Barbell back squats are a popular exercise in the gym and often prescribed as part of a bone health program (as well as a part of most general strength programs) because they load a large number of muscle groups at once. The use of the barbell across the shoulders also limits being restricted by how much weight you can hold in your hands. Not everyone is able to get under the bar, however, due to various differences in their anatomy or injury history etc. Below we outline a few different options to help you be successful with back squats , or if not, what you could do instead. Getting the bar into position on the shoulders A common difficulty people experience is literally just getting the bar into place on the shoulders. There are 2 options for where you can place the bar: high bar, or low bar position. High bar is the most common and it involves resting the bar on your upper trap muscles. Low bar involves rolling the bar a little further down the back to sit more across the top of the shoulder blades. The first 2 minutes of this video discusses how to get in under the bar, specifically outlining the difference between high bar and low bar at minute 1:00-1:23. 

Osteopenia and osteoporosis are common conditions in Australia, with up to 7.5 million people affected by poor bone density. In populations over the age of 50, an estimated 66% have either osteopenia or osteoporosis. These conditions happen when bone density is reduced, and the structure of the bone is affected. This increases risk of fracture, even with a low force injury. Hence, it is crucial for early diagnosis and treatment or management of these conditions, to prevent fractures from happening. To diagnose bone health disorders, dual energy x-ray absorptiometry (DEXA) scans are considered the gold standard diagnostic tool. DEXA scans are safe, low radiation imaging that measure the mineral content of bones, such as calcium content. In Australia, DEXA scans are eligible for Medicare rebates if you meet certain criteria. The criteria are listed in the table below: Patients over 50 with risk factors: - Early menopause - Hypogonadism - Anticipated glucocorticoids/corticosteroid use ≥ 4 months, ≥7.5mg/day - Coeliac disease/malabsorption disorders - Rheumatoid arthritis - Primary hyperparathyroidism - Hyperthyroidism - Chronic kidney or liver disease - Androgen deprivation therapy Patients with a minimal trauma fracture - DEXA recommended to establish a baseline BMD for treatment Suspected vertebral fracture – to be referred for spinal x-ray first - Height loss of 3cm or more - Thoracic kyphosis - New onset back pain suggestive of fracture - Refer for DEXA if fracture is confirmed and therapy is indicated Patients with osteoporosis - T-score equal to or less than -2.5 eligible for one scan every 2 years Patients over 70 years of age - Both men and women eligible - Patients with a normal result or mild osteopenia (measured by a T-score down to -1.5) eligible for one scan every 5 years - Patients with moderate to marked osteopenia (as measured by T-score less than -2.5 and above -2.5 will be eligible for one scan every 2 years) If you do not meet the criteria but still are at high risk of poor bone health, you can still be referred by your doctor for a DEXA scan, but may have to pay for it. DEXA SCAN REPORT INTERPRETATION When you receive the result of your DEXA scan, it can be difficult to interpret what all the alphabets and values mean. Let’s break down how to understand all the different acronyms and numbers. The sites that are typically imaged for DEXAs are usually the L1-L4 or L2-L4 vertebra, the pelvis and the upper part of the thigh bone (femur) and femoral neck. These are some of the areas that are at high risk of fracture, especially in a fall. However, wrists may also sometimes be assessed, especially in patients who are unable to lay supine for scans on the hips or lumbar spine. BMD refers to bone mineral density, which refers to the amount of mineral content (e.g. calcium) in bone tissue. This is your specific bone density value which is used to be compared against other people to obtain your T-score and Z-score. It is also worth noting that the presence of osteoarthritis in one of these areas can artificially inflate BMD in that area, which may explain why one site may be significantly osteoporotic, while another site may have seemingly high BMD. This does not mean that the area is not osteoporotic, as osteoarthritis structurally changes the bone, which still increases risk of fracture. T-score is the standard deviations that your bone density is, compared to a young healthy adult of the same sex. Essentially, this number determines whether your bone density is significantly more or less, compared to that of the peak bone density of a younger healthy adult of the same sex. In populations over 50 years of age or menopausal women, a value of -2.5 or lower is considered osteoporosis, and a value between -1 and -2.5 is considered osteopenia. Other than using the T-score to diagnose osteoporosis, individuals over 50 years of age with a low trauma hip or vertebral fracture are also considered to have clinical osteoporosis. Individuals over 50 years with low trauma fractures in other areas, and a T-score below -1.5 are also considered to have clinical osteoporosis. Z-score compares your bone density to someone of the same age and same sex. The normal range is -2.0 to +2.0. At any age, a value of -2.0 or lower is outside the norm and further investigation should be considered to exclude underlying disease which may be causing bone loss. For younger populations under the age of 50, the Z-score is more accurate in predicting risk of fracture and bone health disorders, rather than the T-score. In some DEXA reports, there may also be some additional values such as Absolute Fracture Risk, Trabecular Bone Score and Vertebral Fracture Assessment. These values do not attract MBS rebates but can be helpful in screening for fracture or risk of it. Absolute Fracture Risk (AFR) uses a calculation tool named FRAX to assess fracture risk over a 10 year period. This may include a percentage value for either a major osteoporotic fracture, or a hip fracture. This is the percentage likelihood that you may sustain a fracture in those categories. This value is calculated by considering a collection of inputs such as demographic information, alcohol use, metabolic diseases and corticosteroid use. It is recommended that adults over 50 years of age with a 20% or greater risk of a major osteoporotic fracture or a 3% or greater risk of hip fracture should be treated to improve bone health. Trabecular bone score (TBS) is obtained via analysis of bone quality and bone micro-architecture. The degree of connectivity and organization within the internal structure of the bone is measured. This score can help predict whether someone is more susceptible to fracture. A higher TBS score represents greater trabecular density, better bone connectivity and less trabecular separation, which is likely to be associated with a lower fracture risk. Vertebral Fracture Assessment/Lateral Vertebral Assessment (VFA/LVA) is a screening tool for asymptomatic vertebral fractures. Fractures detected with this tool should be confirmed by plain x-ray. MY DEXA SHOWS I’VE GOT OSTEOPOROSIS/OSTEOPENIA! WHAT NOW? Hopefully, this blog was helpful in helping you make sense of your DEXA scan! If your DEXA shows or if you’ve been told you have osteopenia or osteoporosis, there are steps that you can take to reduce your risk of fracture and further bone health deterioration. Bone tissue is living tissue which is adaptable and can respond to stimuli. Our bone density classes are aimed at increasing the load and demand on your bone tissue, which encourages bone remodeling and growth. We tailor exercises to a level that is suitable for you. If you are interested to find out more on how to improve your bone health, do reach out or book an appointment and we can discuss your next steps further!

The best type of exercise for osteoporosis and improving bone density in general.

In the 6 years that separate the two instances of my having significant shoulder pain from training, my understanding of pain and injury have changed a lot, and I thought sharing my experience might be of value to other people who are experiencing a new pain, particularly when training.

In recent years, there has been a rise in popularity in glucagon-like-peptide-1 medications, commonly referred to as GLP1s and more likely to be known under their brand names such as Ozempic, Wegovy or Mounjaro. These medications are commonly used to treat type 2 diabetes and certain brands are approved in Australia to be used for chronic weight management. With a number of patients coming through our doors taking these medications, it prompted us to have a look at their impact on bone health. Diabetes impact on bone health According to Healthy Bones Australia, people with type 1 diabetes are at a higher risk of having low bone mass, as the condition can impact them at at time when they are building the majority of their skeletal mass, in childhood and adolescence. While type 2 diabetes is different, and may not have a direct impact on bone density, those with type 2 diabetes have a higher lifetime risk of developing a fracture. The reasons appear to be multi-factorial, some relating to the impact higher blood sugar can have on bone density and architecture, and others relating to complications that can arise as a result of the condition that may result in increased risk of falls later in life. GLP1-s and bone health According to a review by Zhao et al. in 2017, GLP1 medications may be beneficial to bones, if we consider them in isolation to any weight loss. That is, the drugs themselves may actually have a bone preserving effect, though research is currently inconclusive. The main outcome of taking these medications is significant weight loss, and it is actually this that is most likely to have a detrimental effect on muscle and bone health. Studies looking at the impact of these drugs show that in the studies spanning 68-72 weeks, participants lost up to 10% of their muscle mass, which is the equivalent to the muscle mass lost across 20 years of ageing (Mechanick et al., 2025). Another study found that between 25-39% of all weight loss while taking these medications is from muscle mass (Prado et al., 2024). With such rapid loses of muscle, and even just considering the significant loss of size that accompanies significant loss of body mass, it is necessary to consider the bones. Our bones remain dense directly in correlation to how much force is put through them. That is, how much our muscles are contracting and pulling on the bones. With less muscle mass, and less body mass, there is less loading on the bones, and as such losses in bone density can accompany losses in body weight, particularly when occurring in such high amounts and at such high speeds (Jensen et al., 2024). How to reduce muscle and bone loss There are a couple of really important considerations from an allied health standpoint when taking these medications and that is to consult with a dietician alongside taking these medications to avoid completely depriving the body of the nutrients required to continue to function in a healthy manner. The other is to commence resistance based exercise program to maintain muscle and bone mass and to mitigate loss of these tissues as much as possible. Some early research has indicated that exercise can mitigate bone density losses associated with these medications (Jensen et al., 2024). Many GPs are sending their patients for DEXA scans prior to starting these medications as well as referring to physio/exercise physiology and dietetics to facilitate appropriate support throughout the process. This may be particularly important in the context of diabetes or other co-morbidities that might already impact bone health. Take aways: GLP1s like Ozempic and Wegovy are being prescribed for diabetes management and in some cases for chronic weight management A side effect of these medications is often significant weight loss Significant weight loss is likely to include muscle mass Loss of muscle mass results in loss of bone & can be dangerous to your health in the long term You can mitigate these effects with appropriate dietary measures as well as by doing resistance training Getting regular DEXA scans while on these medications likely to help in monitoring their effect on these aspects We offer 1:1 consultations and small group classes to help you with an exercise program to help support you when taking these medications. Click here to get started with any of our physios. References: Healthy bones Australia, https://healthybonesaustralia.org.au/resource-hub/fact-sheets/diabetes-bone-health/ . Zhao C, Liang J, Yang Y, Yu M, Qu X. The Impact of Glucagon-Like Peptide-1 on Bone Metabolism and Its Possible Mechanisms. Front Endocrinol (Lausanne). 2017 May 3;8:98. doi: 10.3389/fendo.2017.00098. PMID: 28515711; PMCID: PMC5413504. Mechanick JI, Butsch WS, Christensen SM, Hamdy O, Li Z, Prado CM, Heymsfield SB. Strategies for minimizing muscle loss during use of incretin-mimetic drugs for treatment of obesity. Obes Rev. 2025 Jan;26(1):e13841. doi: 10.1111/obr.13841. Epub 2024 Sep 19. PMID: 39295512; PMCID: PMC11611443. Prado, Carla M et al. (2024), Muscle matters: the effects of medically induced weight loss on skeletal muscle, The Lancet Diabetes & Endocrinology, Volume 12, Issue 11, 785 - 787 Jensen SBK, Sørensen V, Sandsdal RM, Lehmann EW, Lundgren JR, Juhl CR, Janus C, Ternhamar T, Stallknecht BM, Holst JJ, Jørgensen NR, Jensen JB, Madsbad S, Torekov SS. Bone Health After Exercise Alone, GLP-1 Receptor Agonist Treatment, or Combination Treatment: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2024 Jun 3;7(6):e2416775. doi: 10.1001/jamanetworkopen.2024.16775. PMID: 38916894; PMCID: PMC11200146.

Hi! I’m Jaslynn, I’m the physiotherapist who just joined FKB Physio this month. I graduated from the University of Queensland in 2023 and have since mainly worked in private practice settings. A bit about myself I’m actually from Singapore. I moved here for studies and then stayed for work! Outside of being a physiotherapist, I illustrate designs for t-shirts, occasionally do Brazilian jiujitsu and regularly go to the gym. I’m also miserably trying to work on my cardiovascular fitness. I have a rather terrible caffeine habit that I wish I could kick but alas… coffee is too good to resist. Why did I become a physiotherapist?  I was very fortunate to have had very positive experiences with allied health and alternative health practitioners when I was growing up. Their care and support left a strong impression on me, and I grew up thinking I would love to be able to pay it forward and do that for someone else. After completing high school, I originally considered studying medicine. However, after seeing the lifestyle my sister (who is now a family doctor) led, I didn’t think I would enjoy it. So I started exploring other health professions. I was also interested in fitness at the time, and would get plenty of social media content from physiotherapists on my feed and that sparked my interest! To explore this possibility more, I shadowed physiotherapists in hospitals. I very nearly got put off by it as I was mainly shadowing inpatient physiotherapy and it wasn’t really what I could see myself doing. But on one of the last few days, I got to shadow a physiotherapist on the outpatient department. Immediately I thought; this is it. This is what I want to do. I’m not even joking when I say I had tears in my eyes at that point, but it does sound rather overdramatic now, looking back! Anyway, from then on, I became fully committed to becoming a physiotherapist. Funnily enough, I actually never personally saw a physiotherapist until I was about 18, which is when I started Brazilian jiujitsu and exposed myself to a new world of injuries. Injuries? I’ve had my fair share of injuries, given that I’ve done Brazilian jiujitsu for about 7-8 years now and was pretty obsessive for some of those years. But the one that has affected me the most, and also shaped the way I treat as a physiotherapist, would be my shoulder subluxation in March 2023. To be honest, it was almost entirely my fault. I was competing on that day and had 9 matches. About halfway through my 5 th match, I felt a click or small pop in my shoulder and immediately lost almost all my strength in it. Somehow, I managed to pull through and win that match. A wise person would have stopped there. But I was young and foolish, so obviously, I didn’t. I did a couple of shoulder tests on myself with the assistance of a fellow physiotherapy student, and thought I’d give it a go and at worst I’d just stop if it got really bad. I never got the chance to stop. My left shoulder got into an end range position which I get into all the time in training – but this time I had obviously already damaged some stabilizing structures. I felt my left shoulder shift out of place. It was the most disgusting feeling I’ve ever had in my life, but luckily enough the subluxation spontaneously reduced on the spot. It was the worst injury I’ve had in my life, which really isn’t that bad compared to some of the really messed up injuries you can get. I didn’t have any fractures from it thankfully, nor did I tear any of the rotator cuff muscles, though I believe I did get some labral damage. It did, however, put me out of action from jiujitsu. I wouldn’t say it was a bad thing overall. I learnt a lot about shoulder management from that experience, and also gained a much deeper understanding of patient’s experience of injury. It’s probably not the best way to go about gaining empathy for patients, but it definitely is one of the most effective! An injury is never just physical, it also has emotional, social and psychological impacts. The injury gave me insight to these things, and I think it has made me a much better physiotherapist overall. That’s also why I have a passion for working with athletes, especially martial arts athletes, to reduce injury risk and improve function. But to be honest, this is not really limited to athletes, they apply to most of the general population as well. Anyone who is facing injury, pain or any other dysfunction would know how it can affect their life. And I have come to really realize the importance of having guidance through that process, and being really grateful I can provide that to someone going through an injury, managing pain or other dysfunction. I guess in a full circle sort of moment, I realized I have become a source of support for people going through health concerns like what I received when I was young! So that’s the story of how I got into physiotherapy and my experiences with injury. I think the body’s ability to adapt after injury is amazing, and I think we’re finally in a new era where people are more receptive to actively work on it rather than just rest. It’s really encouraging to see all the class participants at FKBPhysio lifting heavy and working hard to get stronger and improve their health and bone density, and I’m so honoured that I get to be part of the process 😊

Take home points: - Physiotherapy's role in managing pain and injury is often largely about education, finding modifications to lifestyle and activity factors, and rehabilitating strength rather than passive treatment strategies - The medical system can be quick to refer for injections but often do not explain that these are not fixes - Tendinopathy is often not treated & ignored for other pathologies (like bursitis) which can often lead to inadequate management strategies - Early bone loading can facilitate faster/better recovery than complete rest and immobilisation after a fracture

Before we get started... Osteoarthritis: Osteoarthritis refers to joint pain and stiffness with associated joint changes, such as thinned cartilage and additional bone remodelling around a joint (i.e. extra bone laid down around a joint, changing its shape). Osteoporosis: weakened bones - NOT related to osteoarthritis and is asymptomatic Rheumatoid arthritis: an autoimmune condition that requires specific management This blog post specifically discusses osteoarthritis.

From dislocating her knees putting on her jeans to approaching her first 100kg deadlift, our physiotherapist Sarah talks about why she chose to become a physio, and why she is so passionate about supporting people with pain and hypermobility to learn safe ways to move their bodies.