Blog Posts

Osgood-Schlatter’s Disease

When I was about 11 years old, I developed sore heels, which would be diagnosed as Sever’s Disease. I recently wrote a post all about Sever’s Disease, which outlined common signs and symptoms of the condition, along with conservative management techniques. What I did not mention in that piece was that about 12 months after my Sever’s diagnosis, I began to experience discomfort in my knees also, which would be quickly diagnosed as Osgood-Schlatter’s Disease. It was just as debilitating as frustrating, however was able to be managed well with the help of a dance physiotherapist.

What is Osgood-Schlatter’s Disease (OSD)?

osgood-schlatters-site2 2

Similar to Sever’s, OSD is not a ‘disease’ – it is not communicable from one person to the next, but is a condition of adolescence which affects the patella tendon’s attachment to the top of the shin bone. The attachment site is directly over the superior tibial growth plate, the apophysis. In a young person at risk, the area can become irritated and inflamed, resulting in inflammation of the growth plate. Technically called tibial apophysitis, this is Osgood-Schlatter’s Disease.

The growing part of the bone is the weakest part of the osseous-musculo-tendinous unit, until it fuses in late childhood or early adulthood. It can be irritated by direct trauma to the site, or through traction and mechanical stress via the tendon attachment to the bone.

What are the signs and symptoms?

Signs and symptoms that someone might have OSD are:

  • pain at the front of the knee, just below the knee cap
  • swelling around the front of the knee
  • soreness during activity and ache afterwards
  • may be sore or ok upon waking in the morning
  • a painful gait, possibly causing a limp
  • reduced strength and power in jumping activities
  • the development of a bony lump on the front of the top of the shin bone
  • discomfort with or inability to kneel down

How do we diagnose Osgood-Schlatter’s Disease?

A sports doctor or physiotherapist will generally be able to diagnose OSD from the patient’s history and explanation of symptoms in conjunction with their physical examination. XRay’s are typically not required, but may be necessary to rule out something more sinister. Radiological findings, such as a fragmented growth plate, are often visible in healthy, normal knees, as illustrated below.

osgood xray

Who does it affect?

Apophysitis can occur at any growth plate site. OSD affects active, young people; girls aged 8 to 13 and boys aged 10 to 15.

What can contribute to developing Osgood-Schlatter’s?

  • Activities involving running, jumping, and repeated rising movements require repeated and forceful contraction of the quadriceps muscle which connects to the patella and continues as the patella tendon, in turn placing repeated stress on the tendon’s attachment to the tibia
  • Sports like soccer, football, basketball, gymnastics and dancing
  • During periods of high velocity growth, there may be a discrepancy between the length/size of the bone and strength/length of the surrounding muscles and tendons, placing increased tensile strain on the soft tissues and their bony attachments. In line with growth is expected and normal weight gain, which will add additional load.
  • Tightness and/or weakness in the big muscles of the lower limbs (mainly calves and quadriceps), or stiffness in the ankle and foot, decreases the dorsiflexion (plié) range of movement and reduces shock absorption ability when landing from jumps
  • Sub-optimal biomechanics of the lower limb kinetic chain
  • Poor intrinsic foot muscle coordination and strength further reduces the ability to absorb shock when landing from aerial movements, forcing the tendon and it’s attachment to take on more load
  • A sudden increase in training load can strain the tissues beyond their capacity
  • Addition of new skills to a training regime can overload the tissues
  • Time of the year – in Australia, kids tend to grow most in September and January, so growth-related and overuse injuries during these periods are more common

How can physiotherapy help to manage the symptoms?

I wrote a blog recently detailing strategies to help with managing acute injuries, which outlines the POLICE acronym – protect, optimal loading, ice compress, elevate. All of these methods are applicable to the management OSD symptoms.

Physiotherapists can be pretty clever people! We are body detectives, engineers and mechanics, and have a huge bag of tricks up our sleeve to help guide you or your child through OSD. In addition to those outlined in previous articles:

  • Taping techniques to offload the inflamed area and facilitate correct activation of the stabilising quadriceps muscle
  • Massage to release tight quadriceps and calves
  • Mobilising to improve ankle and foot range of motion
  • Assessing biomechanics and addressing contributing factors
  • Retraining optimal movement patterns
  • Strengthening leg muscles
  • Loading the patella tendon appropriately so as to maintain strength without overloading it

Load Modification

A physiotherapist will be able to advise the client on ways to modify their activities and adjust their loading, such as cross training, to allow activity to continue during periods of pain and incapacity. At times when symptoms are severe, the client may require rest from all activities to allow inflammation and pain to settle. Whereas when symptoms are mild or stable, the client may be able to participate in full training. For example, in a ballet class, a dancer may be able to take barre and adage in the centre, but no allegro. Finding balance and working with what the body can tolerate on any given day is key to successful continuation of class or training.

Emotional and Motivational Recovery

See my previous blog about recovery for additional tips to address the non-physical aspects of rehabilitation.

What is the prognosis?

For the majority of sufferers, the prognosis is excellent. Some people are left with a more prominent bony tubercle at the top of the shin bone, which may be uncomfortable to kneel on. Symptoms will come and go, often for up to a couple of years, and will naturally resolve once growing slows.

 

Need some personalised advice on Osgood-Schlatter’s? Get in touch!

info@charissafermelis.com

 

The information and methods outlined above are intended as a guide only and are provided on the basis the reader will be responsible for assessing the relevance and accuracy of the content in reference to their specific situation.

 

Sever’s Disease

When I was 11, I developed a sore heel. I was dancing at a high level, accumulating close to 18 hours of physical activity each week. My heel hurt when I plié and fondu, when I rose on to demi pointe, when I jumped and when I landed. It started in one heel only, but before too long both heels were equally troublesome. My symptoms progressed to the point where I was uncomfortable just walking around. My mum took me to a sports physician, who diagnosed me with Sever’s disease and referred me to a physiotherapist for management. It was this early encounter with health professionals that sparked my interest in the body, how it works, how it breaks, and the ways in which we can manage and prevent injury. I now see many young clients with similar conditions; needless to say I have a keen interest in helping kids (and guiding their parents) through this stage of development.

What is Sever’s Disease

Do not panic – Sever’s Disease is not a ‘disease’! It cannot be contracted or passed from one person to another. It is a ‘condition’ of adolescence, which affects the Achilles tendon attachment to the heel. The attachment site is directly over the growth plate, the apophysis, of the heel, the calcaneus. In a young person at risk, the area can be come irritated and inflamed, resulting in inflammation of the heel’s growth plate. Technically called calcaneal apophysitis, this is Sever’s disease.

Sever-Disease

The growing area of the bone is the weakest part of the osseo-musculo-tendinous unit, until it fuses in late childhood or early adulthood. It can be injured by direct trauma to the site, or through traction and mechanical stress via the tendon attachment to the bone.

What are the signs and symptoms?

Signs and symptoms that someone might have Sever’s include:

  • pain on that back of the heel
  • swelling around the back of the heel
  • soreness during activity and ache afterwards
  • may be sore or ok upon waking in the morning
  • a painful gait causing a limp or toe walking on the affected side
  • reduced strength and power in jumping activities
  • the development of a bony lump on the back of the heel bone

How do we diagnose Sever’s?

A sports doctor or physiotherapist will generally be able to diagnose Sever’s from the patient’s history and explanation of symptoms in conjunction with their physical examination. XRay’s are typically not required, but may be necessary to rule out something more sinister. Radiological findings, such as a fragmented growth plate, are often visible in healthy, normal heels, as illustrated below.

Severs-xray

Who does it affect?

Apophysitis can occur at any growth plate site, but calcaneal apophysitis is the most common. Sever’s affects active, young people; girls aged 8 to 13 and boys aged 10 to 15.

What can contribute to developing Sever’s?

  • Activities involving running, jumping, and repeated rising movements require repeated and forceful contraction of the calf muscle which connects to the Achilles tendon, in turn placing repeated stress on the tendon’s attachment to the calcaneus
  • Sports like soccer, football, basketball, gymnastics and dancing
  • During periods of high velocity growth, there may be a discrepancy between the length/size of the bone and strength/length of the surrounding muscles and tendons, placing increased tensile strain on the soft tissues and their bony attachments. In line with growth is expected and normal weight gain, which will add additional load.
  • Tightness and/or weakness in the calves, or stiffness in the ankle and foot, decreases the dorsiflexion (plié) range of movement and reduces shock absorption ability when landing from jumps
  • Poor intrinsic foot muscle coordination and strength further reduces the ability to absorb shock when landing from aerial movements, forcing the tendon and it’s attachment to take on more load
  • A sudden increase in training load can strain the tissues beyond their capacity
  • Addition of new skills to a training regime can overload the tissues
  • Time of the year – in Australia, kids tend to grow most in September and January, so growth-related and overuse injuries during these periods are more common

How can physiotherapy help to manage the symptoms?

I wrote a blog recently detailing strategies to help with managing acute injuries, which outlines the POLICE acronym – protect, optimal loading, ice compress, elevate. All of these methods are applicable to the management Sever’s symptoms.

Physiotherapists can be pretty clever people! We are body detectives, engineers and mechanics, and have a huge bag of tricks up our sleeve to help guide you or your child through Sever’s. In addition to those outlined in previous articles:

  • Taping techniques to offload the inflamed area and promote activation of the intrinsic foot muscles
  • Massage to release tight calves and feet
  • Mobilising to improve ankle and foot range of motion
  • Assessing biomechanics and addressing contributing factors
  • Retraining optimal movement patterns
  • Strengthening calves and feet
  • Loading the Achilles tendon appropriately so as to maintain strength without overloading it

Load Modification

A physiotherapist will be able to advise the client on ways to modify their activities and adjust their loading, such as cross training, to allow activity to continue during periods of pain and incapacity. At times when symptoms are severe, the client may require rest from all activities to allow inflammation and pain to settle. Whereas when symptoms are mild or stable, the client may be able to participate in full training. For example, in a ballet class, a dancer may be able to take barre and adage in the centre, but no allegro or pointe work. Finding balance and working with what the body can tolerate on any given day is key to successful continuation of class or training.

Heel Padding

Most kids will amass more than 10,000 steps within a normal day, so taking even 1% of stress off each and every step will help reduce stress on the tendon and growth plate.

  • Wear comfortable, supportive, cushioned shoes as often as possible – eg: wearing runners instead of leather school shoes
  • Wear gel heel cups in stiff school shoes and casual shoes, and use fitted heel pads in dance shoes or for activities practised in bare feet (be careful of slipping!), to assist with shock absorption during gait and protect the heel from rubbing or friction caused  by stiff school shoes

gel heel cups clearheel pads fitted

  • Use heel lifts in shoes to take tensile strain off the Achilles – should be adopted for acute and severe pain only as ongoing use of a heel lift can lead to a shortened, tight calf

Emotional and Motivational Recovery

See my previous blog about recovery for additional tips to address the non-physical aspects of rehabilitation.

What is the prognosis?

For the majority of sufferers, the prognosis is excellent. Symptoms will come and go, often for up to a couple of years, and will naturally resolve once growing slows.

 

Need some personalised advice on Sever’s? Get in touch!

info@charissafermelis.com

 

The methods outlined above are intended as a guide only and are provided on the basis the reader will be responsible for assessing the relevance and accuracy of the content in reference to their specific situation.

Dancetrain Magazine – Bodywise

I was recently asked to contribute my knowledge and expertise to the Bodywise edition of Dancetrain Magazine – it’s the second last article, so scroll down!

We focused on methods to assist in physical recovery during busy dance schedules, with tips to help your body during exam and comp time. I’ve outlined additional non-physical methods in a previous blog post – Recovery during dance competition season.

Queries? Questions? Email me – info@charissafermelis.com

Acute Injury Management

I am often asked by parents what to do in the early stages when their child sustains an injury. My response will differ based on a multitude of factors, such as the mechanism of injury, the physical structures that are likely to be damaged and the chronicity of the injury (is it a fresh injury of is it an old irritation that continues to niggle).

The safest bet is to book in to see your dance physiotherapist to have the injury examined earlier rather than later, to accurately diagnose the injury and establish a clear and structured plan for management from the outset. The physiotherapist will be able to assess the injury and determine the most appropriate and individualised course of treatment, which gives the dancer the best chance at making a successful and timely recovery.

However, it is not always possible to get to the physio straight away. The acronym RICE – rest, ice, compress, elevate – is well known amongst active people these days, and more importantly, amongst dance teachers who are often the first person on the scene when a young dancer injures themselves in class. The practise of ceasing the activity and resting immediately whilst icing, compressing and elevating is a good first step in managing an acute injury.

A slight update to the RICE acronym is POLICE – protect, optimal load, ice, compress, elevate. But what exactly does this mean, and how do we go about it? Here are some practical, tried and tested tips (although general in nature) based on my experience as a dancer and physiotherapist working predominantly with young dancers.

Protect

First and foremost – protect the dancer and injured body part from further damage. This might be through splinting or immobilisation, using tape or a brace. Try to limit the risk to other parts of the body; for example, with an ankle injury which is causing the dancer to limp, there is likely to be compensatory loading through adjacent joints, so using crutches until further examination can be carried out might be necessary.

Optimal Loading

Take enough weight and load off the injured area so as to not aggravate the injury or cause discomfort, but continue to move and exercise the unaffected areas as able. For example, if you have a sore toe and only one tiny portion of your body is injured, it is crucial to continue working the rest of your body or modifying certain activities with the aim of preserving strength and condition. Keep working the ankle, the knee, the hip, the body. Whatever is uninjured!

Ice

The idea is to cool down the tissues, to constrict blood vessels with the aim of stemming bleeding into the injured area, as well as limit the accumulation of inflammatory fluid. Icing is also a non-invasive and non-chemical alternative to oral analgesics, so safe for people with medication allergies or those wishing to avoid synthetic drugs. We only need to cool the skin and tissues slightly; there is no need to induce hypothermia and risk an ice burn – ouch!

  • Apply an ice pack to the painful area – the most effective ice pack is a bag of frozen peas or plastic bag full of semi-crushed ice blocks (it stays colder for longer and can mould around body parts)
  • Keep ice on for 20 minutes, then remove for 40 minutes
  • Repeat this every 1 to 2 hours for the first 2 to 3 days

Cold water bathing is extremely helpful for toe, foot and ankle injuries, as the cold water gets into all the nooks and crannies around the foot and between the toes. The gentle pressure around the limb is also helpful, and whilst uncomfortable for a short period of time, has a profound impact on recovery – ever wondered why the footballers wade in freezing cold Port Phillip Bay in the depths of winter…?! The dosage is slightly different compared to icing:

  • You may only need 3 to 5 minutes at a time, then 3 to 5 mins out, and repeat this a few times to accrue a total of 20 minutes in the water, then 40 minutes out

Compress

Applying a firm (but not tight!) compression bandage to the injured area provides a physical barrier for swelling accumulating. If the limb is to be completely immobilised, applying the bandage all the way to the extremity for uniform compressing down the length of the limb. Remember to check the skin regularly – if the skin has changed colour or appears blotchy or shiny, it can be a sign that the compression is too tight and circulation is being compromised.

Elevate

When resting, have the entire limb supported above the level it attaches to the body. For example, for a knee injury, have the entire leg elevated so the foot and knee are resting above hip height, supported on a pile of cushions or pillows, including at night time when sleeping. This becomes challenging for a back injury – sometimes we need to get creative with positioning!

Need some personalised advice on injury management? Get in touch!

info@charissafermelis.com

 

The methods outlined above are intended as a guide only and are provided on the basis the reader will be responsible for assessing the relevance and accuracy of the content in reference to their specific situation.

 

Taking Dance Physio to Regional Victoria

Few things give me more professional joy and inspiration than teaching the next generation of young dancers about their bodies.

Last weekend I ventured out to Bairnsdale in regional Victoria to the Jan Pianta School of Dance – the longest running dance school in East Gippsland, headed up by Jan Pianta. East Gippsland holds a place close to my heart, as my childhood family holidays for many years were spent camping and caravanning around the beaches and bush of the region.

Over the past decade, the scope of dance medicine has widened dramatically. Dance students from recreational dance schools, as well as pre-professional and full time programs are able to access top tier expert dance physiotherapy services and quality care, once reserved for professional dancers. It is now customary for dance teachers in the capital cities to refer their students to dance physiotherapists for injury management, pre-pointe assessments and technique evaluations. However, it is not always possible for rural parents to make multiple trips to the city for specialised dance physiotherapy services. My desire is to bring these services to regional centres, to enable all dancers access to the same dance health advantages and opportunities within their own communities, as are available in urban areas.

The morning was spent with Jan’s senior students, assessing some niggling foot injuries, providing a second opinion on ongoing management, and examining students’ readiness to commence pointe work. The dancers were energised and engaged, taking on new corrections and techniques maturely with the utmost respect for their bodies.

The afternoon involved taking groups of students through practical and educational workshops:

  • Safe Stretching for the 5-9 year olds
  • Active Anatomy for the 10-12 year olds
  • Taming Turnout for the 13+ girls.

The dancers left the sessions with a bunch of homework to do, new concepts to wrap their brains around and a sense of empowerment that they are able to improve their technique and reduce their injury risks them selves with the crafty little tricks.

It was an absolute pleasure to be involved in the physiotherapy care Jan Pianta’s dancers – I can’t wait to see their progress when I head back to Bairnsdale next time.

 

The Rise

Never underestimate the power of a beautifully controlled, expertly executed rise.

Dance physiotherapists place great importance on the technique, control and endurance of a single leg rise to demi pointe when assessing a dancer’s readiness to commence pointe work. It gives us valuable insight into where a dancer may be lacking in their development and areas that must be addressed in preparation for pointe class. I recently contributed a blog outlining the considerations for commencing pointe work.

The rise is also pivotal in the overall function of a dancer’s leg, as it ‘gives rise’ to fundamental technical skills such as the push off and landing in petit and grand allegro, the posture of the standing leg during pirouette, and the step up position of a posé just to name a few.

Regardless of whichever injury a dancer may present with, I will often examine the rise as a starting point and progress the assessment from there.

Qualities I look for when assessing a rise:

  • Comprehensive body alignment in standing – on two legs and on one leg
  • Lower back posture
  • Hip and pelvic stability
  • Knee extension”pull up”
  • Ankle alignment
  • Height of the rise on to demi pointe
  • Foot alignment
  • Toe control
  • Early upper calf muscle activation
  • Precision and consistency throughout the movement
  • How many excellent quality rises can they complete?

When building the ideal rise, establishing optimal technique first is the priority. Only then can we work to gradually build strength and endurance.

Dance physios tend to be quite clever people who can analyse the elements of a rise and predict where the necessary changes are to be made, and how to make them. Either through manual hands-on physiotherapy or through a structured, tailor-made home exercise program. However, we won’t know what to prescribe specifically until we see the rise performed in front of us!

Contact me at info@charissafermelis.com for further information of to have an assessment at home or at your dance studio.

Charissa

Recovery during dance competition season

The winter dance competition season is fast approaching, and for many young dancers it is an exciting opportunity to perform on stage. However, the school holidays, rather than being a time for rest and recuperation between busy school terms, can transform into a hive of additional activity with dancers participating in winter schools and eisteddfods. In Melbourne for example, a dancer may have a performance of her classical solo one morning in Frankston, followed by a jazz troupe that afternoon in Werribee, followed by a lyrical duo in Heidelberg the next morning. Punctuate this schedule with extra rehearsals and workshops; a hectic timetable, with high intrinsic expectation and perceived pressure from teachers and parents can lead to a physically exhausted and emotionally drained young person. And in a few days…term 3 starts!

I remember this all too well. In amongst all this dancing, I somehow needed to find time to stay abreast of school study, engage with my non-dancing peers and also just chill out!

I’ve outlined some methods below to assist with recovery during those heavy dance periods, to maximise performance potential and help minimise the risk of injury.

PHYSICAL RECOVERY

Purpose: reduce muscle soreness, begin the tissue repair process and restore function.

  • Stretch following activity – long indulgent stretches, working through all the major muscle groups, holding the stretch for 30 seconds but repeating each 3 to 5 times
  • Ice pack – utilise an ice pack at home (or a bag of trusty frozen peas!) on any acute injuries to help reduce pain, swelling, bruising and inflammation
  • Soak feet in cold water – to soothe tired feet, especially helpful after dancing en pointe
  • Massage – either by making an appointment with a myotherapist or massage therapist, or by working on a foam roller or spikey massage ball at home
  • Compression garments – wearing compression leggings or compression socks (on flights or on long car trips home after dancing) will help prevent swelling pooling in the feet and assist with blood circulation
  • Postural drainage – resting with the feet elevated up the wall helps with venous return
  • Adequate sleep – the National Sleep Foundation recommends a teenager aim for between 8 and 11 hours of sleep per night
  • Optimal nutrition – replenish glycogen and protein, water rehydration

EMOTIONAL RECOVERY

Purpose: settle the emotions.

Competition season can be an emotionally challenging time, with heightened stress and expectation. It is crucial in the down time between performances to participate in pleasurable activities in a calm environment.

  • Share fun times with family and friends
  • Watch a funny movie with an enjoyable, positive message
  • Read a book
  • Listen to music
  • Spend time outdoors for fresh air and vitamin D
  • Take the dog for a walk
  • Avoid using electronic devices

 MOTIVATIONAL RECOVERY

Purpose: control the thoughts.

Many aspects of dance competition are out of your control – you cannot control what other performers do on the day, you cannot control the decisions of adjudicators, you cannot control the results. So it is important to focus on the things you can control.

  • Make a list of the positive things achieved on each day
  • Keep a training diary to ensure you stay on track
  • Assess short-term goals for the next few weeks
  • Reaffirm long-term goals for the months ahead
  • Make plans to address any problems or obstacles such as costume repairs or choreography modifications
  • See your dance physiotherapist to assess any acute injuries and to develop an ongoing management plan

Research is underway to investigate the optimal recovery regimens for various sports. So my recommendation is to explore the methods outlined above to establish a strategy that works best for you!

Email info@charissafermelis.com for further information.

Best of luck for the upcoming dance competition season!

Charissa

Commencing Pointe Work: What To Consider…

Commencing pointe work is a rite of passage for many young dancers. It is an exciting milestone, eagerly anticipated by dance students, teachers and parents alike.

However, dancing en pointe is not a natural thing for a human body to be doing; few dancers are fortunate to have been born with the exact physical attributes required for safe dancing en pointe.

As a dance physiotherapist, dancers are referred to me by their ballet teachers for a pre-pointe examination. We conduct a thorough physical assessment to determine the student’s strengths and weaknesses, to establish whether the dancer will physically be able to achieve pointe work, and to implement a pre-pointe preparation plan.

The International Association for Dance Medicine and Science has developed the following recommendations for young dancers commencing pointe work:

  • Not before age 12.
  • If the student is not anatomically sound, do not allow pointe work.
  • If she is not truly pre-professional, discourage pointe training.
  • If she has weak trunk and pelvic muscles or weak legs, delay pointe work
  • If the student is hypermobile in the feet and ankles, delay pointe work
  • Consider implementing a strengthening program where appropriate.
  • If ballet classes are only once a week, discourage pointe training.
  • If ballet classes are twice a week, and none of the above applies, begin in the fourth year of training.

Stage of physiological development and mental maturity are key factors. Girls mature at different rates; ‘normal’ encompasses a broad range of physical shapes and variations in emotional intelligence.

Without appropriate foot and ankle bony morphology (shape) and adequate range of movement into plantarflexion (a pointed position), a girl will struggle to actually rise on to pointe. Conversely, a foot that is hypermobile and über flexible, may not have the essential strength within the arch to support the foot shape en pointe. Both ends of the mobility spectrum cause problems; poor habits quickly set in and the likelihood of injury is exacerbated. Hence why developing adequate intrinsic foot muscle coordination, activation and strength is vital.

Repeated single leg rises from flat to demi pointe reveals several technical capabilities. If concerns are identified in any of these, they must be addressed prior to commencing pointe work:

  • Trunk control
  • Pelvic and hip stability
  • Knee control
  • Calf muscle activation
  • Ankle alignment and stability
  • Toe control
  • Balance

Students must be able to accomplish 25 perfect single leg rises (in a row!) before fatigue, to be considered ready to commence pointe class. It will take around 5 weeks to increase repetitions from 15 to 25, so get practising!

Often, pointe classes are scheduled at the end of a normal ballet class, when the students are most fatigued and at the greatest risk of injury, so teachers need to keep this in mind when planning class timetables.

The vast majority of students are not ready to commence pointe work after their initial physiotherapy assessment – there is much homework to do! From my experience, a diligent, patient but motivated student can achieve remarkable things.

CHARISSA FERMELIS

Physiotherapist B.Phty APAM

 

How long have you been sitting at your desk for this morning??

Like me, have you been at your desk all morning in front of a computer, in and out of emails, on and off the phone, but otherwise pretty sedentary? Well…

GET UP – GET MOVING – GET STRETCHING

Simply getting up and about and moving around regularly is enough to reduce nasty things like back pain, neck pain and stress creeping in to ruin your day. I’ve worked on this STRETCHING GUIDE FOR OFFICE WORKERS recently which you may find helpful. Some stretches might seem a bit extreme for your capabilities or a bit NSFW (mum: that means ‘not suitable for work’), so do what you can. Something is better than nothing!

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Photos curtesy of Medibank.

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