Hot pack or cold pack: which one to reach for when you’re injured or in pain

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Andrew Lavender, Federation University AustraliaWhen you injure yourself, you may reach for a hot or a cold pack. Which option is better depends on the nature of your pain, what caused it and how long you’ve had it.

Heat therapy, sometimes called thermotherapy, involves applying heat to an injury or painful area on the body. Hot water bottles or pads that can be heated in a microwave oven are commonly used. Cold therapy, or cryotherapy, can come in the form of water bottles or pads cooled in a fridge or freezer.

Placing something cold at the injury site causes the blood vessels, arteries and veins, to narrow. This reduces blood flow through the area and helps reduce inflammation and swelling. Adding heat to the area has the opposite effect: opening the blood vessels up and increasing blood flow through injured tissue.

These opposite effects are useful in different situations.

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Feeling sore after exercise? Here’s what science suggests helps (and what doesn’t)

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Cooling down to prevent inflammation

We can treat injury or tissue pain with a hot or cold pack, or sometimes alternate the two.

Cold therapy should be used for injuries that result in swelling and inflammation such as joint sprains, muscle strains or bruises. The objective is to slow blood flow to the area and prevent the effects of the injury. Gel packs that can be kept in the freezer, coolant sprays or even a bag of frozen veggies will do the job.

It is important to avoid holding ice in direct contact with the skin for long periods as this can cause skin damage. It is best to wrap ice in a cloth and then apply it.

Cold therapy is most effective in the immediate or acute phase of pain when swelling and inflammation first kicks off. Typically, the treatment should be applied for about 20 minutes and can be reapplied every two hours for a few days. After that, the injury should be well into the healing phase and the swelling and inflammation will subside.

Cold therapy, or applying ice, is often used in conjunction with rest, compression and elevation, known in first aid by the acronym RICE.

So, ice can be useful when we want to limit the initial swelling and pain, since too much or prolonged swelling can impede the healing process. But with less severe injuries like minor sprains and strains, inflammation is part of the body’s healing process and continuing cold therapy can be a barrier to recovery.

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Can’t face running? Have a hot bath or a sauna – research shows they offer some similar benefits

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When to warm up

Heat therapy is generally thought of as being either dry or moist.

Dry heat therapy includes hot water bottles or heated pads. These are easy to apply and are effective for reducing pain. Moist heat therapy includes warm bath, hot wet towel and moist heat packs.

Heat therapy is not recommended for acute management of sprains, strains or contusions as this promotes blood flow and can increase swelling and pain.

Heat therapy can help chronic conditions such as recurring joint pain, neck or back pain.

If pain is due to a strain or sprain, cold therapy should be applied immediately, but heat therapy can help relieve pain from 72 hours post-injury.

Cooling down an injury immediately after it happens can reduce swelling but don’t do it for too long.
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Heat therapy does not mean applying something very hot, rather it should be warm, pleasant and easily tolerated for long periods.

Heat therapy can be very effective for muscle tension or joint stiffness — increasingly blood flow and heating muscles or joints for around 15 minutes before physical activity as a kind of warm up. This approach can also help people engage in activities that might aggravate a chronic injury by loosening and relaxing injured muscles.

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Health Check: do joint and muscle aches get worse in the cold?

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Heat is used differently for bluebottle stings. These are best treated by a medical professional in a hospital emergency department. But, as a first aid intervention, pain can be reduced by applying hot water (42–45°C) to the area for 30–90 minutes.

Alternating hot and cold to an area of pain has been used for decades but there has not been a great deal of research assessing the practice. One study assessed hospital inpatients with heel pain and found greater improvement in foot function after hot/cold therapy compared with a group who underwent standard therapy.

Soaking in it

Athletes commonly use water immersion therapy for recovery.

However, this practice is also not without controversy. One review of the evidence found cold water immersion improved performance, measured by jumping and all-out sprint ability 24 hours after a sporting event. Fatigue was also reduced at 48–72 hours after sports events.

This type of temperature control therapy may also help with recovery after undertaking some sustained physical exertion such as a day of hiking.

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Health Check: why do my muscles ache the day after exercise?

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So, cold first and maybe heat later

The take-home message is that cold packs work well for reducing pain and inflammation in the acute phase of a strain, sprain or bruise — especially when used in as part of the RICE method.

Heat packs are useful for reducing muscle tension and stiffness and pain in the joints, but never in the initial phase of an injury. There is not enough evidence to show alternating the two is particularly useful, while cold water immersion therapy may help recovery after sport or sustained physical exertion.

Andrew Lavender, Senior Lecturer, School of Science, Psychology and Sport, Federation University Australia

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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How to Get a Good Night’s Sleep

The Human Body

Not feeling motivated to tackle those sneaky COVID kilos? Try these 4 healthy eating tips instead

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Clare Collins, University of Newcastle and Rebecca Williams, University of Newcastle

In Australia and around the world, research is showing changes in body weight, cooking, eating and drinking patterns associated with COVID lockdowns.

Some changes have been positive, such as people cooking at home more, and eating more vegetables.

But many people have also reported snacking more, and eating and drinking in response to stress.

As the new year starts, you may be planning to tackle COVID-related weight gain. Before you do, consider that it may be better to focus on your eating patterns, rather than looking to the latest fad diet.

Emotional eating and weight gain

A survey of 13,829 Australian adults found one in five reported drinking more alcohol during COVID. In a survey of over 22,000 drinkers in the United Kingdom, one-quarter reported drinking more than usual over the previous week.

In Italy, of 602 people surveyed about changes in their eating habits during isolation, almost half said they sought “comfort foods” and ate more to feel better.

Eating and drinking alcohol boosts the release of “feel good” chemicals in your brain, making you feel better in the short term.

During times of stress, anxiety and boredom, like during lockdown, food and alcohol can seem like a quick fix. But overindulging isn’t going to help you in the long term.

A new year can be a good time to think about your eating habits.
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According to a global WebMD poll on self-reported weight gain during the pandemic, about one-quarter of people in Hong Kong and Germany reported gaining weight, roughly 45% in Australia, Canada and the UK, and over 60% in Brazil and Italy.

United States respondents who reported putting on weight were asked to estimate how much weight they thought they had gained. Some 49% said less than 3 kilograms, 26% said 3-4kg, and 25% reported more than 4.5kg.

Participants believed a lack of exercise, stress eating and drinking more alcohol were contributing factors.

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Health Check: what’s the best diet for weight loss?

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It’s not just about weight

While weight gain can increase your risk of health problems, recent research suggests having healthy eating patterns is more important than weight.

A US study of 210,000 adults followed for up to 32 years found that irrespective of body weight, having a high diet quality was associated with lower risk of heart disease and stroke compared to having low diet quality.

A “high-quality” diet includes lots of variety within the basic food groups of vegetables, fruit and wholegrains, and includes limited junk food. A “low-quality diet” is the opposite.

Similarly, a Swedish study followed 79,000 adults over 21 years and found that among people with a higher body weight, also having a high-quality diet was protective against dying from any cause. But having a body weight in the healthy range was not protective among those who had a low-quality diet.

While higher diet quality is associated with better overall health, increasing your diet quality can also help reduce weight.

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Health Check: six tips for losing weight without fad diets

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4 tips to improve your diet and beat COVID kilos

Home cooking and eating together

If you spent more time cooking and eating meals at home during the pandemic, keep doing it. As well as being better for you than eating take-away foods and ready-made meals, it promotes well-being.

A study of 160 adults found people who ate healthy foods cooked at home experienced more intense positive emotions and worried less, compared to people who ate away from home.

For adolescents, a review found frequent family meals were associated higher self-esteem and other indicators of better mental health.

Many people were cooking and eating at home more during lockdown.
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Eat more vegetables and fruit

A US study of 133,468 adults found those who increased their vegetable and fruit intakes lost weight. Every extra daily serve of fruit was associated with a weight loss of 250 grams over a four-year period, and every extra daily serve of vegetables with a loss of 110 grams. People who ate more berries, apples, pears, cauliflower, green leafy vegetables and carrots experienced greater weight loss.

This has well-being benefits too. For example, an Australian study which followed 12,385 adults from 2007 to 2013 and found greater life satisfaction, happiness and well-being among those who increased their intake of vegetables and fruit.

Try buying bigger quantities and a greater variety of vegetables and fruit when you do your grocery shopping.

Keep a food diary

Recording what you eat and drink and then checking the kilojoule and nutrient content helps boost your knowledge of what’s in various foods and drinks. It also increases awareness of your eating habits, especially snacking. You can use an app or pen and paper.

Once you’ve recorded your food and drink intake for a few days, you will notice areas to target for improvement.

You might also consider keeping a mood diary. This can help you identify other ways to improve your diet quality. The mood you’re in affects your food choices and your food choices affect your mood. Keeping track of both food and mood helps to identify triggers for eating.

Plan meals and snacks ahead

Check what ingredients you already have and plan meals and snacks to use these up. Next write a grocery list, just for what you need. Even if you’re staying home, prepare your lunch and snacks for the day in advance. This saves you time, money, limits food waste and reduces the number of times you have to think about food.

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How we cook changed during lockdown – and we can learn from this for life after the pandemic

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Visit the No Money No Time website to check your diet quality score using our free healthy eating quiz and find simple, inexpensive and healthy recipes.

If you’d like to learn more about food, nutrition and weight management, enrol in our free online course, The Science of Weight Loss – Dispelling Diet Myths, which starts on January 27.

Clare Collins, Laureate Professor in Nutrition and Dietetics, University of Newcastle and Rebecca Williams, Postdoctoral Researcher, University of Newcastle

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Feeling sore after exercise? Here’s what science suggests helps (and what doesn’t)

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Andrea Mosler, La Trobe University and Matthew Driller, La Trobe University

Have you been hitting the gym again with COVID restrictions easing? Or getting back into running, cycling, or playing team sports?

As many of you might’ve experienced, the inevitable muscle soreness that comes after a break can be a tough barrier to overcome.

Here’s what causes this muscle soreness, and how best to manage it.

What is muscle soreness and why does it occur?

Some muscle soreness after a workout is normal. But it can be debilitating and deter you from further exercise. The scientific term used to describe these aches is delayed onset muscle soreness, or DOMS, which results from mechanical disruption of the muscle fibres, often called “microtears”.

This damage causes swelling and inflammation in the muscle fibres, and the release of substances that sensitise the nerves within the muscle, producing pain when the muscle contracts or is stretched.

This pain usually peaks 24-72 hours after exercise. The type of exercise that causes the most muscle soreness is “eccentric” exercise, which is where force is generated by the muscle as it lengthens — think about walking downhill or the lowering phase of a bicep curl.

Soreness in the days after exercise is normal, and actually results in stronger muscles.
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There’s good news about this pain though. When the muscle cell recovers from this “microtrauma”, it gets stronger and can produce that force again without the same damage occurring. So although this strengthening process is initially painful, it’s essential for our body to adapt to our new training regime.

The inflammatory component of this process is necessary for the muscle tissue to strengthen and adapt, therefore the repeated use of anti-inflammatory medication to manage the associated pain could be detrimental to the training effect.

Will recovery gadgets put me out of my misery? Not necessarily

Before we even think about recovery from exercise, you first need to remember to start slow and progress gradually. The body adapts to physical load, so if this has been minimal during lockdown, your muscles, tendons and joints will need time to get used to resuming physical activity. And don’t forget to warm up by getting your heart rate up and the blood flowing to the muscles before every session, even if it’s a social game of touch footy!

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Even if you do start slow, you may still suffer muscle soreness and you might want to know how to reduce it. There are heaps of new recovery gadgets and technologies these days that purport to help. But the jury is still out on some of these methods.

Some studies do show a benefit. There have been analyses and reviews on some of the more common recovery strategies including ice baths, massage, foam rollers and compression garments. These reviews tend to support their use as effective short-term post-exercise recovery strategies.

So, if you have the time or money — go for it! Make sure your ice baths are not too cold though, somewhere around 10-15℃ for ten minutes is probably about right.

And a word of caution on ice baths, don’t become too reliant on them in the long term, especially if you are a strength athlete. Emerging research has shown they may have a negative effect on your muscles, blunting some of the repair and rebuilding processes following resistance training.

New recovery methods and gadgets are marketed everywhere, but most of them require further research.
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But the efficacy of other recovery strategies remain unclear. Techniques like recovery boots or sleeves, float tanks and cryotherapy chambers are newer on the recovery scene. While there have been some promising findings, more studies are required before we can make an accurate judgement.

However, these recovery gadgets all seem to have one thing in common: they make you “feel” better. While the research doesn’t always show physical benefits for these techniques or gadgets, often using them will result in perceived lower levels of muscle soreness, pain and fatigue.

Is this just a placebo effect? Possibly, but the placebo effect is still a very powerful one — so if you believe a product will help you feel better, it probably will, on some level at least.

The ‘big rocks’ of recovery

Some of the above techniques could be classified as the “one-percenters” of recovery. But to properly recover, we need to focus on the “big rocks” of recovery. These include adequate sleep and optimal nutrition.

Sleep is one of the best recovery strategies we have, because this is when most of the muscle repair and recovery takes place. Ensuring a regular sleep routine and aiming for around eight hours of sleep per night is a good idea.

Ultimately, adequate sleep and optimal nutrition are the best ways to recover after exercise.
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When it comes to nutrition, the exact strategy will vary from person to person and you should always seek out nutrition advice from a qualified professional, but remember the three R’s:

• refuel (replacing carbohydrates after exercise)

• rebuild (protein intake will aid in the muscle repair and rebuilding)

• rehydrate (keep your fluid intake up, especially in these summer months!).

Enjoy your newfound freedom when returning to sport and exercise, but remember to focus on a slow return, and to make sure you’re eating and sleeping healthily before spending your hard-earned cash on the hyped-up recovery tools you may see athletes using on Instagram.

Andrea Mosler, Post-Doctoral Research Fellow, Sport and Exercise Medicine Research Centre, La Trobe University and Matthew Driller, Associate Professor, Sport and Exercise Science, La Trobe University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Physio, chiro, osteo and myo: what’s the difference and which one should I get?

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Charlotte Ganderton, Swinburne University of Technology and Matthew King, La Trobe University

Many of us might not be as fit as we were before the pandemic hit, and as community sport restarts and gyms reopen across the country amid eased coronavirus restrictions, some people might be at increased risk of injury.

If you do pull your hamstring in your first game back, or work from home life has left you with a sore neck and headaches, you might think about visiting a health-care professional to treat your complaint.

But your sister sees a physiotherapist, your mother a chiropractor, your friend an osteopath and your cousin a myotherapist. All of them come highly recommended, so who do you choose to help manage your aches and pains, and what are the differences between the four?

In Australia, physiotherapists, osteopaths and chiropractors have extensive university training and are registered with the Australian Health Practitioner Regulation Agency (AHPRA). Myotherapists have completed an advanced diploma or bachelors degree in myotherapy or “musculoskeletal therapy”, but aren’t registered with AHPRA. All four types of health professionals are primary contact practitioners. This means you don’t need a GP referral to seek treatment.

You will find all four in private health care, but you’re more likely to be treated by a physiotherapist in the public sector (for example, at public hospitals) compared to chiropractors, osteopaths and myotherapists.

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The chiropractic war with reality rages on…

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Similar definitions, on paper

A physiotherapist assesses your problem, provides a diagnosis and helps you understand what’s wrong while considering your general health, activities, and lifestyle. They treat your complaint with a variety of “active” therapies, such as exercise programs and hydrotherapy. They also use “passive” therapies, such as massage, joint manipulation, and mobilisation (a technique used to increase movement of a joint).

There are many different sub-disciplines within physiotherapy. For example, some specialise in treating problems that arise from neurological conditions, like multiple sclerosis or stroke. Some also focus on assisting patients with heart and lung conditions, for example emphysema or after lung infections like pneumonia (or COVID!).

A chiropractor works on the diagnosis, treatment and prevention of mechanical disorders of the muscles, ligaments, tendons, bones and joints, and the effect on the nervous system. They have an emphasis on passive manual treatments, including joint and soft-tissue manipulation, and spinal adjustments. They may also prescribe exercises to help you rehabilitate from your condition as well as provide dietary advice.

Over the last decade, some forms of chiropractic care have come under media and scientific scrutiny, particularly in children and infants, and should therefore be approached with caution.

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An osteopath focuses on the muscular and nervous systems, assessing the structure of the body to determine its impact on function. For example, the position of your spine and pelvis may impact on the way you reach over to weed your garden. Treatment involves a combination of active and passive therapies, including joint manipulation and mobilisation, massage, as well as postural advice and exercise programs.

A myotherapist works to assist your aches and pains by focusing on the muscles and joints. They offer a range of mostly “hands-on” treatments including dry needling, massage and joint mobilisation, but can also prescribe exercises.

The profession is not registered with AHPRA. Myotherapists are not formally recognised under the umbrella of allied health in some regions of Australia. As such, they were forced to delay reopening as coronavirus restrictions eased in Melbourne, as allied health including physiotherapists were allowed to reopen first.

There’s a lot of crossover in treatments offered between the four professions and not all services offered are supported by high-quality scientific research.

The discipline of chiropractic has come under intense scientific scrutiny and should be treated with caution.
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So, what is the scientific evidence?

Understanding if your health-care professional applies evidence-based practice to their treatment will help you decide which therapist is right for you.

Evidence-based practice relates to how any health professional integrates their clinical knowledge with the best available research evidence, and your individual values and circumstances, to assess and manage your health-care complaint. Whether or not this is implemented into daily practice will vary on the individual therapist, and may not be consistent across the entire profession.

Scientific evidence supports the use of treatments where you, as the client, are actively involved in the management of your condition, including education and undertaking an exercise plan — what we call “exercise prescription”.

The breadth of scientific evidence for exercise prescription as a treatment for muscle, ligament, tendon, bone and joint complaints far outweighs the limited scientific support for the prolonged use of “passive” treatments like massage, manipulation, and adjustments. Research suggests these passive treatments should only be used as adjuncts to active treatments. This type of therapy may be appropriate in the early stages of your care, and let’s face it, most people love a massage.

However, in the long term, it doesn’t equip you with the skills required to manage your condition. It may even result in over-reliance on your health-care professional and cost you more in the long run. It’s important to find a health-care professional that empowers you to participate in appropriate exercise, develop skills to self-manage your aches and pains and maintain a healthy, active lifestyle.

The evidence suggests health care that empowers you to take control of your condition is more effective than passive therapies like massage, in the long run.
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Anecdotally, we think that physiotherapists and osteopaths are well equipped to implement an active management plan for your aches and pains. However, as an individual, you should seek out a health-care professional that supports you to manage your own condition. You could do this by speaking to your doctor, reading the biography of your practitioner, or phoning the clinic to enquire about the type of care provided prior to booking an appointment. Your health professional should be someone that walks alongside you and guides you on your rehabilitation journey.

Here are some questions you can ask yourself to help decide if the health-care professional is the right fit for you:

1. will they consider my overall health status, social situation, and hobbies to create a treatment plan?

2. will they educate me on the importance of actively self-managing my aches and pains?

3. will they encourage me to undertake exercise and/or physical activity?

4. will they ask me about my goals and what I want the outcome to be?

5. will they help me determine what to do if my aches and pains flare up in the future?

Charlotte Ganderton, Lecturer, Swinburne University of Technology, Swinburne University of Technology and Matthew King, Postdoctoral Research Fellow and Physiotherapist, La Trobe University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Strength training is as important as cardio – and you can do it from home during COVID-19

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Jason Bennie, University of Southern Queensland; Jane Shakespear-Druery, University of Southern Queensland, and Katrien De Cocker, University of Southern Queensland

We often get bombarded with the message “regular physical activity is the key to good health and well-being”. To most of us, when we hear “physical activity”, we typically think of aerobic exercise such as walking, jogging, and cycling.

But recent evidence suggests muscle-strengthening exercise is very beneficial to our health. In our study, published today, we argue muscle-strengthening exercise deserves to be considered just as important as aerobic exercise.

And the good news is strength training can be done by anyone, anywhere — and you don’t need fancy equipment.

Strength is just as important as cardio

Muscle-strengthening exercise is also known as strength, weight or resistance training, or simply “lifting weights”. It includes the use of weight machines, exercise bands, hand-held weights, or our own body weight (such as push-ups, sit-ups or planking). It’s typically performed at fitness centres and gyms, but can also be done at home.

More than 30 years of clinical research has shown that muscle-strengthening exercise increases muscle mass, strength and bone mineral density. It improves our body’s capacity to clear sugar and fat from the bloodstream, and improves our ability to perform everyday activities such as walking up stairs or getting in and out of a chair. It can also reduce symptoms of depression and anxiety.

In our research, we reviewed the evidence from several large studies and found muscle-strengthening exercise is associated with a reduced risk of early death, diabetes, cardiovascular disease and obesity. Importantly, these health benefits remained evident even after accounting for aerobic exercise and other factors such as age, sex, education, income, body mass index, depression and high blood pressure.

Compared with aerobic exercise like jogging, clinical studies show that muscle-strengthening exercise has greater effects on age-related diseases such as sarcopenia (muscle wasting), cognitive decline and physical function.

This is particularly significant considering we have an ageing population in Australia. Declines in muscle mass and cognitive function are predicted to be among the key 21st-century health challenges.

Most of us don’t even lift — but we should

While the health benefits of muscle-strengthening exercise are clear, the reality is most adults don’t do it, or don’t do it enough. Data from multiple countries show only 10-30% of adults meet the muscle-strengthening exercise guidelines of two or more days per week. Australian adults reported among the lowest levels of strength training in the world.

Our data from more than 1.6 million US adults show nearly twice as many do no muscle-strengthening exercise at all, compared with those who do no aerobic exercise.

The reasons fewer people do strength training than aerobic exercise are complex. In part, it might be because muscle-strengthening exercise has only been included in guidelines for less than a decade, compared with almost 50 years of promoting aerobic exercise. Strength training therefore has been considered by some physical activity and public health scientists as the “forgotten” or “neglected” guideline.

Other factors that may contribute to fewer people doing strength training include the fact it:

• involves a basic understanding of specific terminology (sets and repetitions)

• often needs access to equipment (resistance bands or barbells)

• requires confidence to perform potentially challenging activities (squats, lunges and push-ups)

• and risks the fear of judgement or falling foul of social norms (such as a fear of excessive muscle gain, or of getting injured).

Here’s how to get started

Unlike most aerobic exercise, strength training can be done at home. It can also be done without extensive equipment, using our own body weight. This makes it a great form of exercise during the COVID-19 pandemic, when many people are confined to their homes or otherwise restriced in where they can go.

If you are currently doing no muscle-strengthening exercise, getting started, even a little bit, will likely have immediate health benefits. Guidelines recommend exercising all major muscle groups at least twice a week: legs, hips, back, chest, abdomen, shoulders and arms. This could include bodyweight exercises like push-ups, squats or lunges, or using resistance bands or hand-held weights.

Here are some excellent free online resources that provide practical tips on how to start a muscle-strengthening exercise routine:

• 8 tips for safe and effective strength training (Harvard Medical School)

• 5 tips to build muscle strength (Harvard Medical School)

• Strength training: get stronger, leaner, healthier (Mayo Clinic).

Muscle-strengthening exercise can be performed by anyone, anywhere. And its health benefits rival, and often exceed, aerobic exercise.
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Governments need to step up

Many people find aerobic exercise difficult, impossible or simply unpleasant. For these people, strength training provides a different way to exercise.

The evidence supporting the health benefits of muscle-strengthening exercise, coupled with its low participation levels, provides a compelling case to promote this type of exercise. But historically, physical activity promotion has generally focused on aerobic exercise.

If governments expect more people to do muscle-strengthening exercise, they need to provide support. One strategy may be to provide affordable access to community fitness centres, home-based equipment and fitness trainers. And media campaigns endorsing muscle-strengthening exercise could also be important for challenging negative stereotypes such as excessive muscle gain. It’s unlikely any of these strategies will be successful individually, so we’ll have to tackle the problem on a few different fronts.

Jason Bennie, Senior Research Fellow, University of Southern Queensland; Jane Shakespear-Druery, Accredited Exercise Physiologist, PhD Candidate, University of Southern Queensland, and Katrien De Cocker, Senior Research Fellow, University of Southern Queensland

This article is republished from The Conversation under a Creative Commons license. Read the original article.

How much exercise is too much?

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Paul Millington, University of Bradford; Ally Briggs, University of Bradford; Colin Ayre, University of Bradford, and Jamie Moseley, University of Bradford

The COVID-19 pandemic has made many of us reevaluate our health and take up new exercise regimes. Running and cycling have become increasingly popular as activities that can be carried out by most people without much equipment, while observing social distancing.

There are, of course, a wealth of benefits to cycling and running, but a sudden change in activity levels can put people at increased risk of injury. Muscles, tendons and bones all need time to adapt to increases in activity. And if too much stress is applied strains, tears and even bone injuries – such as stress fractures – can occur.

This shock to the tissues often leads to painful conditions, can thwart people’s well-intentioned plans to exercise and may lead to long-term injury. This can happen anywhere in the body – particularly if you suddenly decide to play two hours of tennis, take an extra-long yoga class or go out for an extra-long run after months of decreased activity.

Injury risk and training loads

Your training should maximise health outcomes while limiting negative consequences, such as injury, illness or fatigue. So how do you know if you are doing too much?

This is where the concept of training loads comes in – which is essentially the impact your training has on the body. Training loads can be affected by lots of things and include factors like how far you run, how long you spend doing yoga or the intensity of your zoom boxercise class.

It is possible to do too much exercise.
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To start off, it’s important to think about the amount of energy your new exercise regime requires. This is because the energy available to the human body is like currency – there is a finite supply. And it’s the brain’s job to prioritise how this energy is spent.

Tissues and organs that keep us alive need a constant energy supply and so take priority. The rest of the energy can then be distributed between other bodily functions such as physical activity, mental stress, healing and recovery.

Excessively demanding exercise regimes that don’t allow time for adequate recovery demand high volumes of energy, and this can leave you with an “energy debt”. This is when there is a lack of energy to support the recovery, healing and adaptation of muscles, tendons, the heart, blood vessels and the brain. This puts your body at increased risk of injury.

How to avoid overload

For many, lockdown has been a fantastic opportunity to incorporate regular exercise into their lifestyle and the benefits of this should not be underestimated. But, of course, while it’s generally believed that when it comes to exercise more is better, there can be too much of a good thing.

To try to reduce your risk of injury it’s important to track and analyse your average daily workload. This should be over the course of a week that you can then compare to the previous four weeks This could be in distance or time and is referred to as the acute:chronic workload (ACWL).

There are two methods to analysing the ACWL – one method is to calculate the percentage difference of the most recent week workload average (acute workload) compared to the past four weeks workload average (chronic workload). The second method divides the one-week acute workload by the four-week chronic workload to provide a ratio. This is known as the acute:chronic workload ratio (ACWR).

To reduce the risk of injury, it’s recommended that novice athletes keep any increase in load within a 5% margin over the course of the month. This could extend to a 10% increase for more experienced or higher-performing athletes.

If using the ACWR method, the recommendation is to keep the ratio in the sweet spot between 0.8 and 1.3 and avoid the danger zone of greater than 1.5, as shown in the graph below.

Figure 1. The U Shape relationship between ACWR and injury risk.

The table below shows three examples of both methods with a traffic light system of green for ideal, amber for borderline – with a relatively higher risk of injury – and red for the highest risk.

Table 1. Example workloads.

It’s also important to consider the intensity of your workouts and where possible use your heart rate as a guide to drive a mixture of low- and high-intensity exercise over the course of a week.

You should aim for around four to five low-intensity workouts for every high-intensity workout. This is the training practice of most elite athletes across multiple sports. This allows for better recovery from intense workouts which probably contribute to consistency of training and reduced risk of injury.

Wearable tech, such as Apple watches, Fitbits, Garmin devices, along with apps such as Strava and Runtastic, are also fantastic tools to help you monitor your activity levels and help manage training loads.

Paul Millington, Lecturer in Physiotherapy, University of Bradford; Ally Briggs, Lecturer in Sport and Exercise, University of Bradford; Colin Ayre, Lecturer in Physiotherapy, University of Bradford, and Jamie Moseley, Clinical Lead and Lecturer in Physiotherapy, University of Bradford

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Ten tips for looking after your back while you’re sitting down

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David Byfield, University of South Wales

Working from home is challenging. Apart from reduced social interaction and the domestic juggling involved, homes are not usually designed to replicate a workplace environment when it comes to employees’ health.

Instead, improvised work stations have become the norm for many people, whether it’s a dining table, a sofa, or even a corner of floor space. None of these are ideal for posture or avoiding back and neck pain. In recent weeks, we have had numerous inquiries at the Welsh Institute of Chiropractic from people seeking advice as a result of their new working conditions.

One of the main challenges facing clinicians dealing with these problems is the number of myths and misunderstandings that exist around low back pain – for example, that it is caused by a weak core (it isn’t) or that it will become persistent and get worse in later life (most cases improve).

This is not to say that low back pain is not a serious health issue, because it most certainly is. It is the most common musculo-skeletal condition in the world, with an estimated 577 million cases at any point in time – and is the leading cause of absenteeism from work. This makes low back pain one of the major public health concerns in most countries throughout the world, with a huge impact on their economies.

On the plus side, there are some encouraging facts about the condition that are well supported by clinical research. For example, we now know that a negative mindset and poor coping strategies are associated with persistent pain, while flare-ups are usually related to changes in activity, stress and mood rather than structural damage.

Also, effective care for low back pain is relatively cheap and safe, and can be improved by better physical and mental health, as well as healthy sleep habits and body weight.

When it comes to ideal sitting positions, these are likely to be different for different people – simple generalisations don’t work for everyone. But studies have demonstrated that “postural variability” (changing your position) and regular subtle movements while sitting are important. This could be as simple as regularly crossing and uncrossing your legs – at both the thigh and ankle – or moving to the edge of the chair and back, or side to side. Think of it as fidgeting to stay fit.

This particular point was addressed in a recent investigation, which recruited 90 participants (61 with no history of low back pain, 29 with) who were asked to sit for one hour, while data was collected on back muscle activity, spine posture and pain.

The researchers concluded that sitting-induced back pain does not appear to be due to posture or muscle activity. Instead, it may be related directly to “micro-movement” – such as fidgeting while sitting (what we call “dynamic sitting postures”). Those who developed pain did not sit differently – but they did move less.

Back to work

So what do these findings mean for those of us working from home or sitting for long periods? Wherever you are sitting – at home or in an office – it is vital to keep moving regularly. And, while sitting itself does not actually damage the spinal structures directly, there are significant benefits from limiting uninterrupted sedentary time to around 20 minutes.

Yoga helps.
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Equally important is the fact that prolonged sitting reduces blood flow to the brain and decreases cerebro-vascular function, which is associated with lower cognitive ability. Reduction in cerebral blood flow is offset when frequent short-duration walking breaks are included in a sitting period.

Here are ten tips courtesy of the US therapist Kelly Starrett to think about before you next sit down to work.

1. Learn to breathe from your stomach.
2. Sit on the edge of your chair.
3. At home, sit on the floor some times instead of a chair or sofa.
4. Sit cross-legged when you can (but keep changing the position and leg regularly).
5. Get up from your chair every 20 minutes.
6. Stay hydrated to keep your body cool, and assist muscle and joint function.
7. Try “man-spreading” (stretching your legs outwards while sitting) which helps to maintain and improve hip function and mobility.
8. Stand up at your desk or elevate your workstation using items such as books or boxes at home.
9. Take the time to perform a full-range hip movement (using the legs for support) and brace the lower back when standing up and sitting down – this avoids placing stress on the lower back and distributes the movement throughout the entire body
10. Try yoga and pilates to supplement your exercise regime – both help to maintain and improve flexibility.

The key message is that regular movement of any kind is important for your health – even when you are sitting down.

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Read more:
Back pain: four ways to fix bad lockdown posture – by copying astronauts

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David Byfield, Professor of Professional Practice, School of Health, Sport and Professional Practice, Faculty of Life Sciences and Education, University of South Wales

This article is republished from The Conversation under a Creative Commons license. Read the original article.