Nutrition and Injury

Posted by Atif Razvi on


Eat your way to a full recovery from injury! In this months newsletter we will be looking at the basics of nutrition to help manage inflammation and speed up our bodies’ ability to repair and recover.

When you sustain an injury, the body goes through 3 main stages of recovery:
1: Inflammation stage (0-5 days post injury). Blood flow increases at the site of injury to deliver a range of chemicals and blood cells needed to help remove damaged tissue and protect against infection. However, if inflammation is prolonged it can lead to a slower recovery,
2: Proliferation stage (Last between 4-6 weeks depending on the injury). New tissue (especially collagen) is formed. This tissue is generally much weaker than the original tissue, and serves as a foundation for further repair.
3: Remodelling stage (Depending on the injury can last up to 6 months). The repaired tissues remodel themselves into strong functional tissue at the site of the injury. If this stage doesn’t occur the tissue is weakened and prone to re-injury.

Food provides the building blocks for repair and recovery. By making simple modifications to our diet, each stage of injury recovery can be supported and optimized.

Nutrition to manage inflammation

Certain foods contain natural anti-inflammatory enzymes, such as turmeric, ginger, garlic, bromelain, flavanoids and blackcurrants. MAke sure to include these in your diet when you sustain an injury.
Supplement your diet with Omega 3 Fats by taking fish oil, cod liver oil, or flax seed oil supplementation, or Omega 3 rich foods such as raw nuts or avocado. These all have an anti-inflammatory function.
Avoid pro-inflammatory foods such as highly processed foods, fatty red meat, saturated fats, caffeine, sugar and alcohol.
Nutrition to support proliferation and remodeling

Muscles and nerves are made from protein and fats. Therefore it is essential that your diet has adequate quantities of good quality fat and protein. In general, it is recommended that a portion of protein is included in every meal that you have. Examples of good fats include coconut oil, Omega 3s, avocado, butter and mixed nuts.
Supplement your diet with Vitamin C and Bioflavanoids to help your body to lay down collagen, the tissue that begins your tissue repair.
Supplementation with specific Amino Acids such as Glutamine, Ornithine and Arginine has been shown to improve tissue repair and lead to reduced time to recovery. Visit your health food / supplement store for more information on these products.
NB: The information above is a basic nutrition guide to help manage and recovery from injury. If you have any specific dietary requirements or health problems, please consult your GP or nutritionist for advice before implementing the advice above.

Moving

Posted by Atif Razvi on


Hey Everyone, Just a friendly reminder to keep moving!

As physio’s sometimes we can be very picky about how we want you to move, stretch, jump, land or sit. We do this because we are looking at restoring the body’s natural rhythm for movement which can be lost or changed as a result of compensating over time.

From our view of the world, managing movement plays an important role in injury risk management. However, there is one important thing to remember… Any type of movement (as long as its pain free!) is better than no movement at all!

With rapid changes in technology our lives have become vastly more static than previous generations. However, advancements in our understanding of the body all point to one thing; move it or lose it! That means that we need continuous movement in life, throughout life.

Research compared the health outcomes of individuals who were very active when they were young and then stopped completely during middle age were compared to those who never exercised regularly. The health risks for the ones who stopped exercising quickly reverted back to equivalent individuals who had never done exercise. Scary stuff! But, those regularly exercise regardless of when you start automatically start reducing the risk for health issues!
You may have heard this before “We are what we repeatedly do”. This is true for our bodies too, if we sit all day, our bodies get very good at being static and tighten up. However, some aspects of life we cannot change, for example, sedentary type jobs. So, we have to choose to schedule regular stretch breaks (aim for every 30mins). When you take a phone call, could you pace up and down the hallway to use that as a break?

Our bodies gain a multitude of benefits from movement; nutrition is provided to our joints, nerves and muscles are stimulated strengthening their connections with the brain, endorphins can be released and stress release, the list goes on. Rain or shine, hot or cold, find something you enjoy doing and get stuck in!

With that in mind, chuck on some shoes and go see where movement takes you!

Maintaining a healthy weight? Diet vs. Exercise explained…

Posted by Atif Razvi on


By Yannik Wouts – Staff Physiotherapist

Being healthy is easy on paper, so why are there so many living such unhealthy lifestyles and why does it seem so easy for some people and harder for others? Unfortunately blanket statements like “eat less, exercise more” don’t help the majority of us to actually see results. There are infinite ways for us to live healthier but in reality, we are only limited to a finite amount of resources e.g. time, money and will power so unspecific recommendations that don’t take into account particularity can be as useless to us as the gym membership we never use.

Diet

A recent meta-analysis was published in the Journal of the American Medical Association by (Johnston, et al., 2014) that looked at 59 individual studies that looked into “which diet works best?”. The outcome of that study was that there were no major differences between the diets, and success was completely dependent on what the individual could adhere to. In other words the diets that worked the best were the diets that both reduced the amount of excess foods that particular person ate (in Western society mainly carb’s and sugar) and ones that matched that persons personal preferences towards taste and how easy it was to prepare.

Many studies have looked into the rise in increased serving sizes around the planet, especially in Western world. In the U.S total energy from intake of food has increased 500 kcal/d per capita since the 1970’s. This is in part due to the increase in amount of food bought outside of the home which has increased 13% since 1970 (1), and what food do most people buy when they’re out on the go… the wrong kind. Not only have meal sizes increased but the amount of calorie intensive foods we ingest has increased, particularly in the past few decades. These two factors have created a perfect storm and are having a massive effect on the rising in obesity levels and weight related illness (2).

Exercise

Exercise is the other main variable to being healthy and maintaining a healthy weight. There is evidence to say global participation in sports hasn’t changed much in the last couple of decades but we are sitting a lot more, both at work and at home. This is having a negative effect on our health (3). The human body is designed to move, to locomote and engage in all manner of manual labour throughout the day. Movement is essential to our survival as a species and hence why exercise is so important. This shift from a physically demanding life to one with few physical challenges has been sudden in the history of our species and as a whole we are not coping with it well.

There has been some misleading research that showed exercise alone has limited effect on weight loss. This is in part due to the fact that when we first start to increase our exercise levels our body hasn’t yet adapted to the increased demand on the muscles and is still running relatively inefficiently (4). During this “transition” time which can change depending on how consistent you’re being with your exercise regime and mean we crave food more (4). Once our muscles are running more efficiently we require less fuel to do the same amount of work, so if we don’t cut back on our intake again we will see a plateauing out on the scales. Also as we exercise we have an increase in muscle which is heavier than adipose tissue (4). Let’s say that a 90kg man wants to lose 0.5kgs in a week. Through exercise alone, he needs to run about 5.5km per day. Through dieting alone, he needs to cut back 500 calories a day (the equivalent of two Starbucks Frappuccinos). Now let me make it clear that this does not mean exercise isn’t important although it is just a lot easier to not consume those extra calories than it is to burn them off later.

There are immeasurable reasons why regular exercise is beneficial but one I’d like to point out is it helps us to maintain a healthy metabolism (5). As stated above exercise alone hasn’t been shown to have a huge effect on weight loss but it does have secondary effects that will help you maintain a healthier balance muscle to fat and keep it there (5). Exercise has been shown to increase your resting metabolic rate (RMR) (5). The RMR is the total energy expenditure the body requires to function for 24 hours. This essentially means regular exercise helps to up-regulate and improve the function of all the organic material in our body. If you aren’t getting in your 30+ minutes of consistent exercise per day you won’t see the benefits. Taking the stairs or walking to work are two ways people can do to bring some regularity to exercise during the day. For a rough guide on how to work out the training zone that is appropriate for you just find your maximum heart rate which is (220-your age) and apply this model.

2e68f13c 1127 453c 9a01 a9df3828396

Aerobic exercise (“relating to, involving, or requiring free oxygen”) has been shown to improve RMR better than anaerobic exercise like weight lifting (6). Like diet there is no particular benefit to doing specific exercise but there are a few points I will make. More intense exercise e.g. running will increase your heart rate more than less intense exercise e.g. walking. It will therefore take longer to burn the same number of calories walking than it would do running. So a 30 minute jog and a 30 minute dance lesson that takes your heart rate to the same level and keeps it there will burn the same amount of calories.

Keeping your heart rate in the training zone is another factor that can be easily over looked. Where the above example can break down is that maintaining a consistent heart rate while jogging is easier than dancing, as you are constantly moving when you jog. Any breaks in dance, to learn a move, talk or rest, will allow your heart rate to drop and you will fall down the ladder of training zones to the point where your exercise may not be having any effect at all. Sports is a really good way to help boost effort though competition and there is some research to say that having a personal trainer or buddy to motivate you to push harder than you would by yourself is beneficial (7). Not everyone is looking to test their physical capacity and may benefit from more relaxed forms of exercise like swimming or walking, again particularity is key.

Yannik’s Top Tips

Find some sort of exercise that you enjoy that gets your heart rate into the training zone,
Do it every day if you can and if not do something even if it’s a walk,
Cut back on the foods and drinks that you personally have an over representation of in your diet (most likely carb’s or sugar), you can eve replace those foods with healthier alternatives that you enjoy,
Make it easy on yourself so you don’t fall back into bad habits,
Use a buddy or trainer to help boost effort, motivation and accountability,
Don’t get into it with the mind-set that there is an end point to your health regime, always look to see how you can improve and incorporate things into your life so it becomes habit and not an effort.
Work Cited:

Nestle, L. R. (2002). The Contribution of Expanding Portion Sizes to the US Obesity Epidemic. American Journal of Public Health, 246-249.
Cara B Ebbeling, D. B. (2002). Childhood obesity: public-health crisis, common sense cure. The Lancet.
Hill J O, W. H. (2003). Obesity and the environment: where do we go from here? Science, 853-855.
Cris A. Slentz, Brian D. Duscha, Johanna L. Johnson, Kevin Ketchum, Lori B. Aiken, Gregory P. Samsa, :. J., et al. (2004). Effects of the Amount of Exercise on Body Weight, Body Composition, and Measures of Central Obesity. Archives of Internal Medicine, 31-39.
Zierath, B. E. (2012). Exercise Metabolism and the Molecular Regulation of Skeletal Muscle Adaptation. Cell Metabolism, 162-184.
Rania A. Mekary, A. G.-P. (2015). Weight training, aerobic physical activities, and long-term waist circumference change in men. Obesity, 461-467.
McClaran, S. R. (2003). The Effectiveness of Personal Training on Changing Attitudes Towards Physical Activity. The Journal of SPorts Medicine, 10-14.
Brownson R C, B. T. (2005). Declining rates of physical activity in the United States: what are the contributors? Annual Review of Public Health, 421-443.
Johnston, B. C., Kanters, S., Bandayre, K., Wu, P., Naji, F., Siemieniuk, R. A., et al. (2014). Comparison of Weight Loss Among Named Diet Programs in Overweight and Obese Adults. The Journal of American Medical Association.

Let’s put a spring in our step!

Posted by Atif Razvi on


From being stuffed into cramped shoes or walking on scolding sandy beaches the life of a foot is not that glamourous. Some people despise them but, crudely put, we wouldn’t have a leg to stand on if it wasn’t for our feet.

On closer inspection, feet are actually marvellous feats of engineering. With 26 intricate bones in a single foot, they are our contact with the ground that readily transmit the forces from our activities through the lower limb. As well as muscles, tendons, and ligaments which run along the surfaces of the feet, allowing the complex movements needed for motion and balance.

I wanted to talk about something called the “windlass mechanism” which serves to support the medial and lateral longitudinal arch creating stability and control to provide a stable base for whole body movement. This helps absorb and release strain on the body from running and jumping type activities which can place up to 8x our body weight in pressure every step!

Plantarfascitis, a commonly diagnosed foot condition is often a result of a poor functioning windlass mechanism and intrinsic muscles on the bottom of our feet. Some common causes include poor biomechanics and exercise overload. A very important part of this mechanism is the use of the big toe, which should take up to 60% of your body weight during walking. As everything in the body is connected, it is not possible to separate out individual joints as culprits for injury, so if you are having issues with you knees, hips or lower back, part of the issue may be coming from how your feet contact the ground.

In order to get this balance right, it is important to get a health professional to take a look to guide you in the right direction to get your movement back! One nice and easy way to get those muscles working and relieve some pain is by taking your shoes off and walking barefoot on the grass. This direct contact increases your bodies awareness of those little but vital muscles in your feet so kick off your shoes and get outside to feel the benefits!

Are you too busy?

Posted by Atif Razvi on

How do you respond when someone asks you how your day has been? Have you noticed how often people respond with busy?

We live in a fast paced culture where we work hard to achieve and fill our lives with meaning and purpose. Being busy is our response to this challenge. The problem with being busy all of the time is that sometimes all of these things we are achieving come at the cost of keeping ourselves in good health and we fall into the cycle of being stressed.

Stress, is a common feeling we all experience at times. Some stress is good for us and helps us to perform our best. But when we are under too much stress for too long, our performance decreases and our overall health and wellbeing is affected.

Stress is a normal response that our body goes through when it is faced with perceived danger or threat to survival. This consists of the body activating something called the sympathetic nervous system where body responds with a number of physiological changes that prepare the body, making it stronger and faster in anticipation of either facing or fleeing from the perceived threat. Some of these changes include increased blood flow to the muscles activated by diverting blood flow from other parts of the body. Increased blood pressure, heart rate, blood sugars and fats in order to supply the body with extra energy. Increased muscle tension in order to provide the body with extra speed and strength.

Although this ‘fight or flight’ response is both normal and highly effective at allowing our body to survive real life stresses such as out running tiger or lifting a car off a child, more often than not our modern day stress is caused by deadlines and assignments. Instead of needing a short burst of strength and speed our bodies are fighting a more sedentary and passive threat. Often leaving our body stressed for extended periods of time. Think of how busy your days, weeks or months are.

Our bodies have an amazing ability to adapt to the environment they are in. When the body remains in this stress response for extended periods of time it prevents our body from its natural cycle of remaining healthy. Our healing, digestion, and breathing are all placed in low priority as our body stays focussed on whatever perceived threat remains.

There are some tell tale physical signs of remaining stuck in this stressed cycle such as aches and pains, stiffness, tiredness, headaches or digestive issues. There are also a number of ways that this affects our ability to think and process clearly.

Luckily there are a number of ways that we can battle this stress response and return our bodies to homeostasis. Physical exercise and breathing are two easy ways to get started. Our physiotherapists are all well trained in understanding the physical signs of stress and can direct you in creating easy and effective daily habits which break the cycle of stress in your life.

Concussion

Posted by Atif Razvi on

Concussion is quickly becoming one of the primary areas of focus in modern sport. This is particularly true here in New Zealand, where higher risk contact sports such as Rugby are so widely played. We are only now starting to recognise the long term effects of concussion; more and more retired athletes are being diagnosed with chronic traumatic encephalopathy (CTE), which until recently was a condition onlyA seen in retired boxers and other combat sport athletes.

While as a whole, sporting bodies are starting to take the dangers around concussion more seriously, and are putting in place previsions to better protect their players, some are still lagging behind. While Rugby Union has had rules directly relating to concussion and the management of concussed players for some time, and is putting significant time and effort into better managing concussions, other sports such as Football (Soccer) are frequently found wanting in regards to their attitudes and regulations regarding the injury.

We, as healthcare professionals, are by no means free of fault in this regard either. The severity, or even the presence of a concussion, is often underestimated, and too often, management of the injury amounts to nothing more than advising the patient to avoid contact sports for several weeks. There is a great deal of misinformation regarding concussions, in both the medical and patient populations. Many people strongly associate loss of consciousness with a diagnosis of concussion, when in actual fact, this occurs in only a small minority of cases, thought to be as few as 10%. Other well recognised symptoms, such as headaches, visual and balance disturbances, confusion and amnesia, are also not going to present in all cases, and are often a sign of a more severe concussion.

The frequency of concussion is also greatly underestimated. Recent studies looking at Rugby Union put the incidence rate, at an amateur/community level of play, at ~1 moderate to severe concussion per game, with the incident rate at professional level play being as high as 2.5 per game.

Undiagnosed or poorly managed concussion can have severe consequences for players. A concussed player will perform as a lower level, is at a significantly higher risk of sustaining other injuries, and recurrent concussions are potentially life threatening. If a player or patient is suspected to have sustained a concussion, the overarching message must be to err on the side of caution and sit out from play.

The International Rugby Board (IRB) are one of the few governing bodies in sport that bar any player diagnosed with a concussion from play for a minimum period of 3 weeks. This ruling is strongly supported by the NZRU, and applies to any level of play.

Given the highly variable nature of concussions, however, simply enforcing a period of rest is not sufficient to properly manage a patient’s concussion. The recent collaborative efforts of a large number of multisector and multidisciplinary groups in Scotland have produced a graduated return to play programme known as the Scottish Concussion Guideline.

The minimum rest period is set at 14 days for patient under age 18, and 7 days for patients over 18. The patient must also be symptom free for 24 (48 hours for patients under 18) at stages 2-5.

Referring patients who present to clinic with concussion through to a physiotherapist can be a good way to ensure that the patient is properly monitored while they progress through their rehabilitation.