we can't approach the forces that we do day to day in walking and moving about generally. If you want train your buttocks then there are lots of exercises which might even be effective! Examples could be lunging, jumping, sprinting, leg press, squat. And many others.
So my tip for today is, do something else rather than spend useless time on these machines. But I'd be interested to hear if any of you have different opinions.
I do a mixture of exercises, using machines, free weights and the gym balls.
However, as a physiotherapist I really can't see the point of the hip adductor and abductor training machines. You know, the ones the girls make a beeline for and spend some time on, imagining it's going to do good things for their buttock profiles.
Somebody looked at the movements of the hips and said "Hey, we can make machines to exercise the hip in-and-out movements!". So the hip abductor and hip adductor muscle training machines were born.
The hip muscles are very powerful and have to cope with stabilising the pelvis in weight bearing and with propulsion of our high body weight every day. This is called walking! Or running or jumping. The forces involved are very high as the muscles are either stabilising or contributing directly to the movement of our whole bodies.
On the machine we can't approach the forces that we do day to day in walking and moving about generally. If you want train your buttocks then there are lots of exercises which might even be effective! Examples could be lunging, jumping, sprinting, leg press, squat. And many others.
So my tip for today is, do something else rather than spend useless time on these machines. But I'd be interested to hear if any of you have different opinions.
Thursday, April 10, 2008
Stretching Muscles After Your Workout
I love to workout in the gym, always have. It's the clanking of metal, the rubber flooring, the smell, it all means muscles and effort.
At the end of my workout I'm always keen to head for the shower. Yes, I try and leave out my stretches if I can. Even though I know they should help me become more flexible and allow me to exert more effort to build muscle.
Stretching is easy to build in to your workout, best at the end. There's lots of guidance around about how you should do them. I've found out a few tips over time.
At the end of my workout I'm always keen to head for the shower. Yes, I try and leave out my stretches if I can. Even though I know they should help me become more flexible and allow me to exert more effort to build muscle.
Stretching is easy to build in to your workout, best at the end. There's lots of guidance around about how you should do them. I've found out a few tips over time.
- Choose a stretch for each major muscle group
- Go to the discomfort point and hold.
- Don't bounce or move about. Relax into the stretch and breathe steadily.
- Hold it for 30 seconds. This is much longer than you think. If you guess you'll always stop too soon. Stretch so you can see a clock with a second hand.
- Go have a shower. Well done!
Achilles tendon rupture and age
Our bodies change with time. If we are lucky this is a slow process and we may not notice it much. Until something pulls us up sharp, that is.
Our ligaments and tendons are very strong to cope with the large loads we put them in sport and recreation. This is fine when we are young. As time goes on however, the loads we put on our tissues get closer and closer to the maximum stresses they will tolerate. You may have several attendances to your physiotherapist before the big one hits.
The achilles tendon is a large structure in the calf with a poor blood supply. It transmits all the forces of our bodyweight as we move about in life. These forces are sometimes very high.
Football (soccer), squash and sprinting in your mid-40s may just not be a good idea. An achilles tendon rupture is a risk and it's a disabling leg injury. If you get operated on it'll be six weeks in plaster and being careful for three months or more. If not, you're in plaster for much longer and it'll be six months or more before you're back to action.
That's a big chunk out of your normal life. And you'll need to spend some time with the physiotherapists to rehab your ankle.
A rupture of achilles tendon is a signal that you are putting stresses on your body that may be excessive. It is possible to be sportingly active over 45 but you need to be more careful with warm up and training if you haven't done it for a while.
If you have a pain problem then a steady and planned approach to activity is vital. Pacing is the important skill here, the ability to make logical measurements of your activity and increase by pre-chosen increments.
Actually, pacing applies to us all at any age. Athletes use the technique to get ready for the Olympic Games, pain patients to control their chronic pain.
Go to Pacing for Pain for a load of information about this important pain management technique.
Our ligaments and tendons are very strong to cope with the large loads we put them in sport and recreation. This is fine when we are young. As time goes on however, the loads we put on our tissues get closer and closer to the maximum stresses they will tolerate. You may have several attendances to your physiotherapist before the big one hits.
The achilles tendon is a large structure in the calf with a poor blood supply. It transmits all the forces of our bodyweight as we move about in life. These forces are sometimes very high.
Football (soccer), squash and sprinting in your mid-40s may just not be a good idea. An achilles tendon rupture is a risk and it's a disabling leg injury. If you get operated on it'll be six weeks in plaster and being careful for three months or more. If not, you're in plaster for much longer and it'll be six months or more before you're back to action.
That's a big chunk out of your normal life. And you'll need to spend some time with the physiotherapists to rehab your ankle.
A rupture of achilles tendon is a signal that you are putting stresses on your body that may be excessive. It is possible to be sportingly active over 45 but you need to be more careful with warm up and training if you haven't done it for a while.
If you have a pain problem then a steady and planned approach to activity is vital. Pacing is the important skill here, the ability to make logical measurements of your activity and increase by pre-chosen increments.
Actually, pacing applies to us all at any age. Athletes use the technique to get ready for the Olympic Games, pain patients to control their chronic pain.
Go to Pacing for Pain for a load of information about this important pain management technique.
Thursday, February 14, 2008
Sciatica Is Not A Good Term
5-10% of low back pain sufferers develop severe leg pain at some stage in their lives. This is usually termed "sciatica" from the greek meaning 'hip pain'. Physiotherapists are often consulted and can be part of the symptomatic treatment of this distressing condition.
Leg pain is difficult to understand. The pain of sciatica is best referred to as nerve root pain or radicular pain. This implies the nerve root (near the disc) is compromised in some way and giving pain in a particular pattern down the leg. The commonest cause is a disc prolapse.
However, disc prolapses are very common and mostly don't give any trouble so it's hard to know if the one you are looking at on the MRI scan is causing the patient's problem.
Low back pain often generates referred pain which can be felt right down the leg, although it is usually aching and non-localised in nature in contrast to the severe, surging pain which every nerve root pain sufferer knows all too well. They can mostly tell you very accurately where the pain is.
Studies have shown that operation can make the leg pain settle down faster than conservative measures (medic speak for waiting) but that there is no difference to how people are two years after the onset of the leg pain.
Most people recover well from nerve root pain episodes but some go on to have longer term problems with their leg pain.
Whatever the outcome it is better to use the term nerve root pain and diagnose this problem accurately if there going to be better understanding of this unpleasant pain syndrome.
Lifting Training Doesn't Help Low Back Pain
All of us who work in NHS hospitals have a lot of mandatory training to do every year. It's part of our contracts and includes cardiopulmonary resuscitation, fire, child protection and manual handling.
There has been a big push to get manual handling training a higher profile and in our department no physiotherapist should touch a patient before they have this. Mainly this is for insurance liability reasons so the organisation can discharge its legal duties to the staff.
I've never been sure whether manual handling training prevents physiotherapists, or other staff, from developing low back pain. Yet it's always seen as "a good thing".
Now the British Medical Journal has published a paper by Martimo et al in the January 2008 issue which reviews research evidence whether training or advice reduces the incidence of low back pain conditions.
They conclude there is no evidence that advice, training and using lifting aids prevents low back pain or the disability from it.
It looks like there may be reasons for manual handling advice and care but preventing back pain may not be helped by this. We don't know enough about what stresses physiotherapists and nurses physically and how this translates into low back pain problems.
There's more about back pain at The Physiotherapy Site.
Tuesday, October 16, 2007
Exercise is good for you. And Bad.
There's so much encouragement to exercise. Everywhere. And it's always positive press, there's never any negative. But watch England's rugby scrum collide with the French scrum and you wonder can it be good for the body.
Many people with diseases and disabilities have been advised not to exercise when they could benefit greatly from it. Increasing your strength and functional ability can lead to good improvements in independence.
Exercising properly is a matter of getting it right, of balancing the intensity of exercise with the ability of the body tissues to cope with the stress. All the skill and benefit of exercise depends on this balance.
Pacing is one of the important, basic skills of getting this balance right. Pacing For Pain gives you the inside information on this technique, and the ebook "Secrets of Pacing".
Many people with diseases and disabilities have been advised not to exercise when they could benefit greatly from it. Increasing your strength and functional ability can lead to good improvements in independence.
Exercising properly is a matter of getting it right, of balancing the intensity of exercise with the ability of the body tissues to cope with the stress. All the skill and benefit of exercise depends on this balance.
Pacing is one of the important, basic skills of getting this balance right. Pacing For Pain gives you the inside information on this technique, and the ebook "Secrets of Pacing".
Wednesday, October 03, 2007
Total Knee Replacement - Which Therapy?
How much and what type of therapy should patients have after total knee replacement? Recent research has shed some light on this difficult question.
Researchers in the UK at the University of Birmingham searched the medical literature for evidence of which kind of exercise was most helpful post-operatively. The results are provisional at best but give some pointers.
The management of knee replacement has changed greatly over the last 10 years. The length of stay in hospital has rapidly and greatly decreased, with a common stay of 4 to 5 days. This has transferred much of the rehabilitation effort to outside hospital units.
The researchers found there was some evidence to support the performance of functional exercises (e.g. balance, coordination, stair climbing, cycling) over just performing static strengthening and range of motion exercises.
At 3 to 4 months after surgery there was a small but useful advantage in doing the functional exercises, but at a year this advantage had disappeared.
I think this means that performing functional exercises may get you back towards normal function a little quicker than not doing them, but that in the long term it does not matter much.
The bigger question remains. Should there be much extensive and intensive therapy after knee replacement to address the obvious limitations in strength, range and abilities after this major orthopaedic surgery?
Reference: Lowe CJ et al. Effectiveness of physiotherapy exercise after knee arthroplasty for osteoarthritis: systematic review and meta-analysis of randomised controlled trials. BMJ (British Medical Journal) 2007, September 20.
Researchers in the UK at the University of Birmingham searched the medical literature for evidence of which kind of exercise was most helpful post-operatively. The results are provisional at best but give some pointers.
The management of knee replacement has changed greatly over the last 10 years. The length of stay in hospital has rapidly and greatly decreased, with a common stay of 4 to 5 days. This has transferred much of the rehabilitation effort to outside hospital units.
The researchers found there was some evidence to support the performance of functional exercises (e.g. balance, coordination, stair climbing, cycling) over just performing static strengthening and range of motion exercises.
At 3 to 4 months after surgery there was a small but useful advantage in doing the functional exercises, but at a year this advantage had disappeared.
I think this means that performing functional exercises may get you back towards normal function a little quicker than not doing them, but that in the long term it does not matter much.
The bigger question remains. Should there be much extensive and intensive therapy after knee replacement to address the obvious limitations in strength, range and abilities after this major orthopaedic surgery?
Reference: Lowe CJ et al. Effectiveness of physiotherapy exercise after knee arthroplasty for osteoarthritis: systematic review and meta-analysis of randomised controlled trials. BMJ (British Medical Journal) 2007, September 20.
Tuesday, November 07, 2006
Concepts Without Explanation (CWE) 2
It's easy to disable people with a word. We can all do it if we deal with patients with health problems of various kinds. They are vulnerable and looking for explanations and understanding. When you give your opinion, they take the idea and convert it into their understanding, often in a visual form, as an image of what is going on.
CWE word of the moment: ARTHRITIS
This is a very powerful word with important meanings for lay people. It conjures up images of destroyed joints, disability and pain. Since arthritis is technically one of the most common conditions in the world this may not be the best way of thinking about it.
As physios or other health workers we are in a great position to do this well. Or badly!
One of the things I have learned in many years working in a hospital is that you should never underestimate the depth of someone's ignorance about their body. That doesn't mean you think they are stupid or patronise them, but don't be surprised when their view of what's going on makes no sense at all. It's our business to find out what these views are and help people towards what we would think of as more realistic interpretations.
Most people have no idea at all what arthritis means. It is usually interpreted as being very negative, as spreading round the body and as being the end of normal function. As such it generates a lot of anxiety.
So using this word comes with a lot of anxiety and we have to be aware of that and offer explanations to clarify the true meaning of the concept as it applies to the patient in front of us. Saying "wear and tear" or " joint damage" may well add up to the same thing so needs the same care.
Over time you develop a "politically correct" dictionary of terms to help you patients understand what their condition means and with the least chance of misinterpretation. That takes some care and the ability to question, listen and respond. So how do you explain? Yes, I'll get onto that another time, along with more danger words from the CWE dictionary.
CWE word of the moment: ARTHRITIS
This is a very powerful word with important meanings for lay people. It conjures up images of destroyed joints, disability and pain. Since arthritis is technically one of the most common conditions in the world this may not be the best way of thinking about it.
As physios or other health workers we are in a great position to do this well. Or badly!
One of the things I have learned in many years working in a hospital is that you should never underestimate the depth of someone's ignorance about their body. That doesn't mean you think they are stupid or patronise them, but don't be surprised when their view of what's going on makes no sense at all. It's our business to find out what these views are and help people towards what we would think of as more realistic interpretations.
Most people have no idea at all what arthritis means. It is usually interpreted as being very negative, as spreading round the body and as being the end of normal function. As such it generates a lot of anxiety.
So using this word comes with a lot of anxiety and we have to be aware of that and offer explanations to clarify the true meaning of the concept as it applies to the patient in front of us. Saying "wear and tear" or " joint damage" may well add up to the same thing so needs the same care.
Over time you develop a "politically correct" dictionary of terms to help you patients understand what their condition means and with the least chance of misinterpretation. That takes some care and the ability to question, listen and respond. So how do you explain? Yes, I'll get onto that another time, along with more danger words from the CWE dictionary.
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