tag:theconversation.com,2011:/ca/topics/physiotherapy-4926/articlesPhysiotherapy – The Conversation2024-02-28T18:02:06Ztag:theconversation.com,2011:article/2202532024-02-28T18:02:06Z2024-02-28T18:02:06ZPersistent shoulder pain: Are exercises always necessary to relieve symptoms?<figure><img src="https://images.theconversation.com/files/566901/original/file-20231206-19-pkjjrg.jpg?ixlib=rb-1.1.0&rect=2%2C0%2C986%2C667&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The presence of pain, especially when it persists over time, is not necessarily a sign that your condition is deteriorating.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>It is estimated that <a href="https://pubmed.ncbi.nlm.nih.gov/15163107/">close to 70 per cent</a> of the population will experience shoulder pain at some point in their lives. </p>
<p>In itself, this pain would not pose a problem if it disappeared as quickly as it appeared. Unfortunately, it tends to persist over time. In half of patients, <a href="https://pubmed.ncbi.nlm.nih.gov/8806252/">the pain persists or reoccurs one year</a> after its initial appearance. It can even persist for several years in some cases.</p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/8917870/">Approximately 70 per cent</a> of shoulder pain episodes requiring consultation with a health-care provider can be identified as <a href="https://pubmed.ncbi.nlm.nih.gov/27083390/">rotator cuff related shoulder pain</a>. This refers to pain and loss of function in the shoulder, mainly during movements requiring the arm to be lifted. Although a number of effective options are available to patients, <a href="https://pubmed.ncbi.nlm.nih.gov/10226960/">a third of them</a> will not experience any significant improvement in their condition, regardless of the interventions used. </p>
<p>There are several possible reasons for this limited success. <a href="https://academic.oup.com/ptj/article/101/7/pzab072/6145046?login=true">Exercise selection</a> and some <a href="https://bjsm.bmj.com/content/52/4/269">psychological and contextual characteristics</a> specific to each individual have been identified as potential hypotheses.</p>
<p>As experts in the field of shoulder pain, we propose to shed light on the effectiveness of various interventions for the management of shoulder pain, and the role that some variables may play in the resolution of this pain.</p>
<h2>Some important questions</h2>
<p>Our research team therefore set out to find out: </p>
<ol>
<li><p>Whether one type of exercise should be prioritized over another in the management of shoulder pain.</p></li>
<li><p>Whether the addition of exercises (the pet peeve of many people who consult a rehabilitation provider) lead to additional benefits compared with an intervention comprising only of education and advice to foster pain self-management.</p></li>
<li><p>Whether some psychological and contextual characteristics, such as participants’ expectations of the intervention effectiveness and pain self-efficacy, are associated with a better prognosis.</p></li>
</ol>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/16446108/">Pain self-efficacy</a> is the level of confidence someone has in their ability to carry out their activities and achieve their goals despite pain.</p>
<h2>How did we go about answering those questions?</h2>
<p>In our <a href="https://bjsm.bmj.com/content/57/8/457">new study</a> published in the <em>British Journal of Sports Medicine</em>, 123 people with shoulder pain lasting for more than three months were randomly assigned to one of three 12-week interventions: </p>
<ul>
<li><p>Education </p></li>
<li><p>Education combined with motor control exercises </p></li>
<li><p>Education combined with strengthening exercises </p></li>
</ul>
<p>Questionnaires were used to monitor changes in participants’ condition over time, particularly in terms of their pain and functional capacity. </p>
<p>Before the start of the intervention, we also used <a href="https://journals.lww.com/painrpts/fulltext/2021/11000/measurement_properties_of_the_pain_self_efficacy.21.aspx">questionnaires</a> to measure participants’ expectations of the effectiveness of the intervention they were about to receive, as well as their level of pain self-efficacy. </p>
<h2>The content of each group</h2>
<p><em>Education</em></p>
<p>Participants in this group received two sessions of education and advice with a physiotherapist. The information was about the shoulder and pain, and the advice included strategies for the self-management of their condition. </p>
<p>Participants were also told about the importance of being active and adopting a healthy lifestyle to optimize the management of persistent pain, including proper diet, hydration, stress management and sleep hygiene. </p>
<p>Finally, participants were asked to watch six short videos on these themes. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/5bUf9VcYLmI?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Example of a video that study participants were asked to watch.</span></figcaption>
</figure>
<p>After viewing, they were asked to identify the aspects they felt were important and those that raised questions in order to discuss them with the physiotherapist.</p>
<p><em>Education combined with motor control exercises</em></p>
<p>As well as receiving this education, the participants in this group completed a 12-week exercise program. </p>
<p>The exercises included modifications in the way they performed their movements to enable them to move their arm with less pain. These modifications were integrated with exercises reproducing gestures involving the shoulder during daily activities.</p>
<p><em>Education combined with strengthening exercises</em></p>
<p>Again, participants in this group received the same education component. </p>
<p>They also received a shoulder muscle strengthening program to be performed daily for 12 weeks.</p>
<h2>The results of our study</h2>
<p><a href="https://blogs.bmj.com/bjsm/2023/04/17/does-the-addition-of-motor-control-or-strengthening-exercises-to-education-result-in-better-outcomes-for-rotator-cuff-related-shoulder-pain/">At the end of the study</a>, participants in all three groups showed improvements in pain and function. However, the addition of exercises (motor control or strengthening) to the education intervention did not lead to additional benefits. </p>
<p>People recruited into the study whose symptoms were considered resolved following the 12-week intervention had more positive expectations regarding the effectiveness of their intervention and had higher levels of pain self-efficacy. </p>
<h2>Key messages</h2>
<p>Adding strengthening or motor control exercises to an educational intervention did not result in additional benefits compared to an approach based solely on education and advice. For some people with persistent shoulder pain, education and advice focusing on pain self-management may be sufficient to promote symptom resolution. </p>
<p>Exercise, in any form, remains a highly relevant intervention for <a href="https://www.jospt.org/doi/full/10.2519/jospt.2022.11306">shoulder pain management</a>, as well as for <a href="https://bjsm.bmj.com/content/53/14/856">maintaining independence</a> and <a href="https://bjsm.bmj.com/content/57/18/1203">optimizing long-term health</a>. </p>
<p>Participants’ pain self-efficacy and expectations of the effectiveness of the intervention they receive may play a role in the prognosis of their shoulder pain. </p>
<h2>But above all…</h2>
<p>When you’re experiencing shoulder pain, it can be beneficial to temporarily reduce certain activities that can aggravate your pain. However, it’s important not to delay gradually reintegrating these activities into your daily routine. </p>
<p>The presence of pain, especially when it persists over time, <a href="https://pubmed.ncbi.nlm.nih.gov/32694387/">is not necessarily a sign that your condition is deteriorating</a>. It could simply indicate that the gestures or activities performed exceed the <a href="https://therunningclinic.com/mechanical-stress-quantification/">shoulder’s current ability to tolerate the load imposed on it</a>. </p>
<p>In any case, don’t hesitate to consult a health professional, such as a <a href="https://oppq.qc.ca/">physiotherapist</a>, who will be able to help you “shoulder” the responsibility of managing your condition.</p><img src="https://counter.theconversation.com/content/220253/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marc-Olivier Dubé is a member of the Ordre Professionnel de la Physiothérapie du Québec (OPPQ). He is the recipient of a postdoctoral fellowship from the Fonds de recherche du Québec - Santé (FRQS).</span></em></p><p class="fine-print"><em><span>Jean-Sébastien Roy received funding from Canadian Institutes of Health Research, Fonds de recherche du Québec - Santé (FRQS), Arthritis Society Canada and Natural Sciences and Engineering Research Council of Canada. </span></em></p><p class="fine-print"><em><span>François Desmeules ne travaille pas, ne conseille pas, ne possède pas de parts, ne reçoit pas de fonds d'une organisation qui pourrait tirer profit de cet article, et n'a déclaré aucune autre affiliation que son organisme de recherche.</span></em></p>Education and advice, as well as exercise, can play a role in the management of shoulder pain.Marc-Olivier Dubé, Physiothérapeute, Chercheur postdoctoral en réadaptation, Université LavalFrançois Desmeules, Professeur titulaire en physiothérapie et en santé musculosquelettique, École de réadaptation, Université Montréal, Université de MontréalJean-Sébastien Roy, Professeur titulaire à l'École des sciences de la réadaptation, Université LavalLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2225132024-02-19T19:04:30Z2024-02-19T19:04:30ZHow long does back pain last? And how can learning about pain increase the chance of recovery?<figure><img src="https://images.theconversation.com/files/576603/original/file-20240219-18-edti6b.jpg?ixlib=rb-1.1.0&rect=60%2C60%2C6639%2C4406&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/upset-mature-woman-suffering-backache-after-1504807832">fizkes/Shutterstock</a></span></figcaption></figure><p>Back pain is common. One in thirteen people have it right now and worldwide a staggering 619 million people will <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7186678/">have it this year</a>.</p>
<p>Chronic pain, of which back pain is the most common, is the world’s <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7186678/">most disabling</a> health problem. Its economic impact <a href="https://www.ncbi.nlm.nih.gov/books/NBK92510/">dwarfs other health conditions</a>. </p>
<p>If you get back pain, how long will it take to go away? We scoured the scientific literature to <a href="https://www.cmaj.ca/content/cmaj/196/2/E29.full.pdf">find out</a>. We found data on almost 20,000 people, from 95 different studies and split them into three groups: </p>
<ul>
<li>acute – those with back pain that started less than six weeks ago</li>
<li>subacute – where it started between six and 12 weeks ago</li>
<li>chronic – where it started between three months and one year ago. </li>
</ul>
<p>We found 70%–95% of people with acute back pain were likely to recover within six months. This dropped to 40%–70% for subacute back pain and to 12%–16% for chronic back pain.</p>
<p>Clinical guidelines point to graded return to activity and pain education under the guidance of a health professional as the best ways to promote recovery. Yet these effective interventions are underfunded and hard to access.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-cognitive-functional-therapy-how-can-it-reduce-low-back-pain-and-get-you-moving-207009">What is cognitive functional therapy? How can it reduce low back pain and get you moving?</a>
</strong>
</em>
</p>
<hr>
<h2>More pain doesn’t mean a more serious injury</h2>
<p>Most acute back pain episodes are <a href="https://www.racgp.org.au/getattachment/75af0cfd-6182-4328-ad23-04ad8618920f/attachment.aspx">not caused</a> by serious injury or disease.</p>
<p>There are rare exceptions, which is why it’s wise to see your doctor or physio, who can check for signs and symptoms that warrant further investigation. But unless you have been in a significant accident or sustained a large blow, you are unlikely to have caused much damage to your spine. </p>
<figure class="align-center ">
<img alt="Factory worker deep-breathes with a sore back" src="https://images.theconversation.com/files/575505/original/file-20240214-24-yvwksc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/575505/original/file-20240214-24-yvwksc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/575505/original/file-20240214-24-yvwksc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/575505/original/file-20240214-24-yvwksc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/575505/original/file-20240214-24-yvwksc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/575505/original/file-20240214-24-yvwksc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/575505/original/file-20240214-24-yvwksc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Your doctor or physio can rule out serious damage.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/asian-man-worker-warehouse-have-accident-2181811499">DG fotostock/Shutterstock</a></span>
</figcaption>
</figure>
<p>Even very minor back injuries can be brutally painful. This is, in part, because of how we are made. If you think of your spinal cord as a very precious asset (which it is), worthy of great protection (which it is), a bit like the crown jewels, then what would be the best way to keep it safe? Lots of protection and a highly sensitive alarm system.</p>
<p>The spinal cord is protected by strong bones, thick ligaments, powerful muscles and a highly effective alarm system (your nervous system). This alarm system can trigger pain that is so unpleasant that you cannot possibly think of, let alone do, anything other than seek care or avoid movement. </p>
<p>The messy truth is that when pain persists, the pain system becomes more sensitive, so a widening array of things contribute to pain. This pain system hypersensitivity is a result of neuroplasticity – your nervous system is becoming better at making pain. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-pain-and-what-is-happening-when-we-feel-it-49040">Explainer: what is pain and what is happening when we feel it?</a>
</strong>
</em>
</p>
<hr>
<h2>Reduce your chance of lasting pain</h2>
<p>Whether or not your pain resolves is not determined by the extent of injury to your back. We don’t know all the factors involved, but we do know there are things that you can do to reduce chronic back pain:</p>
<ul>
<li><p>understand how pain really works. This will involve intentionally learning about modern pain science and care. It will be difficult but rewarding. It will help you work out what you can do to change your pain </p></li>
<li><p>reduce your pain system sensitivity. With guidance, patience and persistence, you can learn how to gradually retrain your pain system back towards normal.</p></li>
</ul>
<h2>How to reduce your pain sensitivity and learn about pain</h2>
<p>Learning about “how pain works” provides the most sustainable <a href="https://www.bmj.com/content/376/bmj-2021-067718">improvements in chronic back pain</a>. Programs that combine pain education with graded brain and body exercises (gradual increases in movement) can reduce pain system sensitivity and help you return to the life you want. </p>
<figure class="align-center ">
<img alt="Physio helps patient use an exercise strap" src="https://images.theconversation.com/files/575501/original/file-20240214-22-gzb0hs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/575501/original/file-20240214-22-gzb0hs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=402&fit=crop&dpr=1 600w, https://images.theconversation.com/files/575501/original/file-20240214-22-gzb0hs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=402&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/575501/original/file-20240214-22-gzb0hs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=402&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/575501/original/file-20240214-22-gzb0hs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=506&fit=crop&dpr=1 754w, https://images.theconversation.com/files/575501/original/file-20240214-22-gzb0hs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=506&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/575501/original/file-20240214-22-gzb0hs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=506&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some programs combine education with gradual increases in movement.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-physiotherapist-exercising-senior-patient-physic-2130321380">Halfpoint/Shutterstock</a></span>
</figcaption>
</figure>
<p>These programs have been in development for years, but high-quality clinical trials <a href="https://jamanetwork.com/journals/jama/fullarticle/2794765">are now emerging</a> and it’s good news: they show most people with chronic back pain improve and many completely recover.</p>
<p>But most clinicians aren’t equipped to deliver these effective programs – <a href="https://www.jpain.org/article/S1526-5900(23)00618-1/fulltext">good pain education</a> is not taught in most medical and health training degrees. Many patients still receive ineffective and often risky and expensive treatments, or keep seeking temporary pain relief, hoping for a cure. </p>
<p>When health professionals don’t have adequate pain education training, they can deliver bad pain education, which leaves patients feeling like they’ve just <a href="https://www.jpain.org/article/S1526-5900(23)00618-1/fulltext">been told it’s all in their head</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/opioids-dont-relieve-acute-low-back-or-neck-pain-and-can-result-in-worse-pain-new-study-finds-203244">Opioids don't relieve acute low back or neck pain – and can result in worse pain, new study finds</a>
</strong>
</em>
</p>
<hr>
<p>Community-driven not-for-profit organisations such as <a href="https://www.painrevolution.org/">Pain Revolution</a> are training health professionals to be good pain educators and raising awareness among the general public about the modern science of pain and the best treatments. Pain Revolution has partnered with dozens of health services and community agencies to train more than <a href="https://www.painrevolution.org/find-a-lpe">80 local pain educators</a> and supported them to bring greater understanding and improved care to their colleagues and community. </p>
<p>But a broader system-wide approach, with government, industry and philanthropic support, is needed to expand these programs and fund good pain education. To solve the massive problem of chronic back pain, effective interventions need to be part of standard care, not as a last resort after years of increasing pain, suffering and disability.</p><img src="https://counter.theconversation.com/content/222513/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Wallwork receives payments for lectures on pain and rehabilitation. Sarah was funded by an NHMRC Investigator Grant awarded to GL Moseley (ID 1178444).</span></em></p><p class="fine-print"><em><span>Lorimer Moseley has received support from: Reality Health, ConnectHealth UK, Institutes of Health California, AIA Australia, Workers’ Compensation Boards and professional sporting organisations in Australia, Europe, South and North America. Professional and scientific bodies have reimbursed him for travel costs related to presentation of research on pain and pain education at scientific conferences/symposia. He has received speaker fees for lectures on pain, pain education and rehabilitation. He receives royalties for books on pain and pain education. He is non-paid CEO of the non-profit Pain Revolution, an unpaid Director of Painaustralia and an unpaid Director of Australian Pain Solutions Research Alliance.</span></em></p>Back pain is common. One in thirteen people have it right now and worldwide a staggering 619 million people will have it this year. Chronic pain, of which back pain is the most common, is the world’s most…Sarah Wallwork, Post-doctoral Researcher, University of South AustraliaLorimer Moseley, Professor of Clinical Neurosciences and Foundation Chair in Physiotherapy, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2028522023-05-16T00:22:13Z2023-05-16T00:22:13ZDo high top shoes actually reduce ankle sprain risk? Here’s what the research says<figure><img src="https://images.theconversation.com/files/523978/original/file-20230503-21-w1vpab.jpg?ixlib=rb-1.1.0&rect=0%2C27%2C5943%2C3944&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Ankle sprain is one of the most common musculoskeletal injuries, particularly in sports like netball, basketball and football where jumping, landing on one foot and sudden direction changes are part of the game.</p>
<p>Ankle sprains can be painful, debilitating and may result in ongoing ankle problems. In fact, people with a history of a previous ankle sprain are <a href="https://theconversation.com/why-do-i-sprain-my-ankle-so-often-and-how-can-i-cut-the-risk-of-it-happening-again-190751">more likely</a> to sprain an ankle again in future.</p>
<p>Prevention is key. In an effort to reduce sprain risk, many people look for “high-top” shoes, where the section around the side of the shoe (also known as the “collar”) extends up closer to the ankle.</p>
<p>But what does the research say? Do high-top shoes actually reduce your sprain risk?</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/523959/original/file-20230503-22-a7yuex.jpg?ixlib=rb-1.1.0&rect=0%2C18%2C6230%2C4128&q=45&auto=format&w=1000&fit=clip"><img alt="A person wears high top shoes." src="https://images.theconversation.com/files/523959/original/file-20230503-22-a7yuex.jpg?ixlib=rb-1.1.0&rect=0%2C18%2C6230%2C4128&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/523959/original/file-20230503-22-a7yuex.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/523959/original/file-20230503-22-a7yuex.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/523959/original/file-20230503-22-a7yuex.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/523959/original/file-20230503-22-a7yuex.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/523959/original/file-20230503-22-a7yuex.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/523959/original/file-20230503-22-a7yuex.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">In an effort to reduce sprain risk, many people look for high-top shoes.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-do-i-sprain-my-ankle-so-often-and-how-can-i-cut-the-risk-of-it-happening-again-190751">Why do I sprain my ankle so often? And how can I cut the risk of it happening again?</a>
</strong>
</em>
</p>
<hr>
<h2>High-tops don’t always help – and can sometimes harm</h2>
<p>Plenty of research exists on this topic but unravelling the truth is complicated by inconsistency between studies. Researchers may have different ways of investigating the issue, of measuring the shoes success, or even different ways of defining a “high-top” shoe. </p>
<p>For example, the reported difference in collar height between “high-top” to “low-top” shoes was considerable, ranging from 4.3 to 8.5cm across <a href="https://journals.sagepub.com/doi/pdf/10.1177/2210491720950325">different studies</a>. </p>
<p>That said, the trend in the current research literature suggests the ankle protection provided by high-top shoes may not be enough to significantly reduce sprain risk while playing sport. </p>
<p>In fact, this design may also reduce athletic performance, and increase the risk of ankle sprain in some people.</p>
<p><a href="https://journals.sagepub.com/doi/pdf/10.1177/2210491720950325">Research</a> does support the idea high-top shoes provide good stability when outside forces may cause an ankle sprain when the person is stationary (for example, when a person standing still is knocked from the side and starts to topple over, putting stress on the ankle).</p>
<p>However, once you start moving it’s a different story. In fact, some research suggests high-top shoes may even increase the risk of ankle sprain in some activities. </p>
<p>This may be because these shoes can change the way we use the muscles in our ankles and legs.</p>
<p>Specifically the muscles on the <a href="https://jfootankleres.biomedcentral.com/articles/10.1186/1757-1146-7-14">outside</a> of the lower leg may start firing later and not work as strongly to stiffen the ankle when your’re wearing high top shoes (compared to low top shoes).</p>
<p>To reduce ankle sprain risk, it is important the muscles on both sides of the legs <a href="https://www.sciencedirect.com/science/article/pii/S0021929016311563?via%3Dihub">work together</a> at the same time.</p>
<p>Tellingly, delayed and weaker activation of the muscles on the outside of the lower leg is <a href="https://pubmed.ncbi.nlm.nih.gov/23899892/">greater</a> in people with chronic ankle instability. This finding suggests high-top shoes may not be the best choice for anyone with a history of ankle sprain. </p>
<p>There is also some <a href="https://www.tandfonline.com/doi/abs/10.1080/026404197367146">evidence</a> wearing high-top shoes may impede athletic performance by reducing jump height and increasing shock transmission to other parts of the body.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/524264/original/file-20230504-26-jbv9o5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/524264/original/file-20230504-26-jbv9o5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/524264/original/file-20230504-26-jbv9o5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/524264/original/file-20230504-26-jbv9o5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/524264/original/file-20230504-26-jbv9o5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/524264/original/file-20230504-26-jbv9o5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/524264/original/file-20230504-26-jbv9o5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/524264/original/file-20230504-26-jbv9o5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">What is crucial when selecting footwear is good fit and good function.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Getting the right fit</h2>
<p>External supports such as tape and braces are effective in both uninjured and previously injured ankles. But they’re <a href="https://meridian.allenpress.com/jat/article/54/6/650/420871/Prevention-of-Lateral-Ankle-Sprains">most effective</a> when used in combination with preventive exercise programs.</p>
<p>What is crucial when selecting footwear is good fit and good function. Footwear should fit the foot in length, width and depth, with a thumb’s width between the end of the longest toe and the tip of the shoe. You should have enough space across the ball of the foot for it to not be pulled tight when standing. </p>
<p>However, around <a href="https://jfootankleres.biomedcentral.com/articles/10.1186/s13047-018-0284-z">70%</a> of people are wearing shoes that are not fitted appropriately. Women and girls more often have shoes that are too narrow, and older males often wear shoes that are too long. </p>
<p>Ill-fitting footwear <a href="https://www.sciencedirect.com/science/article/pii/S0966636221001478?via%3Dihub">can</a> increase falls, induce greater levels of osteoarthritis and impedes natural foot function in adults and children. </p>
<p>Make sure you’ve got the right shoe for the job. Form must suit function.</p>
<p>As an example, there’s merit in wearing a well-fitted high-top sneaker during static, standing based activities.</p>
<p>However, a low-top sneaker may be more beneficial during sporting activities that require frequent stopping, jumping, sudden changes in direction or for people with a <a href="https://jfootankleres.biomedcentral.com/articles/10.1186/1757-1146-7-14">history of ankle sprains</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/running-shoes-may-cause-injuries-but-is-going-barefoot-the-fix-135264">Running shoes may cause injuries – but is going barefoot the fix?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/202852/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kristin Graham is affiliated with Australian Podiatry Association. Non executive member. </span></em></p><p class="fine-print"><em><span>Helen Banwell has received in-kind support from ASICS Oceania and Skobi in the last two years. Neither funded the relevant studies – just gave us the shoes. I am currently involved as an external ‘content expert’ on a study with Monash with Bobux shoes but the study has been on hold since Covid started and I’m not receiving any monies for my involvement. </span></em></p><p class="fine-print"><em><span>Ryan Causby receives funding from Australasian Podiatry Education Research Fund. He is a Director on the Australasian Council of Podiatry Deans and a member of the Australian Podiatry Association.</span></em></p><p class="fine-print"><em><span>Lewis Ingram and Saravana Kumar do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The ankle protection provided by high-top shoes may not be enough to reduce sprain risk significantly. In fact, this design may reduce athletic performance, and increase risk of ankle sprain for some.Kristin Graham, Lecturer in Podiatry, University of South AustraliaHelen Banwell, Lecturer in Podiatry, University of South AustraliaLewis Ingram, Lecturer in Physiotherapy, University of South AustraliaRyan Causby, Dean of Programs (Allied Health), University of South AustraliaSaravana Kumar, Professor in Allied Health and Health Services Research, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2001672023-05-09T04:34:19Z2023-05-09T04:34:19ZWhy exercising your ‘good arm’ can also help the one in a sling<figure><img src="https://images.theconversation.com/files/522913/original/file-20230426-105-itdelq.jpg?ixlib=rb-1.1.0&rect=45%2C5%2C3788%2C2149&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/male-arm-sling-suffering-pain-shoulder-1461799133">Shutterstock</a></span></figcaption></figure><p>Injured limbs need rest. They are often kept in a sling or cast to immobilise them as a way to promote healing. But that can mean smaller and weaker muscles several weeks later. It takes a long time to rehabilitate these muscles and muscle strength and function <a href="https://link.springer.com/article/10.2165/00007256-199010010-00005">may not be fully restored</a> for some people.</p>
<p>Experts are learning more and more about the “<a href="https://theconversation.com/broke-your-arm-exercise-the-other-one-to-strengthen-it-103241">cross-education effect</a>” where training one side of the body results in an increased strength of the opposite side of the body. Our recent <a href="https://pubmed.ncbi.nlm.nih.gov/36849120/">study</a> shows it can also stop muscle wasting in the “unused” arm. </p>
<p>So, how can we harness that effect?</p>
<h2>How it works</h2>
<p>First <a href="https://vlp-new.ur.de/records/lit23174/files/lit23174_merged.pdf">discovered</a> 100 years ago, the mechanisms underpinning the cross-education effect have not been fully clarified yet. But it is <a href="https://pubmed.ncbi.nlm.nih.gov/29995227/">likely associated</a> with neural adaptations in the motor cortex of the brain that controls movement in the body. </p>
<p>Researchers have <a href="https://www.tandfonline.com/doi/epdf/10.1080/10833196.2018.1499272?needAccess=true&role=button">reviewed</a> almost 100 studies and showed the average cross-body transfer ratio between the strength gain in the trained muscle to non-trained muscle ranged from 48% to 77%. So, if your trained arm strength increased by 20% after training the same muscle of your non-trained arm strength might increase by 10% even though you did nothing with that arm.</p>
<p>Such changes <a href="https://pubmed.ncbi.nlm.nih.gov/29995227/">could be due</a> to increased cortical excitability (the brain activity to control movement), reduced cortical inhibition (the signal to stop movements), reduced inter-hemispheric inhibition (the signals that direct movement instructions to one side of the body but not the other), changes in voluntary activation or new brain regions getting switched on. </p>
<p>It appears the type of muscle contraction in the training affects the extent of the cross-education effect. </p>
<p>There are three types of muscle contractions: </p>
<ul>
<li>isometric (static) where the force produced by a muscle is equal to the load to the muscle, such as holding a dumbbell </li>
<li>concentric (shortening) in which force is greater than load, such as lifting a dumbbell</li>
<li>eccentric (lengthening) in which force is less than load, such as lowering a dumbbell. </li>
</ul>
<p>Muscles can produce greater force during eccentric than isometric or concentric contractions. And less fatigue is induced during eccentric than other contractions. <a href="https://www.betterhealth.vic.gov.au/health/healthyliving/resistance-training-health-benefits">Resistance exercises</a> – when muscles work against a weight or force – increase muscular strength and endurance using these types of muscle contractions.</p>
<p>Several <a href="https://pubmed.ncbi.nlm.nih.gov/26037804/">studies</a> report exercise consisting of <a href="https://pubmed.ncbi.nlm.nih.gov/26037804/">eccentric-only muscle contractions</a> (say, lowering a dumbbell but not lifting it) produces <a href="https://pubmed.ncbi.nlm.nih.gov/31524834/">greater cross-education effect</a> than exercise consisting of concentric-only (lifting only) or concentric-eccentric contractions (lifting and lowering). </p>
<p>One <a href="https://pubmed.ncbi.nlm.nih.gov/26037804/">study</a> showed eccentric exercise training affected brain-spine responses and stopping (inhibition) signals of the untrained limb to a greater extent than concentric training.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/522915/original/file-20230426-152-m0lbdx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="woman in gym setting holding dumbbell in one hand" src="https://images.theconversation.com/files/522915/original/file-20230426-152-m0lbdx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/522915/original/file-20230426-152-m0lbdx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/522915/original/file-20230426-152-m0lbdx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/522915/original/file-20230426-152-m0lbdx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/522915/original/file-20230426-152-m0lbdx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/522915/original/file-20230426-152-m0lbdx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/522915/original/file-20230426-152-m0lbdx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Lowering a dumbbell is an example of an eccentric exercise.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/fat-woman-holding-dumbbell-excessive-belly-1774886543">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/is-foam-rolling-effective-for-muscle-pain-and-flexibility-the-science-isnt-so-sure-170878">Is foam rolling effective for muscle pain and flexibility? The science isn't so sure</a>
</strong>
</em>
</p>
<hr>
<h2>What we studied</h2>
<p>In 2021, we <a href="https://bmcsportsscimedrehabil.biomedcentral.com/articles/10.1186/s13102-021-00298-w">compared</a> eccentric and concentric resistance exercise training for cross-education effect in which 18 young people (aged 20–23) performed progressive elbow flexor resistance training with one arm twice a week for five weeks using a dumbbell.</p>
<p>Both eccentric (lengthening) and concentric (shortening) training groups increased muscle strength similarly after the training (by 23 to 26%) for the trained arm. But the non-trained arm showed greater strength increase after eccentric (23%) than concentric training (12%). The cross-body transfer ratio (the correspondence between the strength gain in both sides) was much greater (91%) for eccentric training when participants lowered a dumbbell only compared to concentric training (49%) when they lifted it.</p>
<p>This tallies with our previous <a href="https://pubmed.ncbi.nlm.nih.gov/31524834/">study</a> that showed greater strength gains and cross-education effect from eccentric training.</p>
<p>Published in February, our most recent study involved 12 young men and <a href="https://journals.lww.com/acsm-msse/Abstract/9900/Effects_of_Unilateral_Eccentric_versus_Concentric.216.aspx">showed</a> how training one arm can prevent weakening of the other. No training saw muscle strength and size of the inactive arm reduced by up to 17%. Concentric training reduced the loss to to 4%. But eccentric training increased the immobilised arm strength by 4% and completely abolished atrophy (muscle wasting). </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/four-reasons-swimming-should-be-your-next-workout-197249">Four reasons swimming should be your next workout</a>
</strong>
</em>
</p>
<hr>
<h2>What to ask your physio</h2>
<p>These findings support the recommendation of resistance training using eccentric or lengthening movements of the non-immobilised limb to prevent muscle strength loss and atrophy in real injuries such as ligament sprains and tears or bone fractures and after surgery.</p>
<p>This type of training has not been used extensively in rehabilitation so far. Further investigation into the mechanisms at play is needed but our findings could inform changes to how rehabilitation is implemented. </p>
<p>If you’re injured and or have had surgery and have an arm or leg immobilised, it’s worth discussing with your doctor, surgeon or physio whether exercising the corresponding limb on your good side – especially with lengthening movements against resistance or with a weight – could be worth trying. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/hot-pack-or-cold-pack-which-one-to-reach-for-when-youre-injured-or-in-pain-161086">Hot pack or cold pack: which one to reach for when you're injured or in pain</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/200167/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ken Nosaka does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Working one arm or leg could help strengthen the corresponding injured or immobilised limb and also stop it wasting away from lack of use.Ken Nosaka, Professor of Exercise and Sports Science, Edith Cowan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2023462023-04-20T23:20:21Z2023-04-20T23:20:21ZWhat are dead hangs? What are the shoulder pain risks and how do I do them safely?<figure><img src="https://images.theconversation.com/files/520408/original/file-20230412-26-w7zknd.jpg?ixlib=rb-1.1.0&rect=0%2C24%2C5384%2C2478&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>You might have seen media articles or fitness influencers online urging people to do “dead hangs”, where one hangs loosely from a bar – usually with feet off the floor. The goal is usually to improve upper-body strength and shoulder stability, or stretch out muscles around the shoulder. </p>
<p>But what does the science say? Are dead hangs good for shoulder health?</p>
<p>As with so many things health and fitness, it’s not an easy “yes” or “no”. It really depends on your reason for doing it, your individual biology, and how you do them. For some, dead hangs may risk musculoskeletal injury. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/520405/original/file-20230412-14-evx9jy.jpg?ixlib=rb-1.1.0&rect=0%2C41%2C7008%2C4616&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/520405/original/file-20230412-14-evx9jy.jpg?ixlib=rb-1.1.0&rect=0%2C41%2C7008%2C4616&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/520405/original/file-20230412-14-evx9jy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/520405/original/file-20230412-14-evx9jy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/520405/original/file-20230412-14-evx9jy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/520405/original/file-20230412-14-evx9jy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/520405/original/file-20230412-14-evx9jy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/520405/original/file-20230412-14-evx9jy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">For some, dead hangs may risk musculoskeletal injury.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>The shoulder: a relatively unstable joint</h2>
<p>Dead hangs <a href="https://sciendo.com/article/10.2478/hukin-2018-0057">may</a> improve grip strength and endurance in rock climbers. This suggests that if you’re well adapted to this type of exercise and have very good upper-body strength, dead hangs may bring hand and forearm benefits.</p>
<p>But while dead hangs may be OK for people with good upper-body strength and no shoulder problems, they can be risky for others. People with shoulder hypermobility (excessive motion of the shoulder) or shoulder instability (such as those who easily dislocate their shoulder) may need to be cautious.</p>
<p>The shoulder, by design, is a relatively unstable joint. It has a large ball-type bone called a humerus, which sits in a relatively small socket called a glenoid.</p>
<p>The passive (non-muscle) tissue around these bones (the capsule, labrum and ligaments) creates a generous space around the shoulder joint – all so you can move your arm though a large range of motion. </p>
<p>Because there’s not much passive support in the shoulder, it relies heavily on active muscle coordination and strength to keep it stable.</p>
<p>The coordination of muscles around the shoulder blade help keep the socket in the right place, and the rotator cuff and deltoid muscles help to control the “ball” in the centre of the socket as you move. </p>
<p>All this means dead hangs, if not done correctly, could present a risk for people with hypermobility in their shoulders.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/520403/original/file-20230412-14-78wq4n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/520403/original/file-20230412-14-78wq4n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/520403/original/file-20230412-14-78wq4n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=390&fit=crop&dpr=1 600w, https://images.theconversation.com/files/520403/original/file-20230412-14-78wq4n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=390&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/520403/original/file-20230412-14-78wq4n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=390&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/520403/original/file-20230412-14-78wq4n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=490&fit=crop&dpr=1 754w, https://images.theconversation.com/files/520403/original/file-20230412-14-78wq4n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=490&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/520403/original/file-20230412-14-78wq4n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=490&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The shoulder, by design, is a relatively unstable joint.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Hypermobility and the shoulder</h2>
<p>Some people have excessive motion of their joints due to increased elasticity of joint tissue. This is called hypermobility and may be in the shoulder or all joints. </p>
<p>The overhead arm position of a complete dead hang puts you in a position where, inside your shoulder, the ball is pulled away from the socket. Hanging your entire body weight can, in hypermobile people, cause the tissue to stretch even more.</p>
<p>People with shoulder hypermobility are more <a href="https://www.mdpi.com/2077-0383/11/17/5140">likely</a> to develop painful shoulder <a href="https://pubmed.ncbi.nlm.nih.gov/1864037/">instability</a>, which is when the ball often pops out of the socket.</p>
<p>Shoulder instability may be caused by acute trauma (such as dislocation). Or it can develop over time from a loss of muscle control, deriving from micro-trauma (by, for example, swimming laps in the pool with hand paddles). </p>
<p>Shoulder instability is associated with <a href="https://www.mdpi.com/2077-0383/11/17/5140">reduced strength and coordination</a> in the shoulder muscles. In people under 40, it’s often <a href="https://pubmed.ncbi.nlm.nih.gov/24079437/?">misdiagnosed</a> as “rotator cuff pain” or “shoulder muscle tightness”.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/520401/original/file-20230412-24-c6w2to.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/520401/original/file-20230412-24-c6w2to.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/520401/original/file-20230412-24-c6w2to.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/520401/original/file-20230412-24-c6w2to.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/520401/original/file-20230412-24-c6w2to.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/520401/original/file-20230412-24-c6w2to.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/520401/original/file-20230412-24-c6w2to.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/520401/original/file-20230412-24-c6w2to.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Some people are more flexible than others in the shoulder.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>What can I do instead of dead hangs?</h2>
<p>Dead hangs require good baseline strength, can risk popping the ball from the socket for some people, and can stretch the passive tissue. They are not the best exercise for those for shoulder hypermobility and instability.</p>
<p>So what’s the alternative? A treatment known as the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5023053/">Watson Instability Program</a> has had good <a href="https://journals.sagepub.com/doi/pdf/10.1177/0363546517734508">results</a> for resolving non-traumatic shoulder instability when compared to a general shoulder strength program. </p>
<p>This program focuses on gaining shoulder blade control (such as the upward rotation you get when you reach up to a high shelf). It involves recruiting the shoulder blade and shoulder joint muscles to improve the contact between the ball and the socket.</p>
<p>Building shoulder blade control and strength can help boost broader shoulder strength. </p>
<h2>Still keen to try dead hangs?</h2>
<p>If you are determined to do dead hangs, remember to:</p>
<ul>
<li><p>start with small increments; hang for just ten seconds or fewer at first, and build from there</p></li>
<li><p>don’t allow yourself to get too fatigued; your shoulder joint can become less stable when it’s tired</p></li>
<li><p>try stepping off a box under the bar rather than jumping up to the bar</p></li>
<li><p>keep some “active” tone in your shoulders as you hang; hanging completely passively can come with risk.</p></li>
</ul>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/520659/original/file-20230413-20-msqtax.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/520659/original/file-20230413-20-msqtax.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/520659/original/file-20230413-20-msqtax.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/520659/original/file-20230413-20-msqtax.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/520659/original/file-20230413-20-msqtax.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/520659/original/file-20230413-20-msqtax.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/520659/original/file-20230413-20-msqtax.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/520659/original/file-20230413-20-msqtax.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Try to keep some active tone in your muscles as you hang.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Our team is conducting a trial of the Watson Instability Program. We are investigating brain changes in patients with multidirectional instability of the shoulder. </p>
<p>If you’re female, aged 18-35, have non-traumatic, right-sided shoulder instability and would like to have the chance to receive six months of free Watson Instability Program physiotherapy treatment as part of our study, please contact either of us or read more about the study <a href="https://melbourneshouldergroup.com/fmri">here</a>.</p><img src="https://counter.theconversation.com/content/202346/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Charlotte Ganderton receives funding from Arthritis Australia, Physiotherapy Research Foundation, Swinburne University of Technology, National Institute of Circus Arts and La Trobe University. Charlotte Ganderton is a member of the Australian Physiotherapy Association and Sports Medicine Australia.</span></em></p><p class="fine-print"><em><span>Sarah Warby consults and receives research funds from the Melbourne Shoulder Group. </span></em></p>While dead hangs may be OK for people with good upper-body strength and no shoulder problems, they can be risky for some.Charlotte Ganderton, Senior lecturer (Physiotherapy), Swinburne University of TechnologySarah Warby, Casual Academic, Physiotherapy, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1943312023-01-03T22:54:28Z2023-01-03T22:54:28ZWho is and isn’t suited to barefoot running? And if I want to try, how do I start?<figure><img src="https://images.theconversation.com/files/498602/original/file-20221202-22-kredno.jpg?ixlib=rb-1.1.0&rect=0%2C85%2C4388%2C2276&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>You might have noticed a buzz on social media about barefoot running, with many proponents breathlessly describing it as the most natural way to run. </p>
<p>But not everyone is a fan. The claims made about going barefoot can range from, “It’s the best thing I’ve ever done” to “I tried it and now I’m in terrible pain.”</p>
<p>So what does the research say about how to drop your usual runners and take up barefoot running, and why it seems to work for some people and not for others?</p>
<p>Our new <a href="https://journals.lww.com/acsm-msse/Abstract/9900/Transitioning_to_Barefoot_Running_Using_a.188.aspx">paper</a>, published in <a href="https://www.acsm.org/education-resources/journals/medicine-science-in-sports-exercise">Medicine & Science in Sports & Exercise</a>, tested a new way of switching from traditional shoe to barefoot running, and investigated why some runners may not tolerate barefoot running. We identified two key characteristics of runners who failed to transition to barefoot running.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/498628/original/file-20221202-24-haemsi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man grips his barefoot while sitting." src="https://images.theconversation.com/files/498628/original/file-20221202-24-haemsi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/498628/original/file-20221202-24-haemsi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=264&fit=crop&dpr=1 600w, https://images.theconversation.com/files/498628/original/file-20221202-24-haemsi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=264&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/498628/original/file-20221202-24-haemsi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=264&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/498628/original/file-20221202-24-haemsi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=332&fit=crop&dpr=1 754w, https://images.theconversation.com/files/498628/original/file-20221202-24-haemsi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=332&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/498628/original/file-20221202-24-haemsi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=332&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Barefoot running is just not for everyone.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/children-should-spend-more-time-barefoot-to-encourage-a-healthier-foot-structure-100289">Children should spend more time barefoot to encourage a healthier foot structure</a>
</strong>
</em>
</p>
<hr>
<h2>What we did and what we found</h2>
<p>We studied 76 runners who transitioned to barefoot running over 20 weeks – using a minimal running shoe as an intermediate phase between traditional shoe and barefoot running. </p>
<p>The runners ran in traditional running shoes for the first four weeks. For the next four weeks, they increased their time in minimal running shoes by no more than 20% of their total running volume each week. </p>
<p>After running full-time in minimal shoes for another four weeks, they then spent the next four weeks gradually increasing their time running barefoot by no more than 20% per week. </p>
<p>Finally, they ran barefoot for a further four weeks. </p>
<p>We also asked the runners to do some calf and foot strengthening and stretching, to assist the muscles in the move from traditional shoe to barefoot running.</p>
<p>Using this strategy, 70% of runners were able to successfully transition to barefoot running over 20 weeks.</p>
<p>Pain in the calf when running in minimal shoes and pain in the foot when running barefoot were the main reasons for not being able to switch to barefoot running. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/498633/original/file-20221202-22-plrjho.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two people run barefoot on a beach." src="https://images.theconversation.com/files/498633/original/file-20221202-22-plrjho.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/498633/original/file-20221202-22-plrjho.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/498633/original/file-20221202-22-plrjho.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/498633/original/file-20221202-22-plrjho.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/498633/original/file-20221202-22-plrjho.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/498633/original/file-20221202-22-plrjho.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/498633/original/file-20221202-22-plrjho.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Barefoot running tends to increase stress in the tissues of the foot and calf.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/an-elderly-man-and-a-woman-jogging-at-thebeach-8637985/">Photo by Kampus Production/Pexels</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>So why doesn’t barefoot running suit some people?</h2>
<p>We identified two features that were present in runners who failed to transition to barefoot running. </p>
<p>Contacting the ground first with the heel while running was one, and the other was very mobile feet (which means the arch is more flexible when the foot is bearing weight).</p>
<p>Why? It’s too early to say for sure, but we do know barefoot running tends to increase stress in the tissues of the foot and calf. </p>
<p>Our findings seem to indicate this tissue stress was not well tolerated in those who habitually contact the ground with their heels and/or have very mobile feet when they run barefoot or in minimal shoes.</p>
<p>This may result in pain and eventually injury. We also know <a href="https://journals.sagepub.com/doi/10.3113/FAI.2012.0262">from</a> <a href="https://bjsm.bmj.com/content/48/16/1257">other</a> <a href="https://bjsm.bmj.com/content/50/8/476">studies</a> that running barefoot or in minimal shoes will result in higher rates of foot injury (such as stress fractures of the bones of the foot) and pain in the shin and calf. Traditional shoes usually provide more support and cushioning.</p>
<p>It seems runners who habitually contact the ground with their heel while running find it difficult to switch to contacting the ground with more of their midfoot or forefoot, which is what barefoot running tends to promote. </p>
<p>Those with mobile feet may need their muscles to work harder to stiffen the foot when pushing the foot off the ground while running.</p>
<p>Perhaps a more gradual transition period during which the limit is 10% (not 20%) weekly increase of running in minimal shoes or barefoot spread over a longer period (such as 40 weeks) would enable those wishing to run barefoot to do so without pain or injury. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/498634/original/file-20221202-19-yz54vc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A person stretches their foot." src="https://images.theconversation.com/files/498634/original/file-20221202-19-yz54vc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/498634/original/file-20221202-19-yz54vc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/498634/original/file-20221202-19-yz54vc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/498634/original/file-20221202-19-yz54vc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/498634/original/file-20221202-19-yz54vc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/498634/original/file-20221202-19-yz54vc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/498634/original/file-20221202-19-yz54vc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">If you want to try barefoot running, transition gradually.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Top tips for successful barefoot running</h2>
<p>If you’re keen to try barefoot running, keep these tips in mind:</p>
<ul>
<li><p>transition gradually over at least 20 weeks. Take longer if needed</p></li>
<li><p>use a minimal shoe as an intermediary, if possible</p></li>
<li><p>limit any increase in running in minimal shoes or barefoot to no more than 20% of total running distance per week</p></li>
<li><p>use pain during and in the 24 hours after running as a guide – especially if you feel the level of severity is unacceptable</p></li>
<li><p>consult a sports and exercise health care professional (such as a physiotherapist or podiatrist) if you experience pain or require assistance in transitioning – especially if you have previous injuries</p></li>
<li><p>consult a qualified run coach to assist with your running program</p></li>
<li><p>when barefoot running, protect your feet by running in well-lit conditions so you can see obstacles, and avoid excessively hot, cold or sharp surfaces</p></li>
<li><p>mix it up – people who run in lots of different types of footwear report fewer injuries than those who only run in one type of shoe.</p></li>
</ul>
<p>It may also be that some runners are just not able to switch from their traditional running shoes to barefoot running. </p>
<p>Barefoot running may not be for everyone. It will not make you faster or reduce overall injury rate, and there is no evidence running barefoot burns more calories than running with shoes. </p>
<p>But if you’re thinking of giving barefoot running a go, transitioning gradually – using a minimal running shoe as an interim step – is more likely to result in a successful transition, and keep you running.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/eliud-kipchoge-broke-the-mens-marathon-record-by-30-seconds-how-close-is-the-official-sub-2-hour-barrier-now-191421">Eliud Kipchoge broke the men's marathon record by 30 seconds. How close is the official sub-2 hour barrier now?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/194331/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Natalie Collins has received funding from the National Health and Medical Research Council, Medical Research Future Fund, and Arthritis Australia. New Balance provided all shoes used in this study, free of charge, through the New Balance Global Scientific Award. New Balance had no input into the design of the study or interpretation of the results.</span></em></p><p class="fine-print"><em><span>Bill Vicenzino has received funding from New Balance Global Scientific Award.</span></em></p><p class="fine-print"><em><span>Kathryn Mills has received in-kind support from the New Balance Global Scientific Award. She is the current chair of the International Footwear Biomechanics Group, which is a volunteer role. </span></em></p>Thinking of trying barefoot running? We investigated a new strategy to switch from traditional shoe to barefoot running, and why barefoot running may work for some runners but not others.Natalie Collins, Senior Lecturer in Physiotherapy, The University of QueenslandBill Vicenzino, Professor and Chair in Sports Physiotherapy, The University of QueenslandKathryn Mills, Senior Lecturer, Macquarie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1953542022-12-07T19:05:34Z2022-12-07T19:05:34ZHow physios and occupational therapists are helping long COVID sufferers<figure><img src="https://images.theconversation.com/files/499157/original/file-20221206-17-eaxgmv.jpg?ixlib=rb-1.1.0&rect=52%2C26%2C8622%2C5748&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/therapist-supports-patient-during-running-600w-1367320637.jpg">Shutterstock</a></span></figcaption></figure><p>Treating people for long COVID – that is, symptoms that last <a href="https://www.health.gov.au/health-alerts/covid-19/symptoms#long-covid">longer than four weeks</a> after COVID infection – can be extremely complex due to the wide variety of problems associated with the condition. </p>
<p>While there is no “one size fits all” treatment, there is increasing recognition of the importance of allied health professionals such as <a href="https://pubmed.ncbi.nlm.nih.gov/34719461/">physiotherapists and occupational therapists</a> in <a href="https://apo.org.au/node/318734">providing treatment</a> for people throughout various stages of COVID. </p>
<p>We are still learning about <a href="https://physoc.onlinelibrary.wiley.com/doi/10.1113/EP090802">long COVID</a>, but these experts can tailor exercise training, breathing techniques and ways to manage fatigue safely, to help people get back to their normal roles and routines.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/long-covid-should-make-us-rethink-disability-and-the-way-we-offer-support-to-those-with-invisible-conditions-187531">Long COVID should make us rethink disability – and the way we offer support to those with 'invisible conditions'</a>
</strong>
</em>
</p>
<hr>
<h2>Long COVID and the body</h2>
<p>While the exact mechanism of why people develop long COVID remains unclear, <a href="https://physoc.onlinelibrary.wiley.com/doi/10.1113/EP090802">current evidence</a> suggest lingering COVID virus may trigger a cascade of ongoing inflammatory and immune responses in the body.</p>
<p>This results in signs and symptoms across multiple body systems, including the respiratory and <a href="https://www.ncbi.nlm.nih.gov/books/NBK539845/#:%7E:text=The%20autonomic%20nervous%20system%20is,sympathetic%2C%20parasympathetic%2C%20and%20enteric.">autonomic system</a>, which regulates functions such as heart rate, breathing and digestion. This could explain <a href="https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00299-6/fulltext">common symptoms of long COVID</a> such as brain fog, fatigue, headaches, breathing difficulties and changes in taste and smell.</p>
<p>Estimates suggest somewhere between <a href="https://www.nature.com/articles/d41586-022-01702-2">5% and 50%</a> of those infected with COVID go on to develop <a href="https://www.who.int/publications/i/item/WHO-2019-nCoV-Post_COVID-19_condition-Clinical_case_definition-2021.1">long COVID</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/when-does-covid-become-long-covid-and-whats-happening-in-the-body-when-symptoms-persist-heres-what-weve-learnt-so-far-188976">When does COVID become long COVID? And what's happening in the body when symptoms persist? Here's what we've learnt so far</a>
</strong>
</em>
</p>
<hr>
<p>Allied health professionals – who are not doctors, dentists, nurses or midwives but provide specialised care – such as physiotherapists and occupational therapists can be particularly effective at managing the signs and symptoms of long COVID. </p>
<p>This might be partly because they are used to working with patients to develop strategies and work towards functional goals. </p>
<h2>Exercise training</h2>
<p>Exercise training is the most common treatment prescribed by physiotherapists to assist people with long COVID. Studies have found <a href="https://www.mdpi.com/1660-4601/18/10/5329">exercise programs</a> can help people with long COVID to reverse the effects of fatigue, muscle weakness, shortness of breath and exercise intolerance. </p>
<p><a href="https://www.atsjournals.org/doi/full/10.1164/rccm.201309-1634ST">Pulmonary rehabilitation</a> is an exercise and education program often led by physiotherapist and designed to help people with ongoing lung diseases. Such programs have been shown to be <a href="https://openres.ersjournals.com/content/7/2/00108-2021">effective for people with long COVID</a>. </p>
<p>However, not all exercise programs are suitable for everyone with long COVID. For some people with ongoing fatigue issues, commencing with a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7850225/">graded exercise program</a> that progresses through different positions can also be effective in improving exercise fitness and reducing levels of fatigue. </p>
<p>Repetitive movement exercises such as <a href="https://www.physio-pedia.com/Range_of_Motion#:%7E:text=Range%20of%20motion%20exercise%20refers,muscles%20acting%20on%20the%20joint.">range of motion</a> exercises may be prescribed for joint and/or muscle pain and stiffness. Other therapies such as <a href="https://aci.health.nsw.gov.au/__data/assets/pdf_file/0011/726878/ACI-CPG-for-assessment-and-management-of-adults-with-post-acute-sequelae-of-COVID-19.pdf">falls prevention, muscle strengthening and balance training</a> are also suitable for people with reduced mobility, deconditioning and muscle wastage due to long COVID.</p>
<p>It is important to seek advice from a physiotherapist before commencing exercises as over-exertion can set your recovery back. Thorough assessment of your heart function and fatigue symptoms before returning to exercise – and close monitoring during exercise – are essential because symptoms can fluctuate over time. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/regaining-fitness-after-covid-infection-can-be-hard-here-are-5-things-to-keep-in-mind-before-you-start-exercising-again-180588">Regaining fitness after COVID infection can be hard. Here are 5 things to keep in mind before you start exercising again</a>
</strong>
</em>
</p>
<hr>
<h2>Breathing techniques and inspiratory muscle training</h2>
<p>Apart from prescribing an exercise program, physiotherapists can provide strategies on how to manage shortness of breath, a <a href="https://www.healthdirect.gov.au/covid-19/post-covid-symptoms-long-covid#:%7E:text=A%20person%20is%20usually%20considered,palpitations%2C%20chest%20pain%20or%20tightness">common symptom</a> of long COVID. For example, physiotherapists often teach people how to do <a href="https://respelearning.scot/topic-3-treatment/non-pharmacological-treatments/breathing-techniques/positions-relieve">relaxed controlled breathing</a> to recover from episodes of breathlessness. </p>
<p>People with long COVID may also feel the ongoing need to cough or clear their chest. Secretion clearance techniques such as <a href="https://www.sciencedirect.com/science/article/pii/S0954611111003787">active cycle breathing technique</a> can be useful. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/FF9-jPr9qhU?wmode=transparent&start=52" frameborder="0" allowfullscreen=""></iframe>
</figure>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/35082689/">Inspiratory muscle training</a> involves specific exercises prescribed to strengthen respiratory (breathing) muscles. This often involves taking deep breathes through a device that provides resistance. </p>
<p>This form of training has proven useful to some people with long COVID, but is not <a href="https://erj.ersjournals.com/content/early/2022/02/24/13993003.03101-2021.short">beneficial to all sufferers</a>. </p>
<p>It is important to consult a physiotherapist regarding the best breathing technique for your symptoms, as therapies for people with long COVID work best when they are tailored to the person. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/499160/original/file-20221206-17-5atn4a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="woman blows into respiratory equipment" src="https://images.theconversation.com/files/499160/original/file-20221206-17-5atn4a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/499160/original/file-20221206-17-5atn4a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/499160/original/file-20221206-17-5atn4a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/499160/original/file-20221206-17-5atn4a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/499160/original/file-20221206-17-5atn4a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/499160/original/file-20221206-17-5atn4a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/499160/original/file-20221206-17-5atn4a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Breathing exercises should be closely monitored, as they are not helpful for everyone with long COVID.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-holding-triflow-deep-breathing-600w-1362710012.jpg">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Fatigue management and other treatments</h2>
<p>As well as rehabilitation exercises, both physiotherapists and occupational therapists can provide personalised strategies to manage symptoms and enhance participation in work and daily life for people with long COVID. </p>
<p>For example, they might develop strategies to enhance or compensate for poor attention and memory, or help plan a daily routine to deal with fatigue so people can <a href="https://oce-ovid-com.ezproxy.uws.edu.au/article/00000448-202108001-00008/HTML">re-engage in their usual roles and routines</a>. </p>
<p>Other health professionals can also provide individualised treatment to assist with recovery. <a href="https://www.tandfonline.com/doi/full/10.1080/15622975.2022.2112074">Psychologists</a> may offer non-drug treatments to improve anxiety and depression. <a href="https://www.uhcw.nhs.uk/download/clientfiles/files/Patient%20Information%20Leaflets/Clinical%20Support%20Services/Physiotherapy/Advice%20for%20people%20experiencing%20voice%20problems%20after%20COVID.pdf">Speech pathologists</a> may help someone who has an ongoing hoarse voice. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/499162/original/file-20221206-20-24rvvg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="man lies on couch" src="https://images.theconversation.com/files/499162/original/file-20221206-20-24rvvg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/499162/original/file-20221206-20-24rvvg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/499162/original/file-20221206-20-24rvvg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/499162/original/file-20221206-20-24rvvg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/499162/original/file-20221206-20-24rvvg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/499162/original/file-20221206-20-24rvvg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/499162/original/file-20221206-20-24rvvg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Functional goals and strategies might help people with long COVID get back to their usual routines.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/man-home-sports-suit-lies-600w-1469198108.jpg">Shutterstock</a></span>
</figcaption>
</figure>
<h2>How to get help for long COVID?</h2>
<p>If you have long COVID, ask your doctor to refer you either to a multidisciplinary long COVID program where different types of health professionals work together, or to specific health professionals depending on your symptoms. </p>
<p>Multidisciplinary based programs have been found to be the <a href="https://www.bmj.com/content/376/bmj.o336">most effective</a> in managing people with long COVID. In Australia, <a href="https://www.survivorcorps.com/pccc-australia">there are some long COVID clinics</a> providing monitoring and treatment. However, there is an <a href="https://www.theage.com.au/national/victoria/cloud-over-victoria-s-long-covid-clinics-as-federal-funding-dries-up-20221121-p5bzw3.html">urgent need</a> to establish more of them across the nation. </p>
<p>While long COVID symptoms can be debilitating, it appears many symptoms improve with time. That said, you may be able to recover more quickly with the help of a physiotherapist or an occupational therapist.</p>
<hr>
<p><em>The authors wish to acknowledge the contribution of Kerrie Saliba, who is a senior physiotherapist in the intensive care unit at Liverpool Hospital, South Western Sydney Local Health District and a Western Sydney University masters student, to this article.</em></p><img src="https://counter.theconversation.com/content/195354/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Clarice Tang receives funding from NSW Government, Department of Health and the Maridula Budyari Gumal association. She is affiliated with Western Sydney University, South-Western Sydney Local Health District and is a member of the Australian Physiotherapy Association, Thoracic Society of Australia and New Zealand and the American Thoracic Society. </span></em></p><p class="fine-print"><em><span>Karen Liu is affiliated with Western Sydney University and South Western Sydney Local Health District. </span></em></p>We’re still learning about long COVID – but working with a physio or occupational therapist on goal-setting could help you get back into your usual routine.Clarice Tang, Senior lecturer in Physiotherapy, Western Sydney UniversityKaren Liu, Professor in Occupational Therapy, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1907512022-11-22T23:06:08Z2022-11-22T23:06:08ZWhy do I sprain my ankle so often? And how can I cut the risk of it happening again?<figure><img src="https://images.theconversation.com/files/485185/original/file-20220918-61758-jw77yq.jpg?ixlib=rb-1.1.0&rect=0%2C15%2C5176%2C2894&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/a-person-touching-his-ankle-7298678">Photo by Kindel Media/Pexels</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Are you one of those people who seems to be forever spraining their ankle?</p>
<p>To some extent, ankle sprains are <a href="https://meridian.allenpress.com/jat/article/54/6/603/420863/Epidemiology-of-Ankle-Sprains-and-Chronic-Ankle">part and parcel</a> of being active.</p>
<p>But if it’s happening again and again, here’s what may be going on – and how you can reduce your risk of recurrent ankle sprain.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/485247/original/file-20220919-24-hydelp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man rolls his ankle on a step." src="https://images.theconversation.com/files/485247/original/file-20220919-24-hydelp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/485247/original/file-20220919-24-hydelp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/485247/original/file-20220919-24-hydelp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/485247/original/file-20220919-24-hydelp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/485247/original/file-20220919-24-hydelp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/485247/original/file-20220919-24-hydelp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/485247/original/file-20220919-24-hydelp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Some people end up with what’s known as Chronic Ankle Instability, where they tend to re-sprain their ankle again and again.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-prevent-injury-from-sport-and-exercise-68914">How to prevent injury from sport and exercise</a>
</strong>
</em>
</p>
<hr>
<h2>One sprain can lead to another… and another</h2>
<p>A large <a href="https://link.springer.com/article/10.1007/s40279-013-0102-5">review</a> of ankle sprain studies in the journal <a href="https://link.springer.com/article/10.1007/s40279-013-0102-5">Sports Medicine</a> found most people who actively play sport or train can expect to have a fairly low incidence of ankle sprain per 1,000 hours of training time. But it also said:</p>
<blockquote>
<p>Females were at a higher risk of sustaining an ankle sprain compared with males and children compared with adolescents and adults, with indoor and court sports the highest risk activity.</p>
</blockquote>
<p>The most frequent type of ankle sprain occurs if the ligaments on the outside of the ankle are stretched or torn when the joint moves beyond the normal range of movement. This is known as an inversion or lateral ankle sprain.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/485248/original/file-20220919-27-deaukn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A diagram showing different types of sprains." src="https://images.theconversation.com/files/485248/original/file-20220919-27-deaukn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/485248/original/file-20220919-27-deaukn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=451&fit=crop&dpr=1 600w, https://images.theconversation.com/files/485248/original/file-20220919-27-deaukn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=451&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/485248/original/file-20220919-27-deaukn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=451&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/485248/original/file-20220919-27-deaukn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=567&fit=crop&dpr=1 754w, https://images.theconversation.com/files/485248/original/file-20220919-27-deaukn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=567&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/485248/original/file-20220919-27-deaukn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=567&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The most frequent type of ankle sprain occurs if the ligaments on the outside of the ankle are stretched or torn.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Strong evidence from <a href="https://meridian.allenpress.com/jat/article/56/6/578/466668/Lateral-Ankle-Sprain-and-Subsequent-Ankle-Sprain">studies</a> suggests once people sprain their ankle, they are more likely to re-sprain it. As one <a href="https://meridian.allenpress.com/jat/article/56/6/578/466668/Lateral-Ankle-Sprain-and-Subsequent-Ankle-Sprain">review</a> of the evidence put it:</p>
<blockquote>
<p>a history of lateral ankle sprain is known to disrupt the structural integrity of the ligaments and sensorimotor function, likely impairing an individual’s ability to avoid injurious situations.</p>
</blockquote>
<p>Some ankle sprains might seem to be very minor, with almost no swelling or mobility problems. But some people can end up with what’s known as chronic ankle instability, where they tend to re-sprain their ankle again and again.</p>
<p>Another <a href="https://link.springer.com/article/10.1007/s40279-017-0781-4">review</a> looking at factors contributing to chronic ankle instability found</p>
<blockquote>
<p>feelings of instability and recurrent ankle sprain injuries (termed chronic ankle instability, or CAI) have been reported in up to 70% of patients. The subsequent development of CAI has adverse health consequences including reduced quality of life and early-onset osteoarthritis.</p>
</blockquote>
<p>Once an ankle fracture is excluded, busy hospital emergency departments often send patients home with instructions to ice the ankle and keep off it for a day or two. There’s often no advice to follow up with a physio for rehabilitation.</p>
<p>This is unfortunate, as evidence suggests people with a history of ankle sprains will likely:</p>
<ul>
<li><p>become progressively <a href="https://meridian.allenpress.com/jat/article/50/7/742/112426/Physical-Activity-Levels-in-College-Students-With">less active</a></p></li>
<li><p>have <a href="https://bjsm.bmj.com/content/50/24/1496.long">higher</a> body mass indices</p></li>
<li><p>report more general body <a href="https://bjsm.bmj.com/content/50/24/1496.long">pain</a> and </p></li>
<li><p>generally tend to have a lower <a href="https://bjsm.bmj.com/content/50/24/1496.long">quality of life</a>. </p></li>
</ul>
<h2>Even the other ankle may be at risk</h2>
<p>Research suggests people who sprain their ankle may be more likely to have <a href="https://meridian.allenpress.com/jat/article/56/6/578/466668/Lateral-Ankle-Sprain-and-Subsequent-Ankle-Sprain">injuries</a> to other joints on the same leg, or even the opposite leg. A review in the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4196323/">International Journal of Sports Physiotherapy</a> noted “an ankle sprain is linked to both re-injury and subsequent injury to the contralateral side”. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/485252/original/file-20220919-25-fatvem.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man clutches his ankle" src="https://images.theconversation.com/files/485252/original/file-20220919-25-fatvem.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/485252/original/file-20220919-25-fatvem.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1065&fit=crop&dpr=1 600w, https://images.theconversation.com/files/485252/original/file-20220919-25-fatvem.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1065&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/485252/original/file-20220919-25-fatvem.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1065&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/485252/original/file-20220919-25-fatvem.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1339&fit=crop&dpr=1 754w, https://images.theconversation.com/files/485252/original/file-20220919-25-fatvem.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1339&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/485252/original/file-20220919-25-fatvem.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1339&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">If you’re getting recurrent ankle sprains, see a physiotherapist.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/a-man-holding-his-lower-leg-7298407/">Photo by Kindel Media/Pexels</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Why? It may have something to do with the brain’s tremendous ability to continually adapt.</p>
<p>Just as <a href="http://www.ajnr.org/content/36/11/2048">extended bed rest</a> or prolonged microgravity exposure in <a href="https://doi.org/10.1007/978-3-319-68201-3_3">astronauts</a> can cause changes in the brain and the way it relates to movement, perhaps our brains subconsciously compensate after an ankle injury. </p>
<p>That could be by, for example, via limping or a slight change in the way you walk; perhaps you subconsciously don’t want to challenge the ankle due to fear of re-spraining. This may put other joints or the opposite limb at heightened risk.</p>
<p>This neuroplasticity adds new challenges to the assessment or rehabilitation of ankle injury, and to predicting who is likely to be at increased <a href="https://www.tandfonline.com/doi/abs/10.1080/00913847.2020.1780098?journalCode=ipsm20">risk of subsequent injuries</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/can-supplements-or-diet-reduce-symptoms-of-arthritis-heres-what-the-evidence-says-184151">Can supplements or diet reduce symptoms of arthritis? Here's what the evidence says</a>
</strong>
</em>
</p>
<hr>
<h2>What can you do to reduce the risk of re-spraining your ankle?</h2>
<p>If you’re getting recurrent ankle sprains, see a physiotherapist. They will be able to teach you how to reduce the risk. </p>
<p>Currently the best evidence for reducing the chances of re-spraining your ankle sprain comes down to two main things:</p>
<p><strong>1) Protecting the joint with an ankle brace when active</strong></p>
<p>This could mean using a <a href="https://meridian.allenpress.com/jat/article/54/6/650/420871/Prevention-of-Lateral-Ankle-Sprains">professionally fitted external support brace</a> (not an elastic sleeve). This is a relatively low cost and effective means of risk reduction. </p>
<p><strong>2) Using balancing exercises and ‘proprioceptive training’</strong></p>
<p>Examples of <a href="https://meridian.allenpress.com/jat/article/52/11/1065/112804/Proprioceptive-Training-for-the-Prevention-of">proprioceptive training</a> include:</p>
<ul>
<li><p>balancing on each leg, one at a time, while throwing and catching a ball against a wall</p></li>
<li><p>balancing on an ankle disc or wobble board for three to five minutes daily. </p></li>
</ul>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/485249/original/file-20220919-24-dxnowe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman balances on a wobble disc." src="https://images.theconversation.com/files/485249/original/file-20220919-24-dxnowe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/485249/original/file-20220919-24-dxnowe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/485249/original/file-20220919-24-dxnowe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/485249/original/file-20220919-24-dxnowe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/485249/original/file-20220919-24-dxnowe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/485249/original/file-20220919-24-dxnowe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/485249/original/file-20220919-24-dxnowe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Balancing exercises may help.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>These exercises can help strengthen the muscles and ligaments in your ankle. As one literature review put it:</p>
<blockquote>
<p>Proprioceptive training is a cost- and time-effective intervention that can benefit patients who have sustained a previous ankle sprain during physical activity and can subsequently reduce the risk of further complications.</p>
</blockquote><img src="https://counter.theconversation.com/content/190751/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gordon Waddington owns shares in Prism Neuro Pty Ltd a perceptual neuroscience ability measurement company. He receives funding from the Medical Research Futures Fund, Australian Research Council, NSW Institute of Sport, Queensland Academy of Sport and the Australian Institute of Sport. </span></em></p>Currently the best evidence for reducing the chances of re-spraining your ankle sprain comes down to two main things.Gordon Waddington, AIS Professor of Sports Medicine Research, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1909782022-11-06T19:04:06Z2022-11-06T19:04:06ZGlute force: why big, strong bum muscles matter for your overall health<figure><img src="https://images.theconversation.com/files/490521/original/file-20221019-21-rw40xd.jpg?ixlib=rb-1.1.0&rect=0%2C8%2C5980%2C3965&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>The glutes are the large, powerful muscles in your bum that help support the pelvis, stabilise the hip joint and allow the hip to move. </p>
<p>Countless social media posts extol the virtues of building strong glutes through exercises such as squats. However, most of what you hear from such “gymfluencers” is about how the bum muscles look.</p>
<p>Forget about how they look; what about what they <em>do</em>? Why is having big, strong glutes important for your body to function well?</p>
<p>In fact, having strong bum muscles is crucial to good musculoskeletal health.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/490514/original/file-20221019-14-64isla.jpg?ixlib=rb-1.1.0&rect=0%2C10%2C6720%2C4456&q=45&auto=format&w=1000&fit=clip"><img alt="A person does squats in the park." src="https://images.theconversation.com/files/490514/original/file-20221019-14-64isla.jpg?ixlib=rb-1.1.0&rect=0%2C10%2C6720%2C4456&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/490514/original/file-20221019-14-64isla.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/490514/original/file-20221019-14-64isla.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/490514/original/file-20221019-14-64isla.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/490514/original/file-20221019-14-64isla.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/490514/original/file-20221019-14-64isla.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/490514/original/file-20221019-14-64isla.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Strong glutes are important for overall health.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/were-two-physios-who-ran-away-with-the-circus-heres-what-we-learned-177739">We're two physios who ran away with the circus. Here's what we learned</a>
</strong>
</em>
</p>
<hr>
<h2>Bum muscles hold your body up and protect the hip joint</h2>
<p>The gluteal muscles are a group of three separate muscles, each with unique anatomical structure and function.</p>
<p>The deepest and smallest muscle is called the gluteus minimus, which is very close to the hip joint itself. </p>
<p>Overlaying gluteus minimus is the gluteus medius. This one is relatively large and spans the whole outer surface of the pelvis.</p>
<p>The gluteus maximus is the largest of the three gluteal muscles and <a href="https://pubmed.ncbi.nlm.nih.gov/19449297/">overlays</a> both gluteus medius and minimus. This muscle is what gives the the bum its distinctive bum-like shape, but it plays a very important role in the way your body functions.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/490487/original/file-20221018-17040-tyefa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A diagram of the gluteal muscles." src="https://images.theconversation.com/files/490487/original/file-20221018-17040-tyefa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/490487/original/file-20221018-17040-tyefa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=563&fit=crop&dpr=1 600w, https://images.theconversation.com/files/490487/original/file-20221018-17040-tyefa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=563&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/490487/original/file-20221018-17040-tyefa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=563&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/490487/original/file-20221018-17040-tyefa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=707&fit=crop&dpr=1 754w, https://images.theconversation.com/files/490487/original/file-20221018-17040-tyefa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=707&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/490487/original/file-20221018-17040-tyefa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=707&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The gluteal muscles are a group of separate muscles that work together.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>In combination, the gluteus maximus, medius and minimus gives rise to many hip movements, and provide shock absorption when you’re walking or running. </p>
<p>These muscles work together with your brain to generate a lot of power to hold your body up as gravity tries to pull it down. They also protect the hip joint from impact and from shearing forces that might cause long term damage.</p>
<p>Some of <a href="https://onlinelibrary.wiley.com/doi/10.1002/ca.23510">our</a> <a href="https://www.sciencedirect.com/science/article/pii/S1063458418315127?via%3Dihub">work</a> has identified some people with hip pain also have impairments in the gluteal muscles.</p>
<p>These impairments could reduce the bum muscles’ ability to protect the joint against long term damage and potentially affect a person’s ability to bear weight (for example, when standing on one leg or climbing stairs).</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/490295/original/file-20221018-26-9cipur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man does hip thrusts in the gym." src="https://images.theconversation.com/files/490295/original/file-20221018-26-9cipur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/490295/original/file-20221018-26-9cipur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/490295/original/file-20221018-26-9cipur.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/490295/original/file-20221018-26-9cipur.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/490295/original/file-20221018-26-9cipur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/490295/original/file-20221018-26-9cipur.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/490295/original/file-20221018-26-9cipur.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Don’t skip the glutes.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>A reduction in muscle size and an increase in non-active tissue such as fat has been <a href="https://pubmed.ncbi.nlm.nih.gov/31689358/">reported</a> in hip conditions such as greater trochanteric pain syndrome (a common type of hip pain, also known as gluteal tendinopathy).</p>
<p>The same is also true for <a href="https://www.oarsijournal.com/article/S1063-4584(16)30064-4/fulltext">hip osteoarthritis</a>, which affects the whole joint.</p>
<p>The rates of osteoarthritis in Australia are <a href="https://doi.org/10.1111/imj.15933">increasing</a>, with <a href="https://aoj.amegroups.com/article/view/3664/4322">one in every seven</a> hip joint replacements conducted in people under the age of 55. However, it’s worth noting just because you have signs of arthritis on hip x-ray or MRI, it doesn’t mean you will have pain or <a href="https://www.sciencedirect.com/science/article/pii/S1063458420312310?via%3Dihub">develop</a> <a href="https://bmjopensem.bmj.com/content/7/4/e001199">pain</a>.</p>
<p>Research <a href="https://pubmed.ncbi.nlm.nih.gov/29439949/">suggests</a> the way a person moves may contribute to the risk of hip osteoarthritis in young people.</p>
<p>If you do have hip pain, bum muscle strengthening is <a href="https://www.racgp.org.au/download/Documents/Guidelines/Musculoskeletal/guideline-for-the-management-of-knee-and-hip-oa-2nd-edition.pdf">recommended</a> as the first line treatment.</p>
<p>But strong glutes have also been shown to improve your day-to-day function, especially in those with hip osteoarthritis. </p>
<p>In particular, people with hip osteoarthritis who have stronger glutes walk faster and longer <a href="https://onlinelibrary.wiley.com/doi/10.1002/jor.1100150421">distances</a> and climb stairs <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1002/acr.22329">faster</a> than those with weaker glutes.</p>
<h2>Should I do my bum exercises?</h2>
<p>Ultimately, better bum muscle function is likely to be helpful and is often recommended by doctors, physiotherapists and other health-care practitioners.</p>
<p>They may prescribe certain exercises to strengthen your glutes and target problems around the hip area.</p>
<p>Having weak glutes is associated with:</p>
<ul>
<li><p><a href="https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-019-2833-4">low back pain</a></p></li>
<li><p><a href="https://pubmed.ncbi.nlm.nih.gov/18838402/">patellofemoral</a> pain (pain under the knee cap) and</p></li>
<li><p>greater <a href="https://www.sciencedirect.com/science/article/pii/S1050641117300111?via%3Dihu">trochanteric pain syndrome</a> (the common type of hip pain we mentioned earlier, also known as gluteal tendinopathy).</p></li>
</ul>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/490491/original/file-20221018-8349-md9j52.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two people do deadlifts in a gym." src="https://images.theconversation.com/files/490491/original/file-20221018-8349-md9j52.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/490491/original/file-20221018-8349-md9j52.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/490491/original/file-20221018-8349-md9j52.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/490491/original/file-20221018-8349-md9j52.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/490491/original/file-20221018-8349-md9j52.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/490491/original/file-20221018-8349-md9j52.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/490491/original/file-20221018-8349-md9j52.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Your physio might prescribe glute exercises.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Glute strength may even have a role to play in keeping your <a href="https://journals.lww.com/jwhpt/Abstract/2021/07000/Hip_and_Pelvic_Floor_Muscle_Strength_in_Women_With.5.aspx">pelvic floor</a> in good shape (although further research is required).</p>
<p>That’s not to say doing your bum exercises will automatically cure all these ailments; each case is unique and involves a range of factors. But having strong glutes is, in general, very important for hip and pelvis stability and function.</p>
<p>No matter if you are a gymfluencer, a professional sports person, or just a regular bum-owner, having strong glutes will keep you in good stride.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/physio-chiro-osteo-and-myo-whats-the-difference-and-which-one-should-i-get-149993">Physio, chiro, osteo and myo: what's the difference and which one should I get?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/190978/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Charlotte Ganderton receives funding from Arthritis Australia, Physiotherapy Research Foundation, Swinburne University of Technology, National Institute of Circus Arts and La Trobe University.
Charlotte Ganderton is a member of the Australian Physiotherapy Association and Sports Medicine Australia.</span></em></p><p class="fine-print"><em><span>Adam Semciw is affiliated with Northern Health. </span></em></p><p class="fine-print"><em><span>Matthew King receives funding from the Physiotherapy Research Foundation, Australian Physiotherapy Association, La Trobe University and the Transport Accident Commission . He is affiliated with the Australian Physiotherapy Association, Sports Medicine Australia and the International Hip-related Pain Research Network.. </span></em></p>Forget about how your bum muscles look; what about what they do? In fact, having big, strong glutes is crucial to good overall musculoskeletal health.Charlotte Ganderton, Physiotherapy lecturer, Swinburne University of TechnologyAdam Semciw, Associate Professor in Allied Health, La Trobe UniversityMatthew King, Postdoctoral Research Fellow, Lecturer, and Physiotherapist, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1836192022-07-06T03:38:00Z2022-07-06T03:38:00ZIs netball actually bad for knees and ankles? What does the research say?<p>Netball is one of the biggest team sports in Australia with more than <a href="https://www.clearinghouseforsport.gov.au/kb/women-in-sport/current-state">1.2 million men, women and children playing each week</a>, underpinned by a nationwide footprint of more than 4,000 community clubs.</p>
<p>Across the world more than <a href="https://netball.sport/">20 million people play netball in more than 70 countries</a>. And it’s not just for young women; men play in mixed and male only competitions, 5-7 year olds play in the <a href="https://netball.com.au/woolworths-netsetgo">NEtSetGO</a> program and older players play in the <a href="https://www.playwalkingnetball.com.au/home/">Walking Netball competition</a>.</p>
<p>Despite its popularity, netball continually gets bad rap for joints. Time and time again in physiotherapy clinics, we hear patients say, “I have bad knees because I used to play netball” or “I’m scared of letting my child play netball – isn’t it terrible for joints?”</p>
<p>The research, however, shows a more nuanced story. </p>
<p>Yes, there is a risk of injuring yourself while playing netball but the overall risk of serious injury is relatively small – and far outweighed by the benefit of being fit, active and part of a team. </p>
<h2>What are the knee and ankle risks with netball?</h2>
<p>Unlike other court-based sports, netball has strict <a href="https://netball.com.au/sites/default/files/2020-02/INF-RulesofNetball2020.pdf">rules</a> on footwork.</p>
<p>Players can only take one and a half additional steps after receiving the ball.</p>
<p>They’re also restricted to certain areas of the court, depending on which position they’re playing. </p>
<p>The sudden braking required of netball players requires good strength, body control and footwork. </p>
<p>A recent <a href="https://sportsmedicine-open.springeropen.com/articles/10.1186/s40798-020-00290-7">systematic review</a> reports netball injuries in people aged over 15 predominantly occur in the lower limb, particularly the ankle and knee. Ligament sprains are the most common injury. </p>
<p>Ankle injuries are more common than knee injuries, the systematic review found. And younger players tend to experience more upper limb injuries (such as fractures) than lower limb injuries.</p>
<p>There are more injuries in matches than in training. Pain at the <a href="https://www.researchgate.net/publication/322264795_Incidence_and_prevalence_of_patellofemoral_pain_A_systematic_review_and_meta-analysis">front of the knee-cap</a> is also very common in adolescent girls who participate in jumping and pivoting sports such as netball. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/19236296">Insurance claim</a> data indicates damage to the ACL (<a href="https://www.physio-pedia.com/Anterior_Cruciate_Ligament_(ACL)">anterior cruciate ligament</a>, a major stabiliser of the knee) represents about 13% of the most serious netball injuries presenting to emergency departments. </p>
<p>This equates to a rate of only one injury for every 2,500 participants. However, this figure likely underestimates the actual injury rate as many people with these injuries go straight to their GP or local physiotherapist (rather than hospital). </p>
<p>The limited data available makes it hard to accurately indicate the injury rate in community netball. But in similar court-based sports (such as handball or basketball), the ACL injury rate is <a href="https://pubmed.ncbi.nlm.nih.gov/18063176/">one in every 100-200 players per calendar year</a>. </p>
<p>Though ACL injuries are rare, they are a serious injury often requiring time off work or study and are costly to the <a href="https://pubmed.ncbi.nlm.nih.gov/30587436/">individual</a> and the <a href="https://pubmed.ncbi.nlm.nih.gov/33852440/">health care system</a> via increased risk of arthritis.</p>
<p>So is netball terribly much worse than other sports for joint injury risk? We don’t have enough data to conclusively answer this question. But what we can say from the limited evidence available is the overall risk of knee and joint injury in community netball is low.</p>
<h2>Can anything be done to reduce injury risk for netballers?</h2>
<p>Yes! There is great evidence <a href="https://pubmed.ncbi.nlm.nih.gov/29737024/">injury prevention programs work</a>, reducing ACL injuries in female athletes by up to 67%, other knee injuries by up to 50%, and all lower limb injuries by 30%.</p>
<p>Netball even has its own injury-prevention program, known as <a href="https://knee.netball.com.au/about/">the KNEE program</a> (KNEE stands for knee injury prevention for netballers to enhance performance and extend play).</p>
<p>The KNEE Program is an on court warm-up program aimed at all levels of netball. It aims to improve the way players run, change direction, jump and land (as this is how many knee and ankle injuries happen).</p>
<p>For pain at the front of the knee-cap (<a href="https://bjsm.bmj.com/content/bjsports/50/4/247.full.pdf">patellofemoral pain</a>), there is also great <a href="https://bjsm.bmj.com/content/52/18/1170">evidence</a> that exercises that strengthen the hip and knee muscles – combined with <a href="https://bmjopensem.bmj.com/content/2/1/e000086">advice about activity modification</a> – can help.</p>
<p>For adolescents, patellofemoral pain often occurs during periods of rapid growth, but it is important to see a health professional for exercises and advice, as <a href="https://doi.org/10.1136/bjsports-2016-096384">one in three</a> continue to experience pain 12 months down the track.</p>
<h2>Yes there are risks with netball, but the benefits far outweigh them</h2>
<p>As a fast moving non-contact sport, netball is fantastic way to keep active, improve hand eye coordination and reap the physical, mental, and social benefits of participating in a team sport.</p>
<p>Being physically fit and strong can improve your health and reduce your <a href="https://www.who.int/publications/i/item/9789240015128">risk of illness</a>. </p>
<p>Knees in particular like to be exercised; recreational runners have healthier knees than those who <a href="https://pubmed.ncbi.nlm.nih.gov/28504066/">lead a sedentary lifestyle</a>. </p>
<p>Participation in sport is particularly important for adolescent girls, who are dropping out of sport at <a href="https://www.suncorp.com.au/learn-about/teamgirls/teamgirls-powered-by-suncorp-research.html">alarming rates</a>. </p>
<p>Girls who do play sport have a more positive body image and better states of <a href="https://www.suncorp.com.au/learn-about/teamgirls/teamgirls-powered-by-suncorp-research.html">psychological well-being</a>. </p>
<p>Being <a href="https://www.suncorp.com.au/learn-about/teamgirls/truth-about-teen-girls-and-sport.html">part of a team</a> also helps girls enjoy shared experiences, reduce isolation and be part of something bigger than themselves.</p>
<p>Many sports provide similar benefits but all sports have some risks. If you or your children enjoy netball, keep playing – the overall benefits of netball outweigh the possible risks. </p>
<p>Importantly, netball in Australia can serve as a vehicle for empowerment, providing strong female roles models to inspire current and future generations.</p><img src="https://counter.theconversation.com/content/183619/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kay Crossley receives funding from the National Health and Medical Research Council to investigate knee injuries in sport</span></em></p><p class="fine-print"><em><span>Brooke Patterson and Sallie Cowan do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Yes, there is a risk of injuring yourself while playing netball but the overall risk of serious injury is relatively small – and far outweighed by the benefit of being active and part of a team.Sallie Cowan, Senior Research Fellow and Musculoskeletal Physiotherapist, La Trobe UniversityBrooke Patterson, Research Fellow, La Trobe UniversityKay Crossley, Professor, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1831322022-06-30T23:59:46Z2022-06-30T23:59:46ZHip flexors get weak when we sit too much – but simple stretches and strengthening exercises can leave you less stiff<figure><img src="https://images.theconversation.com/files/468170/original/file-20220610-14-lc8vgd.jpg?ixlib=rb-1.1.0&rect=7%2C46%2C5145%2C3368&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>I am sure you’ve been told you should stand up and move away from your work stations or use a standing desk where possible. One of the major benefits of doing this is to activate and stretch the hip flexor area.</p>
<p>But what are the hip flexors, and why are they so important – and what happens if we let them get weak and stiff?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-do-i-grunt-when-i-bend-over-120976">Why do I grunt when I bend over?</a>
</strong>
</em>
</p>
<hr>
<h2>What are hip flexors?</h2>
<p>Hip flexors are the powerful muscles located at the front of your hip. They include:</p>
<ul>
<li><p>the psoas major and psoas minor, which connect the femur to the spine, and</p></li>
<li><p>the iliacus, which runs from the pelvis to the femur.</p></li>
</ul>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/468162/original/file-20220610-28106-y3wr0g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/468162/original/file-20220610-28106-y3wr0g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/468162/original/file-20220610-28106-y3wr0g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/468162/original/file-20220610-28106-y3wr0g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/468162/original/file-20220610-28106-y3wr0g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/468162/original/file-20220610-28106-y3wr0g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/468162/original/file-20220610-28106-y3wr0g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/468162/original/file-20220610-28106-y3wr0g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Hip flexors are the muscles located at the front of your hip.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Hip flexors are activated when you draw your knee towards your chest. They are important for walking and running. </p>
<p>They’re also very important in sport, as they flex the hip, and work with the quadraceps to extend your knee when you need to sprint or kick.</p>
<p>An athlete with an injured hip flexor will have great difficulty running or kicking.</p>
<p>The hip flexors also work with the glutes and other muscles of the torso to stabilise the spine – which makes them important for posture. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1534530705727926272"}"></div></p>
<h2>What happens when they’re weak or stiff?</h2>
<p>Weak hip flexors may make climbing stairs, running or even walking on a flat surface difficult or painful. It can also can cause other muscles in the area to work hard to compensate. This changes your gait (the way you walk).</p>
<p>Tight hip flexors can make walking and standing difficult because they pull your spine down. This makes you lean forward, which puts strain on your lower back muscles (which work in opposition to keep you upright). </p>
<p>An imbalance between the hip flexors and the opposing muscles pulling your torso in the opposite direction can lead to lower back pain.</p>
<p>Tight hip flexors can reduce the range of motion of the knee. This can result in a stiff knee gait, where the knee doesn’t bend as much as it should. After some time, it can lead to knee pain.</p>
<p>All in all, weak or tight hip flexors can cause your joints or muscles to function in an abnormal way and this can lead to injury.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1532376503203266560"}"></div></p>
<h2>How can I keep my hip flexors in good shape?</h2>
<p>As with all muscles, hip flexors lose strength and mass through lack of exercise. </p>
<p>Another contributing factor is sitting for long periods, which keeps the psoas muscles relaxed in a shortened position for a long time.</p>
<p>This is particularly important for those of us who spend long periods seated at a work desk, and is why many health-care professionals advise taking a break from sitting or opting for a standing desk.</p>
<p>Hip flexors should be kept both flexible and strong.</p>
<p>Stretching exercises to improve flexibility of the hip flexors include:</p>
<ul>
<li><p>lying on your side and pulling one foot to your butt, while keeping your knees close together</p></li>
<li><p>stepping forward into a lunge, going as low as you can while keeping your torso upright. </p></li>
</ul>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/0Tgt2IRn6q4?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Some examples of exercises that help stretch hip flexors.</span></figcaption>
</figure>
<p>Both should cause you to feel the stretch along the front of your upper thigh. </p>
<p>Stretches should be held for about 30 seconds and repeated two to three times each side. They can be done daily or at least three times weekly to gradually improve flexibility. </p>
<p>If you work at a desk for long periods, try to do some stretching in short breaks during the day.</p>
<p>To strengthen the hip flexors you can lie face up on the floor and do <a href="https://www.youtube.com/watch?v=QWwg3d-N6Wg">straight leg raises</a> (one leg at a time), while keeping your arms on the floor alongside your torso.</p>
<p>This takes the strain off your lower back and is easier to do one at a time to start with. </p>
<p>Another great hip flexor exercise is called <a href="https://www.youtube.com/watch?v=aQulHW8xxEY">mountain climbers</a>. For this exercise, take the push-up position and bring one leg at a time to your chest. This can be done slowly to begin with, or quickly as you gain strength and fitness.</p>
<h2>Strong and flexible hip flexors</h2>
<p>So, hip flexors are relatively easy to train. If you are doing any exercise at all you are likely already keeping your hip flexors strong and flexible.</p>
<p>If you are not exercising, the exercises mentioned earlier will give you a place to start.</p>
<p>Combine these with gentle stretches of other muscle groups and some aerobic exercise like walking, jogging, cycling or swimming. </p>
<p>Remember to start gently and gradually increase the intensity, duration and frequency of sessions. </p>
<p>Failure to look after your hip flexors can lead to an altered gait, posture problems, injury and back pain.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/core-strength-why-is-it-important-and-how-do-you-maintain-it-160358">Core strength: why is it important and how do you maintain it?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/183132/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Lavender works for the Institute of Health and Wellbeing, Federation University Australia. </span></em></p>Failure to look after your hip flexors can lead to injury, walking problems, posture issues and back pain.Andrew Lavender, Senior Lecturer, Institute of Health and Wellbeing, Federation University AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1819392022-06-27T03:47:10Z2022-06-27T03:47:10ZPhysio ‘dry needling’ and acupuncture – what’s the difference and what does the evidence say?<figure><img src="https://images.theconversation.com/files/468636/original/file-20220614-22-2dsj01.jpg?ixlib=rb-1.1.0&rect=17%2C250%2C5725%2C3569&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/woman-relaxes-acupuncture-procedure-acupuncturist-600w-1635120196.jpg">Shutterstock</a></span></figcaption></figure><p>Physiotherapists are increasingly offering needling therapies in addition to their standard care. Many Australian <a href="https://australian.physio/research/prf/translation/five-facts-about-acupuncture-and-dry-needling-musculoskeletal-pain">physiotherapists</a> in private practice now offer dry needling or Western medical acupuncture as part of a treatment approach.</p>
<p>Is it just a fad or does science support it?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-why-do-my-muscles-ache-the-day-after-exercise-41820">Health Check: why do my muscles ache the day after exercise?</a>
</strong>
</em>
</p>
<hr>
<h2>Needling, three ways</h2>
<p>Physiotherapists can be trained to use dry needling, Western acupuncture and/or traditional acupuncture. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/23801002/">Dry needling</a> involves penetrating the skin with needles to altered or dysfunctional tissue in order to improve or restore function. This often involves needling muscle trigger points to activate a reflexive relaxation of the muscle. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/28739020/">Western acupuncture</a> uses traditional needling <a href="https://www.sciencedirect.com/science/article/pii/S2005290110600143">meridians</a> (the ancient idea of energy channels through the body) and trigger points. But these ideas are applied to Western understandings of anatomy. In Western acupuncture, points are stimulated to create local tissue changes, as well as spinal and brain effects. The goals is to trigger pain-relieving chemicals, muscle activation or relaxation.</p>
<p>Even though traditional acupuncture points are used with this style of needling, Western acupuncture is not viewed as traditional Chinese medicine. </p>
<p><a href="https://healthtimes.com.au/hub/pain-management/44/research/kk1/acupuncture-for-pain-management/1581/">Traditional acupuncture</a> uses meridian lines or other points based on traditional Chinese medicine assessment methods and approaches. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/465898/original/file-20220530-26-1cisb.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="chinese medicine chart with lines through body" src="https://images.theconversation.com/files/465898/original/file-20220530-26-1cisb.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/465898/original/file-20220530-26-1cisb.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=387&fit=crop&dpr=1 600w, https://images.theconversation.com/files/465898/original/file-20220530-26-1cisb.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=387&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/465898/original/file-20220530-26-1cisb.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=387&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/465898/original/file-20220530-26-1cisb.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=486&fit=crop&dpr=1 754w, https://images.theconversation.com/files/465898/original/file-20220530-26-1cisb.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=486&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/465898/original/file-20220530-26-1cisb.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=486&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A traditional Chinese medicine acupuncture chart from the 1800s.</span>
<span class="attribution"><a class="source" href="https://wellcomecollection.org/works/xk6jb43t">Wellcome Collection</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>All physiotherapists trained in either acupuncture or dry needling meet safety standards which are viewed as within scope by the <a href="https://www.ahpra.gov.au/">Australian Health Practitioners Regulatory Agency</a> and the <a href="https://www.physiotherapyboard.gov.au/">Physiotherapy Registration Board</a>. These standards cover the level of training required, registration to practice and safety standards that include needle safety and hygiene to protect the public. </p>
<p>Minor reported <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7015026/#:%7E:text=Examples%20of%20minor%20adverse%20reactions,pain%20during%20or%20after%20treatment.">side effects</a> related to acupuncture including pain and bleeding or bruising from needle insertion are fairly common. But major adverse events – pneumothorax (collapsed lung), excessive bleeding, prolonged aggravation – are rare. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/this-ancient-chinese-anatomical-atlas-changes-what-we-know-about-acupuncture-and-medical-history-140506">This ancient Chinese anatomical atlas changes what we know about acupuncture and medical history</a>
</strong>
</em>
</p>
<hr>
<h2>What’s needling good for?</h2>
<p>Research into the effectiveness of acupuncture and dry needling is variable. Some studies show comparable results between dry needling and acupuncture, while others show more favourable results for one or the other depending on the condition being treated. </p>
<p>A <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001351.pub2/full?highlightAbstract=dry%7Cdri%7Cneedl%7Cneedling">review</a> that assessed the effects of acupuncture and dry needling for the treatment of low-back pain found they may be useful add-on therapies but could not make firm conclusions due to a lack of quality trials. </p>
<p>Another <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6600071/#CIT0034">review</a> reported the growing popularity of dry needling world wide and across disciplines and points out that many questions still remain regarding the use of needling. </p>
<p>For <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001218.pub3/full?highlightAbstract=acupuncture%7Cmigraine%7Cmigrain%7Cacupunctur">migraine</a> and <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007587.pub2/full?highlightAbstract=acupuncture%7Cheadach%7Ctension%7Cacupunctur%7Cheadache%7Ctype">tension</a> headaches, experts say acupuncture seems to reduce the frequency and intensity of attacks – though more research is needed to compare it to other treatments.</p>
<p>Acupuncture and dry needling may reduce pain and improve function for people with <a href="https://pubmed.ncbi.nlm.nih.gov/17224820/">neck pain</a>. A systematic review found significant differences between acupuncture and “sham acupuncture” (which is performed away from acupuncture points) when used to treat <a href="https://pubmed.ncbi.nlm.nih.gov/22965186/">certain types of chronic pain</a>. However, some research only shows <a href="https://pubmed.ncbi.nlm.nih.gov/33066556/">small and temporary</a> relief for neck pain with dry needling.</p>
<p>Results from randomised control trials support the use of needling for <a href="https://pubmed.ncbi.nlm.nih.gov/27062955">shoulder pain</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/32301166/">tennis elbow</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/32186030/">osteo arthritic knee pain</a>. But a recent systemic review of research reported only weak evidence to support needling to treat <a href="https://pubmed.ncbi.nlm.nih.gov/33760098/">plantarfasciitis and chronic ankle instability</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/465896/original/file-20220530-18-ws2b72.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="man lies on treatment bed while physio inserts needles into his back" src="https://images.theconversation.com/files/465896/original/file-20220530-18-ws2b72.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/465896/original/file-20220530-18-ws2b72.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/465896/original/file-20220530-18-ws2b72.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/465896/original/file-20220530-18-ws2b72.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/465896/original/file-20220530-18-ws2b72.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/465896/original/file-20220530-18-ws2b72.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/465896/original/file-20220530-18-ws2b72.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">An increasing number of physiotherapists offer dry needling or acupuncture treatment.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>Not just for sporting injuries</h2>
<p>Similarly, small randomised control trials have shown acupuncture and dry needling might reduce <a href="https://pubmed.ncbi.nlm.nih.gov/17095133/">problematic jaw pain</a> (<a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/temporomandibular-disorder-tmd#:%7E:text=Temporomandibular%20disorders%20(TMD)%20are%20disorders,may%20result%20in%20temporomandibular%20disorder.">temporo mandibular disorder</a>) and improve mouth opening.</p>
<p>Systematic reviews have reported needling and acupuncture were safe and effective recommendations for the treatment of broad conditions of <a href="https://www.healthline.com/health/tendinopathy">tendinopathy</a> (the breakdown of collagen in tendons) and <a href="https://pubmed.ncbi.nlm.nih.gov/30787631/#:%7E:text=At%20follow%2Dup%20in%20the,for%20the%20management%20of%20FM.">fibromyalgia</a> (chronic pain in the muscles and bones).</p>
<p>For women’s health, acupuncture has been shown to be effective for reducing pain with <a href="https://pubmed.ncbi.nlm.nih.gov/29879061/">periods</a>, compared to no treatment or non-steroidal pain relief medications – but the research had design limitations.</p>
<p>Though <a href="https://www.cochrane.org/CD002962/PREG_acupuncture-or-acupressure-induction-labour#:%7E:text=Acupuncture%20involves%20the%20insertion%20of,with%20onset%20of%20labour%20contractions.">widely used</a> in pregnancy, research into the use of acupuncture to <a href="https://pubmed.ncbi.nlm.nih.gov/32032444/">induce labour</a> reports it may increase satisfaction with pain management and reduce pain intensity. But it may have little to no effect on the rates of caesarean or assisted vaginal birth.</p>
<p>In summary, it appears needling techniques – whether dry needling or acupuncture – generally show positive effects over no treatment or “sham” treatments, but more research and high quality trials are needed. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1435103532856889344"}"></div></p>
<h2>Just one part of a treatment program</h2>
<p>Needling <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001351.pub2/full?highlightAbstract=dry%7Cdri%7Cneedl%7Cneedlin">may be useful</a> as part of multimodal care – that is, when <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4780149/">more than one treatment</a> is used in conjunction to treat a problem. </p>
<p>Physiotherapists may combine needling therapies with exercise prescription, hands-on care including massage, mobilisations and manipulations, and taping techniques. They may also employ therapies that apply external energy such as ultrasound, laser, transcutaneous (under the skin) electrical nerve stimulation and biofeedback.</p>
<p>Finally, while the various needling techniques all use a filiform needle (with a solid filament as opposed to a hollow bore needle), the styles with each can be quite different. Ask what style of needling is being employed to treat you, and if you have a history of finding one style works better for you, discuss this with your practitioner.</p><img src="https://counter.theconversation.com/content/181939/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Dry needling and Western acupuncture don’t incorporate traditional chinese medicine philosophies – but may be helpful for pain and releasing muscle tension.Wayne Hing, Professor, Physiotherapy, Bond UniversityLeigh McCutcheon, Lecturer, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1777392022-03-30T19:08:58Z2022-03-30T19:08:58ZWe’re two physios who ran away with the circus. Here’s what we learned<p>Circus fuses extreme athletic performance, diverse artists and stunning spectacles with a truly global appeal. </p>
<p>Circus is exciting, although sometimes unpredictable. At any moment during rehearsal, performance or travel, injuries can occur.</p>
<p>The task of looking after the health of circus performers is unique. And we’ve been privileged to do that, as physiotherapists treating and helping coordinate artists’ medical care. </p>
<p>We’ve done this in well over 100 cities through 30 countries across North and South America, Europe, Australasia, Asia and the Middle East. While we’ve mainly toured with professional circuses, we’ve also advised junior artists and circus training facilities.</p>
<p>This is what it’s like to work behind the scenes of some of the greatest shows on Earth.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/circus-oz-is-to-close-after-44-years-they-irrevocably-changed-australian-circus-and-brought-it-to-the-world-173586">Circus Oz is to close after 44 years. They irrevocably changed Australian circus, and brought it to the world</a>
</strong>
</em>
</p>
<hr>
<h2>A diverse crew</h2>
<p>Circuses and their performers are diverse. Disciplines include ground acrobatics (for instance, tumbling, hand balancing, contortion); aerial acrobatics (trapeze, silks, straps); manipulation (juggling); character (clowning); and music. Rehearsals and performances may feature fire, ice, water, heights or a range of props and equipment.</p>
<p>You could compare the cast of a large show to an Olympic squad, with a variety of ages, body shapes, sizes and injury risk.</p>
<p>At the elite level, performers may come from a range of different countries, languages and cultural backgrounds. This can add potential challenges such as differing belief systems and attitudes about injury cause and management, training and performance.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/452734/original/file-20220317-19-8716b3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Circus performers, including clown, juggler" src="https://images.theconversation.com/files/452734/original/file-20220317-19-8716b3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/452734/original/file-20220317-19-8716b3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=440&fit=crop&dpr=1 600w, https://images.theconversation.com/files/452734/original/file-20220317-19-8716b3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=440&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/452734/original/file-20220317-19-8716b3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=440&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/452734/original/file-20220317-19-8716b3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=553&fit=crop&dpr=1 754w, https://images.theconversation.com/files/452734/original/file-20220317-19-8716b3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=553&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/452734/original/file-20220317-19-8716b3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=553&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Circuses and their performers are diverse, as are their injuries.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/circus-226087540">Shutterstock</a></span>
</figcaption>
</figure>
<h2>A diverse set of injuries</h2>
<p>While headline-grabbing falls and catastrophic injuries do occur, they are fortunately rare. Most injuries are chronic (long-term) injuries and less-serious acute ones. </p>
<p>The most commonly reported circus injuries are to the <a href="https://www.ingentaconnect.com/content/scimed/mppa/2017/00000032/00000001/art00008">spine and ankle</a>. We also see sprains, strains, and sore lower backs and shoulders.</p>
<p>You might be familiar with many of these injuries. However, circus performers have unique skills, and sometimes require extreme ranges of movement, coordination and strength. They need their bodies to function in ways you or I don’t. This influences how we work with performers to get them back on their feet (or hands).</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/hot-pack-or-cold-pack-which-one-to-reach-for-when-youre-injured-or-in-pain-161086">Hot pack or cold pack: which one to reach for when you're injured or in pain</a>
</strong>
</em>
</p>
<hr>
<p>Circus injury rates are <a href="https://www.ingentaconnect.com/content/scimed/mppa/2017/00000032/00000001/art00008">7.37-9.27</a> per 1,000 artist exposures (the number of training/performance hours, or number of training sessions/shows). Acrobatic injuries are the <a href="https://www.ingentaconnect.com/content/scimed/mppa/2014/00000029/00000004/art00010">most</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3445642/">common</a>. </p>
<p>However, the limited research we have on circus injuries suggests
circus is safer then many other sports. That includes having lower injury rates than contact football (rugby, American football and Australian rules), and gymnastics. </p>
<p>In professional circus, <a href="https://journals.sagepub.com/doi/abs/10.1177/0363546508331138">injuries tend to be minor</a>, requiring seven or fewer treatment sessions and resulting in one or no missed shows. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/453796/original/file-20220323-21-11ghbqp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Fit woman in exercise wear clutching sore lower back" src="https://images.theconversation.com/files/453796/original/file-20220323-21-11ghbqp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/453796/original/file-20220323-21-11ghbqp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/453796/original/file-20220323-21-11ghbqp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/453796/original/file-20220323-21-11ghbqp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/453796/original/file-20220323-21-11ghbqp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/453796/original/file-20220323-21-11ghbqp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/453796/original/file-20220323-21-11ghbqp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Injuries, such as sore backs, are common, and not always reported.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/back-view-sportswoman-sitting-on-mat-1745717915">Shutterstock</a></span>
</figcaption>
</figure>
<p>However, injuries are likely under-reported. Common definitions of injury rely on artists missing training or shows, or seeking formal medical care. Some injuries don’t meet these criteria.</p>
<p><a href="https://www.ingentaconnect.com/content/scimed/mppa/2021/00000036/00000001/art00008">Our research</a> looked at performers’ self-reported lower-limb problems, regardless of whether they missed work or saw a health-care practitioner. We asked them about injuries and/or symptoms such as pain, ache, stiffness, clicking/catching, swelling and instability.</p>
<p>In any given week, we found more than 50% of performers reported problems. In an 18-week period, 86% of performers reported having had at least one week with work-related lower limb problems.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/friday-essay-from-delicate-teens-to-fierce-women-simone-biles-athleticism-and-advocacy-have-changed-gymnastics-forever-124485">Friday essay: from delicate teens to fierce women, Simone Biles' athleticism and advocacy have changed gymnastics forever</a>
</strong>
</em>
</p>
<hr>
<h2>A diverse range of issues</h2>
<p>Some performers also face barriers to recovering from their injuries. <a href="https://www.ingentaconnect.com/content/scimed/mppa/2019/00000034/00000001/art00003">One study</a> found financial constraints and a lack of health-care support were issues.</p>
<p>For instance, full-time artists may have access to travelling medical staff with experience working with circus performers. These artists may also have paid injury leave and comprehensive health insurance. </p>
<p>However, artists performing on short-term contracts or doing gig-based work may need to source their own medical care and are more likely to suffer financial loss if they miss performances. </p>
<p>Other researchers have also reported how aspects of circus culture influence how we manage circus injuries. In <a href="https://www.ingentaconnect.com/content/scimed/mppa/2019/00000034/00000001/art00003">one study</a>, performers said they didn’t always trust health-care practitioners’ knowledge of work demands. This includes circus skill requirements, and training or show schedules. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/453795/original/file-20220323-21-1ow1371.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Athlete's taped wrist and ankle" src="https://images.theconversation.com/files/453795/original/file-20220323-21-1ow1371.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/453795/original/file-20220323-21-1ow1371.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/453795/original/file-20220323-21-1ow1371.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/453795/original/file-20220323-21-1ow1371.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/453795/original/file-20220323-21-1ow1371.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/453795/original/file-20220323-21-1ow1371.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/453795/original/file-20220323-21-1ow1371.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">To tape or not? Some performers may prefer colleagues’ and coaches’ advice.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/injured-athlete-thumb-ankle-injuries-tape-1481951810">Shutterstock</a></span>
</figcaption>
</figure>
<p>Some performers may prioritise advice from colleagues and coaches over medical recommendations. This may be partly because circus is a historic art form where, in many disciplines, training methods have been passed down through generations of performers. </p>
<p>For health-care practitioners, this knowledge can be valuable. So clinicians need to work with artists to come to a shared understanding of how to manage injuries. </p>
<p>Acknowledging the unique nature of circus training and performance, as well as the lack of evidence base to guide medical decision-making in the field, can also help build rapport and ensure a collaborative approach to managing injuries.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/are-clowns-scary-ha-ha-aaaargh-32492">Are clowns scary? Ha ha aaaargh</a>
</strong>
</em>
</p>
<hr>
<h2>Preventing injuries is the goal</h2>
<p>Circus performers are generally adept at managing their bodies, using strength, flexibility and conditioning training to try to prevent injuries and improve their acts.</p>
<p>We have worked with performers to promote self-management, using techniques from more established fields such as sports and dance medicine.</p>
<p>For instance, we looked at adding self-directed <a href="https://www.ingentaconnect.com/content/scimed/mppa/2021/00000036/00000001/art00008">endurance exercises</a> to a performing, touring show. This was welcomed by many performers.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-do-ice-baths-after-sport-help-recovery-or-improve-results-44829">Health Check: do ice baths after sport help recovery or improve results?</a>
</strong>
</em>
</p>
<hr>
<h2>A lot goes on behind the scenes</h2>
<p>For the shows to go on, much behind-the-scenes work is needed from the artists and dedicated support staff. </p>
<p>For those involved in the care of circus artists, this provides not only a uniquely challenging and fascinating workspace, but an amazing view of some of the greatest shows on Earth.</p><img src="https://counter.theconversation.com/content/177739/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Charlotte Ganderton is a research consultant for the National Institute of Circus Arts. Charlotte was previously employed for Cirque du Soleil in its performance medicine team.</span></em></p><p class="fine-print"><em><span>Michael Henry receives funding from the Australian Government in the form of RTPd fee offset and stipend scholarships. He was previously employed by Cirque du Soleil in its performance medicine team. </span></em></p>Circus is exciting, though sometimes unpredictable. At any moment during rehearsal, performance or travel, injuries can occur.Charlotte Ganderton, Physiotherapy lecturer, Swinburne University of TechnologyMichael Henry, PhD candidate, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1764502022-02-22T04:49:59Z2022-02-22T04:49:59ZHow to care for your sore hands and wrists when your life is online<figure><img src="https://images.theconversation.com/files/447232/original/file-20220218-23-1qf909x.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5490%2C3665&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/woman-holding-her-wrist-pain-600w-1504131929.jpg">Shutterstock</a></span></figcaption></figure><p>We are back to pounding keyboards and swiping phones for another year. But with so much of today’s learning, working and socialising happening via devices, hand and wrist injuries are both common and hard to recover from.</p>
<p>Cumulative trauma to the upper limb from prolonged computer use is a significant problem. Technological advances – online meetings anyone? – and the reduced need to leave our desks for inefficient tasks such as photocopying, sending and receiving mail, and chatting with work colleagues (if now working from home) are causing people to remain in static postures for longer periods.</p>
<p>Musculoskeletal disorders of the upper limb are a <a href="https://www.pointsdevue.com/sites/default/files/postural_load_in_digital_device_usage_and_musculoskeletal_disorders.pdf">common phenomenon</a> and are the single largest category of work-related illness, with some studies reporting they make up to <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008570.pub3/full">20–60% of cases</a>. Musculoskeletal disorders are responsible for <a href="https://www.researchgate.net/publication/8174011_Work-Related_Musculoskeletal_Disorders_of_the_Hand_and_Wrist_Epidemiology_Pathophysiology_and_Sensorimotor_Changes">more work-related absenteeism</a> than any other type of disease.</p>
<p>Further, evidence suggests <a href="https://link.springer.com/article/10.1186/s40557-014-0022-3">high levels of smartphone use</a> without regular breaks can result in pain and discomfort in the upper limb. High levels of device use can result in <a href="https://archivesphysiotherapy.biomedcentral.com/articles/10.1186/s40945-020-00096-6">neck</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6405356/">shoulder</a>, <a href="https://link.springer.com/article/10.1186/s40557-014-0022-3">wrist and hand problems</a>. </p>
<p>But anyone who has suffered from hand or wrist pain will tell you how hard it is to rest and treat injuries when so much of everyday life – from domestic chores to technology use – is done manually. So what to do?</p>
<h2>What causes it</h2>
<p>The risk of these injuries from technology use is due to the repetitive motions of the thumb in often awkward, static (or still) postures of the wrist and hand. The main other factor in developing symptoms includes remaining in awkward static postures for extended periods of time.</p>
<p>Common upper limb disorders resulting from high levels of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6405356/">keyboard, tablet and smartphone use</a> are nerve compression disorders (<a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/carpal-tunnel-syndrome">carpal tunnel syndrome</a>) and tendon inflammation (<a href="https://www.webmd.com/arthritis/overview-tenosynovitis">tenosynovitis</a>, <a href="https://www1.racgp.org.au/ajgp/2020/november/lateral-epicondylitis">lateral epicondylalgia</a> or “tennis elbow”). Symptoms from these conditions include numbness and tingling in your hand and forearm, weakness in gripping objects in your hand, or local tenderness at the elbow, wrist and/or hand. </p>
<p>When structures of the hand are repetitively stressed for extended periods, the body doesn’t have a chance to rest and heal. What starts out as a minor irritation can soon exacerbate into a significant problem for everyday living.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/447233/original/file-20220218-7720-n1h9u5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="person sits at desk with sore wrist" src="https://images.theconversation.com/files/447233/original/file-20220218-7720-n1h9u5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/447233/original/file-20220218-7720-n1h9u5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/447233/original/file-20220218-7720-n1h9u5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/447233/original/file-20220218-7720-n1h9u5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/447233/original/file-20220218-7720-n1h9u5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/447233/original/file-20220218-7720-n1h9u5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/447233/original/file-20220218-7720-n1h9u5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Even short breaks can help prevent strain.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/concept-office-syndrome-hand-pain-occupational-2003480063">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-younger-people-can-learn-from-older-people-about-using-technology-107607">What younger people can learn from older people about using technology</a>
</strong>
</em>
</p>
<hr>
<h2>How to prevent it</h2>
<p>The single best piece of advice I can provide is to ensure you have adequate breaks away from your smartphone, tablet or computer. Listen to your body, and ensure you change postures or stop the task if you begin to feel some pain or discomfort.</p>
<p><a href="https://www.uclahealth.org/safety/rest-breaks">Microbreaks</a> – as short as 30–60 seconds – can be effective, especially in jobs that require an extended period of sitting in front of a computer hammering away at a keyboard. Remember, it is the repetitive movements in static postures that you are trying to avoid. These microbreaks are especially important for prolonged smartphone or tablet use. </p>
<p>These breaks should occur every 20 minutes and involve changing the posture through some dynamic movements. This could include standing (if you were sitting), moving your joints through their full range of motion, or even better, getting away from your workstation and moving around.</p>
<p>Build these breaks into your work routine through calendar invites or other software programs that ping you an alert at the desired break time. </p>
<p>Alternatively, schedule tasks close together that requires different postures. For example, you could schedule important phone calls or face meetings between more extended periods of keyboard work.</p>
<p>Good postures and workstation ergonomics <a href="https://academic.oup.com/occmed/article/61/1/19/1451517">can make a real difference</a> in reducing and managing these aches and pains. Ensure your computer is well set up on a desk set at the appropriate height. </p>
<p>Your wrists should be slightly extended backwards (towards the ceiling) when resting on the keyboard. All other equipment on your desk that you commonly use should be within easy reach. </p>
<p>You should have a relaxed posture through your shoulders, neck and arms when sitting for extended periods. Specialised <a href="https://www.academia.edu/30927203/Evidence_for_the_efficacy_of_ergonomic_keyboards_and_mice_in_reducing_repetitive_strain_injuries_and_10_steps_to_achieving_a_healthier_workplace_Reducing_the_Incidence_and_Cost_of_Work-related_Musculoskeletal_Disorders_with_Ergonomic_Input_Devices">ergonomic equipment</a> such as keyboards and mice may be beneficial, as may <a href="https://www.researchgate.net/publication/4257137_Is_Voice_Recognition_the_Solution_to_Keyboard-Based_RSI">voice-to-text software</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-texting-turns-you-into-a-walking-disaster-22244">How texting turns you into a walking disaster</a>
</strong>
</em>
</p>
<hr>
<h2>When the damage is done</h2>
<p>If the pain or discomfort continues to worsen or impacts your engagement in your daily activities, it is important to seek professional health advice before the condition significantly progresses. </p>
<p>An accredited hand therapist is an excellent place to start. These health professionals are registered occupational therapists or physiotherapists who have extensive experience and knowledge of the complex anatomy of the hand and wrist. </p>
<p>They will be able to provide individual advice and treatment to help you manage your condition. Treatments could include tailored ergonomic advice, the prescription of specific exercises, hot or ice packs, and custom orthotic devices (splints). In more serious cases, you may be referred to a hand surgeon, who may provide medication, cortisone injections or surgery to address the underlying causes of symptoms.</p>
<p>Given the rapid changes we’ve seen in our how humans interact with their world, research is helping us better understand how to manage the adverse effects of our exploding technology use. While we know a little, there is still <a href="https://academic.oup.com/occmed/article/61/1/19/1451517">much work to be done</a>. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1428305195935617024"}"></div></p><img src="https://counter.theconversation.com/content/176450/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dave Parsons is an Accredited Hand Therapist and a Board Member of the Australian Hand Therapy Association. He receives some funding from the Australian Hand Therapy Association for his research.</span></em></p>Modern life means if you have wrist or hand pain, it’s difficult to rest and repair the damage. Prevention is key.Dave Parsons, Lecturer, Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1762492022-02-10T03:12:54Z2022-02-10T03:12:54ZAt home with COVID? 5 easy tips to help you breathe more easily<figure><img src="https://images.theconversation.com/files/445551/original/file-20220210-23-3b49ib.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C660&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-calm-african-female-rest-leaned-1733456774">Shutterstock</a></span></figcaption></figure><p>Shortness of breath, persistent cough and fatigue are common COVID signs and symptoms. And the <a href="https://www.health.gov.au/health-alerts/covid-19/case-numbers-and-statistics">vast majority</a> of people will be managing their symptoms at home.</p>
<p>As a cardiorespiratory physiotherapist, I help people with heart and breathing problems manage and recover from a range of illnesses. </p>
<p>Here are some simple exercises to help you navigate COVID at home.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/ive-tested-positive-to-covid-what-should-i-do-now-174458">I've tested positive to COVID. What should I do now?</a>
</strong>
</em>
</p>
<hr>
<h2>Why should I exercise when I have COVID?</h2>
<p>Your body does need some rest when you are sick. However, doing simple, gentle exercises while convalescing with COVID can <a href="https://www.sciencedirect.com/science/article/pii/S1744388121000633?casa_token=DtZHFwAh5-8AAAAA:dmR3Lcvu331IedCvgbEioJ6eJTOSD2jGRD7L3sobJRJBvERfvl2xZfc5InNPZktW--YkUmYH">help improve</a> your symptoms.</p>
<p>People who are older, overweight, or have a chronic condition, such as diabetes, or cardiovascular (heart/circulation) and respiratory (lung) disease, are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7543371/">more likely</a> to have COVID symptoms.</p>
<p>So these groups are among those who would particularly benefit from simple, gentle exercise at home.</p>
<h2>1. Relaxed breathing</h2>
<p>This exercise is particularly useful if you feel short of breath:</p>
<ul>
<li><p>get into a stable and comfortable position. Drop your shoulders and breathe in slowly</p></li>
<li><p>purse your lips (as if you’re blowing through a straw)</p></li>
<li><p>breathe out slowly and steadily through your mouth</p></li>
<li><p>repeat the exercise for a minute.</p></li>
</ul>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/dDpX7pGdPR4?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Here’s what relaxed breathing looks like.</span></figcaption>
</figure>
<p>You can perform this exercise as often as you like. But <strong>stop if you feel dizzy</strong> as taking too many breaths in a row will cause light headiness. </p>
<p>Perform the exercise in a room with windows open. If you are feeling hot, you can cool your face with a damp towel while doing it.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/445543/original/file-20220209-18418-18fi99b.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Person lying on their side on the bed" src="https://images.theconversation.com/files/445543/original/file-20220209-18418-18fi99b.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/445543/original/file-20220209-18418-18fi99b.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=394&fit=crop&dpr=1 600w, https://images.theconversation.com/files/445543/original/file-20220209-18418-18fi99b.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=394&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/445543/original/file-20220209-18418-18fi99b.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=394&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/445543/original/file-20220209-18418-18fi99b.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=495&fit=crop&dpr=1 754w, https://images.theconversation.com/files/445543/original/file-20220209-18418-18fi99b.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=495&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/445543/original/file-20220209-18418-18fi99b.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=495&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Some people will need to lie on their side for this exercise.</span>
<span class="attribution"><a class="source" href="https://apps.who.int/iris/bitstream/handle/10665/344472/WHO-EURO-2021-855-40590-59892-eng.pdf?sequence=1&isAllowed=y">WHO</a></span>
</figcaption>
</figure>
<p>Adopting a comfortable position is key to this exercise. Sitting in a supportive chair may be the easiest for most people. </p>
<p>However, for some people with COVID, sitting in a chair is too strenuous. In these instances, try this exercise in other positions such as lying on your side, as <a href="https://www.euro.who.int/en/health-topics/Life-stages/disability-and-rehabilitation/publications/support-for-rehabilitation-self-management-after-covid-19-related-illness,-2nd-ed">recommended</a> by the World Health Organization.</p>
<h2>2. Deep breathing</h2>
<p>This can improve oxygen intake and calm your nerves:</p>
<ul>
<li><p>get into an upright position. Relax your shoulders</p></li>
<li><p>breathe in deeply through your nose for two to three seconds. Hold your breath for three seconds, if able</p></li>
<li><p>breathe out through your nose or mouth, whichever is more comfortable</p></li>
<li><p>repeat the exercise for a minute. </p></li>
</ul>
<p>Again, <strong>stop if you feel dizzy.</strong> You may cough and bring up some phelgm after this exercise. If you do have to cough, cover your mouth with a tissue and dispose of the tissue immediately in a sealed bag after each use. Wash your hands thoroughly after.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-look-after-your-mental-health-if-youre-at-home-with-covid-174536">How to look after your mental health if you're at home with COVID</a>
</strong>
</em>
</p>
<hr>
<h2>3. Lie on your tummy (if you can)</h2>
<p>You may have heard from others, such as Harry Potter author <a href="https://www.health.com/condition/infectious-diseases/coronavirus/jk-rowling-breathing-technique-covid-19">JK Rowling</a>, about the benefits of lying on your stomach (proning) during breathing exercises to improve oxygenation.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/445545/original/file-20220209-19-f58vmq.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Person lying on their front on the bed" src="https://images.theconversation.com/files/445545/original/file-20220209-19-f58vmq.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/445545/original/file-20220209-19-f58vmq.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=274&fit=crop&dpr=1 600w, https://images.theconversation.com/files/445545/original/file-20220209-19-f58vmq.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=274&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/445545/original/file-20220209-19-f58vmq.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=274&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/445545/original/file-20220209-19-f58vmq.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=344&fit=crop&dpr=1 754w, https://images.theconversation.com/files/445545/original/file-20220209-19-f58vmq.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=344&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/445545/original/file-20220209-19-f58vmq.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=344&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Lying on your front isn’t for everyone and can be painful.</span>
<span class="attribution"><a class="source" href="https://apps.who.int/iris/bitstream/handle/10665/344472/WHO-EURO-2021-855-40590-59892-eng.pdf?sequence=1&isAllowed=y">WHO</a></span>
</figcaption>
</figure>
<p>Proning is common in hospital for people who need extra oxygen. However, the evidence for proning at home is unclear and it is not for everyone.</p>
<p>As you need to stay on your stomach for at least 30 minutes, some people may find this extremely uncomfortable, especially if they have neck and lower back pain. For these people, sitting upright or lying on their side while doing breathing exercises may be better alternatives.</p>
<p>Nonetheless, if you would like to try proning, here are some tips:</p>
<ul>
<li><p>do not try proning after a meal</p></li>
<li><p>choose a firm surface to lie on. Soft beds can make lying on your stomach even more uncomfortable for your back</p></li>
<li><p>turn your head to the side. Place a pillow under your stomach, feet, arms and head for comfort</p></li>
<li><p>ensure you have someone with you at all times, especially when trying this for the first time. Both you and your helper should wear a mask to minimise cross-infection </p></li>
<li><p>do not attempt proning with children under one year old.</p></li>
</ul>
<h2>4. Move regularly</h2>
<p>Even people with relatively mild COVID symptoms may continue to be fatigued after other symptoms have resolved. </p>
<p>Doing simple exercises regularly throughout the day while in isolation can help minimise the effects of reduced mobility during COVID.</p>
<p>You can try sitting on a chair and standing, then repeating that for a minute. Or you could march on the spot for two minutes. </p>
<p><a href="https://www.euro.who.int/en/health-topics/Life-stages/disability-and-rehabilitation/publications/support-for-rehabilitation-self-management-after-covid-19-related-illness,-2nd-ed">Pacing and prioritising</a> your activities to ensure you do regular activities throughout the day can also help manage your fatigue.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/whats-a-pulse-oximeter-should-i-buy-one-to-monitor-covid-at-home-174457">What's a pulse oximeter? Should I buy one to monitor COVID at home?</a>
</strong>
</em>
</p>
<hr>
<h2>5. Know when to seek further medical attention</h2>
<p>If you or a family member experience chest pain, difficulty breathing despite home management, dizziness, new weakness in your face, arm or leg, increased confusion, difficulty staying awake, or have thoughts of self-harm, you will need to seek <a href="https://theconversation.com/covid-can-worsen-quickly-at-home-heres-when-to-call-an-ambulance-166889">urgent medical attention</a>. </p>
<p>You can also use online <a href="https://www.healthdirect.gov.au/symptom-checker/tool/basic-details">symptom checkers</a> for advice on your next immediate action, including when to call an ambulance.</p>
<p>If your COVID symptoms last longer than two weeks, see your local doctor. They may be able to <a href="https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0005/605525/ACI-Respiratory-Rehab-Following-COVID-19.pdf">refer you</a> to a pulmonary (lung) rehabilitation service or physiotherapist who specialises in lung conditions.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/covid-can-worsen-quickly-at-home-heres-when-to-call-an-ambulance-166889">COVID can worsen quickly at home. Here's when to call an ambulance</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/176249/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Clarice Tang receives funding from Multicultural NSW, Department of Health and Maridulu Budyari Gumal. She is affiliated with Western Sydney University and is a member of the Australian Physiotherapy Association, Thoracic Society of Australia and New Zealand and the American Thoracic Society. </span></em></p>Exercise might be the last thing on your mind if you’re at home with COVID. But these gentle breathing exercises can help.Clarice Tang, Senior lecturer in Physiotherapy, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1708782021-12-07T05:55:02Z2021-12-07T05:55:02ZIs foam rolling effective for muscle pain and flexibility? The science isn’t so sure<figure><img src="https://images.theconversation.com/files/433390/original/file-20211123-19-1lw2noj.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C667&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Many physically active people get <a href="https://theconversation.com/health-check-why-do-my-muscles-ache-the-day-after-exercise-41820">muscle pain after exercise</a>, known as “delayed onset muscle soreness” or DOMS. </p>
<p>Foam rolling has emerged as a popular means of alleviating delayed onset muscle soreness and stiff muscles. </p>
<p>You’re likely to find foam rollers in any gym, or you may have one yourself, and many people swear by using them before and after exercise.</p>
<p>But what does the science say? Is foam rolling actually effective in reducing delayed onset muscle soreness, and in increasing flexibility?</p>
<p>Unfortunately, it’s often the case that scientific studies don’t necessarily support anecdotal evidence.</p>
<p>This seems to be the case with foam rolling. The evidence doesn’t strongly support the use of foam rollers – though some studies do show a small benefit.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-why-do-my-muscles-ache-the-day-after-exercise-41820">Health Check: why do my muscles ache the day after exercise?</a>
</strong>
</em>
</p>
<hr>
<h2>What is foam rolling?</h2>
<p>Foam rolling is a type of self-massage, usually using a cylindrical foam roller.</p>
<p>They were first used in the 1980s, and are now usually used in warm-up and/or cool-down exercises. </p>
<p><a href="https://twitter.com/diamandbradscn/status/1462327721799860232">Proponents say</a> foam rolling can reduce muscle pain, and increase flexibility (also known as range of motion).</p>
<p>But the mechanisms underlying these claims are not well known.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/physio-chiro-osteo-and-myo-whats-the-difference-and-which-one-should-i-get-149993">Physio, chiro, osteo and myo: what's the difference and which one should I get?</a>
</strong>
</em>
</p>
<hr>
<h2>How does foam rolling work?</h2>
<p>Foam rollers and other similar devices are claimed to release the tightness of “myofascia”.</p>
<p>Myofascia is a thin connective tissue that surrounds our muscles. It prevents friction between tissues, and transfers force generated by muscle fibres to the bone.</p>
<p>Myofascia can become <a href="https://www.hopkinsmedicine.org/health/wellness-and-prevention/muscle-pain-it-may-actually-be-your-fascia">sticky and tight</a> because of a sedentary lifestyle, repetitive movements that overworks one part of the body, injury, or surgery. Tight myofascia can reduce flexibility.</p>
<p>My research team and I at Edith Cowan University <a href="https://pubmed.ncbi.nlm.nih.gov/25519953/">investigated</a> the role of myofascia in delayed onset muscle soreness.</p>
<p>Participants in our study did ten sets of six bicep curls, and developed very sore arms in the following days.</p>
<figure class="align-center ">
<img alt="Man in gym holding sore arm" src="https://images.theconversation.com/files/435769/original/file-20211206-21-2mkwbu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/435769/original/file-20211206-21-2mkwbu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/435769/original/file-20211206-21-2mkwbu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/435769/original/file-20211206-21-2mkwbu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/435769/original/file-20211206-21-2mkwbu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/435769/original/file-20211206-21-2mkwbu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/435769/original/file-20211206-21-2mkwbu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Delayed onset muscle soreness might have more to do with the fascia surrounding muscles, than the muscles themselves.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>We assessed their muscle soreness one, two and four days after the exercise.</p>
<p>We also assessed their pain using an “electrical stimulator” to quantify the sensitivity of the bicep fascia and muscle to electric current.</p>
<p>We found the fascia surrounding the muscle became more sensitive to electrical stimulation than the muscle itself.</p>
<p>Scientists think tiny tears in muscle fibres are responsible for delayed onset muscle soreness. But our research suggests damage to, or inflammation of, myofascia is more associated with delayed onset muscle soreness than damage to muscle fibres.</p>
<p>Foam rolling claims to stretch the myofascia and thereby <a href="https://pubmed.ncbi.nlm.nih.gov/34502387/">could reduce such soreness and inflammation</a>.</p>
<h2>But the evidence for foam rolling is mixed</h2>
<p>The evidence is still emerging, but there have been some studies into foam rolling.</p>
<p>A <a href="https://www.sciencedirect.com/science/article/pii/S136085921930395X">systematic review article</a> of foam rolling based on 49 studies concluded foam rolling reduced muscle stiffness and pain, and increased range of motion. But the authors stated it should be used in combination with dynamic stretching and an active warm-up before exercise.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4299735/">Another study</a> examined whether foam rolling was effective in reducing delayed onset muscle soreness and enhancing muscle recovery. The participants performed two workouts four weeks apart, each involving ten sets of ten back squats.</p>
<p>One group then foam rolled for 20 minutes immediately, 24 and 48 hours after exercise, while another group did no foam rolling at all. Foam rolling had a moderate effect on reducing delayed onset muscle soreness.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/feeling-sore-after-exercise-heres-what-science-suggests-helps-and-what-doesnt-150277">Feeling sore after exercise? Here's what science suggests helps (and what doesn't)</a>
</strong>
</em>
</p>
<hr>
<p>But <a href="https://pubmed.ncbi.nlm.nih.gov/31024339/">another recent review article</a> with meta-analysis (which combines the results of multiple scientific studies) of 21 studies on foam rolling concluded the effects of foam rolling on performance and recovery were very minor, and foam rolling should be used as a warm-up activity rather than a recovery tool.</p>
<p>The article also found foam rolling before exercise resulted in a small improvement in flexibility by 4%. And rolling after exercise reduced muscle pain perception by 6%.</p>
<p>But statistical significance doesn’t necessarily reflect practical significance. A 4% increase in flexibility and 6% reduction in pain may not be noticed very much by most people. </p>
<p>Also, <a href="https://www.jssm.org/jssm-20-535.xml%3EFulltext">multiple studies</a> found foam rolling increased range of motion, but only for <a href="https://pubmed.ncbi.nlm.nih.gov/31256353/">roughly 20 minutes</a>.</p>
<p>So, the effects of foam rolling on flexibility do not appear to be large and the long-term effects are inconclusive.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1462662033812324352"}"></div></p>
<p>One problem with this area of research is the rolling protocols used in the studies were diverse with no definitive agreement regarding the ideal number of sets, duration, rolling frequency, or intensity.</p>
<p>Interestingly, the magnitude of the effect on range of motion following foam rolling is <a href="https://www.jssm.org/jssm-20-535.xml%3EFulltext">similar to that of stretching</a>.</p>
<p>So if your goal is to increase range of motion, both stretching and foam rolling can be considered as adequate warm-up routines. No previous studies have clearly showed foam rolling was more effective than other interventions to improve flexibility before exercise.</p>
<p>But remember: though foam rolling is generally considered safe, it’s better to avoid it if you have a serious injury such as a muscle tear, unless your doctor or a physical therapist has cleared you first.</p><img src="https://counter.theconversation.com/content/170878/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ken Nosaka receives funding from the National Health and Medical Research Council and Defence Science and Technology.
He is affiliated with the Stay Sharp Program (not-for-profit group in a community in Perth). </span></em></p>Foam rolling is eminently popular, but the evidence is mixed.Ken Nosaka, Professor of Exercise and Sports Science, Edith Cowan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1606582021-05-19T20:18:12Z2021-05-19T20:18:12ZStretching can increase your tolerance for pain<figure><img src="https://images.theconversation.com/files/399789/original/file-20210510-16-kc1x5r.jpg?ixlib=rb-1.1.0&rect=4%2C0%2C1345%2C667&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Stretching exercises are often prescribed by health professionals, such as physiotherapists, to reduce pain.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/">Shutterstock</a></span></figcaption></figure><p>To stretch or not to stretch? </p>
<p>Should you do it before or after exercise? Does it prevent or heal injuries? Stretching is always a hot topic. However, while it is effective in improving flexibility, its usefulness in reducing pain is being questioned.</p>
<p>Back pain is one of the most prevalent health conditions in our society. Up to <a href="https://doi.org/10.1016/j.ncl.2007.01.004">80 per cent of the population may suffer from it</a> at least once in their lifetime. Many sufferers do not improve after treatment. What makes treatments work or not? Answering this question could improve the quality of life of millions of people.</p>
<p>Health care professionals, including physiotherapists, often prescribe exercises such as stretching to reduce pain. It has long been accepted that stretching provides pain relief by increasing range of motion and decreasing muscle tone, which give the impression that there is less pain.</p>
<p>However, this perceived pain relief is rarely found to be directly associated with pain reduction. In fact, a recent study showed that <a href="https://www.dovepress.com/pain-sensitivity-and-torque-used-during-measurement-predicts-change-in-peer-reviewed-fulltext-article-JPR">increased flexibility was actually associated with a greater tolerance for pain, which occurs during the stretching</a>. It’s possible that stretching actually impacts pain perception by activating the areas in our central nervous system that modulate pain.</p>
<hr>
<p>
<em>
<strong>
À lire aussi :
<a href="https://theconversation.com/to-stretch-or-not-to-stretch-before-exercise-what-you-need-to-know-about-warm-ups-151190">To stretch or not to stretch before exercise: What you need to know about warm-ups</a>
</strong>
</em>
</p>
<hr>
<p>I am <a href="https://www.researchgate.net/profile/Hugo-Masse-Alarie">a professor in the physiotherapy program at Laval University and a researcher at Cirris</a>, the centre for interdisciplinary research in rehabilitation and social integration at the university. Together with students from Laval University and McGill University, I have just published new research on the effect of stretching on pain sensitivity: “<a href="https://pubmed.ncbi.nlm.nih.gov/32881712/">Stretch-induced hypoalgesia: a pilot study</a>” in the scientific journal <em>Scandinavian Journal of Pain</em>.</p>
<p>For the study we recruited 22 healthy adults who did not suffer from back pain. Each participant was asked to perform a stretch of the lumbar region (lower back), followed by a stretch of the forearm muscles. Participants were instructed to hold each stretch for three minutes to produce a moderate stretching sensation.</p>
<h2>Stretching produces hypoalgesia</h2>
<p>Before and after each exercise, we measured the pain sensitivity threshold for a muscle of the lower back (erectors of the lumbar spine) and a muscle of the forearm (wrist flexors) using an algometer.</p>
<p>An algometer is a measuring instrument equipped with a sensor that calculates the pressure required to produce a sensation we call a pain threshold. This way we can measure the modulation of pain sensitivity, or the change that stretching has on a pain threshold.</p>
<p>We calculated the modulation for each stretch on the extended area and on an area distant from the stretched muscles. A change recorded in an area remote from the stretch would suggest that the regions of the central nervous system that involve pain control were activated, and therefore that the stretch had a systemic effect.</p>
<figure class="align-center ">
<img alt="A man with a back rests his hand on the lumbar region." src="https://images.theconversation.com/files/397149/original/file-20210426-19-12g3b16.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/397149/original/file-20210426-19-12g3b16.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/397149/original/file-20210426-19-12g3b16.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/397149/original/file-20210426-19-12g3b16.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/397149/original/file-20210426-19-12g3b16.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/397149/original/file-20210426-19-12g3b16.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/397149/original/file-20210426-19-12g3b16.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Back stretches may not benefit everyone who suffers from back pain.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p><a href="https://doi.org/10.1515/sjpain-2020-0018">We observed that both stretches produced hypoalgesia</a>, an increase in the pain sensitivity threshold. In other words, after the participants performed the stretches, the experimenter had to apply greater pressure to produce pain.</p>
<p>Following the wrist extension, stretch-induced hypoalgesia was restricted to the stretched area itself, while following the back flex, hypoalgesia was also present at a distance from the stretched area (the forearm).</p>
<h2>The brain plays a role?</h2>
<p>Stretching is not the only type of exercise that produces hypoalgesia. Several studies have shown that <a href="https://www.jpain.org/article/S1526-5900(12)00808-5/fulltext">aerobic exercise and exercise involving sustained muscle contractions</a> also induce hypoalgesia.</p>
<p>These forms of exercise have received much more attention from the scientific community than stretching has, with some groups of researchers attempting to determine what mechanisms are at work. For example, it has been suggested that exercise-induced hypoalgesia involves the activation of — and interaction between — the opioid and endocannabinoid systems, which control pain. </p>
<p>In a <a href="https://www.jpain.org/article/S1526-5900(18)30456-5/fulltext">recent review or research</a>, the authors suggested that exercise-induced hypoalgesia could be explained by the unpleasant and even sometimes painful effect of these exercises. Indeed, we know that activating nociceptors (pain receptors) induces hypoalgesia by triggering systems that modulate pain, including opioids. </p>
<p>For example, <a href="http://www.doi.org/10.1097/SPC.0000000000000126">holding a hand in a bucket filled with cold water</a> produces an intense pain that induces systemic hypoalgesia. It is possible that similar mechanisms could also explain our results, since stretching produces a sensation that is sometimes unpleasant and even painful.</p>
<p>The remote, and therefore potentially systemic effects, were only present following back stretching. We believe that stretching the back could involve stretching a larger mass of structures (muscles, ligaments, tendons, skin) than stretching the wrist, and could therefore produce a greater effect. These hypotheses should be tested in future studies.</p>
<h2>Stretching is not a panacea</h2>
<p>The immediate benefits of stretching in people with back pain could be explained by the fact that regions in the body involved in pain modulation were stimulated. However, <a href="https://doi.org/10.1111/papr.12804">many people with chronic back pain benefit less from the hypoalgesia</a> that is usually induced by exercise. This could be explained by differences in the functioning of regions in the central nervous system that are involved in pain control.</p>
<p>Back stretches may not benefit everyone who suffers from back pain. Severe back pain that persists over time is usually multifactorial, so general management by a health care professional, such as a physiotherapist, may be necessary to reduce or control the pain. Stretching is only one of the treatment tools available to improve one’s health condition and it is not a panacea!</p><img src="https://counter.theconversation.com/content/160658/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hugo Massé-Alarie has received funding from the Canadian Institutes of Health Research (CIHR), the Natural Sciences and Engineering Research Council of Canada (NSERC), the Fonds de Recherche du Québec - Santé (FRQS) the Canada Foundation for Innovation (CFI) as well as the Government of Quebec, the Canadian Pain Society, the Canadian Musculoskeletal Rehabilitation Research Network, the International Society for the Study of Lumbar Spine (ISSLS), Taisho Pharmaceuticals, Pfizer Inc., Lilly Co, REPAR, the Réseau Québécois en Recherche sur la Douleur (RQRD) and Cirris.
</span></em></p>Some people with back pain see immediate benefits from stretching.Hugo Massé-Alarie, Professeur adjoint, physiothérapie, Université LavalLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1499932020-11-23T05:40:49Z2020-11-23T05:40:49ZPhysio, chiro, osteo and myo: what’s the difference and which one should I get?<figure><img src="https://images.theconversation.com/files/370689/original/file-20201123-15-wuzbbx.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6016%2C2269&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Many of us might not be as fit as we were before the pandemic hit, and as community sport restarts and gyms reopen across the country amid eased coronavirus restrictions, some people might be at increased risk of injury.</p>
<p>If you do pull your hamstring in your first game back, or work from home life has left you with a sore neck and headaches, you might think about visiting a health-care professional to treat your complaint.</p>
<p>But your sister sees a physiotherapist, your mother a chiropractor, your friend an osteopath and your cousin a myotherapist. All of them come highly recommended, so who do you choose to help manage your aches and pains, and what are the differences between the four? </p>
<p>In Australia, physiotherapists, osteopaths and chiropractors have extensive university training and are registered with the Australian Health Practitioner Regulation Agency (AHPRA). Myotherapists have completed an advanced diploma or bachelors degree in myotherapy or “musculoskeletal therapy”, but aren’t registered with AHPRA. All four types of health professionals are primary contact practitioners. This means you don’t need a GP referral to seek treatment. </p>
<p>You will find all four in private health care, but you’re more likely to be treated by a physiotherapist in the public sector (for example, at public hospitals) compared to chiropractors, osteopaths and myotherapists.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-chiropractic-war-with-reality-rages-on-19357">The chiropractic war with reality rages on...</a>
</strong>
</em>
</p>
<hr>
<h2>Similar definitions, on paper</h2>
<p>A <a href="https://choose.physio/what-is-physio">physiotherapist</a> assesses your problem, provides a diagnosis and helps you understand what’s wrong while considering your general health, activities, and lifestyle. They treat your complaint with a variety of “active” therapies, such as exercise programs and hydrotherapy. They also use “passive” therapies, such as massage, joint manipulation, and mobilisation (a technique used to increase movement of a joint). </p>
<p>There are many different <a href="https://choose.physio/what-is-physio">sub-disciplines within physiotherapy</a>. For example, some specialise in treating problems that arise from neurological conditions, like multiple sclerosis or stroke. Some also focus on assisting patients with heart and lung conditions, for example emphysema or after lung infections like pneumonia (or COVID!).</p>
<p>A <a href="https://www.wfc.org/website/index.php?option=com_content&view=article&id=90&Itemid=110">chiropractor</a> works on the diagnosis, treatment and prevention of mechanical disorders of the muscles, ligaments, tendons, bones and joints, and the effect on the nervous system. They have an emphasis on passive manual treatments, including joint and soft-tissue manipulation, and spinal adjustments. They may <a href="https://chiropracticaustralia.org.au/about-chiropractic/">also prescribe exercises to help you rehabilitate from your condition</a> as well as provide dietary advice.</p>
<p>Over the last decade, some forms of chiropractic care have come under media and scientific scrutiny, particularly in children and infants, and should therefore be approached with caution.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/chiropractic-care-in-pregnancy-and-childhood-a-castle-built-on-a-swamp-21757">Chiropractic care in pregnancy and childhood – a castle built on a swamp</a>
</strong>
</em>
</p>
<hr>
<p>An <a href="https://www.osteopathy.org.au/about-osteopathy">osteopath</a> focuses on the muscular and nervous systems, assessing the structure of the body to determine its impact on function. For example, the position of your spine and pelvis may impact on the way you reach over to weed your garden. Treatment involves a combination of active and passive therapies, including joint manipulation and mobilisation, massage, as well as postural advice and exercise programs.</p>
<p>A <a href="https://www.myotherapy.org.au/find-a-myotherapist/what-is-myotherapy/">myotherapist</a> works to assist your aches and pains by focusing on the muscles and joints. They offer a range of mostly “hands-on” treatments including dry needling, massage and joint mobilisation, but can also prescribe exercises.</p>
<p>The profession is not registered with AHPRA. Myotherapists are <a href="https://www.theage.com.au/national/victoria/patients-out-in-the-cold-as-new-rules-exclude-myotherapy-massage-20201019-p566ir.html">not formally recognised under the umbrella of allied health</a> in some regions of Australia. As such, they were forced to <a href="https://www.theage.com.au/national/victoria/patients-out-in-the-cold-as-new-rules-exclude-myotherapy-massage-20201019-p566ir.html">delay</a> reopening as coronavirus restrictions eased in Melbourne, as allied health including physiotherapists were allowed to reopen first.</p>
<p>There’s a lot of crossover in treatments offered between the four professions and not all services offered are supported by high-quality scientific research.</p>
<figure class="align-center ">
<img alt="A patient receiving neck manipulation from a chiropractor" src="https://images.theconversation.com/files/370745/original/file-20201123-19-1xnp0c0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/370745/original/file-20201123-19-1xnp0c0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/370745/original/file-20201123-19-1xnp0c0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/370745/original/file-20201123-19-1xnp0c0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/370745/original/file-20201123-19-1xnp0c0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/370745/original/file-20201123-19-1xnp0c0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/370745/original/file-20201123-19-1xnp0c0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The discipline of chiropractic has come under intense scientific scrutiny and should be treated with caution.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>So, what is the scientific evidence?</h2>
<p>Understanding if your health-care professional applies evidence-based practice to their treatment will help you decide which therapist is right for you.</p>
<p><a href="https://trove.nla.gov.au/work/38685442/version/51347677%20260703009">Evidence-based practice</a> relates to how any health professional integrates their clinical knowledge with the best available research evidence, and your individual values and circumstances, to assess and manage your health-care complaint. Whether or not this is implemented into daily practice will vary on the individual therapist, and may not be consistent across the entire profession.</p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/30826805/">Scientific evidence</a> supports the use of treatments where you, as the client, are actively involved in the management of your condition, including education and undertaking an exercise plan — what we call “exercise prescription”.</p>
<p>The breadth of <a href="https://pubmed.ncbi.nlm.nih.gov/30826805/">scientific evidence for exercise prescription</a> as a treatment for muscle, ligament, tendon, bone and joint complaints far outweighs the limited scientific support for the prolonged use of “passive” treatments like massage, manipulation, and adjustments. Research suggests these passive treatments should only be used as adjuncts to active treatments. This type of therapy may be appropriate in the early stages of your care, and let’s face it, most people love a massage.</p>
<p>However, in the long term, it doesn’t equip you with the skills required to manage your condition. It may even result in over-reliance on your health-care professional and cost you more in the long run. It’s important to find a health-care professional that empowers you to participate in appropriate exercise, develop skills to self-manage your aches and pains and maintain a healthy, active lifestyle.</p>
<figure class="align-center ">
<img alt="A health worker helping a patient's shoulder" src="https://images.theconversation.com/files/370698/original/file-20201123-13-1urwzzo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/370698/original/file-20201123-13-1urwzzo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/370698/original/file-20201123-13-1urwzzo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/370698/original/file-20201123-13-1urwzzo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/370698/original/file-20201123-13-1urwzzo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/370698/original/file-20201123-13-1urwzzo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/370698/original/file-20201123-13-1urwzzo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The evidence suggests health care that empowers you to take control of your condition is more effective than passive therapies like massage, in the long run.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Anecdotally, we think that physiotherapists and osteopaths are well equipped to implement an active management plan for your aches and pains. However, as an individual, you should seek out a health-care professional that supports you to manage your own condition. You could do this by speaking to your doctor, reading the biography of your practitioner, or phoning the clinic to enquire about the type of care provided prior to booking an appointment. Your health professional should be someone that walks alongside you and guides you on your rehabilitation journey.</p>
<p>Here are some questions you can ask yourself to help decide if the health-care professional is the right fit for you:</p>
<ol>
<li><p>will they consider my overall health status, social situation, and hobbies to create a treatment plan?</p></li>
<li><p>will they educate me on the importance of actively self-managing my aches and pains?</p></li>
<li><p>will they encourage me to undertake exercise and/or physical activity?</p></li>
<li><p>will they ask me about my goals and what I want the outcome to be?</p></li>
<li><p>will they help me determine what to do if my aches and pains flare up in the future?</p></li>
</ol><img src="https://counter.theconversation.com/content/149993/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Charlotte Ganderton is affiliated with Swinburne University of Technology and is a member of the Australian Physiotherapy Association. She also works in a physiotherapy clinic.</span></em></p><p class="fine-print"><em><span>Matthew King receives research funding from the Physiotherapy Research Foundation, and La Trobe University. He is affiliated with The Australian Physiotherapy Association, La Trobe University, and the Transport Accident Commission. He has worked in a physiotherapy clinic.</span></em></p>The scientific evidence supports the use of exercise rehabilitation, where you become an active participant in the treatment. Passive therapies like massage won’t help in the long run.Charlotte Ganderton, Lecturer, Swinburne University of Technology, Swinburne University of TechnologyMatthew King, Postdoctoral Research Fellow and Physiotherapist, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1445562020-09-01T08:26:51Z2020-09-01T08:26:51ZShould I stop running if my knee hurts?<figure><img src="https://images.theconversation.com/files/354862/original/file-20200826-7352-mnb3wd.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5964%2C3973&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/group-joggers-exercising-central-park-nyc-508073035">goodluz/Shutterstock</a></span></figcaption></figure><p>The most common site for pain in <a href="https://pubmed.ncbi.nlm.nih.gov/25851584/">recreational runners</a> is the knee. For some, especially older runners, the pain can be a symptom of osteoarthritis. But does running worsen knee pain and osteoarthritis?</p>
<p>A <a href="https://pubmed.ncbi.nlm.nih.gov/30273410/">study from Canada</a> shows that many people – including health professionals – believe running might be harmful to knee joints, particularly in people with knee osteoarthritis. One in two people believes that the repetitive loading associated with running, especially frequent or long-distance running, will speed up the deterioration caused by knee osteoarthritis and shorten the time to having the knee surgically replaced with an artificial joint. </p>
<p>But are these fears about running supported by science? Recreational exercise does not seem to be <a href="https://pubmed.ncbi.nlm.nih.gov/29934429/">harmful to knee cartilage</a>. In fact, exercise is important for cartilage health – the stimulus <a href="https://pubmed.ncbi.nlm.nih.gov/23561529/">brings nutrients to the joints</a>. And people who exercise moderately are <a href="https://pubmed.ncbi.nlm.nih.gov/28240703/">less likely to have knee osteoarthritis</a>. More specifically, recreational runners have <a href="https://pubmed.ncbi.nlm.nih.gov/28504066/">far lower rates of knee osteoarthritis than non-runners</a>. So you could say that <em>not running</em> might be bad for your knees. </p>
<p>However, high-volume or high-intensity running is associated with higher rates of knee osteoarthritis <a href="https://pubmed.ncbi.nlm.nih.gov/28504066/">compared with recreational running</a>, suggesting that there is probably a sweet spot which doesn’t involve being a couch potato or getting too competitive. </p>
<figure class="align-center ">
<img alt="Exhausted runner" src="https://images.theconversation.com/files/354647/original/file-20200825-18-nft8vn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/354647/original/file-20200825-18-nft8vn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/354647/original/file-20200825-18-nft8vn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/354647/original/file-20200825-18-nft8vn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/354647/original/file-20200825-18-nft8vn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/354647/original/file-20200825-18-nft8vn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/354647/original/file-20200825-18-nft8vn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Don’t overdo it.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/tired-woman-runner-taking-rest-after-388376620">Izf/Shutterstock</a></span>
</figcaption>
</figure>
<h2>What if you already have knee pain or osteoarthritis?</h2>
<p>It is not clear whether continuing to run with knee pain or osteoarthritis is bad for your knees, and many researchers around the world are exploring this question. But continuing to run, if you can, will help achieve the many health benefits of regular physical activity, including preventing at least 35 chronic diseases, such as <a href="https://pubmed.ncbi.nlm.nih.gov/23798298/">heart disease, stroke, type 2 diabetes and depression</a>. In general, runners live three years longer than non-runners. And the benefits of running are independent of other things, such as <a href="https://pubmed.ncbi.nlm.nih.gov/25082581/">age, sex, weight, alcohol and smoking</a> In other words, if two people regularly smoked cigarettes or drank alcohol excessively, and one of them was a runner, the runner would still live longer than the non-runner.</p>
<p>Running is an activity that can be done outdoors in most parts of the world and requires minimal equipment. And health benefits can be achieved with as little as <a href="https://bjsm.bmj.com/content/54/15/898.abstract">50 minutes running a week</a>. During the pandemic, the fact that it can be done alone without the help of others further increases its attractiveness and ensures people can continue to participate to stay healthy.</p>
<h2>Three tips for managing running-related knee pain</h2>
<p>You can exercise safely by following <a href="https://theconversation.com/if-your-knee-hurts-keep-exercising-says-expert-93377">simple rules</a>. </p>
<ol>
<li><p>Reducing running volume or intensity (reduced speed, avoiding downhill) will <a href="https://pubmed.ncbi.nlm.nih.gov/28476901/">reduce knee loads and can help reduce pain</a>.</p></li>
<li><p>Seeking help and guidance for therapeutic exercise, such as strengthening the knee and hip muscles, from a physiotherapist or other qualified professional, can reduce knee pain related to running and other activities, including in people with <a href="https://pubmed.ncbi.nlm.nih.gov/31475628/">knee osteoarthritis</a>.</p></li>
<li><p>Carefully consider changing your running technique with guidance from a professional. Changing your running style to a forefoot strike instead of heel strike can <a href="https://pubmed.ncbi.nlm.nih.gov/31823338/">reduce loads on the knees</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/27111879/">running-related knee pain</a>. However, it will increase loads on the ankle, <a href="https://pubmed.ncbi.nlm.nih.gov/31823338/">posing risks to injure other joints and tissues</a>. Increasing running cadence (step rate) or changing the position of your trunk can also reduce loads on the knee and <a href="https://pubmed.ncbi.nlm.nih.gov/26884223/">may help reduce pain</a>.</p></li>
</ol><img src="https://counter.theconversation.com/content/144556/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christian Barton receives funding from a Medical Research Future Fund TRIP Fellowship. </span></em></p><p class="fine-print"><em><span>Ewa M Roos does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>How to run safely with knee pain.Ewa M Roos, Professor of Muscle and Joint Health, University of Southern DenmarkChristian Barton, Senior Post-Doctoral Research Fellow, MRFF Fellow, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1362702020-05-05T13:52:57Z2020-05-05T13:52:57ZCoronavirus: how physiotherapists are helping patients recover<figure><img src="https://images.theconversation.com/files/332708/original/file-20200505-83740-er8htu.jpg?ixlib=rb-1.1.0&rect=21%2C0%2C4771%2C3190&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Physiotherapists can help improve a patient's breathing.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/doctor-wearing-ppe-suit-surgical-mask-1691900056">theskaman306/ Shutterstock</a></span></figcaption></figure><p>Most people who contract coronavirvus (COVID-19) recover. But about 14% will have a severe infection, and a further <a href="https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf">6% will become critically ill</a>. Research shows 16% of those hospitalised need an <a href="https://jamanetwork.com/journals/jama/fullarticle/2763188">intensive care bed</a> – often for <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2004500">prolonged periods of time</a>. Some will need to be placed in a <a href="https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/C0167-specialty-guide-surge-based-on-current-hospital-experience-v2.pdf">medical coma on a ventilator</a>.</p>
<p>During this critical period, specialist physiotherapists will remotely monitor patients and decide if they’re needed to help a patient’s <a href="https://www.sciencedirect.com/science/article/pii/S183695532030028X">respiratory function and physical recovery</a> by looking at factors such as a person’s oxygen levels, blood test results, lung scans, and following discussion with their colleagues. </p>
<p>Here are some of the problems that physiotherapists can assist with when people are in hospital with COVID-19.</p>
<h2>Low blood oxygen</h2>
<p>People with severe COVID-19 infections suffer from low blood oxygen. Patients with difficulty breathing because of the virus will have worsening lung function and won’t be able to circulate oxygen properly to the body’s essential organs.</p>
<p>In moderate to severe cases of COVID-19, <a href="https://www.ncbi.nlm.nih.gov/pubmed/32222812">prone positioning (lying face down)</a> is recommended. Lying face down for hours at a time <a href="https://www.ncbi.nlm.nih.gov/pubmed/32222812">can increase oxygen levels in the blood</a>. This is because it helps match <a href="https://www.ncbi.nlm.nih.gov/pubmed/27400909">air to blood supply</a> in the lungs, and also opens up areas of lung tissue to allow more gas exchange. </p>
<p>Often, this treatment is used when patients are <a href="https://www.ncbi.nlm.nih.gov/pubmed/32309812">still critically unwell</a> due to COVID-19. Moving the patient in and out of prone positioning requires a <a href="https://ers.app.box.com/s/jrgddvp49stn3w5hxwq5u8784p09xx77">large team of specialist staff</a> which can include physiotherapists. Physiotherapists may also <a href="https://ers.app.box.com/s/jrgddvp49stn3w5hxwq5u8784p09xx77">recommend other positions</a>, such as side lying, to assist lung function depending on the patient’s condition.</p>
<p>Physiotherapists can be involved in the treatment of people using <a href="https://breathe.ersjournals.com/content/15/2/110">non-invasive ventilation</a>, or may in some cases suggest or set up this equipment to <a href="https://err.ersjournals.com/content/27/149/180029">improve lung function</a>.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/23709194">Non-invasive ventilation</a> is a form of breathing support that doesn’t involve inserting a tube into the airways. This is usually done through a face mask, or a “<a href="https://www.ncbi.nlm.nih.gov/pubmed/32331217">helmet</a>”, which can limit droplet spread of the virus. </p>
<p>However, the use of non-invasive ventilation in treating COVID-19 is still being debated. Research indicates that non-invasive ventilation did not work well for people with <a href="https://www.ncbi.nlm.nih.gov/pubmed/30884185">other types of viral illnesses</a> such as the Middle East respiratory syndrome (MERS), which might mean there may be a <a href="https://www.ncbi.nlm.nih.gov/pubmed/28101605">high failure rate</a> in COVID-19. Early intubation (placing a tube in the airways) and ventilation is often <a href="https://www.ncbi.nlm.nih.gov/pubmed/32222812">preferred for severe COVID-19</a>.</p>
<p>Non-invasive ventilation can work for some patients with a <a href="https://www.thelancet.com/action/showPdf?pii=S2213-2600%2820%2930181-8">less severe infection</a>, especially if they’re not considered suitable for more intensive forms of treatment, or if ventilators are in low supply. </p>
<h2>Mucus in the lungs and difficulty breathing</h2>
<p>While many people with COVID-19 have a dry cough and don’t have problems with <a href="https://www.sciencedirect.com/science/article/pii/S183695532030028X">excess mucus build up</a> data from one Chinese study reported that 34% of patients with severe COVID-19 had <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2002032">excess mucus</a>. This build up may happen after being admitted to critical care.</p>
<p>For some people very unwell with COVID-19, physiotherapists might deliver ventilator hyperinflation to <a href="https://www.physiotherapyjournal.com/article/S0031-9406(14)00090-X/fulltext">mimic larger breaths</a>, or use a flexible catheter to <a href="https://link.springer.com/content/pdf/10.1007/s00134-014-3565-4.pdf">suction mucus out</a> without the need to disconnect the person from the ventilator.</p>
<p>Patients can also be taught breathing exercises to help them cough up mucus on their own. Those experiencing breathlessness or difficulty breathing can be advised about positioning, relaxed breathing techniques, and about modifying their daily activities. </p>
<p>However, some breathing techniques used to clear mucus will result in coughing. This may spread coronavirus, so physiotherapists will need full <a href="https://link.springer.com/content/pdf/10.1007/s00134-020-06022-5.pdf">personal protective equipment</a>. A <a href="https://link.springer.com/content/pdf/10.1007/s00134-020-06022-5.pdf">negative pressure room</a> (where air can’t be circulated outside the room) is also useful for preventing further virus spread.</p>
<h2>Weakness</h2>
<p>A big focus of physiotherapy during the pandemic will be to get patients <a href="https://www.sciencedirect.com/science/article/pii/S183695532030028X">moving as soon as possible</a>. But this can only happen when the <a href="https://www.sciencedirect.com/science/article/pii/S183695532030028X">patient is well enough</a>. </p>
<p>This can start with simply getting patients to move their arms, legs and body in the bed. Physiotherapists will closely manage vital signs such as oxygen levels, respiratory rate and blood pressure to ensure movements are safely tolerated.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/332714/original/file-20200505-83764-bujvz4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/332714/original/file-20200505-83764-bujvz4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/332714/original/file-20200505-83764-bujvz4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/332714/original/file-20200505-83764-bujvz4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/332714/original/file-20200505-83764-bujvz4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/332714/original/file-20200505-83764-bujvz4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/332714/original/file-20200505-83764-bujvz4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Exercises like sitting on the edge of the patient’s bed can help them build up strength.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/image-blur-happy-asian-elderly-people-1165014496">JOKE_PHATRAPONG/ Shutterstock</a></span>
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<p>Rehabilitation will also vary depending on the patient’s condition. Tiredness or fatigue is reported in about <a href="https://www.ncbi.nlm.nih.gov/pubmed/32240670">40% of patients</a>, so physiotherapists will pace activity and potentially see patients more often for shorter treatment sessions. It can be hard sometimes for people to comply with treatment due to factors such as delirium causing confusion and anxiety, so remembering and building on prior sessions may be affected.</p>
<p>For those with severe infections, even the smallest movements can be exhausting and cause rapid drops in oxygen levels. Rehabilitation will be carefully planned and progress gradually to the patient sitting on the edge of their bed, standing, marching on spot, and walking, depending on how well each is tolerated.</p>
<p>Patients hospitalised with COVID-19 are more commonly people who are older and have <a href="https://www.ncbi.nlm.nih.gov/pubmed/32240670">underlying conditions</a>, such as kidney problems, high blood pressure, diabetes, coronary heart disease and obesity. Some patients can also develop <a href="https://www.ncbi.nlm.nih.gov/pubmed/32105632">lung and kidney, cardiac and liver damage</a> while in critical recovery. All of these factors influence their ability to recover and physiotherapists must carefully judge their rehabilitation.</p>
<p>People may also develop post-intensive care syndrome, which can develop <a href="https://www-atsjournals-org.eu1.proxy.openathens.net/doi/pdf/10.1164/rccm.2018P15">after a critical illness</a>. People commonly experience problems with their physical function, mental health, or cognitive ability. Where possible, physiotherapists will help patients make a full physical recovery so they can return home. Physiotherapists will work alongside a team to help patients during rehabilitation.</p>
<p>Since recovery and rehabilitation take some time, using technologies such as “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5544892/">tele-rehabilitation</a>” or other forms of remote physiotherapy can help patients return to good health even after they’ve left the hospital.</p><img src="https://counter.theconversation.com/content/136270/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Physiotherapists can help patients during and after coronavirus infections.Julie Broderick, Assistant Professor, Physiotherapy, Trinity College DublinCatherine L. Granger, Associate Professor of Physiotherapy, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1229312019-10-07T19:16:58Z2019-10-07T19:16:58ZOnly 2 in 3 physios provide ‘recommended care’, but that’s still higher than medicine<figure><img src="https://images.theconversation.com/files/295331/original/file-20191003-49361-1yplypv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Physiotherapists sometimes use acupuncture to treat knee osteoarthritis and low back pain, but it's not recommended.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/690310138?src=2Z9DIu7FjvgK_D62StOvkA-1-17&size=huge_jpg">NiP Studio/Shutterstock</a></span></figcaption></figure><p>When people visit a GP clinic or hospital in <a href="https://www.mja.com.au/journal/2012/197/2/caretrack-assessing-appropriateness-health-care-delivery-australia">Australia</a> or the <a href="https://www.ncbi.nlm.nih.gov/pubmed/12826639">United States</a>, they receive the recommended care around 55-57% of the time. </p>
<p>Recommended care means they get the tests or treatments that evidence-based guidelines say a patient should receive for their condition. This is usually because they’re the most effective or cost-effective option. The <a href="http://www.acsep.org.au/content/Document/guideline-for-the-management-of-knee-and-hip-oa-2nd-edition.pdf">recommended care for people with knee osteoarthritis</a>, for example, is exercise and weight loss. </p>
<p>Clinicians may not provide recommended care for several reasons. These include wishes of the patient, lack of trust in the evidence or guidelines, or experience providing certain types of care. </p>
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<p>
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<strong>
Read more:
<a href="https://theconversation.com/man-v-mountain-how-to-overcome-the-evidence-overload-7041">Man v mountain: how to overcome the evidence overload</a>
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<p>Doctors often refer patients with musculoskeletal problems such as back pain and osteoarthritis for physical therapy. But until now, it has been unclear how often physiotherapists provide the recommended care for these patients. </p>
<p>Our review of the international evidence, published today in <a href="https://bmjopen.bmj.com/content/9/10/e032329">BMJ Open</a>, found 63% of physiotherapists provided recommended treatments. But 27% provided treatments that weren’t based on evidence and which the guidelines recommended against. </p>
<p>Fortunately, failing to provide recommended care is unlikely to harm patients. Nevertheless, ditching non-recommended treatments could result in more efficient care and fewer resources being wasted. </p>
<h2>Our study</h2>
<p>We reviewed 94 studies from 19 countries, including Australia, to investigate the treatments physiotherapists provided for a range of musculoskeletal conditions. These included back pain, knee osteoarhtirits, neck pain, whiplash, foot or ankle pain and shoulder pain. </p>
<p>We used physiotherapists’ clinical notes to determine which treatments they provided. We then compared their treatment choices with recommendations from evidence-based guidelines, or guidelines that were considered most credible for each condition.</p>
<p>Overall, we found 63% of physiotherapists provided recommended treatments, which appears higher than in hospitals and GP clinics overall. A 2012 Australian audit, for example, found <a href="https://www.mja.com.au/journal/2012/197/2/caretrack-assessing-appropriateness-health-care-delivery-australia">57% of patients surveyed</a> received recommended care.</p>
<p>But in our study, almost half of physiotherapists (45%) provided treatments that guidelines didn’t mention because there wasn’t enough evidence to say if they worked or not.</p>
<p>And one in four (27%) provided treatments the guidelines recommend against. This was usually because the evidence showed they’re ineffective. </p>
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<img alt="" src="https://images.theconversation.com/files/295338/original/file-20191003-49350-cxpuat.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/295338/original/file-20191003-49350-cxpuat.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/295338/original/file-20191003-49350-cxpuat.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/295338/original/file-20191003-49350-cxpuat.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/295338/original/file-20191003-49350-cxpuat.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/295338/original/file-20191003-49350-cxpuat.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/295338/original/file-20191003-49350-cxpuat.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Often, the recommended treatment for pain conditions is to advise patients to stay active.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/301939577?src=P5Rjt83FjOGeVo3hWDiDSA-1-3&size=huge_jpg">Aleksandra Suzi/Shutterstock</a></span>
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<p>Physiotherapists can provide a range of treatments, some recommended and others not, so these percentages don’t add up to 100. Of the 63% who provide recommended care, for instance, some might also be providing treatments that are not recommended or that are not mentioned in guidelines.</p>
<h2>Why does it matter?</h2>
<p>Back pain, neck pain, osteoarthritis and other musculoskeletal conditions can have a substantial impact on people’s lives, and often cause <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32154-2/fulltext">disability</a>.</p>
<p>Traditionally, these conditions were <a href="https://www.cdc.gov/drugoverdose/prescribing/guideline.html">managed with medication</a> and surgery. However, medications such as opioids cause harm and there is growing evidence some common surgical procedures are ineffective. This has <a href="http://www.acsep.org.au/content/Document/guideline-for-the-management-of-knee-and-hip-oa-2nd-edition.pdf">prompted a shift</a> in what is recommended for musculoskeletal conditions.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-guidelines-on-low-back-pain-are-clear-drugs-and-surgery-should-be-the-last-resort-94746">The guidelines on low back pain are clear: drugs and surgery should be the last resort</a>
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<p>Today, clinical practice guidelines <a href="http://www.acsep.org.au/content/Document/guideline-for-the-management-of-knee-and-hip-oa-2nd-edition.pdf">recommend treatments provided by physiotherapists</a> over <a href="https://www.cdc.gov/drugoverdose/prescribing/guideline.html">medication</a> and surgery. </p>
<p>There is, however, a range of treatments physiotherapists can provide.
Some treatments <a href="https://www.nice.org.uk/guidance/cg177">are effective</a>, such as exercise for knee osteoarthritis. Other treatments are not, such as <a href="https://www.nice.org.uk/guidance/ng59">acupuncture for low back pain</a>. </p>
<p>To ensure patients receive the right care, physiotherapists are expected to follow recommendations from clinical practice guidelines. These guidelines are <a href="http://www.acsep.org.au/content/Document/guideline-for-the-management-of-knee-and-hip-oa-2nd-edition.pdf">often multidisciplinary</a> and intended to be used by GPs, physiotherapists, and surgeons. </p>
<h2>Physios manage some pain better than other pain</h2>
<p>When it comes to following clinical guidelines, we found physiotherapists manage some conditions better than others. </p>
<p>For shoulder pain, up to 76% of physiotherapists provided recommended treatments (such as strengthening exercises and massage). Only 8% provided treatments that were not recommended (such as magnetic field therapy, which uses an electrical current to alleviate pain). </p>
<p>There is room for physiotherapists to improve their use of recommended treatments for knee osteoarthritis and low back pain. </p>
<p>For knee osteoarthritis, 65% of physiotherapists provided recommended treatments (to advise patients to stay active, undertake aerobic and strength exercises and lose weight). One in five (21%) provided treatments that were not recommended (such as acupuncture and advice to reduce activity levels).</p>
<p>For low back pain, half provided recommended treatments (advice to stay active and reassure patients that most people recover from back pain without formal treatment); while 18% provided treatments that were not recommended (acupuncture, lumbar braces, or advice to rest in bed until the pain goes).</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/pain-drain-the-economic-and-social-costs-of-chronic-pain-49666">Pain drain: the economic and social costs of chronic pain</a>
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</p>
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<p>Physiotherapists have a lot to offer patients with musculoskeletal conditions. But it’s important they don’t dilute appropriate care with inappropriate care. </p>
<p>Better adhering to clinical practice guidelines could increase the efficiency of physiotherapy services and ensure patients only receive care that is truly necessary.</p><img src="https://counter.theconversation.com/content/122931/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joshua Zadro does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>New international research shows one in four physiotherapists provide treatments that aren’t based on evidence. These treatments aren’t likely to cause harm, but they might waste patients’ time.Joshua Zadro, Postdoctoral Research Fellow, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1191702019-08-23T06:51:22Z2019-08-23T06:51:22ZIt’s not just athletes who get Achilles tendon pain, but exercising is the answer<p>Basketball fans around the world were recently sickened by the footage of NBA star Kevin Durant’s Achilles tendon rupturing during a game. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1138283435083083777"}"></div></p>
<p>But while many think it’s only elite athletes who suffer from Achilles tendon issues, a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4737248/">fifth of the over-50 population</a> actually suffers from Achilles tendinopathy (pain). And while very few of these will be ruptures, the pain can be frustratingly persistent and limit our ability to exercise and enjoy life.</p>
<h2>What is Achilles tendinopathy?</h2>
<p>The Achilles tendon is one of the strongest tendons in the human body. It attaches the calf muscles to the heel bone of the foot, helping you to run fast, jump high, and change direction quickly. During these types of exercises the tendon acts like a spring that propels you forward more efficiently.</p>
<p>Many labels are used to describe what’s going on when the tendon is injured. People are often told their tendon is torn and may think of it as a rope hanging on by a thread. These descriptions are unhelpful and <a href="http://doi.org/10.1016/j.msksp.2019.01.011">inaccurate</a>, often leading to expensive and unnecessary treatments. </p>
<p>We know words are extremely powerful and influence what treatment you think you need. For example, would you do the exercises your physiotherapist gave you if you believed your tendon was hanging on by a thread? Probably not. </p>
<p>Our work has found a painful tendon is not like a torn rope at all. It’s more like doughnuts stacked on top of each other. Even though changes in tendon structure are seen as a “hole” in the middle of the tendon, there is still a lot of delicious doughnut (in other words healthy tendon) surrounding the damaged area. The tendon <a href="http://doi.org/10.1111/sms.12491">adapts by getting thicker</a>, making it stronger and allowing you to exercise. </p>
<p>Critically, pain poorly reflects damage. Tendon pain is not present because the tendon is damaged, weak or hanging on by a thread. More than 30% of AFL players have a “hole” in their tendon when we scan them but are able to play at the highest level with <a href="http://doi.org/10.1016/j.jsams.2018.07.016">no pain</a>.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-why-do-my-muscles-ache-the-day-after-exercise-41820">Health Check: why do my muscles ache the day after exercise?</a>
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<h2>Who gets it?</h2>
<p>Achilles tendinopathy can affect athletes who participate in sports that involve running or explosive movements (Australian football, track and field). Most players do not miss competition as a result of Achilles tendon pain. </p>
<p>But our research found <a href="http://doi.org/10.1111/sms.13086">more than 20% of AFL players</a> report that pain in their Achilles tendon significantly affects their training and performance. That’s four or five of your favourite 22 athletes playing this weekend.</p>
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<a href="https://images.theconversation.com/files/288671/original/file-20190820-170951-11jtxgc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/288671/original/file-20190820-170951-11jtxgc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/288671/original/file-20190820-170951-11jtxgc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/288671/original/file-20190820-170951-11jtxgc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/288671/original/file-20190820-170951-11jtxgc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/288671/original/file-20190820-170951-11jtxgc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/288671/original/file-20190820-170951-11jtxgc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/288671/original/file-20190820-170951-11jtxgc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Some 20% of AFL players suffer from pain in the Achilles tendon that affects their performance.</span>
<span class="attribution"><span class="source">www.shutterstock.com</span></span>
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<p>But most people who experience this type of pain are <a href="http://doi.org/10.1186/s12891-016-0885-2">aged 40-64 years</a>. </p>
<p>That’s because the Achilles tendon bears the brunt of activities like running, playing golf, walking the dog, and stepping off the kerb throughout life. <a href="http://doi.org/10.1002/art.24518">Being overweight</a>, having <a href="http://doi.org/10.1136/bjsports-2015-094735">diabetes</a>, and <a href="http://doi.org/10.1136/bjsports-2015-095100">high cholesterol</a> all increase the risk of developing Achilles tendon pain. Tendon pain can lead to further weight gain and a greater impact on someone’s health beyond just their ability to run and exercise. </p>
<h2>Overcoming tendon pain</h2>
<p>The good news is that painful Achilles tendons rarely rupture. Some 80-90% of people who rupture their tendon <a href="http://doi.org/10.1177/036354658901700305">have never had Achilles tendon pain</a>. Your brain is clever as it uses pain to protect your Achilles tendon by changing your behaviour. But it’s easy to become overprotective.</p>
<p>Completely resting the tendon, either by using crutches or a walking boot, is one thing that should be avoided. This is because of the “use it or lose it” principle. With even two weeks’ rest, your tendon and calf muscles become weaker, meaning a longer recovery time. </p>
<p>Just like muscles, tendons get stronger with exercise. Starting exercise that produces no or minimal pain and progressively increasing the intensity of exercise is by far the best option, <a href="https://journals.sagepub.com/doi/10.1177/0363546506298279">based on research</a>. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-prevent-injury-from-sport-and-exercise-68914">How to prevent injury from sport and exercise</a>
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</em>
</p>
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<p>In consultation with an experienced physiotherapist, this program should include strength training to help strengthen the tendon and the calf muscles. If you want to get back to running, slowly introduce exercise that requires the tendon to act like a spring, such as skipping and jumping. </p>
<p>It can be tempting to look for a quick fix for your pain. But interventions such as <a href="https://link.springer.com/article/10.1007%2Fs00167-016-4062-9">surgery</a> or <a href="https://journals.sagepub.com/doi/10.1177/0363546511404877">injections</a> are often ineffective, costly, and can be harmful. </p>
<p>These approaches should be a last resort, and actually all still require exercise to strengthen the tendon. Unfortunately, there are no shortcuts when recovering from a tendon injury.</p>
<p>Unlike Achilles in Greek mythology, your Achilles tendon does not have to be a point of weakness. Consulting with an experienced physiotherapist to develop a progressive exercise program is the best protection you can have against further injury.</p><img src="https://counter.theconversation.com/content/119170/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sean Docking receives funding from Australian Football League Research Board, GE Healthcare, and the National Basketball Association. </span></em></p><p class="fine-print"><em><span><a href="mailto:e.rio@latrobe.edu.au">e.rio@latrobe.edu.au</a> receives funding from NHMRC and holds current grants from NBA-GE and have previously been awarded grants from AFL and the Australian Institute of Sport. She regularly speaks at conferences about tendon pain and runs courses nationally and internationally. </span></em></p><p class="fine-print"><em><span><a href="mailto:j.cook@latrobe.edu.au">j.cook@latrobe.edu.au</a> receives funding from the National Basketball Association and the International Olympic Committee</span></em></p>Achilles tendon pain is surprisingly common in people over the age of 50. Strength training can help you recover and protect against future injury.Sean Docking, Post-doctoral researcher, La Trobe UniversityEbonie Rio, NHMRC Research Fellow, La Trobe UniversityJill Cook, Professor, Sports Medicine Research, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1097152019-04-25T21:51:12Z2019-04-25T21:51:12ZPain during sex? Incontinence or constipation? You might benefit from pelvic floor physiotherapy<figure><img src="https://images.theconversation.com/files/267435/original/file-20190403-177175-4fvomr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Up to 20 per cent of women have pain during sexual intercourse and up to 40 per cent have issues with bladder control. Physiotherapy can help. </span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>“How did I not know this was a pelvic floor issue? Why didn’t my doctor send me here sooner? Do you have other patients with problems like mine?”</p>
<p>As a physiotherapist, I hear these questions again and again, from people of all ages and genders, who are <a href="https://www.penguinrandomhouse.com/books/558308/a-headache-in-the-pelvis-by-david-wise-phd-and-rodney-anderson-md/9781524762049/">struggling with issues related to the urinary system, sexual function and the lower digestive tract</a>.</p>
<p>Adrian is one example. A 35 year-old active cyclist and successful professional, he has a nagging pain in the private parts that just won’t go away. It is interfering with his sporting activities and ruining his sex life. Pressure from the bicycle seat, the ambitious effort to cycle 100 kilometres in record time, and the stress from a crazy week at work have all resulted in pelvic floor muscle tension and <a href="https://uroweb.org/wp-content/uploads/26-Chronic-Pelvic-Pain_LR.pdf">chronic pelvic pain</a>. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/267437/original/file-20190403-177187-9x2544.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/267437/original/file-20190403-177187-9x2544.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/267437/original/file-20190403-177187-9x2544.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/267437/original/file-20190403-177187-9x2544.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/267437/original/file-20190403-177187-9x2544.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/267437/original/file-20190403-177187-9x2544.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/267437/original/file-20190403-177187-9x2544.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Pelvic floor issues can affect anyone.</span>
<span class="attribution"><span class="source">(Unsplash/JaneSundried)</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>Then there’s Lisa, a 63 year-old woman who is ready to become involved in a new relationship. In her search for a companion, she explores online dating and begins to realize that sex may be involved sooner than later. She worries that she may not be ready, physically, not having had sex for quite a few years, and wonders what she could do to improve her vaginal comfort and physical confidence.</p>
<p>These patients, and many others, did not know that a physiotherapist could help them. In my role as a clinician and as course co-ordinator for pelvic floor rehabilitation at <a href="https://www.mcgill.ca/spot/">McGill University’s School of Physical and Occupational Therapy</a>, I see a huge lack of awareness of the impact that physiotherapy can have on the lives of people suffering these very personal conditions.</p>
<p>From pain during sexual intercourse to urinary incontinence after surgery for prostate cancer, to anal incontinence after pregnancy, physiotherapy can help. </p>
<h2>Pain during sexual intercourse</h2>
<p>Up to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5969816/">20 per cent of women have pain during sexual intercourse</a>. This is a surprising statistic, especially when it predominantly includes active women in their twenties and thirties, who may believe that there is something psychologically wrong with them when all of the gynaecological tests come up negative.</p>
<p>Vestibulodynia, an invisible hypersensitivity at the entrance to the vagina, is considered the<a href="https://www.ncbi.nlm.nih.gov/pubmed/27080365"> most common cause of sexual pain in pre-menopausal women</a>. It can be treated in physiotherapy.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/270823/original/file-20190424-121228-12czx1a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/270823/original/file-20190424-121228-12czx1a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/270823/original/file-20190424-121228-12czx1a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/270823/original/file-20190424-121228-12czx1a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/270823/original/file-20190424-121228-12czx1a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/270823/original/file-20190424-121228-12czx1a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/270823/original/file-20190424-121228-12czx1a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Pelvic floor physiotherapy can help reduce pain during sexual intercourse.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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</figure>
<p>The pelvic floor muscles span the private area under the pelvis. They are responsible not only for helping to control the passage of urine, stool and gas, but also for allowing comfort and pleasure during sex.</p>
<p>These muscles also support the pelvic organs and help with balance and stability. It is important to be able to contract and to relax these muscles. <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/kegel-exercise">Pelvic floor exercises train the muscles for the desired result</a>, and are sometimes referred to as “targeted” Kegels.</p>
<p>In <a href="https://www.issm.info/sexual-health-qa/what-is-pelvic-floor-physical-therapy/">pelvic floor physiotherapy</a>, patients learn exercises, and they may receive manual treatments, biofeedback and/or electrical stimulation. Biofeedback displays pelvic floor activity on a computer screen, making it easier to contract and relax muscles that are usually hidden from view. Electrical stimulation causes a pain-free muscle contraction, with the goal of improving the ability to contract and relax naturally. </p>
<p>Research supports the <a href="https://doi.org/10.1002/14651858.CD005654.pub4">use of physiotherapy</a> in the treatment of <a href="https://doi.org/10.1002/14651858.CD003882.pub4">a variety of pelvic disorders</a>. A team approach is ideal, and, depending upon the condition, may involve collaboration with general practitioners, urologists, gynaecologists, sex therapists and others.</p>
<h2>Prostate, pregnancy and potty</h2>
<p>After surgery for prostate cancer, <a href="https://dx.doi.org/10.5152%2Ftud.2014.222014">up to 40 per cent of men experience problems with urinary incontinence</a>. Pelvic floor physiotherapy teaches men different strategies to control leakage. Men can even consult prior to surgery, in order to prepare. </p>
<p>Women experience an array of pelvic floor issues during and after pregnancy. It is important to mention that <a href="https://www.ncbi.nlm.nih.gov/pubmed/9740521">many women who have had a third or fourth degree tear during delivery will experience issues with anal incontinence later in life</a>.</p>
<p>Some countries systematically refer these patients for preventative physiotherapy and some centres in Canada are now beginning to follow suit.</p>
<p>More than 40 per cent of women also have issues with bladder control. Patients with <a href="https://doi.org/10.1016/j.jogc.2017.11.027">stress urinary incontinence</a> and those with <a href="https://www.cua.org/themes/web/assets/files/4586_v3.pdf">an overactive bladder</a> can experience significant improvement in physiotherapy.</p>
<p>Physiotherapy is considered first-line intervention for <a href="http://www.canadiancontinence.ca/EN/">both types of incontinence</a> by the <a href="https://www.ics.org">International Continence Society</a>, the <a href="https://www.cua.org/en">Canadian Urological Association</a> and the <a href="https://uroweb.org">European Association of Urology</a>. </p>
<p>Constipation is another issue that may be caused by the inability to relax the muscles of the pelvic floor and anal sphincter at the appropriate time. Physiotherapists can work to improve “defecation dynamics” and provide suggestions for lifestyle changes. </p>
<p>In children, constipation may lead to soiling or overflow incontinence. Children may also be seen for <a href="https://doi.org/10.1053/j.gastro.2016.02.015">urinary disorders</a>.</p>
<h2>A co-ordinated physiotherapy plan</h2>
<p>The internet has been instrumental in enabling patients to learn about embarrassing or taboo subjects in the privacy of their own homes, and has led many to seek out physiotherapy as a viable treatment option for pelvic conditions.</p>
<p>Patients consulting for pelvic floor issues learn how the bladder functions, how the pelvic floor muscles can be involved in constipation, what causes the muscles to be such culprits in pelvic pain and how new brain research supports a bio-psycho-social approach for the management of their problems. They find an ally in the physiotherapist, who supports them and directs them towards the improvement of their condition.</p>
<p>A step-by-step coordinated physiotherapy plan is a key element in the interdisciplinary management of patients with disorders related to the pelvic floor.</p><img src="https://counter.theconversation.com/content/109715/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Claudia Brown is co-owner of Physiothérapie Uro-Santé, a company aimed at teaching physiotherapists about pelvic floor physiotherapy. She is also owner and manager of a group of private physiotherapy clinics that offer pelvic floor physiotherapy in the Montreal area, including Physiothérapie Polyclinique Cabrini and La Clinique de Physiothérapie Concorde.</span></em></p>A step-by- step coordinated physiotherapy plan is key for patients with disorders related to the pelvic floor.Claudia Brown, Assistant Professor, School of Physical and Occupational Therapy, McGill UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1096452019-02-13T23:32:03Z2019-02-13T23:32:03ZBack pain? A physiotherapist may offer the most effective treatment, if you can afford it<figure><img src="https://images.theconversation.com/files/258594/original/file-20190212-174864-sktk0g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many cases of lower back pain are best managed through education, exercise and manual treatment.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Back pain is a common and costly health problem. It is the <a href="https://www.ncbi.nlm.nih.gov/pubmed/23245607">leading cause of disability worldwide</a> and a “call to action” recently published in <em>The Lancet</em> highlights the <a href="https://www.thelancet.com/series/low-back-pain">risks of over-medicalization of back pain globally</a>.</p>
<p><a href="https://doi.org/10.1186/s12913-018-3790-6">In our recent research study</a>, published in <em>BMC Health Services Research</em>, we found that many individuals suffering chronic back pain are not able to access non-physician options like physiotherapy. </p>
<p>We compared self-reported use of family physician, chiropractor and physiotherapy services among 25,545 Canadian adults with chronic back pain and found lower use of services among certain groups. </p>
<p>For example, people with lower income and education levels were less likely to seek care with physiotherapists in comparison to family physicians. As were rural and remote residents. </p>
<p>This lack of access is especially unfortunate, as the evidence shows chronic <a href="http://dx.doi.org/10.1155/2014/919621">back pain to be more common</a> among people with lower incomes and those who live in rural or remote areas.</p>
<h2>Over-medicalization of back pain</h2>
<p>Back pain is among the <a href="https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/1471-2474-11-144">most common reasons for seeing a family doctor</a> in many countries. Universal health-care coverage of back pain is usually limited to prescription medications, diagnostic imaging or onward referral to publicly funded medical specialists. </p>
<p>This leads to an over-medicalization of back pain, involving excessive medical investigations <a href="https://choosingwiselycanada.org/imaging-tests-low-back-pain/">using X-rays, CT scans and MRIs</a> and <a href="https://medicalxpress.com/news/2018-03-pain-wrong.html">low-value health-care approaches</a> — such as <a href="https://doi.org/10.1136/bmj.g6380">long-term use of opioids</a>. All of these increase health-care costs and the risk of long-term back-related disability. </p>
<p>Many cases of back pain are in fact <a href="https://www.ncbi.nlm.nih.gov/pubmed/21203890">best managed through education, exercise and manual treatment</a>, or a combination of services in addition to those provided by a family doctor. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/258585/original/file-20190212-174887-1knmn60.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/258585/original/file-20190212-174887-1knmn60.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/258585/original/file-20190212-174887-1knmn60.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/258585/original/file-20190212-174887-1knmn60.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/258585/original/file-20190212-174887-1knmn60.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/258585/original/file-20190212-174887-1knmn60.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/258585/original/file-20190212-174887-1knmn60.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Treatment by physiotherapists for back pain can help curb the use of pain medications like opioids.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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</figure>
<p>In Canada, <a href="http://dx.doi.org/10.1155/2014/919621">one in five adults experience chronic back pain</a> and the health-care costs of this are estimated at between <a href="http://boneandjointcanada.com/low-back-pain/">$6 and $12 billion annually</a>. An estimated <a href="https://www.sanofi.ca/-/media/Project/One-Sanofi-Web/Websites/North-America/Sanofi-CA/Home/en/About-us/The-Sanofi-Canada-Healthcare-Survey/The-Sanofi-Canada-Healthcare-Survey-2017---Full-Report.pdf">one third of Canadians do not have the additional health insurance</a> that would help to cover the costs of non-physician care options like private physiotherapy services. </p>
<p>Ironically, having private health insurance for health costs not covered by the public system is <a href="http://www.wellesleyinstitute.com/publications/poverty_is_making_us_sick__a_comprehensive_survey_of_income_and_health_in_canada/">highly associated with income</a>.</p>
<h2>Physiotherapy can curb opioid use</h2>
<p>Improving access to affordable health care for those who need it was among the several recommendations arising from <a href="https://www.thelancet.com/series/low-back-pain"><em>The Lancet</em> low back pain series working group</a>.</p>
<p>Improving access to non-drug back pain treatment options like physiotherapy is an especially important public health issue in Canada in light of the current opioid crisis. </p>
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<strong>
Read more:
<a href="https://theconversation.com/how-exercise-can-help-tackle-the-opioid-crisis-91822">How exercise can help tackle the opioid crisis</a>
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<p>More than half of opioid users <a href="https://doi.org/10.1136/bmj.g6380">report having back pain</a>. Treatment by physiotherapists for back pain <a href="https://www.wbur.org/npr/613500084/trying-physical-therapy-first-for-low-back-pain-may-curb-use-of-opioids">can help curb the use of pain medications like opioids</a>. </p>
<p>The first and last recommendations of the <a href="http://nationalpaincentre.mcmaster.ca/guidelines.html">2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain</a> include referral to multidisciplinary non-physician care providers. </p>
<p>Unfortunately, the barriers to access for non-physician services outside of what is publicly funded make these guidelines challenging to implement.</p>
<h2>Telehealth and robots can help</h2>
<p>Improving access to physiotherapy and other potentially beneficial services for people with chronic back pain requires rethinking the way typical back care is delivered in Canada. Advocating for insurers and health policy-makers to enhance funding these services would be a good start. </p>
<p>Models of care that include <a href="https://doi.org/10.1016/S0140-6736(11)60937-9">physiotherapists</a> within publicly funded health-care teams have shown benefit. </p>
<p>Ongoing research in Canada is investigating the feasibility and impact of models that <a href="https://doi.org/10.1186/s13063-017-2279-7">embed physiotherapists within family physician’s practices</a>. </p>
<p>Using <a href="https://www.researchprotocols.org/2016/4/e212/">telehealth</a> and other technology like <a href="https://doi.org/10.3138/ptc.2015-77">remote presence robots</a> is another way that rural and remote access barriers to back pain care might be overcome. </p>
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<strong>
Read more:
<a href="https://theconversation.com/how-robots-are-helping-doctors-save-lives-in-the-canadian-north-104462">How robots are helping doctors save lives in the Canadian North</a>
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<p>The gaps in access to care highlighted by our research show that access to physiotherapy care is not equitable among Canadians with chronic back pain. New and innovative approaches are needed to address these access challenges.</p><img src="https://counter.theconversation.com/content/109645/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brenna Bath receives funding from the Saskatchewan Health Research Foundation. She is the current President of the Saskatchewan Physiotherapy Association.</span></em></p><p class="fine-print"><em><span>Catherine Trask receives funding from Canada Research Chairs, Canada Foundation for Innovation, Saskatchewan Health Research Foundation, Workers' Compensation Board of Manitoba, and the Alberta Ministry of Labour. She is past president of the Canadian Association for Research on Work and Health</span></em></p>The over-medicalization of back pain is a global concern. New research in Canada shows that people with lower income as well as rural and remote dwellers are less likely to access physiotherapy care.Brenna Bath, Associate Professor, University of SaskatchewanCatherine Trask, Canada Research Chair in Ergonomics and Musculoskeletal Health, University of SaskatchewanLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1104692019-01-28T12:34:13Z2019-01-28T12:34:13ZPhysiotherapy works better when you believe it will help you – new study<figure><img src="https://images.theconversation.com/files/255770/original/file-20190128-108342-iljlim.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/1216671691?src=WUgM7wrjE_rdR26WZ2judQ-1-12&size=medium_jpg">Master1305/Shutterstock</a></span></figcaption></figure><p>People with shoulder pain who expect physiotherapy to help them are likely to have a better recovery than those who expect only minimal or no improvement, according to our latest <a href="https://bjsm.bmj.com/content/early/2019/01/09/bjsports-2018-099450.abstract">study</a>. We also found that people are likely to have a better recovery if they are confident they will be able to continue doing things that are important to them, such as socialising, hobbies and work.</p>
<p>Shoulder pain affects people of all ages and can become persistent. Injury and overuse are common causes of shoulder pain, but sometimes the cause is unclear. It can disturb sleep, interfere with work, leisure and everyday activities like <a href="https://bmcmusculoskeletdisord.biomedcentral.com/track/pdf/10.1186/1471-2474-14-73?site=bmcmusculoskeletdisord.biomedcentral.com">washing and dressing</a>. Exercise, prescribed by physiotherapists, is an <a href="https://www.thieme-connect.de/products/ejournals/abstract/10.1055/s-0043-120527">effective treatment</a> for shoulder pain, but <a href="https://bjsm.bmj.com/content/52/4/269.short">not everyone</a> benefits from physiotherapy.</p>
<p>Researchers from the University of East Anglia and the University of Hertfordshire in the south-east of England, together with local physiotherapists, wanted to find out more about the characteristics of people who benefit from physiotherapy compared with those who continue to experience persistent pain and disability.</p>
<p>Knowing the outcome is important for people with shoulder pain as it helps them decide whether or not to pursue a course of physiotherapy.</p>
<p>Our study, published in the British Journal of Sports Medicine, included <a href="https://bjsm.bmj.com/content/52/4/269.short">1,030 people</a> attending physiotherapy for musculoskeletal shoulder pain in 11 NHS trusts across the east of England. We collected information on <a href="https://ueaeprints.uea.ac.uk/46920/4/Chester_2013_protocol.pdf">71 patient characteristics</a>, such as age, lifestyle and medical history, and clinical examination findings before and during the patients’ first physiotherapy appointment. </p>
<p>A total of 811 people provided information on their shoulder pain and function six months later.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/255776/original/file-20190128-108358-10tf0b4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/255776/original/file-20190128-108358-10tf0b4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/255776/original/file-20190128-108358-10tf0b4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/255776/original/file-20190128-108358-10tf0b4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/255776/original/file-20190128-108358-10tf0b4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/255776/original/file-20190128-108358-10tf0b4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/255776/original/file-20190128-108358-10tf0b4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Not everyone benefits from exercise to ease shoulder pain.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/1276149667?src=I0wh-349_Skcqm7Jd6mxeg-1-45&size=medium_jpg">Vershinin89/Shutterstock</a></span>
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</figure>
<h2>Surprise finding</h2>
<p>What surprised us was that patients who had said they expected to “completely recover” as a result of physiotherapy did even better than patients who expected to “much improve”.</p>
<p>The most important predictor of outcome was the person’s pain and disability at the first appointment. Higher levels of pain and disability were associated with higher levels six months later. And lower baseline levels were associated lower levels six months later. But this relationship often changed for people who had high “<a href="https://psycnet.apa.org/record/1977-25733-001">pain self-efficacy</a>”, that is, confidence in the ability to carry on doing most things, despite having shoulder pain.</p>
<p>Another surprise finding was that people with high baseline pain and disability, but with high levels of pain self-efficacy did as well as, and sometimes better than, people with low baseline pain and disability and low pain self-efficacy.</p>
<h2>First study of its kind</h2>
<p>This is the first study to investigate patient expectations of the outcome of physiotherapy for shoulder pain. Earlier research shows that high patient expectation of recovery predicts a better outcome following physiotherapy for <a href="https://ac.els-cdn.com/S1836955312701078/1-s2.0-S1836955312701078-main.pdf?_tid=c7b480f6-4388-4934-b715-2fa97e5a0beb&acdnat=1548663956_b01db0efe6ae612d078bef526e4959d0">back pain</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5175452/">neck pain</a>, and a better outcome following <a href="https://www.sciencedirect.com/science/article/pii/S0976566217306355">orthopaedic surgery</a>.</p>
<p>On a similar note, this is the first study to show that higher pain self-efficacy predicts a better outcome in non-surgically managed shoulder pain. Previous research has shown that self-efficacy predicts a better outcome for a <a href="https://www.ncbi.nlm.nih.gov/pubmed/24878675">range of other health conditions</a>. Also, people with higher self-efficacy are more likely to do the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2923776/">home-exercise programme </a> suggested by their physiotherapist.</p>
<p>If you have shoulder pain, there are several ways to increase your <a href="https://www.ncbi.nlm.nih.gov/pubmed/19586583">pain self-efficacy</a>. Work with your physiotherapist to understand and manage your symptoms. Practice your exercises together and ask your physiotherapist for feedback, including how to adjust your exercises to make them harder or easier. Finally, make sure you discuss what you want with your physiotherapy and the activities that are important to you.</p><img src="https://counter.theconversation.com/content/110469/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rachel Chester was funded by the National Institute for Health Research (NIHR CAT CDRF 10–008). Christina Jerosch Herold was funded by the NIHR (NIHR- SRF-2012-05-119). The funders of the study had no role in study design, data collection, data analysis, data interpretation, writing of the report or decision to submit the article for publication. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR, NHS or the Department of Health and Social Care. </span></em></p>If you believe that physiotherapy will help your shoulder pain, it probably will.Rachel Chester, Lecturer in Physiotherapy, University of East AngliaLicensed as Creative Commons – attribution, no derivatives.