Where does physiotherapy end and Exercise physiology start?

By Physiotherapist, Vanessa Boon


Introduction

Our resident Exercise Physiologist, Rachael Kent, sits down with us to share her views on how physiotherapists (physios) and exercise physiologists (EPs) work together, which injuries she sees the most and how physios, EPs and our clients can work together to overcome them. Just as a brief background on Rachael, she has 9 years of experience under her belt, 3 of those working at Exercise Lab at BOSIC. 

 

Vanessa Boon, Physiotherapist at BOSIC
Rachael Kent, Exercise Physiologist and Owner of Exercise Lab Barangaroo

 

What made you decide to pick a career that revolves around exercise? 

I think my general interest in sports, injuries, performance and the musculoskeletal system in general fascinates me. Learning how to train that was, and still is, something that I find really interesting. 

 

Are there any specific sports you enjoy training clients in? 

I love all sports, any form of sport (from golf to soccer to dance), anything that has to do with movement I enjoy learning about and training clients in/towards. 

 

In your words, what does an EP do? 

We use exercise as a therapy to help people move better, recover from pain and help them live a better and healthier life, whatever that means for the individual. 

 

Now for the question that always gets asked, in your opinion, what is the difference between an EP and a physio? 

I think that physios are more hands-on, they look after the client at the initial stages of their journey. Once they are strong enough, can tolerate load and are back to their normal activities of daily living, the EPs then take over to continue to assist them along their journey. I think within BOSIC, we have really found that synergy between the two professions where the EPs deal with the exercises that flow on from the acute care of the physios. 

 

Is there a particular area of the body that you prefer to treat?

I enjoy treating all sorts of injuries and I like having a good variety in my day. Something that does interest me and I feel like I have a good understanding of is the spine. I love working with the back; I think it is crucial to so many movements and so many people have issues with their back but do not have a proper understanding of how to move it. Especially for those in pain, how to get out of pain. 

 

Are back injuries the most common injury you see at BOSIC? 

Yes absolutely, I would say that a large proportion of my clientele have issues along their spine. Working in Barangaroo with the corporates, I think this has a lot to do with their sustained postures. But we also deal with a lot of weekend warriors who sit all week but want to twist, bend and jump all weekend, just asking their bodies for too much. This is not necessarily a bad thing but they just may not have the best training routine or a proper gym program tailored to what they want to do. 

 

What are the top 3 questions that your clients with lower back pain ask you?

Are deadlifts bad?

Why does a bent over row hurt me?

Is there a point that I am going to get rid of my pain? 

 

And what would you say to them? 

Are deadlifts bad? In a general setting I would say that deadlifts are not a bad movement. I just think that they are performed poorly and a lot of people are doing a backbend instead of a hip hinge. 

 

Why does a bent over row hurt me? I don’t think a bent-over row is a particularly bad exercise either, I actually think it is a great exercise if done correctly. Most people have incorrect loading patterns where they put too much load in their lower backs as opposed to loading their thoracic region, particularly their rhomboids and latissimus dorsi. 

 

Is there a point that I am going to get rid of my pain? In regards to pain, that is a really patient specific question but I think people are really afraid when they are in pain and rightly so. You have to be able to talk to someone and manage their expectations in regards to pain, the intensity, frequency and duration. The more you can get your client to understand their time frames and knowing that you do not have a magic wand that can get them better in the first session is really important. 

 

With proper loading patterns/form, if someone is not in pain but would like to learn proper form, is that something you do? 

Yes absolutely, we deal a lot with movement analysis and it is always easier to do a movement analysis if the person is not in pain. If they just want to have a better understanding of how to do movements better or more body awareness it is always easier when someone is pain free. So in that sense, we prefer to do the prehab (prevention) instead of the rehab (treatment). To get the client before the injury happens, teach them the correct movements before they get injured and they can continue on their journey, that would be in the ideal world. Unfortunately we mostly see people after their injury. 

 

Is that acute injury where you feel physio ties in with EP? 

Yeah, absolutely, because when people get an injury over the weekend, e.g they did a deadlift wrong or hurt their back gardening, that is when they give their physio a call, get the release, the relief, start them on that journey of reducing their pain and to the point where they feel strong enough to move and feel like they can be loaded. That is when they are transferred over to EP and I feel like this is the real synergy between the two professions: where physio is so important to give them the “ok” and EP builds onto that by getting them stronger. 

 

So, Rach, do you have an ideal client?

Someone who is motivated for change. They are always the easiest client to work with, they are normally the ones where you see booking in straight away after a referral. If someone comes in with a referral date from 6 months ago, in regards to their state of behavioral change  they are in that stage of contemplation and have not quite gone into the action stage just yet so we have to be more mindful with how we approach it. 

 

Well thank you for taking the time to sit down with me, is there anything else you would like to add? 

Yeah, I think that if you are visiting a clinic where they do not have physios and EPs working together,  you are missing a link. I think physios and EPs work really well together when they understand the boundaries of each profession and it greatly benefits the clients who visit these sorts of clinics. 

 

Vanessa is the Go-To Physio at Barangaroo Physio. If you have a niggle that is not going away or just want to know if we can help, give us a call at 8599 9811 or book in here and let us work with you to achieve your goals! 

What is anaerobic vs aerobic exercise?

podiatry BOSIC

By Physiotherapist, Paulina Backiel 

Introduction

Any type of physical training (including running) requires energy, which, in turn, requires a biological system that transforms energy into movement and/or power. By constantly running the same route at a leisurely pace, you are not utilizing your body’s full potential and may feel like your running performance has plateaued. Our bodies love to be tested/stressed by new challenges because it is how they learn, adapt, and grow.

So what does Anaerobic and aerobic training mean? What are the differences between both types of training? 

To answer this question, we are going to jump right into learning about our human physiology.

Human Physiology, Simplified

The body has many systems, but we will focus on 2 main energy systems that our body uses to allow us to run:

 

1.Anaerobic System 

Does not need oxygen to function

Bi-product: Lactic acid

Example: sprinting

2. Aerobic System (oxidative)

Needs Oxygen present to function

Bi-product: Carbon dioxide

Example: distance running

 

Image taken from Chegg Prep, Chapter 10, Basics of Exercise Metabolism

 

Should I be training both as a distance runner?

 

A 2017 article done by Bolotin and Bakayev shows evidence that increasing the variability in the type of exercises that you do allows your body to recover more quickly.

 

So, for example, runners that mixed up their runs with sprinting (anaerobic) and long distance (aerobic) showed fewer fluctuations between the systems that transform energy into movement (in this case the movement is running). Increasing the variability in exercises allows your body to utilize all of your energy systems more efficiently.  In this particular study, the researchers call this type of exercise program “mixed,” meaning that runners do a combination of both aerobic and anaerobic exercises. 

 

In my next blog, I’ll explain what types of runs you can do to try and target both systems, so stay tuned!! =)

 

If you are interested in getting started with running or just more serious/competitive but don’t know where to start, then start with my personalized running program, Run Faster and Smarter. When you book now, you will save over $300 and I will help you become a better runner in just four weeks. Invest in your health and book in here

 

 

 

References
Bolotin A, Bakayev V. Method for Training of Long Distance Runners Taking into Account Bioenergetic Types of Energy Provision for Muscular Activity. InicSPORTS 2017 Oct (pp. 126-131).

 

 

TOP 3 NO EQUIPMENT TOTAL BODY EXERCISES

FAQs information BOSIC

By Physiotherapist, Vanessa Boon

Are you looking for a simple, yet effective, total body workout? Look no further, because I have put together the three most effective movements so that you can get the most out of your workouts. Don’t forget to book in for an appointment with me here if you need assistance with an injury or custom strength workouts for your core and back.

1. Crab toe touches 

This exercise targets your core, glutes, hamstrings and quadriceps. 

 

How to: 

  1. Sit on the floor with your legs in front of you (feet and knees hip width apart) with your hands behind you and under your shoulders. 
  2. With your feet on the floor, push through your heels and lift your hips towards the ceiling. 
  3. Focus on engaging your core, bring your right hand up while simultaneously lifting your left leg up touching your toes and vice versa. 
  4. Alternate back and forth doing 15 repetitions on each side. 

 

2. Bear stance to full plank 

 

     

This exercise targets your core stability, deltoids and glutes. 

 

How to: 

  1. Start on all fours with your wrists under your shoulders and your knees under your hips. 
  2. Keep your core engaged, back flat, lift your knees off the ground. 
  3. Hold this position, keeping your hips stable and extend your legs out one at a time and bring them back in. 
  4. Alternate back and forth doing 15 repetitions or for 1 minute. 

 

3. Squat + knee lift 

 

     

 

This exercise targets your glutes, hamstrings, quadriceps, hip flexors, adductors and your core. 

How to: 

  1. Stand with feet wider than shoulder-width apart and hands behind your head.
  2. Sit your buttocks back keeping a 50% contraction, hinging at your hips, until your thighs are parallel to the floor. 
  3. Make sure your knees and your toes are pointing forwards. 
  4. As you push up through your heels, lift the right knee to touch your left elbow by twisting your upper body towards the raised knee and vice versa. 
  5. Alternate side to side doing 15 repetitions or as many as you can. 

 

These are my top 3 exercises for those who do not have any equipment at home and do not have much time. These exercises work almost every muscle in your body! Bonus, they train your core stability, coordination and balance. Here is a video link of how to do these 3 exercises:

 
For more information or if you would like a personalised program give us a call at 8599 9811 or book in here.

5 tips for beginner runners

exercise physiology BOSIC

By Physiotherapist, Paulina Backiel

Just starting a new running program? You might have some questions about how you can optimize your runs. Read on for my top 5 tips for beginners! If you need more assistance starting a running program, then book in for my Run Faster and Smarter Program for a personalized run program made just for you. 

 

Tip 1: Breathing

When you are starting to run, this is probably one of the hardest things to control. My best tip would be to breathe through your mouth; this will allow you to get heaps of oxygen in and carbon dioxide out. If, at races, you are a hyperventilator like me, calm your breathing by breathing slowly in through the nose and out through the mouth. Once you are calm you can go back to mouth breathing.

 

Tip 2: Distance > Speed

I cannot stress this enough to my beginner runners: don’t gas yourselves up in the first 100m. This is why I always say to focus on distance rather than speed. In the beginning, you may find that mixing running with a bit of walking can get you that distance. Then, just slowly decrease the amount you are walking (resting) and you will be running the whole distance in no time.

 

Tip 3: Warm-up

This does not mean to stand there and stretch. You need dynamic stretching, which means introducing movement to your muscles. Check out my dynamic stretching blog for more information.

 

Tip 4: Nutrition

Everyone does all these pre-workout drinks, energy shots, and so on and so forth. Personally from a beginner standpoint, I think that for training they are all a bit of BS. The only time I would consider a pre-workout sports drink for a beginner during training (this is not including racing) is when you have a race in a month and need to try it out before race day. Trust me, trying a new sports drink on race day is never a good idea. Your stomach can hate you!

 

Tip 5: Shoes

I’ve written heaps of blogs about shoes so feel free to check them out. But the one thing I would advise for beginner runners is to go get professionally fitted. And this doesn’t mean go to a huge franchise because they will probably put you into their most expensive new thing. As a past employee, I highly recommend a place called Running Science. All you do is tell them what you need your shoes for, your history and goals and they pick out choices for you. The only thing you have to do is see which choice is most comfortable for you. 

 

If you are a runner who has suffered an injury, then I’m your gal! You can book in for a physiotherapy appointment with me here. Once again, be sure to check out my Run Faster and Smarter Program in order to level up your running game. I guarantee that I can get you stronger, and can help you achieve all of your running and fitness goals. 

 

Happy running, 
Paulina

 

Why do I twist when I squat?

FAQs information BOSIC

By Physiotherapist, Nate Chan

 

Do you find yourself always leaning or rotating to one side when you squat?

Recently, squats are gaining popularity in today’s modern society.  Yes they have an endless list of health benefits, however if done incorrectly this may cause a poor performance in your training session or worst case scenario an injury.

 

If you notice that you constantly twist when you squat, you should book in for an assessment with a physiotherapist here

 

 

This lateral shifting of weight could be caused by several factors:

 

1.Muscular strength and/or endurance imbalance

Most commonly, twisting or rotating in a squat is caused by a lack of muscular strength/endurance in either the lateral core strength and/or glutes. A result of a muscular imbalance can be your knees caving in or torso leaning/rotating.

 

2. Poor ankle, knee or hip mobility

The squat requires a lot of mobility in 3 key areas. Without adequate mobility you will be forcing the body to find a compensatory pattern (leaning or rotating the body, reduce squat depth, lifting the heel, and/or knee caving in)

 

3. Hip socket alignment

 Everyone is unique, we are born and built differently. Some people have hips capable of squatting with a narrow stance, and some do not.Therefore, it is finding the correct stance best suited to your body and needs. 

 

Conclusion

In conclusion, building strength and mobility in these various muscles or joints will change your overall positioning, allowing you to squat without leaning or rotating. 

 

The next time you are completing a squat make sure you’re not shifting either side. If you have any questions or queries don’t hesitate to email me at nate@bosic.com.au. 

 

Your physio, 
Nate

Book in for a physiotherapy appointment here.

Save your knees and increase your cadence when you run

exercise physiology BOSIC

By Physiotherapist, Paulina Backiel

 

What is cadence?

Cadence is the rate at how many steps you take per minute.

For example, let’s say in 1 minute you take 65 steps with your right foot and 70 with your left foot. This equals 135 steps per minute (spm).

 

Cadence = Steps per Minute (spm)

 

What is the cadence I should be running at? Is it 180?

 

You may have heard about the 180spm cadence that everyone talks about, however, this is not true for everyone. The number came about when a running coach by the name of Jack Daniels analyzed professional runners in the 1984 olympics and found that the average cadence between all of them was 180spm. This does not mean 180spm is bad, it just means that it is not going to work for everyone. We all have different leg lengths, therefore, we will have different cadence when we run.

 

For example a person with longer legs(longer levers), therefore it would be hard for that person to slow their legs before they touch the ground than a shorter person(short levers). So what you find in common is that taller people will have a slightly lower or equal to 180 cadence and shorter people will generally have 180 or higher cadence.

 

How can you save your knees using cadence?

Most people when they run actually have a very low cadence. This is because we run to music that is on the radio and that is commonly played at 120 beats per minute, so the body ends up copying the rhythm it hears.

Evidence and my own running experience shows that just by increasing your cadence by 10% can improve your running technique and decrease knee pain. These improvements are also shown to last 3 months after the change in cadence. Can you imagine, it can decrease load on your knee by 20%, that is massive! It also has benefits such as decreasing  the load on your hips and more.

 

Conclusion

 

Everyone’s cadence is going to vary, however, it will hover around 180spm. By just increasing your cadence by 10% you can save your knees and improve your overall running technique.

 

Want to improve your running further? Be sure to book in for my Run Faster and Smarter program HERE.

 

Your physio, 

Paulina

 

 

 

 

 

 

 

 

 





Resources

1.Bramah C, Preece SJ, Gill N, Herrington L. A 10% Increase in Step Rate Improves Running Kinematics and Clinical Outcomes in Runners With Patellofemoral Pain at 4 Weeks and 3 Months. The American journal of sports medicine. 2019 Dec;47(14):3406-13.

How can calisthenics help a scapula injury?

BOSIC about us

By Calisthenics Coach, Nathan Leith (Maximum Potential Calisthenics)

 

Have you ever suffered from a chronic injury that’s held you back from consistently progressing your training?

Perhaps you’ve even felt a pain in a location that you have never injured before.

 

Injuries come in all shapes and sizes, sometimes the pain is quite sharp and intense and other times it may be a very dull pain. Major problems can arise in many cases when the actual site of pain is not even remotely close to the initial point of impact or injury location.

 

 

For example… Let’s say that you’re a tennis player who always makes wide arching swings in accordance with your playing style. If you were to injure your foot badly you will instinctively place less pressure through that foot and therefore compensate with your other leg. As the years go by you may maintain this habit which will cause your torso to twist causing some mild scoliosis in your spine. This stance may then cause a dip in one of your shoulders (you see where I’m going with this yet?) which as you continue to play tennis can cause your wide arching swings to place extra tension on your shoulder joint and scapula.

From this hypothetical example we can see where the knowledge of a sports injury professional really comes in handy; often, in order to get to the root of a problem, we first must look at the big picture and then armed with more knowledge, diagnose the scapula injury from a holistic standpoint.

 

The ‘scapula’ is the scientific name given to the shoulder blade which is actually the two large triangular shaped bones that you will find in your upper back. Surrounding this bone is a complex web of muscles that act upon the ball and socket joint that is your shoulder which keeps you moving fluidly within that joint.

 

The scapula is an area of the body often mired in injuries for people from just about any walk of life. From people who are just going about their daily activities like reaching for a jar from the high shelf in your kitchen… to an athlete who stretches and trains on a daily basis.

 

The good news is that these injuries are preventable. 

 

If you have or if you haven’t suffered from scapula injuries the time to begin working on strengthening them up is NOW!

 

If you have an injury you’re not sure about and never taken the time to have it looked at by a professional I highly recommend you have someone like Barangaroo Orthopaedic & Sports Injury Clinic give you a once over.

If you need to see a physiotherapist for an existing injury, book HERE.

 

 

Personally? Well, in the past, I have injured both of my rotator cuffs, one while wakeboarding and the other lifting weights in the gym when I was in a foul mood. The transition from being a bodybuilder who never really stretched at all to a calisthenics coach that loves running and joining in on mobility classes… I’ve performed a full 180 on my approach to training in this regard!

 In our 1on1 PT and small group calisthenics strength and hypertrophy classes we focus on scapular strengthening methods and ALWAYS warm up the body before the training begins. Come enjoy a FREE week on us 🙂

Visit the Maximum Potential Calisthenics website HERE to book now!

 

~Nathan Leith

Tips for a healthier spine while WFH

FAQs information BOSIC

By Physiotherapist, Vanessa Boon

 

While working at the office has its challenges, Working from Home (WFH) does not come without challenges either. We have found that most of us do not have a proper desk setup, we do not get out of the house as much and our step count is pretty poor. While this is stressful for our mental health, it also puts a lot of stress on your physical structures such as your spine. Here are our tips on how to reduce the stress on your back and reduce your risk of an injury!

 

1) Move! 

As difficult as it is to find time to move throughout the day, especially now that we are all working from home, we need to make time to do it. A few easy ways to add in movement in your day would be to: 

  • Stand up every 30 minutes
  • Walk and talk (instead of sitting down for calls)
  • Add an extra few minutes onto your lunch break and go for a walk outside 
  • Do a few squats/lunges/pushups/planks between meetings 

2) Try to create the optimal screen height

Though we may not be able to get it 100% perfect, we can try to make smart and realistic changes. Make sure the top of your computer screen is at eye level, this can be done by putting thick sturdy books under your monitor to elevate it. If you use a laptop, it makes it a little more difficult, but you can use a seperate/bluetooth keyboard. Try

3) “Ergonomic Chair”

Quite a few of us are lucky enough to have ergonomic chairs at work but not at home. These relatively expensive chairs were designed to support the natural curves of your spine and allow for maximal comfort. Most of us do not have these chairs at home but with a simple trick, we can try to mimic the support. Firstly, sit all the way in, roll a small towel, place it behind your lower back and lean on the back rest. Give that a try and see how it feels! 

 

4) Desk stretches 

We have filmed a series of stretches that you can perform at your desk: link video here. Though we would prefer if you could get up and move around, we also understand that not everyone has the time to. These stretches we created for maximal time efficiency as well as stretches the muscles that get the tightest while we are hunched over working. Do each 2 sets of 30 seconds. 

 
If you have any question or would like to find out more, give us a call at 8599 9811 or book in here to talk to one of our physiotherapists and let’s keep our spines happy and healthy!

Why should I strengthen my hamstrings for running?

BOSIC sports medicine

By Physiotherapist, Paulina Backiel

 

Where are our hamstrings located?

The muscles that are most commonly called “the back of our thighs” are actually our hamstrings. They are 3 really strong muscles that help us walk, run, and move with ease throughout the day. 

 

 

What do they do?

Their main action is to extend the leg behind our hip and bend the knee. However, in running, they are extremely important for absorbing the energy we create and controlling our limbs just before we plant our foot back down on the ground. 

 

The muscle that gets left behind.. literally!

Usually when running, the front part of your thighs, your quads, start to overpower your hamstrings. This can lead to an imbalance which could potentially change the biomechanics of your running, resulting in a higher risk of injury. We have a lot of muscles in our lower limbs for a reason, these muscles have to work together to propel us forward, especially in running. If one of these muscles overpowers the other, the weaker muscle has a hard time catching up. When this happens, our running no longer becomes a smooth pattern but disorganized. This is when injuries occur.

 

How loud are you when you run?

When the hamstring is supposed to slow down the leg before it touches the ground but it can’t, that results in the runner hitting the ground too hard with their foot. This will increase the force going into the ground (because it was not absorbed by the hamstring) and then that force comes back at you more than double as much. The faster we go, the more energy our hamstring needs to absorb in order to slow down our foot before it finally reaches the ground. 

 

Other injuries due to weak hamstrings

Another biomechanical issue we see is overstriding. This is when the hamstring gets overpowered and the knee does not bend fast enough before placing the foot on the ground. This is where injuries such as shin splints and stress fractures occur.

 

So are you actually training your hamstrings enough? If not, here are some exercises to try:

 

  • Good Mornings
  • Romanian Deadlift
          •        Progression: Single Leg Romanian Deadlift

Double Leg Hamstring Bridges

      •        Progression: Single Leg Hamstring Bridges

 



Don’t forget to book in for an appointment with a physiotherapist at Barangaroo Physio. I am certified to give running assessments and would be happy to get you started on a strength program so that you can avoid injury and become a stronger runner. 

 

Your physio,

Paulina
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sources:

Schache AG1, Dorn TW, Williams GP, Brown NA, Pandy MG.Lower-limb muscular strategies for increasing running speed.J Orthop Sports Phys Ther. 2014 Oct;44(10):813-24. doi: 10.2519/jospt.2014.5433. Epub 2014 Aug 7.

3 STEPS TO NETFLIX AND CHILL WITH EASE

BOSIC Specials

 

By Physiotherapist, Nate Chan

The What

According to recent studies on average we spend 71 minutes if not more on Netflix per day. However, when we find an addictive show we all spend 2 hours, maybe 3 hours sitting down. Long and behold there’s a greater chance of low back pain. 

The How

How did we end up with this pain?

Let’s take a step back and think about it. We have been sitting at our desk for 8-10hours. We have dinner sitting down with your friends and family. Finally to unwind from the day we sit down and cuddle with our partners watching Netflix. Therefore, the grand total of sitting down went from 8 hours to 12+ hours. 

 

Top Recommendations

To help your back and avoid this ache/niggle here are my top 3 recommendations:

1.Move more. 

This is no better time to multitask.  Use this time wisely to fit in your rehab exercises, stretch or increase your mobility. Here is my favourite stretch to Netflix and chill with:

 

    • Hip flexor to hamstring stretch
    • Fig 4 stretch

 

2. Slouching doesn’t look cool or feel cool.

Slouching generally adds to much strain on your neck and lower back. 

In a slouching position we will be with rounded shoulders forcing us to bend our necks to look up. This will eventually cause neck pain.

 Likewise for the lower back we posterior pelvic tilting and compressing the back making it hard for us to get out the couch. 

TIP: Slide your butt back against the back edge of the couch so you can rest your entire torso against the backrest to sit upright. 

 

3.Ad breaks

Yes ad breaks, but not as you know. Yes, you’re probably thinking, “but I subscribe to Netflix to NOT get ad breaks!” But break time is essential when spending time sitting or lounging.  

Think about scheduling your own breaks during the show or movie (ie every 20minutes) to stretch, go to the bathroom, replenish your snacks, or hell even grab yourself a well deserved drink. Breaking up the TV binge watching cycle will help alleviate the stress on your neck and back so you can watch at the safety and comfort of your own home. 

 

Those are my top 3 Netflix and Chill recommendations. Give those a try and let me know your thoughts. If you are still struggling with pain, don’t forget to book in here or call us at 8599 9811. 

 

Your Physio,

Nate Chan