Physiological and biomechanical changes in the aging runner

unnamed-2.jpg

The New Year often brings resolutions to be more active. Runners who gather renewed resolve to hit the trail may register for an upcoming race to inspire their training. Statistics show that the age of those participating in races is increasing dramatically. From 1980 – 2000, the New York City Marathon showed an almost 200% increase in runners over the age of 40 years(1). When researchers drilled down into the specific age groups, they found that the over 60-year-old brackets quadrupled their participants during that time span(1).

 Researchers attribute the increase in numbers to two likely causes. The first is that aging runners chose to maintain a running program throughout their lifespan. The second reason being that some people decide to start running later in life. Either way, while research and resources typically focus on young elite athletes, the reality is that the runner coming to seek your services will likely be over 40.

 Physiology of aging

 As the body ages, it undergoes changes in function. One change anyone with an aerobic training background knows immediately is the decrease in maximal heart rate recommended during aerobic activity (220 – age = Max Heart Rate (MHR)).  This in turn lowers overall cardiac output (Heart Rate (HR) x stroke volume) and the body’s ability to take in and utilize oxygen during exercise (basic calculation for VO2max = 15.3 x (MHR/Resting HR). There’s no getting around it, aging decreases endurance. Not only that, the lower VO2 max associated with aging is a known risk factor for chronic diseases1. Therefore, running later in life is an effective strategy to decrease one’s risk of declining health due to age(1).

 Better with age

 Knowing that the aging process takes a toll on the cardiac system and therefore, endurance, how does one explain athletes who perform better as they age? The key may be their ability to maintain or improve their running economy. Running economy (RE) is the rate of oxygen consumed during sub maximal running(2).  Good RE requires less energy and therefore less oxygen. Unlike VO2max, age doesn’t seem to effect RE.

 For the aging athlete with less than optimal RE, perceived effort increases as VO2max decreases. Due to the rise in exertion required, runners may lower their training volume or intensity. With a drop in training stimulus, VO2max suffers a further decline. Therefore, the consequential easing off of training from having to work harder magnifies the changes already taking place in the cardiovascular system of the aging athlete.

 Holding back the years

 Though sparse, longitudinal studies of elite runners show that runners who train at more intense thresholds throughout their life span show less decrease in VO2max over time than those who’s training levels off or declines(1). Training to increase VO2max requires near maximal effort over a sustained period of several minutes. Repeated training allows adaptation of the cardiovascular system as it becomes more efficient. While nothing can turn back the clock, training, even in Master athletes, can improve VO2max and stall the effects of aging. Therefore, encourage older runners to train at volumes and intensities at the limits of their abilities.

 Reference

 1.Sports Med Arthrosc Rev. 2019 March;27(1):15-212.Sports Med. 2004;34(7):465-85

 

 

 

Lower back and pelvic pain during and after pregnancy

Roughly 50% of pregnant women suffer from lower back pain or posterior pelvic pain; this increases towards the end of the pregnancy and through the first year after giving birth. The most widely accepted explanation for this is that these areas provide the most compensation for the increase in weight in the abdomen.

This research study is a systematic review, meaning it incorporates a large number of existing studies to draw the most accurate conclusions. This includes unpublished theses, and studies not written in the English language.

Does osteopathy work for lower back and pelvic pain associated with pregnancy?

Osteopathy provides significant reduction of pain, and improvement in function, for lower back and pelvic pain associated with pregnancy.

The key findings were:

  • Osteopathic Manual Therapy (OMT) was significantly more effective than usual care alone, or no treatment.
  • There were no serious side effects of OMT. Tiredness after treatment was a minor side effect.

Techniques that fell under the umbrella of OMT included structural, visceral, and cranial techniques. Specifically, structural techniques were listed as soft tissue manipulation, stretching, joint mobilisation, muscle energy techniques, and spinal manipulation. It is important to note that these techniques were used along with the philosophies of osteopathy. They were not just applied locally to the lower back and pelvis, but holistically, wherever needed to improve the body as a whole.

The study recognised that there was a limited amount of high quality evidence, but that the papers analysed were still significant with regards to OMT. Evidence was low to moderate for the benefit of exercise for pain and function. There was also low quality evidence to support craniosacral therapy, use of a lumbopelvic belt, and acupuncture. Due to the low quality of the evidence, it was difficult to compare to osteopathic treatment. The authors suggested that further research on the topic should involve more long-term follow-up for better quality evidence.

In the discussion, the point is raised that although there is clear benefit of osteopathic treatment, the exact reasons why are unclear. The authors draw the hypothesis that, as manual techniques have repeatedly been shown to reduce pain sensitivity, that these mechanisms allow for better neuromuscular function and control. This leads to the patient beginning to feel better, improving pain beliefs, and and allowing for further pain reduction and benefits to function.

—Franke, H., Franke, J., Belz, S. and Fryer, G. (2017). Osteopathic manipulative treatment for low back and pelvic girdle pain during and after pregnancy: A systematic review and meta-analysis. Journal of Bodywork and Movement Therapies, 21(4), pp.752-762.

WHAT NEW BACK PAIN RECOMMENDATIONS MEAN FOR YOU!

Ditch the pills. That’s what updated clinical guidelines[1] from the American College of Physicians revealed in early 2017. It’s so easy to head straight for the medicine cabinet when a twinge in your lower back has you howling, but a comprehensive review of randomized, controlled trials and systematic reviews on back pain relief is recommending clinicians encourage patients up nonpharmacological routes instead.

Why nonpharmacological treatments?

Regardless of treatment, most acute or subacute low back pain has actually been shown to diminish over time. The risks of popping over-the-counter pain relievers or even prescribed opiates far outweighs the risks of simply letting your back heal on its own.

Expediting the healing process, however, and obtaining relief from pain, enhancing your overall day-to-day functionality, and being able to return to work (if low back pain has prevented you) is possible with noninvasive practices. Surprising to some, the American College of Physicians first recommendation includes heat therapy, massage, acupuncture, and spinal manipulation. If medicinal aids truly are needed, skeletal muscle relaxants or nonsteroidal anti-inflammatories should be administered.

How do those treatments work?

Acute or subacute back pain is typically the result of overused, strained or inflamed muscles. Heat therapy is the simple application of hot packs, warm compress or heating pads to the affected area of your back (a warm bath counts too). Heat therapy helps relax swollen muscles, boost blood flow to the affected area, and eliminate lactic acid waste buildup which, in turn, relieves pain. Unless otherwise indicated by your doctor, heat should be applied for up to 20 minutes at a time, around three times a day.

Massage combines the power of tactile sense with targeted pressure, rubbing, and muscle manipulation to relieve low back pain. A 2011 study[2] found that participants who received one hour weekly massages over 10 weeks experienced low back pain reduction, a boost in functionality, and a reduction in the amount of anti-inflammatories they were taking. Massage therapy should be conducted by a trained and licensed therapist who knows the proper muscle groups to target and manipulate to alleviate back pain.

Acupuncture, while hotly debated at the turn of the century, has picked up steam as a short-term pain reliever for back pain sufferers. This ancient Chinese practiced involves super thin needles being inserted into the body’s skin and tissues at key points (meridians) which affect your body’s natural flow of energy (qi). Researchers believe the practice in fact stimulates a nervous system response which turns on opioid receptors and results in an analgesic effect.

Spinal manipulation which involves jolting and moving joints, massage, and applied pressure can help reduce inflammation, relieve pressure on joints, and improve nerve function. When used in combination with exercise, a 2015 randomized clinical trial[3] found that manual-thrust spinal manipulation reduced acute and subacute low back pain at up to 4 weeks of treatment.

What If My Back Pain is Chronic, Not Just Acute?

Treatment of chronic low back pain goes a step further with the ACP recommending more physical activity as treatment[4] – exercise, yoga, tai chi, multidisciplinary rehabilitation, motor control exercise, and progressive relaxation, for example. Regular physical fitness when completed daily for at least 30 minutes helps increase blood circulation, reduce muscle inflammation, loosen stiff joints, and boost feel-good endorphins.

Mindfulness activities including yoga practice and tai chi weave in meditation, deep breathing, and relaxation techniques to foster positive feelings of self-awareness and peace, also helping relieve stress and anxiety which might be amplifying back pain. Additional treatment incorporating spinal manipulation, biofeedback, and behavior therapy are also in the guidelines for treating chronic low back pain.

What Happens When None of Those Treatments Work?

Inadequate response to nonpharmacological treatments can be frustrating and stressful for both patient and treating clinician. With opioids having a high risk for abuse and addiction, the ACP recommends them as the last, last choice in treating chronic back pain.

Instead, NSAIDS (nonsteroidal anti-inflammatories) like aspirin and ibuprofen can be helpful pharmacological aids when taken in the directed doses. On a chemical level, NSAIDS actually block an enzyme in the body which produces compounds that lead to swelling and inflammation. Acetaminophen, commonly known in the US as Tylenol, is not an NSAID and is not recommended in efforts of reducing painful back muscle inflammation.

It is important to note that the updated guidelines do not address topical therapies (i.e. arnica or capsaicin cream), injection therapies, or the benefits of wearing a back brace for lower back pain. As pain is defined as electrical signals sent from your nerves to your brain, the noninvasive and nonmedicinal treatments that work for you may vary from those that work for the next patient. Treatment that works for you without creating unhealthy behaviors like overeating or not exercising, and with low risk to your organ health (i.e. your heart, brain, and kidneys) is always a good place to start.

LOW BACK RE-ALIGNMENT - HOW DOES IT WORK?

Low back pain (LBP) is such a common problem that if you haven’t suffered from it yet, you probably will eventually. Here are a few facts to consider:  1) LBP affects men and women equally; 2) It is most common between ages 30-50; 3) Sedentary (non-active) lifestyles contribute a lot to causation; 4) Too much or too little exercise can result in LBP; 5) A BMI around 25 is “ideal” for weight management, which helps prevent LBP; 6) Causes of LBP include lifestyle (activity level), genetics – including, but not limited to, weight and osteoarthritis; 7) Occupation; 8) Exercise habits, and the list can go on.

Let’s next look at how an adjustment is done.

When spinal manipulation is performed in the low-back region, the patient is often placed in a side lying position with the upper leg flexed towards the chest and the bottom leg kept straight. The bottom shoulder is pulled forwards and the upper shoulder is rotated backwards at the same time the low back area receives that the manipulation is rotated forwards. This produces a twisting type of motion that is well within the normal range of joint motion. When the adjustment is made, a “high velocity” (or quick), “low amplitude” (a short distance of movement) thrust is delivered often resulting in “cavitation” (the crack or, release of gases). So, WHY do we do this?

Most studies show that when there is back pain, there is inflammation. In fact, inflammation is found in most disease processes that occur both within and outside the musculoskeletal system. We know that when we control inflammation, pain usually subsides. That is why the use of “PRICE” (Protect, Rest, Ice, Compress, Elevate) works well for most muscle/joint painful conditions. We have also learned that IF we can avoid cortisone and non-steroidal drugs (like aspirin, ibuprofen, naproxen, etc.), tissues heal quicker and better, so these SHOULD BE AVOIDED! If you didn’t know that, check out:

MASSAGE ALONE IS NOT ALWAYS THE ANSWER

Often we get calls from people who are looking for a massage. When the receptionist queries their problem often the person is in pain and thinks that a massage will sort it out. The receptionist then explains that osteopaths do massage but they also look for the root cause of the problem.

What do I mean by this?

Often I see people who have back or neck issues which are persistent and some have had massage therapy which has helped but short term. The reason for this is that the spinal mechanics are altered. If the muscles in the back or neck become tight or spasm they will have an effect on the areas where they run to or from, namely the joints in the spine. Also if the joint becomes locked in position known as a “facet lock” this will cause the musculature around the area to contract.

In this situation the muscle is held tight, massage may give some temporary relief but if the joint is not released the tightness and pain will return. Therefore both the muscles and the affected joints need to be worked on in order to achieve total resolve.

So if you are suffering aches and pains then don’t delay and give us a call on 0871260384 and let us get you back on the road to recovery.

Share this:

HAVE you NOTICED A NEW buzz WORD IN HEALTH RECENTLY ? text neck

Children and teens are especially at risk for suffering symptoms of text neck.


Peter one of our Spine-health registered osteopaths, mentioned he is seeing more and more patients with this condition, so I asked him a few questions about this new spine health concern.

Below you’ll find my questions in bold, with his answers following.

What is text neck?

Text neck is the term used to describe the injuries and pain sustained from looking down at wireless devices for too long. The symptoms associated with text neck are:

I believe, as some studies suggest, text neck may lead to the early onset of arthritis and the potential for decreased lung capacity. Of course, text neck does not occur only from texting. For years, we've all looked down to read. The problem with texting is that it adds one more activity that causes us to look down more than in the past. This is especially concerning because young, growing children could possibly cause permanent damage to their spines as they grow.

How often do you see cases of text neck in your own practice?

Studies suggest that 79% of the population, ages 18-44, have their cell phones with them for 22 hours per day. Most of my clients fall in this age range, so I see several cases each day. Recently, a patient came in complaining of severe upper back pain. He woke up and was experiencing severe, acute, upper back muscle strain. I told him I believe the pain is due to the hours he was spending hunched over his cell phone: Diagnosis text neck.

How do you treat text neck?

Prevention is key. I instruct patients to hold their phones at eye level as much as possible. I also remind them to take breaks from their phones and laptops throughout the day. It is also important to practice good office ergonomics.

I also recommend a series of core exercises to help strengthen neck and back muscles. These exercises can help mitigate some of the effects text neck.

Finally, we come up with a comprehensive treatment plan which includes regular adjustments, massage therapy, and cold laser therapy.

HAVE YOU EVER HEARD OF A SPINAL TRANSPLANT! NEITHER HAVE WE. TAKE CAE OF THE ONE YOU HAVE!

Our Osteopath, peter best explains: Let's face it. Work can be a pain. Between deadlines, abrasive coworkers and budget cuts, the full-time office life often threatens to squelch even the cheeriest of employees. Now new research is proving what many of us have suspected for years -- work can be a literal pain, too. Back pain in the workplace is a common occurrence, and yet few workers (and even fewer employers) know what to do to combat it beyond the occasional five-minute stretch at the water cooler.

It's easy to make light of something we are usually able to just mentally push past, but the truth of the matter is, desk life is accelerating damage and even death to our bodies, and our work culture must be revamped in order for many to get out alive.

While it may sound dramatic, both professional statistics and the everyday experience of many office workers currently prove that back pain is an incredibly common problem in the office, and that it can often lead to more dire consequences.

How We Are Murdering Our Backs

Our bodies are not designed for a sedentary lifestyle, and yet in the face of such a technologically driven society, we often feel there is no choice but to spend generous portions of the day sitting in one spot. The average healthy person's back will take a beating from this low-energy lifestyle, leading to increased pain, stiffness and long-term problems. In other words, we prefer electronics over our physical well-being, and this needs to stop.

Our bodies are naturally designed to be active, and sedentary positions cause back muscles to tense up from supporting the rest of the body in a single stance for too long. The spine is also adversely affected and takes much longer to heal. We are unable to recover from much of this damage once it occurs, and women in particular will incur unsightly varicose veins that result in the same circulatory blockages that can cause the back pain.

Despite many companies promoting ergonomic working conditions, countless employees continue to practice poor posture and typing at their desk. This adds additional strain to the back, leading to long-term (and oftentimes permanent) damage to the lower back's ligaments. Outside of sitting all day at the office, some of us additionally sit in heavy traffic during our daily commute and also sit while eating lunch. This only adds to the stress on our back.

Finally, sitting contributes to obesity, which of course leads to undue strain on the back. Our joints and muscles are not designed to endure extra weight as the years go by, and as our bodies are aging and growing more frail, we are demanding they take on more work. It's a process that is detrimental to the whole of our systems, but often starts in the back. So, if you want to kill yourself while making a buck, consider continuing in your work routine. However if you're looking for a solution, read on.

If you already consider yourself to be particularly active,other things can cause back pain the workplace, including excessive force upon the back or repetitive movements for multiple hours.

Bu visiting archview clinic our team of professional osteopaths, physiotherapist exercise therapist and orthopaedic massage therapist will restore the curvatures you may have lost due to hours of hunching over your desk. At archview will customise a spinal corrective plane to set you on the way for a younger and more youth full spine.

BOOK ONLINEOR CALL 0871260384

DON'T LET BACK PAIN AFFECT YOUR GOLF:

If you are holding back on your swing for fear of a previous injury returning or perhaps the ache in your back is taking the enjoyment out of the round of golf then you should consider osteopathy.

Our Osteopath at DUBLIN CITY OSTEOPATH, gives tips and advice to Golfers with Back or Neck The following is some useful information on how our clinic is aware of the demands of golf on the body. 

 As peter mentions “In Recreational Golfers Injuries Usually Occur Because of” 

  •  Sporadic play with associated lack of fitness and poor motor control. 
  • Poor swing control due to lack of spinal mis-alignments, stiffness, muscle weakness & poor balance. 
  • Poor fitness leading to body fatigue by the end of a long walk up & down hills etc. over an 18-hole course. This negatively affects fine motor control leading to swing inaccuracies causing impact injuries, overuse injuries, sprains and strains. 

 Through personally designed treatment plans, our patients at the clinic have enjoyed increaselength to their drives and an improved short game. Less or no pain from previous injuries and more energy throughout the 18 holes, and consequently more enjoyment! 

Lets see how it works and share some of our insights.

Our Dynamic Approach to Golf Biomechanics through Osteopathy 

 The Neck (Cervical Spine) This area is one of the most important for your golf game. Good stable mechanics for the golfer’s eye-to-ball connection is fundamentalin allowing the whole body swing to work correctly. 

The Mid Back (Thoracic Spine) The middle of the back or thoracic spine can make or break the golf swing. A flexible and supple T-spine will allow for smooth swing mechanics, while restrictions( mis-alignments) will inevitably lead to poor performance and/or injury.

The ribs need to be able to expand, contract and rotate. This allows the diaphragm to move freely. Rotation can be restricted if the muscles between the ribs, (the intercostal muscles) are tight. You may have felt pain in your ribs after a day of hitting balls. This could be your intercostal muscles telling you they have worked too hard or are dysfunctioning. 

The Low Back (Lumbar Spine) Among professional and amateur golfers, low back pain has been cited as the most common golf-related injury.

It is estimated that 10-33% of all LPGA and PGA touring professionals are playing whilst injured at any given time and that half the group will develop chronic low back conditions. In the modern swing, the golfer finishes in a lordotic ‘reversed C’ position. This reversed ‘C’ leads to hyper-extension of the lower back which adds increased stress on the spinal joints and para-spinal muscles of the lumbar spine. Increased loads on the lumbar spine during the golf swing, together with the large forces generated by these muscles, predispose the golfer to muscular strains, spondylosis (degenerative spine conditions), and associated risk of herniated discs. 

Peter will help improve your golf biomechanics and posture thereby directly improving your golfers handicap.

Peter will identify the ‘at risk’ areas of your spine with our spinal muscle scan (semg) link to exercises to improve their game