Enhancing Performance

Physical preparation:

Why is this important?

  • Training for more than 80% of your scheduled training time increases the ability for you to reach your performance goals.
  • Physical preparation provides an opportunity to bulletproof athletes through key work-on’s and the ability to identify areas that will help to reduce injury risk.

What is physical preparation?

  • Physical preparation is preparing you through training prior to competition by incorporating generic and individualised programming into your routine such as warm up or pre gym activation that influences injury risk and the burden to the athlete due to injury.

Recovery:

Why is it important?

  • Good recovery ensures athletes are physically, physiologically and psychologically prepared for all training sessions and competitions.

What is recovery?

Recovery incorporates many different components including;

SLEEP – Studies have shown athletes are likely to have reduced or poor quality sleep due to training schedules. Both sleep quality and quantity impact upon performance. For tips on sleep hygiene have a read of our sleep hygiene blog here.

NUTRITION – Eating the right food at the right time consistently.

Recovery is AWESOME!

Active recovery: After games and trainings, do a low intensity warm down e.g. low intensity swim for 15mins.

Water/fluids: Remember to hydrate.

Eat: The right food at the right time. Refer to a nutrition plan from a performance nutritionist.

Skins/compression: Post competition, you can wear for up to 15 hours following.

Overnight/sleep: Sleep as much as you can! Extending sleep has been shown to positively impact performance. See our blog on sleep hygiene for a better night sleep.

Massage + option of ice baths post competition: Ice baths should be 2 x 5mins with 2 min break in between.

Exercise: Training block within competition season including our physical preparation!

There are many ways simple exercises can be incorporated into your current training program to reduce the risk factors associated with each individuals chosen sport. 

If you are wanting to learn more about ways to enhance your performance please get in touch with us via email reception@buretaphysio.co.nz or call 07 576 1860.

Achilles Tendon & Ruptures

I have seen a few Achilles Tendon (AT) ruptures over the last few months, so I decided to write a blog about this injury. I hope it guides patients that have experienced this type of injury and explains how to reduce the risk of recurrence or reinjury if you have already suffered from an Achilles rupture.

Those that have experienced a rupture can confirm it is a long recovery process that can range anywhere between 6-12 months post rupture. The most common mechanism of injury in both the sporting and non-sporting environments are eccentric contraction of the calf muscle group (calf is on stretch as the heel hits the ground) and when the trunk of a person’s body is opposite to the direction in which the person’s foot is planted, e.g. when they change direction suddenly.

The Achilles tendon anatomy and Risks for Achilles rupture

A: Muscle tendon Junction (MDT): where the calf attaches to the tendon

B: Mid portion (the middle part of the tendon)

C: Insertional (part of the tendon that inserts onto the heel bone)

Achilles Tendon (AT) ruptures commonly occur in the active individual with underlying Achilles tendinopathy that they were unaware of (2/3 of people had no experience of pain prior to the rupture). Patients will commonly report they heard or felt a pop at the ankle when ruptured but this symptom is not always reported. Many described this as “feeling as though they were shot from behind”. This is most commonly pain free at the time of the incident.  Those that do experience pain during or after the rupture, will commonly report pain starting at the ankle acutely and then migrating towards the calf over the next few days. Patients will usually complain of weakness and an inability to stand, walk, or run on their foot as they could prior to the rupture.

Males are more prone to AT ruptures and unfortunately, we do not know why however, females with an absent menstrual cycle, on hormone replacement therapy (HRT) and over 40 are also at a greater risk.

Higher risk individuals to AT rupture also include people within the age group of 30- 40 and 60-75 years old. Other factors that predispose you to tendon injuries are those that are:

  • Taking regular medication – steroids, quinolone, or HRT (hormone replacement therapy)
  • Genetic factors
  • History of a previous rupture (this is the largest risk factor)
  • Previous cortisone injection into a tendon for pain relief! Please DON’T DO THIS EVER! Cortisone has been shown to weaken a tendon!

Most tendon ruptures occur at the mid-portion of the Achilles and this is usually due to existing tendon degeneration however, this can occur in individuals with NO tendon pathology too.  As mentioned before, this is usually the group that does not have pain with their tendon prior to rupture as most people that suffer from tendinopathy pain seek treatment and therefore begin rehabilitation that builds strength and capacity in their calf and Achilles complex and therefore their risk of rupture is reduced. So remember if you are someone who is struggling with Achilles tendon pain that has been persisting for a short or long period of time ensure you seek an assessment of this from someone who is experienced in tendinopathy pain so that you can get this on the right track. It is important you do this rather than being afraid your tendon may rupture as that is extremely unlikely in your case.

It is less common that a healthy tendon will rupture unless it has been exposed to a significant external force in which case rupture at the MDT portion of the Achilles will occur.

Management of AT ruptures

These can be managed conservatively or surgically but in New Zealand, the majority of these injuries are treated conservatively. This, at times, differs in the elite athlete population but research shows us that after 18 months post rupture the outcomes of surgical vs conservative care are largely the same. The conservatively managed population has a slightly higher risk of re rupture and the surgically managed group has a higher incidence of infection, but overall results are relatively even, and good function regained. Other things that may be taken into account when considering surgical vs conservative management are whether the injury is acute (5 days) or chronic (3-6weeks); the size and location of the tear, and the Orthopaedic surgeon’s availability and assessment of the individual.

Overall, there is little difference in recovery and return to play with the 2 approaches. The main difference is that with operative management, the person may regain functional use of the foot a few weeks earlier than conservative BUT with all approaches, there are risks and benefits for each. As a physiotherapist, I would always encourage my patients to consider a conservative approach.

The most important contributing factor determining the success to a full return to function is the quality of the REHABILITATION post rupture.

 Both surgical and conservative approaches protocols include;

A: Immobilisation in serial casting in a plantarflexed position (pointed foot position)  for (2-3 weeks) whilst using crutches to avoid putting weight through the tendon.

B: At 3 weeks they are put in a moon boot with wedges keeping the foot into a pointed position and 1 wedge is removed on a weekly basis until the patients’ foot is in a neutral (flat foot) position. The Doctor will advise on when gradual weight bearing can occur.

C:  Ideally from around 6 weeks the patient will be able to gradually start weight bearing and commence light exercise (guided by Doctor and Physio).

D: At 10 weeks post rupture, the patient is usually allowed to remove the boot and walk, gradually increasing walking time and distance.

The important thing during this initial phase of recovery is that we allow the tendon to heal properly and develop sufficient stiffness!  A long Achilles repair leads to less function as the final outcome.

The immobilisation period is important as it bridges the gap of the Achilles and promotes the tendon healing in a shortened rather than lengthened position. A tendon that heals in a lengthened position is less likely to be able to develop appropriate strength and force which leads to a less than satisfactory outcome including a greater likelihood of re-rupture.

Rehabilitation post rupture

As a physiotherapist, we want to ensure that we regain ankle and forefoot mobility, regain and optimise your calf and foot endurance, strength and proprioception of BOTH legs.

We also aim to achieve proximal strength through your hips, core and the remainder of your lower limb as this will facilitate recovery and a greater overall outcome.

We will guide you through sport specific training and return to play programmes to reduce the risk of re-rupture and ensure not only a return to play but more importantly over time a return to performance.

I always advise my patients to start physiotherapy ASAP as there is a lot we can do to help facilitate recovery without affecting the injured area. When you are out of the serial casting and put in the moon boot, we will then start with hands on treatment to regain ankle and foot mobility whilst protecting the AT.

It is comforting to know that 80% f people return to full sporting activities following a rupture and that the Achilles tendon can tolerate the force being put on it! With each running step the AT has a load of 6 X bodyweight put on it!

With appropriate rehab, you can feel confident and enjoy a return to sport without being afraid to re-rupture, provided you have done your homework.

If you have any questions or concerns regarding any Achilles pain you are having or have had, please contact us to talk to a qualified Physiotherapist

Written by Dunia Mouneimne – Senior Physiotherapist

Returning to Exercise Post Childbirth – What should I know?

Editors note: If you are an athlete who is post-partum there is a section further down below that is important for you to read.

Over recent years we have seen an emerging social phenomenon with successful return to sport of many elite athletes. Guidelines and important points for athletes and non-athletes returning to exercise post childbirth are included in this blog.

Ideally seek medical guidance prior to returning to exercise post-partum. If you have had an uncomplicated pregnancy and birth your physiotherapist is one of the best suited professionals to seek advice from at this point.

The general guideline is that healthy women gradually return to physical exercise aiming to accumulate 150 to 300 minutes per week. Low impact endurance training should start gradually but can start early as desired as there is minimal impact on the pelvic floor. Return to high impact exercises and strength training may need to be delayed several months. Some exercises need to be more gradual especially exercises increasing intra-abdominal pressure. The initial focus should be on strengthening pelvic floor muscles.

Important points to be aware of for athletes and non-athletes:

  • The pelvic floor is weak and injured in most women postpartum and will require rehabilitation to return to its “normal” functions. Those who struggle to perform the above exercise guidelines and those that have not completed pelvic floor muscle training prior to the birth may need an individualised and supervised programme to regain appropriate strength and control.
  • Any physiological changes that occur during pregnancy and persist for four to six weeks post birth, such as elevated hormone levels, may mean your joints are more mobile than normal so take care with activities that require large amounts of movement, flexibility and dynamic exercises.
  • Certain birth types may lead to complications. For example, C sections are more likely to cause abdominal pain postpartum.  Pain management and wound healing are therefore important prior to any return to exercise.
  • Low back pain is common so must be considered prior to return to exercise. An assessment of this with a specific treatment and rehabilitation programme may be required.
  • Stretched, weakened or separated abdominal muscles (Diastasis recti abdominis) may also delay or impede exercise ability.
  • Increase energy and fluid intake if breastfeeding when returning to exercise.  Ensure particularly when breastfeeding that nutrition demands of both lactation and training are met. The caloric cost of breastfeeding is estimated to be around 600 kilocalories per day.
  • Adequate intake of calcium and vitamin D during breastfeeding is essential.
  • Ensure adequate hydration throughout the day.
  • Consider psychological readiness to return to exercise as this is important post childbirth. Fear of movement is common particularly post C section and has been associated with restricted postpartum physical activity.
  • Exercising after breastfeeding will likely be more comfortable to avoid engorged breasts.
  • Take care with those exercises that cause high gravitational load on the pelvic floor or high impact activities in early stages.
  • Complicated births such as a forceps delivery or levator ani avulsions are likely to slow down return to exercise post-partum and potentially lead to elevated complication rates of pelvic floor dysfunction and pelvic organ prolapse if time is not given to heal appropriately and rehab is not completed.
  • Ensure that return to exercise is gradually increased.
  • Consider the importance of individualized breast support – support rather than compression is important from a comfort perspective.
  • If an obvious Diastasis Rectus Abdominis (gap in between abdominal muscles) see a physiotherapist for an assessment to have a programme prescribed at the correct level and to ensure safe return to exercise without complications
  • Sexual dysfunction is common postpartum. Those suffering may benefit from pelvic floor rehabilitation to improve this.

Stress incontinence (involuntary emission of urine when pressure within the abdomen increases suddenly, as in coughing, running or jumping) is one common post-partum complication. Pelvic floor rehabilitation post childbirth can be used successfully in resolving this issue in a large percentage of the population. If you or anyone you know is suffering from any stress incontinence, please contact the clinic and book in for a pelvic health assessment as this is often an extremely limiting condition that can be resolved relatively easily.

  • Factors that may predispose you to post-partum stress incontinence are:
    • Giving birth,
    • Increasing age,
    • Vaginal delivery,
    • Pregnancy stress incontinence,
    • Running related pre pregnancy incontinence,
    • Partaking in high impact activities,
    • Women with multiple children, and/or
    • Return to high impact activities before the body has healed i.e., running.

Exercise guidelines:

  • Research highlights that all post-natal mothers, regardless of delivery mode, should be offered pelvic health assessment from six weeks post-natal to comprehensively assess the abdominal wall and pelvic floor. In NZ this is uncommon and requires the mother to generally access private health providers for this. There is currently a movement for this to change so all mothers in NZ can access private pelvic health physiotherapy assessment and rehabilitation in the future which we believe is essential to the long term health and wellness of mothers in NZ.
  • High impact activities, such as running, are associated with a sudden rise in intra-abdominal pressure and load the pelvic floor as a result.  For this reason, it is advised that you return to low impact activities post-partum prior to a return to running.
  • Low impact exercise can be implemented within the first three months post-natal followed by a return to run between three to six months.

Key signs or symptoms of pelvic floor and or abdominal wall dysfunction:

  • Urinary and or faecal incompetence,
  • Urinary or faecal urgency that is difficult to defer,
  • Heaviness pressure bulge dragging in the pelvic area,
  • Pain with intercourse,
  • Obstructive defecation,
  • Pendular abdomen, separated abdominal muscles and or decreased abdominal strength and function, and/or
  • Musculoskeletal lumbar-pelvic (low back) or pelvic pain.

Risk factors for potential issues returning to running and sport:

  • Less than three months post-natal,
  • Pre-existing hypermobility conditions i.e., Ehlers-Danlos,
  • Breastfeeding,
  • Pre-existing pelvic floor dysfunction or lumbar-pelvic dysfunction,
  • Psychological issues that may predispose a post-natal mother to an inappropriate intensity or duration of running as a coping strategy,
  • Obesity,
  • C-section or perineal scarring, and/or
  • Relative energy deficiency in sport (RED S).

A referral to a pelvic health physiotherapist is further highlighted if any of the following signs and symptoms are experienced prior to or after attempting returning to run:

  • Heaviness or dragging in the pelvic area,
  • Leaking urine or inability to control bowel movements,
  • Pendular abdomen and or noticeable gap along the line of your abdominal middle,
  • Pelvic or lower back pain, and/or
  • Ongoing or increased blood loss beyond eight weeks post Natal that is not linked to your monthly cycle.

An inability to exercise may affect both your mental and physical wellbeing. It can be socially isolating not being able to complete exercises as you previously had. Please ensure that you reach out to us for an assessment if this sounds like you.

To book a pelvic floor assessment please call 07 576 1860 or email reception@buretaphysio.co.nz.

Exercise in Athletes Post Partum

Across the board, athletes return to sport sooner than non-athletes with a greater percentage within six weeks post-partum. Research also highlights that a large percentage of those athletes returning to elite sports post childbirth return to the same if not a higher level of performance. If you are intending on returning to competitive sports post pregnancy, ensure you include a multidisciplinary team in your planning.

Be aware that just as if you were returning to running or sport post injury, when you had a significant reduction in your training load, this is a period that exercise must be gradually resumed. Ideally, this would start with pelvic floor rehabilitation, alongside low impact activities, prior to a gradual reduction in high impact activities and those that result in significant increases in intra-abdominal and pelvic pressure such as lifting weights.

Moderate to vigorous physical activity in sport will not negatively affect breastmilk volume, alter the composition of breastmilk or affect infant growth if there is appropriate food and fluid intake.

Note that post-natal women with a history of RED-S (relative energy deficiency in sport) are at increased risk of stress fractures, pelvic dysfunction and fertility issues so must have appropriate multidisciplinary involvement regarding their return to training.

Things to take note of:

  • Regaining functional control of the abdominal wall to manage intra-abdominal pressure and load transfer should be achieved prior to return to run or sport, otherwise overload and compensatory strategies may occur.
  • Return to running with a diastasis if it is functional i.e. it is present but there are strategies to control intrabdominal pressure and transfer load across the abdominal wall that are adequate.
  • Shoe/boot size can alter permanently with pregnancy and footwear previously worn should not be presumed to be the correct fit.
  • Sleep deprivation in athletes is associated with increased injury risk. Sleep is key for recovery from both physical and psychological stress and is frequently restricted in the postpartum period. Utilise naps as able to optimise sleep quantity.
  • Utilise sleep hygiene guidelines to optimise sleep quality.
  • Similar to post injury situations, build training volume prior to increasing training intensity.
  • Minimise large and sudden increases in load.
  • Take note of key individual signs that need to be monitored during your return to run/sport i.e. heaviness, dragging, incontinence or moderate to severe pain may suggest excessive training distance or intensity.
  • Mild musculoskeletal pain 0-3/ 10 which settles quickly after a run with no pain lasting into the next day is often acceptable; as is used in the management of tendinopathy and other conditions.
  • If running with a buggy it must be a buggy that is specifically designed for running. Two handed technique where it is possible should be utilised and ideally your baby is greater than six months old as per buggy manufacturers guidelines. Note also that pushing a buggy has an increased energy cost when compared to running independently.

In summary:

Post-natal women will benefit from individualised assessment and guided pelvic floor rehabilitation for the prevention and management of pelvic organ prolapse, the management of urinary incontinence and for improved sexual function post childbirth.

Return to running is not advised prior to three months post-natal or beyond this if any symptoms of pelvic floor dysfunction are identified prior to or after attempting return to running.

Exercise in Athletes During Pregnancy

Until recently, sport culture has generally positioned motherhood into a woman’s post athletic life. But in recent years many examples of elite sportswomen have demonstrated a successful return to sports performance at the highest level.

Research has confirmed that vigorous physical activity has no adverse effects on the course of the pregnancy, the labor, or on the fetus and is not associated with an increased risk of preterm birth or reduction in gestational age at delivery by women who were well trained pre pregnancy. Well trained women can benefit substantially from training at high volumes during an uncomplicated pregnancy. Such training has also been shown to facilitate a successful and quick return to competitive sport after pregnancy.

Whilst this is the case there is a lack of easily obtainable information regarding specific forms of exercise such as strength training while pregnant.

Athletes should have their exercise regime overseen by an expert health provider to ensure the safety and wellness of the mother and her unborn child. This is particularly important with the fetus as small for gestational age.

  • There are a number of forms of sport that are generally considered more unsafe and should be avoided while pregnant. These include:
    • abdominal trauma or pressure ie weightlifting, contact or collision sports such as rugby or martial arts 
    • those that involve projectile objects or striking implements ie hockey or cricket
    • sports involving falling ie judo, skiing, skating, horse riding
    • extreme balance coordination and agility sports ie gymnastics, water skiing
    • sports that involve significant changes in pressure ie scuba diving, skydiving
    • heavy lifting greater than submaximal high intensity training
    • altitudes greater than 2000 meters
    • exercise in the supine position or even motionless supine posture after 28 weeks of gestation

Some modifications to exercise techniques or programs may be required to accommodate anatomical and physiological changes as your body changes throughout the pregnancy.

All pregnant women are advised to do pelvic floor exercises to improve the tone of the pelvic floor muscles reducing the complications of pelvic floor weakness post birth including but not limited to urinary incontinence.

  • Avoid large increases in body temperature during exercise. Remain well hydrated, avoid hot or humid exercise environments where possible.
  • Use controlled stretching only.
  • Avoid wide squat lunges or unilateral leg exercises that place excessive shearing forces on the pubic synthesis and case pubis pain.

Come and see one of our physiotherapists that work in this field if you are suffering from pelvic pain, lumbar spine or other musculoskeletal pain during your pregnancy. We can also help you with designing an exercise programme that is suitable for you during your pregnancy as well as get you started on an appropriate pelvic floor exercise programme to reduce many of the complications that are common post childbirth.  

Also don’t forget to discuss your post-partum plan with your physiotherapist so you are comfortable regarding what you need to look out for, when and how you can start and what you can do to ensure the most problem free return to exercise possible post birth.

To book please call 07 576 1860 or email reception@buretaphysio.co.nz.

Exercise During Pregnancy

In the general population, in the absence of contraindications, all pregnant women are encouraged to be physically active for at least a minimum of 150 minutes per week. This should consist of moderate intensity aerobic activity. Depending on your usual volume of exercise it is common for this total volume to be reduced in the first and third trimesters due to a number of pregnancy related issues such as fatigue.

The below guidelines are a great starting point for exercising during pregnancy. These guidelines relate to those women who have an uncomplicated pregnancy. If you have additional health or pregnancy related concerns, please ensure you speak to your health care provider prior to undertaking exercise when pregnant.

  • Exercise during pregnancy does not increase the risk of adverse pregnancy or birth outcomes

  • Research says that pregnant women who were inactive prior to pregnancy should be encouraged to be active during pregnancy commencing low intensity activities such as walking and swimming and progressing to the lower end of the range recommended and national guidelines of 150 minutes per week or 30 minutes per day of activity on most days. If you are unsure throughout, please seek advice from your health care practitioner.

  • There is strong evidence to support the benefits of physical activity for pregnant women including improvement or maintenance of:
    • muscle strength and endurance
    • cardiovascular function and physical fitness
    • decreased risk of pregnancy related complications such as hypertension
    • reduced back and pelvic pain
    • improved fatigue levels
    • improved mental health including reduced  stress, anxiety, and depression
    • reduction in excessive gestational weight gain and postpartum weight retention
    • fewer delivery complications
    • to aid in the prevention of urinary incontinence
  • Those who should be cautious with or complete low level exercise only with professional collaboration with medical personnel include those with a history of:
    • previous spontaneous abortion
    • history previous preterm birth
    • mild to moderate cardiovascular or respiratory disorder
    • anemia
    • malnutrition or eating disorder
    • twin pregnancy after 28th week
    • obesity  BMI >30
    • intrauterine growth restriction
    • other significant medical conditions such as poorly controlled type one diabetes or hypertension
  • There are contraindications to physical activity during pregnancy and these include those women who have below:
    • ruptured membranes
    • signs of preterm labor
    • hypertensive disorders of pregnancy
    • incompetent cervix
    • growth restricted fetus
    • high order multiple gestations eg  triplets
    • placenta previa after week 28
  • Woman who have experienced the following symptoms should seek advice from antenatal care provider before continuing exercise:
    • abdominal pain
    • amniotic fluid leakage
    • calf pain or swelling
    • chest pain tightness or palpitations
    • decreased fetal movement
    • dizziness or presyncope
    • dyspnea (shortness of breath) before exertion
    • excessive fatigue
    • excessive shortness of breath
    • muscle weakness
    • pelvic pain
    • preterm labor
    • severe headaches
    • uterine contractions
    • vagina bleeding
  • If any of the above complications relate to you please ensure you discuss any planned or proposed exercise regime with your lead health professional.

Our Pelvic Floor Physiotherapists can ensure you get an exercise plan that works for you and your pregnancy. To book please call 07 576 1860 or email reception@buretaphysio.co.nz.

Managing Pelvic Health in Men

There is currently a rising tide of interest, knowledge and training in Pelvic Health Physiotherapy in New Zealand. 

In society we hear more and more about pelvic floor muscles post pregnancy, helping control incontinence and reducing the complications of prolapses but what about Men’s Pelvic Health. What’s down there and what’s happening? Taboos are breaking down, guys are becoming more proactive about their health status whether they like it or not and Pelvic Health is a really important area.

Right Guys! Conditions of incontinence, bowel dysfunctions, sexual dysfunctions and Post Operative complications can now be dealt with and remedied by Pelvic Health Physiotherapy. In many cases we want to prehab your pelvic floor muscles to prepare them for future function and strength so timeframes to recoveries and returning to functional abilities is optimised. With 95-99% of males incontinent post prostate surgery, Pelvic Floor muscle exercises can reduce leakage timeframes from 12 months to 3 months as well as improve sexual function. Over 1 million kiwis suffer continence issues. 20% of people being Male yet 84% of people will suffer in silence and not go see their Health Professional.

Bureta Physiotherapy now has a dedicated Pelvic Health team passionate about Men’s and Women’s Pelvic Health, Mel Smith and Marcel Gyde are looking to break down the barriers, normalise pelvic concerns, and provide a professional and progressive physiotherapy service to the Men and Women of the Bay of Plenty. So lets not suffer in silence. Lets open our minds and take that first difficult step to gain your normal life back that’s challenging the future. 

To book a Pelvic floor assessment please call 07 576 1860 or email reception@buretaphysio.co.nz.

Marcel Gyde

Men’s and Women’s Pelvic Health Physiotherapist

Do You Suffer From Back Pain?

Lower back pain is common, with 40-80% of people experiencing it in their lifetime. Back pain can be extremely painful and debilitating and is rated 6th in the world for burden of disease, contributing towards 25-30% of medical costs.

Back pain is unfortunately re-occurring, meaning if you have had it before, you will probably experience it again in future. As physiotherapists, it is important that we equip our patients with the skills, strategies, and education for managing their back pain and preventing it from getting worse.

Back pain can refer pain to areas above and below the knee. It is essential when you present pain that occurs away from the lower back region, that the back is cleared as being the cause of your pain. Pain from the back can cause central, unilateral, or referred pain. The referred pain that one may experience can occur as gluteal, hip, groin, hamstring, shin, calf and even foot pain. Back pain can be associated with numbness and loss of muscle power of structures below the knee or above the knee. This is usually associated with a nerve root being pinched or compromised.

As a physiotherapist, when treating a patient with referred pain, numbness and/or muscle power loss, the aim is to try get the pain to ‘centralise’   i.e. move the pain away from the legs and bring it towards the back. We want the pain to stay in the back as this tells us that the nerve root is not being compromised anymore and we are on the right track to resolving the referred pain. Often when the pain centralises, the pain in the back worsens, although it may not feel nice, it is a good sign, and it is what we want to restore your full function and reduce your pain eventually.

It is important that if you are presenting with back pain or your level of function has been compromised at all such as weakness in the legs, unable to have control over or bowel and bladder or numbness in a saddle shape distribution by your hips that you see a physiotherapist or a doctor for an assessment.

It is also important that if you have persistent night pain, night sweats, unexplained weight loss, or a history of cancer that you get assessed by your doctor or physiotherapist to ensure that there is no serious pathology going on such as cancer.

Things that you can do to reduce the re-occurrence of back pain:

  1. Exercise or move frequently.
  2. Avoid sitting or standing too long in ONE position.
  3. Ensure you are sitting with good posture at work, avoid slouching.
  4. Ensure you are getting up regularly from your desk chair.
  5. Ensure your work setup is ergonomically correct.
  6. Ensure you implement correct lifting techniques if your job is physical.
  7. Repeat your prescribed back exercises as maintenance or more often if you feel your back pain starting.
  8. Get your gluteal muscles strong and working properly so that you protect your back if working with heavy equipment.
  9. Balance the amount of time you spend sitting/ bending forward with standing and walking.
  10. Ensure you have a comfortable pillow and mattress so you are able to sleep comfortably.

If you have any questions or concerns regarding any back pain you may have, please contact us to talk a qualified Physiotherapist

Written by Dunia Mouneimne – Senior Physiotherapist

The Underestimated Importance of Breathing

“But I’ve been breathing all my life, why do I need to ‘Practice’ breathing?”

.. is a common response I hear from clients who get given breathing retraining exercises as part of their rehab. Why should you practice something you do every moment without thinking about it, right?

Fatigue. Anxiety. Brain fog. Breathlessness. Headaches. Bloating. An upset gut. A tight chest. Dizziness. Numbness or tingling. Neck, shoulder or back pain. Poor concentration. Full body tension. Muscle ache.

Any of these symptoms sound familiar? While most these could be due to other medical issues, they are also all signs of a poor breathing pattern. Breathing is a natural, instinctual reflex that is necessary for our survival. However, the way that we breath can often become altered due to many subtle influences on our body over time. Factors like stress, hormones, poor posture, asthma, caffeine, perceived pressure, medication and having a blocked nose to name a few. Throughout our lives our individual experiences and thoughts can shape how we breath. This in turn can influence how we move, react and interact.

Our breathing pattern controls our body’s PH level, it transfers oxygen (O2) into our tissues via our blood and it is responsible for getting rid of carbon dioxide (CO2) as we exhale. When this delicate balance of chemicals is thrown out of balance our body internally responses in ways which cause some of the above symptoms and more. Often these changes can be subtle, however their long-term effects can leave the body working inefficiently and leave you with unexplained nagging symptoms.

One of the most powerful effects of our breathing pattern is the one that communicates to our nervous system whether we are relaxed, or we are in a state of stress or danger. Hyperventilation may make you think of a person breathing frantically into a paper bag, but this occurs anytime we breath faster than 14 breaths per minute. Breathing out too fast decreases our CO2, making our PH more alkaline. This reaction invokes the sympathetic nervous system (SNS), often referred to as the “fight or flight” response. The SNS is wonderful when you are trying to run away from a chasing dog or are late for a meeting, however if we continue to breath out too fast we can often stay in this mode longer than we need to. Robbing us of calm, relaxed, unstressed moments in our day. Decreasing our CO2 levels, ie. breathing out too short and sharp also effects the ability of O2 to be transported by our blood to our tissues. And we all know we need oxygen for pretty much every function of the body.

Ideally at rest, we want to breath 10-14 breaths her minute, inhaling through our nose into our belly. Another common poor breathing habit is when our chest and shoulders lift up toward our ears when we breath. If this is the case, we likely do not activate our diaphragm; the muscle that lives in our belly that is meant for breathing. This muscle functions similarly to our heart, in the way that it does not fatigue to the point it needs rest. When we breath with our chest, neck and shoulders we ask the muscles in this area to draw air into our lungs. The issue here is that those muscles like our arm and leg muscles are skeletal muscles, which means they work on a fatigue and recovery system, they can not go and go and go like the diaphragm. Breathing with your belly can be as much a mental challenge as it is a physical one if you are not used to it. There is often a subconscious drive to keep still through our lower ribs and belly as the want for a flat stomach is a social norm these days.

Breathing well can even mean the difference between a calm logical reaction to something a loved one says, or a fly off the handle emotional reaction. In other words, breathing well strengthens the area in the brain which reacts with calm logical through to stimulus called the hippocampus. If we are in a state of hyperventilation and stress and our SNS is in control our reaction will more likely be processed by another area of the brain called the amygdala. The Amygdala reacts based on previous stimulus threat and can cause those irrational, inappropriate reactions.

So, for all those achey necks, stressed out brains and feelings of overreaction out there, give your body the well-deserved rest it is screaming for. Sit down, place a hand on your belly, once you have exhaled fully, breath in through your nose slowly to the count of 4 and let your belly rise up into a big balloon. Then breath out SLOWLY, for longer than you breathed in. Feel your body pause and rest here for a moment and then repeat.

The way you breath is one of the most underestimated but essential aspects of your health and wellbeing. These are just a few of the amazing ways our breathing can improve our daily function and help us to live a more enjoyable life. If this has rung some bells for your body and you are ready to make lasting changes, book a breathing assessment at Bureta Physio by calling us on 07 576 1860 or fill in the form below.

Melanie Smith BHSc Physiotherapy

Physiotherapist & Qualified Bradcliff Breathing Practitioner 

Knee Pain and Tramping

Knee pain does not mean you have to stop what you love! If you enjoy hiking, tramping, mountain running, even walking up and down the mount here is some advice for you.

People often experience knee pain when walking up and down hills, especially in an overnight or multi day tramp. This blog will address different approaches you can do to reduce the load on your knee joint and therefore decrease knee pain.

Our knee has two joints, one where the thigh bone (femur) and the shin bone(tibia) meet, called the tibiofemoral joint. The other joint is between our kneecap (patella) and the thigh bone (femur) called the patellofemoral joint.

Strength Exercises
Biomechanics the way we move, is an important aspect to work on. When walking downhill, your tibiofemoral joint has a compressive force of 7-8.5 times your body weight, even more for females.[1] When running, there is 4 or more times your body weight or more your knee has to absorb.

Firstly, we want to offload the shock absorbed by the joint and ensure our muscles take this load. We do this by strengthening the proximal muscles which include our gluteal and core muscles. Off loaded (non-weighted) exercises e.g. side planks, clams etc. are a good place to start strength work. Working into a loaded position such as lunges, bulgarians and step ups are then going to make it more functional for walking.

Ensuring our other leg muscles are also strong is beneficial, such as calf muscles, quadriceps, hamstrings and your feet muscles. This aims to offload the knee joint and make the surrounding muscles absorb the load. Seeing a physio or other movement specialist will be vital to make sure your technique is good to target the right muscles, otherwise there is no point in doing these!

Walking Technique
To decrease the body weight compressive force your knee joint has to absorb, you can shift your weight onto your heels, sit back, keep your knees bent and land softly when walking downhill. Slow and controlled is the secret. Running downhill or walking with straight legs is not beneficial.

When increasing your speed on any incline or terrain, make sure you do not increase your stride. Lengthening your stride, increases the load on your knee.
When walking uphill try pushing through your heel and squeezing your gluteal. Aim to not let your knee go over your toe or drop inwards.

Other Helpful Tips
The lighter your tramping pack, the less load through your knees.  Clearly there are health and safety essentials for tramping but try not to overpack. Same with your own body weight. The less you weigh, the less load your knees/legs need to absorb when going downhill or have to push uphill.


Shoes Comfort is essential. Hiking boots versus trail shoes is the big debate and this depends on what you feel comfortable wearing. Make sure you have completed some big walks in your shoes before undertaking a multi-day hike – avoid those blisters!

Hiking poles
I am a big believer in hiking poles. They can offload your knees by 30%! So, if you have any knee issues or are worried about hiking, I recommend investing in some poles. They will last you a lifetime. Make sure you get adjustable hiking poles. Poles should be longer when going downhill and shorter when walking uphill.

Note: When walking on flat surfaces your elbows should be at 90 degrees. This is to protect your shoulders.

Recovery
After walking or running, especially on a multi-day hike, recovery is key. Stretch or roll your thighs/quadriceps, calves, glutes and hamstrings at the end of walking activity. If you’re out in the bush, find something you can use e.g. drink bottle for rolling your thighs.

Primers or muscle activation before starting for the day is a lot better than stretching. Ask your physio to provide some glute primers.
You can add nutritional supplements to help recovery or decrease inflammation such as omega 3’s, ginger and turmeric, but consult a nutritionist for more advice regarding this.

If you have any questions or concerns re any knee pain you may have please contact us to talk a qualified Physiotherapist

Written by Annaliese Horne Physiotherapist


[1] Kuster, M., Wood, G.A., Sakurai, S. et al. Downhill walking: A stressful task for the anterior cruciate ligament?. Knee Surg, Sports traumatol, Arthroscopy 2, 2–7 (1994). https://doi.org/10.1007/BF01552646

The Importance of Resistance Training

Resistance training is regarded as any type of exercise that builds strength and muscle mass but it is not just for the gym-bro’s and rugby players – It has a wealth of benefits reaching far beyond getting bigger, stronger muscles. This blog will outline some key benefits of resistance training and then explain why it is an important part of rehabilitation from acute and chronic injury or pain.

Slows down muscle loss as we age:

Muscle starts to deteriorate when we reach our 30’s. After age 40, we lose on average 8 percent of our muscle mass every decade, and this phenomenon continues to accelerate at an even faster rate after age 60. Studies show that this loss of muscle hastens the onset of diseases, limits mobility, and is linked to premature death. Resistance training slows this down by working the muscles at a level where they are forced to adapt and maintain, or even improve their strength and size.

It keeps our bones nice and strong:

Similar factors that help you maintain muscle are the same factors that keep your bones strong and dense. As you age, your bones become more brittle – a process known as osteopenia. The end of the spectrum here is osteoporosis, where your bones are at a much greater risk of fracturing. Resistance training helps delay this process from occurring and can even reverse the process once started. Consistent evidence also suggests that exercise therapy and specific resistance exercises for the lower limb reduce pain and improve physical function in hip and knee osteoarthritis.

You live longer:

Research shows those with higher muscle mass tend to live longer than those with less muscle. This relationship remains after accounting for traditional markers of disease, and it showed that low muscle mass was an even better predictor of premature death than obesity.

It helps you lose fat:

Probably the best way to burn fat and hold onto muscle is to combine a good diet with resistance training. Throw some aerobic exercise into the mix as well and you have yourself a recipe for optimal health and a better quality of life.

So where does resistance training fit in to your rehabilitation programme?

For a start, as a protective mechanism, resistance training has been shown to reduce acute sports-related injuries (i.e., joint sprains, muscle strains, etc) by over 30% and overuse injuries (i.e., tendon pain) by 50%.

If you are unfortunate enough to already have an injury, resistance training makes up the bulk of your rehabilitation to best prepare you to return to sport, work, or just life. This is because when we injure a joint, we naturally have an inability to fully contract the muscles around that joint due to pain, inflammation and/or swelling. Once this process – called arthrogenic muscle inhibition – kicks in, it is a “use it or lose it” situation. Our body cannot utilise the muscles to their full potential, so the muscles become weaker. Progressive resistance training therefore helps to reverse this process and gradually re-train the muscles to become stronger and function better than they did prior to the injury so the joint can tolerate sport/work/life again.

Resistance training is the closest thing to the fountain of youth that we have. To attain the above benefits, the World Health Organisation recommends we perform resistance training exercises that work the full body at least twice per week.  These results take time and adherence to a structured, progressive programme to achieve. That is where your physiotherapist can help. Come talk to us at Bureta Physiotherapy + Wellness if you have any questions regarding the best way to achieve your goals.

Written by Grayson Harwood Physiotherapist