Do you get pain in a muscle group when you are running or playing sport that is releaved by rest but returns next time you run? You stretch and have massages but it just doesn't seem to improve and it is getting in the way of you achieving your goals. You may have a "Boimechanical Overload Syndrome". These exertional lower limb problems maybe diagnosed as shin splints, compartment syndrome, or just tight calves or hamstrings but what is really going on and how do we treat it.

Why are the muscles overloaded? Perhaps weakness is an issue and a graduated strengthening program will help. Perhaps an old injury has left you stiff in the ankle and changed your gait. Perhaps your running style is overloading a muscle group. If you have changed to forefoot running you may be overloading your calf. If you are overstriding you maybe making your hamstring or shin muscles work too hard. Poor balance on one leg may allow excessive foot movement that causes lateral calf pain.

A physio can assess you for weakness, loss or range and motor control. They can assess you running and help get you back on track.

Here is some guidance for returning to sport or heavy work after being ill. If you have no symptoms with normal activities and walking for 500m you may be ready to start. Gradually increase your activity, watching out for return of symptoms or excessive fatigue. Check with your GP if there are any prolonged symptoms or you have other medical conditions.

A sprained ankle is usually the result of landing on an uneven surface or twisting akwardly. A mild sprain will mean over stretching the soft tissues but when ligaments and tendons become injured your ankle requires physiotherapy assessment and rehabilitation.

Untreated ankle sprain can result in chronic ankle instability where recurrent injury is common and often people stop playing sport and being active as a result. Your physiotherapist can treat your pain and swelling in the acute stage, then progress you back to having a strong and stable ankle. Sometimes a more serious injury will require scans and perhaps surgery but conservative management is appropriate in most cases. If surgery is necessary intensive rehab post surgery will optimize your prognosis. 

Gordonvale Physiotherapy has to be very careful not to allow the COVID virus into our clinic. We have all been vacinated but even so, there are consequences of the people in our clinic becoming exposed. Many of our clients and some of our staff are vunerable to this virus. Even a weaker bout of the virus could make them very sick. If a staff member gets sick we will have to close down for at least 7 days, probably longer.  We then would not be able to provide our services to the communtiy for that time. As a small business that would mean paying sick leave for all the staff without any income for an extended period, and no obvious government assistance on the horizon. If we had a few episodes of having to close down, we would really struggle as a business to survive. This is just our business. Imagine every other business in town having to go through a similar thing. Mask up, social distance, wash your hands and minimize your exposure to others and help us all get to the other side of this safely. 

Is exercise recommended for RA?

Exercise is an important part of managing RA.

People with RA who exercise have:

• higher levels of fitness

• better muscle strength and size

• greater ability to do daily tasks

• improved mood and emotional well-being.

Exercise can also help you maintain a healthy body

weight and improve the health of your heart and blood

vessels. Some types of exercise may also help improve

the strength of your bones and reduce your risk of

osteoporosis (thinning of the bones).

Many people with RA are anxious about exercising.

This may be due to fear of causing damage to the joints

or the presence of pain. However research shows that

people with RA can participate in regular, appropriate

exercise without causing joint damage or worsening of

symptoms. Everyone’s fitness levels and limitations will

be different so start with activities that suit you. While

some people with arthritis will find a five kilometre

walk easy, others may find walking around the block

difficult enough to start with. If you have damage

to the larger joints in your legs, such as your hips or

knees, it is generally recommended to avoid activities

that put excessive force on those joints (for example,

running and jumping). Talk to your rheumatologist

(arthritis specialist) to find out if there are activities that

you should avoid. You may also find it helpful to ask a

physiotherapist for advice on exercising safely.

What types of exercise could I try?

There are many activities that are safe and effective

for people with RA. Any activity that works your

muscles a bit harder or causes you to ‘puff’ a little,

without increasing your pain or other symptoms, will

be beneficial. Choose activities that you enjoy and are

convenient. Activities that are particularly useful include:

• Water exercise: Many people with RA prefer

exercising in water. The buoyancy of the water takes

pressure off painful joints and you may find you

can move more freely than you can on land. Warm

water can also be soothing for sore muscles and

stiff joints.If you are new to exercise or your

RA is limiting your ability to exercise, you may find it

useful to have one-on-one hydrotherapy sessions with

a physiotherapist. 

• Strength training: Muscle weakness is very common

in RA. A combination of pain, fatigue (tiredness) and

the disease itself often leads to weakening and wasting

of the muscles. This can make it even more tiring to

do your normal daily activities. Research has shown 

that muscle weakness in RA can be prevented and

even reversed by strength training. Strength training

involves working your muscles a little harder than you

do in normal life. You do this by working with hand

weights, leg weights, gym machines, resistance bands

or even just your own body weight (eg. doing pushups).

The key to successful strength training is to:

- start with supervision from a qualified health or

exercise professional who understands RA

- learn the right way to do the exercises and how

much resistance to add to prevent injury

- keep challenging your muscles by doing different

exercises and using more resistance.

Strength training may also improve the strength of your

bones and help prevent a condition called osteoporosis.

What about during a ‘flare’?

During a ‘flare’ it is usually recommended to rest the

affected joint(s). You should still gently move the

affected joint(s) as far as is comfortable several times

a day as this may help prevent stiffness. However you

should not apply any force or resistance to the affected

area. For example, if your wrist is affected, do not

use any weights or resistance bands with that arm. If

you are feeling otherwise well, you can still do some

gentle exercise for the rest of your body. Talk to your

rheumatologist or physiotherapist for more information

Safety tips

• Check with your doctor or rheumatologist

before starting an exercise program.

• If possible, see a physiotherapist or exercise

physiologist for advice about specific exercises.

They can suggest safe exercises tailored to your

condition and make sure you are doing your

exercises correctly so you don’t cause an injury.

• Always build up slowly. When you first start, do less

than you think you will be able to manage. If you

cope well, do a little bit more next time and keep

building up gradually.

• Always start your exercise by doing some gentle

movements to prepare your muscles and joints for the

activity. This will help prevent pain and injury. You

may find it useful to use heat packs or warm showers

before activity to loosen up stiff joints and muscles.

• Never place your joints under excessive pressure or in

unsafe positions that can increase your risk of injury.

Wherever possible, learn exercises from a qualified

health professional and exercise under supervision.

Physiotherapists are ideally placed to assist in the prevention of falls through assessment, education and exercise prescription.

Whether it is in the home, in the garden or out in the community, falls risks are out there.

Staying safe involves

• Being as strong and fit as possible.
• Maintaining or improving good balance and co-ordination.
• Removing risks around the house and yard.
• Wearing safe footwear.
• Using the correct walking aid.
• Appriopriate glasses
• Correct medication
• Asking for help when needed

Make a playlist of Spotify or itunes to get you up and moving everyday.

Here is mine.

• 9 to 5
• Time Warp
• Dancing Queens
• My Sharona
• Grease
• Rocking All Over the World
• Wake me up before you go-go
• Footloose
• Time Warp
• Candyman
• Sisters are doing it for themselves

The British Journal of Sports Medicine has just published some new guidline for exercises during pregnancy. Evidence would show that women who exercise have a 40% decrease in having gestational diabetes, there is lower weigh gain, improved cardiorespiratory fitness and decreased incidence of high blood pressure. Only a small group of women should not exercise so see your doctor if you have preterm labor, pre-eclampsia, risk of decreased fetal growth or any other concerns. 

All women should be physically active through out pregnancy. Gains are very good in people who have been previously inactive. You may need to start at a lower, comfortable level but should gradually build up.

The ideal is to get 150 mins of moderately intense exercise each week. This should be over at least 3 days but it is best to be active on most days. A variety of aerobic and resistance activity is good and some Yoga on top of this may be of benefit.

Exercise can be walking, swimming, stationary bike, gardening, gym or special classes.

Pelvic floor exerices are important as many women have urinary incontinence during pregnacy. It is best to see a physiotherapist to check you are doing these correctly.

If you get light headed or uncomfortable doing exercises in lying on your back you can turn onto the left side or raise trunk 30 degrees to take the pressure off the large blood vessels.

High intensity interval training has not really been tested yet so you should take care with the limits you take your workout to. Stay comfortable and painfree. Avoid exercising in the heat as dehydration can cause fainting and heat stress can be dangerous. 

Exercise in early pregnancy appears to show no increased risk of miscarrage.

Some safety precautions to be considered are, avoid high risk of falling or trauma to belly, scuba diving and high altitude training.

Exercising 30 mins 5 days per week would be ideal but a 10-15 min walk after breakfast or dinner every day may be better for some. Listen to body and rest if tired and don't do activities that cause pain.

Being physically active below this level is still helpful so start at your level and gradually increase you level of activity as the pregnacy continues.