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At Sydney Sports and Orthopaedic Physiotherapy we want to stay connected. In addition to this website, our Facebook page, our LinkedIn account and our newsletter, we thought that a BLOG would be a great way to share our thoughts on Physiotherapy, Pilates, Common Injuries and other topics of interest.
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When exercising for more than 90 minutes it is wise to be taking on some form of carbohydrate during training and events.
For endurance athletes carbohydrate is important in raising blood sugar, delaying muscular fatigue, and enhancing performance!
Possibly the most convenient and most commonly used are energy gels. Generally these are a gel (approx 35g) which have immediate impact and slow release carbohydrate – some also have a caffeine kick – a personal favourite.
How often should you take them?
Most gels recommend anywhere between every 30 mins – 60 mins – depends on the ingredients and what works for you.
Make sure you take the gels with plenty of water, approx 200-300ml. And make sure you test the gels you are going to use on race day during training runs first!
Arthritis is one of the most common causes of chronic disability in Australia with over 3.85 million Australians affected , roughly 1 in 5 of us. Most of us have heard of the large variety of supplements out there aimed at treating the condition – fish oil, krill oil, glucosamine, chondritin and the list goes on. A recent study in the US found that a third of arthritis sufferers have tried using supplements to manage their symptoms . However with the ever increasing number of supplements on our supermarket shelves all proposing sensational effects, one can be left feeling overwhelmed by the choices; which types work? Are combinations better? What can they actually help with? I’ve taken to the medical journals to see how they each match up, with some interesting findings.
Glucosamine is the most common supplement used by people with osteoarthritis and has been subjected to the most testing. When researchers from the Cochrane Group in the US pooled the results from 25 studies with 5000 patients they found that on average glucosamine reduced peoples pain by almost 25%. The type of glucosamine product had an affect too, with those using glucosamine sulfate showing the most consistent reductions. They also found modest but positive improvements in function across the group.
Chondritin: The research for chondritin, the second most common supplement, isn’t quite as favourable. Early studies in the 80′s and 90′s were promising for its pain relief potential and launched it into the public eye as a viable option, but in the last 5 years with more strict regulations, the findings are inconsistent. Furthermore, theres no evidence to suggest its better than glucosamine sulphate and nothing reliable to suggest that a combination of the 2 is better than glucosamine alone. So although some people may notice modest benefits, there isn’t enough scientific proof to confidently recommend it over the others.
Omega 3′s, 6′s, 9′s (fish oils) and Krill oil- Whilst there have been several veterinary studies completed on the effects of fish oil supplements for arthritis in dogs, there haven’t been any large high quality trials showing fish or krill oil to have a significant effect on pain in humans. Future research might prove otherwise, so watch this space for any updates.
There are a few other weird and wonderfuls commonly suggested for their anti inflammatory benefits- including ginger, tumeric, vitamin E and even a plant from the Amazon called Cats Claw. However none of them have had a consistently worthwhile effect and thus are not supported by any of the research studies.
So when placed under the close scrutiny of the medical research community – glucosamine sulfate is the clear favourite. Whilst its by no means a cure, it has had ongoing positive outcomes on pain and function in people coping with osteoarthritis.
It has been a long held opinion that exercise (or more specifically the impact of running/jumping) leads to a breaking down over time of the joint’s protective covering (articular cartilage) and the subsequent development of arthritis.
Exercise and injury are definitely linked, of that there is no doubt. But is it fair to link arthritis to exercise?
Well the jury is still out on that one!
In 2008 results were published from a 21 year long study monitoring the ‘disability’ levels of 961 people. Half were runners and continued to exercise, half did not run.
Interestingly the disability levels of the runners did not increase as one would expect. In fact they were less! This led them to state that….
“Increasing healthy lifestyle behaviors may not only improve length and quality of life but also hopefully lead to reduced health care expenditures associated with disability and chronic diseases”.
In 1990 Konradsen, et al, also evaluated a possible association between long-distance running and OA, via retrospective evaluation of former competitive runners who ran 20-40 kilometers per week for 40 years average, versus sedentary controls. They found little to no risk of OA with lifelong long distance running.
When we bear weight through our joint surfaces we compress and release load. This leads to a squishing out and sucking in of synovial fluid (the fluid in between our joints which bathes the joint surfaces). That is how oxygen and nutrients are delivered to the joint surface and certainly explains why a daily run or any other workout is useful for maintaining healthy cartilage.
These research papers lend support to the theory that osteoarthritis is caused mainly by genes and risk factors like obesity (obese men and women are at least four times as likely to become arthritic as their thinner peers), rather than daily exercise or wear and tear of joints. My feeling is that if there is a strong history of OA in your family, and/or if there is persistent and consistent pain and swelling in the knee in response to running, you are probably better off switching to lower impact activities (such as swimming, cycling, cross-country skiing, or at the very most, treadmill running). Then once settled bring your exercise levels back up as far as you can without setting off another pain episode.
Here are some options for training to optimise running capacity without having to end your running career!
Osteoarthritis (OA) is a common disorder in a large percentage of the population. There are many factors, which may increase your risk of developing this condition such as being overweight or being inactive. Having had injuries causing ligamentous strain/laxity – which will cause an increase in uncontrolled micromotion at the joint surface – and also surgery such as knee ACL reconstruction are factors. Fractures into the joint surface are also a precipitator of early onset arthritic change.
OA is deterioration of the articular hyaline cartilage in a joint with reactive new bone formation (osteophytic activity) usually seen at the joint margins. BUT studies have shown that movement at the joint surface causes a compression/release effect which assists in increasing joint nutrition, keeping the cartilage alive.
So there is little evidence to support the notion that load bearing exercise ‘wears out’ the joint surface.
However if a joint is ligamentously lax or is in poor alignment, or simply loaded repeatedly in a suboptimal position then wear and tear (arthritic change) will ensue.
In order to limit the effect of excessive joint wear, improve your body positional sense. Exercises like Pilates, yoga and Tai-Chi are excellent ways to improve your body’s sense of its alignment in space.
If you are going to start running, swimming or any sport that involves high repetition of the same activity, make sure your form throughout the exercise is as good as it can be. Digital video analysis is now easy to perform in a physio clinic and can be used to highlight how techniques can be worked at to reduce ligamentous strain and improve biomechanical alignment.
Even if you have arthritis and it can be painful to exercise at the start, maybe try exercising in water, on a bike or just by not pushing yourself too hard in the early stage. It’s more important to exercise than to rest…you just have to find the right level.