What I Learned from watching MAFS

OK - I admit it - I am a "Married at First Sight" (MAFS) fan.

Please don’t judge me, it is a heavy cross to bear.

But this year has been a huge let down.

My wife Fiona and I got half way through the season and decided it was just too much.

So what did I learn?

Absolutely - Nothing !!

I sat down recently, hoping to write a witty blog post, but I have nothing to show for this years season unfortunately.

I’m glad at least one of the couples seemed to get together in the end.

But the rest of the cast were pretty much intolerable right from the get go.

Bottom line it’s a fun little show and a good way to switch the brain off for the evening.

Bring back hip hopping Deano from last year, I say !

And thank god the footy is back for 2019…..

Go the mighty Crows !!

The Obstacle Is The Way

This blog post was inspired by Ryan Holiday’s book, The Obstacle Is The Way, which describes how employing the philosophy of Stoicism can turn our ‘trials into triumphs’.

This book got me thinking about how we approach issues such as sporting injuries, chronic pain and loss of function that we see in the clinic.

Obstacles such as chronic pain are becoming more prevalent in Australia, with one in five adults reporting they suffer with moderate to severe pain everyday.

It is clear, as a rehab community, we are collectively not doing a great job at helping.

The longer I work as a physio, the more I see how the right mindset and beliefs are a key factor in recovery.

Reading more about the Stoic philosophy, I could see how my values as a health care practitioner aligned closely with with this approach.

The average person has about 50,000 thoughts per day, and for someone who is in chronic pain, you could imagine a large percentage of those thoughts could be centered around these three questions:

  • what is going on?

  • how is this going to get better?

  • when is this going to get better?

When they experience injuries, it’s common for athlete’s (even weekend warriors) to feel anxious and depressed.

One study of 343 male college athletes found that 51 percent had some symptoms of depression after being injured.

Addressing beliefs and attitudes early on can provide the foundation to a successful return to full function.

Downward Spiral Of Injury

We know that a previous injury is the biggest risk factor for another injury.

And that means as a rehab community, we have some work to go in terms of educating and providing injured people a comprehensive rehabilitation program in order to prevent compensations and further issues.

Without inadequate rehab, a downward spiral of pain and injury can develop, eventually leading to burnout.

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Stoicism - a little background

Getting back on topic!

Stoic philosophy was founded in Athens in the early 3rd century BC, and was practiced by the likes of Epictetus, Seneca and Marcus Aurelius.

Ryan Holiday writes specifically of being inspired by Marcus Aurelius, whose quote inspired the book:

“The impediment to action advances action.

What stands in the way becomes the way.”


Marcus Aurelius, as well as being one of the most successful Roman Emperors, had his own private struggles with chronic pain in the chest and stomach.

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His personal notes practicing Stoic philosophy, The Meditations, refers many times to psychological strategies for coping with pain and illness.

His physical resilience and endurance was remarkable, despite not having ideal physical health he was to become one of the most respected emperors in Roman history.



Mindset Shift

One of the biggest lessons taught by the Stoics was to re-conceptualise your obstacles from something to avoid to something to welcome, as a means of growing stronger and more resilient.

Obstacles give you important clues as to where you may have some ‘weak links’ and provides an opportunity to turn them into strengths.

Following a Stoic philosophy involves re-wiring your thinking, shifting from negative emotions such as from worry, anger and frustration to calmness, gratitude and hope.

To be clear, negative emotions can be healthy and natural.

But at some point, they become more of a hindrance to your forward progress.

With the right plan in place, and plenty of patience, grit and perseverance according to leading sports scientist Tim Gabbett, you can turn yourself into an unbreakable athlete. 

“It is a rough road that leads to the heights of greatness” - Seneca

“It is a rough road that leads to the heights of greatness” - Seneca

Short Term Pain Coping Strategies

Of course if your only goal is to avoid pain, there are some strategies that can bring about some fast relief.

Using pain-relieving medication has it’s time and place.

But unfortunately we’ve seen the long term consequences of opioid medications (e.g. tramadol, oxycontin and codeine) that can sometimes lead to addiction and other serious side effects.

And we now know from the research that these drugs create a long-term increased pain sensitivity, making your pain levels greater than before you started taking them.

The other problem is once you come off the medications, you haven’t any had an opportunity to learn from your pain and injuries, so you essentially need to start all over again.


Instead of relying on pain medications, here’s eight practical strategies, inspired by the Stoic Philosophers, over 2000 years ago, to help you overcome your pain and live the best life you possibly can:

  1. Accept Pain And Injuries 100%

The Stoic philosophers were big on understanding the rhythms of nature.

Just like stormy weather, it would unwise and naive to believe you would never have a pain or flare-up in your body.

No one gets out of life without serious challenges along the way and no one is immune to experiencing pain.

However, the difference lies in how we perceive and respond to it.

A real life example world would be to consider how a sailing boat gets from point A to point B if there is a direct headwind blowing in their direction?

Would the sailor just give up and think it’s not worth the hassle?

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The experienced sailor would no doubt accept that unfavourable winds are going to happen some of the time - that is a normal part of life, and they wouldn’t get overly emotional when it occurs.

For the sailor who is committed to reaching point B, the solution, is to change tack.

If the boat turns onto a 45 degree angle, then the sails are able to pick up the wind and use it to the boats advantage.

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Progress is no doubt slow and frustrating, but it is still forward momentum and getting you closer towards your goal.

When the winds eventually turn favourably, you would have built up a decent reserve of resilience and capacity.

Bottom line: there is a season for pain and it is a normal and inevitable part of life.

Keep breathing, batten down the hatches if necessary.

The storm will pass.

2. Let Go Of Your Fight Against Pain

Following on from the first point, counter-intuitively, to overcome your pain, you must be at peace with your pain and fully accept it.

The struggle, the fight and the mental battle against your pain only ends up wasting precious energy and resources, that could otherwise be better spent.

Being trapped in a state of resistance and anxiety leads to your body into a fight or flight mode where your muscles are held in a constant state of tension.

This can lead to even more problems than your initial injury.

Common muscles that are involved in the fight / flight response are:

  • neck / trapezius

  • hip flexors

  • lower back

  • TMJ jaw

  • shoulders

Once you can find acceptance, a significant burden is literally lifted from your shoulders.

With the guidance of a health care professional, it’s important to let go of your anxiety and find a place inside that is relaxed.

“Sometimes, your only way out of the pain is through the pain”


3. Imagine The Worst Case Scenario

The Stoics proposed, rather than avoiding the pain, we must accept it and then confront it.

Once you are feeling more relaxed and in control of your emotions, Stoicism actually encourages you to imagine the worst case scenario in terms of your pain experience.

If you could courageously come to terms with the worst case scenario - and see how, while it would be difficult, you would definitely still be able to cope.

Practicing this exercise mindfully can help reduce the fear around pain, injury and loss of function, knowing that you will be able to manage, no matter how bad things get.

4. Good vs Bad?

Injuries can often be thought of as ‘bad’.

But are they really?

This reminds me a of a story about a farmer.

One day his horse runs away. And his neighbor comes over and says, to commiserate, “I’m so sorry about your horse.” And the farmer says “Who Knows What’s Good or Bad?”. The neighbor is confused because this is clearly terrible. The horse is the most valuable thing he owns.

But the horse comes back the next day and he brings with him 12 feral horses. The neighbor comes back over to celebrate, “Congratulations on your great fortune!” And the farmer replies again: “Who Knows What’s Good or Bad?”

And the next day the farmer’s son is taming one of the wild horses and he’s thrown and breaks his leg. The neighbor comes back over, “I’m so sorry about your son.” The farmer repeats: “Who Knows What’s Good or Bad?”

Sure enough, the next day the army comes through their village and is conscripting able-bodied young men to go and fight in war, but the son is spared because of his broken leg.

And this story can go on and on like that. Good. Bad. Who knows?

Be at peace with your path and have faith that everything happens for a reason.

There is no good or bad to the practicing Stoic, there is only perception.


5. Switch From Goal Oriented To Process Oriented

While you can learn the principles of Stoicism, the philosophy is actually one of action.

A Stoic needs to focus his attention on action in the present moment of time because neither the past nor the future can be changed.

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Being process orientated, you start to focus on all of the small daily things you need to do that all add up to produce the end result.

Come back to the present moment.

That is where the power is to change your life for the better.

Take the focus off being pain-free and instead put your focus on the process.

What are the small daily tasks you need to do to become pain free?

“Luck is what happens when preparation meets opportunity.” ― Seneca


6. Understand Your Pain

“We are more often frightened than hurt; and we suffer more in imagination than in reality.” Seneca

There is no doubt that ongoing pain that is unexplained can be frightening.

With the help of your Physio and Doctor, if you can understand that some degree of pain is a normal part of the healing process, you can relax in that knowledge.

It’s important to realise that whatever pain you experience should be related to a certain physiological process.

For example:

Ankle sprain —> inflammation around the ligament, you can expect some soreness for 4-6 weeks

Lower Back pain —> occasional flare-ups, especially if sitting too long. Disc injury takes around 3 months to heal

Tendon degeneration —> worst in the morning and with sudden changes in training volume, hills or speed work

Knee - patello-femoral syndrome —> (pain in front of the knee cap) take on average 3 months to get better and pain relates to irritation behind the knee cap and gets worse with squats, kneeling and stairs

Nerve related irritation or damage —> could be many months or years of altered sensation in the affected area

Muscle pain —> the most common source of musculo-skeletal pain - lack of oxygen to the muscle from poor posture, excess muscle tightness or injury.

Chronic pain (more than 6 months) —> relates to increased sensitivity in the nervous system which magnifies minor tissue problems. It may come down to the fact, that we all have wear and tear and issues in our body, for whatever reason, the body and nervous system has decided to heavily focus on that particular area.

If there is ongoing pain and you are not sure why, then you may need to talk to your health care provider in more detail.

7. Develop A Growth Mindset

Stoic philosophy has a lot in common with the Growth Mindset approach, developed by Carol Dweck.

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According to this approach, the most important word in the dictionary is ‘yet’.

Re-frame your challenges…

“I haven’t completed the marathon…yet”

“I haven’t felt strong and pain-free in my lower back…yet”

“I’m not sure what it feels like to walk without pain…yet”


8. Train Your Mind To Endure Pain And Discomfort

It takes practice to exhibit self-control with our perceptions of life’s obstacles.

You can practice - the next time your stub your toe or get a paper cut.

Pause for a moment and see if you can absorb the sensation of discomfort - without reacting to it.

One of the great things about exercise is that it is a form of discipline where you willingly put yourself in a position of discomfort for a period of time, with the hope that you will come out the other side better off physically or more importantly mentally afterwards.

As you practice pushing yourself to the threshold, you will build a reserve of willpower to draw from as necessary, creating a “Inner Citadel” of strength and resilience.

For me personally, that is one of the reasons I enjoy the process of running so much.

Every time I go for a run, I know I will confront the pain of a body wanting to stop.

To achieve any sort of reasonable time, you need to learn to listen to your bodies pain, but constantly re-directing your attention and keep pushing to achieve your goal.

“Faced with pain, you will discover the power of endurance” - Epictetus


Conclusion

Pain and injuries are never easy.

But with the right attitude, they can be an valuable internal guide to making you better and stronger than before.

What seem like insurmountable obstacles become once in a lifetime opportunities.

If you’d like to find out more about Stoic philosophy, I’d highly recommend you check out the book, The Obstacle Is The Way.

Now it’s over to you,

What’s the biggest obstacle you’ve faced? What benefits were you able to derive from it?

I’d love to hear your thoughts in the comments section below.

The Number 1 Risk Factor For Developing Knee Arthritis

A new study has shown there is likely to be a 276 per cent rise in knee replacement procedures from 2013 to 2030 (based on data from Australia's joint replacement registry).

Pretty staggering ! 😱

The biggest risk factor for knee arthritis leading to a total knee replacement is being overweight, which overtime stresses the knee joints (70% of Aussies are overweight).

This article talks about your options, especially if you want to avoid surgery.

Main points 💥

✅ Gradually increase your activity levels and incorporate targeted strengthening exercises to build the muscles around the knees.

✅ This can make them stronger, help to maintain appropriate co-ordination and reduce pain.

✅ Don't be fearful of exercise and movement, even if you do feel some pain. Pain doesn't equal damage.

✅ Running 💯% does not cause knee arthritis. On the contrary, runners have less chance of developing arthritis because they generally not overweight.

✅ Consult with your GP and Physiotherapist who can develop a customised plan to get you moving well again.

✅ Individual movement assessment can help you identify your weak links and help get you on the fast track.

✅ For more info about how Physio can help with your knee pain and get you moving well again 👇

http://www.kinfolkwellness.com.au/knee-pain-adelaide

Neck Pain Triggers and How to Avoid Them

Persistent neck pain can be really frustrating but it’s very common.

One of the main issues is that neck pain can be triggered quite easily.

You can have the best treatment and exercise program in the world, but if you inadvertently trigger it day after day, it simply will not get better.

This goal of this blog post is to help identify some common triggers of neck pain.

If you can identify the main triggers, you will get to the root cause of the problem and reduce the likelihood of getting a flare-up.

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Who gets neck pain?

Studies have shown around 65% of us will experience an episode of neck pain every year.

Once you’ve had an episode of neck pain, it’s common (about 50% the time) to experience further flare-ups down the track.

The research shows neck pain is more common in:

  • office and computer workers

  • women aged between 30-50 years old

For some people, the pain can last a few weeks and is only a minor inconvenience.

For others though, the pain can last many months and develop into a chronic pain cycle of pain, weakness and fear of ongoing damage.

First things first: Get Yourself Checked Out

If you’ve had ongoing neck pain for sometime, you will need to get a check-up with your GP or Physio to rule out red flags.

Red flags make up about 1% of neck problems and can include things such as:

  • nerve impingement

  • disc related pain

  • inflammatory pain

  • auto-immune disorders

  • hyper-mobility

  • arthritis

  • cancer

We tend to fear neck pain more than other pain

Ideally, the neck is highly mobile that allows us to see in all directions.

Evolutionary speaking, if we are unable to see potential dangers around us, our nervous system goes into a strong protective response.

This may include:

  • increased muscle tension

  • increased anxiety

  • increased pain and perception of threat

Some of the neck pain you feel may be related to this increased nervous system sensitivity.

It’s important to be aware of this extra sensitivity, otherwise you will mistake the pain for ongoing tissue damage.

Left unchecked, these ongoing negative thoughts about the body can do much harm in the form of fear, avoidance of movement and increased anxiety and depression.

If you have ongoing neck pain and you’ve been assessed by a Physio / Doctor and found to have no red flags or structural issues, it’s important to understand that most neck pain is coming from the muscles.

Muscles of the neck

The neck is designed for movement and is made up of 44 muscles which help control movement of the head.

When the muscles become overloaded, they become tight and reduced movement results.

Lack of movement means the muscles have a reduced blood and oxygen supply.

If the muscles continues to get overloaded for long enough, the muscle fibres form a trigger point / knot that can cause ongoing pain.

Each muscle has a typical referral pattern, where the pain spreads into a different part of the body (see picture below of the common trigger point in the upper traps).

The most common trigger point in the  Upper Trapezius  muscle that refers up to the temple and behind the eyes.

The most common trigger point in the Upper Trapezius muscle that refers up to the temple and behind the eyes.

A note about imaging findings

If you’ve had x-rays or a CT/MRI of your neck, it most likely picked up some findings in the neck such as disc bulges, degeneration and spurring.

Whilst these things can definitely trigger off a pain response initially, it is unlikely to be the major cause of ongoing pain.

The good news:

Many people have these changes on scans, but most people have minimal or no pain (see table below).

The majority of the degenerative features are likely part of normal aging process and unassociated with pain.

As you can see in the study below, disk degeneration is present in 68% of 40 year olds who are completely asymptomatic.

As you get older, the chance of having a disc bulge around 70% by the age of 60.

Once again, this is in a group of people who don’t have any pain.

Be careful  who you listen to in terms of how you’re scan results are being  interpreted.    Source: Brinjikji W et al

Be careful who you listen to in terms of how you’re scan results are being interpreted.

Source: Brinjikji W et al

The most common triggers of neck pain and how to avoid them:

1. Lifting heavy / awkward things that increase the strain on your neck

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Lifting heavier things that you’re used to can cause overload of your neck muscles and joints.

This might be at the gym, carrying groceries in from the car or lifting young children.

Just to clarify, you can still lift heavy things, especially if you have a good capacity built up gradually over the years.

It’s just best to avoid carrying heavy things that you are not accustomed to.

“It’s not the load that breaks you down, it’s that load you’re not prepared for” - Tim Gabbett

So take care in the gym, and know your limitations. If you need to, have some sessions with a trainer who who help show you the right technique.

I know it’s a hassle, but take a bit of extra time to make a couple of trips (or ask someone to help) to carry your groceries. It can make a world of difference to the health of your neck.

2. Sustained Positions

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One thing the neck hates is being is locked in one position for than 20 minutes at a time.

Holding sustained positions for long periods of time tends to increase the tightness in muscles such as the upper trapezius (top of your shoulder) and sub-occipital muscles (base of your skull).

The most common sustained position is from looking down at your phone constantly.

We know (from the picture above) that the further down you look, the bigger the strain on your neck (up to 30kg of pressure when looking right down). Our necks are simply not designed for this.

Make sure to bring your phone up to eye level, otherwise you will place considerable strain on your neck muscles.

Make sure to bring your phone up to eye level, otherwise you will place considerable strain on your neck muscles.

What is the best sitting posture?

A key point to keep in mind, is there is no one perfect posture.

Don't get fooled into thinking you have to always have a perfectly upright posture all the time.

Some people who follow this line of thinking get very anxious if they don’t have perfect posture.

This anxiety can further increase the muscle tension and pain in the neck.

Rather than focus on finding the one perfect posture, always remember:

“The best posture is your next posture”.

Meaning that you need to keep yourself moving and changing positions frequently.

If much of your work is based around a computer, a sit to stand desk would be a very good investment.

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3. Inefficient Breathing patterns

Test your breathing patterns.  Place one hand on your upper chest and one hand lower.   Take 3 deep breaths and notice which hands lifts up first.

Test your breathing patterns. Place one hand on your upper chest and one hand lower. Take 3 deep breaths and notice which hands lifts up first.

We take approx. 21,000 breaths per day.

Each one sending a message to your nervous system - either a message of 'safety' or 'danger', depending on the pattern.

Habitual shallow breathing and subconscious holding of the breath can maintain a sympathetic (fight/flight) dominant state.

This is common in people who have neck pain - and they tend to breathe more using the upper chest muscles. These are known as the accessory breathing muscles.

These accessory breathing muscles are the scalenes, sternocleidomastoid, pecs and lats that attach from the ribs to the spine.

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If they are constantly working through upper chest breathing, they become overly tight and can cause the neck to become tight and painful.

Learning how to breathe efficiently through the diaphragm is the foundation of optimal movement and recovery.

Take your hands around the bottom of your rib cage and as you breathe in expand outwards, like you’re trying to blow up a balloon.

Feel your lower ribs expand from the front, back and sides - that is your diaphragm muscle.

If you’re feeling a lot of neck pain, try taking 5 deep breaths into your diaphragm.

Breathe in for 5 seconds and then out for 5 seconds.

Keep your upper chest and shoulders relaxed.

“As you become more mindful of your breathing, you will find you become more present, gather all your scattered aspects back into yourself and become whole”. ~ Sogyal Rinpoche.

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4. Stress

Aside from injuries and poor posture, stress also plays a big role in ongoing neck issues. 

When we get stressed, the 'fight or flight' system is activated in our bodies, sending messages to our muscles to contract. 

As this muscle tension becomes chronic, the tightness reduces our flexibility and produces pain.

Stress can come from many sources such as:

  • relationship probems

  • financial strain

  • lack of close support networks

  • poor nutrition

  • not getting enough exercise

  • not understanding why you’re in pain and being constantly worried about it

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If you are feeling anxious or stressed in other areas of your life, this can increase the sensitivity of your nervous system.

Like a magnifying glass, it amplifies the sensation you feel.

If you have a lot of underlying stress in your life, sometimes a minor twinge in your neck can be perceived as extremely painful.

Your capacity for dealing with muscular tension issues can be dramatically reduced.

The way to move forwards from this is to take note of all your stressors and try and address them as best as you can.

Very often some support from a qualified psychologist can be extremely helpful and you could speak to your GP about getting a referral.

Other tips for decreasing stress in your life:

  • take time for you - everyday - to do something you enjoy

  • exercise more - at least 30 - 60 minutes per day of vigorous exercise

  • eat well - take the time to prepare healthy meals at home

  • get out in nature as much as you can

  • ask for support from those around you - don’t be a martyr

  • see the bigger picture - there’s always someone worse off that you and life is too short to not be enjoying it every day

5. Poor Quality Sleep

It's important to invest in a good mattress and pillow, as we spend one third of our lives in bed.

These pillows are recommended by the Australian Physiotherapy Association:

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Finding the right pillow is a very individual process so you may need to experiment with a few different types in order to find the one that fits you best.

Check the distance between the side of your neck and your shoulder. That gives you an idea of the pillow height you need to keep your head and neck supported when you sleep on your side.

Getting enough sleep is important.

If you’re burning the candle at both ends, you can’t expect your body to be able to re-charge and perform optimally.

If you have insomnia related to an ongoing pain issue, follow these sleep hygiene tips:

  • wake up early (no later than 6am) and get moving by exercising for 45 -60 minutes. Find an exercise that you can do that increases your heart rate without stressing your body too much. It might be swimming, hiking or jogging.

  • don’t nap during the day as you’re trying to build your ‘sleep pressure’ so when your head hits the pillow at night, you will go straight to sleep

  • avoid caffeine after midday

  • take a warm bath an hour before bed

  • don’t drink and fluids after 7pm to avoid bathroom breaks in the middle of the night

  • get into bed around 9pm and quietly wind down so you’re feeling sleepy at 10pm

Physio treatment of neck pain - what works?

Our approach is to resolve acute neck pain quickly and return to doing what you enjoy, but we also have a focus on getting to the root cause of the problem and limit recurrence.

Personalised Exercise Programs

Exercise is beneficial in people with neck pain.

There is good evidence to show that exercise and building capacity is the best approach to helping reduce neck pain in the long-term.

The best exercise is based on our personalised assessment with a Physiotherapist.

A comprehensive program will involve a combination of stretching, strengthening and improving joint mobility.

Some PDF of some common neck stretches we prescribe can be downloaded for free here.

Dry Needling

This study recommended dry needling for immediate pain reduction in upper body myofascial trigger point dysfunction. It certainly can be quite intense and can take a few days to work itself out, but we find dry needing to get the most effective release of the muscles.

Using heat on the neck via a wheat pack is really helpful, especially in the evening before bed.

Prognosis: What To Expect

In an ideal world, pain would get better progressively step by step.

Reality though can be very different, and more often than not, we see a two step forward, one step back sort of pattern (or a bit more dramatic as in the picture below).

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The thing to keep in mind is staying positive, (and it can help to lower your expectations a little).

Life can easily get in the way of stopping you from doing what you need to do to get better.

If you’re really committed to overcoming your neck pain, make getting better a priority in your life, (for at least for a 3 month period).

Often that is about the right amount of time to significantly build your foundation and capacity.

“Long term consistency trumps short term intensity” - Bruce Lee

Conclusion

With the right management plan in place, neck pain is very manageable.

If you’ve had neck pain for a long term, we expect there will always be some ups and downs.

But overall you should be very hopeful of making a significant recovery and getting back to enjoying life again.

If you’re after some more personalised advice and treatment for your neck and you wish to get some relief right away, use our simple online booking system to make an appointment. 

If you would prefer to speak to us directly,  call us 1300 657 813


Running Might Protect Against Knee Arthritis

This study reported that runners had roughly half the incidence of knee osteoarthritis as walkers.

https://www.ncbi.nlm.nih.gov/pubmed/23377837

"Recreational running at any time in life does not appear detrimental, and may be protective in regards to developing knee osteoarthritis”, the researchers concluded.

So why is there such a deep rooted belief that running causes knee arthritis?

Maybe it's the runners with a poor foundation (poor flexibility, core strength, hip strength) that give running a bad rap and find their knees getting overloaded.

But it is clear now that the biggest risk factor for developing knee arthritis is being overweight and having a high BMI.

The clear message from the research is:

Being inactive and over-weight poses a much greater risk of developing knee arthritis, than if you keep fit (especially with running) and maintain a healthy body weight.

Having accurate beliefs is so important, and understanding that running plays an important protecting role against arthritis forms an important part of keeping your joints healthy.

For runners who have experienced some joint pain, it’s about building a solid foundation of muscle strength and capacity to offload the joints.

Want to learn about about how to build your foundation for running?