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    Musculoskeletal Health Australia
    13/Jan/2024
    Health InformationMSK articles

    Make a splash with water exercise

    We all know that when our muscles and joints are stiff or painful, it can be hard to move. But we also know that regular exercise is essential for managing musculoskeletal conditions. It helps reduce pain and stiffness, and improves joint mobility and strength. It can also improve balance, sleep quality, lower stress levels, improve mood and help us maintain a healthy weight. It’s practically magic!

    But when you’re in pain, exercise can feel like the very last thing you want to do. So what to do?

    Just add water!

    There are so many benefits to exercising in warm water:

    • the warmth is soothing and helps relieve pain and stiffness
    • the buoyancy supports your body and lessens the strain on your joints
    • water resistance enables you to gradually build up flexibility, strength and stamina
    • anyone can do it – no matter your age or level of fitness.

    What is water exercise?

    A water exercise program is much more than just going for a swim. Swimming regularly is an excellent way to improve your heart and lung fitness without putting too much strain on your joints, but for a complete workout you need to do a range of exercises which move all your joints and work all your muscles. You can easily do this in a warm water pool.

    There are different ways you can exercise in water

    1. Water exercise classes
    You can enjoy the fun, motivation and social interaction of exercising with others in a class that suits your capabilities and fitness level. In these classes all participants follow the same general exercises.

    Many recreation and fitness centres run water exercise classes and cater to a wide range of abilities and fitness levels.

    Contact your local centre and talk with an instructor to find out what’s available and to discuss your exercise goals. And ask if you can visit the centre and observe a class before you sign up so that you can be sure it’s the right fit for you.

    2. Hydrotherapy
    Hydrotherapy is specialised exercise therapy run by a health professional such as a physiotherapist or exercise physiologist in a specially heated warm water pool. The exercises are tailored to you and your specific needs. You can do hydrotherapy on your own with the health professional or in a small group.

    3. Going solo
    You can do your own water exercises in a warm water pool at home or in recreation centres, fitness clubs, swimming schools and retirement villages.

    Here are some tips for getting started with your own program:

    • If you’re not sure what exercises to do, talk with a qualified instructor or health professional. We’ve also included links to some general exercises in the More to explore section below.
    • Choose a time when the pool is fairly quiet so you can move safely and confidently around the pool area and you’re less likely to be knocked by enthusiastic swimmers and others enjoying more boisterous water activities.
    • Check the ease and safety of access into the centre, around the dressing area and into the pool.

    Swimming is also a good form of water exercise you can do on your own. While it doesn’t work all of your muscles and joints through their range of movement, it’s excellent for your heart and lungs.

    What if you can’t swim?

    If you can’t swim, that’s ok. Water exercise classes take place in water that’s about chest height. So you can stand with your head above the water. You can also use flotation devices to give you the confidence to get moving in water if you’re feeling a bit apprehensive.

    Tips for exercising in warm water

    Whether you’re exercising at home or in a community pool, participating in a class or doing your own exercises, you’ll get the most benefit from your exercise session and ensure your safety and wellbeing by following these tips:

    • Don’t go into the water if you’re sick, have any wounds or skin irritations/infections.
    • Check out the venue to see if it’s suitable for you. For example, is the pool easy to access? Are the change rooms accessible and comfortable? Is the venue close enough for you to go to regularly? Do the class times and opening hours of the venue work for you?
    • Begin your exercise program with short sessions and gradually build up over time.
    • Perform each movement as gracefully and smoothly as you can.
    • Keep the body part you’re exercising under the water. This may require you to squat or bob down at times.
    • Come out of the water immediately if you feel light-headed, dizzy, drowsy, extremely fatigued or nauseous. These reactions are possible if you spend too long in very warm water. Drink some water and sit or lie down for a while.
    • Stop doing an exercise which causes severe pain or discomfort. Consult your doctor, physiotherapist or exercise physiologist if your joint symptoms increase significantly after an exercise session.
    • Ease up if you experience mild to moderate joint or muscle pain for more than a few hours after your exercise session. Some increased pain is normal after exercise, especially when you’re starting out, but if you’re in pain hours after your visit to the pool, you’ve likely overdone it. Reduce the intensity next time – but don’t stop.
    • If you’ve had a joint replacement, keep in mind the movements you were instructed to avoid by your surgeon or physiotherapist.
    • Consider wearing water shoes if you find you’re slipping and sliding in the pool. They’ll give you some grip to help you keep your balance.
    • Have a drink after a water exercise session to replace the fluid you’ve lost through perspiration.
    • Take care when moving in wet areas around the pool, including in change rooms, to avoid slipping and falls.
    • Rest afterwards if you feel tired. Exercising in warm water can be quite draining.

    And as always, follow COVID-safe practises and abide by any rules that are in force in your state or territory.

    So there you have it. Exercising in the water. It’s a great addition to your exercise routine that’s effective, fun and safe. Why not give it a go?

    Call our Helpline

    If you have questions about things like managing your pain, your musculoskeletal condition, treatment options, or accessing services be sure to call our team. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@muscha.org) or via Messenger.

    More to explore

    CONTINUE READING
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    Karla Wignall
    12/Dec/2023
    MSK articlesMSK Kids Blogs

    Uni Life

    This blog was written by Sass, a member of our Teen Talk group.

    So. You want to know what life might look like at Uni with a musculoskeletal condition / arthritis? Well, as an individual whose bones/joints/various other systems dislike her, and who has completed her first year of uni, allow me to provide an insight into my experience in the hope it can help you too.

    Right. Starting off strong with disability services. You should absolutely get in touch with any disability services on campus ASAP. Do. Not. Wait. They can help you navigate your Uni experience as a person with a chronic condition. I waited too long, and was ✨stressing✨ when in reality I could have fixed that by being on top of getting my accommodations earlier.

    Ok, you’ve got your accommodations. What can you expect now?

    For me, my hypermobility makes fine motor skills inconveniently painful, and so in line with this (and the general nature of Uni assignments often being digital) I was able to access my exams and tasks on a purely digital basis unless absolutely necessary. When I couldn’t use tech, I was provided with a student peer who scribed for me, and they were all the most lovely people. I also got extra time, which I rarely used if at all, but it’s good to have that up your sleeve regardless if you might need it.

    Uni is also a very social time, and let’s be honest, socialising can be a little draining sometimes (where my introverts at?). The most important thing to remember here is that you should surround yourself with friends who are able to understand that you may require more rest or downtime, and/or that you may need activities to be modified for your enjoyment. Please, please, please, promise me you won’t burn yourself out by not speaking up about your needs. You deserve to be respected in all situations.

    Managing the stress of exam season? Been there, and I’ll unfortunately continue to do that for the next two years! How I manage involves reading before bed to ensure I get good sleep, going on gentle walks, basically trying to reduce stress. I drink a lot of tea as well, and have the occasional hot choccie (gotta treat yourself, right?) and this helps me to relax. Also, I’ve been trying to stop myself from comparing my results to others. You are in a race ONLY WITH YOURSELF. Your only opponent is your personal best.

    Ok, in summary:

    respecting your needs + having reliable friends + not comparing yourself to others + getting accommodations ASAP = good year.

    Now, in the words of Ignatius Loyola, go forth and set the world on fire. 🙂

     

    If you’d like to write a blog to share with our community, please contact us

    Contact our free national Help Line

    If you have questions about managing your pain, your musculoskeletal condition, treatment options, mental health issues, or accessing services be sure to call our nurses. They’re available Monday to Thursday between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    More to explore

    CONTINUE READING
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    Karla Wignall
    12/Dec/2023
    MSK articlesMSK Kids Blogs

    What to expect when taking your child to a physio

    Our child has seen so many specialists and now they have been told to go to a kid’s physio. Are you thinking how will a physio help? Or how will this be any different to any other appointments we have? What do I tell my child they will be doing with them?

    I am Nicole Pates, a Titled Paediatric Physiotherapist and director of Western Kids Health, a paediatric clinic in Perth Western Australia. I have been a Paediatric physio for over 13 years and these are the things I would like you to know about seeing a paediatric physio.

    Children and teenagers, as we all know, are different from adults. Not just physically, but in all of their systems. Their brain is growing and their understanding of their body and how it works is constantly changing. Add into that school, friends and puberty and well, it can be a lot. Let alone managing chronic pain and fatigue on top of this. This is why it is important to work together with a physiotherapist who is experienced in working with kids and teens, who understands growth and development. You can search for a Titled or Specialist Paediatric Physiotherapist, who has undertaken extra study or experience in paediatrics, on the Australian Physio website https://choose.physio/find-a-physio

    For families of children with persistent pain and / or fatigue, finding the right help can be tricky.  You can find a practitioner experienced in working in paediatric pain on the Australian Pain Society website  https://www.apsoc.org.au/Home/wcontent2/60

    Once you have chosen a physiotherapist you will be *hopefully* be on your way to an appointment. You may be required to fill out some questionnaires or forms, prior to your initial appointment, depending on your reason for visiting the physiotherapist.

    Typically, an initial appointment for children with chronic musculoskeletal / rheumatological conditions will be an hour or potentially more. For some families at Western Kids Health, we might sit down for 2 hours with not just physio but also OT and psychology. I encourage you to contact your chosen clinic to find out more about the first appointment. It is important to dress in clothes that are comfortable to move in and take a water bottle if needed.

    Your physiotherapist may ask lots of questions in the first appointment. Not just about your child’s condition, symptoms, history, current team and limitations but also about their strengths, likes and future goals. Your physio will then watch how your child moves and plays, particularly the things they are having trouble with.

    We love watching kids move and figuring out the different reasons as to why they might be having trouble or moving differently.

    Being able to identify the activities that trigger your child’s symptoms, understanding their experience and watching how your child moves will enable your physio to work with you to formulate a plan. This plan should be collaborative and based around your child’s goals such as getting back to school, sport or hobbies. Having pain or fatigue can be so annoying and make moving and doing things difficult. But with chronic conditions, waiting for the pain or fatigue to go away before you get back into things can be an endless waiting game. Your physio will help you get back into doing things in a way that is meaningful, fun and supported.

    Your physio may also provide education around:

    • Symptoms such as pain and fatigue and potential triggers / aggravators
    • Strategies on how to bring awareness to and strategies to minimise triggers and aggravators
    • Why your child may be experiencing pain.
    • How best support your child and their pain journey through supportive language in a progressive mindset

    Your physio will also work hard to understand where your child’s physical function is at present and work out a plan to build on their activity level, strength, balance, movement control and most importantly, function over time. Your physio will support your child (and you!) with a plan for flare ups or set backs.

    Other team members who your physio may recommend supporting you are

    • An Occupational Therapist, who assists your child to minimise the impact symptoms may have on sleep, school and relationships
    • A Dietician to understand your child’s nutrition needs whilst they are growing and create plans to support and meet these needs
    • A Psychologist to build coping skills and resilience and manage mental health symptoms such as low mood, stress or anxiety. This is important as often these symptoms are contributing to or exacerbating your child’s ability to engage in the physical rehab.

    At Western Kids Health we run specialised groups in conjunction with the Arthritis & Osteoporosis Association of WA, including group hydrotherapy and strength and conditioning classes.

    Hydrotherapy and physical conditioning for children with conditions like Juvenile Idiopathic Arthritis is safe and effective. Building strength through range is essential to keep your joints healthy. Your physio will work with you to help your child understand their body’s reactions and sensations as they try new activities. This will help your child build their capacity and understanding of body awareness. Your physio will help explore what movements and types of exercise work best for your child’s body, and most importantly making it fun!

    You should see improvements over time with the right support and if you aren’t seeing those improvements, or your child isn’t reaching their goals, please discuss this with your therapy team.

    Contact our free national Help Line

    If you have questions about managing your pain, your musculoskeletal condition, treatment options, mental health issues, or accessing services be sure to call our nurses. They’re available Monday to Thursday between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    More to explore

    CONTINUE READING
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    Lisa Bywaters
    16/Nov/2023
    Health InformationMSK articles

    When coffee isn’t enough

    Or how to manage fatigue

    We all get tired. We overdo things and feel physically exhausted. It happens to us all. Usually after a night or two of good quality sleep the tiredness goes away and we’re back to our old selves.

    But fatigue is different.

    It’s an almost overwhelming physical and/or mental tiredness. And it usually takes more than a night’s sleep to resolve. It generally requires multiple strategies, working together, to help you get it under control.

    Many people living with a musculoskeletal condition struggle with fatigue. It may be caused by a chronic lack of sleep, your medications, depression, your actual condition (e.g. rheumatoid arthritis, lupus, fibromyalgia) or just the very fact that you live with persistent pain.

    Fatigue can make everyday activities difficult, and can get in the way of you doing the things you enjoy. The good news is there are many things you can do to manage fatigue and get on with life.

    Exercise and being active. While this may sound like the last thing you should do when you’re feeling fatigued, exercise can actually boost your energy levels, help you sleep better, improve your mood, and it can help you manage your pain. If you’re starting an exercise program, start slowly, listen to your body and seek advice from qualified professionals. Gradually increase the amount and intensity of activity over time.

    Take time out for you. Relaxation – both physical and mental – can help you manage your fatigue. I’m not just talking about finishing work and plonking down in front of the TV – though that may be one way you relax and wind down. I’m specifically referring to the deliberate letting go of the tension in your muscles and mind. There are so many ways to relax including deep breathing, visualisation, gardening, progressive muscle relaxation, listening to music, guided imagery, reading a book, taking a warm bubble bath, meditating, going for a walk. Choose whatever works for you. Now set aside a specific time every day to relax – and choose a time when you’re unlikely to be interrupted or distracted. Put it in your calendar – as you would any other important event – and practise, practise, practise. Surprisingly it takes time to become really good at relaxing, but it’s totally worth the effort. By using relaxation techniques, you can reduce stress and anxiety (which can make you feel fatigued), and feel more energised.

    Eat a well-balanced diet. A healthy diet gives your body the energy and nutrients it needs to work properly, helps you maintain a healthy weight, protects you against other health conditions and is vital for a healthy immune system. Make sure you drink enough water, and try and limit the amount of caffeine and alcohol you consume.

    And take a note out of the Scout’s handbook and ‘be prepared’. Consider making some healthy meals that you can freeze for the days when you’re not feeling so hot. You’ll then have some healthy options you can quickly plate up to ensure you’re eating well without having to use a lot of energy.

    Get a good night’s sleep. Good quality sleep makes such a difference when you live with pain and fatigue. It can sometimes be difficult to achieve, but there are many things you can do to sleep well, that will decrease your fatigue and make you feel human again. Check out our blog on painsomnia for more info and tips.

    Pace yourself. It’s an easy trap to fall into. On the days you feel great you do as much as possible – you push on and on and overdo it. Other days you avoid doing stuff because fatigue has sapped away all of your energy. By pacing yourself you can do the things you want to do by finding the right balance between rest and activity. Some tips for pacing yourself: plan your day, prioritise your activities (not everything is super important or has to be done immediately), break your jobs into smaller tasks, alternate physical jobs with less active ones, and ask for help if you need it.

    Write lists and create habits. When you’re fatigued, remembering what you need at the shops, where you left your keys, if you’ve taken your meds or what your name is, can be a challenge. And when you’re constantly forgetting stuff, it can make you stress and worry about all the things you can’t remember. Meh – it’s a terrible cycle. So write it down. Write down the things you need at the supermarket as soon as you think of it –a notepad on the fridge is a really easy way to do this. Create habits around your everyday tasks – for example always put your keys in a bowl by the door or straight into your bag, put your meds in a pill organiser.

    Be kind to yourself. Managing fatigue and developing new ways to pace yourself is a challenge. Like any new behaviour it takes time, effort and lots of practice. So be kind to yourself and be patient. You’ll get there. It may take some time, and there may be some stumbles along the way, but you will become an expert at listening to your body, pacing yourself and managing fatigue.

    Talk with your doctor. Sometimes fatigue may be caused by medications you’re taking to manage your musculoskeletal condition. If you think your medications are the issue, talk with your doctor about alternatives that may be available.

    Fatigue may also be caused by another health condition – including anaemia (not having enough healthy red blood cells to carry oxygen around your body), diabetes, high blood pressure, fibromyalgia and being overweight. If you’re not having any success getting your fatigue under control, your doctor may suggest looking into other potential causes.

    So that’s fatigue…it can be difficult to live with, but there are lots of ways you can learn to manage it.

    Tell us how you manage. We’d love to hear your top tips for dealing with fatigue.

    FIRST WRITTEN AND PUBLISHED BY LISA BYWATERS IN OCTOBER  2020

    Call our Help Line

    If you have questions about things like managing your pain, COVID-19, your musculoskeletal condition, treatment options, telehealth, or accessing services be sure to call our nurses. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    More to explore

    CONTINUE READING
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    Lisa Bywaters
    16/Nov/2023
    Health InformationMSK articles

    Anti-inflammatory diets

    Anti-inflammatory diets have been around for some time. There are many websites, books and blogs promoting the benefits of eating anti-inflammatory foods.

    This type of diet sounds tempting, not only because of the foods they promote – which are all delicious – but because the idea that we can fight inflammation with the foods we eat sounds so attractive and natural!

    So what is an anti-inflammatory diet, what are they supposed to do and what’s the evidence (if any) behind them?

    First – the what

    The theory behind these diets is that certain foods have anti-inflammatory properties, while others cause inflammation. So if we incorporate more of the anti-inflammatory foods and less of the pro-inflammatory foods in our diets, it may help lower levels of inflammation for people who have arthritis, psoriasis and other inflammatory conditions.

    Sounds logical, right? Maybe??

    Next – the evidence

    OK, so this is where it gets a little murky. There’s really not a lot of conclusive evidence to support these claims. Studying the effects of diet is a tricky business, as this article in VOX explains. When we look at treating chronic diseases, research “involves looking holistically at diets and other lifestyle behaviors, trying to tease out the risk factors that lead to illness. Nutrition science [is therefore] a lot more imprecise. It’s filled with contradictory studies that are each rife with flaws and limitations. The messiness of this field is a big reason why nutrition advice can be confusing.” (1)

    So we often have to use things like observational studies, self-reporting or information gleaned from studying the effects of dietary changes on lab animals.

    Which means the data we obtain is often contradictory and isn’t conclusive. For more information read: The messy facts about diet and inflammation by Scientific American.

    Does this matter?

    Maybe not. Two popular anti-inflammatory diets are the Mediterranean diet and the DASH (Dietary Approaches to Stop Hypertension) diet.

    Both diets have a heavy emphasis on eating:

    • foods that are as unprocessed as possible,
    • a rainbow of fresh whole fruits and vegetables (not juices),
    • whole grains such as brown rice, quinoa, oats, whole grain breads and pasta,
    • beans, lentils, chick peas and other legumes,
    • nuts and seeds,
    • fish, seafood and poultry,
    • healthy oils such as olive, vegetable, canola.

    They both recommend people eat less:

    • red meat,
    • foods high in sugar, salt and fat,
    • highly processed foods.

    So if we look at this type of diet, it’s actually a healthy, well-balanced diet. Eating a variety of different foods, in a range of different colours means that we’re giving our body a wide range of important vitamins and nutrients.

    In the end, whether you call it an anti-inflammatory diet, a Mediterranean diet or DASH diet, it doesn’t really matter. And whether it has an effect on inflammation, only time and further research will tell.

    But if you eat a nutritious, well-balanced diet you’ll certainly feel better overall. Eating well helps us maintain a healthy weight, is important for our physical and mental health, can help us sleep better, be more active, reduce our risk of developing other health conditions, and just generally makes us feel good.

    Tips to change your diet

    If you want to make your diet more like the anti-inflammatory style of diet, here are our top tips:

    • Talk with your doctor and seek advice from an accredited practising dietitian.
    • Start small. You don’t have to change your entire diet at once if that seems overwhelming. Make small changes such as reducing the amount of processed foods you eat, eating more fruits and vegies each day, swap red meat for fish, lean chicken (skin-off), beans or lentils.
    • Get adventurous. There are a lot of websites that provide easy recipes that follow this type of eating plan. We’ve listed some in the More to Explore section.
    • Portion size is still important. Many of the plates we use, especially for dinner, are far too big. And we tend to fill them. The simple solution is to use a smaller plate. When dishing up your meals, imagine your plate is divided into quarters. Aim to fill two of those quarters (or half the plate) with colourful vegies or salad, one quarter with protein (fish, legumes, tofu, meat) and the last quarter with carbohydrate foods such as rice, noodles, potato or bread roll.
    • Exercise is also important. A healthy diet doesn’t work on its own. We also need to be active every day to maintain our weight, control our pain, improve our sleep and improve our mood and mental health.
    • Reduce your intake of:
      o Sweet foods such as cakes and biscuits. Swap them for fresh, in-season fruit.
      o Refined grains such as white rice and white bread. Swap them for whole grains.
      o Trans-fats and saturated fats.
      o Ultra-processed foods. These are foods that have gone through a LOT of processing and are far from their original state. They generally have salt, sugar, fat, additives, preservatives and/or artificial colours added.

    Final words

    At the end of the day, these diets are all about eating a variety of healthy foods. And as we come into warmer weather, these are the sorts of foods that make us happy, feel lighter and more energetic. So – if you’re not already – why not give it a go?

    FIRST WRITTEN AND PUBLISHED BY LISA BYWATERS IN SEPT 2020

    Call our Help Line

    If you have questions about things like managing your pain, COVID-19, your musculoskeletal condition, treatment options, telehealth, or accessing services be sure to call our nurses. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    More to explore

    Reference

    (1) I asked 8 researchers why the science of nutrition is so messy. Here’s what they said.
    Vox, 2016

    CONTINUE READING
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    Musculoskeletal Health Australia
    25/Oct/2023
    MSK articles

    Get your hands dirty

    Gardening, pain and musculoskeletal conditions

    Gardening’s a wonderful way to get out in the fresh air and sunshine. It can also be extremely relaxing, and it’s often a good workout.

    But if your condition sometimes impacts on your ability to garden, there are many things you can do so that you can still get into your garden and enjoy yourself.

    • Pace yourself – don’t try to do too much in one go. And take regular breaks. This’s a good opportunity to rest – but also to sit back and admire your work, contemplate what to do next, and imagine future gardening projects.
    • Contain it – use pots and other containers for small, manageable gardens. You can use regular garden pots or containers, or be creative and use other containers you have lying around – e.g. old wheelbarrows, teapots, colanders, tyres, boots. Check out Pinterest for some great ideas.
    • Create raised garden beds – this will take a bit more planning and work, but by raising your garden beds you can access them with less bending or kneeling. Perfect if you have a sore back, hips or knees.
    • Use thick handled tools – there are a wide range of thicker handled garden tools that are great if you have painful hands or difficulty gripping. You can also buy thick rubber or foam tubing from the hardware store, cut it to length and fit it over the handles of your existing gardening tools.
    • Use cushioned knee supports – knees pads, kneeling mats, or even gardening stools can help cushion and protect your knees and help you get up and down off the ground.
    • Get some help – whether it’s family, friends, or a local handyman or gardener, get some help if you have some big jobs that need doing – e.g. creating raised garden beds, pruning trees, mowing lawns. You don’t have to do everything yourself.
    • Keep hydrated – make sure you drink plenty of fluids. Gardening can be hot, strenuous work, so don’t let yourself become dehydrated. Keep a water bottle close by.
    • Talk with an OT – an occupational therapist can help you find ways to modify your activities to reduce joint pain and fatigue and save energy. They can also give you tips and ideas about different aids and equipment available.

    These are just a few things you can do to stay active in the garden, so that you can get out in the fresh air and enjoy getting your hands dirty. If you love to garden, and have suggestions or tips for others, please let us know. We’d love to hear from you.

    Originally written and published by Lisa Bywaters in May 2018.

    CONTINUE READING
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    Musculoskeletal Health Australia
    24/Oct/2023
    Health InformationMSK articles

    Seven sleep tips for people in pain

    You know what it’s like. It’s 3.00am and you’ve just woken up. Again. You glance at your clock and do the maths – only 4 hours until it’s time to get up. This is really taking a toll on you – your mood, your performance at work, and your pain levels.

    So what can you do?

    1. Avoid using technology in bed. The blue light from laptops, tablets and smartphones suppresses the hormone melatonin, which makes us sleepy at night. So be sure to stop screen use at least one hour before bed.
    2. Get out of bed. Don’t lie in bed tossing and turning. Have a warm drink (e.g. milk, no caffeine), do some gentle stretches or breathing exercises and go back to bed when you feel more comfortable.
    3. Develop a sleep routine. There’s a reason we do this with babies and small children – it works! As often as possible, go to bed and get up at the same time each day. Your body will become used to this routine and you’ll find it’s easier to fall asleep and stay asleep.
    4. Don’t look at the clock. Constantly checking the time can make you anxious, which makes it hard to sleep. Try removing your clock from the bedside, or cover it up at night.
    5. Try some relaxation techniques. There are as many ways to relax as there are stars in the night sky (well, almost) so there’s bound to be something that suits you. Consider trying mindfulness, visualisation, deep breathing or a warm bath before bed. These techniques will help you become more relaxed and may help you manage your pain better so that when you go to sleep, you sleep well.
    6. Be active during the day. As well as the many other benefits of regular exercise, it’ll help you fall asleep and stay asleep longer.
    7. Seek help. If pain is constantly keeping you awake at night, talk with your doctor about other things you can do to manage your pain and get some decent sleep.

    And check out our A-Z guide to managing pain. It’s full of tips and strategies to help you manage your pain.

    First written and published by Lisa Bywaters in June 2018

     

    CONTINUE READING
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    Lisa Bywaters
    24/Oct/2023
    Health InformationMSK articles

    A weed by any other name

    Medicinal cannabis and you

    Marijuana, dope, pot, grass, weed, Mary Jane, doobie, bud, ganja, hashish, hash, wacky tobaccy…they’re just some of the common names for cannabis.

    Whatever you call it, it’s been used for medicinal purposes for thousands of years, until it became a banned or controlled substance in most parts of the world.

    But for decades there’s been renewed interest in its use in healthcare, with many countries – including Australia in 2016 – decriminalising it for medicinal use.

    Last year alone the Therapeutic Goods Administration (TGA) granted over 25,000 applications from doctors to prescribe cannabis, mostly in the form of an oil.

    So let’s weed out some of the facts and explore the use of medicinal cannabis for pain and musculoskeletal conditions.

    Is it marijuana or cannabis?

    It’s both. They’re just different names for the same plant – marijuana is the commonly used name, cannabis is the scientific name. The preferred name for its use in healthcare is medicinal cannabis, to draw the distinction between medicinal use of cannabis and the illegal, recreational use of marijuana.

    The tongue twisters – cannabinoids

    It’s a tough word to say – far harder than musculoskeletal! – but an important one when we talk about the properties of cannabis. Cannabinoids are the chemicals found in the cannabis plant. They bind onto specific receptors (CB1 and CB2) on the outside of our cells and can affect things like our mood, appetite, memory and pain sensation.

    Cannabis has more than 140 cannabinoids. The two major ones are tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is the cannabinoid linked with the sensation of feeling ‘high’ that’s associated with recreational marijuana use.

    Cannabinoids also occur naturally in our body (endocannabinoids) and can also be created artificially (synthetic cannabinoids).

    How’s it taken?

    Medicinal cannabis, both plant-based and synthetic, comes in many forms including oils, capsules, oral sprays and vapours. Smoking isn’t an approved preparation as it can cause damage to the lungs and airways.

    Does it work?

    At the moment, evidence for its use to treat pain associated with arthritis and musculoskeletal conditions is lacking.

    Cannabis has been illegal for so long that we don’t have the thorough, scientific evidence we need about: side effects, which cannabinoids (e.g. THC, CBD or a combination) may be effective, dosages, the best form to use (e.g. oil, capsules etc), the long-term effects, or the health conditions or symptoms it may be beneficial for. Research is emerging, but we need a lot more.

    Because of this lack of research, the Australian Rheumatology Association doesn’t support the use of medicinal cannabis for musculoskeletal conditions. Their concern is that we don’t have enough info to ensure cannabis is safe and effective for people with musculoskeletal conditions.

    The Therapeutic Goods Administration (TGA) has also stated that there’s “not enough information to tell whether medicinal cannabis is effective in treating pain associated with arthritis and fibromyalgia”.

    Possible side effects

    As with any medication – and medicinal cannabis is a medication – it can have side effects. They include: dizziness, confusion, changes in appetite, problems with balance and difficulties concentrating or thinking.

    The extent of side effects can vary between people and with the type of medicinal cannabis product being used.

    How do I access it?

    Unfortunately it’s a complicated process. We aren’t at the stage where a doctor can just write a prescription that you can fill at any chemist. Medicinal cannabis is an unregistered medicine, which means your doctor must be an Authorised Prescriber or must apply for you to have access to it through the TGA’s Special Access Scheme.

    But if it’s something you’d like to try, talk with your doctor about whether it’s a possible option for you. Together you can weigh up the risks and benefits for your specific situation.

    You need to be aware that medicinal cannabis is not on the Pharmaceutical Benefits Scheme (PBS), so if you can access it, you’ll likely have to pay significant costs.

    Another option for gaining access to medicinal cannabis is to consult a doctor at a specialised cannabis clinic. This also comes at a price, however it may be an option if your doctor isn’t an authorised prescriber or they’re not well-informed in the use and prescribing of medicinal cannabis.

    Driving and medicinal cannabis

    If you’re using medicinal cannabis it’s important that you know exactly what’s in it. If you’re taking a product that you’ve obtained through legal prescribers that only contains CBD, you can drive. However if you’re using a product that has any THC in it, whether on its own or in combination with CBD, you can’t drive. It’s currently a criminal offence to drive with any THC in your system.

    Talk with your doctor and/or pharmacist for more information.

    Interactions with other medications

    As with any substance you ingest, there’s the potential for medicinal cannabis to interact with other medications and supplements you’re taking. So before prescribing medicinal cannabis, your doctor will review your current medications to reduce the risk of any negative effects.

    However if while using medicinal cannabis you experience any unusual symptoms, discuss these with your doctor.

    Finally

    For many people the use of medicinal cannabis could be a long way off. And unlike the way it’s often portrayed in the media, it’s unlikely to be a panacea or magic bullet that will cure all ills.

    It also won’t work in isolation – you’ll still need to do all of the other things you do to manage your condition and pain, including exercise, managing your weight, mindfulness, managing stress, pacing etc.

    The important thing is to be as educated as you can and be open in your discussions with your doctor.

    And be aware that cannabis for non-medicinal purposes is still illegal in Australia.

    First written and published by Lisa Bywaters, Dec 2020.

    For more detailed information about medical cannabis in Australia watch our webinar

    Medicinal cannabis in Australia: Weeding out the facts 
    Dr Richard di Natale, outgoing Senator and former leader of the Australian Greens, and Prof Iain McGregor, Lambert Initiative for Cannabinoid Therapeutics, University of Sydney discuss the use of medicinal cannabis in Australia – what it is, available forms, access issues in Australia and the current evidence for use.

    Call our Help Line

    If you have questions about things like managing your pain, your musculoskeletal condition, treatment options, COVID-19, telehealth, or accessing services be sure to call our nurses. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    More to explore

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    Lisa Bywaters
    04/Oct/2023
    Health InformationMSK articles

    Visiting a rheumatologist

    If you’ve been experiencing persistent joint or muscle pain, stiffness and/or inflammation that you can’t explain (e.g. from a fall or strenuous physical activity), you should discuss your symptoms with your general practitioner (GP).

    Many conditions can cause these symptoms, so to work out what’s causing your symptoms, your GP will:

    • Take your medical history. They’ll ask you about your symptoms, when they started, how they affect you, your family medical history and other health issues you may have.
    • Do a physical examination. They’ll look for redness and swelling in and around the joint and test your joint’s range of movement. They may also look for rashes, check your eyes and throat, and take your temperature.
    • Order scans and other tests. Depending on the condition your GP thinks you might have, they may send you for tests to check for levels of inflammation in your blood or specific genetic markers. You may also have scans such as x-rays, ultrasound or CT (computed tomography) to get a clearer picture of what’s happening inside your body.

    When your GP has gathered all of this information, they may refer you to a rheumatologist.

    Rheumatologists are doctors who specialise in diagnosing and treating problems with joints, muscles, bones and the immune system. You need a referral from your GP to see a rheumatologist, whether they’re in private practice or a public hospital outpatient clinic.

    Your GP may refer you to a rheumatologist if:

    • they think you have, or they’ve diagnosed you with, an inflammatory type of arthritis such as rheumatoid arthritis or ankylosing spondylitis, so that treatment can be started as soon as possible
    • your symptoms improve with treatment but come back when you stop taking medicine
    • your symptoms don’t respond to treatment or get worse over time
    • you develop unexpected complications, such as a fever, rash, or fatigue
    • you have unusual test results.

    Preparing for your first consultation

    When you make an appointment to see a rheumatologist, you should ask them some questions so that you’re prepared. This may include:

    • What do I need to bring with me?
    • How much will my out-of-pocket expenses be?
    • How long will my appointment be?
    • Is there parking available, or accessible public transport?

    Armed with this information, you can be proactive and prepare for your consultation.

    It can be helpful to make notes about your symptoms – when you first noticed they appeared, how they affect you day-to-day – as well as other health conditions you have, medicines or supplements you take regularly and information about your family medical history.

    It’s also helpful to write down questions you want to ask your rheumatologist. Put them in order of the most important first, in case you don’t get through your entire list.

    Your consultation

    Seeing a specialist can sometimes be overwhelming, especially if you’re feeling unwell or anxious. There can also be a lot of information to absorb. That’s why it can be helpful to bring a family member or a friend to your appointment. They can provide emotional support, help you ask questions or write down any important information. They can also be a second set of ears to hear what the specialist says and help you recall this information later. It can be hard to remember everything, especially when you’re feeling anxious.

    Wear comfortable clothing that can be easily adjusted or removed if necessary, so that the rheumatologist can examine you.

    And don’t forget your referral, x-rays, scans and other test results, your list of questions and any other bits and pieces you were asked to bring!

    Your first consultation with your rheumatologist will be more thorough than your consultation with your GP. They’ll:

    • review your medical history
    • ask lots of questions about your symptoms, such as when you’re most stiff or sore, and how long you’ve had pain and symptoms
    • do a comprehensive examination of your joints, including counting the number of tender and swollen joints
    • refer you for further blood tests and imaging if required.

    It’s important to know that there are many different types of musculoskeletal conditions, and many have similar symptoms. So it can take time to get a diagnosis. Your rheumatologist may provide you with a prescription for medicines and suggest some self-care options that you can do while you wait for your diagnosis.

    Follow-up consultations

    Once your diagnosis has been made, your rheumatologist will provide you with information about your condition and a treatment plan.

    Your treatment plan will fit your specific symptoms, needs and preferences. However, it will usually involve a combination of:

    Depending on your diagnosis, you may need regular consultations with your rheumatologist.

    How often they occur will depend on your condition, how well it’s responding to treatment and the medicines you’re taking, as some specialised medicines can only be prescribed by a rheumatologist. Some people see a rheumatologist regularly, while others are mainly treated by their GP, with the rheumatologist on hand for specialist advice. Some consultations with a rheumatologist may be done via telehealth.

    Follow-up consultations are generally shorter than your initial one. Your rheumatologist will talk with you about how you’ve been doing since you began treatment. They’ll assess how well you’re responding to treatment and if you need to change your medicines or add additional ones. They’ll also do a physical exam and order any further blood tests or imaging if required.

    Your rheumatologist will also talk with you about your self-care and other things you can do to manage your condition.

    It’s important to take an active role in these consultations. Ask questions, and if you don’t understand the answers, ask them to explain further or for more information. Talk with your rheumatologist about your goals for treatment – they may be things like reducing pain and fatigue, but also more personal goals such as getting back to playing golf regularly or planning an overseas trip. Together you can ensure your treatment plan supports your goals.

    Ongoing care

    The aim of treatment for musculoskeletal conditions is low or no disease activity. This is called remission. It doesn’t mean your condition has been cured, but your treatments keep it under control.

    With the significant advancements we’ve had in medicines in the past few decades and targeted treatments for many types of musculoskeletal conditions, achieving remission can be a real possibility.

    If you achieve remission, your rheumatologist may reduce the dosage and/or frequency of the medicines you’re taking. They’ll monitor you to see how you’re doing and make changes as required. And you won’t need to see them as often.

    If you haven’t achieved remission, the aim will be to control your condition and its effects on your body and life as much as possible. This will determine how often you need to see your rheumatologist in the future.

    Costs

    The cost to see a rheumatologist varies. Part of the cost is subsidised by Medicare, but there is usually a gap payment that you’ll need to make. When making an appointment, ask about out-of-pocket costs.

    If you have a Medicare card, you may be able to attend a rheumatology clinic at a public hospital if you cannot afford out-of-pocket expenses to see a rheumatologist privately. Talk with your GP about your options.

    Contact our free national Help Line

    Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, COVID-19, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    More to explore

     

    First written and published by Lisa Bywaters in May, 2022.

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    Inflammation-002.jpg
    Lisa Bywaters
    04/Oct/2023
    Health InformationMSK articles

    What is inflammation?

    We talk about inflammation a lot. But what is it? What’s happening in your body when you have inflammation?

    Acute and chronic inflammation

    There are two types of inflammation – acute and chronic.

    Acute inflammation

    Acute inflammation is your body’s reaction to things such as an infection (e.g. a cold or infected wound) or an injury (e.g. a sprained ankle or bee sting).

    Symptoms associated with acute inflammation are:

    • pain
    • redness
    • swelling
    • heat
    • loss of function (e.g. difficulty moving a swollen ankle after spraining it or difficulty breathing through your nose when you have a cold).

    What’s happening in your body with acute inflammation?

    When you sprain your ankle, or get an infection, your immune system automatically springs into action.

    Cells close to the source of the injury or infection release chemicals known as inflammatory mediators (e.g. histamine). They increase blood flow to the area, widening blood vessels and allowing more blood to reach the injured tissue. As a result, the area becomes red and feels hot.

    The extra blood to the area enables more immune cells to reach the injured tissue. This includes white blood cells, or leukocytes, whose role it is to defend your body against infections and disease and start the healing process.

    Depending on the cause, acute inflammation can occur quickly and generally goes away quickly.

    Chronic inflammation

    Chronic inflammation is persistent, low-level inflammation that lasts for months or years. With chronic inflammation, the inflammatory process often begins when there’s no injury or illness present; and it doesn’t end when it should. When this happens, white blood cells may target and damage nearby healthy tissues and organs.

    We don’t really know why chronic inflammation occurs. It doesn’t seem to serve a protective purpose as acute inflammation does.

    However researchers have identified factors that increase your risk of developing chronic inflammation, including:

    • chronic infections
    • physical inactivity
    • poor diet
    • obesity
    • imbalance of gut bacteria
    • disturbed sleep
    • smoking
    • stress
    • ageing.

    Many people don’t know they have chronic inflammation, but they may feel symptoms such as:

    • body and joint pain
    • fatigue and insomnia
    • weight gain or loss
    • frequent infections
    • depression, anxiety and mood disorders
    • digestive problems (e.g. constipation, diarrhoea, acid reflux)
    • skin rashes.

    Chronic inflammation is associated with many diseases, such as rheumatoid arthritis, lupus, heart disease, diabetes, cancer, and bowel diseases like Crohn’s disease and ulcerative colitis.

    If you’re concerned about chronic inflammation and have symptoms like those above that have been troubling you for some time, see your doctor . They’ll talk with you about your symptoms, do a physical exam, and may decide that blood tests are necessary to look for signs of inflammation.

    The blood test will look for elevated C-reactive protein (CRP), which rises in response to inflammation.

    Inflammation is helpful until it’s not

    It’s important to remember that inflammation isn’t inherently bad. Acute inflammation serves a vital role in our health and survival. It helps us recover from injury and infection. However, when it’s chronic, it can negatively affect our health.

    Always talk with your doctor if you have symptoms that are distressing you or making you feel unwell.

    Contact our free national Help Line

    Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, COVID-19, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    More to explore

    This article was first written and published by Lisa Bywaters in April, 2022.

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