We often think of exercise as a means of working on our muscle strength, flexibility and cardiovascular health....but what about our bone health? Bones are a living organism which are continually depositing and re-modelling, which simply means that everyday our body breaks down old bone and creates new bone tissue.

As we age more bone is lost or broken down than is created - this is a normal process of ageing. If we lose too much bone it can lead to a low bone density and a weakness of the bone structure, both characteristics of Osteoporosis. This results in an increase to the fragility of the bone, making it more susceptible to breaking. Osteoporosis is often referred to as a “silent disease” as it usually goes undiagnosed until a fracture occurs from a simple trip or fall that would not usually result in a fracture. The diagnosis is made following a DXA scan and it is classified as mild, moderate or severe, depending on the state of the bone.

Needless to say, falls prevention is one of the most important components in the management of Osteoporosis (you can read tips on how to prevent falls here).

*There is often confusion between osteoporosis and osteoarthritis. To think of it very simply: osteoarthritis is overgrowth of bone and osteoporosis is undergrowth of bone.*

What exactly is Osteopenia?

Osteopenia is really early stage Osteoporosis, when the bone has started to lose density and the structure of the bone has started to weaken. A diagnosis of Osteopenia, by a DXA scan, does not necessarily mean it will progress to Osteoporosis, take it almost as a warning sign - often by making some simple lifestyle changes you can prevent the progression of the disease.

What can you do to reduce the risk of developing Osteopenia & Osteoporosis?

You can incorporate some simple lifestyle changes to prevent the development of Osteopenia or Osteoporosis and also to help manage the disease to prevent it progressing further.

1. Diet

Calcium is required for bone health and Vitamin D is required for our bodies to absorb the Calcium (one needs the other to work effectively). Ensuring you meet recommended daily levels of both of these can reduce the likelihood that you will develop osteoporosis or Osteopenia.

2. Smoking

Smoking can accelerate bone loss and affect the absorption of calcium by the body which is essential for bone health. Reducing or ceasing smoking will help to reduce the risk of developing Osteoporosis.

3. Alcohol

An intake of over 200ml of alcohol per week has been shown to be associated with the development of Osteoporosis.

4. Exercise

Our bodies need weight-bearing exercise to stimulate new bone growth. Exercises focusing on strength and balance have also been shown to reduce the risk of falls, which will reduce the risk of sustaining a fracture.

5. Body Weight

Studies show that low body weight or low body mass, particularly amongst postmenopausal women, increase the likelihood of the development of Osteoporosis.

6. Medications

There are certain medicines that can cause bone loss (e.g. glucocorticoids). If you are on medications and concerned they are affecting your bone health you should discuss this with your doctor.

*In certain circumstances medications or injections may be required in the management of Osteoporosis.

What exercises are good for bone health?

1. Weight-bearing exercises

These types of exercises are essential for bone remodeling. Examples of these include:

• Walking
• Dancing
• Step ups or stair climbing
• Aerobics
• Playing tennis

2. Resistance exercises

Resistance exercises can help to strengthen bones and muscles. These are exercises involving:  

• Working against your own body weight 
• Using bands or weights

3. Balance Exercises

Exercises that appropriately challenge your balance have been shown to reduce the risk of a fall or a trip and in turn reduce the risk of a fracture occurring. Examples include:

• Exercises standing on one leg
• Exercises with your feet close together
• Exercises standing on an unstable surface
  (see some examples here).

If you would like to incorporate some of these exercises into your routine you can try our two week free trial!

Information based on:

Kanis, J. A., Cooper, C., Rizzoli, R., Reginster, J. Y., & Scientific Advisory Board of the European Society for Clinical and Economic Aspects of Osteoporosis (ESCEO) and the Committees of Scientific Advisors and National Societies of the International Osteoporosis Foundation (IOF) (2019). European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 30(1), 3–44. 

Lane N. E. (2006) Epidemiology, etiology, and diagnosis of osteoporosis. Am J Obstet Gynecol. Feb;194(2 Suppl):S3-11.

National Institutes of Health Osteoporosis and Related Bone Diseases National Resource Center (2018). Exercise for Bone Health. NIH Publication No. 18-7879-E.

Irish Osteoporosis Society: www.irishosteoporosis.ie

Do you find yourself feeling tight or stiff when working from home? Do you have your work station set up appropriately? Here are some tips & tricks to help keep you pain free while working from home!

How to set up your work station:

1. Chose a comfortable chair with a backrest.
2. Make sure your desk has enough room underneath it for your legs to easily fit.
3. Ensure that your shoulders are relaxed, upper arms comfortably by your side and wrists in a neutral position (not bent up/down).
4. Your keyboard should be directly in front of you within a comfortable reach and your mouse alongside it.
5. Bring your chair as close to your desk as manageable (adjust the armrest height if in the way).
6. Sit with your back comfortably resting against your back rest.
7. Place both feet flat on the floor, or if they do not reach (if you’re of short stature like me!) place them in a box or stool.
8. The upper third of your screen should be at eye-level and at arms length from you.

Other tips to keep any niggles at bay:

1. Try not to overthink your posture - our bodies are built to move and adapt: your next posture is your best posture!
2. Aim to get up from your desk and move at least every thirty minutes.
3. If you can, use a headset when taking calls.
4. Try to incorporate as much movement as you can into your work day:
   

   - Can you take a work call while going for a walk?

   - Can you take a video call standing rather than sitting?

5. Try to keep a routine and structure in your day.
6. Exercise! Not only will it help to keep you physically in check but mentally and emotionally too 😊

Keep yourself moving at your desk:

Here are some simple exercises to do at your desk, for times when you do not have the opportunity to get up and move:

1. Seated twist - get your upper back moving!

1. Move yourself forward in your chair, away from the backrest, and keep your feet on the floor.
2. Sit up tall and place your arms across your chest (like you are making the letter ‘X’).
3. Inhale and grow as tall as you can through your spine. Exhale and twist to your right.
4. As you breathe in, grow tall again and each time you exhale see can you twist a little further. Aim for about 5 breath cycles.
5. Repeat this to the left side.

**You may feel a tightness or stretch feeling in your upper back. If you feel any pain please stop the exercise immediately.**

2. Stretch out your shoulders and neck:

1. To stretch your right side: sit comfortably and tilt your left ear towards your left shoulder.
2. You should feel a stretch in the right side of your neck or across the top of your shoulder.
3. If you would like to intensify the stretch: sit on your right hand and/or place your left hand onto your head to gently pull a little further.
4. Aim to hold the stretch for 20-30seconds.
5. Repeat on the opposite side.

**You should not feel any pain, if you do please stop the exercise immediately**

3. Stretch your low back and hips:

1. To stretch your right side:
2. Move yourself forward in your chair, away from the backrest and keep your feet on the floor.
3. Place the outside of your right leg/ankle across your left thigh.
4. Sit up tall and gently lean forward.
5. Hold for 20-30 seconds.
6. Repeat on the opposite side.
7. You should feel a stretch in your right low back or buttock area.

**You should not feel any pain, if you do please stop the exercise immediately**

🌟If you find these exercises helpful, you can see detailed videos on a variety of exercises and injuries in our Members' Area, alongside a comprehensive on-demand library of Clinical Pilates Classes. 🌟

Information based on:

Chartered Physiotherapists in Occupational Health & Ergonomics (2020). A Guide To Working Well and Safely in Your Home Office. Ireland: ISCP.

**Please note: The information in this blog post is for general information and not meant to replace a medical or physiotherapy assessment.

Are you aware of your ability to balance? Do you incorporate balance practices into your daily or exercise routine? Do you know why is balance important?

⭐ Have you ever wondered why the Physio-Led Pilates Classes include exercises in standing, challenging your balance (which everyone just loves😆)? We'll you're about to find out! ⭐

What exactly does "balance" mean?

Balance is defined as the maintenance of an even distribution of weight which enables someone to remain upright and steady.

When do we need to rely on our ability to balance?

Our ability to balance is continually challenged - even with simple everyday tasks!

⚠️ Did you know:⚠️ we rely on our balance to keep us upright when sitting! Most of this comes from our core muscles and trunk control.

As we walk, each time we take a step we are balancing on one foot for a short period of time. When we run the time spent on one leg increases dramatically! As you can imagine, if you struggle with balancing on one leg, your body has to work a lot harder when you walk or run and this can make you more susceptible to an injury, particularly from the low back down.

Your balance is challenged even further when changing levels, e.g. going up or down a step, stepping off a curb or out of the shower/bath. If that’s not already enough, the even greater challenge to balance is standing/walking/running on an unstable surface. These unstable surfaces can be something as simple as a soft surface (e.g. a thick carpet, grass, sand) or an unpaved or cobbled road.

So how hard is it really to balance?

How hard does YOUR body have to work when doing a simple balancing task?

Well why don’t you give it a go to find out...try stand on one leg for 30 seconds. You might be thinking pfft that’s easy(!) but give it a go.... you may be quite surprised at the challenge!

If it is relatively simple for you...can you stand on one leg with your eyes closed? This not only assesses your balance but also your proprioception (your joints’ awareness of where they are in space). This is particularly important in preventing ankle injuries when it comes to stepping off a curb or playing sport.

⚠️ Did you know:⚠️ for adults over the age of 65, balance exercises are advised at least twice per week to reduce the incidence of falls and injuries.

Do balance exercises reduce injuries?

YES! The inclusion of balance exercises into a daily or exercise routine have been shown to reduce falls and injuries occurring.

⭐TIP: If you have osteoporosis it is particularly important to important to work on your balance to reduce the risk of a broken bone occurring from a fall.

Amongst the sporting population, including balance exercises in your regular training have been shown to:

• Reduce risk of ACL tears
• Reduce the risk of overuse knee and ankle injuries
• Reduce the risk of lower limb (hip,knee & ankle) sports injuries
• Reduce the risk of re-injury to the ankle

⚠️ Did you know:⚠️ balance exercises are included in professional sports training programmes, including the FIFA-11+ injury prevention programme for footballers!

So now you know why balance exercises are included in the Physio-Led Pilates Classes....p.s. I enjoy those exercises just as much as you do 😂

⭐TIP: There are simple ways to incorporate balance exercises into everyday life - next time you are brushing your teeth or waiting for the kettle to boil try standing on one leg!

Based on information from:

Hrysomallis, C. Relationship Between Balance Ability, Training and Sports Injury Risk. Sports Med 37, 547–556 (2007). https://doi.org/10.2165/00007256-200737060-00007.

Sherrington C, Whitney JC, Lord SR, Herbert RD, Cumming RG, Close JC. Effective exercise for the prevention of falls: a systematic review and meta-analysis. J Am Geriatr Soc. 2008 Dec;56(12):2234-43. doi: 10.1111/j.1532-5415.2008.02014.x. PMID: 19093923.

Have you injured your knee? Is your knee now swollen or tender? Is the movement of your knee restricted? Can you walk?....Should you get an x-ray??

As clinicians we often use a screening test (the Ottawa Knee Rule) to help guide our decision making in whether or not to refer for an x-ray after a knee injury.

A knee x-ray is required in the following scenarios:

• You are unable to put weight through the leg for 4 steps after the injury occurs (limping is allowed).

OR

• You are aged 55 or over.

OR

• You have tenderness over the bony bump on the outside of your leg, just below your knee (head of fibula).

OR

• You have tenderness of your kneecap only (i.e. nowhere else around the knee is tender).

OR

• You cannot bend your knee more than 90 degrees.

*It is important to note that this screening test is only valid for up to 7 days after the injury has occured.*

These guidelines are for clinicians to combine with their own assessment and clinical reasoning skills. They should not replace an assessment by a medical professional nor medical advice. These guidelines purely act as a screening test to help us rule out the possibility of a bony injury to the knee.

Did you know: x-rays are also often used to assess for arthritic change in the knee BUT they are not necessarily needed for a diagnosis of arthritis to be made (read more here).

Information based on:

Stiell IG, Greenberg GH, Wells GA, McDowell I, Cwinn AA, Smith NA, Cacciotti TF, Sivilotti ML. Prospective validation of a decision rule for the use of radiography in acute knee injuries. JAMA. 1996 Feb 28;275(8):611-5.

Bachmann LM, Haberzeth S, Steurer J, ter Riet G. The accuracy of the Ottawa knee rule to rule out knee fractures: a systematic review. Ann Intern Med. 2004 Jan 20;140(2):121-4.

Have you rolled over on your ankle or injured your foot? It’s more than likely sore, swollen and a combination of glorious colours!

How do you know if it’s just a sprain (soft tissue injury) or if there may be a fracture (bone break) involved?

As clinicians there are a set of guidelines which we use as a screening test to help guide our decision making in whether or not to refer for an x-ray after an ankle/foot injury. These are called the Ottawa Ankle Rules.

Going by these these rules:

An ankle x-ray is required if there is pain around the ankle area AND:

• You are unable to put weight through the leg for 4 steps after the injury occurs (walking with a limp is okay).

OR

• You are tender on either of the sticky-out bony bumps located either side of the ankle (particularly towards the rear of these bone bumps) or any bony tenderness above or below these bumps.

A foot x-ray is required if there is pain around the middle of the foot AND:

• You have tenderness over the sticky-out bony bump on the outside of your foot (located about halfway between the outside of your heel and your little toe).

OR

• You are unable to put weight through the leg for 4 steps after the injury occurs (a limp is okay)..

OR

• You have tenderness over the bony bump on the inside of your foot (a few centimetres in front of the bony bump on the inside of your ankle).

It is important to note that these guidelines are for clinicians to combine with their own assessment and clinical reasoning skills. They should not replace an assessment by a medical professional nor medical advice. These guidelines purely act as screening test to help us rule out the possibility of an ankle/foot fracture.

Information based on:

http://www.theottawarules.ca/ankle_rules