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We are constantly being told these days how good exercise is for us. It can improve our physical fitness, our mental health and reduce the risk of numerous chronic diseases such as diabetes and heart disease.

Pregnant women used to be told to rest or take it easy, as it was believed that exercise might be harmful for the mother and /or her baby. These days there are more and more studies showing us that lifestyle behaviours during pregnancy can have a huge effect on the woman’s health and that of her baby. Physical activity is now being proposed as a therapeutic measure to reduce pregnancy complications and optimise maternal-fetal health worldwide.

Some of the suggested benefits of physical activity for pregnant women include:

• Improved muscular strength and endurance
• Improved cardiovascular function
• Reduced back and pelvic pain
• Reduced fatigue, stress, anxiety and depression
• Reduced risk of pregnancy-related complications such as pregnancy-induced hypertension or pre-eclampsia
• Reduction in excessive gestational weight gain with fewer delivery complications, and
• Prevention and management of urinary incontinence

What exercise should you do during pregnancy?

• If you were inactive prior to falling pregnant the recommendations are to start being more active by slowly increasing the duration of gentle exercise, such as walking.
• Pregnant women should accumulate at least 150 minutes of moderate intensity physical activity each week to achieve clinically meaningful reduction in pregnancy complications
• This physical activity should be accumulated over a minimum of 3 days/week, however being active daily is encouraged.
• Pregnant women should incorporate a variety of aerobic and resistance training activities to achieve greater benefits. Adding some gentle stretching, such as yoga or pilates may also be beneficial
• Pelvic floor muscle training exercises should be performed daily, to reduce the odds of urinary incontinence. It is advised to get proper instruction on technique to get maximal benefits.
• Women who experience light-headedness, nausea or feel unwell lying on their back are recommended to modify their position and avoid exercising in this position. Do. not exercise on your back in the second and third trimesters.

Some safety precautions for exercising whilst pregnant, include:

• Avoiding activities which involve physical contact or danger of falling, as this may increase the risk of foetal trauma (such as martial arts, horse riding, skiing, hockey, gymnastics, cycling)
• Avoid scuba diving
• Avoid physical activity in excessive heat, especially with high humidity
• Maintain adequate nutrition and hydration – drink water before, during and after physical activity.
• Know the reasons to stop physical activity and seek medical advice immediately if they occur.

First trimester: Correct pelvic floor exercises, proper technique for core exercises, fix any postural imbalances and continue exercising.

Second trimester: Correct pelvic floor exercises, no exercising on your back, no heavy lifting, no new exercise (except Pilates), prevent pelvic pain, maintain muscle strength, improve deep core strength.

Third trimester: Pelvic floor exercises, no exercising on your back or tummy, maintain fitness and strength.

Post-natal:  Whether you had a natural or caesarean delivery, the first 6 weeks is gentle. Enjoy being a mum and focus on walking, pelvic floor exercises and correct deep core exercises. It is best to get your tummy and pelvic floor muscles checked by a physio before returning to exercise. When your baby is 12 weeks old and you have been cleared by your health professional, you can slowly return to your normal exercise routine.

If you have any concerns regarding exercising whilst pregnant or have any aches and pains during your pregnancy it is probably best to seek some advice from a health practitioner, such as your doctor or physiotherapist.

The team at Clifton Hill Physiotherapy have a lot of experience in helping women to start and continue exercising during their pregnancy by managing any aches and pains you have.

We also run small supervised group exercise classes at our Clifton Hill Rehabilitation and Pilates site. Here we provide a tailored exercise program for you to help you to achieve your exercise goals.

Clare Williamson

Physiotherapist

Pilates instructor

References:

Mottola MF, Davenport MH, Ruchat S-M, et al. 2019 Canadian guideline for physical activity throughout pregnancy, British Journal of Sports Medicine 2018; 52: 133-1346

https://sma.org.au/sma-site-content/uploads/2017/08/SMA-Position-Statement-Exercise-Pregnancy.pdf

There is a taboo topic that women are fearful of discussing but should be discussing…something that everyone likes to ignore because it can be embarrassing and a little awkward. The reason we should be discussing prolapse is that 50% of women over the age of 50 that have had a vaginal birth will experience this issue! But it doesn’t just effect women over 50. And there is something we can do about it!

Prolapse of the pelvic organs; commonly known among health professionals as “POP”.

It will affect many women throughout the lifespan and in fact one in four women are currently experiencing one or more prolapse symptoms. These symptoms can include a feeling of heaviness in the vagina, difficulty emptying the bladder or bowel properly, a sense of a lump or bulge in the vagina. What is a prolapse anyway? How does it happen and what are the symptoms? But more importantly how can I prevent it and what can be done for it?

POP means a weakening of the vaginal walls allowing the organs that sit adjacent (bladder, cervix or rectum) to sit lower in the pelvis allowing them to be felt more in the vaginal walls. This issue commonly occurs after a difficult vaginal birth, particularly those involving forceps. It can also occur from long term (years) of straining on the toilet to pass a bowel movement.

POP is commonly the reason that we see women give up sport. The impact of running, jumping, skipping, lifting heavy weights is that is can worsen the symptoms and severity of a prolapse.

The great news is that pelvic floor physiotherapy can help prevent and treat prolapse! We can identify women that are at higher risk to help them understand prevention. We can treat those that are already dealing with prolapse with exercises, lifestyle advice and now a new service at Clifton Hill Physiotherapy – a support pessary.

Issy is credentialed and trained to fit silicone pessaries. This is a product that can allow women to get back to activities which were previously too symptom- provoking or causing concern about worsening their prolapse.

So what is a pessary?

Well it certainly isn’t a new invention although they have come a long way in the past 10 years. They are a soft, silicone device of various shapes; often a ring or a cube which is inserted into the vagina to help support the vaginal walls. Think of it like scaffolding to help support a building. It can be used for sport, lifting toddlers, or every day. When fitted correctly they are completely comfortable and there should be no way of knowing it is even there.

A pessary can be completely transformative. We have fitted them in women who are now back into their running, basketball, cross-fit or general life activities without the worry of making their POP worse. In fact in some women it can actually improve the POP.

If you’re interested in discussing prolapse or a pessary come in and see one of the lovely physiotherapists in the Women’s health team who can help guide you through the process.

Isabella Lees-Trinca 

B Physio Grad Cert Continence and Pelvic Floor Rehabilitation

issy@cliftonhillphysiotherapy.com.au

Busting the myth of Osteoporosis – Physiotherapy can help more than you think.

Osteoporosis – what does it mean?
Osteoporosis is a condition that affects bone density, due to a depletion of minerals like Calcium. This results in the bones in your body being more brittle and more prone to fractures, even with minor bumps or falls.

How would I know if I have Osteoporosis?
Osteoporosis is very common: it has been found to affect over 1 million Australians! 1 in 3 women, and 1 in 5 men over the age of 50 years old are affected and will suffer an osteoporotic fracture (International Osteoporosis Foundation).

Check you risk factors:
– Age: > 50 years old.
– Gender: Females at greater risks due to hormonal changes through life.
– Family history: Genetic predisposition.
– Calcium intake: low calcium results in lower bone density.
– Vitamin D levels: Vitamin D helps absorb Calcium and can also have an effect on bone density.
– Medical history: corticosteroid medication side effects can include low bone density, digestive  malabsorption disorders and chronic illnesses such as rheumatoid arthritis chronic kidney/liver disease can lead to osteoporosis.
– Lifestyle factors and exercise history: low levels of physical activity or low osteogenic exercise levels result in low bone density. Smoking, excessive alcohol consumption and being overweight have also been shown to increase risks of osteoporosis.

There usually are no symptoms until a fracture occurs, so having regular bone scans past the age of 50 is recommended, in consultation with your GP (Osteoporosis Australia).

What type of exercise should I do if I have Osteoporosis? – Osteogenic Exercises

Osteogenic exercises – quite surprisingly, they are actually impact-based exercise training. Unlike the common belief that patients with osteoporosis should stay away from any impact to protect their bones, controlled impact training actually provides an appropriate stimulus of ground reaction force to help stimulate and promote stronger bone density.
This contradicts the commonly thought myth of having to avoid activities like jumping, running or any other impact type of activities when one has been diagnosed with osteoporosis.

Playing basketball or netball is more osteogenic than swimming or cycling – because the body has to adapt to the jumping and impact landing involved in basketball and netball. In other words, our bone production centres react to the specific type of exercise we perform (stimulus) and adapt to the amount of force our body is exposed to.

That’s where your Physiotherapist can help!

Physiotherapists are experts in exercise rehabilitation and will help tailor an exercise program that will match your physical levels and start some impact and resistance training in a safe way for you to slowly and gradually build up your bone density and lean muscle mass.

Introducing: the “Better Bones Program”

– Based on the research study LIFTMOR from Griffith University, in Queensland, published in 2017: “High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial”.

The LIFTMOR study compared a control group, who performed home-based exercises focused on prevention of falls, to a High Intensity Resistance and Impact Training (HIRIT) group, who performed twice weekly physiotherapist-supervised exercise classes for a period of 8 months.
It was found that the HIRIT group had significant improvements at multiple levels compared to the control group at follow-up.

Benefits shown from the LIFTMOR study:
– Increased bone mineral density, measured at the femoral neck and lumbar spine
– Improvement in height (reduction in thoracic kyphosis)
– Increased back extensor strength which has been associated with a reduced risk of vertebral fractures
– Improved general function

Here at Clifton Hill Physiotherapy, we have decided to apply this evidence into clinical practice and we are excited to announce the launching of Bone Health classes!

Brief overview of the class:

– Targeted for anyone 55 years of age and above

– Involves 4 key exercises based on the LIFTMOR study: 1. Deadlifts
2. Overhead press
3. Back squats
4. Jumping chin-ups with drop landings.
The other exercises will aim at improving balance and core strength, arm and leg strength to achieve better function.

– Performed ideally x2/week as per research recommendations

You will first have an individual consult with one of our Physiotherapists to determine your base starting level of fitness and physical capacity to ensure that the exercise and weights you will use are appropriate and safe. The Physiotherapist will also introduce you to the 4 key exercise components and familiarize yourself to the gym prior to joining classes.

Contact our physiotherapists to enquire for more information and for class registrations.

References:

Websites
https://www.iofbonehealth.org/facts-statistics

https://www.osteoporosis.org.au/

https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/estimating-the-prevalence-of-osteoporosis-in-austr/contents/summary

Watson, S. L., Weeks, B. K., Weis, L. J., Harding, A. T., Horan, S. A. and Beck, B. R. (2018), High‐Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial. J Bone Miner Res, 33: 211-220. doi:10.1002/jbmr.3284

Adriane Kablyuk
Physiotherapist

Clare qualified as a physiotherapist in 2000 from the University of the West of England. Since then Clare has worked in the UK, New Zealand and Australia in hospital and private settings. Clare has also completed a Certificate IV in fitness and clinical pilates and recently decided to return to studies and has just completed her Masters in Musculoskeletal Physiotherapy at La Trobe University.

Clare has managed a wide range of acute and chronic musculoskeletal, orthopaedic and sporting conditions over the years and particularly enjoys post-operative rehabilitation of clients.

Clare has experience in hydrotherapy, clinical pilates, and exercise prescription and utilises these skills in combination with hands-on techniques to provide an individualised management plan to promote optimal function and movement, required for returning to work and day-to-day activities. When not working Clare can be found walking the dog, in the gym,  scuba diving in the bay or completing DIY projects around the house.

Professional memberships:

Australian Physiotherapy Association (APA)

Musculoskeletal Physiotherapy Australia

What’s the big deal?

ACL – anterior cruciate ligament- is a major stabilising ligament of the knee- it controls the forward sliding motion of the lower leg and provides rotational stability with movement.

Commonly there will be accompanying bone bruising or fracture, possible cartilage or meniscus tears, or damage to other ligaments in the knee.

In the short term, the injury can result in time off work, inability to participate in sport, and prolonged rehabilitation. On average, professional elite athletes require 9 months out of sport and recreational athletes will take 12 months.  Longer term, there is a high risk of osteoarthritis in people who have suffered an ACL injury, particularly if you sustained a concurrent meniscus injury. The cost of primary ACL reconstructive surgery in Australia between 2014-2015 has been estimated at $142 million, which includes surgical costs only and not the rehabilitation, burden of injury or time off work (Zbrojkiewicz, D., Vertullo, C. & Grayson, J., 2018).

How do they occur?

There is a small subgroup of ACL injuries that occur with contact- that is a direct blow to the knee- e.g. another skier collides with your leg resulting in injury.

The vast majority of these injuries however occur in a “non contact” manner.  In other words, because of a landing error or twisting movement.  It may be a movement that you have done countless times before, a small bump in the air prior to landing, or a timing error causing an awkward movement.

What can we do about them?

There is a growing body of evidence that many of these non-contact injuries can be prevented, and with the cost of ACL injury and the rate of injury on the rise it is crucial that we do everything that we can to avoid them.

“Neuromuscular” training programs have been shown to be effective in reducing the rates of ACL injuries.  These programs are warmup routines that include balance, agility, plyometrics and landing control.   Soccer, netball and AFL have all released sport specific programs that are readily available and should become part of your team’s warm up today (see links below).
A 2018 study (Webster & Hewett) showed neuromuscular training programs reduce the overall rates of ACL injuries by 50%, and in females by 67%. The research shows that the more you do these routines, the more effective the programs are at reducing the rate of injury.  They are not only effective at reducing the rate of serious knee injury, but also all lower limb injuries.  And if that’s not enough to get you started they have also been shown to be PERFORMANCE ENHANCING!  Vertical jump and sprinting ability can improve with regular performance of a neuromuscular program (Garrison et al, 2011).

It is essential that we implement these widely from grass roots level up, and that if you’re not already doing them that you start today!

Footy First http://www.aflcommunityclub.com.au/index.php?id=906

Netball Knee https://knee.netball.com.au/

FIFA 11 Soccer http://www.footballfedvic.com.au/fifa-11plus/

Jane Higgs

Musculoskeletal Physiotherapist

Clifton Hill Physiotherapy

References

Dargo, L., Robinson, K. & Games, K. (2017). Prevention of Knee and Anterior Cruciate Ligament Injuries Through the Use of Neuromuscular and Proprioceptive Training: An Evidence-Based Review. Journal of Athletic Training, 52 (12), p 1171-1172.

Donnell-Fink, L. et al, (2015). Effectiveness of Knee Injury and Anterior Cruciate Ligament Tear Prevention Programs: A Meta-Analysis. PLoS ONE 10(12): e0144063.

Garrison, T., Smith, T., Tutalo, S., Barber-Westin, S., Campbell, D. & Noyes, F. (2011). Benefits of neuromuscular training program for knee injury prevention and performance enhancement in high school female basketball players. Journal of Strength and Conditioning Research, 25, pS12-S13.

Ramirez, R., Baldwin, K. & Franklin, C. (2014). Prevention of anterior cruciate ligament injuries in female athletes. Journal of Bone and Joint Surgery, 2 (9): e3.

Shaw, L. & Finch, C. (2017). Trends in Pediatric and Adolescent Anterior Cruciate Ligament Injuries in Victoria, Australia 2005–2015. International journal of environmental research and public health, 14, 599.

Webster, K. & Hewett, T. (2018). Meta-analysis of meta-analyses of anterior cruciate ligament injury reduction training programs. Journal of orthopaedic research. doi: 10.1002/jor.24043. [Epub ahead of print]

Zbrojkiewicz, D., Vertullo, C. & Grayson, J. (2018). Increasing rates of anterior cruciate ligament reconstruction in young Australians, 2000–2015. The Medical Journal of Australia, 208 (8): 354-358.