Tackle Your Morning Joint Stiffness

Waking up with ache and stiffness in our joints is something most of us have experienced. It is easy to blame it on age, but that may not be the whole story; you may also feel stiff when standing up from sitting for too long, or when moving your joint after staying in the same position for a while, like after sleep.

The stiffness generally resolves once you start moving or after a hot shower, however, there are ways to ease it even before you start your daily routine. Before we suggest some in-bed exercises, let’s look at understanding why the stiffness occurs in the first place. There are 2 main components within our joint structure:

Articular cartilage is a smooth, white connective tissue that covers the end of our bone within the joint and allows the 2 bones to glide smoothly over each other.

Synovial fluid is the thick, colourless liquid inside the joint. It plays an important role in contributing to low friction within the joint, providing nutrients to articular cartilage, and facilitating clearance of waste from the joint.


What Causes Morning Joint Stiffness?

1. Age Related Changes To Joint Structure

With age, all joints eventually start showing a degree of degeneration. Our articular cartilage surface becomes rough and less elastic. Synovial fluid inside the joint becomes less thick as well, losing some of its effectiveness as a lubricating agent. The combination of these changes increases the amount of friction inside the joint, leading to the feeling of stiffness.

2. Reduced Anti-Gelling Agent In The Joint

On the surface of the joint, there is a lining of surface-active phospholipid, which is an anti-gelling agent for synovial fluid. With articular cartilage degeneration, we start losing this layer and as a result, it is easier for the synovial fluid to become more solid – like when not moving. We can compare this gelling phenomenon to making gelatine. Stirring a hot gelatine keeps it in liquid form thoroughly, but when you stop moving it, it starts to gel together and becomes more solid.

3. Higher Joint Volume

Our body removes excessive synovial fluid through its lymphatic system, assisted by joint movement. For most of us, sleep is the longest time where our joints stay inactive and the flow of fluid out of our joints is sluggish. As a result, there is increase in joint volume in the morning, making it harder to get moving.


How Do I Ease My Morning Joint Stiffness?

The draining the fluid out of your joints or “stirring” of the synovial fluid to break its gelling effect can help ease some of the stiffness that you experience. This can be achieved by doing simple range of motion exercises that are light on the back and knee joints, making them a great choice to start your day.

Knee rolling in bed: Roll to one side and hold for 3 seconds. Repeat this for 10 times each side. You should feel a gentle stretch over your back or hip while doing the exercise.

Single knee hug: Hug your knee and hold it for 10 seconds. Repeat 3 times for each side.

Cycling in bed: Imitate cycling movement on the bed for 1 minute. The further your leg is from your body, the harder it will be. Do as you can tolerate.

Shaking your legs in sitting: Lift your leg alternatively on each side while you sit over the edge. Do this for 1 minute.

Written By: Anson Wong, B.Sc. (Hons) Physiotherapy (MY)

Anson has 9 years of experience in physiotherapy, and specialises in musculoskeletal and sports injury rehabilitation. His main areas of focus include the shoulders, knees, and ankles. He is also a Certified Mulligan Practitioner.

Should I Worry About My Lower Back Pain (LBP)?

Current evidence-based practice shows that most of the time the answer is no. For the majority of cases of lower back pain, having a better understanding of the causes and getting some expert guidance from your physio you can fully resolve the problem.

 

Biopsychosocial models: Factors that can influence lower back pain

We are often dealing with lower back PAIN and not lower back INJURY. Physiotherapists use an evidenced-based approach for the management of LBP by way of a biopsychosocial model. This means we need to consider the BIOLOGICAL tissues that are involved in the episode of LBP, the clients’ PSYCHOLOGICAL perceptions and emotions related to the episode of LBP and the SOCIAL context in which this episode of LBP relates to.

 

Taking this is biopsychosocial approach is vital as we know that in most episodes of LBP the physical factors alone are not the only causative influences and that there is significant influence from our body systems. In LBP the structural tissues involved need to be viewed as a source of input that potentially generate a response of pain. This input is open to interpretation and modification by our central nervous system that can either magnify or inhibit the potential pain according to how our body, physically and physiologically, and our mind, emotionally and psychologically, perceives the input as either dangerous or innocuous. This central nervous system process of interpretation and modification is directly influenced by:

  • sleep quality
  • emotional stress, moods
  • fatigue
  • nutrition
  • other health problems
  • physical activity levels
  • mental illness
  • context of symptoms e.g. home, work, sport
  • personality types eg. fearful, depressed, anxious

 

Simply put, when we are tired, run down or stressed our pain thresholds are often reduced. For these reasons the treatment of LBP needs to be dealt with regarding entire body systems including the hormonal, metabolic, psychological and immune systems and not just the involved structural tissues of the musculoskeletal system.

 

When we are tired, run down or stressed our pain thresholds are often reduced.

 

Are imaging scans and X-rays helpful in identifying the causes of lower back pain?

In some cases, getting scans and X-rays unnecessarily can actually increase the experience of pain

 

In most cases of LBP imaging in the form of scans and X-rays are not needed. In fact, getting scans and X-rays unnecessarily can actually increase the experience of pain in some clients! Did you know that half of all over 30 year old’s and two thirds of all over 40 will have degenerative changes in their lower back seen on imaging. If you’re over 60 it is uncommon to not have degenerative changes! When unnecessary scans or x-rays are performed the presence of degenerative changes are often misleadingly blamed for the cause of an episode of LBP when they have no influence whatsoever. The anxiety and fear created regarding the presence of these degenerative changes can sensitize our nervous system and we can increase our experience of LBP. This is unhelpful!

 

Reducing lower back pain by addressing the triggers

When addressing back pain, consider the triggers and how to address them, such as improving nutrition.

 

Let me explain further about addressing lower back pain by thinking about this comparison. When we experience a gradual onset head ACHE and feel some pain, we don’t call it a head INJURY and certainly we do not rush off to the doctor, receive some strong medications and get some scans of our brain. We generally think about what the triggers of that head ache are and try to address them. It may be drinking more water, getting more quality sleep, having improved nutrition, being less sedentary, taking some exercise or decreasing the stress in our lives.

 

Why then when we experience some gradual onset low back ache and feel some pain, we don’t call it a low back INJURY however some of us will rush to the doctor, receive some strong medications and get some scans or X-rays of our lower back. We generally will not think about what the triggers of that back ache are and try to address them. It may be drinking more water, getting more quality sleep, having improved nutrition, being less sedentary, taking some exercise or decreasing the stress in our lives.

 

LBP should be viewed similarly like tiredness, sadness, headaches, constipation or stomach upsets. They are not fun but very common experiences and predicaments of life that most of us experience from time to time.

 

So, try not to worry the next time you experience some gradual onset LBP. For the majority of cases having a better understanding of the causes and influences and getting some expert guidance from your physio you can fully resolve the problem.

 

Article by Michael Bushell, B.Sc. Physio (Aust); M. Manual Therapy (Aust); M.S.P.A. As an Australian Physiotherapy Association (APA) Titled Musculoskeletal Physiotherapist with over 24 years of clinical experience, Michael is a highly qualified physiotherapist with expert knowledge and skills in all areas of musculoskeletal and sports physiotherapy.

You can’t go wrong by being strong! Strength training for sports injury prevention

You may be a talented rugby player, a novice marathon runner, a coach to a high school badminton player, a senior fitness enthusiast or a weekend warrior playing park football. Whichever example matches your profile, statistically you’ve either been injured yourself or have had to coach an individual through an injury. Although injuries are never completely unavoidable there are clear, evidenced-based are ways to reduce the risk.

baseball
When playing sports, there is always a risk of injury, but this risk can be minimised

Is there any evidence on the benefits of strength training for injury prevention?

The utilisation of strength training for injury prevention is not a new concept, but for some reason some coaches, trainers and athletes still don’t see it as a necessary addition to a workout plan. Recent high-quality studies have elucidated that incorporating strength training in athletic or fitness training decreases the risk and/or severity of injury over and above other modalities for injury prevention. A systematic review of all high-quality studies investigating the effect of various injury prevention strategies concluded strength training reduced acute sports injuries risk by 1/3 and the risk of overuse injuries by almost a half. Interestingly static stretching did not provide any meaningful injury prevention benefit1. Simply put, having a strong muscle is less likely to be injured than having a long muscle!

Marathon runner
Research indicates that strength training reduces acute sports injuries risk by one third1

What is the physiological basis of strength training to reduce injury?

Resistance training provides dynamic loads on the body, creating physiological adaptive changes in the bone, muscle, and connective tissue (tendons and ligaments). Bone has an incredible ability to rebuild itself, so when a load is placed on bone it triggers a genetic expression to activate the cells that produce new bone, the bone is remodelled increasing its density and therefore making the bone stronger and more resilient. This decreases the chances of a future bone injury. As muscles, tendons, and ligaments are the support system of every joint, they are at high risk for being injured with the complex, dynamic movements associated with sports and exercise. Resistance training helps strengthen muscle and tendons, enabling them to resist and generate greater forces, while increasing the stability of the ligaments which decreases their risk of becoming injured.

weight lifting
There is a clear dose-response effect between strength training and its injury prevention effect

How much resistance training needs to be included in a training program to be effective?

A recent systematic review asked this question. The authors concluded that there is a clear dose-response effect between strength training and its injury prevention effect. This means that the greater the volume and intensity of strength training undertaken the greater the injury preventative effects were experienced2. Also, the types of strength exercises performed did not have a significant influence on those preventative effects. A full-body resistance training regime is recommended to help lower this risk of injury in any athlete and improve your sports performance regardless of skill level and activity type. This may equate to 2-3 short sessions a week containing 4-6 exercises.

Building a strength training program to suit your needs

Your physiotherapist can specifically design a strength training program suitable for your fitness and sporting goals. We typically follow this process:

  1. Initial assessment: One on one consultation to understand your current fitness, lifestyle, needs and goals
  2. Training plan: A customised and detailed program aimed at helping you increase your strength and reduce the risk of injuries
  3. Progress review: A regular review to assess your progress and fine tune your training plan based on your body’s condition and latest goals

So start getting strong because you can’t go wrong!

 Article by Michael Bushell, B.Sc. Physio (Aust); M. Manual Therapy (Aust); M.S.P.A.  As an Australian Physiotherapy Association (APA) Titled Musculoskeletal Physiotherapist with over 24 years of clinical experience, Michael is a highly qualified physiotherapist with expert knowledge and skills in all areas of musculoskeletal and sports physiotherapy.

References:

  1. Lauersen, Bertelsen & Andersen, The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials, 2014.
  2. Lauersen, Andersen & Andersen, Strength training as superior, dose-dependent and safe prevention of acute and overuse sports injuries: a systematic review, qualitative analysis and meta-analysis 2018

Q&A with Wendy, our women’s health physio

Q. Post-pregnancy I leak when coughing or when trying to run despite having worked on my pelvic floor – why is that?

A. In the case that your pelvic floor muscle is weak and requires strengthening, there is a level of skill required to train it properly. It is a fan shaped muscle and for it to work optimally, we need to contract it according to the direction in which the muscle fibres lie.

Written by Wendy Casterton, Physiotherapist

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What is going on and what can be done to improve things?

Women’s health-related issues are manifold and can be complex in nature. As such, it is often difficult to get a clear diagnosis and explanation as to what is going on and what can be done to improve things. This can lead to a serious level of compromise in our quality of life, affecting us in our personal relationships as well as socially and professionally. Nevertheless, physiotherapy centred around the very specific anatomy of a women’s pelvis and abdomen can help to address these problems, helping to restore confidence in your body and achieve your life goals.

Written by Wendy Casterton, Physiotherapist

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