Physical activity encouraged to benefit health
May is “exercise is
This is an initiative
launched by the American College of Sports Medicine (ACSM) and the American
Medical Association (AMA) in November 2007.
It is time for
everyone to recognise, emphasise and celebrate the valuable health benefits of
exercise on an international level including us here in South Africa.
“As a member of the
Exercise is Medicine community we at Blaauw and Partners Biokinetics are
committed to encourage physical activity for the health benefits for all South
is a fast growing public health problem and contributes to a variety of chronic
diseases and health complications including obesity, heart disease, diabetes,
hypertension, cancer, depression, arthritis and osteoporosis,” says Becky
Blaauw from Blaauw and Partners Biokinetics.
“In addition to
improving a patient’s overall health, increasing physical activity has proven
effective in the treatment and prevention of chronic disease.”
activity at the correct intensity, reduces the risk of heart disease by 40%, it
lowers the risk of a stroke by 27%, it reduces the incidence of diabetes by
almost 50%, it reduces the incidence of high blood pressure by almost 50%, it
can reduce mortality and risk of recurrent breast cancer by almost 50%, it can
lower the risk of colon cancer by over 60%, it can reduce the risk of
developing Alzheimers disease by one-third and it can decrease depression as
effectively as Prozac or behavioural therapy.
According to the
ACSM, able patients are advised to participate in at least 30 minutes of
physical activity and 10 minutes of stretching and light muscle training five
days per week.
A survey conducted by
ACSM found four out of 10 physicians talk to their patients about the importance
of exercise and nearly two thirds of patients would be more interested in
exercising to stay healthy if advised by their doctor.
“We invite the
members of the community to take part in this international focus on
celebrating ‘exercise is medicine month’ by becoming more physically active.
“If you already have
many of these problems it is not too late. You can still better your quality of
life by doing physical activity correctly and in a controlled environment,”
Q: I'm sure I'm not
alone in wondering exactly what biokinetics is - please explain.
A: After 18 years in private practice, I still regularly get asked that question. One of the founders of the profession is our own "Bokkie Blaauw" in Somerset West. Professor Blaauw, who started the biokinetics centre at Stellenbosch University in 1986 with a couple of other universities, moulded the concept of biokinetics as we know it today, which is based on the use of exercise as a therapy.
Q: Is it acknowledged
by the medical profession?
A: Yes, biokinetics is a medically recognised professional discipline, and to quality one needs a four-year university degree with a one-year internship. We work closely with doctors and other medical practitioners. Although biokinetics is one of the youngest health professions in South Africa, it has been recognised by the Health Professional Council of South Africa and services can be claimed from your medical aid.
Q: What examples of
applications are there?
A: Our scope of practice includes many areas, such as orthopaedics. We apply scientifically-based exercises using specialised equipment to either help prevent disease, or to do final phase rehabilitation following the onset of disease or injury. To illustrate, we can use an isokinetic machine that can test muscle strength and balance to rehabilitate an athlete or anybody with a orthopaedic problem, so that they can play sport again, and have a better quality of life. Pre and post operative muscle strengthening is also recommended to facilitate optional recovery.
Q: Who are your most
regular clients, and what are the kinds of conditions they present?
A: One of the most common problems we see in our practice is back problems. This is not surprising, as research shows that 80% of the world's population has or has had back problems at least once in their life time. One of the biggest problems in today's society is bad posture, which can lead to back problems. This is as a result of the modern era of sitting in motor vehicles, behind computers, wrong footwear, incorrect schoolbags and an era of children sitting for hours in front of the television. A sedentary lifestyle is one of the major culprits of back problems. We have found that a lot of adulthood problems is as a direct result of our bodies being out of alignment which causes compensation and stress on the joints. The younger we are the easier it is to rectify alignment problems. However, elderly patients have also been found to benefit tremendously from corrective exercises. Small changes in posture can make a big difference in alleviating pain. A biokineticist can do a posture analysis to determine if you have any deviations from the norm. Corrective exercises are then prescribed. Unfortunately, there are certain cases where exercise cannot prevent a back operation. We also specialise in exercised after back surgery to obtain maximum recovery.
Q: I heard you talk
at a cardiac health seminar a few years back. How do heart conditions feature
in your work?
A: Another very important job for the biokineticist is to treat patients with cardiac problems. There are a few reasons why a patient after major heart surgery should exercise at a biokineticist. Firstly, to ensure safety. A biokineticist has safety equipment available such as a defibrillator and has advanced CPR. Secondly, a biokineticist specialises in safe exercises for your specific condition and stage of recovery after bypass surgery. Thirdly, exercising at a biokineticist helps build up a patient's confidence and interaction with other cardiac patients helps recovery. And lastly, formal supervised cardiac exercises have been shown to have the safest and best outcome for the cardiac patient - especially after surgery - and patients have been shown to recover quicker. Exercises also help control patients with cardiovascular disease such as with high blood pressure, cholesterol and diabetes. We work very closely with the cardiologists and the Helderberg cardiac support team to get the best continuity and possible treatment for the patients.
A: People with arthritis and autoimmune disease can benefit hugely. When I started the practice with my husband 18 years ago there were only four known autoimmune diseases, and now there are over 80. This is unfortunately one of the fastest-growing diseases in the world.
Correct exercise can
help slow this process down. Parkinson's patients have also been shown to
benefit tremendously from specialised exercises. And remember, specific
exercise can often do so much more than a little white pill, without the side
Can school backpacks influence posture and therefore contribute to
By Becky Blaauw.
Becky graduated cum laude from Stellenbosch University in 1995 and has been in private practice in Somerset West for twenty years. She is married to fellow biokineticist Professor Bokkie Blaauw and has two sons. She recently undertook a research project into the effects of heavy school backpacks on children's musculoskeletal systems during their growing years.
Like all parts of the body, the spine is prone to a number of specific diseases. A common disease is scoliosis, a condition that involves curvature or deformity of the spine. Ten in every 200 children develop scoliosis between the ages of 10 and 15. Although boys and girls seem equally affected, the curvatures in females are three to five times more likely to progress into more pronounced postural defects that have longer lasting consequences.
There are two types of scoliosis:
Structural scoliosis involves a curve in the spine which is irreversible, caused by both unknown factors normally found at birth, and known factors such as spina bifida, cerebral palsy or muscular dystrophy.
Functional scoliosis involves a curve in the spine from postural compensation due to gait changes, leg length discrepancies and muscle imbalance. This type of scoliosis can be reversed. For the purpose of the article the scoliosis I refer to is functional scoliosis, which is found in a large percentage of all school-age children, as well as in adults. Many functional curves become fixed as the brain attempts to guard the over-conpensating muscles. This compensation for asymmetric stresses occurs through altering the balance in associated soft tissues and adjacent skeletal structures.
While heavy school backpacks do not in themselves cause structural scoliosis, it is well documented that these bags and the way they are carried cause muscle imbalance and thus contribute to functional scoliosis.
The 21st century has seen many changes in the way schoolbags are carried: from carrying school cases as in generations gone by to carrying backpacks slung over one shoulder, this one-sided carrying of a heavy weight through a good portion of the school day contributes to functional scoliosis and therefore back problems in the future. It was therefore recommended that school children wear back packs, with straps over both shoulders, to equalise the weight carried on the shoulders, thus minimizing back pain and the possibility of future problems. Backpacks have now become the number one choice of bag for today's scholars, used by millions of children worldwide every day. However, it has been found that even children wearing backpacks are still suffering from back-, neck- and shoulder pain.
In most schools in South Africa it is seen as ‘not cool' to wear your satchel with both straps over the shoulders, and it would seem that principals are powerless, or unwilling, to change this damaging culture.
How backpacks can hurt
When carried correctly, in a way that keeps the weight distributed evenly across the back, backpacks are the best way to carry schoolbooks and can even help strengthen the muscles that support the spine. Carried incorrectly by overloading or slinging over one shoulder, the backpack can strain muscles and joints, leading to back and neck pain.
To understand how a heavy or improperly worn backpack can affect a child's spine, it is important to understand how the spine works. Humans are born with 33 separate bones called vertebrae that make up the spine and support the majority of the weight imposed on it. Between the vertebrae are spinal discs that function as shock absorbers and joints, absorbing the stresses placed on the spine.
When more stress is placed on the spine than can be absorbed by the discs, the spine becomes unbalanced which can lead to injury. So for example, a heavy backpack pulling a child backwards causes the child to compensate by either bending forward or arching their back. Slinging a backpack over one shoulder can cause a child to lean too far to the one side to offset the weight. Over time, this overcompensation can lead to poor posture, muscle strain and pain. Further, backpacks with tight, narrow straps that dig into the skin can interfere with circulation and nerve function, causing tingling, numbness and weakness in the arms and hands.
Maximum load in backpacks
Research shows that a child should not carry more than 10-15% of their body weight on their backs. However, an Italian study revealed the weight of the average child's backpack to be 22-27% of their body weight.
When my own son, now 11 years old and weighing 40kg, started complaining of backache, I weighed his school back pack and found that at 10kg, my son was carrying 25% of his body weight on his back. Quite a wake-up call!
Can schoolbags cause later arthritis?
While no long-term studies have been done, it is logical that heavy schoolbags will be a contributing factor to developing osteoarthritis in adulthood. Alignment of the joints is of utmost importance to ensuring equal pressure is placed on all bones, and misalignment causes wear and tear on various parts of the body, ultimately contributing to osteoarthritis.
When the neck has a normal curve, the weight of the head is balanced and neck muscles endure only minimal strain. However, if the neck is straight or in a ‘Forward Head Posture (FHP)' position to counteract the effect of a heavy backpack, constant strain is placed on neck and shoulder joints, predisposing the child to arthritis which can begin even at young ages.
In one recent study, researchers assessed approximately 1000 students aged 12 to 18 from 10 different high schools in Adelaide, South Australia, with and without their school backpacks. When the students carried heavy backpacks, significant changes were visible in their head and neck angle, with the youngest students displayed the greatest posture changes.
Investigating posture backpacks
A study conducted at Blaauw and Partners Biokinetics investigated this matter. The study was to see the effect of an ordinary backpack compared to a newly designed posture backpack on the upper spine of school children. A posture backpack is specially designed to eliminate the load on the child's neck and back, through the use of additional chest and hip straps.
Together with a Grade 9 school pupil, who initiated the investigation for a school project, a posture analysis was done on 10 subjects aged 14 to 15 years. Subjects were photographed wearing a posture backpack and a standard backpack, each weighing 7.5kg, and the percentage of body weight carried in their backpacks was determined as an average of 12% of body weight.
Software called PosturePro was used to calculate a posture number, which is a measure of selected anatomical markers. The posture number is influenced by every aspect of the body's alignment with the ideal posture set at zero. Therefore, the closer the posture number is to zero, the better the posture is. What became evident was that the posture number moved closer to zero when students wore the posture backpack, showing the positive effect that these backpacks have on the child's posture.
The posture backpack
had a positive effect on the following aspects of posture:
Decreasing stresses on the neck vertebrae
Decreasing the degree of Forward Head Posture (FHP)
Decreasing kyphosis – the medical condition where a person's upper spine
It was concluded that the posture backpack has a significant effect in negating the bad effects of carrying heavy backpacks in schoolgoing children, and thus reducing the risk factors contributing to osteoarthritis in the upper spine during adulthood.
From this small study, significant results were determined, and provide a solid basis for a more indepth study to be carried out on the benefits of wearing a posture backpack.
Warning signs a backpack is too heavy
If you notice your child displaying these signs, check to see the weight and type of their school bag:
Change in posture when wearing the backpack
Struggling to lift and put on or take off
Pain when wearing the backpack
Red marks on the shoulders
Tingling or numbness in the arms
Preventing injury when carrying a backpack
Pack lightly: The combined weight of the
backpack and its contents should not exceed 10-15% of the child's body weight.
Girls and younger children should aim for the lower end of this percentage
Organize the contents: Pack heavier items
closest to the back, and spread items across all compartments so that the
weight is evenly distributed
Use both shoulder straps to distribute
the weight evenly across the back. Shoulder straps should be adjusted to allow
the child to put on and take off the backpack without difficulty and permit
free movement of the arms.
Tighten the straps to keep the
backpack close to the body. The backpack should rest evenly in the middle of
the back. Make sure the backpack does not extend below the lower back.
Use a locker (if available). Don't carry
everything needed for the day all the time. And unless that laptop, iPod,
makeup bag or, for the little ones, favourite action figure is REALLY needed,
leave it at home.
Squat down, bending at the knees, not at the waist, when lifting
or lowering a heavy backpack.
Do back strengthening exercises to build up
the muscles that support the spine.
Encourage your child to tell you about any pain or other
symptoms he or she may be experiencing because of a heavy backpack. Be on the
alert for any outward signs of discomfort.
If your child mentions back or neck pain, pay
attention and don't ignore their complaints. If the pain persists, make an
appointment with a paediatrician or medical specialist.
Although a backpack won't cause scoliosis, it can disguise a
spinal curve that may be developing. Onset most commonly takes place during the
‘growing years' of 9-15, so be sure that your child is screened regularly for
If the homework load seems to be excessive, talk to
your child's teacher or school administrators.
Ensure that the school provides lockers, and allows enough
time for students to stop by their lockers throughout the day. If the school
does not have lockers, it's time to lobby for them.
Lobby for the school to introduce a rule that all
backpacks must be carried on both shoulders both around the school during
the day and on the way to and from school.
If possible, and if there is a secure locker at
school, consider buying a second set of textbooks to keep at home.
Wear a specially designed posture backpack
Please remember back pain in children that persists for more than 5 days should be seen to by your doctor, physiotherapist or biokineticist.
Enquiries about posture backpacks can be made at Blaauw and Partners Biokinetics: 021 852 7148 or www.blaauwandpartners.co.za
For further reading on this topic, please refer to these publications:
1.Markwicker J, MS PT. Backpack fitting and Posture. November 2'3. www.npioline.org/articles/backpack-fitting-and-posture
2.Sheir-Neiss GI, et al. SPINE (Philia Pa 1976) 2003 (May 1):28(9): 922-930. "The association of backpack use and back pain in adolescence"
3.Neuchwander TB, et al .SPINE (Phila Pa 1976) 2'0 (Jan 1): 35 (1): 83-88. "The effects of backpacks on the lumbar spine in children: a standing magnetic resonance imaging study."
4.Asher A. "Backpacks and back pain – The Links between Backpacks and Back Pain." http://backandneck.about.com/od/childrenissues/tp/Back-Packs-Back-Pain.htm
5.Ramprasad M, et al. Indian Pediatr. 2'0 (Jul 7): 47(7):575-580 "Effects of backpack weight on postural angles in pre-adolescent children."
6.Rodrigues-Oviedo P, et al. Arch Dis Child. 2'2 (Aug): 97(8): 730-732 'School children's backpacks, back pain and back pathologies."
7.Chansirinukor W, et al. "Effects of backpacks on students: measurement of cervical and shoulder posture." www.ncbi.nlm.nih.gov/m/pubmed/11
9.Scoliosis research society. www.srs.org/patient_and_family/kyphosis
10.The effects of school bag design and load – PubMed Mobile. 2'1 www.ncbi.nlm.nih.gov
11.The effects of backpack load placement on posture. 2009 www.ncbi.nlm.nih.gov/m/pubmed/19369727
How to treat a Pulled
Muscle – by Becky Blaauw
Pulled Muscle, what
are the options of getting back to my sport in the fastest most effective way?
All sportsmen are faced with this situation in their sporting career. What do you do? Let's look at the options:
1. Stretching a pulled muscle: If your muscle is niggling or you feel a dull ache on the sport field stretch it out. At this stage you probably have not strained it yet. But if there is a sharp pain you may have strained the muscle. In this situation it is not a good idea to stretch. Remember your muscles are like rubber bands, so a strained muscle is like an overstretched band with damage to the fibers. It does not make sense to stretch it even further.
2. Heat or Ice. Ice is still the preferred treatment straight after pulling a muscle. After 24 hours you can apply a combination of ice and heat to help blood flow into the injured area, to help the muscle recover faster.
3.Massage is another useful tool but should be applied at the correct time of injury. If the muscle is a light strain or cramp, massage can be applied immediately. However if there is evidence of a strain where there is some bleeding in the muscle, only apply massage after 72 hours.
4. Anti-inflammatories can help reduce inflammation and pain associated with the injury. But often anti-inflammatories masks the pain and the sportsman will continue with his/ her activities with detrimental consequences. So my advice is to use anti-inflammatories wisely i.e.: do not use them for more than 5 days and do not resume your sporting activity with them.
So my best advice is to rest the muscle totally for 5 days with a combination of ice, anti inflammatory and massage. Next step is to see your Biokineticist so they can assist in getting you back on the sports field. A pulled muscle can take anything from 2 to 6 weeks to get back onto the field. Remember a muscle that is not rehabed correctly, no matter how big or small, can become a reoccurring problem that may even end up as a catastrophic problem for the athlete. Make sure your muscle is ready to take on the exertion that sport places on it.
Hydrotherapy is the
use of water in the treatment of many different conditions including
arthritis-related conditions. It differs markedly from swimming as it involves
specially designed exercises that are performed in a warm-water pool, with a
temperature of around 33 – 36C.
Hydrotherapy is not aquarobics, which by contrast is a lot more strenuous. Hydrotherapy is generally more focused on slow, controlled movements initiated by the therapist to resolve specific joint or muscle problems, while you relax in the water and allow the therapist to direct your body movements.