Baseball is a sport I have been involved in for many years, from club level through to national competition. Through my academic development, I have come to the conclusion that baseball in Australia remains relatively underdeveloped from a strength and conditioning (S&C) perspective, particularly given the increasing performance demands associated with pitch velocity, pitch volume, and spin rate. While many developing athletes utilise plyometric (plyo) balls and banded warm-ups prior to games, current research suggests that these methods, when implemented in isolation, may hinder performance or increase injury risk if not supported by a well-structured strength and mobility program (Reinold et al., 2018; Zhang et al., 2023).

Resistance training (RT) plays a critical role in both sport performance and overall musculoskeletal resilience. When prescribing RT for baseball athletes, it is essential to understand the mechanical loading patterns and physical demands of pitching. During the pitching motion, the elbow is exposed to forces of approximately 1090N shortly after ball release (Diffendaffer et al., 2023). Without sufficient torque capacity and surrounding muscular strength, this may place excessive stress on the UCL (ulnar collateral ligament) and GHJ (glenohumeral joint).

Shoulder ER (External Rotation) at 90d Shoulder Abduction and Pitch Cycle

(Diffendaffer et al., 2023)

   

(Diffendaffer et al., 2023)

   

From a performance standpoint, RT has demonstrated clear benefits. Upper body strength training alone has been shown to increase pitch velocity by approximately 1.69 mph compared to control groups (Lachowetz et al., 1998). In contrast, weighted ball programs, while effective for velocity development, appear to present a different risk profile. Reinold et al. (2018) reported an increase in pitch velocity of approximately 1 m/s (~2.2 mph); however, this was accompanied by a 24% injury rate within a small cohort over a short-term intervention period, including four elbow injuries.

Additionally, weighted ball programs have been associated with increases in PROM (Passive Range of Motion) for shoulder ER of approximately 4.3° (Reinold et al., 2018). This increase in ER may reflect reduced neuromuscular control and poor positioning efficiency during high-velocity throwing, particularly in athletes lacking sufficient strength and control through these ranges. Increased PROM in ER may heighten anterior loading of the GHJ and contribute to altered joint mechanics. Over time, this may result in compensatory adaptations, including posterior shoulder tightness and increased loading of the medial elbow (Melugin et al., 2021).

With respect to mobility, thoracic spine (T-spine) mobility appears to play a greater role in injury mitigation than direct pitch velocity increases (Skopal et al., 2024). Reduced thoracic rotation has been associated with increased elbow valgus stress and compensatory movement patterns during pitching (Okamura & Iida, 2025). Conversely, improving T-spine mobility may help in reducing these stresses by enhancing kinetic chain efficiency.

Practical interventions to address these factors include:

• Mobility: Open books, quadruped T-spine rotations, windmills
• Motor control: Anti-lateral flexion exercises (e.g., suitcase carries), rotational control drills
• Strength and power integration: Medicine ball rotational throws, hip–shoulder separation drills

Example Exercises (Diffendaffer et al., 2023).

These strategies provide a foundation for improving trunk mechanics, reducing compensatory patterns, and decreasing medial elbow stress during the pitching cycle.

In summary, there is no single “best” method for increasing pitch velocity. An effective approach requires a multifactorial strategy incorporating thoracic mobility, RT, plyometric-based interventions, and sport-specific resisted throwing. Practitioners should remain cautious of excessive increases in shoulder ER PROM, as this may contribute to joint instability and increased reliance on passive structures (Reinold et al., 2018). When appropriately integrated, these methods can enhance performance while minimising compensatory movement patterns, reducing medial elbow stress, and limiting overload of the GHJ.

Further research is required to better define optimal programming strategies that maximise performance outcomes while minimising injury risk in baseball athletes. However, an understanding of the key phases of pitch delivery allows practitioners to more effectively prescribe interventions targeting delivery inefficiencies (Zhang et al., 2023).

   

Written by Megan Dame, Accredited Exercise Physiologist

What is the Menstrual Cycle? 

The menstrual cycle plays a pivotal role in preparing a Woman’s body for pregnancy (Better Health). If a Woman is not pregnant the uterus sheds its lining from signals sent from the uterus and marks her period (Better Health).

A menstrual cycle is measured from the first day of your period until the first day of your next period (Better Health). The menstrual cycle on average length is 28-29 days (Better Health).

Four Phases of Menstrual Cycle

 There are four main phases of the menstrual cycle (Better Health):

1. Menstruation: This is referred to commonly as a period, where the uterus lining sheds and flows out of your vagina as blood, some cells, and mucus. A period on average last three to seven days.
2. The follicular phase: This is the part of a woman’s menstrual cycle when the egg matures in her ovaries (Better Health). It occurs on the first day of your period and goes for 13-14 days (Better Health).
3. Ovulation: The matured egg is released by the ovary and travels along the fallopian tube to the uterus (Better Health). It occurs two weeks before the Woman’s next period and last for 16-32 hours (Better Health).
4. The Luteal phase: This is when cells in the ovary release the hormones progesterone and estrogen, which increase the thickness of the lining in the uterus to prepare for pregnancy. If a fertalised egg is implanted in the lining of the uterus progestogen is continued to be produced to sustain the thickness of the lining, and if pregnancy does not occur progesterone production drops and the uterus will shed causing her period to start again.

                                                                                               (Aunt Flow)

Effect of Menstrual Cycle on your Exercise

The hormones in our body play a pivotal role in many bodily functions, they are the body’s form of chemical messengers that send signals into the bloodstream and tissues. Research has found that female hormone levels of estrogen and progesterone can have an impact on the following (Exercise Right):

• Muscle development
• Utilisation of energy
• Fat gain and loss
• Thermoregulation
• Energy expenditure

Why Train in Sync with your Menstrual Cycle

Learning how to train in sync with your Menstrual cycle could help (Exercise Right):

• Manage stress
• Increase your immunity
• Improve performance
• Leave you with a sense of feeling stronger
• Reduce fatigue
• Manage symptoms of Premenstrual Syndrome (PMS)
• Increase sustained energy.

What is Cycle Syncing?

Cycle syncing involves choosing a type of exercise that pairs with one of the four phases of a Women’s menstrual cycle (Exercise Right).

During each phase the hormone levels change which can affect energy levels. Cycle Syncing guides you on how to modify your exercise routine in accordance with these changes in hormone levels, to gain maximum benefits from your routine (Exercise Right).

How to Cycle Sync with Exercise

During the four stages of a Women’s Menstrual Cycle, different modes of exercise are recommended (Exercise Right):

1. The Menstrual Phase: Optimal time to engage in light movements like yoga, walking or light strength training as a drop in hormone levels can cause you to feel low in energy during this phase.
2. The Follicular Phase: Optimal time to make progress in your training performing

High-intensity training (HIIT) and sprinting. During this phase, the body is found to have higher pain tolerance, increased endurance levels, and the increased ability of the body to use carbohydrates as fuel.

3. The Ovulation Phase: Optimal time to perform light resistance training. A phase where the body has a greater chance of being prone to injury and strength levels are high.
4. The Luteal Phase: Optimal time to perform active recovery (mobility and stretching) and deloading (reduce the intensity of training for a short period) strength training. This phase results in the body relying on fat as a greater fuel source, body temperature can increase, and retain greater amounts of water which can reduce energy levels.

 (Vecteezy)

Ultimately, what you chose to do is up to you and how your body feels. An Accredited Exercise Physiologist can help you tailor an exercise program taking these phases into consideration to suit you best.

How Do you Track a Menstrual Cycle?

 One alternative to tracking your Menstrual Cycle and working out what phase you are entering is through apps. Below are some suggestions of apps that can track your Menstrual Cycle:

• Clue
• Flo
• Ovia Fertility

Keep in mind that the length of periods and menstrual cycle can vary not only from person to person, but also from cycle to cycle, and using an app is providing an estimate but not a perfect prediction. A Woman’s Menstrual cycle can be affected by things like physical and emotional stress and changes in routine.

]]> https://strongandstable.com.au/prostate-cancer-exercise/ Thu, 11 May 2023 03:21:32 +0000 https://strongandstable.com.au/?p=17919

Written by Curtis Allderidge, Accredited Exercise Physiologist

What is Prostate Cancer?

The prostate is a male sex gland located at the base of the bladder (size of a walnut) and its primary function is to produce seminal fluid. Prostate cancer (PCa) happens when an abnormal growth of the cells in the prostate gland develops (malignant tumour) which is driven by the hormone testosterone. PCa is the second most common cancer diagnosis in men (first is lung cancer) and the fifth leading cause of death worldwide.¹

What Are the Signs and Symptoms of Prostate Cancer?

• Frequent urge to urinate, trouble urinating or pain during urination.
• Blood in urine or semen.
• Unexplained pain in lower back, upper thighs, or hips.
• Unexpected weight loss.

How is Prostate Cancer Diagnosed?

The average age of PCa diagnosis is 66 years old.² Most PCa are detected via elevated levels of Prostate-Specific Antigen (PSA). If PSA levels are greater than 4 ng/mL a biopsy will be performed and PCa will be suspected, but not all men with elevated PSA levels have PCa, some mean may have benign prostatic hyperplasia (enlarged prostate) or prostatitis (infection or inflammation of the prostate). If a diagnosis of prostate cancer is confirmed, PSA levels will continued to be monitored during and after treatment to check the effectiveness of the treatment.

Other forms of diagnosis include:

• Digital rectal exam: a doctor is able to feel the size of the prostate and check for any abnormalities.
• MRI (Magnetic Resonance Imaging): can assess the prostate size and identify any abnormalities as well as where the tumour might be located within the prostate.
• Biopsy: a small surgical procedure where a needle is used to remove multiple small samples of tissue from the prostate gland. The samples are sent to a lab for examination to confirm the presence of cancer.

Prostate Cancer Risk Factors

• Non-modifiable (cannot be changed):
  • Age (after the age of 50 years, the odds of developing PCa rapidly increase).
  • Family History (having father or brother with PCa doubles risk).
  • Ethnicity (African American men have the highest incidence of prostate cancer worldwide and are more likely to develop the disease earlier in life).
• Modifiable (can be changed):
  • Obesity (increases insulin resistance and inflammation).
  • Diet (increased consumption of animal fat and alcohol, and lower intake of fruits and vegetables).
  • Physical activity (increased levels of physical inactivity and sedentary behaviour increase cancer risk).
  • Environment (exposure to chemicals and carcinogens).

What Treatments Are Available for Prostate Cancer?

Active surveillance: is a strategy that involves monitoring your prostate cancer closely and choosing to undergo treatment if it advances. It’s an option for men who have *low-risk* prostate cancer.

Radiation therapy:

• External beam radiotherapy: High energy X-ray beams are directed at the prostate, with treatment often performed 5 days per week for 4-8 weeks.
• Internal beam radiotherapy: radioactive material is inserted directly into the prostate which releases concentrated amounts of radiation.
• Side effects:

• • Fatigue / Tiredness*
  • Rectal Bleeding
  • Tenderness
  • Erectile Dysfunction
  • Incontience
  • Insomnia
  • Weight Loss
  • Urinary toxicity

Surgery: Removing the prostate (radical proctectomy) is used to eliminate the cancer when it is confined to the prostate.

Hormone Therapy: Androgen deprivation therapy (ADT) is considered of the cancer has spread beyond the prostate (aggressive form) and is generally in the form of tablets or injections. Its goal is to reduce the amount of circulating testosterone in the body to slow the growth of the cancer.

• Side effects:
  • Fatigue / Tiredness*
  • Muscle and strength loss
  • Body fat gain
  • Lower Bone Mineral Density (BMD)
  • Depression
  • Hormonal Toxicity
  • Erectile Dysfunction
  • Gynaecomastia

Chemotherapy: kills cancer cells throughout the body, including those outside the prostate, so it is used to treat more advanced cancer and cancer that did not respond to hormone therapy. Treatment is usually intravenous and is given in cycles lasting 3-6 months.

• Side effects:
  • Fatigue / Tiredness*
  • Hair Loss
  • Nausea
  • Mouth Sores
  • Peripheral Neuropathy
  • Cardiotoxicity
  • Cognitive Impairment (Chemo Brain)
  • Muscle and Joint Pain

(Picture reference: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7301662/)

How Can Exercise Help?

Unfortunately, cancer treatments come with a vast range of side effects but exercise can thankfully counteract the majority of them! The good news is, prostate cancer patients who commit to an exercise program display lower PSA levels, delay the initiation of ADT by 2 years, experience greater quality of life, less fatigue, and have a lower risk of developing cardiovascular diseases.²

There is evidence that exercise is essentially “medicine” for those on ADT. It addresses several adverse effects such as muscle loss, strength, fatigue, declining physical function, bone loss, and depression/anxiety.³ Recent studies have concluded that exercise is actually more effective at improving Cancer Related Fatigue (CRF) than pharmacological interventions.⁴

Exercise during chemotherapy and radiotherapy can combat fatigue, cardiotoxicity, muscle weakness, improve body composition, balance, muscle strength, and significantly reduced urinary toxicity (specific radiotherapy treatment side effect).⁵

How Can an Exercise Physiologist Help?

Exercise Physiology has an essential role in recovery during and post cancer treatment. Not only do Exercise Physiologists provide you with exercise, they can also provide you with education and fatigue management strategies.

Exercise Physiologists will provide an individualised exercise program – that means that each exercise program is different and tailored to a person’s needs and goals. There is not a “one program fits all” for all prostate cancer patients. Each person is undergoing different treatments, will respond differently to exercise, and experiences their own unique side effects from the cancer treatments.

Exercise Guidelines

Progressive Resistance Training:

• 2 days per week
• 8-10 exercise (targeting major muscle groups, especially muscles around the hip and spine)
• 2-3 sets of 8-10 repetitions at a relatively high intensity (70%+ of 1RM)

Weight-Bearing Impact Exercises (i.e., jumping, bounding, hopping, skipping):

• 4 days per week
• 2-4 impact exercises, progressing from a total of 50-100 jumps per session
• Progressive resistance training is recommended before beginning weight-bearing impact exercises

Aerobic Exercises:

• 5-7 days per week
• 30 minutes of continuous training such as cycling, walking, rowing.
• Aerobic training can be broken into 10 minutes blocks spread throughout the day.

Other Things to Consider:

• Pelvic floor Assessment
• Mental health supports
• Dietician
• Support groups

Websites for further information regarding Prostate Cancer:

1. https://www.pcfa.org.au/#
2. https://www.cancer.org.au/cancer-information/types-of-cancer/prostate-cancer
3. https://www.astrazeneca.com/our-therapy-areas/oncology/prostate-cancer.html
4. https://australianprostatecancer.org.au/about-prostate-cancer/

References

1. Rawla P. Epidemiology of Prostate Cancer. World J Oncol. 2019 Apr;10(2):63-89. doi: 10.14740/wjon1191. Epub 2019 Apr 20. PMID: 31068988; PMCID: PMC6497009.
2. Keogh JW, MacLeod RD. Body composition, physical fitness, functional performance, quality of life, and fatigue benefits of exercise for prostate cancer patients: a systematic review. J Pain Symptom Manage. 2012 Jan;43(1):96-110. doi: 10.1016/j.jpainsymman.2011.03.006. Epub 2011 Jun 2. PMID: 21640547.
3. Edmunds K, Tuffaha H, Scuffham P, Galvão DA, Newton RU. The role of exercise in the management of adverse effects of androgen deprivation therapy for prostate cancer: a rapid review. Support Care Cancer. 2020 Dec;28(12):5661-5671. doi: 10.1007/s00520-020-05637-0. Epub 2020 Jul 22. PMID: 32699997.
4. Mustian KM, Alfano CM, Heckler C, Kleckner AS, Kleckner IR, Leach CR, Mohr D, Palesh OG, Peppone LJ, Piper BF, Scarpato J, Smith T, Sprod LK, Miller SM. Comparison of Pharmaceutical, Psychological, and Exercise Treatments for Cancer-Related Fatigue: A Meta-analysis. JAMA Oncol. 2017 Jul 1;3(7):961-968. doi: 10.1001/jamaoncol.2016.6914. PMID: 28253393; PMCID: PMC5557289.
5. Lin KY, Cheng HC, Yen CJ, Hung CH, Huang YT, Yang HL, Cheng WT, Tsai KL. Effects of Exercise in Patients Undergoing Chemotherapy for Head and Neck Cancer: A Pilot Randomized Controlled Trial. Int J Environ Res Public Health. 2021 Feb 1;18(3):1291. doi: 10.3390/ijerph18031291. PMID: 33535507; PMCID: PMC7908197.
6. Campbell KL, Winters-Stone KM, Wiskemann J, May AM, Schwartz AL, Courneya KS, Zucker DS, Matthews CE, Ligibel JA, Gerber LH, Morris GS, Patel AV, Hue TF, Perna FM, Schmitz KH. Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable. Med Sci Sports Exerc. 2019 Nov;51(11):2375-2390. doi: 10.1249/MSS.0000000000002116. PM

Written by Megan Dame (Accredited Exercise Physiologist)

What is Polycystic Ovary Syndrome?

Polycystic ovary syndrome (also known as PCOS) is a hormonal condition that affects 18-13% of women or people with uterus of reproductive age (Jean Hailes).

To be diagnosed with PCOS two of the following three criteria must be meet:

• Anovulation: Refers to when ovulation is skipped and an egg is not released from the ovary during the menstrual cycle, causing irregular or absent periods.
• Hyperandrogenism: An excess number of androgens (sex hormones) in the body. It can cause acne, increased body hair, and decreased breast size.
• Polycystic ovaries: Diagnosed with an ultrasound a condition involving enlarge ovaries with small cysts on the edges.

Unfortunately, 70-80% of women and people with uterus with PCOS have fertility issues

(Health Direct)

Cause of PCOS

PCOS’s exact cause is unknown, however, there appears to be an influence from the following factors (Jean Hailes):

• Family history: Women and people with uterus with PCOS are 50% more likely to have an immediate relative with PCOS
• Hormonal imbalance: An imbalance of insulin (a hormone that controls blood sugar levels) and androgens (male-type hormones, like testosterone) can cause PCOS symptoms
• Insulin resistance: 85% of Women and people with uterus with PCOS are diagnosed with insulin resistance, which is when the cells in your body don’t respond to the hormone insulin as well and cannot take up blood sugar from the body as well.
• Weight: PCOS can occur in all body types, although women with PCOS are at risk of being overweight or obese as they produce too much insulin or the insulin they produce does not work as it should causing weight gain or greater difficulty losing weight.

                                            Factors that contribute to PCOS (Jean Hailes)

Common Signs Symptoms  

Signs and Symptoms of PCOS can vary and present with different severity in women (Jean Hailes). Some symptoms of PCOS include (Jean Hailes):

• No period or irregular periods
• Excess hair growth on the face or body
• Mood changes
• Sleep apnoea (a sleeping disorder with abnormal breathing rate)

Exercises Benefits on Managing PCOS

Exercise can play a pivotal role in improving several signs and symptoms of PCOS (Exercise Right). The following benefits of engaging in exercise with PCOS include (Exercise Right):

• Stabilising mood, improving fertility, and reducing insulin resistance

This is best achieved by engaging in Cardiovascular Exercise such as walking, jogging, or swimming. As cardiovascular exercise can release the feel-good hormones endorphins improving mood, it can help balance hormones which can improve fertility, and increase sensitivity to insulin reducing a women’s resistance to the hormone.

• Improves body composition, increases metabolic rate, and reduces insulin resistance

Strength Exercises like squats and push-ups best achieve this. As strength training can increase muscle mass and reduce fat tissue, by also increasing lean muscle mass it increases your resting metabolic rate and insulin sensitivity.

• Decreasing waist circumference and increasing cardiorespiratory fitness

A high-intensity interval training (HIIT) program of alternating between a short bout of high to low intensity work can achieve this. Research has found interval training can reduce waist circumference more than going for a continuous brisk walk, which can reduce PCOS symptoms like reducing testosterone levels. PCOS women are two times more likely to have a cardiovascular event (like a stroke or heart attack) and engaging in HIIT can reduce your blood pressure reducing your risk of a cardiovascular event.

Exercise Role in Improving Insulin Sensitivity

One of the key factors that contributes to the development of PCOS is thought to be insulin resistance (Jean Hailes). This occurs when the body doesn’t respond to insulin, a hormone responsible for keeping blood sugar (glucose) levels in a normal range (Jean Hailes).

When a woman’s body has high levels of insulin, it can increase the production of male like hormones such as testosterone (Jean Hailes). This can impact ovarian function, including ovulation, which is why managing insulin resistance is important part of treating PCOS (Jean Hailes).

Exercise is a natural therapy that can help reduce insulin resistance and therefore manage PCOS. In fact, the positive effects of exercise on insulin resistance can happen almost immediately when you start exercising and can last for up to 48 hours (Exercise Right). Exercise can stimulate muscles to take up blood glucose and use it as fuel reducing glucose concentration whether or not insulin is present (Exercise Right). Exercise also increases insulin sensitivity, making it easier for muscle cells to use any available insulin to take up glucose during and after activity (Exercise Right).

So where to now?

The most effective form of exercise management for PCOS is one you enjoy and stick to. Seeking assistance from an Accredited Exercise Physiologist is a great way to start and ensure you are exercising appropriately for your condition. An Accredited Exercise Physiologist can develop a tailored exercise program along with providing you with lifestyle education to help you achieve your goals.

]]> https://strongandstable.com.au/exercise-and-multiple-sclerosis/ Thu, 27 Apr 2023 09:25:19 +0000 https://strongandstable.com.au/?p=17878 Written by Kelsie Vickery, Accredited Exercise Physiologist

Multiple Sclerosis (MS) is an autoimmune disease, characterised by demyelination (plaque development) throughout areas of the brain and spinal cord. This slows or interrupts the transmission of nerve impulses in the central nervous system, which can lead to a variety of symptoms, depending on the location of demyelination.

Common symptoms of MS include:

• Extreme fatigue
• Heat sensitivity
• Muscle weakness
• Tremors
• Loss of balance
• Walking impairments
• Cognitive concerns
• Depression and anxiety

(Shutterstock) 

These symptoms can have a significant impact on people’s lives, often resulting in reduced ability to complete activities of daily living, decreased participation in the community and decreased levels of physical activity (which increases the risk of a variety of other chronic health conditions). However, regular physical activity has a wide variety of benefits for individuals with MS, such as:

• Increases muscle strength and endurance, which will improve ability to complete daily activities/tasks
• Increases cardiorespiratory fitness and heart health
• Decreases risk of cardiovascular diseases
• Decreases fatigue
• Decreases pain
• Improves mood
• Improves mobility/gait
• Improves balance and decreases risk of falls
• Improves cognition
• Improves quality of life

(Shutterstock)                                                    (Exercise Right) 

What exercise is best?

Both aerobic and strength exercise is safe and recommended for individuals with MS. The recommended guidelines for individuals with mild to moderate MS include:

• 30 minutes of moderate intensity aerobic exercise on 2-3 days per week. Aerobic exercise is exercise that focuses on increasing heart rate and breathing. This includes walking, running, cycling, swimming, rowing and elliptical.
• Strength training of major muscle groups on 2-3 days per week. Strength training is exercise that uses resistance (e.g. weights and bands) to increase the demand on muscles.

For individuals who are new to exercise, or who have had a significant break from exercise, it is important to start slowly. Even 10 minutes of walking or small amounts of exercise broken up throughout the day is beneficial. The best type of exercise is the type that you enjoy and that is completing regularly.

(Charles Stuart University News)

Strategies to Common Barriers to Exercise

Fatigue

1. 1. Consider the time of day that you exercise. Some people find they have more energy at particular times in the day, so utilise this time to get some exercise in.
   2. Pay attention to how you feel each day – on days where you have had poor sleep, or are sick, reduce exercise intensity. Focusing on low level walking, stretching and balance exercise are best on these days.

Heat sensitivity

1. 1. Wear light clothing
   2. Exercise indoors or in the shade on hot days if possible
   3. Stay hydrated by drinking plenty of water during sessions

An Accredited Exercise Physiologist can help develop an exercise program that is safe and specific to your goals and individual needs, and can help work through some of the barriers to physical activity.

COVID-19

Covid-19 is an infectious respiratory disease caused by the SARS-CoV-2 virus. The latest evidence suggests that people with chronic diseases, conditions, or a compromised immune system are at the greatest risk of experiencing severe symptoms during and post-infection.

Symptoms

Majority of people will experience mild to moderate symptoms and recover without any special medical treatment, but some in rare and severe cases will require hospitalisation and urgent medical attention.

Symptoms vary from individual to individual but the most commonly reported symptoms include (1):

• Fatigue/Tiredness
• Dyspnea (shortness of breath)
• Cognitive Impairment (brain fog and memory issues)
• Angina (chest pain)
• Persistent Cough
• Muscle Weakness
• Joint Pain
• Insomnia (poor sleep quality)
• Memory and Cognitive Issues
• Heart Palpitations
• Dizziness

The current research notes that women are more susceptible to physical decline and fatigue following covid infection but there is not yet an identifiable reason as to why this is the case?!

What is Long Covid?

Long Covid is defined as a set of persistent physical and mental symptoms that lasts for more than 12-weeks after the initial Covid diagnosis and the symptoms being experienced cannot be explained by any other alternative diagnosis.

Benefits of exercise for Long Covid

Long Covid has been shown to cause deconditioning due to the prolonged experience of symptoms and sedentary behavior such as bed rest. Fortunately, exercise can counteract both deconditioning and sedentary behavior.

Exercise benefits:

• ↓ Severity of Symptoms
• ↑ Mental Health
• ↑ Immunity
• ↓ Joint Pain and Muscle Weakness
• ↑ Cardiovascular Fitness
• ↑ Muscle and Bone Strength
• ↑ Body Composition (increased muscle mass and reduced body fat percentage)
• ↓ Risk of Developing Cardiovascular and Chronic diseases
• ↓ Inflammation Biomarkers

How can an Exercise Physiologist help with Long Covid?

Exercise Physiologists will perform an assessment and then develop an individualised and periodised exercise rehabilitation program based on the severity of a person’s Long Covid condition.

Education and strategies will be given during consultations as to how better manage the prolonged symptoms being experienced i.e., fatigue, muscle stiffness, weakness, and joint pain etc.

It is well shown in the literature that any form of physical activity helps to improve mental health by releasing chemicals such as endorphins and hormones that help improve mood. (2).

Group exercise also helps to lower feelings of loneliness and isolation, so that might be something to look at, especially in regards to individuals suffering from Long Covid. (3)

Exercise is imperative as lung functioning and cardiac health are some of the most impacted bodily systems effected by covid. The exercise programs prescribed by Exercise Physiologists will appropriately and constantly challenge the cardiovascular, respiratory, and muscular systems.

If you’re suffering from long covid and are wanting to return to work, improve your quality of life and activities of daily living, Exercise Physiologists are here to help.

Websites for further information:

• https://www.coronavirus.vic.gov.au/long-covid
• https://www.coronavirus.vic.gov.au/
• https://www.health.gov.au/health-alerts/covid-19
• https://www.australia.gov.au/

References:

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8806149/#:~:text=Mild%20COVID%2D19%20cases%20include,of%20lower%20respiratory%20tract%20disease.
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5928534/
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5398226/

What is Pelvic Organ Prolapse?

Pelvic Organ Prolapse also referred to as POP, is when one or more of the organs in the pelvis (bladder, rectum, or uterus) becomes weak or loose and protrudes into the vagina (Continence Foundation of Australia).

The pelvic organs are supported by the interaction of ligaments, muscles, and connective tissue that make up the pelvic floor (Continence Foundation of Australia).

When the pelvic floor becomes weak it can impair its function of (Women’s Health Collective):

1. 1. Supporting the pelvic organs
   2. Resisting downward pressure from Intra-abdominal Pressure (an increased abdominal pressure caused by actions like coughing and sneezing)
   3. Closing of sphincters.

(Photo Source: Jean Hailes)

How common is POP?

POP affects up to 50% of adult women, and commonly occurs after having menopause, if you are overweight or after giving birth (Continence Foundation of Australia).

Types of POP

There are three common types of POP, including (Office on Women’s Health):

• Dropped bladder (Cystocyele): This is when the bladder bulges into the vaginal space and is the most common form of POP.
• Dropped uterus (Uterine): This is when the uterus bulges into or out of the vagina.
• Dropped rectum (Rectocele): This is when the rectum bulges into or out of the vagina.

What are the Signs and Symptoms of POP?

Common signs and symptoms of POP, but are not limited to include (Continence Foundation of Australia):

• An observable bulging lump out of your vagina
• A dragging sensation in the vagina
• Difficulty emptying bladder or bowel
• Recurring urinary tract infections
• Pain in the lower back, pelvis, or abdominals
• Lack of sexual sensation
• Struggles to keep a tampon in.

Please see your General Practitioner if you are experiencing these above symptoms and have not been diagnosed with POP, for further investigation.

Stages of POP

There are 4 stages of POP that will help guide the most appropriate treatment pathway for you. These include (Women’s Health Collective):

• Stage 1: The organ is greater than 1cm away from the vaginal opening and is in the upper half of the vagina.
• Stage 2:  The organ has descended to nearly the vaginal opening.

Stages 1 and 2 are common stages in women postpartum and can be reversed.

• Stage 3:  The organ has everted 1cm and protrudes out of the vagina. Conservative interventions like exercise can manage symptoms.
• Stage 4: The organ has completely everted and outside of the vagina. Typically require a combination of approaches both surgically and conservative.

How does exercise help POP?

Whether you do or do not require surgery, exercise plays a pivotal role in strengthening your pelvic floor muscles and the muscles surrounding them. Particular exercises can greatly manage and improve symptoms from POP, however, certain exercises can make symptoms worse (Exercise Right).

An Accredited Exercise Physiologist is appropriately trained in prescribing exercises that are safe and effective for managing POP.

Exercises to Avoid if you have POP

The following exercises are advised against if you have POP as it can make your symptoms worse:

• Valsalva moves (holding your breath)
• Plyometric exercises (impact exercises like jumping and hopping)
• Wide legged exercises (side steps and wide legged squats)
• Weighted exercises that place a large amount of downward pressure (lat pull down, back squats, overhead press)
• Core exercises that result in poor recruitment of your core (sit-ups and crunches)
• Exercise involving prolonged static standing.

Safe Exercises if you have POP

The following exercises are supported if you have POP as they will not make your symptoms worse (Women’s Health Collective):

• Low impact cardiovascular exercise like walking
• Swimming
• High rep low to medium weights
• Speed walking.

Exercise Treatment for POP

In regards, to exercise treatment for managing POP an Accredited Exercise Physiologist can guide you through a tailored program that includes (Women’s Health Collective):

1. Teaching you how to correctly recruit the muscles that make up your true core (Transverse Abdominis and Pelvic Floor) to ensure correct support to your pelvic organs.
2. Ensure you have good posture as a forward posture can increase downward pressure on the pelvic floor and can impact bladder and bowel control.
3. Strengthen the muscles that surround your pelvis like your glutes, hamstrings, adductors, lower back, and abdominals as these muscles support your pelvic floor.

Top Tips to Consider when Strength Training with POP

Below are listed some important things to consider when performing strength training with POP to reduce downward pressure on the pelvic floor (Women’s Health Collective):

• Exhale on the hardest part of the movement and inhale on the easiest part of the movement (e.g., inhale as you squat down and exhale as you stand up)
• Vary the positions you are in during your training session, for instance, perform a range of sitting, standing, and lying exercises
• Start initially with feet in a narrow stance
• Progressively increase repetition of an exercise before increasing weight.

Further Resource

https://www.continence.org.au/who-it-affects/women/prolapse#signsandsymptomswilldependonthetypeandlevelofprolapse

(Photo Reference: https://www.australiangolfdigest.com.au/)

Feeling tight and stiff during your golf swing? Experiencing pain? Can’t rotate your arms or hips as far as you’d like to hit the bar as far as possible? If your swing doesn’t look like Tiger’s I have some good news for you, there’s room for improvement to be made.

Golf is essentially a rotational sport and having good mobility around the shoulders, upper back, and hips will have your golf swing feeling better than ever. This enables you to have a better swing arc from the back swing all the way through to the follow through.

Thoracic Spine

(Photo Reference: https://www.kenhub.com/en/library/anatomy/thoracic-vertebrae)

The thoracic spine (upper back) is an area where most people tend to lack mobility. Most of the rotation of the torso during a golf swing is provided by the thoracic spine. If this area is stiff, you won’t be able to rotate as freely as you’d like which limits the amount of force you can produce during your golf swing – making it far from optimal.

If you find that your lower back is getting sore after a day on the course, you probably have poor thoracic mobility. This is because when you’re swinging the golf club, the lower back is overcompensating for a lack thoracic mobility and experiencing some of the rotational forces it shouldn’t be experiencing in the first place.

Shoulders

(Photo Reference: https://www.kenhub.com/en/library/anatomy/the-shoulder-joint)

The shoulders are required to move in different ways during a golf swing, as will the lead (dominant) and trail (non-dominant) hand depending on if you’re right or left-handed. Having adequate amounts of shoulder mobility, especially external rotation of the shoulders are very important for golf, improving both the back swing and follow through. External rotation is the action of rotating your shoulders outwards from the centre of your body. Once again, having good mobility will improve technique and lower the chance of injury.

Hips

(Photo Reference: https://www.kenhub.com/en/library/anatomy/hip-joint)

Having proper amounts of rotational mobility of the hips will enable you to better apply and transfer the force from the ground through the hips and redirect it into the golf ball – particularly internal rotation (the twisting movement of your thigh inwards from your hip joint). Poor hip mobility will also lead to excess forces through the lower back just like with the poor thoracic mobility mentioned above.

Mobility Exercises

The mobility exercises I have provided you with below are example exercises to promote improvements in mobility of the thoracic spine, shoulders, and hip joints. The exercises below are specifically aimed at improving thoracic rotation, shoulder external rotation, and hip internal rotation which as you now know, are key areas to improve your golf swing.

When new ranges of motion are acquired through mobility are joints become less stable, this is because our body is not yet use to the new range of motion and we have not had the chance or opportunity to develop stability or strength within these foreign (new) positions that we can now move our body or limbs into.

Therefore, stability exercise are needed to enhance our control and enable us to gain confidence in the new ranges of motion we now have. Increased levels of stability allow us to increase force and power production, so as well as hitting the ball with better mechanics, we’ll be able to hit it much further too. I’ll go over stability exercises for golf in another blog post in the near future!

Please note:

• When performing these exercises its important to not hold your breath, you must ensure that you’re breathing normally throughout each movement.
• If you experience any numbness, tingling or severe pain when performing any of the mobility exercises you must stop immediately and move onto another part of the body.

Thoracic Mobility Exercise

Thread the needle with rotation, 1 x 10.

·       Begin on all 4’s with wrists under your shoulders and knees under your hips

·       Slowly slide your right hand along the ground between the gap between your left knee and hand

·       DON’T push as far as you can – just until you feel some tightness or restriction in your thoracic or ribcage and HOLD!

·      Take 2 big deep breathes in then return and perform on other side

Shoulder Mobility Exercise

Pectoral Doorway Stretch, 1 x 1min.

·       Hold the doorframe and gently twist your torso to the opposite side

·      Ensure to twist your body not just your neck or shoulders.

Hip Mobility Exercise

Hip 90/90 Dynamic Stretch, 1 x 10.

·       Begin on the floor sitting upright and with your legs bent (as pictured) starting with either leg.

·       If you can’t get into the exact position as seen in the picture, that’s okay (only perform this movement with the range of motion you already have).

·       Slowly alternate side to side recreating the 90/90 stretch.

·       Ideally, you want both knees being able to touch the ground each time you slowly alternate from side to side.

In Summary

1. Better mobility will improve your golf swing mechanics.
2. Longer back swings allow you to produce greater club head speed.
3. Poor mobility from your hips, to thoracic through to your shoulders will impair your ability to create high quality and powerful swings.

Are you someone who:

• Has a desk that’s too low for your height?
• Sits on an uncomfortable kitchen or dining chair?
• Has a keyboard that makes you curve your shoulders?
• Sits at a desk between 5-6 hours per day?

These can all lead to increased pressure in your joints and muscles in your neck, mid and lower back.

It’s time to find the right work ergonomic station for you.

Sitting at a desk in front of a laptop or monitor is becoming more common as people continue to work from home post the COVID-19 pandemic.

A safe, ergonomic workstation intervention may be a practical management option to prevent or reduce pain.

Here are 5 quick and easy tips that to reduce pain whilst sitting at your desk:

1. CHAIR

The best chair is one that is adjustable so that it supports the natural ‘S’ curve of your back.

Your desk should be at the height of your elbows when your hands are on the keyboard. The chair should also be at a height where your thighs are parallel to the floor whilst your feet are flat on the ground or on a foot rest to allow optimal hip positioning. Sitting on a chair with no back support may cause you to curve your shoulders which may lead to strain on your muscles and joints.

(Theatre Seat Store, 2021)

2. MOUSE & KEYBOARD

These items should be close to you whilst at your desk to ensure you do not have to overstretch. If using a laptop an external wireless keyboard may be best fitted to ensure it is closer to your body. Your wrists should be flat on the keyboard and not angled up to reduce the overuse of your forearm muscles which could cause wrist injuries. Remember to tuck in your elbows when you are typing on your keyboard. An external mouse may also be beneficial so you do not have to overextend to use the trackpad on your laptop.

3. MONITOR

For the best ergonomic positioning, the top of your screen whether it be a laptop or desktop should be just below eye level. The monitor should also be an arm’s length away from your body.

4. POSTURE

Try not to lean to one side of your body and avoid slouching or leaning back in your chair when working. The optimal position is sitting up straight with your shoulders relaxed.

(Wirecutter, 2020)

5. TAKE REGULAR BREAKS

By standing up and moving around it allows your neck and back joints to have a break. A sedentary lifestyle increases chances of numerous conditions such as cardiovascular diseases, obesity, and diabetes. Walking and movement can also help alleviate stress and have a positive impact on your mental wellbeing.

Why not try Osteopathy Australia’s 40:15:5 every hour

SIT for 40 mins

STAND for 15 mins

MOVE for 5 mins

(Osteopathy Australia, 2021)

 WHAT WE CAN DO

As Osteopath’s we can assess your ergonomic workstation and treat musculoskeletal concerns. Treatment methods may include soft tissue therapy, muscle energy techniques, articulation, dry needling, cupping, manipulations, mobility and stretching.

Please contact Strong and Stable on  9762 0976 or Book Online to organise your assessment and treatment plan.

References:

Davis, K., Kotowski, S., Daniel, D., Gerding, T., Naylor, J., & Syck, M. (2020). The Home Office: Ergonomic Lessons From the “New Normal”. SAGE journals, 28(4), 4-10. https://doi.org/https://doi.org/10.1177/1064804620937907

Dubey, G., Tripathi, H., & Naqvi, Z. (2019). Ergonomics for Desk Job Workers -An Overview. vol 9, 257. https://www.researchgate.net/publication/334972044_Ergonomics_for_Desk_Job_Workers_-An_Overview

Heneghan, N. R., Lokhaug, S. M., Tyros, I., Longvastøl, S., & Rushton, A. (2020). Clinical reasoning framework for thoracic spine exercise prescription in sport: a systematic review and narrative synthesis. BMJ open sport & exercise medicine, 6(1), 713- 717. https://doi.org/10.1136/bmjsem-2019-000713

Louw, S., Makwela, S., Manas, L., Meyer, L., Terblanche, D., & Brink, Y. (2017). Effectiveness of exercise in office workers with neck pain: A systematic review and meta-analysis. The South African journal of physiotherapy, 73(1), 392-392. https://doi.org/10.4102/sajp.v73i1.392

van Niekerk, S.-M., Louw, Q. A., & Hillier, S. (2012). The effectiveness of a chair intervention in the workplace to reduce musculoskeletal symptoms. A systematic review. BMC musculoskeletal disorders, 13, 145-145. https://doi.org/10.1186/1471-2474-13-145

van Vledder, N., & Louw, Q. (2015). The effect of a workstation chair and computer screen height adjustment on neck and upper back musculoskeletal pain and sitting comfort in office workers. The South African journal of physiotherapy, 71(1), 279-279. https://doi.org/10.4102/sajp.v71i1.279

What is Endometriosis?

Endometriosis is a health condition where cells like the ones that line the uterus are found elsewhere in the body, typically occurring in the pelvis and abdominal cavity (Jean Hailes).

Our body is not designed to remove these cells, so during each menstrual cycle adhesions and scar tissue develop from the release of oestrogen a hormone that fuels endometriosis (Jean Hailes).

1 in 9 people with utersus of reproductive age is affected by endometriosis

(Jean Hailes)

What Causes Endometriosis?

Unfortunately, the cause of endometriosis is unknown (Jean Hailes). However, certain factors can increase a woman’s risk of developing endometriosis such as (Jean Hailes):

• Family history of endometriosis
• Backwards menstruation, where the blood flows backwards along the fallopian tubes into your pelvis
• Dysfunction of the immune system, involving the immune system failing to stop the endometrial tissue growth outside the uterus.

Common Signs and Symptoms

Each woman with endometriosis can experience different symptoms. The severity of the symptoms is commonly related to the location of endometriosis, rather than the extent of the disease (Jean Hailes).

Common symptoms of endometriosis include:

• Abdominal, lower back, and pelvic pain
• Heavy menstrual bleeding
• Abdominal bloating
• Fatigue
• Painful periods
• Gastrointestinal (stomach and intestines) issues
• Painful intercourse
• Pelvic floor dysfunction
• Fertility concerns

The Benefit of Exercise for Endometriosis  

There are several benefits of exercising to manage endometriosis (Endometriosis Australia):

1. Exercise can provide pain relief: Exercise releases feel-good hormones which are a natural form of pain relief, reducing a common symptom of endometriosis.
2. Exercise can reduce internal inflammation: Exercise can stimulate the immune system resulting in an anti-inflammatory response, calming the endometriosis inflammation.
3. Exercise can reduce pelvic floor and abdomen cramping: Endometriosis sufferers can commonly experience an overactive pelvic floor which can create muscle spasms and tension that are painful, the correct exercise can train the muscles of the pelvis, hips, and abdomen on how to relax.
4. Exercise can manage constipation: A common symptom of endometriosis is constipation. Exercise improves digestion and bowel health, which can alleviate constipation.

Best Form of Exercise for Endometriosis

The pain experienced from Endometriosis can cause muscle guarding, where the body braces itself to protect against pain (Exercise Right). This muscle guarding can cause tightness in the pelvic floor, abdominal wall, and hip flexors (Exercise Right).

Exercise based on releasing and stretching these tight muscles is favourable for endometriosis, for instance, a glute stretch, foam roller quad release, butterfly stretch, and overball abdominal release.

The next progression is strengthening the muscles of the lumbopelvic (spine-hip) region, to ensure correct activation of these muscles, and balance out the mobility (stretch) and strength of the muscles to manage symptoms.

Exercises to help strengthen and ensure correct coordination of the lumbopelvic region include clams, backwards walking, and tabletop hold.

Exercises to Avoid with Endometriosis  

Initially, when first diagnosed with endometriosis the following exercises should be avoided, including (Exercise Right):

• High-intensity abdominal exercises as they can place a significant load on your abdominal and lower back like a crunch.
• High-impact exercises like tuck jumps, running, and star jumps.

This does not mean you can never perform these exercises again. However, in the initial stages of endometriosis diagnosis, rest, and recovery to assist your body in healing are important. Followed by managing associated symptoms before progressing to exercises that are high intensity and impact in nature.

Guidance

 An Accredited Exercise Physiologist is specialised in prescribing exercise for individuals with health conditions such as endometriosis and can help you create an exercise plan that is tailored to you and your condition.

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