Living Well with Osteoarthritis: A guide to keeping your joints healthy

Review from Harvard Medical School:

Arthritis can be distracting. Distressing. And disheartening. It can make you hesitant. It can frustrate — and even prevent — you from doing all the things you love to do. It is, quite literally, a pain.

The good news is that you can live — and live well — with osteoarthritis, the most common type of arthritis. You can get relief from its pain and its consequences.

Don’t let arthritis pain get in your way!

End the relentless aches and aggravation and start enjoying a more active and pain-free life once again!

The report will brief you on breakthroughs in joint replacement surgery. Do you want to learn about the role of physical therapy as well as complementary procedures. And because medications remain the first line of defense, the report examines the effectiveness, safety, and possible side effects of more than 40 medications used to treat arthritis and relieve its pain.

Self-care strategies for coping with arthritis: Exercise

Even the healthiest people find it difficult to stick with an exercise regimen. But those with arthritis commonly discover that if they don’t exercise regularly, they’ll pay the price in pain, stiffness, and fatigue. Regular exercise not only helps maintain joint function, but also relieves stiffness and decreases pain and fatigue. Feeling tired may be partly the result of inflammation and medications, but it’s also caused by muscle weakness and poor stamina. If a muscle isn’t used, it can lose 3% of its function every day and 30% of its bulk in just a week. A recent review of numerouse studies asserts that both aerobic and muscle-strengthening exercises are safe and effective for people with chronic arthritis. Below are brief summaries of different forms of structured exercise programs (most of which are offered by local Arthritis Foundation chapters) and their potential benefits.

Land-based programs. These include community-based group classes led by health or fitness professionals with specialized training in instructing people with arthritis. Examples include Fit and Strong!, a program targeted to older adults with osteoarthritis; the Arthritis Foundation’s Exercise Program (AFEP); and its Walk with Ease program. All include some combination of a warm-up routine and three standard exercise goals, plus specialized activities to enhance body awareness, balance, and coordination. Studies have found that people with arthritis in their hips, legs, and feet who took Fit and Strong! classes were able to exercise longer, felt more confident about their ability to exercise, and reported less joint stiffness compared with those in a control group. Many of the benefits lasted between six and 12 months. Those attending AFEP classes for eight weeks had less pain, stiffness, and fatigue, and these improvements persisted at least six months, as well. In one study, people who completed the Walk with Ease program (which also teaches participants about managing their disease) had more confidence, less depression, and less pain, compared with participants who attended classes focused on pain management.

Water-based programs. Also known as aquatic or pool therapy, these group classes are done in water that’s nearly 90° F and feature a variety of exercises, including range-of-motion exercises and aerobics. According to one study, people who took the Arthritis Foundation Aquatic Program improved knee and hip flexibility, as well as strength and aerobic fitness. Other investigations suggest water exercise lessens pain and boosts physical functioning, and the benefits after the 12-week session were sustained for three months after the last class.

Strength and resistance training. This form of exercise, which uses equipment such as weight machines, free weights, and resistance bands or tubing, strengthens not only muscles but also your bones and your cardiovascular system. Resistance training improves muscle strength, physical functioning, and pain. One Japanese study compared people with knee osteoarthritis who either took NSAIDs or did twice daily knee extension exercises to strengthen their quadriceps (the muscles on the front of the thigh). At the end of the eight-week study, both groups had less pain and stiffness, as well as improved functioning and quality of life.

Tai chi. With origins in Chinese martial arts, this low-impact, slow-motion exercise also emphasizes breathing and mental focus. A number of small studies suggest tai chi helps people with different forms of arthritis, mainly by increasing flexibility and improving muscle strength in the lower body, as well as aiding gait and balance. The Arthritis Foundation, along with Dr. Paul Lam, a family physician and tai chi instructor, developed a standardized form of tai chi designed specifically for people with arthritis. Based on Sun-style tai chi, one of the discipline’s five major recognized styles, it includes agile steps and a high stance (meaning the legs bend only slightly).

Yoga. Scant research has explored the benefits of yoga for people with arthritis. One study showed that people with knee osteoarthritis who took eight weeks of Iyengar yoga (a form of yoga that focuses on correct body alignment, and uses blocks, belts, and other props to assist in performing postures) had less pain and could function better at the end of the study. Another study of people with rheumatoid arthritis found benefits from participating in twice-weekly Iyengar sessions for six weeks — namely, less pain and depression and greater mobility. But both studies were quite small, and neither included a comparison group.

For further information please visit Dynamic Osteopaths or contact us at

Scientists unravel the molecular secret of short, intense workouts

Scientists unravel the molecular secret of short, intense workouts

Sports Medicine: Fitness. Link Sports Med: Fitness

In the last few years, the benefits of short, intense workouts have been extolled by both researchers and exercise fans as something of a metabolic panacea capable of providing greater overall fitness, better blood sugar control and weight reduction – all of it in periods as short as seven minutes a few times a week.

Now, in a new study, scientists from the Florida campus of The Scripps Research Institute (TSRI) confirm that there is something molecularly unique about intense exercise: the activation of a single protein.

The study, published recently by The EMBO Journal, revealed the effects of a protein known as CRTC2.

The scientists were able to show that following high-intensity exercise, which enlists the sympathetic nervous system’s “fight or flight” response, CRTC2 integrates signals from two different pathways – the adrenaline pathway and the calcium pathway, to direct muscle adaptation and growth only in the contracting muscle.

Using mice genetically modified to conditionally express CRTC2, the scientists showed that molecular changes occurred that emulated exercised muscles in the absence of exercise.

“The sympathetic nervous system gets turned on during intense exercise, but many had believed it wasn’t specific enough to drive specific adaptations in exercised muscle,” said Michael Conkright, PhD, a TSRI assistant professor who led the study. “Our findings show that not only does it target those specific muscles, but it improves them – the long-term benefits correlate with the intensity of the workout.”

Mobilizing Resources

In the genetically altered animal models, this resulted in a muscle size increase of approximately 15 percent. Metabolic parameters, indicating the amount of fuel available to the muscles, also increased substantially – triglycerides went up 48 percent, while glycogen supplies rose by a startling 121 percent.

In an exercise stress test, the genetically altered animals improved 103 percent after the gene was activated, compared to an 8.5-percent improvement in normal animals.

“If you think of the adrenaline system as something that mobilizes resources when you encounter, say, a bear on your way to work, what we found is that the system also gets you ready for your next bear encounter,” Conkright said.

The new findings open the door to a range of potential exercise enhancements.

“Nothing can supplant exercise; however, just by activating one protein, we clearly improved performance in animal models,” said Staff Scientist Nelson E. Bruno, MD, PhD, the first author of the study and a member of the Conkright laboratory. “We are now searching for molecular therapeutics that will activate the CRTC2 protein so that even an average exercise routine could potentially be enhanced and made more beneficial.”

Further information can be found at Dynamic Osteopaths or by contacting

Sports Medicine: Exercising With Lower Back Pain: Prescription for Health

Sports Medicine: Exercising With Lower Back Pain: Prescription for Health

Sports Medicine – Exercise is medicine!

Back pain is one of the most common medical complaints in the world. Don’t let low back pain get you down! A well-designed exercise program can help speed recovery from low back pain, reduce pain levels, and possibly prevent reinjury. In fact, regular physical activity has been shown to increase muscle strength and endurance, enhance mobility and reduce the risk of falling is superior to spine therapy at helping people cope with back pain and at keeping it under control! The key to maximizing the benefits of exercise is to follow a well-designed program that you can stick to over the long-term.

Getting Started

The goal of exercise training is to improve overall fitness (cardiovascular, muscle strength and endurance, flexibility, coordination and function).

Talk with your health care provider before starting an exercise program and ask if they have specific concerns about you doing exercise. Most people do very well with regular exercise and sufficient time, but some people do need surgery.

The goal of exercise training is to improve overall fitness (cardiovascular, muscle strength and endurance, flexibility, coordination and function) while minimizing the stress to the lower back.

Choose low-impact activities, such as walking, swimming, and cycling.

Strong abdominals, back, and leg muscles are essential for helping you maintain good posture and body mechanics. Once the acute pain subsides, you can begin doing light strengthening-training exercises designed to help your posture.

Yoga and tai chi may help relieve or prevent lower back pain by increasing flexibility and reducing tension. Be careful, however, not to do any poses that could exacerbate your condition.

Start slowly and gradually progress the intensity and duration of your workouts.

Do low- to moderate-intensity cardiovascular exercise for 20 to 60 minutes at least three to four days per week.

Exercise Cautions

Avoid high-impact activities such as running.

While low-impact aerobic activities can be started within two weeks of the onset of lower back pain, exercises that target the trunk region should be delayed until at least two weeks after the first sign of symptoms.

Never exercise to the point of pain — if something hurts, don’t do it.

Your exercise program should be designed to maximize the benefits with the fewest risks of aggravating your health or physical condition. Consider contacting us here at Dynamic Osteopaths to cover realistic goals and design a safe and effective program that addresses your specific needs.

For more information, visit us at Dynamic Osteopaths in Solihull and Birmingham at or email us at

Sports Medicine: Back pain and Exercise

With in musculoskeletal medicine, specifically back pain, it can often be identified that back pain a hugely related to muscular responsiveness and how exercise in clinical formats can vastly reduce back pain and delay forms of invasive surgery.

The below link explains this further, providing real case studies.

Sports Medicine: Back pain and Exercise

For further information contact Dynamic Osteopaths

Dynamic Osteopaths have clinics operating out of Solihull and Birmingham.

Applied Biomechanics of the Golf Swing: Sports Osteopathic Perspective on Spinal Motion Part: 1

Adam R. Whatley, PT., M.Ost (Sports Osteopath)

The biomechanics of the spine during golf swing biomechanics and the relationship to cases of low back pain and performance have become of growing concern within professional and amateur golf. Golfing performance is orientated around hitting the ball further and more precise, whilst putting as minimal stress through the spine as physically possible. It is therefore due to this reason that a high amount of studies have been performed in relation to the biomechanics of the spine (typically the lumbar spine) and how performance can be improved. Now, with the growing number of amateur golfers in development, this particular concern grows with importance, particularly with the fact that the majority of golfers do not understand the importance of ‘out of season conditioning training’, which is crucial for preparation for the on-going season. This in my clinical opinion coming from a performance background is one of the most valued reasons for why the incidence of injuries develops, along with ‘under-performance syndrome’.

As an Osteopath, I believe it is not only the anatomical factors that should be acknowledged and examined, but in my opinion it is more important to assess and evaluate the whole functional biomechanical relationship between the ground reaction forces to the functional biomechanical loads placed upon the lumbar spine. This is where my background in sports and exercise physiology is perfectly adopted. When we use specific motion of the lumbar spine in the initiation of a proper golf swing, we can see that the deep stabilising muscles are extremely important, as too are the global, prime mover muscles. Vast amounts of evidence shows that the spinal segmental stability during motion is essential to Imageminimize rotational stress on the joints.  

The deep inner-core muscles that act to stabilise the spine during dynamic motions are more effective and anatomically suited for specific spinal stability and are activated first and are the muscles involved in prime rotation of each individual spinal segment. The fine control of these muscles are controlled by neurological innervations (nerves), whereby, any irritation to the neurological supply can consequently result in functional alterations and performance adaptations.Image


It is widely established that back pain has a huge relationship to spinal instability and visa-versa, which ultimately affects performance. Any decreases of the neuromuscular control will decrease spinal stability. Therefore it is essential to evaluate the golfers swing in detail. Recent reports have shown that professional golfers, as opposed to amateur golfers tend to show better overall body conditioning. They also tend to have greater single leg functional control. In addition there is an advantage in superior club head speed, which is related to the amount of spinal rotation and scapular glide at the top of the backswing.

Functional Evaluation:

Evaluation of correct technique when performing any activity is important in order to produce an advantage functional dynamics. For instance, if during the evaluation it is determined that the erector spinae and the external oblique muscles (superficial muscles) are firing as the primary spinal stabilizers instead of the stronger, deeper transverse abdominus and multifidi muscles (deep core muscles), then the individual may be compensating for lower back spinal dysfunction. Consequently, this can develop chronic cases of overuse injuries due to poor biomechanics during the golf swing.Image

Spinal degeneration is also of huge importance with golf performance, due to the can biomechanical alterations (reduced range of motion, reduced spinal stability, reduced spinal curvature and so on…). The curvature of the spine is of huge importance also in golf as increases lordotic (lower back) curve can increase stress on the posterior segments, particularly during the backswing, and also reduces the range of motion in this area. However, this can result in extension, which then can facilitate improved rotation. Reductions can limit the backswing and directly affects the power generated to ball connection. A decreased lumbar curve (common in the older generation) will also decrease the segmental range of motion. Its effect on the backswing will be similar, however, the approach to improve proper biomechanics in the region will differ. In my clinical opinion, it is extremely important to examine the lumborsacral angle (lower back), which if increased, will result in decreased range of motion within the extremely prominent area of injury within the majority of sports medicine.Image

Sacroiliac joint:

The sacroiliac joint is an extremely important joint between the base of the spine (sacrum) and the pelvic bone, which has the role in load transfer from the pelvis to the spine. Dysfunction within this joint is commonly seen with golfers and is associated with cases of lumbar spine dysfunction or instability and pain, associated with overuse. Due to the complexity of this integral joint, dysfunction is often associated neurological alterations, increased muscular demands and spasm within the lower back and the gluteal muscles. Thus, ultimately creating alteration in the range of motion of the lumbar spine on the backswing and reductions of strength

Ground reaction:

Evaluation is of the lower extremities and their effects on the postural biomechanics of the spine are very important and should be considered. The lower extremities play an important role in the outcome of the golf swing, particularly the mechanics of the foot and ankle joint and how they impact the ground and react in rotation. Assessing the foot and ankle for any structural defects that may interfere with the normal segmental movements of the spine is of extreme importance in biomechanics. This involves assessing for the presence of pronation and navicular integrity. If dysfunction if present this can well result into biomechanical alterations, muscular imbalances and spinal motion dysfunction, ultimately affecting spinal segmental stability. Since there will always be some biomechanical stress put on the spine and sacroiliac joints during the swing, it is very important to have balance and stability in your foundation, particularly on your backswing. The transfer of force from the back foot on the backswing, to the front foot on the downswing and acceleration, will determine the distance of the ball.

The importance of posture and proper spinal biomechanics during the golf swing is essential to preventing injuries in the low back and maximizing the distance and accuracy of golf shots. The lumbar spine must be in a stable position during the stance phase; the lower spinal segments to approximately L3-L4 are locked in flexion and the upper lumbar vertebrae are in extension. The transitional level where there is a slight shift from flexion to extension becomes a stress point for the lumbar spine. It is necessary for there to be normal neuromuscular function in this phase. When evaluating a patient’s stance phase, I have found that if there is interference with the neuromuscular innervations, the deep muscles, particularly the multifidi, the erector spinae, and external oblique muscles are activated too soon.