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Exercise Physiology for hip and knee Osteoarthritis

Osteoarthritis (OA) of the knee and hip is a very common condition associated with aging and something we see quite a bit of at Central Performance. OA is a condition that involves changes to a joint and breakdown of the cartilage inside the joint, this can then also affect the bones and ligaments within the joint. Approximately 2.1 million Australians are affected by OA, with approximately 25% of Australians over the age of 45 affected.

It is becoming more widely recognised that exercise should be a front line treatment for osteoarthritis, particularly for the hip and knee. The Royal Australia College of General Practitioners (RACGP) put out new guidelines for the treatment of knee and hip OA in 2018. Within these guidelines for the treatment of knee and hip OA exercise and weight-loss were the only treatments that were strongly recommended. There was better evidence for exercise than there was for medications or surgery.

While changes to the joint associated with OA cannot be reversed, exercise can help to alleviate or manage the symptoms, improve your ability to perform activities of daily living, reduce disability and improve quality of life. Exercise physiologists, who are trained to prescribe exercise for the treatment of chronic conditions such as OA, are well skilled to develop and prescribe exercise programs for patients who are suffering from OA of the knee and hip.

An exercise physiology treatment program for OA will be personalised depending on the results of your physical assessment, your current functional ability, your confidence with exercise and your goals.  A exercise physiology program for a client with knee and hip OA will generally program through three stages:

  1. Specific local strengthen exercises for muscles around the knee and/or hip.
  2. Increase ranges of motion of motion of the knee and/or hip.
  3. Progress exercises to full-body exercises to increase strength and confidence in movements that replicate activities of daily living such as stair climbing.

Your treatment will usually begin with exercises to increase strength of the muscles surrounding the knee and hip joints to help stabilise the joints and improve your symptoms. As your strength and pain improve your treatment will progress to increase range of motion at the hip and knee. The final step of your exercise physiology program is to progress again to full-body exercises that will have great carry over to day-to-day activities. The whole program will be guided by your symptoms and measured against your goals.

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Exercise physiology for Patellofemoral Pain Syndrome

Patellofemoral pain syndrome (PFPS) is a condition typified by a vague, diffuse pain around the knee. It is often most noticeable during running and walking up and down stairs or hills and is a frustrating injury because it can severely limit a sufferer’s ability to partake in sports and activities they enjoy. While the pain usually isn’t associated with significant damage, the pain itself can be severely limiting. One of the first steps to getting back to activities pain-free is to reduce the aggravating activities to allow the pain to settle and to start a strength training program.

Traditionally it was thought that the most important muscles to help prevent and relieve PFPS were the VMO (one of the quadriceps muscles on the inside of the patella) and the gluteus medius (one the glute muscle on the outside of the hip). However, recent research shows that specific exercises for those muscles have no better outcomes than general exercises. Therefore, the goal of strength training for PFPS should be to have a comprehensive program to strengthen the whole lower body to not just rehab PFPS but improve performance and reduce the risk of other lower limb injuries.

Here is a sample of exercises we use for runners and other athletes recovering from PFPS:

Split Squats:

A fantastic foundational exercise, split squats help develop strength in the quads, hamstrings and lateral (outside of the hip) glutes as well as develop balance in a split stance position. These place more emphasise on the quads and lateral hip muscles than the other exercises in the program.


Another fantastic foundational exercise, deadlifts are great for developing strength in the hamstring, glute max (the big, main glute muscle) and back muscles. Deadlifts particularly strengthen hip extension which is very important in running and athletic movements.

Calf Raises:

Surprisingly the calf muscles (gastrocnemius and soleus) are the muscles that receive the most load during running (6-8 x bodyweight), more than the quads (4-6 x bodyweight), hamstrings, glute medius (2.6-3.5 x bodyweight) or glute max (1.5-2.8 x bodyweight). Therefore, it is important to strengthen these muscles to improve their ability to cope with the loading they receive during running .

Suitcase carry:

A great, simple exercise for the lateral core muscles which play an important role in helping keep the pelvis level during running.

These four exercises together provide a comprehensive strength program that strengthen almost all the muscle of the lower body. Together with a temporary reduction or modification to activity and exercise they can help get you back to what you want to do pain-free.

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How does Pilates help with my low back pain?

Low back pain is one of the world’s most common conditions and is a leading causes of disability and work absence worldwide. It affects over 80% of the world population and can result in a significant personal, social and financial burden.1 Low back pain usually settles down within 4-6 weeks but has an 80% chance of reoccurring within 12 months of the initial injury. Exercise therapy is the most common form of treatment for low back pain. It is low cost, easy to access, has a positive biological affect on the body and is recommended in most clinical practice guidelines.2

The Pilates method aims to improve posture and body awareness while building strength. The six basic principle of Pilates includes tightening the ‘powerhouse’ (trunk and gluteal muscles), concentration (cognitive attention), control (postural management), precision (accuracy), flow (smooth transition) and breathing while performing a range of exercises.2
It is a great way to get people moving in a smooth and controlled way. At Central Performance we use the reformer, wunda chair and mat-based exercises in a circuit style approach so that the exercises are varied and fun. These exercises use springs and body weight as resistance and can be adjusted to your ability. Our initial assessment involves a history of your injury and a physical examination to determine your exercise program. Than we get started! Starting on four 1-on-1 sessions to get used to the various exercises on your program. From there the choice is yours. Continue with 1-on-1 sessions or move to our group classes (max 4 people).

But how does this help with low back pain?

Just move! Our backs love movement. The worst thing to do when you have low back pain is to stop moving and stop exercising. Pilates allows you to move and exercise in a nice controlled and monitored way without using heavy weights. It can be a way of progressing your exercise tolerance or to transitions back into gym-based exercise.

I need a stronger core to get rid of my back pain!

This is often a very common perception in today’s society. We are often told to strengthen our core to prevent low back pain. However, if you have had ongoing or episodic low back pain than you may already bracing and overusing your core subconsciously to help ‘protect’ your back. Before strengthening your core it is important to regain normal relaxed movement of the spine. This relaxed spinal movement can fundamentally change the way your back behaves day to day. Pilates is a good way of starting off this process, using controlled movement of the spine before progressing to more progressive strengthening exercises, whether it be at the gym or harder Pilates exercises.

  1. 1. Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2163-2196
  2. 2. Yamato TP, Maher CG, Saragiotto BT, Hancock MJ, Ostelo RWJG, Cabral CMN, Menezes Costa LC,Costa LOP Pilates for low back pain. Cochrane Database of Systematic Reviews 2015, Issue 7

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Nutrition for the Female Athlete – Part 1

Eating Advice For Active Women 

This is the first part of a 3-part series covering some nutrition considerations that relate specifically to women during exercise. For female athletes, weekend warriors and regular exercisers, hormone changes across the month can dampen motivation to exercise and can affect performance. This 3-week blog series will delve into the hormones that are impacted during the menstrual cycle, dietary strategies to assist performance at different stages of the cycle, and a concept known as the ‘female athlete triad’.  


The Female Athlete Triad

The female athlete triad is an interrelationship of menstrual dysfunction, low energy availability (with or without an eating disorder), and decreased bone mineral density.

Particularly common in young female athletes, amenorrhea, or the absence of menstruation for 3 months or longer, can lead to decreased bone health as bones lose calcium due to lower estrogen levels. Over time, this can lead to increased risk of fractures/breaks, bone mass loss, osteopenia and osteoporosis. A loss of menstruation often occurs when there is low energy availability. The body is using all its energy for metabolic processes and for training/exercise/competition, so may not have enough energy left to cover other daily demands such as menstruation. Low energy availability doesn’t just affect those with low body fat percentages or with diagnosed eating disorders, it can exist in those with adequate body fat levels! This can occur from an imbalance of training demands and food intake, especially when there are time constraints and other commitments involved.



Signs and symptoms of the Female Athlete Triad

  •   •  Delayed menarche in young females (absence of first menstruation by age 16 years)
  •   •  Amenorrhea (absence of menstruation for more than 3 months)
  •   •  Weakened immune system – you may find yourself getting sick more often
  •   •  Reduced performance and recovery
  •   •  Poor bone health (determined by bone mineral density below normal)
  •   •  Low moods or irritability
  •   •  Restriction of food intake or certain food groups, or skipping meals regularly to achieve weight loss 

If any of these signs or symptoms sound familiar to you, our sports dietitian can provide guidance on managing your health while fuelling exercise demands. Contact reception on 9280 2322 or head to our online bookings page to book in a chat with Kelsey.

Now that you know what the female athlete triad is, the next blog post will focus on hormone changes across the menstruation cycle and how this can impact performance. Luckily, there are dietary strategies that can be used to optimise performance at different times of the month.  Stay tuned!

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Eating Tips To Battle Cold & Flu This Winter

After a long summer it seems the Australian winter is finally upon us; the time of year when cold and flu symptoms are on the rise. It seems as though everyone around you will have advice for how to beat your cold or flu, from drinking honey, ginger and lemon teas, or jumping into a sauna to relieve congestion. It can be hard to separate fact from fiction when it comes to the abundance of remedies, so our dietitian has some simple and reasonable advice for you to follow this winter.
Food can play a really important role in preventing and reducing the severity of colds and flu, which is no surprise because 80% of the immune system is located in the digestive tract. Healthy gut bacteria, proteins and other chemicals are just some of the warriors in the digestive system that help to fight off infections. Before illness comes on, it is important to eat a healthy diet to provide the immune system with these nutrients it needs to fight off infections. Here are just some of the foods that help to protect your immune system and should be included in the everyday diet:


Berries are a great source of Vitamin C which is an antioxidant that has antimicrobial properties, protects immune cells from damage and contributes to maintaining a healthy immune system. Vitamin C can also help to reduce duration and severity of colds. Frozen berries have the same nutrition value as fresh berries, so it doesn’t matter if you buy frozen.


Capsicum contains twice the amount of Vitamin C as citrus fruits. Vitamin C boosts white blood cells to help fight infections. Include capsicum in stir fries or salads.


Broccoli contains Vitamins A, C and E which are antioxidants. Antioxidants assist in preventing cell damage and reduce risk of certain illnesses. Broccoli is best when cooked for the shortest time possible, to keep in the good nutrients


These all have anti-microbial properties, helping to prevent illness. Use these together when cooking stir fries and pasta dishes.


Yoghurt is a good source of probiotics to keep your gut healthy and boost immune function. Choose the unflavoured varieties for benefits e.g. plain Greek yoghurts or plain Chobani/Yo-Pro yoghurts


Salmon is high in Omega-3 (essential fatty acids) which will help to maintain healthy cells and assists with reducing inflammation, particularly important for recovery for those with heavy training loads.


Brazil nuts are high in a nutrient called selenium that helps to protect the body’s cells from oxidative damage. Deficiencies of selenium have been associated with increased risk of illnesses. Incorporate brazil nuts into your diet a few times a week to reap the benefits.


But what happens when you do get a cold or a flu?

Being sick will often result in a decrease in appetite, so every meal consumed while sick is an opportunity to choose nutrient rich foods that will help to fight off infection and speed up recovery. Some foods that should be included in the diet during a bout of cold or flu includes:

Citrus fruits, tomatoes, pumpkin, capsicum and sweet potatoes

What do citrus fruits, tomatoes, pumpkin, capsicum and sweet potatoes have in common? These foods are all high in Vitamin C, which is an antioxidant that has been found to assist with reducing the severity and longevity of colds by protecting cells from damage. Try a roast vegetable tray with tomato, pumpkin, capsicum and sweet potato, or snack on some oranges or mandarins.


Garlic has antimicrobial properties so acts as an antibiotic that can help to reduce the severity of your cold.

Vietnamese Pho

Chicken soup has long been a favourite of Mum’s everywhere to help fight off a cold, but Vietnamese Pho is another great option! This big bowl of warming soup will help to rehydrate you by providing plenty of fluid and electrolytes and provides a source of protein. You can even order extra meat to boost the protein content!

Supplements that reduce the severity and duration of colds can be really useful, particularly when you don’t feel like eating a lot! The following are good quality supplements that I recommend you to use while sick:

  • Luckily, we can get a lot of vitamin C from food, so it isn’t always necessary to have Vitamin C supplements daily, but they can be helpful once you do get sick. Vitamin C supplements come in many forms so choose one that is of good quality and is non-acidic (so you don’t feel sick/get reflux when using).
  • Probiotics help restore gut bacteria after illness, supporting a healthy immune system. Look for a good quality probiotic with 40-50 billion CFU’s (listed on the product).
  • Zinc has an antiviral effect in the body and is usually obtained in the diet from poultry and red meats. If you find you are eating less than normal while sick, a zinc supplement can come in handy to assist with reducing the longevity of your cold.

Lastly, the most important thing you can do for yourself is to eat a healthy and varied diet to protect your immune system. Make sure you rest and eat well when sick, using supplements if needed to help reduce the longevity and severity of colds and flu. Book in an appointment with our dietitian to find out more about how a healthy diet can positively affect your wellbeing.

This article was written by Kelsey Hutton, our Accredited Practising Dietitian.

To book an appointment with Kelsey or to ask her a question call her on 9280 2322 or contact the clinic.



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