Osteoporosis is a common yet silent disease because most people don't know they have it until they suffer a fracture. Early scans and detection are slowly becoming more common, but there are still too many older adults who are unaware of their bone health and when they finally decide to do something about it, the osteoporosis has progressed significantly, leading to greater time and difficulty to address it. There is good news, specific types of exercise can significantly improve bone density and reduce fracture risk. That’s where the Onero™ program comes in. What Is the Onero Program? Onero™ is an evidence-based exercise program specifically designed to prevent osteoporotic fractures. Developed from research conducted at Griffith University, it focuses on the type of exercise that’s been scientifically proven to improve bone strength! The program isn’t your standard walking or light resistance routine. It uses high-intensity resistance and impact training , which stimulates bone growth far more effectively. These types of exercise are generally avoided by the older population, due to deconditioning and fear of causing actually a fracture or another injury. However, when it is applied in a supervised and structured manner, injures can be avoided and bone strengthening can occur. When bones are exposed to high-intensity resistance and impact, they respond by getting stronger, just like muscles! But it needs to be heavy! This is key! Mal smashing out a heavy deadlift! Specific exercises allow us to tolerate the higher loads to apply the right kind of force to bones, especially in key areas like the spine and hips, where fractures are most common. The most common question: Is it safe if you already have osteoporosis and an osteoporotic fracture? (such as vertebrae crush fracture) Yes! The Onero program is clinically supervised and tailored to each person’s condition and ability. Most people will not start with the heavy exercises; they must first work on their exercise technique and tolerance to resistance training to build up to heavier loads.Each participant is carefully screened in an initial assessment and sessions are modified if needed. The research behind Onero has shown it to be safe and effective, even in older adults with diagnosed osteoporosis. Ask your Mum, Dad and Grandparents about their bone density! If they’re over the age of 50, it is highly recommended to get a DEXA scan (if they haven’t already), they are cheap and give a good indication on bone health. If it shows low bone density, then it can be addressed early before any fractures occur. The Onero program is a powerful, research-backed way to fight back. Stronger bones mean fewer fractures. Want to know more? Get in touch to see how the Onero program can benefit you or your parents! https://www.asrehab.com.au/onero

Osteoarthritis (OA) is the most common form of arthritis, affecting millions of people worldwide. It’s often associated with joint stiffness, pain, and reduced mobility. It is often described as ‘wear and tear’ and ‘bone on bone’ which has negative connotations and often makes sufferers avoid movement due to the fear of damaging their joints further. This couldn’t be further from the truth, in fact the most effective and evidence-based ways to manage OA isn’t rest, it’s movement and strength training! Example of an osteoarthritic knee joint (picture from www.knee-pain-explained.com/osteoarthritis-knee-pain.html ) “If I have arthritis, won’t weights make the bone on bone worse?” It’s a question I hear all the time, this is where exercise physiology comes in. Osteoarthritis has often been described as a “wear and tear” condition, but that’s an outdated view. It’s more accurate to think of it as a joint adaptation issue influenced by mechanical stress, inflammation, lifestyle factors, and muscle function. While cartilage changes are part of OA, pain isn’t always correlated with the amount of cartilage loss seen on scans. In fact, many people with severe joint changes on imaging report little to no pain and vice versa! Pain in OA is often the result of how the body moves and loads joints, along with deconditioning, fear of movement, and chronic low-grade inflammation. How an Accredited Exercise Physiologist (AEP) can help: Assess the Individual, Not Just the Joint No two people experience OA the same way. An AEP will look beyond your X-ray or MRI, considering your movement patterns, strength levels, goals, and pain triggers. Build Strength to Support the Joint Stronger muscles = less joint load. Improving the strength of muscles around an arthritic joint (like the quadriceps for knees or glutes for hips) can significantly reduce pain and improve function. Improve Movement Efficiency OA often leads to stiff, guarded movement. An AEP can guide you through mobility work and functional training to help restore smoother, more confident movement. Encourage Safe, Sustainable Activity Fear of pain often leads to inactivity, which worsens joint health over time. AEPs help break that cycle by building your confidence with progressive, achievable exercise plans. Support Long-Term Management Exercise isn’t just about short-term symptom relief—it’s part of a long-term plan to keep you doing what you love. Whether it’s gardening, walking, or playing with your grandkids, movement is medicine. “But What If It Hurts?” Another common and very valid question. A bit of discomfort during or after exercise doesn’t mean damage is happening. In fact, most of the pain disappears as you exercise, the muscles a warm up and the joint is able to move more. This is essential to maintain cartilage health and reduce pain over time. Your AEP will monitor your response to exercise closely, adjusting your program as needed to keep you progressing safely and confidently. Osteoarthritis doesn’t immediately mean you have to jump into a replacement surgery. With the right guidance and a tailored exercise plan, you can move better, hurt less, and maintain the activities you enjoy. If you’re unsure where to start or what is safe for your osteoarthritic joint, contact an AEP today! https://www.asrehab.com.au/exercise-physiologist

Everyone knows what pain is and will experience it in their lives, it’s a normal and important sensation needed for survival that protects us from harm but also tell us if any structural damage has occurred. Pain is fully governed by the nervous system and brain. No Brain, No Pain. This gives pain a complex interplay between mechanical, emotional, and sensory stimulus which creates the pain we experience. A good way to think of pain is like an alarm, it’s telling you something is not quite right and to act on it. For example, if you put your hand into an open flame, you experience a painful burning sensation, so you pull your hand away before any burns have occurred. This is normal. However just like a faulty smoke alarm that won’t stop beeping after the smoke has been cleared or a sensitive car alarm that goes off from a slight touch, our pain ‘alarm’ can become overactive, which is very much the case for persistent and long-term pain. When we experience pain for a long time, there are changes to our brain and nervous system, to take in more information from our environment; we tend to ‘feel things’ in that area easier. For example, those with long term back pain feel their back as soon as they do anything physical, because they are so focused on protecting their back, they are much more sensitive to any stress on it. So to work on this, we need to retrain our ‘alarm’ (ie brain and nervous system), this is different for each person, which is why in rehab, we treat the person, not just the pathology or scan. Treating the person is a combination of retaining movements, modifying daily habits and behaviors, managing stressors in our lives (easier said than done) and strengthening our weak areas. It all depends on the person but also a competent practitioner is needed to be able to identify what needs to be addressed and worked on. It is usually much more than just ‘correcting’ one thing.

There is a difference between injury (ie tissue disruption) and tissue stress! Pain is like an alarm, it is a sensation to tell you something is not quite right and to act on it. It is there to stop you from hurting yourself but also to alert you if structural damage (ie an injury) as occurred. How do you tell if pain is just the alarm or if an actual injury has occurred? Especially if it’s something inside the body we cannot see? The big key is there an increase in pain when more load is placed on the area, such walking after rolling your ankle. If there is an increase in pain when more stress is placed on the area, then it is more likely there is damage to a structure that will be required to heal. This would be an injury. However, if the pain comes on gradually or in a specific position or posture and you are still able to “push through the pain”, then it is unlikely that there is structural damage. You still experience pain due your alarm telling you that you are approaching your tissue capacity. The approach to addressing these is completely different, generally an injury needs to be off-loaded (bracing, taping, modifying lifestyle etc) to allow the healing process to occur, while pain that comes on gradually doesn’t need to be offloaded to such a degree, usually modification of activity, addressing movement dysfunction and lifestyle modifications allows the stressed area to settle down.

I’ve previously written about when pain is not always an injury, but when there is an injury ie actual physiological disruption of tissue, there is a healing process that needs to take place! This is unfortunately a slow process and much slower than most people think. A common misconception is bone healing, most people know that a broken bone is in a cast for six weeks and once the cast is off they’re good to go. This is however just the first stage of bone healing (callus formation), full bone healing takes up to 9-12months! All tissue in the body heals at different rates and there’s many aspects that influence this, such as the type of tissue, it’s location, blood supply, co-mobidities, medications and health in general. We want to optimise healing as much as possible which means we need to give the body the best environment to promote healing. The first thing to look at is your general health, if you eat poorly, have unhealthy habits such as smoking/vaping and are inactive, your body will be slower to heal, it is as simple as that. Making positive changes to your health will give the injured tissue the nutrients it needs to heal optimally. Secondary is addressing the stress on the tissue. Tissue stress is good, it promotes the tissue to heal, but it needs to be dosed appropriately at different stages of the healing process. This is easier to do for different areas, such as an ankle, you can go on crutches or in a moonboot, this significantly reduces the stress through ankle. This is more difficult to do for a lower back (braces for backs do exist, but they’re not very effective). So there needs to be a change in the way we go about our lives reduce the stress on the back to allow the injured tissue to heal. This can be adjusting the way we do repeated movements throughout the day, sitting postures and positions as well as modifying work duties. This then needs to be gradually progressed to promote the tissues to heal, as well as improve its capacity to take on stress so the injury is less likely to happen again. All tissue heals at different rates and we have to understand this and work with it, instead of trying to skip steps or rush.