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Osteoporosis prevention and management

Osteoporosis prevention and management

8 February 2024

Osteoporosis is a common condition characterised by a reduction in bone density and quality, leading to an increased  risk of fractures. As per the Royal Orthopaedic Society, risk factors for developing Osteoporosis include; smoking, too much alcohol and low body weight. We also know the females, particularly post menopausal females, are at higher risk of being diagnosed.

Recent research has suggested that resistance training can be highly beneficial for individuals with osteoporosis (Zhang et. al 2022). (3)

Resistance training involves placing stress on bones, which stimulates bone remodelling and increases bone density. This can help counteract the bone loss associated with osteoporosis, making bones stronger and more resistant to fractures. Resistance training targets not only bones but also muscles. Strengthening muscles can improve balance, stability, and coordination, which are important for reducing the risk of falls and fractures, particularly in older adults with osteoporosis. Regular resistance training has numerous other health benefits, including improved cardiovascular health, better insulin sensitivity, and enhanced mood and well-being. These benefits contribute to overall better health and may indirectly help in managing osteoporosis.

The LIFTMOR trial 2017 (2) shows that targeting large multi joint strength exercises is an effective way of enhancing – or at least limiting a reduction in bone density. Through the use of 4 fundamental exercises; deadlifts, overhead presses, back squats and a chin up landing drill, positive results were shown.

The frequency of resistance training for individuals with osteoporosis can vary depending on factors such as your current fitness level, overall health, and goals. However, general recommendations suggest aiming for resistance training exercises at least 2-3 times per week with a day of rest between sessions to allow for muscle recovery. This frequency was also tested and shown to be efficacious and superior to previous programs for enhancing bone at clinically relevant sites, as well as stature and functional performance of relevance to falls in postmenopausal women with low to very low bone mass. (Watson et al 2017) (2)

Another important component in the management and prevention of Osteoporosis is nutrition (Garach et. al 2020). (1). The correct nutritional changes to your diet can support bone health, especially when combined with resistance training. Some key components to consider include:

  • Calcium: Adequate calcium intake is essential for maintaining bone health. Good dietary sources of calcium include dairy products (such as milk, yogurt, and cheese), leafy green vegetables (such as kale and broccoli), tofu, almonds, and fortified foods (such as fortified plant-based milk alternatives and breakfast cereals). Aim for the recommended daily intake of calcium, which varies depending on age and sex.
  • Vitamin D: Vitamin D helps the body absorb calcium and plays a crucial role in bone health. Sources of vitamin D include sunlight exposure, fatty fish (such as salmon and mackerel), fortified foods (such as fortified dairy products and cereals), and supplements. Consider getting your vitamin D levels tested and talk to your healthcare provider about supplementation if necessary.
  • Protein: Protein is important for maintaining muscle mass and supporting bone health. Include sources of lean protein in your diet, such as poultry, fish, beans, lentils, tofu, eggs, and dairy products. 
  • Magnesium: Magnesium is involved in bone formation and metabolism. Good dietary sources of magnesium include nuts, seeds, whole grains, leafy green vegetables, and dairy products. 
  • Vitamin K: Vitamin K plays a role in bone metabolism and may help reduce the risk of fractures. Include foods rich in vitamin K, such as leafy green vegetables (such as kale, spinach, and Swiss chard), broccoli, Brussels sprouts, and fermented foods in your diet. Limit Sodium and Caffeine: High sodium intake can increase calcium excretion in the urine, potentially weakening bones. Limit your intake of high-sodium processed foods and try to minimize added salt in your diet. Excessive caffeine intake may also negatively impact calcium absorption, so moderate your consumption of caffeinated beverages. 
  • Maintain a Healthy Weight: Being underweight can increase the risk of osteoporosis and fractures. Aim for a balanced diet that supports a healthy weight and includes a variety of nutrient-rich foods.

We are proud to be able to assist all of our patients at Opus who require assistance in the prevention or management of osteoporosis through a full MDT approach including our Sports Medicine physician – Dr Porter, physiotherapy team and nutritionist. Through our expertise we are able to implement the important points made above into the patient’s package of care.

Reference List

 

  • Muñoz-Garach, A., García-Fontana, B. and Muñoz-Torres, M. (2020). Nutrients and Dietary Patterns Related to Osteoporosis. Nutrients, [online] 12(7), p.1986. doi:https://doi.org/10.3390/nu12071986.
  • Sl, W., Bk, W., Lj, W., At, H., Sa, H. and Br, B. (2018). High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial. [online] Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research. Available at: https://pubmed.ncbi.nlm.nih.gov/28975661/.
  • Zhang, L., Zheng, Y.-L., Wang, R., Wang, X.-Q. and Zhang, H. (2022). Exercise for osteoporosis: A literature review of pathology and mechanism. Frontiers in Immunology, 13. doi:https://doi.org/10.3389/fimmu.2022.1005665.
Athlete performing a sprint drill against a wall outdoors

Injury Prevention for Skiing

Injury Prevention for Skiing

31 January 2024

There are many risk factors that could cause injury when skiing which include equipment, technique, experience, education, awareness and snow related injuries (Hebert-Losier and Holmberg,2016). Research has shown that ski equipment (highly shaped, short and wide skis) has the most impact when preventing injuries (Spörri et. Al, 2017). Nevertheless, it is important to ensure professional and amateur skiers meet the physical demands of skiing to further reduce the risk of injury; this can be achieved through endurance training and strength and conditioning (Hebert-Losier and Holmberg,2016).

Sport specific strength training is key for improving technique and delay in muscle fatigue (Sandbakk, 2018). In order to formulate a ski specific strength programme, it is important to understand the most common injuries caused by skiing.  Spörri et. all established 80% of injuries occur while the skier is turning and 19% when landing. Upper limb injuries are caused by crashes (96%) and knee injuries are the most common in skiing (83%). Hewett et. al used a screening method to assess the valgus loading of the knee to predict the risk of ACL injuries. The athletes who sustained ACL injury had a higher valgus angle compared to the uninjured athletes (Spörri et. al 2017).  In order to reduce the valgus angle in the knee, it is important to focus on strengthening hip abductors, hip external rotators (Dix et. al 2019) and quadriceps to support the knee within the sagittal plane when skiing (Morrissey et. Al 1987). Additionally, recent studies have shown the importance of core strengthening exercises in preventing ACL injuries in alpine skiing. Raschner et. all found athletes with reduced core strength or core strength imbalance had an increased risk for an ACL injury (Spörri et. Al, 2017). Therefore, a strength training programme focusing on core and lower limb strengthening is key to reducing the risk of injury in skiers.

Endurance training for alpine skiing is crucial for performance (Neumayr et. Al 2003) and in reducing the risk of fatigue. The traditional recommendation for cardiovascular endurance training is a minimum of 20 minutes within 70%-80% of maximum heart rate (Morrissey et. Al 1987). However more recent research has shown high intensity interval training (HIIT) is also an effective method of improving endurance for skiers. Sandbakk et. al found aerobic HIIT improves endurance and ‘oxygen uptake at the ventilatory threshold’ (Sandbakk et. al 2013) in junior cross-country skiers. Furthermore, active on-hill recovery within training has shown to ‘optimize blood lactate clearance’(Spörri et. al 2017) and ‘increase run completion rate’ (Spörri et. al 2017) therefore highlighting the importance of endurance training in the prevention of injury.

Neuromuscular training for skiers is key to preventing falls. Jacopo et. al established that including a neuromuscular warm- up programme for skiers had a positive impact on dynamic balance by improving their lower limb awareness and control (Jacobi et. al 2018). However recent studies show neuromuscular training programs reduce the risk of ACL injuries apart from alpine ski racing. This is likely due to ski boots further challenging the athletes’ balance (Spörri et. al 2017).

Reference List

 

  • Dix, J., Marsh, S., Dingenen, B. and Malliaras, P. (2018). The relationship between hip muscle strength and dynamic knee valgus in asymptomatic females: A systematic review. Physical Therapy in Sport, 37. doi:https://doi.org/10.1016/j.ptsp.2018.05.015.

  • Hébert-Losier, K. and Holmberg, H.-C. (2013). What are the Exercise-Based Injury Prevention Recommendations for Recreational Alpine Skiing and Snowboarding? Sports Medicine, 43(5), pp.355–366. doi:https://doi.org/10.1007/s40279-013-0032-2.

  • Morrissey, M.C., Seto, J.L., Brewster, C.E. and Kerlan, R.K. (1987). Conditioning for Skiing and Ski Injury Prevention. Journal of Orthopaedic & Sports Physical Therapy, 8(9), pp.428–437. doi:https://doi.org/10.2519/jospt.1987.8.9.428.

  • Neumayr, G., Hoertnagl, H., Pfister, R., Koller, A., Eibl, G. and Raas, E. (2003). Physical and Physiological Factors Associated with Success in Professional Alpine Skiing. International Journal of Sports Medicine, 24(8), pp.571–575. doi:https://doi.org/10.1055/s-2003-43270.

  • Sandbakk, Ø. (2018). PRACTICAL IMPLEMENTATION OF STRENGTH TRAINING TO IMPROVE THE PERFORMANCE OF WORLD-CLASS CROSS-COUNTRY SKIERS. Kinesiology, [online] 50(1), pp.155–162. Available at: https://hrcak.srce.hr/ojs/index.php/kinesiology/article/view/6420 [Accessed 26 Jan. 2024].

  • Sandbakk, Ø., Sandbakk, S.B., Ettema, G. and Welde, B. (2013). Effects of Intensity and Duration in Aerobic High-Intensity Interval Training in Highly Trained Junior Cross-Country Skiers. Journal of Strength and Conditioning Research, 27(7), pp.1974–1980. doi:https://doi.org/10.1519/jsc.0b013e3182752f08.

  • Spörri, J., Kröll, J., Gilgien, M. and Müller, E. (2016). How to Prevent Injuries in Alpine Ski Racing: What Do We Know and Where Do We Go from Here? Sports Medicine, [online] 47(4), pp.599–614. doi:https://doi.org/10.1007/s40279-016-0601-2.

  • Vitale, J.A., La Torre, A., Banfi, G. and Bonato, M. (2018). Effects of an 8-Week Body-Weight Neuromuscular Training on Dynamic Balance and Vertical Jump Performances in Elite Junior Skiing Athletes. Journal of Strength and Conditioning Research, 32(4), pp.911–920. doi:https://doi.org/10.1519/jsc.0000000000002478.

  • White, G.E. and Wells, G.D. (2015). The Effect of On-Hill Active Recovery Performed Between Runs on Blood Lactate Concentration and Fatigue in Alpine Ski Racers. Journal of Strength and Conditioning Research, 29(3), pp.800–806. doi:https://doi.org/10.1519/jsc.0000000000000677.

Athletes training with battle ropes in a gym

Is there an increased injury risk to football players during the busy Christmas schedule?

Is there an increased injury risk to football players during the busy Christmas schedule?

12 December 2023

It’s that time of year again where the managers at the top premier league clubs resent the hectic fixture list that’s thrown at them. Less time to prepare and to recover and as a result, a risk of a reduction in the quality of performance. However, is there also an added risk to the player’s well being? With a forced significant change in their pre and post match routines, are they at higher risk of injury?

If we take a look at one of those clubs affected in this manner, West Ham (European Champions and Premier League heavyweights), their fixture list over the next month consists of 10 games. A mix of league, Carabao cup, FA Cup and Europa League games make for an incredibly intense festive period. As a club that doesn’t have the same luxury, as say Man City, when it comes to squad size, and therefore the ability to rotate playing staff, there is a good chance you will see a very similar starting 11 in most of these games. The intensity of each of these games, the colder weather, the travel up and down the country and into Europe are all factors that can impact how a player feels and therefore performs on the pitch.

Julian, Page and Harper, 1, (2020) conducted a systematic review on the effects of fixture congestion on performance during male professional football matches and found that performance variables such as low and moderate intensity distances covered during the 90 mins reduces. They also suggest a possible reduction in tactical performance, with decreased synchronisation between the players.

Page et. al, 2, (2022) have then gone on to take a look at a direct correlation between fixture congestion and injury in professional male soccer. They state that overall injury risk is increased during matches completed within fixture-congested periods. This is further supported by findings from a substantial European competition review which shows an increase in hamstring and quadricep muscular injuries during periods of fixture congestion. 3. (Bengtsson et. al 2014)

This leads to a very valid point of discussion, that these findings could help provide a source of scientific evidence for governing bodies to elicit change  to support player welfare and develop a more sustainable match calendar that promotes a player’s career longevity.

In the meantime however, it will continue to be a period of time where coaching and medical staff will have to regularly review and adapt their training, pre and post match plans in order to keep injury risk at a minimum and performance levels as high as possible. Players may be required to take on a role of being more active in their own recovery away from the training ground. Nutrition plans being altered to suit the increased regularity of match days. The use of alternative therapies such as heat, ice and compression when at home and ensuring plenty of sleep and rest when the opportunity arises.

Reference List

 

  • Julian, R., Page, R.M. and Harper, L.D. (2020). The Effect of Fixture Congestion on Performance During Professional Male Soccer Match-Play: A Systematic Critical Review with Meta-Analysis. Sports Medicine, 51. doi:https://doi.org/10.1007/s40279-020-01359-9.

  • Page, R.M., Field, A., Langley, B., Harper, L.D. and Julian, R. (2022). The Effects of Fixture Congestion on Injury in Professional Male Soccer: A Systematic Review. Sports Medicine. doi:https://doi.org/10.1007/s40279-022-01799-5.

  • Bengtsson, H., Ekstrand, J., Waldén, M. and Hägglund, M. (2014). MUSCLE INJURY RATES IN PROFESSIONAL FOOTBALL INCREASE WITH FIXTURE CONGESTION: AN 11-YEAR FOLLOW-UP OF THE UEFA CHAMPIONS LEAGUE INJURY STUDY. British Journal of Sports Medicine, 48(7), pp.566.2-567. doi:https://doi.org/10.1136/bjsports-2014-093494.19.
marathon recovery guide

Lower back pain in Golf

Lower back pain in Golf

23 November 2023

Lower back pain (LBP) is the most common injury for golfers as 34.5 % of all golfing injuries involve the lumbar spine. It is important to understand the golf swing in order to identify the cause of injury and provide optimum treatment. Most injuries occur due to the impact of the golf club and the follow-through phase. Follow-through phase promotes lumber extension and eccentric contraction of abdominals in order to generate force and rotation; this places increased pressure on the spine and intervertebral discs (Finn et. Al 2013). Hosea et. al found that the compressive load during a golf swing was considerably higher in professionals than amateur golfers, with a difference of 7584 N versus 6100 N. The compressive load in a professional golf swing is equivalent to 8 times body weight (Dale and Brumitt, 2015). It is important to compare this to cadaveric studies which have shown disc prolapses to occur at 5,500 N; this highlights that the golf swing (in both amateur and professional golfers) is able to generate enough force to injure the lumbar spine (Lindsay and Vandervoot,2014).

The golf swing is repetitive, asymmetric in nature and dependent on the dominant hand; this can determine the location and severity of LBP. For example, in a right-handed golfer, the right- sided external obliques, paraspinal muscles and abdominals take the most impact and therefore the right lumbar region is most commonly injured. Also, the end position of the golf swing is called reverse C position which promotes lumbar extension and increases the risk of facet irritation. In more severe cases, spondylosis and discogenic back pain can occur from poor technique and severe muscle imbalances. (Finn et. Al 2013)

It is important to focus on muscle imbalances, thoracic and lumbar mobility and technique to prevent and recover from LBP. From analysing the swing mechanics, core stability exercises are essential in LBP rehabilitation (Evans and Oldreive,2013). Horton et al. found a delay in muscle activation in abdominal muscle for golfers with LBP, especially the lead external oblique during back swings; this further highlights the importance of core strength and endurance in protecting lumbar spine. (Horton et. Al 2001). Hip stabilisation and mobility is equally important to aid trunk rotation and lumbar stability. Vad et. al demonstrated that reduced lead hip rotation (internal and external) and lumbar spinae extension were found in golfers with LBP; this may be due to decreased hip rotation in the leading lower limb causing more force to be directed into the spine (Vad et. al 2004). Therefore, ensuring glute strengthening exercises in rehabilitation are key to provide a base of support for trunk rotation. (Finn et. Al 2013)

Reference List

 

  • Dale, R.B. and Brumitt, J. (2016). Spine biomechanics associated with the shortened, modern one-plane golf swing. Sports Biomechanics, 15(2), pp.198–206. doi:https://doi.org/10.1080/14763141.2016.1159723.

  • Evans, C. and Oldreive, W. (2000). A Study to Investigate Whether Golfers with a History of Low Back Pain Show a Reduced Endurance of Transversus Abdominis. Journal of Manual & Manipulative Therapy, 8(4), pp.162–174. doi:https://doi.org/10.1179/jmt.2000.8.4.162.

  • Finn, C. (2013). Rehabilitation of Low Back Pain in Golfers. Sports Health: A Multidisciplinary Approach, 5(4), pp.313–319. doi:https://doi.org/10.1177/1941738113479893.

  • HORTON, J.F., LINDSAY, D.M. and MACINTOSH, B.R. (2001). Abdominal muscle activation of elite male golfers with chronic low back pain. Medicine & Science in Sports & Exercise, 33(10), pp.1647–1654. doi:https://doi.org/10.1097/00005768-200110000-00006.

  • Lindsay, D. and A. Vandervoort, A. (2014). Golf-Related Low Back Pain: A Review of Causative Factors and Prevention Strategies. Asian Journal of Sports Medicine, 5(4). doi:https://doi.org/10.5812/asjsm.24289.

  • Vad, V.B., Bhat, A.L., Basrai, D., Gebeh, A., Aspergren, D.D. and Andrews, J.R. (2004). Low Back Pain in Professional Golfers. The American Journal of Sports Medicine, 32(2), pp.494–497. doi:https://doi.org/10.1177/0363546503261729.

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Lower back pain in Golf

Are we finally seeing the necessary consistent respect towards reducing the risk of head injuries in Elite sport?

14 November 2023

What a game. What a Rugby World cup. What a final performance from both the Springboks and Kiwis. But, as always when there is any form of controversy in a big match, we will ask the question. If New Zealand captain Sam Cane didn’t have his yellow card upgraded to a red card so early on in the contest would it have been the same outcome? The rugby fan in me would love to have seen 15 vs 15 for a full 80 mins of course. However, to witness the sense taken by the officials in making an example of what is a direct shoulder to head shot, on the biggest stage there is, was a great decision. We need to protect contact sport athletes around head and spinal injuries and I personally hope this particular event will help to amplify this.

Some fantastic research was done into the frequency and type of head injuries experienced at the 2019 rugby world cup. Across 45 matches, 68 head injuries occurred with just over half of these players being removed from the field of play (Cooke et al 2023). 1. It’s going to be fascinating to see if with the recent changes in approach to the treatment and discipline of head injury related incidents in this year’s tournament correlates to a significant statistical shift compared to 2019.

Thankfully there has been much change In recent years in both the medical management of head injuries in rugby union and also the disciplinary approach to offending players.

A huge contributing factor to the progression of management and increase in discipline towards head injuries has been driven by the recent cases of ex players receiving a diagnosis of dementia with probable chronic traumatic encephalopathy. A recent paper on ‘Football’s Influence on Lifelong health and Dementia risk (FIELD)’ found that ex-professional international rugby players had twice the risk of developing dementia in later life than compared to the general population (Russell et. al 2019)2.

From the medical side, there’s been much clearer guidelines set out on the in play decision making on concussion and also on the return to play protocol. The emphasis on both the ‘recognise and remove’ principle and ‘Graduated return to Activity and Sport (GRAS) programme’ are highlighted in the HEADCASE extended guidelines posted by the RFU. 3.

Hopefully, the sensible refereeing decision made in last weekend’s final will have had a suitable impact on all those involved in the coaching and playing of rugby union. Understanding the importance of trying to abide by the safe tackling laws of the game, should correlate to us seeing less cases of longer term head injury consequences in competitors of the sport.

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The Importance of Pilates in Physiotherapy

The Importance of Pilates in Physiotherapy

20 October 2023

Pilates is a form of resistance training that focuses on improving muscular strength, mobility, posture retraining and balance. Pilates incorporates more of a dynamic approach to exercise and can be adapted using various equipment. The mind-body connection is the foundation of Pilates which promotes isolated muscle activation and joint mobility.

Pilates has been modified to be used as an adjunct to physiotherapy, especially to aid women’s health and chronic lower back pain (CLBP) due to its focus on transverse abdominus, multifidus, diaphragmatic breathing and lumbo-pelvic control (Wells et. Al 2014). Pilates also incorporates a holistic approach to strength training, which is achieved by mind-body connection and breathing. Focusing on a muscle, breath or movement helps to redirect thoughts away from stress and create a meditative practice (Memmedove,2015).

There are various types of Pilates equipment which include reformer, chair, cadillac and mat. The equipment enables the exercises to be modified to the patient’s needs; for example, the springs and ropes on the reformer can provide more stability compared to a mat based Pilates exercise. Luz Jr et. Al found that equipment based Pilates reduced patient specific disability and kinesiophobia  (Luz Jr et. al,2014) and therefore aids recovery from injury.

Pilates exercises can be adapted for all age groups and can promote independence for elderly patients. The combination of strength and balance training enables an increase of activities of daily living (ADLs) and prevention of falls (Ferandez-Rodriguez et.al 2021). In addition to preventing injury, more recent studies have shown Pilates to lower the severity of temporomandibular dysfunction, fasting blood glucose and HbA1c level in type 2 diabetes in women (Parveen et. al 2023).

Pilates has been proven to progress both physiological and psychosocial aspects of patients’ well-being. However, there is evidence to suggest that there is no difference between Pilates and other forms of strength training in improving “dynamic strength, isometric strength, resistance strength, balance and flexibility” (Pinto et. Al 2022). It is crucial to understand that there is no optimum form of rehabilitation, and this highlights the importance of patient specific care.

Reference List

da Luz, M.A., Costa, L.O.P., Fuhro, F.F., Manzoni, A.C.T., Oliveira, N.T.B. and Cabral, C.M.N. (2014). Effectiveness of Mat Pilates or Equipment-Based Pilates Exercises in Patients With Chronic Nonspecific Low Back Pain: A Randomized Controlled Trial. Physical Therapy, 94(5), pp.623–631. doi:https://doi.org/10.2522/ptj.20130277.

Fernández-Rodríguez, R., Álvarez-Bueno, C., Ferri-Morales, A., Torres-Costoso, A., Pozuelo-Carrascosa, D.P. and Martínez-Vizcaíno, V. (2021). Pilates improves physical performance and decreases risk of falls in older adults: a systematic review and meta-analysis. Physiotherapy. doi:https://doi.org/10.1016/j.physio.2021.05.008.

Memmedova, K. (2015). Impact of Pilates on Anxiety Attention, Motivation, Cognitive function and Achievement of Students: Structural Modeling. Procedia – Social and Behavioral Sciences, 186, pp.544–548. doi:https://doi.org/10.1016/j.sbspro.2015.04.009.

Parveen, A., Kalra, S. and Jain, S. (2023). Effects of Pilates on health and well-being of women: a systematic review. Bulletin of Faculty of Physical Therapy volume , 28(1). doi:https://doi.org/10.1186/s43161-023-00128-9.

Pinto, J.R., Santos, C.S., Souza Soares, W.J., Silveira Ramos, A.P., Scoz, R.D., Teixeira de Júdice, A.F., Alves Ferreira, L.M., Baltazar Mendes, J.J. and Amorim, C.F. (2022). Is pilates better than other exercises at increasing muscle strength? A systematic review. Heliyon, [online] 8(11), p.e11564. doi:https://doi.org/10.1016/j.heliyon.2022.e11564.

Wells, C., Kolt, G.S., Marshall, P., Hill, B. and Bialocerkowski, A. (2014). The Effectiveness of Pilates Exercise in People with Chronic Low Back Pain: A Systematic Review. PLoS ONE, 9(7), p.e100402. doi:https://doi.org/10.1371/journal.pone.0100402.

Woman stretching her arms and wrists