Last Friday Dr Chris Hasenkam presented to the team at Pace Health Management, talking all things gluteal tendinopathy. The inservice was informative for both the team of exercise physiologists and Chris himself, going from differential diagnosis and workup, through to all aspects of management, with a focus on exercise and education of course! Thanks to Pace Health Management for hosting an excellent inservice, a team of progressive exercise physiologists working across the south eastern suburbs of Melbourne and Mornington Peninsula.

Did you know that after menopause, the lack of oestrogen in the female body makes our risk of medical illness similar to males?

Without the protective effects of oestrogen, our risk of hypertension and heart disease increases.
Not only that, but our bones start to lose density and strength as well.

The good news is that we can still improve our risk profile for these issues with lifestyle choices before and after menopause.

Weight bearing exercise and weight training protect our bones.

Cardiovascular fitness reduces blood pressure and heart disease risks.
A diet with adequate calcium and omega 3 fatty acids protects both bones and heart.

Putting it all together helps to maintain a healthy body weight, adequate bone and muscle mass and a positive, healthy future forecast.

Weight bearing exercise includes walking, running and jumping. Cycling and swimming are not considered weight bearing but do have multiple health benefits.
The big difference with weight bearing is the forces through the bones. The force of impact results in tiny mechanical electrical signals being sent in the bones. These signals tell the bone cells to produce more bone and to slow down bone breakdown.
Weight bearing exercise in adolescents has been shown to improve their adult bone density, therefore reducing their chance of osteoporosis.
In older adults, weight bearing exercise slows bone loss, helps to maintain a healthy bone mass and body weight and has even been shown to help with osteoarthritis management.
So, pull on your supportive sneakers and get out there….. just don’t go too hard too early. You need to give your bones time to adapt to the new stimulus. A slow increase over 3 months is best, but keep it consistent.

Unfortunately, as our reliance on technology increases, so does the incidence of thoracic spine pain and pain referred from the thoracic spine.

The basic issue is postural overload. More specifically, compression through the spine in prolonged flexion postures, lack of lower rib excursion in breathing and strength loss as a result of sedentary lifestyles.

Fortunately, most cases of thoracic pain will respond to manual intervention and strengthening, but it is important to be aware of the causative postures and try to avoid them. The thoracic spine is not as mobile as the neck or lower back, but is still designed to flex, extend, rotate and laterally flex. Unfortunately, much of our working life is spent in flexion and then slumping in exhaustion on the couch at the end of the day.Simple measures to help improve thoracic function include regular stretch breaks, incorporating extension, rotation and lateral flexion movements. Also- consider upper back strengthening to hold the spine more upright. This can often be done with an exercise band and a door handle, so it’s not too onerous.If pain persists, careful clinical examination is required to try to identify the source of the pain. The thoracic area is complex. There are facet joints, costovertebral joints, costotransverse joints, discs and numerous ligaments on both sides of each vertebra. Sometimes it can be difficult to say where the pain is starting. This is one occasion where bone scanning with SPECT CT can be helpful to identify the inflamed joint, but, be warned, scans are often negative.
If sensitisation is suspected, a trial of amitryptiline may help reduce pain. Occasionally injections are required. Rehabilitation of mobility and strength are ALWAYS imperative.If you would like to chat to one of our Doctors regarding this, please call (03) 9770 2398 to book an appointment.

Does your menstrual cycle affect your ability to exercise? Or, are you interested in understanding it better? Dr Alice McNamara is currently doing her Sports Medicine Research into menstrual cycle tracking and elite female athletes. During the last few weeks, she has been involved presenting to the Victorian Institute of Sport Athletes and Coaches with their Sports Medicine team led by Dr Susan White.

A few summary points:
• Female athletes have a monthly indicator of health; their menstrual cycle.
• Everyone is different, and getting to know it can give you more control.
• If it affects your sport, it is likely that it can be managed better. We would love to help.
• And, we think 1 in 5 female athletes have seen a change in their menstrual cycle during COVID!

If you are interested in this topic and would like to discuss it further, please call (03) 9770 2398 to book an appointment with Dr Alice.

Pictures: Dr Alice competing.

#MPsportsphysicians #morningtonpeninsula #Mornington #Frankston#narrewarren #Berwick #sports #athlete #sportsphysician #Exercise 


Iron deficiency is much more common in athletes, particularly female athletes.

Menstrual blood loss is one factor, but we also use iron in muscle growth and repair.
This is not a problem if your dietary intake can keep up, but red meat is the best available source of iron and it can be hard to eat enough. Vegetable sources are harder to extract the iron from, putting vegetarians at more risk.
If your iron stores go low enough, you can end up anaemic. In general, athletes don’t get to this stage as they present with fatigue much earlier than that or are diagnosed on blood tests before symptoms start.
In the general population, iron stores of 20 – 30 are considered adequate. In athletes , we aim for 50 to account for the demands of training and everyday life.


Shoulder impingement can be divided into functional and structural.
The usual presentation of functional impingement is someone under 40 years of age. They will commonly be involved in overhead sports such as tennis, swimming, gymnastics of football.
They may have a history of instability of the shoulder or have generalised ligamentous laxity.
Essentially, impingement occurs when the humeral head translates too far anteriorly in overhead positions, placing strain on the upper rotator cuff and compressing the subacromial space. Sometimes, when the instability is more pronounces, biceps and subscapularis can be involved.
Treatment is conservative first. NSAIDs for pain relief and cuff and scapular stabiliser retraining.
Injections are rarely required and discouraged.
Structural impingement occurs on an older population and results from a narrowed subacromial space. This can be from swollen tendons, bursitis, AC joint osteophytes, glenohumeral arthritis or full thickness rotator cuff tear. In this group, it important to asses the integrity of the cuff with XRAY and ultrasound.
Anyone under 60 with a full thickness tear should be considered for surgery to avoid shoulder joint arthritis. Anyone with >50% thickness cuff tear can be monitored, but may need surgery. < 50% tears are usually monitored with 6-12 monthly ultrasound and rehabilitated.
Injections are often helpful to relieve pain, but muscle retraining remains important.
Decompression surgery my be required if all else fails.


Sports Medicine by Sport and Exercise Medicine Physicians

Mornington, Frankston, Narre Warren/Berwick

Unfortunately, just because the pain has gone, it doesn’t mean that the bone is strong enough to run or resume sport.
Bone strengthens through load. After a stress fracture, it needs to be gradually reloaded to allow the force lines to strengthen and prevent further damage.
You can start some strengthening quite early and then progress to more dynamic loading, but just because the pain has gone at 2 weeks, it doesn’t mean you are fixed. You still have 4- 8 weeks to go!

Sports Medicine by Sport and Exercise Medicine Physicians

Mornington, Frankston, Narre Warren/Berwick


Every day our immune system protect us from a lot of pathogenic microbes and viruses that we are constantly exposed to.
Immune function can be influenced by many factors such as genetics, stress, aging, nutrition, sleep and physical activity level.
Recent researches have revealed that a person’s level of physical activity influences the risk of some infections, specially upper respiratory tract infections (URTIs).
URTI is an illness caused usually by a virus or bacteria which involves transmission through the upper respiratory tract, including the nose, sinuses, pharynx, or larynx. Common cold, sinusitis and tonsillitis are examples of URTIs.
In fact, when you do moderate intensity exercise, regularly, your susceptibility to illness reduces because this type of exercise boosts your immune system.
Regular exercise increases white blood cell (body’s immune system cells that fight pathogens) function and also both directly and indirectly decreases stress hormones.
On the other hand, strenuous exercise causes increased levels of stress hormones (adrenaline and cortisone) which suppress white blood cell function and have negative effect on the function of immune system.
That is why vulnerability to infections increases for a period following prolonged moderate to high intensity exercise or an unaccustomed high intensity exercise session.
Another possible reason for higher risk of getting URTIs after high intensity exercise is higher rate and depth of breathing during exercise and subsequently, higher exposure to pathogenic microbes and viruses.
So if you want to boost your immune system and be safe, do exercise regularly, avoid overtraining, eat healthy, sleep enough, practice relaxation techniques and of course do not forget to be wash your hands and maintain social distance!
If you’d like to know more about the content discussed in this article, please call (03) 9770 2398 to book an appointment with Mona.
Sports Medicine by Sport and Exercise Medicine Physicians
Mornington, Frankston, Narre Warren
By Dr Mona Shabghareh
In patients with diabetes type one, the Pancreas’ ability to produce insulin is impaired. Therefore, this type of diabetic patients needs insulin replacement therapy to maintain their blood glucose level in the normal range.
It is critical to take a proper dose of insulin to prevent hypo-glycemia or low blood glucose level.
Many researches have shown that moderate levels of exercise can reduce blood glucose levels by multiple mechanisms and this effect is more significant if you exercise for a longer duration. The effect of exercise on blood sugar is additive to the effect of insulin and it can last up to 24 hours.
On the other hand, high intensity exercise may lead to an increase in blood sugar level by increasing stress related hormones such as adrenaline and cortisone. In addition, injuries that may happen during exercise and sport participation can also increase blood glucose levels.
So despite the fact that regular exercise have a lot of health benefits such as reducing the risk of heart and vascular disease, improving your mood, making your bones and muscles stronger and helping you to control your body weight, it can lead to hypo or hyper-glycemia or even be detrimental to your health if you do not know how much and what type of exercise suits you.
The best way to ensure you are doing the correct thing is by consulting with an expert physician.
However, some other helpful tips include;
1. Checking your blood glucose levels before and after an exercise session. It is safe to do exercise only if your blood glucose level is between 6.6-10 mmol/L.
2. Always have some quickly digested carbohydrate (such as fruit juice or barely sugar) available when you are exercising.
3. Eat something 1-2 hours prior to exercise.
4. Avoid dehydration.
5. If you want to inject insulin prior to your exercise session, use a site away from the exercising muscles to inject.
6. Do not drink alcohol after exercise as it dehydrates and lowers blood glucose level.
7. You should adjust your pre-exercise insulin if you are doing strenuous activity for longer than 1 hour.
8. Be aware of the signs of hypo-glycemia and stop if they appear.
9. Avoid exercising in extreme temperatures.
Based on the guidelines from the American College of Sport Medicine (ACSM), you should visit and be evaluated by a Sports Physician or Cardiologist if you are over 35 years old or have had diabetes for a couple of years or want to do any exercise that exceeds the demands of brisk walking.
If you’d like to book an appointment with Dr Mona Shabghareh, please call (03) 9770 2398