16.Feb.15 | Legacy

vegesThe holiday period is unique for many things….over-indulgence, sunburnt tourists, lots of
cricket and the rolling out of year end news articles relating to research. Yes, journalists
holiday too!
A recent news piece piqued my interest….the statistics relating to the weight (or over-weightedness!!) of the Australian population.

Since 1989 the average weight of Australian men has increased by 6.5kg to 85.9kg. That of women 5.7kg to 71.1kg (Australian Heart Foundation).

On the same day at a family BBQ I was attempting to explain to my children the hard and substantial gut of one of the party-goers.  Historically worn like a badge of honour by Australian men, this “Abdominal adiposity” has proven relationships with cardiovascular disease, chronic kidney disease and type 2 diabetes.  This is said to occur due to the fact that this form of obesity promotes chronic low-grade microvascular inflammation.

So the fat enveloping the gut contents, as well as the internal organs, is making our microscopic blood vessels inflamed, and this has a dire effect on the whole body. Not just the organs mentioned, but the entire musculoskeletal system!

There is data suggesting a relationship between this “gut fat”, and tendon injury and pain (Gaida 2009).  Logically, the presentation of many sore tendons in the body, or “all over” body soreness and ache, may have its origin in the excessive fat in the region of the gut. That is, the sore Achilles AND shoulder AND tennis elbow combined, OR the stiff and aching first few minutes in the morning, may be due to “gut fat”.

And it doesn’t have to be the hard, pregnant, ‘basketball in tummy’ look. You might be quite active, but carry a little around the middle.  Malliaras (2007) found in high level volleyballers a girth circumference of greater than 93cm for men, and 83cm for women, increased risk of knee tendinopathy.

In the latest British Journal of Sports Medicine, Alex Scott reviews this topic beautifully, coining the term ‘metabolically disturbed tenocytes’ to explain that tendons can be weakened by the biological effects of too many lipids in the bloodstream (high cholesterol).

Injury management practitioners need to be holistic problem solvers. Is it time for the local physiotherapist to begin prescribing diets, especially those aimed at insulin resistance?

Is part of my tendon management regime to the client the measurement of girth circumference, and the discussion of the:

  1. Paleo diet– the favourite of the world’s leading Sports and Exercise medicine physicians
  2. Intermittent Fasting (5/2 diet)- http://www.bbcgoodfood.com/howto/guide/what-52-diet
  3. Intermittent Fasting (16 hour fast)- https://au.news.yahoo.com/thewest/a/25315870/skip-brekkie-to-keep-waist-slim/?

So, happy Febfast! Get regular exercise. Have fun with your eating but maybe think about when and what you eat. Take on board that “abdominal adiposity” has general health implications, but it may increase your risk of muscle, tendon and joint aches and pains.

Paul Visentini is a Specialist Sports Physiotherapist (FACP) and a Director at Physiopsorts Brighton.
Paul has a special interest in the lower back/pelvis, overuse injuries of the lower limb, as well as the assessment of bike set-up and its relationship to injury.
Follow him on twitter @paulvisentini