Thursday, 29 September 2016

Gluteus Medius

Gluteus Medius

We have been focusing on gluteus medius (or glute med) of late because of the role it plays in standing and walking. The glute med is a lateral stabiliser of the pelvis and is imperative in stability during foot strike. A lateral shift and/or drop of the pelvis is often associated with poor glute med control which increases the load through the lateral structures of the hip, most notably, the TFL.

You may have heard of “runner’s knee” or “ITB friction syndrome” before? This refers to a tight ITB (fascia which connects from the TFL to the lateral aspect of the tibia) most often related to an increased load through the ITB associated with poor glute med control. If left untreated, this can lead to trochanteric bursitis in which the bursae surrounding the greater trochanter becomes inflamed and painful. Once again, highlighting the importance of lateral hip stability and glute med control.

Here in the clinic we see numerous patients with lower back pain in conjunction with one of the aforementioned conditions. Essentially, an imbalance in hip musculature (whether it be due to strength and/or tightness) can lead to mal-alignment of the pelvis. This results in an uneven distribution of load through the lower back and associated tightness and pain. By correcting pelvic alignment and control through glute med strengthening, this can inherently de-load the lumbar musculature and reduce lower back pain by improving lumbo-pelvic control.

Our next video will also be on glute med control so keep a look out!! 


To check out these and other videos, go to: https://www.youtube.com/watch?v=i6jg_4AAncg

Thursday, 7 July 2016

Cerebral Palsy: The importance of Exercise
by Allanah McDonnell
 

Cerebral Palsy (CP) is a broad term referring to disorders of the brain that have resulted in lack of motor control or spasticity of the muscular system. CP is the most common disability in children within Australia, with a child being born with CP every 15 hours. I first became interested in CP whilst working at Woolworths and befriending Paralympians who were training close by. I was amazed that these athletes had overcome a motor function disorder and could run 100m in 11 seconds. This led me to think about what interventions in their early life made this possible. Fortunately for many of the CP Paralympians, their cases are milder forms as the disorder can be extremely debilitating. In some of the more severe cases the child could have difficulty not only moving with control but swallowing and breathing can often be troublesome as well. From there, I researched and discovered that a combination of medications and physical therapy are the optimal prescription to improve functional capacity.

For those whose children suffer from CP there are pharmaceutical therapies available to help reduce symptoms and improve muscular control. From the age of 2 onwards Botulinum toxin type A (Botox) can be introduced as this reduces rigidity, promoting muscular control. With the addition of BoNT-A, it then significantly decreases over-activity of the musculature, physical therapy will have more feedback and increased progression as the rate limiting factor has decreased.

The focus of PT is to promote functional movements that are relevant to everyday life such as sitting, standing, walking, reaching/grabbing etc.  The main goal is to improve the quality of life for the child and the family. Physical therapy also takes into account the challenges the family has with menial tasks such as bathing, feeding and dressing as these alone can be exceptionally hard. A systematic review of physical therapy interventions by Antilla et al. 2008, explored the effectiveness of these interventions based on existing studies. Their findings however were inconclusive as majority of studies differed greatly in their mode of therapy thus cross examination was difficult.

However this is where ‘testimonials’ can be evidence enough for the benefits of exercise itself. Madelyn is 3 years old now, she was born 7 weeks premature and at 5 weeks old she contracted HSV Meningitis causing significant brain damage to the left hemisphere and right frontal lobe. At 18 months she developed autoimmune encephalitis which further regressed her condition. Ultimately these have led to the diagnosis of Quadriplegia Cerebral Palsy (GMFCS 5), Epilepsy and Global Developmental Delay.

Maddy has little to no control over her musculature previously being unable to hold trunk upright, position head or move without a mobility aid. Maddy attends physical therapy weekly. Even with the regression from EC she uses her left arm to control her right, maintain an upright position and head control so she can not only move but be interactive with her peers as well. Melissa her mother fully supports physical therapy and its benefits, ‘Early intervention is so crucial and Madelyn is the way she is now because of early intervention and a lot of hard work and dedication’.  

There is however the downfall of costs for not just therapy but mobility devices and all other medical expenses such as medication, doctors and school etc. However without these Maddy would be limited in her life and the progress she has made would have been inconceivable. ‘Therapy gives you hope because the therapists often see the potential that medical professionals (doctors) don't see,’ says Melissa. This is how we practice, we focus on the small goals without losing sight of the big ones, to make each person’s quality of life as rewarding as possible; whether that be the ability to pick something up or running 100m.

For more information on cerebral palsy see their website, which also has information for volunteering and donating both of which are greatly beneficial to all those who suffer.

Anttila, H., Autti-Ramo, I., Suoranta, J., Makela, M., & Malmivaara, A. (2008). Effectiveness of physical therapy interventions for children with cerebral palsy: A systematic review. BMC Pediatrics., 14-24.



Thursday, 7 April 2016

Plyometric Training for everyday living.

As children, running, jumping and playing hopscotch was part of everyday activities; however, as we age our activities change. Jumping is an activity that is avoided by most adults either by choice or lack of need in their daily lives. 

The skills to develop rapid force production, involved in jumping are as important as balance and strength in keeping us healthy. Participating in regular plyometric training could help prevent a fall and reduce the loss of bone mineral density as we age.

Plyometric training was first identified as a useful training technique for soviet athletes in the 1980’s and has been used extensively for a large variety of athletes. However, every child does some form of plyometric activity through everyday play. 

The aim of plyometric training is to generate large amounts of force over the shortest amount of time as possible. Initially plyometric methods involved dropping from a height forcing the system into eccentric contraction (forced stretch while under contraction load) then contracting concentrically (shortening the muscle, main method of movement) as quickly as possible resulting in jumping. This is still applied in depth jumps. Today, the term plyometric is associated with any jumping exercise, even some that take time to load up rather than the rapid transfer of contraction methods.

Plyometric training largely focuses on concentric contractions: that is the shortening of muscles. It can also be applied to eccentric movements which can be more beneficial for injury prevention. Eccentric contractions are controlled lengthening of the muscle while still contracting. How does this help? By increasing one’s ability to generate substantial force quickly it will reduce the risk of falls. For instance, if you tripped you would be able to move your leg quickly enough to stabilise and prevent yourself from falling completely. In the elderly, falls are the number 1 reason for hospitalisation and loss of independence. 

It has long been known that bone mineral density (BMD) reduces as we age. We typically reach peak BMD in our 20’s. A reduced BMD increases the risk of fractures and broken bones from falls. Females are at greater risk of low BMD and increased rates of BMD loss especially post-menopausal women. There are several things that have a positive effect on BMD by reducing the rate of loss, or increasing the peak BMD for younger people. These include consumption of calcium rich foods regularly, getting enough vitamin D through exposure to sunlight and strength training. Of the many types of strength training, plyometric training has been shown to have the greatest impact on BMD.

Exercises and recommendations
There is a large variety of plyometric exercises employed by athletes that require equipment and coaching. Fortunately many can be done in the home or any open space. It is best to perform exercises on a soft surface such as grass or a yoga mat.

Firstly jumps, there is a vast variety of jumps, all of which apply plyometric principles.  Two common jumps are explained:
Basic 2 footed jump, it is not a requirement to leave the ground. The aim is to create maximal force acceleration through the calves, quads and glutes vertically. This is done by bending the knee and hips, then straitening them by pushing into the ground as forcefully as possible.

Single leg jump, start standing on one leg bend the knee. Then create maximal contractile force pushing into the ground straightening the knee trying to propel yourself as high as possible, again it is not a requirement to leave the ground.  But the action and force generation are key goals.

Once these simple jumps have been mastered, jumping or hopping directionally will increase the workout and increase stability and balance. Square jumping is one such method. Start by jumping forward then to the side, then back, finally back to the start.   

Depth jumps are very common for increasing force absorption. Start standing elevated to the ground then step off onto the ground and jump as soon as possible. Aim to have as little contact time with the ground as possible. 

Agility training is also another good method to increase force production rates without jumping. The fast changing of direction places similar stress on the tendons and muscles that stimulate the rapid force production. A simple agility set up is 4 points evenly apart, and stand in the middle.  Reach out and touch one of the points before returning to the centre as fast as possible.  Continue reaching out to each of the points and return to the middle each time.

Plyometric exercises are a great additive to your work out to increase speed and power with many other health benefits. They do require substantially more effort than conventional strength training and should be performed on non-consecutive days. So next time you see the kids playing hopscotch why not have a go!

Mark McCutchan
QUT Student Exercise Physiologist

Monday, 14 March 2016

Stretching

Have you ever wondered why stretching is incorporated into a workout routine?  To gain insight into the benefits and limitations of stretching, it is important to have an understanding of the underlying physiology and to define the different types of stretching.

Physiology
Specialised nerve endings called proprioceptors (found in joints, muscles and tendons) detect any changes in tension or force within the body. These proprioceptors related to stretching are located in both tendons and muscle. When a muscle is stretched, proprioceptors detect the change in length and trigger a stretch reflex that initially attempts to resist the change in muscle length by causing the stretched muscle to contract. When you hold a stretch for a prolonged period of time (greater than 30 seconds) the muscle spindle becomes accustomed to the new length and reduces its signaling of being ‘on stretch’. There are also ‘golgi tendon organs’ which are located in the tendons of the muscle .Again, they detect the change in tension. When this tension exceeds a certain threshold, it triggers a lengthening reaction that inhibits the muscle from contracting and causes it to relax.

Stretching types
There are several different ways to stretch, including: static, dynamic, ballistic and PNF (proprioceptive neuromuscular facilitation).

When you hold a static stretch there is an immediate increase in length of the muscle, this is called visoelastic deformation. However, the lengthening is not permanent and usually goes back to it’s original length shortly after finishing the stretch. Longer-term flexibility from stretching is thought to be due to a muscle’s increased tolerance to an uncomfortable stretch sensation. To gain this flexibility, a stretch stretch should be held for longer than 30 seconds.

Proprioceptive Neuromuscular Facilitation (PNF) involves a stretching and contraction component. Similar to static stretching, when the force is sensed the muscles first resists the stretch and then the golgi tendon organs activate and inhibit force produced which means the muscle relaxes, becomes more accustomed to an increased muscle length. The muscle is stretched so that tension is felt, the individual then contracts the stretched muscle group for 5 – 6 seconds while a partner, or something that they can use to apply tension to, applies sufficient resistance to inhibit movement. The contracted muscle group is then relaxed and a controlled stretch is applied for about 20 to 30 seconds.

During a ballistic stretch, the muscle is taken to a stretched range of movement and then a “ballistic” movement is repeatedly applied followed by an equally short relaxation period in an attempt to force the muscle past its normal range of motion. Research has found that ballistic stretching does increase flexibility, however, it is generally not recommended due to excessive muscle forces that place high levels of stress on the muscle and tendon, making injury more likely than a static stretch.

Timing of stretching

Research indicates that stretching before a workout can cause an acute decrease in both maximal strength and power; a feeling of weakness in the stretched muscle; along with a minimal decrease in risk of injuries. Thus, static and PNF stretching is more effective if completed post training or on a separate day (such as a stretching class).

Rather than static stretches, research indicates that best practice before a workout is to increase blood flow along with some dynamic stretching (moving your body through an active range of motion). Research has found that a dynamic warm up can result in short-term increases in strength, power and other measures of muscle performance. It gradually allows your brain to coordinate the passive elements (ligaments and joint capsules) with the active elements (muscle and tendons), which in turn warms up the whole system (your joints, muscles, nerves, coordination, technique, mind) not just one part of the system (muscles)! It's important to do 2-5 minutes of cardio pre dynamic stretches.

Summary:

Static stretching           
  • Completed after training or on a separate day (such as a stretching class)
  • Hold stretch from 30 seconds up to 2 minutes
  • Click here for example.
Ballistic
PNF
  • Completed after training or on a separate day.
  • Hold resisted stretch for 6-10seconds and static stretch for 30 seconds, repeat 2-4 times
  • Click here for an example
Dynamic
  • Completed before training
  • Dynamic movements for a warm up should be specific to the activity. A dynamic warm up should be done for 5 – 10 minutes after 2-5 minutes of easy cardio
  • Start with a walk and then a light jog then include such movements as
    • Standing leg swings
    • Walking lunges
    • Monster walks
    • Butt kicks
    • Each movement can be done for 10-20 repetitions or over a 10-20m distance and repeated 2-3 times. For examples, click here.
       
Experiment with different dynamic warm ups and static/PNF stretches for cool down - see if you notice a difference in your workout performance and recovery! 
  

Sunday, 28 February 2016

Plums and Weight Loss

Landline recently aired a program on the antioxidant-rich plum accidentally bred by Queensland Scientists ten years ago.

The Queen Ganet plum being hailed as a potential weapon in the fight against obesity. Scientists gave plum juice to obese rats with the same health problems humans have from being overweight -  high blood pressure, a fatty liver, poor heart function and arthritis. When the plum juice was placed in their food (and nothing else was changed within their diet), they lost weight. Additionally, their blood pressure, fat levels, as well as liver and heart function all returned to normal levels.

The Queen Garnet plum has high levels of anthyocyanin, which is a flavonoid high in antioxidants. One plum a day provides the required daily antioxidant levels. The anthocyanin pigment is found in other purple, red and blue foods (such as blueberries, strawberries, raspberries etc). There is increasing evidence that these foods help to reduce inflammation and the structure and function of the gastrointestinal system.

As discussed in previous EPB newsletters, the gut has its own genome and the gut, brain and health connection is extremely significant. Reducing inflammation in the gut and having a balanced level of bacteria is essential for a healthy weight and mind. With this information in mind, it's safe to say that a Queen Garnet plum a day will not go astray!.

The Queen Garnet plum is available from two main sources:
1. The high end grocers if you live in Brisbane or the Gold Coast
2. Woolworths has them throughout the eastern states and they should be available for more than a month.

Nutrafruit, the licensed marketing company, will have powder based products available later in the year (capsules, tablets, powder, etc). Additionally, they finished their first commercial bottling run last week – this is a single strength plum nectar in 250ml bottles. It is suitable to drink straight (about 3 serves per bottle); to mix with water (still or sparkling); or to add to cereals and yoghurt.

For further information, go their website: 
www.nutrafruit.com.au