IMG-20130212-WA0004

Hydrotherapy and exercise in water

Water is a safe, fun and uniquely challenging environment in which to exercise; it displaces up to 80% of a person’s weight (buoyancy effect) which makes it easier to move in water and provides the body’s joints with extra space which contributes to better range of motion and therefore ability. Muscle toning and strengthening becomes possible in the water for people who experience significant pain and dysfunction when attempting exercise on land: this includes arthritic conditions, overweight individuals as well as spinal conditions and injuries.

The hydrostatic pressure of water is also greatly beneficial to circulation: it assists the body in venous return, takes some stress off the heart and can help in decreasing swelling in the body, especially the extremities (legs and arms). The warm temperature of the water also contributes to better blood supply to the whole body which means there is more oxygen being delivered to the body as a whole and thus the body’s natural healing processes get a boost.

IMG-20130426-WA0001

Exercising in water is also a total body workout – the lungs and intercostal muscles have to work a bit harder in the water so respiratory rate increases while at the same time heart rate is naturally decreased so the stress on the heart is much less with more oxygen going round the body – and it feels mostly effortless.

IMG-20130212-WA0003

In addition, there are specific motion techniques the biokineticist uses such as Bad Ragaz, active assisted and active resisted movements and incorporation of proprioceptive neuromuscular facilitation (PNF) stretching patterns. A combination of all these exercises and movements make up a hydrotherapy session which means it is also of benefit to children with special needs such as spina bifida and cerebral palsy as well as adults with spinal cord injuries, multiple sclerosis, ankylosing spondylitis, joint rehab post-surgery – almost anything will benefit from being in the water.

hydro new

And you don’t have to know how to swim; the biokineticist is in the pool during the session to assist, demonstrate and carry out the various stretch and movement patterns.


 

Information adapted from:
– Introduction to Hydrotherapy Course (2009) by Dr G Joubert
– The Benefits of Aqua Aerobics Exercise from www.aerobicsworkout.net/aqua-aerobics-exercise.php
– Benefits of Water Aerobics from www.squidoo.com/benefits-of-water-aerobics

Kids' therapy

Biokinetics for the Low Muscle Tone Child

Muscle tone refers to the stiffness, or tone, of muscles. The various postural muscles of the body (supporting the spine and pelvis i.e. the trunk) are crucially important in helping us sit up properly and adjust our body position while we carry out daily activities. In children this becomes especially important as weakness in these trunk muscles can stunt development and lead to learning and concentration problems.

Some neurological conditions create low muscle tone due to areas of the brain being affected in-utero, during or after birth. These children generally need therapeutic intervention early on and may require years of exercise therapy to help correctly stimulate the brain and body to function as well as possible. However, more common, is low muscle tone from disuse: children are not as active anymore and so these muscles do not have a chance to develop and strengthen the way they should.

Exercise is fun

Parents also need to help out with home therapy programs for best results

This can lead to critical developmental milestones being delayed (such as crawling, sitting up and walking) or if the child is already entering a school environment they may battle to concentrate on their lessons as their trunk muscles are unable to keep them sitting up – the resulting slouched posture interferes with concentration and therefore learning. These children will need occupational and exercise therapy to correct the muscle tone and help them catch up to their peers and age-appropriate motor ability.

Biokinetics can assist the low muscle tone child alongside their occupational therapy by providing stimulating exercises which can be done at home as well to develop as much strength as possible. Swimming is often a great activity as it requires the use of entire body’s muscles plus motor coordination to correctly achieve a buoyant body position and stroke pattern. I usually combine swimming teaching with hydrotherapy when dealing with children in the pool: children learn best through play and positive reinforcement i.e. if they are having fun and don’t even notice the session is about therapy then their hard work does not feel like hard work and they are rewarded through praise and having fun.

Water therapy and exercise

Children have fun while gaining important motor skills in the pool

Aquatic therapy

Water is a great place for kids to become stronger

 

Pictures used from 10 Uses for an Exercise Ball with Children found on http://nspt4kids.com/parenting/10-uses-for-an-exercise-ball-with-children/  and The Aquatic Therapist from http://www.aquatictherapist.com/index/pediatric/
Low back pain

Biokinetics for low back pain

Low back pain is becoming more common among individuals of all ages, gender and activity levels. The most common cause of non-specific low back pain is weak core stabilising muscles and poor posture ².

The spine is made up of 33 individual bones called vertebra: 7 cervical vertebra of the neck. 12 thoracic vertebra of the trunk, 5 lumbar vertebra of the lower back and 9 fused vertebrae of the sacrum ¹. The vertebrae form a protective tunnel around the spinal cord from the brain down to the sacrum. Nerves exit the side of each vertebra to innervate specific areas of the body; these nerves can be found next to bone, muscle and ligaments ¹.

Spine anatomy

Structures of the spine

Vertebral discs are located in between each of the vertebra of the spine to act as shock absorbers during the force distribution the body experiences while we move about. There are also many ligaments and muscles running along the spine to support it and keep it aligned correctly ¹.

If there is an injury to any of the joints in the vertebrae or inflammation, this creates dysfunction – an interruption in the correct function of each muscle and joint in the spine. Most often this translates into muscle spasm and pain; because of this pain we tend to try avoiding using the affected muscle which in turn leads to disuse atrophy ³. The affected muscle becomes deactivated and unable to fulfil its function correctly, which in turn puts even more pressure on the other muscles and structures of the spine leading to further pain and dysfunction ³.

Biokinetics use the science of movement and exercise to find exactly which muscles need to be strengthened and which stretched in order to prescribe an exercise program to target these muscles and create a better balance between supporting muscles (the core) and the rest of the body. Exercises include flexibility work: stretching hamstrings, gluteals, quadriceps, muscles along the spine. Flexibility will improve the muscles’ ability to move more and thus allow the joints on either side to move better as well. Better movement leads to less pain and inflammation ². Strength work usually begins with self-awareness: being able to locate the deep core muscles, these include the pelvic floor muscles (Kegal exercises), the erector spinae and multifidi muscle groups alongside the spine and the gluteal muscles. Teaching the brain to activate these muscles is the first step in improving spinal stability so that all other movements have a strong foundation to work from ².

Most individuals feel a significant improvement within a few sessions of starting biokinetics if there are no other underlying conditions (these will be discussed in more detail in other posts).
.
References used in this article

  1. Hamilton, N. & Luttgens, K. (2002). Kinesiology. Scientific Basis of Human Motion. [10th ed.] McGraw Hill.
  2. Houglam, P.A. (2005). Therapeutic Exercise for Muscoluskeletal Injuries [2nd ed.] Human Kinetics.
  3. Ulrich, P.F. (n.d.). Back Muscles and Low Back Pain. Retrieved on 5 January 2016 from http://www.spine-health.com/conditions/spine-anatomy/back-muscles-and-low-back-pain.
Keep going

Motivation to keep exercising…some basics

Many articles will cite 21 days as the amount of time needed to form a new habit – this is not always true – but it’s a great way to start a countdown to making change (for the better) that will become an integral part of your lifestyle. Our attitude is one of the biggest obstacles to staying motivated and going on even when you don’t feel like it. These mental barriers need to be confronted in order to start and maintain a regular exercise routine (or any good habit really). I will deal with this topic in more detail in another post later.

We’ve all heard (and made) many excuses to why we can’t or won’t exercise today – address each one and find a way to overcome it. Here are a few to get you going:

“I don’t have the time…”

Solution: you can devote small chunks of time throughout the day to exercise – in the end it all adds up. For example doing sit ups during tv commercials. You can also do 10min of walking in the morning + 10min of body weight exercises (like push ups or sit ups) + 10min of walking in the evening = 30min that day.

 “I’m too tired”

Solution: nine times out of ten you will feel much better after your session as exercise gives us more energy – more oxygen circulating to the brain so your work capacity improves among many other benefits

Keep going

Keep calm and always keep moving

“I’m afraid of getting injured”

Solution: learn correct warm up and cool down techniques from your biokineticist and chat about how they can help you get started with a program and how to increase and progress over time. As your confidence on your ability increases you will find that doing more challenging exercises become easier to execute

“What do I wear to the gym?!”

 Solution: wear what you are comfortable in. Going to the gym is not Paris Fashion Week – make sure your clothes are breathable and allow lots of movement. Most people are generally too busy worrying about themselves to take any notice of others

“It’s too expensive”

Solution: you only really need a decent pair of training shoes, comfy sweat pants and t-shirt to get started whether you will be training at gym, at home or walking round the block.

“I don’t feel like it”

Solution: You may not want to, but you need to! Exercise is good for you in so many many many ways. More energy, better weight management, improved concentration, feeling healthier and stronger, almost all chronic condition symptoms start improving or going away…the list goes on

“Who will look after the kids?”

Solution: hire a babysitter or find a friend or relative who can help out for that hour while you go exercise, or hop on the bike at home while the kids are taking a nap. Alternatively you can involve your kids in exercise as a family – there are a myriad of fun home exercise for kids and adults to do together if you get creative enough

Fitness as a family

Exercising together as a family can be fun and a great time to bond

I’m too old to get active now anyway”

 Solution: not true! Age doesn’t matter. You should become even more active after retirement and even try learn new skills which have always been on your wish list (such as ballroom dancing or swimming). Do more gardening, take more walks, play with the grandchildren. The more active we are as we get older the more endurance we will have to keep doing ordinary, everyday things without pain, discomfort and injury

So what are you waiting for….?

Never quit

Just keep going one step at a time


I made use of images from:

http://hypnosishealthinfo.com/exercise-motivation-booster-hypnosis-mp3/

https://www.pinterest.com/digarcee/running-again/

http://wellfesto.com/tag/motivation/

http://www.cliparthut.com/curl-exercise-clipart.html

http://www.clipartsheep.com/family-fitness-exercise-ball-illustration-exercising-stability–clipart

Person stretching their quads

Stretching for flexibility

Why stretch?

Injury prevention The ability of a muscle to stretch determines the range of movement of the various joints of the body. If a muscle between two joints (like the hamstring) is restricted due to lack of flexibility then the joints on either end (your hip joint and knee) cannot move through their full range of motion which in turn affects the joints connected to these joints (the rest of your pelvic structure, lower back, ankles) and so on, creating an inflexible and inefficient movement pattern which over time can lead to poor posture, joint pain, muscle pain and injury. Using equipment such as foam rollers can assist in providing a good stretch to various muscle groups like the ITB, quadriceps or hamstrings.

Foam rolling

An example of a foam rolling to stretch the ITB

Static Stretching

This is the traditional form of stretching where the position of the joint is maintained without any movement for 20 to 60 seconds at a time. These stretches are generally the most commonly known as there are a large number of standard stretch positions for all major muscle groups of the body.

Shoulder and upper back opener

Forward fold shoulder stretch

Calf stretch

Calf stretch against a wall

Side lying quad stretch

Quadriceps stretch lying on your side

Figure-4-Stretch

Figure 4 gluteal (bum & hip) stretch

 Dynamic Stretching

Makes use of various continuous exercise movements for a certain number of repetitions to increase the range of motion which the muscle can achieve stretching before exercise vs stretching after exercise.

Arm swing

Dynamic stretch: arm swings

Leg swings

Dynamic stretch: leg swings

(above images from http://www.nutritioulicious.com/2013/09/dynamic-vs-static-stretches-the-importance-of-both/ and http://fitting.2ndswing.com/stretchingwarming-dynamic-stretches-golf/)

Should I stretch before or after exercise?
Current trends in research and literature reveal conflicting information regarding this debate, however it is generally accepted that performing dynamic stretches before exercise helps improve blood circulation to the muscles as well as helping to become mentally prepared for physical exertion.

The nature of static stretching is slow and controlled and most beneficial when there is increased blood flow and the muscles are warm after exercise, hence the muscle fibres can reach greater lengths without injury and mentally, static stretching becomes a great way to cool down after exercise.

 

Good body alignment during squats and lunges

Correct exercise technique is important not just for optimum fitness results but also to keep your body safe and thus (hopefully) injury-free. A very common error, most often because of lack of knowledge, people do not squat or lunge correctly. There are a myriad of factors that influence a person’s ability to do either one of these such as leg strength, familiarity, pelvic stability and body awareness, so it is important to get as many of these (ideally all) as correct as possible to reduce injury risk.

Exercise type: squat

How to do a squat

A basic squat involves keeping your feet about shoulder-width apart, spine upright, chest up then pushing the hips backwards and bending the knees as in the image below. The position of the arms can assist in balance if needed.

A basic lunge involves stepping forward, bending the knees to go downwards while maintain an upright spine and level hips, then pushing upwards again to reverse the motion and step back to the starting position.

Exercise type: lunge

How to do a lunge

So to achieve a healthy body alignment in either of these exercises it is important to be aware of what your body is doing throughout the movement – using a mirror and a spotter is a great way to achieve this. Traditionally “knees behind the toes” is a good general cue to help with alignment: one should always aim to keep the knee joint behind the toes, even over the ankle joint itself of possible, to keep the shear forces going through the knee at a minimum (these forces may lead to overuse of the cartilage in the knee and increase the chances of an injury). Another great way of getting this alignment right is to keep your knee over the second toe of the foot. Therefore, you should still be able to see your toes when performing a squat or alunge as in the picture here.20150901_132102Also important to remember is to check on whether your knee is caving inwards which often happens if the foot is over-pronated upsetting the biomechanics of all the bones in the ankle, shin, knee, thigh and pelvis. This next picture shows an example of this which I found on https://www.silversurfers.com in an article called The Strength of Strength.

Correct alignment

Body alignment when lunging

Because we all have different body types and are at varying stages of strength and ability when exercising some people may find it more difficult to achieve the ideal alignment, but as long as you aim to get most of these alignments right, with practice, lunges and squats will become easier to do which will also make it easier to find and correct any issues. However, if you are in doubt or need extra help then get some more professional help with your exercise techniques.

Pool session

How can a biokineticist help you?

What is it that we do? And how do you pronounce this long word? Well first of all, the long word can simply be shortened to “bio” which is much easier to say. Secondly, it can be broken down into exactly what we do: “bio-“ means life, anything to do with the body. “Kinetics” refers to movement, energy. This gives you “life through movement” which is also the slogan of our Biokinetics Association (www.biokinetics.org.za).

In essence a bio uses movement and exercise as medicine.

Biokinetics exercises in action

Exercise as medicine

As a biokinetics student we have to learn physiology and anatomy so that we know what the body is made up of and how it works, then what can go wrong and finally we are taught how to fix it using exercise prescription. Each person who walks through the door is different even if they have the same condition and therefore each person will have unique needs and responses to the movements and exercises prescribed. An initial full depth assessment is necessary to establish these needs and give the me, the bio, a detailed picture of the state of the body: muscle tone, posture, pain levels, previous injuries and medical history.

Hip joint range of motion

How far can you move?

This big picture is then broken down into phases of exercise adaptation over some weeks where the patient must learn better or new movement patterns, muscle control, correct muscle activation. Normally I prescribe a set of exercises to do at home which complements what is done in sessions with me. As various milestones and goals are met the exercises are made more complex and challenging until the maintenance or return to sport phase is achieved – the patient is no longer a patient and is fully recovered and can once again live life.

So in short, the body functions like a (kinetic) chain: if one link is weakened or not working the way it should all the other links will be affected in some way eventually. It is the bio’s job to identify this weakest link, find out why it’s not performing as it should and prescribe the correct exercises to fix this to what is was and preferably to make it even better.

Walking on the treadmill

Moving is good for us!

 

BASA logo

So what is the difference between biokinetics and physiotherapy?

A question I get asked very often… The difference is how we approach the injury and what type of therapy and rehabilitation is done, this is our scope of practice.

Physiotherapy deals with first phase rehab – the recovery needed just after an injury or surgery – with the physio working to decrease pain, improve range of motion and getting basic muscle function back.

The biokineticist then takes over into final phase rehab which builds on what was done at physio and takes the injured part into full movement and full functional strength (or in the case of athletes) a return to sport. There is an area of overlap between the two disciplines so it is therefore ideal to work with a team who are constantly referring back and forth between each other to ensure the patient gets the best treatment possible.

An example of the two disciplines working together would be treating a teenage rugby player who tore a knee ligament during a match: once the initial rest period is over (prescribed by the doctor) the physio would use massage or ultrasound to manage pain, swelling and stimulate healing in the knee. Over several weeks specific movement and manipulation of the joint retrains the muscles of the thigh to work correctly, improves the joint range of motion, ensures there is no pain and the athlete can fully weight bear on that leg before being referred to the bio. The bio then works with the athlete to regain full use of the knee through specific exercises that target the thighs, pelvis and lower leg muscles which eventually become even more specific to rugby which ensures the athlete is fit when returning to play and does not re-injure the joint (ideally).

So, both the bio and physio play an important role in fully rehabilitating injuries and should not be overlooked or skipped as movement and exercise can truly be the best medicine.