I listened to a podcast this week from Adam Meakins & Ben Cormack, two physios I really respect, discussing how important it is for us as physiotherapists to do our best to try and encourage people to move regularly. And that the biggest benefits tend to come from getting people going from doing no regular exercise to doing any regular exercise. At all. 5 minutes as opposed to 0 minutes. The podcast is here, if you want to listen. Alternatively search "NAF Physio podcast" and "Changing other people's behaviour towards exercise". This resonated with me, as I think sometimes we can get too caught up on wanting to provide the ‘optimal’ plan for someone. I have been guilty of recommending the WHO exercise guidelines to people, not really realising that stating that their suggestion of 300 minutes of exercise a week is probably a total turn off for someone who is a complete beginner. They discussed the importance of having success with sticking to a plan, and not having any ill-effects form it (i.e. avoid doing something that will give you muscle pain afterwards if you are trying to get into the habit), as this tends to lead to positive feelings that make it easier to repeat again next time. (This makes sense to me too. I don’t mind having sore muscles because I know it goes away - but I realise people new to exercise think that this will happen every time they exercise & are too freaked out to continue.). They suggested aiming to get someone starting with a goal as small as 5 minutes a week. Or 5 minutes twice a week. And build up from there. Having a clear structure with goals they can tick off. This makes sense to me. As someone who is very goal-oriented myself, I get massive satisfaction from ticking off sessions in a structured training plan towards a goal, rather than just ‘exercising’. It makes sense that this is true for a lot of people!  My main tips for getting into a routine with exercise: Book it in at the start of your week, like you would a medical appointment Find something you enjoy, or at least don’t hate Do it at a time that feels good for you (do not get up early to exercise if you hate getting up early!) Have very, VERY achievable goals, that are based on process, not outcome (i.e. “I will do go on my exercise bike for 5 minutes 2x this week”) Start VERY small. Build up once you have had success. Set goals based on what you can definitely achieve, not what you wish to achieve - that can come in time Social support - a friend doing it with you, or going to group classes - really helps

What is does the trabecular bone score reported on your DXA scan mean? A trabecular bone score (TBS) is something you might see on your DXA scan, which you may have had to check your bone density (BMD). If you want to learn more about DXA scans, check out our blog post on those here. TBS is a measurement that comes from the lumbar spine (lower back) and looks at bone microarchitecture, rather than its density. Bone microarchitecture refers to the tiny internal structure and organisation of bone. Essentially, how the bone is built at a microscopic level. Bone density (BMD) tells us roughly how much material there is actually making up our bones. Bone microarchitecture tells us how that material is arranged, that is, the thickness, number and connectivity of the internal struts and plates that give the bone its strength. Inside our bones, particularly trabecular (spongy) bone, there is a complex network of tiny structures called trabeculae. Healthy bone has a well-connected, relatively robust network. With osteoporosis and ageing, changes can occur such as: trabeculae becoming thinner some trabeculae being lost the connections between them becoming weaker or disrupted the overall internal structure becoming less able to withstand loading. TBS analyses the texture of the lumbar spine image from your DXA scan to provide an indirect measure of trabecular bone microarchitecture. The measurement is taken at the lumbar spine as that is where the degraded microarchitecture is likely to be the most significant. Why could TBS be important? TBS can be important, because bone density does not always give the full picture of how at-risk one is of sustaining a fracture. Many low-trauma fractures occur in people who have osteopenia, but not osteoporosis. Incorporating a trabecular bone score alongside bone density can provide a more accurate fracture risk assessment calculation. A degraded TBS can identify additional fracture risk that may not be captured by BMD alone. This can be particularly useful when interpreting a DXA result in someone whose BMD is in the osteopenic range. You will see the number reported as something such as: TBS: low (severely degraded), medium (partially degraded) or high (minimal degraded). You may then also see a ‘TBS adjusted FRAX’, which indicates that when calculating your risk of sustaining a fracture in the next 10 years, the technicians have included your BMD as well as your TBS scores (as well as other risk factors included in that calculation). In people with certain health conditions, TBS may be particularly useful alongside BMD, as bone mineral density alone may not fully reflect fracture risk. This may be especially relevant for people with secondary osteoporosis. Secondary osteoporosis occurs when bone loss is caused or contributed to by another factor, such as an underlying health condition or certain medications. In contrast, primary osteoporosis develops in association with factors such as ageing and hormonal changes, including the decline in oestrogen after menopause. Examples of situations where TBS may provide additional information alongside BMD include: Long-term glucocorticoid use Chronic kidney disease Endocrine disorders Some inflammatory or rheumatological conditions Aromatase inhibitor treatment Other causes of secondary osteoporosis In some of these conditions, bone microarchitecture may deteriorate even when BMD does not appear particularly low. TBS can provide additional information about bone health that may help clinicians assess fracture risk more comprehensively. Treatment considerations As always, exercise is recommended as a part of osteoporosis or osteopenia management, regardless of TBS score. It is uncertain whether exercise can change a degraded TBS. TBS can change in response to osteoporosis medications, although the response varies depending on the treatment. Antiresorptive medications such as bisphosphonates and denosumab tend to preserve or modestly improve TBS, with changes generally smaller than those seen in BMD. Anabolic medications, which stimulate new bone formation, tend to produce larger and earlier improvements in TBS. The statement suggests TBS may therefore be useful alongside BMD when monitoring treatment, particularly with anabolic therapies. Not all machines are able to perform a TBS reading, so it is worth enquiring when booking your scan if it is something you can access. Take homes If you are interested in learning more about your TBS score, or wonder if it something that might be relevant for you, it is worth discussing with your GP, or even more appropriate, your endocrinologist, who is likely to be able to provide an in depth assessment of its relevance to you and your bones.

When we think about balance, we often think about muscle strength, eyesight or sensation in our feet and legs. But there is another important part of the balance system that you might not have considered: your vestibular system . Your vestibular system is located in your inner ear and provides your brain with information about the movement and position of your head. This information works together with information from your eyes and body to help you maintain your balance. It also helps keep your vision stable when your head is moving. When the vestibular system isn't working properly, some people experience dizziness or a spinning sensation. For others, the main symptom may simply be that you don't feel as steady as you used to . 5 signs your balance problems could be vestibular 1. You feel unsteady when you turn your head Do you feel less stable when looking over your shoulder, turning to talk to someone or moving your head while walking? Your vestibular system helps your brain respond to head movement and coordinate your eyes and body. If there is a problem with this system, these everyday movements can sometimes make you feel less steady. 2. Your vision feels blurry or "bouncy" when you move You may notice that signs or objects seem to move, jump or become blurry when you're walking or turning your head. This can occur when the vestibular system isn't providing the brain with the information it needs to keep your vision stable during movement. 3. You feel dizzy when getting in or out of bed Brief episodes of spinning or dizziness when rolling over in bed, lying down, sitting up or looking upwards can be a sign of benign paroxysmal positional vertigo (BPPV) . BPPV occurs when tiny calcium-carbonate crystals in the inner ear move into one of the semicircular canals, where they can interfere with the normal detection of head movement. BPPV can often be treated with specific repositioning manoeuvres. 4. Busy environments make you feel unsteady Do shopping centres, supermarkets, crowds or walking through busy environments make you feel uncomfortable or off-balance? Your brain has to process a lot of visual and balance information in these situations. People with vestibular problems can find visually busy environments particularly challenging. 5. You've had unexplained falls or near-falls If you've started falling or nearly falling without an obvious reason, there may be several possible contributors, including problems with your vestibular system. Vestibular problems don't necessarily cause obvious dizziness. Imbalance can sometimes be the main symptom. Vestibular assessment and rehabilitation at FKB Physio FKB Physio offers vestibular assessment and rehabilitation with Helen Beeley, Senior Physiotherapist , who has more than 30 years of clinical experience and a particular interest in vestibular disorders, falls prevention and rehabilitation. If any of these symptoms sound familiar, or you have concerns about dizziness or your balance, an assessment may help identify what is contributing to your symptoms. What happens during a vestibular assessment? Helen will ask about your symptoms, when they occur and what activities or movements affect them. Depending on your presentation, your assessment may include: eye movements and visual stability balance in different situations responses to head movement walking and turning positional testing if particular movements trigger dizziness how your eyes, inner ears and body work together to maintain balance. The assessment is individualised because there are many different reasons why someone may feel dizzy or unsteady. If BPPV is identified, specific positional testing and treatment manoeuvres may be appropriate. Other vestibular problems may be managed with exercises designed to improve gaze stability, balance, walking and tolerance of movement .  If you're experiencing dizziness, unsteadiness or changes in your balance, a vestibular assessment can help determine whether your inner ear may be contributing and what treatment may be appropriate.

Does everyone with a sore shoulder need a scan?

What is the most effective way to fit different types of exercise in across a given week?

How to design a strength training session that makes sense

How (and why) to warm up for resistance training

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Hip pain? You’re not FAI-king it!