Archive for category: Physiotherapy Column

Written by: Caitlin Sargent

What is Low Energy Availability?

Research is coming to understand more and more about Low Energy Availability (LEA) and its wide-ranging implications on almost all systems of the body. Physiotherapists are well placed to help pick up on these signs to assist in early intervention. As with most conditions, prevention is better than a cure and the earlier treatment starts the better. So what is LEA?

Energy availability is very self-descriptive! It is measured using the equation below

Energy intake (ie food) – energy expenditure (exercise + energy needed for daily life) = energy availability

How can it present?

If there is inadequate energy intake for the activity being undertaken, then energy availability will be low which can have a number of consequences. These can include:

• Poor immune function
• Gastrointestinal dysfunction (including increased gut sensitivity)
• Poor bone health/reduce bone mass
• Endocrine/thyroid dysfunction
• Menstrual dysfunction
• Impacts on growth and development (in younger athletes)
• Cardiovascular anomalies

As a physiotherapist, we may see:

• Increased injury rate
• Poor sleep and recovery, extreme fatigue
• Decreased co-ordination
• Irritability, depression or decreased concentration
• Decreased muscle strength and endurance performance
• Decreased training response

The science

While this is an evolving area of research, some recent studies suggest that up to 45% of recreational athletes and up to 80% or elite athletes either have or are at risk of LEA. In a sporting context, it is also referred to as relative energy deficiency in sport (RED-S).

It is relevant to note, that while disordered eating can play a role, many people are not purposely restricting their food intake. The combination of heavy training causing appetite suppression and underestimating the caloric demands of life + training is a factor in the high incidence of LEA.

Treatment for LEA/RED-S is usually led by a dietician (+/- psychologist if needed) and consists of fuelling strategies and modified activity until baseline health functions return. Physiotherapists can help play an important role in identifying LEA and managing graduated return to exercise/training.

References

https://bjsm.bmj.com/content/55/1/38

https://pubmed.ncbi.nlm.nih.gov/26841435/#:~:text=Low%20energy%20availability%20(LEA)%20describes,impairing%20health%20and%20athletic%20performance.

https://bjsm.bmj.com/content/bjsports/49/7/421.full.pdf

Written by Catherine Mullins

What is Neuroplasticity?

Neuroplasticity is the lifelong ability of the brain to undergo structural and functional changes in response to experiences. The medical world once thought that the brain stops developing in childhood but we now know that ongoing changes occur right up until death.

Information in the brain is transmitted from neuron to neuron via synapses (spaces). This is done through action potentials sending electrical signals along the neurons causing neurotransmitters (chemicals) to be released across synapses, attaching to the next neuron and continuing the process. Each synapse (space) can be linked to multiple neurons, therefore receiving information from a variety of sources. Neuroplasticity looks at the changes that can be made between neurons and synapses.

How does it change

Change can occur through the strengthening of existing connections, elimination of existing connections, or forming of completely new connections. Neuroplasticity is a huge component of rehabilitation following damage from strokes etc but it also very useful in recovering from acute injuries (eg changing balance and reaction times) or from chronic pain (changing movement strategies and functional capacity).

Not all neuroplastic changes are beneficial. Sensitisation of the nervous system can occur with strong or continuous stimulation, release of chemical mediators or by activation of the neuroimmune system.  This can negatively impact the firing of neurons by decreasing the amount of input needed to fire (reduced threshold) or increasing the reaction to a normal level of input (increased responsiveness). This means that things will start to cause a response at a much lower level of input, or with an exaggerated response.  I often use the analogy of a fire alarm.  We need a fire alarm to alert us when there is smoke and fire for our safety (i.e. a cut on the hand from a knife) but when the alarm goes off with burnt toast (i.e. a pen across the back of the hand) or even with steam from the kettle (a feather or clothing on the back of the hand), this is less useful and less accurate for us.

What causes changes

It’s not just physical input that can create change. Most people have heard of stress releasing cortisol into the body which is beneficial for the fight or flight responses but over time excess cortisol in the brain can prevent neuroplastic changes from occurring. Lifestyle factors such as poor sleep/nutrition or under or over exercising can lead to systemic inflammation in the body, increasing chemical mediators that further sensitise the nervous system.  

Deliberate engagement creates stronger connections. In the words of Donald Hebb, “neurons that fire together, wire together”.  The more that you follow a pathway, the stronger that pathway becomes. It’s all about deliberately choosing the pathway you want to follow!

Look out for Catherine’s next blog on Neuroplasticity in Chronic Pain

At Barefoot Physiotherapy we have noticed a recent influx of pregnant ladies seeking us out for the aches and pains associated with pregnancy and for guidance remain as healthy and strong as possible throughout their pregnancy. One thing I often get asked is what positions are going to be best to feed their new baby in; whether that is breastfeeding or bottle feeding.

As a higher percentage of our pregnant mum’s develop discomfort and pain in the mid to lower back region it is important that you have a comfortable breast feeding position to alleviate any unnecessary discomfort and for your long term back health.

There is no one best ‘realistic’ position for bottle or breast feeding your baby. So below are some tips and strategies on how to minimise any upper or lower body aches in sitting or lying positions.

General Tips:

• Important to bring baby to breast rather than bring breast to baby.
• Check body isn’t twisted and shoulders are relaxed.
• Keep a glass of water nearby because once baby starts feeding you may be holding the position for a decent time.
• Try and take quick position breaks when your baby takes a break to burp.

Breast Feeding/ Bottle Feeding Positions in Sitting:

• Firm and supportive chair (be able to relax into chair to support lumbar curve).
• Upper part of body resting against back of chair, one foot on footstool on side you are feeding from.
• If you are feeding in a chair that reclines, limit the time spent in it or use pillows to support the lower back region.
• Once baby has started feeding place a pillow underneath your baby for more cushioning and to take pressure off your upper body.

Breast Feeding/ Bottle Feeding Positions in Lying:

• Try and lye on your side with a pillow under your head and between knees and baby lying next to you.
• Try not to turn neck too far towards baby rather once baby has latched on keep your head and neck in a neutral position.

If you or anyone you know of is experiencing any pregnancy associated pains, muscle joint or possible nerve irritation please contact us. We can determine if it is a musculoskeletal issue before having to see a GP. We are open 5 days a week and a couple Saturdays a month. We have early and late appointments available. Please call us at 1300 842 850 or Click here to book an appointment.

With the increasing popularity and availability of the massage gun, one of the most common questions we get asked in the clinic is “Do those massage guns really work?”. So we thought we would break it down for you all.

What does a massage gun do

Massage guns aim to provide percussive or vibration therapy. The idea being that as the massage gun head oscillates in and out, small vibrations occur in the muscle, replicating the percussive techniques that massage therapists are trained in. If you’ve been to the clinic, you’ll know that this is not a technique that we commonly use. It is predominantly used for post-exercise recovery and occasionally in a pre-exercise/warm up capacity. In our experience, we don’t see it playing a significant role in injury recovery. This is also why, when we prescribe self-releases, we always encourage maintaining constant pressure on the tight spots for 60-90 seconds for most muscles, as this is what is usually required to make a noticeable change in the muscle tightness.

The evidence

There is some evidence that indicates percussive therapy administered by a massage therapist can help prevent delayed-onset muscle soreness (DOMS) and provide some relief for muscle tightness. As with most soft tissue treatment, the mechanism for this is largely neural – that is, the massage causes a response from the nervous system which responds, providing a short-term change in the tissue. This can be from increased blood flow or short-term inhibition of certain nerve endings which contribute to muscle tightness. Due to massage guns being relatively new on the market, there is minimal evidence at this stage investigating if they have a similar effect as percussive therapy performed by massage therapist.

How a massage gun works

Similar to rubbing your shin if you hit it on the coffee table, massage guns can also decrease pain in the short term by using the “pain-gating” theory. That is, if the brain is busy processing the input of touch (either your hand or a massage gun), it can’t produce pain too. This may actually be one of the bigger selling points of massage guns. Often the discomfort of doing self-releases is a preventative factor for people. So with therapy guns often being far more comfortable, this barrier can be removed. While the preference would be sustained pressure on a single spot for 60-90 seconds, if the realistic options are massage gun or no release… we would definitely choose massage gun! If you are looking at getting a massage gun or using one for the first time – think less is more. That is – pick the smaller vibrations and the flattest head (most come with a variety of attachments) and start with just 1-2 minutes per muscle group.

Let’s talk knee injuries.

The knee joint is relatively simple and moves as a hinge joint (i.e bending and straightening). The joint itself is an articulation between our femur (thigh bone) and our tibia (shin bone) for the hinge movement and patella (kneecap) sitting over the front to increase our quad strength. There are a series of ligaments, articular cartilage and muscles that are involved in this joint.

Ligaments and Meniscus

Collateral Ligaments: attach between the femur and the tibia outside the joint capsule and control side to side movement. The medial collateral ligament (MCL) is on the inside of the knee and the lateral collateral ligament (LCL) is on the outside.

Cruciate Ligaments: inside the joint capsule making an ‘X’ attaching from the femur to the tibia and prevents movement forward and backward. The anterior cruciate ligament (ACL) attaches from the front of the joint surface on the tibia to the back of the joint surface on the femur and the posterior cruciate ligament (PCL) attaches from the back of the joint surface on the tibia to the front of the joint surface on the femur.

Patella Tendon and Ligament: attaching the patella to the quadriceps muscle and tibia respectively.
Articular Cartilage: a smooth and slippery covering at the ends of the bones to allow for smoother movement.

Meniscus: a ‘C’ shaped piece of fibrocartilage within the knee joint for shock absorption.

Common Injuries:

Because of the relatively simplistic nature of the knee joint it is often exposed to increased load if there is restriction in the hip or ankle (check out our blog on accumulative strain). In addition to this, it is often injured in a single traumatic event. And these injuries may include a ligament sprain, meniscal tear or even bone fracture.

The most common ligament sprains are the MCL (from a direct hit to the outside of the knee or an awkward change of direction) or the ACL (from a pivot on a planted foot and straight leg or from hyperextension with high load). The meniscus can also be damaged from awkward pivoting or repeated knee bending (eg squats).  These three injuries frequently present together – “the unhappy triad” due to their similar mechanisms of injury.   

So if you present to physio following a sudden injury we’ll ask what happened at the moment of injury (including any sounds); whether you are experiencing instability, catching, locking, giving way; if certain positions are more uncomfortable; the amount of bruising and swelling at the time of injury. And we’ll then use a variety of orthopaedic tests to assess the integrity of these structures.  Depending on the results of these tests we can decide if it’s necessary to scan the knee.  Most lower level injuries can be successfully managed with conservative treatment (i.e physio and exercise) and do not require surgical intervention.