Welcome to our first newsletter for 2012. In this issue, Neil explores some well-held misconceptions about muscle strengthening and offers instead a new concept of conditioning that emphasises muscle 'firing' patterns. Jason looks at the corporate world of sports drinks and warns 'don't believe what you read'. Finally Tim explores pain in children and how a true injury can be distinguished from non-serious discomfort.

The winter sports season is in full swing and we are currently providing many of our local sporting teams with physio coverage for injuries. We would like to acknowledge our proud association with:

• Kalamunda & Districts Football & Sportsman's Club Inc. (Cougars)
• Kalamunda & Districts Basketball Association (Suns)
• Kalamunda & Districts Netball Association
• Kalamunda & Districts Junior Football Club (Tigers)

Our popular Pilates Floor classes are in full swing and filling fast so if you would like a safe and gentle way to regain or keep your fitness, then see the details of the classes on our website. We anticipate running our 'Sports Core' classes again this year that are designed for the athletic population and involve more demanding levels of exercises to really make you sweat! If you are not sure whether these classes may be of benefit to you, we will let you try one for free! Just ask our receptionists about this offer when you contact the clinic.

On April 14th, Tim will join forces with Vibrant Gym and Fitness in Walliston to help highlight awareness about Spinal Muscular Atrophy (SMA), a genetic disease that results in widespread muscle wasting and death in a large number of infants. Tim will be at Vibrant Gym from 9am performing posture checks and imparting valuable information about this condition. Please come along to help support this cause.

Jason and Neil are gearing up for the '3' and '5' Dams Road Cycling Race on Sunday 15th April, which involves up to 250kms of riding from Perth up and around the beautiful Perth Hills and water catchment areas. Good luck to the guys and do yourselves a favour: take the Monday off work!

The Mead Street Physio website has been recently upgraded and is now jammed full of really great self-management ideas on how to help deal with your injuries. To access all our resources online, simply go to meadstreetphysio.com.au and register as a 'Member' by following the sign-in prompts in the top corner of the screen. Once you have created a password online, you can view all our helpful resources in addition to receiving the quarterly newsletter automatically via email. This is one way we think we can assist more people to understand and cope with their pain.

Are we actually strengthening muscles with rehab?

By Neil Drouet, Physiotherapist & Exercise Physiologist

It's a bit like death and taxes; the one thing guaranteed when you see the physio - you know you're gonna get some exercises. Something to ponder about when you are given exercises at the physio to "strengthen" weak or underfiring muscles is how the strengthening process is occurring and what actually constitutes strength. Here's an example:

Consider an exercise we commonly give to people suffering from a hip or knee injury from running - a leg raise while lying on your side. The aim of this exercise is to strengthen the gluteus medius muscle on the side of the hip. This muscle controls movement at the pelvis and stops you walking or running like a supermodel (think of the trademark hip-waddle on the catwalk). During running this muscle should contract every time your leg hits the ground. The average runner hits the ground with each leg approximately 70-90 times per minute. Consider someone who is training for the City to Surf, a 12km race over an hour or so. If you do the maths this equates to somewhere between 4,200-5,400 contractions against three to five times your bodyweight (that's how much impact you have while running) over the course of the race. This increases to around 20,000 for a four-hour marathon run.

Now, lets compare that to what we normally give you: 3 sets of 10 repetitions (30 reps) lifting just your leg weight. Very different to the 50 sets of 100, with a 10kg weight around your ankle that you would need to do to match the efforts required for the race. Secondly, think of strengthening in terms of what the word means - the ability to increase how much force you can actually impart in a particular movement. Five thousand repetitions sounds a lot more like endurance to me!

As I have worked with patients over the years and also set out my own rehabilitation programs for various injuries, I've thought about this quite a bit. I have come to the conclusion that what we are actually doing is improving our muscle control in terms of increased awareness of the muscle contraction, increased firing of of the muscle as your body gets used to selectively using it, and improved isolation of the muscle from neighbouring muscles (in the example above, this would be your hip flexors, back muscles and deep hip rotators). It's then, when you actually start getting that muscle involved in the functional task, that the strengthening actually occurs; that is, when you actually go for a run. This is slowest part of the process, and it can take up to eight weeks to see a change in muscle size or its strength and endurance.

So when given an exercise to help "strengthen" a weak or underfiring muscle, think about what you are trying to achieve when you are completing your exercises at home. Focus on developing an awareness of the muscle or movement you are performing, and gaining a more acute sense of how it actually feels, so you can feel it better during the actual task or sport you want to perform. It really helps to slow down the movement to actually feel it. Focus on feeling the muscle turn both on AND off. Don't worry about doing too many extra repetitions or increasing the resistance, but instead focus on putting in more concentration so that you can truly "learn" the exercise. You'll then find that after a few months you'll be rewarded with a stronger and more efficient muscle or movement.

Neil Drouet is both a Physiotherapist and Exercise Physiologist with a special interest in exercise prescription and sports injury management, particularly at an elite level. He is also an accredited Level I Triathlon Coach and conducts bike fits and group exercise programs.

Drinks anyone?


By Jason Wells, Sports & Musculoskeletal Physiotherapist

During the summer months we are all too well aware of the need to hydrate during exercise. Popular running culture has championed the need to keep up an athlete's fluids, particularly during endurance exercise in the heat. The recommendations of large sporting drink companies such as Gatorade, as well as popular magazines such as Runners World, wrongfully claim they are based upon scientific evidence. Discussions in these forums continue to claim that dehydration, or the loss of body water, is the greatest threat to exercise in the heat. Further, if your body's fluid levels drop below a critical level (>2% body weight) then your performance will suffer and you may be more prone to heat stroke. Finally, the sensation of thirst is not enough to accurately reflect this loss of body fluid during exercise. Consequently, recommendations of drinking past the point of thirst have consistently encouraged over drinking.

In contrast, the scientific community is realising that there is a growing divide between their findings and recommendations that are based upon current evidence, and those of the multi-national sports drink companies. As a consequence of research in this area, the scientific community is moving away from blanket statements of "one size fits all" to more modest individualised guidelines in which thirst is recognised as the best physiological indicator of each subject's fluid needs during exercise.

Unfortunately, the large sports drink companies and some international sporting bodies have not kept pace with this scientific advice. Gatorade websites promote their "Fluid Loss Calculator",
which is erroneously branded as "scientifically based" and recommends fluid intake that could be excessive in some individuals and may actually lead to weight gain. Further to this is the fact that these fluid calculators vary from country to country according to which Gatorade website you use.

It is interesting to note that in the 2002 Runners World Magazine, a special advertisement from Gatorade posted in the lead up to the Boston Marathon read "… you don't often feel thirsty early in a run, but that's exactly when you need to start drinking". Perhaps because of such statements and the perceived dangers of dehydration, two runners died in the Boston Marathon as a direct result of over-hydration. Over drinking can lead to a life-threatening condition called 'hyponatraemia' in which the body's plasma sodium levels are diluted beyond critical levels. Consequently, the most current scientific advice encourages a modest, individualised approach to hydration that is guided by the sensation of thirst, which is the best indicator of an athlete's fluid needs during exercise.

Jason Wells is a Sports & Musculoskeletal Physiotherapist with over 22 years of experience in clinical sports medicine practice. He has a special interest in complex pain syndromes and has recently completed a Graduate Diploma in Psychology.

Children with Muscle and Joint Pain: Growing Pains or Injury?

By Tim Laferla, Physiotherapist

Differentiating between general growing pains and an actual injury can be a difficult task in children. The skeleton of a child is quite different to that of an adult. Firstly, at each end of the long bones in children, cartilage plates exist that form the centre of the bone's growth and development. As cartilage is much softer than hard bone, excessive forces near these plates of cartilage can cause injury. Excess force in the area of these growth plates can be attributed to a range of factors including tight muscles, repetitive muscle action, and other alignment or postural abnormalities that can indirectly lead to pain, such as flat feet. Consequently, children can suffer from a unique range of skeletal and muscular problems that are not observed in the adult population.

The exact causes of growing pains are still unknown. One theory is that as the skeleton grows muscles tend to lag behind the growth of bones so they can become tight and painful. Growing pains typically occur between the ages of 3 - 12, and most growing occurs during adolescence. This is a relatively normal part of growing up; however, not everyone will suffer from growing pains in childhood. It can be very difficult to differentiate these sorts of pains from real injuries.

Some indicators of a true injury include:

• Sudden onset - for example, sprains or strains which can be attributed to a specific event such as twisting a joint or pulling a muscle during physical activity.
• High pain severity - growing pains are typically mild to moderate and may spontaneously resolve or slowly dissipate. A higher severity of pain may indicate an injury.
• Symptoms worsened by activity - typically, symptoms of injuries and painful conditions will become worse with activity that involves the painful muscle or joint. Growing pains typically occur in the evening/night after a particularly active day.
• Focal area of pain - injuries and painful conditions are generally localised to a specific area of the body, whereas growing pains tend to be more generalised and non-specific.
• Joint Pain - growing pains tend to occur in the muscles of the legs (front of thighs, back of thighs and calves) rather than in joints.
• Swelling - swelling, redness, warmth or bruising tend to indicate an inflammatory process, which is uncharacteristic of growing pains
• Painful to touch - the child with growing pains is often quite happy to let you touch the painful area where as the child with a true injury will usually avoid letting anyone touch the area
• Limping - generally, growing pains will not affect your child's ability to walk.

Physiotherapy has a lot to offer for both injuries and growing pains. Many of our treatment techniques such as massage, heat, acupuncture, stretching and exercise can reduce and eliminate growing pains. If your child is in pain, prompt action can save ongoing distress and disability.

Tim Laferla is a Physiotherapist with a special interest in childhood injury management. To book your child in with Tim just call our clinic number 9293 1800 or email us via our webpage.

Firstly, let us define the 'off-season'.  It is the period of time between the last competitive game and the 'pre-season'.   It is the time of self-directed fitness and so having a clear idea of what to do is paramount.

One way of ensuring an active recovery period is to do cross-training.  That is, pick a sport that you don't compete in.  So for footballers and netballers for example, that may be swimming or cycling.  2-3 sessions at 60-70% of maximum effort would be ideal.  Stretching, self-release work with myofascial elements with the use of rollers, and light to moderate weight training would also be appropriate.  For resistance training, avoid heavy weights and focus on "core" exercises for stability around the spine and pelvis.  More reps and lower resistance with only modest amounts of power work will allow your tired body recover over the summer.

Consider yoga, pilates, swimming or cycling over summer.  It allows the regeneration of the seasons injuries while maintaining a good level of fitness.  Remember, it is easier to keep some baseline fitness over summer rather having to start from scratch and risk injury in the preseason.

Mead Street Physio Notice Board

Spotlight on Osteoarthritis

Osteoarthritis (OA) is common.  Everyone over the age of fifty will have signs of degeneration of some of their joints.  What makes some people's joints become sore and osteoarthritic depends upon a number of internal and external factors.       

The process of OA begins with either susceptible joints or a history of trauma to the joints.  It is caused by mechanical forces but is modified by your body's own response to these forces, particularly your genetic predisposition and immune system response.  External factors that can contribute to the onset of OA include:

• Occupation
• Joint injury
• Level of sports participation
• Intensity of sports/activity training
• Bone mass index

The causes of OA are explained by two competing theories.  The "Wear and Tear" Hypothesis explains OA in terms of repeated weight-bearing stress on the joint as may occur with running or heavy impact exercise.  The "Muscle Dysfunction" Hypothesis describes how when the muscles around a joint weaken, there is an increased likelihood of greater force through the joint.

Recent scientific research has found some interesting findings with regard to exercise and OA. 

• Strengthening and endurance exercises relieves symptoms in people with mild to moderate OA
• Regular running actually increases joint space width in OA knees, while exhaustive running decreases joint space.

The take-home messages from these findings are:

• Control your symptoms associated with OA
• Do strengthening and endurance exercises
• If you run, don't stop even if your Xrays show signs of OA, as running builds muscle strength.

Mead Street Physio offers a range of exercise types to help control the effects of OA including Pilates, gym, mat work, and tailored running/cycling/swimming routines.