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May is Osteoarthritis (OA) Awareness Month, and it’s a great opportunity to highlight what matters most: you can move well, stay active, and feel better with the right approach. The management and the outcomes of OA are changing and progressing, which as a physio, is just amazing news!

Osteoarthritis is a common joint condition that regularly affects the knees, hips, hands, and spine. It reflects natural changes within the joint over time—but importantly, it’s something we can work with, not against.

Common symptoms of osteoarthritis

OA can present in different ways, but the most common symptoms include:

• Joint pain during or after activity
• Stiffness, particularly in the morning or after rest
• Reduced range of motion
• Swelling around the joint
• A feeling of weakness or reduced support in the joint

These symptoms can vary day to day, and with the right plan, they can be well managed and improved.

What helps most? Movement.

Joints respond positively to the right kind of movement. When guided properly, exercise can reduce pain, improve mobility, and build strength to support the joint.

The key is knowing:

• What exercises to do
• How much to do
• When to progress
• When to ease off

That’s where physiotherapy plays a central role.

How physiotherapy can help

1. Pain relief to get you moving

In the early stages—or during flare-ups—hands-on treatment can help reduce pain and improve comfort. This may include:

• Manual therapy to improve joint movement
• Dry needling to reduce muscle tension and sensitivity

These approaches can help you settle symptoms and move more freely, creating a better starting point for exercise.

2. Personalised exercise and loading

Long-term improvement comes from building strength and resilience around the joint.

A physiotherapist will guide you through:

• Targeted strengthening exercises
• Gradual progression of load
• Movement strategies tailored to your lifestyle and goals

This helps your joint become stronger, more capable, and more tolerant to activity.

3. Clear advice and a plan forward

Just as important as treatment is knowing what to expect and what to do next.

Physiotherapy provides:

• Clarity on how to manage symptoms day to day
• Guidance on activity levels and progression
• Support in deciding when (and if) further options should be considered

Most people do very well with a structured, conservative approach. And if symptoms aren’t improving as expected, your physiotherapist can help guide you toward the next appropriate step, ensuring you’re making informed decisions.

A positive outlook

Osteoarthritis doesn’t stop you from living well. With the right support, you can:

• Stay active
• Build strength
• Reduce pain
• Continue doing the things you enjoy

If you’re experiencing joint pain or stiffness and want a clear plan to move forward, our team can help you get started with a personalised approach.

Every year in June, Migraine and Headache Awareness Month shines a light on one of the most common yet misunderstood health conditions worldwide. Many people experience headaches regularly, but few realize that physiotherapy can play an important role in reducing pain, improving function, and enhancing quality of life.

Headaches can present in different ways and may have various causes. Common types include:

• Tension-type headaches — often linked to stress, muscle tension, posture, and prolonged desk work.
• Migraines — neurological headaches that may involve throbbing pain, nausea, sensitivity to light or sound, and visual disturbances.
• Cervicogenic headaches — headaches originating from dysfunction in the neck and cervical spine.

For many individuals, headaches are not just occasional discomforts; they can affect work performance, sleep, exercise, mood, and daily life.

Modern lifestyles often involve long hours sitting, screen exposure, poor posture, stress, and reduced movement. These factors can contribute to:

• Tightness in the neck and shoulder muscles
• Joint stiffness in the cervical spine
• Muscle imbalances
• Increased nervous system sensitivity

When the muscles and joints around the neck become irritated or restricted, pain can refer into the head, creating headache symptoms.

Physiotherapy focuses on identifying the contributing factors behind headaches and addressing them through a personalized treatment approach. This may include manual therapy to release tight structures, specific exercises to improve neck stability and mobility, postural education, or soft tissue techniques when appropriate. Breathing and relaxation strategies can also help regulate the nervous system, which is often a key factor in recurring headaches.

Not all headaches are the same, and not all require the same approach. If headaches are frequent, linked with neck pain, or affecting your quality of life, a physiotherapy assessment may help identify underlying physical contributor.

What would life look like if headaches no longer interrupted your work, exercise, or time with family?

If you’re like most people in Dubai, you probably glance at your wrist (or phone) at the end of the day to check whether you hit your 10,000 steps. Maybe you feel a small win if you did, or a twinge of guilt if you didn’t. For most of us, that number has become a quick mental shorthand for ‘I was active enough today,’ a stand-in for fitness, health, even general wellbeing.

But here’s the question almost nobody asks, if something in your body is still recovering from an injury or overuse, does your step count actually tell you that?

Spoiler: not really, and that gap matters more than you’d think.

The 10,000-Step Myth

The “10,000 steps a day” target wasn’t born from rigorous research, it traces back to a 1960s Japanese marketing campaign for a pedometer (the device’s name roughly translated to “10,000-step meter”). It stuck because it was catchy, not because science proved it was the magic number for health.

That doesn’t mean steps are meaningless. Movement is good. But treating a daily step count as a measure of ‘recovery’, or worse, as a green light to push through soreness or fatigue, is where things go wrong.

What Step Count Doesn’t Measure

Your smartwatch counts steps, estimates calories, and maybe gives you a “readiness” or “body battery” score. But it generally can’t directly assess –

1. Tissue healing status – whether a strained muscle, tendon, or joint has actually had time to repair

2. Nervous system fatigue – accumulated stress that shows up as poor sleep, irritability, or plateauing performance

3. Movement quality – you can rack up 12,000 steps with a limp, a stiff hip, or poor walking mechanics, and the watch won’t know or care

4. Inflammation levels – a sore knee can still log plenty of steps before it tells you something’s wrong

This is why someone can hit their step goal every day, feel ‘active’, and still be walking around with a nagging issue that’s quietly getting worse.

A Real-World Example

We regularly see clients who say something like, ‘I don’t understand why my Achilles still hurts. I’m hitting my steps every day, I must be moving enough.’

But movement isn’t the same as recovery-appropriate movement. If an injury needs reduced load, modified movement patterns, or specific rehab exercises, simply walking the same routes at the same pace, even if it adds up to an impressive step count, can actually delay healing rather than help it.

So What Should You Actually Pay Attention To?

Instead of fixating on the step number alone, here are better signals to check in with –

1. How does the area feel the next morning, not just immediately after activity? Pain or stiffness that’s worse 24 hours later is a more reliable signal than how you felt during the walk.

2. Is your walking pattern even? Watches don’t detect asymmetry, but you, or a physio, can.

3. Sleep quality. Genuinely one of the best recovery indicators, and many wearables actually track this reasonably well.

4. Range of motion. Can you move the joint through its full range without compensating?

The Bottom Line

Wearables are a great motivational tool, and there’s nothing wrong with aiming for an active lifestyle. But don’t let a step count override what your body is actually telling you. If something feels “off” despite hitting your numbers every day, that’s worth listening to, not ignoring.

If you’ve got a nagging ache that doesn’t seem to add up with how active you’ve been, it might be worth getting it properly assessed. A quick check now can save weeks of frustration later.

Have questions about an injury or niggle that just won’t go away? Get in touch with our team at The Physio Centre, we’re here to help you move better, not just move more.

The FIFA World Cup is one of the most physically demanding tournaments in sport. Players sprint, jump, tackle, change direction at incredible speeds, and often compete every three to four days. While fans focus on goals and celebrations, another battle takes place behind the scenes, the race to recover before the next match.

This is where physiotherapy becomes an essential part of elite football.

Football Pushes the Human Body to Its Limits

During a single 90-minute match, professional footballers may:

• Cover 10–13 kilometres
• Perform dozens of high-intensity sprints
• Accelerate and decelerate hundreds of times
• Execute rapid changes of direction
• Experience repeated physical contact

These demands place enormous stress on muscles, tendons, ligaments, and joints. Even players who finish a match without an obvious injury often experience muscle damage, fatigue, and reduced performance in the days that follow.

Recovery is no longer just about rest, it is an active process.

Recovery Begins the Moment the Final Whistle Blows

Physiotherapists begin working with players almost immediately after the match.

The first objective is to reduce the effects of fatigue and prepare the body for the next training session or game. Recovery strategies may include:

• Individual movement assessments
• Mobility and flexibility exercises
• Active recovery sessions
• Manual therapy when appropriate
• Progressive strengthening exercises
• Load management based on each player’s physical condition

Every player recovers differently. Factors such as playing time, previous injuries, position on the field, and overall fitness influence the rehabilitation plan.

Injury Prevention Is the Real Goal

One of the biggest misconceptions is that physiotherapists only become involved after an injury.

In reality, much of sports physiotherapy focuses on preventing injuries before they occur.

Professional teams continuously monitor movement quality, muscle strength, joint mobility, balance, and running loads. Small changes in these areas can indicate that a player is at greater risk of developing an injury.

By identifying these warning signs early, physiotherapists can modify training, prescribe targeted exercises, and help athletes remain available for competition.

After all, the best injury is the one that never happens.

Picture this…

It’s 1987.

Jane Fonda is on television, someone is wearing neon pink lycra that defies all known laws of fashion, and an entire room of people are enthusiastically grapevining to synthesiser music that sounds suspiciously like it was produced on a Casio keyboard.

Fast forward to today, and something unexpected is happening.

Aerobics is quietly making a comeback.

Not necessarily the fluorescent G-strings worn over leggings (thankfully), but the idea of exercising together, moving to music, and actually having fun while getting fit.

As physiotherapists, we spend a lot of time encouraging people to exercise. Yet for many adults, the word “exercise” immediately conjures images of lonely treadmill sessions, complicated gym equipment, or expensive boutique fitness classes.

Maybe we’ve forgotten something…

Exercise is supposed to be enjoyable

What Exactly Was Aerobics?

Traditional aerobics classes combined continuous movement with upbeat music to keep your heart rate elevated for an extended period.

Think:

• Step touches
• Grapevines
• Knee lifts
• High knees
• Star jumps
• Jazz hands (optional… but highly encouraged)

Was every movement biomechanically perfect?

Probably not.

Was it fun? Absolutely/apparently so.

The Good

It Gets You Moving

The biggest predictor of good health isn’t finding the “perfect” exercise.

It’s actually doing it.

Aerobics improves:

• Cardiovascular fitness
• Balance
• Coordination
• Bone health through weight-bearing activity
• Mood
• Energy levels

Many people who hated running happily attended aerobics classes three or four times a week because they genuinely enjoyed them.

Consistency beats perfection every time.

Music Is More Powerful Than We Think

Ever noticed how cleaning the house somehow becomes easier when your favourite song comes on?

Exercise works the same way.

Music can:

• Reduce the perception of effort
• Improve motivation
• Help maintain rhythm
• Make exercise feel shorter
• Increase enjoyment It’s hard to be miserable while dancing to a good playlist. (Unless the instructor insists on eight consecutive burpees.)

Community Matters

One of the biggest strengths of aerobics wasn’t the exercise.

It was the people.

Regular classes create friendships, accountability and support.

You’re far less likely to skip a class when Lexi from the front row notices you’ve disappeared.

The Not-So-Good

Let’s be honest…

Some aspects of 1980s aerobics deserve to stay firmly in the history books.

“No Pain, No Gain”

Fortunately we’ve moved beyond the belief that every workout should leave you unable to sit down for three days.

Exercise should challenge you—not destroy you.

One Size Doesn’t Fit All

Older aerobics classes often assumed everyone should jump, bounce and twist exactly the same way.

Modern exercise recognises that people have:

• Different injuries
• Different fitness levels
• Different goals
• Different bodies

Modifications aren’t “cheating.”

They’re smart.

Technique Sometimes Took a Holiday

Have you ever watched old aerobics videos?

Hundreds of people moving at high speed while the instructor enthusiastically shouts, “Higher! Faster! Keep going!”

Meanwhile someone’s knee is quietly filing a formal complaint.

Good movement quality still matters.

And Then There Was the Fashion…

Let’s take a respectful moment to remember:

• Neon lycra
• Leg warmers
• Giant scrunchies
• Headbands
• High-cut leotards
• Tiny shorts
• Enough hairspray to affect local weather patterns

Fashion historians may never fully explain why we collectively agreed this looked amazing.

Some trends deserve nostalgia.

Not necessarily resurrection.

So… Is Aerobics Back?

Sort of.

Today’s versions have evolved into:

• Dance fitness
• Step classes
• HIIT with music
• Zumba
• Functional fitness classes
• Group circuit training

The principle hasn’t changed.

People like moving together.

People like music.

People enjoy exercise that doesn’t feel like punishment.

The Physiotherapy Verdict

From a physiotherapy perspective, aerobics can be an excellent form of exercise when:

• The intensity matches your fitness level.
• Movements are modified for existing injuries.
• Progression is gradual.
• Good technique is encouraged.
• You actually enjoy it.

The best exercise programme isn’t the one that’s scientifically perfect.

It’s the one you’ll still be doing six months from now.

Anterior knee pain (pain at the front of the knee, often around the kneecap) is one of the most common reasons people seek physiotherapy. It can affect anyone — from athletes to office workers — and is often linked to activities like running, stair climbing, or prolonged sitting. 

Typical Symptoms

People with anterior knee pain often notice discomfort during:

• Going up or down stairs
• Running or jumping activities
• Squatting or bending the knees deeply
• Sitting for long periods (“theater sign”)
• Kneeling or lunging

The pain may feel sharp during activity or like a dull ache afterwards, and it can be accompanied by stiffness or mild swelling.

When knee pain strikes, it’s common to hear advice such as: “You just need stronger quads and glutes” — often followed by a prescription of squats, lunges, and hip thrusts. While these are excellent strength exercises, they are not always the right starting point for someone with anterior knee pain. In fact, attempting them too soon can make symptoms worse, as they place high loads on an already irritated joint.

Why Rehab Comes First

Before heavy strengthening, the knee needs to go through a phase of rehabilitation. This involves:

• Pain reduction and inflammation control – through load management, soft tissue work, and gentle mobility exercises.
• Activation of key stabilisers – small, controlled movements to re-engage muscles like the VMO (vastus medialis oblique), hip abductors, and deep gluteal muscles.
• Movement retraining – teaching your body to move efficiently so the kneecap tracks correctly and stress is spread evenly.

Safe Starting Exercises

Some low-load activities can often be started early to maintain fitness and muscle activity without flaring symptoms:

• Gentle cycling (low resistance, pain-free range)
• Straight leg raises
• Calf raises
• Hamstring curls or bridges
• Side planks on the knees
• Triple extensions
• Light resistance band work for hips and core

Only once pain has settled and control has improved can you safely progress to more demanding exercises like squats, lunges, and hip thrusts — where strength gains will truly be effective and sustainable.

The Bottom Line

For anterior knee pain, jumping straight into heavy quad and glute training can often backfire. A physiotherapy-led approach focuses on targeted rehab first, so you can return to full strength training without setbacks. Think of it as building the foundation before constructing the house — the stronger the base, the longer your knees will last.

With the Six Nations in full swing, England are unfortunately without their number 10 and skipper following two ankle injuries in just a few months. Over the past few months, the England captain has had an unlucky run of injuries. In November, he limped off in the final quarter after sustaining an ankle injury vs Australia. In January, it was reported that he had returned to training and had be selected to captain England in their 2022 Six Nations campaign. Unfortunately this is where the England skippers preparation for the six nations ended. According to the Saracens website, he sustained a similar injury to his right ankle this time and underwent surgery towards the end of January. As with most professional athletes, injury information is hard to come by and the rehab is kept quiet behind closed doors. There has been no official statement from the player or the club over what injury he sustained, so all the information we have available is the replay (match highlights available on Youtube). However, in true rugby style the video shows a pile of bodies competing for the ball on the ground, with a slowly emerging injured Owen Farrell at the bottom. Therefore, we will hypothesis what injury the flyhalf had. Of course, I cannot comment on this new injury as there is no video evidence or information available regarding this injury.

Reviewing footage of injuries is an important feature in the medical management of patients. Being able to see the mechanic of issues can aid diagnosis and can be used to formulate a ‘prehab’ programme to strengthen specific structures if the injury is common in that specific sporting discipline. From the footage, we can see the player diving to catch the ball with one of the opposition players landing on the outside of the leg; causing direct impact to the ankle and the Fibula. I would also suggest there is a large amount of rotation occurring at the ankle joint as he twists for the ball. From the medical assessment, we see the doctor and physio squeezing the lower leg, causing significant pain to the player. Assessment of the ankle looks fairly pain-free. We also see the player walk off, without the need for a stretcher. Therefore we will hypothesise the injury to be a Fibula fracture. The club’s official statement was that the player had had surgery on the ankle with a prognosis of 8-10 weeks. Fibula fractures can be treated both surgically and non-surgically dependent on the type of fracture and structures involved

What does the ankle rehab look like?

The good news is that Owen Farrell had progressed with his recovery as we would have expected. He had returned to squad training within weeks of the injury and was on course to return to rugby within his initial prognosis time frame.

Early phase

Middle phase & functional

I will start with an unusual ‘rehab’ intervention as it can go through all the stages – psychology! As with any sport, return from injury is a tough affair. Therefore the psychological impact of injury needs to be considered. Setting a realistic prognosis as early as possible to prepare the player for their journey can help. Goal setting/milestones can be helpful for the patient/athlete so they can see their progression. Integration into the team setting should also be a consideration e.g. The England captain should be able to join in with the entire upper limb strength training programme. This is an area that is perhaps neglected somewhat at amateur level sport however most professional athletes have access to psychological support. Physiotherapists certainly have a role to play here though as often we will be the ones doing most of the rehab and seeing the player regularly. It also worth pointing out that during this stage of rehab, he will be completing it with his club, not at international level!

If you think he’ll be resting up for the first few days, you’d be mistaken. Like all professional athletes, they need to remain top of their game, therefore changing their training immediately after injury is necessary. They need to maintain their cardiovascular function, their strength, coordination etc. With this lower limb injury, upper body gym training will still continue as normal. There may be some adaptions for standing exercises however he can continue training nonetheless.

Postoperatively, the first few days will focus on reducing swelling, pain and maintaining ankle range of motion. Simple movements of the ankle and knee, regular elevation and analgesia will all occur at this stage. The benefit of being an elite athlete is having access to a hydrotherapy pool. Once the wound is closed and healing well, it’s likely he’ll be in the pool completely with a combination of ankle mobility, strengthening and cardiovascular exercise. Another potentially useful piece of equipment, in this case, would be an anti-gravity or water treadmill that can be used in the early rehab stage. This allows the player to walk/run with reduced weight on the ankle and this can easily be progressed from 10% to 20% etc. another key aim of both hydrotherapy and anti-gravity treadmill training is to normalize the walking pattern (gait). As much as possible we want to avoid limping and altered biomechanics to minimize the risk of mechanical pains in other joints.

We can almost look at this as a building phase. We are trying to build the strength back up, improve mobility and coordination. And of course, avoiding significant pain during our rehab. This can be a lengthy phase of rehab dependent on the limitation that the patient presents with. In the England captain’s case, I would assume he progressed fairly well and had hopefully maintained a lot of his strength and power were given how quickly he had his surgery and how quick his prognosis was. If we were to see a patient with a severe lower limb injury that required weeks of non-weight bearing and bracing, the muscle wastage would be much more severe therefore this ‘building’ phase would be significantly longer.

• Return to full weight-bearing – if weight bearing is restricted. As emphasized in the previous stage, we want to ensure a normal gait patient before we progress to running.
• Return to weight-bearing strength training.
• Balance, proprioception and coordination training.
• Return to running – phased return via a return to running programme and impact programme. As strength building and control in the ankle return, the rehab plan will start to become more rugby focus and more functional.
• Start progression into sprinting and including direction changes.
• Sports specific drill e.g direct changes, high ball catching and landing.
• Then in this stage of recovery, we will start to see integration into team training on a phased return.
• Contact training – with rugby being such a physical sport, he will like to return to contact training on a 1 to 1 with coaches/physio’s/S&C – utilizing tackle bags and shields before progressing in rucking and mauling
• Strength testing, CV testing, speed, agility will all start to occur at the end of this stage to ensure the play is safe to return to play and full training

Return to play/competition

The final stage of rehab will require the player to have a full range in the ankle, full strength, full power, full speed. The England captain will be in full team training by this stage including contact training. We can sometimes see this stage of rehab when we watch sports live, specifically team sports. We see players return as substitutes, playing 15-20mins whilst their full match fitness returns. Over the final few weeks of rehab, we see the play return to full matches and hopefully, they return to the starting lineup.

Are you suffering from an ankle injury? Please feel free to contact us to make a booking here.

I’m Andreia, a Senior Physiotherapist, Pilates fan, and lover of the outdoors. I grew up in a small village in Portugal, surrounded by nature and animals, and as a kid I was always on the move — playing football (nicknamed “Tractor”), climbing trees, and exploring the world around me. My journey as a physiotherapist started in Portugal, took me to Australia, and in 2014 an exciting opportunity brought me to the UAE, which I now proudly call home. When I’m not in the clinic, you’ll find me on a Pilates mat, exploring nature, or diving ( one of my favourite ways to escape the world for a little while) and curled up with a good book to better understand the body and mind. 

Q&A Employee Spotlight: Andreia Longo

Where are you from originally?

I grew up in a small village in Portugal, surrounded by nature and animals. I was always outdoors—climbing trees, playing football, and exploring whenever I could.

Were you always sporty?

Definitely! I played football as a kid, I had so much energy and I’d run over everyone.that people nicknamed me “Tractor.” Movement has always been a big part of my life.

What led you to become a physiotherapist?

I’ve always loved movement and initially wanted to be a Physical Education (PE) teacher. But after breaking my leg playing football and experiencing physiotherapy firsthand, I realized I wanted to help people heal and get back to what they love. Physiotherapy felt like a natural path.

What areas do you mainly work with in the clinic?

I focus on assessing and treating musculoskeletal conditions, helping people recover from injuries, and improve their overall physical function and movement.

How would you describe your treatment style?

I keep things practical and patient-focused. I believe in proper assessment, clear explanations, hands-on treatment when needed, and exercise programs that are realistic and effective.

How did your journey bring you to the UAE?

My journey started in Portugal, then took me to Australia for a while. In 2014, an opportunity came up in the UAE, and I decided to take the leap. It’s been home ever since.

What do you enjoy most outside of work?

I love being outdoors, spending time with friends, and reading. I’m also into diving (it’s one of the best ways for me to completely switch off).

Anything people might not know about you?

I’m endlessly curious about how the body and mind work together, and I’m always learning, whether that’s through movement, books, or life experiences. ​

Ramadan is a time of spiritual reflection, devotion, and community, but it also presents unique challenges for those looking to maintain or enhance their fitness routines. Whether you’re strength training to build muscle or engaging in cardiovascular activities, understanding how fasting impacts your body and how to optimize your nutrition and hydration can make all the difference.

Understanding the Physiological Impact of Fasting

Fuel Stores and Energy Availability

Fasting during daylight hours depletes glycogen stores—the primary source of quick energy stored in the liver and muscles. Over time, the body shifts to utilizing fat as an energy source, which is a slower process and less effective for high-intensity activities.

• Muscle Protein Breakdown: Without consistent protein intake, your body may begin to break down muscle tissue for energy, especially if caloric intake is insufficient.
• Dehydration: The lack of fluid intake during fasting hours can lead to dehydration, which affects both performance and recovery.

Nutrition Tips for Breaking the Fast

Breaking your fast thoughtfully is key to replenishing energy stores and supporting your fitness goals:

1. Prioritize Balanced Meals

Aim for meals that include carbohydrates, protein, and healthy fats to ensure sustained energy and muscle recovery:

• Carbohydrates: Replenish glycogen stores with nutrient-dense options like whole grains, sweet potatoes, fruits, and legumes.
• Protein: Support muscle repair and growth with lean protein sources such as chicken, fish, eggs, or plant-based proteins like lentils and tofu.
• Fats: Include healthy fats like avocados, nuts, seeds, or olive oil to provide long-lasting energy.

2. Include Nutrient-Rich Foods

• Electrolyte-Rich Options: Incorporate foods like bananas, dates, and coconut water to restore electrolytes lost during the day.
• Antioxidants: Add vegetables and berries to combat oxidative stress and support overall recovery.

3. Hydrate Strategically

Begin with water or herbal teas to gently rehydrate before moving on to solid foods. Aim to drink at least 2-3 liters of water between Iftar (the meal breaking the fast) and Suhoor (the pre-dawn meal).

Fitness Goals During Ramadan

For Strength Training and Muscle Building

Building muscle requires a calorie surplus and adequate protein intake. To optimize your training:

• Focus on Protein Timing: Ensure you consume 20-30 grams of protein at Iftar and again at Suhoor to provide amino acids for muscle repair.
• Incorporate Creatine: If you use supplements, creatine can support strength gains and recovery.
• Training Time: Aim to strength train after breaking your fast when your body is refueled and hydrated.

For Cardiovascular Activities

Cardio exercises, like running or cycling, rely heavily on glycogen stores:

• Carbohydrate Loading: Include complex carbs in both Iftar and Suhoor to fuel endurance activities.
• Hydration: Ensure you’re adequately hydrated before engaging in cardio, as dehydration significantly impairs endurance performance.
• Low-Intensity Options: Consider moderate-intensity activities during fasting hours and save higher-intensity sessions for after Iftar.

Hydration Strategies

Dehydration is a common concern during Ramadan. To stay adequately hydrated:

• Drink Regularly: Sip water consistently between Iftar and Suhoor.
• Monitor Electrolytes: Replenish sodium, potassium, and magnesium with electrolyte drinks or natural sources like coconut water.
• Avoid Caffeine: Limit caffeinated beverages, as they can increase fluid loss.

Signs of Dehydration

• Dark-colored urine
• Dizziness or lightheadedness
• Dry mouth or skin
• Fatigue or cramping during exercise

If you experience these symptoms, prioritize hydration and adjust your activity levels accordingly.

Identifying Underfueling and Adjusting Your Routine

Underfueling can undermine your fitness goals and increase the risk of injury. Watch for these signs:

• Prolonged Fatigue: Feeling consistently tired despite adequate sleep may indicate insufficient calorie or nutrient intake.
• Poor Performance: A noticeable drop in strength or endurance.
• Increased Muscle Soreness: Slow recovery from workouts.

Adjustments to Prevent Underfueling

• Increase Calorie Intake: Include calorie-dense foods like nut butters, avocado, and dried fruits.
• Supplement Strategically: Use protein shakes or smoothies to easily boost intake. • Plan Your Workouts: Focus on shorter, more efficient sessions if energy levels are low.

Conclusion

Balancing fasting and fitness during Ramadan is achievable with thoughtful planning and awareness of your body’s needs. By prioritizing nutrient-dense meals, staying hydrated, and tailoring your exercise routine, you can maintain your fitness goals while honoring the spiritual and communal aspects of the holy month. Remember, listening to your body is key—adjust as needed and consult a healthcare professional or physiotherapist for personalized advice.

Ramadan Kareem !

When writing blog posts, we would usually aim for the target audience to be the general population. Giving out advice on all things health, fitness and rehabilitation. However, with clinicians being so busy and perhaps not having as much time to dive into research – I thought it would be a good idea to do a blog/literature review on all things back pain. One of the most widespread and difficult things to treat – low back pain divides opinion around the world on how it should be treated. I took a look at the recent literature to show you how I approach things, and what the literature says works, and what doesn’t.

To start with, we must give a definition. Low back pain can be defined as pain or discomfort located between the costal margin (ribs) and gluteal fold, which may or may not have referred pain into the legs.(1) Now that we all know where our low back is, let’s move on.

When we treat back pain, there are many things that we need to consider from a clinicians perspective. Starting with the age, activity levels, how the injury occurred, previous medical history, particular patterns to the pain, biopsychosocial factors (more on this later). We are taught to go through a thorough subjective/verbal history to get a clear understanding of the person sitting before you, rule out any serious causes (cancer, infection), how their injury came about and how it’s been behaving since that point. We then go through a battery of tests, some things are uniform – like range of motion and strength, and others are more ‘special’. However from this point onwards, it depends who you trained with (university, mentors) and the self-learning you’ve done in order to ascertain what is causing the persons pain and what will work to fix them. So what does the research say on this?

Low back pain (LBP) is known to be the leading cause of disability & most common non communicable disease worldwide.(2) It can be divided into 3 different sub categories, acute (less than 6 weeks), sub-acute (6-12 weeks) and chronic (>12 weeks). On top of the serious causes listed above which make up approximately 1-2% of cases, 5-10% of cases will consist of neurological deficits (radiculopathy, cauda equina syndrome). This leaves a significant chunk of cases in the ‘non-specific’ range. We know that 39-76% of patients fully recover after an acute pain episode, which also suggests that a significant portion will go past this 6 week mark and potentially into the ‘chronic’ timeframe. The research backs this up, with the global 1 year prevalence of chronic LBP in older adults is 13-50%.(3) International guidelines and research suggest that in this ‘non-specific range’, it is neither possible nor necessary to identify a root cause or source of the pain to effectively treat LBP.(4) The use of imaging (MRI) is also not recommended, especially within the first 4 weeks. It is only indicated if more serious pathology is suspected, or the client is not responding to treatment.(15)

A framework that is commonly taught in University’s across the world now is the biopsychosocial model. This considers a multifaceted approach to treating injuries, and it is how I will break down the research behind treating such injuries. First you must understand each of the three elements when it comes to physiotherapy.

Bio – genetics, stiffness, mechanism of injury Psycho – fear of movement, catastrophizing, mental state Social – work/home environment, cultural background, relationships

Biological

The thing that everyone will initially go to and the reason why a lot of you are reading this, will be the biological element. Even if you’re a clinician reading this, I have no doubt that you have heard that your hamstrings are too tight, your glutes don’t fire or your core is too weak. All of these things can have merit and can play a role in LBP, but they are just part of the story.

What does the research say in regards to this? Well, there is evidence that somethings work, however it is unlikely that one kind of exercise training is the single best approach to treating chronic low back pain. Research suggests that ‘active therapies’ such as pilates, resistance training, motor control/stabilization & aerobic exercise training can all impact LBP positively.(3) There is also recent evidence to suggest that diaphragmatic training (breathwork) can have a positive effect on the active stabilisers of the spine, thus improving LBP.(16) The most important element however, is how we guide patients through the process. When the patient is guided and actively encouraged to exercise and move in a forward thinking way, this tends to be the most effective overall. (3)

A WHO systematic review(8) has shown that NSAID’s (non-steroidal anti-inflammatory drugs) and spinal injections (corticosteroid) have been shown to improve pain in the short term, and acupuncture is supported to work in the subacute phase (6-12 weeks). While potential treatments to avoid include TENS, PENS, Interferential and ultrasound. This is not to say they may not have an placebo effect on the right candidate! The placebo effect is becoming more recognized in the literature for playing a significant role in overall patient outcomes,(9) but its impact on chronic pain is still dubious, due to the complex and individualized elements of pain experiences.(10) Pretty much throughout the literature it rejects the need to offer anyone a belt or corset to manage LBP.

There are different opinions on combining therapies, and they are the most used clinically.(6) But despite being the most common route taken by therapists, there are some studies that suggest the evidence is poor. Studies that look at the spine and chronic pain as a whole state that combined therapies work well in the early and mid-phases of treatment. Overall what seems to work best, is when the patient has a part to play in guiding treatment routes.(7)

Psychological

Having completed a Level 6 degree in Mental Health and completed my Masters dissertation on the impact that mental health disorders can have on people with chronic pain, it is something that I definitely look into when working with someone over a number of sessions. I am by no means an expert in this field, but I do not think you need to be to have an understanding and ability to refer someone on for better guidance when required.

Everyone understands that there is an increase in LBP as we get older, but perhaps less understand the psychological link. In a study of 190,000 (+) people throughout 43 countries, it was found that those with chronic LBP were twice as likely to suffer from anxiety, depression, sleep deprivation or psychosis.(5) The link with mental health has long been researched, and there are positive signs across the healthcare industry that this sub section of LBP is starting to be treated as a symptom.

Having experienced low back pain myself, I understand the burden it can play on your mental health. There are a number of aspects to life that pain can effect, such as playing your favourite sport, playing with your child, grandchild, niece or nephew. It has an overall effect on the social aspect of your life, and as I have referenced earlier; there is a very strong link with mental health disorders.

Social

The effect of an individual’s background on their pain is very significant. As clinicians, we must take into consideration the impact that social status, work/life balance, relationships and cultural background all have on a person’s perception of pain and how you can guide them best to recovery. Taking the time to understand and get to know someone while treating them is undervalued, and may just unlock the door to the next step of progression on their path to full recovery.

Prevention of Low Back Pain – Can we?

There has been a lot of recent research looking into prevention of LBP. The overall economic effect is pretty substantial with days missed from work and impact on national health resources, so it is in everyone’s best interests to try and be proactive rather than reactive on the subject of LBP.

There is little to no evidence for things like shoe insoles, back belts or lumbar supports for prevention of LBP.(11,12) While the same could be said for specific mattresses or desk chairs preventing any low back pain, there may be some improvement in existing back pain with a medium support mattress.(12) The usual culprits of weight management, smoking and sleep quality are the ones we should be focusing on (outside of general strengthening, it must be said). Obesity can place an increased load upon the spine and surrounding structures, while smoking effects spinal discs by decreasing blood flow, thus reducing overall disc height.(13) Overall sleep quality and significant rest have been shown to be related to developing LBP.(14)

Understanding and accepting the psychological component of LBP, means we must accept the role that psychological factors such as stress, work dissatisfaction and depression have in LBP. Addressing these issues seem to not only positively impact mental health, but could benefit overall physical health too.

Conclusion

As I’ve said at the beginning, we are all taught a little bit differently through our career, but it’s very important for us to keep up to date on what the research says works, and what doesn’t with LBP. I know for sure it is not a ‘one size fits all’ approach. We need to treat people individually, gain their trust and build on that relationship with treatment approaches that are proven to work time and time again. The real winner here is exercise in general, and should be a staple throughout any rehabilitation process. There are many studies to back this up, and there are many studies demonstrating the importance of having someone guide you through that process. I will finish with the very infamous ‘more research is needed’, which is true, but we are slowly starting to make progress here.

Bibliography

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